Thanks to a seating planner with a sense of humour I found myself sitting next to Andrew Lansley’s chief of staff at a private dinner this week. If the Tories win, she will be starting this summer sitting at my old desk in Richmond House as a Tory health special adviser.
She seemed perfectly pleasant. It is a shame that her boss’s policy of scrapping targets for the NHS will lead to longer waits for operations, visits to the A&E taking 12 hours or more, and people dying unnecessarily because the NHS couldn’t help them in time. It didn’t seem polite to point out they would have blood on their hands if they implemented their policies for the NHS. It might have spoiled the atmosphere somewhat.
The Tories have cleverly turned ‘targets’ into a dirty word in the public services. With a little unwitting collusion from the public sector unions, the Tories have blamed the ‘target culture’ for every inefficiency and annoyance experienced by the public dealing with the NHS, schools or criminal justice system. ‘Targets’ have joined ‘health & safety’ and ‘political correctness’ in a pantheon of things wrong with the world, if you read the Mail, buy Jeremy Clarkson’s books and vote Conservative. In fact ‘health & safety’ is why little children don’t work in factories anymore, and ‘political correctness’ is why no one tells racist jokes in the office any more (and these are good things, Mr Clarkson).
The way the right wing take something progressive and positive and turn it into something negative and evil-sounding (and vice versa) is well-documented. Frank Luntz, the republican strategist and Fox News commentator has made a living out of it. It was he who got Bush to retune ‘global warming’ to ‘climate change’ and ‘drilling for oil’ into ‘energy exploration.’
His memorandum in 2009 to Republicans opposing Obama’s health reforms sets the standard. He advises use of phrases such as ‘Washington takeover of healthcare,’ and in a single paragraph sets out the right’s argument:
‘As a matter of principle, America should strive to offer the most people the best quality, most timely healthcare in the world. What does that mean? First, Americans should not have to wait weeks for the tests they need or months for treatment. Second, no one should be denied the healthcare they need because of government limits, restrictions, or rationing. Third, no government bureaucrat should interfere in the doctor-patient relationship. And fourth, we have the right to know all the information about our condition and our treatment options. As we prepare for much needed healthcare reform, let’s learn from the mistakes of Canada and Europe and not repeat them.’
It’s cunning stuff. Note the use of ‘rationing,’ ‘bureaucrats’ and ‘the mistakes of Canada and Europe.’ It hits all the right buttons for an American audience, and you can hear it being parroted across the debate on healthcare reform. An analysis of the congressional record shows an increase in Luntz-inspired phraseology (‘Luntz-isms’?) since the memo was issued. ‘Rationing,’ ‘bureaucrats’ and ‘takeover’ all zip up the charts, as Republicans frame the debate with their own language, and the ideas that underpin them. But the real impact was felt on the streets of Massachusetts this week, where voters could be heard echoing these phrases as the justification for voting for Republican centre-fold hunk Scott Brown.
In the UK, the Tories are attempting something similar with the NHS. They claim that establishing an independent board to run the NHS, removing the performance framework with its stretching targets for improvements, and ceding power to their pals in the BMA will somehow be good for us. But it won’t. And you don’t have to take my word for it. A report this week by the Nuffield Trust showed that in England, where Labour’s health reforms have been allowed to work their magic, the NHS works better than in Scotland, Wales and Northern Ireland. The Nuffield report is a vindication of ‘target culture’ because patients in England get faster, better care thanks to the framework of targets, incentives and performance management introduced by Labour in England (and opposed by the Tories and Scottish Nationalists).
All parts of the NHS throughout the UK have had big cash increases. Only England has had a detailed Public Service Agreement (PSA) between the NHS and the Treasury to link improvements to funding. Now, ten years on, England has a better health service: more operations, shorter waiting lists, and less waste.
We need to be more robust in defending our record on health, which is only a little short of a miracle. When was the last time you heard about a winter NHS crisis, or saw TV pictures of people on trolleys in hospital corridors? Under the Tories it was as inevitable as the Queen’s Christmas broadcast. Under Labour it is a fading memory. By eliminating the long waits that the Tories used to ration NHS treatment, Labour has saved countless lives.
But more importantly, we need to press forward with the reform programme: more foundation trusts, more incentives for managers to improve efficiency, more power to patients to demand better treatment, more use of the third sector and private sector to deliver innovative care, and a better system of redress for patients when things go wrong.
Most of all we need to tell people that if Andrew Lansley and his nice adviser get their feet under the desks of the department of health they will remove patients’ rights to see a cancer specialist within two weeks of referral, scrap the waiting times guarantees, and, by lighting a bonfire of NHS targets, return it to the days of long waits and delayed operations. The Tories’ only NHS target is to return it to a two-tier system, with the poorest queuing up for treatment and the affluent going private.