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Tuesday, June 14, 2011 

Pause? Repeat.

There are times when you can't help but marvel at the amazing feats of rhetorical dexterity achieved by politicians. It's even more remarkable when the modern media, that supposed cynical, feral beast which always manages to cut through the bullshit to the truth takes on the main role of convincing the nation that their leaders aren't in fact men with feet of clay.

The government's success in turning its "pause" on their proposed NHS reforms into a substantial victory will probably become a case study in how to rescue presumed lost causes. Just two months ago Andrew Lansley stood up in the Commons and announced that his seemingly well-laid plans were in fact causing such disquiet that they needed to be brought to an immediate halt. Never mind that the consultation period on his initial white paper,which the Department of Health had presented as giving overwhelming support to his proposals had long since passed. There now needed to be more scrutiny, more thinking done on something so major.

Those of us who imagined that this was another example of the government attempting to legislate too quickly and not being able to see the wood for the trees couldn't have been more wrong. Everything had been sown up in advance. In was brought Prof. Steve Field, a practising GP, not an outright critic of Lansley's plans but in fact a keen supporter, albeit it one with some reservations. He and his future forum would review everything, and make recommendations in due course. Out would go the worst excesses, those parts which would have always been politically unacceptable once it was actually noticed they had been proposed in the first place, such as the opening up of the NHS to any outside provider who could offer a better deal and the role of Monitor in actively promoting such competition, and in would come ever so slight changes which most likely would have been inserted during further readings or forced by the Lords. Hence now the commissioning boards which would have been purely made up of GPs must have at least two lay members, as well as a nurse and a consultant on them, while the 2013 deadline for the abolition of primary care trusts will be "relaxed".

Everyone then has either had their personal objections somewhat pandered to, or can claim victory for their part in either ordering or demanding the "pause", with the exception of Lansley himself. GPs concerned they were going to be left holding the blame if things went wrong can point to the others on their boards, not to mention the health secretary, who takes on ultimate responsibility for the NHS and its continuation as a "comprehensive service". Managers, hospital consultants and nurses have all been told their views have been taken on board and will have representatives at various points of the commissioning process. Those healthcare firms looking to cream off the easy jobs might be perturbed at first, but nothing has actually substantially changed from the initial plan: their opportunities will just be "slowly phased" in. The Liberal Democrats can claim it was down to their sudden discovery of how disastrous the bill was that the "pause" took place, as they did at the weekend, despite Clegg and friends having initially signed off and voted for it, while Cameron has had a smashing time over the past few weeks making the same speech over and over again about how much he loves the NHS, just to drill it in to anyone who thinks the fact he's a Tory means he secretly wants to privatise the whole damn thing as soon as he can. The Tory backbenchers, ever wary of the Lib Dems gaining the upper hand, looked like mutinying until they saw the actual changes and decided quite reasonably that they're fairly minor. Potential banana skin sighted, the Conservatives have deftly skipped over it.

As for the media, the majority still can't get enough of Cameron's shiny bonce. The novelty effect of having another party leader alongside him also hasn't yet worn off, and everyone's written Lansley's obituary already anyway, so it was only natural to portray this as another great success for this new Teflon leader. Oh, and there was a shouty doctor too, always helpful when going into actual details is as mundane as it is on this topic. This whole nauseating stunt had it been attempted by Labour would have resulted in those involved being pilloried for resorting to such spin, a word it seems which has mysteriously fallen out of favour now the Tory-supporting press have their one true loves back in power. Only a few naysayers are pointing out that this top-down reorganisation, the exact thing the coalition promised they wouldn't do is now going to take place just as the NHS needs to be making massive efficiency savings. Cameron after all made his one great promise that he'd cut the deficit rather than the NHS, while Labour for once being both realistic and honest declined to ringfence the health budget, knowing that savings have got to come from somewhere.

This isn't by any means the end of the matter; it's just another temporary sticking plaster on reforms that haven't been anywhere near properly thought through, where it's still not clear that GPs are ready to take on a commissioning role despite have signed up to the pathfinder consortia, and where if the waiting lists continue to increase real, open, discontent with the coalition's promises and policies will begin to develop. A highly embarrassing political mess though, one of the coalition's own making, has been turned into a shining example of Cameron's leadership abilities and the Liberal Democrats' influence within the government, with all the blame shifted onto the unfortunate Lansley. Everyone wins, except for us plebs in the long term. And isn't that what modern politics sets out to achieve?

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