Health secretary circulating transcript of interview by deputy prime minister in January endorsing NHS reforms
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Andrew Lansley is irritated that Nick Clegg is rubbishing his NHS reforms after hailing them in January. Photograph: Martin Argles for the Guardian
If you want to know why Andrew Lansley is spitting tacks right now look no further than Andrew Marr.
On Marr's programme on Sunday Nick Clegg trashed the original Lansley blueprint for the NHS as a "disruptive revolution". The deputy prime minister felt free to criticise the health and social care bill as "bad" because he has reached agreement with David Cameron on some of the key changes. Lansley has been sidelined.
This is very hard for Lansley to take because Clegg hailed the reforms just a few months ago on the same Marr programme as a fusion of Liberal Democrat and Tory thinking. I wrote this morning that Lansley has been circulating to colleagues the deputy prime minister's remarks on the Andrew Marr Show on 23 January:
AM: Huge change to the NHS just coming down the line. Was that in the Liberal Democrat manifesto?
NC: Actually funnily enough it was. Indeed it was. We were one of the primary critics in opposition of what we felt was a top...
AM:...I don't remember you saying you were going to get rid of Primary Care Trusts and pass it down to GPs.
NC: We certainly said we were going to get rid of Primary Care Trusts. We said we were going to get rid of strategic health authorities. I remember constantly on the stump saying to people that our NHS was...
AM:...what is so bad about the NHS...
NC:...well can I just...
AM:...that this has to be imposed on it because it's going to be an enormously complicated, probably quite expensive and certainly controversial change?
NC: What it seeks to do is something incredibly simple, which is make sure that patients are right at the centre of the NHS; that their wishes and their needs are absolutely the guiding principle of the decisions that are taken. And that's why we've asked the people who know the patients best - the GPs - to play a greater role in deciding where that patient goes, where the money goes in the system.
AM:...but their job is to look after us...
NC:...but can I just...
AM:...not to shuffle money around.
NC:...can I just complete the thing? At the moment where the money goes in the system is entirely driven by unaccountable layers of administration and bureaucracy - not accountable directly to patients, not accountable directly to local communities. And one of the hidden virtues of our reforms, something we campaigned on in opposition very vigorously indeed, is to give dramatically new powers to directly elected local authorities, particularly in providing oversight on how public health is provided in areas. And I think...
AM:...this is a slightly different thing that I'm talking about. I'm talking about giving 80% of the budget to the GPs, and I'm just saying to you that people expect their GPs to be thinking entirely about their clinical well-being and there's a danger that it's going to put a sort of mistrust into the relationship between the GP and the individual.
NC:...but you can't look after the clinical...You can't look after the clinical well-being of a patient if at the same time your decisions don't lead to financial consequences. It's a very simple idea. At the moment you've got basically bureaucracy answering to the Secretary of State at the top in Whitehall taking decisions for patients. We're reversing that and saying no, the decision should be taken because of the needs of the patient, and I think that will lead over time - I agree it's an ambitious programme of reform - but over time I think it'll leave patients with a feeling that they are at the centre of it. They're not constantly at the beck and call in a system over which they've got very little control.
One department of health source said:
Our health plans represent both Lib Dem and Conservative thinking.
The date of the Clegg interview on Marr is significant. Just eight days later, on 31 January, the health and social care bill received its second reading in the House of Commons. Not a single Lib Dem voted against the measure. Only two Lib Dems who were present, John Pugh and Andrew George, abstained.
Three Lib Dem MPs – Gordon Birtwistle, John Leech and Andrew George – made speeches during the debate which lasted five hours and 45 minutes. Birtwistle spoke in favour while Leech and George raised concerns. Birtwistle and Leech voted in favour of the bill. George abstained. A total of four Lib Dem MPs – Andrew George, Gordon Birtwistle, John Pugh and Stephen Lloyd – intervened on other speakers during the debate. Pugh abstained, Lloyd voted in favour.
So why the change of heart by Clegg between his two appearances on the Andrew Marr Show? That would be down to the vote against the NHS reforms at the Lib Dem spring conference in March.