Andrew Lansley wouldn't go as far as admitting that the Conservatives made a mistake, but he has decided to quietly drop the flagship "patient passport" policy just months after the general election.
The South Cambridgeshire MP, and Conservative health spokesman for the past two years, was always rumoured to oppose in principle his party's co-payment health policy, whereby patients could have opted to have 50% of their private healthcare provision funded by the state.
Mr Lansley first tentatively announced the decision to drop the idea of patient passports at a recent event staged by the NHS Confederation, when he told NHS managers that "diversion of resources to subsidy of private care", could "frustrate" the principle of meeting high standards of service delivery on the basis of limited, taxpayer funded resources. "It is more important to engage the public positively with choice and competition to everyone, than to be directed into a benefit for a minority," he said at the time.
Several weeks later, the Conservative shadow health spokesman rebuts the charge laid by some of his peers that patient passports policy flopped at the polls. It was more the case that his party's distinctive health policy "did not really get an airing during the election", he said. He blamed this on Labour, "who tried to trash it", carefully dodging the fact that his own party opted to focus on other policy issues instead, such as immigration.
But whatever his arguments, the affable Mr Lansley's own comments confirm that he was never a fan of the policy, which he believed gave the impression that the Conservatives were trying to offer more to the rich than to the poor. "The message was not simple and it was not the same for everybody," he said. "When you have an election campaign it has to be simple and something everybody can relate to."
He explained the change as a sophisticated decision based on the fact that the government has already brought in the private sector to bring down NHS waiting lists, making the idea of sending people off to the private sector redundant. "Under these circumstances it would be a diversion of resources out of the NHS," he said. "It is undesirable to subsidise people who could buy into the private sector any time."
Known as a "thinker" in political circles, Mr Lansley is considered in all his responses. He enjoys devoting time sketching out the future NHS landscape, and admitted he spent nine enjoyable hours drafting his NHS Confederation speech last month in a comprehensive outline of the broad policy strokes. Now he needs some follow-up speeches in which he colours in the detail, he laughed.
Mr Lansley's problem is that on so many fronts, the Conservatives are at one with Labour health policy: on cutting the number of primary care trusts; on patient choice; on the increased use of markets in the NHS; and on the return to GP fund-holding first introduced under the Tories. Now it seems, there is even cross-party agreement that extending co-payments would undermine the principle of quality of access based on need, not ability to pay.
Mr Lansley keenly claimed Labour had stolen most of the Conservatives' wardrobe. "To some limited extent before the election, but more after the election, the Labour government has been reflecting the policies that we put forward in the general election campaign," he said. "I don't think we have a monopoly on innovation. I just think partly because of a reasonable philosophy and of experience we are pretty good at coming forward with the kind of ideas the Labour party has used."
His complaint is that the way Labour has introduced good ideas has been let down by the government's "piecemeal" approach to reform. For example, the decision to introduce a white paper on out-of-hours care later this year is, in his eyes, a mistake based on "old-fashioned thinking" about the role of the NHS. The government should be setting its focus on NHS commissioning, while letting real competition determine delivery.
The Conservatives have learnt lessons from the internal market they introduced in the 1990s. This time around what Mr Lansley has in mind is a completely free market within the NHS, free of tariffs, and overseen by a strong regulator to ensure fair play and high standards, and safeguard competition on the grounds of cost.
His call for stronger regulation is refreshing from a shadow minister whose party often pledges ideological opposition to the "burdens" of regulation. But Mr Lansley is no ideological politician, but a pragmatist who stitches a coherent vision for healthcare delivery that he believes can provide patients with the flexible NHS that patients are clamouring for.
While he insisted the NHS no longer has to be "nationally owned" under the free market principle, it must nevertheless stay free at the point of use. The lack of uniformity of services offered through competition to taxpayers should be welcome, not shunned, according to Mr Lansley.
But by far his most radical proposals surround the thorny issue of health inequalities. Mr Lansley remains unconvinced that throwing money at the problem is the way forward. "It is a flawed strategy," he said. The underpinnings of inequalities are down to standards of living, family structures, and unemployment, not health services, he said. "I am not saying do not give people equal health services but do not pretend that giving more money for diabetes or chronic diseases means you are going to deal with the origins of health inequalities," he said. "You are treating the consequences of health inequality."
He pointed to the need for a more robust approach to flush out the underlying problems. "The NHS should be proactively using substantial resources across government to intervene and try to deliver positive improvements in people's standards of living," he said. But he dismissed the government's health agenda, which he said failed to offer a coherent strategy. "There is no strategy," he insisted. The fact that the public health minister is a junior role says it all, according to Mr Lansley.
