We desperately need NHS reform, but does NHS reform need this Bill?
Nik Darlington 3.42pm
Mr Miliband, I want to make this very clear, these remarks do not necessarily represent those of the Tory Reform Group. Much like individuals in the Labour party can have an opinion that may not represent the collective Labour view - such as your ineffectiveness as a party leader - what I write or what anyone else writes on these pages is not, unless explicitly stated, official TRG policy.
Over the past 48 hours, a commonly held misconception has been that criticism of the Health Secretary and the Health & Social Care Bill in its current form equates to a rejection of NHS reforms. The status quo in the NHS cannot continue. As Philip Collins writes in a brilliant op-ed for the Times (£) today:
“The NHS needs to change beyond recognition. The population is ageing. Health inflation runs at 7 per cent per annum. Chronic diseases and the flow from social care have the potential to bankrupt the service. There are too many hospitals and the effective power in the system is still located there. The NHS needs to save £20 billion by 2015 just to stand still. This is, on its own, a demand for a 4 per cent improvement in productivity a year.”
Let’s consider the article on Tuesday by Craig Barrett, whose strident criticisms were misshapen by Ed Miliband at PMQs in order to claim that even Tories don’t trust Tories on the NHS. I’ll admit it was a brilliant and uncomfortable line, but without the protection of parliamentary privilege his assertion that the TRG had “come out against the reforms” would have come close to slander.
As I told the BBC yesterday, Craig’s article was misrepresented by Ed Miliband. Yes, Craig questioned the rationale for the Bill and its presentation; yes, he attacked the Bill’s progenitor, Andrew Lansley.
But Craig also said:
“The NHS must be continually analysed and rationalised to ensure that it is fit for purpose in the modern world.”
Whatever his opinion about the Bill and the Health Secretary, Craig’s belief that we must reform the NHS is a belief we all share in the TRG. I have written in support of Andrew Lansley and in support of reforming the NHS on these pages before (a link to that article also appears in Craig’s post).
But NHS reforms cannot be thought of in isolation to present circumstances. For instance, Stephen Dorrell, the former health secretary and current chairman of the Health Select Committee (and TRG patron), has a valid point when he says that it will be difficult to reconcile reform with the considerable efficiencies and productivity gains the NHS must achieve in the immediate future (cf. Philip Collins above).
Electoral considerations may play a part in how some Conservatives look at this controversial NHS Bill. But the future of the NHS - as Craig wrote, “one of the great glories of post-war Britain” - oughtn’t be reduced to the base winning of votes.
It must be about what is right for the NHS, and the guiding aims of increasing competition, devolving decision making and adapting a 1940s monolith for the twenty-first century are altogether right for the NHS.
These reforms are very much the right reforms. They are what Mr Lansley set out to achieve. They are what he still wants to achieve, and he should be given the support to do so. I don’t believe he should resign and I don’t believe this is the time for the Prime Minister to sack his Health Secretary. That would look weak and desperate. It would also undermine the very real case for reform.
But since the opponents of reform have been permitted to shout loudest and longest, this Bill has been marmalised beyond recognition. The Labour party have acted reprehensibly, let me make that very clear. But the whole issue has become far too toxic. It pains me to say this, but that is why I believe it needs serious reappraisal.
That doesn’t mean I do not support reform, or that I am more concerned about what the voters will think in 2015.
On the contrary, it is the strongest evidence that I do support practical and meaningful reform of the health service. Because in this presently spiteful and distrustful environment, I just can’t see how that is going to happen.
Follow Nik on Twitter @NikDarlington
