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

OLI SCARFF/AFP/Getty Images
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Harriet Harman: “Theresa May is a woman, but she is no sister”

The former deputy leader of the Labour Party urged women to unite across the divided party.

The day-long women's conference is usually the friendliest place at Labour party conference. Not only does it have a creche and a very clear emphasis on accessibility, but everybody who attends starts from a place of fundamental agreement before the sessions have even begun. For that reason, it's often ignored by political hacks in search of a juicy splits story (especially since it takes place on Saturday, before the "real" conference action really gets underway). But with the party divided and the abuse of women on and off social media a big concern, there was a lot to say.

This year, kick off was delayed because of the announcement of Jeremy Corbyn's victory in the leadership election. The cheer for the renewed leader in the packed women's conference hall was far bigger than that in the main hall, although not everybody was clapping. After a sombre tribute to the murdered Labour MP and former chair of the Labour Women's Network Jo Cox, Harriet Harman took to the stage.

As a long-time campaigner for women's rights, veteran MP and former deputy leader of the Labour Party, Harman is always popular with women's conference - even if her position on the current leadership and her status as a former Blairite minister places her out of sync with some of the audience. Rather than merely introducing the first speaker as the agenda suggested, Harman took the opportunity to make a coded dig at Corbyn by doing a little opposition of her own.

"Theresa May is a woman, but she is no sister," she declared, going on to describe the way that May, as shadow spokesperson for women and equalities under William Hague, had been a "drag anchor" on Harman's own efforts to enact pro-women reforms while Labour were in government. The Thatcher comparison for May is ubiquitous already, but Harman made it specific, saying that like Thatcher, Theresa May is a woman prime minister who is no friend to women.

Harman then turned her attention to internal Labour party affairs, reassuring the assembled women that a divided party didn't have to mean that no advances could be made. She gestured towards the turmoil in Labour in the 1980s, saying that "no matter what positions women were taking elsewhere in the party, we worked together for progress". Her intervention chimes with the recent moves by high profile former frontbenchers like Chuka Umunna and Yvette Cooper to seek select committee positions, and Andy Burnham's campaign to become mayor of Greater Manchester.

Harman's message to women's conference was clear: the time for opposition to Corbyn is over now - we have to live with this leadership, but we can't let the equalities legacy of the Blair years be subsumed in the meantime. She ended by saying that "we have many leaders in the Labour party," pointing to Jess Phillips, the chair of the women's PLP, and Angela Rayner, shadow minister for education, women and equalities. Like Burnham, Cooper et al, Harman has clearly decided that Corbyn can't be unseated, so ways must be found to work around him.

Rayner followed Harman onto the stage. As one of Corbyn's shadow ministerial team, Rayner is far from in agreement with Harman on everything, and rather than speak about any specific policy aims, she addressed women's conference on the subject of her personal journey to the front bench. She described how her mother was "born on the largest council estate in Europe and was one of twelve children" and "never felt loved and didn’t know how to love, because hugs, cuddles and any signs of affection just wasn’t the norm". She went on to say "mum won't mind me saying this - to this day she cannot read and write". Her mother was in the audience, attending her first Labour conference.

As a former care worker who became a mother herself when she was just 16, Rayner is a rarity at the top of Labour politics. She told the Guardian in 2012 that she is used to being underestimated because of her youth, her gender and her northern accent: "I'm a pretty young woman, lots of red hair, and everyone expects me to be stupid when I walk into a meeting for the first time. I'm not stupid and most people know that now, but I still like to be underestimated because it gives me an edge. It gives me a bit of stealth."

The mass shadow cabinet resignations in June propelled Rayner to the top sooner than an MP only elected in 2015 might have expected, and she has yet to really prove her mettle on the grind of parliamentary opposition and policy detail. But if Labour is ever to win back the seats in the north where Ukip and Brexit are now strong, it's the likes of Rayner that will do it. As Harriet Harman herself shows, the women and equalities brief is a good place to start - for even in turbulent, divided times for Labour, women's conference is still a place where people can find common ground.

Caroline Crampton is assistant editor of the New Statesman.