When a new plan or new money is announced for the NHS, Tory governments accompany it with demands that the service cut waste. “The public… want to know that their taxes are spent effectively,” wrote the Chancellor, Philip Hammond, as Simon Stevens, the NHS England chief executive, launched a ten-year plan endorsed by the Prime Minister.
I have some sympathy for Hammond. The NHS’s quaint ways become more evident as my wife and I grow older and seek its services more often. Why do hospitals notify us of appointments through the post rather than by email or text? Why, at one hospital we attend, do we sit initially in a spacious waiting area of cutting-edge technology before being summoned, by digital notice board, to wait in a stuffy, overcrowded room which has apparently been preserved from the 1950s so that consultants can wander in to summon patients in person while carrying fat, dog-eared paper files?
But the biggest waste of resources is caused by failed ministerial reorganisations. The most recent was the Health and Social Care Act 2012, designed by the Tory health minister Andrew Lansley and later described by the King’s Fund, the leading health think tank, as “a costly diversion”. The new NHS plan demands the removal of the “counterproductive” effects of sections that were supposed to foster competition and thus increase “efficiency”.
However efficient the NHS, it will shortly be overwhelmed, according to reports, by obese patients needing hip or knee replacements. The Royal College of Physicians says obesity is not caused by “individual greed” but is a disease that should not attract “stigma”. Matt Hancock, the Health Secretary, replies that “it absolutely is a matter of behaviour”. This is a pointless argument. Obesity is a disease most commonly, though not exclusively, caused by consuming too much of the wrong sort of food and drink, just as lung cancer is a disease most commonly, though not exclusively, caused by inhaling tobacco smoke.
Smoking was cut dramatically through a combination of taxation, outright prohibition and propaganda. Something similar could be done for over-consumption of bad food. No doubt many lovers of Krispy Kreme doughnuts will feel stigmatised, just as smokers did, particularly if, like me, they got through 40 a day. But at least we smokers gave up and lived to tell the tale.
A Far East love affair
The Foreign Secretary, Jeremy Hunt, who says that post-Brexit Britain should learn from Singapore’s “dynamism” and “vitality”, is not the first British politician to look to our former colony for inspiration. The Labour cabinets of the 1960s and 1970s were besotted with Lee Kuan Yew, Singapore’s first prime minister, who stayed in office for 31 years and made his country what it is today. A Cambridge University graduate who canvassed for Labour in the 1950 general election, he was regarded as a model social democrat. Harold Wilson described him as “one of us”, George Brown (Labour’s foreign secretary in the late 1960s) as “the best bloody Englishman east of Suez”.
On Lee’s death in 2015, the former Labour MP Tam Dalyell recalled that “LKY mesmerised senior members of the Labour cabinet” and that no invited speaker – not even Oliver Tambo, the anti-apartheid leader in South Africa – ever transfixed a Labour party conference as Lee did in 1968.
In reality, Lee was never much of a socialist, still less a democrat. He embraced low taxation, rejected state-funded welfare as too expensive and inimical to enterprise, and locked up Marxist opponents. He once admitted that he had more than 100 political detainees “against whom we are unable to prove anything in a court of law”. By then, Margaret Thatcher had taken over as Lee’s cheerleader. She proclaimed in 1985 that she admired him above any other world leader “for the strength of his convictions, the clarity of his views… and for his vision of the way ahead”. Ever since, Singapore has been the right’s favourite country.
One size fits all
I deliberately refrained in the above item from mentioning Singapore’s small population (5.8 million) which, some of Hunt’s critics say, makes it an inappropriate model for the UK (population 66.6 million). The same could be said of the Scandinavian social democracies that we lefties so often praise: Norway, Finland and Denmark all have smaller populations than Singapore while Sweden has only just over four million more. Britain is a country of medium size which often deludes itself that it’s a big country, but strangely seems also to dream of being a plucky minnow.
Before Dominic Cummings became campaign director of Vote Leave – where, according to Benedict Cumberbatch’s portrayal in Channel 4’s Brexit: the Uncivil War, his demonic genius secured victory in 2016 – he worked for Michael Gove at the Department for Education. It was largely thanks to him that most secondary schools were converted into privately run academies (leading to no discernible improvement in pupil performance) and GCSEs made so eye-wateringly difficult that fee-charging schools now opt for easier alternatives.
I once asked to interview Cummings but he replied that “im afraid… my life is boring other than the bits i won’t talk about” (sic: punctuation is for lesser mortals). I continued to follow his blog, which, though he is now 47, reads as though it were written by a 19-year-old student trying to impress his tutors with how widely he has been reading.
After leaving Gove’s office in 2014, he blogged a 136,000-word essay on schools and universities. He advocated “an Odyssean education… to train synthesisers” (his italics) capable of “a cool Thucydidean courage to face reality”. Which sounds exactly what we shall need after Brexit.
This article appears in the 09 Jan 2019 issue of the New Statesman, The Brexit Showdown