by Michael Dugher

When Parliament returns this week after the half-term recess, the spotlight will once again return to the battle over the government’s changes to the NHS. The so-called “listening period” is at an end and we will see if Andrew Lansley has really listened, or if the pause to the health and social care bill was merely a cynical, cosmetic exercise designed to shore up Nick Clegg’s position and maintain the coalition as a going concern. John Healey, Labour’s shadow health secretary, has done a brilliant job exposing the true nature of the government’s proposals for the NHS. He will table nearly 40 amendments once the bill comes back to the Commons to test the government’s willingness to listen and think again. But the government’s approach to the NHS tells us everything we need to know about the Tories and Labour’s attack might similarly apply to other areas of government policy too.

First, the changes to the NHS demonstrate that the Tories are reckless. Like in other areas – the so-called strategic defence and security review leaps to mind – the changes were rushed, careless and ill-thought through. The new bill is the largest legislative document in the history of the NHS. With its 136 clauses, the original text of the bill was so large that the chief executive of the NHS, David Nicholson, joked that it was “the only reorganisation you can see from space”.  The coalition agreement stated that it was the government’s intention to “cut the bureaucracy at the heart of the NHS”.  Yet the British medical association (BMA) claimed that the changes will “replace one bureaucracy with a perhaps even more dangerous one”. As John Healey has highlighted, the usual process for sound public policy, namely that of consultation-legislation-implementation, has been reversed.

David Cameron has tried desperately to “detoxify” the Conservative brand. He knew that central to the old image of the Tories as the “nasty party” was consistently polling so badly in the “who do you most trust to protect the NHS” question. Cameron has also read Tony Blair’s book. Blair once famously said: “Every time I’ve ever introduced a reform, I wish in retrospect I had gone further”.  But when it comes to the proposed changes to the NHS, the Conservatives are guilty of seriously over-reaching themselves. They simply do not understand that the national health service is a cherished institution for the British people.  We all want to see improvements – big ones – but all governments must proceed with care.

Second, the Conservative approach shows that they are out of touch. The government’s attitude is that it knows best and, as such, ministers have been exposed as arrogant (made worse by their inexperience). They failed to engage with stakeholders sufficiently early and, like the poll tax 20 years ago, political ideology has been allowed to triumph over everything else. There is neither expert support nor public backing for these reforms.  In a recent poll, four out of every five doctors believed plans to introduce full scale marketisation will harm the NHS.  The commonwealth fund found that only three per cent of Britons felt that a radical reorganisation was needed.  The royal college of nursing voted overwhelmingly that they had no confidence in the secretary of state, and the BMA labelled the reforms as “damaging, unmandated and unjustified”.  Even the Conservative-led health select committee criticised the plans, saying they are unlikely to improve patient care.

When Labour left office, patient satisfaction in the NHS was at an all time high, with 65 per cent of patients saying they were either happy or very happy with the health service. This is in stark contrast to the 35 per cent of people who felt satisfied in 1997. Waiting times were at an all time low, with nine out of ten patients being treated inside 18 weeks. Labour did increase investment in the NHS to record levels – for example overseeing the biggest programme of hospital building in the history of the NHS.

But as well as being the great investors in the health service, Labour also believed in reform.  The difference is that when we set up foundation trusts, which devolved decision-making to local communities, Labour ensured that accountability was maintained, as were the guarantees essential for a national service. Fraser Nelson, the right-wing editor of the Spectator, put it astutely on Twitter last week: “Lansley fails to acknowledge Labour’s achievements on the NHS and believes he is inventing reform. Hence, this needless Bill”.

The third key characteristic that defines the Tory approach is that they have the wrong priorities that put at risk the public service. Labour opposes the health and social care bill not because we are against reforming the NHS, but because these changes are the wrong sort of reforms. David Cameron pledged no privatisation, no cherry-picking from private providers, no new charges for healthcare services and no competition for its own sake. But, as John Healey said recently, “this is exactly what his NHS plans and legislation are designed to do”.

The health service is already showing signs of strain in the face of this massive reorganisation. Maximum waiting times for diagnostic tests and treatment have been rising since July 2010, treatments are being rationed and frontline jobs are being cut. The overall budget for the NHS will be subject to a real terms cut of £1.2 billion over the next four years, not the real terms increase that was promised by the Tories before the election. When Lansley told yesterday’s Independent on Sunday that “financial pressures loom large on the horizon for the health service”, he neglected to mention that the pressures in question were created by the government.

Which brings us to the last thing that defines the Tory approach to the NHS: it is another example of broken promises. With higher inflation, alongside the decision to take £1 billion out of the NHS budget to pay for the government’s raid on social care elsewhere, there will be a reduction of 1.22 per cent in funding for the NHS in England next year. But as well as promising to protect the real terms funding for the NHS, Cameron also said he would “stop the top-down reorganisation of the NHS that have got in the way of patient care”.  His government, abetted by the Lib Dems who have consistently voted in Parliament for these changes, are doing precisely that. The cost for this almighty reorganisation is estimated to be between £2-3 billion.

David Cameron will apparently make another “I love the NHS” speech this week, advancing the case for his reforms. Tomorrow, Andrew Lansley will face questions in the Commons for the first time since the end of the listening exercise. When it comes to the NHS, the government’s approach can be defined as reckless and out of touch. They are pursuing the wrong priorities that put at risk the public service and they are breaking their promises. But the same can be said for other areas of government policy too (their attitude to the police is an obvious example).  When Parliament returns on Tuesday, from the Opposition benches, Labour will be saying just that.

Michael Dugher is Labour MP for Barnsley East, a shadow minister and parliamentary private secretary to Ed Miliband.

Tags: Andrew Lansley, health and social care bill, Michael Dugher, NHS

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