Saturday, May 28, 2011

Are Lansley's health reforms now dead in the water?

First David Cameron announces a “pause” in the government’s plans to reform the National Health Service in order to listen further to the views of health professionals and the public.

Then the doctor’s trade union, the British Medical Association, reveals that it thinks the Health and Social Care Bill should be scrapped, and any changes achieved without legislation.

Finally, deputy premier Nick Clegg announces that the Bill is to go back before a committee of MPs for further scrutiny, setting back its likely passage through Parliament by at least six months.

The question on the lips of many Westminster watchers this weekend is: Are the government’s NHS reforms dead in the water?

Predictably, backbench Tory MPs are up in arms over Mr Clegg's intervention, claiming yesterday that he had "bounced" the government into delaying the Bill.

They made clear that whatever changes are ultimately made to the Bill, there are certain "red lines they wish to draw against Lib Dem encroachment on the original blueprint.

In an email sent to all Conservative MPs yesterday, backbencher Nick de Bois called on his colleagues to "reclaim the debate" over the NHS.

He said the "red lines" should include the requirement for all GPs to take on responsibility for primary care across England – ignoring the fact that GPs themselves oppose this provision.

The backlash against the reforms was growing long before the Lib Dems' hopes of changing the voting system went up in smoke, but it was nevertheless this that proved the tipping point.

Once the Tories decided to throw the kitchen sink at AV, it was obvious that Nick Clegg would have to be thrown some sort of bone to keep the Lib Dems in the government, and it was equally obvious that this would be it.

Politically, sacrificing a set of unpopular health reforms in exchange for keeping a voting system that kept them in power for most of the 20th century might seem like a smart move for Mr Cameron.

But the downside is that so much had been invested politically in these reforms that the now seemingly-inevitable retreat will be seen as a major blow to the Prime Minister's authority.

Even if the reforms are not dead in the water, the political career of Health Secretary Andrew Lansley surely is.

If the government ultimately decides to press ahead with the changes, Mr Lansley is likely to be replaced by someone who can more successfully sell them to the relevant stakeholders.

If on the other hand they are watered down or abandoned, his job is almost certain to go to a more emollient politician who can re-build bridges with the health professionals.

The latter scenario is surely the most likely one. Tory MPs want the new GP fundholding consortia in place by April 2013, but in the light of Mr Clegg's latest intervention, this is looking like an increasingly forlorn hope.

The danger for the government is that, if the measures do not reach the statute book this summer, the institutional upheaval will still be ongoing in the run-up to the next election, due in 2015.

Mr Cameron is nothing if not a pragmatist, and he will surely view the prospect of organisational chaos in the NHS as a risk he can do without as he prepares to face the country again.

In those circumstances, it would make more sense for Mr Lansley's proposals to go into the next Conservative manifesto rather than into a revised Health and Social Care Bill.

And who knows - if Mr Cameron can win an outright majority next time, the Tories might even be able to claim a mandate for them.

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Saturday, May 21, 2011

Opponents come to aid of Great Survivor

The story is often told of the new MP who remarked on what a pleasure it was to look across the Chamber into the eyes of his enemies. The old sweat next to him responded: "No laddie, they are your opponents; your enemies are behind you."

Never was this hoary old adage more true than in the case of the Justice Secretary, Kenneth Clarke.

Like Tony Blair, Denis Healey and Rab Butler before him, Mr Clarke has always been one of those politicians who are more popular outside their own parties than they are in them.

There can be absolutely no doubt that had Mr Blair been up against Mr Clarke in either of the 2001 or 2005 elections, his majorities would have been significantly smaller. But the Tory Party might also have split in two.

As we have seen this week, Mr Clarke continues to divide opinion. Many on his own side – not to mention the right-wing tabloid press – would not have been at all displeased to see him lose his job over his comments on rape.

By contrast, it was instructive to see the conscience of liberal Britain,
Shami Chakrabarti, passing up the opportunity to twist the knife in Mr Clarke when they appeared alongside eachother on the BBC's Question Time on Thursday.

But it was not Shami who ultimately saved him, but a much more obvious 'opponent' - Labour leader Ed Miliband.

The moment Mr Miliband urged David Cameron to sack Mr Clarke over the Commons Despatch Box on Wednesday, it became virtually for the Prime Minister to do so.

My initial reading of this was that it was a smart piece of politics by the often under-rated Mr Miliband.

Keeping Mr Clarke in the government is, after all, in Labour's interests - firstly because, because he exacerbates the divisions between Mr Cameron and his backbenchers, and secondly because the policy agenda he is pursuing is not so very different from Labour's own.

Others might argue that this is way too Machiavellian for the young opposition leader, and that Mr Miliband was simply showing his inexperience.

Either way, the man who has become the great survivor of British politics lives to fight another day.

There is much less confidence this weekend in the future of Mr Clarke's Lib Dem Cabinet colleague, Chris Huhne.

Essex police are now formally investigating claims that he asked someone close to him to take some speeding penalty points he allegedly incurred in 2003 before he became an MP.

Mr Huhne has described the claims as 'inaccurate' but his denials seem to be cutting little ice with some colleagues.

One Lib Dem insider was quoted as saying on Thursday: "The conventional wisdom is that Huhne will end up having to go. He is being highly reckless in taking it to the wire like this. Chris clearly doesn't think they will find the evidence. He wants to brazen it out. He is brazen. That's what he does."

The departure of Mr Huhne would doubtless have a further destabilising impact on the Coalition, already under strain as a result of the AV referendum debacle.

Under the terms of the Coalition agreement, he would have to be replaced by another Lib Dem, with Ed Davey, Jeremy Browne and Norman Lamb among the potential candidates

Meanwhile more able Tories in the ministerial middle-ranks would once again be forced to wait their turn, as was the case when David Laws was defenestrated after just 17 days in office.

Maybe that is one of the reasons some of them were so keen to see the back of Mr Clarke.

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Saturday, May 14, 2011

The gamble that paid off

And so the problems continue to pile up for Nick Clegg and the Liberal Democrats.

First it was the local elections and the loss of 700 council seats, then the overwhelming referendum 'no' vote to electoral reform, now the finding of 'serious breaches of the rules' in relation to rising star David Laws' expense claims.

And it's not over yet. There are serious question marks over the future of another of the party's leading lights, Energy Secretary Chris Huhne, following claims by his ex-wife that he asked someone else to take some penalty points for a speeding offence.

The allegations have been denied, but with further revelations expected in tomorrow's Sunday papers, some Westminster observers are rating Mr Huhne's survival chances as "less than 10pc."

Is this what happens when a party that has been out of power for the best part of a century finds itself struggling to adapt to its new responsibilities, or is it simply a run of bad luck?

Either way, it was hardly surprising that Mr Clegg should have sought to reassert his party's influence in government this week, with the government's NHS reforms likely to be the new battleground between the Coalition partners.

Mr Clegg at least has public opinion on his side as far as that one is concerned , but the harsh reality is that he dare not push the Tories too far.

If he gets too big for his boots, Prime Minister David Cameron can simply threaten him with a general election which would in all likelihood delivery a Conservative majority and a Lib Dem wipeout.

For all the initial focus on the council election carnage, it is the AV referendum result that will hit the Lib Dems hardest, setting back for at least a decade the cause of electoral reform that is closest to the hearts.

With the benefit of hindsight, the whole thing now looks like a car crash waiting to happen.

As one pundit put it: "Here is a referendum recipe for disaster. Choose an issue that no one cares about, get the most unpopular man in Britain to champion it, and hold it on a day when everyone will use it to kick the most unpopular man in Britain."

Yet it's too simplistic to blame the failure of AV entirely on Mr Clegg, and in any case the outlook at the start of the campaign looked very different, with the 'yes' camp seemingly comfortably in the lead.

In this and other respects, the referendum reminded me of the one that took place in the autumn of 2004 on whether the North-East should have an elected assembly.

On that occasion, too, the 'yes' camp seemed to have a fair wind to start with, but lost the initiative once people started to take a closer look at exactly what was on offer.

Just as the people of the North-East might have supported a less lily-livered version of regional government than the one actually put before them, so the UK public might have supported a genuine form of proportional representation given the opportunity.

Instead, they were offered what appeared to many as a non-choice between the status quo and the 'miserable little compromise' – Nick Clegg's words -that was AV.

In the days following the general election last May, there was a perception that Nick Clegg had emerged as the big winner of a contest that seemed initially to have produced only losers.

If I'm honest, I may have bought into some of that myself, but the result of the AV referendum forces us to revise that view of history.

The truth is that Mr Cameron's great gamble of offering the Lib Dems a referendum on the voting system in return for handing him the keys to Number 10 Downing Street has handsomely paid off.

Twelve months on, the Conservative leader has finally proved himself the real election victor.

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Saturday, May 07, 2011

Is Clegg's only option now to join the Tories?

Ever since the Coalition government was formed a year ago with the intention of governing for five years, a single overarching question has hung over its ultimate long-term survival.

It is what would happen if and when membership of the Coalition became a political liability for one or other of its partners.

Well, to no-one’s great surprise, least of all mine, that question has now assumed a certain degree of urgency.

The Liberal Democrats’ calamitous performance in Thursday’s council elections will surely lead to fresh unease among party members over just how long they can go on being David Cameron’s fall-guys.

Even leaving aside the result of the referendum on the voting system, still to be officially announced as this column goes to press, it was a bad, bad night for Nick Clegg and his party.

The loss of Newcastle City Council to Labour after seven years was not the half of it.

That result merely restores what has always seemed to be the natural order of politics in the city after a Lib Dem interregnum which was initially a consequence of the post-Iraq backlash against Tony Blair.

More damaging by far was the slump to 15pc of the national share of the vote, some 22pc behind their Coalition partners whose support held steady from last year’s election.

There will doubtless be some bemused Lib Dem activists who wonder why they, rather than the Conservatives, are currently taking the political hit for the government’s spending cutbacks.

There are several reasons. For starters, while those who voted Tory last May were by and large supportive of the cuts, that is not necessarily true of Lib Dem voters.

It stands to reason therefore that Conservative support is holding up better in the wake of the cuts than that of a party whose supporters were more in sympathy with Labour’s more gradualist approach to deficit reduction.

More specifically, the cuts are disproportionately affecting many of the areas, particularly in the North, where the Lib Dems were doing quite well until Thursday night.

But the biggest and most fundamental reason for the Lib Dem collapse is that the decision to enter the Coalition, and the way Mr Clegg had handled the relationship with the Tories, has left many voters confused about the party and what it stands for.

Ever since Paddy Ashdown abandoned “equidistance” between the two main parties in favour of a closer relationship with Labour, it has been perceived as a centre-left party – a perception strengthened by its opposition to the war in Iraq.

In the light of this, Mr Clegg should perhaps have taken more care to appear as a reluctant participant in the Coalition, emphasising that he was joining it purely in the interest of providing stable government rather than out of any sense of policy convergence.

But by making it appear instead like he and ‘Dave’ were enjoying some kind of ideological love-in, he has alienated that segment of Lib Dem support for which the Tories have always been the enemy.

The end result is that Mr Clegg may well now face a leadership challenge, if not from fellow Cabinet member Chris Huhne, then quite possibly from someone outside the Coalition such as former deputy leadership candidate Tim Farron.

Given the Lib Dem collapse on his home territory of Sheffield, he may struggle even to remain an MP at the next election.

On the face of it, probably his best chance of retaining his seat would be to do something which many of us think he should have done a long time ago.

It is to join the Conservative Party.

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Saturday, April 16, 2011

When two tribes go to war....

At the beginning of this year, I wrote that if the Coalition government survived 2011, it would in all likelihood achieve its original objective of serving out a full five-year Parliamentary term.

What I was trying to say was not so much that it will all be plain sailing from 1 January 2012 onwards, but that if there was a point of maximum danger for the Cameron-Clegg government, it will come this year rather than any other.

The past few weeks seem to have proved the point, as tensions have erupted between the Coalition partners over a series of issues ranging from the NHS to immigration.

A year on from the opening TV debate between the party leaders which shaped the 2010 election campaign, serious commentators have started to pose the question whether another election might not be so very far off.

Last week I focused on the health reforms, and the ongoing Lib Dem-inspired backlash against health secretary Andrew Lansley's plan to hand control of the NHS budget to GPs.

Although they refrained from saying as much, the Lib Dems will doubtless have been privately rubbing their hands with glee at Mr Lansley's humiliation at the hands of Royal College of Nursing conference on Wednesday.

The yellows showed no such restraint however when Chancellor George Osborne suddenly enlivened what has thus far been a sleep-inducing campaign on whether to change the voting system.

Mr Osborne criticised the role of the Electoral Reform Society in simultaneously receiving taxpayers' money to run some of the referendum ballots and helping to fund the Yes campaign, saying: "That stinks frankly."

The comments earned the Chancellor a rebuke from his own Lib Dem deputy, chief secretary to the treasury Danny Alexander, who accused his departmental boss of "pretty desperate scaremongering."

It showed that, although the two sides have agreed to disagree on the subject of voting reform, it is very hard to have a civilised disagreement when the whole future of how we conduct our politics is at stake.

Predictably, however, the week's biggest Cob-Lib bust-up arose over Prime Minister David Cameron's decision to make a speech highlighting the impact of immigration on local communities.

Lib Dem Cabinet colleague Vince Cable said his words were "very unwise" and that the PM risked inflaming extremism.

Partly this was down to the timing of the speech, three weeks before some local elections in which the British National Party will once more attempt to make inroads.

But it also exposed real disagreements over the issue at the heart of the Coalition, with business secretary Dr Cable consistently arguing that putting a cap on immigration will limit firms' abilities to recruit key workers.

The Lib Dems have pointed out that Mr Cameron's wish to take net migration back to the levels of tens of thousands a year rather than hundreds of thousands is Conservative, as opposed to government policy.

The Coalition Agreement speaks merely of an "annual limit" on people coming to the UK from outside the European Union for economic reasons, making no reference to specific numbers.

One of the commentators who openly speculated this week that the Coalition might not see out its five-year term was the constitutional expert Vernon Bogdanor.

He pointed out that while the leaderships of both parties will almost certainly want to hug together until the end, the fate of coalitions is determined by restless, committed party members whom leaders cannot always control.

Mr Bogdanor is right to point out that it is the wildly differing nature of the two parties' memberships that gives the Coalition its inherent instability, while the good relations between their respective leaderships have hitherto been its biggest strength.

If this week's events are anything to go by, however, that may not always be the case.

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Saturday, April 09, 2011

A listening government - or a government in retreat?

Of all the changes introduced by the Coalition government since it took office last May, it is fair to say that its proposed reforms to the National Health Service have been the most politically controversial.

What about the cuts, I hear you say? Haven't they caused much more widespread public anger and made a much deeper impact on local communities?

Well, yes. But there was a broad political consensus dating back to well before the general election that spending cutbacks needed to be made – the only real disagreement being about the extent of them.

More importantly, the Coalition had a mandate for them. Labour lost the election primarily because, rightly or wrongly, the party was seen to be in denial about the size of the deficit and the remedial action needed to address it.

By contrast, the NHS reforms were not even spelled out in the Coalition Agreement, which infamously promised that there would be "no more top down reorganisation of the NHS."

Indeed, the agreement implicitly accepted that Primary Care Trusts would remain, promising a stronger voice for patients locally through directly elected individuals on the boards of their local PCT."

However when the legislation was published, it turned out that health secretary Andrew Lansley was proposing the abolition of PCTs and the transfer of their entire commissioning role to GPs.

Much of the anger felt by Liberal Democrats over the reforms can be traced back to this piece of perceived duplicity on Mr Lansley's part.

There is said to be anger in Number 10 at the way Mr Lansley has handled the reforms – but to my mind the fault lies more with Downing Street for not paying sufficient attention to their likely political impact.

As with the Forestry Commission sell-off debacle, No 10 seems to have been so focused on deficit reduction in the government's early days that it took its eye off the ball in other, seemingly less contentious areas.

Deputy Prime Minister Nick Clegg must bear some of the blame too, for not realising the strength of feeling in his own grassroots against the proposals.

It is only since his party's Spring conference delivered a huge thumbs-down to the reforms that Mr Clegg has started to argue for changes to the legislation.

So it was no great surprise that, this week, the government was forced to announce it was taking a raincheck on the implementation of the reforms while it conducted a further "listening exercise" with the public and health professionals.

It amounted to an admission that the reforms had been introduced without the necessary buy-in from either the public or, more importantly, those people who will be charged with making them work.

Should we see it as the prelude to a dramatic U-turn? Or is it simply a belated effort by Prime Minister and ex-PR man David Cameron to 'sell' the proposed changes?

Time will tell….but Mr Cameron's apparent openness to changes in the legislation suggests this is more than mere window-dressing.

The backbench health committee of MPs, for instance, wants to see the new fund-holding commissioning bodies drawn from a much wider membership, including councillors and hospital doctors.

Although this is more in tune with the spirit of what was in the original Coalition agreement, any weakening of the central proposal to hand power to GPs will be seen as a major political reverse for Mr Cameron.

The political commentator Benedict Brogan said of this week's events: "The underlying impression was one of an administration in retreat, forced to trim on policy because it got the politics wrong."

Mr Cameron is finding that the line between being a "listening government" and a "weak government" is sometimes a very fine one.

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