Norman Lamb threatens to quit over NHS reforms

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Cameron's NHS debacle grinds on

Cameron must know how much he has misjudged the NHS reform plans when Norman Tebbit objects to them for going to far.

In an article for the Mirror, Tebbit - a former chairman of a charity supporting a hospital actively involved in medical training - highlights the dangers of private sector cherry-picking on the viability of NHS hospitals:

"One problem is that within the NHS there are teaching hospitals, often centres of excellence, which apart from treating patients, also have the responsibility of training doctors and nurses. That all takes time and costs money. Private hospitals are under no obligation to do training and do not have to carry those costs... Even worse for the teaching hospitals, if the private hospitals can hoover up all the straightforward routine surgery, like hip joint replacement, where can the young surgeons gain the experience which would allow them to move on to more difficult surgery?...Another problem for the NHS hospitals is that they cannot refuse to treat patients. Whether it is a drunken fool with a cut face from a street brawl, or a young mother with cancer or a heart attack, no one can be turned away, but the private hospital can pick and choose."

This reflects an earlier piece he wrote for the Telegraph, in which he concluded:

"The public and private sectors are very different animals. They cannot just be told to compete. There are many parts of the public sector which are high cost, flabby and inefficient. But it also carries the costs of services which the private sector is not required to provide".

The question that many must be asking is how - when it was clear from a very early stage that these reforms would be hugely controversial and unpopular - Cameron managed to so woefully misjudge the situation?

UPDATE APRIL 10

Anthony Wells, over at UK Polling Report, has detailed analysis of the latest YouGov poll. One startling statistic is that only 3% of voters think that the government should continue with their reforms as they currently stand - including only 5% of Conservative voters.

Wheels come off government's NHS 'listening exercise' barely a week in

The passage of the Health and Social Care Bill is now looking close to disastrous. With opposition to the Bill rife amongst professionals from across the NHS, even normally sympathetic papers are questioning the way the reforms have been handled:

• The Telegraph has described the exercise so far as a 'fiasco', arguing that the suggested reforms were "not part of the Coalition Agreement, and it is fair to say that few ministers anticipated such complex changes to the health service at a time when the Government is committed to so many other public service reforms".
• The Mail, whilst supporting the principle of the reforms, declared that "countless Britons believe the Health Secretary is rushing his pet project through with far too little warning or consultation... During the election, the Tories gave almost no inkling of the revolution they had in mind for the NHS. Since then, Mr Lansley has appeared determined to brush aside all objections – as if he is afraid of proper scrutiny".

Cameron no doubt thought the 'listening exercise' launched earlier this week may alleviate some of these problems. But there have subsequently been a number of worrying signs that the Government intends not to listen, but rather to tinker with existing proposals, presumably because Cameron and Lansley believe the problem is one of presentation rather than substance. Hence the surfacing of a confidential memo drawing red lines around the core parts of the reforms and signs that Lansley will be selective with regards to who he speaks to during this so-called consultation.

The Government has a big problem here. Firstly, this attempt to delay and re-present the policy won't persuade the countless numbers of people opposed to the Bill.

Secondly, the rank and file of the Liberal Democrats are clearly not going to let the reforms go through without substantial changes - illustrated by the petition by the left-leaning Social Liberal Forum that would radically alter the core of the reforms. This petition proposes that the Bill should:

a) ensure the Health Secretary has a duty to provide a fully comprehensive and free health service, with no gaps and no new charges;
b) provide more local democratic accountability for the health service;
c) curb the market obsession of the proposed reforms to prevent quality being relegated behind price and prevent the cherry-picking of profitable services by the private sector undermining and fragmenting existing provision;
d) slow down the pace of change so that the NHS, facing its toughest settlement for decades, does not implode from the stress of another massive reorganisation.

The significance of the choices that the Government makes cannot be underestimated politically - and are certainly crucial for patients. Nick Clegg is not in a position to let the reforms sail through with only minor amendments, despite the fact that he and his fellow Lib Dem MPs were minded to let this happen prior to their party conference.

Lansley, meanwhile, is increasingly looking like he is on borrowed time.

Top Tory telling us something we all knew already

Delivering a line like "we are making cuts that Margaret Thatcher...could only have dreamed of"with a smile on your face is never a good look for a Tory politician.

NHS reforms - is the Government finally thinking again?

We already know that swathes of health groups, medical professionals (including GPs) MPs (encompassing both opposition parliamentarians and members of the yellows and blues) and large numbers of the general public are opposed to the direction of Andrew Lansley's NHS reforms.

We also know that Cameron is getting jittery. Well, the Independent claims today that he is set to give Lansley the Spelman treatment and announce a rethink of the proposed reforms. A leading article in the same paper (which had previously given the Government the benefit of the doubt on the issue) argues that the path that the Health and Social Care Bill has taken "poses alarming questions about competence at the heart of government".

Meanwhile, David Owen has penned an excellent piece in the same newspaper, which he sums up as follows:

"It is a tragedy that the NHS is being subjected to this inept, ill-conceived and damaging legislation. It has to be drastically amended and given much greater scrutiny...Without such sustained scrutiny and a deliberate slowing down of the procedures, the NHS is heading for a train crash and David Cameron, as the train driver, and Nick Clegg, as his guard, will forever be held responsible".

If the Prime Minister is going to put a stop to Lansley's plans, then good. A 'u-turn' here may be of consequence to Westminster watchers (and indeed this does have political ramifications for the Government, not least the Lib Dems), but it pales into insignificance compared to the consequences for millions of British people of not re-thinking the plans as they stand.

Osborne's Corporation Tax cut - a huge cost to the UK, with little benefit

When Osborne proudly announced that the government would be squandering what little money it has chosen to spend on a cut in Corporation Tax, he was supposedly bolstered by the announcement from advertising firm WPP that it was to relocate its head office back to the UK in response, having jumped ship to Ireland a few years earlier.

This, Osborne could now claim, justified his surrendering of billions of pounds of revenue to fund  reductions in the tax. He could now dust off and wheel out the classic neo-liberal line that lower tax rates on businesses always increase revenue by encouraging investment (and by discouraging companies from relocating abroad).

However, there are two problems with this story. The first concerns WPP and second the wisdom of cutting UK corporate taxes.

First, lets take WPP. It's announcement was met with gleeful back-slapping amongst Osborne and his friends at the Treasury. However, its press statements omit a central fact: WPP's head office is Ireland barely qualifies for the term - it's almost non-existent in fact, with what appears to be a measly eight employees. It's original 'relocation' to Dublin has, unsurprisingly, been described as a 'tax dodge'.

In other words, relocating its head office back to London, where it already houses its far, far more employees, will make no discernible effect. Accountancy Age backs up this view, describing the tax cuts as "a £6.7bn gamble to attract businesses to the UK".

"...any relocation of its tax base will result in few, if any, jobs being moved. The same is true of publishing company UBM, who are also likely to move their tax base back to the UK, and pharmaceutical company Shire. As with WPP, their moves to Ireland did not affect their UK workforce numbers to any meaningful extent and a move back will have the same effect".

Secondly, what about cutting UK Corporation Tax? Well, this was already, before the current Chancellor had his seat at the Treasury, the lowest amongst the G7.  Furthermore, there is evidence - provided by the Treasury itself -  that very few companies actually relocated for tax reasons since 2007/08. And, amongst those that did, their tactic was often to relocate in name, but actually then continue to retain a significant staff presence in the UK.

The fact is that George Osborne has, in the face of huge spending cuts to frontline services that will affect millions of British people, handed billions to some of the largest multinational corporations on the planet - and potentially for absolutely no benefit.

"We should all be clear what is happening here"

The Guardian today published a statement from Tom Morris, Artistic Director at Bristol Old Vic, which was released in response to the Arts Council's announcement of funding for cultural venues and projects across the country. Despite the Bristol Old Vic getting a better deal than some, he expressed eloquently what many in the arts community feel about the Government's 'deficit reduction' programme. In unusually strong words compared to many of his colleagues, he also expressed concerns about the wider impact of spending reductions:

"We should all be clear what is happening here.

Arts Council England has been asked to make big cuts and to be progressive too. There is no way to make this scale of cut without making horrible and unpopular decisions.

Bristol Old Vic is lucky enough to be in receipt of a standstill grant; this is good news for us and good news for Bristol. In addition, we're excited about a new conversation with Arts Council England about how they can support us in developing touring work. However, many organisations and cities have not been so fortunate. It would be easy to blame Arts Council England, but this is not their fault. They have been set a riddle to which there is no fair solution.

 The arguments about the fantastically efficient economic and human impact of arts investment have been brilliantly rehearsed over recent weeks, but this is not the main issue today.

 People across the public sectors should take note of today's news, not because the arts should be favoured at the expense of health or education or benefits, but because similar cuts will soon be made across the board in all sectors. We can see the detail of our sector early, because Arts Council England has decided to give us as much time as possible to plan.

Surprisingly, this is not a party political issue. There are many people who support and belong to all three major parties who agree that the scale of cuts across the public sectors is too high. In the face of today's news, we should stand beside doctors, teachers, policemen, lawyers, local politicians and the many, many voters across the country to argue for a more enlightened approach to deficit reduction."