Editor's Blog 29th September 2008: Conservative Party Conference 2008 - Andrew Lansley, the hair apparent

Something has happened to Andrew Lansley’s hair. The shadow health secretary’s barnet is looking distinctively … different. Now as regards a discussion of male grooming (albeit the sinister connotations that have accrued around that phrase mean that I shall not be using it again) – a discussion of male preening, let’s say, I am not your ‘go-to’ person This much is obvious if you have ever met me. Or even seen a photograph.

But there is definitely a change in the Lansley bouffant. Maybe it is the perkiness that comes with the sense that office, and power, are edging inexorably nearer. Perhaps it has been ‘feathered’ or ‘layered’ or one of those other inexplicable things that hairdressers do, when they’re not asking you if it’s your day off or whether you’ve been on holiday.

Whatever the reason, it is distracting. When you are expecting a serious, sober and detailed analysis of NHS policy flaws, failings and foibles, follicles should be towards the back of the agenda. Although, when I sat immediately behind David Cameron at the Kings Fund, it was impossible not to be distracted by is distressingly flawless hair and complexion. Richard E Grant on his best hair day ever would envy Cameron’s raven thatch, but the Cameronian skin had babies’ bottoms beat out of sight (which of course, back in the day, passed for Conservative policy on the family).

Why am I focusing on superficial things about appearance? Because they certainly matter to an opposition which is continuing with its process of ‘detoxifying the brand’ of Conservatism. Speaking of which, several speakers have used the formulation “modern Conservatives” at this conference. We have had New Labour. Now we are assessing Modern Conservatives.

The shock of the modern
So, what are Modern Conservatives? Well, Lansley lost no opportunity to remind a placid hall that the NHS is “David’s number one priority”. That’s another thing: presumably as part of some beatific pre-PM ritual, the Leader of the Opposition’s surname has gone missing. At every reference, he was “David”. Mercifully, we were spared “Dave”, but “David”, "David”, “David” … was this an attepmpt to portray Mr Cameron as a man facing Goliath?

Blessed are the plasterboarders
Policy-wise, the only initiative was a promise of “the choice” of single-room accommodation in all hospitals “within five years under a Conservative government, every patient will be given a choice to book a single room, every hospital will have single isolation rooms, and every expectant mother will have access to a single room.” Single rooms in hospital wards would increase by 45,000 during their first term in government, to nearly 100,000. The proportion of beds in single rooms would increase from 28% to 55%.
Lansley suggested that all maternity and mental health patients would be allocated a single room, and later added that 35% of single rooms would be for those admitted to hospital for an operation.

Blessed are the plasterboarders. Perhaps this is the Conservative plan to revive the economy and the construction industry. There are loads of unbought rubbish little box-flats that developers have been carpet-bombing city centres with: maybe these can be co-opted? Back-of-a-fagpacket figures suggested a likely cost of £1.5 billion to amend hospitals in this way. And of course, they won’t be able to do a thing about the top-performing foundation trusts (as David Nicholson found over the deep clean and mandatory infection control matrons) – unless of course they re-nationalise them. Who knows? Stranger things are happening in these uncertain economic times.

But of course, they will point out that they have not promised single-occupancy rooms for all within five years: just “the right to choose”. Which is all very well and good. I have, theoretically, the right to pop into a big-city restaurant and order a bottle of Petrus. Or a top car dealership and specify my Bentley. However, if the supply is not there (or indeed, I can’t persuade them I have the money, then the choice is just that: theoretical.

Moreover, the £1.5 billion figure is possibly going to be sufficient for the infrastructure work needed in non-PFI hospitals (because PFIs can charge ludicrous management fees for even minor changes like lightbulb changes or new powerpoints, let alone putting in new single rooms!), but the extra nursing and ancilliary staff that you will need to operate significant new numbers of single bed rooms will be significant. No matter how many waiting or access targets you abolish.

And of course, the first time someone is harmed or dies in a single room because of a medical or other error, the Daily Mail won’t lose a second in dubbing them “death chambers”, or something equally catchy.

Lansley told the conference hall the NHS values “were just as relevant today as in 1948”, which may have taken aback delegates who rather liked his predecessor Dr Liam Fox’s ‘patients’ passport’ proposal (to subsidise private sector care to 5% of NHS tariff cost). He referenced the importance of healthcare coverage in the US Presidential election contest.

Rightly, he raised the issue of the UK’s relatively poor health outcomes in comparison to European neighbours. Choice would, Lansley proposed, be the means to align the enthusiasm of NHS staff for patient-centred care with greater responsiveness in the system, leading to better outcomes. This is good and challenging stuff to emphasise, and moreover, shows some real political courage. The problem once in office will be that for a variety of reasons, outcomes can prove stubbornly intractable, thus creating possible incentives to cheat – in much the same way that of course the target culture has done.

He re-emphasised the proposals to allow people whether to choose to register with GPs nearer to work or closer to home. A ritual bashing of polyclinics received the only genuinely spontaneous applause of the session.

Numeracy issues
Numeracy issues did crop up with disturbing regularity, during and after the speech. Lansley also suggested that choice would solve the NHS productivity rate “falling by 2.5% a year”, but did not identify that productivity falls as more staff have been employed year-on-year. Lansley is not a foolish man, and will hopefully not believe some of the rhetoric spouted (by himself and others) about growth in numbers of bureaucrats and pen-pushers.

Moreover, the unduly obsequious ‘questions’ from the floor – almost all from prospective parliamentary candidates – revealed some attitudes towards NHS management that, while popular by delegate applause, did not look wildly Modern. Measurement and from-filling was by definition “wasteful bureaucracy”, which may make commissioning and outcome measurement a bit of an uphill struggle.

Moreover, in a moment of pure 1990s nostalgia, one speaker used figures about the number of managers in the NHS being greater than the number of hospital beds. Isn’t it great that we’ve advanced the debate about the NHS all the way back to counting furniture? And are we not meant to be trying to provide more care outside unsafe, MRSA-ridden hospitals and closer to home? You can’t have one without the other.

And brilliantly, another referred to the Government’s plans to close 1,700 GP surgeries – an allegation deconstructed first on this website.

Lansley concluded with a commitment to “making the NHS an example for the world, the best in the world” – a pledge that received a strangely-muted reception from the audience, who applauded for barely ten seconds.

The atmosphere at the health session was strangely flat and unengaged. Perhaps there are Party members who still feel that this is not their innate territory. Maybe the banking and economic turmoil simply directed minds elsewhere. Nonetheless, there was a sense of an opportunity missed and of a connection not made.