Sketch: Gloating and humiliation end NHS saga

A surprisingly bleak end to the NHS reform saga
A surprisingly bleak end to the NHS reform saga

It was the denouement we'd all been hoping for. But this wasn't comic; all three of the actors had more than a tinge of tragedy about them.

By Alex Stevenson

There they were, finally, striding down the corridor of Guy's hospital in central London towards a rather awkward event. David Cameron and Nick Clegg were talking to each other with some semblance of cheerfulness. Shambling behind them, bringing up the ministerial rear, came health secretary Andrew Lansley.

Entering the room, they faced a terrible prospect. Three podiums faced the television cameras, the snappers, the press, and – worst of all – the policy experts. Behind them were a horde of NHS staff, complete with stethoscopes and harassed expressions. They had got their way, after all. It was time to gloat.


This trio have been through a torrid few weeks. But none have had it harder than Lansley, the man whose mood was summed up by one senior insider during the NHS 'listening pause' as "subdued". Cameron took the middle of the three podiums linked up in front of us. The men on either side of him appeared in very different moods.

Clegg was relaxed, even jovial. He did not beam – it is not deputy prime ministerial to beam. Instead he was relaxed and self-assured.

Alas, the same could not be said for Lansley. He looked shifty and nervous. Had he been a suspect walking into the dock, the jury would have not waited a second before declaring him guilty.

As it was he had to endure a far more terrible judgement. His leader, the myriad NHS crowd behind him, the journalists in front of him – all had written off his NHS reforms as a calamitous mistake. He could not keep his head still as Cameron, sarcastically, talked of a "humiliating U-turn". It was almost a nervous twitch.

Both Lansley and Clegg's demeanour visibly settled as Cameron got stuck into his open spiel. They appeared reassured by his repeated, stabbing assessment of the demands made by healthcare staff. "Done," Cameron stabbed. Lansley sighed a deep sigh of relief. "Done." Clegg nodded in all the right places.

This was real drama: three figures, each with their own story to tell, trying to get through one of the largest and most significant government U-turns in the history of – well, the last year, anyway. They frowned, they grimaced, they did their best to stand tall in the face of a nation's scorn. It was, indeed, a little tragic.

Reading from left to right, we begin with the leader of the Liberal Democrats. His fatal flaw is enjoying being in power too much. It prevented him from openly trumpeting this as a Lib Dem victory. That's what the grassroots have been craving for so many months. Now their leader has given it to them. Strange, then, that he pooh-poohed the idea that he might want to raise this in the 2015 TV debates. "I wouldn't put it like that," I thought I caught him saying. Really? Alright then. We won't either.

Instead we shall confine ourselves to observing that Clegg did pointedly flag up the advantages of coalition to this process. This is a "different type of government", he told us. "We're not afraid to bring together the best of what we've heard."

His language, too, was more open when it came to admitting past mistakes. Even though he signed the foreword to that white paper, the errors aren't really on him. So he waxed lyrical about "not getting it right". Lansley lunged to gulp a glass of water. He was firmly against "heavy-handed top-down restructuring of the NHS". Was that Cameron's eyebrow twitching just a little bit?

Towards the end of the session, when he had relaxed even more, a philosophising tone crept into his rhetoric. Clegg came out with a remark which, if it had happened at a drunken party, would probably have been preceded by 'the thing about the NHS is'...

"It's the closest thing this country has to a national religion," he explained, conveniently forgetting the Church of England. The liberal in the coalition had gone too far. Step forward the leader of the Conservative party to observe: "We're not having a go at the archbishop..."

Apart from this mild gaffe, Clegg's gravitas held largely intact. He did not need to rub it in, for the facts speak for themselves. The image of the party's deputy leader, Simon Hughes, gleefully doing the rounds beforehand more than suffices, believe me.

Exhibit B, then, is the prime minister. He gave his usual polished performance in delivering his speech, as he always does. It was those extras, as always, which proved revealing. He gazed with equanimity upon Clegg as the latter gave his speech. He even smiled at one point. Not so with Lansley. Here the PM was frowning, looking serious.

How to read this? On face value, as Cameron explained, it was a good thing that the listening pause had taken place. "Democracy, as someone once said, is government by persuasion," he observed. Or perhaps Cameron is happy to go with a subtext that this is a great victory for the Lib Dems at the expense of the Conservatives. It is a tactical defeat for the Tories, but remains a strategic one for the PM.

But wait - there's yet another layer of subtext here. The reason Lansley's awful proposals were allowed to slip through the No 10 net last summer was because of Cameron's very weak initial style of government. He gave his secretaries of state too free a rein during the first months of power; nowhere did this result in greater catastrophe than in the NHS. How fortunate that the Lib Dems are providing a convenient cover for the PM's own failures. He has subsequently beefed up his policy staff, of course.

It would be going too far to detect any obvious awareness of this fact in the PM's outward appearance this lunchtime. He was, and remains, all things to all people. "I accept absolute responsibility," he intoned, before pointing out almost immediately afterwards: "I think Andrew Lansley has handled himself extremely well."

But here is one clue which we might interpret as being a sign of guilt. Whatever is to happen to Lansley – and it is hard to imagine his career going much further after this debacle – one thing is certain: Cameron deliberately went out of his way to prop him up.

Even stuttering from the health secretary received assistance. Lansley concluded one passage with the immortal words, "there is a fourth change, but it escapes me for the moment". He smiled, looking rather hopeless. "I thought it was a very clear answer," Cameron said firmly.

And again, later on, Cameron asked: "Andrew, how are you going to handle this for the future?"

Privately, Lansley will feel extremely grateful for this. This must surely be a Cabinet minister's worst nightmare, so he needs all the help he can get. "We didn't get it right," he said at one stage, before correcting, humbly: "I didn't get it right..."

It was desperate stuff. His voice briefly quavered as he insisted "I want more for the NHS". At least he recovered some zeal when addressing a question about learning the lessons from this fiasco. "We've got to see how we listen and engage in turning the principles into practice." Was he speaking generally, or just about doctors and nurses?

Maybe it was the reminder that Cameron and Clegg will one day face each other in TV debates again that prompted them to turn to talk to the NHS staff in the audience behind them. After some last-ditch listening, the trio made for the exit. Standing there, anonymous in the crowd by the door, was the chief doctor, Hamish Meldrum of the British Medical Association, arguably the most important opponent to the reforms he has finally slain. Lansley barely flickered an acknowledgement as he bustled past. Cameron and Clegg's greetings were more effusive – but they did not shake his hand.

Time will tell what becomes of these three men. They may end up dealing with more important issues even than the National Health Service. Perhaps the end is nearer than they think. Whatever happens, I'll bet none of them will forget this odd little episode. It's not often in politics that the drama is so compelling.

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