Jeremy Hunt speaks at the Conservative conference in Manchester last month. Photograph: Getty Images.
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Hunt wants to do for the NHS what Gove did to schools. How should Labour respond?

In a closely fought battle, when hospital wards face closure in marginal seats, there will be irresistible temptation for Labour to make promises that can’t be kept.

There is one simple Labour answer to the question of what is wrong with the NHS: nothing, apart from its misfortune in having fallen into Tory hands. Most opposition MPs know that is less than the whole truth but there are clear incentives not to complicate the picture.

The British public reveres the idea of the NHS even when it is disappointed by the reality. Voters also trust Labour much more than the Tories to share that reverence. The collective national memory is hazy on detail but the foundation of a free health service under a Labour government, its deterioration under Margaret Thatcher and rehabilitation under Tony Blair are folkloric.

That is why David Cameron made vows of love for the NHS the centrepiece of his campaign to “modernise” his party and why he must rue his televised pledges not to subject it to “pointless top-down reorganisations.” Labour would happily broadcast those clips on a loop as evidence that the Prime Minister’s pledges are bunk.

The Tory defence is that a budget crisis made drastic reform unavoidable. Change hurts, but the status quo was unsustainable. In other words, true belief in the NHS means willingness to confront long-term challenges. What Labour depicts as duplicitous vandalism, the Conservatives call visionary courage. (Besides, add ministers, the health budget has been ring-fenced to shield it from the ravages of austerity.)

Those arguments, while comforting to Tory ideologues, dissolve on contact with political reality. Cameron is on film saying one thing before doing the opposite. The moment when Prime Minister threw his weight behind a vast and, for most people, incomprehensible reconfiguration of health services, he evacuated his entire stock of trust as a guardian of the NHS. As headlines about staff shortages and waiting times in accident and emergency wards start colonising the front pages, Cameron will struggle to disentangle the mess he says he inherited from the last government from the one he patently made for himself.

Downing Street is braced for a difficult winter. The cold season always produces a spike in demand for the health service and it is already struggling to cope. Meanwhile, Cameron gets conflicting advice about how to respond. Earlier in the year he appeared to share the view of Tory grandees, including veteran health ministers, who counselled that Labour cannot be beaten on the NHS and that a Conservative’s best bet is always to aim for de-politicisation. According to this view, the Prime Minister should treat a winter crisis as a force of nature, appealing to the country’s stoicism and praising the fortitude of hospital workers, as he might do in the event of an earthquake. Labour’s constant partisan attacks might then be made to look tribal and opportunist. Andy Burnham, shadow health secretary, already risks coming across as the NHS doom-monger-in-chief.

The more aggressive approach, preferred by Lynton Crosby, Cameron’s campaign chief, and adopted by the Prime Minister over the summer, is to target Labour’s record. The Tories feel they have won an argument about reckless spending by the last government and want to deploy some of that political capital to insulate themselves from blame for health service misery. The charge is that problems were ignored when the money was flowing and that Burnham, as Labour’s last health secretary, is therefore disqualified from the debate about what to do now that the money has run out.

Jeremy Hunt, the current Health Secretary, has a third way. He aims to position himself as the champion of patients against an unresponsive health bureaucracy. He takes as his model Michael Gove’s approach to local authority schools, casting himself as the raiser of standards and the scourge of complacency in a system that embraces mediocrity and is fixated on only ever doing things the way they have always been done. “Jeremy is always going on about what Michael is doing at Education,” says a senior Department of Health insider. That is the impulse behind calls for more Ofsted-style regulation of hospitals and for GPs to offer more appointments outside normal office hours. Hunt would like to present the problems in the NHS as justification for reform. Labour responds that he is cynically dumping responsibility for the fiasco onto beleaguered doctors and nurses.

The Health Secretary’s strategy cannot repair the damage done by Cameron’s broken promises, although he has found the line the Tories probably ought to have taken in the first place. It is fair to point out that the health service is unprepared to deal with an ageing population whose clinical needs are getting more expensive and whose expectations of care and convenience are conditioned by the service culture of a 21st Century consumer-oriented market economy. Today’s patients are less patient than their forebears. Nor is it controversial to say the NHS budget will struggle to cope with those demands, regardless of who is in power.

Burnham has recognised that conundrum. His answer is an ambitious integration of health, social care and mental health services. In theory, this “whole-person care” mission saves money by deploying resources more wisely, intervening early to prevent solvable problems becoming chronic. It is a sensible long-term agenda but tricky for Labour to sell since it costs money up-front to implement and looks like another dreaded reorganisation.

The easy option would be to bury reform in the manifesto and campaign as if the glory days can be restored simply by freeing the health service from Cameron’s clutches. Labour front benchers insist the message will be more realistic and more nuanced than that. “We are not going to do a rehash of ‘they’ll cut the NHS, we’ll save it,’” one shadow cabinet minister tells me.

That is easy to say now. In a closely fought battle, when hospital wards face closure in marginal seats, there will be irresistible temptation to make promises that can’t be kept. There is an old pattern, followed at various times by all parties, of campaigning as if the NHS can be left alone, realising in office that it must change and then having to confront the anger of voters who feel duped. The Tories have committed that blunder on a colossal scale. The opposition’s advantage is clear. Less obvious is how Labour exploits the situation without making the same mistake.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

This article first appeared in the 13 November 2013 issue of the New Statesman, The New Exodus

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Inside Big Ben: why the world’s most famous clock will soon lose its bong

Every now and then, even the most famous of clocks need a bit of care.

London is soon going to lose one of its most familiar sounds when the world-famous Big Ben falls silent for repairs. The “bonging” chimes that have marked the passing of time for Londoners since 1859 will fall silent for months beginning in 2017 as part of a three-year £29m conservation project.

Of course, “Big Ben” is the nickname of the Great Bell and the bell itself is not in bad shape – even though it does have a huge crack in it.

The bell weighs nearly 14 tonnes and it cracked in 1859 when it was first bonged with a hammer that was way too heavy.

The crack was never repaired. Instead the bell was rotated one eighth of a turn and a lighter (200kg) hammer was installed. The cracked bell has a characteristic sound which we have all grown to love.

Big Ben strikes. UK Parliament.

Instead, it is the Elizabeth Tower (1859) and the clock mechanism (1854), designed by Denison and Airy, that need attention.

Any building or machine needs regular maintenance – we paint our doors and windows when they need it and we repair or replace our cars quite routinely. It is convenient to choose a day when we’re out of the house to paint the doors, or when we don’t need the car to repair the brakes. But a clock just doesn’t stop – especially not a clock as iconic as the Great Clock at the Palace of Westminster.

Repairs to the tower are long overdue. There is corrosion damage to the cast iron roof and to the belfry structure which keeps the bells in place. There is water damage to the masonry and condensation problems will be addressed, too. There are plumbing and electrical works to be done for a lift to be installed in one of the ventilation shafts, toilet facilities and the fitting of low-energy lighting.

Marvel of engineering

The clock mechanism itself is remarkable. In its 162-year history it has only had one major breakdown. In 1976 the speed regulator for the chimes broke and the mechanism sped up to destruction. The resulting damage took months to repair.

The weights that drive the clock are, like the bells and hammers, unimaginably huge. The “drive train” that keeps the pendulum swinging and that turns the hands is driven by a weight of about 100kg. Two other weights that ring the bells are each over a tonne. If any of these weights falls out of control (as in the 1976 incident), they could do a lot of damage.

The pendulum suspension spring is especially critical because it holds up the huge pendulum bob which weighs 321kg. The swinging pendulum releases the “escapement” every two seconds which then turns the hands on the clock’s four faces. If you look very closely, you will see that the minute hand doesn’t move smoothly but it sits still most of the time, only moving on each tick by 1.5cm.

The pendulum swings back and forth 21,600 times a day. That’s nearly 8m times a year, bending the pendulum spring. Like any metal, it has the potential to suffer from fatigue. The pendulum needs to be lifted out of the clock so that the spring can be closely inspected.

The clock derives its remarkable accuracy in part from the temperature compensation which is built into the construction of the pendulum. This was yet another of John Harrison’s genius ideas (you probably know him from longitude fame). He came up with the solution of using metals of differing temperature expansion coefficient so that the pendulum doesn’t change in length as the temperature changes with the seasons.

In the Westminster clock, the pendulum shaft is made of concentric tubes of steel and zinc. A similar construction is described for the clock in Trinity College Cambridge and near perfect temperature compensation can be achieved. But zinc is a ductile metal and the tube deforms with time under the heavy load of the 321kg pendulum bob. This “creeping” will cause the temperature compensation to jam up and become less effective.

So stopping the clock will also be a good opportunity to dismantle the pendulum completely and to check that the zinc tube is sliding freely. This in itself is a few days' work.

What makes it tick

But the truly clever bit of this clock is the escapement. All clocks have one - it’s what makes the clock tick, quite literally. Denison developed his new gravity escapement especially for the Westminster clock. It decouples the driving force of the falling weight from the periodic force that maintains the motion of the pendulum. To this day, the best tower clocks in England use the gravity escapement leading to remarkable accuracy – better even than that of your quartz crystal wrist watch.

In Denison’s gravity escapement, the “tick” is the impact of the “legs” of the escapement colliding with hardened steel seats. Each collision causes microscopic damage which, accumulated over millions of collisions per year, causes wear and tear affecting the accuracy of the clock. It is impossible to inspect the escapement without stopping the clock. Part of the maintenance proposed during this stoppage is a thorough overhaul of the escapement and the other workings of the clock.

The Westminster clock is a remarkable icon for London and for England. For more than 150 years it has reminded us of each hour, tirelessly. That’s what I love about clocks – they seem to carry on without a fuss. But every now and then even the most famous of clocks need a bit of care. After this period of pampering, “Big Ben” ought to be set for another 100 or so years of trouble-free running.

The Conversation

Hugh Hunt is a Reader in Engineering Dynamics and Vibration at the University of Cambridge.

This article was originally published on The Conversation. Read the original article.