The NHS reform bill is reckless politics

Tom Bailey

Image © UCL Conservative Society

The former Tory Chancellor of the Exchequer, Nigel Lawson, famously called the NHS “the closest thing the English have to a religion.” This oft-quoted truism is once again doing the rounds as the furore over the Health and Social Care Bill boils on despite continuous opposition from almost everyone in the profession and large swathes of the public. Ed Miliband even had a good soundbite in PMQs when, citing supposed (and since refuted) opposition to the reforms from the Tory Reform Group, he hit Cameron with the line that ‘Even the Tories don’t trust the Tories on the NHS.’ Lawson’s judgement remains an apt assessment of how important the NHS is to the British people and the corresponding distrust of creeping privatization into this most popular institution of the welfare state. For an example of this instinctive distrust of marketisation of the NHS, last week’s Question Time saw the American business woman, Julie Meyer, jeered by the audience when she suggested that we should turn it into a ‘trillion pound British healthcare industry.’ Perhaps this response was unsurprising given how America somehow squanders away 16.2% of its GDP on healthcare (as opposed to 9.3% for the UK) and yet leaves around 50 million people, or approximately 16% of its population, without healthcare. However, I want to focus on the bad politics surrounding this bill. I lack sufficient expertise and willpower to dissect or examine the 367 page bill itself.

Firstly, this bill was not democratically mandated. The much cited Coalition agreement set out that the government would ‘stop the top-down reorganisations of the NHS that have got in the way of patient care.’ Further to this, the Tory 2010 manifesto stated that ‘more than three years ago, David Cameron spelled out his priorities in three letters – NHS. Since then, we have consistently fought to protect the values the NHS stands for and have campaigned to defend the NHS from Labour’s cuts and reorganisations.’ Occasionally there has been an attempt by the government to claim it is not top-down but bottom-up change. However, one Tory MP argued that ‘stripping out primary care trusts (PCTs) and strategic health authorities is as top down as it comes.’ Even if certain clauses in manifestos gave hints of coming organizational changes, no radical transformation was openly offered up at the last election by either the Tories or the Lib Dems. Instead, the government is open to accusations of dishonesty and hypocrisy given the record of both the Tories and Lib Dems in critiquing overly zealous top down New Labour reforms of the NHS.

Secondly, the reforms seem to needlessly invite political blame for future problems. The NHS faces considerable funding squeezes even without the reforms. Historically, the NHS’s budget has grown at 4% annually whereas the present government is trying to keep its rate closer to 1%. This will inevitably lead to problems. The coalition could have let the NHS continue in its present form and reverted to default setting of blaming all the problems on the lack of money and Labour’s reckless spending over their 13 years in government, as they have on the economy or in every other area of policy. Polls seem to suggest that this strategy has been working elsewhere. Instead of such an approach, this bill provides Labour with a causal explanation for future NHS difficulties that cannot be blamed on Gordon Brown alone. If waiting lists are up, services dysfunctional and satisfaction down with the NHS by 2015, Labour can no longer be held up as solely responsible, an excuse which is getting fairly tired as it is. It is inviting a backlash at the ballot box on an issue Cameron had aimed to neutralize in his Tory detoxification project.

Lastly, the political message of the bill seems to be built upon two contradictory narratives. Firstly, the government has continued the stance taken by every government since Thatcher, blaming the public service workers for not working for the best interests of the service user, i.e. the patients and the public. This has been evident in Cameron’s attempts to portray NHS doctors of the BMA as being like any other trade union or his recent attacks on nurses. This approach alone would have left the debate over the reforms be a by now familiar political pitched battle. As Peter Hoskin put it on The Spectator, it would have resulted in ‘on one side, the ‘trusted’ health professionals blaming government policy for any failures; on the other, the government blaming ‘producer interests’ for the same.’ However, the government also took the line that more power should be given to the professionals who run the service. Presumably, this was an attempt to differentiate from the New Labour reforms of targets and central co-ordination. This second element seems to contradict the first. Lansley stated in 2010 that he wished to transfer power away from bureaucrats and for the NHS to be ‘led by patients and professionals, not by politicians.’

Presumably, as the power should be with the professionals and, as they are shouting for the bill to be scrapped, they are right? Lansley cannot both claim that professionals should run the NHS and now ignore their widespread opposition to his NHS reforms.

There are undoubtedly many excellent reasons against the current NHS reforms but the bill’s problems are as much political as they are structural. The NHS was important to detoxifying the Tory brand but now Cameron seems to have let Lansley set back that process. It has drawn criticism from Conservative Home, one of the representative blogs of the centre right, and in one recent poll 65% of people polled believed the bill should be withdrawn. Without this bill, the NHS’s problems could have been blamed on Labour’s profligacy in government. However, in coming years Labour will be able to pin NHS problems to the coalition bill and its revolutionary structural changes. The NHS bill is a considerable political gamble on the already financially stretched English ‘religion.’

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