A Tory health minister was at the centre of controversy after she was secretly recorded saying that the government could no longer exert much day-to-day control over the increasingly stretched NHS.
The public health minister, Jane Ellison, told a private meeting of the Tory Reform Group that providing political direction to the NHS was like being on a high wire without a safety net – which she described as "exciting".
The remarks were seized on by Labour as evidence that coalition reforms of the NHS driven through by Andrew Lansley, before he was sacked as health secretary in 2012, have created far more confusion and less clear lines of command, rather than greater efficiency. Labour accused Ellison and other ministers of trying to wash their hands of responsibility for the coalition's reforms, as NHS costs soar, waiting lists rise and more and more people are unable to see a GP swiftly. On the tape, leaked to the Observer, the minister appears to place responsibility for the government's declining influence on the NHS on the reforms themselves, saying that power has been given away without the public realising. Ellison, a health minister since last October, said that Lansley's successor Jeremy Hunt had done a "brilliant job", "turning the narrative round" from one focused on reform of NHS structures to one focusing on patients and patient care.
At the meeting, on 8 June, she also said that people were unaware who was responsible for the NHS today. "I don't know how much any of you realise that with the Lansley act we pretty much gave away control of the NHS, which means that the thing that most people talk about in terms of health [the NHS] … we have some important strategic mechanisms but we don't really have day-to-day control.
"From a political point of view, it is a bit like being on a high wire without a net at times, it can be quite exciting."
For Labour, shadow health minister Jamie Reed said Ellison might find the newly constituted NHS exciting but patients "in full-to-bursting A&E departments will not".
He added: "Andrew Lansley's NHS shakeup was a £3bn fiasco that nobody wanted and nobody voted for. All it succeeded in doing was in increasing bureaucracy and driving costs up. Now ministers are simply washing their hands of responsibility for our NHS." Since Lansley was sacked by David Cameron, Hunt has been battling to neutralise the NHS as an issue, after two years in which controversy over the reforms united most of the medical profession against the government and dogged the coalition.
Anger at the reforms was compounded because Lansley's plans were not spelled out in detail in the 2010 Conservative manifesto and they were driven through despite Cameron's promises that he would not allow further "top down" reorganisation.
The Lansley act paved the way for groups of GPs, who were given budgets to buy care for their communities, to be formed into clinical commissioning groups. These groups can buy in care from the private sector. Many responsibilities of the Department of Health were moved to a new, politically independent NHS Commissioning Board, now called NHS England.
In the foreword to the 2010 act, Cameron and Nick Clegg wrote that they were making the NHS "more accountable to patients" and freeing staff from "excessive bureaucracy and top-down control".
GPs and others have complained that, in place of the old system, new layers of bureaucracy have sprouted up and it is often unclear who is responsible for what.
Labour claims that, rather than improving the NHS, the reforms have made it worse, with rising costs – including estimates that the NHS will face a £20bn-£30bn annual funding gap by 2020 , lengthening waiting lists and increasing delays for patients wanting appointments with their GP.
A Department of Health spokesman said: "Giving operational control for the day-to-day running of services to doctors was the right decision – but we have always been clear that ministers are responsible for the NHS, and we are proud of its performance in challenging circumstances."
