If the Coalition doesn't reform the NHS it will never get control of its budget

By Tim Montgomerie

The Lib Dems were fully signed up to the NHS reforms until a few months ago. Nick Clegg - with David Cameron - personally signed the introduction to the NHS White Paper. John Redwood posts the additional evidence. But, now, it is obvious that the pause in NHS reforms is becoming a full retreat. These are some of today's headlines:

• "Lansley’s NHS reforms may be junked to assuage Nick Clegg" - Times (£)
• "Clegg-Cameron pact to kill NHS reforms: Lansley is warned his entire bill could be scrapped unless he falls into line" - Daily Mail
• "Clegg threatens to veto NHS reforms in bid to reassert himself" - Independent
• "Clegg threatens to veto health reforms" - FT (£)
• "Nick Clegg threatens to veto Coalition health reforms" - Telegraph
• "Nick Clegg and David Cameron agree key changes on NHS plans" - Guardian
• "The Lib Dem leader said he expected significant changes to the planned NHS revamp and would block the legislation unless he was happy with it." - BBC

Let's make no mistake. The Tory leadership is allowing Nick Clegg to claim the credit for the NHS u-turn but there is no great unhappiness in Number 10 at the policy switch. George Osborne, in particular, has been worried for some time that the Lansley reforms could become deeply unpopular and imperil the Conservative party's chances of re-election.

But it's just as likely that the NHS will imperil Tory election chances if it isn't reformed:

• Despite the fact that the NHS is continuing to receive more money than any other part of Whitehall there are already signs that the machine is creaking. Waiting lists, for example, are starting to rise.
• If inefficiencies in the NHS aren't tackled (there's 2020Health's report today on massive fraud in the organisation) we won't get value for money for patients and taxpayers.
• 84% of Tory members agree that "If we don't reform the NHS and get better value for existing investment the Government will soon be under enormous pressure to increase the health budget".
• The public sector wage bill (highlighted today by Policy Exchange) is a particular drain on the NHS. Andrew Haldenby of Reform has rightly questioned the government's suggestion that every "frontline" NHS job is essential for improving healthcare.
• Nick de Bois MP has pointed to the NHS' relatively poor treatment record compared to other healthcare systems.

This doesn't mean that the Lansley reforms are the right reforms (I don't feel qualified to make that judgment) but there are no easy options for the government on the NHS. No reform or half-hearted reform certainly doesn't tackle the NHS' fundamental efficiency problems.

PS And if we are to present the NHS climbdown as a victory for the Liberal Democrats I think we should insist on something in return. I can only echo what Andrew Lilico wrote on Saturday: "Give them the NHS reforms and demand EU and ECHR reforms."