The Waugh Room

Monday 4th April 2011 | 15:19

Lansley and Cameron's shared problem

The accepted wisdom in Number 10 seems to be that Andrew Lansley has so far failed to get across the point of his NHS reforms.

Some insiders whisper this is all a question of presentation and that the PM now needs to sprinkle some of his stardust over the issue. The first Cam/Clegg 'listening' exercise, now expected on Wednesday, will try to repackage the policy.

But lest we forget, we've been here before. Way back in January, the PM was so worried about the lack of salesmanship on Lansley's behalf that he himself fronted the launch of the Health and Social Care Bill.

The PM tried to get on the front foot with a speech at the RSA (where Ed Miliband did his own public services speech today) on January 17. He previewed it with an interview on the Today prog that same day.

The main message was that an ageing population and soaring health costs mean that radical reform and efficiencies were needed for the NHS to even stand still.

In an attempt to freshen up the spin and connect with the punters, the PM went further. Without reform, more people would die of heart disease, he warned. "These reforms are not about theory or ideology - they're about saving people's lives," he said.

At one point, the PM even raised the spectre of us losing an NHS free at the point of delivery. Failure to reform would mean failure to find the cash to fund a free service, he suggested.

It didn't quite work. So the PM again hit the airwaves later that month on the day the Bill had its second reading. He denied the plans were about privatisation and were more about patient choice. Again, it didn't do enough to quell a doubting BMA and others.

The PM even managed to let slip that his own brother in law, a hospital doctor, had passed on concerns about "giving too much power to the GPs".

Finally, when confronted by Ed Miliband* in PMQs the other week, the PM himself seemed unsure about some of the details of the 'cherry picking' nature of the private sector input to the reforms. That wasn't Lansley's failure to communicate, it was the PM's.

Department of Health insiders admit that an organisational change is hard to sell to the punters. But if even the Great Communicator himself can't persuade the public about these reforms, it's no wonder that Lansley (not for nothing is he dubbed Angela Lansbury by some colleagues) is struggling too.

Maybe the PM's own failure to cut through to the public is why the Libs have been pushing hard not just for a presentational change but a real change in policy: a delay in implementation.

Ultimately, it says everything that perhaps the most succinct summary of these complex reforms has come in the form of the now-infamous Lansley rap**. You may not agree with the rapper, but he sums up a difficult idea with all the skill of a tabloid hack.

 

 

 

FOOTNOTES:

*I put to Ed Miliband today that the NHS's£20bn/year efficiency programme, the real driver for the rash of ward closures we will see soon, was started under his own Government. He said that he didn't "resile" for one moment from Labour's efficiency programme but argued that the GP commissioning plan would result in "chaotic" hospital closures rather than planned closures. I'm not sure that the punters would think that's an important distinction once their local A&E or maternity unit is gone. Still, Miliband rightly pointed out that it was David Cameron who promised a "moratorium" on closures while in Opposition.

** I'm told that the Conservatives were so worried by the Lansley rap that there was a plan to get CCHQ to troll the comments on YouTube and call the rapper a dangerous lefty. Surely this can't be true....?

 

UPDATE: Maybe the real problem was caused not by Lansley, but Cameron. A strategic decision was made by the Tory party leader in Opposition to neutralise the issue of the NHS by simply not talking about reform. Lansley had worked for years on his plans for GP commissioning but was effectively silenced for the election campaign (apart from making reassuring noises on 'moratoriums' on ward closures).

So if the PM now thinks that GP commissioning is so important to maintaining a free and properly functioning NHS, why didn't he shout that from the rooftops? It's a question to which he knows the answer.

Will he be honest enough on Wednesday to tell us that he simply feared the public would run a mile from anything that suggested the NHS wasn't safe in his hands?