NHS reforms offer still more pain, even less gain for the Lib Dems

Clegg should have learnt from tuition fees that complex arguments can't sell hated reforms and that

Nick Clegg will urge the Liberal Democrats to "tear off the rear view mirror" in a rally to open the party's spring conference in Gateshead this evening. It is a curious metaphor that is meant to signal optimism and determination - looking only at the governing road ahead, not nervously behind at the hard path already travelled. It could also be interpreted as denial.

The message will be reinforced by party chair Tim Farron, whose speech is previewed in a Guardian op-ed this morning. He invites Lib Dems - instructs them even - to stop feeling guilty about the compromises that have been made for the sake of coalition. Farron describes power as "an occupational hazard" for serious political parties and one from which the Lib Dems ought not shy away.

This coordinated message is meant to signal the fact that, as one strategist put it to me recently, "the party is coming out of its defensive crouch." There is cautious confidence that this May's local elections will not be a repeat of last year's massacre. Campaign resources are being more strategically focused; recent council by-election wins give grounds for optimism.

Meanwhile, Lib Dem MPs, most activists and Clegg himself are all fed up with the expectation that they ought to be apologising for the very fact of being in a coalition when, from their point of view, that is an epic achievement. What, after all, would have been the point of all those years in opposition if the chance to enact party policy had been turned down? The challenge, according to this analysis, is to explain to a sceptical and inattentive public quite how much Lib Dem policy is actually being introduced and what a triumph this is, making the country fairer; or fairer, at least, than it would have been had the Tories been able to rule unrestrained.

And there lies the biggest problem. Partly by necessity, partly through ill-judgement, the Lib Dems have ended up winning many little things, while the Conservatives have won very big things. The two defining issues of this parliament could well end up being George Osborne's economic choice to press ahead with austerity at an accelerated pace and David Cameron's decision to forge ahead with unpopular and poorly understood NHS reforms. Labour are convinced the public will turn against both. (The evidence only supports that assertion with regard to the health service.) Either way, the Lib Dem role is cast firmly as accomplice, which is the classic trap for junior coalition partners - maximum pain if it goes wrong; minimum credit if it works. The "pupil premium" and tweaks to the House of Lords won't alter that equation much.

Lib Dems gathering in Gateshead today know that much, which is why they are agitated about the Health and Social Care Bill. This time last year, a rebellious mood at the party's spring conference helped spur Clegg into demanding a "pause" in the legislative process to reconsider the whole thing. There is a growing sense in the party that the reforms have not changed enough (or are not judged to be anything other than trouble by the public) to justify endorsement. Would not the Lib Dems be able to signal their true worth in government by vetoing the measure altogether? Might they not then be able to campaign on a claim to have saved the NHS? To that end there is a motion in the works - yet to be scheduled for debate - calling for the health reforms to be scrapped.

Senior Lib Dems (and a large number of Tories, including some close to Downing Street) wish Clegg had killed the bill last year. Instead, the reforms have been mangled enough by constant amendment to persuade the public that the whole thing is a shambles, but not enough to convince anyone that the underlying intent has been changed. This is, without doubt, a disaster for the government.

David Cameron hopes that, once the furore around the actual legislation is out of the way, a process of explanation, education and reassurance can reconcile people to the changes. The one person in politics best equipped to know how wrong that assumption is should be Nick Clegg. It is exactly the technique he tried after his party's u-turn on tuition fees. (One reason to hold on to that rear view mirror for a while, perhaps.) He explained over and over again how the new system was, in fact, fairer than the old one, how it was the best option available, how the underlying principle that had led him to make his anti-fees pledge in opposition was kind of honoured by measures being taken to mitigate ... blah, blah. No matter.

A visceral sense of betrayal created an emotional barrier that no rational argument could penetrate. There is a danger of the same happening with the NHS. Once people decide that Cameron and co. have reneged on a fundamental pledge to protect the health service, they aren't going to be swayed by a claim that cuts and chaos are a different kind of protection - special long-term protection that requires pain in the short-term. Anger is rarely appeased with a graph. And, of course, when that happens, Clegg's amendments, adjustments and moderations will be worth nothing. No one thanks the midwife at the birth of a monster.

This problem expresses a wider strategic challenge for the Lib Dems - and for Clegg in particular. The party is having to work out how to make coalition government work and educate voters about what that means at the same time. It also has the misfortune to be allied with the Tories, who aggravate a unique kind of hostility among a section of the population whose votes Clegg needs. That distaste is deep-rooted and cultural; it transcends day-to-day politics. This tribal barrier is not unique to British politics, but it is especially pronounced by European standards. Clegg's sense of how coalition ought to be part of the Westminster repertoire is derived, in part, from his experience of the continent.

He is taking the Lib Dems on a transition from being one kind of party to something completely different. He took over something distinctly British, mildly eccentric, contrarian, and comfortable in opposition and is turning it into a technocratic, professional party of coalition. It is like remodelling the Campaign for Real Ale as McKinsey. Tricky.

The most compelling argument for what Clegg is trying to do (leaving aside how effectively he is managing it) is that there is no alternative. A party that refuses the opportunity to govern forfeits the right to be taken seriously. But given the Lib Dems' poll ratings, the grass roots could be forgiven for wondering how much more pain they have to endure before the political dividends of the transformation are felt. On this journey it isn't the rear view mirror Clegg has to worry about, it's everyone in the back chanting "are we nearly there yet?"

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

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Obama's Hiroshima visit is a wake up call on the risks of nuclear weapons

The president's historic visit must lead to fresh efforts to rid our world of destructive missiles and safeguard our futures.

We now know more than ever the dangers of an accidental or deliberate detonation of a nuclear weapon. We also realise that there can be no adequate humanitarian response to such a nightmare scenario.

Malfunctions, mishaps, false alarms and misinterpreted information have nearly led to the intentional or accidental detonation of nuclear weapons on numerous occasions since 1945, according to testimonies by experts and former nuclear force officers. In the past two years alone, the organisation Global Zero has documented scores of “military incidents” involving nuclear weapon states and their allies, alongside the increasing risks stemming from cyberattacks.

Put this together with recent insight into the appalling long-term health impact of the Hiroshima and Nagasaki explosions themselves, and the sheer human cost of any future nuclear bomb blast, and you have a truly alarming picture.

We were in Hiroshima and Nagasaki last year, speaking to survivors, or hibakusha, as they are known. More than 70 years on, their lives, and the lives of countless people in Japan, are still overshadowed by these two watershed events in the history of modern warfare.

After the detonations, Red Cross staff struggled in unimaginable conditions to relieve the suffering caused by the atomic blasts. With hospitals reduced to rubble and ash and medical supplies contaminated, the provision of even basic health care was well nigh impossible.

But the nightmare is far from over even today.

Doctors at the Japanese Red Cross Society hospitals in Hiroshima and Nagasaki say that some two-thirds of the deaths among elderly hibakusha are from probably radiation-related cancers. And aside from the physical symptoms, the psychological trauma is still ever present.

No-one who visits Hiroshima’s Peace Memorial Museum, or who sees the continued suffering of thousands of elderly survivors, can be in any doubt of the catastrophic and irreversible effects of nuclear weapons. Nor could they in good conscience argue that these weapons somehow act as guarantors of global security or protectors of humanity as a whole.

Of course, the bombs in the arsenals of nuclear-armed States today are far more powerful and destructive. And modern research only makes the case against them stronger. Studies suggest that the use of nuclear weapons now even on a limited scale, would have disastrous and long-lasting consequences on human health, the environment, the climate, food production and socioeconomic development.

Health problems would span generations, with children of survivors facing significant risks from the genetic damage inflicted on their parents.

Seventy years after the dawn of the "nuclear age", there may be no effective or feasible means of assisting a substantial portion of survivors in the immediate wake of a nuclear detonation.

And make no mistake. The devastation of a future bomb will show no respect for national borders. It is likely to ravage societies far beyond its intended target country. Which makes the continued existence of nuclear weapons and the risk that entails a global concern.

Faced with these conclusions, you might imagine the international community would pull back from the brink of potential tragedy and take steps to eradicate these weapons.

Sadly, last year’s review conference of the Treaty of the Non-Proliferation of Nuclear Weapons, which had the opportunity to advance disarmament, failed to do so.

The International Red Cross and Red Crescent Movement has called on States to negotiate an international agreement to prohibit the use of and completely eliminate nuclear weapons within a binding timetable. We reiterate that call today. The political will to rid the world of this menace must urgently be found.

Until the last nuclear weapon is eliminated, there are essential steps which nuclear States can and must take now to diminish the danger of another Hiroshima and Nagasaki.

It is imperative that these States and their allies reduce the role of nuclear weapons in their military plans, doctrines and policies and cut the number of nuclear warheads on high alert status. The current modernization and proliferation of nuclear arsenals is leading us towards potential catastrophe.

The horror of Hiroshima and Nagasaki and the human suffering inflicted still holds powerful lessons. President Obama’s landmark visit on Friday will surely be a powerful reminder of the terrible destruction that nuclear weapons wreak.

We must act on this reminder.

To truly pay homage to those whose lives were lost or irrevocably altered by the Hiroshima and Nagasaki bombings, President Obama’s visit must galvanize the international community to move without delay towards a world free of nuclear weapons.

The fact that these weapons have not been used over the past 70 years does not guarantee a risk-free future for our children. Only the prohibition and elimination of nuclear weapons can do that.

Peter Maurer is President of the International Committee of the Red Cross. Tadateru Konoe is President of the International Federation of Red Cross and Red Crescent Societies and of the Japanese Red Cross Society.