Despite trying to pin the health reforms on Andrew Lansley, David Cameron says he helped design them, he has backed them in public and is ultimately responsible.
Ahead of the return of the health and social care bill to the House of Lords today, the papers are full of stories David Cameron is seeking to distance himself from the coalition’s heavily-criticised reforms and hang them round the neck of Andrew Lansley.
The truth, of course, is vastly different to the lines briefed out by Downing Street – the bill is as much the prime minister’s as it is his embattled health secretary’s. As the excerpts below show, he says he helped design it, he has repeatedly backed it in public and he is responsible for it – this is David Cameron’s disastrous NHS reorganisation.
• In July 2010, David Cameron, alongside Nick Clegg and Andrew Lansley, personally signed the foreword to the white paper – “Equity and Excellence: Liberating the NHS” (pdf) – which set out the government’s NHS reorganisation plans:
“The NHS is a great national institution. The principles it was founded on are as important now as they were then: free at the point of use and available to everyone based on need, not ability to pay. But we believe that it can be so much better – for both patients and professionals.
“That’s why we’ve set out a bold vision for the future of the NHS – rooted in the coalition’s core beliefs of freedom, fairness and responsibility.
“We will make the NHS more accountable to patients. We will free staff from excessive bureaucracy and top-down control. We will increase real terms spending on the health service in every year of this Parliament.
“Our ambition is to once again make the NHS the envy of the world. Liberating the NHS – a blend of Conservative and Liberal Democrat ideas – sets out our plans to do this.”
• In April 2011, Mr Cameron told Sky News’s Dermot Murnaghan he had “been involved in designing these changes way back into opposition” with Mr Lansley, and takes “absolute responsibility with him for all the changes we are making”:
DM: “Well you were ploughing on until you ran into so much political trouble. Mr Lansley for a long time seemed to be in charge of the process himself, it was only when Number Ten took on board the enormity of the proposed changes, isn’t it?”
DC: “No, not at all. I mean I have been involved in designing these changes way back into opposition with Andrew Lansley, I take absolute responsibility with him for all of the changes we are making but I do think it is right when you have an asset as precious as the National Health Service, if you have the time to just stop and make sure you are getting everything right and at the same time what I’m finding is when you go particularly to hospitals, a lot of this is about reassuring clinicians in hospitals, hospital doctors, that they will have a really big part in this future NHS.”
• The prime minister has regularly defended the reorganisation inside and outside Parliament:
“First of all, let us be clear about the fact that the reforms are about cutting bureaucracy and improving patient care. They were drawn up by us as a coalition to improve the NHS.” – PMQs, March 2011
“It’s because I love the NHS so much that I want to change it… Because the fact is the NHS needs to change. It needs to change to make it work better today and it needs to change to avoid a crisis tomorrow.” – Speech at Ealing Hospital, May 2011
“Three weeks ago, I made the case for change in our NHS. I said we would be kidding ourselves if we thought we could simply stick with the status quo. We need to change the NHS to make it work better today.” – Follow-up speech on the NHS, June 2011
“Of course there are doctors in the health service who don’t like the idea of greater choice and competition and other organisations being able to provide free healthcare services to patients. But I believe patients want that sort of choice and rapid, quality treatment and that’s why it’s right to make these reforms.” – Interview with the BBC, October 2011, in response to a Telegraph letter from doctors and academics warning “the proposed reforms will disrupt, fragment and weaken the country’s public health capabilities”
• Cameron’s former No. 10 adviser James O’Shaughnessy recently revealed that during the “pause” last year “it did take the energy of Steve [Hilton] and the prime minister and Oliver Letwin and others to keep pushing it through”:
“We came in with what we thought were fairly well thought through proposals that then did seem to be running into opposition at a variety of levels, whether it’s the House of Lords or staff or other groups.
“I think there was a lesson in there for all of us which is actually, if you look where we’ve got to with the health bill, the fundaments of what we were trying to do are still there but it did take the energy of Steve and the prime minister and Oliver Letwin and others to keep pushing it through, to weigh in behind that and adopt different tactics in order to get the same principles across.” – “David Cameron’s Big Idea” (listen), BBC Radio 4, January 2012
• And just last week, at PMQs, David Cameron made it clear he would not back down – even citing Tony Blair in his support:
“Let me tell the Right Honourable Gentleman something that Tony Blair once wrote about the process of reform. Now there is a man who knows a thing about bonuses and pay.
“He said this – listen, listen:
‘It is an object lesson in the progress of reform: the change is proposed; it is denounced as a disaster; it proceeds with vast… opposition; it is unpopular; it comes about; within a short space of time, it is as if it has always been so. The lesson is instructive: if you think a change is right, go with it. The opposition is inevitable, but rarely is it unbeatable.’
“That was someone who knew a thing or two about reform.”
Mr Cameron may run, but he can’t hide from the reality that these are his reforms, that he has resolutely stuck by them, and that he is ignoring pretty much everyone who cares about the NHS and is refusing to kill the bill.
• Miliband goes on attack as fight to save the NHS stepped up – Shamik Das, February 6th 2012
• Sign my petition to drop Lansley’s monster – Dr Kailash Chand OBE, November 24th 2011
• Cameron’s fantasy list of NHS reform backers – Shamik Das, September 7th 2011
• Doctors still fear coalition health reforms – Daniel Elton, June 27th 2011
• So who backs Lansley’s health reforms then? – Dominic Browne, June 1st 2011
• Doctors tell Lansley: “Stop this bill” – Dominic Browne, March 15th 2011
• So, Mr Cameron, who backs your NHS reforms? Erm… – Shamik Das, February 2nd 2011