How far will Clegg go on the NHS U-turn?

Norman Lamb’s intervention on the NHS posed a tricky dilemma for Nick Clegg. In responding to the strong criticisms made by his closest aide, Clegg was likely to reveal his own thinking on how to fix NHS reforms.

Yet, if you read the papers today, you’ll see two very different interpretations of what Clegg wants. The clashing theories go something like this:

1) Big U-turn Clegg is more than happy for Lamb to make the case for GPs being given an opt-out on commissioning services. His BBC interview even hinted at PCTs being saved. Clegg hedged his remarks in order to smooth over coalition tensions (Lansley hates Lamb) and maintain the pretence that politicians listen during a “listening exercise”.

2) Minor concessions Under this scenario, Lamb spoke out because Clegg wasn’t going far enough to stop the Lansley reforms. During his BBC interview Clegg suggested he was open to ideas but gently made clear Lamb was wrong. In particular, he argued giving GPs an opt out could create a two tier service. Instead Clegg raised the possibility of the 2013 deadline being relaxed by a year or two — something the NHS chief executive has already said will happen.

My sense is that the second scenario is closer to the truth. Clegg thinks health professionals, the Lords and his party can be won around with a few piecemeal changes to the deadline and accountability structures. These are the implicit boundaries for the “listening excercise”. Funnily enough, they are also the easiest compromise to reach within the coalition.

Lamb’s message is that these concessions won’t be enough. The trouble for Clegg is that following the advice of his most senior aide will be tantamount to asking Lansley to walk the plank. Once again Clegg finds himself in quite a bind.