I was on a panel at the RSA Tuesday evening which focused on the future of health policy. Given the line up contained both Polly Toynbee and Andrew Haldenby, I thought the discussion was going to be more adversarial than it turned out to be. Instead, everyone broadly agreed that the NHS needed to reform in order to continue providing the level of service we’ve come to expect. There was disagreement on how to go about that, obviously, but the ability for the government to change things in order to improve was unanimously approved.
The point I made was to wonder where the political capital for any governing party to make the changes necessary was going to come from. Say whatever you like about the Lansley health changes; the attack from Labour that really stuck was “the Tories said they weren’t going to change to NHS – then they did”. In other words, it was the fact that change had occurred at all that struck the public as a negative.
This applies not only to health but to all public services. And it’s an issue for both the Left and the Right. The Tories will be scared to change anything in quite the same way again (which won’t preclude them just cutting things altogether instead, obviously). If you’re left-wing and you’re saying: “Good. I’m glad the Tories won’t change anything ever again”, I will say here that Labour are just as scared from the opposite direction. Their membership pines for things such as renationalisation of the railways; the party won’t promise this due to this exact fear of the public at large disliking large scale change, even reforms that seem broadly popular. What if something goes wrong? Better to stick to what we have and not worry too much. Let the next lot sort it all out.
Thinking this all through, the Left actually has a lot more to fear from this trend. If a government doesn’t feel like it has the political space to make public services adapt to contemporary needs, the likelihood is that more and more will simply be quietly privatised. Even, dare I say it, by a Labour led government. In prep for Tuesday’s event, I re-read David Laws controversial Orange Book chapter. A little bit leapt out at me: David’s assertion that more and more dentists would leave the NHS and go into private practice, thereby making it virtually impossible for the NHS, at some point in the future, to provide dental care. Now, a decade on, we have the chair of the British Dental Association suggesting that the government actively wants dentists to go private in order to save money in other areas for the NHS. This is how privatisation of public services might well happen – not with a bang but with a barely audible whimper.
What’s the solution? Ideally a less grumpy public, one that had renewed faith in politicians to get done what need be done. I’m not going to hold my breath on that one. Apart from that, I can’t see a way out.