Michael White: NHS policy pronouncements

Health inclusion; friendly carers; and much more. The prospect of a hanging certainly concentrates the mind. But the blizzard included an above-party report from the Labour controlled Commons health select committee, chiding ministers for tardiness in addressing the funding side of long term care: 10 years wasted and then a hasty bill.

London is awash with key marginals, seats incidentally where hospitals are less likely to close

Yet it warns against “despair and alarmism”. Society still has 30 years’ grace before the post-war baby boomers are enfeebled, say the MPs. But why did the green paper exclude some options, such as Sir Derek Wanless’s idea of pound for pound matching funds, in its belated search for consensus?

Good stuff and proof that what the committee calls “pre-election point scoring” can still be resisted. The same could be said of last week’s HSJ exclusive that Cabinet colleagues had reined in Andy Burnham’s “preferred provider” speech as hostile to NHS competition policies - popular though it is with Labour’s union paymasters.

I wish I could report a similar high tone from the Commons debate on healthcare in London, which rapidly degenerated into a squabble over NHS London’s local closure plans, who or what is to blame - and which party will best tackle the capital’s inequalities.

It was launched by Andrew Lansley to promote a halt to sector-wide configuration proposals… “until more effective consultation has taken place” - and not at all while they are still doing a good and needed job. Not hard to spot the Tory interest here.

London is awash with key marginals, seats incidentally where hospitals are less likely to close, an academic study reported the other week. Labour was traumatised to lose Wyre Forest to nice Dr Richard Taylor over a hospital row in 2001.

Lansley was rightly mocked for seeking to postpone hard choices. But, apart from the eagerness of almost all speakers in all parties to defend their local hospital, two worries struck me. One came from Lib Dem health spokesman Norman Lamb, echoed by other MPs: that NHS London’s reorganisation plans are driven by finance, not clinical need: by the cost of private finance initiative projects.

There have been 20 major PFI schemes, costing £2.6bn, in London, but the charges over their lifetime will be £16.7bn and are “squeezing resources of other health services”, Lamb protested.

Me, I might live with that provided patients get their money’s worth, long term.

Too many of the debate’s anecdotes suggested otherwise. Thus £30m was spent on a new casualty department at Whittington Hospital, only to see closure now threatened. Health minister Mike O’Brien disapproves so it probably won’t happen.

The other telling complaint, echoed around the chamber via emails sent by NHS dissidents, was led by Iain Duncan Smith. You keep saying Lord Darzi’s review was about “bottom-up clinician led” reform, but it isn’t, the Tory ex-leader told O’Brien. It is secretive and bureaucratic and the consultations are a stitch-up.

Such charges recall Lib Dem fury over threatened closures at Kingston Hospital, which I talked of here on 2February 25. It is still exercising local MPs, except they are no longer alone. This has been going on in the capital since Virginia Bottomley ducked closures in overprovided central London and only Labour ex-minister Tony McNulty called for holistic debate between strategic and local needs.

St Helier Hospital in the south London seat of Mitcham and Morden has just got heads-up for a £220m rebuild. No, it is not a marginal. But yes, it is Labour.