Nicholas Timmins

Buried away in the sweeping proposals from the government commissioned review of how sickness absence from work should be handled is a small bombshell.

Alongside a new independent assessment service to which patients would be sent after 4 weeks on the sick, plus a new brokering service to help people swap a job they can’t do for one they can, is a proposal for tax relief on private medical insurance and private medical treatment aimed at getting people back to work.

This is a highly sensitive issue. In his determination to seal the NHS off as an electoral issue for the Conservatives, David Cameron, in one of his earliest acts as party leader ruled out tax relief for private medical care – declaring that “we should not use taxpayer’s money to encourage the better off to opt out”. Read more

Nicholas Timmins

The private finance initiative – or at least the PFI as we know it – is dead. That’s what the fiercest critics will hope given the Treasury’s announcement of a “fundamental reassessment” of the model.

But don’t be too sure.

George Osborne, the chancellor, is looking for a model that “is cheaper, accesses a wider range of private sector financing sources, and strikes a better balance of risk between the private and public sectors.” Read more

Nicholas Timmins

Andrew Lansley is to prevent primary care trusts from arbitrarily setting minimum waiting times and caps on the number of NHS treatments. In principle quite right too.

But the NHS also still has maximum waiting times – despite the health secretary’s initial attempt to scrap them as a Labour “top down” target.

So cash pressured primary care trusts, and their successors the clinical commissioning groups, will not be allowed to set minimum waits but will still have to attempt to honour maximum ones when longer waits have always been the way the service copes when spending is tight.

Over the next four years it is set to get very tight indeed as demand rises but the money remains flat in real terms.

So how can it cope? The good ways include redesigning service to deliver high quality at lower cost – in effect increasing efficiency – although the service’s ability to do that on the scale needed is in question. The bad ones are likely to include raising the threshold for Read more

Nicholas Timmins

It is party conference time. And the old convention that each party let is opponents have their week in the sun is dead.

Gordon Brown is partly responsible for that. His decision to go to Iraq to be televised supporting our boys in the middle of the Conservative party conference in 2007 – just head of the general election he was minded to call but bottled – left the Tories spitting teeth.

Today was part of their revenge. Andrew Lansley declares that some 20-odd NHS hospitals may not be financially and clinically viable because of the scale of their PFI debts – their payments are too high a chunk of their turnover – and that is all Labour’s fault. As indeed is the separate build up of debt which some carry and which, as things stand, will prevent them becoming free standing NHS foundation trustsRead more

Nicholas Timmins

Monitor, the current foundation trust regulator and, under the government’s NHS plans, soon to be the health service’s new economic regulator as well, has scrapped, at least for now, its plan to appoint a new chief executive.

The move demonstrates the profound uncertainty that still haunts Andrew Lansley’s reforms, despite the end of  the famous “pause”.

Shirley Williams, the Lib Dem peer, has made clear that her party in the Lord still intends to try to amend the bill, whatever deal has been done in the Commons. The large medical mafia in the Lords and Labour will doubtless seek to do the same. Read more

Nicholas Timmins

As David Cameron, Nick Clegg and Andrew Lansley strutted their stuff at Guy’s Hospital today, arguing that lots of detail had altered over their NHS plans but that the fundamentals remained the same, who quietly re-emerged as the most powerful man in the NHS?

Answer: Someone who wasn’t there – Sir David Nicholson, the NHS chief executive. Up until the “pause”, Sir David had been the most powerful since his appointment as chief executive designate of the commissioning board was forced on Andrew Lansley back in December in the first sign that the government was panicking about the health secretary’s NHS reforms. Read more

Nicholas Timmins

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. Read more

Nicholas Timmins

Amid all the confusion about what is to happen to the coalition’s controversial NHS bill, maybe the one person who actually knows is Eric Pickles.

Right now David Cameron is talking to his bunch of NHS worthies, Nick Clegg to his, Andrew Lansley to his own kitchen cabinet, while Paul Bate, Cameron’s new health adviser has his own separate set of consultees as each tries to decide what can be salvaged from the bill … not that these groups do not overlap more than somewhat.  Read more

Nicholas Timmins

The Liberal Democrats in their election manifesto wanted local authorities to do the purchasing of NHS care. Even now, during Cameron, Clegg and Lansley’s “pause” in their NHS reforms, their activists are pushing hard for councillors to be given a much bigger role in commissioning.

This is a really bad idea. And Enfield council, in the first test of what the Liberal Democrats would like to be the new regime, have just demonstrated why. Read more

Nicholas Timmins

“We the willing, led by the unknowing, are doing the impossible for the ungrateful.” Well, not quite.

But the quote attributed to Mother Teresa might be the new slogan for Whitehall civil servants, where, the Institute for Government has just noted, there has been a spectacular turnover at the top. Read more

Nicholas Timmins

Ken Clarke may be in the dog house for telling the Daily Telegraph the brutal truth – that the worst of the cuts have yet to be felt, that the government is going to find that difficult and that middle England still hasn’t properly grasped the scale of what is to come.

But that assessment pales into insignificance compared to a chilling warning that Chris Grayling, the work minister, has allowed his department to issue. Read more

Nicholas Timmins

Civil service morale has – perhaps unsurprisingly – taken a distinct knock in the face of the spending cuts.

But the staff’s increased scepticism that the top of the office knows what it is doing is most marked with Andrew Lansley’s NHS reforms, Eric Pickles major deconstruction of the local government department, and in Vince Cable’s business department.

Staff are also appreciably less convinced that the department’s board is clear about what it is up to at Michael Gove’s education department and in the Home Office, headed by Teresa May.

Each of these departments has seen an 11 to 13 percentage point dip in the proportion of civil servants who believe that the department’s board “has a clear vision for the future of my organisation”.

The results come from Whitehall’s massive annual survey of morale to which more than 300,000 civil servants responded. Read more