Editor's blog Tuesday 19 October 2010: The late Equity And Excellence legislation?
Here we sit, in a very short-lived PCT (standing for pre-CSR tension).
Which I will illuminate with a story from a colleague who had a chat with an external consultant to the Department of Health earlier today.
Said external consultant reports that Health Secretary Andrew 'The Liberator' Lansley is, contrary to appearances, distressed by the adverse "commentary" that his White Paper has been generating.
This person also reported that The Liberator had been working on the principle that if he doesn't get his reforms embedded, legislatively speaking, by the end of the year, he may have missed his moment.
Interesting. My source for this is a good one.
Now clearly, this is essentially gossip. But it seems like a piece of gossip that is true.
The half-baked nature of the White Paper proposals, including the draft version's plans for GP consortia to be without accountable officers, reeked of rush. Latterly, it would appear that the Coalition Cabinet has supped full on the horrors of Tony Blair's 'A Journey' (business class, natch), and swallowed his line that reform must be driven through fast hook, line and sinker.
And this morning, the health select committee opened its enquiry into commissioning, with NHS top boss Sir David Nicholson and colleagues attending.
Unfortunately, we can only report on the first thirty minutes or so - as a technical fault halts the broadcast (and perhaps recording) of proceedings just at the point where GP Dr Sarah Woolaston MP told the NHS and DH supremo "the fact remains that this is a massive reorganisation". The video ends with this section ad nauseam. Given Mr Lansley's increasingly weak defence of the E&E reforms as 'bottom-up', it's like being trapped in The Liberator's most proctological nightmare.
There were some telling points made in what we could see of the session. When questioned about the abolition of the intermediate tier of management (SHAs), Nicholson replied, “I am sure you will have some kind of sub-national mechanism … a variety of mechanisms whereby the National Commissioning Board will be powerful nationally but active locally … NCB will have to have some mechanism locally”.
Just as telling was something non-verbal: Dame Barbara Hakin's face was a study in glumness.
But on the subject of the timing of the bill, Nicholson was forthcoming. Originally, rumours had suggested that the response period to the consultation would be just weeks.
However, Nicholson's opening response included the fact that the DH "response to consultation will come out in December as a precursor to the bill". This was, as a colleague points out, the timeline given in his recent 'Dear Comrades' letter.
The Times' David Rose bothered to follow it up, and confirms that DH will only say the DH response will be in December and the legislation is to follow "shortly after".
This could mean that the legislation may not come before the house in 2010 - especially if the Parliamentary schedule gets derailed.
If the health bill does make it to the Commons in 2010, it will be in the form of very sketchy enabling legislation, leaving all the detail to be filled in by statutory instruments (AKA Orders In Council) from the Secretary Of State For Health.
(And there is an interesting thing about statutory instruments: they limit Parliament's room for manoeuvre. Parliament can accept or reject a statutory instrument, but cannot amend it.)
In short, it could all start looking and feeling a bit (OK, even more) off-schedule.
If so, it will matter. A lot.
The CSR tomorrow will be a game-changer for the Coalition Government. It is true that not all the cuts will be loaded into the first year, and it does not matter. Real people will be losing real jobs, which pay real mortgages. Real services will be reduced or stopped.
The losers of jobs will be competing for jobs that the private sector does not currently appear to be producing. The losers of services will be angry.
To weather the guaranteed storms of unpopularity, the Conservative Party will be looking to see that it is gaining traction with its reforms. If health - budget-protected health, remember, now the Conservatives are "the party of the NHS" - looks and feels detail-lite and behind schedule, that will not be reassuring.
A Liberator may be many things, but late is not one of them.