Tag Archives: NHS

Reform or no reform, decision or indecision, government choices about the NHS have real consequences for patients like me


2011 is already shaping up to be a hugely important political year. We’ve had the Arab Spring and in the last couple of months alone, landscape shifting national crises in phone hacking and the riots. Coalition government is still a whole new kettle of fish that could boil over at any moment. No one’s quite sure, still, where Ed Miliband is going to take the Labour party. The Euro continues to dance with death. And Obama may have killed Bin Laden but is yet to throw his own economy a convincing lifeline.

Amidst the naming, shaming and blaming in the aftermath of England’s rioting, debates about coalition cuts and reforms have once again been lost in the robotic chanting of ideology. Earlier this year the general public mobilised in a reassuringly democratic fashion to force a pause or “listening exercise” in NHS reform. There are whispers in some parts that David Cameron and Andrew Lansley intend to ignore the concerns of the people, under the radar. But Nick Clegg, following his electoral and referendum humiliation in May, ensured us he’d keep an eye on them. Trouble is no one trusts him anymore.

What I’m about to write is more personal than political. I’ve said before that all my political writing has an element of my personality, in that I do my best to express strong opinions, beliefs or half formed ideas I’ve concocted from things I’ve read or consumed. Even professional political commentators are aware that their own preferences influence their coverage. But I’m the first to admit that, as a young man, I am often dealing naively in the abstract. My opinion on defence cuts or the symbolic importance of the Euro is rather ignorant and useless in reality. The NHS however is for all of us and can affect the quality of our everyday lives dramatically. We should all feel able to speak out about its future.

In late September I will begin university life after a gap year I probably wouldn’t have chosen to have. A couple of years ago I was very ill. I lost a lot of weight and barely ate anything. I was frequently in severe pain and unable to socialise with friends in the summer holidays. I could muster enough energy to complete school work and little else. Eventually I was diagnosed with the digestive condition, Crohn’s Disease (http://www.nacc.org.uk/content/home.asp).

After passing through various rungs of the National Health Service I found myself with a steady and capable team of staff at the Inflammatory Bowel Disease clinic of my local hospital. A variety of treatments got me through Sixth Form and I was relieved to do well in exams, unaffected by the Crohn’s. In order to continue my recovery I chose to have a gap year, although it didn’t feel like I had much choice. I simply had to get healthier.

I started a new treatment of fortnightly injections. This was intended as a longer term solution because I had been taking powerful drugs that could have harmful side effects in the future. Thankfully the injections worked and continued to do so. I could return to a “normal life” with the limitations of my condition minimised. I felt grateful to be as healthy as I could be. My worries were mostly those of ordinary people my age and I was able to grow as a freelance writer and enjoy the year.

Now though health related stress is making a comeback. With university imminent I am organising the altered delivery and storage of my treatment. And at the last meeting with my doctor a few months ago I was told that the National Institute for Health and Clinical Excellence or NICE, who are basically in charge of what doctors can spend on expensive drugs, would want to reassess my case at some stage. The guidelines say that if you’ve been well for a year you should be taken off the costly treatment. I was assured this wouldn’t happen during my transition to university but I am not naive. At some point the decision will be taken away from my doctors.

So then we come back to NHS reform. I had always been instinctively against the predominantly Conservative proposals. But my doctor said something along the lines of; if it were his choice he obviously wouldn’t even consider withdrawal of the treatment for a long while. David Cameron has constantly talked of empowering GPs and specialists to make decisions like this which could benefit patients like me. Was I against these reforms or not?

The main problem is a lack of understanding. Do you fully understand what is being proposed? I don’t. I’m betting no one, bar those involved with the actual legislation, really does. The pause has actually complicated things further. In fact even those with all the facts of the legislation can’t comprehend every little consequence in real life for real people. Letting doctors decide sounds good. But shouldn’t the bulk of their time be spent treating patients? Shouldn’t someone independent make such decisions?

My attitude towards NHS reform has taught me that whilst I lean to the liberal left or centre with my political thinking, my actual opinions can be rather conservative. Change has always stressed me out in everyday life. If something as vital as the NHS ain’t broke, don’t meddle with it, especially when the country is trying to save money. I got better eventually, that’s all that matters.

I’ve long thought that the real way to help improve standards and ensure sustainability for the future is to cut down the sprawling responsibilities of the NHS, whilst reinforcing vital areas. It seems logical and fair that treatments that aren’t essential should not be given priority. Equally those that bring about their own illnesses should come second to the more deserving and hard done by. We need tougher health based taxes to directly fund the NHS and ease its burden, doing whatever we can to discourage the abundance of drinking and smoking cases that weigh it down. Granted this view comes from the fact that I was born with asthma and have other conditions, like Crohn’s and eczema, I could do nothing to prevent. I hold a selfish view. But then everyone gets their opinions from somewhere and all I believe in is a fair, efficient health service.

Again though what I thought I believed has been turned upside down by what’s happening to me in real life. NICE are the body responsible for ensuring that the NHS spends its money wisely and on those who need it. They are also the body that could at any point in the future remove my funding and leave me without treatment. I might stay healthy or I could plunge back into an illness it will take a long time to escape from. It could be even harder to recover second time round and the injections might not work twice.

The NHS is something Britain is envied for around the world and it is a genuine reason to be proud of our country. Cameron is saying Britain is broken again and pictures of the riots have been beamed out internationally. But we can be proud of the NHS. Overall I am happy with what it has done for me but the uncertainty hanging over my future proves it’s not perfect. It can’t be. It aims to be perfect, trying to make everyone better all of the time. Because it reaches so high it can’t get it right for each individual; whatever politicians decide to do will not change this fact.

But every decision they do make about the NHS will have life changing consequences for someone, somewhere in the system. For people like me
and people far worse off than me. So they should continue to think carefully
and trial new ideas before making sweeping changes. I’ve written before about
the government’s NHS plans but this article is an admission. I do not know
whether it’s best to stick or twist. All I can yelp ineffectually into the
blogosphere is that I hope the decision makers understand the gravity of what
they are doing, and that we keep doing our best to keep up and pay attention.

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Miliband can defeat his critics and Cameron’s leadership by reinventing the nature of opposition


Like it or not, love him or loathe him, David Cameron has proved himself to be a competent and capable leader in his first year in Number 10. He has shown himself to be easily the most adaptable Prime Minister of the 21st century and perhaps the most versatile and formidable party leader too. He has embraced the unique hurdles and challenges of coalition government to at once deliver radical policy his party believes in and please the electorate. He has vowed not to make the mistake of Tony Blair’s early years, in which political capital went unspent. He’s taken a blitzkrieg approach to numerous important issues and departments, somehow taking most of the country with him through a combination of confidence and yellow human shields.

Ed Miliband on the other hand, has been constantly under fire from both the media and Britain as a whole, and his own party. His leadership is generally, and not unjustifiably, characterised as ineffectual and inactive. He has more often than not chosen to stand by and do nothing but protest vocally at government plans. He has claimed to be the voice of Britain’s ordinary people and its “progressive majority”. His critics say that this majority doesn’t exist and even those that think it might, recognise that it has to be earned and forged from blood, sweat, tears and most crucially of all, policy.

Labour under Ed Miliband has produced almost no policy. His supporters and aides will argue that he’s been focusing on healing Labour’s image, bruised and battered by thirteen years of controversial government. But there has been no clear rebranding or change of direction either. The publication of elder brother David’s would-be acceptance speech last week highlighted just how much more Ed could have done from the start. I was critical of David’s lazy leadership campaign and even praised Ed’s more concrete vision. Looking at David Miliband’s speech though, it’s hard to argue with those who say he would be doing better as leader right now.

The speech sets out the deficit as Britain’s key political argument. It simultaneously does more to defend Labour’s record in government and admit its mistakes than Ed has done. It systematically addresses key areas with attractive focus; Ed’s speech tended to waffle more generally, focusing on alerting the world to the fact that he was an alright sort of guy. Well now we all want to know what he’s going to do to prove it.

To make things worse for the victorious Miliband, his shadow cabinet has hardly had time to settle. Alan Johnson didn’t last long as Shadow Chancellor. There has already been more than one reshuffle. Ed Balls, finally in the role he has craved for so long, is Labour’s only ray of activity. Last week he announced the one concrete policy they have in opposition; increase the bonus tax on bankers. Balls intends to gather support from rebellious Lib Dem and even Conservative MPs to push a Bill through Parliament that would take more money from the banks to fund employment schemes for the young and house building projects; to stop the rot on growth.

Now it’s obvious that one of Miliband’s weak points has been his inability to do much else besides bash the banks. Credible Prime Ministers cannot afford to make such powerful enemies or be defined by the one headline grabbing policy. But the plans of his money man Ed Balls are exactly the type of thing Labour should be doing more of. The government’s refusal to invest in the economy or change course on its programme of cuts is doing lasting damage. Labour cannot afford to just talk about this. They should hit the coalition where it hurts; by acting to safeguard the national interest it claims to be working for.

And Miliband could go further. He could say that a Labour government would not just build homes for struggling first time buyers but insist that they are all green. Labour needs a new stamp that marks out policy as theirs, which goes further than simply investment vs. cuts. As David Miliband set out, Labour has to acknowledge that it will tackle the deficit; the question is how will it do it differently?

 Ed should make it abundantly clear that he is proposing policies for consideration now, intending to pass them now because to act too late would let the state of the economy and the government’s initiatives do irreparable harm. More house building would kick start the construction industry; more homes would get the property markets moving and add stability to a fragile, slow recovery.

Miliband has continually fallen back on the fact that the party in opposition traditionally keeps its cards close to its chest until an election. People should not be expecting him to be outlining detailed policy now, he says. I defended criticisms of him early on by using the argument that he shouldn’t rush through thinking about such important issues. But he has had time now. He must have some ideas. And he needs to start sharing them.

This is not an ordinary government. The coalition can be stalled, halted and persuaded on almost any issue. Parliament is not a sea of blue and carefully selected opposition proposals could become law. The NHS “listening exercise” and the rethink of Ken Clarke’s justice reform are examples from the past week alone where Cameron has been swayed enough to track back. Ed Miliband needs to do something bold to win the respect of voters. Disclosing genuine alternatives in full and frank detail will show that Labour care enough to act in the country’s interest, not their own.

I write just hours after both leaders in the contest for the nation’s political affections made important speeches on policy. As is the trend of late, it was David Cameron’s that made the greater impact. Speaking to a meeting in London of a foundation called GAVI, backed by Bill Gates, which provides vaccines for the world’s poor, the Prime Minister would have won over voters usually hostile to all things Tory.

His detoxification of his party has been enormously successful and pledging £814 million (the biggest donation of any nation) to an effective charity, goes a long way to satisfying his own voters, thanks to a clear strategy, and others in the electorate. With one speech Cameron scored moral points as well as talking convincingly about finding a clear foreign policy role for Britain based on duty, encouraging private sector growth and stable, democratic government.

Miliband’s speech was also important. It aimed to win back the agenda of community from Cameron, who has dominated the thinking of voters even with his unsuccessful Big Society idea. Miliband talked of responsibility and made surprisingly tough statements about those who didn’t give back not receiving welfare support. There were strong strains of the Blue Labour ideology Miliband recently endorsed, which focuses on democracy and accountability at the grass roots. It was about the overall narrative direction of Miliband’s leadership and designed to answer critics.

However whilst it’s important Miliband finds a stronger and more defined guiding vision for his party, action is what the public wants from him now. For an opposition leader options are limited, so action essentially means policy announcements. The Labour leader needs to be braver and take some gambles with his leadership, to both win over the country and protect it. No one will reward him for waiting until the election.

Notes from the news: Germany’s green energy revolution, Super Injunction Twitter row and Health Reform debate


Amongst the scandalous stories of super injunctions, celebrity gossip ruling the internet and ideological feuds in Parliament, genuinely groundbreaking news from Germany that could have global implications is hiding. Angela Merkel, the Christian Democrat Chancellor, has taken the decision in the wake of Japan’s nuclear crisis at Fukishima caused by a devastating earthquake, to phase out Germany’s substantial nuclear programme. The speed and scale of her plans are unprecedented anywhere in the world, according to an article from The Guardian.

Merkel is far from a progressive or left leaning politician. She is also a realist not an idealist. This makes the news even more momentous and significant, for if Europe’s largest economy takes such action others will follow. The Guardian say that it seems the rationalist in Merkel has decided to take drastic measures to avoid an equally unexpected event as the Japanese Tsunami, bringing Germany to its knees and causing a catastrophic safety hazard.

Merkel is targetting green energy as a huge area for future economic growth. She will be putting her country at the forefront of development, making it a world leader, as President Obama’s positive rhetoric remains just that because of moves by Republicans to block carbon emission caps. The Japanese may also reconsider their decision to continue with nuclear power if other nations are adopting safer, more environmentally friendly alternatives.

Other countries may feel compelled to up their own efforts so they don’t miss out on market share. Green jobs have the benefit of being completely sustainable. An abundance of endless energy could lead to ambitious projects in terms of transport and infrastructure. Clean energy would generally lead to higher standards of living. I’ve long argued that if governments take up the challenge of climate change and replacing fossil fuels there are exciting and inspiring opportunities.

In terms of the domestic impact here in the UK of Merkel’s decision, it may encourage Liberal Democrats, who have long ruled out nuclear energy in their manifestos. Given the divisions now in the coalition following a heated election and referendum campaign, Lib Dems might push for increased direct government funding for offshore wind farms. Merkel recently opened Germany’s first sizeable offshore wind facility and her plans put it at the heart of Germany’s energy needs. The UK has 40% of Europe’s potential offshore wind energy, so there is huge scope for expansion. The Energy Secretary is a Lib Dem, Chris Huhne, who recently confronted his Conservative cabinet colleagues. There is a possibility he’ll push for more for his department in light of Merkel’s u-turn.

Here is the Guardian article: http://bit.ly/lb7lYk

The Telegraph has a prominent article about Jemima Khan being falsely named as a celebrity with a super injunction. She was wrongly accused of trying to gag the media because there were indecent pictures of her and Top Gear presenter Jeremy Clarkson. The incident, with countless other names leaked on Twitter, has prompted further debate about the usefulness of the legal measure in the internet age. It is possible to restrict publications like newspapers but the internet, and Twitter in particular, has an extremely fast mind of its own.

http://bit.ly/ksFV7M

Meanwhile in the House of Commons MPs have been debating the government’s proposed NHS reforms. There has been widespread opposition from doctors, nurses and other health professionals. Labour have pounced on the ill feeling and Nick Clegg vowed not to let the Bill pass if people’s concerns weren’t met, as part of his drive for a “louder voice” for Lib Dems in government following their election mauling.

Much of the opposition centres on the privatisation part of the Bill. There is a fear that the Conservatives are trying to privatise the NHS by “the back door” which is exaggerated. But there are issues with creating any sort of market in health. Personally I think private, high quality hospitals do have a role to play. But I feel uneasy about any market and don’t see the need for it. The NHS should simply prioritise and drop some treatments that are not essential, leaving them entirely to the private sector. This would be controversial but would save huge amounts of money and improve the standard of care for everyone, if measures were made to protect the poor.

One Lib Dem has suggested the Bill be scrapped completely: http://ind.pn/m18c8I

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.

New Balls please…Does Ed’s reinvention answer Labour’s call for a genuine alternative?


Prior to and during this year’s historic General Election my opinion of the then Schools Secretary Ed Balls was pretty low. In countless TV appearances his arrogant, aggressive demeanour failed to endear him to me, the general public or the voters in his constituency, which he nearly lost. One appearance on a Daily Politics education debate stands out in my mind. Balls had a strong argument backed with evidence, but his bullying behaviour of the unlikeable Tory Michael Gove alienated capable Lib Dem David Laws and I suspect the viewers at home. His intense, wide eyed robotic stare gave the impression of an obsessive madman, with whom it was pointless to try and reason. I always felt afraid for the children accosted to play with him for the cameras and prayed they would escape the education minister’s clutches, unscarred by those unblinking, shining orbs. Behind the insane eyes I suspected that Gordon Brown had long ago replaced Balls’ human brain with a Tory termination calculator, more suited to Labour’s attack dog.   

The Conservatives had rightly singled him out as their Michael Portillo of 1997; an unpopular Labour big gun to be toppled to highlight the scale of the reversal, the sheer triumph of Cameron’s new blues. As it happened Balls clung to his seat and not enough red dominoes fell in the wake of the blue tide to give Cameron a majority. The fall of Balls did not materialise as the symbolic story of a Conservative return and was replaced by the drama of coalition negotiations. And with the resignation of his long term mentor Gordon Brown, Balls felt free to step out from his shadow (after a deal with his able, intelligent wife) and run for the party leadership.

Since this decision Balls has quietly transformed himself into the country’s most able Opposition politician. It’s now pretty much the generally accepted consensus that he has run the best campaign of all the Labour leadership contenders, one that focuses on the fatal flaws of the coalition and proposes serious counter policies, as opposed to sifting through the wreckage of New Labour and whining on about the party’s identity. When Brown took over from Blair the expectations were that Balls, Brown’s protégé, would eventually clash with Blair’s heir David Miliband. Due to the fact that Brown had just acquired the top job and Balls was expected to be made Chancellor, and the storm of the financial crisis was yet to break disastrously over Brown’s popularity, Balls was once favourite to become the next leader. If he retains any of the arrogant self confidence that was evident during the election campaign, he will no doubt be finding it hard to take that even the most gushing articles about him do not give him a hope in hell of success. His carefully targeted, policy driven push for the leadership has been undermined by the Miliband family feud and an image of a bullying suck-up that he can’t quite shake off.

Frankly it’s a damn shame Balls didn’t conduct himself with a little less brash brutality and a little more civility in his formative political years. If it were not for the lingering impression of a ruthless career politician, who shamelessly and tribally attached himself to one of New Labour’s rising stars, it would be far more difficult for Balls to be pinned down as a leftist candidate, with no credible chance of success. Of course it might be said that Balls would not have got where he is today by behaving differently, and that a degree of forcefulness is necessary for success in politics but his track record has nevertheless made it difficult for the party or the country to imagine him as leader. It also must be asked whether or not Balls’ transformation is genuine, as he cannot surely have shed all his unattractive qualities overnight, but the facts of his policy decisions seem to mark him out as Labour’s best hope for an alternative vision to the coalition right now.

Rightly Balls places himself in the progressive camp by backing AV and a graduate tax. He disagrees with the coalition’s package for AV, because of its various measures to redraw constituency boundaries but says he would back it in a modified form. He has called for higher taxes on the wealthy and set out a sensible argument for reducing the deficit through fair tax rises like a NI rise, that only hits those in employment, rather than the coalition’s planned VAT increase. He has been the only shadow minister to effectively challenge the new government in his area, successfully landing blows against new Schools Secretary Michael Gove, not just for his building programme cuts but on the wisdom of the free schools project. Crucially as well as setting out his own fresh, progressive policies, Balls has shown the leadership qualities and level-headedness to stick to positions Labour adopted whilst in government he still believes to be right, despite media hype swinging the other way. On the economy Balls insists that new stimulus packages are still needed to ensure jobs, housing and growth and that the pressing need for drastic deficit reduction is an ideological myth created by the Tories. Whilst the truth probably lies between the extremes of the coalition’s cuts and Balls delay and extra spending, it is refreshing to have a Labour leadership candidate point out the lunacy of the culture of fear surrounding the deficit. Balls also has the weight of past policy judgements he called right behind him, such as his opposition to the euro and creation of an independent Bank of England, but his reluctance to draw attention to his aggressive past has meant he cannot point these out in the leadership contest as enthusiastically as he would like. There is an undoubted logic and sense to Balls’ arguments, as economic growth has always been the best way to reduce the deficit through higher tax receipts.

Whilst Balls looks unlikely to become the next leader of the Labour party there are already rumours of a deal between him and David Miliband. Such a deal would probably see Balls finally have the long coveted Treasury in his sights. Before this leadership election I would have been sceptical about Balls as Chancellor and much preferred the steady hand of Alistair Darling in control of the nation’s finances. However Balls has refreshed his image sufficiently, or at least cleverly concealed his flaws, to present himself as a competent and radical member of a new look, progressive Labour front bench that could offer the country a genuine choice and avoid the gloom of prolonged Opposition.

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.