NHS Defenders Value Ideology Over Healthcare Outcomes, But Voters Increasingly Disagree

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A startling new poll from the Reform think tank suggests that the public’s devotion to government-provided healthcare may be a mile wide but only an inch deep, threatening to burst the leftist bubble of blind, uncritical NHS worship

Today being Valentine’s Day, a predictably saccharine hashtag is trending on Twitter as British people exhort one another to #LoveYourNHS.

And so begins another round of unthinking, unending hymns of praise to the National Health Service, egged on by ideological zealots who wake up in a cold sweat at the mere thought of anyone but the government directly providing all healthcare services in the land, and amplified by thousands of well-meaning but uncritical Britons who have been indoctrinated to believe that because the NHS once delivered their baby / set their broken leg / dug out their inflamed appendix / scooped them off the road after they walked in front of a bus they now owe their eternal thanks not to the medical professionals who helped them, but rather to the bureaucratic system which (dis)organised their care.

These odes of praise generally fall into one of a few well-defined groups. First, there are those predicated on the simple-minded assumption that no other advanced country in the world has figured out how to provide universal healthcare to its citizens:

 

Then there are those who displace their relief and gratitude at having been successfully treated or sympathetically cared for away from the medical professionals who deserve the praise toward a faceless government bureaucracy and the fifth largest employer on the face of the Earth (right after McDonalds):

 

Then there are those who just like to take any excuse to bash the Evil Tories and paint themselves as virtuous defenders of institutionalised compassion, struggling against heartless conservatives who want poor people to die in the street when they get sick:

 

Bringing up the rear are the Part-Time British Exceptionalists, leftists who normally scoff at any expression of patriotism or national pride, but who on hearing or reading the letters “NHS” immediately transform into the worst kind of stereotypical Ukipper, ranting and raving about how our healthcare system is the “envy of the world” and our country the birthplace of all that is good and compassionate, all the while furiously failing to notice the rather glaring fact that no other country in the world has copied our unique and outdated post-war system of socialised healthcare delivery:

 

And last but not least are the childishly simple gestures of reverence and affection – poems, songs and the like – which reveal the truly infantilised and subservient attitude held by many of the NHS’s loudest defenders toward the service:

 

Because these various types of people – NHS High Priest, NHS Congregant, NHS Faith Militant and so on – are so loudly vociferous in the press and on social media, I and many others had rather simplistically assumed that their angry squawking spoke for the country as a whole. But a new poll taken this year shows that in fact the British people have a far more nuanced view of the NHS and the need for serious healthcare reform than the leftist NHS hagiographers would have us believe.

The Reform think tank has published a fascinating poll, taken in January, which revealed some rather striking findings, including:

58 per cent of British voters believe that the NHS needs reform more than it needs extra money, according to a new poll commissioned by the independent think tank Reform.

64 per cent of voters believe that it should not matter whether hospitals or surgeries are run by the government, not-for-profit organisations or the private sector provided that everyone has access to care. This is 2 per cent higher than in 2014, despite the Populus poll of 2,106 people being conducted on the day Carillion went into liquidation.

The think tank finds that 59 per cent of voters would nonetheless be willing to pay higher income tax to fund the NHS. This is up from 33 per cent in 2014. On average, British voters would be willing to pay ÂŁ5.25 extra a month, which is 0.4 pence in the pound of income tax.

The statistic that most of us are already familiar with is the final one – that a healthy majority (in this poll 59 percent) of Brits would be willing to pay higher income tax in order to support the NHS. We cannot escape stats and narratives like this because the media (and on this subject even the supposedly conservative-leaning newspapers are doggedly left-wing) trumpet the news from dawn to dusk.

But looking at this number alone is highly misleading, because all it tells us is that a majority of people would be willing to pay more money for the NHS, not whether they want to do so or even believe that it is necessary. And that is where the other two statistics come in, rather awkwardly for NHS defenders who loudly insist that everything would be perfect if only we firehose more taxpayer money at the same, unreformed system.

We learn in the first bullet point that a full 58 percent of voters believe that the NHS needs reform more than it needs more money, which suggests that contrary to the prevailing narrative, voters are not automatically opposed to significant reform and in some cases might even welcome it if the reforms were woven into a coherent, comprehensive plan to improve healthcare outcomes for patients. And who can seriously argue that the NHS could not do more to find even top-line efficiency savings when we see non-jobs and full-time union rep roles draining local trust budgets?

 

But it is the second bullet point which is truly surprising – the fact that a full 64 percent of voters don’t give two hoots whether the hospital or medical facility where they receive treatment is government-owned and operated or run by non-profit or even private service providers.

This flies in the face of everything that we are told about public opinion towards the National Health Service. We may as a country (wrongly) favour the re-nationalisation of the railways, but when it comes to healthcare it appears that we are far more pragmatic, preferring what works to leftist ideology or sentimentality for a system which has operated since 1948.

From the Reform blog:

This is an important message for politicians who have questioned the premise of the outsourcing model following Carillion’s liquidation. The reality is that public services would grind to a halt without private and third-sector involvement. Almost one-third of government spend (£242 billion) is spend on external providers for goods and services from paperclips to the trident nuclear deterrent. The NHS spent £54 billion on external suppliers in 2014-15. This model has delivered value for money through increased competition. While the execution of some contracts can be improved, it seems voters are more concerned with access to services than ideological arguments on either side.

Why this growing openness to non-government provision? It could potentially be a case of “the grass is greener on the other side” – the rail operators are already privatised, and so dissatisfaction is more likely to be expressed in terms of a desire to roll the system back to a previous state, whereas NHS delivery (particularly hospital care) is almost always government-provided, making fresh alternatives seem more appealing. This is very likely a factor.

But such is the strength of public feeling on the issue – with 64 percent supporting radical change – that I don’t think “grass is greener syndrome” can account for the entirety. On the contrary, it seems as though the Left have massively overplayed their hand, thinking that they stood on a rock-solid foundation of obstinate support for preserving the NHS in aspic when in fact they are on a bed of quicksand.

Interestingly, the Left have likely done this to themselves, to a large extent. Having bleated for decades that we have only X or Y number of days to “Save Our NHS” only for the NHS to persist through Tory and Labour governments alike, and with left-wing commentators, members of the NHS Industrial Complex and alarmist agitators like Owen Jones penning articles suggesting that the “NHS as we know it” has in fact already been abolished, perhaps the general public has finally tired of their endless hysteria and started to take it for what it is – cynical emotional manipulation.

And if there really is a new openness to healthcare reform, then all it would now take to finally break free from British healthcare exceptionalism – the blind devotion to a tattered post-war consensus dogma which suffocated all previous impetus for healthcare reform – is a purposeful, visionary government with a clear mandate to lead and a Cabinet brimming with talent and political courage.

Oh well.

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NHS Hagiographers Continue To Use Commonwealth Fund Survey As A Shield Of Bias Confirmation

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Britain’s NHS idolaters cling to the Commonwealth Fund’s rosy but skewed assessment of the National Health Service like shipwreck survivors cling to floating wreckage

Brexit is not the only issue which reveals the intellectual limitations and paucity of vision of our politicians. Simply whisper the letters “NHS” and the vast majority of parliamentarians instantly turn into zombies, mindlessly repeating the same worn-out old paeans of praise to centralised government healthcare as though they were under the control of a hypnotist.

There are few better demonstrations of this pathology than yesterday’s segment on BBC This Week, in which Andrew Neil questioned uncritical acceptance of the Commonwealth Fund study (the only survey which routinely rates the NHS favourably) and Kate Andrews of the IEA gamely tried to advance the heretical notion that Britain might do well to learn from other advanced countries when it comes to organising healthcare delivery.

This went down like a lead balloon with bipartisan couch-warmers Anna Soubry and Alan Johnson, whose minds are both welded shut against any information that might suggest that the NHS is not, in fact, the “envy of the world”. Neither host Andrew Neil nor Kate Andrews are able to break through this veil of self-imposed ignorance:

From the segment:

Andrew Neil: Let’s just take the Commonwealth Fund now, because you politicians on both sides, you’re always using it —

Alan Johnson: Well, it’s the only one —

Andrew Neil: No, it’s not. It’s the only one in which the NHS does well, and actually in the Commonwealth Fund it measures inputs, not outputs, not patient care. Indeed, on the patient care – on actual health outcomes – even in the Commonwealth Fund the NHS comes tenth out of eleventh. The Guardian remarked on the Commonwealth Fund: “the only serious black mark against the NHS in Commonwealth Fund research was its poor record of keeping people alive”.

Alan Johnson: Yeah, America came eleventh, by the way, but…

Kate Andrews: Why America? Why not Germany or Belgium or Switzerland or France?

Alan Johnson: Because you came on here and said Trump has a point, are we supposed to talk about Sweden when you said Trump has a point?

Kate Andrews: You’re right, I did say Trump had a point, this whole point is that the NHS is failing, that doesn’t make America any better. Look, I’m from America, I’m not coming over here saying look, adopt the American system”, as I said in the video I wish both countries would look at Switzerland. But let’s stop painting this black and white decision because it’s not about USA versus NHS.

Alan Johnson: The Commonwealth Fund is the only one who measures things like health inequalities and fairness and how it affects the poorest —

Kate Andrews: What is fair about thousands more people in European countries surviving? What is fair about that? What is fair about the fact that 13,000 more people in Germany every year will survive the five most common types of cancer? What is fair about that?

Alan Johnson: [Becoming more incoherent and hysterical with every passing moment] You quote that without saying — as if the NHS was very keen for people to die of cancer —

Kate Andrews: No, of course they’re not, but we can do something about this —

Alan Johnson: One of the biggest problems is early reporting, is people going to their GP, particularly men —

Anna Soubry: Absolutely, it’s the biggest factor.

Kate Andrews: Great. Well, you need access to the GP, don’t you? You need shorter waiting times.

Anna Soubry: We have – please, please, don’t tell me that you don’t have – depends on where you live —

Kate Andrews: The waiting times for this country are appalling compared to their European counterparts.

Anna Soubry: [Disingenuously talking about same-day emergency appointments rather than scheduled GP appointments] Excuse me. Your GP, it depends exactly where you live, because certain GP surgeries like mine, I can see my GP if I want to on the morning that I have – I can ring up and can get in straight away. It depends where you live —

Kate Andrews: That doesn’t sound like a very fair system. It doesn’t sound like a postcode lottery is a very fair system.

Anna Soubry: No, it’s not a postcode lottery.

Kate Andrew: Well he [Alan Johnson] is talking about fairness, and that’s what the NHS is good at, but you were talking about a postcode lottery system. There’s nothing fair about that system, and there’s not a lot that’s very good about it either.

So the NHS is perfect, equality of dismal outcome is preferable to aspiring toward excellence, and if you are one of those people whose deaths would have been prevented by another, superior healthcare system it’s your own stupid fault for not seeing your GP (the unnecessary gatekeeper to practically all NHS care) on time. So say Tory wets and Labour centrists alike.

This is mental subservience to the Cult of the NHS, pure and simple. Every day, the high priests of the NHS surpass themselves in new feats of bias confirmation. One might think that the NHS coming second from last in the rather key metric of keeping people alive might give pause for introspection, but throw up any fact or scenario which suggests that the NHS is inferior and immediately two things happen.

Firstly, up goes the wall of ignorance and denial. Why are you fussing about health outcomes anyway, they splutter. Don’t you know that fairness, ease of access and cost-effectiveness are the only metrics worth considering? And if that doesn’t work, then out comes the good old US/UK false dichotomy, where NHS defenders pretend, quite slanderously really, that anybody who questions the NHS model or expresses an interest in learning from other countries secretly wants to emulate the US system.

Kristian Niemietz has also been fighting this lonely fight against uncritical acceptance of the Commonwealth Fund survey for a long time:

The Commonwealth Fund study is the outlier among health system rankings, because it pays little attention to outcomes – it is mainly based on survey responses and general system characteristics. But it has one category which does relate to outcomes, and in that category, the UK comes out 10th out of 11 countries. So even the preferred study of NHS cheerleaders confirms that in terms of outcomes, the NHS is one of the worst systems in the developed world.

Niemietz concludes:

The jingoism of Little Englanders is sometimes unedifying, but it is not nearly as cringeworthy as the NHS patriotism of the left. The NHS is the country’s most overrated institution. It is the Carling of healthcare systems. It achieves nothing that dozens of other healthcare systems do not also achieve, and usually better – and it’s time we admitted that to ourselves.

I made the same point in a television interview several years ago, pointing out that if you want to make a staunchly internationalist, post-patriotic left-winger sound like the stereotypical swivel-eyed Ukipper all one has to do is whisper the letters “NHS”, at which point they will immediately start ranting about British superiority and exceptionalism, waxing lyrical about how we alone have unlocked the secret of compassionate, universal healthcare delivery, while the other, benighted nations of the world look on at us in envy.

If the NHS is ever to be meaningfully reformed, if healthcare outcomes are ever to improve in Britain relative to the countries which are overtaking us, this wall of ignorance and denial must be torn down. But just from the facial expressions and physical demeanour of Anna Soubry and Alan Johnson in this BBC This Week segment, you can see that they will not be reasoned with. And if politicians who style themselves as pragmatic centrists cannot take the emotion out of an argument and drop the NHS hagiography for an honest discussion of healthcare reform, what chance is there?

This is a cult, plain and simple. When people cannot look dispassionately at a government service but instead debase themselves by sanctifying it (as though universal healthcare were in any way unique to Britain), observing its holy days, quoting its founders and worshipping its historical figures, what you have is a cult.

 

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Stephen Hawking vs Jeremy Hunt: The Insidious Cult Of The NHS

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Stephen Hawking vs Jeremy Hunt, a beloved national treasure going up against somebody who actually knows a thing or two about healthcare systems – in NHS-worshipping Britain, this could only end one way

If your car breaks down in the middle of the desert, who would you rather have come to your aid – the world’s most famous and accomplished concert pianist, or a fully equipped mechanic with a bit of a bad reputation?

Unless you particularly want to die of dehydration amid the sand dunes you pick the dodgy mechanic every time. At least he has some experience with the subject matter at hand, after all. And would you listen to angry protestations from other people who said that the concert pianist was equally entitled to tinker with your car, just because he has been driven around in many cars throughout his career? Of course not. Making use of the functions of an automobile is not the same as understanding how a vehicle works or being able to diagnose technical faults with the engine.

And yet as soon as the national conversation turns toward Our Blessed NHS, this kind of common sense goes out the window. So desperate are many British people to receive confirmation bias-affirming propaganda about “Our NHS” that when theoretical physicist Stephen Hawking got into a debate with Health Secretary Jeremy Hunt on the subject of healthcare, people essentially chose the concert pianist over the mechanic. Proudly and unequivocally.

This is the mental poison spread by the Cult of the NHS. It warps thinking, is impervious to reason and transforms what should be a measured, rational and unemotional debate about how best to provide healthcare services to a country of 70 million people into a frenzied orgy of emotionalism and unconditional praise for government bureaucracy, combined with a seething intolerance of anybody who dares to question the status quo.

Most unbecoming for a scientist, Stephen Hawking leaned heavily on emotional rather than empirical arguments to make his case, writing in the Guardian:

Like many people, I have personal experience of the NHS. In my case, medical care, personal life and scientific life are all intertwined. I have received a large amount of high-quality NHS treatment and would not be here today if it were not for the service.

The care I have received since being diagnosed with motor neurone disease as a student in 1962 has enabled me to live my life as I want, and to contribute to major advances in our understanding of the universe. In July I celebrated my 75th birthday with an international science conference in Cambridge. I still have a full-time job as director of research at the Centre for Theoretical Cosmology and, with two colleagues, am soon to publish another scientific paper on quantum black holes.

Whereas in France, Germany, Australia, Canada or Japan he would have been left to die in the street? This is misleading, emotionally manipulative balderdash of the first order. Newsflash, Stephen Hawking – the NHS did not save your life. Doctors and nurses and technicians and administrators did. And all of these professions can be found outside of our own creaking nationalised healthcare system.

Universal healthcare and treatment free at the point of use are not innovations unique to the United Kingdom. Other countries manage to do it too, using a variety of different delivery models – many of which achieve better healthcare outcomes (ultimately the only thing that matters to patients) than Our Blessed NHS.

And Stephen Hawking knows this full well. Yet he is happy to take advantage of the British public’s sentimentality for the NHS and lack of awareness of healthcare in other countries to create a false impression that motor neurone disease patients such as himself – indeed, people suffering from any disease or injury – are somehow left to die on the street in other countries, and that it is only in socialist Britain that people enjoy modern healthcare. This is the kind of dishonesty and low skulduggery that belongs in the field of politics, not science. Hawking should be ashamed of himself.

But he isn’t done yet. He continues:

Last year my personal experience of the NHS and my scientific life came together when I co-signed a letter calling for healthcare policy to be based on peer-reviewed research and proper evidence. The specific issue addressed in the letter was the “weekend effect”. Jeremy Hunt, the health secretary, had claimed that thousands of patients died unnecessarily because of poor hospital care at the weekend, and used this to argue that we needed to implement a seven-day NHS. I had mixed feelings about the issue. Having spent a lot of time in hospital, I would like there to be more services available at weekends. Also, it seems possible that some patients spend more time in hospital than is necessary because certain diagnostic tests can only be done on weekdays.

However, as we showed in the letter, Hunt had cherry-picked research to justify his argument. For a scientist, cherry-picking evidence is unacceptable. When public figures abuse scientific argument, citing some studies but suppressing others to justify policies they want to implement for other reasons, it debases scientific culture. One consequence of this sort of behaviour is that it leads ordinary people to not trust science at a time when scientific research and progress are more important than ever.

Yes, we wouldn’t want to cherry pick evidence now, would we Stephen? Like resolutely pretending that the only alternative to the NHS is “a US-style insurance system”, conveniently ignoring the wealth of other examples out there?

But even more asinine than this is Hawking’s assertion that healthcare policy should be based on “peer-reviewed research and proper evidence”. This is all well and good as far as it goes, but we are talking about designing complex human organisations here, not conducting a controlled physics experiment.

The only peer-reviewed research and evidence that can possibly be brought to bear on the question of how to design an optimal healthcare system for a medium-sized advanced economy will come from the social sciences, which are inexact and often unquantifiable by their very nature. What’s more, in academia the social sciences are populated almost exclusively by leftists and are effectively locked into a self-perpetuating purity spiral. When there is no diversity of perspective or political thought in the field, how can one have the slightest confidence in the outcome of the resulting studies?

Do you really think that scientists check their political opinions at the door of the library or laboratory? If so, where were all the economists during the EU referendum declaring in TV interviews that Brexit might be bad for the economy but still worthwhile overall? They were nonexistent. Why? Because they all started from a place of liking the European Union and wanting Britain to remain a member. Facts and evidence which contradicted this desired outcome were determinedly pushed aside, again and again.

Oliver Norgrove gets it right on this point:

The other issue I have with Professor Hawking’s comments is that they essentially capture the nauseating emotional connection that Brits have with healthcare provision. It is odd because healthcare needs are, by their very nature, private and oughtn’t represent bargaining chips for politicians at election time. ‘Groupthink’ surrounding the NHS is rife and poisonous. I particularly loathe the term ‘our NHS’. In using it we promote unhealthy tribalism, which blockades against meaningful debate about how we improve a stagnant system of healthcare. Diluting this poisonous emotional attachment is perhaps the first step to achieving a market-based system, similar to those seen all around the continent.

Notice also the reliance upon using the American healthcare system as some kind of stick with which to beat free marketeers in Britain. It is as if there are only two structures globally, and we must protect one from becoming the other. Professor Hawking, a clever man, knows full well that by instigating comparison with the United States he can more aptly generate support for the maintenance of the NHS. Which I believe, given changes to demographics, life-expectancy and population-induced strains, is bad for our healthcare outlook.

Increasingly, academics believe that, almost by right, they are entitled to transfer their authority in a particular field to other fields, often for the sake of making noise and boosting their own public profile. This became especially apparent during Britain’s referendum on European Union membership. Of course, I am not saying that academics should not have the right to speak and be heard. Nobody values the importance of free speech more than I do. The issue is that by association alone they are afforded disproportionate exposure and their words a special (and often unwarranted) significance. This is damaging to debate as it promotes laziness and useless conventional wisdom.

And besides, Stephen Hawking doesn’t really want to design an optimal healthcare system. No, he is attached to the present system for emotional reasons, and is busy corralling facts and figures which confirm his own biases and preferences. A rational scientist would start with a blank sheet of paper, not a crayon drawing of the NHS logo with girlish hearts scribbled all around it, Ă  la Hawking.

Yet Hawking preposterously claims to be a dispassionate observer in all this:

A physicist like me analyses a system in terms of levels of approximation. To a first approximation, one can see the situation facing healthcare in this country in terms of forces with different interests.

Quite. So let’s talk about the NHS Industrial Complex, that byzantine and interconnected web of special interests from pharma companies to suppliers to logistics providers to medical schools to clinical staff on the taxpayer dollar, to the army of administrators and bureaucrats required to run what is – astonishingly – the fifth largest employer on the face of the Earth. All of these actors have a vested interest in the current system perpetuating itself – it’s how they get their pay cheques and make their profits. Disruption to steady-state operations is therefore unwelcome and to be resisted at all costs, even if there are potential windfalls for patients.

But these are not the malevolent forces that Stephen Hawking wishes to discuss. He wants to go on a generic leftist rant about the “multinational corporations, driven by their profit motive” – forgetting that the profit motive he so despises helped to spur the development of many drugs and healthcare technologies which save lives every day. He also takes the economically illiterate view that there is a fixed amount of money in the economy and healthcare system, and that shareholder profit necessarily means less funding available on the front line. This is nonsense, as any sixth-form economics student could have explained.

Hawking ends his cri de coeur with this rousing message:

If that all sounds political, that is because the NHS has always been political. It was set up in the face of political opposition. It is Britain’s finest public service and a cornerstone of our society, something that binds us together. People value the NHS, and are proud that we treat everyone equally when they are sick. The NHS brings out the best in us. We cannot lose it.

Isn’t it funny that if you want to make an establishment leftist sound like a frothing-at-the-mouth Ukipper all you have to do is whisper the letters “NHS”, at which point they will immediately start ranting about British culture and values, the importance of our unique island history and our unquestioned superiority over every other country.

And yet we see smug, superior headlines from the likes of the Independent, sardonically declaring “It’s brave of Hawking to take on an intellect like Hunt“, as though Stephen Hawking’s brilliance when it comes to physics somehow automatically translates to the complex political and organisational considerations involved in healthcare reform. This is basic, superficial thinking of the first order – and yet nearly every newspaper clapped along like trained seals, without stopping to think whether Hawking really has any credentials to be pontificating on the future of the NHS. He doesn’t.

Stephen Hawking is little more than an NHS Ukipper, with no more right to meddle in British healthcare reform than your garden variety Ukipper should be allowed to go up against Michel Barnier in the Brexit negotiations. But his ignorance and emotional manipulation are given cover by a bovine public raised to worship the NHS unquestioningly, and by a sycophantic media who prefer to make smartass headlines about Jeremy Hunt’s intellectual deficit rather than stopping to question who makes the better argument.

And as it happens, both men are wrong. Stephen Hawking is busy trying to reanimate the mortal remains of Aneurin Bevan, while Jeremy Hunt is tinkering around the edges of a failing system which needs redesigning from the ground up.

This is what passes for a debate about healthcare reform in this country, and the cost of all the virtue-signalling, NHS-worship and half-hearted reforms can be counted in human lives.

 

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The SpAdocracy And Theresa May’s Flawed Manifesto Plans For Social Care

The Thick Of It

Social care funding and other important policy questions are too important to be decided solely by a couple of Bright Young Things and Special Advisers ensconced in Downing Street

The problem with Theresa May’s disastrous, miscalculated decision to shoehorn dramatic changes to the funding of social care into the Conservative (In Name Only) manifesto – and then perform a humiliating U-turn live on TV – is that it was cooked up by a couple of her closest, most trusted advisers and then foisted on the Conservative Party and the country with zero wider consultation.

The Guardian lifts the veil on the dysfunctional Court of Theresa May:

The manifesto for Mayism was stitched together on an upper floor of Conservative campaign headquarters over the past few weeks by a tight-knit team of the prime minister’s most trusted advisers.

While May has been out on the road giving stump speeches nearly every day, her policy team has been holed up in Matthew Parker Street in Westminster composing a document intended to redefine Conservatism, drawing a line under the elitism of the Cameron era and the individualism of Thatcher.

The document is pitched as representing May’s firmly held world view, but it also has the fingerprints of Nick Timothy and Fiona Hill, her two co-chiefs of staff, all over it.

The pair, who reigned supreme over May’s Home Office, have been the subject of complaints from MPs that they act like deputy prime ministers instead of Downing Street aides. Now the election campaign has started, they run the show at CCHQ with a tight grip.

Who needs cabinet ministers, think tanks, non-profit organisations, lobbyists, the general public or anybody else in the political ecosystem when you have two loyal SpAds ready and willing to deconstruct and rebuild core functions of the state quietly, in the shadows?

More:

MPs have complained privately over the past 10 months about the centralised nature of Downing Street, with May, Timothy and Hill sucking policy decisions away from Whitehall departments and other ministers. It comes as no surprise to them that May’s campaign focuses on her personal leadership qualities to the exclusion of other senior figures in the party, with the case for that focus bolstered by the prime minister’s strong poll ratings.

Cabinet ministers say they are not being sidelined, although the reality looks somewhat different. Of 15 campaign events for the press held by the Tories so far, all but one have been fronted by May herself, speaking of “strong and stable leadership” and the need for a mandate to carry through Brexit at every opportunity.

A few – including Boris Johnson, Michael Fallon, Amber Rudd and David Davis – have been used for some media interviews, but they are mainly kept away at constituency visits. By Wednesday, senior cabinet ministers such as Philip Hammond, Johnson and Rudd had seen the manifesto and approved its contents.

But its composition was very much a matter for May’s inner circle.

It is quite frightening to realise just how quickly harebrained, incomplete and otherwise controversial policies can find themselves shoehorned into a party manifesto (and then swiftly become law) if they are adopted and pushed by a well-connected member of the SpAd-ocracy.

In fact, prior to calling the general election the Conservatives had planned to hold at least a basic level of consultation on reforming social care, but some bright spark apparently decided that it would be far simpler to ram the changes through by including half-baked ideas as firm manifesto pledges, as the Telegraph reports:

Politicians who will deliver the Conservatives’ new care policy if they win re-election were left in the dark about their manifesto commitments, it can be revealed.

Senior Government sources have told The Sunday Telegraph they were left “completely surprised” by the wide-ranging package of reforms announced this week.

A series of social care policies were due to be put out to consultation this summer, including some of those adopted by the party in its manifesto.

However the changes would have been followed by months of consideration with less political risk if they were dropped or altered after industry feedback.

As I type, Theresa May is scrambling to defend her social care policy and her broader judgment in a television interview with Andrew Neil (the closest that the prime minister will condescend to participating in a debate) and frankly failing miserably, all of which could have been avoided if her core team behaved less arrogantly and if British political parties sought to formulate and enact legislation in a more open, inclusive way.

When President Barack Obama sought to overhaul the American healthcare system early in his first term, he didn’t slap a fully worked-out, prescriptive solution for single-payer healthcare on the table and demand that everybody get behind the main principles “or else”. While American conservatives rightly point out that the extensive consultation exercise was partly cosmetic and not nearly as welcoming of right wing input as it was portrayed, the fact remains that when American political leaders wanted to change something which impacted millions of people and a significant share of the US economy, there was a consultation (or at least the pretence of a consultation) before the first draft was issued. Sure, congressmen were expected to vote on the final bill having had only a few hours to read it, if they could even be bothered, but this was after every aspect of healthcare reform had been discussed in excruciating detail in committees, public town halls and in smoke-filled rooms with the special interests who (rightly or wrongly) have the power to make or break reforms.

This style of policymaking seems to be anathema to the British system. When David Cameron won re-election in 2015 based in no small part on the promise to hold an EU referendum, he cooked up his own list of demands for the European Union and marched off  to Brussels to negotiate them (and we all know how well that worked out). Cameron and his team presumed to know – without engaging in any special consultation, public or otherwise – exactly what changes the British people wanted to see in our relationship with the EU, without once bothering to actually ask our opinion. The only thing more laughable than David Cameron deciding on our behalf what issues to raise with Brussels was the fact that they still sent him away empty-handed and humiliated. This arrogant, presumptuous approach to government was, and nearly always will be, a recipe for failure.

Few people would disagree that the way we fund social care needs to be tweaked at the very least, if not wholesale reformed. But doing so is an enormously complex process, involving the intersecting demands and interests of numerous groups and political principles. There are the interests of homeowners, taxpayers, council and private care providers, current and future care recipients, all of which will be in competition with one another and must be balanced to maintain a functional system.

But whatever one’s view on the ideal model solution, the manifesto pledge as it stands – together with recent panicked talk of a potential “cap” on care payments, made after four days of relentlessly negative headlines – seems politically naive at best. It is a blunt policy solution, a sledgehammer to crack a nut, and the kind of half-baked idea that would have been kept firmly away from the media had there been any serious ministerial input to the drafting of the Tory manifesto.

Now, there is nothing wrong in principle with having a core team of advisers and ideological kindred spirits aiding a new prime minister as she seeks to put her stamp on the party and the country. Margaret Thatcher did just that when she came to power in 1979, bearing the ideas of the Institute of Economic Affairs and the Centre for Policy Studies. As Leader of the Opposition she had read the famous “Stepping Stones” report which diagnosed Britain’s ailments and proposed radical solutions to lift Britain out of near-terminal economic decline.

But the emergency circumstances in which Thatcher pushed through her reforms were far different to today’s more benign environment. When the country faces existential threat, as we did in the late 1970s, some justification can be made for strong and decisive leadership which doesn’t wait around seeking to hand-hold and achieve consensus before acting. And while some people with a flair for the dramatic might claim that Brexit represents a similar crisis, Brexit and the rise of populism is far more a crisis of political legitimacy than economic survival – and political legitimacy is undermined, not improved, by ramming through ill-considered reforms to the social care system.

Ultimately, the cause of good policymaking is never well served when a couple of “Bright Young Thing” Special Advisers – often with wide but shallow portfolios, and no democratic mandate of their own – decide to rewrite government policy and plan to reshape our national institutions on the back of a napkin. I’m sure that Nick Timothy and Fiona Hill, Theresa May’s collective brain trust, are extraordinarily bright and capable people – on paper, at least. But the accumulation of evidence increasingly suggests that they lack street smarts, let alone a decent political radar, which is rather strange given their respective biographies. Ted Sorensen they are not.

Hopefully Theresa May will learn from this debacle. She intends to lead the country – never mind the Conservative Party – in a direction that many people have reservations about, some of them quite justified. To succeed in office, she will need to draw on the best that the entire conservative movement has to offer, including those wings of the party that she continues to vilify (cough, libertarians).

And for somebody like Theresa May, a self-confessed pragmatist with no overarching vision for government of her own, that means widening the circle and taking some more advice before tearing up the social contract, crashing out of the single market without a transitional arrangement or implementing Ed Miliband’s 2015 Labour manifesto by the back door.

 

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NHS Heresy, Part 4 – Junior Doctors Would Sell Out The NHS In A Heartbeat, If The Price Was Right

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Brave and principled defenders of Our NHS? The junior doctors would knife Aneurin Bevan’s vision in the back and happily serve an Evil Tory privatised healthcare system (how awful) if the price was right

Few people have been pronounced more saintly in 2016 than the holy NHS Junior Doctors, whose brave, principled and not-at-all-about-money industrial dispute with Jeremy Hunt and the Evil Tor-ee government has seen these humble, altruistic folks fight bravely and against the odds to safeguard the future of Our Blessed NHS.

Oh, wait. Nope. Turns out that most of those cherub-faced stethoscope swingers would throw the NHS under the bus and see the National Health Service privatised if it meant more money flowing into their pockets.

Kristian Niemietz of the IEA reports:

While I never believed for a second that the junior doctors’ strike was a People’s Struggle against the demonic forces of neoliberalism, I did believe that most junior doctors had convinced themselves of it. I was under the impression that they sincerely believed that that they were fighting The Just Cause on behalf of The People. Slogans like “Save our NHS” were everywhere, after all, and we always find it easy to convince ourselves that what is good for us also happens to be good for everybody, even if in roundabout ways.

And yet, in a recent survey of almost 10,000 junior doctors, 93% said they would accept “complete privatisation” of the NHS if it resulted in “substantially” increased salaries. Surely, some will dismiss these figures as a vicious smear, while others will accuse junior doctors of hypocrisy and opportunism. I think neither response is appropriate.

In practice, many doctors already act in accordance with the preferences expressed in this survey. Last year, about 8,600 UK-trained doctors went to work abroad, with Australia being a particularly popular destination. Australia has a universal public insurance system, in which the government commissions and pays for most healthcare, but in which the delivery is largely private and market-based. They are not doing anything immoral, because there is nothing immoral about private, market-based healthcare; in fact, the Australian system produces some of the best outcomes in the world. Come to think of it, even in the UK, most GPs are self-employed, not NHS employees. This means that technically, they are part of the dreaded – whisper it – private sector.

It would, however, suit junior doctors to quit the populist, anti-capitalist posturing. And the rest of us should try to keep our anti-capitalist knee-jerk responses in check. Even when it comes to healthcare.

My emphasis in bold. And you read that correctly – 93% of all those doctors who love to paint the NHS logo on their faces and protest Jeremy Hunt would happily live in an Evil Tory dystopia of privatised healthcare if it meant they were paid a market wage.

Niemietz is kinder and more understanding in his piece than I am inclined to be. Personally, I think that the junior doctors’ strike was just another example of the NHS Industrial Complex – that vast connected web of connected special interests who have a direct stake in the world’s fifth largest employer continuing to operate along broadly the same lines as it does at present – flexing its muscles and throwing the entire country under the bus for their own economic gain. But that’s just cynical old me.

There is no disputing, however, that nearly every tawdry public (and private) sector dispute in modern history has been justified by the protagonists on the supposed grounds of “public safety”, whether it is London Tube drivers suddenly becoming concerned about safety on the Underground in time to tack an extra day onto their Christmas holidays, Southern Rail train drivers convinced that taking over responsibility for opening and closing their train doors will lead to regular platform bloodbaths, or the sainted junior doctors.

We have known since May that pay was the only real red line for junior doctors, though surprisingly none of their placards made reference to the desire for more cash – they chose instead to go with their “Save Our NHS” angle instead, to elicit maximum public sympathy (by whipping up maximum public fear). We have also known, thanks to the steady stream of junior doctors moving abroad to work for other, better healthcare systems than our own anachronistic NHS, that their supposed high-minded commitment to socialised, government-provided healthcare is often outmatched by the desire for a bigger pay cheque and a larger slice of finite taxpayer funds.

But now we find out that not only would many junior doctors consider abandoning the NHS and selling their services to hospitals in other countries, but that they would actively support the tearing down of Our Blessed NHS and its replacement with a privatised system here in Britain. The commitment to socialised public healthcare is literally tissue paper thin with these people, even more flimsy than the home-made banners on which they proclaim themselves to be tireless warriors fighting to defend the Best Healthcare System in the World.

Will the revelation of this hypocrisy change anything? Probably not. The Guardian and other sycophantic leftist outlets will no doubt continue to gush over the various vested interests within the NHS Industrial Complex, as instructed by High Priests like Owen Jones:

Ask a striking junior doctor why they’re taking this action, and you won’t simply hear an eloquent spiel about their contracts. It’s the very future of the NHS – which they have committed their lives to – which they fear is at stake. There are the government’s policies of marketisation and fragmentation – yes, accelerating what previous administrations did – stripping the “national” from NHS.

“Committed their lives to”? Heavens, you would think that these people had pledged themselves as members of the Swiss Guard, the Night’s Watch or the Order of the Phoenix, the way that Owen Jones talks about them, rather than simply signing up as employees of the fifth largest bureaucracy on the face of the planet.

But it is sneaky what Owen Jones does here, suggesting that people become doctors out of a desire to work in a large government bureaucracy rather than feeling the call of a vocation to heal. Other countries seem to manage to recruit and train doctors without danging the carrot of getting to work for a massive state-owned bureaucracy in front of them, but Jones would have us believe that we only have doctors and nurses because people are so dreadfully inspired by Aneurin Bevan’s rusting 1948 vision. Nonsense, of course, but very effective propaganda from the NHS Industrial Complex.

The NHS Industrial Complex is made up of many different actors, all with their own motivations. One has the ideological leftists like Owen Jones, whose entire worldview relies on supporting a monolithic state healthcare provider churning out a precisely equally dismal service to every postcode in the UK. Then one has the worker bees within the organisation itself, whose medical or bureaucratic expertise rarely qualifies them to pass judgment on the optimal healthcare system for a country of 65 million people. And then one has the vast supply chain serving the beast, which is motivated primarily by a desire to preserve and expand existing revenue streams and avoiding risky disruption.

How fortunate that this cast of villains and useful idiots is able to hide behind the junior doctors – most of whom are eminently decent people supporting a superficially worthy cause – as they press for the preservation of the status quo, the scuttling of reform and a wider pipeline direct from the bank account of every UK taxpayer direct to the fifth largest organisation in the world.

But perhaps now that we know that the NHS Industrial Complex’s most photogenic spokespeople are actually more than happy to upend the whole system, spit on Britain’s national religion and see the NHS fully privatised so long as the pay rise outweighs the public vilification, the junior doctors’ collective halo might tarnish a bit.

Still, there are always the nurses. Everyone trusts a good nurse.

 

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Save Our NHS

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Top Image: University of Liverpool Faculty of Health & Life Sciences / Wikimedia Commons

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