Wednesday, 14 March 2012

Lansley's fight back

Clare Gerada wrote to the PM last week, asking for a truce, and for the chance to re-engage with the process of discussing how the health bill might be implemented. We also found out today via Paul Corrigan’s blog (, that on the same day that she wrote this letter, she was asking some people to write to the PM to express their opposition to the same Bill.

The role of Clare in the organised opposition to the Bill is worth a quick look: as a partner at the Hurley Group GP practices, I know of some people who have questioned her motivation for opposing the Bill: she helps run an organisation that has fared very well out of current primary care arrangements. I suspect that her organisation will continue to thrive after the reforms, but there is still the whiff of something not quite right about it all.

Furthermore, if the same person is putting out conflicting messages on the same day, then many would assume that either the person is conflicted, or they are trying to manage competing interests. Writing to the PM to express her cooperation does not sound like the Clare Gerada we have seen in the media over the last few months, but asking people to email their opposition to him certainly does. Draw your own conclusions from that.

But this isn’t about Clare Gerada - the point I would like to make is much broader than that. The scenario I gave is just a good way of framing the discussion.

Much of the criticism about the Bill has centred around two general areas: firstly, there has been the contents and impact of the Bill itself, and secondly, there has been the communication and process management by Andrew Lansley. I’m not really expert enough to offer you guidance on either of those issues, but perhaps you will indulge some of my reflections on Andrew Lansley.

In the last couple of weeks, Lansley has been heard to utter that the miscommunication of the health reform has not been down to his misplaying of the situation, but due to opponents either misunderstanding what it contains or wilfully misrepresenting its likely effects.

The nature of this fight back from the Secretary of State was both unsurprising and surprising at the same time. We should not be shocked that a man under pressure gets bullish in response to widespread criticism, but it does smack of something like chicanery or self-delusion to blame public perception of the Bill on other people.

If the contents of the Bill have been misunderstood, then that says something about its complexity, which has created the need to speculate about its impact. Lansley is gutsy to swerve responsibility for that.

Furthermore, if Lansley is accusing others of wilfully misrepresenting the Bill, then he is doing exactly what many people who oppose the Bill have done to him. Last week, I decided that the most productive viewpoint to take was to assume that Lansley’s vision encapsulated in the Health Bill is his earnest opinion of what needs to be done to help the Health Service meet the challenges of the next generation. Along the way, he has been accused of many things, most repeatedly of privatising the NHS, but maintaining this opinion of him made any kind of decent dialogue of travel from either side impossible.

A different response to the one Lansley has taken would have been to acknowledge the concerns that have been raised, and instead of just saying that they are the product of confused or lying minds, address them directly. The same issues and concerns have been stated and restated by a great many people, and accusing this plethora of educated, engaged parties of either incompetence or deceit is not the move of an enlightened man. Imagine how impressive it would have been if Lansley had humbly, honestly and patiently talked us through the problems as we see them, and explained how his interpretation differed. In all honesty, I’m not sure many people would have given him the chance to do that, but it would have been nice to see him try.

But he didn’t do that - having been accused of incompetence and poor communication himself, he decided to do the same to his critics. This I fear was a missed opportunity: Lansley is going to win this particular fight, but I suspect that he has exhausted most of his political surplus in doing so - political influence that he is still going to need in abundance to make a success of the reforms, and to stop them becoming the glaring failure that does for this government at the next election.

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