Cowper’s Cut: Health policy and politics – caffeinated or decaffeinated?

I’ve written about the importance of meaning in this column previously. I’m back to the subject today, on the specific area of policy and politics.

This is a strange time to be writing about the politics and management of the NHS. This little and large world has almost always been interesting over the two decades I’ve been doing my best to analyse it, but just now it’s downright strange.

There is the extraordinary experience of watching the bonfire of the sanities that is Brexit consume all the oxygen in the room. Brexit has divided the nation, and exacerbated the internal (un)civil wars in both main Westminster political parties.

Despite the obvious fact there are better ways to do this intrinsically difficult thing (which was sold to the ill informed as being easy), there is simply no good Brexit deal in prospect, as Andrew Rawnsley’s magisterial Observer column yesterday rightly concludes: 

“There has never been a deal available that would allow the United Kingdom to continue to enjoy all the many benefits of its partnership with the EU, as the Brexiters once promised, from the outside… any deal negotiated by any prime minister was bound to be suboptimal, because there are no terms more favourable to Britain than those that it currently enjoys as a member of the EU… The problem with Brexit is not Theresa May. The problem with Brexit is Brexit.”

Meanwhile, the evidence of criminality around Vote Leave is increasing. The Taxpayers’ Alliance conceded that it smeared a whistleblower.

‘Let’s fund our NHS instead’

HSJ readers know that Brexit matters hugely because it is very likely indeed to hit the economy, and thus public spending. More broadly, they have been at the front line of discovering, via the £350 mn “fund our NHS instead” bus campaign that shameless political lying matters because it works on ill informed voters. (The death of shame in our politicians is another subject for another day.)

The meaning of both parties’ thinking on health policy is almost impossible to discern. It has become much like decaffeinated coffee or tea: one of the main reasons for consuming it has been removed, and you’re left with something insubstantial and pointless.

New taxes?

It’s interesting to see Matt Hancock telling the Telegraph that he is attracted to the recommendations of the joint health and HCLG Commons committees’ joint report on funding adult social care, in particular the idea of a hypothecated sounding tax on the over 40s.

Funding social care has been a vote killer at both the 2010 (Labour’s death tax) and 2017 (the “no cap” manifesto meltdown) general elections.

Mr Hancock’s implication to the Telegraph is that only cross party support can get movement in this regard. This idea ignores the fact that within living memory, a Labour government (remember them?) put up taxes in 2002 to fund more spending on the NHS and it was electorally popular with Conservative voters. 

Retoxifying the brand

The Conservatives are so traumatised by the retoxifying effect of the Lansley NHS reforms (that as I wrote in this column more than once, burnt through their hard earned NHS political capital but very largely didn’t happen) that they have become scared of health policy. It is their intellectual Kryptonite.

The consequence of this fear is, as I was the first person to observe in 2015, they simply offshored their health policy responsibility to NHS Commissioning Board boss Simon Stevens. This political reality was admitted by Spectator editor Fraser Nelson in the opening salvo of HSJ editor Alastair McLellan’s new politics interview series The Bedpan three weeks ago.

I couldn’t tell you what Labour’s health policy is in great detail. I know there would be more money, and more attention on the determinants of health, and of course less “privatisation”; but I am not sure that amounts to serious thinking about how to recover national access and waiting standards (or drop them?) and sort out the problems over workforce, access and culture.

So when it comes to health policy, the Conservatives have Simon Stevens, and Labour have, to put it charitably, a lack of strong definition and differentiation. It all sounds and feels a bit decaffeinated to me.

The politics has not been taken out of the NHS and health policy: it has simply been outsourced. This has a lot of meaning. It points towards various things, which I’ll touch on in a following column.