The coalition get lost in their own spin cycle on the NHS reforms

The listening exercise report is being released today, and it remains unclear whether Clegg will get his way on the healthcare bill.

Nick Clegg David Cameron

So, the Liberal Democrats have saved the NHS from their own reforms. You may recall these –  the ones their leader put his signature to and that their parliamentary party voted for twice. Nick Clegg told his party to “toast its success” in securing 11 out of 13 demands on NHS reform.

But wait: the Tories too are spinning. Sky News reports, from David Cameron’s meeting with new MPs, that the reforms are going full steam ahead, and any stories otherwise are “political posturing by the Lib Dems”. One MP said:

“The tone of the meeting was that this is a reforming government and the reforms are going to proceed.”

Meanwhile the listening exercise Future Forum report is only being released today, and it remains unclear whether or not Clegg will get his way and the whole bill will have to begin its journey through parliament again. Some Lib Dems remain worried however. Leading critic amongst MPs John Pugh, said:

“The role of [Stephen] Bubb in chairing the listening exercise on competition is seen by many as a clear conflict of interest.

Asking Sir Stephen to sum up on competition rules is as neutral as asking Simon Cowell to tell us about the merits of TV talent shows.”

Clearly, there is a lot more detail to be worked through, not least in the legislation itself, before policy clarity starts to emerge. The headlines this week will say more about politics within the coalition than provide an accurate forecast of how the NHS will change under coalition reforms.

So perhaps another brief “pause” is in order to reflect on the health policy landscape, over the last year. Four big themes emerge:

1. The NHS is a top political priority – again:

After neutralising it during the general election, Cameron now faces rigorous scrutiny of moves and motives. Lansleys reforms were in essence about taking political accountability out of the NHS. Yet as the FT comments (paywall):

“Far from removing the NHS from politics, his bill has injected more politics in to how the NHS should be run than at almost any time since 1946.”

2. Passing the bill is not the end for the coalition, it is just the beginning:

In their desperate rush to get reforming early, the coalition got the order wrong: legislation usually comes after consultation, not before. The legislative process will now drag on for many months more. Meanwhile, frontline service pressures are starting to build-up: trust hospitals which cannot function financially under the new regime, local authorities and NHS commissioners restricting eligibility to services, and waiting lists that are rising.

3. The policy muddle for the coalition risks generating weak NHS leadership:

Given how fundamental are now the differences  – on commissioning and competition especially – between the coalition partners, it is hard to see how this will change in terms of health policy from now on. At a time when the NHS faces the biggest financial challenge of its existence, requiring 4 per cent cash efficiencies per year for four years, a scenario of health ministers will be playing out coalition power struggles (and blame shifting) is not unlikely.

4. The NHS reforms remain a solution in search of a problem:

The weakness of these reforms is that they were a solution, in this case full-scale markets for public services, chasing a problem. The NHS was already focused on an ambitious efficiency programme initiated by Labour, anticipating tighter settlements. The reforms have brought managerial chaos and uncertainty, and a £3 billion price-tag. Record public support for NHS service has not translated into any meaningful support for the coalition’s reforms.

Throughout this debate, Labour has consistently highlighted the failings of the bill, yet been subject to criticism that, six months after a leadership election, it does not yet have a detailed alternative. It will of course need more policy detail, but in fact Labour’s efficiency programme already anticipated the necessary change in direction following austerity in public finances.

Perhaps the real lesson is that the incremental reform approach  – a focus on standards, universal improvements, backed by comprehensive planning with a dose of selective competition –  of the Tony Blair and Gordon Brown years, that delivered high public satisfaction and respectable waiting times –  is a reasonable alternative to the spin and counter briefing that characterises coalition health policy today.

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15 Responses to “The coalition get lost in their own spin cycle on the NHS reforms”

  1. Watching You

    The coalition get lost in their own spin cycle on the NHS reforms: writes Trevor Cheeseman

  2. enayat2006

    The coalition get lost in their own spin cycle on the NHS reforms: writes Trevor Cheeseman

  3. Ed Brown

    The coalition get lost in their own spin cycle on the NHS reforms: writes Trevor Cheeseman

  4. Young Greens

    RT @leftfootfwd The coalition get lost in their own spin cycle on the NHS reforms: #keepnhspublic

  5. Michael

    The coalition get lost in their own spin cycle on the NHS reforms I Left Foot Forward –

  6. Pubteam

    RT @TheRightArticle: Coalition get lost in their own spin cycle on the NHS reforms I Left Foot Forward –

  7. Ed's Talking Balls

    I have to agree with you on this.

    It’s pathetic watching the Lib Dems trying to claim credit here. It won’t work either: the public aren’t going to buy this ‘we’re on your side really, honest’ when their party is really only about self-interest. Hence the desperate, expensive, futile attempt to foist AV on us and, now, the noisy rebellion against NHS reform (when a voice was found, coincidentally, in the media after embarrassing local election results).

    And the Conservatives don’t know what they’re doing either. Lansley wanted change; several to the right of him would like to see an even more drastic overhaul; Cameron is putting across some very confused messages. Whoever is in charge of government communication wants sacking.

  8. paurina

    The coalition get lost in their own spin cycle on the NHS reforms I Left Foot Forward –

  9. Karen Aspinall

    RT @leftfootfwd: The coalition get lost in their own spin cycle on the NHS reforms

  10. NHS reforms: The Government is turning the clock back – — News Addicts

    […] reportPulseExperts demand changes to NHS plansBelfast TelegraphBBC News -The Independent -Left Foot Forwardall 867 news […]

  11. Duncan Stott

    The first time the Lib Dem parliamentary party voted for the bill was the Bill’s second reading on Jan 31st. When was the second time?

    The party’s position on the NHS reforms changed at Spring Conference in March, when the party membership voted for amendments to the Bill in order to get support.

    Now Lib Dem MPs are beholden to the Coalition Agreement, and then to Lib Dem party policy (and of course individually to their constituents). The Bill contains some elements that are present in the CA, so it had to be voted through in its early form. But in areas not spelled out in the CA, it is the Parliamentary Lib Dems’ job to push for our policies.

    @Ed’s Talking Balls, this push for amendment has been happening since March’s policy change, not after the (entirely expected) bad election results in May. Lansley announced the pause in the Bill in the Commons on April 4th.

  12. Trevor Cheeseman


    The second time was in Commmitee on 31 March, when they failed to support Labour’s amendments. Some Lib Dems have gone public on occasion (take a bow Andrew George and John Pugh), but most are like my local Lib Dem member.

    When I went to lobby him in late January he said he was supporting the Bill and patronisingly told me: “Don’t believe everyting you read on 38 degrees”; six weeks later he was proclaiming his concerns about the NHS reforms in the local paper…

    The Lib Dem leadership got themselves in this mess because Clegg’s instincts lie with the Orange Book brigade – for example his comments about “breaking-up” a tax-funded NHS. Thank goodness for Evan Harris and the grassroots party.

  13. mr. Sensible

    I cannot believe that the Liberal Democrats are trying to rewrite history on this. They will be found out.

  14. Kevin leonard

    No matter who claims to have “Saved” the NHS all sides are lying as changes already in place will drive forward from now on the ultimate privatisation as government claim they need to take measures because of uncertainty caused by outside influences and hand over control of some parts for “safe keeping” to their private health care partners.

  15. Geoffrey Payne

    The Liberal Democrat party is a democratic party in which elected representatives can attend their party conference and cannot be stitched up by the party leadership.
    There are a significant number of public sector employees within the party, including many within the NHS and it was clear at our conference that we had an oevrwhelming majority in favour of amending the NHS conference motion last March.
    The party leadership decided not to oppose these amendments supported by Evan Harris, Baroness Shirley Williams and the Social Liberal Forum and were then duty bound to follow through, which is what they did.
    I am not sure the Labour party is accountable to its members in the same way.
    I do regret the current problems the NHS faces over the next few months as a result of this volte farce, and no doubt there are still going to be problems with the bill, but clearly had the Tories governed alone the original policies would have passed, and that would have been much worse.
    I hope what comes out of this is that Nick Clegg will listen more to the members of his party, and in turn the left will stop sniping and try to work more with the Lib Dems.
    It would be right for 38 degrees, “Save Our NHS”, the BMA and other campaigning organisations to take credit for what has happened. In the end I think the most significant impact has been made by the Social Liberal Forum in their intervention at the Lib Dem party conference.

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