Andrew Lansley was a disaster who deserved to be sacked
The former secretary of state took a wrecking ball to NHS structures, alienated every interest group and patronised those who disagreed with him.There should be no sentiment about Andrew Lansley’s departure as health secretary, no matter how hard he worked, how gutted he is to lose the Tory health brief after nine years or how much he cared about the health service. By every measure of high political office, he was a disaster and he deserved to be sacked.
As a strategist, he failed to look for the most pragmatic way to achieve his desired outcome. He simply would not recognise that taking a wrecking ball to NHS structures – at a time of intense financial stress, rising demand and the necessity for widespread changes to clinical practice – was foolish. He compounded this mistake by imposing a structure that resembles a London tube map.
Compare that with Michael Gove’s pragmatic approach of bending the existing academy programme to his will.
As a politician, Lansley managed to turn virtually every interest group against him, gave the opposition almost limitless opportunities to attack and lost the confidence of the public. He was so inept that even after the extraordinary spectacle of “the pause” – when the government just about managed to get the policy back into some sort of order – he again careered into a political ditch as it went through the Lords. Sharp, charming health minister Earl Howe had to tow him out.
Lansley was a shocking communicator, from ill-tempered media interviews to the hectoring tone he adopted with the professions. His idea of consultation was to repeat what he had said in the hope that this time you would finally concede he was right. Ridiculing managers as “bureaucrats” was just one indicator of his ineptitude – alienating with a single word the very people who had to implement his reforms.
So what has he left for Jeremy Hunt? The new secretary of state has arrived at a particularly sensitive time.
The mandate with which parliament will lay down its priorities for 2013-15 and beyond is out for consultation until 26 September.
This will set the boundary between the political influence of ministers and the operational independence of the NHS commissioning board. Lansley had promised to take the politics out of the day to day running of the NHS. Now Hunt has to decide how he will interpret that. Having just taken on “the biggest privilege of my life”, Hunt may be surprised at just how little direct control of the NHS is envisaged for him.
It is tempting to construe Lansley’s departure as further strengthening the already near-omnipotent position of Sir David Nicholson, the commissioning board chief executive, but that does not necessarily follow. Hunt will not be there simply to provide a more credible front for Lansley’s reforms; he will want to be seen to set his own priorities. He can be expected to champion choice, and may well energise the use of private sector providers. He will also want to stamp out local fires on care rationing.
He can be expected to be pragmatic. While Lansley revelled in the detail, Hunt will want to focus on what works and what can be achieved.
A serious concern is that his priorities may be short term and election focused. On reconfiguration, for example, Lansley eventually came round to the need to concentrate some services in fewer, high quality centres.
Pushing through such changes is essential if the NHS is to have a hope of maintaining quality while finding savings, but it will require strong political nerves and an acceptance of how crucial these changes are to the health service’s future. The temptation for Hunt to stall on these changes until after 2015 will be strong. (He has done the usual constituency campaigning to protect local services, in his case Haslemere hospital and the Royal Surrey A&E, although, of course, it does not necessarily follow that he will adopt the same approach nationally.)
As the tunnel of public sector cuts gets ever longer, he will be needing to balance the great pressure in healthcare with the crisis in social care. Under Hunt, the NHS budget could get more permeable, moving money across to social services under the guise of integrated care.
And finally there is the Francis inquiry (into deaths at Stafford hospital), now reporting in October. In the absence of any stronger indication of his likely response, it is worth noting that as shadow minister for the disabled he expressed concern about the detrimental impact of bureaucracy and regulation on providers. There is a grave risk of the government over-reacting to the Francis inquiry. It will be to the benefit of the NHS and patients if he keeps his questioning approach to regulation to the fore when deciding his response.
This article was published by Guardian Professional at: http://www.guardian.co.uk/andrew-lansley-disaster-deserved-sack?
Tags: Andrew Lansley, Health Direct, Health Professionals, National Health Service, NHS, preventable crisis