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Tuesday, April 05, 2011 

An accident prone coalition.

For a government less than a year into its first term, the coalition is already becoming remarkably accident prone. All governments through initial hubris or power of will tend to implement reforms which they either later regret or have to put right; others become so addicted to legislation that they either manage to bore or overwhelm those potentially opposed into submission: just witness New Labour's astonishing 21 criminal justice acts, a figure which itself can't be properly verified so prolific were the additions to the statute book.

The key difference with the coalition is that the policy u-turns and clarifications it's been forced to make ought to have been glaringly obvious to anyone even slightly in touch with the political mainstream. Caroline Spelman's crackpot scheme to sell off the nation's forests, regardless of the possible merits of reforming the Forestry Commission, was the kind of idea which should have been squashed when first proposed. Excepting banning the WI and riding roughshod over objections to new housing developments (which, oh, the coalition is also planning to do) nothing could be more seemingly calculated to rile up the Tory heartlands than the potential padlocking off of local woodland. Yet somehow it not only went through cabinet, all but three from the respective coalition parties also voted against an amendment urging the government to rethink the sell-off.

Once again proving the truism that politicians and indeed we as a species never learn anything from our mistakes, Andrew Lansley duly stood up in the Commons yesterday and channelled Spelman over his reforms to the NHS. While the changes are not being abandoned wholesale as the forest sell-off was, we are instead going to have a "pause" or a "natural break" in the proceedings as everyone is being urged to reconsider their respective positions. Lansley's gambit from the beginning in promoting his white paper was cunning, so cunning in fact that it was just too clever: his idea was through handing over commissioning to GPs, many of whom have long believed that they could do a much better of running the NHS if only they were given the chance, he could at the same time buy support for the work of building on Labour's introduction of the private sector, allowing or more accurately forcing the newly formed GP consortia to buy services from "any willing provider".

What's more, it almost worked. With most GPs so delighted at the prospect of wielding the knife as it were, with "pathfinder" consortia already representing 87% of England, it took a while for most to take notice of the other changes being introduced. It was only last month at an extraordinary special representative meeting that the British Medical Association called for the withdrawal of the entire Health and Social Care bill, while the Liberal Democrat spring conference, motivated by the opposition of Shirley Williams and Evan Harris called for major changes.

Quite why it took the Liberal Democrats so long to realise that they'd been duped is unfathomable. After all, the coalition agreement specifically called for an end to top down restructuring of the NHS, while the white paper proposed the abolition of both primary care trusts, which the Liberal Democrats had wanted to democratise, and strategic health authorities. It's the top down restructuring to end all top down restructuring, and yet without the disquiet at the speed of the reform rising they may well have voted for it regardless. Whether you go with Nigel Lawson's observation that the closest thing we have to a national religion is the NHS, or Tory MP David Ruffley admitting that it even makes them socialists, the only thing more popular than trees is our free at the point of use health care system, however much we complain about it and want to improve it. Once you get even close to suggesting that much of what it does can be farmed out, or that private firms can cherry pick what they want to do at a profit while the state is left with the hard cases, you have a problem on your hands.

And yet David Cameron, the man who said his priority was the NHS and that he'd protect it from cuts was up until very recently not only defending the bill but praising Lansley's work to everyone. Almost needless to say, along with everyone else in the cabinet who'd let Lansley get on with it, Cameron was nowhere to be seen as his health secretary was forced into his new strategy of delay. If Gordon Brown became known as Macavity, never being around when the shit hit the fan or when it was time to take responsibility, then Cameron is putting in a remarkably similar performance. This failure to pin the blame directly on the prime minister has been the biggest failure of the opposition to the coalition so far: Nick Clegg and the Liberal Democrats have rightly been targeted for propping up a Tory government intent on using however much time it has to embark on an economic and social experiment of slashing the state and hoping the private sector can fill in the gaps; unfortunately this has been to the detriment of properly nailing Cameron first and the Conservatives second for their aloofness at what they're about to unleash.

This ultimately is why Lansley's plans have had to be temporarily frozen. It's not that the Liberal Democrats are threatening to oppose the bill, or that the doctors themselves have become militant, it's that Cameron's image, carefully cultivated as the protector of the NHS, was in danger of being permanently sullied. Lansley instead is the one being left out in the cold, widely being described as dogmatic and unwilling to compromise, having only done what was asked of him regardless of it conflicting so obviously with both the coalition agreement and indeed with the manifestos of both parties. It could well be that this is a bluff, with only piecemeal changes to the bill made, as after all, Cameron himself is still fully behind plans which would see the entire public sector opened up to the private sector. More likely however is that the Liberal Democrats will be given enough compromises to claim that they've stopped Lansley's worst excesses, something they'll especially prize if the AV referendum fails, while the Conservatives will show themselves as being willing to listen to reasonable criticism. Even if this turns out to be the case, it shows once again that the coalition firstly isn't as clever as it thinks it is and secondly that through the right strategy and target it can be potentially defeated. Cameron, if it wasn't already clear enough, is the key.

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