Last week the four main candidates for the north Norfolk constituency held a husting to debate the climate emergency. They quickly agreed the problem was too big for party politics: the parties should cooperate to find and implement the best national strategy. Two minutes later they were squabbling over cheap party shots. No sign of any strategy. No comment from the floor because voters are inured to this behaviour. The Supreme Court may regard the parliamentarians as the bastion of democracy but many are beginning to doubt it.
In its lumbering way, parliament does many small things well enough but when it comes to major national issues such as the climate emergency, the NHS, adult care or transport infrastructure, party game playing ensures that little or no progress is made, especially when it puts votes at risk.
The last Labour government’s constructive proposals for funding adult social care were labelled a “death tax” by the Tories and no more was heard of them. Seven years later, Theresa May’s similar proposals were branded a “dementia tax” by Labour and nearly lost her the election. The adult care green paper is over two years late and has missed so many deadlines that they have stopped issuing them: “A Department of Health and Social Care spokesperson said: ‘We will set out our plans to reform the social care system at the earliest opportunity to ensure it is sustainable for the future.’” It has probably been written but its publication is delayed perhaps for fear of the negativity it will receive.
The House of Lords Economic Affairs Committee’s July report in July called for urgency, £8bn. in additional funding (para. 41) and, importantly, consensus across political parties (para. 19). John McDonnell appeared to agree with this last point at Labour’s 2019 conference but MPs in other parties believe he was being economical with the truth; it may be just an electoral ploy. The Shadow Health and Care secretary, when approached, did not appear to indicate any willingness to cooperate and nor has the current Secretary of State.
In March 2018, almost 100 MPs “called on Theresa May to establish a cross-party commission to address the crisis in the NHS and in social care. A letter sent to the Prime Minister calls for a parliamentary commission and signatories include 21 select committee chairmen and 30 former ministers.” Given the current Parliamentary arithmetic, why should the government reject the only plausible way forward?
Norman Lamb and Lord Saatchi have long pressed for a cross-party approach to long-term strategy for the NHS. We know it is massively wasteful and, with an ageing population and above inflation costs of medicines, technology and staff, it will become unaffordable. Chucking another £20bn at the problem from time to time does nothing to address the reform it needs.
In its 70 years the NHS has been subject to only one strategic review: the Royal Commission set up by Harold Wilson in 1975. Too big, unfocussed and cumbersome it may have been but many of its recommendations are relevant today. For example, the Commission considered the NHS too big. To stop politicians meddling, it should be divided into autonomous regional public corporations and not remain part of the Department of Health. Such regions would each still be twice as large as NHS Scotland and four times larger than NHS Wales. Each would better match resources with local needs. Strange as it may seem, the 1979 Secretary of State did not agree. A pity.
The Commission and Labour opposed prescription charges. The then Health Secretary, like the current one, thought otherwise: (Hansard 1805): “When we debate the problems of the drug industry we are told that it is responsible for forcing large quantities of unnecessary drugs on patients who do not need them. When we impose a disincentive to that [prescription charges] we are told that people will be deprived of care that they need. Labour Members cannot have it both ways.”
Back in January 2018, The Guardian was the only voice raised against a new commission on the grounds that it would take too long and we already had all the answers. That non-sequitur escaped them. In any case, we need cross-party consensus so that NHS reform has continuity through changes of government. As the last Commission pointed out, political meddling is a large part of the problem. The differences between the 1975 Royal Commission and the convention we need now are speed, focus and composition. Clearly a neutral chairperson will be needed but the rest should be the same MPs who will have to enact the results – not a large club of elderly experts, however wise.
The electorate is right to demand that parliament delivers. Politicians must cooperate to do so. Luckily three of these challenges, the NHS, adult social care and transport infrastructure, are for England only: Scotland, Wales and Northern Ireland must find their own solutions.
If political parties cannot deliver on the major issues of our time, the people will demand the leadership who can. Without greater responsibility by our politicians, our democracy itself is at risk. To take a rule from the Rugby World Cup, they must use it or lose it.