From Janet Daley:
To understand exactly why Mr Lansley is being so recklessly brave, it is necessary to go back 25 years to the late 1980s, when a young and dynamic politician named Ken Clarke set about trying to reform the NHS. Mr Clarke realised that the service was bureaucratic and hopelessly inefficient. He attempted to address this problem by taking power from the producer interests that dominated this vast, ramshackle and Stalinist organisation. His solution was heretical ? give power instead to the patients who used the NHS and were often treated with contempt. The mechanism was GP fundholding, which enabled local doctors to call the shots from the ground, rather than bigwigs from the centre.
Mr Clarke?s reforms were, for a short time, brilliantly successful. But they were greeted with total horror by the entire medical establishment, which regained its poise when Mr Clarke was promoted to home secretary after the 1992 general election. Clarke?s successor, the useless Virginia Bottomley, stealthily undermined his reforms, which were killed off after New Labour came to power in 1997.
Labour?s initial hostility to NHS reform was a terrible pity, and we are all paying the price. It meant that when Tony Blair opened the taps on spending after the 2001 general election the new money was captured by the vested interests. According to some estimates, barely a quarter went on patient care, with much of the remainder squandered on massive pay increases and the creation of an even more monolithic bureaucracy. It was open to Mr Lansley, on his appointment as Health Secretary nearly two years ago, to have made his peace with the producer interests. Many forecast that he would do that, and had he done so he would have reaped the rewards: adulatory leaders in the Guardian, praise from the BBC, respectful treatment in the medical journals. Instead he revisited Ken Clarke?s reforms.
The major proposal of his Health and Social Care Bill involves the destruction of two layers of useless bureaucracy, the primary care trusts and strategic health authorities. These are to be replaced by ?clinical commissioning groups? ? in effect a resurrection of the GP fundholders of 25 years ago. Needless to say, Mr Lansley?s attempt to get rid of the vested interests that have dominated the NHS for half a century has been greeted by an almighty explosion. The King?s Fund, a think tank run by Chris Ham, who advised New Labour on health reform during its most disastrous period, is scathing. So are the doctors and health unions.