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Tuesday 14th June 2011 | 18:11
For all the ink spilled on the NHS J-turn*, there seem to be two extra reasons for the PR and policy disaster of the last year:
1. The PM made a big strategic decision not to talk about the need for reform in the general election campaign. In fact, it was made clear to Andrew Lansley that he should keep schtum so as not to frighten the horses. The only message David Cameron and Andy Coulson wanted in the election campaign was that the NHS is safe in Tory hands (and to prove the no-change approach, a moratorium on hospital closures).
With no debate on the need for reform before the election, it was perhaps no surprise that people swiftly felt the Lansley reforms had no electoral mandate.
I put this to the PM directly at his Guy's hospital event today as I asked him whether he would personally take some of the blame. He denied the party had not talked about reform, but he did accept it was far from all Lansley's fault:
"I am every bit as responsible as Andrew Lansley. It was the whole Cabinet, the whole Coalition went ahead with these reforms. [Clegg looked uncomfortable at this point] And the whole Coalition, the whole Cabinet decided to press the pause button.
"I do not attempt in any way to pass the blame off to anybody else. I accept full responsibility for the reforms going ahead in the way they did. I think Andrew has handled this situation extremely well. I think in politics you have to be big enough to admit when you don't get it right and that's exactly what I've done."
2. Once in office, the PM didn't focus on health policy and delegated to Lansley. When things began to look sticky at the turn of the year, he sent in 'policy guru' Oliver Letwin to go over the reform plans with a "fine tooth comb". Danny Alexander was also sent in to check the financial viability of the plan. Both men gave it a clean bill of health. Some teeth, some comb.
Alexander could possibly be forgiven for thinking that the reforms would ultimately save money after an initial cost (tho all of those costings now appear to have been thrown out of the window due to a delay, but that's another story).
Yet Letwin was the man who was supposed to have applied his huge brain to the policy itself. He signally failed to spot the problems in terms of competition, regulation, structure and timing.
Letwin, some forget, acted as a policy adviser on the poll tax for Mrs T. And what a success that was.
Still, the reason the PM needs a policy 'backstop' is perhaps more revealing: those who have worked with him say that Cameron can be well, just a tad 'lazy'.
He's fantastic in a crisis, they say, and knuckles down to sort out problems when he needs to. But in 'peacetime' he can actually take the path of least resistance. In short, the criticism is that the PM is a classic 'crammer', someone who can swot like hell to get his First yet fails to see the strategic road ahead.
If the NHS fiasco is to be avoided on future policy, maybe the PM needs to do his homework on time every week, instead of leaving it to the last minute. Or leaving it to Letwin.
*FOOTNOTE The phrase J-turn, as opposed to U-turn, suggests that the reforms are still going in the same direction but with a leftward quirk to satisfy critics. Full copyright for the phrase should belong to Andy Cowper. See his blog here.
Of course, it's worth pointing out that Letwin's defenders would say that it was never his job to spot the political backlash that would ensue. They may also add that today's hotch-potch of reforms looks a lot more unwieldy and incoherent than a competition-led and GP-driven plan.
UPDATE: There remain a huge number of unanswered questions about this mish-mash of a bill. Paul Goodman over at ConHome has just seven.
Far from solving his NHS crisis, could it be that the PM has just ensured that rows over different bits of the bill will now dog him for several more months (given that the Lords will surely now drag it out until the New Year and possibly til next spring)? With Labour likely to constantly claim 'you can't trust the Tories on the NHS', that's not a nice backdrop to your difficult second year. And all this is before the cuts start to bite.
One final point. It's come to a pretty pass when both the Speccie's Fraser Nelson (put the voters out of their agony) and Labour's John Healey (modernisation doesn't require new legislation) are among those saying that the better course would have been to junk the entire thing.
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