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Editor’s blog Thursday 2 July 2009: Why Andrew Lansley won’t be the next health secretary

Hello. You will probably have already seen the row over Sally Gainsbury of Health Service Journal’s reporting of what Andrew Lansley said to her about workforce pay negotiations. She asked if he was happy with negotiations between the unions and NHS Employers beginning before the announcement of the next CSR.

In sum, Lansley told Sally Gainsbury that there was no problem; that it didn’t need government involvement; and that “pay determination shouldn’t be set in line with financial allocations; it should be set in line with what is necessary to recruit, retain and motivate the workforce that you require. It’s a fallacy to say the amount of pay for 2012-13 depends on how much money the government has”.

The somewhat staggering nature of this latter comment prompted his office to issue a statement to Sky News to the effect that Sally Gainsbury had misinterpreted his remarks, and that pay rises should be below the rate of increase in NHS funding.

Leaving aside the fact that most sensible people think that whatever politicians promise now, the rate of NHS revenue funding increase beyond 2011-12 (and perhaps before) will be very small if it is positive at all, there is a remarkable thing here. Lansley’s team appear to be making the not-inconsiderable mistake of accusing a well-respected journalist of making up a quote.

There are journalists who I could believe would do that. Sally Gainsbury is not one of them.

I’m very unclear whether they deny outright that Mr Lansley said what he said. Given that HSJ print it in quotes, I will put a considerable wager on them standing by it.

His reply contained another extreme foolishness: “The health care employers, frankly, ought to have some idea of what their underlying financial baseline is.”

What. The. Fuck? They are going to have no idea what the underlying financial position will be in the period in question. They are not Mystic Meg, Russell Grant or Johnathan Cainer. The only possible explanation for this remark is that the NHS will no longer be tax-funded by the point in question. This is not Conservative Party policy (I checked this, after getting a fact wrong in a presentation yesterday and being rightly corrected by a speaker affiliated to the party).

Unexpected foolishness
Now I have had a great deal of respect for Mr Lansley. He has made what seems like an unprecedented effort by an opposition health spokesman to understand the real problems of the NHS, and tirelessly travelled the country meeting staff from all levels of all types of organisations. Even those people who do not share his politics speak well of his understanding of the NHS.

Accordingly, I find both this very stupid remark somewhat out of character (even if we allow for the very hot weather). Equally, the crass attempt at media management by his team is an own-goal out of the top drawer. Hats off.

Gentlemen and players - the sequence of health secretaries
This brought back to me what started as a tongue-in-cheek idea for a blog post, discussed over drinks at the NHS Confederation bash in Liverpool. The thesis chimes with this moment of madness: it is that Andrew Lansley is not going to be the next Health Secretary.

This is not rooted in the occasional hint that Cameron has given that the party is “not there yet” on health policy. It is rooted in two observations.

The first observation is that Lansley has studied the NHS so long, he has to some extent gone native. He can out-policy some policy people. He certainly knows his subject (which makes this outburst all the more bizarre). He also probably therefore knows that making some nasty cuts runs high risks of producing some nasty side-effects and unintended consequences. If NHS spending has to be cut seriously, which many think could happen, the politics of it might require a barbarian butcher rather than a civillised surgeon.

More poetically, the health secretary job has of late alternated strictly between the old sporting duality of ‘gentlemen and players’.

This is certainly the case since 1997. Frank Dobson – old Labour gentleman. Knew not-too-much about the NHS; good teller of dirty jokes and media performer; not seriously involved in policymaking (couldn’t be, really, since manifesto commitments stuck Labour to Tory spending plans for almost all his tenure). Alan Milburn – player par excellence (although often using Simon Stevens’ brain), wanted to be NHS chief executive himself, to Alan Langlands’ considerable irritation.

John Reid – gentleman. “Oh fuck, it’s health”: a subject in which he had not interest (wanted MoD). As he admitted to Tessa Jowell when leaving the job, warning her off DH, “Don’t touch health - I’ve spent all the money”. Good public speaker, avuncular with menace.

Former Accenture management consultant Patricia Hewitt? Well what do you think? Yes, player: had to be to survive the shitstorm of Reid’s spending and the emerging Crisp deficits. Hard-line meant she had to be followed by an oil-on-troubled-waters gentleman, in the person of Alan Johnson. Gentleman – did very little seriously wrong, mollified the unions et al (leaving Ben Bradshaw to rile the BMA).

Now it is Andy Burnham: former health minister under Hewittt, former NHS Confederation parliamentary officer. Has to be deemed a player. Unlikely to be moved before the general election.

In the logic of this sequence, the next health secretary is therefore due to be a gentleman.

And Lansley is in the precise mould of a player.

Bob Sang obituary
The Guardian, by the way, runs a nice obituary of Bob Sang today.