Who's saving the NHS from who?
As you listen to Liberal Democrats declare that they are riding to the rescue of the NHS I can't help recalling a story I heard a while ago. It relates to Nick Clegg's reaction to attending a service at Westminster Abbey to celebrate the 60th anniversary of the NHS. As well as prayers and blessings the service on 2 July 2008 included a speech by Prime Minister Gordon Brown and the reverential playing of a sound recording of a speech by the founder of the NHS, Labour's Aneurin Bevan. Clegg complained to friends that only in Britain would they turn an organisational structure into a cause for a religious service.
Clegg, you see, is rather more radical than some have recognised. In part, that's because of his strong European roots - he was brought up by a Dutch mother, worked in Brussels for the European Commission and then became an MEP. British affection for the NHS stems partly from memories passed down the generations of what health care was like before it was created and in large part from a comparison with American healthcare. From a European perspective the NHS doesn't look that special. After all you're not asked for your credit card before going to hospital in France or Holland.
No wonder then that Clegg signed up to the Orange Book - published in September 2004 - which proposed that the UK should adopt a Euro style health insurance model. His ally David Laws - who'll be back in the spotlight this week - wrote the chapter which observed that:
"The NHS is a system that fails to allow for the disciplines of choice, diversity and competition which can help to ratchet up standards"
The current NHS proposals were drawn up not just by the Tory Andrew Lansley but by his Lib Dem Deputy Paul Burstow. They were reviewed and approved not just by the Conservative Oliver Letwin but by Clegg's soulmate Danny Alexander. The foreword to them was signed not just by David Cameron but by Nick Clegg too.
So they are, to coin a phrase, all in it together when it comes to the NHS.
Both Cameron and Clegg realised too late the political danger of the reforms they'd agreed to. Both are now trying to reassure voters that they are not planning to privatise the NHS and to assuage the anger of hospital consultants and nurses who fear that GPs will not fund them as generously as politicians who, down the years, have found campaigns to keep hospitals open hard to resist. Both know NHS reforms that go wrong could destroy their personal as well as political reputations.
The battle is on for the credit for changes which - in broad outline if not all detail - have, I'm told, been agreed. After staging 100 meetings in which 10,000 NHS staff have been engaged I am told by a Tory source that it is a statement of the obvious that "no bill is better than a bad bill" but that "everyone expects to improve and not dump" the NHS plan.
Lest anyone read this blog as me suggesting that the Lib Dems are a threat to the NHS or that both Coalition partners are equally a threat let me be clear. I am not. Indeed, choice, diversity and competition are words that were used by previous Labour Health Secretaries who allowed private companies to provide not just cleaning or pharmaceutical but clinical services.
Ever since the NHS became a national religion politicians have competed to say that they love it more or can be trusted to save it. However, for more than two decades - ever since the Conservative White Paper of 1989 when Margaret Thatcher decided to keep the health service and not to dismantle it - debate has been about how much choice, diversity and competition it is possible and desirable to have within the NHS.
Update 17:00: Lib Dem sources insist it was their man - not the prime minister - who brought about the "pause" in the NHS reforms when he threatened to halt the Bill altogether if David Cameron refused to review it.
In response to my earlier post they do not deny that Nick Clegg is a "health reformer" and you can see why. Thanks to The Independent for reminding me of an interview they ran in September 2005 in which Clegg - then his party's foreign affairs spokesman - said "I think breaking up the NHS is exactly what you do need to do to make it a more responsive service" and refused to rule out an insurance based model.
"I don't think anything should be ruled out. I think it would be really, really daft to rule out any other model from Europe or elsewhere. I do think they deserve to be looked out because frankly the faults of the British health service compared to others still leave much to be desired."