Monday, 4 April 2011

The Man who bet everything on Black...

Forgive me for repeating myself, but I can't help watching the Great NHS Battle of 2011 with a mixture of fascination and horror.

I've pointed out how very unwise it is to dump a 3 billion re-organisation on the NHS without its desire or consent.

The NHS is the one universal policy, the one institution we value over all others. It has vast public support and is a national treasure Labour are seen as better at managing.

It's clear for all to see that Andrew Lansley's health reform plans are in trouble. They have no support amongst doctors, nurses, patients or GPs, the Lib Dems voted against them at their conference, Tory backbenchers know they will cost them seats and possibly put the EU in charge of competition laws. The mighty 38 Degrees have taken on the cause, with a 250,000 signature petition and the BMA voted overwhelmingly against the plans.

So what to do?

Well, traditionally, policies this unpopular are gently discredited from behind the scenes and we all agree that no more should be said on the matter. The minister in charge of such chaos is quietly shuffled off to another department and subtly the narrative starts to change toward something much more palatable and popular.

Political opportunism? You bet. But also vital for a government to survive. If something is genuinely unpopular, you just ought to accept that you got it wrong and move on. If not you risk looking as though you think you "know bes,t" think you can push through any policy "for our own good". You risk a poll tax or an Iraq hanging around your neck that blocks every future message you ever want to send.

A quick flick through today's papers however reveal a charm offensive is underway. The Telegraph tells us that "David Cameron will this week take control of the government's Health Reforms amid fierce criticism of the plans"

So the man who was convinced that only he could win an election for the Conservatives, now believes that only he can "sell" an unpopular Health policy. PR Dave will save the "brand" and the "product" with a series of oh-so-earnest "meetings"

Cameron's personal ratings are still better than either Miliband's or Clegg's. During the election campaigns last year, do you remember seeing anyone else in front of a camera? You certainly didn't (and still don't) see Osborne. You didn't see Theresa May or Oliver Letwin. Not hide nor hair of Lansley or Grayling. "Lansley who?" May have been more accurate.

Seems we have another Teflon-messiah with over-reaching self belief.

But to stake your ratings and political capital on an unpopular and failing health policy is like betting everything on black. If it remains unpopular, you will evermore be linked in the public psyche to NHS attacks.

For quite some time, Cameron trod a delicate path. He delegated well, kept out of departmental squabbles and wafted around looking statesmanlike. People liked it. If a policy went wrong, Dave stepped up to reassure and largely, people thought, "Oh, phew, that's OK then. Dave seems like a nice bloke."

To think that that will work with the NHS is quite remarkable. I suppose the closest example I can think of is Blair resolutely clinging to Iraq when all around him were edging, then fleeing away. It didn't turn out well. For evermore, every message Blair wanted to share started with the words "Iraq-blah-blah-Iraq". Domestic politics faded into the background and Iraq was all anyone ever heard.

If you think it's an unlikely comparison, just wait to see the reaction when a domestic issue like the NHS takes centre stage. When wards and hospitals start to close, when operations aren't scheduled and maternity units can't deliver babies. Even Tory backbenchers will walk away from that level of carnage. The public will run.

There is of course a way out. It's brutal, but politics is brutal. Drop the unpopular bits, reassure the public ad nauseum and replace Lansley. I don't think Cameron will. He is loyal - Coulson showed us that. He may fall into the trap of defending the indefensible until it really damages him, just as he did with Coulson. He may keep Lansley around long after he becomes a liability, just as he did with Coulson.

Or, Clegg might see his greatest chance to revive his ailing party quite spectacularly.

Nothing would give his party a greater boost than the words "I'm sorry, my party is sorry, but some prices are simply not worth paying. If power and influence means the destruction of our National Health Service, then that is something my party simply cannot be a part of ."

The Health Reforms would fail, we may well see an election and Clegg would shoot straight to the top of the opinion polls before you could say "NHS Saviour".

But that almost certainly won't happen either. Will it?


  1. And yet labour started the privatization of the NHS, through the back door. His idea on allowing his mate to carry out cleaning contracts saw the massive rise in MRSI.

    Private hospitals were allowed to take on large scale contracts from the NHS.

    Reading of MRI scans went to a private company in Spain.

    The NHS is safe in labours hands, which labour party is that the socialist one or the blue one.

    ( Labour)
    The government has announced one of the biggest ever health privatization schemes - selling off the contract to supply and equip hospitals across England. But the workers threatened with privatization are balloting for strike action to oppose the government’s plans.
    The department of health announced that on 1 October German company DHL, best known as a parcel courier, will take control of the contract - worth £22 billion in purchases over ten years.

    Hazel Blears, praised the role of private firms and the voluntary sector in providing public services for the NHS, echoing the views of two of her cabinet supporters, John Reid and John Hutton.

    The Labour party or new labour put billions into the NHS with a plan to flog off many parts of it.

    Every dam party that comes to power takes a long hard look at flogging off the NHS or parts of it.

    Luck I'm not trying to become part of the Labour party.

  2. Robert,

    I think that you can make a clear distinction between the provision of equipment, ancillary and support services and medical decisions.

    The debate of whether the former can best be provided in-house or by third parties is separate from deciding who needs an operation, how long should they wait, etc.

    The labour changes you have outlined pertain to the former, the proposed changes under Landsley focus on the former. The fact that their primary focus may change from the encouragement of competition, I.e. Privatization), to “value for money", does little to impact the quality of service people have the right to expect. Cameron has steadfastly maintained that as long as the service is “free” at point of offering, the public should be, and will be, unconcerned with these and all other aspects of NHS service delivery.

    Now, considering that under Labour, customer satisfaction with the NHS service had risen quite dramatically, the Tory coalition policy to either section of care services largely t companies headed by Tory contributors or on the basis of the provision of lowest cost options, it is difficult to see how the service will not deteriorate. The creation of multiple GP consortia, as well, does little to counter act the issue of post code lotteries in the provision of medical care.

    I believe that Miliband is correct to point out that there never was a public mandate for the Tory coalition policy changes contained in the proposed bill.

  3. correction,

    I meant say Landsley changes focus on the latter.

  4. Ah but Robert is bitter and doesn't want to see those distinctions.

    Is there anything more pointless than looking back?

    Of course Robert forgets the vast investment that raised confidence, reduced waiting lists, improved cancer care, increased nursing levels on wards, raised the UK to 2nd most efficient health system in the world, cleared backlogs of "un-commercial" procedures.....

    Much easier to just blame everyone else rather than living in the here and now.

  5. Actually, Thatcher started the ball rolling with the internal market. Then the neoliberals got into their stride, realising that there were huge profits to be made by privatising public services. This culminated in the 95 Uruguay GATS agreement and the setting up of the World Trade Organisation. The GATS treaty signed up to by the EU has been implemented by every government since... first under Major, and perpetuated by New Labour. This is why the Tories talk about evolution not revolution.

    But we know that the Tories are really on the back foot because Tony Blair is supposed to be going to reject the Lansley health reforms! As if he had not been the major proponent of the hidden stealth privatisation....