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.

4th February 2011: The day of Nick Clegg’s quiet rebirth

http://www.nickclegg.com/nccom_news_details.aspx?title=Nick_Clegg%3a_Building_a_New_Economy&pPK=54d272f1-39c9-4d00-8a27-5666c0d029c9

Whatever happened to “I agree with Nick”?

What happened to the t-shirts churned out with that slogan and what happened to the most popular politician since Winston Chuchill?

David Cameron, the Conservatives, the Coalition and the cuts happened. And Nick Clegg’s identity as not only a politically savvy leader, likeable for remembering the names of questioners in the audience, but an ideologically well meaning man, was lost under all the public outcry. As the distinctive voice of his party became ever diluted by its partnership with the Conservatives, so did Clegg’s own progressive world view.

I’ve long championed Clegg on this blog. Frankly it’s been tempting to turn on Britain’s most hated man at times. But it would have been weak and naive to dismiss Clegg for compromising in government. He was absolutely right to enter into coalition. His choice of partner was unavoidable and fair. It was constitutionally correct and right for the British people. Not all of the policies of the Coalition necessarily are though. In fact some, many even, are damn right damaging.

More importantly from a Lib Dem point of view it’s been impossible to reconcile drastic deficit reduction with most of the progressive policies requiring investment in their manifesto. Finally though, today in Rotherham, Clegg delivered a speech daubed with innumerable fingerprints from that manifesto. And it’s the most convincing argument in favour of the government’s economic strategy so far.

Last year when David Cameron embarked on a foreign policy tour, I called on him to use sustainability and green growth as a unifying message to take around the world from Britain. Since then, and his failure to do anything of the sort despite promises of a “jobs mission”, President Obama has announced a focus on clean energy in his State of the Union address. And now Nick Clegg has made the ideological link between environmental and economic sustainability.

Nick Clegg’s speech has the potential to seriously worry Labour. It returns to the more inspirational language he used in the election. It makes a rational argument for a brand new economic model. Nowhere does Clegg make the mistake of saying it will end boom and bust, as Gordon Brown did, but that’s clearly the intention by creating a sustainable foundation for growth and diversifying Britain’s output. He makes it clear the government will plan for growth and eliminating the deficit is merely the means to an end of prolonged growth. The Conservatives, even Chancellor George Osborne, have made such a fetish of cutting that it seemed to be all this government stood for. Clegg reminds people of the future, of an optimistic vision. As with Climate Change, most have neglected to point out the opportunities created by the solution to a serious problem.

The speech will also reassure Lib Dems. To an extent, it reassures me. Clegg’s four pillars of growth are all sensible and recognisably linked to the key points on the front of his election manifesto. Investment over debt, regional balance, hard infrastructure (high speed rail, energy) and soft infrastructure (education and skills). For me the undertone of the speech was that were it not for the deficit and some conflicting priorities with Conservative colleagues, Clegg would be implementing an investment led, green economy alongside new measures for fairness. Fairer tax and better education. Green jobs and better transport.

Clegg ended his speech at the Carbon Capture plant speaking about Carbon Capture and Storage. The government appears to be committing to CCS. And about time to. For a long time the potential for exporting CCS technology, to emerging, gargantuan economies like China already packed with coal power stations, has been enormous. Britain could not only minimise upheaval and expenditure in converting her own energy supplies but make huge profits and create jobs by genuinely affecting the world’s carbon output through pioneering and exporting the technology. Clegg makes the economic case for CCS, but ties it to Climate Change for progressives. This is the way forward: realistic ways of getting emissions down.

However despite shifting the debate wisely to sustainability and articulating the reasons for government economic policy better than anyone so far, Clegg will remain under pressure from Labour. Firstly this speech shall probably wrongly achieve minimal publicity. Secondly, and more importantly, Clegg’s pillars of growth are undermined and contradicted by Coalition policy. They remain mostly on a wish list in the partly fulfilled Lib Dem manifesto. If there’s a commitment to education and “soft” infrastructure, despite the pupil premium it’s hard to justify cuts to universities. High Speed Rail makes slow progress, there’s no solid government money for green energy and jobs. The cuts hit traditionally poorer regions disproportionately hard. Labour should still be able to make the case that yes we want sustainable growth, but you needn’t cut as fast and deep, you needn’t delay all attempts to spark growth, despite a reasoned argument from Clegg about properly targeting spending. And you need growth in order to cut the deficit, sooner not later.

There are loads of good things in this speech I’ve wanted to see for a while. But the bottom line is they don’t go far enough and they’re outweighed by cuts, cultural devastation and unemployment. However if the Coalition pick up Clegg’s argument and Osborne’s Budget contains growth policies in keeping with a futuristic vision, Labour will find it harder to land blows on a plan of long term optimism. And whatever happens, Clegg’s proved his political credentials once more.