Editorial Tuesday 15 May 2012: Having congress with Andrew Lansley and Ed Miliband

So. We have had congress with Andrew Lansley and Ed Miliband.

And do we regret it? No, indeed we do not. All consenting adults, etc.

Although it was a bit short on surprises.

There is a ritual element to all national conferences in health, and roles were played to type.

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That said, the RCN was desperate to avoid having to take its place on the political naughty step, garnered by Patricia Hewitt’s infamous 2006 reception.

It seemed very much as if delegates had been put under informal but heavy manners to keep things polite-ish with Mr Lansley.

A jack-in-a-box reprieved
Mr Lansley (saviour, liberator) is, of course, enjoying a slight revival of fortunes anyway. To date, his political obituarists - myself included - have been wrong not a few times. Our Saviour And Liberator springs back with jack-in-the-box resilience.

Part of this is simply an element of relief that the unpopular Health Bill has become the unpopular Health Act. It’s not much, but government is tough and you have to take what you can get.

Another reason is Einsteinesque relativity. Two months ago, Mr Lansley was vulnerable to attacks every time government policy was mentioned. Even people who knew nothing about the NHS reforms knew that they were very far from popular.

Since then, the Murdoch affair has semi-claimed the scalp of culture secretary Jeremy Hunt (who, with a baleful symmetry, was being touted by some as a potential health secretary post-Olympics), and via the Brookes-Coulson issues, started to move closer to That Nice Mr Cameron.

If Murdoch has something directly incriminating about Mr Cameron, he is keeping his powder dry. For all this, Restoration-faced Chancellor George Osborne’s recent Budget – cutting the 50p tax rate for huge earners, while failing to raise tax thresholds for pensioners (and taxing pasties!), alongside the double-dip recession, have kicked at the Government’s prime asset: its reputation for economic competence.

This has undermined the breezy, officer-class self-assurance of Mr Cameron and dented Mr Osborne’s reputation as a political strategist.

Latterly, senior Tories such as Philip Hammond and William Hague have argued respectively that the debt crisis is UK households' fault (which is pretty much utter bollocks), and that we should just work harder.

It is as if they are trying to make a political crisis out of an omnishambles.

The Opposition should not be getting itself over-excited: there is a long way to go to the next election, and they currently have few discernible policies. (The latter is broadly as it should be, but the next eighteen months must combine increasingly-effective opposition with fast, smart and realistic policymaking.)

So Mr Lansley looks safer for now, partly in relative terms … and partly because few will want to walk into the health portfolio given the guaranteed turbulence that lies ahead.

Mr Lansley’s performance
Unless big annual pay rises for nurses are rolling in (as if …), the role of the government performer at the RCN Congress tends to be masochistic.

Mr Lansley started smartly, and deserves great credit for limiting his opening remarks to about four minutes: his keynote point being the importance of caring for patients. "I'm not going to bother with the speech, I'm just going to deliver the keynote for me ... how we improve the quality of care we deliver to people”.

Alluding to Mid-Staffs, he referred to “the wide variety of care quality in the same hospital. We know that one key factor was leadership, and importantly the leadership of nurses”. He added, “the reforms have to be about improving care ... about using resources more effectively, getting resources to the front line".

Mr Lansley was hot on technical detail, as ever.

Likewise, he was as uncontrite as ever, telling delegates that the number of clinical staff has gone up. One delegate shouted “bollocks” at this. So did Channel 4 News’ fact-check, though more politely.

Mr Lansley ploughed on, "we have an Act now - the Act does not permit privatisation of the NHS (sundry heckles) ... we won’t have a debate about that now; we have an Act". It was a one-man encore of the listening exercise.

Mr Lansley’s speech was short to maximise time for questions. I won’t say for Q&A, because that would imply a symmetry of answers that we did not see, especially on the repeated question of putting a mandatory nurse on CCG boards.

The questions ran the whole gamut, from angry to angry. Job losses, pay freezes, being told how to care.

A couple were witty: “the Conservatives being the party of law and order, how do you feel about £100 having been stolen from my wages to put into NHS pension scheme that made Treasury £100m(?) profit?”. Also, “why, when we agree with you, are we a professional body; and when we disagree with you, just another trades union?”

The thing that rather kills a politician is laughter. Mr Cameron may find this, when the Rebekah Brooks-related Raisa the police horse and his LOL text message sign-offs are used in the next general election campaign (as they surely will be).

And Mr Lansley provoked it a few times. When he said, “you can't do QIPP by cutting the quality of care and services to patients ... if you think cuts are making care unsafe,  you have a responsibility to report it”, the nurses laughed at him.

When he continued, “the director of nursing has a responsibility to listen to you”, they laughed louder.

And when he reiterated towards the end that there should be no cuts to quality to achieve The Nicholson Challenge £20 billion efficiency and productivity gains, they laughed again.

There is a theme there, which should probably concern him. In the wrap-up, RCN supreme Peter Carter emphasised that Mr Lansley’s (relatively) un-hostile reception had been, in terms, stage-managed; and that Mr Lansley should have no doubt about nurses’ feeling undervalued and un-heard by some – but not all – employers. Carter echoed anger and concern about job cuts and resource shortages.

Time will tell whether getting out un-booed and merely laughed at will leave Mr Lansley thoughtful … or merely relieved.

Mr Miliband’s performance
Ed Miliband had the far easier role with “>his speech: to love-bomb the audience.

He did so fine, launching a new ‘grass up cuts’ campaign, not wholly un-reminiscent of what the RCN did last year in the run-up to Congress. He also asked them to help run the NHS in partnership, or something. I'd read the small print if I were you, nurses.

Mr Miliband created a bit of a hostage to fortune when the Francis Public Inquiry report comes out, saying “you are the backbone of the NHS. You represent everything that’s great about public service. 
You are the best of Britain”.

Smartly, he also noted PM Cameron’s line from 2009 promising that “There will be no more of those pointless re-organisations that aim for change but instead bring chaos ...”.

There was one line which makes spectacularly little sense in Miliband’s speech: “Britain would not be getting out of bed in the morning without the NHS”.

That’s just nonsense. Romanticise the NHS by all means, but don’t talk utter drivel. It insults people’s intelligence.