Buckle up NHS! The broader NHS politics of the next decade just got a lot rougher.

To give you all a few extra minutes in bed, regular readers will recall that I read the Daily Telegraph’s opinion pieces for you every morning. For the last few months, they have been raging about the deterioration of what they see as ‘their’ country. And they see it getting worse and worse.

The NHS is often seen as a signal of this decline. It has now become a cause.

Last week Allison Pearson wrote a comment piece headlined with “The NHS is killing us – it is an enemy of Britain.

A headline like that sort of gives you the drift of the argument straightaway. The main point of today’s post is that whilst many readers may be shocked by the idea that the NHS is “an enemy of Britain”, they (and all of us) need to get used to hearing it.  Over the next decade, this is going to be the tenor of some of the political debate about the nature and the future of the NHS.

It will be ugly, and much of it will be extreme. And much as most of you will want to ignore it and let such extremists get on with rowing amongst themselves, my strong advice is to get used to this form of discourse.

I am afraid that if you want an NHS to be there at the end of the decade, you won’t be able to ignore this.

I am not suggesting that everyone should start writing shocked letters to the Telegraph. But you do need to be aware that this line of argument has started and will rage (and I do mean rage) over the next decade.

And it won’t be defeated by tut-tutting about the extremes of emotion and language involved. That language and emotion will become a normal part of the discourse swirling around us.

So it’s worth paying attention to how the argument is framed. And at whom it is aimed.

First it tackles big emotions – front and centre. I don’t want to speak for you, but I see a lot of evidence that the NHS saves lives. So she says it kills people. My experience of the NHS has been as a friend for Britain – she believes it is an enemy. And the word ‘enemy’ to the patriotic Telegraph has a very precise meaning. Enemies want to destroy our country.

Appreciate the boldness of this.

As she continues,

“The NHS is enemy of the British people, not our friend. That is a very hard thing to accept I know because it goes against everything we have been taught”

And here note the word ‘taught’. At the moment behind every far-right argument lies a belief that we – decent British people – have been misled and duped. Usually by a clever liberal elite. And in the case of the NHS that liberal elite has taught us that the NHS is a friend. But we all know that really they have just conned us – as teachers (elites) do.

“The NHS is now in such a state of collapse, so chronically kaput, that it is actually killing people. Men, women and children who should be alive today are dead because they were born British. Lost forever to their loved ones because Britain has a health service with some of the worst outcomes of the developed world.”

Again, tackling our emotions head on. You lot think that this health service looks after the people of our country, and we are lucky to have it. In fact, it kills us, and we are very unlucky to have it.

“Being born British should not be a death sentence in any circumstances. As long as we go on believing in the NHS it will.”

Again, as we link the nation to the NHS, we are clutching to our collective bosom an institution that is killing our citizens.

Some wider politics of this. By and large for much more than a century the Telegraph has supported the Conservative Party. But for much of my last 9 months of daily reading it has spent most of its effort attacking an existing Conservative Government. When, in this year’s budget, a Conservative Chancellor said that the NHS was the biggest reason that people were proud to be British, it pushed them a bit over the edge.

Their difference with the Conservative Chancellor is detailed in this argument,

“When Jeremy Hunt used his budget speech in March to claim that the health service is “the biggest reason most of us are proud to be British” many people watching at home cried – “You what?”

A political line is being drawn here which sets itself not just against the NHS but against where the current Conservative Government stands.

The politics here rolls forward to beyond the next election. It’s engaging in a fight over what the post-election Conservative Party will stand for.

Will it believe that the NHS is “the biggest reason most of us are proud to be British”?

Or will it believe that the NHS is killing us it is the enemy of Britain?

It’s quite difficult to see how it can believe in both of these propositions at the same time. Let’s roll forward history for a moment, and in doing so the second argument wins.

In a previous post I  quoted one of her fellow Telegraph contributors outlining how they will develop a case for a referendum on the NHS.

If there is a referendum on the future of the NHS it will not be settled by facts and figures – just as the one in 2016 on leaving the EU it will be settled by emotions that talk to experience.

What will settle any referendum on the future of the NHS will be the emotions that succeed in talking to people’s experience of how the NHS as a health service actually delivers health care.

Surrounding the rhetoric of this argument are real current experiences that people have had of the real current health service. For many people that is not a good one. I don’t think it currently draws many people to the conclusion that the NHS is killing people, but the experience of pain and distress for a lot of people is not a positive one.

Let’s pretend that in 2030 there is a referendum on the future of the NHS. If the overwhelming actual experience of the NHS is a bad one, these extreme emotions will speak to those majority bad experiences. If that’s the case I think the far-right argument has a chance of winning. (remember they only need 50% plus 1)

If, on the other hand, over the next five years or so the NHS creates many more good experiences, then progressive emotions about the NHS will attach to those experiences and we will win.

Some of us arguing for reform of the NHS use the phrase that the NHS needs to “reform or die”.

When we say it, this is what we mean.