So parliament has prevailed, the popular will has been heard, and the UK will not go to war in Syria. MPs looked to their constituencies, looked to the polling data, looked to the legacy of mistrust and antipathy bequeathed by the Iraq war, and voted accordingly.
Democracy in action, the executive held to account. Whatever your thoughts on military intervention, it is surely right that matters as important as going to war are subject to democratic decision making in parliament, where the popular will can be heard.
Why, then, for matters as important as the NHS, have we surrendered democratic accountability and parliamentary sovereignty with barely a whimper? Where is parliament’s strength, where is regard to the popular mandate, as our NHS is dismantled?
From the NHS’s foundation in 1948 until 2012, the Secretary of State for Health had a legal duty to secure a comprehensive health service for us all. If there were failings, he or she was answerable to parliament - and ultimately to the electorate.
This is no longer the case. The 2012 Health & Social Care Act abolished this legal duty for the first time. The Secretary of State is now at liberty to raid the NHS coffers - another £2billion was clawed back last year alone - without being held accountable for the results.
The blame for the impact of government spending cuts on the NHS is “localised” to 211 Clinical Commissioning Groups. Groups who are not elected, and are not accountable to our elected parliamentary representatives in the way the old Primary Care Trusts were.
Don’t get the healthcare you need? Your local MP will now tell you it is absolutely nothing to do with them. And since the Health & Social Care Act, they are technically correct.
The presence of a few hapless GPs on the Commissioning Groups provides a useful scapegoating opportunity. Thatcher’s heirs see public service-imbued professionals as an inconvenient bulwark against a free market. The so-called “local decision makers” (in reality, cuts administrators) are misleadingly elided with “GPs” in general. Tory MPs tell constituents campaigning against hospital closures that the cuts are “greedy GPs’” fault, backed up by an obliging media full of doctor-bashing stories.
Alongside blaming GP commissioners, government also blame the providers - the NHS Trusts themselves - for the disintegration of the NHS. Hunt tells parliament that problems such as staff shortages are not his responsibility but that “a few Trusts may have made bad decisions” - as if any Trust could reasonably be expected to square funding shortages with decent patient care.
And when personalised budgets - currently being widely rolled out - take hold, the blame won’t even be on the commissioning groups - it will be on you, the individual patient, who has failed to manage your own budget adequately. Only those able to afford top-up insurance will be worry-free.
Ill-health is no longer a fear that we can expect to find democratic, collective, accountable solutions for, if this government has its way. It is an individualised problem.
The ‘localisation of blame’ started - it must be admitted - under previous governments who split the NHS up into fragmented local bodies. It was Labour Health Secretary Alan Milburn who talked of ‘rewarding’ well-performing trusts with autonomy, and John Reid who suggested that parliament couldn’t ask questions about these “autonomous” “Foundation Trusts”.
This government has taken that principle and applied it to the whole NHS. It has washed its hands of responsibility, ducked being held accountable by parliament and voters.
Junior Health Minister Diane Abbott MP said yesterday that she would make an informed decision on the Syria vote after having read the information and “listened to the debate”.
But in relation to the NHS - how much is being privatised, what impact are cuts having - informed parliamentary debate is now impossible.
When Abbott asked in parliament how much of the NHS was being outsourced to bungling health contractors G4s, she was told by junior Health Minister Daniel Poulter that:
“The Department does not centrally collect information on the contracts which individual national health service bodies hold with private sector companies.”
Her colleague Barry Sheerman MP was later given the misleading answer that the Department of Health had spent a princely £790 on G4S last year.
The fact that G4S in fact holds hundreds of millions of pounds worth of NHS contracts? None of parliament’s business, it seems.
It’s not just G4S - last month Lord Turnberg raised a question about NHS contractors generally and was shocked to be told by health minister Earl Howe that:
“NHS England does not hold a central record of contracts that have been awarded to private sector organisations.”
Establishing the facts about NHS privatisation and cuts falls instead to underfunded grassroots campaign groups like Keep our NHS Public and the NHS Supporters Federation, and campaigning websites like this one.
The accountability and information vacuum is everywhere, and is getting worse, even as the government talks of “transparency” (which seems to be mostly about making our data transparent to the corporations).
If your MP asks in parliament how many nurses work at NHS Trust hospitals in your area, and if this has changed over time, the Secretary of State must furnish an answer.
But if your MP asks how many nurses work for an NHS service that has been privatised (including to a charity)? Government will refuse to give parliament that information on the basis that it is “commercially confidential”, as health minister Paul Burstow did in 2011.
And in the future your MP may struggle to get information even about NHS bodies - in March this year Earl Howe wrote to parliamentarians suggesting that parliament was no longer an appropriate place to ask many of their health questions, now we had so many quangos.
Whilst doctors and the public worry about the NHS collapsing, the government appears remarkably sanguine. If no-one is in charge, it’s an unholy US-style mess and patient care disintegrates? Well, there are always private health insurers and private hospitals, funding the party and its friendly think tanks and advisors…
We must not let this happen.
The irony of the Tories seeking to hold the last Labour government accountable for the state of the NHS - whilst legislating away their own accountability - was not lost on the current Labour leader. Ed Miliband used the occasion of the NHS’s 65th birthday to make a trenchant attack on the government’s abolition of its legal duty to provide a comprehensive NHS.
Crucially, Miliband pledged to “reinstate the Secretary of State’s duty to provide a comprehensive health service”. Labour members are organising around motions to Labour conference to re-affirm and strengthen this commitment - preferably through a firm manifesto commitment for immediate emergency legislation should a Labour government be elected in 2015.
We have just seen the importance of parliamentary democracy in relation to matters of life and death overseas. It would be good to restore it at home, too.