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Three Stabs and You’re Out

Posted by Dr No on 10 February 2012

cameron_clegg.jpgBroken Arrow is today staggering around, two daggers in his back. Earlier this week, Downing Street let it be known that there was a view that he should be ‘taken out and shot’; today, the editor of ConservativeHome has let it be known that three cabinet ministers want pretty much the same thing. That’s right: within the space of a few days, both Downing street and a bevy of cabinet ministers have let it be known: Lansley, and with him his blasted bill, must go. Other Tories, including Dodders, have been twiddling knives, but Dodders is a gentle man, and one suspects a stab in the back from him would be more Private Godfrey bear-hug than Corporal Jones bayonet.

Hacksaw got away with smashing the miners because there was sentiment in the country that their militant union ways were wrong. But no such anti-doctor, let alone anti-NHS sentiment exists: indeed quite the reverse. Doctors regularly top the poll as the most trusted profession, and the NHS remains the opium of the people. There may be – there always will be – opposition to these sentiments in some quarters, but there is no doubt that the great majority hold the NHS, and those who serve in it, as a much loved and valued core at the heart of our lives.

For a political party to embark, as the Tories did, without mandate or sizable Commons majority, on a path that put the iron fist of privatisation inside a velvet glove of choice, adorned with a glittering ring of clinical commissioning, displayed an alarming – these people are our government, for Heaven’s sake – degree of political naivety. From Day One, it has been crystal clear to Dr No that if the bill was enacted, not only would it destroy the NHS as a comprehensive national health service, it would, inevitably, as scandals like Southern Cross, Winterbourne View and the PIP implant fiasco became everyday occurrences, destroy any Tory hopes of electoral victory, not just at the next election, but for a generation. Labour in power for a generation, without effective opposition: a grim prospect indeed. For, whatever one may think of our two main parties, there is no doubt that either in power without opposition is a bus ticket to Hell.

Dr No has said before, and continues to say, there are two groups who can halt the reckless folly that is the bill. The first is GPs: if they won’t play ball, the bill wont happen. The Tory plan to let private commissioning in through the back door will be foiled, and even Dr No doesn’t think the Tories are stupid enough to turn round and welcome – and be seen to welcome - the vultures in through the front door. If the GPs say no, the bill won’t happen; and Dr Clare Gerada has been both bold and brave in moving her colleagues, most of whom want the bill withdrawn, in this direction.

The other group is of course Tory politicians. For many long dark months they have been blind to the dire threat the bill poses to their political future. Now, at last, there are signs that, both in Downing Street and in the cabinet, some have at last woken up to the grave danger staring them in the face. Broken Arrow is staggering around, two cold blades of steel lodged in his back. All that is needed now is for the third man to step forward, and insert the third, final and fatal last blade.


I really hope that this is a signal that the Tories are getting ready to rebel on the HSCB, but I won't believe it until it happens.

But we do not know who, or even if they are tories, there being more than three Lib Dems in the cabinet.

Most of the Tory sentiment against the bill is similar to my own comments at number nine on the ConservativeHome piece. The Bill has been amended into an incoherent mess, and is a distraction from the real priorities of the government.

The break up of the PCTs and handing of power to GP Commissioning Groups has already happened. These can already commission from private providers, and buy in commissioning expertise if required. Both of these were well established by the last Labour Government. The £20 000 000 000 worth of efficiency savings were in Mr Darlings budget of March 2010.

Steady as she goes, without this bill, would have been in the same direction, with only a few details differing. It is simply not worth expending political capital on.


Rebellion, or vested interests, or simply to get back at PM for other reasons, etc,etc? So, after reading Dr Phil's comment,

Read this ...

It's getting hot in there! ... and Dr Phil, is a U turn possible ... at all?

AM - Yes, ma'am, as you say. Dr No respectfully suggests this looks like reply tit for tat. We are going to see a lot more of this. Most of it will be dull, very boring, and based on wild nonsense. It's all beginning to feel a bit like a rough pub ten minutes before closing time - or the deadline to get the bill through.

Wise Tories won't want any of this. They will quietly appreciate that the bill is their bus ticket to the beach. Those who can will apply brakes before the bus slips over the ridge; those who can't will, if they have any sense, jump bus.

Boots - we presume they are Tories - to quote the original ConservativeHome post: "Speaking to ConservativeHome, three Tory Cabinet ministers have now also rung the alarm bell."

Dr No blows in the political wind like Churchill, while lacking any of Churchill's abilities. Sometimes he thinks the opposition is more important than the government, and at the moment he sees a bent and idiotic bunch of Tories heading for the very long grass. More moderate Tories are saying: hang on - the Poll Tax did for Maggie - and that was only the Poll Tax! If we wreck the NHS, then maybe we will never see another Tory government in our lifetime.

Seems eminently sensible thinking to Dr No. The last thing we want is one unbridled party in power. But if the Tories carry on as they are, that is what we will get - and it won't be the Tories.

The thing about the HSCB is that it does goe against the natural instincts of traditional conservatism; thrift and small government. It is manifestly neither of these and I did wonder if the grass roots might rebel against it. It seems that they have.

"Mr Cameron said he strongly supported the founding principles of the NHS, including "health care for all, free at the point of use, unrelated to the ability to pay".

Isn't that quote from this BBC article is what the NHS currently stand for and what everybody was fighting to preserve? Well, here is another guarantee that won't change, so fight already won!

I was one of the first to oppose that bill right from the beginning, but since the 5 pledges, I thought let's wait and see what the Lords say, and I will stick to that ... that said, I can't really understand those who oppose outright now that the bill has been amended - what are the basis now for opposition?!

Dear Dr No,

I think that the three were probably Tories, probably including IDS as he is very close to Tim Montgomerie, and Ashcroft as he funds Conservative Home. I read that blog occassionally and it is dominated by UKIPers lso not always representative of Tory grass roots.

One worrying development is that the HCSB is that it has become a Totem. David Cameron has today come out saying the bill is essential and backed Lansley to the hilt. He cannot back down without massive loss of credibility. Similarly to withdraw the bill would be to gift a goal to Labour. The issue is no longer one of how to reform the NHS but one of personal pride. That is not a good way to reform anything.

If the bill fails then David Camerons enemies in the party will have their knives in his back.

The Mail story out today, suggesting that McKinsey have in effect been drafting whole chunks of the legislation whilst simultaneously brokering privileged access for their corporate healthco clients to the Pongos at the Dept of Health AND to information on what is coming, will presumably up the pressure. It does add strongly to the narrative that the underlying reality of Lansley's Monster is a stitch-up that will allow the global HealthCos to get their claws into the UK taxpayer via the NHS.

It will also (I predict) stiffen opposition amongst healthcare employees yet further, as it makes clear that the private Healthcos would want to control staffing matters. Andy Cowper on his HealthPolicyInsight blog quotes one email from a McKinsey exec:

‘We had good discussions... on how international hospital provider groups may help to tackle the performance improvement of English hospitals. They would be ready to step in if there were £500million revenue on the table, can keep real estate and pensions with NHS, needs free hand on staff management. This may now be a time when both sides [the NHS and foreign firms] may usefully explore their position as an input into how policy would be shaped".

'Free hand on staff management' would, I guess, be widely interpreted as both 'more cheaper people doing jobs, e.g. noctors not doctors, HCAs not nurses' and also 'worse conditions of service if you want to keep your job so that we can cut costs whilst returning corporate profits'.

On the latter, Mrs Dr Aust comments often that the NHS runs on goodwill, and staff going the extra mile. But that is presumably sustained by a good wallop of what the ethicists call 'reciprocity' - i.e. the NHS does right by its employees, on the whole (or at least compared to the private sector) so they go the extra distance for the service and for the patients.

What happens to that if private providers take over big chunks of the service?

You might suspect that the question was the answer.

(PS no links, I'm afraid, as Dr No's sabre-toothed spam filter usually rejects anything with even one link in it)

"He cannot back down without massive loss of credibility. Similarly to withdraw the bill would be to gift a goal to Labour. The issue is no longer one of how to reform the NHS but one of personal pride."

Oh dear! We're doubting PM's integrity now, are we?! That he will 'vemently' support 'anything' that would harm the country for 'self'?!!! ... well, I'm afraid, that is nasty, besides, the evidence of PM's record so far points to the opposite! ... let's not forget, at the very least, that he gave himself a 25% pay cut soon as he took office, and said on numerous occasions that he doesn't care if carrying out policies that he believes are good for the country means that he would serve just the one term! This was his own principal talking! ... one of the very reasons why I believe he will break the record, because commitment + principal will always shine through! ... the very reason I question the commitment and principal of those who know naught about the NHS or the bill yet are still opposing without valid reason now! ... 'self'?

I know the media has been awash with such ridiculous talk lately, of people who know not suddenly declaring themselves 'expert' ... in such cases logic says 'follow at your own peril'!

To start with, ie the original bill, GPs were happy they would be given the reins but hospital docs were unhappy they were excluded - that has now been amended to include them. Then everybody was afraid the government was forcing an American cut throat for patients system where patients would go bankrupt to finance their health through vulture insurance policies - PM's pledged the current values and principal of the NHS are to remain intact, and he repeated that again and again ... already, over 50 foundation trusts are in support, are they all off the rails?

Even Andy Burnham, whom I respect and admire for being a peron of high integrity says here, although in high tone' as you would expect from an opposition, said that he wasn't against reform but that he wants it 'toned down', so, who's talking of 'scrap'?! Again to those who do, please give reasons since implementation has gone so far already, it would be crazy not to allow 'test' and return to naught at extortionate cost in times of need! The article here says Lansley may well be remembered for being 'the architect of the modern NHS', and it may well be so, or not ... but how will we know without 'test'?!

As for the 'risk assessment report' mentioned in that article, I think publishing it now would be unfair since lots of amendments have been decided already that it renders such report irrelevant as it's no longer representative of the true picture!

As for the 20 billion savings, as Dr Phil said, those were decided by Labour ... as I remember well, it was close to the end of their term in office, and when the QIPP was sought. I also recently read somewhere that PM has said that 7 billion of that have already been saved ... food for more thought ....

... not forgetting Lord Darzi, who a few months ago wrote an article, was it in the Telegraph?, saying that he wanted to see hospital docs having a role too, now done - and calling for more integration of service and questioning the line of accountability ... and that's what we are waiting to hear about from real experts scruitinising, not in the media but - at The Lords!

A modern NHS that breaks the monopoly that stifles opportunity, efficiency and innovation Alcatraz gang culture [if only evident by all the current unreasoned opposition] to one that will allow innovative brains like the docs and nurses who write here to shine like stars for the sake of their patients and be rewarded for it too, as they should too! ... and so, if their is a 'good' chance reform will do that, I, with all my eggs in the NHS basket, am 'very' willing to take the risk!

Modern vision, one which will remove cielings from above people's heads, and bottoms from those non deserving too ... one that will cut off the NHS rust with contrition to let the precious metal beneath shine through!

And I am waiting for the Lords to confirm this will be the case ....

Whatever the merits or not of the bill, it has now become a personal issue. David Cameron is an old friend of Andrew Lansley, and perhaps that personal loyalty has swayed him too much. A government is not a dinner party meeting of friends. It needs to have effective and coherent policies. The HCSB is no longer coherent. Indeed with monitor and the national commissioning board it is a further centralisation.

I am quite happy with some of the principles of the bill, but agree with mr Montgomerie of Conservative Home. It is a distraction from the real business of the govt. Any difficulties from the austerity will be blamed on the HSCB. I think Dave Herdsons analysis here is spot on :

Yes, I know Andrew Lansley was a good boss to DC in the past, and with all due respect to Dave Herdsons analysis, I can't believe that top leadership, although always endeavouring to gather support and influence votes as everybody else would as per human nature, that it would do so and neglect to put country first and foremost, as is their 'duty' to do so and the reason why they are at the top. Hence IMHO the circulating argument that everybody is running around just for the sake of vested interests and the h*ll with all else is not only misleading but, if true which I am sure it is not, indicate that we already live in a jungle ... and that there is no point to try anything at all including attempts to grow, advance, reform, anything since we are all savage that is!

I still believe in honour and integrity and believe that is why this fierce debate on the NHS is happening; to make sure the end result will be of benefit for all ... cos I 'think' our leaders, and I too, ain't savage Dr Phil, eh? ;-D

Dr A - Dr No apologises for the sabre-tooth tiger in his spam-catcher - he had hoped it had calmed down. If you can't get links through in anchor (link) tags (if that is what you were trying to do - couldn't find anything in the logs to say what had been rejected or why), you may be able to include them as the url (which will be converted to a link - see the comment two above).

Dr No agrees with Mrs Dr Aust - much of the old NHS ran on good will, and that will disappear faster than it already is once a commercial climate comes to the fore. No £6,200 McBennett junkets for the rank and file!

Dr No has also noticed that the NHS reform debate is becoming increasingly up close and personal. Maybe this is the inevitable end-game in these things; but it still risks becoming an unhelpful distraction. Nonetheless, Dr No is also inclined to suspect that Hot Burning Coales' recent BBC One appearance may have hotted things up a bit...

But most of all, Dr No hopes that rank and file Tory MPs will wake up the fact that, whatever their ideological leanings, the HSCB if enacted is their passport to political oblivion. As he noted earlier, the last thing we want is any party in power unopposed by an effective opposition.

I have to say that, if 'Burning Hot' Coales is the best that the Govt media managers can 'front up' for the media - in terms of "GPs speaking out for the Bill and the reforms' - then they must be really desperate. Her pronouncements always strike me as, not just ill-informed/inaccurate, but borderline incoherent. But they are chock-full of impassioned rhetoric, of course - rather like what one often hears from politicians. I wonder if Dr C is destined to be medicine's answer to Katharine Birbalsingh?

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