POLITICS
The Prime Minister's plan for health: bullying, lying and inoperative statements
BRUCE ANDERSON
Alastair Campbell and Tony Blair need to learn a lesson from this miserable affair. It would be unrealistic to expect them to give up bullying and lying; those are this govern- ment's moral foundations. But in future they must use a bit more finesse. The Win- ston episode bore all the marks of panic.
In the aftermath, the panic continued. By Sunday, Robert Winston was hiding from the press, not wishing to explain whether he had said what he had later denied saying — and who it was that had forced these humili- ations upon him. But if he had watched the David Frost programme, he might have cheered up. As a result of Lord Winston's comments — which No. 10 claimed that he had never made — the PM promised an extra £11 billion a year for the NHS. The Winston text seemed to have become the most expensive interview of all time.
But within hours, a new problem had arisen. Mr Blair had not cleared his pledge with the Chancellor, who was unhappy. So were other spending ministers, who saw their hopes for expanded programmes dis- appearing into an NHS black hole. Some ministers even had the temerity to raise intellectual questions, about the first time that has happened in two-and-a-half years. If the NHS's existing structures are inade- quate, they argued, what is the point of sim- ply throwing more money at the problem? We should think before we spend.
The Treasury encouraged this discord; it always likes to sow dissension among the spending departments. During a mid-Seven- ties spending round when Reg Prentice was Education Secretary and Joel Barnett Chief Secretary, the future Lord Barnett said to the future Lord Prentice: 'Tell you what, Reg; if you back me against all the other buggers — I'll back them against you.' Gor- don Brown is now trying to back all the rest against the Department of Health, with some success. By midweek, Sunday's com- mitment had become a mere aspiration. But though this was a more elegant volte-face than No. 10 had organised for Lord Win- ston, it was equally unconvincing.
Someone must have given Alastair Camp- bell a book on Watergate as a Christmas present. Mr Campbell, halfway through, has come upon press spokesman Ron Ziegler's famous comment that such and such a Nixon statement was now 'inoperative'. What a brilliant wheeze, thought Alastair; how use- ful for Tony. If the poor chap found time to read to the end of the book, he would realise that the Ziegler tactic did not actually work.
But it is not just the low politics which are making the Tories so cheerful. They also think that they are winning the intellectual argument. Suddenly, it seems that almost everyone who has thought about health agrees that the days of monolithic state spending and provision are over. In an age of rapid scientific advance, why should the NHS be exempt from change? Does anyone believe that a system designed over 50 years ago in an aura of postwar austerity could possibly be appropriate in a much more affluent era? We do spend too little on health and it is not enough for Mr Blair to pledge — sorry, Alastair, aspire — to raise UK spending to the EU average in GDP terms. While it is unnecessary to emulate the Americans or the Germans, who spend more than twice as much as we do, we ought to aim to rival the French, who spend 9.6 per cent of GDP as opposed to our 6.8 per cent. But over a quarter of that French expenditure is privately funded, as opposed to just over one seventh in Britain. We can- not have a health service geared up to ensure that every patient can benefit from the best available treatment without a much greater use of insurance-based funding.
On Tuesday, Man Milburn tried to deny that proposition. A few weeks earlier, when he took over the Health portfolio, Mr Mil- burn had sounded effective: not hard, admit- tedly, when you take over from Frank Dob- son. But the intellectual content of Tuesday's speech was worthy of Mr Dobson. Alan Mil- burn may be able to think, but at present he is not allowing himself to do so. That is why he sounds thoughtless, and the Tories cheer- ful. 'This is Labour's ERM,' chuckled one close Hague adviser after Tuesday's debate.
But before reaching such a dramatic con- clusion, there are two caveats: one intellec- tual, the other political. The first is that it is easy to exaggerate the role of health spend- ing in promoting health; the countries which spend significantly more than Britain do not enjoy significantly greater life- expectancy. I suspect that the two greatest medical contributions to good health are a good doctor who combines common sense with diagnostic acuity, and a well-run hospi- tal. I have had a number of friends who have been neglected, in some cases fatally, by apparently well-qualified doctors whose abilities were not equal to their qualifica- tions. One wonders what proportion of medical graduates really can practise medicine at the highest level and how, as a layman, one could tell.
Ill people incubate infections, so hospi- tals have always been dangerous places, and still are. Failures in hospital hygiene cost patients unnecessary suffering and the NHS E1 billion a year. Here again, the key variant is people, and leadership.
A generation ago, hospitals got such leadership via matron: some female battle- ship whose voice sounded like teak mari- nated in gin over several decades, who had a visage and demeanour to match, who could spot a speck of dust or a nurse's crooked cap at 500 yards, and of whom all but the most senior consultants went in ter- ror. Those days are gone with the Ealing comedies, but there ought to be a contem- porary equivalent. Too many hospitals have an ethos of failure, with staff who do not care and no one to inspire them or at least compel them to do their duty. Money alone cannot ensure ethos and leadership.
The second caveat relates to the danger of confusing informed opinion with public opinion. There may be a new consensus among the informed that the NHS needs to be recast, and this will happen over the next decade or so. But we should not underesti- mate Mr Blair's ability to fight the next election on the old lines, claiming that he has spent tens of additional billions on improving the NHS, while the Tories would abolish it. It is not yet clear that this would be an ineffective electoral gambit.
It would require a complete lack of inter- est in intellectual complexity, a contempt for serious debate and a shameless disregard for the truth. So what is new? In No. 10, they are already salivating.
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