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November 30, 2010 10:31 pm
Oliver Letwin, the cabinet’s policy guru and fixer, has been charged with scrutinising the Department of Health’s plans for a shift of power and accountability in the NHS, amid mounting concern at the Treasury and Downing Street over its implementation.
Both Number 10 and Andrew Lansley, health secretary, insist there is no significance in publication of the NHS bill being pushed back to January, and that there is no rowing back on plans to hand up to 80 per cent of the NHS budget to GP commissioning consortia.
But after Sir David Nicholson, the NHS chief executive, conceded last week that primary care trusts, which currently control the budget, are “in meltdown” and that “Stalinist” central controls will be needed to keep the NHS finances in place, Number 10 sources say Mr Letwin has been charged with challenging the implementation plans.
The Treasury expressed reservations in July about the shift to GP commissioning. But one senior Treasury official said: “We have now got to get a grip on this,” amid fears that the NHS could lose financial control in the run-up to the changes.
One Number 10 insider said: “There is no change in the policy. But Oliver is starting to ask all the important questions that need answers.”
Another added: “Andrew [Lansley] has all the answers when he is asked the questions about how the implementation of all this will work. We are just not sure they are the right ones.”
A senior Lib Dem source in the coalition said: “It is only right that we have a second pair of eyes looking at all this. We can’t afford to get this wrong.”
Aides to Mr Lansley are adamant there is no rowing back and that “David Cameron is 100 per cent behind all this”.
Mr Lansley insisted on Tuesday there was no rethink under way, and said a response to the consultation on the white paper will emerge before Christmas. But he added: “It does not mean that we will do everything in the way that we first suggested in the white paper. This is a major reform.
“There are aspects of implementation of the reform that people have made comments on, and we will take them on board.”
The prime minister has made much virtue of acting as “chairman” and not “chief operating officer” of the government, trusting policy lieutenants such as Michael Gove at education, Iain Duncan Smith on welfare and Mr Lansley to get on with reforms they conceived in opposition.
But partly as a result, both Downing Street insiders and outsiders say Number 10 lacks the subject specialists such as Andrew Adonis, Paul Corrigan and Simon Stevens in education, health and elsewhere who inhabited Labour’s policy and delivery units.
“There just isn’t anyone in Downing Street with the expertise to challenge Andrew’s assertions,” one insider said.
Jonathan Powell, Tony Blair’s former chief of staff, said the coalition sees Labour’s approach as having been too target and command and control-driven. “There is some truth in that. But you do need expertise in Downing Street to keep an eye on strategy and implementation, otherwise departments can just go off and do things that don’t work, and you have no oversight. It was not just command control freakery on our part.”
From the outside, he said, implementation oversight in Number 10 “looks weak”.
Sir David appeared to hint last week that clusters of primary care trusts might survive the switch to GP commissioning in 2013, saying that was a matter for the NHS commissioning board, due to start operating in 2012.
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