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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.

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The politics of Nationalisation, the NHS and the General Election of 2015

Filed Under (Narrative of reform, Reform of the NHS, Secretary of State) by Paul on 12-09-2012

Since Monday’s post appeared a number of people have asked me to clarify what I meant by the Government failing to make critics pay for constructing even the oddest arguments against their reforms.  What am I suggesting? What should Governments, or any other major institution  do when they are involved in an argument with opponents?

It seems to me that a proper argument is a bit like a tennis match. One side of the argument serves and the other side replies. The server returns again and so on until one side plays a better shot. The server then resumes. Sometimes the receiver will win the next serve depending on how quick, or how skilled, they are.

Just as in tennis the server has an advantage. If they are good at serving they will consistently put the receiver on the back foot. Sometimes the server wins point after point because the receiver simply doesn’t have a reply.

In politics after an election the Government always starts the game. And in the summer of 2010 the Government started the argument about NHS reform with their White Paper. It was a powerful serve which received no immediate reply. It was a good first point, but strangely the Government didn’t serve again until December 2010 when it published its Health and Social Care Bill. This was a strange game of political tennis.

As was noticed at the time there were very long gaps between points because the Government did not have a narrative to explain what it was trying to achieve and why it needed to be done. If it had had a narrative, a story for its reforms, then it could have served up a new and important argument about its reforms 3 or 4 times a week. Each would have provided a clear example of what was wrong with the NHS and how their reforms were going to improve things.

Famously this didn’t happen. And through the winter of 2010/11 a large number of different organisations started to serve (arguments) against the Government. For several months there was a different argument against the reforms being made by one organisation or another nearly every day. Virtually none of these arguments were returned by the Government. This meant that if you wanted to win a point against the Government about NHS reform you didn’t really have to serve very well because no one was going to return.

What might it have looked like had they replied? The reply to an argument, like a good tennis shot, must take the sting out of the original argument. But if the return is any good it will also play the shot with their own force, style and power (and yes, the obvious word for the analogy is spin on the ball). So the Government’s return (argument) not only has to take on the original but also needs to put the original server onto the back foot.

This is what I meant by creating a cost to organisations that are criticising the reforms. If they know the Government is going to reply with both force and the development of a new argument they also know that they will get into arguments with the Government that are wider and deeper – and very different.

If, on the other hand, opponents of reform know they will not have to handle the Government’s return then they don’t have to think very much about how the rally is going to be played out. They know there will be no rally because the Government will simply not return the ball.

Let me give a recent example from the last few days which will demonstrate what I mean by this. When you are given a new job in the Cabinet, commentators and members of other political parties spend quite a bit of time finding out everything you have ever said about the area that your new post covers. This is all fair game in politics.

With Jeremy Hunt commentators have uncovered a number of issues – some around homeopathy and one around the fact that he once wrote that the NHS needed to be denationalised.

The Labour Front Bench have jumped on this phrase and are using it to raise questions about the Government’s NHS reforms. They believe that they have found a useful stick with which to beat the new Secretary of State – or to continue with my tennis analogy that they have an Ace they can play again and again because there is no return to such a serve.

How he deals with this will tell us whether the new Secretary of State is any better than his predecessor at the task of argument and communication.

His problem is that nearly everyone, including the Labour Front Bench, just assumes, because of their experience of the last 2 years, that anything they come up with that sounds OK will never get a response.

But let’s look a bit at how that charge of denationalisation might not really be a winning Ace.

The opposition Front Bench think that it’s an ace because there is a strong belief amongst the public that the N in the NHS (National) should be maintained and strengthened. They are correct in this assumption. The N in the NHS matters a lot to the public.

They believe therefore that catching any Conservative politician talking about denationalisation will be a winner because any attempt to return the ball will be seen as being against the N in the NHS and will lose them the argument where it matters -with the public.

So they believe that there is literally no answer to this tactic. So they can go on using it again and again and win point after point.

But the word ‘nationalisation’ is very different from ‘national’. There are not many voters in the country who believe that the word nationalisation sums up how the Government should work with both the economy and major institutions. I am not saying that everyone is in favour of private enterprise, but I am saying that the word ‘nationalisation’ is generally not a good word to describe political actions.

There are of course some people in the Labour Party who are passionately in favour of nationalisation. It was after all the Labour Party in the 1945-1950 Government that nationalised many industries and in the 1980s the Labour Party opposed Margaret Thatcher’s denationalisation of the major utilities including telephones. At the time the Labour Party was convinced that it was right to be in favour of nationalisation, but most electors did not.

Most of the public do not have good experiences of how nationalised industries treated them and for the last 30 years arguing for renationalisation has not been a vote winner.

There are some in the Labour Party who lament this and believe that the party should return to a policy of nationalisation as a major plank of their economic policy.

I suspect that if that section of the Labour Party were to win the argument and the party was to go into the next General Election with a policy of renationalisation of major industries, the current Government would be very happy indeed. They would believe it would guarantee them the next election, and a further five years in power.

Whilst the leadership of the Labour Party are quite rightly looking for a range of new economic policies to put before the electorate on 2015, the phrase nationalisation does not represent something new.  It represents something very old indeed. It would be difficult for the Labour Party to say that a policy of nationalisation would in any way be a new policy.

So whilst the Labour Front Bench feels that the word nationalisation is not an easy one for the Government in terms of NHS reform, the phrase is not necessarily an easy one for them either.

To return to my tennis match. We will find out whether Jeremy Hunt has the capacity to make an argument by how he deals or does not deal with the Labour Front Bench charges on denationalisation.

If he is to continue his predecessor’s incapacity to argue then we will see no reply. He may try to ignore it and serve in another way.

But if he can argue well he will develop an answer to NHS denationalisation that will deliver a return that raises the spectre of a Labour Front Bench return to a policy of nationalisation of the economy.

If he were to return the ball this way it could cause some problems for any follow up Labour argument to this charge because some Labour MPs will agree with the charge that they should nationalise the economy, and some won’t.

This is an example of what I meant by the making of an argument having a cost. If you make an argument against a good opponent it might come back at you in a way that betrays a weakness in your own game.

This argument will therefore have not only taken the sting out of the original Front Bench Opposition’s  serve but will have used the very power of that original serve to have returned the ball to a weak spot on the server’s backhand.

Let’s see if the new Secretary of State is up to this style and speed of play.

Comments:

3 Responses to “The politics of Nationalisation, the NHS and the General Election of 2015”


  1. What is often forgotten in the debate is that a large part of the NHS has always remained in the private sector, namely primary care. GPs, dentists, opticians and pharmacists were not nationalised, unlike hospitals which were. Dentists, opticians and pharmacists obtain a sizeable proportion of their earnings from non-NHS sources.
    What is nationalised is the commissioning of primary care and the financing of NHS services, although patients charges mean that there is a significant patient contribution.
    Why do ministers, shadow ministers and commentators like yourself always ignore primary care?


  2. Almost any sort of response would be better than the attitude that “We, the Conservatives, know what is best for us, you didn’t give us an electoral mandate, but we don’t need to pay any attention to that – or to our pre-election manifesto – and we just can’t be bothered to waste time explaining anything at all to either the electorate or any of the stakeholders involved or affected.
    Especially professional bodies or NHS organisations – or anyone else who know what they are talking about!
    How dare anyone question us!”

    This is the impression I have received from the Conservatives – and indeed the Coalition: and no-one voted for the “Coalition Agreement” either and probably wouldn’t have done had they had the opportunity.

    Jeremy Hunt is going to have his job cut out to explain to anyone not only why his predessor felt no need to communicate properly, but also *why* this extremely expensive, risky and disruptive top-down restructuring of the NHS was necessary (especially in the current financial climate) in the first place, and why, if it was necessary, it has been bungled to the extent that the vital infrastructure such as support and management of GP computer systems – and the funding for it – has not been make clear even now – only 6 months before the “reforms” come into full operation in 6 months time!

    Michael, the DH and politicians – under all governments – have shown total ignorance of either the existence or the business of General Practice – except when looking for someone to blame.
    Isn’t this the real reason for the Act?
    Loudly proclaim that GPs are in control – then arrange the CCGs so that GPs are in a minority, and the NHS CBA to have even greater powers than were held centrally previously – and letting NHS CBA re-write the rules on an almost daily basis (which makes planning almost impossible), on CCG funding which is somewhat less than a third of the funding for PCTs?


  3. Paul,

    What you haven’t considered in your tennis analogy is that perhaps the government isn’t interested in having a tennis match. It’s not actually interested in what professionals within the health service think needs to be done to make it work. We can hit ace after ace, but at the end of the day noone’s hitting back because the government does not consider the health professions’ opinions to be of importance. That is the cold truth of the matter. Many people far more able than I have gone through the reforms with a fine tooth comb and put forward alternatives and the government did not change a jot of what was proposed. They really don’t care what we think. That’s it.

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