Nhs

Although it is nearly 20 years ago, I can still recall being lobbied by the representatives of a private consortium who had nascent plans to redevelop a hospital in south London using the then fabulous new idea we called the private finance initiative.  Before you jump to too many delirious conclusions, the meeting took place in my office, not in an expensive restaurant, and it was the only one I ever had with the group. I may have splashed out on a plate of civil service issue custard creams. At the time I was the special adviser to the then Secretary of State for Health, Virginia Bottomley, and the main item on her desk - and mine - was a plan daringly called 'Making London Better' which, when you got down to it, involved shutting down quite a lot of London hospitals.

No public sector strike is easy to sell to the public. I recently did a stint of jury service and witnessed the chaos caused by court staff, members of the PCS union, striking over pensions. It’s one thing working around the inconvenience of jury service, but it’s quite another being kept on the premises when there is little chance of the courts actually sitting, as proved to be the case. But, the BMA have it doubly difficult. Today, doctors decided to strike for the first time in more than 40 years. Doctors have a reputation for being well-paid, a reputation that is ingrained and, when one examines the NHS pay structure, not wholly unmerited.

If you want to know why the great Labour-NHS argument about healthcare is wrong, read today’s National Audit Office report on the provision of diabetes care in England. Diabetes is one of this country’s biggest health problems and it is getting worse. There are currently over three million people with diabetes here today, and, on some estimates, by 2020 there will be nearly four. In the last 15 years the number of people with the condition in England has more than doubled. Yet according to the NAO, the treatment they receive from the NHS is little short of shocking.

David Cameron’s big parenting push this week is a reminder of what the Prime Minister would have liked to have been before the economic crisis intervened. Cameron believes that encouraging stable, loving families is the best way to prevent social failure. Doing that reduces the demand for government and, so the logic goes, shrinking the state then becomes a lot easier.   How the government can try and help people be better parents without falling into the nanny state is undoubtedly tricky. But Cameron’s emphasis so far has, rightly, been on simply giving people more information to help them make their own decisions.

The birth of the White Paper on public service reform was a tortuous business — but, now it's been out for several months, the government is keen to make the most of it. David Cameron is launching an ‘updated’ version today, with a few new proposals contained therein. He also has an article in the Telegraph outlining those ideas, including the one that seems to be getting the most attention: draft legislation to give people a ‘right to choose’ their public services. It feels like both an important and potentially inconsequential moment all at once. Enshrining choice in the laws of this land is a powerful symbol that people shouldn't have the state's idea of ‘good’ foisted upon them.

At two thirty this afternoon, the Deputy Speaker announced to the House of Commons that the Queen had granted Royal Assent to the Health and Social Care Act. It seemed fitting that the House was debating assisted suicide at the time. The agonies of watching this cursed legislation twitch and stumble its way onto the statute book were enough to make anyone with half a concern for well-ordered public policy start Googling the names of Swiss exit clinics. Albeit there would have been the risk that Number 10 had already paid for Andrew Lansley's ticket to join you there. Suddenly, though, the politics of health are very different. Mr Lansley, for all the opprobrium he has borne, has his Parliamentary mandate. He has won.

A few months ago, I was invited to speak at the Health Service Journal conference, and hugely enjoyed meeting various reformers from within the NHS (and, of course, their enemies). One representative from the NHS Confederation pointed out that in most countries which were run by coalitions, the junior party was always given control of health — because nothing good can ever come from it. When things are going well, you hear nothing. When flu epidemics strike, then health is a horrible brief. A good point, which David Cameron may be taking to heart. Patrick Hennessy reveals in tomorrow’s Sunday Telegraph that Cameron is mulling a pre-Olympics reshuffle which would replace the hapless Lansley with a Lib Dem.

So here we are again. At least Lord Justice Leveson had the humanity to give us a couple of weeks off whining celebrities, shifty ex-journalists and declaiming newspaper editors. From the Health and Social Care Bill there is no respite. The Bill is back in the House of Lords and Liberal Democrat guerrillas are wound up for a fresh assault on the lumbering mule train as it passes through. Does anyone care any more which bit of this battered and bleeding legislation has been chosen for further victimisation in this week’s shenanigans?

Will there be further changes to the Health and Social Care Bill? Liberal Democrat President Tim Farron certainly wants some, as he told ITV’s Party People last night: ‘If the new competition introduced through this Bill is removed, then I think it’s better on the books than it is off it… What I want is for the Lords to propose changes that will remove the new competition elements from the Bill and I would like the Government to give way on those things. It's all to play for.’ Farron’s echoing the call made by fellow Lib Dem Shirley Williams last week and by a group of activists who have submitted an emergency motion for their party conference in two weeks.