If anyone thought Stephen Dorrell would take a break from talking about health after standing down as chairman of the House of Commons health select committee, they were quite wrong. The Spectator finds him in his Portcullis House office preparing to give a speech to the think tank Reform — his first since quitting the post — on how to make the health system better at delivering social care. He has no intention of leaving the NHS alone, even though he’s no longer leading the group of MPs whose job it is to scrutinise health policy.
But, strangely, he stumbles when asked if he’s proud of the NHS. ‘Pride is a funny thing,’ he says carefully. ‘I’m fully signed up to the principle that access should be based on need, not ability to pay. What we have to be more open to is thinking what that principle means in a society of informed consumers.’
He explains that health ‘is a partnership between the care system and individuals. It isn’t state charity; it isn’t something that’s handed out by state institutions without requiring engagement with individuals’.
He’s similarly careful when contemplating whether the government can really export the NHS brand around the world. Ministers announced that they wanted to sell the NHS brand abroad in 2012 after Danny Boyle’s opening ceremony at the Olympic Games advertised it as one of the things Brits are proudest of about their country. But in his Reform speech, Dorrell attacked this display — not because he objected to pride in the NHS, but because he was surprised anyone thought it unique to this country that a society should want its citizens to have equal access to health care.
Nevertheless, ministers think they have something sufficiently unique that other countries want to copy, and they are determined to export it. Just six months ago Ken Clarke led a trade delegation to China to sell the health service’s expertise in building hospitals, training staff and IT and management systems.
Dorrell warns that while the NHS has plenty it can sell abroad, it has a lot to learn from other countries too. ‘We have examples of very good care and we have examples of less good care,’ he says. ‘Other people have examples of less good care, and the delivery of care is a global business.’ But he can see clear areas where the UK can sell its health care brand abroad, including pharmaceuticals, biotech and medtech, as well as specific treatments and techniques such as talking therapies.
He is more concerned with the need to improve the NHS at home, with an ambitious plan to change the entire attitude of the health service so that it focuses on the care that people need throughout their lives rather than the medicine and hospital treatment that they often need when that early care has failed.
‘Quite often what we’ve got is a system that is designed around medicine and not enough on delivery of care and support,’ he says. ‘What we actually want as individuals is a care system that has medicine available when necessary, and it’s a completely different thought process.’
Whether or not this is sensible policy making, is it really advisable for a Conservative to be proposing more major changes to the NHS? Didn’t the last reorganisation cause his party so many political problems that Dorrell is suggesting something that simply cannot happen? He is no fan of the Health and Social Care Act, arguing that its architects promised far more than they could ever deliver. And he argues that his own proposals for reform might not need legislation, or at least not ‘a new blockbuster’ of a Bill.
But while he does accept that his party has been wounded by its last legislative foray on the health service, he also fears that the Tories are too pessimistic about their chances of winning the war with Labour to be the party of the NHS at the 2015 general election.
‘There are twin dangers here,’ he warns. ‘Labour sometimes falls into the trap of believing that it’s there because of what happened in 1948 and therefore they sound proprietorial, and it offends people in the health service and it offends the people for whom the health service hasn’t performed properly.
‘The Tory party sometimes is guilty of the opposite kneejerk reaction, that it can never win. Actually, I don’t think that’s true either. We have a good story to tell. It’s always said the Tory party doesn’t support the health service. If it didn’t support it, some time over the past 70-odd years when there had been a Tory government in power, presumably they would have done something about it. So in reality there isn’t a huge difference of principle between the major political parties.’
It’s clear that this former select committee chairman doesn’t feel he’s finished arguing about the NHS. But he may have a big battle on his hands before his party takes up the changes that will make him really proud of the health service.
This piece first appeared in the print edition of The Spectator magazine, dated 12 July 2014.
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