With a certain grim inevitability, dear old Lord Lansley, Our Saviour And Liberator has made a return to the fray with this extraordinary interview with the Institute For Government.
It would be fair to say that the past near-decade away from the health policy scene have not been a period of introspective reflection and self-examination for a man who always said that those who supported his failed 2012 legislation were "absolutley right" and its opponents "completely wrong". A Manichean to his fingertips, is OSAL.
So, what does the Good Lord have to say for himself? Well, the only fault of his was trying to do too much, too fast, apparently.
Right. And if you buy that line, I've got some cryptocurrency I can sell you.
Lord Lansley says “the central thing in the course of my period in office was I wasn’t particularly fussed about extending competition in the NHS at all. People imagined that was what I was doing, but I wasn’t doing that. What I was doing was extending patient choice, which is a different thing”.
OSAL adds, “there wasn’t external competition to NHS providers, there was a determination to hold NHS providers to account by the commissioning process.” Ahistorical doesn’t begin to cover this.
His aspirant rewriting of history continues: “NHS England has become so obsessed with its own powers that it’s decided the only way to manage anything is to acquire control of everything.
"Because the civil service, and indeed public servants generally, are obsessed with control, they are not obsessed with outcomes. And what I wanted them to do was to focus on outcomes, which would mean they would hold people to account for the outcomes … but not necessarily make themselves the owners of all of these providers. That’s, of course, what they wanted to do.”
It gets better: “The essential proposition was that commissioning should be led by clinicians and should be the central focus of NHS activity in delivering better outcomes within budgets. There was always too much complication around that. I was aware of that. “The trouble is, because I knew all the detail, people kept asking me about the detail, so I had to explain all the detail. But nobody else much understood it.”
AHEM AHEM A-FUCKING-HEM!
The delusions keep getting bigger and bolder: “as a major programme of transition, by April 2013 when all the new organisations came into being, I think it all worked really well. I think it all happened.
“And if I may say, in 2014, in advance of the next general election, NHS England published their Five-Year Forward View, and all the main political parties signed up to it. The only argument was about how much extra money the NHS was going to get.”
Of course, this is nonsense. The Holy Lansley Trinity of choice, competition and clinical commissioning drove precisely nothing in NHS change in the subsequent years. It was all about The Nicholson Challenge savings of £20 billion.
That was why Simon Stevens' subtle subversion of the 2012 Act with the Five-Year Forward View was as necessary as it was effective.
Calling Sir David Nicholson
The former Comrade-In-Chief may be interested to learn that Lord Lansley HAS Had Thoughts about him: “in the Department of Health, many senior positions were filled by NHS managers. And they, of course, had a completely different approach. They hated it all. They hated the reforms; they were the enemy within. Because they saw the reforms as handing power to clinicians, and by extension removing jobs and control from the hands of the NHS management.
"So, I had to negotiate aspects of the reforms with David Nicholson in order to keep him on board, and to keep the NHS managers on board, in order to keep the programme for implementation on track. But there were things like the continuation of commissioning support units and the form that commissioning support units took that I would not have done were it not for David Nicholson protecting his own people in the NHS and in strategic health authorities.”
Well, it's a take. Wrong of course, demonstrably and almost totally so, but clearly that's how it looks from Lansleyland. He goes on, “and I personally think it’s less true now, of course, because many of those have all moved out into NHS England and they’re trying to turn NHS England into the Department of Health.”
I mean, you've got to smile. This is just such inept, self-justifying crap that it would take a heart of stone not to laugh.
It gets even more [chef finger-kiss] with the following exchange:
GA: "One final question about your time as health secretary: looking back at the Health and Social Care Act now, what do you think its legacy is and will be?"
AL: "Well, the principal one would be NHS England."
Yes, that is the same Lord Lansley who, a mere few paragraphs above was slating NHS England.
I didn’t think it could get any better, but here it comes: “NHS England, from the government’s point of view, is an enormously successful innovation. It has taken control of the NHS, albeit it now wants to be a monopoly operation, it actually is the commissioning side, and it does hold providers to account now in ways that the Department for Health was never capable of doing, where the providers were always playing political games. They can’t play political games with NHS England because, unlike ministers, they don’t come and go.
“They can set a 10-year strategy. In 2019, they published a 10-year plan. The NHS has never had such a thing before. NHS requires NHS workforce plans, and they’ve never had one before, and NHS Education, and now NHS England working with NHS Education, will develop that.”
(They can't, and won't.)
“A 10-year plan for the NHS will be a striking long-term change for the NHS, and that will be the principal legacy from the 2012 Act.”
Remarkable, really. Lord Lansley's heroic capacity for self-deception is matched only by the poverty of his attempt to re-write history.
Nobody who was paying any attention will be fooled for even a second.