Michael White: will Lansley's Healh Bill survive the 'big push'?

As an analogy it came to mind twice in recent days. Once when News International loyalists claimed the Guardian had got the Millie Dowler hacking “completely wrong” instead of slightly wrong, before things get worse for the Murdochs. The other is the final push against Andrew Lansley’s Health Bill by assorted politicians, think tanks, medics and NHS unions.

Unlike those other two doomed counter-attacks it may gain some useful ground in the end game negotiations on the bill: a clarification here, a concession there, much like the Welfare Bill battle in the Lords this week. Remember, Lansley loyalists are defending the Tory case too: “Four die thirsty and starving on our wards every day,” thundered Monday’s Mail.

Like the Commons health committee’s mid-week report (Lansley’s reform is undermining the Nicholson efficiency reforms, leaked accounts reported) the Mail’s charges – it only said its figure included deaths in private hospitals in the small print – were hardly new. But I think I detected a change of focus in Labour’s critique of the bill when Andy Burnham, ex-health secretary, now back as Lansley’s shadow, launched a Commons debate entitled “NHS (Private Sector)”.

Unlike John Healey, from whom he took over, Burnham knows his subject intimately because he lived it as a minister. Burnham has to reconcile what he says now with what he did in office, like Healey’s patron, Ed Balls, who has belatedly modified his stance on cuts in recent days – annoying the unions in the process.

Burnham didn’t get it all his own way in the debate. Andrew Lansley knows his stuff too. But you can see how the debate will unfold after the secretary of state gets his bill and the model he has created turns out to be drop-dead gorgeous or Frankenstein. Burnham’s starting point, his Commons motion, therefore acknowledged “the important role for the private sector in supporting the delivery of NHS care”.

Cautious words, but Burnham also praised its contribution to slashing waiting lists and times, and went on to argue that there must be “agreed limits” to its involvement. Lansley’s sneaking out of a 49 per cent cap on hospitals’ private patient income over the Christmas lull, coupled with hospital autonomy and a “no bailout” regime, goes far too far, he told MPs.

It amounts to privatisation, a word he keeps using. That bit allowed Lansley to accuse Burnham of lapsing into pre-Blairism along with Frank Dobson, who made a robust Old Labour contribution, added by Lib Dem Dr John Pugh. He claimed the NHS has been in the grip of free market ideologues for the past eight years.

Nonsense there from Pugh, and some from Lansley and Burnham too, surely? The health secretary says Labour put no caps on private patient income and that specialist hospitals like the Marsden were allowed to keep theirs at 30 per cent. The coalition’s bill both caps and regulates much better. The NHS will remain free and fair, although greater private and voluntary sector provision will make it more efficient. That’s the wholesome theory.

Don’t confuse pluralism with privatisation, warned Stephen Dorrell, the coalition’s health Gandalf. I agree: trying to create an NHS market is not the same as privatising it. But plenty of predators lurk, ready to exploit the naivety of Lansley’s vision. It could be Frankenstein, more likely a curate’s egg: good in parts.