Politics is full of the bitterest of ironies. Deep inside Andrew Lansley’s reform of the NHS was a desire to take politics (or at least as much of the politics as may be possible) out of the NHS.
Today, as a result of producing the biggest bill in the history of the NHS – far longer than the founding act of 1946 - he has subjected the NHS to the biggest bout of political in-fighting since its foundation.
Nick Clegg, the deputy prime minister and Liberal Democrat leader, is claiming that the Lib Dems have achieved at least 11 of the party’s 13 “red lines” over the reforms.
The prime minister, by contrast, is today reassuring his backbenchers that the most important of his health secretary’s reforms remain – for example an evolution to more competition over who actually provides health care.
This argument will not be settled today or tomorrow when the government formally responds to the end of its listening exercise. It will rumble on as the bill is redrafted and redebated - not least because the Labour party leadership will encourage this wound to fester, despite appearing to lack any clear idea itself of what it would do.
At the highest level, what Andrew Lansley wanted was an NHS shorn of at least some of its day to day politics.
A system in which the secretary of state essentially did nothing much except raise the money for the NHS from the Treasury. He or she would then set a few high level targets for the service (better cancer outcomes, improved mental health care).
These were to be delivered by a statutorily independent NHS Commissioning Board who in turn would oversee a bunch of GPs, working in consortia, who would buy the care locally.
They would do so following guidelines on the best way to commissioning care provided by Nice, the National Institute for Health and Clinical Excellence, while a new regulator would ensure patients got the services they needed at best value for money by using a mix of competition where appropriate, and regulation where necessary.
The design was pristine in its purity, allowing politicians to stand back from the day to day running of the service.
Instead, by producing such an enormous and detailed bill – when most of this could have done with minimal legislation – and by explaining it so badly, Mr Lansley opened his every flank to attack by the sceptics. Far from removing the NHS from politics, his bill has injected more politics in to how the NHS should be run than at almost any time since 1946.
Jim Pickard
Kiran Stacey