Having waited 10 months, and the wrong side of a white paper, to appoint a No 10 policy specialist (pdf), David Cameron’s No 10 health adviser must be working overtime.
In yet another speech on the NHS, Cameron today offered “five guarantees” attempting to show the prime minister is committed to the NHS, and that “he is hearing what is being said” during his listening exercise.
The five pledges are: to keep waiting lists low, maintain spending, not to privatise the NHS, to keep care integrated and to remain committed to the “national” part of the health service.
They are interesting, as they reveal coalition insecurities. The pledge on waiting lists is already vulnerable as quarterly data demonstrates; “the broad trend since June  is upwards,” comments the Kings Fund think tank.
A combination of a tight settlement and inflation means pledge two, on spending, is already compromised, as previously highlighted by the OBR.
Pledge three reflects real concern, not least about image. Just weeks ago the Department of Health was on the verge of releasing official guidance on “any willing provider”: the opportunity for charitable and private sector providers to be licensed to provide a range of current NHS services.
A chorus of disapproval from NHS staff about the risks of fragmentation has postponed this, for a while at least. “Integrated care” as a phase is woolly, but it appears Cameron partly sees it as about hospital staff as well as GPs leading commissioning. Commitment to the “national” in NHS, is perhaps most surprising, since it represents the antithesis of the thrust of Lansley’s NHS vision, with a previous lack of embarrassment about a postcode lottery.
The speech therefore, is significant. As the Telegraph comments:
“Such is the concern in Downing Street at the damage the issue of NHS reform is causing the government, that Cameron will put his reputation on the line with a personal pledge to protect its core values.”
Moreover, a report (pdf) from Lord Ashcroft on potential Tory voters, following private polling, confirms this view:
“Many [potential Tory voters]in our research believed the NHS was subject to cuts, though the government maintains its budget is being protected and increased. Most people were sceptical of the proposed reforms, and those who had noticed that some health professionals opposed them tended to take the same view.
“Nobody seemed to know is why the reforms were needed and how, even in theory, they were supposed to improve things for patients.”
Cameron’s latest remarks show a significant change of tone from his showpiece public services reform speech, just 12 weeks ago. There he proclaimed that “we are injecting competition, saying to the private sector, community organisations, social enterprises and charities: come in and deliver great public services”.
In terms of politics, some commentators are already highlighting this as “the biggest failure to win the battle for public opinion on public policy“ since the poll-tax.
So what does Cameron really believe when it comes to the NHS? It is hard to say with any certainty. Christopher Hitchens’ commentary on the PM seems particularly apposite: “He seems content-free to me. Never had a job, except in PR, and it shows.”