During last weekend’s NHS-traumatised Lib Dem conference in Gateshead I thought I heard Baroness Shirley Williams say she would never countenance the health service (we’re talking England here) being treated “like gas, water or electricity”, in other words as a privately run, publicly regulated utility.
It’s easy to mock the Lib Dems, clumsily learning how to wield real political power for the first time in a century. But Williams’s concern has been widely aired during Andrew Lansley’s Health Bill, now staggering towards royal assent. The health secretary too has long since abandoned the easy comparisons he made with such Thatcher-privatised utilities as phones and gas in a keynote speech to the NHS Confederation in 2005.
It’s still worth reading. But Lansley, who rightly criticised the rail regulatory regime in 2005 (it’s since been changed), is still citing flawed Tory bus privatisation in speeches. Because buses competed primarily on price they drove down services in rural areas (it worked OK in cities, he argues), making it important that the new NHS won’t compete on price (he insists this is the case), but on quality.
Like you probably, I’m sceptical about this and much else, including assurances that EU competition law won’t move in on UK healthcare. But I’m also sceptical about adamant claims made by bill-bashing partisans in Gateshead and elsewhere. In a series of votes St Shirley’s assurances were rejected by activists and Nick Clegg, virtually disowning the bill, was made to look churlish and weak. It amounted to an invitation to Lib Dem MPs and peers to split on 17th century lines: Clegg’s court party vs rebel country party.
The deputy prime minister’s popularity has slumped and he is braced for another hammering in the 3 May local elections. Labour is up in the polls and guess who tops the shadow cabinet pops? Why, nimble Andy Burnham, who seems to be getting the credit for John Healey’s freedom of information campaign to get those risk registers published (will ministers hang tough against the latest court ruling?) and his own shamelessly populist “save our NHS” campaign.
No wonder Williams was especially cross with Handy Andy in Gateshead, although her attack on the Guardian’s Polly Toynbee’s inaccurate and “tribal” coverage rebounded: Toynbee fired a detailed salvo back. On Tuesday’s Radio 4 Today show up popped cheerful Clare Gerada, president of the Royal College of GPs, to stir the pot, inviting ministers to drop the bill and negotiate to restore NHS stability.
“Let’s ditch the ideology, let’s look at the evidence,” Gerada explained, complacently adding that the NHS is outperforming most healthcare systems, giving fantastic value for money and “improving at the fastest rate we have ever seen”. Such talk shows that ideology and political innocence is not confined to politicians: we may all love and admire the NHS but its specific performance can still be woeful, as HSJ routinely reports.
Yet on Radio 4 last week Gerada attacked the “increased fragmentation, increased costs and less collaboration” implicit in Mr Lansley’s bill. We must not let it suffer the fate of privatised railways, she said. Steady on again, Clare. We know the train operators are annoying, that the purchaser/provider split between trains and track has a downside and that it costs more in subsidy.
But does anyone, including you, really think that our train services are worse today than under dear old British Rail? Not the record one billion-plus users; they just want better services and lower fares via the increased efficiency, which the McNulty review identified. The issue for the NHS is how, and it won’t go away - for Burnham, Gerada or St Shirley.