Show Hide image

The NHS is Britain’s beating heart – don’t let it flatline

After 30 years of meddling with the NHS, are we now at risk of destroying our most precious public s

I have hazy memories of my parents getting their first telephone. It was the late 1960s, and telecommunications was a public service. There was a waiting list but, in time, we got to the head of the queue. An engineer from the General Post Office installed the necessary equipment and we were connected - or at least, connected any time our neighbours weren't using their phone: ours was a "party line". I don't recall any grumbles about the tortuousness of the process, nor about having to share with the people next door. The sense of wonder at what was now possible must have mitigated any frustration. It was marvellous to be able to speak to relatives and friends from the comfort of home, without having to trudge to the phone box.

The National Health Service was viewed in much the same way. My father developed cancer when I was two years old. He was swiftly cured but irrevocably damaged, and he struggled thereafter with chronic ill-health. His illnesses had knock-on effects on various members of our family, myself included. Between us we saw a lot of the NHS. At the centre of it (to my eyes) was our GP, a good-hearted man with half-moon glasses and a somewhat distant manner. When he needed expert assistance, a referral would be made. Waiting times were sometimes long but were accepted with stoicism: the professionals we eventually saw did their best. Looking back, I recognise the profound comfort in those experiences for my parents, who had grown up knowing what medical care could be like - and its financial implications - before the advent of the NHS. No matter how threatening or scary things got, no matter what time of day or night, this health service was there to help and asked nothing in return.

In the mid-1980s, I entered medical school in Nottingham. Like most aspiring doctors, I knew what I was going to be: a public servant, working extremely long and often antisocial hours, the whole arduous endeavour sustained by a powerful sense of doing something important and worthwhile. I would be joining an unquestionable force for good, grouped under the fluttering blue-and-white standard of the NHS.

But even as I embarked on my training, society was changing under the Thatcher government. The emerging citizen-consumer was increasingly exasperated by the inefficiency of state monopolies; no longer could we tolerate waiting months to have something as commonplace as a phone line installed or repaired. Margaret Thatcher's solution was privatisation and exposure to market forces. British Telecom was sold off in 1984, two years after a licence had been granted to its first competitor, Mercury Communications. British Gas and British Petroleum soon followed. It was only a matter of time before government attention turned to the biggest state monopoly of them all.

I was nearing qualification as a doctor when the then secretary of state for health, Kenneth Clarke, published his 1989 white paper, Working for Patients. The huge, sprawling, multicellular organism of the NHS would be cleaved in two, hospitals becoming providers, wooing and responding to the demands of purchasers in a so-called internal market. Competition, survival of the fittest, would deliver a patient-centred NHS, something even the new breed of health service managers, ushered in by the 1983 Griffiths report, was failing to achieve.

The white paper was greeted with consternation in Nottingham. The city had two general hospitals. Each had the full complement of acute care services and they shared the emergency work, alternating days "on take" for admissions. Specialised departments were located at one or the other site. Co-ordinated by the health authority, they supplied virtually all hospital care for the local population between them, with little unnecessary duplication. Now they were to become independent trusts, no longer co-operating, but competing for each other's business.

The central dilemma with the model was: who, in practice, would the purchasers be? In any normal market, they would be the consumers. But in an era when most people's access to medical information was limited to the family copy of Home Doctor, patients could not realistically make informed decisions. The That­cher government's response was to invite GPs to become purchasers, controlling budgets on behalf of their patients. Generous management allowances and the freedom to reinvest savings provided incentives for uptake. Wave after wave of practices signed up, until eventually about 50 per cent of GPs - covering 60 per cent of the population - were fund-holders.

The Labour opposition was incensed by the scheme, arguing that it was creating a two-tier service. By this stage, I was working as a junior hospital doctor in a surgical speciality and the evidence was stark. The admissions office had a card system along the length of one wall, with a slot for each patient on the waiting list. The nearer a card moved to the left, the closer the admission date. Patients from fund-holding practices were flagged with red stickers. When any were in danger of exceeding the eight-week treatment time specified in the fund-holding group contract, they were simply bumped along, displacing those from non-fundholding practices who had already been waiting longer.

Unfair advantage

There were other perversities. A fund-holding practice's budget was set according to its activity in the year before entering the scheme. GPs routinely maximised referrals and prescribing in the run-up to budget-setting to ensure a decent allocation. It was not hard to make savings that could be reinvested. I spent a year working at a fund-holding practice in Oxfordshire in the mid-1990s. A consultant orthopaedic surgeon was contracted to run a clinic at the health centre every fortnight; patients had in-house physiotherapy and counselling. A handsome meeting room had been built and computers upgraded. Other practices opened branch surgeries; elsewhere NHS osteopathy and acu­puncture were made available. Fund-holding GPs and their patients had never had it so convenient or so good. Non-fundholding surgeries, such as the Oxford city practice I went on to join, were being left behind.

The 1997 election result was a great relief. True to its reputation as the party of the NHS, New Labour soon scrapped fund-holding and the internal market. Budgets were returned to health authority control in the form of primary care trusts (PCTs). I remember listening to the closing flourish of Gordon Brown's first Budget speech when he pulled from his metaphorical hat £1.2bn extra funding for the health service. Labour backbenchers sent up a raucous cheer, their reaction to the announcement reflecting my own surge of elation. Here at last was a government prepared to back the NHS with proper resources. The rhetoric of Blair's first term was about ensuring excellent health care for all, regardless of where you lived or who your GP was. New Labour, it seemed, was a party that understood our public service values.

National Service Frameworks (NSFs) began to spew from the Department of Health, dictating to doctors every aspect of the care they must provide for common, important conditions. I took the lead in my practice for the heart disease NSF; we welcomed it as a template against which to assess our standard of care.

All too soon, however, the rigid, controlling instinct of the New Labour regime emerged. The National Institute for Health and Clinical Excellence (NICE) was founded, its remit to abolish postcode lotteries in NHS treatment and further to promulgate a centralised vision of health care. Targets for hospital waiting and for access to GP care were imposed, spawning unintended consequences that inconvenienced or adversely affected more patients than they helped. The NSFs became incorporated into the 2004 GP contract as the tick-box-obsessed Quality and Outcomes Framework (QOF), straitjacketing doctors' ability to tailor treatment according to patients' individual needs. More and more managers were employed to survey and to audit and to enforce compliance with these various initiatives.

My GP colleagues and I have become press-ganged into the role of pill-pushers, the tyranny of QOF subjecting patients to bewildering and sometimes injurious choices of drug, irrespective of circumstances. The only way to practise holistically is to "exception-code" patients, removing them from QOF. But exception-code too many, and the managerial thought-police are quickly on to you - you're incompetent, you're a maverick, or even worse you are setting out to defraud. The distrust and disempowerment of dedicated professionals have been a kind of poison, choking off the immense goodwill that was the lifeblood of the NHS.

To compound matters, at some point during Tony Blair's second term, the decision was taken to revisit the Thatcher experiment. The language had to be distinct, so commissioners rather than purchasers would call the shots. And there could be no return to a two-tier service; all GPs were expected to become involved in the new, practice-based commissioning. Audaciously, Blair went where Thatcher had never dared to tread. The provider market was no longer to be internal: it was opened up to the private sector, treatment reimbursed at fixed-tariff rates. To kick-start the process, New Labour guaranteed returns to a number of independent-sector treatment centres (ISTCs), whose staff are often brought in from overseas, with qualifications, training and experience that are unfamiliar to local practitioners.

ISTCs have proved popular with many patients, who appreciate the plush facilities and short waiting lists that overgenerous block contracts have endowed. But, for the local NHS, there is uncertainty over clinical quality. One of my patients was given an inappropriate orthopaedic operation two years ago. The pieces are still being picked up by an experienced consultant at the local district general hospital. Nor is this an isolated case. Several other patients had to have camera examinations of their bowels repeated as part of a review of 1,800 procedures carried out at our local ISTC, following allegations of failure to diagnose cancer.

Even where quality of care is good, patients who have investigations that detect significant pathology then have to be referred on to consultants at the district general hospital, fragmenting their care and generating additional stress and anxiety, because ISTCs are not contracted or able to manage the conditions they diagnose. ISTCs have destabilised the existing NHS hospitals they rely on for safety-netting, cherry-picking patients at lowest risk and leaving the old providers to deal with complex, high-risk patients whose care is, as a consequence, more expensive. Training the next generation of doctors has been rendered problematic by the skewing of case-mix (patient categories) in medical teaching centres.

Franchised out

Allegedly to disrupt vested interests, New Labour also opened up general practice to the private sector. PCTs were compelled to award an increasing proportion of primary care contracts to commercial organisations. Under Lord Darzi's NHS Next Stage Review, every PCT was forced to commission a new "8-till-8" health centre - funded at levels a conventional practice could only fantasise about - the thinly disguised agenda being to expose existing surgeries to the white heat of (unfair) competition. The fluttering blue-and-white flag of the NHS to which I had once rallied has become a mere franchise, something to be waved by any organisation granted entry into the health-care arena, no matter its motivation.

In spite of the resources New Labour squandered to open up the provider market, practice-based commissioning proved an abject failure. By the time the policy was launched, PCTs had become mature, self-sustaining bureaucracies. With a few notable exceptions - where enlightened PCTs granted GPs substantial freedom of commissioning, and where some impressive innovations and efficiencies were achieved as a result - practice-based commissioning barely drew breath, smothered by managers unwilling to relinquish control.

The relief I felt last May when Labour was finally evicted was every bit as strong as that I'd experienced in 1997. Andrew Lansley appeared to be offering us the opportunity to reinvent the NHS as a modern public service - GP commissioning consortiums collaborating with consultants and other stakeholders to deliver joined-up, efficient, patient-centred care pathways. We had seen our efforts bear fruit in the few places where practice-based commissioning was allowed to flourish and there was an appetite to restore the public-service ethos that New Labour had so wilfully destroyed.

At what price?

Yet, in the months since the white paper was announced, clinician enthusiasm has been ever declining. Recent polls find only a minority of GPs continuing to back Lansley's plans and there has been an extraordinary convergence of concern among virtually every body representing the NHS, from unions such as the BMA, Unite and Unison, to the royal colleges of every medical and nursing discipline, to the NHS Confederation and various independent think tanks such as the King's Fund. There is anxiety about the pace and scale of the reforms, and disquiet about shifting responsibility for rationing on to doctors whose time-honoured role is to do their best for each patient. The show-stopper, though, is the picture that has recently emerged of Lansley's version of the provider market.

This is to remain external, with "any willing provider" (AWP) allowed to pitch for business under the NHS franchise. We have had more than enough experience with New Labour to appreciate the downsides, but the profession could probably live with AWP, relying on the commissioning process to factor in holistic care, were it not for Lansley's completely unexpected determination - smuggled into a brief mention when the Health and Social Care Bill was published on 19 January - to permit providers to compete not just on quality (as now), but also on price. The NHS regulator, Monitor, will be tasked with compelling this price competition. Far from collaborating with providers to design holistic, patient-responsive care programmes, GP consortiums will be bound by competition law and could face legal challenges, should they seek to work organically with selected organisations.

This surprise emphasis on price competition might at first seem reasonable, given the pressures on public spending. But the evidence strongly suggests that price competition lowers quality of care. One need only consider the NHS's single, disastrous experiment with it. Under the terms of the 2004 GP contract, PCTs were handed responsibility for commissioning out-of-hours care for patients, with no national tariff to adhere to. In order to win contracts, many commercial organisations bid low - either as a loss-leader to eliminate local, GP-led competition before increasing contract costs, or in the sincere belief that they could provide adequate care at bargain-basement prices.

In my own area we are all thankful that the PCT has continued to commission out-of-hours services from a not-for-profit company run and staffed by local GPs, which recently achieved second place nationally in a survey of quality. Elsewhere in the country, cut-price out-of-hours providers - by definition often dealing with patients with acute or life-threatening conditions - frequently depend on non-medical staff working to inflexible protocols, or on agency doctors who have little knowledge of local services, and whose language and communication skills can be markedly deficient.

At best, these apparently cheaper services consume more resources as inappropriate admissions multiply. At worst, patients needlessly suffer and die. All these services looked good on paper when the tenders came in. It takes a long time, and a lot of harm to patients, before deficiencies of quality become apparent; and it can be legally difficult to break a contract even when the provider seems to be failing.

Crossed wires

My family moved house recently. BT royally loused up the redirections we had commissioned on our old phone numbers. Innumerable operatives in call centres around the globe were unable to rectify matters, some simply hanging up when the going proved too difficult. In the end, even the high-level complaints manager we were allocated admitted it was beyond her power to put things right.

Disgruntled and nonplussed by BT's failure to make amends, we investigated switching providers, only to find that our contracts render any move prohibitively expensive. We are stuck, at least for the next year. Never mind, it really doesn't matter - it's only phones. But what if it did matter? What if this was a matter of life and death, or of life-enhancing care? What price would we then put on a health service that was there for us - not for profit - no matter how threatening or scary things were, no matter the time of day or night, and which asked nothing of us in return?

Phil Whitaker is a novelist and GP working in the south-west of England

This article first appeared in the 28 February 2011 issue of the New Statesman, Toppling the tyrants

LOUISA GOULIAMAKI/AFP/GETTY IMAGES
Show Hide image

How Vladimir Putin lost Ukraine

Putin’s war cost Russia its centuries-long shared identity with its neighbour. Now, Kyiv risks betraying the spirit of the Maidan revolution.

When the Russian inquest finally comes, the answer will be clear. It was President Vladimir Putin who lost Ukraine – after a millennium of shared east Slav identity. When the Ukrainian inquest into who lost the ­Euromaidan’s “Revolution of Dignity” finally comes, the answer, on the present evidence, will also be clear. It was an elite core of politicians and oligarchs who first worked a miracle in fighting Russia’s military Goliath to a stalemate – only to revert to kleptocratic business as usual when the acute threat eased.

Ukrainians’ consolidation of a distinct national identity after centuries of being regarded as a fuzzy subset of the dominant Russians – and after a quarter-century of independence – began in February 2014. It sounds banal to say that when one nation attacks a neighbour, especially if the two have regarded each other as brothers for a thousand years, the victims feel aggrieved and pull together against the attacker. But this is what happened when Putin launched his undeclared war on Ukraine, sent hooded “little green men” to take over Crimea’s regional parliament by intimidation, and then annexed the peninsula. The mutation of this early tactical success into strategic failure is best traced by reviewing the players and the dynamics as Ukraine held off Russia and crystallised its singular new identity.

On the Russian side only one actor matters: Putin. When the old Soviet Union split apart in 1991, its kleptocracy was replicated in its two biggest east Slav successor states. By 2015 Russia ranked a joint 119th out of 167 countries on Transparency International’s Corruption Perceptions Index. Ukraine was 130th. A Wild East capitalism prevailed, in which emergent oligarchs carved up the state’s wealth through murky privatisation deals. But there was one main political difference between the two countries. Putin quickly restored the primacy of politicians over Russian tycoons after he became president. In Ukraine, oligarchs were able to use their new wealth to dominate politics.

When Putin suddenly broke out from Europe’s seven-decade peace order in February 2014, Western policymakers asked the diminished number of Kremlinologists in their midst why he was acting this way. Some, such as Dmitry Gorenburg, an associate at Harvard’s Davis Centre for Russian and Eurasian Studies and a military analyst, pointed to fear as the Russian president’s root instinct. Putin has shown little interest in economics; he has not worried about looming inflation or capital flight, or Russia’s distorting reliance on oil and gas revenues. What he was afraid of, it seemed, was unchecked democratic contagion: as transmitted from Poles in the 1980s to restive East Germans and then Czechs in 1989, to Ukrainians in the mid-2000s, and even on to Muscovites in 2011/12 before Putin managed to stop their street protests.

This analysis is plausible. In 1989, as a young officer of the Soviet Committee for State Security, Putin was serving with the KGB’s Dresden outpost. He saw the Berlin Wall fall – overnight, under the press of East Berliners who mistakenly thought it had been officially opened. He later faulted the then Soviet Communist Party chief, Mikhail Gorbachev, for failing to intervene militarily when the wall crumbled, or when protesters stormed the Stasi headquarters across the street from his office to halt the incineration of incriminating files by East Germany’s adjunct of the KGB. He watched Moscow’s 20 top divisions, which encircled Berlin for half a century after the glorious Soviet victory over Hitler in 1945, retreat ingloriously a thousand miles to the east.

Putin further witnessed the swift break­away of Moscow’s external empire, in the stampede of the freed central Europeans, from Estonia to Romania, to join the European Union and Nato, and the 1991 break-up of Moscow’s internal Soviet empire. He called the collapse of the Soviet Union the “greatest geopolitical catastrophe” of the 20th century. And as late as 2008 – 17 years after more than 92 per cent of Ukrainian citizens, including the 21 per cent ethnic Russian minority, had voted for independence – he told President George W Bush, “You have to understand, George, that Ukraine is not even a country.”

***

Most agonising of all, in his first term as Russia’s president in the 21st century, Putin had to listen to American triumphalism about the series of pro-democracy “colour revolutions” in the streets of ex-communist Serbia in 2000, Georgia in 2003 and Ukraine in 2004. For him, as a career secret policeman, these revolutions represented no broad social yearning for “dignity”, as the Polish Solidarity leader Lech Walesa first phrased it. Rather, it was an inexplicable victory by American CIA manipulations – in what was Moscow’s own sphere of influence, by right – over the manipulations of Russia’s FSB, successor to the Soviet KGB.

The uprising that aroused the most angst in the Kremlin was the Orange Revolution on Kyiv’s main square, or maidan, where protesters demanded and won a repeat of the 2004 election after blatant vote-rigging in favour of the then prime minister, Viktor Yanukovych, the pro-Russian heir apparent to the Ukrainian presidency. It was bad enough for Moscow when the west Slavs in Poland and Czechoslovakia instantly ditched their Slavic identity for a European one in the 1990s: Poland uprooted systemic corruption, built robust democratic and judicial institutions, and went from having a poverty rate that matched Ukraine’s to a per capita GDP three times the size of its neighbour’s today. It was devastating when the Little Russians, too, began to do so, rejecting Yanukovych and Russia’s network of control in the rerun of the vote in 2004.

In the event, Putin need not have worried. The Orange Revolution self-destructed in the fratricide between its two top leaders, who forfeited leadership to Yanukovych in the reasonably fair 2010 election.

On the Ukrainian side of the 2014 Euromaidan revolution, four figures stand out. The two chief rivals are the Ukrainian president, Petro Poroshenko (worth $979m, and number six on Novoye Vremya magazine’s 2015 list of the richest Ukrainians), and the then governor of Dnipropet­rovsk in central Ukraine, Ihor Kolomoyskyi (number two on the list, at $1.9bn).

Poroshenko was a second-tier oligarch who had served briefly as foreign minister in the Orange Revolution government and as minister for trade and economic development under Yanukovych in 2012. He helped fund the pro-Europe, anti-corruption protest against Yanukovych’s authoritarian rule from the movement’s spontaneous inception in November 2013, and his TV news outlet Channel 5 gave full coverage to the three-month agora and its estimated one million participants.

After Yanukovych finally sent his special police to suppress the protest by killing dozens of the demonstrators in late February, the Ukrainian president’s own Party of Regions deserted him. He absconded to Russia overnight with an estimated personal fortune of $12bn, amassed in four years in office. Parliament, by a majority that suddenly included the Party of Regions, appointed an interim president and government and set presidential elections for May 2014. The “Chocolate King”, as Poroshenko was nicknamed for his confectionery empire, was duly elected president of the new Ukraine with a 54 per cent majority.

Kolomoyskyi, who also holds Israeli and Cypriot citizenship, was called back to Ukraine from his Swiss residence by the improvised government just as Russia was annexing Crimea. He was appointed governor of his own regional stronghold of Dnipropetrovsk with a mandate to mount a defence against the Russia-stoked secession brewing in neighbouring eastern Ukraine. Kolomoyskyi was famed for his hostile takeovers of rival banks as well as oil, media and other firms. He quickly raised and underwrote several militias among the 40 to 50 volunteer battalions that sprang up to fight against westward spread of the start-up separatist Donetsk (DPR) and Luhansk (LPR) People’s Republics. These battalions were instrumental in holding the line against separatist/Russian forces and giving the Ukrainian state time to rebuild the army that Yanukovych had bled of its budget.

Two oligarchs who did not cast their lot in with post-Euromaidan Ukraine were Rinat Akhmetov (at $4.5bn still the richest Ukrainian, even after losing more than half of his wealth over the past year) and Dmytro Firtash, whose net worth has fallen to $1bn. Both had been leading supporters of Yanukovych and his party, and since his departure they have hedged their bets between Kyiv and Moscow. Their recent losses have resulted partly from a redistribution of their wealth to other oligarchs.

Akhmetov, the son of a coal miner who rose to become the “godfather” of the Donetsk clan – and the owner of Shakhtar Donetsk football club – has his coal and iron base in the war-ravaged Don Basin (Donbas) and relies on Moscow’s goodwill there. Firtash, who under President Yanukovych controlled the lucrative distribution of Russian gas through Ukrainian pipelines to Europe, is also dependent on Russia. In spring 2014, he asked the Russian oligarch Vasily Anisimov to pay a record Austrian bail of €125m ($141m) in cash to get him out of jail. Under the bail terms, Firtash is barred from leaving Austria as he awaits the final legal decision on a US extradition request on charges of international bribery. Yet from Vienna he still wields his political clout, funds several Ukrainian parties across the political spectrum and, it is widely reported, brokered a division of power between Poroshenko and Vitaly Klitschko in the run-up to the May 2014 presidential election, in which Klitschko stood down as a candidate. (The former world heavyweight boxing champion is now mayor of Kyiv.)

***

Putin no doubt saw his annexation of Crimea – and his follow-on campaign to reconquer Catherine the Great’s “Novorossiya”, comprising the eastern 40 per cent of today’s Ukraine – as compensation for the abrupt downfall of his acolyte Yanukovych, and thus the end of Russia’s rightful suzerainty over all of Ukraine. Europeans, Americans and Ukrainians, on the contrary, saw the first formal takeover of a neighbour’s land in Europe since the Second World War as Putin’s return to a 19th-century concept of “might makes right”, as well as a violation of international law and treaties Moscow had signed to respect Ukrainian borders.

The West was cautious in reacting. It baulked at getting sucked into another intervention in a theatre of complicated logistics and little geopolitical interest. It knew as well as Putin did that Moscow enjoys escalation dominance in its home region by virtue of geography, its claim to a vital interest in Ukraine that the West lacks, and the Russian president’s willpower in a world of European peace and US exhaustion. It had no desire to put Putin’s repeated brandishing of his nuclear weapons to the test over a second-order confrontation. The West therefore responded by imposing financial rather than military sanctions, which Putin prematurely scorned as a pinprick.

In addition, Putin misread Ukraine’s military resilience. Easy success in Crimea – and strong domestic approval of his boasts that he was restoring Russia’s greatness in the world – emboldened him to probe further in eastern Ukraine. Ukraine’s ragtag army had put up no resistance in Crimea, for three reasons. First, years of embezzlement of defence budgets had left it with only 6,000 combat-ready soldiers and with two-decade-old weapons. Second, it was subverted by the many Ukrainian officers who were loyal to Moscow rather than Kyiv. Finally, there was Ukrainians’ sheer disbelief – despite Stalin’s mass starvation of Ukrainian peasants in the 1930s – that Russians would actually shoot at their proclaimed younger brothers.

Putin expected an equally cost-free operation in the Donbas. He seemed to believe his own propaganda that disgruntled Russian-speaking citizens of eastern Ukraine were Russians manqués and would rush to rebel against Kyiv, if only the charge were led by a few Russian commandos. Eastern Ukraine was, after all, the part of the country in which identity was most blurred; easterners paid little attention to differences between Ukrainians and Russians in everyday life, and most had cousins in both Russia and western Ukraine. In a way, the region was the ideal test of Putin’s construct of a unifying goal to fill the vacuum left after futurist communist ideology evaporated. The campaign was first presented as Putin’s dream of a Eurasian Union, but that was dropped once it became clear that Ukraine would not be a part of it. Thereafter it was repackaged as gathering in fellow ethnics left outside the “Russian world” by the Soviet collapse, and then as retaking the tsarist Novorossiya.

At first, the Russian-backed secessionists took quick control over roughly two-thirds of the Donetsk and Luhansk oblasts, or provinces. Putin, however, overestimated the warrior zeal of the easterners and the usual gripes of any province about the meagre payouts it gets from central government. In the early days, the local people warmed to the promises of higher pensions made by the separatists. And grandmothers visibly enjoyed acting as civilian shields by surrounding local administration buildings that were occupied by separatists and preventing Ukrainian soldiers from reclaiming the offices. But as the novelty wore off and the hardship of war increased, Moscow and the secessionists it sponsored increasingly had to rely on a motley band of mercenaries and Donbas criminal gangs that did well in firefights only when they were assisted by Russian “volunteers” and armed with the heavy weapons the Russians were shuttling across the border.

In purely military terms, Putin probably could have escalated in the spring of 2014 from the kind of limited, disguised and therefore deniable warfare that the West calls “hybrid”, replacing the hooded “little green men” with regular Russian soldiers in marked uniforms in an all-out invasion of the Novorossiya oblasts. That was certainly the Russian president’s threat in massing 80,000 troops on the northern, eastern and southern borders of Ukraine and exercising them on high alert.

As late as September 2014 Putin boasted to President Poroshenko that if he so desired, “Russian troops could be in Kyiv within two days – and also in Riga, Vilnius, Tallinn, Warsaw, or Bucharest.” But he did not invade when Ukraine’s provisional government was still shaky – and still reeling under the Russian show of force.

Three reasons for Putin’s decision not to order an invasion in spring 2014 might be inferred. The first was a tactical reduction of his bellicosity at a time when the European Union was still debating financial sanctions on Russia for annexing Crimea. The second was the weakness of the novice Ukrainian government, which could foreseeably have collapsed and left Kyiv with a political vacuum the Russians could fill without firing a shot. The third was perhaps a premonition in the Russian army that it was being overstretched and that an occupation of its neighbour, given Ukraine’s strong military tradition, might turn into a quagmire of messy guerrilla warfare.

Putin’s military threats to Ukraine were counterproductive and stoked Ukrainian anger. In May 2014 a Pew survey found that 77 per cent of Ukrainians, including 70 per cent of those living in eastern Ukraine outside the Donbas war zone, thought that their country should remain united instead of breaking up. And in early July, even before the shooting down of the Malaysian Airlines MH17 civilian jet by a Russian-made Buk missile fired from insurgent territory, Pew reported that 60 per cent of Ukrainians had a general negative view of Russia. It was a sharp reversal from 2011, when 84 per cent of Ukrainians had viewed Russia positively.

The Euromaidan spirit drew in ever more Ukrainians who had been politically passive. Volunteers flocked to enlist in the army, in the revived National Guard and in the private militias raised and paid for by Kolomoyskyi and other oligarchs. Civilian volunteers cooked and delivered food to recruits. Techies designed and built their own surveillance drones from scratch to observe border areas that Ukraine no longer controlled.

Ukrainian veterans who had once formed the backbone of the Soviet army’s rough equivalent of Western non-commissioned officers, together with local Afgantsy – veterans of the Soviet army’s doomed expedition in Afghanistan in the 1980s – gave the rookies accelerated basic training. Weapons factories in Ukraine that had once supplied the Soviet army managed to repair 20-year-old tanks and build new ones even as the battles raged. And morale was vastly better on the side of Ukrainian defenders against a threat to their very existence than it was among opportunistic rebel mercenaries and criminal gangs. By mid-August 2014, Ukrainian troops had recaptured most of the rebel territory and reduced the Donetsk and Luhansk People’s Republics to two small pockets.

That was too much for Putin. At the end of August, he signalled his red line in the sand: he would not let his proxies be defeated. He sent elite airborne troops into the Donbas to mount a counteroffensive alongside separatist/Russian ground forces armed with Russian heavy weapons. Within days, they broke the Ukrainian siege and restored the secessionists’ control of about half of the territory that the DPR and LPR had ruled at their height.

President Poroshenko understood the message and immediately proposed a truce, and the German chancellor, Angela Merkel, brokered the Minsk ceasefire of 5 September. The shaky agreement at least reduced the scale of violence for five months, until the separatist/Russian forces made a fresh effort to break through strengthened Ukrainian lines in January and February of 2015 – and failed. A further shaky “Minsk-2” truce followed. But on 1 September 2015 the heavy guns abruptly fell silent and, for the most part, remained silent. For the first time in a year, overjoyed babushkas in the separatist Donbas enclave could walk across the front lines to reach Ukrainian-held towns seven kilometres away and buy salo (pork rind), butter and eggs at far cheaper prices. They returned to tell journalists that their greatest wish was simply for the fighting to stop.

***

At the end of September Putin opened a front in Syria, and reportedly redeployed some special forces from Ukraine to the new battlefield. Ukraine dropped off Russian TV bulletins. The war there had
caused 8,000 deaths and forced 2.4 million people from their homes. It was clear that Putin was belatedly acknowledging that the war also had strategic costs for Russia.

He had first lost all of Ukraine, with the exception of Crimea, to the Euromaidan that he despised. He had failed to salvage Novorossiya for Russia. He had failed, too, to maintain the shelled and charred Donbas region in any form he wanted to annex or subsidise – and keeping it as a zone of frozen conflict for future mischief-making wasn’t much of a consolation prize. He had provoked the West into resuscitating Nato and imposing sanctions that damaged the Russian economy. He had alarmed Belarus, Kazakhstan and Turkmenistan into distancing themselves somewhat from Moscow.

Moreover, the Russian war in Ukraine raised the spectre of the failed Soviet invasion of Afghanistan that killed 15,000 Soviet soldiers in the 1980s and gave birth to the Russian Committee of Soldiers’ Mothers, which tries to ferret out facts about their dead sons. Last May, after many inquiries by the committee about Russian casualties in Ukraine, the Duma passed legislation banning the spread of information about Russian casualties across the border. In this context, it seemed unlikely that Putin would risk incurring a rise in Russian deaths by resuming heavy fighting in Ukraine.

This appraisal, however, takes the pressure off the Ukrainian oligarchs to grow beyond the robber-baron stage and become patriotic philanthropists. On the present evidence, they no longer sense much urgency with regard to implementing reform legislation, installing the rule of law, building democratic institutions and rooting out kleptocracy as opposed to exploiting it.

Putin has surely lost Ukraine. The Ukrainian oligarchs have not yet surely lost their own country. But how ironic it will be if he manages to melt their urgency into complacency by easing the pressure on Ukraine, thus paving the way for that final loss of the Revolution of Dignity. It would give the last laugh to Georgy Arbatov, the Kremlin’s leading Americanist who prophesied as the Cold War ended: “We are going to do to you the worst thing we possibly could – we are going to take your enemy away.”

Elizabeth Pond is based in Berlin and is the author of several books about Germany, Europe and the Balkans. They include “Beyond the Wall: Germany’s Road to Unification” (Brookings Institution)

This article first appeared in the 05 February 2015 issue of the New Statesman, Putin's war