Andrew Lansley will be given the public backing of both David Cameron and Nick Clegg today, as the leaders make clear that they trust the Health Secretary to force through all necessary changes to his NHS reform plans.
Senior Tories and Lib Dems have questioned Mr Lansley’s appetite for altering reforms, suggesting that he is too involved in the detail and wedded to his blueprint to sacrifice key elements because of political pressure.
But the Tory and Lib Dem leaders will effectively reject this argument today when they appear together to stress that they are “listening” to concerns. This will make it harder for Mr Cameron to sack Mr Lansley if the plan goes wrong.
Their support comes amid warnings from George Osborne, the Chancellor, that the unravelling of Mr Lansley’s reforms could undo the work in opposition of “decontaminating” the Tory brand on health.
Yesterday Mr Clegg talked up the extent to which the Government was prepared to change the shape of the reforms. “It would be irresponsible to press ahead regardless. That would be reckless,” he told the radio station LBC, adding later that it would “absolutely” look again at GP commissioning.
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However, it remains far from clear that the Government is planning to make more than minor tweaks. No coalition figures are publicly suggesting that primary care trusts, which are due to be scrapped in 2013, should wholly or partially remain in place.
Today the government will announce the creation of an “NHS Future Forum” under Professor Steve Field, former chairman of the Royal College of General Practitioners and long-time supporter of the Lansley reforms, to advise ministers on potential changes.
Sir Stephen Bubb, from the voluntary sector organisation Acevo, will chair a choice and competition panel.
The Deputy Prime Minister suggested yesterday that the 2013 deadline might slip, although Department of Health sources suggested that 2013 was still the deadline for groups of GPs to take over healthcare spending, despite what Mr Clegg said in the House.
Mr Clegg also made clear that his priority was to calm fears that the private sector could squeeze out public hospitals. However, much of this has already been addressed in recent weeks, with changes to give NHS work only to “any qualified provider” rather than “any willing provider”.
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Government sources suggested yesterday that ensuring the medical profession was no longer hostile to the reform plan was a key objective of the “pause” in the legislation. Many critics suggested that they would endorse a compromise plan set out by the Health Select Committee on Monday.
Three key sticking points — on making GPs more accountable, expanding those involved in budgetary decision-making, and reducing the regulator’s power to drive competition — are addressed in the committee’s report.
Professor Chris Ham, chief executive of the King’s Fund, a think-tank, said the report contained recommendations that would improve the Bill. “The real choice is not between the status quo and change, but between the right reforms, executed well, or poorly planned reforms that could undermine NHS performance,” he said.
His sentiments were echoed by Nigel Edwards, acting chief executive of the NHS Confederation, who described the committee’s report as a “forensically accurate” view of the problems with the reforms. However, he questioned the need for more political input into NHS decision-making.
Nurses and doctors are backing the idea of broadening those involved in commissioning decisions. Under the select committee’s proposals, Mr Lansley’s envisaged GP consortiums would become local commissioning authorities.
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They would contain a majority of GPs, but also include a hospital doctor, a nurse, a public health expert, a social care representative and a councillor.
Mr Lansley is likely to agree that the GP consortiums contain a broader group of representatives but not that they are replaced altogether. Another area of compromise is likely to be the use of “health and wellbeing boards”, which were a key part of the Liberal Democrat manifesto and could be given more say over GPs’ plans.