A consensus has formed in the commentariat that besides George Osborne’s stewardship of
the economy, Andrew Lansley’s healthcare reforms could become the government’s vote-loser. The political facts are as simple as the forms are complex.
One, David Cameron ran a campaign based on a promise to protect the NHS. Many people thought that meant from cuts and culls alike. The Health Secretary’s reforms look, whatever the truth may be, like they are going back on the PM’s promise.
Second, the reforms can only be successful if a range of stakeholders – voters, practitioners, analysts – have been brought along, and had a chance to debate the issues. What Michael Gove has done so brilliantly is to pick up a debate Tony Blair began. Nobody can today argue that the government’s school programme has not been examined. No such decade-long debate has taken place about the NHS. Nor is there even the smallest semblance of bi-partisanship on this issue.
Third, while based exclusively on an unscientific poll of my unrepresentative friends, I believe most people think the NHS is fine. This is my simple argument. Most voters are healthy and only come into contact with the NHS if they experience an emergency, when the NHS performs brilliantly. So their personal experience is one of competence. That means the argument has to be won intellectually, on facts and figures about non-emergency care, rather than on personal experiences. Much harder.
Then there is the matter of the reforms themselves. To state the obvious, they are complex and many people doubt that GPs will be able to handle additional responsibilities.
If No 10 could recast the reforms, I bet they wouldn’t hesitate, however much they profess faith in Andrew Lansley, who is said to “eat, and sleep” the NHS. Sometimes it is important not to be “for turning”; at other times discretion is the better part of valour. Barack Obama may have been right to push healthcare reforms, but may nonetheless suffer for the timing and way he did it. The same may be the case for David Cameron. At the very least, they need to be much clearer about why the reforms are needed.
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