Michael White: like a civil war, the Health Bill has divided political families

I suppose this is hardly surprising. Mr Lansley provides the market model while ex-communist Sir David Nicholson revels in the “Stalinist” tag and warns consortia he will not release his grip until they have proved their worth. Beijing’s own grip shows no sign of weakening yet.

As the dust settles (briefly) on the row sparked by the bill’s publication, what is startling is the way the issue has divided political families, as civil wars sometimes do. Thus loyalists are pleased to find Janet Daley warning in her Sunday Telegraph column that, unless NHS reforms are pushed through quickly, vested interests will block them as usual.

Daley was a Trotskyite leftie in her Californian youth and clung to ideological certainty in her march to the right. She is scornful of the British Medical Association’s “producer” interests, but happy to advocate public service “revolution”, which will empower, well, who exactly? Consumers or health professionals like BMA members?

As noted here some conservative analysts are fearful of “too much too fast”. It could leave the system much as it is now: the Nicholson Commissioning Board behaving like the DH and GP “clusters” looking like - and staffed like - large GP-led PCTs. Efficiency savings? Ah, that’s the gamble.

Yet Professor Julian Le Grand, wise and mild health adviser in Tony Blair’s Number 10, insists - like wise and mild Stephen Dorrell - that all we are seeing here is evolution, not Daley-esque revolution. Le Grand sees a sensible development of proven policies of choice and competition that work to raise standards and lower costs in England.

Scottish and Welsh politicians and medics would call that simplistic. Yet Labour ex-MP and GP Howard Stoate, now chairing a commissioning consortium emerging in Kent, is backing (most of) the bill, at odds with Labour health spokesman John Healey.

In a speech last week Healey damned Lansley with faint praise - “No MP knows more about the NHS” - while accusing him of sidelining the Lib Dems to promote a covert ideological agenda; “the half-hidden truth”.

It will take the “National” out of NHS (Ed Miliband echoed that line at Prime Minister’s Questions) and open the service to fragmentation and widespread privatisation, via the “any willing provider” formula and David Cameron’s stress on “a level playing field”.

I suspect that’s going too far and point to last week’s HSJ scoop - the US firm Humana’s decision to withdraw from Britain because it doesn’t think Tory policy provides enough scope. The outcome of Lansley’s upheaval - no part of the service goes untouched - is likely to proved mixed and unpredictable. Things rarely prove as good - or as bad - as they seem on the day.

Ministers brush aside concern that competition by price will drive standards down, and stress their bill puts quality at the centre of the tendering process, as Labour did not while deploying pricing mechanisms itself when in office. Lansley and Nicholson both emphasise that.

Lansley ended the week in good heart. Oliver Letwin’s team had been through his telephone book of a bill and found no flaws - despite the 6,000 responses to his consultation. Critics were largely predictable. All the same it is a gamble with a big G. If voters think the state is reducing its role to a regulator and taxpayer-funded quasi-insurer it won’t stop them blaming politicians when things go wrong.