In a break from the arch-centralisation of the Blair/Brown years, David Cameron's plan for policy development and presentation was to leave it, as much as possible, to his ministers. It backfired. Prison, pension, and health reforms have all caused major problems for the government in recent months, leaving the Prime Minister with little choice but to join the front line of some dangerous political skirmishes.
In a break from the arch-centralisation of the Blair/Brown years, David Cameron's plan for policy development and presentation was to leave it, as much as possible, to his ministers. It backfired. Prison, pension, and health reforms have all caused major problems for the government in recent months, leaving the Prime Minister with little choice but to join the front line of some dangerous political skirmishes.
The Health Bill was particularly hazardous, thanks, in part, to some unfortunate timing. After the Liberal Democrats took a hiding in May's local elections their embattled leader, and Deputy Prime Minister, Nick Clegg, was forced to make a stand against the NHS reforms to demonstrate some political strength. Suddenly, it looked as though the coalition could be ripped apart.
Enter Cameron. The PM ordered a 'pause' in the Bill's progress through the Commons so that the NHS Future Forum – a group of 45 healthcare experts – could review the increasingly unpopular reform proposals. And while the panel deliberated, he set about managing public expectations, making five health service pledges: to keep waiting lists low, to maintain spending, not to privatise, to keep care integrated and to remain committed to the 'national' part of the NHS.
With much of the heat drawn out of the debate, the Forum unveiled its findings last month. Its recommendations received broad support (not least from Lib Dem backbenchers who were proving the most troublesome critics) and the government duly adopted them. The Bill's safe passage now appears assured.
It's not been a outright victory, with the 'pause' having stalled the momentum of clinical commissioning.
Now it seems that the majority of commissioning groups will be ready by 2013, but they will have to jump through various hoops first (such as getting approval from local 'Health and Wellbeing Boards'). And while all GPs and practices must be members of the rebranded 'clinical commissioning groups' (formerly known as 'GP Consortia'), they will only assume commissioning duties when they are "willing and able".
Without doubt, the last few months have tested the resolve of the coalition government and shown that, when it comes to the NHS, you simply can't separate the policy from the politics. Here the Prime Minister outlines some of the key challenges his team faced getting the Health Bill back on track.
What are the risks of these reforms?
The real risk is in doing nothing. We all know what challenges the NHS faces: an ageing population, and rising costs of treatments and new technologies. If we sit back and hope for the best, there will be a crisis in a few years' time. That's why we need these reforms.
Not including the UK, which country has the best
health system?
Every health system has its strengths and weaknesses. I passionately believe that the ideal at the heart of the NHS – of healthcare, free at the point of use, funded by us all, available to us all when we need it – is the envy of the world. But it's clear that on results for patients for things like cancer, heart disease or stroke – when you compare to us to countries like our European neighbours – we're not up there with the best. That's why I want to reform the NHS – to make the NHS the envy of the world not just because it is free, but because it is the best.
Has it been possible to separate the politics from the policy in the development of this Bill?
You can never separate politics from policy – we're in politics to put the policies in place which will put Britain back on the right track. But I think the big changes we've now made to the reforms – where we've listened to the doctors, nurses, NHS experts and patients and are now acting on their recommendations – have been the right thing to do. Ultimately, the NHS is about the patients that it serves – not about politicians – so it's been right to listen to those patients and the doctors and nurses who care for them in improving the Bill.
How will Monitor's role be redefined? Will this lack
of emphasis on competition hamper efficiency savings?
We are making big changes to Monitor's role. Rather than promoting competition as if it was an end in itself, we're making clear that Monitor will need to allow the integration which works so well for patients. That's not going to hamper the drive to increase efficiency – it's going to safeguard it, because we're making clear that efficient, integrated services which work well for patients can carry on doing exactly what they're doing now. We're also supporting that integration by ensuring that commissioning groups don't just include GPs, but also include nurses and specialists and work closely with social care services.
Government policy refers to improving/increasing 'competition and choice' in the NHS. This has been a common part of the health service lexicon for some years now. So why the recent furore over so-called privatisation by stealth'?
The fact of the matter is that competition drives up quality, and it's absolutely right to say that choice and competition has existed for many years – the last Labour Government did a lot of work to drive it through the NHS. Labour's Health Minister Lord Darzi said recently that the NHS is up for competition – and he works in a London hospital which competes with other hospitals not just within London but with the rest of the world. But competition challenges vested interests – and that is where the accusations of 'privatisation' come from. It's a complete myth – the NHS will remain free at the point of use, based on need and not ability to pay, and we will never privatise the NHS.
Are many of the Future Forum's recommendations in line with the Bill's intentions even though they were not detailed in the original document?
The independent NHS Future Forum made absolutely clear that the principles of the White Paper – more patient choice and information, more clout for the public, less bureaucracy and putting doctors and nurses in charge – are the right ones for patients and the NHS. Where the Future Forum's work was invaluable was in saying, "in order to realise your intention, you need to make sure your plans do this" – and that's why we've made substantial changes to the original package of reforms.
