For the good of the NHS, Andrew Lansley must admit defeat

Craig Barrett 1.46pm

One of the more delicious aspects of the last Labour governments was their dawning realisation that, contrary to everything Gordon Brown wished to believe, the Tories had not spent the 1990s trying to destroy the NHS.

Having abolished trust hospitals, the Labour government was forced into a humiliating retreat when it introduced the suspiciously similar “foundation hospitals”. And ministers went on to double spending on the NHS without a commensurate improvement in service or efficiency.

The NHS is one of the great glories of post-war Britain. A Liberal concept, enacted by a Labour government in the teeth of opposition from the British Medical Association (see Nik’s past posting here).

However, only the most blinkered dinosaur or Pilgrim would deny that the same idea today would be viewed as an unworkable and bureaucratic behemoth.

We ought not consider the NHS purely in financial terms because the benefits to the nation’s health and well-being must outweigh the mere cost. Yet that is not an argument for it to remain unchallenged or unreformed. The NHS must be continually analysed and rationalised to ensure that it is fit for purpose in the modern world.

Consequently it has become something of a political football. Who remembers "The War Of Jennifer’s Ear" or "24 hours to save the NHS"? Andrew Burnham’s hyperbole over the weekend about how these reforms will kill the NHS do him little credit as an supposedly serious politician.

However, his comments are illustrative of a truly massive problem sitting at the heart of Government - no one actually has any idea what Andrew Lansley is trying to achieve.

His reforms carry no support among the Liberal Democrat side of the coalition and there are very few Tories who appear to be ready to put their heads above the parapet and defend him or his ideas. Is this because of a lack of support, a fear of electoral disaster or a genuine incomprehension of what Mr Lansley might be trying to achieve?

Irrespectively, the public mood is such that people are happy to feast on the media painting his plans as change that nobody wants, least of all the doctors, the nurses and other healthcare workers.

The Government was wrong to push these changes as a flagship bill. The fact that many of the reforms do not even require primary legislation makes the resulting headache look embarrassingly self-inflicted. Without a proper mandate, it looks undemocratic.

Mr Lansley seems like a man clinging to a time-bomb that only he cannot hear ticking. The Government urgently needs to look at what he is trying to do and accept that it needs drastic, perhaps total, reconsideration.

Is politics truly the art of the possible? What is certainly impossible is ploughing on without confidence. This is the situation in which Andrew Lansley now finds himself, where self-confidence is no match for the lack of confidence held other people.

That we need urgently to consider what this Health Bill is doing is obvious. In all likelihood that means starting all over again. Moreover, it is clear to me that the current Health Secretary is not the man to preside over this process.

For the good of the NHS, Andrew Lansley must admit defeat and head to the backbenches.

Follow Craig on Twitter @mrsteeduk

PMQs: Cameron must follow Nye Bevan’s example and stand up to the BMA

Nik Darlington 2.02pm

Medicus est timendum magis quam morbi.

'The doctor is to be feared more than the disease.'

This is what the BMA, backed up by recalcitrant Liberal Democrats and the Labour opposition, want the Government to believe.

Some Conservative MPs are wobbling, having signed a critical motion insisting that Andrew Lansley reconsiders his healthcare reforms. There will be some concessions in light of the Lib-Dem spring conference but the Health Secretary has insisted that changes will not be significant.

Unsurprisngly, therefore, Ed Miliband played on the acrimony and led with healthcare today. The Prime Minister described his opponent as “feeble” for relying on the work of others, scorning, “just as he has to back every other trade union, he comes here and reads a BMA press release.”

The Spectator's Peter Hoskin instantly termed David Cameron's remarks a declaration of war on the BMA. James Kirkup for the Telegraph described it as “opening fire” with a ”full-frontal attack”. However you portray it, battle lines are drawn.

If you know your history, you will be aware that the BMA has form when it comes to opposing healthcare reforms. In 1946, the doctors stood aggressively in the way of the biggest reform of them all - the Labour Government’s creation of a National Health Service. When a survey was taken in 1948, only 4,734 doctors were in favour of a National Health Service (out of 45,148 polled), which puts the pitiful vote over the weekend into embarrassing context.

They even went so far as to equate Nye Bevan’s grand plan to Nazism. These are the words of a former BMA chairman:

"I have examined the [NHS] Bill and it looks to me uncommonly like the first step, and a big one, to national socialism as practised in Germany. The medical service there was early put under the dictatorship of a ‘medical fuhrer’. The Bill will establish the minister for health in that capacity."

When Bevan held a summit with BMA leaders, one of them, Dr Roland Cockshot, recalled:

"We screwed our nerves up, we might have been going to meet Adolf Hitler. We were quite surprised to discover he talked English."

We should be thankful that these mild-mannered family doctors have outgrown such hyperbole. They no longer refer to Government ministers as genocidal Nazis, limiting their accusations to “damaging” and “ideological”.

These doctors have an amnesic institutional memory. The irrational and irascible opposition to the NHS in 1946 was founded partly on the belief that the Labour Government was eroding doctors’ cherished independence. How ironic, then, that the intention of a significant amount of this Government’s reforms is to hand power back to doctors and other healthcare professionals.

The Conservatives have been offering greater independence to doctors and nurses since the early years of David Cameron’s leadership, and long before that. Like the Tories, the Liberal Demcrats pledged in their 2010 manifesto to “scrap Strategic Health Authorities”, “sharply reduce centralised targets and bureaucracy”, put “front-line staff in charge of their ward or unit budgets”, and give “Local Health Boards the freedom to commission services for local people”. The two coalition partners’ plans last May were remarkably similar.

If David Cameron does fear the doctors, he is not showing it, and nor should he. Constructive dialogue is one thing, and the doctors - who are working day in, day out tirelessly to save lives - have a right to be concerned about aspects of the reforms and the pace of change. Changes must be made, yet the BMA motion insisted on the complete withdrawal of the NHS Bill.

The UK’s health outcomes have for some time been falling behind other countries, in spite of record investment. Meanwhile, pressures on our system continue to increase, with new technologies, more expensive drugs and an ageing population. Reform is vital.

The Prime Minister made reference to Gordon Brown as the ‘roadblock of reform’, and Ed Miliband as the ‘son of roadblock’. He was, of course, speaking not only to the man opposite him across the despatch box, but to men and women in white coats resistant to change in any form.

Throughout the history of the NHS, every step of the way, the vested interests of the BMA have dragged their feet. Nye Bevan defeated the doctors through bloody-minded will and character. As a result, we have a National Health Service that, in spite of its quirks and quandaries, is the envy of the world. David Cameron must display a similar force of character to that great Labour politician, and thus give the NHS a fighting chance of justifying its iconic status.

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