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The winners and losers from the NHS saga

By Tim Montgomerie
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The NHS professionals: Not for the first time they've protected their near monopoly. Moves towards greater competition (English translation = more patient choice) have been delayed.

Andrew Cooper: The PM's new pollster warned that the NHS reforms were creating a massive gap between the public and the Conservatives.

Shirley Williams, Evan Harris and other Yellow B**tards: George Osborne decided that the NHS reforms were dead when he looked at the arithmetic in the Lords. This - more than the furrowed brow of Andrew Cooper - was the decisive factor. All the focus has been on the fact that the Tories are a minority in the Commons. The Conservatives are in an even weaker minority in the Lords. If interest groups like the BMA or ACPO convince enough Baroness Williams's that a reform is a bad one, it will be very difficult to pass.

Stephen Dorrell: Behind-the-scenes John Major's Health Secretary and the current Chairman of the Health Select Committee was warning that the Lansley plan was too complex and too unsettling for NHS staff. Downing Street will be listening attentively to him in the months ahead. "He was proved right," one Cameroonian tells me.

Nick Clegg: To many people he looks silly for having had to abandon NHS changes that he had only recently signed up to. To other eyes he also looks weaker - having had to be led by the anti-Orange wing of his party against reform. Overall, however, the Deputy PM used the NHS row to reassert his position in the Liberal Democrats after the humiliating AV campaign result. Add in the fact that Chris Huhne is now badly damaged goods and Clegg is a more secure Lib Dem leader than was true one month ago. 

Jeremy Heywood: The Permanent Secretary at Downing Street was worried about the Lansley plan. The decline of Letwin and Hilton (see below) means that Heywood and the civil servants he picked to run the policy unit are relatively more powerful.

Nick de Bois: He fought hard for the NHS reforms (eg here). A new MP, he demonstrated independence of thought, mettle and was a very effective media performer.


Patients: See above on how the NHS staff have gained.

David Cameron: The PM spent five years establishing his credentials as a different kind of Tory who would protect the NHS. Yesterday's polling from ComRes showed that he's now put all of that at risk. He's now in the worst of all possible worlds. He attempted a reform that ended the safety-first tactic but has now pulled back from the reforms that might have modernised the NHS.

George Osborne and taxpayers: He may have played the decisive role in stopping the Lansley reforms but most insiders now expect he'll need to find extra money for the NHS by the second half of the parliament to stop a money-guzzling and unreformed health service from running out of cash.

Andrew Lansley: He won the sympathy of Tory backbenchers for the way he was treated shabbily by Number 10 and Nick Clegg, in particular, but Lansley failed to use his many years as Tory health spokesman to win a critical number of friends within the NHS establishment. He may be health secretary in name but Number 10 now regard David Cameron as the chief salesman of Coalition health policies. Don't bet on Mr Lansley keeping his job after the Olympics. Why the Olympics? Because Mr Lansley is likely to be replaced by Culture Secretary Jeremy Hunt (who won't be moved until after the last medals have been hung around the winners of London 2012).

Steve Hilton: The PM's guru was a big believer in NHS reform. It was one of the components of his "everything must have changed by 2015" ambition. Hilton looks to have lost much of the NHS reforms as well as his ambition to revolutionise public service delivery. I wouldn't bet against Hilton leaving Downing Street by the end of the year. If he does go it would be a big moment for Cameron. Hilton presses Cameron to leave his comfort zone and be more radical than is his instinct. The Coalition would be impossible if Hilton had his way on everything but it needs his restlessness.

Oliver Letwin: The Gandalf of the Tory circle is the biggest loser of all. Right at the heart of the Cameron project from before day one - influencing thinking on climate change, redistribution, taxes and co-operation with the Lib Dems - the Cabinet Office minister has been responsible for bomb-proofing policies so they don't explode in Cameron's face. The man who once advised Margaret Thatcher on the community charge (poll tax) clearly failed on the NHS reforms. "Cameron," I'm told, "will never rely on him in the same way again."


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