Friday, March 16, 2012

We need more than this two-way choice

There is plenty of concern about the NHS. What there isn't going to be, necessarily, is very much protest. This could be for a few reasons. Mass rallies lost credibility for many after they were ignored in our government's determination to invade Iraq. Second, the appeal of going down to London to be kettled for the day is limited, is a headcount on the Strand really so much more pursuasive than a tally of retweets? Third, it might be that the most angry are the least able to march. But beyond all of that, there's also the lack of really compelling alternatives to the path we're taking. We can shout all we like, but I'm struggling to spot other policies waiting in the wings. 

Labour finally got associated with a coherent message with #dropthebill and the risk register work has gradually developed into wide consternation, not least amongst groups who were probably involved in providing evidence for it. And there's no doubt that huge amounts of committed people are campaigning hard and effectively. What doesn't seem clear to me is what would happen if the bill did get dropped. I've had glimpses of the work NHS staff have put in to prepare for what they have seen as the inevitable. They've gritted their teeth and worked through years of uncertainty, which would be considerably extended if the bill was dropped, especially if we had yet more limbo period to thrash out what was going to happen next. Many of the changes so far (if you take out the cuts, which you really shouldn't) are structural and I've seen good arguments put forward that local authorities are the right place for their teams. But if it came to an election, voters would need to be reassured that Labour's policy wouldn't be the same with a slightly different colour. There was little to suggest a different course under the previous government. Yes, Stoke has benefited hugely from health centres and hospitals which are just being completed now, but many were funded under PFI initiatives which enriched the private sector by turning a lot of taxpayer money into profit and calling it debt. Super-rich company directors don't build hospitals; construction workers, engineers and associated trades do. Call me a radical, but would it be so bizarre to just collect taxes to pay for hospitals and then hire those people directly?

If I was casting round for an idea that was better than asking the Queen for help, I'd look back to the people who won power all those decades ago and managed to get the NHS created in the first place. What can we learn from them? We take the NHS for granted and it's probably fair to say that the people who aren't angry or worried aren't imagining a Britain without it. The politicians of my lifetime, at least the ones who have hung onto power, have often been apologetic about the presence of a cradle-to-grave health service, at times treating its recipients like spongers rather than deserving citizens. Where is the party standing proud and saying that the NHS, as it was originally imagined not after years of fragmentation and reorganisation, is just what we still need? Why have we been allowing departments to become so stressed and stretched that people die or get treated inhumanely? What is wrong with us that we can't see the problem in declaring people fit to work while they are receiving chemotherapy? When did we stop seeing that one very good reason for funding people through university is that, statistically, better educated people are healthier? Where are the leaders reminding us that we are a country that fights side-by-side together in peace as well as wartime? (Sidenote: they are in some places, like the Tolpuddle Festival, but that doesn't flow well with heartfelt rhetoric of this post)

A lifetime NHS which links up with everything else and treats people like responsible citizens is the only way to chip away at our timebombs. Public health officials can be heard speaking out to say that exercise is one of the greatest tools we have to prevent expensive ill health. Yet exercise programmes are often still funded without too much fanfare because media departments are worried about the headlines and politicians are too frightened of newspapers whose commercial interest is in keeping us all in fearful, passive consumption. The NHS has done an amazing thing in lengthening people's lives, but we have a way to go to make sure that everyone's old age is dignified and full of joy. As a taxpayer I object every time anyone suggests that we want to see some sort of retribution meted out upon people who had the bad manners to call upon the help of the state. A trusting, caring society with good systems of accountability does not need to constantly worry whether others are fiddling the system, but it seems our distrust is filtering from the top all the way down.

Healthcare is not just the responsibility of the NHS or just national government, but local government too. It's a whole infrastructure of different services that connect together and if they are all made fragile through cuts there is the prospect of the whole lot collapsing. The common thread is that they are supposed to be within the remit of the people we vote for. Without bold politicians in amongst their parties and their communities listening, getting stuck in and debating every view and putting more people onto platforms until the different figureheads look and sound even a little bit different to each other, our movement has a limited choice: fight in ways we don't really believe will work, or stay quiet. We need to start talking, planning and imagining what the future could look like. 

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