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.

Public vs Private? A Lib Dem Dilemma

All hospitals look and feel essentially the same. They are the same mass of endless corridors, stretching on and on, filled with nurses and clipboards and trolleys but still somehow feeling like big, empty tubes brimming with nothing but still, sterile, clinical air that gnaws and chews at the nerves and wellbeing of patients before spitting them out from some unidentifiable artery drenched in anxiety. They have the same mockingly soft carpet, the same peeling paint from the same cold metal chairs, the same trundling squeaks from the laundry cart or doom laden whines of consultant’s doors. They are littered with the same old people riddled with ailments, the same proud photos of ill people remarkably overcoming their unlucky genetic hand, the same criss-crossing, numberless signage with countless departments. They are staffed by the same kindly but ordinary people, who for whatever reason work in the service of other people’s health and are without fail exposed, despite the reassuring professionalism or caring compassion behind the smiles, by the thick scent of disinfectant hanging in the air as the messengers of pain, discomfort and humiliation.

This hospital though was rather more particular than others. The walls had been whitewashed in an attempt to impose the familiar order but the age of the building meant that the corridors were endless but twisting and unpredictable, the windows suddenly large, the carpet non-existent, pipes peppering the wall like the workings of a rusty cruise liner. The floor abruptly sloped at times and the rooms were inconsistent in size. The reception area was a modern pod inserted into the post-war whole, plastered with the usual abundance of signage but beyond this all was quiet, free of clutter and business. My chest x-ray took all of thirty seconds and was carried out by a single nurse, the only member of staff in the entire corridor, who had rehearsed her lines perfectly from years of service. There was no whiff of doom in the air, merely the cold tinge of the metal plate and a slight chill from the corridor as I put my shirt back on. The results would filter through the NHS bureaucracy to my GP in a week, she said.

A relatively comfortable routine test then, that despite a handful of distinctive features at this hospital, ought to be as simple and painless across the country. In the run-up to the election David Cameron was desperate to make his party the party of the NHS, an institution he and others clearly now see as a fundamentally British ideal, not simply a Labour one. Since coming to power Cameron and his government have reaffirmed their commitment to “ring-fence” NHS spending and protect it from the comprehensive spending reviews due to steamroll through the budgets of other departments in the autumn. Presumably this is because Cameron, and it would seem the entire political class, rightly believe that healthcare should meet the same standards nationally and be available to all for free and that to provide such a service is a key indicator of a modern, civilized nation. Despite Cameron’s championing of the “Big Society” when it comes to health he has adopted a position he has often dubbed as “big government”.

Cameron’s emphasis on the “Big Society” and the masses of waste that inevitably stem from the contrary “big government” spending approach, mean that a dangerous debate is emerging that is set to compromise efficiency and fairness in the race to slash the budget deficit. Cameron has wrongly insisted that spending must be conducted in either a reckless way involving “big government” control or a devolved, fair, effective “Big Society” way. The reality is that government has an enormous role to play, often with taxes and spending injections but also that it must occasionally extend freedom to the private sector for jobs it would do better. The NHS is easily the biggest strain on government spending and Cameron has sought to impose his “Big Society” rhetoric on it in a way by encouraging local control and a purge of absurd bureaucracy. This purge would aim to increase efficiency and effectiveness by doing away with ludicrous regulations that prohibit nurses from giving injections but allow them to carry out blood tests for example, as well as cutting wasteful spending. Any attempt at streamlining efficiency is always welcome but ultimately as hollow as the Conservatives’ promises of “efficiency savings” during the election to deal with the deficit. The problem goes much deeper. If Cameron was serious and sensible about tackling “big government” spending he would address NHS spending as it accounts for such a large chunk of the state’s expenditure. He would prioritise treatment for those truly ill and scale back other projects such as IVF and cosmetic surgery currently available via the NHS. He would ease the tax burden on private hospitals and encourage those who could afford private treatment to use it, whilst increasing taxes on anything that adds to the NHS workload, for example alcohol, tobacco, particularly harmful fats and additives in food. To take these sensible steps that would lead to a higher quality NHS for those ill and injured through no fault of their own, genuinely deserving of treatment, Cameron’s government would have to make unpopular choices and introduce tax rises and it is far simpler to be hailed as moral crusaders for preserving the inalienable right of free health care above all other areas that are trivial in comparison.

By writing a blank cheque to the NHS Cameron makes the axe fall harder elsewhere in Whitehall departments. This is foolish given that certain things only the government can do and others government ought to do more with. For example the MOD is set to face massive cuts which could be even more devastating if the Chancellor wins his ministerial battle with Liam Fox, the defence secretary, to ensure the Trident replacement is paid for out of the MOD budget, not the Treasury’s. “Defence of the realm” Cameron insisted this week, “should always remain any government’s first priority”. And yet somewhere Britain’s capabilities shall suffer irreversibly, be it through the loss of a fleet of helicopters destined to safely ferry troops tasked with an ambitious withdrawal target around Afghan provinces or through the loss of jets, or troops or aircraft carriers. A Strategic Defence Review might lead to a much needed rethink in the direction of defence strategy but it will also herald the scaling back of Britain’s global influence, it is simply a question of how much prestige we shall concede.

In my opinion defence is not the only area that can only effectively be administered by government being hit hard by the proposed cuts. The energy department’s budget is under threat and Liberal Democrat Energy Secretary Chris Huhne has already stressed that the bulk of his budget is consumed by the safe disposal of nuclear waste. Britain could be well placed to avoid the worse of energy crisis and turmoil in the future if proper investment is given to renewable sources, particularly wind as we have 40% of the potential wind energy in Europe within our territory. However the coalition government’s ideological spending decisions mean that their only efforts will be the “encouragement” of private investment in these industries, at a time where swift and direct action must be taken to kick start a long term, essential process of diversification and development. Private investment is in any case bound to be slow as we emerge from recession and the industries are yet to be regarded as ripe for profit. This is all ignoring the fact that a country surely ought to have a great deal of direct control over its energy production for reasons of security, independence and stability in the long term and yet we are happy to surrender the keys to our daily lives to vulnerable, private, foreign companies?

Staying with climate change a “big government” solution to transport emissions and efficiency would also be preferable, but unthinkable without a major redistribution of government spending. At the moment government expenditure helps maintain the railways and yet private companies control prices and provide largely unattractive services. Government control would allow a fresher, greener, cheaper and more widely used transport network and would inevitably have to be offset by tax rises on the motorist. All of this talk of nationalisation style policy and tax rises is far too left wing for the coalition government, but the Liberal Democrats called for such revolutionary transport policy in their manifesto, to invigorate the economy and lead the way on emissions cuts. Instead the Lib Dems are being sucked into an alliance of slashing not just in spending but in government influence. It might be liberal to rein in the police and even to make sure benefits are only paid to those genuinely in need, but it can also be liberal for government to make transport cheap and appealing to all, ensure a consistent, cheap energy supply and take direct charge of basic education in schools. This divide between big state and small state liberals has long been a feature of the Liberal Democrats and may continue to be an issue.

Several contributors to DemoCritic have warned that the Lib Dems must be careful in coalition and I have urged them and us, the voters, repeatedly on my blog to ensure the Conservatives do not have unlimited use of orange and yellow human shields in Parliament. When it comes to Cameron’s “Big Society” agenda Nick Clegg has promised that it upholds liberal values. But during the election he dismissed the slogan as a gimmick designed to disguise rushed, ideological deficit reduction that threatens not only the economy but the efficiency and fairness of our state. Clegg and those in his party must endeavour to ensure what’s good about the “Big Society” goes ahead and the Labour party and the electorate must continue to call for what Cameron labels “big government” solutions when they are right and suitable.