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.

Two Eds really are better than one

It has been one of those weeks in politics. As well as dull but incredibly important legislative procedure on issues like voting reform and the EMA, there have been the scandalous, newsworthy, headline-grabbing stories which get everyone interested and have the potential to set the tone of debate for the foreseeable future. On Friday the big story was supposed to be the once charismatic, fallen and tainted PM Tony Blair giving evidence for a second time at a historic war inquiry. Instead both of the major parties faced employment crises that sent morale on an undulating, yo-yoing rollercoaster ride.

At the end of that ride it seems Labour, against the odds, have emerged with their heads held high and full of hope. The resignation of David Cameron’s long-term spin doctor Andy Coulson proves them right on a point they’ve been making in Opposition for months. With little policy of their own to use as ammunition against Coalition cuts, Labour have relished the niggling issue of Coulson’s shady past at the News of the World. By finally quitting Coulson has reinforced Labour’s attempts to expose the “new” politics of the coalition as the same old dishonest, elitist governance of old. Coulson may have tried to serve his employer well one last time with the timing of his announcement, shrouded as it was in theory by the gargantuan story of a Labour frontbench reshuffle so soon after the selection of the original line-up. But for the moment at least it’s Labour that are buoyed by events and the Tories feeling somewhat dejected.

Back in October I aired my views on this blog about the announcement of Ed Miliband’s first Shadow Cabinet. To me the appointment of Alan Johnson was a mistake, and far be it from me to blow my own trumpet, but events have proved my initial musings correct. Johnson went from gaffe to gaffe, showing a worrying lack of knowledge for his brief. Labour continually failed to land palpable hits on economic issues, despite a plethora of targets laid bare by Con-Dem cuts. Meanwhile Ed Balls, after a dynamic and impressive leadership campaign, languished largely unnoticed as Shadow Home Secretary. No one seemed to be pro-active enough to take the fight to the Conservatives on damaging policies in a noticeable way. Balls’ wife, Yvette Cooper, also wasted away shadowing the foreign office brief, despite widespread backing in the party and the potential for public support. The only Labour frontbencher scoring economic points was Shadow Business Secretary John Denham, and even he has left glaring gaps in his arguments and been error prone.

Alan Johnson’s sudden resignation due to personal issues so soon into his new, vital job may be a blessing in disguise for Labour and everyone wishing to see credible Opposition to Coalition cuts. Despite the mistakes, Johnson has once again proved in his short tenure his capacity to be likeable and approachable to ordinary voters. The revelation that it was in fact his wife having an affair, not him, ensures the prospect of return to the Labour frontbench in a smaller, popular role in the future. With Johnson’s static, timid fiscal presence brushed aside though, Labour can at last forge a bold new and distinctive direction on all things economic.

I praised Ed Balls during his leadership campaign for going a long way to reshape his bullyboy image. More than any other candidate, Balls looked as if he’d give Labour a truly individual position on policy. Continually described as Labour’s “attack dog” Balls will now have much greater freedom to bite at the heels of the Coalition. As Shadow Chancellor he’ll have to respond to hot, topical issues like tuition fees and bankers’ bonuses; fresh and emotive in the public consciousness. He’ll also have to start winning the argument on growth and investment vs. spending cuts.

Already though he has shown signs of defending Labour’s past record more effectively, explaining his decision to now back the plan he once opposed to halve the deficit within four years, by citing better figures driven by Labour’s spending whilst in government. He’s also been wise to already criticise the government, not for risking a double-dip recession, which looks unlikely, but for wasting an opportunity for greater growth and wider prosperity because of ideological decisions. And growth, Balls will emphasise, is the swiftest, most sustainable route to deficit reduction.

There are still those warning against the potential problems of two Eds at the top though. The primary fear is a return to the Blair-Brown standoff that came to define and overshadow New Labour. This concern adds the extra interest of a helping of recent political history to the mix of this story. Will Labour repeat past mistakes, despite Miliband’s proclamation of a new generation? Even if the new team propels Labour back to government, the same old potentially lethal questions will hang ominously over the partnership between the leader and the treasury.

However I think the doubters are at the very least premature to suspect Balls of wanting to derail Miliband’s revival of the party. Despite the fact he ran for leader, it’s no secret that the job Balls has always wanted is Chancellor. Finally in a position to seize his goal, he is unlikely to turn his fire on his own party. Much more likely is that Balls will electrify the chamber, as one Labour source believes he will, and unleash an avalanche of devastating balls of criticism at the government. He’ll add much needed guts and yes, “Balls”, to Labour’s Opposition. He’s already proved his aptitude for Opposition politics during his leadership campaign.

Balls’ wife will also have greater opportunity to play a key role, replacing her husband as Shadow Home Secretary. She’ll no doubt start picking apart government policing plans. But once again Ed Miliband showed a disappointing lack of courage with his emergency reshuffle. Already he’s failed to take climate change seriously or offer serious backing to voting reform or a graduate tax. And by handing Balls Johnson’s old job, not his wife, he once again missed an opportunity to make his generation truly a new one.

Failing with his initial selection of a cabinet though meant he simply had to give the role to Balls. Who will, I believe, do a genuinely excellent job and accelerate Labour’s journey back to power. The two Eds plan to have adjacent offices and the fears of a Blair-Brown fallout seem unfounded to me. Nevertheless they will not disappear and had Miliband boldly plumped for the equally qualified Cooper, he would have avoided the shadow of New Labour he is so desperate to escape.