NHS U-turn?

The Sunday Telegraph report that Cameron was ambushed by Tory MPs at last weeks 1922 backbenchers' meeting where they expressed their concerns over the Health and Social Care Bill. Since September I've been giving talks on the white paper and people have asked me how to stop the policy and I've told them that the only way is to target backbench (particularly shire) Tory MPs and carefully tell them what it will mean to their constituents. Clearly others have realised that this is the right thing too. Further, the Telegraph also reports that Cameron had a two-hour meeting with Sir David Nicholson, the Chief Executive of the NHS who warned him that unless the programme was slowed down, there was a danger that the NHS could lose control of its spending "plunging the service into chaos".

However, this does not appear to be a u-turn, it is merely a welcome watering down, nothing more.

The Telegraph reports that the Bill will be changed with:

• New clauses limiting the ability of private firms to "cherry-pick" the most lucrative work, by ensuring that payments match the complexity of treatment;
• Attempts to redefine the role of the system's regulator, so that value for money replaces promotion of competition as its prime duty;
• Improved public accountability for the GP consortia, which are intended to ultimately take control of around £60 billion of public money each year.
• Mr Cameron's intervention means the timetable for the reforms will be relaxed, with 2013 no longer treated as a deadline, and no doctors forced into consortia against their wishes. However, in parts of the country where GPs do not agree to form such groups, powers could instead be given to GP consortia from other parts of the country.

There is nothing in there about the damaging "Any Willing/Qualified Provider" policy nor the removal of the NHS as the default provider, which Cameron himself has promoted. There is nothing about the removal of the responsibility of the Secretary of State for the provision of healthcare. Nor is there anything about the overarching power of the new quango, the National Commissioning Board.

The last point in the list above is worrying. If consortia from other parts of the country can take over commissioning then there will be a crisis of independence far worse than a postcode lottery: people will see a private organisation from another area force rationing on them. In fact, this may well be a PR disaster for Cameron since people in the area having rationing forced on them may point to the difference between what is happening to them and the policies of the area of the overlord consortia.

Finally, what happens to Lansley, what happens to tweedledum and tweedledee (Alexander and Letwin) who signed off the original Bill at the end of last year? If Cameron forces any significant changes then he is saying that all three were wrong and crucially, it shows that he cannot trust Letwin to act as a troubleshooter. The LibDems will also see Alexander as too closely wedded to Letwin since he did not recommend changes to the Bill before publication.