For the last couple of days I have been trying to unravel my main worry about the NHS long term plan. This stems from the fact that the NHS – within the present constitution – has been encouraged to frame its own plan with very little intervention from politics and politicians. Consequently there will be little opportunity for politics and politicians to be part of the argument with the public about its content.
Today I’m trying to close that circle with a reflection on today’s big politics – the politics of Brexit. I promise that next week that I will return to the NHS bubble to talk about what the plan might achieve internally.
One of the most powerful interventions in the referendum campaign came in a public meeting when a pro-remain speaker, talking about the fall in GDP that was likely if we left the EU, was heckled by a pro-leave member of the audience. She said, “It’s your GDP not mine that will go down”.
This struck me as one of the most erudite political interventions of the last few decades. Of course, as any economic text book will tell us, GDP means the whole country’s Gross Domestic Product. Statistically it’s the sum of everyone’s annual wealth in the country.
However for that heckler (and, as it turned out in the vote, millions of others) their alienation from the national economy was such that they didn’t see how it related to their real personal economy. So you can say that GDP will go up or down by 1, 2 or 4% a year. That’s all very interesting for you. But I’m poor and will likely be a bit poorer whatever happens. That’s my GDP.
This reflected the powerful experience of millions of people and demonstrated a profound alienation from things that we all (including me) talk about as if they are inclusive.
Those inclusive sentences we use that we think embrace everyone? In real terms – in real lives – they don’t include, they exclude.
The whole political experience of the ‘left behind’ is key to understanding the Brexit vote and has become a motif for understanding everything. I personally have been involved in what I felt was inclusive politics for most of my life – trying to ensure that excluded groups were included. And for many millions of people that had failed – quite catastrophically.
So here we are in one of many weeks of maximum Brexit and it’s also the week after the publication of the NHS long-term plan. How is the frame for the plan different because of the experience of the millions of Brexit voters left behind?
For the last decade most politicians of all parties have used the collective possessive adjective ‘our’ before the NHS. It’s a good political word as it seems to include both speaker and listener in ownership. What we are talking about is something for which we are jointly responsible. It’s a good phrase and echoes the way in which many members of the public feel about the NHS
(OK I’m sure there are many within the NHS that have come to wince at what they feel is a political subterfuge – but there are many worse uses of language than this!)
The point of my heading is that using ‘our’ will work very well so long as there is no contention about what comes out of the NHS long-term plan. It will remain OUR plan for as long as we all agree about everything. However the moment that there is contention and disagreement – how powerful will the plan be in holding everything together as the way forward?
I say this because the NHS will use this plan as shorthand for an argument.
Honestly, look at most STP plans and somewhere in the first page will be the phrase – “Following the Five Year Forward View we will do x or y or z”. Having the five year forward view (and now having the NHS long-term plan) means that you don’t have to go back to arguments or first principles. All you have to do is say that long-term plan (already referred to in the NHS as the LTP) argues for this and that sort of ‘wins’ the argument.
But it doesn’t.
It only wins the argument if, over the next few months, there is a constant and powerful argument going on that is being made to persuade the public to what is a new policy for their NHS.
I am worried about that not happening in Surrey. But in terms of Brexit I am much more worried about that not happening in Wolverhampton, Stoke and Hartlepool.
Reading the plan it probably has a lot more to say about reducing health and healthcare inequalities than any previous plan. Its content would – if implemented – reduce the very bad inequalities experienced by those living in those towns and cities.
But unless the effort is put in to make the case with people living in those cities – in their terms – in their language – the plan is not ‘our’ NHS plan. Those who are, and have been, left behind will not feel ownership and will not play a big role in the process of relationship building that the NHS – more than any other English institution – needs them to.
I know this is asking a lot of the NHS but it does have a different significance to the public than most other institutions and needs to play a big role in making sure people are not left behind (or feel left behind).
I can imagine NHS leaders saying that it’s not fair to expect them to carry out that task. And of course it would be wrong to expect the NHS to do it on its own.
But that responsibility comes as a consequence of the fact that the NHS long-term plan is the only major domestic spending increase of public money for the past and the future few years. If we don’t use this money to plan in a very different way to start healing the relationship with those who feel left behind, we will just put it off for another few years and compound the problems of alienation in society.