The legislation opening up England's health service to marketisation should never have been passed. The so-called serious media did not hold the government to account, analyse its intent, fully report public opposition or cover the response of medical professionals in what will prove to be a profound failure of British democracy that ranks with the Iraq war.
The Health and Social Care Bill has just passed through Parliament. A huge step towards privatising the NHS has been taken. The most cherished of UK public institutions is being dismantled and large private providers are already signing contracts. All this is against the wishes of a large majority of the public and an even larger majority of health-care professionals.
A big question is why did the national news media fail to cover the issue clearly, honestly and accurately? Their failure to hold David Cameron, Andrew Lansley and their colleagues to account, or to adequately represent the views of professionals and the public was, at times, very frustrating. It demonstrates the weakened state the UK news media. If hacking reveals the deficits of tabloid journalism, this failure represents the deficits of ‘serious’ broadsheet newspapers and national broadcasters.
In many respects, one should look to the actions of the political class first. David Cameron had a seven year career in corporate public relations. The Conservative Party went to extremes to manage its image on the NHS, to obscure its true intentions, and used every trick in the media management playbook to do so. The Conservative-led Government went well beyond spin as it regularly and blatantly misled and now misleads the public about the NHS and the bill.
The very weak opposition from the Labour Party and the leaderships of the BMA and many professional bodies added to the problem. The Department of Health had already been infiltrated by McKinseys consultants under New Labour (see Player and Leys, 2011). For most of the last year, Labour was unclear on its own policy direction and thus was virtually silent. Equally importantly, the leaderships of the BMA and several Royal Colleges, bypassed their memberships and were in active dialogue with the Government. Few initially were prepared to condemn the bill publicly. So, without authoritative and high-profile opposition, why should journalists have been concerned to investigate and cover the large, highly complex details of the bill?
However, these are now chronic problems in political journalism generally. An over-dependency on Westminster sources, and a general unwillingness to cover detailed policy matters, are two important failings of UK news (see Davis, 2010). Far too often, actual legislation is not considered newsworthy enough to report unless there is internal party conflict or scandal attached. There is also a problematic hierarchy for newsgathering that ensures government sources dominate, with the official opposition trailing behind. Far too often other smaller bodies, groups of professionals and the wider public are excluded altogether from the reporting beat. These problems are common across the UK broadsheet press, whether they be from the left (Guardian), centre (Independent, Times) or right (Telegraph, Mail, Express) of the UK political spectrum. They are also too apparent in national news broadcasters including the BBC.
This was all too apparent for much of 2011. Professional opposition was widespread. Keep Our NHS Public, 38 Degrees, Spinwatch and others began scrutinising the bill and campaigning at an early stage. New local BMA groups sprang up all over the country in an attempt to force their leadership to engage with its ordinary members about their concerns. Numerous articles and blogs appeared, written by health professionals who had scrutinised the bill in far more detail than politicians or journalists[i]. Public meetings took place regularly - and across the UK, not limited to England. Many demonstrations took place. Marathons were run. Barely any of this was reported or drawn upon in the early stages, or appeared in smaller pieces and letters buried within. Opposition stories focused primarily on disgruntled Liberal Democrats.
Under such circumstances, far too often the Government was given too much space to set the reporting agenda and to define the debates themselves. Serious concerns at all levels were ignored until very late. Perhaps the most concerning of these was the Conservative Leadership’s total disregard for democratic institutions and practices. On Andy Coulson’s advice, Lansley and Cameron’s long-term privatisation agenda was completely obscured in opposition and during the election. The headline pitch was about securing the NHS: ‘cutting the deficit not the NHS’ and ‘no more top-down reorganisations’. The plans were not part of the published Coalition Agreement. Lansley’s long term links and dialogue with private health care lobbyists and providers was barely mentioned (see Spinwatch). The same went for the part played by McKinseys. It was also clear to all professionals on the ground that many parts of the bill were already being implemented all through 2011. Civil servants repeatedly blocked the publication of their own risk assessments. Why wasn’t this disdain for democratic process challenged in media reporting?
Similarly, lies and misrepresentation were regularly reported on front pages without challenge. The NHS was portrayed as being inefficient and having comparatively poor health outcomes in comparison to other countries. But much of the evidence used was certainly debatable (see Roy Lilley). Cameron and Lansley regularly stated that the majority of doctors supported them. But, from an early stage polls showed that two thirds of doctors were very concerned and critical. Towards the end it was over 90%.
That GPs were already forming themselves into
Clinical Commissioning Groups (CCGs) was promoted as a sign of positive embrace. But GPs were given no choice as they watched
PCTs being dismantled and new funding structures imposed. News coverage
continually reported the line that doctors would be in charge of the budget and
that this was about doctor empowerment and patient choice. As doctors in the newly formed CCGs have already found out, their influence over the NHS budget is actually more controlled by Whitehall than ever. CCGs are also having to look to private consultancies to take on key management roles. GP power looks like it will be no stronger than
All along, Lansley, Cameron, Clegg and then Shirley Williams publicly stated there was no privatisation taking place. The word ‘reform’ is the most common description. But, plain and simple, this is a large step towards privatisation. Bupa, currently flooding the UK with advertising, knows this. So do Virgin, Sainsbury’s, United Healthcare, Circle, and Care UK.
What is happening is ‘reactionary’ and ‘regressive’ and threatens to take the UK public health system back to its pre-1945 state. £20 billion of ‘efficiency savings’ are really £20 billion of ‘cuts’. Again and again Government words and phrases have gone unchallenged - until the last months of the bill. When they were, professional association objections, were all too easily discounted as the calls of ‘self-interested unions’. Labour’s challenge, now led more convincingly by Andy Burnham, was dismissed as ‘opportunistic’. Lansley was chastised for failing to clearly explain the Government’s case to the public. His real failure was his inability to mislead as convincingly as Cameron.
In the last months, Labour, the BMA and most of the Royal Colleges joined in publicly condemning the bill and demanding its withdrawal. That was widely reported. General coverage and editorials, even in the Conservative-supporting press (Telegraph, Daily Mail and Mail on Sunday), became more critical. Some journalists, such as Polly Toynbee of the Guardian, objected loudly and regularly. But, by then, the bill had progressed too far and too publicly for the Conservative Leadership to be able to pull back.
Commentators have suggested that this might be the current Government’s Poll Tax moment. A far more appropriate parallel is Iraq 2003. Then, and now, the Prime Minister and a small cabal, forced through a momentous policy decision through a mixture of stealth, threats and lies. They did it with utter disregard for democratic processes, Parliament or public opinion. Far too many journalists failed to ask questions or seek alternative opinions over a protracted lead-in period (see account in Davis, 2010). Unfortunately, this is set to continue. We have an under-resourced news media, incapable of critical self-reflection on its out-dated practices and failings. They are little match for a ruthless administration with a media management operation as slick and determined as any peace-time government we have ever witnessed.