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Government U-turn on the NHS? Don’t count on it

One of Tony Blair’s greatest regrets was a belief that he’d failed to use his first term in office to aggressively push forward what his key supporters labelled “public sector reform”, but should more accurately be described as “marketisation”. As the twilight of his premiership approached, Blair more than compensated with a near-obsessive drive to introduce markets into Britain’s public services. The unveiling of “Trust schools” in a White Paper just months after the 2005 election was one striking example.

Trust schools were to be independent non-profit making organisations. Private companies would be able to establish them. They were to be taken out of local authority control and would directly employ teachers themselves. Half the governors would be appointed by the Trust, watering down the power of local parents.

Perhaps unsurprisingly from the Party that had established comprehensive education, there was a backlash that wasn’t confined to those the media habitually writes off as the “usual suspects”. Former leader Neil Kinnock, ex-Education Secretary Ruth Kelly, and leading ex-ministers John Denham, Nick Raynsford and Angela Eagle all spoke out against the plans. All in all, up to a hundred Labour MPs joined this apparently gathering rebellion.

In the end Blair offered a number of “concessions”; and leading “rebels” (most of whom had never rebelled in their political lives) helpfully announced that they were now satisfied with the legislation. It wasn’t enough, though, and 69 Labour MPs stuck to their guns. Only with the enthusiastic support of Cameron’s Conservatives was the legislation passed.

But Blair had skillfully deployed a tactic he used again and again. Neither he nor his advisors believed for a second they would pass the legislation in its original form. The trick was simple: propose something radical, knowing it could never pass; announce a number of already prepared concessions, peeling off a useful “moderate” rebel leadership; and still end up implementing a set of transformational policies.

The left at the time warned of the “direction of travel”. They were right: New Labour laid the foundations of many the policies being introduced by the current Government which have already provoked hundreds of thousand of people to take to the streets.

When hearing chatter about Government U-turns over Health Secretary Andrew Lansley’s attempt to dismantle the National Health Service as we know it, it is worth bearing this in mind.

What is being proposed – as the medical journal Lancet  puts it – is the end of the NHS. Although the plans involve abolishing the 151 Private Care Trusts – which is already taking place – and replacing them with around five hundred GP consortia, in practice these will end up being managed by private companies who will be handed the bulk of the NHS’s budget.

This dramatic reconstruction of one of the nation’s key institutions was never put to the electorate. It has been universally opposed by all relevant parties: from trade unions to the British Medical Association. The Government is pushing through this agenda while the NHS faces real term cuts of 4% a year because of growing demand. Given that even Conservative ex-Chancellor Nigel Lawson described the NHS as the “closest thing the English have to a religion,” taken together, this is as provocative as it gets.

No wonder, then, that there has been a growing public backlash – despite continuing public confusion over what the Government’s plans actually mean. There is little doubt that Lansley’s plans played a major role in swelling the number of people who took to the streets on 26th March. In the face of growing pressure, there were reports in the Sunday papers that a panicking Cameron wished to ditch the plans. Yesterday, Andrew Lansley made a humiliating statement to the House that promised further consultation – an almost unprecedented move after a Bill has gone through the Second Reading stage in Parliament.

But don’t buy talk about a U-turn. Like Blair before him, Lansley must have known there was little chance of pushing through such a transformational policy in its entirety. So, he will surely announce “concessions”; he’ll claim that he has compromised, and taken the criticisms onboard, thus defusing opposition. But the danger is he will end up getting most of what he wanted, even if he has to slow the whole process down. The direction of travel is clear: an ever-expanding role of the private sector in an increasingly fragmented National Health Service.

Even if a humiliated Lansley is forced to take a bullet and resign for mishandling this longstanding dream of the Tory Right, this will remain the Government’s agenda.

And if the Party that founded the NHS is going to draw a line under any part of its past, this surely has to be it. As Fraser Nelson has pointed out, it was New Labour – largely under former Health Secretary Alan Milburn – that began driving radical market-based policies into the heart of the NHS. As Nelson puts it: “It may pain Lansley to admit it, but Milburn’s blueprint was more pro-market than anything Margaret Thatcher attempted…” The Tories could have just quietly kept pushing Milburn’s reforms to their logical conclusion, Nelson argues.

Ed Miliband’s leadership must not fall into the trap of merely extracting concessions from Lansley. The entire programme has to be opposed, and that means repudiating New Labour’s policies too. An alternative plan that democratically involves NHS staff, patients and the wider public – but without involving the market principle – should be proposed. When – or if – Miliband enters Number 10, the creeping privatisation of the NHS unleashed by New Labour must finally be sent into reverse.

One Comment

  1. Syzygy says:

    I agree entirely … the so-called ‘U-turns’ are actually ‘swerves’ which will allow the inevitable stealth privatisation to continue unabated.

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