I wish to examine the curious case of the possible resignation of Mr Norman Lamb. Many people will not have known until the last couple of days the importance of Mr Lamb. He is a trusted adviser to the Deputy Prime Minister. He is a Lib Dem NHS expert, who has said that the NHS policies need changing.
Mr Lamb we are told has been in continuous discussion with Mr Clegg about the NHS and the government’s proposed reforms since May 2010. In that case, Mr Lamb must have been actively involved in Mr Clegg’s participation in drafting the crucial July 2010 White Paper setting out the need for and nature of the very wide ranging NHS reforms.
Mr Clegg was one of three signatories of the Preface on the title page of the White Paper, “Equity and Excellence: Liberating the NHS”, with Mr Cameron and Mr Lansley. The one page Preface said the following:
“We will make the NHS more accountable to patients. We will free staff from excessive top down control…
“We will empower health professionals. Doctors and nurses must be able to use their professional judgement about what is right for patients. We will suppport this by giving front line staff more control.
“Of course our massive deficit and growing debt mean there are some difficult decisions to make. The NHS is not immune from these challenges. But far from being reason to abandon reform, it demands that we accelerate it…”
This seems to be crystal clear. Mr Clegg with the help of Mr Lamb signed up to a radical programme of health reform. There were no ifs and buts, no minority report, not even some precautionary spin against the details. Inside the document they co-authored it said all PCTs would be abolished, “Money will follow the patient”, “providers will be paid according to their performance”. The document pledged £20 billion of efficiency savings, and a reduction in NHS management costs by a dramatic 45% in four years. “We will radically delayer and simplify the number of NHS bodies”. The NHS providers of health care were to be converted into social enterprises, freed to compete. The private sector was also to be invited to compete to provide better health care. There were to be maximum prices, but no restriction on price competition beyond that. Monitor was to have a duty to promote competition, to ensure better quality and value for money for the NHS. The approach of providing good quality care free at the point of use was preserved but much else was to change to deliver it in a patient friendly way.
Many people now say they did not understand the nature of the NHS reforms, or how wide ranging they were. Many claim not to have read the Conservative Manifesto which had in it the main outlines, or the Lib Dem one which also covered some of this ground. It is strange however that those most concerned about the NHS today claim they were in ignorance of the scope of the changes. Why did they not bother to read the seminal consultation document, this White Paper, issued ten months ago? Surely when this was launched with considerable publicity it was the time to catch up and make an effort to understand the plan. Why didn’t they have the row then before the legislation passed the Commons easily? Where were they when the Bill made swift passage?
Mr Lamb must have read the White Paper and given his views before and afterwards. Mr Clegg was presumably broadly happy with the document, and in his interview yesterday still seems to be happy with the main themes within it.
Mr Lamb needs to be careful. He is in danger of being used by the enemies of the government and the enemies of Health reform at a sensitive time for the government he supports. If he makes Mr Clegg flip flop on his robust support for the White Paper he weakens his party as well as the government. It just leads people to ask why did Lib Dems sign up for these reforms in 2010, only to seek to overturn them in 2011 at the first sign of concerted Labour and Union opposition? May-July 2010 was the time to show political caution, the time to cause trouble on these proposals. For a signatory to the White Paper 2011 is the time to show some steel and determination to put through the vision they signed up to ten months ago.