Speed of NHS reform means Andrew Lansley has

Speed of NHS reform means Andrew Lansley has

Andrew Lansley health secretary

The likely inflation rate means that Lansley’s promise that the NHS budget is going up in real terms is unlikely to be met. Photograph: Lewis Whyld/PA

Health secretary is one of the toughest jobs in the cabinet, not least because of the public’s feelings towards the NHS: people love the health service and its staff but are not always satisfied with it.

Even allowing for the difficulty that such a paradox poses for the NHS’s political master, Andrew Lansley has had a bumpy seven and a half months in the job. His tenure has been marked by own goals, claims of broken promises, opposition from many senior medical figures and, lately, concern in Number 10 and across the coalition that his zeal to reform the NHS could become a liability.

The first indication that Lansley is not blessed with the common touch came in June when, addressing the British Medical Association’s conference, he launched an unscripted attack on Jamie Oliver and the healthier school meals introduced by the chef’s 2005 Jamie’s School Dinners series. Teachers, doctors and many parents see the more nutritious lunches as good for children’s health and education.

But the health secretary cited them as evidence that “if we are constantly lecturing people and trying to tell them what to do, we will actually find that we undermine and are counterproductive in the results that we achieve”. School meal uptake had fallen since Labour introduced the new minimum nutritional standards, he added – which was not true.

Criticism of his remarks came from many quarters, while Oliver – almost a national treasure – attacked Lansley’s inaccuracy over take-up rates and his “insult to the hard work of hundreds of thousands of dinner ladies, teachers, headteachers and parent helpers who strive to feed kids a nutritious, hot meal for 190 days of the year”. Lansley insisted his remarks had been misconstrued, but did later apologise to him, Oliver said.

A week later came what some saw as another PR blunder involving public health. Lansley said that big food and drinks companies would not face new regulation in return for helping meet the cost of Change4Life, the biggest ever healthy eating and fitness campaign.

Health campaigners were “horrorstruck” at what they saw as ministers “rolling over on their backs in front of the food lobby”. Lansley later said it was part of encouraging such firms to be more responsible.

But it was the unveiling of the health white paper on 12 July that began a process which has culminated in even senior government colleagues harbouring doubts about Lansley’s style, judgment and determination to foist radical reform on the NHS in England, come what may.

The sheer ambition of the proposed shake-up – handing GPs £80bn of NHS funds to spend, scrapping the local primary care trusts that are the NHS’s bedrock and introducing much more competition between hospitals – caused surprise. It also led to Lansley, and sometimes David Cameron, being put on the spot about how the service’s biggest restructuring since its creation in 1948 squared with the Conservatives’ pre-election promise of “no more top-down reorganisations of the NHS”.

That is not the only Tory election pledge on health that now looks less than robust. Few in the NHS would agree that the service’s budget is going up in real terms, as Lansley promised. The rise is 0.1% a year for the next four years – better than most government departments. But the likely inflation rate, as estimated by the Office for Budget Responsibility, means that it’s actually a cut.

Similarly, there has been scrutiny of the £1bn ministers have allocated for social care, and which has been added to the Department of Health’s budget, even though funding for older people’s care at home has always gone to the Department for Communities and Local Government.

Lansley stressed that the cherished NHS would be protected through the hard times. But every day brings a new story about NHS organisations cutting back on services, such as IVF or non-urgent hip or knee surgery, in order to save money. It is also likely that tens of thousands of NHS jobs are likely to disappear, initially mainly through natural wastage – again, in order to help balance the books. It is hard to see all this as protection of the NHS.

There are few enthusiastic advocates of the NHS reforms – except for Lansley himself. Most of the medical and NHS establishment think he is going too far, too fast, and complained two weeks ago that he had listened to their concerns but ignored them almost completely.

Inthe Guardian, Tory MP and ex-GP Sarah Wollaston becomes the first Conservative to voice the deep misgivings. Next month will see the legislation for reforms begin its parliamentary process, which will test Lansley’s judgment, and the government’s backing of him.

Sources : Guardian-Health

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