How Jeremy Hunt plans to improve the NHS (and boost his own standing)

By Paul Goodman
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The Financial Times this morning reports the conduct of a Cabinet Minister who arrived at his Department in a position of strength. Philip Hammond is digging in over cuts to his budget.  Meanwhile, the Daily Mail reports the plans of another, who came to his Department in a position of weakness.  Jeremy Hunt is planning for prescriptions to be available online.  The latter Minister is more exposed to public wrath than the former. Rightly or wrongly, voters are more concerned about the NHS than defence, and the Conservatives have long been targetted on the health service by their opponents.  Remember Tony Blair claiming in 1997 that Britain had a fortnight to save the NHS?

Tim Montgomerie set out on this site last year how the Health Secretary aims "to be angrier than any voter at NHS failures".  But Hunt's plan to champion the interests of patients is only part of his larger strategy to improve the health service - and, in the process, leave the Department stronger than when he arrived. To understand it, it's essential to grasp that the NHS is experiencing the tightest financial squeeze in its history: its budget may be protected, but the rise is planned to be 0.1% a year until 2015.  Like other western countries, Britain is experiencing a rise in the number and proportion of older people, and is struggling to contain the health costs that follow.

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The new politics of the NHS ring-fence

By Peter Hoskin
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Jeremy Hunt is setting out a “back to basics” approach to care in the NHS today, but he may just want to go back to bed after reading the main editorial in today’s Sun. “The NHS is one of our proudest creations,” it notes half-way through – so far, so positive – but then it continues, “But Cameron’s insistence on ring-fencing its funds creates a climate in which idiocy and incompetence go unchecked.” Ah.

The problems with the NHS ring-fence were clear as soon as it was erected, before the election. There was a mismatch between the Tory Opposition’s insistence that “more” could be achieved for “less,” and their Brown-style argument that only they could be trusted with the health service because only they would shield it from cuts. Sure, they deployed demographic arguments too … but the politics were still inconsistent.

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Dropping plan for minimum alcohol pricing is sensible

By Harry Phibbs
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In The Times on Saturday Matthew Parris offered (£) a DIY guide to pointless political advice. One is to urge politicians to "stay the course" and "not to wobble" - this is when you happen to like their proposal. Another is to warn politicians against a "refusal to listen" or "stubborn dogmatism" - this is when you don't like their proposal.

This is a Government which typically sticks to its policies on the big issues but makes u-turns on smaller matters. The modest "u-turns" on the spare room subsidy seem pretty reasonable to me - as does pressing ahead with the general policy.

We had another u-turn in the news today with the plan for minimum alcohol pricing being ditched. I am pleased. This is the sort of nannying that politicians are often attracted by. I remember talk of banning alcopops a couple of decades ago. It is an unattractive condescending brand of politics. It punishes the innocent along with the guilty. Most young people who drink alcopops don't then go on a rampage. Similarly most of those looking for special offers when they buy booze are doing so because they have to be careful with their money. They are not "pre loaders" but pensioners in council flats.

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Maude heads queue of Conservative MPs who believe Nicholson must go

By Paul Goodman
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I wrote on this site last week that the Mid-Staffs hospital horror requires the resignation of David Nicholson, and Jeremy Hunt replied that the NHS Chief Executive has apologised - "and now Labour must too.  The Sun claims today that Francis Maude has urged the Prime Minister to dismiss Nicholson, and notes that the Cabinet Office refused to comment on this claim when asked.

The Mail reports that "yesterday it emerged Mr Maude has argued for weeks that Sir David’s departure is necessary if accountability is to mean anything in the public sector", and reports that "a Cabinet source" as saying: "Francis Maude has been one of the voices telling No10 that Nicholson should go, from the point of view of civil service accountability more than anything else."

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Is Number Ten so defensive over the NHS that it has forgotten how to attack? (As, over Mid-Staffs, it should.)

By Paul Goodman
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Tony Blair swooped on a cowed Conservative front bench with all the histrionic skill and focused outrage at his disposal.  In the same horrified tones that he had used to respond to the heart-breaking murder of Jamie Bulger, he read details of deaths to gasps of horror from Labour MPs.  The breast cancer sufferer found by her husband crying and alone, surrounded in blood and urine...the 95-year-old woman with diarrhoea, vomiting and water leaking from her swollen legs, who lay unexamined by a doctor for four days...the woman who was told to “toilet in her bed”, and discovered a male patient sleeping across her legs.

"And all this happened," the Prime Minister concluded, glancing down at Alastair Campbell's script, "on the watch of a party who told us that the NHS was safe in their hands."  His Deputy plunged the knife in even more directly: "It proves what we've always said," John Prescott said on Question Time that evening, before deploying a classic Labour attack line: "You can't trust the Tories on the NHS".  Downing Street clung on to the isolated NHS Chief Executive just long enough to ensure that the media's wrath had reached boiling-point - it commissioned a swift inquiry - before sacking him in as brutal and humiliating a manner as possible.  "Blair sacks angel of death," screamed the Mirror.

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Tory Cabinet ministers and Lib Dems have one message for Osborne: Cut the ring fences

By Tim Montgomerie
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George Osborne is getting a very similar message from his Conservative and Liberal Democrat colleagues: Lift the ringfences.

Liberal Democrats are telling the Chancellor that they won't accept further cuts to welfare if he isn't willing to cut richer pensioners' benefits and, potentially, also "gently trim" the budgets for the NHS, schools and aid. Unlike the Tories, the Lib Dems' 2010 manifesto did not promise to ringfence key Whitehall budgets or the perks paid to better off pensioners.

And from his Right, Tory Cabinet colleagues are also saying that the next round of spending cuts will only be acceptable if the whole of Whitehall shares in the pain. Cabinet ministers like Theresa May feel that she's already achieved the near impossible. She has cut the budgets of the police for the first time ever and without a breakdown in law and order. On the contrary, crime has actually fallen by 10%. Eric Pickles is equally proud of the cuts he has made. Cuts to local government have been frontloaded but there hasn't been a meltdown for Tory councillors at the ballot box. Public opinion polls suggest that voters are seeing through Labour attempts to 'shroud wave' while, for example, maintaining reserves.

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Michael Fallon launches Thatcherite attack on Labour's failed approach to regulation of banks and the NHS

By Tim Montgomerie
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In an address to the Centre for Policy Studies tonight the Business Minister Michael Fallon MP will launch a strong attack on the regulatory culture that grew up during Labour's years. He will attack Labour and the European Union for imposing social and environmental costs on business - via regulation - that it was too frit to pay for itself, via taxation. He will say that regulation must become a last resort because it distracts businesses from their first task of creating wealth and jobs and forces them to devote scarce time and resources to compliance. Worst of all, he'll argue, the compliance and regulatory regimes have often completely failed to achieve what they set out to achieve and he'll focus on banking and NHS regulation to substantiate his argument.

On banking regulation Mr Fallon will say:

"Despite employing 2,600 people and an annual budget of £300 million, [the Financial Services Authority] failed to spot the risks the banks were taking and to restrict excessive leverage.  Despite thousands of pages of guidance, it ended up losing five of the ten big banks entrusted to its supervision. The subsequent fallout imposed massive costs - on UK taxpayers and on our economy.  It left our generation with a legacy of debt, public and private; it almost fatally weakened and unbalanced our economy. And all this in the name of regulation."

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When will we see a Danny Boyle-style pageant showing nurses mistreating their patients?

By Paul Goodman
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A recent British Future poll found that the three institutions which make people most proud to be British are, in reverse order, the Monarchy, the Armed Forces...and, topping the poll, the NHS.  The survey thus suggests that Danny Boyle had his finger on the popular pulse when he portrayed those all-singing-and-dancing nurses in his Olympics spectacular.  It can be claimed that the Mid-Staffs horror will transform this benign voter view of the NHS, for three main reasons.  First, because the shaming details of how patients were treated will make them think again.  Second, because the post-Francis Report reforms will work.  And third, because Jeremy Hunt will change perceptions of the system through his campaigning as a patients' champion.

I am sceptical.  The appalling tales of what happened in Mid-Staffs - the women who arrived to find her mother's hair covered with faeces, the old man forced to stay on a commode for 55 minutes wearing only a pyjama top - are unlikely, in themselves, to shift public attitudes formed over 65 years.  This is not only because the left has a vested interest in championing the ideal of a centrally-planned system designed in an era when communism seemed to be the wave of the future.  (Please note Paul Abbott's brilliant blog on this site about the silence of 38 Degrees over Mid-Staffs.)  It is also because voters' views are partly shaped by fear.  They value the NHS they know because they're frightened of an alternative for which they might to pay upfront.

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Cameron favours accountability and transparency as response to Stafford Hospital scandal

By Harry Phibbs
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David Cameron reported to Parliament today on the findings of the Francis Report on how the scandalous neglect of patients at Staffordshire Hospital between 2005 and 2009 was able to occur.

Mr Cameron said:

The Inquiry finds that the appalling suffering at Mid-Staffordshire hospital was primarily caused by a “serious failure” on the part of the Trust Board which…

…failed to listen to patients and staff…

…and “failed to tackle an insidious negative culture involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities.”

But the Inquiry finds that the failure went far wider.

The Primary Care Trust assumed others were taking responsibility and so made little attempt to collect proper information on the quality of care.

The Strategic Health Authority was “far too remote from the patients it was there to serve, and it failed to be sufficiently sensitive to signs that patients might be at risk.”

Regulators, including Monitor and the then Healthcare Commission, failed to protect patients from substandard care.

Too many doctors “kept their heads down” instead of speaking out when things went wrong.

The Royal College of Nursing was “ineffective both as a professional representative organisation and as a trade union.”…

…and the Department of Health too remote from the reality of the services they oversee.

The way Robert Francis chronicles the evidence of systemic failure means we can not say with confidence that failings of care are limited to one hospital.

Mr Cameron identified from the report three failings - not just failings with this individual hospital but with the wider NHS culture. 

First "a pre-occupation with a narrow set of top-down targets" which excluded listening to what patients, their relatives, and many staff were saying.

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Can Cameron heal his divided Conservative coalition? Here are three suggestions for the Tory leader...

By Tim Montgomerie
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81 Tory MPs rebelled on David Nuttall's EU referendum motion.

91 Tory MPs voted against Lords reform.

143 Tory MPs have voted against the Coalition's policies at some point. 37 are hardcore rebels.

136 Tory MPs voted, last night, against the Tory leadership's position on gay marriage. Another forty abstained.

Technically, of course, last night's vote wasn't a rebellion against government policy. It was a free vote. But it was certainly a vote against one of David Cameron's most important initiatives since becoming Prime Minister and also against his model of modernisation. Read today's papers and the result is certainly being presented as a rebellion against his authority. The party looks divided in the eyes of voters and voters don't like divided parties. Very divided. Some gay people may have new confidence in the PM but less faith in the Conservative Party.

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