20 OCTOBER 2001, Page 11

Sometimes it takes a foreign war to solve a domestic crisis like the NHS


People of my father's generation tell me that after the second world war the world looked different for more than the obvious reason. Abroad, of course, a great conflict had been settled by force of arms. But at home the process of war had changed the way people thought and felt, not just about international politics, but about each other, about citizenship, public service and social justice. Historians say this helps explain what might otherwise appear as perverse: the defeat of Churchill's party at the 1945 general election.

There are some obvious reasons. A prolonged national emergency in which patriots stood shoulder to shoulder would have had a degrading effect on the class system; war had forced Britain to pilot a sort of emergency socialism; the free market had become a dangerous luxury, and profit unfashionable: and war had raised returning soldiers' expectations of the rewards of peace. We can easily see how such changes in human outlook would have influenced the political climate.

But I wonder whether there is, too, a subtler way in which the diversion of a nation's attention to a gripping but temporary crisis of a theatrical kind can alter the mood afterwards. A huge distraction outdoors can help us, when we return to the hearth, to get domestic things into perspective.

When we have become overwrought we are well advised to sleep on it, or take a holiday. Better even than rest or recreation is to throw ourselves wholeheartedly into another and unrelated task for a while — mow the lawn, clean the car, bomb the hell out of a small, defenceless country — then return to the original problem. When we do, we often find the difficulty less daunting and the answers clearer.

This. I think, is not only because a second look suggests new options; often we were aware of the options from the start. What afflicts — and what taking a break cures — is having got our teeth so locked into one argument that we cannot draw back and balance it against others. Positions become entrenched; people and parties get stuck; rigid positions are taken up; promises and ultimatums are given; pride and anxiety tangle into impasse. A very loud bang somewhere over the horizon can be just what we need to shake us out of it.

Beneath the fog of this unwise but horribly diverting 'war' on 'terror' I sense a quiet shift taking place at home. Our rigid 20th-century mental model of the way a national health service should be constructed is gently loosening. We can now imagine its coming apart.

And no, have no fear that I am about to launch another pamphlet, fly another kite, commend an exciting new think-tank report. I have no expertise in this subject and no ambition to acquire it. I have little idea what should replace the NHS we've got. Well-documented plans have been falling stillborn from the press for years and there is no shortage of ideas. That is not what I am writing about.

I am writing about the way an idea's time comes. It steals into our heads and homes at night when we are dreaming perhaps of evil, bearded men in caves and tremendous explosions in faraway mountains — and we awake to find the unthinkable suddenly thinkable and the thinkable thought.

And it is all so obvious. Not only is it obvious now, but we struggle to imagine how it was not obvious yesterday. Which of us — even those who do not think of ourselves as right-wing head-bangers — has not read and understood a hundred times the case for re-examining the whole Bevanite ideal of a universal, monolithic, nationalised health service delivering an absolutely standard product. unrationed and free at the point of use? Which of us has not read the case for re-examination sympathetically?

And which of us, having read it sympathetically, has not tossed the pamphlet into the bin?

The reason has not been philosophical, but pragmatic. 'This is not practical politics,' we've said, 'people just won't wear it.' We have repeated the cliché that our NHS has acquired a holy status in British politics, the one thing that even Margaret Thatcher never dared touch and which Tories finger at their peril. For people who want to be re-elected, we told ourselves, desecrating the shrine of the NHS was taboo. 'The NHS is safe in our hands' was what a realis

tic politician needed the voters to believe, and all he needed them to believe.

I have a hunch that that is slipping away.

The other morning (the Tory conference having been curtailed) I listened to Nicky Campbell's phone-in programme on BBC Radio Five. Following lain Duncan Smith's promise at Blackpool to send his scouts across the Channel on a mission to find out why other countries' public services are better than ours, Mr Campbell had assembled the usual handful of think-tank wallahs, commentators and spokesmen to discuss the issue. It was around the health service that much of the argument turned. Many listeners phoned in.

I was amazed at the cairn, undogmatic approach of most who did. They did not talk like Tory activists (or even Tory supporters) or well-heeled people with private health insurance. The theme common to so many of these views was that our NHS is failing, and cannot go on like this. Callers were interested in any proposals for turning things round. More than one complained at how the debate had been hidebound by ideology. Few sounded shocked that old certainties should be disturbed. All at once, the 'vandals' were not the upsetters but the stick-in-the-muds and heads-in-the-sand.

Between this radio discussion now and any such discussion just a little while ago so little had changed, and so much.

I was not a supporter of lain Duncan Smith's bid for the leadership of the Conservative party. At the hustings during his campaign I did not think he explained his ideas for reform of the NHS powerfully, though he explained them often. I did not think his speech at the party conference last week set out the reformist agenda, or anything else, with any kind of brilliance.

But at least he set it out. Now he looks like sticking to it. And when this war proves unaffordable and the smoke from Afghanistan clears and all the troubles it was meant to solve remain unsolved, and we bring our disappointed gaze back to the small country at our feet, we may find that perfectly affordable ideas for a perfectly soluble problem look at last discussable in a grown-up way. Mr Duncan Smith is right about this and brave to run with it. I begin to think it will do him no harm at all.

Matthew Parris is a political columnist of the Times.