Crystal ball-gazing – Lansley and the NHS


How to solve a problem like Lansley…and/or the Health and Social Care Bill

I had a recent exchange with Tim Hardy on Twitter via Puffles not so long ago. It was following a series of tweets by various people going after Health Secretary Andrew Lansley and the trending hashtag calling for Lansley to be sacked. I commented that any sacking of Lansley would not inevitably lead to the falling of the Health and Social Care (HSC) Bill, but the falling of the Bill would more than likely lead to the falling of Lansley.

Some people have called the HSC Bill David Cameron’s poll tax moment. As things currently stand, I don’t agree. That’s not to say that it won’t become it. As I’ve commented in previous posts, Cameron is much more ‘hands off’ compared to his predecessors. He’s given his cabinet ministers a much greater level of policy flexibility than Blair or Brown ever did. Duncan Smith has had a free reign at the DWP, Pickles in local government reform, Lansley with health until things communications-wise went belly-up, leading to the ‘pause’. (Little policy-wise seems to have changed – the opposition to the Bill has, if anything become more vocal).  At the moment, the problems with the Bill have been presented as Lansley’s mess-up, not Cameron’s.

What of Labour? Recent sessions of Prime Minister’s Questions have been revealing in terms of Labour’s strategy: They want to pin this on Cameron. Miliband seems to have made this a credibility issue for Cameron. If Miliband can make this stick, then Cameron does run the risk of the HSC Bill being his poll tax moment. But at the moment, it has not stuck.

Lansley has no option but to keep ploughing away. If the HSC Bill falls, he falls with it. Parliament and the healthcare professions cannot have any confidence in a secretary of state whose flagship piece of legislation (and it’s a monster of a Bill) falls in Parliament due to opposition to it. He’s fighting for his political career and probably knows it too.

As for Cameron, what are his options? He could plough on as normal and three-line-whip MPs when all of the amendments come back from the Lords, overturning them as Grayling and Duncan Smith did with the Welfare Reform Bill. But given the level of opposition – in particular from the professions, some MPs might be a little wary – in particular Lib Dem MPs in marginal constituencies. Hence it’s not as straight-forward as battering MPs into submission.

He could drop Lansley, but who would he replace him with? It’s not as if the political gene puddle of the House of Commons is teeming with talent. Which of the ministers of state are cabinet ministerial grade? In particular, which one would want to take over the poisoned chalice that is the Health brief? It might be an opportunity to bring back David Laws – a former Cabinet Minister highly regarded by Cameron and other Tories – but would they accept an additional Lib Dem coming into the Cabinet? There have been rumours of Alan Milburn – ex Labour Health Secretary being ennobled and parachuted in, but apart from those saying he’d never take it, it causes the furore of a Secretary of State not being directly accountable to the Commons. Mandelson and Adonis faced this problem in the dying days of Brown’s administration – even though as secretaries of state they were two of the most highly regarded.

He could drop the Bill, but again I think he’d struggle to keep Lansley who would inevitably have lost the confidence of the professions he’s responsible for. Having dropped the Bill, the inevitable question that follows is: “Now what?”

Exactly. Some of the reforms have already started – organisations making preparations (as is understandable) for the future reforms in expectation that a government with a majority in Parliament will get its flagship legislation passed into law. What do you do if you are running an NHS trust or some other agency, preparing for these changes only to see the legislation needed to complete it, fall? A massive state of flux would inevitably follow as minister decided what they wanted to do next. Amongst other things it would involve working out what changes they would want to make that did not need primary legislation.

How long would that state of flux last for? Difficult to say – policy-making is a very complex process. What I don’t understand with Lansley is how he could have got so much so wrong so badly. He had so many years in opposition to prepare for the changes that he wanted to bring in. By the time he took office after the 2010 election, it should have been clear what he wanted to do. All of that groundwork should have been done – certainly the professions should have been worked with in a manner to deal with many of the problems and issues that they have raised. It may well be one that the Conservatives in particular will want to look at should the Bill fall. It may well be one that Parliament would look at through the Health Select Committee. If anything because a huge amount of public money has been spent on preparing the Bill as well as Parliamentary time.

Would the falling of the HSC Bill cause the Coalition to collapse? Unlikely – for two reasons. The first is that the set up of the Coalition is still better for both Cameron and Clegg. In the Coalition, Cameron can keep the right of his party under more control inside the Coalition than governing alone. Clegg arguably still needs more time for both the tuition fees U-turn to disappear into the distant past (perhaps in the way Blair and the Iraq war had done by the 2005 election), as well has for more time for key Lib Dem pledges to kick in. (E.g. the £10,000 income tax threshold). The second is that Labour currently don’t look like an alternative government. They’ve been landing a few more hits of late, but it’s one thing to land hits & quite another to set out a clear, coherent and popular alternative. My blogpost Labour and Ed explains more.

What do I think will happen?

I genuinely don’t know. We live in interesting times.


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