Being on retreat means being behind the game when it comes to the news. So, I have picked up on the latest NHS shenanigans with a certain incredulity. Given the lesson learned from Tony Blair – that New Labour behaved during its first term in office as if it was still in opposition and didn’t move quickly or radically enough to instigate change – it is understandable that David Cameron wants to get as much done as quickly as possible.
However, he is hampered by three factors: (a) his big ideas (the Big Society, for example) have coincided with massive financial retrenchment… with the former being undermined by the latter; (b) there seems to be little dynamic coherence between the major initiatives launched; and (c) the sheer incompetence of the process for legislation.
Is the NHS fiasco the third or fourth claw-back of confidently announced initiatives? The difference here, however, is the enormity of the changes proposed and the fact that NHS reform represents the flagship policy of the new government. Clawing back the sale of forests is one thing, but announcing a ‘pause’ in the legislative process for NHS reform is of a completely different order.
The arguments can continue about NHS efficiency (provided we remember that efficiency of itself is not the raison d’etre of the NHS) and whether or not care might be delivered more effectively (which is the point of the NHS). The inevitable pros and cons of different ways of organising health care must be weighed up – and it must be recognised that any and every system will have pros and cons – but we must not confuse ends with means.
The worrying thing this time, however, is that opposition to the reform of the NHS is huge and crosses many social and professional boundaries. Some resistance will surely be down to inertia, insecurity, vested interests, fear of change and institutional bloodymindedness. That happens in any institution. But, what is interesting here is that the opposition is informed, unconvinced by the proposals and fearful of potential disarray in the system – not for the sake of the system, but for the sake of the people for whom the system is supposed to exist.
There are two dangers here for the government. First, they rehearse the Thatcherite mantra that it is not the policy that is wrong, but that some poor people out there just haven’t understood it – that once they have understood it, they will obviously have no objection. In this case the policy has been understood and is being questioned in substance by very well-informed people. Patronising opponents won’t work any more.
Secondly, the process appears to be driven by a political dynamic and not one that serves the service itself. That is to say, it might be helpful if a pilot scheme or three were introduced in order to road-test the proposed reforms. A process in which the public was able to see what the outcome might look and feel like is far more likely to win over sceptics than an ideologically driven rush for change. But, we don’t do pilot schemes any longer, do we – in education, health or anywhere else?
I have no problem with proposals for ways of improving the NHS (given the caveat above that improvements always bring with them unanticipated or unintended deficits). I have no problem trying out alternatives. I am open to be persuaded that reforms are necessary and might be helpful. But, I am not happy to see legislation passed on proposals that have not been properly thought through, not tested in the real world (as opposed to on Excel) with real people, not communicated in a way that is respectful and convincing, and possibly shaped to solve a different problem (finance rather than health).
It must have been humiliating for the Health Secretary, Andrew Lansley, to stand in the House of Commons, unsupported by Cabinet colleagues, and announce a ‘pause for listening’ in the legislative process. Yesterday David Cameron had to take personal control of the ‘presentation’ and (bizarrely) state that consultation during the next couple of months will be ‘genuine’.
It’s a mess. And it is just the latest in a line of incompetently handled initiatives in this government’s first year in office. As Blair says in his book A Journey, it is far harder being in government than in opposition. It’s also hard, having listened to the Tories accusing the last government of incompetence, now to see such obvious incompetence in office.
Wouldn’t it be great if the Prime Minister could treat us like adults, apologise for the systemic process and communication failures of his government so far (forests, education, NHS, etc.) and announce a more mature way of doing things. It’s his first year and the economic pool we are paddling in is horrible, so we might even be sympathetic. But, while he pretends that everything is under control, that all the problems are the fault of the previous administration and that all his colleagues are competent for their office, we will continue to be suspicious.