What a political week! The NHS may have ended up with a better-than-expected settlement from Alistair Darling’s comprehensive spending review, but voters will not be grateful to ‘Bottler Brown’ and his mates for a while.
Sir Derek Wanless may have urged an even bigger cash allocation, but other experts are sounding sceptical about both this and junior health minister Lord Darzi’s interim report. Meanwhile, the cock-a-hoop Tory front bench even accused Number 10 of faking a cardiac unit opening in Basildon - claiming the real opening had happened three months previously.
We all knew something was in the wind. All that government activity, Mr Brown to Baghdad, the CSR and Lord Darzi’s report allegedly brought forward. On Radio 4’s Today, I heard Lord D call the NHS ‘the envy of the world’. My, he’s learning fast, I thought. And then it was all called off, the right decision for both the government and the country but a climbdown: Gordon blinked first. Close friends of his tell me it had never been his gut instinct to go for an election. But he let his advisers’ speculation get out of hand, as Jim Callaghan did in 1978. Health secretary Alan Johnson, no teenager he, was always for caution.
Be that as it may, the Bottler government has taken a serious hit - accused of being both partisan and indecisive - from which it will take time to recover. David Cameron has gone up a notch in public esteem. He judged the crisis well.
Various theories explain the fatal blow to the election scenario, from Mr Cameron’s virtuoso speech in Blackpool - look, no autocue - to shadow chancellor George Osborne’s attack on inheritance tax, even to ex-health spokesman Dr Liam Fox’s instant salvo against Mr Brown’s Baghdad trip: playing politics with soldiers’ lives, he said.
Mr Cameron’s speech is worth a backward glance. ‘The one thing a lot of families rely on more than anything else, my own included, is the NHS,’ he said. As we have noted here before, this is because of his son, Ivan, five, born with cerebral palsy and epilepsy. Cameron is a child of serious privilege, but a disabled child is a leveller.
His pitch on the NHS, as in other Tory speeches, was that Labour had tried to do right by the service, but failed. ‘If we don’t understand why Labour are failing we won’t succeed. I think it’s because the reform has been top-down.’
By that he meant targets, reorganisations, that big IT system, all contributing to low staff morale. At one level that’s glib: many NHS staff are very happy, others are made miserable by colleagues, patients or the Daily Beast.
But when one reads criticisms of Lord Darzi 24 hours later, you notice themes common to left and right. The Reform think tank accuses Alan Johnson (and Lord Darzi) of presiding over a ‘retreat’ to the central direction and heavy spending of the early Blair years - in contrast to the competitive/incentives approach of the 2004 NHS improvement plan.
Lord Darzi, who is chiefly looking at hygiene and GP access, insists he is consulting like crazy across the country (he spoke to 1,500 staff and 1,000 patients, read 1,400 e-mails!).
But Reform isn’t alone in challenging the proposed Health Innovation Council (Champion of innovation: Lord A Darzi) as a new version of a failed, centralised model. Both Unison and the Commission for Patient and Public Involvement in Health are worried about a closed-door, top-down approach. The King’s Fund warns ministers to ‘resist the temptation to issue central directives’ in favour of ‘practical and effective’ local change. The left-leaning Health Emergency lobby urges them to stop bureaucratic bulldozing ‘in the teeth of staff and public opposition’.
Shadow health secretary Andrew Lansley agrees - and goes further. ‘Ara Darzi is an honest man set among thieves, a talented clinician who is being used by Gordon Brown for political ends,’ he declares. The Lansley Who Never Forgets recalls how then-Sir Ara was used to help Labour win the post-Peter Mandelson 2004 by-election by producing a report that saved Hartlepool’s general hospital. But only for a bit.
In vain does Alan Johnson protest that the Darzi report was published as promised, to the day (he said on 4 July it would take three months). It was caught in the crossfire.