Michael White on coalition compromises

Andy Burnham, or Candidate Burnham as he has become since we last met, is amazed that the agreement does not appear to implement the Tory pledge to abolish NHS targets - a startling climbdown, he says, although HSJ reports more detail is now expected in a revised NHS operating framework for this year.

Secretary of state Lansley counters that his new focus on outcomes and on professional autonomy will have a more benign effect. Targets will not be explicitly abolished, more phased out.

Ho hum. New governments deserve the benefit of the doubt, so let’s leave it there, especially in a week when Lansley told officials at his department (not yet renamed the Department of Public Health, I see) they would have to share the painful £6bn Osborne-Laws spending haircut.

Most of the coalition health agreement was easily reached because there weren’t huge differences between the parties. Besides, it’s easier to agree year-on-year real term spending increases than cuts, even though we all know it won’t really be that sunny.

Lansley gets only one bill in the Queen’s Speech programme (leaked version), to strengthen the role of patients and professions in NHS decision-making. But that also allows the creation of his beloved independent NHS board “to allocate resources and provide commissioning guidelines”.

If you want to know how well I think that will work, just look at the way the armed forces allocate resources - often very badly - but still proceed to blame elected politicians when things go wrong on the battleground. Let’s wait and see.

Two dropped stitches stand out in the seamless coalition knitting, both of them apparent Tory concessions. One is the concession of an independent review on long-term social care of the elderly, the subject of pre-election squabbling. Is this a kick into very long grass, as Burnham fears? Time will tell.

Equally intriguing from a government which promises less political interference from the centre (don’t hold much breath) and less NHS re-organisation is directly elected individuals on primary care trust boards. This is presented as “a big concession” to a Lib Dem campaign pledge.

Here is what Lansley, putting a bold face on it, says: “We have been considering for some time how best to connect PCTs to local communities and involve local authorities in the development of public health strategies. What better way than for PCT boards to be made up of a balanced mix of NHS appointees, local authority appointees and members directly elected by the general public?”

Ok, if you say so, minister. You can find his still-evolving thinking in his Autonomy and Accountability framework document (2007). Lansley has a paper for everything; now the papers meet real life. But he looked very happy when I bumped into him in a corridor last week - “never so happy” after years of frustration, say those who know him well.

One mystery I have still not resolved is why the Lib Dems Mr Elderly, Paul Burstow, is the minister in charge of that hot potato, not Norman Lamb, the party health spokesman since 2005. No-one seems quite sure and Lansley himself did not pick his team. That was done higher up.

But Norfolk Lamb has emerged as political and parliamentary adviser to deputy prime minister Nick Clegg, with a No 10 pass and is said to be thrilled. So do not worry for him: plenty to worry about nearer home.