Editor's blog Sunday 20 March 2011: The chameleon selling of NHS 'modernisation'

Another day, another batch of bad news stories for Andrew Lansley’s NHS reforms.

(I’ve typed that so often, it feels as if it deserves its own acronym, but ADABOBNSFALNR will never catch on. It sounds like the name of a Nordic volcano that's going to screw up everyone's travel plans, which, when you think about it ...)

Today’s trio of tribulations carry quite a sting.

Open primaries, primary care and a Greek tragedy
Firstly, Conservative MP and GP Dr Sarah Woolaston (Totnes), the first Conservative candidate to be elected by an ‘open primary’, came out with a devastating piece in the Tory party pulpit Sunday Telegraph, attacking the reforms.

Woolaston has a day job to which she can return – always a useful thing for someone wanting to criticise their own party’s flagship public sector reform policy. Her day job is as a GP, giving her comments both piquancy and power.

(She is also clearly smart enough to know that her iconic status as first open primary Tory MP gives her a degree of air cover.)

Woolaston rhetorically asks, ”is there something of the Trojan Horse about the Health and Social Care Bill? No top down reorganisation of the NHS promised on the outside but perhaps the greatest upheaval in the organisation's history inside”.

Courageously, Woolaston warns that the vast system that is the NHS requires management, citing a recent conversation with a soon-to-be-abolished PCT manager, who told her they were only staying in post because if they did not, commissioning consortia would fail fast and the job of commissioning would be given to the private sector.

She is clear that the NHS ”risks going 'belly up' rather than 'bottom up'. It is not Greeks that could destroy the NHS, but if Monitor, the new economic regulator, is filled with competition economists with a zeal for imposing competition at every opportunity, then the NHS could be changed beyond recognition. It is no use ‘liberating’ the NHS from top down political control only to shackle it to an unelected economic regulator”.

Telegraph political editor Patrick Hennessey continues Mr Lansley’s displeasuable read of the Sunday papers with his report of leaked documents confirming that PM David Cameron’s promise in a piece for the Telegraph to open up state provision of a few weeks back will form a prominent part of Restoration-faced Chancellor George Gideon Osborne’s budget this week.

The leaked document will reportedly ”set out an across-the-board change that opens all spheres of government activities to outside providers, except in a small number of specific cases (the judiciary and national security)".

It is not wholly obvious why this is going to form a part of a budget speech – unless there is some plan for tax breaks. Given the current state of the Exchequer, one would think and hope that ought not to be on the agenda.

The Telegraph’s own report on Woolaston’s article concludes with a line stating, ”Mr Cameron has privately told MPs there will be ‘no retreat’ from the plans, although he admitted there were problems with ‘presentation’”.

This mirrors precisely what we have been hearing about the Bill – that whatever the emollient noises made to worried Lib Dem and Tory backbenchers, the plans are only for minor changes, with the intent being to guillotine opposition in the Lords and get the Bill onto the statute books before 2012 dawns.

DH hides NHS record public satisfaction rate
Meanwhile, The Observer’s political editor Toby Helm reports that DH-commissioned Ipsos MORI opinion polls on public satisfaction with the NHS are being withheld.

The DH has now had this data for six months, which is said to show public satisfaction at a record high. However, the DH could not tell Helm when it would be published.

This story is bad for Lansley and the Coalition in several ways. They have made much of “letting sunlight in as a disinfectant”, of presuming that much more data should be available. Hypocrisy on this issue leaves them deeply exposed.

With Dr Woolaston’s well-phrased attack and the hiding of data that will embarrass those seeking to justify NHS ‘modernisation’, Ed Miliband will be rubbing his hands ahead of the next PMQs.

Answering the wrong question
PM David Cameron’s presentation skills are formidable. Andrew Lansley’s are not (although several people report him to be personally charming). When Lansley is challenged or criticised, a slightly camp querulousness creeps into his ‘you’re completely wrong!’ replies – which a sufficiently ruthless opponent could exploit.

The question that Cameron and Lansley have decided they face is ‘how do we sell this NHS reform plan?’

That is not, of course, necessarily the right question. Nonetheless, it is the one they have set themselves to answer.

As the Conservatives increasingly adopt their ‘heir-to-Blair’ stylings in health, Project Sell The NHS Reforms reminds this observer of Tony Blair’s heroic faith that he could change people’s minds about the legitimacy of the war in Iraq.

Blair was the actor-manager of his generation, and a very good lawyer-salesman. And he couldn’t change people’s minds about Iraq. He was better than Cameron and Lansley put together.

Cameron and Lansley don’t plan to change their reforms much. They plan a respray, hoping to change the exterior colour to adapt to the environment or scare off rivals.

Just like a chameleon.