Andrew Lansley

Nick Clegg, Andrew Lansley and David Cameron at Guy's HospitalA month ago, ministers gathered round the cabinet table to be told by Andrew Lansley that the health bill was about to finally pass through parliament and become an act. Those attending banged their desks – partly in celebration, partly with pure relief. After 14 months of delays, negotiations and public rows, one of the most unpopular pieces of legislation from this session was finally about to be left behind.

Except it wasn’t. From next month MPs will start voting all over again on Lansley’s plans. What many in the coalition didn’t realise was that the act (as it now is) made so many changes to the infrastructure of the NHS that parliament will face a series of votes simply to create the bodies necessary to make them work. Clinical commissioning groups, Health Watch, Health Education England, Public Health England: the plethora of new quangos at the heart of the act all need to be legislated for. Read more

Michael Gove featured heavily in today’s PMQs. Ed Miliband began his questions by asking whether the prime minister would condemn the education secretary’s recent comments that the Leveson inquiry was having a “chilling effect” on freedom of speech.

But it was during the inevitable debate on the health bill that Mr Gove played an unspoken, but important role.

Ministers seem to be changing their tone in a subtle way when defending the NHS reforms, taking on some of the tactics deployed by the education secretary when he was pushing through the Free Schools agenda.

Instead of talking up how radical the plan is, the government is now downplaying it. We hear that the bill is about “evolution, not revolution”, and more strikingly that it is building on what Labour did while they were in government.

It was this latter point that the prime minister stressed today, reeling off a list of former Labour health secretaries or advisers who back competition in the NHS (which is not the same as backing the bill, mind). He added: Read more

David Cameron, Nick Clegg and Andrew Lansley meet medical professionalsToday’s report from the London School of Economics into whether competition works in the NHS is likely to be cherry-picked (to use an apt term) by both sides in their fights for and against the health bill.

Ministers will love its headline finding, that competition works in the NHS. The researchers found that after Labour introduced competition between hospitals in 2006, waiting times before operations (an internationally recognised measure of transparency) fell. Using the kind of terminology only academics can, the report’s authors found “moderate but statistically significant” reductions in patients’ length of stay. They added:

These 7 to 9 per cent gains would have produced non-trivial savings.

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When Andy Burnham returned to the health beat for Labour, some in Andrew Lansley’s team were delighted. This is the man, they pointed out, who said he would not ringfence spending on the NHS. He even said that to do so would be “irresponsible” – hardly a vote-winning tactic.

David Cameron clearly thinks the same thing – that by shifting the focus of the health debate onto Burnham and his refusal to promise extra money for the NHS, he can nullify the controversy surrounding his health bill.

That is why, several times during today’s session of prime minister’s questions, Cameron insisted:

That’s what you get if you get Labour: no money, no reform, no good health service.

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David Cameron and Nick CleggSo the fighting is over, now comes the reconciliation. David Cameron’s concessions on the health bill – giving more leeway on GP-led commissioning and changing the role of the medical regulator (Monitor) so it is no longer purely to promote competition – have made the breakthrough. Nick Clegg is willing to support the proposals and is telling his parliamentary party exactly that now.

There will be a statement next Tuesday by the NHS Future Forum on their views on what should happen to the service, but Cameron’s speech has made that less relevant: he has made the key achievement of winning back the Lib Dems. The FF’s statement will be followed quickly by a ministerial statement and the coalition government will then take the reforms forward together.

The question now is whether each can take their own parties with them. The obvious problems will come at the Liberal Democrat end – Cameron’s repeated references to competition on Tuesday show he is not completely rejecting the Lansley reforms, even though some Lib Dems will settle for nothing less. Read more