Trade deals with Trump could give the NHS a heart attack

In a posh pub the other day a retired surgeon of some distinction suddenly raged against governments which had “politicised the NHS” (he had Tony Blair in mind) and against managers who so often intervene nowadays to stop people like him doing their job, sometimes cancelling operations a dozen at a time.

How he longed for the good old days when doctors and nurses decided these matters!

I periodically encounter outbursts like this whenever I articulate more than a layman’s passing interest in NHS policy and practice.

In my experience, surgeons seem especially sensitive, more artistic than, say, GPs, though I know a good-but-irascible GP who routinely complains that official committees are a waste of time because the politicians never listen.

Like a wise doctor, I let them get it off their chests.

But in old age I also defend the political class, not because it’s doing well at present but because its evasions and inadequacies usually reflect the weaknesses of the wider electorate.

Sorry, but it’s true in health care as much as in Brexit or the wisdom of electing a narcissistic and unstable New York property billionaire of doubtful morals to solve your very real problems in Ohio. So I point out how much money Blair and Brown put into the NHS budget and how well (OK, patchily) the “invest and reform” mantra did for a while. The left will never win in Britain until it comes to terms with Blairism.

‘But I now accept that rising demand and falling real-terms budgets, the yawning structural hole that is near-bankrupt social care, have combined to push the system closer to the brink – in summer as well as this mild winter – than for 20 years’

But you can’t keep confidently running the NHS on a battery which has been slowly draining since the bankers’ bust of 2008. Like my angry surgeon I have been watching BBC2’s fly-on-the-ward Hospital series, based on St Mary’s Paddington, nerve centre of my own (and the BBC’s?) local trust, Imperial.

Everyone is wonderful, even the stoical patients waiting in pain for an ICU bed. But, unsurprisingly, the word I kept underlining was “stress”. It’s like a newspaper office on deadline, not that 24/7 online, cash-poor Fleet St isn’t much more stressed now, too. Stress can be unhealthy.

Since writing my last HSJ column I’ve had two minor outpatient appointments, so has my wife. My sister (66) broke her wrist playing badminton. We all had exemplary treatment on stress-free wards, despite familiar pressures. This column belongs to the Keep Calm Tendency and recoil from hyperbolic Red Cross talk of a “humanitarian crisis” (Syria is one of those).

But I now accept that rising demand and falling real-terms budgets, the yawning structural hole that is near-bankrupt social care, have combined to push the system closer to the brink – in summer as well as this mild winter – than for 20 years.

‘Trump’s attack on Obamacare will increase its popularity while reminding Brits how much worse things might be’

Does busy Theresa May, her style reassuringly stress-lite, still not get this? Does Jeremy Hunt and his staff officers, pouring over flash points on NHS map tables like World War I generals in their chateau behind the lines, get it? The prime minister made an excellent speech on mental health this month but failed to join up the dots that form the bigger picture.  

Her language is far from reassuring. Hunt is too passive; he allowed Phil Hammond (who does understand the care crisis) to duck the challenge in his autumn statement. Jeremy Corbyn? Who?

The void led to the extraordinary spectacle of Simon Stevens, their senior civil servant, publicly contradicting his bosses and (so far) getting away with it. Tenacious Tory health committee chair Sarah Wollaston MP/GP does the same.

It is one thing for consultants or GPs to attack ministers, their working practices and pay (£300,000 a year for some locums!) are easy targets for Daily Mail’s Trump-like rage. But Wollaston has credit in the bank of public opinion. If Stevens even threatened to resign over broken budget promises it would trigger a major crisis.

Trusts are noisily rationing procedures, some GPs innocently ruminate over surgery top-up charges (egged on by newspapers which rarely challenge their readers health-averse habits), columnists dust off a ring-fenced health tax.

Big, loud alarm bells

No chance of that, but No 10 would be wise to use Hammond’s March 22 to pay up gracefully and try to harness it to that long-awaited “adult debate’’ about the NHS we can afford. My perverse hunch is that President Trump may actually be helpful. His Day One attack on Obamacare, a half-baked pledge to replace it with something “cheaper, but better,” will increase its popularity while reminding Brits how much worse things might be.

I haven’t finished yet.

Mrs May has been talking bilateral trade deals with Mr Trump. When the EU (population 500 million) talks TTIP trade with the US (population 320 million) we could be fairly confident that core NHS’s structures would remain protected from predatory US health corporations. When Brexit UK (population 65 million) tries the same with “Only America First” Trump, watch out. As Labour’s John Healey (remember him?) says, “big loud alarm bells”.

Michael White is a former political editor of the Guardian