Are ministers in Alan Johnson’s health team now finding their feet in their new jobs after a lacklustre start? Are they landing a few blows on the other side too despite renewed talk of a broad consensus on the NHS’s future?
Though Dawn Primarolo has taken media stick for highlighting middle class tippling at home as a serious health problem - she is probably right - I thought I detected a surer touch in the way ministers fielded routine problems at this month’s Commons question time.
During the health segment of the annual Queen’s Speech debate, Mr Johnson even managed to fight off charges from Andrew Lansley, his Tory shadow - plus Ken Clarke, still a formidable ghost of health Christmas past - that his team is less committed to NHS reform than was former health secretary Patricia Hewitt’s.
The health secretary insisted that Labour’s choice and competition regime, introduced since Alan Milburn succeeded Dobbo, does not simply mimic Mr Clarke’s internal market because competition is on quality of care - not on price.
Mr Lansley appeared to confirm that a Cameron government would retreat from the single tariff system and allow GP commissioners to ‘negotiate [price] discounts or negotiate improvements in quality’ in the model he is devising.
But all this will do health ministers little good while it remains unclear what Number 10 wants from them. Previous teams knew what What’s His Name wanted: do they or the public yet know Gordon Brown’s mind? No. Number 10 is adamant that the new prime minister is as committed to reform as WHN was, but we do not yet hear the words fall from the boss’s lips.
Instead when Mr Johnson made his ‘glass half full half empty’ statement on independent sector treatment centres the other day, Unison rejoiced that plans are being trimmed and the private sector sounded off angrily in the pages of the Financial Times. After all, it is the business elite’s paper.
In blogs and articles Nick Timmins, the FT’s influential public policy pixie (number 23 in HSJ’s top 50), has been leading the charge that Mr Brown is behind Mr Johnson’s apparent retreat from private sector choice options. But is it true?
From what I hear, my cautious answer is ‘I don’t think so’ or ‘certainly not yet’. Comrade Al’s statement describes his own attitude as ‘pragmatic, not ideological’. Can his decision to cancel six second-wave independent centres and pull the under-performing West Midlands diagnostic centre be justified in those terms?
Health officials I talk to say yes. By moving now they save the NHS money long term, whatever legal action may emerge as a result of last week’s statement.
So would Ms Hewitt have reached the same conclusion? Pause.Probably yes. And don’t forget the private sector was getting premium rates to draw it into the market, officials remind me. The easy ride was bound to end: no guarantees now, just a more level playing field.
Mr Johnson’s statement included what are meant to be encouraging signals to the private sector to get more involved in advising primary care trusts on local commissioning.
In stressing that it is ‘essential’ that patients know they can now choose a hospital, Mr Johnson also seems to be admitting one private sector complaint, that some PCTs are ‘hiding’ the private option for NHS patients on their choose-and-book software.
In short, it seems to me that the King’s Fund’s more balanced response to the independent centre cull - which notes both choice and the expanded NHS capacity that independent competition has helped to stimulate - is the wiser one.
Nick Timmins makes a good point when he recalls that then Labour minister Barbara Castle’s union-driven assault on pay beds in the 1970s inadvertently helped save the private sector from decline. Will Mr Brown’s cull give it another stimulus among anxious health customers, he asks?
That is surely premature. But the situation requires Mr Brown to clarify his position soon. There are hints that he may.
Meanwhile an FT editorial offers a rare joke: the NHS must not behave like patients who stop taking the medicine as soon as they start feeling better.