Perhaps I underestimated Liberal Democrat determination to amend the bill (only one bill in this column) or push it under a bus.
The conflict of wills and votes is not over, but Nick Clegg’s “yellow bastards” – as Tory MPs called them last week – are putting up more of a fight than expected.
“I don’t know how we get out of this mess without first getting rid of Lansley,” a veteran Lib Dem confided at the weekend as he explained that Tory MPs and peers are queueing up to endorse the Clegg critique of the bill for which all but two Lib Dem MPs voted only in January.
Hang on, protests Labour’s John Healey. It’s our lonely critique, expounded last autumn and focused on the 82 competition clauses to redesign Monitor, which is now rallying politicians and medical critics. Alas, politics is an ungrateful business and sometimes it is wiser to share the credit.
Healey himself admitted to the Guardian last week that: “There were sometimes some areas where we may have pursued competition for its own sake,” with independent sector treatment centres for example. As the parties struggle to get traction on muddy ground they are all having to adjust their stance. It’s not suitable to be enshrined at the heart of the NHS.
As Number 10 tries to put together compromises which must clear many hurdles – MPs and lords, militant Lib Dems and equally determined Tories for whom Mr Lansley is a new hero – my Lib Dem chums are wasting their time if they think David Cameron will reshuffle his health secretary for their sake.
Remember who lost the 5 May elections and AV vote big-time? The Lib Dems. “Push your luck with me, sunshine and I’ll call an election” Cameron must feel like telling Nick Clegg in private, however much they smile while “arm-wrestling” (copyright King’s Fund) in public.
Yet those Yellow Bastards know Cameron is desperate not to damage his NHS brand and would not welcome an election over the Lansley bill either. Right wing Tory MPs know they need YB votes if they are to get any bill at all. “The changes will be quite substantial because nothing else will work politically. The health community would be down on us like a ton of bricks,” says one coalition insider.
So Lib Dems are confident they can substitute collaboration, integration and regulation as New Monitor’s core function, replacing a presumption in favour of competition; impose a research and training levy on private providers who will not be allowed to undermine the viability of basic services; and even resolve potential GP conflicts of interests in awarding contracts by broadening consortium membership.
In his King’s Fund speech last week Lansley explicitly rejected suggestions that “competition [is] utterly at odds with that other essential ingredient I’ve mentioned – proper integration of healthcare” and pointed out what wonders competition has done for mobile phones. Evidently he doesn’t know how competition-battered Nokia is these days.
But I sense he’s ready to trade (“remember, he loves the job”) in the Cameron-Clegg souk, as he showed by backtracking over the retention of cancer networks only this month. He was even nice about managers, although he thinks the army could offer leadership skills; not a student of defence procurement overspends, by the sound of it.
So look to a report from Steve Field’s ad hoc advisory committee and a deal – “everything points to a deal” – by late June. Some amendments will be made at the Commons report stage before the third reading ahead of the summer hols in mid-July, some probably kept for the Lords to chew over in the autumn. Grandstanding will all take time.
“The NHS deserves more than a political fix,” says Healey. But that’s what it getting.