Cameron’s operation Barbarossa

by Dan Hodges

It was a moving scene. David Cameron fixed the final clasp on his greatcoat, set his tall Shako cap upon his head and slid the brown leather pack across his broad shoulders. There was much he wanted to say to his tearful wife and children, but the words would not come. Instead, he turned and, without a backward glance, stepped into the darkness and was gone.

When the prime minister announced on Monday his comprehensive NHS reform programme, he was announcing the invasion of Russia. Cameron is about to drive his party through thousands of miles of cruel, frozen, inhospitable terrain. They will face fear, famine and deprivation. Experience suffering beyond endurance. And then they will come home, broken, bitter and defeated.

“Every year we delay, every year without improving our schools is another year of children let down, another year our health outcomes lag behind the rest of Europe, another year that trust and confidence in law and order erodes”, he said. Brave words. Defiant words. Utterly, utterly futile words.

“The Tories don’t understand what they’re taking on”, said one former Downing Street adviser who walked through the fire of Blairite modernisation.

“They’re trying to implement structural change as a way of introducing cultural change. The challenge with the NHS is to get it customer-facing. You can’t do that through re-organisation and edict. You have to find a way of taking people with you”.

David Cameron has more chance of getting John Bercow elected chair of the 1922 committee than he does of taking the country with him as he restructures the NHS. Politics is a fundamentally unfair business. In the last years of the Labour government great strides were taken in getting to grips with the chaos of the immigration and asylum system. Politically, ministers needn’t have wasted their time. Labour was still seen to have lost control of the issue and be instinctively standing the wrong side of the debate.

It’s the same with the Tories and NHS reform. David Cameron clearly has a direct emotional attachment to the health service and his pledge to ring fence health spending was a central plank of his election campaign. But if he dressed in a white coat, turned up at PMQs sporting a stethoscope and won a starring role in “Casualty”, he still wouldn’t be able to convince the country the NHS is safe in Conservative hands. “Cameron isn’t dealing with an institution”, said our No.10 reform survivor, “he’s dealing with one of the three great national myths: the army, the BBC, the NHS”.

Listening to debate about just one element of the intended reforms – the abolition of the PCT and SHAs and transfer of their commissioning roles to local GPs – the inherent problems of the Cameron/Lansley strategy were exposed. There was a very sensible, sober assessment of the need for rationalisation of capacity, reallocation of resources and extension of patient choice. Then a GP popped up and said, “we weren’t trained to manage, we were trained to treat our patients”. Game over.

It is impossible to fight and win a logical, evidence-based argument on the NHS. Emotion will always prevail. Just ask David Lock. In 1997 Lock won Wyre Forest for Labour with a comfortable 7,000 majority. Then he made a mistake. Loyally, he accepted the wisdom of government plans for the downgrading of A&E services at Kidderminster general hospital. The avalanche of local opposition that followed saw him buried beneath an 18,000 majority by Dr Richard Taylor and the Independent Health Concern party. The lesson was learnt; hospital closures are bad for a politicians’ health.

Cameron has decided to unlearn it. As he sets his sights on the distant spires of the Kremlin, he has chosen to defy not just popular opinion, but history.

Thatcher’s perceived destruction of the NHS destroyed her party’s reputation on the issue for a generation. Major’s attempt to drive through reform contributed to his annihilation in 1997. Blair, by his own admission, will forever bear the scars of his reform efforts.

The NHS is protected by three ranks of highly skilled, highly motivated defenders: the press, the professionals, and the public. The graphs, charts and spreadsheets will be cast to the winds the first time the News at Ten zooms in on the tired, tear-stained face of Mrs Everywoman, 72, receiving word that her hip replacement has been cancelled for the fifth time.

How can a doctor’s judgment be questioned? They  are the men and women we entrust as daily arbiters of  life and death. The public? You think the students are trouble, wait till you’re faced with a progressive coalition comprising the local residents association, the choral society and the WI.

But Cameron will press on. Through the sheeting blizzards, and razor winds he will drive resolutely forward. The stragglers in marginal seats will simply be abandoned where they fell.

Cameron’s march has many motivations. He sees the promise of efficiency savings. He believes, too, that change, not continuity, is the mood of the moment. But above all else he is influenced by his predecessors. He is seeking to cement his definition as both the son of Thatcher and the Heir to Blair. Both of “the great ones” passed this way. They did not secure the ultimate triumph. But their names still rest upon the tomb of the honored political dead. He is already thinking of his legacy.

And as he reaches for that that legacy, he will spill much blood and treasure. For Labour’s health team, which has already spent a successful winter harrying its opponents, it will be like shooting fish in a barrel.

“After less than a year of Conservative-led government, the NHS is already showing signs of strain. Patients who now see their operations cancelled or services cutback will be the victims of this reckless NHS reorganization”, said John Healey.

Incompetence, callousness, recklessness. A ferocious charge from Miliband’s Cossacks. But who will stand firm and defend the beleaguered government troops? Not the press. Not the professionals. Certainly not the public.

That’s when the doubts will set in. Realisation will dawn. The isolation. The hopelessness. The sheer futility.

Because even Major and Blair, when they set out on their own modernisation journeys, did so with, respectively, the cushions of a growing economy and an overflowing exchequer. Margaret Thatcher was able to catch the nation unawares. Unable to believe a 40 year social compact was being torn up before their eyes, people only awoke to what was happening to their cherished public services when it was too late.

Cameron enjoys neither the resources nor the element of surprise. And so it will begin. The long, slow, cruel retreat. Every footstep will seem a mile. Every yard a lifetime’s journey.

There will be recriminations. Bitterness. Heads will roll. But if he’s lucky, very, very lucky, Cameron may return with just enough of his old guard still standing to fight another day.

But the experience will have chastened him. Like his predecessors, he will bear the scars. So, too, his followers. Never again will they stray so far from their borders. Be enticed by glory and riches from afar. Slowly, almost imperceptibly, their faces will become creased, and their hair flecked with grey. And one day they will awake, and want to live only for their memories.

Meanwhile, in the distance, the spires of the NHS will still glisten. Beckoning another resourceful, invincible general to his fate.

Dan Hodges is contributing editor of Labour Uncut.

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10 Responses to “Cameron’s operation Barbarossa”

  1. Tim Sewell says:

    Stirring stuff Dan, but complacency is a dangerious thing. We should always remember that the expenditure of so many billions of public pounds has health corporations from here to the other side of the globe in a state of continuous salivation. With the connivance of a corporate media and a disaffected public it’s not hard to see a tipping point being reached where those corporations’ considerable lobbying and marketing resources combine with that media to push through at least a partial commercialisation of the NHS.

    Remember, businesses have no purpose other than the enrichment of their shareholders. They are bound, legally and instinctively, to stop at nothing in the acquisition of new opportunities. Any endeavour or service which doesn’t contribute to their bottom lines is by its existence anathaema to them and must be co-opted.

  2. oliver says:

    @Tim Sewell “Remember, businesses have no purpose other than the enrichment of their shareholders.”

    But you say that like it’s a bad thing!

    This really does underline the ideology that’s being articulated by the Tories: the NHS is merely a business opportunity. It doesn’t appear on the radar in any other terms. The vast majority of Tory front-benchers don’t need. Even Cameron’s use of the NHS – exploited to the full – was a case of smoke and mirrors.

    @Dan Hodges: I wish your scenario was the case, that the NHS is some kind of glistening fortress that will withstand the ideological cannon-fire of this government. However, I can’t see it. I’d love this to be this generation’s Poll Tax, but I have my grave doubts. Without wishing to be defeatist but perhaps the student protests – and maybe, more recently, Tunisia – have given a false sense of optimism. I hope it’s not the case, but I genuinely wonder whether people have got the stomach now for wide-scale protest.

    Part of this is due to the way that existing protests are being reported – a predominantly right-wing media has done its best to frame all this with disdain and have focused on the wrong points – but part of this, unfortunately, is down to New Labour. There’s a lot of people with short memories: the Poll Tax wasn’t the last time people really took to the streets to voice protest. The last time was during New Labour’s watch, concerning this country’s involvement in recent wars. A lot of people, of various political colours and stripes, spoke out repeatedly but they weren’t listened to. It didn’t make a scrap of difference. People protested and they were ignored. I know people who were relatively politically vocal – even if not affiliated – and concerned over various issues (not necessarily single platform dissidents) who have now joined the rank and file dispossessed.

    They care that the NHS is being dismantled – along with welfare, education &c. – but it’s perfectly understandable that they no longer see the point in protest.

    As long as people are still able to say ‘this might be a Poll Tax’ moment rather than a ‘this might be an Iraqi War’ moment, there’s always going to be an issue over, for some, it’s worth taking to the street.

  3. Dan Hodges says:


    It’s a long, long time since anyone here accused me of complacency…


  4. Phil Ruse says:

    Here I am, a Conservative coming to a Labour supporting website expecting to be outraged and finding myself in agreement! Not out of love for the NHS, though I love the principle, but the implicit recognition that billions of pounds of public money is spent on a service in need of re-organisation & that *still* isn’t customer facing.

    And you’re right; we have a cottage hospital in my home town, no-one is sure what exactly it does but if I were to suggest it should be closed and the money spent elsewhere, I’d be run out of town!

  5. Will says:

    A great piece. I think that you capture the difficulty and likely outcome well. My family use the NHS all the time (chronically sick wife and daughter) and I have to say I wish that we could reform the NHS to make it a better organisation.

    Care is still way below what we should have and often it isn’t money that is the issue its the way that we are treated. The way that everything has to be done the way the health professionals decide to do it. Opening hours in our area aren’t good. Its run on far too much of a statist centralised formula.

    One of the GP’s that was looking to get involved commented the other day about talking to ambulance drivers to bring more A&E call out patients to a GP surgery as too many of them don’t need hospital treatment. The cost savings could be enormous which could then be spent on other needs within the NHS.

    Personally, I don’t care whether my daughter or wife is treated by a for profits company or a public NHS – I just want them well. Its a false argument private bad, public good. The argument should be good treatment good, bad treatment bad.

  6. oliver says:

    @Will: I’m not sure that it’s a false argument for a couple of reasons. The Tories seem enamoured with a lot of things ‘American’. An American model of private care would be as disastrous for millions in this country as it is disastrous for millions in Americans. Secondly, privatisation within our own country doesn’t have a sparkling precedent: I’m genuinely struggling to see where the majority of non-shareholders have benefited from the privatisation that’s happened over the last couple of decades. In every scenario I can think, of the customer appears to have been shafted.

    I’d argue that the privatisation that’s already happened within the NHS has been a disaster. The nightmares of dirty hospitals and the like really came into their own after trusts began to tender out cleaning contracts &c.

  7. Chris says:

    Cameron’s reforms will be bad for patients but very good for healthcare service companies, especially the ones that donated piles of wonga to the tory party. I wonder how the voters/patients will react when they’re denied a treatment by a private company which at the same time is making fat profits?

  8. Andy Bagnall says:

    Great piece as always, Dan. Two things to remember, though, with apologies for probably stretching the metaphor too far:

    1. Barbarossa failed because the Russians were prepared to see huge swathes of their territory decimated. While I hope you are right that these reforms are ultimately defeated, they will almost certainly do much damage to the institution of the NHS before they are. 2. Barbarossa failed because of the constant harassing of the columns by partisans and the resistance at Stalingrad – both at huge cost to the Russians. Labour must be constantly

  9. Andy Bagnall says:

    …harrassing the tories on this policy but not in a way that positions us against reform per se, or in a way that suggests we no longer think the NHS must be more user focused and with more patient choice. Otherwise, we may find that, like the Russians, ultimately defeating the reforms comes at great cost to ourselves!

  10. You write this almost as if you actually think Lansley is right. New Labour is just Cameroonism, I guess.

    “or Labour’s health team, which has already spent a successful winter harrying its opponents, it will be like shooting fish in a barrel.”

    No it hasn’t. Liz Kendal has worked hard, I will accept that, but we rarely hear from Healey, and when we do he gives a speach that praises Lansley and gets thrown back at Labour every week by Cameron. That was a failure and bad politics. There is nothing good about Lansley, he is incompetent and does not have a clue about how to run the NHS, praising him for meeting lots of people was a daft thing to do.

    I find it distasteful for you to talk about this battle in such a way. Cameron has to be stopped, simple as that. The problem is that Labour, and the Press, have ignored health policy for too long. Activists like me who tried to get Labour to fight the 2010 election based on the NHS and what we would lose if Cameron won were met with a puzzled look: Labour just didn’t think that Lansley could dismantle the NHS. Yet that is what he wants to do. Well now it is time that Labour fought the fight that they should have done last year. Fight for our NHS.

    Blair was wrong in many aspects of his reforms (ISTCs and private Darzi centres were just a step too far towards privatisation). It is about time that Ed Miliband said so. He can easily say that Labour thought that using the private sector to get waiting lists down to 8 weeks (as they were last year) was a good thing but we should not have paid ISTCs 11% more, nor allowed them to do the work risk free (and buy back their clinics when their contracts end). We should say that building £60bn of hospitals is a good thing, but we should have been more careful about PFI and even used the credit crunch to re-negotiate the contracts to our favour. Miliband could say that polyclinics are a good idea (they work well in Cuba) but Labour should never have insisted that they have to be privately run. Mea Culpa. Let’s get some water between the good Labour reforms and the bad Lansley reforms. Once we have done that, then we can fight, tooth and nail to keep the NHS in public hands.

    If we do, the public will be 100% behind us.

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