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The principles of the Government's NHS reforms will remain - but changes are on the way as Cameron reportedly takes personal charge of selling the package

By Jonathan Isaby

5.30pm update:

Andrew Lansley has just made a statement to the Commons, in which he said that NHS modernisation was both necessary and in patients' interests and announced the well-briefed pause for further consultation at this stage in the NHS and Social Care Bill's passage through Parliament.

He says there are already 220 commissioning pathfinders, representing 87% of the country, whilst 90% of local authorities are committed to introducing health and wellbeing boards.

However, the speed of progress has brought substantive concerns, some of which, he said, are misplaced, some of which are genuine - but the Government wants to listen to, engage with and learn from patients, staff and others.

As such, there is now a natural break in the passage of the bill to pause, listen and engage with those who want the NHS to succeed, and the Government will then bring forward further amendments in due course.


Cameron and LansleyThe papers yesterday and today have been full of speculation about how the Government is to retreat on aspects of its NHS reforms.

Headlines favour words like "U-Turn", but the Government is insistent that the principles of the reforms embodied in the Health and Social Care Bill remain strong as ever; rather, the Bill is expected to be put on hold for several months as soundings are taken about the detail, with it then likely to be subject to government amendments when it continues its passage through Parliament.

Today's Daily Mail summarises the areas in which the Government is expected to be "giving ground" as follows:

1. Ministers will spend the next three months asking doctors and patients for suggested changes
2. Plans to make GPs responsible for commissioning health services could slip past the current 2013 deadline
3. Private firms will be banned from ‘cherry picking’ the most lucrative parts of the NHS
4. The Bill will spell out that every GP doesn’t have to take on responsibilities but can leave it to others in their area
5. The new NHS regulator will prioritise value for money, rather than promoting the free market in health services
6. Councillors will sit on the GP consortia which will run the health service, giving local democratic accountability

A Downing Street spokesmen yesterday said that much of what the media was reporting was “ill-informed and filled with inaccuracies”.

But it is widely reported this morning that Health Secretary Andrew Lansley will appear on a platform together with David Cameron and Nick Clegg later this week as part of a "sales exercise" and to announce how the Government is proceeding. Some reports such as that in the FT (£) suggest that Cameron is now taking personal charge of selling the reforms, in what will be seen as a snub to Lansley,

All a Downing Street spokesman has formally said at this stage is that:

"The Bill has now successfully finished committee stage in the Commons and there is a break before it moves to the Lords. We have always been prepared to listen. We will also stop Labour's approach of giving preferential deals to the private sector."

The latest ConHome Members' survey saw 73% wanting the reforms to go ahead and 59% expressed the view that significant amendments would be seen as a Lib Dem victory.

Ex-Lib Dem MP Dr Evan Harris - now vice-chairman of the Lib Dems' federal policy committee - is reported in this morning's Guardian as stirring it up, voicing support for a list of amendments which are said to be the minimum requirements to satisfy his party's membership.

It is notable that LibDem opposition to the NHS reforms really only crystallised after their spring conference rather than earlier at the time of the Bill's second reading in Parliament. However, any changes to the Bill will doubtless be seen as a Lib Dem win - something onto which Nick Clegg may dearly need to cling if AV is defeated in next month's referendum and he is faced with internal dissent after a difficult set of elections to boot.

At the other end of the spectrum, there is an opinion piece by none other than Lord Tebbit in today's Daily Mirror, expressing his worries about "the difficulty of organising fair competition between the state-owned hospitals and those in the private sector".

There have been mutterings from a small number of Tory MPs, although the suggestion in one weekend report that Cameron was "ambushed" at the 1922 Committee last week on the issue has been scotched to me by a variety of reliable sources.

Whatever Cameron et al do announce later this week, the media will seize on it as a retreat or "U-Turn", of which there have been a few too many of late (school sport, forests, EMA...). This is far from ideal, since it will embolden the Government's opponents and discourage allies from defending unpopular measures.

Serious questions need to be asked of how the ground has been prepared (or rather not) for these changes to the NHS. As I said in regard to the policy on forests, "people need to be persuaded that something is broke before they can be convinced that a fix is required". In this situation, people have felt the reforms were ideological rather than a way of getting better value for money in an era when the money has run out.

There's no doubt difficult decisions will have to be taken on the NHS in the years to come in order to match budget with demographics, dealing with the increasing costs of treatments and an ageing population. Alas these reforms have thus far risked connecting all the difficult decisions to the reforms rather than as unavoidable measures.

This saga has not been Andrew Lansley's finest hour: one of his great selling points has been that he knew the NHS and its staff better than anyone, having held the health portfolio since 2003 - but it seems to have counted for little when it was needed, with many big NHS stakeholders rejecting his reforms and the wider public failing to be convinced too.

James Forsyth summarised the problem in the Mail on Sunday yesterday when he quoted a source as saying: "Andrew knows everything but can’t explain it in three simple sentences. And if you can’t do that in modern politics, you’re in real trouble."

But the blame for the current situation should not be laid exclusively at Lansley' door. In today's Daily Mail, Iain Martin suggests that Cameron has been "excessively devoted" to Lansley and that as a result "the Health Secretary was subjected to little scrutiny by his colleagues, even when he came up with his dizzying series of radical reforms".

> Paul wrote about all of this for Comment is Free on Friday and in January wrote about the risks and opportunities of Lansley's healthcare revolution here and here.


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