Nick Clegg’s speech on the NHS this morning was not as bad as many feared it would
be. It recognised that there is a role for competition in the NHS, something that the Lib Dems were questioning last weekend, and that the NHS needs to be opened up to any qualified provider. But,
on the other hand, the idea that any willing provider should be able to deliver NHS services — an idea which was in the manifesto of all three parties — will now only be introduced at a
glacial pace. There’ll also be a two-tier NHS for the foreseeable future with some areas having GP-led commissioning, while NHS managers continue to do it in other parts of the country. And
Monitor will not be able to enforce competition.
What the speech made absolutely clear was that the original proposals are off the table; hence Clegg’s offer to submit the bill to a new round of parliamentary scrutiny. This is a pity for three reasons.
First, it will embolden all the enemies of public service reform. As I say in this week’s magazine, Cameron is already going wobbly — to Steve Hilton’s frustration — on significant bits of the reform agenda. But having blinked in the fight over the NHS, Cameron is going to come under a lot more pressure from the producer interests and the permanent bureaucracy.
The next reason to worry is that the new scheme is highly likely to be a disaster. It has been dreamt up in a matter of months with the aim of keeping both sides of the coalition happy. As tuition fees shows, this can often lead to a policy that ends up not working for anyone.
Finally, if the new package does not deliver, it will discredit the whole idea of NHS reform. This is why so many Tory reformers are now arguing that the best thing for Cameron to do, would be to junk the bill. They say — rightly — that huge amounts of the original Lansley plan can be done without legislation and that is what the coalition should get on with doing.
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