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By Paul Goodman
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David Cameron knows that the NHS bill may not now do much good to the health service and is certainly doing a lot of harm to the Government.  The coherence of Andrew Lansley's original plans has been compromised by a mass of amendments to the bill.  If the Cabinet's big hitters have confidence in it, why weren't they making the case for it yesterday on TV and radio?  Come to think of it, why wasn't the Health Secretary doing so?  Is he now unwilling to make the case for his own flagship measure?  Its plight is far from being own creation alone – indeed, he has not been well treated by Number 10 – but it is real, bad, and likely to get worse.

However, the Prime Minister also grasps that there would be consequences were the bill simply to be junked.  Lansley would probably and understandably quit.  Parts of the Parliamentary Party would then laud the latter as a martyr to Downing Street indecision and Liberal Democrat obstructionism.  The lobby would ramp up the game of "Who's Next?", and pile pressure on the next vulnerable Cabinet Minister they could find.  Ed Miliband would slam Cameron for weakness, and the charge could hit home.  It has not penetrated so far, despite about-turns on forests, school milk, coastguards and more.  But singling out Lansley would risk it doing so.

However, there is a way round this impasse, which is first to replace the Health Secretary as part of a wider shuffle and then "kill the bill". This would give the lobby wider changes to write about, dampen backbench criticism, and draw the sting from Miliband's inevitable attack.  The question that follows is whether there is any compelling reason not soon to carry out a reshuffle which is due at some point this year anyway.

The critics would try to caricature a spring reshuffle as a panic measure.  But Downing Street could reasonably counter that it is sensible to bring in new Ministers before the new Parliamentary session and a fresh series of bills.  So, then: if the whole Department is not to be turned over the Liberal Democrats, who could replace Lansley as Health Secretary?  (I will leave other Cabinet changes for another day.)

Whoever takes the job would need the political muscle to sort out the current mess and the presentational skills to sell the revised policy.  He or she would also need to be prepared for the coming NHS crisis which will happen regardless of the bill's fate – complete with closed wards, patients on trolleys, and health authorities demanding more money.   In this age, he would also need to use the NHS himself.

My list of candidates from within the Government is:

  • Ken Clarke.  With his massive experience, Clarke would impose himself on the Department.  The presence of the man who drove through GP fundholding would be a reproof to the charge that the Government is backing off reform.  He is a bad fit at Justice to backbench and party views on the ECHR.  But would he leave Cabinet rather than go back to health?
  • Francis Maude.  Maude has the seniority and Whitehall know-how to assert authority, kill the bill, and salvage parts of the original reforms.  His Cabinet Office grounding means that he knows the unions backwards – which would be useful in a health crisis.  But there is something about the fit of Maude to the NHS which somehow doesn't feel quite right to me.
  • Damian Green.  He is among the most able of the former Shadow Cabinet members who didn't make it to Cabinet, and it would be very hard to portray him as a hatchet-faced hardman.  But it would be a big promotion to one of the most difficult Cabinet jobs of all, and raise knock-on questions about the left-right party balance in Cabinet.
  • Chris Grayling.  Grayling was a Shadow Health Minister.  He thus has an acquaintance with the subject.  And, generally, he deserves promotion.  But, again, a move to health would be a risky one (the same logic applies to the energetic Grant Shapps) and remove Grayling from welfare reform – which he knows, understands and is making a real contribution to.
  • Jeremy Hunt.  He has no front bench experience of NHS matters, his Cabinet post is relatively junior, and he has no background in the health service.  That he is such a hot tip for the post is perhaps a reflection on the competition.  But Hunt is very bright, smooth, cool, and a nimble operator.

I suspect that the Culture Secretary would hate the prospect of moving from the lush pastures of Culture – with the Olympics tantalisingly close – to the bleak moonscape of health.  I heard him speak insightfully about the coming games only a few weeks ago, and not to allow him to see his work through would be hard on him.

However, politics is a rough old business.  That the Olympics are so close is a reminder that the preparatory work for them has largely been done.  So it is not essential that Hunt stays in post until after they finish.  The question that follows is whether he is really the candidate best suited to manage the termination of the health bill and the NHS crisis that is coming down the tracks.

Cameron's preference for order and stability in front bench appointments is well established.  Given the expectations that now exist, Hunt's appointment to health would both fit happily with this instinct and help to offset the drama of terminating the bill.  The most straightforward solution is sometimes the best one.  Hunt should go to health as soon as possible.   

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