Dare one step further and keep Lansley in post for the full term
Andrew Lansley is the best prepared health secretary of modern politics. During his time as shadow health spokesman, Labour went through five health secretaries.
Far from everyone in the NHS agrees with his policy programme, which has a number of inconstencies in urgent need of attention, but almost everybody who has met him respects his knowledge and commitment to the NHS.
It would send a powerful message to the NHS that the new government was prepared to recognise the damage done by chopping and changing ministers
That, of course, is a problem for some on the right of the Conservative party. The former member of the SDP is believed to have “gone native” through his long contact with the NHS and is therefore incapable of delivering the “radical” change they believe the NHS requires.
HSJ has been briefed against the new health secretary consistently - and the first anti-Lansley text of the new era arrived within hours of his appointment. The decision not to appoint Mark Simmonds - part of the shadow health team - was the cause of the latest burst of anger and, to be fair, many in the health service were as surprised as he was that he was not offered a job. Mr Simmonds had taken the lead, for example, on the Tories’ plans to develop GP commissioning.
The allegation went that Mr Lansley was surrounding himself with a weak team who would not challenge his vision.
The other - more credible - view is that in appointing an ex-health minister in Simon Burns, the new government is attempting to avoid the mistake made by New Labour of sending a team into Richmond House with no relevant ministerial experience.
Paul Burstow - another surprise choice, this time over Liberal Democrat health spokesman Norman Lamb - and the department’s representative in the House of Lords, Earl Howe, are also brimming with useful knowledge.
But it is Mr Lansley who is key. It is he who has convinced many senior figures that the Conservatives finally “get” the NHS. Take, for example, Professor David Kerr’s appointment as a policy adviser. He has the clinical credibility and experience of major reform programmes to help the Tory plans stay on track. The fact that this former New Labour supporter should sign up to work for a Conservative government is another testament to the secretary of state’s ability to engender confidence in those who would not normally be natural supporters.
The common theory regarding Mr Lansley is that his close relationship with the NHS would be used as an electoral asset, but that he would be reshuffled within a year.
Heaven knows what pressures will bear on the new prime minister as he attempts to keep his new coalition together - but he should fiercely resist any politically motivated pressure to move Mr Lansley. In fact, he should go further, much further.
Mr Cameron should announce - in the spirit of “the new politics” - that Mr Lansley will serve all five years of this fixed term parliament as health secretary.
With a couple of sensible provisos over performance and conduct, there is no reason why he cannot do this. It would send a powerful message to the NHS that the new government was prepared to recognise the damage done by chopping and changing ministers - and the need for stability and consistency at this crucial stage in the NHS’s history.
Mr Lansley himself underlined this point when speaking to DH staff last week. He rightly identified the dangers of politicians constantly trying to reinvent strategy. He said his “ambition” was to switch to a “consistent and coherent” approach and, as a result, make reforms sustainable.
That sustainability would be significantly enhanced, if the NHS could move forward knowing another politician was not waiting in the wings waiting to impose his or her priorities on the service. David Cameron has already transformed the landscape of British politics. Confirming Mr Lansley in post for the lifetime of the Parliament would be another audacious and admirable decision.
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Readers' comments (8)
Roy Lilley | 20-May-2010 8:11 pm
fabulous analysis - well done.
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john ashcroft | 20-May-2010 8:25 pm
I agree, right on the nail.
Though I would agree with Ken Clarke, get rid of SHAs.
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Clive Peedell | 21-May-2010 0:39 am
Alistair,
I agree with you that Andrew Lansley is a very knowledgeable and well prepared SoS for Health. For example, he was impressive during the MTAS/MMC debacle, demonstrating a detailed understanding of some very complex medical training issues.
I also think you are correct to identify him as being key to radical NHS reforms because he is ideologically committed to market based reforms of the NHS. This is absolutely clear from his recent dealings with the BMA. If the Government want to deliver a market based NHS, then Lansley is definitely the man needed to achieve this.
I do however disagree with your comments about the secretary of state’s “ability to engender confidence in those who would not normally be natural supporters” regarding Professor David Kerr’s appointment as a policy advisor. Nothing could be further from the truth. Professor Kerr is a clearly a natural supporter of Tory policy because he is a staunch advocate of market reforms in terms of patient choice, competition and PbR. This only serves to emphasize the similarities between New Labour policy (post 2004) and Tory policy. Despite changing sides, Professor Kerr has actually remained entirely consistent in his views. In fact his recent article in the Telegraph suggests he was disappointed that New Labour didn’t go far enough to the right.
http://www.telegraph.co.uk/health/7407486/My-prescription-for-the-NHS.html
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John Coakley | 24-May-2010 3:06 pm
Clive - It is not right wing to support PbR, patient choice or competition. The BMA is a trade union. Its members are doctors. The BMA will therefore view doctors' interests as trumping those of patients. This is worth constant repetition.
It is a perfectly respectable Marxist position to place the needs of the patient above the demands of the doctors and long may Mr Lansley continue to do so.
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Clive Peedell | 24-May-2010 10:44 pm
Hi John,
The key point here is that PbR, Patient Choice and pleurality of provision are the key components of a healthcare market. The aim is the "creative destruction" of the NHS. This is not only my opinion, but also that of Simon Stevens, who was one of the key architects of New Labour's NHS reforms.
Market reforms turn patients into consumers. In fact, reformers like Mark Britnell commonly use the term "consumer" rather than patient.
The majority of doctors respect the concept of the social contract. The interests of patients just happen to be in keeping with the interests of doctors. They want a high quality local service delivered by highly trained and professional people. That is also what most of the medical profession want to. Protecting the NHS is fundamentally important to doctors and patients. This is not the case when it comes to the private sector, where the bottom line is always the quaterly share price.
If you want to talk left wing politics, then why not heed the views of Jon Cruddas and John Trickett, who wrote a very interesting piece in the New Statesman in 2007:
“After years in opposition and with the political and economic dominance of neoliberalism, New Labour essentially raised the White flag and inverted the principle of social democracy. Society was no longer to be master of the market, but its servant. Labour was to offer a more humane version of Thatcherism, in that the state would be actively used to help people survive as individuals in the global economy - but economic interests would always call all the shots”
Hence, former Labour cabinet Minister, John Denham, was quoted in the Chartist (2007):
“All public services have to be based on a diversity of independent providers who compete for business in a market governed by Consumer choice. All across Whitehall, any policy option now has to be dressed up as “choice”, “diversity”, and “contestablity”. These are the hallmarks of the “new model public service”
available@: http://www.chartist.org.uk/articles/labourmove/march06denham.htm
The bottom line here is that our domestic policy has been dictated to by the international financial markets. Our economy became so reliant on the City of London, that the Labour party was forced to the right. The risk of capital flight was felt to be so high, they had to adjust domestic policy accordingly, including privatisation of public services. This also explains why all the political parties came closer together.
The last 2 years has clearly shown how we are at the mercy of the international markets, so I find it hard to understand your position. I suspect the feeling is mutual!
Anyway, best wishes. Hope to speak and debate again soon, John.
Clive
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Judy Viitanen | 25-May-2010 2:19 pm
Yes Alastair, I totally agree with your viewpoint. Let's hope things auger well at the DH, with Lansley now at the helm. I also think he made a wise move appointing Freddie Howe - he's very open and has a well-balanced take on the challenges within the NHS and healthcare arens.
If you are still loking for ideas for your leader article: '20 questions to put to Andrew Lansley' - how about this:
"If professional commissioners in PCTs are still learning to do it, how does he ensure he doesn’t increase bureaucracy by taking commissioning down a further level to GPs?" .....
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John Coakley | 25-May-2010 2:26 pm
Well here goes Clive.
Since I became a doctor in 1980 (having come from a fairly 'medical' background), I have always supported the 'creative destruction of the NHS' which I believe has been organised very largely around the needs of the staff of the NHS (I can give many examples of this and I am sure you can too). I had always regarded my position as left of centre. The important word is 'creative'.
I don't dispute that individual clinicians do their utmost for the patients in front of them, but clinicians have by-and-large seen the organisation and delivery of services as beneath them (except in the private sector of course). This has created a vacuum which has been filled by others, despite the recent exhortations from all and sundry for more clinician engagement. Our 'leaders' are happy to sit on the sidelines and heckle, and do so very effectively. This in the long term means that doctors are ignored. We have to get involved in the 'creative destruction' and welcome it.
Our dependance on the international financial markets is obvious, and irrespective of the governing party, cannot be easily controlled without global action. This isn't going to happen outside of worldwide communist rule, which I would find interesting but improbable.
Politicians thinking that they can control international finance are, I am afraid, more Canute than Marx.
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Anonymous | 25-May-2010 11:09 pm
John,
I don't think that either Obama or Angela Merkel are like Canute, and neither are communists! Yet, they both advocate greater global regulation of the markets, as did Gordon Brown and other international leaders at the G20 summit.
I'm afraid that the idea of "creative destruction"
in a single payer system is flawed and doesn't sit well with the concept of universality of care, because it means that there will be winners and losers. This inevitably results in loss of some services. Since the private sector are being encouraged to enter the market, this means that the unprofitable services will lose out.
As for doctors being ignored, this will result in failure of reforms, as Chris Ham has commented. In any case, democratically elected representatives of the medical profession have been excluded from policy making ever since the "Working for patients" white paper. Rudolph Klein called this the end of the "double bed" for policy making.
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