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- The Observer,
- Sunday May 20 2001
It's there to be read in black and white. On your behalf, I've been comparing and contrasting the manifestoes: a dirty job, but someone's got to do it. This is what the Labour manifesto has to say about the future of the National Health Service: 'Labour is opposed to the privatisation of clinical services which is actively being promoted by the Conservatives.' Here's the response: 'We will create a new type of hospital - specially built surgical units, managed by the NHS or the private sector - to guarantee shorter waiting times.'
Have you spotted what I am up to? The first quote, excoriating the 'privatisation' of the health service, comes from Mr Blair's manifesto of four years ago. The second quote, actively promoting the involvement of private companies, comes from Mr Blair's manifesto for this election.
Sometimes you have to pinch yourself to be sure that you are not dreaming. Among the 'Ambitions for Britain' set by a Labour Government is the ambition to bring the private sector into the running of the health service. Behind their hands, Ministers go much further than the hedged words of the manifesto. 'Surgical factories', the rather grisly name for fast-track units, could be entirely managed by private companies. On the quiet, government advisers have told health companies that anything is possible and everything is up for grabs, from taking over failing health authorities to running GP surgeries.
I can hear you: what on earth has happened to the party of Nye Bevan? Well, one thing that has happened to it is power. The men and women who came into Government four years ago had spent all their adult lives believing in the power of the state to provide good things for the people. They finally got their hands on the levers of government - and made a shocking discovery: the state was pretty awful at delivering. Ministers were amazed at the huge variations in performance between different schools. They were staggered that the clear-up rate for a crime can be excellent in one police force and woeful in the neighbouring constabulary. They have been astonished that the same operation can cost many times more at one hospital than it does in another.
On reflection, this should not have been so surprising. For the previous 18 years, public services had been run by Tories who, in their guts, did not believe in them. The Conservatives were so busy rolling back the frontiers of the state that they did not trouble to devote much thought or energy to making the remaining public services efficient and consumer-friendly.
Had he known the mess he would inherit, perhaps Tony Blair would not have been so excessive in the boasts he used to make. 'Ten days to save the NHS!' he cried during the last election campaign. An older and wiser Mr Blair now asks for 10 years. I would estimate that the public are actually prepared to give him about two years to deliver the large improvements he pledges. Some of his colleagues are already fatalistic. 'The second term will be bloody,' one Minister close to the leadership groaned to me recently. He did not believe that what the public expect from the NHS can ever be matched by the reality.
If New Labour fails the health service, then the Prime Minister will have a lot more to worry about than Sharron Storer, the woman who exploded in his face about cancer care on the doorstep of a Birmingham hospital. There will be millions of wrathful Sharrons waiting to take their vengeance on New Labour. If those who believe in the state fail to reform public services, then those who don't will win the argument for breaking them up and selling them off.
A torrent of extra funding is beginning to flow into health, education and the police. But Mr Blair speaks from both experience and necessity when he says that 'money is not enough'. He has quietly dropped the promise he made during the influenza crisis the winter before last to bring British spending on health up to the European Union average within five years; a pledge which so infuriated his Chancellor that Gordon Brown roared at him: 'You've stolen my fucking Budget!' Unless the cash is accompanied by reform, it will be like trying to fill a bath with the plug out.
There is nothing intrinsically wrong with harnessing expertise and disciplines from the private sector for public endeavour. The vital principle is that the NHS is a service free to all at the point of delivery. That is the end that matters. Everything else is an argument about means.
What a ferocious argument that is going to be. During the Q&A which followed the manifesto launch, I suggested to Tony Blair that many people would be bitterly opposed to what he had in mind. He did not quarrel, though he declined to be drawn into my question about precisely who would hate it: not a good idea to spell that out three weeks before polling day, the Prime Minister smiled.
We can all work it out. When he says that he will not allow reform to be impeded by 'vested interest', that is a lightly coded way of saying that the Government will have to confront the unions and the professional bodies.
The tussles with lawyers and teachers during New Labour's first term will be but a skirmish compared with the struggle that will rage with health workers and police officers. The Prime Minister will send David Blunkett to take over the Home Office after the election not just because - in his own private joke - 'I will make Jack Straw look liberal'. Mr Blair has been impressed by the way in which his Education Secretary beat down the opposition of the teaching unions to performance-related pay.
The Prime Minister evidently hopes that Mr Blunkett can persuade the police to come along quietly. Good luck to him. The last politician to attempt to reform the police was Kenneth Clarke. Even that formidable bruiser retired hurt. The assault and battery inflicted on Jack Straw by the Police Federation conference will be as nothing to the reception Mr Blunkett can expect if he makes a serious attempt to tackle the antediluvian practices of the police and extract from them greater value for the taxpayers' money.
Resistance to reform within the public sector will be harsh. To my mind, the even tougher obstacle is presented by the private sector. Is it actually up to the task of providing the 'world-class' health and education that Blair promises? Where is the Government going to find oodles of brilliant managerial talent? From the board of Marks & Spencer? Among the men who made British Telecom the great success it is today? Please don't tell me Government head-hunters will be recruiting executives from Railtrack. The risk is that the business types that will be attracted to the public sector are the ones who are failures at running real companies.
Does the Prime Minister appreciate what a punch-up he is inviting? The excitement about John Prescott's rumble in Rhyl will soon fade away. When it is long forgotten, the fight to improve public services will define New Labour's second term, for good or ill. Tony Blair tells us that his is not a programme 'for a quiet life'. I suspect even he has not yet grasped just how rough a life it is going to be.
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