Is Lansley in a majority of one?

There are emerging three key figures in health policy: Andrew Lansley, the Secretary of State for Health; Stephen Dorrell, the chair of the Health Select Committee and Sir David Nicholson, the Chief Executive of the NHS. That is the top three men in the government, in the Commons and the civil service.

Dorrell is a former Tory Health Secretary, but he is no Lansley-stooge, indeed it looks like he is quite a powerful thorn in the side of Lansley. Dorrell gave a rather interesting interview with Health Service Journal (subscription, but there is a non-subscription comment article available that summaries what he said).

The Conservatives said that they would not cut the NHS and would deliver year-on-year "real terms" increases in funding. We all know this to be utter lies, and Lansley's enthusiasm for continuing the "efficiency savings" in the NHS that were announced by Andy Burnham earlier this year, shows that he relishes cutting the NHS. Tories do not change their spots. What Dorrell is saying is that the financial situation is the most important and Lansley's aren't:

And the message was this: delivering the £15bn-£20bn efficiency savings first identified by NHS chief executive Sir David Nicholson last year must be the priority. The reforms set out in Liberating the NHS, the government’s white paper, have a part to play in achieving this goal - especially in making them sustainable - but they are secondary.

Andy Cowper at Health Policy Insight quotes Dorrellin more detail:

“This reform of commissioning is important up to and only in so far as it reinforces the capacity to deliver the Nicholson challenge (the £15-20 billion un-spend by 2014). If you get that wrong, healthcare delivery is at risk"

Further, Dorrell is worried about accountability. This is something that I think Lansley is ignoring at his peril. A couple of weeks ago I spoke with my MP (a shire Tory) and he made it clear that his constituents regard the government as being responsible for the NHS and if the NHS fails then the government has failed. Dorrell says something similar:

"I’m in favour of liberalising the system, but I’m not in favour of imagining the secretary of state isn’t ultimately accountable for what’s delivered tomorrow morning in surgery in every part of the NHS, because he is ... Nobody should believe [he] makes all the decisions; but he is accountable for the structures under which those decisions are made. And if the structure delivers [negative] outcomes, you get into that world where you find yourself on the Today programme, quite rightly”

The Conservative manifesto and the NHS White Paper states that the aim is to absolve the Secretary of State of any responsibility for the NHS. It seems that Dorrell disagrees, and I think most of the public do too. Basically, if my neighbour is denied care it may well be the local GP consortia telling her that the money simply isn't there, but we all know that the money isn't there because Lansley did not ensure that it would be. At the next election, he will not be able to shirk that accusation.


Sir David recently wrote a letter to Lansley saying that he too thought that the efficiency savings were the most important and urging Lansley to slow down with his re-organisation.

It certainly seems that only Lansley believes that his re-organisation is the priority. HSJ report:

A government adviser attending the HSJ summit left the event concluding in sad surprise that many NHS leaders “really don’t like the [white paper] reforms”. No, they do not.

Meanwhile Andy Cowper also reports:

a consultant working in DH, who says "they have the strange confidence of the 300 at Thermopylae. No-one else thinks they are going to win". 

This is worrying since it implies that they know they are fighting everyone else, but they are insistent that they are right even though everyone else thinks they are wrong.

If there are problems with the NHS this winter then perhaps Lansley being in a majority of one may make him realise that 1) he is the Secretary of State, which means that he is responsible and 2) ambitious, expensive and disruptive re-organisations can only be done at a time when money is plentiful and so the sensible thing is to scale back the plans. The problem, as the HSJ article says, is that much of these policies (including the plan to take all NHS hospitals out of public ownership) is the brain-child of Oliver Letwin, and Lansley may find that he does not have the authority to scale back the plans.