Michael White: a deal must be cut to restore certainty to the NHS

And quite right too: tough love on dirty private habits is in the patient’s interest, the NHS’s and the taxpayer’s.

It must be 20 years since our GP asked my then-teenage son, who’d turned up feeling unwell, if he smoked – “Yes.”

“Well, come back when you don’t,” said the GP. It took 10 years of struggle for him finally to kick the habit. But every case is different. All sorts of doctors have been telling my friend “Uncle” to go easy on the booze for at least as long. Many of them are now dead, but Uncle is 84 and still sinking more units than this week’s report from MPs advises.

What concerns me this week is one of Andrew Lansley’s own dangerous lifestyle choices: his Health Bill which emerged from its protracted committee stage passage through the Lords (15 days of detailed debate) on 21 December and now faces more amendment before it returns to the Commons and heads to Buck House for the Royal Assent.

Health minister Lord Howe is a pretty well regarded pair of safe hands, but he’s had them full with complaints from Labour, backbench Lib Dem and crossbench peers, including the usual clutch of medical grandees. Unlike the Welfare Bill, where 14 Lib Dem peers joined Labour (others abstained) and the non-party crossbenchers to defeat the coalition, that hasn’t happened – yet. Sceptics, who believe they won the arguments but not the votes, now accept the bill must pass but not without significant clarification.

So the final stages of the bill are fraught with danger to ministerial high blood pressure, even without the distractions of the unfolding breast implant scare and its remedies. Ministers don’t want to talk about the bill’s report stage – due to start in early February, subject to backstairs negotiations now underway – and independent-minded Lib Dem peers are adamant they’re not going to be bounced as they were during Eric Pickles’ Localism Bill.

For starters Labour points to the report of the Lords constitutional committee (chair, Labour ex-health minister Margaret Jay) which made three demands before Christmas: that the secretary of state’s accountability to Parliament should not be weakened; that his old duty to promote a comprehensive health service should not be undermined by his new duty to promote autonomy among providers; and that clinical commissioning groups must act consistently with the secretary of state’s comprehensive duty.

In effect both sides agreed to a second “pause” to match the Cameron-imposed “listening” pause last spring. But decisions are now urgent to restore certainty to the NHS. Labour’s own shopping list includes the persistent non-availability of the bill’s risk register (despite a year of nagging); clarification of the role of Monitor as regulator (financial, not economic) and the competition issue to underpin the universality of NHS provision, the “social solidarity” concept.

“There must be no presumption that competition is necessary or required or to be promoted, it is to be used where appropriate,” says a Labour briefing paper. The shoddy “failure” regime must be simplified. CCGs must be coterminous with local authorities and have proper governance. Public Health England and HealthWatch England must be properly funded and independent.

Training and education (a Lib Dem concern too), the private patient cap, research and regulation, the list is long – and time is finally running out. But a deal must be cut.