The NHS “reforms” break an implicit election promise – and do not go nearly far enough

Cast your minds back to the days of the last election. All the talk was of cuts and the campaign was curiously short on optimism. Nick Clegg rocketed to popularity because of his outsider status and a rare ability to sound slightly hopeful about the odd issue. Cameron and Brown battled over grim details, tainted by all that had gone before. One of the few rays of hilarity to shine out of the darkness was the very British ridicule of one of our current Prime Minister’s key policies and publicity stunts.

I’m referring, of course, to Cameron’s notorious airbrushed poster campaign. The abnormally clean image of the old Etonian presented on billboards everywhere to the entire nation, took the Tory drive for renewal to the laughable extreme. Dave was not wealthy and out of touch, merely handsome and approachable. As funny as the image and tactics themselves were however, it’s the snappy quoted message alongside his shiny face coming back to haunt the Prime Minister now.

I certainly do not pretend to even partially comprehend the reforms to the NHS this Conservative led government is proposing. Indeed the lack of understanding from its own ministers seems to be a large part of the problem. And it’s no secret the Conservatives have long planned a shake-up, fuelled by the steadfast belief of their long serving top dog on health, Andrew Lansley. However whilst the faults and flaws of the plans that are becoming clear are extremely important, in terms of political capital and strategy for Number 10, they are in many ways besides the point when it comes to that infamous election promise.

“I’ll cut the deficit-not the NHS” translated for voters to “This is a new kind of Tory party that treasures the NHS above all else. We will not mess with it anyway.” Cameron will argue his promise did not say he wouldn’t change the NHS and that it needs modernisation for the better. But he knew the implication of his promise and the votes it would win him. His protestations about the benefits of his reforms will therefore mean little to those his promise swayed.

It’s also especially hollow given that the Prime Minister has since watered down and diluted that concrete pledge, which formed the symbolic heart of his campaign, again and again and again. First it became merely a safeguard for frontline services and then promised improvements, like an increase in the number of midwives, were scaled back and ultimately scrapped altogether, with even plans to maintain current numbers reversed. Fears about privatisation which the reasonable man might have attributed to overzealous, sensational leftist press, are now emerging to have hard evidence behind them. 50,000 jobs are set to be cut. How exactly is this not cutting the NHS?

If the workers within the system themselves were in favour Cameron would have a much stronger argument. But countless GPs have written to newspapers, as well as other types of professional, warning against the changes as unnecessary and damaging. The Prime Minister continually insists that locals have the right to opt in our out, but what are those that oppose and don’t sign up to the scheme meant to do? Even in my quiet rural area GPs feel overworked and many local people distrust the vested interests of certain doctors. Is handing over the biggest budget in the country to them really a good idea and what people want? It’s doubtful if the new system will even be able to produce what the public need.

Another argument constantly wheeled out by the Tories is the pressing need for modernisation and reform, which make it necessary. There is nothing necessary about these plans though. Whilst the health service has its flaws, the current system leads to a mostly positive service. There are undoubted challenges in health care such as an ageing population and emerging drugs, which often seem insurmountable. Government proposals do not do enough to ease the burden and according to many that know, they actually complicate the fight. For a leadership so keen on cutting the deficit, you would think that such costly, ideological plans could wait for better times.

 It would also do more good in the long run, and reduce the deficit substantially, to work out some realistic spending priorities centrally. Vital areas and treatments need to be protected nationally and things the NHS can’t afford to provide should be phased out. The private sector does have a role but it should grow independently of the NHS and take up the slack for treatments it shouldn’t be wasting resources on. Taxes and other initiatives should encourage healthier living. Devolving decisions to GPs is no magic pill, no silver bullet and it doesn’t even equip the NHS for the critical, worsening challenges it will face in the future. It would be a far more sensible decision for the government to begin a nationwide debate about what we expect, want and need from our NHS now. It would fit with the “new politics” of plural cooperation and potentially produce actual solutions.

Perhaps the main reason the government looks less likely to bow to pressure from the public on this issue is the Prime Minister’s ego and pride. He’s been happy to recognise the weaknesses of coalition and concede on issues like the forests and sport in schools. But the NHS plans are too inextricably linked to Cameron’s personal brainchild; the Big Society. Its philosophy of localism and choice in the community over centralised solutions marries nicely with Lansley’s ideas for health. The health reforms open the way for the sort of community cohesion and interaction, fuelled by voluntary, charity involvement, that Cameron wants to see. He genuinely believes it’s the path to a social recovery for Britain that’s sustainable and empowers government to do what it does best, as well as liberating people from the state. He’ll continue to be blind to all the irreversible wounds the “reforms” will inflict on the NHS itself and his popularity with the people as long as it remains tied to his vision. His recent attempt to re-launch the initiative demonstrates his huge commitment; it cannot afford to fail.

The real shame for the country and even the Conservative party, is that Cameron’s election pledge could have been a clever way of dumping a responsibility and challenge for maximum political gain. His implicit promise of not touching the NHS meant it could have been left as it was, a gargantuan issue for a future administration to tackle, ticking over just fine for the time being. There are after all, enough problems for the coalition to face. If this government had done mostly nothing on health, the public would have thanked them for it, the Conservatives especially. But Cameron is so determined to be radical and appear to be so, that he will press on, regardless of the consequences. It may prove to be the well meaning project that took his remodelling of the state too far.

Roman’s next move could topple his Chelsea Empire

It surely can’t be the same season and yet it is. Chelsea began this campaign steamrolling the opposition and notching up impossible scores. Drogba and Anelka and co were unstoppable. But this weekend Chelsea crashed out of the FA Cup, the one trophy their fans must have been counting on their team to comfortably retain. The coming week is make or break for the blues as they take on Copenhagen in the Champions League. After letting slip the Premiership to a way below par Manchester United side and an Arsenal team still in development, Chelsea’s only hope for silverware this term is in Europe. Carlo Ancelotti started this season as if he could do no wrong after reclaiming the title for the London side after a 3 year stay in Manchester, but it would seem he has to win the trophy Chelsea owner Roman Abramovich has always coveted and never won to keep his job.

Indeed it feels as if Abramovich’s tenure as Chelsea owner has reached a sort of tipping point. The unspoken fear around Stamford Bridge has always been what if the big Russian tires of his English plaything and leaves the club. It was the one consoling thought for many football fans as they watched Chelsea steadily ascend to the heights of world football; that the situation was unstable and one day Chelsea would crash and burn. It’s been said again since unfathomable amounts of oil money were ploughed into Manchester City. But so far Roman’s defied the expectations and hopes of the doubters, and continually funded his club. He’s proved the role model and catalyst for countless other investors to take the leap into English football. And thanks to Roman’s success and commitment, fans have even started welcoming benefactors in lots of cases.

Since the departure of the Special One however, Abramovich’s record with managers has been poor, with Ancelotti the only real success, besides Hiddink who was a temporary measure. And the chopping and changing of managers has disguised the relentless decline of the club’s squad. Once unbeatable and prized assets like Drogba, Lampard and Terry are ageing and no longer capable of consistent greatness. Once again Roman dipped into his vast wealth to try and resurrect his empire during the transfer window. Fans might have been reassured by this continued investment and the arrival of Torres and Luiz. But the Spaniard from Liverpool is yet to ignite and is not a long term solution. David Luiz displayed commanding defensive ability and sublime passing on his full debut against Fulham, alongside experienced Terry at centre back. It will take a whole clutch of young signings like Luiz to rejuvenate a Chelsea squad that has been neglected and has become predictable.

Ancelotti is coming under considerable fire of late for his tactical decisions. There’s no doubting that he is playing far too narrow through the midfield and into the hands of opponents that no longer see Chelsea’s defence as invincible. He’s certainly trying too hard to accommodate Torres without thinking first of the need for results and team chemistry. But in many ways Ancelotti is limited by his squad, a group of players he had little hand in selecting. There are an abundance of central midfield players in the Chelsea team, all of them quality players, and Ancelotti is trying to play to his strengths.

The danger is that Abramovich will simply sack another top class coach and there will once again be a period of upheaval. There’s an unquestionable need for change and fresh legs at Chelsea, but this will be best managed through continuity as well. It’s a real shame that the pressures of modern football and the heavy egos of club owner’s mean that managers no longer get time to shape a side to their vision. If Roman Abramovich is truly serious about winning the Champions League, and establishing Chelsea as a long term force at the top of football, he’ll keep faith in a manager who’s already proven himself and back him with the resources he needs. Top coaches deliver with time as Alex Ferguson proves. Take a reactionary axe to his management team as well as his squad and Roman might see his football empire crumble into mediocrity.