The Case of The Duplicitous Mr. Lansley
“You fill me with interest,” said Holmes. “Pray give us the essential facts from the commencement, and I can afterwards question you as to those details which seem to me to be most important.” (The Adventures of Sherlock Holmes: The Five Orange Pips)
The Coalition government has big plans for the NHS. Any attempt to question these plans is met with cheap jokes and derision. Any opposition to them is met with loud bullying. The Prime Minister yesterday labelled the British Medical Association as just another trade union and dismissed their concerns. Naturally. What do doctors know about the NHS? This is the second time recently that his words have hues of “the enemy within”, after Cameron called public servants “Enemies of Enterprise” in his speech for his party’s Spring Forum.
The man pioneering these plans, the cabinet’s quarter-back on this issue, is Andrew Lansley.
Andrew Lansley looks reasonable and even kind. He sounds honest and passionate. His self-published résumé makes much of the fact that his father worked for the NHS all his life. His eldest brother trained as a teacher and his younger brother is a policeman. What objection could anyone possibly have to a man like that re-organising the NHS? None in principle. But the selection of the candidate in charge of an institution as precious as the NHS merits great care. It merits a look at underlying philosophies; a look at motives, both stated and obscure; a look at conduct and propriety of process.
Andrew Lansley claimed £78,370 in MP expenses between 2004-05 and 2007-08. That’s an average of almost £20k each year. When details emerged at the time of the expenses scandal, he was made to pay some of it back by David Cameron. The following year (2008-09) he claimed £48,376.14.
Andrew Lansley associates himself closely with an array of free-market-worshipping think-tanks and vested-interest lobbying groups, including an organisation called 2020 Health. He has described them as “providing valuable impact to health policy”. They are, according to their literature, an “independent grass-roots think-tank, funded by people like you, for people like you”. They are in fact heavily funded by large pharmaceutical and health conglomerates. Their Chairman in a former Tory Health Minister and UK CEO of an international network of private health insurers. Their founder and CEO is a former Tory party parliamentary candidate. This is only the tip of the iceberg. I advise the reader to look at this 15-minute film for a fuller impression.
Andrew Lansley’s private office received a contribution of £21k from John Nash, chairman of Care UK, and his wife. A small part of the bumper £200k donated by Mr Nash to the Conservative party in the last five years, matched by Dolar Popat, founder and chief of the TLC Group, who was recently handed a peerage by Cameron. Popat’s contributions include a gift of £25k in July, registered a week after the reforms were announced. A spokesman for Mr Lansley said: “Donations from private individuals in no way influence policy-making decisions.”
What would we call the conduct described above if it pertained to the government of, let us say, a central African state?
“It is an old maxim of mine that when you have excluded the impossible, whatever remains, however improbable, must be the truth.” (The Adventures of Sherlock Holmes: The Adventure of The Beryl Coronet)
In yesterday’s PMQs, the Prime Minister misquoted (for the second time in as many months) the shadow Health Secretary John Healy as having said:
“No-one in the House of Commons knows more about the NHS than Andrew Lansley… these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley.“
Here are some pertinent parts of that same quotation, found in a speech to the King’s Fund, that Mr Cameron left out:
“No-one in the House of Commons knows more about the NHS than Andrew Lansley… The Health select committee concludes – in so many words – and as I believe, that these are the wrong reforms at the wrong time, “blunting the ability of the NHS to respond to the Nicholson challenge” to improve services to patients and make sound efficiencies on a scale the NHS has never achieved before. But these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley… I acknowledge the ambition but I condemn this as the core philosophy being forced into the heart of the NHS. It’s wrong for patients. It’s wrong for our NHS. It’s wrong for Britain.“
In that speech, John Healy went on to say:
“In politics and public policy I think we often look and talk too much about ‘what’ we’re doing, and not enough about ‘why’… These why questions have a straightforward answer. Andrew Lansley is a Conservative. Like Oliver Letwin, George Osborne and David Cameron – who’ve all now given him backing – he believes in the free market… They believe that competition drives innovation, that price competition brings better value, that profit motivates performance, and that the private sector is better than the public sector.“
We have nothing sinister in mind, drones on Cameron. We have the founding principles of the NHS at the basis of any reform. Nick Clegg moves his head up and down in the background, in rhythmic agreement, like a dashboard nodding doggy.
But what are those founding principles? Here they are from the horse’s mouth, in a truly extraordinary speech made on the tenth anniversary of the NHS by Nye Bevan, its creator under Attlee, more than half a century ago:
“Two main conceptions underlay the National Health Service. The first was to provide a comprehensive, free, health service for all the people of the country at time of need. The second was the redistribution of national income… the best way to finance the scheme, the fairest and most equitable way, would be to obtain the finance from the Exchequer funds by general taxation, and those who had the most would pay the most. It is a very good principle. What more pleasure can a millionaire have than to know that his taxes will help the sick? The redistributive aspect of the scheme was one which attracted me almost as much as the therapeutical.
We shall see how civilised hon. Members opposite are. To them, the financial principles are much more important than the therapeutical principles.“
We have changed, protest the government. These reforms are purely practical, not driven by ideology. This is not privatisation through the back door.
Here is what Mr Lansley said in his speech A Vision for The NHS in 2005:
“I came into politics because I saw how Margaret Thatcher’s Government created Britain’s enterprise culture. Twenty years on, we need to be the Party that will transform Britain’s public services. Unlocking social enterprise to match the enterprise revolution of the 1980s in industry.“
In any case, says Cameron, “we have ruled out price competition in the NHS.” What’s more, Andrew Lansley says in an interview with the FT:
“Our modernisation plans have always been about competition on quality, not on price.”
“There are two choices: a regulated price, or opening up progressively to price competition… if the standards required to be met and the quality of information to purchasers and patients is established, then I believe it will be right and secure to permit price competition.“
Or maybe I did not misunderstand. Maybe Mr Lansley and this government have a complex relationship with the truth. And wouldn’t that be reason enough not to trust them with the demolition of this most cherished of services?
“Holmes,” I cried, “I seem to see dimly what you are hinting at. We are only just in time to prevent some subtle and horrible crime.”
“Subtle enough and horrible enough… He has nerve and he has knowledge.”
(The Adventures of Sherlock Holmes: The Adventure of The Speckled Band)