Michael White: ministers are puzzled by the BMA’s hostility

As health ministers geared up for a gruelling week promoting Andrew Lansley’s new Health Bill, the BMA’s Hamish Meldrum delivered an attack on cue.

Ministers are puzzled by the BMA’s hostility and believe the docs’ trade union has misjudged their reforms. While most GPs have been sitting on the fence, ministers argue, the progress made by pathfinder pioneers has persuaded the majority that the consortium model is both inevitable and desirable, whatever Labour and the NHS unions say. I’d say the wider public jury is still out.

At the start of the week - before Wednesday’s publication of the bill - two dramatic interventions occurred which more or less cancelled each other out. On Monday David Cameron made a significant speech on public service reform which sought to address his critics’ fears. It will be liberating for NHS staff, effective for finance directors and fairer for the neediest NHS patients. That’s a very bold claim, but it is evidently what he believes. Ditto free schools. Many fear the opposite - including me.

Ignore the Radio 4 row-ette about a “second-rate” NHS, a verbal slip. Cameron’s important message for NHS managers was when he recanted the excesses of Thatcherism.

“There was insufficient respect for the ethos of public services - and public service… public sector employees don’t just provide a great public service - they contribute directly to wealth creation,” Cameron said.

He then complained that, while New Labour made some good reforms, it had this aspect back to front: over-reliance on the state, insufficient regard for what the private and voluntary sector can contribute, ie Big Society.

We’ll find out who’s right. Tony Blair could have said most of what Cameron did, as could many Labour ex-health ministers, although possibly not Frank Dobson. But Cameron’s speech was offset by pre-publication publicity for the health select committee’s report, delicately but sharply criticising the pace, politics and presentation of the Lansley reforms.

Committee chair and Tory ex-health secretary Stephen Dorrell is clearly trying to be a team player, loyal to his party and trying to keep his committee on board. At his press conference Labour’s Valerie Vaz and Tory GP Sarah Wollaston were both more openly critical. There is no evidence this sort of structural change will produce better outcomes, said Vaz.

“Someone’s tossed a grenade into PCTs,” said Wollaston.

Dorrell plays a subtle game, looking forward to what his committee will study carefully during the bill’s passage, but also back to the “surprise” shift between the coalition agreement in May and the white paper which abolished PCTs in July. Ministers decided within those two months that PCTs were costly and their culture was wrong.

“There needed to be discontinuity [to] engage clinicians more effectively with the structure,” he suggested. Maybe, although the version I have is that once they had decided to create supervisory health and wellbeing boards at local and democratic level as well as create commissioning consortia there wasn’t much left for PCTs to do.

The potential for creative managerial chaos clearly scares the mild mannered Dorrell, whose report quotes NHS chief executive Sir David Nicholson’s remark about being “able to see it from space”. But he chooses - like Cameron - to stress continuity with Labour policies.

Where Cameron seems to agree with Dorrell is in saying the reforms have been badly sold. I guess that’s why he made Monday’s speech. He’s better at big picture stuff than Lansley. Plenty to keep both busy.