Nhs

Listening is seriously damaging the coalition’s health. The Sunday Mirror carries a report that chimes with a week of rumours in Westminster: the NHS reforms are going to be significantly diluted to appease warring Liberal Democrats. The Mirror adds that Lansley is likely to quit in protest. Matt d’Ancona argues, in his essential column this morning, that this is not a listening exercise but a ‘full blown carefully orchestrated retreat’. It is, if you will, a political version of the battle of Arnhem: the NHS reforms were a reform too far in this parliament, so tactical withdrawal is now imperative. Clegg and Cameron’s signatures are on the original White Paper.

The British Medical Association (BMA) has always been a trade union with elements of professionalism on the edges. Its report this week on the NHS reforms was the work of unadulterated, self-serving trade unionism. Our modern trade union leaders would have been embarrassed to publish it, even Bob Crow. It tries to portray competition as the opposite of co-operation, when competition is the opposite of monopoly, in this case a public sector medical monopoly. Competition describes an arrangement under which teams of people co-operate with each other to find better ways of serving customers than rival teams of collaborators. The co-operation of which the BMA speaks is a weasel word for producer domination.

Nick Clegg’s speech on the NHS this morning was not as bad as many feared it would be. It recognised that there is a role for competition in the NHS, something that the Lib Dems were questioning last weekend, and that the NHS needs to be opened up to any qualified provider. But, on the other hand, the idea that any willing provider should be able to deliver NHS services — an idea which was in the manifesto of all three parties — will now only be introduced at a glacial pace. There’ll also be a two-tier NHS for the foreseeable future with some areas having GP-led commissioning, while NHS managers continue to do it in other parts of the country. And Monitor will not be able to enforce competition.

I know most CoffeeHousers aren't particularly enamoured of paywalls, but the Times has given you a persuasive reason (£) to dive behind theirs today. (Or least to borrow a copy of the paper.) It's the first of three reports by Camilla Cavendish on the NHS, this one concentrating on the Way Things Are Now. It is both a disheartening read and a powerful reminder of how taxpayers' cash is being funnelled into a system that is dysfunctional in the extreme. Here is one snippet for your displeasure: "Care in Britain ranges from world-class to shocking. Between 1998 and 2006, 1.6 per cent of bowel cancer sufferers died within a month at the Manchester Royal Infirmary, compared with 15.6 per cent at Queen’s Hospital, Burton upon Trent.

'NHS good, private health bad'. 'State good, market bad'. 'Four legs good, two legs bad'. Whenever political leaders get into a tight corner they have to find allies fast. There is no time for reasoning to work its gentle magic. Basic sentiments need to be stirred and the popular favourite is usually hate. Yesterday Mr Clegg used this classic strategy to rebuild his support base. The cold-hearted Tories were at it again, dismantling that icon of compassion the NHS. In public they were declaring their undying love for it but out of sight they were promising fat profits for ‘health care corporations’ once the new law was passed. Mr Clegg even resorted to another child-like contrast.

If there's anything that stands out from Andrew Lansley's interview with the Sunday Times (£) it is his air of quiet defiance. Of course, the Health Secretary sounds some of the conciliatory notes that have crept in to the government's rhetoric since they decided to pause, listen and engage on NHS reform. But he also stands up for the original reforms as he conceived them. "From my point of view," he says, "the White Paper was setting out what sensible, intelligent people inside the NHS were saying." For him, the concerns that remain are not with the general thrust of his reforms, but with "implementation, the nuts and bolts of how it will work." Lansley also makes sure to bind Cameron into the White Paper.

Number 10 has now taken charge of coalition health policy to such an extent that the Department of Health press office was caught unawares by the news that the Prime Minister was to deliver a major speech on health next week. David Cameron is determined to present the coming substantial changes to the Lansley reform plan as the changes he wants, not the ones forced on him by the Lib Dems. To that end, the head of the NHS future forum, a body Cameron has set up to oversee the NHS listening exercise, Steve Field telling The Guardian that he thinks all competition should be removed from the bill is helpful to Cameron. But these sentiments will exacerbate the growing concerns in Conservatives circles that the bill is going to end up being so diluted as to be pointless.

Why should Cameron ditch the Lib Dems? Coalition has made his party more radical, more electorally successful – and the worst ideas in the Cabinet come from men with blue lapels. Take Andrew Lansley. His press release today would have been shocking had it come from a Lib Dem, and denounced as dangerous leftist nonsense that renders the government's overall message incoherent. Ed Balls' arguments against cuts have routinely been challenged in Coffee House. So we can hardly be expected to applaud when his arguments are plagiarised by a Tory. The hapless Lansley, whose needless and complex heath reform bill has stalled, is today trying to win back the initiative by attacking Balls and Miliband from the left.

Another story to sour Andrew Lansley's cornflakes this morning: the King's Fund has released a "monitoring report" into the NHS which highlights, among other things, that hospital waiting times are at a 3-year high. The figures they have used are available on the Department of Health website — but unshackled from Excel files, and transcribed into graph form (see above, click for a larger version), they are now, it seems, a discussion point. The Today Programme tried to bait a couple of NHS chieftains on the matter earlier. The worst they could extract from either of them was that, "[waiting times] haven't got massively longer now, but people are worried about the future.

There’s a fantastic post by Nicholas Timmins at the FT’s Westminster blog. Using the example of Enfield Council, which has just blocked moves to close failing wards in a local hospital, Timmins argues that councils commissioning healthcare is a recipe for disaster: ‘The reason council commissioning of care is a not a good idea is that it mixes representation without taxation. Councillors have democratic legitimacy. But they don’t raise the money for the NHS.

Is Andrew Lansley hearing rather than listening? Dame Barbara Hakin, one of the Department of Health’s national managing directors, has written a letter to some GPs that suggests the pace of health reform will not be affected by the ‘legislative pause’. Hakin writes: ‘Everyone within the Department of Health is very aware of the support shown by the GP community to date and we have been struck by the energy and enthusiasm demonstrated in pathfinders across the country. Therefore, although the Government has taken the opportunity of a natural break in the passage of the Health and Social Care Bill, we are very keen that the momentum we have built to date should not stop.