NHS Reform – Has the penny finally dropped for Cameron?

The signs are all there when a relationship starts to falter. He doesn’t look you in the eye, won’t sing your praises in public anymore, avoids direct questions about your future together and doesn’t even let you sit next to him at Prime Minister’s question time in parliament….

Andrew Lansley, UK secretary of state for health is certainly feeling the cold – and not because it’s snowing outside. It’s the cold shoulder that will be providing the chill as he is increasingly sidelined while the political argument supporting the Health and Social Care Bill slowly unravels.

There seems to be a significant shift in commentary on the Bill recently, as it faces the next report stage in the House of Lords next week. There have been some cracking debates on TV and in the press as informed stakeholders become increasingly frustrated with the blinkered view of the Coalition health ministry.

On BBC’s Newsnight, the Health Minister Simon Burns was made to sit in silent agony as Jeremy Paxman read out the very long list of professional organisations opposed to the Bill. Burns, who in my opinion always has something of the pantomime about him, had to quash his usual flamboyance as he shifted uncomfortably in his seat, clearly desperately formulating some sort coherent repost to this growing list. The best he could manage is ‘If you talk to the GP’s - the people on the ground doing the commissioning, you will see the support for this Bill’.  He failed to comment on the fact that the Royal College of General Practitioners, who represent 50,000 members are vehemently in opposition. He ignored the question on why the majority of medical bodies rejected the Bill but claimed with great glee that the Royal College of Gynaecologists was in support of the radical NHS reshuffle. (There has to be a joke there but I can’t think of one I can print). Burns repeated the same mantra in other interviews this week as Lansley remains strangely absent. Mr Burns, please, change the record.

So Lansley is heading for the dark recesses of Prime Ministerial rejection, but sending another minister into the fray with equally weak argument and who clearly struggles with supporting this tragic Bill is not a good strategy.

The language surrounding NHS reform is becoming emboldened. A headline in the UK Times yesterday reads ‘Tories turn ‘toxic’ as Health Bill falters and reshuffle approaches’  reporting that the atmosphere within the Tory benches is ‘toxic’ as it dawns on them just how damaging this Bill could be not only to the NHS but to the party. Zoe Williams, the Guardian journalist summed up the situation beautifully on a politics show earlier today saying ‘It’s a car crash’

I wonder if David Cameron realizes now just what a car crash this is. As another journalist, Andrew Pierce commented. ‘This could be Cameron’s Poll Tax’ (referring to the local taxation policy Thatcher introduced which was the beginning of her downfall). But what can he do? Hope, as Pierce suggests, that The Lords will let him off the hook by rejecting the Bill? But the equivalent of a motorway pile up has already started. Despite the lack of legislature to back it up – the existing structure of the NHS is already changing beyond recognition. PCTs and SHAs are dismantled or merged, NHS Trusts are panicking as they scrabble to achieve Foundation status, staff are disengaged, Clinical Commissioning Groups are struggling to rise to their new challenge, the private sector has become totally vilified and patients are confused.

Yes, I think the penny has dropped, but removing Lansley or even stopping the Bill won’t avoid the metaphorical car crash. Fasten your seat belts – it’s going to be a rough ride.