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

Getty
Show Hide image

Don't bet on James Brokenshire saving devolution in Northern Ireland

The Northern Ireland secretary's decision to extend talks makes a settlement less, not more, likely. 

The deadline for the parties at Stormont to form a new executive has passed without an agreement. Northern Ireland secretary James Brokenshire has – as was inevitable – taken the least difficult option and opened a “short window of opportunity to resolve outstanding issues”.

Talks have been extended for a “short few weeks” – Brokenshire’s interpretation of the “reasonable period” allowed after the initial three weeks after the election elapsed. Despite his earlier warnings, there will be no snap election (for which he conceded there was “no appetite”).

Unhelpful though the tortured semantics of “a short few weeks” are, we can assume that new negotiations may well as last as long as the impending Commons recess, which begins on Thursday and ends on April 11th – after which, Brokenshire said, he will bring forward legislation to set regional rates in the absence of an executive. This, though not quite direct rule, would be the first step in that direction.  

So what changes now? Politically speaking and in the immediate term, not a great deal. For all the excited and frankly wishful chatter about the two parties approaching the final talks afresh after Martin McGuinness’ funeral last week, Sinn Fein and the DUP remain poles apart.  

The former declared talks to have failed a full day before the deadline, and Sinn Fein president Gerry Adams has since said there has been “no substantive progress” on the key issues at hand – particularly the DUP’s “minimalist” approach on the Irish language and marriage equality. Seemingly unassailable differences remain on a new Bill of Rights and measures to deal with the legacy of the Troubles. As such, both Adams and Sinn Fein's new leader Michelle O’Neill continue to stress their election lines: equality, respect, integrity, and, perhaps most tellingly, “no return to the status quo”.

Brokenshire clearly recognises that there will be no new executive without some movement on these issues: yesterday he referred to the talks to come as an “opportunity to resolve outstanding issues”. He is right to do so: Sinn Fein’s demands are, for the most part, as yet unimplemented provisions from the Stormont House and Fresh Start Agreements of 2014 and 2015. 

But will the DUP budge? It appears unlikely at first glance. Sinn Fein’s approach to negotiations has only heightened tensions between the would-be coalition partners, whose relationship has regressed to the openly adversarial (DUP leader Arlene Foster yesterday expressly blamed Sinn Fein for the collapse in talks).

There looks to be little appetite for compromise on Sinn Fein’s headline demands. The DUP’s opposition to historical prosecutions of Troubles veterans is well-publicised, and appears to be aligned with UK government thinking.

Nor does there appear to have been any real shift in the party’s position on legal recognition for the Irish language. Speaking on the BBC’s World at One yesterday afternoon, Ian Paisley Jr stressed in pretty woolly terms to the DUP’s commitment to “promoting minority languages”, which, however true, is not the commitment to an Irish language act that Sinn Fein are asking for. That the spirit of Paisley’s remarks was essentially the same as his leader’s contrarian take on the issue – she said, provocatively, that there was much a need for a Polish language act as an Irish language act – is not a promising sign.

The continuing fallout from the Renewable Heat Incentive scandal that triggered last month’s election also complicates matters. Though the London press have already relegated this public spending scandal to the footnotes, the full ramifications are yet to be seen. A full list of claimants was last week published by the Belfast News Letter, and the longer the process of negotiation and renegotiation drags on, the clearer the answer to the question of who exactly benefited from the scheme’s mismanagement becomes. Though, Foster's penance in the wake of the DUP’s calamitous election performance has gone some way to rehabilitating her public image, the taint of corruption could retoxify the brand. It isn’t difficult to see why veteran Stormont horse-traders like Reg Empey, the former leader of the UUP, believe an executive may well be unachievable until the inquiry into "cash for ash" delivers its ruling – a process which could take a year.

The political impasse, then, looks as insoluble as ever. Leaders of smaller parties such as the non-sectarian Alliance have blamed Brokenshire for the startling fact that there were no roundtable talks at any point during the past three weeks. The Northern Ireland secretary’s decision to extend talks for another fortnight could bury power-sharing as we know it for good. From Wednesday, the civil service will take control of the province’s budget, as per Section 59 of the Northern Ireland Act. The permanent secretary of the Department for Finance will immediately have access to just 75 per cent of available funds, and, if the situation persists, 95 per cent.

In the worst case scenario, this means cuts could well come hard and fast. All the better for Sinn Fein - as I wrote earlier this month, the imposition of austerity and Brexit from London offers an opportunity to parlay short-term pain into long-term political gain. Meanwhile, Brexit secretary David Davis has admitted that Northern Ireland would automatically rejoin the EU in the event of a border poll. The path to a united Ireland via direct rule looks clearer than ever before.

Unionists are not blind to this existential risk – and here Brokenshire’s bizarre insistence that he was ready to call Northern Ireland’s third election in twelve months exposes his political naivety. He maintains there is “little public appetite” for a new poll. He might be right here, but that doesn’t mean a revanchist DUP would refuse the opportunity, if it arose, to go back to a unionist electorate it believes have taken frit at Sinn Fein’s post-election manoeuvring. Some in the party are keen to do so, if only to put to bed what they deem to be premature and melodramatic talk of imminent Irish unity.

Another election would suit Sinn Fein’s long game. The more dysfunctional and unworkable devolved politics in the North, the stronger the logic for a quick transition to a united Ireland in the EU. Much of the Northern Irish political establishment deem Brokenshire a lightweight - as do many in his own party. That he seems not to have realised that threatening a new election wasn’t much of a threat at all – or foreseen this avoidable mess - does nothing to dispel that notion. 

Patrick Maguire writes about politics and is the 2016 winner of the Anthony Howard Award.