All things considered, I thought that Andrew Lansley looked and sounded in quite good nick when he popped up at the Nuffield Trust’s recent conference to deliver a pep talk about his reform plans and an upbeat power point projection on progress so far.
“Is he demob happy?” more sceptical listeners asked after the secretary of state had left.
As usual, my answer was no. Lansley isn’t going anywhere, not yet. If he did jump or get shoved in a summer reshuffle, the job would have to go to a Tory, not to the Liberal Democrats (as some Nuffield types thought), not to Paul Burstow or Norman Lamb, let alone to a born-again David Laws, whose robust views on a health market – which he expressed in the controversial Orange Book (2004) – would frighten his own side without appeasing right wing Tories. Health is too important to David Cameron.
Who then? Someone dull but competent, who doesn’t make waves: a pity Phil Hammond has already had to become Liam Fox. In any case, it ain’t going to happen, said I.
So it was unsettling to read at the weekend that Downing Street looks set to overrule him by imposing the 40p a unit minimum pricing policy for alcohol which Cameron and Nick Clegg want, but the drinks industry and its elected allies don’t. It isn’t done and dusted and Tory troops are stroppy. But Number 10 is keen and will prevail.
More than that, it was also being reported that, ahead of Tuesday’s Westminster demo for better social care, the health secretary had been told to postpone his white paper (again) to make sure it doesn’t prove to be another political car crash.
That doesn’t sound promising for a chap’s career either, does it, any more than did the noisy defections of Lord Crisp, who used to run the NHS, and Sam Etheridge, previously a favoured Number 10 GP. At times it sounds like the Syrian Free Army.
But Lansley’s camp remains adamant that he will stay put in order to implement the newly enacted health act – the indispensable man, the one who claims to understand it.
Delay on the social care white paper? No, not really. Those cross-party talks, the ones torpedoed by that “Labour’s Death Tax” poster in 2010, are under way.
Consensus on something that is this important is vital. It will take time, is the official line. OK, if you say so, we’ll wait and see as we have been doing with the bill as it went down to the wire.
Amid all this political drama, there was some useful space carved out in the Lords in the closing sessions.
Why abolish the respected Health Protection Agency and replace it with Public Health England, an untried executive agency accountable to, yes, Andrew Lansley, peers asked? Because we want transparent lines of accountability, they were told: another case of fingers crossed.
As stated above, I thought that Lansley made a much better fist of his Nuffield conference speech than he did last year. He was more relaxed and less burdened with jargon, although I swear I heard him equate the “median” hospital waiting time with the “average”, which is not the same thing at all. But the speaker who impressed me most was Dr Donald Berwick, a champion of US public health and Obamacare.
“The customer gets treated the way the management deserves to be treated,” was a new one on me. And “transparency is almost a panacea”. Calm and saintly he explained that the “fee-for-service” model for paying doctors has almost bust US healthcare and harmed too many patients. The future is not salaried but “gain-sharing.” Got that?