Am I just imagining it? Or did Andrew Lansley start to modify his combative message to the NHS, its suspicious staff and customers, even before Stephen Dorrell’s striking intervention in the reform debate courtesy of last week’s HSJ?
Of course, it is standard procedure for public figures to insist the message has not changed and that they have been saying it all for ages. Indeed ex-health secretary turned select committee chair, Dorrell himself, has been reassuring Westminster colleagues that he didn’t really tell HSJ anything he hasn’t said before.
‘As in 1990, Dorrell argues now for quiet pragmatism, for letting change evolve’
Maybe, but timing and impact is often what matters. With the right wing think tank Civitas also suggesting that GP consortia may prove a reorganisational distraction from the NHS’s day job, Dorrell saying similar things, albeit more politely, is significant.
At the weekend the Labour opposition pounced eagerly on an ominous Guardian interview given by Clare Gerada, new chair of the Royal College of GPs. In it she warned that public anger may turn on doctors if they are seen as the NHS’s “new rationers” under GP led primary care with no NICE shield.
Quite right too, I’d say, although Dr Gerada may be dismissed as an over-emotional leftie. Mr Lansley persists in asserting that the professions broadly support his reforms - themselves driven by economic necessity not just in Britain, but in advanced healthcare systems facing ageing populations and rising costs around the world.
Fine, and Stephen Dorrell doesn’t say the white paper is wrong. He favours a rebased form of PCT in which accountability comes via clinicians, not managers, and there is a toehold for Bupa and US health maintenance organisations - on competition grounds to show what (if anything?) they can teach us.
After all, he was kicking round ideas for making commissioning more effective when he was Ken Clarke’s junior health minister during the GP fundholding era in 1990 - and frustration with bureaucratic impediments, never since resolved, were already high.
Then as now, Dorrell argued for quiet pragmatism, for letting change evolve :”Do you announce that things are going to change or do you just get on with it?”
In other words, lots of ideas in the July white paper fit into a consensual pattern for making the NHS do better for less. That is the Dorrell-backed No 1 priority, Sir David Nicholson’s project to gouge out £20bn worth of efficiency costs over four years - much bigger than those tiny budget increases (or is it cuts?) MPs quarrel about.
In the Commons mid-week they all debated NHS reorganisation, a happy battleground for Labour back in opposition. Lansley accused his shadow John Healey of returning Labour to its pre-Blair-Milburn position as “the party of stasis, inertia and inactivity”. He also insisted the reforms “are not a radical departure from the past”. Labour helped create 900 practice based commissioning organisations. Doctors have always commissioned services. What has been wrong is that their decisions were not linked to costs.
That strikes me as a more Dorrell-esque approach than the Big Bang theory of urgent abolition of PCTs, although he also says he’s been open about replacing PCTs for years.
Healey’s challenge across the Commons floor was interesting too. When did Lansley tell David Cameron about abolishing PCTs contrary to the coalition agreement’s “no top-down reorganisation” pledge? Whitehall gossip now says the health secretary was furious about that “bizarre addition” to the Lib-Con pact and ignored it, annoying Treasury costcutters as well as Number 10.
Dorrell denies personal ambition and I believe him. All the same, I had forgotten that, at a youthful 58, he is less than five years older than Lansley.