ANDREW LANSLEY Unlucky Or Incompetent? Many Doctors Will Have Been Pleased by Andrew Lansley’S Departure from the Health Department in the Government Reshuffle
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NHS ANDREW LANSLEY Unlucky or incompetent? Many doctors will have been pleased by Andrew Lansley’s departure from the health department in the government reshuffle. Nigel Hawkes assesses where it went wrong for one of the best informed health secretaries long apprenticeship does not who, if not the health secretary, is to answer in he was not being allowed to lay out his stall and always lead to a happy inherit- parliament for the spending of almost £100bn that might lead to trouble, he was over-ruled. ance. In politics the best example (€126bn; $159bn) a year? And realists were is Anthony Eden, glamour boy made uneasy by the party’s promise to defend Uneasy compromise of the 1930s, whose decades of district hospitals to the death, with a moratorium The policy succeeded, in that it kept the NHS away waitingA for the top office ill prepared him for it. on closures. Although it was an easy way to win from the limelight during the election campaign. The same might be said—on an altogether more local popularity— Jeremy Hunt, the new health But it also failed, because the C onservatives modest scale— of Andrew Lansley, who lost secretary, was heavily involved in a campaign in did not win an overall majority. Lansley was his job as England’s health secretary in David 2006 to “save” Royal Surrey County Hospital— excluded from the ensuing discussion about how Cameron’s reshuffle. Seldom has any health the policy could not easily be reconciled with the differing Conservative and Liberal Democrat secretary known more about the NHS than C onservative promises to let clinical priorities health policies could be reconciled. When he saw Lansley: he could make it his specialist sub- determine the pattern of services. the health section of the coalition agreement he ject on Mastermind. But he leaves office almost Almost all the elements of what became the objected, but was again over-ruled. His reaction wholly unmourned. To make so many enemies Health and Social Care Act were in place by was understandable, because the document in such a short time calls for a special kind of the time of the 2010 election. They were not was a muddle. Primary care trusts, for example, genius or bad luck on a prodigious scale. secrets, but neither were they trumpeted. Hav- were to become half appointed, half elected, with Yet it all started well. By the time of the 2010 ing established their credentials with the pub- their chief executives appointed by the secretary election, David Cameron and Andrew L ansley lic, the Conservatives were reluctant to spell out of state. There was also a pledge (which had not had successfully detoxified the C onservative their health policies in detail and risk losing the appeared in the Conservative manifesto) to stop brand as far as the NHS was concerned. confidence gained. Lansley told Nick Timmins, top-down reorganisations of the NHS, and while C ameron’s experience of the care received by whose account of the Health and Social Care Act, the coalition agreement confirmed Conservative his young son Ivan, who had cerebral palsy and Never Again?, provides an indispensable source: policy over general practitioner commissioning, epilepsy and died aged 6 in 2009, made his dec- “I can remember it being said explicitly to me ‘our it was silent on whether this would be voluntary larations of support for the NHS ring true. Lansley presentation will be radical reform on education or compulsory. had managed, as shadow health secretary, to rid and reassurance on health.’ And reassurance Anxious to avoid the “two-speed” NHS created himself of the patient passport, an idea cham- was about spending.”1 Timmins adds that when by fundholding, where GPs could choose to opt pioned by his predecessor Liam Fox that would Lansley warned others in the shadow cabinet that in or out, Lansley decided that GP commission- have enabled patients to take NHS money and ing had to be compulsory. He says this decision spend it on private treatment. His website then He responds poorly to being was finalised after the election, in late May or listed as his two proudest achievements helping challenged, seeing it not as an early June 2010. But if it were to be compulsory, to win the 1992 election and “transforming the opportunity to persuade but as the primary care trusts would have little left to public’s view of the Conservative Party’s support evidence of a lack of understanding do—they would become a shell. So the deci- for the NHS.” sion was made to abolish them, along with the strategic health authorities that oversaw them, Missed signals and which the Liberal Democrat manifesto had In opposition Lansley had tramped the health already lined up for the chop. Suddenly what conference circuit for years and made countless could plausibly be presented as an extension speeches outlining his plans. Some of them, such of Labour’s policy of cautious marketisation as the promise to abandon centrally imposed combined with practice based commissioning targets, had considerable attraction for became precisely the kind of top-down reorgani- clinicians. Others, such as setting the sation the coalition agreement had promised NHS in England free from the control to avoid. of the secretary of state, raised issues Politically, this was a tough sell. It of constitutional importance to which called for qualities Lansley simply does Lansley never found a clear answer— not possess. While personally likeable COLLINS/PA KATIE 22 BMJ | 15 SEPTEMBER 2012 | VOLUME 345 NHS MACIEKMUSIALEK/DEMOTIX/PA STEFANROUSSEAU/PA ARCHIVE/PA He’s behind you: Cameron lost faith in Lansley’s that the decision that Lansley should go was ability to deliver; and (r) protests grew against his reached some time ago by Cameron and George health bill; with his successor Jeremy Hunt Osborne, but delayed until it could be part of and undoubtedly well informed, he responds the summer reshuffle. Nick Clegg, the deputy poorly to being challenged, seeing it not as an prime minister, would not have stood in the way opportunity to persuade but as evidence of a because he was keen to get Norman Lamb— lack of understanding. He managed to quell reportedly blackballed by Lansley as health the doubts of the Treasury and other minis- minister in 2010—into the post. ters, who wobbled when they read the draft of the white paper outlining his plans—prob- Responsibility deals ably the last moment at which they could have Although Lansley’s tenure was dominated by the been stopped without huge political embar- GEOFFCADDICK/AFP/GETTY Health and Social Care Act, he was also responsi- rassment—but never managed to enthuse the Lansley’s intimacy with the detail, so ble for the controversial responsibility deals with public or to keep the profession onside. disabling when the job was to sell the the food and drinks industries. With excellent tim- Paul Corrigan, a health adviser to Tony Blair, broad principles, would have been an ing, Professor Simon Capewell of the University recalls the time Lansley went to the Royal advantage in the next two years of Liverpool chose the day before the reshuffle C ollege of Nursing in April 2011, with his reform to denounce Lansley’s deal with the food indus- bill becalmed and fighting for his political life.2 could lead you to the spade. His continued pre- try as a gross dereliction of duty. Expecting the Rather than simply acknowledging the failure to eminence was not originally part of Lansley’s industry to work together to cut fat, sugar, and salt get his message across, he said: “I am sorry that plans but became expedient as the reorganisa- l evels in food is like “putting Dracula in charge my policy has failed to communicate itself to tion spiralled into a vortex of red tape. Making of the blood bank,” he told the Independent.3 you,” as if the policy was responsible for its own the transition happen is so tricky that it calls for In more measured terms, the Commons Health communication. That, indeed, was what he genu- an iron grip, paradoxical in view of the fact that C ommittee has reached similar conclusions, inely seemed to believe. When asked by T immins the changes are meant to make the NHS free and s aying it was unconvinced the deals would be why people had not understood his plans, he self improving. effective in resolving issues such as obesity. responded: “What’s not to understand?” Lansley leaves before the precise shape of the So Andrew Lansley leaves the only job in poli- new NHS is known, because that depends on the tics he ever wanted with a chorus of catcalls in Wrong timing? set of rules by which the Commissioning Board his ears. There’s no obligation to feel sorry for While many are glad to see him go—“Thank God will operate—the mandate. There are the mak- politicians who fail; they choose to stand for he’s gone” wrote the NHS management blogger ings of a row over this already, the government office. But Lansley did try to put the patient at Roy Lilley—others have more mixed feelings, wanting a prescriptive document with tightly the heart of the NHS, a worthy ambition. And if not about the sacking then about its timing. defined outcome measures, the board appar- he took the trouble to understand the system, For better or worse, the reforms are now an act ently favouring a looser wording that leaves it something not every one of his predecessors has and are rapidly being implemented.