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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The economics of outrage: Why you haven't seen the end of Katie Hopkins

Her distasteful tweet may have cost her a job at LBC, but this isn't the last we've seen of Britain's biggest troll. 

Another atrocity, other surge of grief and fear, and there like clockwork was the UK’s biggest troll. Hours after the explosion at the Manchester Arena that killed 22 mostly young and female concert goers, Katie Hopkins weighed in with a very on-brand tweet calling for a “final solution” to the complex issue of terrorism.

She quickly deleted it, replacing the offending phrase with the words “true solution”, but did not tone down the essentially fascist message. Few thought it had been an innocent mistake on the part of someone unaware of the historical connotations of those two words.  And no matter how many urged their fellow web users not to give Hopkins the attention she craved, it still sparked angry tweets, condemnatory news articles and even reports to the police.

Hopkins has lost her presenting job at LBC radio, but she is yet to lose her column at Mail Online, and it’s quite likely she won’t.

Mail Online and its print counterpart The Daily Mail have regularly shown they are prepared to go down the deliberately divisive path Hopkins was signposting. But even if the site's managing editor Martin Clarke was secretly a liberal sandal-wearer, there are also very good economic reasons for Mail Online to stick with her. The extreme and outrageous is great at gaining attention, and attention is what makes money for Mail Online.

It is ironic that Hopkins’s career was initially helped by TV’s attempts to provide balance. Producers could rely on her to provide a counterweight to even the most committed and rational bleeding-heart liberal.

As Patrick Smith, a former media specialist who is currently a senior reporter at BuzzFeed News points out: “It’s very difficult for producers who are legally bound to be balanced, they will sometimes literally have lawyers in the room.”

“That in a way is why some people who are skirting very close or beyond the bounds of taste and decency get on air.”

But while TV may have made Hopkins, it is online where her extreme views perform best.  As digital publishers have learned, the best way to get the shares, clicks and page views that make them money is to provoke an emotional response. And there are few things as good at provoking an emotional response as extreme and outrageous political views.

And in many ways it doesn’t matter whether that response is negative or positive. Those who complain about what Hopkins says are also the ones who draw attention to it – many will read what she writes in order to know exactly why they should hate her.

Of course using outrageous views as a sales tactic is not confined to the web – The Daily Mail prints columns by Sarah Vine for a reason - but the risks of pushing the boundaries of taste and decency are greater in a linear, analogue world. Cancelling a newspaper subscription or changing radio station is a simpler and often longer-lasting act than pledging to never click on a tempting link on Twitter or Facebook. LBC may have had far more to lose from sticking with Hopkins than Mail Online does, and much less to gain. Someone prepared to say what Hopkins says will not be out of work for long. 

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