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Political straws in the wind and the NHS

Filed Under (Big Society, Coalition Government, Reform of the NHS) by Paul on 12-01-2011

Thinking back to when I was a political special adviser in the Department of Health (2001-2005) there were several times when I and my colleagues was surprised by sudden surges of political interest in NHS stories. Some of that interest seemed to come from the media itself but also, underneath and around that, there were powerful emotions that the public had about the NHS which suddenly seemed to surge forward unexpectedly from outside of the media themselves.

It felt, in Whitehall, very difficult to keep track of why and how these occurred but when they did, they were significant and not at all controllable. You had to ride with them

In the last few days I think there have been three political straws in the wind that have come from outside the health cognoscenti that are reflections of something going on under the radar.

First Nigel Edwards from the NHS Confed was on the today programme on 29 December making the important point that the real issue about changing the NHS concerned the importance of cultural change and not just the technical issues upon which most people were concentrating. Did the people who were being put in charge of the new reforms actively want to carry them out and will the whole system change culturally to allow that to happen?  Really important issues that those of us “in the trade” talk about and spend our working lives trying to develop.

But not big political stuff. So when the presenter concludes by saying that this was “destined to be the biggest story of 2011” you can’t help but think – where did that come from?

Why is it that the leading daily current affairs programme looks at the coming year and sees the politics of the NHS as the biggest story? In January 2011 it’s not politically what the Government and the Opposition are talking about – that is still dominated by the economy in general and public expenditure in particular. But the Today programme looks beyond that and in talking as it does on a regular basis to the wider political class, that class might be saying that the NHS will be a big story in 2011.

Is this true?

Second, post Christmas, some of the traditional Tory papers such as the Express and the Mail have lead over and over on the issue of flu and deaths from flu. At one level this is not surprising since the picture they paint of society for their readers is usually one where the world went to hell in a handcart at some stage just over 50 years ago and there is nothing but high anxiety to be had in our day-to-day existence since then.

So headline after headline screams that people are dying of flu and then following up with the inevitable “who is to blame?”, they question why there is not more vaccine, and why hasn’t the Government done something about it.

(The interesting thing about both these papers is that for 3 days a week they will be castigating the state for getting over involved in the lives of their readers – who apparently just want to get one with their lives and stop being pushed around by the state; and the other three days castigating the state for not getting much more involved to protect their readers from the awful vicissitudes of life. But newspapers do not have to rule the country and consistency in their approach is unnecessary)

Every week when I worked in the DH we would get a weekly update on the number of people diagnosed with flu. You could compare the numbers with last year and the worst year for the decade etc etc. It was always a scary graph because you knew that it could have a very powerful impact on the NHS, but you were following the numbers rather than intervening since the intervention should have been planned much earlier.

Whilst flu and swine flu are important it’s difficult to see why people getting flu in winter is such a big, big story.

But then you remember that the “big” politics of what this Government are trying to do is to say that all sorts of things that we have previously looked to the state to do, should now be done by others. So what the media are doing is not just raising issues about the flu but testing just how capable is the government of saying, “this is really nothing to do with us”. It is the responsibility of patients and their medical professionals and we, the Government, are not involved.

So the media test that. They ‘hold the Government to account’ for issues around flu and what has of course been interesting is that this Government – despite having an overall ideology of “nothing to do with us guv” have responded to the question “What are you doing about the flu?”, by pointing out how they have taken and will take responsibility.

Under pressure they have not been able to hold the political line.

This is really encouraging for the media who will now regularly come up with a topic and say what is the Government doing about it? The Government may want to maintain a laissez-faire stance on this, but on the evidence of this flu story, it will time and again get dragged into describing how it is carrying out a responsibility that it claims it doesn’t have.

The third straw in the wind was in the political pages over the weekend and concerned the Oldham and Saddleworth by election. Nick Clegg has been up there and on two reported occasions has held public meetings. And the issue that dominated both of these meetings was “worries about the NHS”.

There is no big local NHS story. There is no big national NHS story. The NHS is the one thing that has not been cut in the last few months. You might expect that student fees, or cuts in education or the police would dominate the Q and A. But the issue that dominates two Q and As with the Deputy Prime Minister is “worries about the NHS”.

Let’s roll forward to this coming Friday. If the Lib Dems do not win that seat and if the Deputy Prime Minister reflects upon these Q and As he may want to know why the one issue that dominated public concerns was the one part of public expenditure that had not actually been cut.

Why were the Lancashire public worried? And does that have any impact on politics?

I really don’t know why they are worried. But If they are worried because they have a  vague anxiety that the Government are “messing about with the NHS and that makes me anxious”, then as that messing about becomes a bigger and bigger political issue and then a reality on the ground, things could get very explosive.

Next week the Bill is published and after that the direction is set.

But these straws in the wind seem to say that the NHS will be a much bigger and stronger political issue in 2011 than in 2010.


One Response to “Political straws in the wind and the NHS”

  1. Paul – I agree there are growing signs of concern outside the Westminster bubble. The campaigning group 38 degrees have now chosen NHS changes as one of their major themes.

    The scale of the market driven reforms envisaged, not just at the margins a la New Labour, means more people are worrying about what is coming. The reforms have no champions across the NHS workforce, the public was not warmed up during the election, and many people have had negative experiences of the market in public services from rail privatisation, to dentistry and local transport monopolies.

    People are starting to realise how the boundaries of the NHS are being redrawn, patch by patch. How long before IVF is only offered in a minority of communities?

    Yet like tuition fees, a key issues remains: what is the real position of the Lib Dem hierachy (and I do not mean Paul Burstow). Would be interested to read a future column from you on this.

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