The sacred cow: splice, dice and if that fails blow the s**t out of it

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.

Dave Howells is a writer and illustrator. See more of his work here.

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6 Responses to “The sacred cow: splice, dice and if that fails blow the s**t out of it”

  1. william says:

    Btw,since we are talking about poll tax, where is Gordon Brown MP,the mastermind of Labour’s greatest electoral defeat for years?

  2. I have been chronicling this, from the beginning of last year, over at my site the deception was there (hence the name of my site) but you could read between the lines to get to the real policies.

    As to the Bill. Well it is so long because half of it is tearing apart the 1948 Bill. The other half is resuscitating the old policy of GP fundholding (the Tories introduced it in the 90s and it one of the reasons why they lost the 1997 election) and implementing policy of “Patients’ Passport” (which Cameron formulated for the 2005 election, another election they lost). The Tories are definitely tenacious, if the electorate rejects their NHS policies they just rename them and try again.

    Your description as this being the privatisation of the NHS is spot on. The Co-operation [sic] and Competition Panel (part of the Department of Health) said in a report this week that the underlying rationale of the Any Willing Provider policy is that

    “[hospitals] that do not attract sufficient patients face the prospect of being unable to meet their financial obligations.”

    Or to put it simply, close down. The hospitals who are expected to gain patients are private providers, the ones who are expected to lose them are NHS hospitals. This will be a bit-by-bit privatisation.

    The government says that we will have “patient choice”. Well let’s use it. Let’s start a campaign to only use a hospital that is 100% NHS. (I have to caution you here because some private companies are masquerading as NHS, some call themselves social enterprises – for example Circle, others are blatant shareholder owned but they use the NHS logo because they do NHS work.) If every patient only uses NHS hospitals then the CCP doctrine will be turned on its head, and it will be the private hospitals that will go out of business, not the NHS hospitals.

  3. Richard says:


    The standard of Tory trolling really has taken a nosedive. It seems you can’t adjust to being in Government. Not surprising really as you didn’t win the election.

  4. william says:

    Conservative party 36 percent of the vote ,Labour 29 percent.Please remind me which Labour leader.Richard,reversed 13 years of electoral success.

  5. UniteJon says:

    As said, the NHS could be the Tories poll tax for this government. But what I don’t understand is why Labour is being so soft on them. This isn’t a time for pretty rhetoric, it’s a time for spitting feathers and shouting out at the top of your voice “You lied to the voters!”

    If there’s anything that can limit the damage that this government is going to do, it’s going to be a swing in public opinion that turns the populist press (and hopefully the LibDems) against the Tories.

    The changes don’t even make good economic sense. How does allowing the corporate giants to syphon off billions from the NHS budget make it more efficient. It won’t – the savings will come from hospital and specialist unit closures and front line job losses – lots of them.

    If we don’t make a stand now, when at some point in the future we get sick and need health care, we’d better have the money to pay for it privately, because there is a very real possibility that only the most profitable treatments will remain part of the NHS service. The writing is on the wall.

  6. @UniteJon

    I suspect that the reason for the breakneck speed of the Health and Social Care Bill through parliament is so that they get it through the Commons before the May local elections. If people say on the door step that they do not want this bill and Lib Dems (as expected) are voted out in huge numbers, Lib Dem MPs will think again about voting for it.

    The government have said that they will not allow amendments to this bill other than government amendments. This is profoundly anti-democratic, yet the government can say this because they have the support of Lib Dem MPs. It really is about time they stood up to their over-masters and started to assert Parliamentary authority over the Executive.

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