Michael White: FT freedoms and the election

Gosh, there must be an election looming!

The other day shadow health secretary Andrew Lansley said a Tory government would encourage employee partnership models in community healthcare provision. It is part of his drive to decentralise authority, raise efficiency and morale, as well as - ah yes - save cash.

Oh yeah? Who is likely to be health secretary by then?

Mr Lansley has previously talked about John Lewis style “mutuality”, even hinting it might have a role to play in foundation trusts. But, as the recent furore over David Cameron’s EU policy (reckless) demonstrated, the growing likelihood of regime change at Westminster means the Tories get closer attention.

Mind you, ministers are not sitting back passively. At the weekend sharp-eyed reporters spotted that No 2 health minister Mike O’Brien had slipped out a consultation paper seeking urgent advice from all NHS chief executives on the 2003 cap on foundation trust private income.

It is being done with a view to a policy review “to complete in the spring”, ie before the expected 6 May election, but - wait for it - then to be subject to “a public consultation” before any reform.

Oh yeah? Who is likely to be health secretary by then? Why, the same Andrew Lansley, whom his party leader singled out for praise (just to clear up speculation that he wouldn’t get the job) in his big NHS speech last week.

We know Mr Lansley’s view on private income caps. At a foundation trust conference on “governing in challenging times” in September he told hospital executives there would be a single economic regulator - handling both prices and competition - and that all 122 foundations would get more freedom.

That freedom would include an end to those caps which were conceded to Labour rebels in 2003 and set at each hospital’s then private income level, 0 per cent for some, 30 per cent for that special case the Royal Marsden. It was part of the price of voting through the foundation hospital concept. Chancellor Brown played an ambiguous role.

On Monday this week cross-bench social policy expert Baroness Meacher tried again to amend the final stages of Andy Burnham’s Health Bill. Why? To lift that cap.

The foundation lobby has long wanted it. Network director Sue Slipman says the concept covers far more than private patients’ fees: all sorts of commercial activities including joint ventures and charitable donations. It is holding them back, she told The Guardian.

Having witnessed the creative role charitable funds have played in third sector housing associations (my wife used to fundraise) I can believe it. And Burnham has now conceded the point in principle by allowing all mental health trusts a 1.5 per cent cap.

Yet, win or lose in the Lords, Meacher was wasting her time because the Commons would not accept it. “We’ve gone as far as we’re prepared to go with the [rule] relaxation for mental health trusts and launch of the [O’Brien] review,” a senior party source tells me.

The Tories point out that Alan Johnson’s concession last year that people could now make “top-up” payments for certain treatments - those costly cancer drugs - count against the cap. So urgent action is needed, but Labour would not get reform past its MPs.

But Labour ministers seem to be sending out mixed signals. Andy Burnham’s remark about the NHS as “our preferred provider” was supposed to cheer the pure public sector lobby just as O’Brien’s move on caps will encourage the mixed health economy crowd.

Cunning or floundering?