No, Brexit Is Not A Distraction From NHS Or Housing Crises

According to John Rentoul, writing in The Independent at the weekend: “Brexit is distracting the centre of Government – No 10, the Cabinet Office and the Treasury – from attending to the pressing problems facing the country.” You can see his point. The demands exerted by negotiating a Brexit deal in Brussels that neither party wants, while fending off a Remainer-dominated parliament in London, is hardly conducive to solving big and worsening domestic problems.

He is rightly sceptical about the government’s ambitions to build the millions of houses the country needs; and who isn’t outraged that 22,800 elective operations were cancelled in England as a consequence of ‘winter pressures’? But neither is the fault of Brexit. They are just the latest instalments in a long line of policy failures that existed long before that delicious jolt to the system intruded on the banal politics that existed before 23 June 2016. Does he really think that government would have got its trowel out by now and built the 250,000 homes a year it has been promising? Or that it would have got its act together and solved the social care crisis, and in turn solved one of the underlying causes of the NHS crisis?

No, Rentoul is wrong. Brexit isn’t a distraction from more pressing matters. However big the crises of housebuilding and in the NHS – and they are as considerable as they are longstanding – Brexit, and the crisis of democracy we face if it is not implemented will be that much bigger. But if we get it right – and it is a mighty big ‘if’ given the concessions already made by the UK negotiators – and those who seek to undermine it fail in their attempts to sabotage the popular will, Brexit has the potential to genuinely transform the agenda across public policy.

Even if it is thwarted as sovereignty and independence are sacrificed in the name of maintaining a relationship with the supranational body we are supposedly trying to leave, the popular sentiment behind Brexit can’t so easily be put back in its box. Whatever happens over the coming weeks and months, it has the potential to be the catalyst for replacing the managerial target-setting that has plagued public services for decades with a culture of political contestation over competing visions of our collective future. Policy-makers, once deprived of the shelter provided to members of the EU from their respective citizenry, will become more exposed – as they should – to the pressure to act that comes from the questioning and debate generated by the public’s critical engagement with those who govern in their name.

None of this is automatic of course. The disengagement of the masses from politics in the UK has been a decades long process with its roots in the failure of past political projects of left and right. Also, the technocracy, restraint and risk-aversion that played a part in voters rejection of the elites at home and abroad and their reawakening as political subjects, continues to dominate public life. And it continues to stifle progress in building lots more houses and ensuring fewer beds are blocked, as surely as it inhibits those negotiating our exit from the EU or failing to plan for our post-Brexit future. The stasis that was with us before the summer of 2016 is still there if less seemingly immovable. It is only by truly involving the people in the policy process – an old mantra amongst policy wonks curiously absent of recent – that we can finally shift it.

First published in Huffington Post

Another Christmas of crisis for the NHS

‘Tis the season for NHS tales of woe, featuring ‘bed blockers’, diverted ambulances and long waits on trolleys in hospital corridors. That the NHS is in crisis again as winter takes hold is as inevitable as Christmas itself.

This time around the cause of the Christmas non-cheer around the NHS was triggered by the stepping down of Lord Kerslake, from his chairmanship of King’s College Hospital Trust, following a decision by NHS Improvement to put the trust into financial special measures. While the government cynically sought to blame the trust’s problems on Kerslake and his team, he argued in the Guardian that ‘fundamentally, our problems lie in the way the NHS is funded and organised’. Massive overspends, recruitment crises and crippling pressures on services are indeed commonplace across the NHS.

‘The government and its regulator’, he says, ‘are simply not facing up to the enormous challenges that the NHS is currently facing’. And this isn’t just about funding. Despite an extra £2.8 billion promised in the Budget for struggling health trusts (short of the £4 billion a year demanded by NHS chief executive, Simon Stevens), and the £350million announced in the Budget to address winter pressures (coincidentally the same amount that was plastered on the side of that Brexit bus), the problems in the NHS persist. They will not be fixed, it seems, by simply throwing more money at them.

From primary care to home care, young people’s mental health to dementia care, the system is in meltdown. The number of patients waiting in A&E for more than four hours has more than doubled in as many years. The number of ‘long-stay patients’ in hospitals has also increased, largely as a result of an absence of care provision in the community for those who are fit enough to go home. And with bed occupancy levels now approaching 95 per cent, the likelihood of yet another Christmas log-jam in NHS hospitals is increasing.

Crisis preventative measures, such as encouraging people to have the flu jab and to consult their pharmacist rather than their GP if they have a minor ailment, are reportedly having an impact. And yet the overall demand on services is still intensifying as the resources at the NHS’s disposal become more scarce. You know things are bad when an article in the British Medical Journal could — only half tongue-in-cheek — blame the ‘highly dedicated and responsive GP, Dr Brown Bear’ in the kids’ cartoon Peppa Pig for ‘fostering unrealistic expectations about family doctors’.

We need to go beyond the usual to-and-fro of NHS cheerleading on the one hand, about how much Brits ‘heart’ it, and NHS doom-mongering on the other hand, where the spectre of its imminent privatisation is constantly being raised. People like Stephen Hawking aren’t helping when they lend their name to a legal dispute against the establishment of accountable care organisations (ACOs), which they say herald the beginning of the end for ‘our NHS’, when in truth they are just institutional arrangements designed to integrate ‘silo’ services across the health and care system.

But Hawking is right that we need ‘proper public and parliamentary scrutiny, consultations and debate’ in relation to the NHS. As is Kerslake when he says: ‘We desperately need a fundamental rethink. Until then we are simply kicking the can down the road.’ Instead of obsessing over paper targets, or targeting peoples’ lifestyles and behaviour through the health system, the political class needs to engage the nation in a debate about the future of the NHS. Whether that ends in radical reform or starting all over again is open to question — but we know for sure we cannot continue with the crisis-ridden and cash-strapped status quo.

First published in sp!ked