Choice, competition and GP power in the NHS

Something important happened in Prime Minister’s Questions yesterday. David Cameron started to defend the principles of the health Bill. Ed Miliband asked one of his rather weak rhetorical questions, asking why opponents of the Bill had not been invited to Monday’s meeting in No 10:

Does that not tell him that he has lost the confidence of those who work in our National Health Service?

Cameron in reply simply ignored the question:

What I want to know is, when is the right hon. Gentleman going to ask a question about the substance of the reforms? He does not want to ask about choice, because the Opposition used to be in favour of choice but will not back it in the Bill. He does not want to ask a question about competition, because they used to favour competition but now will not support it in the Bill. They used to support GPs being put in charge of health budgets. They backed that, but they will not support it now it is in the Bill. Why not ask a serious question?

It may be too late.

But at least the Prime Minister has belatedly come out fighting for the principles that guided Tony Blair’s health reforms: “choice”, “competition” and “GPs being put in charge of health budgets”. Blair and his health secretaries had enough trouble with the first of those, and were forced by the Roadblock to Reform Within to come up with euphemisms for the second, including “contestability” and “diversity of provision”. As for the third, it took Blair too long to realise that unwinding the Tory GP fundholders reform had been a mistake, when the scheme should have been extended to all GPs.

The Bill has been so loaded with sops to the Liberal Democrats — who are still not satisfied, it would seem — that we have to ask whether the spatchcock Bill is better than no Bill at all. It probably does not make much practical difference either way (although handing over public health to local councils seems counter-productive).

If the Prime Minister’s instincts are right, that is the most important thing. Presumably Andrew Lansley’s instincts are the same, but what is more important in the Secretary of State is the communication skill to sell the reforms. Bring on Anna Soubry. Or whoever.

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