NHS pledges - do even the politicians making them, believe them anymore?

Recent history suggests NHS pledges are there to be broken - or subverted. Perhaps voters would prefer less manifesto, and more information on the financial interests driving policy making. 

Carl Walker
15 April 2015

Image: Santa Dash through Liverpool, by Ben Kidlington / Flickr.

"Nick (Clegg) has made mental health a huge thing for our party - it's going to be one of the five key pledges on our manifesto." : Danny Alexander.

You have to hand it to Danny Alexander. The Lib Dems time in coalition will be remembered above all for their broken pledges – not to mention their support for austerity which has damaged mental health and cut mental health funding more sharply than other healthcare.

So Alexander’s almost childlike capacity to still attach meaning to a Liberal Democrat political pledge is rather endearing; like a child still trying to find ways to believe in Santa.

There is an illness now endemic in Westminster. Pledgitis is a disease both savage and strange in its grip. The key symptom is an uncontrollable desire to make promises that everyone knows won’t be kept. Moreover, on hearing the pledges of other, opposing politicians, the illness compels you to react with a slew of yet more counter-pledges.

Pledgeitis seems to be particularly virulent when talking about the NHS.

The disease is thought to have its origins in the New Labour era, if not earlier.

But David Cameron may have been the vector who brought in a virulent, mutated form, where even the person making the pledge knew it wouldn’t be kept.   

Cameron had a particularly nasty bout of pledgeitis at a speech to the Royal College of Pathologists in 2009. He pledged never to tamper with the NHS with all the vigour of Nye Bevan reincarnate.   

Once elected, from 2010-2012 he drove through an act of parliament to impose on the NHS the biggest change it has seen in 70 years.

But you see this is what pledgeitis does to you.

We knew that Nick Clegg had gone down with it when he pledged to put treatment for mental health conditions on a level with physical health from 2015.  

Our politicians now swap NHS pledges on an almost daily basis.

Miliband pledges a profit cap on private healthcare companies, that is quickly criticised as ‘unworkable’.

Clegg pledges to invest £3.5bn in mental health over the life of the next parliament.

Labour guarantees one-to-one midwife care during labour and birth.

Cameron hits back with a pledge for £8bn to meet Simon Stevens NHS funding target. Of course he already made an NHS spending pledge a few months ago (£2bn per year in his autumn statement), and he has no idea how it can be funded (or if it’s enough) but it doesn’t matter because he made a pledge.

You can almost feel the euphoric release of endorphins that accompanies the temporary relief from their illness.  

Soon I expect one of these poor souls will pledge to personally cure everyone of every illness in the world and to do it within the space of a parliament. And then their opposing number will promise to do it in half the time.  

The causes of this strange condition are manifold and complex.

We might recall how the 1997 New Labour pledge to ‘cut NHS waiting lists’ had the (unwanted?) side effect of a ‘concordat’, signed in 2000, for far greater NHS funding for the private health industry.

Now the Lib Dems pledge to reduce mental health waiting lists – despite having closed  1,500 mental health beds since 2010, with private players like Alpha Healthcare  expanding fast into the gap. Alpha – whose private mental health facilities for young people in particular have been dogged by deeply worrying inspection reports - is owned by one of the Lib Dems largest donors, the Choudhrie family, we might note.   

So - how can we cure the politicians of pledgitis and save an increasingly befuddled general public?

Perhaps we could forbid politicians from making any NHS pledges or in the lead up to general elections.

We could ask them instead to produce one, more meaningful public document in the lead up to future general elections.

This document would list all party funders and their health-related investments. All party candidates and advisors and their health related investments. And it would list all meetings between parties and private healthcare executives, the insurance industry, and their lobbyists and front groups. All nicely in date order, brought together for the first time one nice easy to read glossy document. No more, no less.

A confused public would finally have a clearer picture of exactly which way the parties are going to be leaning on the key issues of NHS privatisation and cuts.

So voters would be able to see at a glimpse whether more than half of the donations to the Conservative Party came from the City of London as they did in the last election year, 2010, and think about what that means.  

We’d see who is in the Conservative Party’s  ‘Leader's Group’ (annual membership £50,000), Treasurers' Group (£25,000) and Renaissance Forum (£10,000).

We could reflect on an itemised list of the private health care firms with Tory links that have been awarded NHS contracts worth nearly £1.5billion since 2012. And that Care UK has won a string of huge contracts including much of the 111 service and prison healthcare. Its former chairman John Nash and his wife have boosted Tory coffers by £247,250.

Maybe it would be useful for people to think pre-election about how Circle Health landed £1.36billion worth of health service work after several ­of its investors gifted £1.5million to the Conservatives. In fact Circle Health’s parent company Circle Holdings PLC is owned by a series of hedge funds, all of whom were founded by major Tory party donors. Maybe people really won’t care that Lansdowne Partners (29.2% stake), founded by Sir Paul Ruddock, donated £692,592 to the Tories or that the owner of Odey Asset Management (14.8% stake), Robin Odey, donated £220,000.

Of course, we’re told that ‘it doesn’t matter who provides services, so long as standards remain high’. But Circle continues to win contracts, even as its flagship privatised hospital contract ran into the ground on the back of an inspection report that highlighted severe patient neglect, short-staffing, and the worst rating for ‘caring’ of any hospital ever.

From the ongoing cash bonanza to Tory-linked recruitment agencies, to the sale of our blood plasma service to Mitt Romney’s Bain Capital, such a document may even prompt a rethink on the Westminster rules that currently allow MPs and Lords to vote on legislation even if they have a financial interest - a conflict banned at local council level. 

But perhaps more importantly, it will put to an end to election period breakfasts of the British public being collectively ruined by front page news articles where crazed and party leaders promise to give every single family in Britain access to their GP 25 hours a day simply because the other guy promised 24. 

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