Lansley’s devil is in his detail

The Conservative health team has developed a fascinating strategy for getting around David Cameron’s strict policy against having policy.

The strategy seems to be this: say something which sounds ostensibly like something no one can object to – like pledging real terms increases to the NHS budget - but when asked how this unobjectionable thing fits in with the thoroughly objectionable reality of recession, job losses, massive government debt and atrophying tax receipts, pop out that of course some unpleasant things will have to happen elsewhere; like 10 per cent cuts to pretty much the rest of public spending.

They did it again this week, when I asked Mr Lansley if he would countenance NHS employers and unions starting negotiations now about the next pay settlement, which will apply from 2011-12.

NHS managers want those talks now as they hope to stitch the unions into agreeing super low pay increases as a trade off against the job losses that could follow too high a settlement.

But health secretary Andy Burnham threw a realpolitik spanner into that plot a couple of weeks ago when he told HSJ a new pay deal couldn’t be signed without an overall NHS spending settlement. He said: “It’s hard to sign a new pay deal without knowing what the next spending review is. We couldn’t sensibly sign a new deal, but we could do the preparatory work.”

So I asked Mr Lansley if he felt the same. His surprising response is worth reproducing verbatim, as the Conservatives are now accusing HSJ of misunderstanding it:

“I can see no objections to the health care employers and staff side getting together. It doesn’t even, strictly speaking, require government to do that. The health care employers, frankly, ought to have some idea of what their underlying financial baseline is. In truth pay determination shouldn’t be set in line with financial allocations, it should be set in line with what is necessary to recruit, retain and motivate the workforce that you require. It’s a fallacy to say the amount of pay for 2012-13 depends on how much money the government has. It’s actually - for all healthcare employers - it is what is the pay environment within which we are working nationally and locally. I see no reason why there should not be a collective negotiation about those things without government to be involved.”

“Wow!” you might think: few doubt NHS funds are going to be squeezed over the next half a decade at least. But here we have the likely future health secretary saying he will detach pay increases from the size of the actual NHS pot. The unions will have fun with that blank cheque come the nitty-gritty of pay talks!

But hold on, here comes the hidden bit of policy: Rebutting HSJ’s reporting, Mr Lansley is now claiming he wasn’t talking about pay increases possibly being above the rate of increase in overall NHS funding (which all expect to be very low as it is). He actually meant they should be below.

Here’s what his office told Sky News:

“The problem in recent years has been that staff pay has simply increased in line with the huge rises in the NHS budget.

“In these times of increasing financial pressure we need to ensure that we move to a situation where pay is instead defined by what is necessary to recruit, retain and motivate the staff, and also what is affordable for local healthcare providers. Future NHS allocations will not be able to accommodate inflationary staff costs.”

So there we have it: Conservatives pledge real terms cuts to NHS wages. At last, a policy! And one even that a number of NHS finance directors could agree with. But why does it have to be so hard?

** UPDATE **

You can read Alastair Campbell’s response to this and his analysis of how the Conservatives are managing – or not managing – their messages about health policy here.