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After Lansley

The reshuffling of Andrew Lansley is potentially the most significant sacking of a health secretary in living memory.

Within moments of his appointment as secretary of state for health Jeremy Hunt declared the new job a “huge task”. Despite the fact that the former culture secretary has been taking briefings on the health reforms since, at least, the start of the year, Mr Hunt knows he faces a brutal learning curve.

Andrew Lansley held the Conservative health brief for nearly a decade – an almost unprecedented length of time. During that time he developed plans for the reform of the NHS which manifested itself in this year’s health act. Those plans were twisted by the coalition government’s negotiations and then revised endlessly during the passage of the act. However, the final product was recognisable as Mr Lansley’s vision.

That vision was a highly personal one. Few senior players in the Conservative party bothered to try and understand Mr Lansley’s plans and those that did make the effort become lost in the foot hills of the former health secretary’s immense knowledge.

Of course, as the reforms became reality senior figures in the health service had to get their head’s around the proposed changes. But, few if any, agreed with the totality of the health secretary’s ideas. The tattered narrative of the reforms was held together by one man.

And now he has gone and as a result those senior health service figures – led by Sir David Nicholson – will have their power and influence further increased.

There will be considerable protestations from Mr Hunt and all that having a new man at the top makes no difference to the direction of travel. That will not be true. We are not about to see any dramatic U-turns, but policies will begin to be retrospectively tweaked to fit a range of new agendas.

Mr Hunt’s focus will be on more effectively communicating change and getting negative NHS stories off the front pages. The implementation of the reforms – and crucially how that task is interpreted – will be largely left to civil and public servants.

Policy direction will be increasingly influenced by key advisors at Number 10 – just as it was during the Blair years. They will be focussed on making the electorate feel good about the NHS – and will care much less about the technocratic reforms so close to Mr Lansley’s heart. Choice and consistency of care will be the priorities, something that is likely to manifest itself in the first mandate to the NHS Commissioning Board due in October.  

But it would be disingenuous to suggest that Mr Hunt will simply be a PR man. Despite the analysis above, he faces a to do list that would daunt even the boldest of politicians.

His immediate check list includes, but is not limited to, deciding: if regional pay will work in the NHS; what he should do with South London Healthcare, the NHS’s first ‘bankrupt’ trust, and whether other struggling organisations should suffer the same fate; and if the Hinchingbrooke franchise model should be pursued at George Eliot or elsewhere.

Finally, of course, there is the publication of the Francis inquiry into care failings at Mid Staffordshire Foundation Trust which is likely to be published in November. As Sir David has acknowledged, the inquiry’s findings could clash with key elements of the reforms. Managing the consequences of that without a detailed knowledge of how the system hangs together will be fearsomely difficult.

In the longer term, of course, Mr Hunt has the challenge of being true to Mr Lansley’s word that the health secretary will remain above rows over hospital reconfigurations and the ‘rationing’ decisions of clinical commission groups. The health secretary’s job is very different to the one that Mr Lansley inherited. Will the new tenant of Richmond House be prepared to take the political risks that such a role carries?

Readers' comments (15)

  • Sorry to ask lots of questions Alastair, you probably had a word limit - what do you think will happen to the other ministers working in health: more changes there too? And is Francis II in November, not 15 Oct? Is Lansley's move to the House a demotion in ministerial ranking/ pecking order terms? Reading about JH's background, how will relationships with DN et al change - will he have more/ less autonomy? Who will the policy advisors be, do you think?
    So interesting......

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  • Hi Anon 2:14
    Re: Junior ministers - we'll know later today/tomorrow, but I think there will be quite a lot of change.
    Re: Francis - submitted to DGH on 15, but they'll want some time to react
    Re: Lansley - yes, it's a demotion
    Re: Hunt and advisors - watch this space

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  • Remove the negative stories from the front pages Alastair? In a good way or a bad way? Cure the NHS, Stafford

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  • Expected this guy to be sacked rather than promoted - anyway Rupert Murdochs health policy should be interesting

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  • I have worked with the former SoS and let it be known, I was not a fan.

    Not a fan because of his well known shortcoming in regard to listening...to anyone, perhaps save a few trusted GPs in his constituency. This was ultimately his undoing. Not his reforms, though disliked in many quarters and misunderstood in many more. Not his reforms that focused on 'outcomes' not processes and seeked to put patients at the centre of the NHS. Both worthy and necessary. He failed because he couldnt communicate; couldnt sell the dream.

    So, now we have a new SoS with nowhere near the depth of knowledge of AL and I suspect nowhere near the level of personal commitment to making the NHS 'better', but the PM thinks he is a better salesman. More photogenic; more smiley? Fluff not substance I contend...think back to his Minister for Murdoch portfolio.

    Whether AL was right or not, he had personal strength of character. This is a quality vital in all leaders. Think of the best and worst bosses you have had. Dont confuse 'best' with the guy that wanted to be your chum; that let you leave early to watch a soccer match on TV; that routinely gave you a good appraisal even though you knew your performance was at best average. No, think of courage, commitment, integrity. I didnt like AL, but I respected him. From the little I know of the new SoS, I am sure people will think him approachable with a nice smile and he speaks Japanese, always an impressive trick. But shall we respect him in the morning? I suspect not.

    Mark me well, on these pages in 6 months time people shall be saying, AL wasnt so bad after all....

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  • This guy is a natural privatiser and his appointment is another manifestation of the lurch to the Right and to the marketisation of health services. His real test will come when the cuts bite deeper and there is mass shroud waving by patients and doctors alike. There will be no one like Murdoch with whom he can chummy up.

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  • Anonymous 8:44 AM: Lansley may have had 'personal strength of character' and may have been 'committed'. These are vital qualities in a leader. But the most important quality of all is to be RIGHT. To look into the distance, see the horizon and correctly assess what will be best for the pack or tribe the leader leads. The problem with Lansley is that he was WRONG. He was WRONG to assume that healthcare is a business just like any other, that the customer in this business is always right and that the average GP has either the time, training or will to determine where the billions will be spent. He was WRONG to unilaterally abolish what structures were in place (PCTs and SHAs) before anything to replace them was even remotely ready. This was wanton 'creative destruction' that will reverberate for years to come. NO, NO, NO. He was NOT just a bad communicator, he was completely, manically WRONG.

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  • Anon 5.28, and at the worst possible time, when we had so many savings to make, providing such a distraction at a crucial time.

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  • Regardless - its all too late - the damage is done. Millions spent on developing CCG's (with very high salaries) utilising big companies such as KPMG to get them to take off position. Meanwhile we have cancer patients who can get drugs to help them stay alive. Great ! We have now got JH whose behaviour in the past is well documented, rewarded and promotoded and we are expected to look up to him as a leader??

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  • Ministerial appointments point back to the common sense (or otherwise) of the PM.
    Did Cameron not understand that the NHS a) is at breaking point and needs TLC, not PR, and b) is a political time-bomb waiting to go off shortly before the next election?
    Did Cameron not understand the depth of feeling in the country against JH cosying up to Murdoch? Did Cameron's advisers not realise this either?
    In the end it points back to Cameron's poor judgement.

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  • Alastair, you say :
    "Mr Hunt’s focus will be on getting negative NHS stories off the front pages...and .. the electorate feel good about the NHS."
    Interesting to see at the next election how the electorate will consider good news the taking over of NHS hospitals by private companies.

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  • Correct- the policy was wrong , the CCGs are not clinically led- very few clinicians there at all. Many managers, often of limited experience and expertise. Expext years of poor decision making which will come back to bite and destroy the NHS through fragmentation of patient pathways, competition not collaboration between providers and a drop in quality and safety; so much money wasted - oh wait- maybe that was the plan.....

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  • Remove the negative stories from the front pages Alastair? In a good way or a bad way? Cure the NHS, Stafford

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  • The last thing the NHS needs is TLC! It needs leadership which Nicholson obviously can't give. Hunt? Who knows. What frightens me about these strings of comments here from people who clearly know far, far more about the NHS than I ever will in spite of reading tens of thousands of pages of Mid Staffs evidence, is that patient safety is absent. The top priority for PM, Hunt, Commissioning Board is galvanising the NHS front line into action on that. What do you folks think when you read articles in HSJ about the scale of harm, scale of complaints, etc? I worry deeply about that. Have you noticed what a mess Mid Staffs is still in? Cure the NHS, Stafford

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  • Whatever you think of Mr Lansley or his successor, whether we're in the right place or on the brink of disaster, we don't need more outrage or more ideas but to make the best of the situation and retire the NHS from political sport. A sensible starter for ten for Mr Hunt here: http://www.networks.nhs.uk/editors-blog

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