David Cameron, England's NHS, and the tiger in the bathroom

As it becomes impossible to deny the devastation being wreaked on the National Health Service by 2012's Health & Social Care Act, who is really pledging to fix it?

Carl Walker
9 February 2015

Image: Wikipedia

The coalition’s NHS ‘reforms’ have been “disastrous” and have contributed to the current crisis in the NHS, the Kings Fund think tank has admitted.

Their report, released on Friday, noted that the Health and Social Care Act has wasted billions and left a strategic leadership vacuum where nobody is now in charge of the most important public service we have. The one that keeps people alive.

The Kings Fund is a little late - most NHS campaigners, health workers and NHS experts have been saying just this for a long time.

So how were the ‘reforms’ smuggled through the public policy detector? And what does this say about our current political infrastructure?

The Tories hid their intention from crucial public, media and professional scrutiny before the election. Shortly afterwards they were launched in a white paper by then health secretary Andrew Lansley - a professional politician who had never worked in the health service and whose previous highlight had been coordinating one of the least successful general election campaigns in recent conservative party history in 2001.

Once announced, the ‘reforms’ ran into almost universal opposition from medical professionals who could see they were unworkable and fundamentally damaging. The reforms purported to put GPs at the centre of the decision making. But Lansley had loaded the deck in advance with ‘Section 75’ regulations forcing these new ‘clinical commissioning groups’ to put all services out to competition or face the threat of costly legal battles.

How do we make sense of a political system which allows a complete novice to badly sell off our most precious public service? The Health and Social Care Act wasn’t a policy or an act of parliament as much as it was a Frankenstein’s monster, spawned when private funds throw enough money behind a limited man's ideological fixation. No more, no less.

So what we do about it? The coalition now look like the hapless protagonists in the film the Hangover. Waking up from a particularly brutal stag they find a fully grown tiger destroying their hotel bathroom. They have no idea how it got there and no idea what to do with it. All they know is that it’s tearing their bathroom to pieces.

Cameron is in a tough position now the wreckage is being revealed. Not only did he select the man who put the tiger in the room - he specifically promised us all that there would definitely be no tiger in the room should he win the last election.

The response in the coming weeks will be to fix the story rather than the policy. In keeping with our moribund political fixation with spin over substance, the PR gurus will engage in caffeine-fuelled late night brainstorms to sort this tiger story out. Maybe they should tell the public that it’s not really a tiger, just a very big cat.

Already Cameron has sought to distance himself from the tiger by saying that it wasn’t technically them but Lansley who put the tiger in the room in the first place. That Lansley told them everyone really wanted a tiger in the room, and they really didn’t notice the howls of protest at the time.

Or maybe the spin will be that although the tiger isn’t perfect, it’s still better than a hotel bathroom without a tiger in it.

Meanwhile Labour - whilst finally admitting that tigers can cause a lot of damage - continue in practice to champion an approach which essentially says that what’s needed is a smaller tiger. This - approach is embodied in Clive Efford MPs backbench National Health Service bill which doesn’t abolish private involvement at all.

Professor Alyson Pollock’s proposed NHS Reinstatement Bill is something quite different. A growing movement is recognising that we need her proposed new bill, one which says that the only solution is to get the tiger the hell out of the room. That it is finally time to rid our NHS of the damaging privatisation and cuts which are causing chaos around the country. This bill would stop bucketloads of health care money being diverted into the new Audi upgrades of shareholders, solicitors and accountants currently drawing from the £5bn-plus market bureaucracy costs each year. This one doesn’t even let the tiniest, cutest little tiger stay in the bathroom. Because, at the risk of straining an analogy, little tigers grow into big tigers. Small private involvement will inevitably escalate into bigger private involvement. There has yet to be invented a private healthcare company whose fundamental aim wasn’t to increase the amount of public health spend that they currently capture. It’s just what they do.  

The list of 2015 political candidates who have pledged to support the NHS Reinstatement Bill makes interesting reading. It is backed by a growing number of candidates - and officially by the Green Party, the SNP, and the National Health Action Party. Their leaders, Natalie Bennett, Nicola Sturgeon and Clive Peedell, have all pledged to finally take the tiger out of the room. Over to you, Ed Miliband.

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