Show Hide image

Forget Lansley – Cameron is the one to blame for the NHS fiasco, says Mehdi Hasan

The row over NHS reform is an example of not just political misjudgement on Cameron’s part but dishonesty.

Andrew Lansley, the Health Secretary, is having a miserable time. Vandals have painted "Hands off our NHS, Tory scum" on the wall of his constituency office in south Cambridgeshire. A rap video on YouTube - in which Lansley is denounced as a "grey-haired, manky codger" and called a "tosser" by members of the public - has gone viral, with hundreds of thousands of hits.

Humiliated, Lansley has had to appear in the Commons to announce a "pause" to his NHS reforms and a period of listening. Consider the formidable army of critics arrayed against the Health Secretary and his Health and Social Care Bill: the British Medical Association, the British Medical Journal, the Royal College of GPs, the King's Fund, the NHS Confederation, the health select committee, the Nuffield Trust, the Social Market Foundation, Unison, Policy Exchange, the Lib Dem grass roots, David Owen and Norman Tebbit. It is difficult to dismiss them all as "vested interests".

As Lansley is mocked and ridiculed, David Cameron floats above the fray, intervening from on high to "rein in" his "dogmatic" Health Secretary, who makes an easy fall guy. Rumours abound that he is for the chop, come the first reshuffle after May's local elections. "It's so unfair," says a cabinet colleague. "Andrew is one of the nicest men in politics." In politics, however, niceness is irrelevant. (And Lansley is not as nice as he seems: he once boasted that the Tories campaigned on immigration because it "played particularly well in the tabloids and has more potential to hurt [Labour]".)

Where the buck stops

There are two main issues at stake in the question of NHS reform - the Prime Minister's judgement and his honesty. At his first conference as Tory leader in 2006, Cameron declaimed that his political priority could be defined in three letters: NHS. Cameron, whose late son, Ivan, had been treated in NHS hospitals, went out of his way in opposition to neutralise one of the party's Achilles heels.

In government, he gave his full support to the Health Secretary from the moment the controversial reforms to the NHS - involving the abolition of primary care trusts, the transfer of budgets and commissioning powers to GPs and a much bigger role for the private sector and competition law - were unveiled, nine months ago. He cannot now evade responsibility. On 23 March, Cameron defended the Health and Social Care Bill in the Commons: "The point of reforming the NHS is to safeguard it for the future." In a speech on 17 January, he denounced the "status quo" in the NHS, declaring: "We can't afford not to modernise."

The recent NHS debacle is a symptom of a wider malaise: the Cameron-led government's preference for pace and haste over debate and deliberation. Cabinet ministers - including the Prime Minister - have told friendly journalists that they have read and imbibed the lesson
of Tony Blair's memoir, A Journey. It is, in the words of the Education Secretary, Michael Gove: "Don't hang around."

As naive and inexperienced cabinet ministers rush off in different directions to embark on "radical", "bold" and "controversial" reforms to health, education, welfare and local government, the Prime Minister is often nowhere to be seen. Tory commentators, such as ConservativeHome's Tim Montgomerie, have noted Cameron's lack of attention to detail. Gordon Brown may have been a workaholic and control freak but a disengaged and distracted approach is not the solution, either.

Some have remarked that the Prime Minister sees himself as chairman rather than chief executive of UK plc. So who is the chief executive? There have long been grumblings from Tory backbenchers that the Prime Minister is in need of a "Leo McGarry figure" - a pointed reference to the fictional chief of staff in the US television drama The West Wing - someone who bangs heads together on behalf of his boss, the president, and looks out for trouble.

Given its complex and contentious nature, the 299-clause Health and Social Care Bill was an accident waiting to happen. Late last year, the Prime Minister despatched his Cabinet Office minister Oliver Letwin to review the reforms. A hands-on, rather than hands-off, leader would have immersed himself in the arguments - and much earlier, too.

Instead, on 16 March, at PMQs, Cameron was left floundering as Ed Miliband held a copy of the bill aloft and quoted various clauses at him. "Why does the Prime Minister not answer the question?" asked the Labour leader. "Does he even know whether the health service will now be subject to EU competition law?"

Broken promises

The row over NHS reform is an example of not just political misjudgement on Cameron's part but dishonesty, too. First, Cameron, as leader of the opposition, promised that there would be "no more pointless reorganisations" of the health service and the coalition agreement pledged to "stop the top-down reorganisations of the NHS". How does the Prime Minister square this pledge with his bill, described by Chris Ham, chief executive of the King's Fund think tank, as "the biggest organisational upheaval in the health service, probably, since its inception"?

Second, Cameron promised to "ring-fence" the NHS budget and increase spending on health care in real terms over the lifetime of this parliament. But the King's Fund's chief health economist, John Appleby, says that, given the recent revision to inflation figures by the Office for Budget Responsibility: "It looks like, for the moment, at least, the pledge won't be met." Appleby calculates that the real cut in spending on the NHS will amount to £900m by 2015.

Third, Cameron promised to promote the NHS as a comprehensive and national service and protect it from privatisation. But his proposals will transform the NHS into a fund that purchases services from a range of providers - from not-for-profit "social enterprises" and foundation trusts to for-profit private companies. Writing in the British Medical Journal, the academics Allyson Pollock and David Price conclude: "The bill, as drafted, amounts to the abolition of the English NHS as a universal, comprehensive, publicly accountable, tax-funded service, free at the point of delivery."
On the health service, as in the case of spending cuts, benefit changes and "free" schools, Cameron the "compassionate Conservative" is going far beyond the reforms of Margaret That­cher. Say whatever you like about the Iron Lady, but the NHS was safe in her hands.

Mehdi Hasan is a contributing writer for the New Statesman and the co-author of Ed: The Milibands and the Making of a Labour Leader. He was the New Statesman's senior editor (politics) from 2009-12.

This article first appeared in the 11 April 2011 issue of the New Statesman, Jemima Khan guest edit

David Young
Show Hide image

The Tories are the zombie party: with an ageing, falling membership, still they stagger on to victory

One Labour MP in Brighton spotted a baby in a red Babygro and said to me: “There’s our next [Labour] prime minister.”

All football clubs have “ultras” – and, increasingly, political parties do, too: although, in the case of political parties, their loudest and angriest supporters are mostly found on the internet. The SNP got there first: in the early days of email, journalists at the Scotsman used to receive bilious missives complaining about its coverage – or, on occasion, lack of coverage – of what the Scottish National Party was up to. The rest soon followed, with Ukip, the Labour Party and even the crushed Liberal Democrats now boasting a furious electronic horde.

The exception is the Conservative Party. Britain’s table-topping team might have its first majority in 18 years and is widely expected in Westminster to remain in power for another decade. But it doesn’t have any fans. The party’s conference in Manchester, like Labour’s in Brighton, will be full to bursting. But where the Labour shindig is chock-full of members, trade unionists and hangers-on from the charitable sector, the Conservative gathering is a more corporate affair: at the fringes I attended last year, lobbyists outnumbered members by four to one. At one, the journalist Peter Oborne demanded to know how many people in the room were party members. It was standing room only – but just four people put their hands up.

During Grant Shapps’s stint at Conservative headquarters, serious attempts were made to revive membership. Shapps, a figure who is underrated because of his online blunders, and his co-chair Andrew Feldman were able to reverse some of the decline, but they were running just to stand still. Some of the biggest increases in membership came in urban centres where the Tories are not in contention to win a seat.

All this made the 2015 election win the triumph of a husk. A party with a membership in long-term and perhaps irreversible decline, which in many seats had no activists at all, delivered crushing defeats to its opponents across England and Wales.

Like José Mourinho’s sides, which, he once boasted, won “without the ball”, the Conservatives won without members. In Cumbria the party had no ground campaign and two paper candidates. But letters written by the Defence Secretary, Michael Fallon, were posted to every household where someone was employed making Trident submarines, warning that their jobs would be under threat under a Labour government. This helped the Tories come close to taking out both Labour MPs, John Woodcock in Barrow and Furness and Jamie Reed in Copeland. It was no small feat: Labour has held Barrow since 1992 and has won Copeland at every election it has fought.

The Tories have become the zombies of British politics: still moving though dead from the neck down. And not only moving, but thriving. One Labour MP in Brighton spotted a baby in a red Babygro and said to me: “There’s our next [Labour] prime minister.” His Conservative counterparts also believe that their rivals are out of power for at least a decade.

Yet there are more threats to the zombie Tories than commonly believed. The European referendum will cause endless trouble for their whips over the coming years. And for all there’s a spring in the Conservative step at the moment, the party has a majority of only 12 in the Commons. Parliamentary defeats could easily become commonplace. But now that Labour has elected Jeremy Corbyn – either a more consensual or a more chaotic leader than his predecessors, depending on your perspective – division within parties will become a feature, rather than a quirk, at Westminster. There will be “splits” aplenty on both sides of the House.

The bigger threat to Tory hegemony is the spending cuts to come, and the still vulnerable state of the British economy. In the last parliament, George Osborne’s cuts fell predominantly on the poorest and those working in the public sector. They were accompanied by an extravagant outlay to affluent retirees. As my colleague Helen Lewis wrote last week, over the next five years, cuts will fall on the sharp-elbowed middle classes, not just the vulnerable. Reductions in tax credits, so popular among voters in the abstract, may prove just as toxic as the poll tax and the abolition of the 10p bottom income-tax rate – both of which were popular until they were actually implemented.

Added to that, the British economy has what the economist Stephen King calls “the Titanic problem”: a surplus of icebergs, a deficit of lifeboats. Many of the levers used by Gordon Brown and Mervyn King in the last recession are not available to David Cameron and the chief of the Bank of England, Mark Carney: debt-funded fiscal stimulus is off the table because the public finances are already in the red. Interest rates are already at rock bottom.

Yet against that grim backdrop, the Conservatives retain the two trump cards that allowed them to win in May: questions about Labour’s economic competence, and the personal allure of David Cameron. The public is still convinced that the cuts are the result of “the mess” left by Labour, however unfair that charge may be. If a second crisis strikes, it could still be the Tories who feel the benefit, if they can convince voters that the poor state of the finances is still the result of New Labour excess rather than Cameroon failure.

As for Cameron, in 2015 it was his lead over Ed Miliband as Britons’ preferred prime minister that helped the Conservatives over the line. This time, it is his withdrawal from politics which could hand the Tories a victory even if the economy tanks or cuts become widely unpopular. He could absorb the hatred for the failures and the U-turns, and then hand over to a fresher face. Nicky Morgan or a Sajid Javid, say, could yet repeat John Major’s trick in 1992, breathing life into a seemingly doomed Conservative project. For Labour, the Tory zombie remains frustratingly lively. 

Stephen Bush is editor of the Staggers, the New Statesman’s political blog.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide