Michael White: in reality, even a centralised model devolves power

As a result, not much media attention was paid to MPs’ attempts to analyse what Nye Bevan meant by his famous “bedpan boast” 60-plus years ago. It seemed to symbolise the frustration of last week’s two day recommittal of the bill. 

I’ll come back to that. First Ms Dorries’ doomed campaign (lost by 368 votes to 118) which should serve as a textbook case of how not to do things.

No, I don’t think David Cameron intended crude innuendo when he suggested she was “extremely frustrated” about his refusal to back her, although loutish MPs sniggered. He was certainly a bit ungracious as well as slippery in claiming that the royal colleges back Andrew Lansley’s bill.

Number 10 is also massaging NHS waiting time statistics, always a bad sign.

But it is not smart politics to suggest (as Dorries did) that your PM has been “blackmailed” by Nick Clegg, any more than it was smart of medico-ex-MP Evan Harris to boast on Twitter that he had “applied pressure” on Clegg over Ms Dorries’ campaign.

Nor was it wise to hog an hour of a 90 minute debate – Dorries’ ally, Labour’s Frank Field, begged her to shut up – or alienate allies like the Society for the Preservation of Unborn Children as well as foes. Even Field voted against her.

Observers did not have to look far to see shrewder role models. In winding up the debate health minister Anne Milton was sensibly conciliatory towards Ms Dorries and her backbench allies.

Yes, the abortion advice which pregnant women get could be improved. No, this muddled proposal is not the right way forward, she said. Dr Sarah Wollaston, Totnes Tory GP-MP and frequent scourge of Lansley’s bill, was also impressive as the bill headed to the Lords.

She still complains about the bill’s complexity and continues to demand changes like caps on private sector income in NHS hospitals.

But Wollaston gets the point which many medico-critics don’t: Lansley’s NHS reforms are now past the point of no return. It has been an avoidable shambles. Thus – as HSJ reported last week – ministers have only now produced a failure regime for foundation trusts which curbs the original vision of market based capital funding. It is, incidentally, a power that third sector housing associations have enjoyed for decades.

But the bill must proceed – and Wollaston voted for it for three reasons worth repeating here.

“First, clinicians will be in charge of commissioning. Second, the public will be able to see what clinicians are doing. Third, neither clinicians nor the public will allow privatisation to happen” she predicted. Let’s hold her to it.

My hunch is that the Lords will huff, puff and tweak the bill’s details, but also reach that conclusion too despite renewed protests from next week’s Lib Dem conference and the pleas of Baroness Shirley Williams.

When NHS consultants in Sussex are accused of milking their waiting lists, when GPs have “ghost patients” (also for cash gain) and sinister data on baby deaths has just been unearthed in Barrow it is hard to defend the status quo.

The centralised model that had won the Second World War was what Bevan had in mind in 1946 when he predicted that “the sound of a dropped bedpan in Tredegar [his constituency hospital] would reverberate around the Palace of Westminster” in the new NHS.

That did not mean Nye picked the bedpan up himself, ministers protested. In reality power has always been devolved. We only seek to make that explicit.