- Conservative election poster 2010
A few recent news articles about the UK’s Conservative and Liberal-Democrat(Conservative) coalition government – the ConDem’s – brutal attack on the National Health Service.
There should be no sentiment about Andrew Lansley’s departure as health secretary, no matter how hard he worked, how gutted he is to lose the Tory health brief after nine years or how much he cared about the health service. By every measure of high political office, he was a disaster and he deserved to be sacked.
As a strategist, he failed to look for the most pragmatic way to achieve his desired outcome. He simply would not recognise that taking a wrecking ball to NHS structures – at a time of intense financial stress, rising demand and the necessity for widespread changes to clinical practice – was foolish. He compounded this mistake by imposing a structure that resembles a London tube map. Compare that with Michael Gove’s pragmatic approach of bending the existing academy programme to his will.
As a politician, Lansley managed to turn virtually every interest group against him, gave the opposition almost limitless opportunities to attack and lost the confidence of the public. He was so inept that even after the extraordinary spectacle of “the pause” – when the government just about managed to get the policy back into some sort of order – he again careered into a political ditch as it went through the Lords. Sharp, charming health minister Earl Howe had to tow him out.
Lansley was a shocking communicator, from ill-tempered media interviews to the hectoring tone he adopted with the professions. His idea of consultation was to repeat what he had said in the hope that this time you would finally concede he was right. Ridiculing managers as “bureaucrats” was just one indicator of his ineptitude – alienating with a single word the very people who had to implement his reforms.
NHS hospitals that impose pay cuts on staff will see health professionals leaving in protest and the quality of care coming under threat as a result, nurses’ leaders claim.
Care in the south-west of England, where 20 NHS trusts are seeking to bring in local pay rates, will suffer if the plan goes ahead, according to the Royal College of Nursing (RCN).
The trusts are taking a reckless gamble because the region’s sizeable elderly population and falling number of nurses mean it is badly placed to cope with a “skills drain” of NHS staff angry at having their pay cut, it says.
Health unions, including the British Medical Association which represents doctors, are furious that the trusts have formed a cartel in an attempt to bring in localised pay rates, fewer holidays and reduced sick leave, as part of their efforts to cope with flat budgets and contribute to a £20bn NHS-wide savings drive. They fear that, if successful, the move by the South-West Pay, Terms and Conditions Consortium could erode the NHS’s long-established system of national bargaining and agreed pay scales.
The consortium has told staff that unless they accept changes that the RCN calls “draconian”, the jobs of 6,000 of the 68,000 staff employed by the 20 trusts could go. Pay typically takes up about 65% of a hospital trust’s budget.
In a briefing analysing the potential impact of the move, which the RCN has sent to the 20 trusts, it warns: “Reducing the pay, terms and conditions of staff in the south-west is not the only choice that employers have, and this course of action is highly likely to negatively impact on patient care. Not only is there a real risk that staff will be forced to leave the NHS, but it will also be difficult to recruit, and the morale of remaining staff will be damaged further.”
In an accompanying letter, Dr Peter Carter, the RCN’s chief executive, adds that the move “will create a skills deficit in the region that will impact on the ability of trusts to provide high-quality care” and will increase rather than reduce staffing costs because it will involve extra bureaucracy and constant negotiation.
“We do want to break up the NHS. We don’t want to privatise it, we want to break it up.” Nick Clegg.
Opponents said the comments about the NHS, in a 2005 interview in the Independent, showed that Mr Clegg had no understanding of the way the health service works.
In the interview, carried out while Charles Kennedy was leader and two years before Mr Clegg took the job, he said: ‘I think breaking up the NHS is exactly what you do need to do to make it a more responsive service.’
Asked whether he favoured a Canadian or European-style social insurance system, he said: ‘I don’t think anything should be ruled out. I do think they deserve to be looked at because frankly the faults of the British health service compared to others still leave much to be desired.
‘We will have to provide alternatives about what a different NHS looks like.’
Under a social insurance system, members pay into an insurance scheme, either themselves or through an employer, to guarantee their healthcare. It means that those who pay into a more expensive scheme can get better care.
Under the NHS, however, everyone pays into the same scheme through taxes – and is then guaranteed care that is ‘free at the point of use’.
In the interview, Mr Clegg said ‘defending the status quo’ is no longer an option. Instead, he called on his party to ‘let its hair down’, ‘break a long-standing taboo’ and be ‘reckless’ in its thinking.
‘We do want to break up the NHS,’ he said. ‘We don’t want to privatise it, we want to break it up. Should the debate be taboo? Of course not, absolutely not.’
A year earlier, Mr Clegg had contributed to the notorious Orange Book in which those on the right of the party discussed how policies should change under Mr Kennedy’s leadership. The conclusion of the book outlines in more detail the type of insurance scheme he was outlining.
‘The NHS is failing to deliver a health service that meets the needs and expectations of today’s population,’ it said.
John Lister, of the lobby group Health Emergency, said: ‘These comments show Mr Clegg does not understand the NHS. He seems to be ignorant of the fact that social insurance schemes in Europe are far more expensive.’
Shadow Health Secretary Andrew Lansley said: ‘The NHS is one of Britain’s most loved institutions. People will be worried that Nick Clegg wants to “break it up”.’ [!!! That’s Andrew Lansley pretending that the NHS is safe in Tory hands before the election !!!]
What Britain now has is a blue-orange coalition, with the little-known Orange Book forming the core of current Lib Dem political thinking. To understand how this disreputable arrangement has come about, we need to examine the philosophy laid out in The Orange Book: Reclaiming Liberalism, edited by David Laws (now the Chief Secretary to the Treasury) and Paul Marshall. Particularly interesting are the contributions of the Lib Dems’ present leadership.
Published in 2004, the Orange Book marked the start of the slow decline of progressive values in the Lib Dems and the gradual abandonment of social market values. It also provided the ideological standpoint around which the party’s right wing was able to coalesce and begin their march to power in the Lib Dems. What is remarkable is the failure of former SDP and Labour elements to sound warning bells about the direction the party was taking. Former Labour ministers such as Shirley Williams and Tom McNally should be ashamed of their inaction.
Clegg and his Lib Dem supporters have much in common with David Cameron and his allies in their philosophical approach and with their social liberal solutions to society’s perceived ills. The Orange Book is predicated on an abiding belief in the free market’s ability to address issues such as public healthcare, pensions, environment, globalisation, social and agricultural policy, local government and prisons.
The Lib Dem leadership seems to sit very easily in the Tory-led coalition. This is an arranged marriage between partners of a similar background and belief. Even the Tory-Whig coalition of early 1780s, although its members were from the same class, at least had fundamental political differences. Now we see a Government made up of a single elite that has previously manifested itself as two separate political parties and which is divided more by subtle shades of opinion than any profound ideological difference.