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Richard Marsh: We've faced opposition to health reform before, and we must see it through once again

Richard Marsh is a former Special Adviser to Virginia Bottomley when she was Secretary of State for Health

Screen shot 2011-10-15 at 16.51.48On the Spectator's Coffee House blog earlier this week, Fraser Nelson posted a mordant denunciation of Andrew Lansley and his handling of health reform. It was evidently an anguished cry from someone who wants to reach the party. Sadly, however, the Speccie's editor slid into hyperbole - as does much of the opposition to the Government's health reforms -  when a different interpretation is available.  Can things really be as bad as all that?

For a start, the author was writing after returning from a gathering of "health professionals" - never the best vantage point from where to retain either one's humour or sense of proportion.  I would wager that almost all of those who were there take the left-wing whip.  Not only do they regard Conservatives and Conservative policies with innate suspicion; they hold that the very idea of a Conservative Health Secretary is an abuse against nature.  They also represent the authentic reactionary voice of the status quo. Of course Nelson is right to say that such people will blame everything that goes wrong on the reforms. They always do, and have always done so since time immemorial. It is either that or the "cuts". This isn't hard to understand:  it absolves them of the responsibility to look to their own failings of leadership or imagination in explaining, for example, why half of our hospitals cannot meet basic standards of care for the elderly.

Nelson says that the Health Secretary's bungling is of epic proportions, indeed that it has dealt an historic blow to the cause of reform. Again, some perspective might help. Precisely the same hurricane of outrage was unleashed against the original internal market reforms nearly 25 years ago. A few years on from that and Virginia Bottomley, whom I advised as health secretary (officially I might add), was mocked and misrepresented by those fighting her efforts to change the balance of healthcare in London from too many hospitals to better primary care.  Today we are told that there is a consensus around the idea that there is a surfeit of hospital beds. Perhaps, though in my experience many of those signed up to that consensus are away over the hills when it comes to the dirty business of actually shutting hospitals.

At least Mrs Bottomley (as she then was), and Ken Clarke before her, had the Government of which they were part behind them.  Andrew Lansley has had to push through his programme in circumstances where the Liberal Democrats, for entirely political reasons unconnected to health, chose to mug him on the way.  Seeing that the Government itself was split, is it any wonder that the opponents of the changes were emboldened in their efforts, and prepared to use ever more rococo distortions of the Bill's purpose to carry their charge?  Criticisms of Mr Lansley's communications skills miss the point. Dealt such a hand, it is hard to imagine any politician, certainly from the current hamper, coming through unscathed.

There have certainly been failings in both tactics and presentation. The biggest in my view was the ill-advised manifesto commitment against "top-down reorganisation". This has given untold ammunition to opponents and may yet cause more trouble in the Lords given its relevance to the argument around the Salisbury Convention. Mr Lansley, who knew his own policy better than anyone, must have realised that it was incompatible with keeping things as they were.  It is also true that ministers have struggled to provide a convincing rationale for the changes. To those who warn endlessly about the Government's hidden agenda, I just want to scream out: never mind that, please can it just do a better job putting its finger on the unhidden one.

It is difficult to refute Nelson's argument that the Bill isn't needed even if the reforms are, without coming over as precisely the sort of health geek who is so damaging to the cause.  But it should be obvious, for example, that if GPs are to be given powers to determine directly how budgets are spent - a good thing - then those powers must be vested in law, in the process abolishing primary care trusts who held them before. Equally, the Secretary of State's laudable objective of removing political interference from operational NHS matters needs to be given statutory force through the creation of a national commissioning board.

Camilla Cavendish, in a Times (£) column this week, said that the Bill won't close any hospitals or open up any all-night surgeries. True, but that is not what we write laws for. The Bill is complex, and clumsy in its way, and it has provided an endless feast of opportunity for those who would in any case be desperate to thwart the Government's will.  If it succeeds, however, it can and must open the gate to forces that will drive the changes the NHS so badly needs.


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