Why Andrew Lansley should stay - and why he might go
Andrew Lansley must go. That is the demand of many of the opponents of the government’s health reforms. They are wrong.
For all the missteps, misunderstandings and mishaps Mr Lansley is still best qualified for the job of health secretary among those available for the position within the current government. Those who wish him gone would do well to consider the alternatives. Mr Lansley’s knowledge of and commitment to the NHS gives him the ability to fight off the far more radical and damaging alternative remedies for reforming the service which always bubble under the surface of the Conservative party.
The health secretary is, partly, a victim of his own good intentions. He gave instructions to those drafting the Health Bill to write it in a permissive manner so as to give local decision-makers maximum flexibility.
He now privately admits that this permissiveness went too far, allowing critics to paint all kinds of possible damaging scenarios which Mr Lansley claims, with some justification, were never the point of the reforms.
That is how he is justifying the month-long “pause” in the legislative process. It is a chance to expose the scare mongers for what they are and to work out the tweaks that will clarify those intentions. He is genuinely relaxed about most proposed clarifications (commissioning accountability, safeguards over private sector involvement).
In the meantime, Mr Lansley has said there should be no “pause” in the reform process as it effects the restructuring of the NHS.
He has done so in the knowledge that this is no longer his call. The £20bn Quality, Innovation, Productivity and Prevention challenge is the priority on the ground – and that is firmly in control of NHS chief executive Sir David “fireproof” Nicholson. Primary care trust clustering is continuing apace and the QIPP mission is being rapidly transferred to emerging commissioning consortia.
HSJ readers will know that calls for the structural changes to be slowed to reflect concerns around GP readiness have already been addressed by Sir David in HSJ. He has made it very clear they will get “hard” commissioning budgets when he thinks they are ready – whether that is before April 2013 or after it. “Centralise before localising” is his current modus operandi.
Mr Lansley’s job is to stay out of Sir David’s way. Not defaulting to manager bashing as the health secretary did in the House of Commons debate on Tuesday might help the NHS chief executive rally his increasingly disillusioned troops from whom every day brings another leaving do.
Staying out of Sir David’s way will allow Mr Lansley to spend more time supporting the prime minister and his deputy as they begin their explaining and listening campaign.
This may be essentially a PR exercise (with the possibility of a few tweaks on the rudder) for Mr Cameron and Mr Lansley, but the stakes could not be higher.
Fail to convince the doubters and the substantive changes demanded by doubters, which clearly include Nick Clegg, will be hard to resist. Post the 5 May AV referendum, these demands may be being made by a Liberal Democrat party which feels it has nothing to lose from all out resistance to the reforms.
It will also be the case that, if the health reforms are still a hot issue in the summer, it will be Mr Cameron, rather than his health secretary, who is accused of not listening.
These would effectively re-toxify the NHS as an issue for the Conservative party. Faced with that potential outcome, the prime minister will know even substantive policy changes will not suffice and that he needs to make a big political gesture.
He may even reluctantly conclude that: Andrew Lansley must go.
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Readers' comments (19)
Anonymous | 5-Apr-2011 4:39 pm
According to the story on this page "Committee's recommendations fits with policy says leading GP"..."Dr Kingsland said some of the criticisms and concerns about the reforms had arisen because the government had tried to set out too much detail in legislation." According to Alistair above "The health secretary is, partly, a victim of his own good intentions. He gave instructions to those drafting the Health Bill to write it in a permissive manner so as to give local decision-makers maximum flexibility."
Doesn't that just say it all - the whole thing is such a pigs ear no-one can make sense of it?!
And no, I disagree fundamentally with this article. Lansley should go now. His arrogant bone-headed refusal to contemplate any idea than his own has left us halfway down the path of one reform, which we're going to have to morph into another, which will lead to a third one in 2015. And every month between now and then, we've got to save £400m with this anarchy going on around us. In any walk of life, that's dole queue time, and ministers should be no different.
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Anonymous | 5-Apr-2011 6:28 pm
perhaps Steven Dorrell would be better placed than Mr Lansley to lead the reforms?
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Anonymous | 5-Apr-2011 9:22 pm
Alastair - I agree with your comments to a point. I haven't met Lansley but have met Paul Burstow and was certainly impressed with his knowledge of his brief and my understanding is that AL is simialr in terms of knowledge. I also buy that he 'cares about the NHS'
Your article though also makes reference to the manager bashing. As NHS managers I accept that we aren't the heroes of the NHS and neither should we be. As you have argued in the past though the NHS needs high quality managers and management. Manager bashing makes this worse as does the continual reference to bureaucrats.
At some point either now or in some months we will have a SOS who has and has no prospect of having a working relationship with NHS managers who aren't GPs. If the time to go isn't now it will certainly be sometime well before we reach that point. Let's hope the pause is genuine and the listening translates to hearing!
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Anonymous | 6-Apr-2011 12:33 pm
Right or wrong the current changes have been so badly managed, so horribly miscommunicated, we have to hope that some active listening does take place after the stonewalling that has gone on up to now - but there is no doubt that Landsley has to go...knowledgable or not, we need to secure the best politiical leadership and management for the service and it clearly isn't what has gone on since last July.
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Anonymous | 6-Apr-2011 1:34 pm
I also disagree. Lansley has responsibility for £bns of taxpayers money. Firstly he sets out reforms for which there is no mandate having hoodwinked the public that the NHS is safe in Conservative hands and secondly, this has been so badly managed that how can he be trusted to deliver his brief no matter how deep his knowlesge of the NHS? In a service which is struggling to meet its financial challenge, this mismanagement will already have cost the NHS £ms in poor managment and lost talent.
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Anonymous | 6-Apr-2011 7:37 pm
Should I stay or should I go now?
yo me enfrio o lo sufro
If I go there will be trouble
Si me voy - va a haber peligro
And if I stay it will be double
Si me quedo es doble
So you gotta let me know
Pero me tienes que decir
Should I stay or should I go?
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Anonymous | 6-Apr-2011 7:50 pm
Andrew Lansley is the author of the ignorant idea of abolishing PCTs - when all that was needed was to switch power from Board to PEC, and merge PCTs that lack management capacity. Listening to him stumble on PM Radio 4 todaywas hideously embarrassing. He just does not realise that commissioning is about populations and macro-economics,its about joined up systems with local government, its not about local GP practice initiatives. To pass management of the part of the NHS that works to the one that doesn't is startling.
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Anonymous | 7-Apr-2011 9:36 am
I suppose Lansley can be reassured he has one friend in McLellen. Of course McLellen is wrong, not because the lynch mob is on the move but because Lansley did not tell the truth. Lansley may have good intentions. I thought so. But his actions are to dismiss just about anyone who disagrees with him. This apparent arrogance could be there to hide his lack of competence. When politicians act unilaterally without involving 'relevant experts' we should all worry because we end up with 'pure politics' rather than something fit for purpose. Handing £billions to GPs sounds good in political circles but in practice it will increase already huge transaction costs, extend postcode lottery care, fragment planning and end economies of scale. It cannot add anything to raising standards or outcomes. It might save money on specific areas but overall it won't make a dent in £20bn. Dorrell summed up the errors in the bill and what could be done instead. Even that long list doesn't improve quality and save £20bn. I have never seen the NHS in such a mess at the top. In time this confusion will filter to the front line. Perhaps it already has.
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Anonymous | 7-Apr-2011 11:58 am
I agree with most of the previous comments and Alistair Mcllelan makes very valid points but as a long-serving NHS manager I find Mr Lansley's comments and general manager bashing dispicable and deeply offensive. He really should read Carnegie's, 'How to win friends and influence people'. He could learn a lot. Interesting interview he had on BBC's PM last night when he was in typically beligerent mood point blankly refusing to be drawn on whether PCT's could survive if that is what the listening exercise showed, constantly re-iterating the need for clinical leadership. The PCT I worked in had a well-known GP as it's CEO, working very closely with 2 PBC groups and utilising managers at all levels, many of whom had been nurses, paramedics, AHP's, etc before using these skills to develop their careers further to bring experience to the commissioning functions. His constant bouts of 'hearing, but not listening' is staggering for such an intelligent man. I hope he has a Road to Damascus experience on his travels and is genuine in wanting to listen to ALL the views, not just his own.
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mike batt | 7-Apr-2011 12:26 pm
The trouble is incoherance. Lansley may well "care about the NHS", but the concept of the NHS is incompatable with general philosophy of the conservative party and of these reforms. As is any form of local commissioing (PCTs or GPs), or patient choice as a market lever.
What did PCTs do: Did they plan local services, or enforce DH targets and try not to run out of money?
If you are going to make commissioners very accountible to the centre - you will just have PCTs again (and they failed- right?)
If you lose the accountibility - then unelected GPs are in charge of taxpayers money.
Lansley needs to go; either in favour of someone who will re-introduce DHAs and forget commissioing, or someone who will turn us over to a regulated social insurance based system.
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chris adams | 7-Apr-2011 2:27 pm
I can feel a spread bet coming on!
Let's say the departure date is February 4th 2012. What would your bet be? How much per day, and long or short?
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Anonymous | 7-Apr-2011 8:17 pm
Lansley is not a credible figure, it would be farce should he stay in post, if the Con Dems survive the May carnage and probably the loss of the AV vote , my guess it will be a Liberal Sec of state brought in to take the heat out of this, but thats highly unlikely as we can start counting the days this coalition has left in office.
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Anonymous | 8-Apr-2011 10:36 am
Chris
Good call ! I'd put £50 on Lal out of office in an Autumn reshuffle, and Stephen Dorrll approached to be SoS. If he refuses, Vince cable is next in line.
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Anonymous | 8-Apr-2011 3:52 pm
With the Select Committee report, Dorell looks like a real contender.
For those who haven't seen it, the cartoon in Thursday's Sun ('voice of the conservative') is very interesting.
It shows Cameron and Clegg dressed in white coats holding ear trumpets intently to their ears, with a patient (named NHS) looking very poorly in bed. Cameron is saying 'We're listening - Speak up man'
Lansley is stood at the bottom of the bed - grinning - with an iPod plugged into his ears.
I wonder what this says about what the people at the very top think...
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Anonymous | 8-Apr-2011 5:01 pm
A very large part of AL's current predicament is that he appears to have no credible media strategy. What he is doing was always going to be a hard sell, not least because it came out of the blue.
But his media people have made it much worse. They have allowed the entire narrative to focus on money and management structures that no lay person understands. From the outside looking in, it just looks like doctors and politicians fighting over power and money.
But go back to the original white paper and the big message is about patients being put "first", about "no decisions without me", about an "information revolution" in which ordinary citizens and patients would be given quick access to all the information they need.
That is where AL and his media people need to return the spotlight - to the patient. True, his Information Revolution is late and in a complete mess because he gave it to the head of Connecting for Health to construct - someone who can not communicate to her staff, let alone the public (she actually shouted at a conference delegate this week!).
Nevertheless, if AL wants to improve things he needs to come up with some hard announcements that clearly indicate he is putting the patient first. Ideas might include:
- giving the Consumers Association a formal role on the Commissioning Board (Which? is trusted brand and have excellent health people)
- bringing all public-facing health systems (Choose and Book etc) together on the www.nhs.uk platform ("everything you need to know about health in one place")
- re-introducing central waiting time targets (to make clear that the consumer comes first)
- announcing the right to a five yearly Bupa-style health check for all adults via GPs
- announcing a single click NHS complaints system from the main NHS website, clearly signalling patients interests will be put ahead of doctors, hospitals, civil servants etc
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Anonymous | 11-Apr-2011 9:50 am
Excellent contribution anon 5.01pm you would get my vote for SoS. There will be a vacancy soon if you are interested!!!!!!!
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Anonymous | 11-Apr-2011 4:41 pm
I agree ... anon 5.01pm has it exactly right. Focus less on management bashing and more on what the purpose of the reforms should be.
The limbo that is now being felt in primary care land is ridiculous. I'm currently "working my notice" as a displaced Director from PCT land, and actually thought I would land a job (without having to take my redundancy at vast expense to the public purse) as I may well be able to work with the GPs to get the consortia right. It's so uncertain now even the most go ahead GP pathfinders aren't quite sure what they're being asked to do.
So, don't pause for long. Inertia is not a better solution than trying to get the reforms to work!
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Anonymous | 12-Apr-2011 4:59 pm
I would also fully support Anon 5.01 as SOS!
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Anonymous | 14-Apr-2011 9:42 am
I think Andrew Langley has already failed completely in the NHS reforms and no listening now will fix this failure. The RCN closed to 100% vote of no confidence in him yesterday is a real signal for him to go now! If he doesn’t voluntarily go now and his boss continues to keep him, then the Tory-led government is likely to be brought on its knees after the May elections. AL wants to turn caring GPs into medical accountants, your health care and mine will be in really trouble should this mess go ahead! His repeated apology yesterday is too little and late and must go now!
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