Richard Horton, editor of the Lancet: Cowards, betrayers and appeasers have destroyed the NHS

All three parties have colluded in the creation of ideal conditions for an unprecedented colonisation of the NHS by an aggressive, profit-seeking private sector. NHS SOS, a new book edited by Jacky Davis and Raymond Tallis, explains how it was done.

NHS SOS: How the NHS Was Betrayed and How We Can Save It
Edited by Jacky Davis and Raymond Tallis
Oneworld, 288pp, £8.99

Andy Burnham, the shadow secretary of state for health, tells a revealing story about his last days in the Department of Health, back in May 2010. As Burnham was saying his goodbyes to civil servants in Richmond House, David Nicholson, the fierce chief executive of the National Health Service, warned that if he returned after the election, his priority would have to be efficiency – achieving a better NHS with less money. A financially fragile health service could tolerate no more reorganisations.

When, just two months after the election, Burnham read Andrew Lansley’s extra - ordinary white paper Equity and Excellence: Liberating the NHS, he was dumbstruck. A huge top-down reorganisation was being proposed, despite what he knew to be the department’s view that such changes were unwanted and unsustainable. Something seemed to have gone very wrong at the heart of government.

What we now know – and what Jacky Davis’s and Raymond Tallis’s new book, NHS SOS, so lucidly describes – is that a very British coup had taken place. During the run-up to the election, the Conservative Party had claimed that there would be “no more top-down reorganisations of the NHS”. Despite this, Lansley soon infiltrated the Department of Health, ignored the advice of his most senior civil servants and implanted his carefully constructed plan to end more than 60 years of consensus that it was the duty of the secretary of state to provide a comprehensive, continuous and equitable health service that was free at the point of use.

Lansley set about a major – indeed, revolutionary – reversal. Like many coups, this did not result in immediate victory but it started a civil war within the NHS that today threatens to create further crises, providing justi - fication for even more destructive reforms in the future.

Conservatives have an honourable philosophy that unites them and that seems to make some intuitive sense. They argue that competition is by far the best way to solve society’s ailments. Competition certainly works in sorting out the best football teams from the worst. In business, competitive instincts can sharpen minds to create new products that transform important aspects of our lives. It would be entirely natural to think that competition among health providers would enhance the quality of our NHS. The problem for the Conservatives is that there is not one shred of reliable evidence to prove that competition improves health. On the contrary, we know only too well that creating competitive markets in health is extremely harmful.

The US has the most advanced marketbased health system in the world. There, competition has driven up costs, created enormous variations in the quality of services available and fuelled distortions and disparities that make the idea of equity a pipe dream. Despite this, Conservatives, ably and surprisingly supported by their Liberal Democrat partners, have succeeded in creating conditions for the unprecedented colonisation of the NHS by an aggressive, profitseeking private sector. For these reasons, it is a simple, although appalling, truth that the Health and Social Care Act 2012 marked the end of the NHS.

NHS SOS explains how it was lost. It is a painful story and one that we must confront if we are to have any hope of reclaiming what was once ours. There were three catastrophic failures. The first great error was made by the Labour Party. As Tallis argues, “Labour was most culpable.” It was a suc - cession of Labour ministers, led by Alan Milburn and Patricia Hewitt, who prepared the NHS for privatisation. Having betrayed their visionary Labour forebears, many of them went on to line their pockets with well-paid consultancies in the private sector that they had done so much to foster.

The second failure lay with the media and especially with the BBC. Journalists consistently failed to ask questions about who would profit from Lansley’s reforms. They failed to explain the conflicts of interest staining so many of those designing his plans (from management consultants such as McKinsey to “think tanks” such as the King’s Fund). And they failed to point out that Lansley’s bill would dissolve the vital link between the secretary of state and his duty to provide care.

Perhaps the most atrocious betrayal of all came from an unexpected quarter – the medical profession. The British Medical Association pursued a policy of appeasement, which rendered it guilty of a crime of quite astonishing proportions: the death of a health system that had led the world in proving that a universal right to health could also be a universal symbol of our respect – and responsibility – for one another.

The Royal Colleges preferred to fight their own internecine wars rather than unite in opposition to a government that they each privately detested. The most senior medical leaders within government – notably the chief medical officer – chose to remain silent. The authors of NHS SOS use words such as “feeble” and “dismal” to describe their medical colleagues. They are too kind.

Tallis writes, “There is room for hope.” Maybe. Labour must unequivocally commit to repealing the Health and Social Care Act 2012. Campaigns must be launched, political pressure applied, evidence of harm gathered, so-called leaders held to account. Most of all, we need “an urgent inquest into the abysmal failure of professional leadership” within medicine.

What we have learned from the past decade is this: Labour, yes Labour, initiated a process that eventually erased an institution that had become a beacon of advanced democracy. The Conservatives happily used Labour’s perversions to accelerate this destruction. And the Liberal Democrats? They colluded and connived. If there is a hell, I look forward to the day when I meet these cowards, betrayers and appeasers – burning in obloquy.

Andrew Lansley, upon arrival at the Department of Health, ended "more than 60 years of consensus" that secretary of state should keep the NHS "free at the point of use". Photograph: Getty Images.

This article first appeared in the 15 July 2013 issue of the New Statesman, The New Machiavelli

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Nigel Farage's love for Dunkirk shows how Brexiteers learned the wrong lessons from WWII

Film has given Britain a dangerously skewed perspective on World War II

For months now it’s been hard to avoid the publicity for what seems like an epidemic of new World War Two films for 2017. June brought us Churchill (starring Brian Cox), which concerns Operation Overlord and the allied invasion of Normandy in 1944. A month later, in July we were pushed back four years, to Dunkirk, with Christopher Nolan’s film of the evacuation of Allied troops from French soil in the summer of 1940. April had already brought Their Finest, a comedy about making a - let us not let the irony go unacknowledged -  stirring film about the evacuation of Dunkirk in the event’s more or less immediate aftermath and November will bring us Darkest Hour, some events in which will predate all three earlier films, as Gary Oldman’s Churchill struggles through the earliest days of his war premiership.

This glut is peculiar. There are no significant round anniversaries to commemorate (e.g. Dunkirk is 77 years ago, the Normandy landings 73). More, we’re meant to be in the middle of a series of commemorations of the horror and waste of the Great War of 1914-18, but that seems to have slipped away from us in the political turmoil that’s engulfed this country since 2014. Instead, it’s to the Second World War we return yet again. To modern Britain’s founding myth.

It’s a coincidence, of course, that these films should come along together, and at a seemingly odd time. They were developed separately, and films takes so long to conceive and produce that no one could have anticipated them arriving together, let alone arriving in a toxic Brexit Britain where they seem like literally the least useful things for anyone in the UK to watch right now. As works that will inevitably, whatever their own creative intentions and merits, be hi-jacked by a press and political culture that is determined to gloss its opposition to the UK’s membership of the European Union, and its appalling mishandling of the process of exit with garbled references to, the conflict the films portray.

This is an impression that is not exactly dismissed by Nigel Farage posting to twitter of an image of himself standing next to the poster for Dunkirk, along with a statement in which he encourages all young people to see the film. For what reason, we’re entitled to wonder, does he make this encouragement? Does he admire the sound design? Or the aerial photography? Or is he just a big fan of Mark Rylance and Harry Styles? Or perhaps he is, inevitably, indulging in a behaviour that some might call "nostalgic"? Of pining for the past. Except, of course, nostalgia requires an element of pain. The suffix "algia" the same as employed when referring to chronic conditions. For Farage and his ilk there is no pain in this behaviour, just the most extraordinarily banal comfort.

Farage is asking us and asking the young who voted against his chosen cause by an overwhelming majority, and who are are sickened by where he and his ilk have brought us - to share in his indulgence. To enjoy, as he does, those fatuous analogies between the UK’s isolation between Dunkirk and Pearl Harbour with its imminent failures in European politics. To see that "escaping from Europe with nothing is at least better than not escaping at all". Or to believe, once again, in a "plucky little Britain, standing up against the might of a wicked mainland European tyranny, its back against the wall".

All this, confused, indeed nonsensical, as it is, is being invoked, as surely as the anti-EU right have always invoked Churchill. This is despite his own family recognising him, as the EU itself does, as the fervent pro-European he was. Indeed, he was one of the founding fathers of the whole post-war pan-European enterprise.

What Farage and his behaviour demonstrates, yet again, is that British culture, in many ways, learned not merely the wrong lessons from the war against Hitler, but exactly the wrong lessons. It’s a lesson that found its most enduring, poisonous expression in Margaret Thatcher’s breathtaking assertion that the European Union was a "third attempt" by Germany to take over the world.

In contrast to the rush of war films in cinemas, television has recently given us glimpses into theoretical worlds where Nazism did succeed in conquering the planet, in Amazon Prime’s The Man In The High Castle and BBC One’s SS-GB. There are lessons too, in these alternative histories, proper lessons that we have collectively failed to learn from the real one. Which is that fascism or authoritarianism are not diseases to which anglophone countries are somehow miraculously immune due to [insert misunderstood historical fetish of choice].

The Man in the High Castle, particularly in its more subtle first series, goes out of its way to show Americans that their lack of experience of collaboration with Nazi occupation is a result of circumstance, even luck. Not because collaboration is a peculiarly European tendency. SS-GB also worked hard to demonstrate the helplessness of occupation, and how that leads to the sheer ordinariness of collaboration. Both show the understanding that while fascism from the outside is funny accents and funny uniforms, fascism from the inside is your neighbours informing on you and the absence of the rule of law.

That experience of occupation, of subsequent complicity, and humiliation, felt by many other other European nations, is absent in Britain. Farage’s fellow Leaver Liam Fox, without anything resembling self-awareness, asserted that "the United Kingdom is one of the few countries in the European Union that does not need to bury its 20th century history". Fox’s remark summed up, again seemingly unintentionally, the oafishness of the principle Brexiteers. A group who exemplify a culture that boils a vast and unimaginably complex conflict down to the title sequence of Dad’s Army - an animation in which a Union Flag is forced off the European continent by a trio of Nazi triangles, and after returning home bobs around defiantly. A group who, in a strange and witless inversion, have fantasised themselves into a position where they see the Britain’s membership of the European Union as the occupation the country once avoided.

This is the UK’s postponed tragedy. At a timethat European countries experienced national humiliations which fundamentally reconfigured their understandings of their place in the world, the UK got yet another excuse to shout about how much better it was than everyone else.

I’m a child of the very late Seventies. I grew up in a world where (British) boys’ comics were dominated by war stories rather than science fiction or superheroes, where literally everyone knew several people who had fought in World War Two - and almost everyone someone who could remember World War One. That war was the ever-present past. I am, as a friend who teaches history neatly phrased it "Of the last post-war generation." After me, the generations are post-post-war. They are free. The moral clarity of the war against Hitler has, in the end, been a curse on British culture - a distorting mirror in which we can always see ourselves as heroes. 

But, not, of course, all other generations. The war generation collectively (I make no claim that there were not exceptions) understood what the war was. Which meant they understood that the European Union was, and is, its antonym, not an extension of it. Unlike their children and the eldest of their grandchildren, they had real experience of the conflict, they hadn’t just grown up surrounded by films about how great Britain was during it.

The Prime Minister who, or so he thought, had secured Britain’s European destiny had also, as he related in his autobiography, seen the devastation wrought by that conflict, including by shells he himself had given the order to be fired. Like Helmut Kohl, whose worshipped, conscripted older brother died pointlessly fighting for Hitler, and Francois Mitterrand, himself captured during the fall of France, his experience was real and lived, not second hand.

This can be seen even in the voting in 2016 referendum. That the young principally voted Remain and the old voted Leave has been often noted. But if you break that over-65 vote up further, there’s a substantial flip to back towards Remain amongst the oldest voters, the survivors of the survivors of World War Two. After all, someone who is 65 today was born nearly a decade after the war ended. It was their parents’ war, not their own. A war that has been appropriated, and for purposes of which those who fought in it would, collectively, not approve.

Let’s return to Dad’s Army, after all, BBC Two does often enough. Don’t Panic! The Dad’s Army Story (2000) a cheerful history of the sitcom great written and presented by Victoria Wood contains a telling juxtaposition of interviewees. The series' surprising continued popularity is discussed and Wendy Richard (born 1943) expresses a nostalgia for the war years, and how people banded together during them. This is a sentiment which Clive Dunn (born 1920) bluntly dismisses. “Like most people I had a foul war,” he says, and disgust and horror briefly pass across his face.

It’s the difference between those who remember war, and those who only remember war films.