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

Nicholas Timmins

Andrew Lansley, the new health secretary, could be about to make his first big mistake.

In opposition, he sided with professional hatred of Labour’s myriad targets in the NHS, and now – although he hasn’t yet quite said it in words of one syllable – he appears set to scrap the lot, including the 18-week wait: the promise that no-one need wait more than 18 weeks from seeing their GP to their hospital treatment starting.

Yesterday he quoted approvingly from one of the many inquiries that have already been held into the scandal at Mid-Staffordshire hospital, which said the fear of front-line staff that they would lose their jobs if the waiting time targets were not met contributed to the hospital’s appalling standards of care.

Waiting time targets were also in part blamed for the huge outbreak of hospital acquired infections at Maidstone and Tunbridge Wells.

But two exceedingly bad cases do not invalidate the waiting time goal. More than 200 other NHS trusts have got waiting times down, managed their finances more or less successfully, and not subjected patients to appalling standards of care. In other words they have managed apparently conflicting objectives successfully, as virtually every business has to do. Read more

Nicholas Timmins

One important question for the new coalition – and anyone interested in policy – is just how far is either party now held to what was in their manifesto or their previous political commitments. Or is it now ground zero for everything?

Both parties have already given appreciable ground on previously cherished policies to form the coalition.

But in the run up to the election campaign David Cameron told pensioners “you have my word” that winter fuel payments, free bus passes and TV licences, along with the pension credit, would be protected. Read more

Nicholas Timmins

A hung parliament will produce governmental paralysis and economic mayhem. Well maybe. But may be not.

The Institute for Government, which like the Institute for Fiscal Studies tries to offer up a few facts to inform the fevered pre-election debate, has a neat briefing on hung parliaments on its website.

One particular piece of Powerpoint is well worth the look for those who fear that a hung parliament will see the UK knocking on the door of the IMF within days.

It plots governments, whether they be coalitions, majority or minority controlled, against the size of their structural deficit. Read more

Nicholas Timmins

The three main parties’ health spokesman – Andy Burnham, Andrew Lansley and Norman Lamb – took part in a not entirely even tempered election hustings today in front of worthies from the British Medical Association, the King’s Fund and the Royal College of Nursing. 

But it produced one good laugh. Early on, Mr Burnham declared on one particular issue: “I would agree with Norman ….” – a statement that produced instant giggles from the assembled doctors, nurses and policy wonks.   Read more

Nicholas Timmins

Tensions continue to rise over the transition between Labour and the Tories that may or may not take place after May 6. And after their furious row over the social care “death tax” there is increasingly little love lost between Andy Burnham, the health secretary and Andrew Lansley, his Conservative opposite number.

Lansley is cross with Burnham, the health secretary, for going ahead and appointing a new chair of Monitor, the independent foundation trust regulator, just ahead of the election. Burnham appears incandescent with rage at Lansley, for questioning his judgement.

Burnham vetoed earlier candidates to take over Monitor in the autumn, leaving it temporarily leaderless. Now, suddenly, he has given Steve Bundred, the outgoing chief executive of the Audit Commission, a four year, £75,000 per annum contract to do the job from May.

Last week he put in a courtesy call to Lansley to run through the short list of candidates. Lansley said he didn’t want to know the names. Read more

Nicholas Timmins

Not in the sense that the arrival of the new personal pensions in 2012 will cause riots on the streets. But in the sense that a once simple policy goal becomes so complicated by practical considerations and compromises along the way that it fails. Spectacularly.

Ministers yesterday announced, in outline, how people will be charged for the new pensions - and the way that is to happen may just prove the straw that breaks the back of the scheme.

The goal for the new personal pensions – now known as NEST – was clear when Adair Turner’s Pensions Commission recommended, back in 2005, that they should be introduced from 2010.

A simple, low cost pension, into which millions of lower to middle income earners with no pension provision would be automatically enrolled, through with the right to opt out.

Since then the timetable has slipped, and a series of practical considerations have led to a swift start becoming a decidedly prolonged roll outRead more

Nicholas Timmins

Andy Burnham’s policy that NHS organisations are now the health service’s “preferred provider” is proving something of a running sore.

Given the [still small] amount of care that the NHS already buys from the private and voluntary sector, and the way that has expanded over recent years, at least some competition and procurement lawyers believe that rowing back to a preferred provider approach may well breach EU competition law. Read more

Nicholas Timmins

Nicholas Timmins is the FT’s public policy editor

An election may be coming, but nothing quite forgives total abuse of statistics.

Stephen O’Brien, the Conservative health spokesman, is accusing the government of trying to tie the next administration in to some £4bn’s worth of central NHS IT contracts by completing a deal ahead of the election that is aimed at saving £600m from them.

 Read more