Sunday December 31, 2006
The sight of Hazel Blears standing on a picket line outside a Salford hospital seemed a traditional scene from the last days of a Labour government. From 1929 to 1974, radical politicians would come to power determined to make the lives of the majority a little bit better. Invariably, there would be a run on the pound and a crisis of confidence and, far from strengthening the welfare state, Labour Prime Ministers would order huge reductions in public spending, as Ramsay MacDonald did in 1931, or a cut in the free treatments offered by the NHS, as Clement Attlee did in 1951, or the imposition of an austerity package drawn up by the International Monetary Fund, as James Callaghan did in 1976.
After all these crises, you saw the same sad spectacle we saw this Christmas: Labour MPs protesting against what their own government was doing to their constituents.
Except that this time we have a Labour government like no other. The pound is strong. Capital is flowing into Britain. Far from presiding over the slashing of benefits and public expenditure, the 1997 Labour government has poured money into the public services. For all that, Ms Blears is still reliving her left-wing youth by protesting against ‘the cuts’ on picket lines and only holding herself back from a chant of ‘Maggie, Maggie, Maggie, out, out, out!’ by the thought that Maggie has been out and Tony has been in for some time now.
Because the troubles of the public sector come after a Labour government that has been an economic success, they are far more serious than the failures of the 20th century. If you are over 30 and on the left, think back to your youth. In the early Nineties, you would have said the answer to the problems of the NHS was more money and ought now to be thankful that Labour has done what you wanted and delivered it. I suspect you are not brimming over with gratitude because wards are being closed and all but the most purblind defenders of the public sector are admitting that vast increases in spending have failed to bring commensurate improvements in services. This time around, no one can blame the City or foreign exchange dealers for the frustration of Labour’s plans. The guilty parties are less comfortable culprits.
For instance, it feels almost blasphemous to criticise doctors. With the decline of religion, they have replaced the clergy as confessors and comforters. The media still treat them as the protectors of the NHS’s soul, even though the money they are sucking out of the service has put at risk the future of health care free at the point of delivery. British GPs are now the best paid in Europe. Their average annual income is £106,000, while a few are making £250,000.
As ‘Dr Crippen’, the anonymous author of the NHS Blog Doctor site, put it: ‘The really high-achieving entrepreneurial GPs do not waste time seeing patients. They employ others to do that… the extra money has been earned by hitting government targets [which] have little to do with health care, but a lot to do with “process” and bogus but quantifiable “healthcare achievements”.’
The Department of Health’s blundering has overpaid GPs by £300m a year, about half the current deficit of the NHS. A scandal? Not if you read a medical press that defends the phenomenal rise of GPs’ salaries as furiously as the Daily Telegraph defends Goldman Sachs bonuses. When Nicholas Timmins of the FT wrote a mild piece for the British Medical Journal that politely asked whether GPs deserved their pay rise, furious correspondents thundered that CEOs got huge salaries, so why shouldn’t they.
There are many replies – if it is wrong for fat cat managers, it is wrong for GPs being the most obvious. But the wider argument is that the NHS cannot survive if the public comes to believe that increases in funding will be pocketed by professionals who give little in return. If GPs were offering home visits and Sunday surgeries, taxpayers might be happy to fund Europe’s most expensive doctors, but they will not put up with money for nothing indefinitely.
New Labour deserves a lot of the blame, of course. It has failed to manage medical wage inflation, even though it has created a NHS that has more managers than medical consultants, then added legions of management consultants to advise the managers.
The waste of public money brought by management consultants running riot in the public sector has been documented many times. David Craig, a consultant turned whistleblower, estimates in Plundering the Public Sector that £70bn has gone down the drain. What isn’t usually pointed out is that the supplanting of the old Civil Service by McKinsey, Accenture and all the other experts in clocking up billable hours didn’t initially appear as great a capitulation to corporate snake-oil salesmen as it now seems. The left of the mid-Nineties was suspicious of civil servants who had known only Conservative governments and bringing in outsiders initially seemed like a way of shaking up a bureaucracy dominated by Tory attitudes.
As it is, I suspect that it is leftish attitudes to other people’s money which must change if the Conservative revival is to be stopped. Too many on the liberal-left, including me, don’t feel in our bones that it is as wrong for the state to take billions of pounds from taxpayers and waste them on, say, the fatally overambitious National Health Service IT project as it is for the owners of Farepak to take the Christmas savings of thousands of poor families and throw them away.
The failure to be angry about the fleecing of taxpayers who earn far less than either management consultants or medical consultants presents the Conservatives with an opening. For successful arguments don’t always come from confrontational politicians. Sleek public-school boys with smooth manners and appeasing smiles can also win the battle of ideas.
They can now sigh and murmur that they understand perfectly why voters once believed that putting more money into public services was a good idea, but – let’s face facts – Labour tried it, it proved a terrible waste and it didn’t work.