Fraser Nelson

Will the coalition defeat the roadblocks to reform?

Will the coalition defeat the roadblocks to reform?
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The biggest reform to the NHS since its inception since 1948. A move away from bureaucracy towards a proper internal market. GPs commissioning. A revolution, taking on the vested interests. Yes, there was so much to savour in the NHS Plan of 2000 - enough, Alan Milburn would later joke, that he kept re-announcing its policies for the next three years and getting headlines. Well, the Tories can play at that game too. Now, it has been reannounced by Andrew Lansley and called the coalition NHS White Paper.

This is, in my book, a compliment to Lansley. In opposition, he sided with the unions and attacked Labour from the left on the "stop the cuts" platform. Now, he is picking up some of the discarded Blair reform agenda – centrally, GP commissioning. It's a great idea (and was when Milburn proposed it ten years ago) - rather than waste money through Primary Care Trusts, the GPs would have the power and budget to do things themselves. It is happening already under the Labour reforms, a great example being Sue Page from NHS Cumbria (the peerless Nick Timmins from the FT tells her story here). She will eventually reform herself out of a job. But, believe me, other PCTs will fight until the bitter end to stay alive. While Milburn was up for a fight – and saw it as a battle, against the vested interests and Gordon Brown – Lansley thinks he'll get there by happy co-operation. Perhaps he's right. But I doubt it.

I have a piece in the Daily Telegraph saying how depressing it is to see history repeat itself so much. The Blairites latterly had the right agenda: on schools, and hospitals. It would be a narrowly partisan Conservative who did not applaud the direction and resolve of Blair. I bow to no one in my admiration for Michael Gove's schools agenda, but Blair got there first. No-one, now, remembers the day when the Daily Telegraph proclaimed "All state schools to go independent," and Blair said he'd fight the teachers unions to do this in five years. If he had, then every pupil today would be in an independent school and Gove would not have a schools policy.

Gove realises this. He expresses admiration for Adonis and says he'd make him a minister "like a shot" if he'd accept the offer. But any reform-minded Tory should ask a simple question: why should they succeed where Blair failed? Sure, there's no Brown. But there are new enemies who hold power – and who did not, unlike Brown, hand it over at the last election. Brussels, Strasbourg, the unions, the quangos, all will fight to the death to keep their power. So the Cameroons' problem is not so much political, but organisational. And that is a far harder battle.