Biting the Bullet on the NHS: Thatcher returns to the healthcare debate

In recent weeks, the government's plans for reforming the NHS have come under increasing pressure from Labour, the BMA and most recently, the RCN passed a vote of no confidence in Andrew Lansley's management of the bill by 96%. This has forced the government to take up its 'listening exercise' while the bill sits in the middle of the law making process in Parliament. So are the reforms (which is the largest in the NHS's history since its creation) an application of free-market principles as its critics argue or is it another 'difficult but necessary' consequence of deficit reduction?

The government's 'listening exercise' came under heavy fire, even as it took its first tentative steps with a joint press conference of the PM, deputy PM and the Health Secretary. It was accussed of being just another PR exercise, typical of a Prime Minister who thinks his delivery rather than substance is failing (as labour supporters claim). Andy Burnham, the former health secretary claimed just that, and Ed Miliband looked to step up the pressure by calling for the reforms to be completely 'junked'. Ignoring this cheap choice of word, it has become common place these todays to expect no less from the leader of the opposition who continues to fail to provide any alternative, let alone constructive criticism. Similarly, as Labour's election coordinator, Andy Burham's comments seem symmetrically, strategically placed, not to save the policy from its flaws, but to contribute to its sabotage. Having burnt off this fog of partisan presentation which seems to blur all mediums of policy communication and reporting, I can turn to the more serious task of the debate over substance....

As in all other areas of policy, the government's plans were founded in the argument over the national deficit and government plans to emilinate the structural deficit of the state by 2015. Quite simply, the NHS is operating in the economic circumstances of the previous decade where it could afford to suffer from the inefficiencies which plague it thanks to Labour commmitments of large-scale investment and funding. Today, the NHS's ineffeciences are neither sustainable nor economically acceptable. To combat this the governments plans propose to move the responsibility to commission services and therefore control the NHS budget from Primary Care Trusts (PCT's) to GP Consortia. Firstly, this will make savings by removing the PCTs as a management level entirely and moving their role as commissioners to GP Consortia, the very practicioners who are meant to be most in touch with public concerns over care. Secondly, the government is trying to cut out inefficiencies in the large acute trusts (hospitals) by opening up the commissioning of services to all service providers including private and volunteer companies. This means acute trusts can become centres which specialise in emergency or unplanned care and no longer provide the more simple planned care routes for which there is a far greater demand and which it provides so inefficiently, therefore saving the NHS money. This solutions appears both logical and credible.

However, critics including Mr Miliband argue this process is against the values embedded in the NHS since its creation. On the 4th April while addressing the RSA, Ed Miliband claimed of the Health and Social Care Bill, 'on grounds that it doesn’t meet the challenges of the future, that it weakens rather than strengthens accountability and that it threatens the ethos of the health service, these changes are simply wrong.' His first contention is really a technical point in which he is simply reflecting that David Cameron's plans are more economically driven than in the interests of reforming healthcare to deal with future challenges, a key platform on which he is basing his reforms. This is true because, as lobbyists for the acute trusts have argued, private providers will 'cherry pick' services which have relatively cheap costs, receive higher demand and has larger profit margins. Therefore they are unlikely to provide the more major and serious services which attend to the changing needs of an ageing population. His second point about accountability plays on the fact that there will be a conflict of interest in the new structuring system where GPs are both commissioners and service providers. Thus, they are likely to have vested interests in where the money goes. Finally, he makes a symbolic point that the apparent 'privatisation' of the NHS is against the 'ethos' and values upon which the NHS has been guarded since its creation. Rather than seeking out an internal solution, he remarks that David Cameron has simply turned to the free market for a solution which will jeopardise the position and symbolic significance of the NHS in the public's eyes, in the nations identity and for every government to come.

Although the claim of privatisation is rather weakened by the fact that the costs of a service will continue not be determined by the provider but by the commissioner (which retains the principle of selection by quality rather than cost, as acute trust representatives maintain), a larger proportion of healthcare provided in this country will come from private companies. More ideologically important to Mr Miliband and representatives of acute trusts (all those who work in hospitals), private companies will reap profits from the taxpayer whereas, under previous NHS providers, all profits would have been reinvested within the acute trusts, a sour point for all who respect and value the principles of the NHS. Ultimately, despite all these criticisms, the point remains that we can no longer afford an NHS ridden with such inefficiences. Very much like Mrs Thatcher before him, Mr Cameron has decided this failing industry cannot be subsidised just because of the symbolic importance it holds in the minds of the nation, the free market must reign. And for all his just criticism, Mr Miliband has been unable to provide an alternative idea let alone a viable solution. Sticking to his ideological guns he will continue to hold the position that these 'cuts' are threatening frontline services and most importantly: jobs. So, politically, the debate returns to the age old partisan question: is unemployment a cost worth paying? Even if this 'listening exercise' is just a PR stunt, we know who holds power and we know who will say yes.

The 'catchphrase majority'

It was a critical week: The budget was delivered, Libyan rebels regained ground and UK protesters took to the streets. As Ed Miliband accurately argued in his response to the budget, the continuing absence of growth in our economy does stall confidence and keeps that light at the end of the tunnel ever so dim. A 0.5% contraction in the last quarter of 2010 was followed, unwelcomingly, by the figure for growth in 2011 being downgraded from 2.1% to 1.7%. George Osbourne meekly arguing that this allowed more 'scope' for growth between 2012 and 2015. In compensation he also offered  us a 1p cut in fuel duty which many critics have appropriately referred to as a 'drop in the ocean'. So the politicians have had their say. The government claim they have put fuel into the tank of the economy while Ed Miliband argues the budget is 'hurting but not working', but what do the electorate think?

250,000 protesters are a powerful symbol. When all but 300 of them were moderate and peaceful people demonstrating, it was a chance for the alternative way to step forward and claim the moment. What we got instead was another empty slogan from Ed Miliband calling the government to change course and listen to the 'mainstream majority'. I'm not sure how many more labels 'the squeezed middle', 'alarm clock Britain', 'Middle England' or the 'Big Society' (pick your choice) can handle. However, in this case, Ed Miliband's choice of words, when attempting to capture the essense and spirit of all those who disagree with government policy, has been proved wrong. An ICM/Guardian poll shows that Ed Miliband's 'mainstream majority' represents only 35% of people who think the cuts go too far, down 10% from last November. Meanwhile, 28% of people think the government has got the right balance and 29% think they don't go far enough. For now the electorate has cautiously embraced the budget and seemingly backed the coalition agenda.

From Bad to Worse

Times are tough for Nick Clegg. Not as a Deputy Prime Minister or as a member of government but as leader of the Liberal Democrat Party, the minority partner in the coalition government. His party continues to sit around the 10 point mark in the poll ratings and activists are only becoming more vocal about fears of their participation in the coalition. The rejection of NHS reform at the Liberal Democrat Conference wasn't just a reflection of the party's discontent on that one specific policy area but was an expression of how criticisms of the Liberal Democrats propping up a Conservative agenda in government is really starting to get to Lib Dem grassroots.

Most recently, Nick Clegg has been forced to abandon his place as the focal point of the Yes to AV campaign especially after Ed Miliband, leader of the Labour Party stepped up pressure by stating he would not share a paltform with Clegg despite both their parties supporting the Yes Vote at the referendum. It has to raise doubts over the likely success of the Yes Vote if the leader of the party which is its greatest proponent has been forced out of that particular arena and if the other supporting party's leader is willing to sacrifice unity on the issue for political oppurtunism. If the strategy to change the electoral system fails on the 5th May, the Liberal Democrats and Nick Cleggs' political fortunes in the future fall entirely on the coalition's ability to bring about marked economic recovery and growth by the time of the next election.

The Quiet Before the Storm

The tragic events of the humanitarian crisis in Libya and the aftermath of the natural disasters in Japan have captured the attention of the media all around the world. As precarious, devastating and regretable as the situations are of the resident people of these nations it has provided David Cameron with a brief period of rest from the onslaught over his more controversial and devisive plans domestically for the economy and, most pertinent currently, his plans for the NHS.

It has always been a tactic for governments hampered by opposition and tired from exercising large amounts of political will on domestic issues to turn to foreign affairs over which they can achieve a greater degree of consensus. Barack Obama's change in agenda to Nuclear arms reduction talks with Russia after the gruelling battle over healthcare in the US is a perfect example of this. Despite Labour allegations of incompetence for the ditched SAS mission, the Venezuelian persuasion of the foreign secretary and the rather quiet response to initial proposals for a no-fly zone, David Cameron has been vindicated by a UN Security Council Resolution authorising the use of all military force except military occupation to protect civilians. Having achieved consensus on the international stage, Cameron will be glad (at least for a short while) in the political points it gives him over Labour with politcal and strategic allies across the Channel and the Atlantic.

However, more vocal opposition to his NHS reforms not least by grass-roots Liberal Democrats and the BMA gave further weight to Labour's criticism in this weeks PMQ's. Continuing disappointment over growth figures, unemployment and a lack of public affection for the concept of a 'Big Society' racks up pressure on the government as we approach budget time. David Cameron will want to remain emmersed in his success on international issues for as long as possible before the media's attention swiftly returns to more partisan soundbites over our limping economy.

innocent bystanders or lazy cynics?

Every five years Parliament must be dissolved and the parties are forced to go on the campaign road and convince people to vote for them. For almost three weeks the people hold the power over who will govern before, traditionally, another single party wins a majority and forms a government for another five years. During these five years, the people hold little to no direct power. Effectively, the executive within the government decide policy and then rely on the party whips to see the bill through. The mechanisms of opposition are weak and the opposition party is left to play devil's advocate and pick on the U-turns and mistakes of the party in power. Of course, many argue this system was designed to produce strong government with a strong mandate and decisive policy action. However, with the coalition introducing fixed parliaments of five years, the scars of the expenses scandal, it seems the people are moving further and further away from where power really lies. Although the student protests earlier in the year show that the act of protest isn't completely dead, too many of us are bystanders to the progression of politics.A mixture of cynicism, a lack of political education and ignorance all contribute to the growing disillusionment. The hung Parliament was the strongest signal of this. As this coalition enacts some of the most divisive and crucial policies within one of the most unstable and difficult periods in Britain's recent history, perhaps the people will be forced to have their voices heard, and hopefully, the parties will be forced to listen...

Why the AV referendum isn't a referendum at all

I do support a move towards greater proportionality in our electoral system. It is a great shame that this referendum will fail to actually address whether the people of this country, who ought to be sovereign in our political system, actually want to move towards greater proportionality. The issue of electoral reform has been shelved ever since the Labour Party began to seriously address it in the Jenkins commission of 1997. However, after the commission's results showed that reforming the current First Past the Post system would always be agaisnt the interests of the party in government, they let the issue recede to the sidelines. Today, the agenda for electoral change was decided not by the people but as part of the behind-closed-doors party dealings of the hung Parliament. It was the attempt of Gordon Brown and Alan Johnsons to woo the Lib Dems that AV began to dominate discussions over alternative systems. This allowed the Conservative Party to counter and buy off the Lib Dems with a simple 'yes or no' referendum on the option of AV. If we are going to pay all the costs to put on a referendum why can't we actually make it comprehensive and decisive? The forthcoming referendum just screams of political self-interest and partisanship rather than public service especially given the natural advantages of the NO Campaign. While the YES Campaign will have to overcome the severe gap in the public's understanding of the current system and the option of AV, the NO Campaign can effectively just run a negative campaign playing on fears of the costs and complexity of the AV majority system. It seems likely the 5th of May will crown another victory for the two-party system rather than provide an oppurtunity for democracy.

'A complete mess'

This week, more than ever, David Cameron used the legacy of the last government to beat off criticisms of further cases of his government's cuts at Prime Minister's Questions. Not only has it become his favourite 'come-back' at the dispatch box but he seems to believe it provides endless justification for his government's decision making. It will forever be a key political tactic of a government to blame their predecessors for the issues they face. Not only does it allow them to influence public perceptions of where responsibility lies but allows them to justify challenged or unpopular policies by blanketing all negative connatations on to their opponents. But how far is the government's economic agenda decided by necessity rather than ideology?

Many political commentators today argue that ideology is a dying term with all the three main parties aiming to occupy the centre ground and win the votes of middle Britain. However, the threat of the word still enjoys great prominence among both the parties and the public. Labour have naturally championed those who believe the the government's economic policy is driven by old Conservative ideology (steam-rolling over any liberal recommendations) which seems to have fuelled David Cameron's enthusiasm for his favourite phase. Which view will hold sway with the public will be crucial as the parties navigate their way through the next four years of the parliament.