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.

Peaceful Protest or Manic March?

And of course, following on from my last post, those that died for our country died to preserve democracy, freedom of speech and the right to peaceful protest.

If you weren’t marching yesterday the impression you will have gained from the national media is one of troublemaking tearaways, descending on London with their purposeless, ignorant views, intent on causing damage and achieving thrilling highs with each frustration filled kick at the establishment, at unprepared police. If you were at the protest, as I was, you would have seen in excess of 50,000 perfectly peaceful but passionate people with a clearly shared general aim. I say “seen” but really you couldn’t see a lot beyond the immediate placards in front and behind you, but you could sense and feel the masses. My friend described it as a “sea of placards”. I went the whole day blissfully unaware that anything truly violent had taken place. The headline of The Times today reads “Thuggish and disgraceful”, in what I view to be a disgraceful piece of reporting. Of course for the media the story of the day was the eruption of rare violence but it is wrong to falsely brand such a vast swathe of respectful young people as “thuggish”. For one thing The Times headline takes out of context a quote from a police officer who had actually praised the majority of those attending the day, whilst condemning the minority his men were consequently surprised by.

Having said that I did not witness any violence all day, I did make it to Conservative Party HQ at Millbank, scene of the carnage, and the tense atmosphere in the air was chilling. Chilling in an exciting way. I was for the most part not fearful at all during my brief stay at Millbank. High-vis wearing organisers made half-hearted attempts to steer us away from the throng at Tory HQ, but having remembered what it was and just past the MI5 offices (which were apparently locked down at some point), I was keen to get a glimpse. I’d say we got about half way in but there was still a sizeable crowd between us and the doors, so later I could not say if glass had already been smashed or violence was already in progress. There was a fire going though, off to our left over more heads. It was fuelled by placards and the crude wooden sticks used to hold them aloft. Later I would see pictures of Cameron dunked into the flames in the papers, at the time I could only see the glimmer of orange reflected on the roof and smell the thick black fumes. Helicopters swirled past the towers overhead. Enthusiastic chanting, full of essentially harmless vitriol, went on with an endless intensity not noticeable elsewhere on the march. And as we left the sickening boom of an explosion close at hand foreshadowed the grisly scenes I would later learn about.

There was admittedly something exciting and inspiring about the atmosphere at Millbank, something I find slightly shameful having seen the damage caused there at some point during the day afterwards. There was an irresistible sense of something being done, of our indignation and righteousness being more adequately expressed. As someone I saw interviewed later on BBC News 24 said, the coalition now had Thatcher’s riots to go with her cuts. I do not in any way condone the violence, as it has undoubtedly smeared the message the ordinary marcher like myself was striving to hammer home, but there was a feeling amongst us that we ought to do something more than just walk and the added venom at Millbank was intoxicating. The country and the politicians needed to be sent a shocking signal, a wake-up call, which forced them to acknowledge the scale of the cuts was real and catastrophic, and as negative and transforming anything Thatcher or those before her dared to enact. But it’s almost certain the majority of the actual perpetrators were not even true to the cause but the moronic fanatics such large scale protests inevitably attract.

Prior to the seductive feel of the siege at Millbank, the march had been an impressive spectacle but an occasionally tedious and tame affair. The only glimpse of genuine revolutionary zeal before the flickering flames and fists pumping in the air at Millbank, was a red-hatted man with a megaphone in Parliament Square. This extraordinary speaker loitered in the area where protesting banners and signs permanently reside opposite Parliament; the sort proclaiming Iraq to be a war crime and Afghanistan a corporate expedition etc. Like a stand-up comedian he playfully bantered with the crowd, which had ground to a halt so that it was slowly trudging past Big Ben and the Commons at best. Groups were beginning a sit-down protest, with Nick Clegg probably still inside after taking over PMQ duty. Girls mounted traffic lights, litter swirled at our feet and drum beats pounded the air in the distance. He flattered us at first, saying what intelligent students we must be. Then he casually slipped in the conspiracy, urging us to use our intelligence and “connect the dots”. Just as I worried he was getting predictable, came his call to arms: “Think about it there aren’t enough police in this city to stop you all. Marching is good but won’t get it done, join me and occupy the city.” Or something to that effect, but more charismatically phrased. I was struck into excited laughter by the audacity of it. We hadn’t come to occupy London, Hitler and Napoleon had spent an awful lot of money and time and expertise trying to accomplish the same thing. Our spontaneous occupation, led by megaphone man, seemed unlikely to succeed therefore, but at the same time, glancing around me, the sheer numbers told me we would have a good go at it if we all stood together. The fantasy, that of a bygone age of socialist revolution, of people power and the possibilities of sudden change, truly motivated me.

Earlier at the march’s official start point on Horse Guards Avenue, speakers had tried to rally the troops. On the ground and in the thick of the towering placards however, the reality was that you could not hear the rhetoric, merely catching snatches of the speech. Each would unmistakeably end with the refrain “NO IFS, NO BUTS, NO EDUCATION CUTS” though. At times I think it may have been just as well for me that I could not hear the speakers, as I heard a glimpse of something about Trident at one point and there was inevitably other overly idealistic or socialist rhetoric I didn’t necessarily support. The striking white buildings on the avenue, dotted with innumerable windows, looming over us on each side, channelled the wind and the noise so that it was both a loud and cold wait for the off. The time was filled with idle talk about the changes being made by the coalition, its worst effects and the need for an alternative to march in support of.

There is undoubtedly a need for a well thought through alternative if opponents of the government’s scheme are to be credible, but the leading article in The Times today is unfairly harsh about the ignorance of students. It claims that the government system is an improvement in some ways, with the rise to £21,000 salary threshold, and it is only fair graduates pay for their education. However it neglects the deterrent such greater debts will act as to ordinary students from ordinary families, it ignores the fact that £21,000 is still an average wage and will often be earned without the burden of debt by those who didn’t attend university and “benefit” from it and most critically of all The Times ignores the key chant of the protest. We were marching against the absurdity of the government cutting funding by 40% (as well as the vital EMA payment, which needed tightening reform, not abolition) and then raising fees to plug that gap, creating a system which the students effectively pay for themselves and which is no better in terms of quality than the current one. British universities will continue to slide in comparison to international competitors, the government’s key claim, that their plan is sustainable, falls flat on its face.

Having said this I did feel absurd at times, marching alongside some with overly optimistic demands. I also felt bad for the unrelenting criticism coming the way of Nick Clegg. Whilst Clegg clearly made a terrible political miscalculation pledging himself and his party against any rise in fees, I still stand by my view of him espoused on this blog as an essentially admirable politician. As head of the junior partner in the coalition this is clearly one of the decisions that is principally Tory in its motivation. If the Lib Dems had total parliamentary control (an almost impossible to imagine scenario) then the spending could have been structured elsewhere to honour a pledge to students. As it was Clegg opted for some influence rather than none and has to bow to Cameron’s party on the bigger issues. The fact that the violence erupted at Tory HQ suggests the demonstrators and activists know who the real villain of the plan is, but there is still understandable anger about the Lib Dem “betrayal”. Clegg also set himself up for a frighteningly fall with his constant talk of honesty and honour in politics. I’d like to think he would still back a progressive alternative should one be found (hurry up Labour!) and I’m sure he’ll hope to return to the issue, perhaps with different allies. As it is though I did feel uplifted to be marching in solidarity with others against cuts to education; that Clegg should not have accepted so lightly and should have done more about.

When we did finally set off it was at a shuffling, rather than marching, pace. Having built up a lot of enthusiasm standing stationary for long periods, I was keen to stride ahead, but had to be content with feeling part of a massive, snaking entity, writhing through London streets, demanding to be heard. The shuffling continued with the occasional more spacious period, past Downing Street and painfully slowly through Parliament Square, all the way to the drama of Millbank. I took far too much pleasure in muttering to myself that David Cameron was miles away in China, as ignorant students directed personally tailored chant after chant at his famous black doorway as we passed Number Ten. I wished for a widescreen HD overview of events, for an action replay as I always did at live football matches in packed stadiums. It would have been nice to truly comprehend the scale of events from beyond my tiny worker ant perspective; to know where best my many, multiple protesting talents were to deployed. Where did they need me I wondered?

Despite the blinkered vision it was wonderful to feel part of history, to feel part of something greater with meaning, even if in reality it would prove politically ineffective. And as usual I loved wandering around London, seeing the Thames from all angles, absorbing that skyline. I’m getting far too used to and seduced by it. On top of it all I managed to share it with friends, as opposed to my usual solitary travels, some of whom I had not seen in a while. I didn’t get long enough in their company and I didn’t plant my flag within the bowels of Parliament, but all in all me and the beard had a good day out on the march.