NHS reform is a never-ending nightmare for Cameron

The Prime Minister could end up with a reputation as the man who broke the NHS.

The NHS bill cleared a legislative hurdle in the Lords this week . But that doesn't really solve any of the political problems facing the government's reforms. Of those problems, one of the biggest is that the coalition doesn't seem to have a clear grasp of why Andrew Lansley's plans are causing so much difficulty.

The one thing everyone can agree on is that the plans have been appallingly presented. Lansley cooked them up in the Department of Health without much input or scrutiny from Downing Street. (So blindsided was the prime minister that the episode triggered a whole re-organisation of the Number 10 policy operation earlier this year.) According to one senior civil servant at the heart of the operation, when Cameron was first presented with Lansley's plan he skimmed the introduction and then turned to his aides in shock and disbelief and said "have you read this stuff?!" He had, until then, had no idea of the scale of what was being planned.

There was a moment, towards the end of January, when a u-turn was still an option. But Cameron feared looking weak by abandoning such a huge public sector policy drive - and, reasonably enough, worried that dropping the reforms would implicitly confirm voters' suspicions that the Tories had some hidden agenda on health. A u-turn would make it look as if they had been rumbled. The way senior figures in government tell the story, Cameron's foot hovered between the brake and the accelerator, finally choosing the latter. That now looks like a huge mistake.

The essential miscalculation was the PM's assumption that if he personally threw some weight behind the cause - deploying the powers of persuasion in which he has considerable confidence - the public mood might shift. Of course, the Conservatives did not count on a Lib Dem backlash, sanctioned from the top of the party as a device to "differentiate" the junior coalition partner (fearful of losing its identity) over an issue of famous toxicity to the Tories. Some of the Lib Dem turbulence around the NHS earlier this year was principled objection to the reforms but some is retaliation for the Tories' personal attacks on Nick Clegg during the referendum campaign on the alternative vote. The compromise package that ended up before the Lords this week was therefore a mangled monster consisting of the original Lansley plan with heaps of ad hoc Lib Dem caveats, brakes, disruptions and supposed safeguards.

And there lies the government's problem. The reform it is now trying to sell is the expression of Westminster political choreography and not a coherent response to the needs of the health service. Everyone in the NHS knows it and voters can sense it.

Cameron and Lansley have tried to sell the need for reform on the grounds that the health service cannot cope with rising levels of demand without major structural change (especially when there is no more money to fund the existing system). My own impression is that they haven't got that message across too well. One thing, however, is certain and that is their failure to persuade people of the follow-up assertion that the only solution lies in much more private sector involvement using much more vigorous competition to provide services. The Lib Dems and Labour are just as queasy about bald expressions of that view - it is, essentially, the Blairite model of public sector reform and has advocates in all three main Westminster parties.

But opponents of Lansley's plans don't need to rebut the theoretical premise on which it rests because (a) they can just accuse the government of unleashing needless revolutionary chaos in the NHS, which is plainly true and (b) they can accuse the prime minister of reneging on a pledge not to do (a), which is also true. Plus, (c) voters' mistrust of the Tories over the health service is visceral. Whatever it is the Tories are doing will raise suspicions of an ulterior motive; Cameron and Lansley have done everything possible to confirm that view by failing to sell the reforms on their own terms. You can't credibly insist that there will be no privatization of the health service when the core concept of the reforms is to promote more competition and more private sector involvement. OK, so it's not privatization in way that BT and BA were sold off in the Eighties, but it's hardly reinforcing the "national" in National Health Service.

The only way to actually persuade people that the Lansley plan is any good would be to sell the first principle of increased marketisation in health care but, implicitly, the Tories have accepted that such an approach is toxic to their political reputation. Besides, changes demanded by the Lib Dems have corrupted Lansley's vision enough that - even if it were the best way forward (which I doubt) - it can't be implemented as the health secretary envisaged. Meanwhile, there are £20bn of "efficiency savings" to be found, which will feel like cuts and inflation at around 5 per cent, which will have an impact on health budgets that will also feel like cuts. Every doctor and nurse in the country will have motive and cause to blame the government for every refused treatment and every bad outcome.

David Cameron needs to wake up to the fact that he has allowed a process to get underway whose long term outcome could easily be an historic reputation for him as the man who broke the NHS.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

Photo: Getty
Show Hide image

The age of China's female self-made billionaires – and why it could soon be over

Rags to riches stories like Zhou Qunfei's are becoming less common.

Elizabeth Holmes, 33, was the darling of Silicon Valley, and the world’s youngest self-made female billionaire. Then, after a series of lawsuits, the value of her healthcare firm plummeted.

Holmes might have abdicated the billionaire crown, but another tech queen was ready to take it. Only this time, the self-made female billionaire was not a blonde American, but Zhou Qunfei, a 47-year-old from China. She dropped out of high school and began working at a watch lens factory as a teenager. In 1993, when she was in her early twenties, she founded her own company. Her big break came ten years later, when Motorola asked her to develop a glass screen for smartphones. She said yes.

Zhou is in fact more typical of the SMFB set than Holmes. Of those listed by Forbes, 37.5 per cent come from China, compared to 30 per cent from the United States. Add in the five SMFB from Hong Kong, and the Middle Kingdom dominates the list. Nipping at Zhou’s heels for top spot are Chan Laiwa, a property developer who also curates a museum, and Wa Yajun, also a property developer. Alibaba founder Jack Ma declared his “secret sauce” was hiring as many women as possible.

So should the advice to young feminists be “Go East, young woman”? Not quite, according to the academic Séagh Kehoe, who runs the Twitter account Women in China and whose research areas include gender and identity in the country.

“I haven’t seen any of these self-made female billionaires talking about feminism,” she says. Instead, a popular narrative in China is “the idea of pulling yourself up by your boot straps”. So far as female entrepreneurs embrace feminism, it’s of the corporate variety – Sheryl Sandberg’s book Lean In has been translated into Mandarin.

In fact, Kehoe believes the rise of the self-made woman is down to three historic factors – the legacy of Maoist equality, and both the disruption and the opportunity associated with the post-Mao economic reforms.

Mao brought in the 1950 Marriage Law, a radical break with China’s patriarchal traditions, which banned marriage without a woman’s consent, and gave women the right to divorce for the first time.

In Communist China, women were also encouraged to work. “That is something that was actively promoted - that women should be an important part of the labour force,” says Kehoe. “At the same time, they also had the burden of cooking and cleaning. They had to shoulder this double burden.”

After Mao’s death, his successor Deng Xiaoping began dismantling the communist economy in favour of a more market-based system. This included reducing the number of workers at state-owned enterprises. “A lot of women lost their jobs,” says Kehoe. “They were often the first to be laid off.”

For some women – such as the SMFBs – this was counterbalanced by the huge opportunities the new, liberal economy presented. “All this came together to be a driving force for women to be independent,” Kehoe says.

The one child policy, although deeply troubling to feminists in terms of the power it dictates over women’s bodies, not to mention the tendency for mothers to abort female foetuses, may have also played a role. “There is an argument out there that, for all of the harm the one child policy has done, for daughters who were the only child in the family, resources were pushed towards that child,” says Kehoe. “That could be why female entrepreneurs in China have been successful.”

Indeed, for all the dominance of the Chinese SMFBs, it could be short-lived. Mao-era equality is already under threat. Women’s political participation peaked in the 1970s, and today’s leaders are preoccupied with the looming fact of an aging population.

“There has been quite a lot of pushback towards women returning to the home,” says Kehoe. Chinese state media increasingly stresses the role of “good mothers” and social stability. The one child policy has been replaced by a two child policy, but without a comparable strengthening of maternity workplace rights.

Meanwhile, as inequality widens, and a new set of economic elites entrench their positions, rags to riches stories like Zhou Qunfei's are becoming less common. So could the Chinese SMFBs be a unique phenomenon, a generation that rode the crest of a single wave?

“Maybe,” says Kehoe. “The 1980s was the time for self-made billionaires. The odds aren’t so good now.”

Julia Rampen is the digital news editor of the New Statesman (previously editor of The Staggers, The New Statesman's online rolling politics blog). She has also been deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.