My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

Read my statement in full »

More on right wing culture and the politics of the NHS

Filed Under (Conservative party, Right wing ideology) by Paul on 24-08-2009

Following on from my last post a number of people have asked me about the relationship between culture and the structure of the politics of the NHS and what might it mean for the politics of the UK over the next few months.

One clear way of understanding culture is that it is the way we do things round here. Since the UK is a diverse society, the way in which we do things round here differs given where ’round here’ is. Scotland does have a different culture from Wales or England and that culture is reflected in its politics. English culture is varied between the north and the south and between rich and poor and is diversified by ethnicity.  Quite often cultures have very little understanding of each other and mainly this doesn’t matter. But when one culture has a lot more power than another then the powerful culture will often blindly impose itself on the other culture and squash it.

Sorry for the lecture but what does all this mean for the NHS?  First something about the politics of the last 12 years. The politics of the last period has secured the principles of the NHS for at least the next two elections. There are a higher proportion of the English people who agree with the principles of the NHS – free at the point of need with equal access for all and paid for out of general taxation- than ever before. However much the majority of people moan about this or that experience of the NHS, their recent experiences have secured the public’s belief in the institution to a greater extent than ever before.

This belief is not simply an idle thought but something that really matters to people. The vast majority of the English public really love the basic principles of the NHS. Ex Sec of State for Health John Reid used the phrase “It was the best gift that the British people had ever given to themselves”.

What David Cameron has come to realise is that if you want to win an election you cannot be seen to be disagreeing with those principles.  If over 80% of the population believe in something then messing with it is electoral suicide. If he wants to win the next election then he has to claim that the Conservatives are the party of the NHS.

With only 15% of the population against the principles of the NHS that’s pretty obvious. However, it’s a bit of a problem if the 15% that are against it are all in your cultural group. It’s also a problem if that small minority of the population all lead the opinion formers of your section of society. So whilst 15% means very little electorally it’s a problem if they are all very powerful people who write the columns in the papers that hold the Conservative party together.

Here is where culture and politics interact very powerfully. The British people have decided for over 60 years now to provide their health service in a different way from how they provide other goods and services. We do not distribute food or housing to the people of the country based upon need – but we do so based upon the ability to pay. Over the last 60 years distributing goods and services based upon people’s ability to pay has become more and more normal and it’s only a very small proportion of the population that would disagree with that.

Except for health services where nearly everyone agrees with that.

So for the vast majority of the public, its opinion and its culture wants to distribute health services in an entirely different way to the way that it wants to distribute nearly all other important goods and services.

If you want to lead the country political leadership has to learn to live with the way in which the public express that difference. However for the opinion formers of the right, who have seen ability to pay as a principle gain more and more weight,  that NHS is an anomaly which at best is a laughable anachronistic puzzle and at worst drives them into a rage. Why should people be so daft as to think that such a relationship could work? From within their culture it cannot and must not work.

For the most part the powerful culture of the right can let this lie. They do not sit around in dinner parties talking about the NHS because if health services come up for themselves and their relatives, they are bought either directly or through insurance.

It may be because I have worked in the NHS, but a lot of my time is spent discussing not the finer points of policy but the experiences both good and bad people have had in the NHS. People talk about their NHS a lot. Their experience helps form their culture.

But if you don’t use it you don’t have those experiences and you don’t have that culture. In that case the NHS only comes up in your life in an ideological way and not in an experienced way. So for most of the right, their experience of the NHS is political and not practical. They just don’t get what everyone else is going on about. Given this distance, they could say “Well given we don’t know much about it, lets not bother”. And for the most part that happens.

But these people- right wing opinion formers- can’t simply let something as big as the NHS go by without trying to form opinion about it as they do everything else. They have to do what they think they do and form opinion. And they do so from a mixture of rage and bewilderment. Whatever this thing – the NHS is – how can people be so stupid as to both believe in it and think it can work?

And here is David Cameron’s problem. He needs to lead a political party which presents itself as the party of the NHS, when a large number of the opinion formers on whom he depends to lead right wing opinion believe that the NHS is at best a basket case and at worse a complete heresy undermining English society.

He will know that most of the people who are in the core of his political formation will have, deep in their culture a belief that the NHS is wrong. His problem is how you keep all of that culture quiet for a year. Especially when that culture is convinced that it runs our world.

Recent events have taken the odd searchlight of US right wing politics to uncover what right opinion formers think. There will be other equally unforeseeable events.  In the next few months almost anything is going to be lifting the corner of the ideological carpet of the right and what will peek out is a diatribe against the principles of the NHS.

On every occasion David Cameron will be left expressing his personal opinion about a belief in the NHS and trying to nail the carpet down over the bizarre and angry opinions about the NHS that are where the right is and has been for 60 years.

David Cameron’s personal belief in the NHS makes my case about culture. I am sure that his personal experience over the life of his son has, over many difficult and ultimately harrowing nights in hospital, left him personally believing that the NHS is a great institution. All of these experiences have created a culture for him.

But many of the others of the right have a culture of rage and bewilderment about the NHS that nothing will stop them expressing.

There is a phrase in the management of change that should be keeping David Cameron awake at night “Culture eats strategy for breakfast” and whilst he may be in charge of a right wing political strategy he cannot be in charge of right wing culture.

Leave a Reply