'Opening up' paper remains firmly shut

Years ago, in 1989, while attending a seminar at the Institute of Economic Affairs, then the intellectual power-house of Thatcherism, I recall being struck by how its disciples, having opened up local government to market forces, now regarded the NHS as the next big challenge. In the end it was too big even for the IEA.
Fast-forward 22 years, and a Conservative prime minister is grappling again with the same subject, namely, how to bring the private sector into the NHS. And like his predecessors, David Cameron is finding it problematic.
Ostensibly, his much-trailed Open public services White Paper has been delayed until after the May local elections, because of international events. In fact, it is delicate negotiations over the degree of private sector involvement in the NHS and welfare, and how these are to be operated and monitored, which is causing the hold-up.
Mr Cameron has been much exercised by Tony Blair’s comments in his autobiography that he regretted not being more radical about public sector reform. The present PM believes it is unfinished business but he, like his predecessors, is finding it more complex than first envisaged, especially when dealing with the NHS.
Paradoxically, although local government has been bearing the brunt of cuts this year, the sector has been traditionally well advanced in the plurality of its service provision. So, rather than trying to bring in more large-scale private companies to an already-mature market, Messrs Cameron and Pickles instead are keen to open councils up to social enterprises and small private operators. Mr Pickles’ not unexpected announcement to the CBI this week that the two-tier code in local government would go was aimed not at the big half-dozen strategic suppliers but the social enterprise market.
Perhaps this explains the surprise comments to an LGA seminar last week by the otherwise-Blairite Hazel Blears, that social enterprises were merely a stalking horse for full-scale privatisation.
With local elections looming, Labour set for big gains and the Cameron White Paper stuck in the post room, we may well find the 1980s battleground of private v public making a repeat appearance.