The Bedpan examines the views of influential figures from (usually) outside the health world who nevertheless have interesting views on the challenges facing the NHS. It is named after Nye Bevan’s apocryphal quote.
As David Cameron reminds us on page 227 of his 700-page autobiography, he signalled the arrival of a new “compassionate conservatism” by declaring in 2006 that he could spell out his number one priority in three letters: “N.H.S”.
Strange then that just 20-odd pages of For the Record address healthcare, and that those mostly deal with failure.
Most politicians have a defining experience that colours their approach to wielding power. For the former prime minister, this was clearly the short life of “our darling Ivan”.
In a highly moving and self-aware chapter, he gives an insightful view into caring for a child with a life-limiting illness.
“We learned a lot about navigating the system to try and get the best for your child. When dealing with epileptic seizures in the A&E department, watch out for the four-hour waiting target: there is a danger of an entirely unnecessary hospital admission
“Once your child is in hospital ward, try to order your next batch of drugs hours before you’re due to leave, as they take forever to come.
“When doctors begin their ward rounds, never leave your child’s bedside: it is the only time you have a real chance to find out what on earth is going on.”
Yet Mr Cameron’s commitment to the NHS does not lead him to seek to understand it. This he leaves, by his own admission, to his old friend Andrew Lansley.
He argues that the 2012 NHS reforms were both “logical” and “evolutionary” and places the blame for their failure as much on unfair accusations, the accidents of history and the personalities involved as his own carelessness.
He acknowledges the Conservatives were “still battling against the preconceptions that [we] had sinister motives towards the NHS”, and that accusations of “Tory cuts” and “privatisation by the back door” had a “particular potency”. This was not the intention of the reforms, he says, but “our reputation was set”.
He admits his party was “battling against their own promises”, having declared “we will stop the top-down reorganisation of the NHS”.
This promise was broken, he claims, because his Lib Dem coalition partners demanded the scrapping of primary care trusts (rather than seeing them “wither on the vine” as the Tories had intended). However, he had not kept his word. “When it came to Cameron’s law of broken promises, I didn’t follow my own advice”, he ruefully concludes.
And then there was the newly appointed health secretary.
“Andrew Lansley… was too [DC’s italics] submerged in the detail. The jargon he’d use was baffling. I remember sitting in cabinet when he shared his reform white paper. It was like an artist unveiling a piece he’d spent years on, and everyone wondering what on earth it was.”
He regrets the fact that Mr Lansley was unable to “build a coalition of support”, with those “who should have been supporting us, whose members we were giving more powers – the royal colleges and others – falling away”. He had no such hope for the British Medical Association who “you know will oppose anything, whether it is a good idea or not”.
The battle against the Health and Social Care Act was the “first time” he feared the coalition would “unravel” with many Lib Dem MPs unhappy about the reforms, which was “ironic given the central role they had played on PCTs,” he remarks.
Mr Cameron admits he should have “stepped in earlier and got him [Mr Lansley] to slow down and modify his plans” and that “time and energy were wasted”. But in conclusion he declares that, despite the reforms “being a solution in search of a problem”, they were “not quite the disaster our critics predicted” and did lead to some “improvement”.
If that is wishful thinking, the rest of the brief section on health is sometimes a little desperate in trying to prove his time in office “achieved [the] strides in healthcare I’d dreamed of”.
He rails against “targets” and “bureaucracy”, particularly the number of managers. Yet, of course, all the headline targets he inherited are still in place, the NHS struggles with a fractured management system and, thank heavens, the number of managers is again approaching 2010 levels.
Mr Cameron even has the temerity to boast of a falling waiting times “in our first two years”.
The former PM praises his two health advisers Paul Bate and Nick Seddon for their wise advice that he should “pick a small number of really big issues” to personally put his weight behind. He chose four.
The cancer drug fund did not have a happy life, and the push on dementia has, tragically, run out of steam. The fight against anti-microbial resistance does enjoy a greater profile, but that is largely due to the efforts of chief medical officer Dame Sally Davies.
It is perhaps in the area of genomics and the launch of the 100,000 Genomes project, that Mr Cameron can truly claim to have helped healthcare “stride” forward.
Mr Cameron acknowledges that his governments never found an answer to “the social care crisis” but fails to explore why in any depth.
The former PM is disingenuous to the point of misleading the reader on NHS funding. He had promised: “We will always support the NHS with the funding it needs.” This was another broken pledge, with the NHS seeing the longest period of constrained funding in its history. It is not one Mr Cameron admits to.
And that is pretty much that. No mention of, for example, the arrival of Simon Stevens as NHS England chief and the funding settlement around the Five-Year Forward view, or the NHS’ unprecedented efficiency drive, or the response to the Francis report.
Instead, we get a brief mention of 2015’s “seven-day NHS” promise and a repeat of the discredited claim there “was compelling evidence that mortality rates went up at the weekend”. Tellingly, he adds: “I knew from my own experience with Ivan that patients and their families got a less good service as the week came to an end.”
He claims the reform of the junior doctors contract was directly linked to improving the NHS’ “flexibility”, adding: “I charged Jeremy Hunt with delivering the change. I knew he would be unwavering, and when the heat on him increased – I would stand by him all the way, including during the [BMA-led] strikes by junior doctors.”
Revenge, perhaps, for 2012?
If there is any political or influential figure you would like HSJ to interview, please email firstname.lastname@example.org.
Next week: Domestic abuse campaigner and Labour MP Jess Phillips
Coming up: Manchester mayor and former health secretary Andy Burnham
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