|Lansley's reforms: now in Clegg's hands?|
The Guardian has, quite rightly, pointed to the recent communication by NHS Chief Executive David Nicholson, in which he said this:
"It will not have escaped your attention that the NHS has been the subject of considerable debate in Parliament and the media. My message to you is simple: whilst we cannot help but be interested in these debates, especially when they potentially affect our own futures, we must not allow ourselves to be diverted from our core purpose and responsibilities in the year ahead".
For those who were hoping the massive opposition from across the health professions might have persuaded the Government to drop their reform programme, it doesn't look particularly positive, even with the Prime Minister's warm words (particularly as Cameron's 'consessions' seem to basically involve continuing with the same proposals, but at a slightly slower pace).
However, it looks like the Liberal Democrats might be finally waking up from their post-election slumber. Nick Clegg - up until now looking very out of step with his own party on this - has now issued this ultimatum to his Conservative partners:
- quality not price should drive competition;
- services should not be commissioned by family doctors alone;
- GP consortia if unprepared, should not go ahead in 2013;
- the NHS constitution principles must be protected;
- GPs need to work together with councils.
These are all welcome suggestions - but are the least that could be expected given the pressure that Clegg has felt from his grass roots supporters. In fact, it could equally be concluded that Clegg is trying to satisfy his party members but by conceding the minimum possible. He did, after all, allow the existing Bill to get through the Commons intact until the Sheffield Lib Dem conference vote forced his hand.
If these are as far as they go, Clegg's suggestions aren't enough. The silence on one issue is almost deafening: privatisation. Nowhere does he oppose one of the central problems that so many people have with the Health and Social Care Bill - that they will allow private companies to take over NHS commissioning services, and grant them even more of service provision.
Asking that "services should not be commissioned by family doctors alone" or that GPs "work together with Councils" are potentially not much stronger than the 'concessions' Lansley has been promising. Private companies could still be the beneficiary of outsourced commissioning work. Private providers could still massively increase their influence throughout the service.
This, ultimately, is the 'red line' that Clegg is going to have to address. His own party members reflect the views of the majority of the British people on this one: allowing the privatisation of the National Health Service isn't something that will command support in the country, no matter how many Tory MPs and their media allies want it.
It also is a useful indicator (particularly coupled with the forest privatisation fiasco) just how difficult it will be for Cameron to undertake his far-reaching plans to facilitate the outsourcing of all other core public services. If the PM had thought that the principle of a genuine 'public' sector was one he could quietly drop, then he almost certainly doesn't now.