This article is from the February issue of Total Politics
David Cameron is masterminding a mission to ensure health remains a neutral issue between now and 2015. The PM knows the Conservatives must do all they can to stop Britain’s NHS become a concern on voters’ minds. Neutralising the public’s fears about the issue is part of the No 10 re-election strategy. Cameron can’t do this on his own.
He has placed huge trust and faith in health secretary Andrew Lansley to help him deliver on this objective. Those who have lined Lansley up for the axe in a 2012 reshuffle will be proven wrong, I understand. He stays put to deliver on a new plan to put patients first.
The personal chemistry is very good at close quarters, well-placed observers report. And crucially, the PM believes Lansley was not wholly to blame for the crisis that hit the delivery of his Health and Social Care Bill. It’s worth pointing out that Lansley was once the PM’s boss and their ties were forged in the heat of battle. A young Cameron was promoted to head the political section of Lansley’s Conservative Research Department in 1991. It was here they collaborated to draw up the successful 1992 general election manifesto – confounding all commentators and most Conservatives at the time.
So what does this plan look like?
Cameron has decided to focus on the real practicalities that patients and their families experience. He wants to concentrate on three deliverables between now and the May 2015 general election. There will be a commitment to do the basics better than before – ridding hospitals of infection and a relentless pursuit of cleanliness. Nurses will go on hourly rounds, matrons or ward sisters handed more authority so they once again rule the roost in a way crudely described as ‘Carry On Nursing’ by The Sun.
He even wants to improve the way patients are fed and watered while in hospital.
His team is now working with the Royal College of Nursing’s chief executive Peter Carter to deliver a better patient care experience. Officials will be ordered to drive up NHS results in treating the major illnesses like heart disease and cancer so they compare favourably with those in other countries.
The PM has often been heard telling colleagues that if it can be done overseas, it can and must be done here. And he wants a ‘big bang’ approach to public health aimed at easing the pressure on the NHS by getting us all to live better so we need it less. Minimum pricing for booze is on the agenda. Further pledges from the food and drink industries on calories are expected.
That’s not all, though.
The PM and Lansley are under pressure to deliver the ‘Nicholson challenge’ – the need to find efficiency savings across the entire health service laid down by Sir David Nicholson last year. They have already ring-fenced the health department’s budget so that £1 in every £7 taken in taxation goes straight into its veins. But that money is being stretched.
People are living far longer. Drugs are more expensive. Treatments and technology cost a fortune. And crucially, we all expect – no, we demand – more from our NHS.
The PM must constantly reassure voters that he believes in the NHS. His pollster Andrew Cooper knows only too well that Conservative leaders must work ceaselessly to convince a sceptical public. Floating voters are 90 per cent more likely to back the Conservatives in an election if they are reassured that Mr Cameron can be “trusted” with the NHS, studies show.
Women voters, too, are a part of this conundrum. They are more likely than men to be exposed to the NHS and are the first audience for health professionals complaining about budget cuts. So Cameron believes he must meet the practical needs of patients by listening to and working with doctors and nurses.
Last year’s difficulties over the Health and Social Care Bill took ministers by surprise. They were taken aback by the scale of opposition they faced.
Many of those organisations Lansley canvassed before the 2010 general election had seemed in favour of what was proposed. This communication failure might have cost another cabinet minister his job. But Lansley retains the PM’s confidence.
Insiders point out that trying to reform the NHS wholesale is virtually impossible.
You only have to look at Labour health secretary Alan Milburn’s doomed attempt to bring in foundation hospitals to realise how hard it was to change just one aspect.
Reshaping the entire service in a comprehensive bill has opened the government up to opposition on multiple fronts, with everyone demanding a say. So an operation is underway to reset the narrative post the bill.
The PM is passionate about the NHS from a patient’s point of view. He and wife Samantha know more than most parents should about the NHS, its strengths and its challenges.
George Pascoe-Watson is a partner at Portland Communications
Comments
Richard Blogger (@richardblogger) / January 26 2012 11:06am
You only have to look at the last two years to see how the mess of the health policy is entirely Lansley's fault. Take a look at Lansley's original plan: the NHS Autonomy and Accountability policy paper. This said that SHAs and PCTs were to survive and adding support to GP commissioning. It was a policy that was already showing promise under Labour, and Lansley just wanted more of it. Over time, such a policy probably would have lead to the *eventual* abolishment of PCTs and SHAs, and lead to Lansley's goal of GP commissioning, but it would have been over many years.
This would have allowed the NHS to evolve with little detrimental affect on patients. But Lansley made the bizarre decision to go for revolution. Talk to anyone in the service - top to bottom - and you'll find that this decision is so destablising that the system will break soon. Cameron's strategy make look good on paper, but it will be rapidly shelved when Lansley's top-down disorganisation of the NHS means that people are not getting cataract and hip ops.
For the opposition Lansley is the right man for the job. He has been very incompetent (look at his policy for GP consortia - every single part of this policy has been changed so that rather than being "liberated" Clinical Commissioning Groups are more tightly constrained than GPs under PCTs). For the opposition the longer that incompetent Lansley is in post, the easier it will be for them.
niav / January 26 2012 11:23am
My brief interractions with the NHS can be summarised in three words: indifferent, incompetent, rude.
I don't expect or demand anything from the NHS - I use private health care. So please stop saying "we all".
Socialised, centrally planned health care will always do worse compared to private alternatives. The difference comes from looking at people as customers or nuissances.
What I expect from the government in relation to the NHS would be an opt-out or voucher system, so that I don't continue paying for something I don't need or use, and in fact I despise. I'm aware it won't happen though, too much socialism in this country.
CHF / January 26 2012 12:50pm
"The PM has often been heard telling colleagues that if it can be done overseas, it can and must be done here."
But do they organise their health services in such a top-down completely centralised way? Do they finance it in the same way? Do they blow billions on "Connecting for Health" (then cancelling chunks of it)?
The NHS is unique in its organisation in many ways. Perhaps it shouldn't be.
Martin Rathfelder / January 27 2012 9:32pm
Mr Cameron may be a bit optimistic about the time it takes to deliver results from his chosen policy options. Especially as his proposed reforms have alienated most of the NHS workforce.
Kim Holt / January 28 2012 1:56pm
I find this saddening .
There are many committed health professionals who care deeply about the NHS and struggle to provide high quality care for their patients on a daily basis. This is not because of lack of money, but system failures, too much bureaucracy and the culture. The NHS treats its staff very very badly in many places , and oppresses many who try to raise concerns. There is a lot to be proud of in the NHS, and the good things are at real risk with this BIll whilst the bad might only get worse.
Please could we be aware of the risks? That might help us to feel confident re these changes?
Dr Kim Holt
Consultant Paediatrician
London