The first is that few people seems to know what Lansley is doing and that he is losing the confidence of Number 10 and Number 11. Clearly Lansley chose badly to launch into his re-organisation with so much gusto, setting an impossible to meet timetable. The Department of Health, which had said the Health Bill would appear in October, then "before Christmas", now say that the Bill will be published in January. The DoH say that they are having problems addressing the 6,000 replies to the White Paper consultation (including one from yours truly). Well, to be honest, with the largest re-organisation in the NHS's 60 year history, what did Lansley expect? A competent minister would have realised that his timetable was unattainable. But it is not the incompetence that is the most worrying, it is the arrogant authoritarianism that exudes from Lansley: he always behaves as if he can never be wrong.
Andy Cowper says that an insider suggested to him that there could be ministerial changes in the Department of Health. Perhaps this will mean that the DoH will concentrate more on the £20bn "efficiency savings" and less on Lansley's uncalled-for re-organisation. Stephen Dorrell, chair of the Health Select Committee, and Sir David Nicholson, NHS Chief executive, are both in favour of making the "efficiency savings" the priority. Lansley, however, would not like to see his big idea playing second fiddle, so presumably the only way to switch the priorities would be for Lansley to be given another job in government.
Another interesting point from Andy Cowper comes from his reporting of an answer by Health Minister Earl Howe in response to a question about Any Willing Provider. Howe says:
"The drive to competition and ‘any willing provider’ is a shorthand away of saying that Monitor is there to police unfairness in competition; not to drum up artificial competition where there is none. Where services work well, delivering good outcomes, I don’t think services have much to fear. Where they’re falling short, getting too expensive or could be more cost-effective, there ought to be scope for other to do better."This should make the free-marketeers cringe. Those obsessed with the free market say that quality and cost-effectiveness only emanate from competition. Howe is saying that if a monopoly provider is cost-effective and high quality then there is no need to apply competition. Interesting volte face.
In fact, this seems pragmatic. Outside of the metropolitan areas, hospital trusts are often monopoly NHS suppliers with no local private providers. Such trusts are clearly NHS and have high public support. Competition for competition's sake would upset a lot of local people, and in a shire county, those people will mostly be Tory voters. So basically, competition will only be forced on a county district hospital if it is performing badly. Actually, this sounds rather Blairite, a bit like the New Labour policy of forcing failing schools to become academies.