by Dave Howells
What Tony Blair did in three words, “Education, education, education”, David Cameron did in three letters: “N.H.S”. That was how he set his stall out at the last election. If they couldn’t get away with being “the party of the NHS”, try though they might, at least they could be “the party that wouldn’t fuck it up”.
Before 1997, Labour had a similar problem with the economy, so New Labour was born and the party was rebranded as one that was pro-business and “extremely relaxed about people getting filthy rich”. Labour committed to stick to the Tories’ spending plans during its first two years in office. There. Done. Now the country could exorcise itself from the grip of the Tories without having to worry that a Labour chancellor might give the Treasury PIN number to too many poor people, or that the wheels would come off UK Plc.
In 2010, the Tory problem was being trusted full stop. But they were particularly vulnerable to accusations that they might go selling off “the family silver”, especially our treasured National Health Service. Because, after all, when it comes to flogging off state-owned assets to the private sector at bargain basement prices – be they railways, telephone networks, council houses, or (more recently) forests – the Conservatives have got form. So, in a move straight out of the New Labour playbook, the Tories said they would stick to Labour’s spending plans, funding for the NHS would be maintained at its existing levels (in-line with inflation, no less), and there would be no more costly “top-down reorganisations”. Oh, and Dave changed their logo to a tree and rode around on a bike a bit. There. Done.
Then came the credit crunch, a global financial crisis, the mother of all recessions and the near implosion of market capitalism. And, all of a sudden, sticking to Labour’s spending plans didn’t seem like quite the stroke of genius it once had done. Much better to abandon the “don’t scare the horses approach” – seeing as they’d already bolted anyway – and opt instead for a public sector slash and burn under the cloak of “deficit reduction”. Wrap that in the rhetoric of their tried and tested “Labour profligacy with the public purse” yarn and some nursery school household budget comparisons, and there you had it. The only hard bit would be keeping George Osborne’s poisonous smirk under wraps while they did it.
But on the NHS – on the face of it at least – Cameron didn’t dare budge. Come election time that poster was everywhere, with Cameron all polished and porcelain-like, straining every sinew to do “earnest and reassuring” next to the words “We’ll cut the deficit, not the NHS”. The Conservatives had a “simple, practical, common sense, human understanding” of this “fantastic and precious fact of British life” we were told, and any Tory who said otherwise got a very public beat-down (recall Daniel Hannan’s “the NHS is a 60-year mistake” gem). Britain was broken, apart from the NHS, was Cameron’s line.
Cut to the present day and, having stood for election on the promise of “no more costly top-down reorganisations”, the NHS is now braced for “the most radical restructuring since its inception”. A mere two pages in the Tory manifesto have miraculously morphed into a bill nearly 370 pages in length – four times the size of the one which originally founded the NHS.
Doctors, nurses and trade-unions have described the reforms as “extremely risky” and “potentially disastrous”. A recent open letter to the BMA from doctors adversely criticising its placid acquiescence to the government’s plans warned that the reforms “will fundamentally undermine the founding principles of the NHS by creating a much more expensive and inequitable market-based system”. Uber-Blairite turned Tory inequality Tsar, Alan pro-private sector Milburn, predicts “anarchy”. New Tory MP and former GP, Dr Sarah Wollaston, has likened the reforms to “tossing a grenade” into the NHS (specifically, the primary care trusts). The British Medical Journal has described the plans as “mad”. While The Lancet predicts a “catastrophic break-up” and “the end of the NHS” and just this week it has been reported that 50,000 NHS staff are set to lose their jobs.
I’m no doctor, but this doesn’t sound like the sticking plasters on the status quo that Cameron campaigned on. This is a deliberate car crash and the private sector are the ambulance chasers. All of which while the NHS is enjoying record-level approval ratings.
Cameron has claimed that these reforms, rather than being a “top-down reorganisation”, will actually be “bottom up” – a semantic side-step that reveals him for the dodgy used-ideology salesman that he really is. He will probably describe the effects as “modernising”, “redistributive” and “decentralising”. But, make no mistake, the grenade that will do this is being thrown from the top.
Cameron knew he couldn’t sell messing with the NHS. So he didn’t try. But whether the Tories like it or not – and most of them almost certainly don’t – the NHS is a sacred cow in the national consciousness; a living, breathing monument to post-war idealism that said yes, in one sense, Dave’s right, “we are all in this together”. Sure, it’s far from perfect – as the disturbing report last week from the health service ombudsman highlighted. But, even so, any inkling that Cameron was going to send it off in a meat wagon to be sliced, diced, and sold off as happy meals to the private sector and Cameron would have been dismissed by the electorate quicker than he could have removed the wisteria from his chimney.
“If not now, when”? Cameron has asked. How about when you’ve won an election for starters, and how about when you’ve done it on the promise of “the most radical top-down reorgnisation of the NHS since its inception”? A structural reorganisation might not hit the same raw nerve as the trebling of tuition fees or the scrapping of EMA, but it should. If anything deserves to be Cameron’s poll tax, it’s this.