Michael White: mixed-market debate feels like déjà vu all over again

A bit like Andrew Lansley, to whose rescue he rode this week.

But both are right to point out that Liberal Democrats signed up for last summer’s health white paper and (mostly) voted for the Health Bill in January. Much of it was visible, just below the surface, in the coalition agreement. They are, as Labour’s health spokesman John Healey said in Monday night’s excited debate, “up to their neck in it”. So was David Cameron.

What’s changed? We know what’s changed. Lib Dem activists took fright over tuition fees, then over health and much else. Voters rubbed their noses in it (and in AV voting reform) last Thursday so Nick Clegg is looking for an easy scalp. The Health Bill looks like it. Cameron doesn’t want to lose his Lib Dem shield, so he’ll play along with it, whatever he may think privately of his Softie Walter friends.

Except that Clegg’s threatened veto is easily evaded with little more than cosmetic concessions on timing and options for GP commissioning and wider inclusivity. What really matters are the substantial changes which the anti-coalition of political parties, NHS unions (including medics and royal colleges) and peers can impose on the bill, if they can agree what matters. That may be hard.

Will Lansley jump or be pushed? If Cameron decides to junk the whole bill (as a Financial Times editorial urged this week), I’d say he’d resign. But I’m pretty sure it won’t come to that because Lansley will bend with prevailing winds and has a lot of backbench support  – as was noisily shown on Monday night, especially on the free-market right.

Even Ken Clarke, usually seen as a leftie, is on his side and thinks he’s been badly treated, “hung out to dry” in the current jargon, as Cameron consults his new NHS Future Forum panel and – the rumour mill claims – sidelines his health secretary.

Remember, Clarke introduced many of the market reforms as health secretary in 1988-90, and is defiantly loyal both to friends and policies. Monday’s debate was a 20 year “déjà vu all over again”  for older MPs.

So don’t expect Clarke to be moved to Lansley’s job, one of several rumours, along with Jeremy Hunt, culture secretary, and the evergreen Stephen Dorrell who plays a deft hand as Lansley’s candid friend – supportive, but also not – and is not angling for the job. In a Commons corridor I happened to bump into Lansley just before the debate. He was serenely calm and talked about “turning a drama into a crisis” (or was it the other way around?).

Totnes GP/MP Sarah Wollaston’s speech is worth reading, sensibly Dorrell-ite in its emphasis on a mixed health economy in which multidisciplinary integration of health and social care is more important than competition. Lib Dem rebel John Pugh made similar points and spoke of the bill’s “Jekyll and Hyde” nature. The US model for healthcare is fine, he said, it’s just “political suicide” in Britain.

Labour’s problem is that its own mixed-market remedies in office were not very different and John Healey struggled to explain fine distinctions. But he is surely right to suggest that Monitor’s new role as economic regulator is key. Yes, there has been market competiton and private provision in the NHS for years, but if becomes explicit in law then cherry-gobbling EU and US lawyers may start crawling all over those hapless GP commissioners.

Expect Labour to concentrate on inserting duties on Monitor to promote integration and cooperation.