Monday, February 27, 2012

Politicians and media pundits from across the political spectrum have been lining up to compare the Health and Social Care Bill to the Poll Tax. The comparisons are obvious. A seemingly simple idea that was scrambled beyond recognition as it was transposed into legislation, that was hugely unpopular, unworkable in practice, and which ended the career of a member of the cabinet and his prime minister. Yet there is a much more recent analogy, Tony Blair’s decision to invade Iraq. The parallels are striking.

Few questioned John Major’s rationale for going to war with Iraq in 1990, given that it had just invaded Kuwait but, a decade later, many people struggled to ascertain quite why we were attacking Iraq, given that the countries most closely linked to the events of September 11th were Afghanistan and Saudi Arabia. Similarly, having been promised “no top down reorganisation of the NHS”, many were extremely puzzled when the Prime Minister proposed to do exactly that.

Tony Blair needed to provide evidence to justify his decision, giving the English language the alliterative term “dodgy dossier”. David Cameron had to do the same so he produced statistics that seemed to show the UK underperforming on a wide range of measures, from health outcomes to patient satisfaction and productivity. Yet within days the evidence was discredited. Although deaths from heart attacks had lagged behind France, they were catching up very rapidly and would overtake it with a year or so just by doing more of the same. The public was not clamouring for change; satisfaction with the NHS was at an all time high. And, as a recent Lancet paper showed, the story of declining productivity is a myth.

But there was other evidence underpinning the government’s case. In 2000 it was secret material that we were unable to see on grounds of national security. Now it is a risk register that must be hidden lest it alarm us.

Of course, Tony Blair could point to the widespread international support he enjoyed. Countries such as Georgia, Macedonia, Latvia and Albania, each contributed a few companies of troops to the overwhelmingly Anglo-American effort, encouraged by some judiciously targeted financial support.  Yet the big guns, such as France, were missing this time round. David Cameron can also point to support, from groups such as National Association of Primary Care, which on a good day could also contribute the equivalent of a few companies, although as disillusionment has set in even among these groups, it might be more optimistic to hope for a platoon. In contrast, the Royal College of General Practitioners, comprising the equivalent of four NATO divisions, is displaying open disdain. Almost all of the other Royal Colleges, each of which could contribute at least a few brigades, are equally perplexed, with the few that continued to believe that the government must understand what it is doing, such as the paediatricians and physicians, finally jumping ship, just as Turkey when it realised the folly it risked being sucked in to. Then there are organisations that have discovered, to their bemusement, their names listed among supporters of the Bill (or at least of its highly debated “intentions”) when they are nothing of the sort, just as Costa Rica and the Solomon Islands had to ask to be removed from the list of members of the “coalition of the willing”.

In 1990, Tony Blair made clear that, once the troops had deployed to Saudi Arabia, there was no going back, regardless of what decisions were made by the UN Security Council, in the same way that events in the first few weeks of the First World War were dictated by the railway timetables. Once started, they could not be stopped. In 2012, even though the Bill has not even been approved by parliament, and indeed if it is, it is unlikely to bear much resemblance to what it looks like now, David Cameron says that it is essential to advance and any delay will cause chaos. Those warning that chaos will instead be the consequence of advance are ignored.

In 2000 the invading troops were closely pursued by a pack of multi-national corporations, such as Blackwater and Haliburton, salivating at the prospects of the vast profits they were about to make, accompanied by organisations whose ownership and business model was opaque in the extreme. In 2012, the Health and Social Care Bill is being pushed forward by a different set of corporations, such as McKinsey & Co and KPMG, again accompanied by operations such as Circle Health, whose business model in Hinchingbrooke Hospital remains a mystery to outside observers.

Finally, there is the aftermath. Few believe that life under Saddam Hussein was perfect. Yet what came after was far, far worse. What will happen if the Health and Social Care Bill is enacted is a matter of speculation. However, virtually all academic analyses have concluded that what emerges will be more expensive, fragmented, and dysfunctional.

David Cameron has frequently claimed to be continuing policies on public sector reform begun by Tony Blair. History will judge whether this is the only thing that these two prime ministers have in common. Indeed, there may be a case for booking Sir John Chilcot and his inquiry team to stay on to explain how we failed to learn from experience yet again. 


Martin Rathfelder said...


Mouse Mat said...

Clear, precise, devastating - a car crash by appointment. Thank you Martin.

Mouse Mat said...

Clear, precise, devastating - a car crash by appointment. Thank you Martin.

Philip Smith said...

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