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The ten year old article that's shaping the Government's NHS policy

by Paul Goodman

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Screen shot 2011-06-28 at 11.07.18 I'm very slow to clear out old books, and one caught my eye last weekend.  Wedged almost out of sight on my Wycombe bookcase was a volume called "The Blue Book on Health (radical thinking on the future of the NHS)", edited by Edward Vaizey, now a Minister in two departments.  A memory tugged at my elbow and wouldn't let me rest.  I hauled the book out of the shelves.  There at the very front of the collection of essays which make up the book, published the year after William Hague's 2001 election defeat, is one by the Government's Director of Strategy, Andrew Cooper.

Cooper is sometimes painted as a polling automaton, mechanically following the results of his survey wherever they lead - whether on crime, immigration...or healthcare.  And his article, titled "Trust in health", was clearly informed by polling.  But it it isn't simply an crunching of numbers: Cooper has views.  Vaizey summed them up in his introduction.  "Just as he showed in A Blue Tomorrow, unless we are fiercely honest with ourselves about how the public see the Conservative approach to the NHS, we will risk squandering our opportunity...One of the main reasons that we lost power in 1997 was because the public did not trust us on key issues such as health and education."

The four-point thrust of the argument of the man who's now Director of Strategy is as follows:

  • In Opposition, Labour lied "riotously" about the Conservatives' NHS record. They "deliberately created the myth of a Tory government that was viciously cutting health funding and trying to privatise the NHS by stealth".
  • But in Government, Labour had failed to improve the NHS.  "If...the obvious problems in the NHS were caused by under-funding and lack of political commitment, Labour was plainly the antidote to both.  Yet nothing happened.  Improvements did not follow.
  • None the less, the party wasn't regaining trust on health... "Liam Fox...was right to point out to the Party's 2001 annual conference that Labour merely "got the benefit of the doubt".  He was wrong to go on flatly to assert that "they won't get it next time".  It is dangerous, and unfounded, complacency."
  • ...Because it had not yet got "permission to be heard" on the matter.  "The Conservtive Party does not, in marketing parlance, have permission currerntly to talk about how bad things are in the health service...We also have no business impugning Labour's motives."

If I go on to say that Cooper's proposed solutions to this problem were rather flimsy, this is perhaps because weakness in them follows from his argument.  If you don't have "permission to be heard" from voters, after all, it follows that nothing you can do is likely to make much of a difference to their view.  Cooper floated admitting "where and how we went wrong" (although he also wrote that such honesty "does not necessarily mean that past Conservative Governments were wrong to do the things they did"), "not overstate the extent of crisis", not "undermine or outstrip" Labour spending, and supported a "cheque-stub audit" of the NHS.

But whether you agree with Cooper's view or not - and I believe that his analysis was essentially correct - what's striking is the way in which an ageing essay in a now obscure book penned almost a decade ago maps out the thrust of NHS policy since Cameron won the Conservative leadership in 2005.

  • The new Conservative leader dropped the "Patients Passport" proposal that had featured in the 2005 election manifeso, thus fulfilling Cooper's advice that "Conservatives should not overstate...the readiness of the British people to countenance very radical plans for reform.
  • He put the NHS centre-stage of his first speech as Party leader, emphasising that his three priorities were "NHS, NHS, NHS" - thereby aiming, in a major decontamination exercise, to achieve the "honest, proportionate, decent and likeable" politics that Cooper had lauded.
  • He went into the election with a rhetoric of continuity and a policy of radicalism.  This was puzzling, but Cameron either had his eye off the ball or presumed Lansley had squared the interest groups, or both.

As I say, Cooper's polling was important and Osborne's intervention crucial, but if one had simply first read Cooper's 2002 essay, and then guessed what it would mean if implemented almost a decade later, one would end up much where the Government is now.  Or, rather, with a pre-election Conservative policy of doing almost nothing by way of NHS market reform, other than allowing GPs to start taking over from PCTs where they want to, as has already happened in Cumbria, West London and elsewhere.  If Cooper had been Director of Strategy before last May, I suspect this is what policy would have been in the first place.

On healthcare, it's striking how consistent he's been during three Tory terms on opposition.  On immigration, Iain Martin wrote recently that he "has recently become messianic on the subject, telling colleagues in recent weeks that the Government’s failure to reduce the numbers of immigrants flocking to Britain will badly damage Cameron’s reputation."

If I find an early essay on the subject by Cooper, I'll be sure to let you know.


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