The secretary of state for health lost responsibility for his NHS reform policy in April 2011. By April this year he will have lost responsibility for the implementation of that policy
Back in April last year the chair of the Health Select Committee commented that the government had ‘lost control of its health policy’. For two months the government outsourced the formulation of health policy to the Future Forum and then accepted all of the recommendations from the random group of people who made it up.
As far as the Prime Minister was concerned pride was swallowed and the right to construct their own policy given up in favour of buying the support of the professions – at any price.
This partly explains David Cameron’s anger when, a couple of weeks ago, he realised that nearly everyone who was opposed to the Bill in April 2011 remains against it in February 2012. (To be quite clear, there are now more organisations opposing the Bill than there were in April 2011 – so in fact the pause and the ‘U’ turn have had a reverse effect).
From the Prime Minister’s point of view – what was the point of suffering the humiliation of a public U-turn if it gained no support for the policy? (It was this that led a No 10 spokesperson to say that someone ‘should take the Secretary of State for Health out and shoot him’).
I felt, after the summer, once they had reformed their reforms, that what the government would do would be to find a new narrative for their muddle – and then they would be back in control.
They didn’t find that new narrative, and over the last couple of weeks we have seen some frantic cobbling together of a variety of stories in an effort to find one that will stick. My feeling now, in February 2012, is that they have less control over their NHS reform policy than they had in April 2011.
Why do I think that? Partly this is a reflection of the front page, public nature of the politics of NHS reform. Lots of governments have had lots of rows about lots of policies. These rows move the policy from page 6 to page 1 and bring the issue to the attention of a wider public. Then, after a little while, the policy then goes back to page 6 and the politicos and the public forgets about it.
But the row about NHS reform has been a big one for a long time. It is this that makes the Prime Minister so resolute about getting the Bill through – in the hope that we can then all forget about it as it will no longer be on the front page.
But really, it’s too late now. The policy mess has been in and out of the front pages for about a year. Starting with the LibDem spring conference last February when this became a major political story it has bounced around the front pages ever since. People have internalised the phrases ‘radical government’, ‘NHS reform’ and ‘big political row’ and the passage of the Bill will not prevent them being retained in the public mind.
Political commentators and the public may forget a policy row that has bounced around for a month – but when it’s been going on for a year the big political row about NHS reform lodges in minds and memories.
So government policy is more out of their control now more than ever – because it has appeared to be out of control for a year.
Another reason for them being less in control now than a year ago is that more and more of the reforms are being implemented. It is no longer a discussion in Parliament – it is real change on the ground in the NHS – and it is on the ground that the government has least control.
Partly this goes back to the government’s Maoist rhetoric of the summer of 2010. Their cultural revolutionary assault on NHS bureaucrats must have felt good at the time. The fact that their policy was to liberate the NHS from its own managers would have felt great to many new Conservative MPs.
But the difficulty for the government was that the very managers they were deriding as being the problem were the only people who could implement their reforms. As they move further and further into the implementation phase, Andrew Lansley will look at the people around him – in organisations such as the National Commissioning Board – and recognise that they are all the same people he was deriding just 18 months ago.
There are then two phases during which he lost control of his policy. In April 2011 he was told by the Prime Minister to give policy formulation over to the Future Forum and put whatever they wanted into his Bill. Now, as more and more of the actual implementation of his reforms takes place, it is being carried out by the very people he saw as the main problem in the previous regime.
In April 2011 he lost control of his policy. By April 2012 he will have lost control of his implementation.
Paul Corrigan was formerly senior health policy adviser to Tony Blair when he was prime minister. This post first appeared on Health Matters