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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Owen Smith interview: “I’m pretty red”

The Labour leadership challenger is struggling to win over a left suspicious of his past. 

The south Wales valleys embody the history of the labour movement: its victories, its defeats, its heroes, its villains. It was this resonant location that Owen Smith chose for his speech on the morning of 22 August. Labour Party members had that day begun voting on whether the 46-year-old Pontypridd MP should replace Jeremy Corbyn as their leader.

“Our history, our party was literally hewed from the hillsides around where we sit today,” Smith told a small audience at the Ely Valley Miners Welfare Club in Tonyrefail, a short distance from his home. The Welshman cited the Taff Vale judgment of 1901, which ruled that trade unions could be sued for losses caused by industrial action. It was this decision that spurred on the establishment of a Labour Party in parliament to repeal the law (as it would do in 1906 in alliance with the Liberal government).

Smith spoke later of marching with miners from the Maerdy Colliery as a 14-year-old, on the day they returned to work at the end of the 1984-85 strike. “I saw that they were utterly unbowed,” he recalled. “But they were ultimately defeated.”

Such moments, he concluded, proved the need for Labour to win power and to maintain “a powerful voice in parliament” – something he believes Jeremy Corbyn is incapable of providing. On 28 June, less than a year after Corbyn’s landslide victory, 172 MPs (81 per cent of the Parliamentary Labour Party) endorsed a no-confidence motion in him. Sixty-five shadow ministers, including Smith (who was then the shadow work and pensions secretary), resigned from the front bench.

Yet though Smith enjoys the overwhelming backing of the PLP, few believe he will prevail among members. He achieved only 53 constituency nominations, against the leader’s 285. On social media, where internal party contests are increasingly decided, Smith’s reach is minuscule compared to that of Corbyn (who has 795,000 Facebook fans to his 14,000).

The day before Smith spoke in south Wales, he won the endorsement of Sadiq Khan, the Mayor of London and Labour’s most senior elected politician. He was subsequently also backed by the Scottish Labour leader, Kezia Dugdale. Neil Kinnock and Ed Miliband have trumpeted his cause. Yet Smith-supporting MPs fear that such declarations count for little. “It’s like the Remain campaign and the Archbishop of Canterbury,” one told me, suggesting that Labour members, like Leave voters, ”weren’t listening” to such grandees.

Corbyn’s allies and foes alike are already preparing for the aftermath of the leader’s anticipated victory. The former warn that rebel MPs put themselves at risk of deselection by members. In response, some have threatened privately to form a parliamentary breakaway group and bid for the status of the official opposition.

Smith, unsurprisingly, insists that he can win. “I think the CLP [Constituency Labour Party] nominations don’t truly reflect the views in CLPs,” he told me when we spoke after his 20-minute address. The challenger, dressed in his favoured combination of dark suit and open-necked white shirt, welcomed the black coffee proffered by his aide. “They reflect the fact that some of the people who are new members and are supportive of Jeremy were very organised . . .

“Anybody who knows the Labour Party knows that selections are very often won by the sleepers: the people who don’t go to CLP meetings and don’t necessarily shout from the rooftops.” Smith’s hopes rest on those who share Oscar Wilde’s view: “The problem with socialism is that it takes up too many spare evenings.”

Cartoon: George Leigh

Smith first publicly revealed his leadership ambitions in an interview with me back in January. “It would be an incredible honour and privilege,” he said. I wrote then of a widespread view among Labour MPs that the next leader “will at least need to be from the party’s soft left to be acceptable to the party membership”. When the rebellion against Corbyn came, it was this consideration that proved decisive. Smith was embraced as a Miliband-esque socialist and a parliamentary “clean skin”, untainted by the New Labour years, having been elected in 2010. By contrast, his initial rival, Angela Eagle, had been an MP since 1992 and voted for the Iraq War.

However, Smith proved to have a more ambiguous past than some of his backers anticipated. Corbyn’s supporters swiftly unearthed a series of interviews from 2006 in which their opponent made a notably centrist pitch. Smith, then a by-election candidate in Blaenau Gwent, south Wales, defended Tony Blair (suggesting that they differed only over the Iraq War), supported private-sector involvement in the National Health Service and praised city academies. “I’m not someone, frankly, who gets terribly wound up about some of the ideological nuances,” he told Wales Online.

Since then, he has struggled to reconcile these positions with his increasingly left-wing programme: opposing private provision in the NHS, returning academy schools to local authority control, banning zero-hours contracts and imposing a wealth tax of 1 per cent.

“To be honest, my opponents have extrapolated rather a lot in an attempt to brand me as a ‘Blairite wolf in sheep’s clothing’,” Smith told me. “Well, I’m nothing of the sort, I’ve always been a democratic socialist and I always will be. My views haven’t really changed at all, I’m someone who has been on the left of the party.

“My dad [the Welsh historian Dai Smith] is someone who’s been on the left of the Labour movement all his life. I’m someone who’s been surrounded by people who’ve been on the left of the Labour movement all their lives. It should come as no surprise that I’ve come out of that background and I’m pretty red. Because I am.”

Yet a former shadow cabinet colleague told me that Smith did not stand out as “a radical” in meetings: “The only time that I remember him becoming really animated was over further tax-raising powers for Scotland and the implications for Wales.”

What Smith believes in most, some say, is himself. The shadow chancellor, John McDonnell, described him as “one of the most ambitious career politicians I’ve met”. Others have dismissed him as a “Big Pharma lobbyist” because of his past as head of policy and government relations for Pfizer.

“I’m not ashamed that I had a life outside politics before I became an MP,” Smith told me. “Yes, I worked for Pfizer and I also worked as a BBC journalist and as an adviser to the last Labour government on the peace process in Northern Ireland.

“People don’t want career politicians – they want men and women who have had experience of working in business and in the different sectors that make up our economy. Critics may use it against me, but my time in business has helped me understand what’s wrong with it and how we can make it work better.”

Corbyn’s supporters, however, allege that Smith’s left-wing pledges would not withstand contact with centrist colleagues. The degree to which the challenger has rebutted this charge shows that he recognises its potency.

He has offered to make Corbyn party president or chair if he wins, to allow Corbyn to act as “a guardian of Labour’s values”. In his speech, Smith vowed to increase member influence by making conference votes binding on the leadership.

Throughout the 1980s, another soft-left Welshman, Neil Kinnock, struggled to assert authority as the hard left retained control of vital bodies. Smith’s proposals risk replicating this conflict. But he told me that he would respect Labour’s conference even if it endorsed stances such as Trident abolition (Smith joined CND as a teenager but later renounced unilateralism). “I do think in order to reassure members that, under my leadership, we would listen hard to them and act in accordance with their views, conference does need to become sovereign once more,” he said.

Tony Benn’s dream of internal democracy appeared to be within reach. I asked Smith whether he would support other reforms such as a reduced MP nomination threshold for leadership candidates (Corbyn allies have proposed a cut from 15 per cent to 5 per cent). “All of these things can be debated,” he told me. “I’m not sure it should be 5 per cent: I need to look at it when we get closer to it. But I am convinced that the left needs to be able to put up candidates in this contest, I’ve always felt that.”

Smith’s assertion is contradicted by a colleague who described him as having been “furious”, “apoplectic” when Corbyn made the ballot last year (he supported Andy Burnham’s campaign).

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Smith is less equiovcal over the mandatory reselection of MPs. “That would be a really retrograde step for the party,” he told me. “It would be an uncomradely way for us to do business.” He is critical of the Corbyn-aligned group Momentum, some of whose members are spearheading deselection efforts. “I fear an attitude within Momentum that they are a separate organisation and they shouldn’t be,” he told me. “It’s hard to argue that they’re loyal and supportive if they’re organising a bloomin’ great really in the same town at the same time in competition to the Labour Party” (the group will hold its own four-day conference alongside Labour’s in Liverpool).

Some of those close to Corbyn, such as John McDonnell, have unhesitatingly described themselves as Marxists (in 2006, the shadow chancellor named Marx, Lenin and Trotsky as his “most significant” intellectual influences). I asked Smith whether he believed Labour could encompass such views. “Yes, I think we’ve always been a broad church and there have always been people who’ve come from that tradition,” he replied. “There are two broad traditions: the extra-parliamentary tradition, that has always seen parliament as a compromise and parliamentary socialism as a compromise, from [the trade unionist and theorist] Noah Ablett here in south Wales with The Miners’ Next Step through to Ed Miliband’s dad [Ralph, a Marxist historian] ... and the mainstream social democratic tradition that I came from.”

He added: “We’ve had this battle in the Labour Party over the ages, haven’t we? Except now I think it’s more serious because there is a very real danger, with Labour at such a low ebb and politics fragmented more broadly, and so many more parties and so many options for people and such a lesser tribal attachment to the Labour Party, that we can’t afford those fractures.

"If we splinter, there’s lot of other places for people to put their vote.”

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Though they will not say so publicly, some of Smith’s supporters believe Labour would remain unelectable under his leadership. A former shadow cabinet minister told me that he was offering a “warmed-up Ed Milibandism, which was rejected by the voters”. Smith naturally contests this analysis. “I don’t think that we lost the last election because we were too left-wing,” he said. “The proof is that the Tories have engaged in all sorts of these policies ... Theresa May’s opening speech upon becoming leader was to talk about social injustice, economic insecurity, lack of security in the workplace. Labour values, Labour words in a Tory mouth, evidence that the broad story we’re telling about Britain is right.”

Smith said that, unlike Corbyn, he would resign if he became leader and lost a confidence vote by MPs. “Yes - I would [resign]. We are a party that believes in parliamentary democracy and, as such, it is only right that the leader commands the support of his or her colleagues in the Commons.”

Should Corbyn win the contest, as expected, Smith will not return to the shadow cabinet but act as “a loyal backbencher”.  He pledges to resist any breakaway: “I'm Labour, I've always been Labour and I will never stop being Labour," he said. 

Speaking of his fear that Corbyn would seek to remain leader even if the party lost the next general election, he said: “I’m deeply worried about it. I think he’s determined to hang on come hell or high water. And what does that say about him? ... I think he is more concerned with his version of the Labour Party being sustained and being victorious than he is with the Labour Party being victorious in elections. I think he is actually prepared to sacrifice unity and victory - two great words that have traditionally been emblazoned on Labour banners through the ages - in order to secure control of the party.”

The trouble for Owen Smith is that, for all his combative talk and appeal to the left, he is trapped between his past pragmatism and his present radicalism. 

Tony Benn, Corbyn’s late mentor, divided politicians into “signposts” and “weathercocks”: those who shape opinion and those who are shaped by it. He would have branded Smith a “weathercock”. Even if he wins, Smith risks being remembered not as a politician who resolved his party’s contradictions, but as one who embodied them.

George Eaton is political editor of the New Statesman.

This article first appeared in the 25 August 2016 issue of the New Statesman, Cameron: the legacy of a loser