It is hard to think of a starker failure in domestic government since the poll tax
No one, but no one, thinks that the health and social care bill returning to parliament this week is any good. Nurses and doctors have lined up to denounce it – even GPs, whom the legislation claims to put in charge. Professional resistance can be dismissed as "producer interest", but not so the joint editorial published by three specialist periodicals, including the Health Service Journal. The journal is generally supportive of exposing medicine to competition, yet it damns the particular market-based reforms on offer as "unnecessary, poorly conceived, badly communicated" and "a dangerous distraction". Meanwhile, a committee dominated by coalition MPs has just concluded that the current upheaval "complicates" necessary cost-cutting, and displaces "truly effective" reforms.
Even the health secretary cannot any longer really believe in the watered-down product he is saddled with punting. The one hope for the bill which Andrew Lansley had originally articulated intelligibly was removing politics from healthcare. But, after a year of amendments and grudging stand-offs with the Liberal Democrats, he has utterly failed in this – as is underlined by the latest concession, which explicitly reaffirms that he will retain full political responsibility to parliament.
Having foolishly nodded the legislation through in the Commons, the Lib Dems blundered again by failing to kill the bill – as they could have done – when their members and peers revolted. Instead, they settled for fudge. The bill before parliament is littered with warm words such as "integrated", which mean entirely different things to advocates of planning and cheerleaders for restructured competition. It may well fall to the courts to determine what on earth whole passages mean. And yet – carried along only by the crack of the government whip – this unloved legislation rolls towards the statute book. The strongest remaining argument for passing it is that the hard-to-manage mess of half-disbanded care trusts could descend into uncontrollable chaos if new rules and structures of some sort, however flawed, are not agreed on soon.
Mr Lansley's great error was to allow the charged words "Tory", "cuts", "health" and above all "privatisation" to combine to become the story of the bill. The technocrat imagined that he could quietly impose a new healthcare market, and that England would soon bow to its logic. He not only misread opinion, but also mistook a well-founded concern to restrain medical profiteering for socialistic superstition. Last month the Guardian revealed that millions were being diverted to the likes of KPMG and McKinsey to teach "business skills" to GPs. On Friday, it emerged that a cash-strapped health department was having to stump up £1.5bn to trusts that cannot afford repayments under the PFI – the last great brainwave for getting the private sector involved. Public fear of racketeering is not boneheadedness. The medical marketplace will never be one where consumers (or, as they were once known, patients) can be sovereign – the knowledge gap with "producers" is too great.
David Cameron, like Mr Lansley, initially banked on voters being indifferent to health service structures so long as health service standards were maintained. He might have been right, too, were it not for the fact that the NHS is facing the sharpest spending squeeze in history. Seduced, perhaps, by his own comforting rhetoric about not cutting the service, the prime minister failed to see it coming. But with the queues for treatment lengthening – long waits are already up by 43% since the coalition came to power – the presumed indifference will soon give way to rage.
One of the few predictable effects of the reforms is that they will make it harder to manage scarce resources by imposing rationalisation; another is that all this frenzied ministerial activity will ensure that blame for the problems that flow from inescapable scarcity will now be laid squarely at the coalition's door. It is hard to think of a starker failure in domestic government since the poll tax.