The latest government NHS reorganisation is an unprecedented admission of the failure of the Lansley reforms. Labour needs to be careful in its response

by David Talbot

In a grey side-room at the Royal College of Nursing conference in early 2011, a grey-looking Andrew Lansley attempted to defend his controversial reforms of the NHS. In what was surely an unintended ‘Nicola Murray moment’, the then Health Secretary, in the moments after the Congress had unanimously passed a vote of no confidence in him, uttered: “I am sorry if what it is I am setting out to do has not communicated itself”.

It was a gift to Ed Miliband’s Labour Party. It repeatedly called on the reforms to be scrapped, with the now King of the North, Andy Burnham, burnishing his credentials as Labour’s saviour of the NHS. It wasn’t just politicking, though, with healthcare professionals labelling it as “the wrong reform, not just now but at any time in the future”. The bill’s passage didn’t get a smoother time in Parliament either. The House of Lords alone tabled 374 amendments and it was debated for over 14 months with with 50 days of parliamentary debate, in what was – and still is – the most scrutiny that any bill has had in the history of Parliament.

Lansley was sacked less than a year and a half after his nuanced apology in Liverpool. His ambition to reconfigure the NHS, nine years in the making, had derailed the coalition, stultified and appalled vast swathes of the NHS and, ultimately, cost him his job. He left a toxic legacy within the NHS profession towards the Conservative-led coalition, with the more affable Jeremy Hunt moved into place with the (sole) brief to dampen the NHS as an election issue.

When the Conservatives held their pre-election party conference in late 2014, fifty thousand activists greeted them with ‘Save Our NHS’ placards turreted in the air. Miliband, in a leaked exchange with BBC executives, was said to want to “weaponise” the NHS in the run-up to the 2015 general election.

All of this context and more would suggest that the Conservatives’ plan to undo all this, as leaked to Health Policy Insight last week, is at best an unwise idea. The jazzily-titled Integration and Innovation: working together to improve health and social care for all has all the hallmarks of Dominic Cummings’ exasperation last year. In the early and shambolic attempts to prepare the UK for the coming pandemic, Cummings is said to have remarked that when he pulled levers, nothing occurred within the NHS machine. These proposals are, from beyond his political grave, the attempt to remedy that.

The central theme running throughout the draft bill is for the Government to ‘take back control’. NHS England’s operational independence, arguably the one Lansley reform that has actually worked, would be revoked. One of the few areas that the UK has got right thus far in its response to the COVID-19 pandemic, and which the Government has had little to no control over, is its vaccination roll-out, utilising, as it does, NHS expertise, infrastructure and staff to administer.

What is not clear is why the Government wants to do this now, when the effects of COVID-19 will reverberate within the NHS for years, what it would use these powers for and how, most importantly, it would make the NHS better at delivering care to patients. It appears at best a surly and politically-motivated attempt to limit the powers of the former health advisor to Tony Blair, and now Chief Executive of NHS England, Sir Simon Stevens. The irony that Stevens has the current Prime Minister’s legacy in his hands is not lost on some.

What, then, should the Labour Party do and say in response? There are lessons to be learnt from its campaigning on the NHS not just from the coalition years, but up to 2019 as well. Labour’s Medicines for the Many proposals appalled industry and when Corbyn attempted to shoe-horn charges of ‘selling off the NHS’ to Donald Trump’s America, he did not even involve the current Shadow Health Secretary in its launch.

All of which lends itself to the conclusion that a new Shadow Health Secretary will be needed to take on these reforms. The considerable talents of Yvette Cooper, both as a frontline politician and forensic, as a term of compliment, cross-examiner as Chair of the Home Affairs Select Committee would refresh Labour’s front bench.

That aspects of the government’s draft proposals, such as closer integration and reduced competition, have been heralded for years by the NHS will complicate a uniform ‘oppose’ platform. But that the Government is seeking to undo the NHS landscape it itself legislated for only 9 years ago is without precedent. It is political failure of the highest order and Labour, unlike Lansley, must get its response right.

David Talbot is a political consultant


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34 Responses to “The latest government NHS reorganisation is an unprecedented admission of the failure of the Lansley reforms. Labour needs to be careful in its response”

  1. A.J. says:

    Surely all the NHS needs is a lot more clapping. That ought to fix everything.
    Seriously, why the continuing pretence that it is a National Health Service when it is clearly nothing of the kind? Our nearest local hospital – which is beginning increasingly to resemble a small airport – is supposed to score pretty highly – or so I’ve heard. God help the rest. On the other hand my younger daughter had no fewer than eight appointments cancelled in a row at another hospital within driving distance. A formal complaint got us nowhere.
    Sorry, but the so-called NHS, as some think tank reported, is nothing much.

  2. Alf says:

    Labour’s Tory-lite Blair cultists privatised more of our NHS than the proper Tories ever did. That’s the truth.

  3. Tafia says:

    You do know this only applies to NHS England yes?

    The three devolved countries – Scotland, Wales and N Ireland control their own NHSs the wat they want. Incidentally, Labour run NHS Wales is the worst performing of the four NHSs according to the stats and in some areas of measure they have given up trying to sort the problem and no longer compile the stats and have scrapped targets. (Also, did you know they do not pay their student nurses when on placement but NHS England does?)

  4. Anne says:

    Agree with the last paragraph- the introduction of ‘Commissioning groups’ to buy services for patients has not been successful- it introduced many people paid high salaries with no patient contact, on these groups. Many managers who were made redundant were just sidelined into other commissioning roles. ‘Agenda for changed’ tried to address this by rewarding clinical staff, but this was made difficult, so success was limited.
    From its inception the funding of the NHS has proved to be a challenge. Also the nature of the NHS has changed beyond recognition- more day cases, high technology and improvements in treatments offering better patient outcomes, but there is something that has remained the same – this is the main users of the NHS are our seniors. Often when seniors are admitted to hospital, treated but if it is unsafe for the patient to return to their own home – this becomes a problem. The funding for social care is a big issue. This problem has been addressed in a limited form with schemes such as ‘closer to home.’ A complete overall of the social care sector is required.
    Dental care, which was a service originally in the NHS, has been nearly fully privatised. Many of us pay quite substantial monthly fees which does not cover all treatments. This service has certainly resulted in becoming a two tear service of those who can afford to pay and those who can not. Looking at the amount of people who are currently using food banks – these will not be able to afford dental care. It would be unthinkable to to privatise the NHS to this level. The NHS should remain a service free at the point of care from the cradle to the grave.

  5. A.J. says:

    It might be as well for Matthew Hancock to deliver himself into the hands of the NHS – and soon. The poor chap is clearly cracking up.

  6. A.J. says:

    Possibly those using foodbanks should avoid anything sugary.

    Of course – as I’m sure Anne very well knows – the NHS is not actually ‘free’ and is often not good value for money whichever way you look at at. The chap who services my boiler was once an NHS manager and smiles and shakes his head over just how gullible the public are.

  7. A.J. says:

    I find it amusing that each generation of Labour politicians imagine that they somehow own the NHS – although so-called ‘Conservatives’ are often pretty dim and dismal in this respect, the more so with this current bunch of bullies, buffoons and shysters.
    I seem to remember reading that a fair number of Attlee’s colleagues were either hostile or indifferent to the creation of a National Health Service but it was thought a nice toy to play with would keep the noisy Nye Bevan quiet while the grown-ups worried about the horrible export problem etc.
    I see the earlier Conservative proposals – under Willink? – are being discussed in at least one national newspaper.
    A few years ago a journalist – quite possibly in a right-leaning newspaper – expressed doubts that the young would put up for long with the NHS in its present form. This was on the basis that the young all too often expect instant gratification whereas the old farts amongst us are used to waiting, grumbling, then weeping tears of gratitude at being seen after twelve hours or more.
    Those who claim to ‘love’ the NHS should be a major cause of worry. An amusing sideline on Labour and the NHS can be found in Alan Watkins’ excellent book on his legal tussle with the absurd, odious Michael Meacher.

  8. A.J. says:

    An interesting – and rather bold – article in ‘The Independent’ suggesting a radical change in funding. This particular journalist often strikes me as having a mind of her own.
    Talk to the right people under the right circumstances – not only GPs – they’ll tell you they wouldn’t mind the public laying a bit of cash down before being booked in for an appointment.
    Fools like my late father (who wasn’t even a Labour voter) and others I’ve known (invariably feather-bedded) take the Polly Toynbee line: they wouldn’t mind paying a bit more in income tax so long as it went towards paying for schools and hospitals. Others whine that ‘we don’t put enough money into it’ – as if we ever could.
    Idiots like David Blunkett rabbit in the ‘Daily Mail’ about ‘our beloved NHS’. All I know is that I had a very frightened wife with cancer and that her treatment was patchy to put it kindly. My God, there are some excellent people working in the NHS, but also a significant number who would benefit from a few swift kicks up the backside.

  9. A.J. says:

    I do wonder how the health service in Scotland will fare after independence. Would the EU be able or willing to hand out subsidies?
    According to cancer patients with whom my wife communicates through some kind of forum, the Welsh are suffering rather badly.
    Is Northern Ireland in a much better position?
    By the way, if anyone fancies taking out a contract on Hancock and finds themselves reliant upon crowdfunding I’d be more than happy to toss a tenner into the bucket.

  10. A.J. says:

    Apparently Starmer – or possibly Dodds – is going to show ‘a bit of leg’ in the not too distant future: perhaps next week or the week after. Expect ‘Our NHS’ to be right there at the top of the list: as predictable as death and taxes. You see, the trouble with Labour is it expects to go on singing the same old song forever and ever, even when it has forgotten half the words. Worse, it never sings in tune. Of harmony there is none.
    It may have escaped the attention of many but the NHS has been run – hence funded – by so-called ‘Conservatives’ from 1951 to 1964, 1970 to 1974, 1979 to 1997, then from 2010 until, well, now. Would Polly Toynbee and her many devotees insist on telling us things were better with Wilson, Callaghan, Blair and Brown? Probably. But do we believe them?

  11. At the risk of being castigated for making a noise while AJ is in his pulpit, the real test is looking at how countries without a NHS serve their citizens’ health needs. Having spent most of my life, and I’m pretty old, living in countries with very rudimentary government health systems, I have some experience of this.

    Yes, of course the NHS is very far from perfect. It’s inefficient and has too many layers of top heavy management, a bit like the BBC. It has been starved of funds to keep up with a country’s health needs as the population ages. The problem is the alternatives aren’t so bright. Once private insurance companies get involved the cost goes up. The hospitals and senior doctors and management get rich while the insurance companies generate even more profit. Dropping through the cracks in such a system is far from pleasant.

    Another example of what can go wrong in starving a state owned system of funds would be the railways. In the ’60s it was running out of money. This opened the door to the present privatization. The state still contributes while private companies take out their profit. Are British railways the best in the world? Not anywhere near by most comparisons.

  12. John O Reid says:

    Richard Burgon saying labour shouldn’t be a party for the working class, they already have a party-the Tories
    Is like blue labour saying the middle class students in the Labour Party shouldn’t be The party of champagne drinking protest groups they already have a party for that The liberal democrats

  13. A.J. says:

    It is becoming clearer by the day that Starmer and the people around him are fools. The references to Attlee, Wilson and Blair are so much hot air and waffle. Even people who vote Labour will have little or no idea about the government of 1945-51, Harold Wilson and the white hot technology twaddle are less meaningful to them than The Beatles – that is, if they ever give the 60s a thought. As for Blair – balance Polly Toynbee’s beloved Sure Start centres against the Iraq War, the likes of Prescott and Mandelson, the lying venality of Blair and his wife. I could think of a whole lot more.
    Labour are doing nothing but floundering in the swamp. They took three defeats in the 50s, four between 1979 and 1992, and only won again by Blair promising to be a bit more like Margaret Thatcher. The last card was thus flung onto the table. What does Starmer intend to be? A Blair tribute act?
    The photograph of him seen today, laughing his head off with Corbyn, is damning. Do he and his people really imagine people to have such incredibly short memories? Best to rely, instead, upon pig-ignorance. After all, potential voters are never terribly well informed, now, are they? But enough probably recognise stupidity and horsefeathers when they encounter them.
    Attlee – courageous but often out of his depth. When he weakened the Party began to divide – almost fatally -between Left and Right.
    Wilson – achieved nothing but handing the running of the country over to the likes of Alan Fisher and ennobling and enriching a lot of shady characters.
    Blair – his real contribution to British politics was to get people voting ‘Conservative’ again, albeit in the unlikely guise of David Cameron and his successors.
    Starmer and his people are going to have to do a whole lot better than this.

  14. A.J. says:

    ‘The New Statesman’: ‘Keir Starmer Needs One Big, Defining Idea’. The NHS probably can’t be it. An interest in ‘rejoining’ the EU? Honest but would bring its own problems. Something original on ‘the economy’? Nope, can’t think of anything that Sunak isn’t already contemplating. Education? Not much scope there.
    Labour’s patriotism wheeze lasted just an hour or two longer than Hancock’s Cash For Coughs.
    Will anything – anything at all – be in place for the spring elections? Er, we’d have locked down sooner, harder and longer had Jeremy been in Number Ten… and that’s about your lot…
    The only thing Labour can be thankful for is that they lost in 2019. Had they been in charge of the police now, the press would have made mincemeat out of them.

  15. A.J. says:

    Perhaps a bigger role for Alex Sobel would prove amusing – I mean, a vote-winner.

  16. A.J. says:

    A fair amount of orthodox drivel from Rawnsley in ‘The Observer’, backed up by the semi-literate responses one is so accustomed to in every newspaper from ‘The Guardian’ to the ‘Glasgow Herald’. Sorry, squire, we don’t do sophisticated or measured and still imagine that calling people ‘Tory Scum’ is, er, creative not to mention radical.
    Is the NHS seriously underfunded? Or is it that it fails to spend its money wisely?

  17. Tafia says:

    Meanwhile, the Campaign Against Antisemitism is kicking off big time about Rayner’s charge of anti-semitism being quietly dropped, Oxford University Labour Club condemns John McDonnell for consorting with transphobes, BLM will be fielding candidates in some inner city wards in May going head-to-head against Labour (which it says is racist) and two Labour-supporting Black socialist groups – Grassroots Black Left & Labour Black Socialists, withdraw their support for Labour saying its racist and islamophobic, and the Labour aligned Socialist Lawyers Group bans one of its members – Starmer.

    Meanwhile, as Starmer launches his patriotism drive, Khan does his utmost to under-mine it by appointing a man to his statues committee who verbally abused the Queen. 4 other appointees are bordering on certifiably insane.

    On the election front, Labour fall further behind the Tories at a point in the electoral cycle where every opposition had always been in the lead for a generation or more. The worst performing at this stage (other than Corbyns second outing) being Miliband – who was 8-10% in front.

    And as for the antics on Enfield Council………

  18. A.J. says:

    Apparently Starmer has brought in Lord Mandelson to advise him. Let’s hope it isn’t about mortgages or passport applications.

  19. steve says:

    New Labour twaddle.

    Yawn.

  20. Tafia says:

    According to FoI data, the Mayor of London’s (Sadiq Khan) “Violence Reduction Unit Community Seed Fund” dished out £50,000 to an organisation known as ‘4Front’ in 2019/20, and £46,042 in 2018/19 in the hope of delivering ” a youth-led intervention project for 100 young people involved in and affected by serious youth violence” on a local estate in London.

    $Front went on to align itself to BLM, attack a police station and physically attack police officers in Barnet after one of it’s ‘saved’ youths was caught in possession of 13 bags of cannabis.

  21. Tafia says:

    So far this month there have been 9 polls with field work entirely in Feb, giving a Con average lead over Lab or just over 4%.

    The previous 9 polls produced a average around 2.5% but the outlier YG with a 4% Lab lead is in that batch and excluding that we get just over 3%.

    So which ever way you view the ‘outlier’ YouGov poll, the Tories are firmly in front (when at this stage in the cycle the government of the day is usually behind) and that lead is growing and is also outside the margin of error so there is no argument they have their noses in front.

    Covid will fade quickly now and the public’s attention will switch to the economy at large – Tory home turf that the public almost always trusts the Tories more than Labour.

  22. Tafia says:

    Late last year in Wales it became known that Welsh social housing providers had been levying unlawful charges on certain tenants. A curious business in which the Senedd’s lawyers had to explain the law to ‘Welsh Government’ lawyers!

    After being informed, the ‘Welsh Labour Government’ hurriedly introduced backdated legislation, which of course covered the collective arse of Labour’s cronies in housing associations and the third sector.

    Perhaps more importantly, the legislation avoided having to make refunds to the tenants. And all because somebody in Corruption Bay cocked-up. Given the way Wales is run the person responsible will probably be promoted.

    https://www.bbc.co.uk/news/uk-wales-politics-56000070

  23. A.J. says:

    Candidly, the Labour Party needs now to be careful about far more than the National Health Service. Not a day goes by without some article, often in ‘The Guardian’, more or less admitting that the present government cannot be beaten without the formation of pacts and – possibly – PR.
    Starmer is being written off; Momentum is stirring once again; a tacit admission is being made that Labour is now a middle-class party and scarcely (in any meaningful sense) anything more than a middle-class party: ‘progressive’ to the core. So, the appeal will probably be switched to seats in the south.
    Can’t see delegates from Labour, the Liberal Democrats, Greens, possibly the SNP agreeing on anything for more than five minutes: not even whether they drink tea or coffee. Labour is still too divided/tribal for that to happen. Or do Compass have it right?

  24. Tafia says:

    A LABOUR council is splurging £700 a day in consultancy fees using grant money earmarked by the Government to help fund essential services.

    Bury Council is spending thousands of pounds to hire a consultant based 100-miles away in Herefordshire to help organise May’s local elections. The taxpayer money was given to the council by the Government as part of a COVID-19 expenditure pressures grant in December.

  25. Anne says:

    As AJ seems to have a lot of time on their hands she might offer to help at the food banks – just to supervise that recipients are not receiving any products that contain sugar. Might be a more productive use of her time.

  26. A.J. says:

    Just who does Keir Starmer imagine he is? C.R. Attlee, that’s who – remember him? The Labour leader who looked a bit like Crippen. Modest little chap with a lot to be modest about.
    1945 – ah, breath in the dense, smoke-laden, socialistic atmosphere, open another tin of Spam and think about putting bread on ration. Much singing of the ‘Red Flag’, opening of bottles of Krug by certain Welsh members, ‘We Are The Masters Now’.
    Covid-19 must come pretty close to 1939-1945. I wonder what the Jews think. We know what some in the Labour Party think: that the Holocaust was a mere detail in the history of the Second World War.

  27. A.J. says:

    Just wait until I see that Tom Kabasi, says Sir Keir, I won’t half give him a piece of my mind.
    If only I could remember where I left it.

  28. Tafia says:

    Rayner’s office announces a brand spanking new policy of £10 per hour for care workers (big deal – the going rate round here in this part of Yorkshire is £9.80 and will go up next month in line with NLW). But is it a new policy or is it an existing one that gained absolutely no interest first time around.

    17 February 2021:
    “Labour’s Deputy Leader Angela Rayner, who was a home care worker before becoming an MP, will today argue that a pay rise for social care heroes is “well overdue””.

    23 November 2020:
    “Speaking at online rally for fair pay organised by Labour Unions this evening , Rayner, who was a care worker before becoming an MP will call on the government to end “poverty wages””.

    It totally avoids several facts. Firstly, most care workers are in the private sector and government cannot dictate private sector wage levels bar at what level they start (NLW/NMW). Those that work for councils on low pay – including Labour-run councils, are controlled by those councils and again government cannot dictate how much a council should pay various grades of staff, not forgetting that if councils pay their staff more they have to either raise council tax more or curt other services. Voters aren’t stupid – they are not going to vote for higher council tax bills.

  29. A.J. says:

    I was wrong. Not the NHS. Bonds. Coming the day after we receive a letter from the building society telling us they’ve cut the interest paid on our account. My wife – working class as they come – is close with money. I doubt whether what Sir Keir had to say will thrill her.
    The name’s Bond, Keir Bond.

  30. A.J. says:

    I can’t help wondering what it is Andy Beckett is trying to tell his readers in today’s ‘Guardian’. Just be patient and finally the voters will get tired of the so-called ‘Conservative Party’ and plump for Labour in a big way, as they did in 1945 and 1997? (I think we can hardly count 1964, as Lord Alec came close to winning). Well, yes, perhaps. But what if Labour lose and lose badly at the next election? What will happen after the post-mortem? Either Labour will swing once again to the Far Left or the Party will fall apart and then have to put itself back together again in a vaguely ‘progressive’ way by chumming up, Compass-style, with, well, some of the other parties. And what of Scotland and the SNP?
    I hope ‘The Guardian’ are not overpaying Mr.Beckett. He is providing neither genuine entertainment or value for money by stating the bleedin’ obvious: that, often and often, the voters opt for Heath, Thatcher, Major etc. etc. because their Party is mostly lacking in any firm ideological thrust. Some call it ‘the centre ground’. The average modern Labour activist certainly fails to grasp this point, ranting and finger-jabbing and even sometimes echoing Barbara Castle: the Party is too good, too pure, for the average voter. Unfortunately the reverse happens to be true: Labour lose because, all too often, they’re no bloody good at all.

  31. A.J. says:

    According to the EU obsessive Will Hutton, Keir Starmer has caught the public mood. So, holidays, brimming pint glasses, cuddles with granny etc. etc. That, needless to say, is not at all what Hutton is referring to. Welcome to WillWorld, the neo-liberal theme park for the experience of a lifetime, guaranteed tidy and harmonious. No smoking anywhere in the grounds, please. Some of his readers love him, demanding, as a matter of immediacy, readmission to the EU, abolition of FPTP, the greening of the inner-cities, Boris Johnson kicking his dog before falling under a bus to the accompanying shrieks and whoops from the ticket-buyers of WillWorld. Children, please, no teasing the Toynbee, she might bite you…

  32. A.J. says:

    Although there is a bit of silly nostalgia for Corbyn and Momentum to be discerned here and there, it looks as if the majority are finding favour with the Neal Lawson approach – fraught as that it with difficulties and dangers. If I were Starmer I should be wary of the SNP but be willing to talk to the Liberal Democrats and to Caroline Lucas – in the hope of finding common ground on a variety of issues (our future relationship with Europe being well to the fore). But Labour – the party of business? – needs to be clear with its members and activists, and with the electorate, whether they are socialist or neo-liberal. There is little use in consulting Mandelson then pretending to enjoy clog-dancing and whippet-racing.

  33. A.J. says:

    So the entire Labour Movement is simply awash with patriotic feeling, is it? Cue for laughter.

  34. John P Reid says:

    AJ Feb 14 8,08 Am Spot on
    as for the other comment about Alex Sobel, I hope that was a joke, unless there’s more mythical Orange book Libdems who could vote Labour, that labour think it needs to win

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