So after Prof. Steve Field’s emollient smoothing of the jagged edges of Lansley’s health privatisation fetish, that’s now all done and dusted then? Almost certainly not. The Lansley bill is just the latest in a long line of attempts to wrest the NHS out of the public sector and place it firmly, like every other public service and public industry, within a competitive market. Thatcher started it by bringing in managers to instil business disciplines, introducing an internal market by splitting commissioning from provision of services, and by giving tax breaks and other preferential benefits to private health. Blair too this further with independent Foundation Trusts, independent sector treatment centres, and measures to enforce equal access for private care as for the NHS. Lansley tried to take it a quantitative step further, but has been checked – temporarily: ‘retirer pour mieux reculer’. So what will happen next?
Cameron has two objectives. One, the far more important one, is to damp down inflamed public opinion and prevent, in typical market jargon, the re-toxification of the Tory brand. He may just achieve that – for the moment – given the weight of orchestrated PR put behind it. The second is to keep the LibDems on side – a much easier task because, even if he made much smaller concessions, they would have been forced to grasp them enthusiastically and claim victory since they are in no position to jump ship.
Cameron himself however emerges from this debacle a diminished figure. Whilst he’s at his best in using his PR talents to spatchcock together the irreconcilables, he’s also added to his reputation as a rather shallow leader with little interest in detail and certainly no commanding ideology, who prefers to let others get on with it and then hang them out to dry if it goes belly-up. He was of course, as Prime Minister, copied in on the NHS bill at every stage of its development and will have given his consent at each stage, only getting involved when it looked as though his own retention of power at the next election risked being wrecked by Lansley’s extremist market outlook.
So where from here? There are still quite a lot of loose ends in the revised bill which could still cause trouble. The mix of competition and integration in Monitor’s new remit could still, steadily over time, shift more towards the former than the latter. Private health care firms are not meant to cherry-pick (lucrative) patients, but since that is always what their profit motive drives them to do, how are they to be prevented? The 2013 deadline has been put back, but that is only a temporary respite; there is no ideological change of heart at all. There is still no check on a substantial outsourcing of commissioning to big private health corporations (many of them US), and hence no diminution of a major conflict of interest. And of course the £20bn cuts still coming down the track by 2015 could up-end the best intentions…………….