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.

In The Loop

Imagine a world in which Tesco invaded Denmark. That’s right the supermarket, grabbing itself a piece of prime Scandinavian real estate. Imagine television listings brightened by the presence of celebrity game show, Rape An Ape, complete with catchy theme tune. Imagine a political landscape in which David Cameron was a forgotten has-been like the Conservative leaders that preceded him and Tony Blair roams the streets of Baghdad, bearded, greying and haunted by his contorted legacy. These mad and brilliant ideas are all generated by the brain of Armando Iannucci for his hilarious and unique BBC series Time Trumpet. Loving this as much as I did I had no hesitation in snapping up In The Loop from amongst the many varied seasonal offers at HMV.

Released in 2009, In The Loop is of course a feature length, larger scale version of The Thick of It, an enormously successful political satire first launched on BBC4 that has since acquired a cult following. The popularity of the show is not just down to witty and intelligent scripts, but perhaps largely due to the superb and vibrant character that is Malcolm Tucker, political spin doctor. Played magnificently by Peter Capaldi, Tucker is Number 10’s attack dog, unleashed to deal with media storms reflecting badly on government. He spits out line after line of venomous insults, dripping with graphic and vulgar imagery. He hovers around in a frenzy, fretting about the incompetence of others. His swearing is so loud and non-stop that in one scene a passing American accosts him; “Enough with the curse words pal”. Tucker simply replies with a volley of typical vitriol.

In London Tucker is the big cheese, charging about confidently, marching into ministerial offices like he owns the place and intimidating cabinet members. Tom Hollander is an impressive addition to the cast as a bumbling everyman figure, essentially well meaning but conscious of his infant career. He tries valiantly to talk sense to Tucker, only to be bulldozed aside and dominated like the rest. A few too many slightly opinionated responses to interview questions about the developing situation in the Middle East and a “will they/won’t they” war (no prizes for guessing the recent crisis used for inspiration), and Hollander’s International Development minister is dispatched to Washington to quell fears about his resignation and bribe him back on side. Hilariously and accurately he is repeatedly told to stick to the government line, without being told clearly what this is, in fact he is simply baffled by the repeated blasts of explanation from Tucker.

In The Loop is impressive because once things shift to Washington the writers do a wonderful job of creating believable and amusing Yank career vultures too. Across the pond their own inter-departmental war is raging, between those for and against conflict, and no one will overtly announce what they’re rushing around and bickering about. A funny speech from Hollander’s character back home, trying to be ambiguous about the UK’s stance with typical MP speak, has been adapted and taken on by the pro-war Americans, with the cliché phrase “climb the mountain of conflict” isolated.

Tucker tags along for the ride, keen to ensure his mistake prone minister doesn’t balls up again. Hollander is accompanied by his geeky and clumsy new aide, played by Chris Addison, who gives a warm and funny performance. He is surprisingly well connected and becomes crucial to the plot, whilst remaining inept. Drawing his Washington trip he beds an old American university colleague and when this is found out by his British Foreign Office girlfriend on his return, he comically and awkwardly attempts to claim he did it to try and stop the war. Things zip along with laughs in every scene, the stateside action broken up with a constituency visit and an irate Steve Coogan, until the climax of a vote at the UN for or against military action.

Prior to the vote Malcolm Tucker is slapped down by his American superiors. In Washington he is a castrated beast, a joke to the hot shot Yanks. Push aside his vulgarity and the obvious point of the film and the series, to get us to look at the ridiculous and distorted nature of modern political spin, truly engineered and evolved by Blair with Alastair Campbell, and Tucker is irresistibly likeable as a character. He is weirdly brilliant at what he does. And bewilderingly you root for him as he rises from the ashes, despite the immorality and twisted motivation. You don’t mind so much as Hollander’s eventual moral stand is crushed by his masterful scheming. You laugh along and rejoice in his charisma and sheer balls, as he and fellow Scott sidekick Paul Higgins, playing Senior Press Officer Jamie McDonald back in Britain, smash their way to their objectives. In The Loop is an intelligent and endlessly funny Christmas present, but however much Tucker’s insults have you splitting your sides, you wouldn’t want him around the family turkey dinner table.