There is a host of issues that provoke public protest as the coalition government strips away public services and our national wellbeing, too often through brutal and ill-considered policies and actions. How to choose between these issues? Lately we have had protests over tuition fees, the abolition of education maintenance allowances, library closures and the sale of forests - the middle class influence seems evident to me.
What astonishes and alarms me is that there is as yet no sign of major protest over the government’s plans for the NHS. The brazen breaking of Liberal Democrat promises to combat and remove tuition fees inspired the rage that fuelled the student protests. Yet, as Oliver Huitson sets out in his recent post, the Conservatives are incubating as great a betrayal over the NHS, an issue which deeply affects the whole population, without creating a similar reaction.
David Cameron’s whole pre-election strategy stood on explicit and implicit promises that the NHS was safe in his hands and that spending on the service would rise annually in real terms. The Conservatives also pledged an end to shake-ups in the NHS while Andrew Lansley was laying plans for what he rightly admits is a ‘revolution’ in the service.
But so far there is no sign of public anger. This is partly because Cameron continues the subterfuge, with honeyed words of reassurance that stress his own family’s experiences and praise NHS doctors and nurses. These words lay the foundations of a greater subterfuge: that GPs will take control of most NHS spending in the interests of their patients and their choice of health-care.
The reality hardly needs repetition here. The very existence of a collective enterprise like the NHS is offensive to the market fundamentalists in both coalition parties, all the more so because it is so popular that they dare not openly dismantle it. So it is to be done by stealth. Instead of GPs, private companies will take on most commissioning on their behalf. Instead of publicly funded and regulated provision, it will be run by the naked rule of competition which opens health-care to ‘any wiling providers’. Price not quality will be the driver. As Brian Landers pointed out in his recent OurKingdom post, the private providers will receive public subsidies to compete with health service bodies. Not only are these fundamental changes being made without proper public debate; they are being rushed through in spite of deep concern among all those who work in the service.
As Will Hutton’s Commission on the NHS (on which I sat) discovered, the NHS is far and away the most popular institution in the country. Asked by us to choose the ‘most valuable’ institution from a list of seven institutions, 63 per cent of those polled put the NHS first; Parliament came next with 12 per cent, then the police (11 per cent), the BBC(4 per cent) and royal family (3 per cent). Alan Milburn points out that the NHS now scores the highest satisfaction rate in 30 years.
So where is the case for a revolution that looks likely to end in chaos? But where also is the protest? Evidence is welling up of the damage that these changes will do. Labour’s parliamentary opposition is amassing the case against. Informed and professional opinion urges caution on the government, but their intervention is governed by restraint. The civil society campaign, which emerged in the Thatcher era to defend the NHS, seems to have disappeared.
What of the trade unions? Of course, their primary responsibility is to try and protect the jobs of their members. But as they consider their campaign against the cuts agenda, could they not focus a large part of their activity on the defence of the NHS? There would be real benefits for them in terms of their public reputation. They have at their disposal resources that could supply the spine for a major public campaign. Think how well they and their members campaigned against the BNP, taking the case for decency to the doorstep, and routing the party at election time.
Just an idea.