Editorial Thursday 27 July 2016: Politics, comedy and the Overton Window

The Overton Window is a political theory, which holds that there is a finite range of ideas that voters will find electorally acceptable.

The range of the Overton Window is finite, but crucially, it’s not fixed. Items can move or be moved from fringe to mainstream, and vice versa. Look at Euroscepticism in the Conservative Party for a perfect example: fringe in the late 1980s; mainstream today.

Jeremy Corbyn is an opulently useless leader of the opposition and of the Labour Party, but as a far-left-winger, he is a roaring success: he has shifted the Labour Party membership’s Overton Window considerably to the left.

Even if Pontypridd challenger Owen Smith achieves the considerable task of beating Jeremy Corbyn in Labour’s leadership election, Mr Corbyn has won. Labour’s prospective policy platform under Smith will be considerably to the left of Ed Miliband’s

Which was considerably to the left of Gordon Brown’s.

Health Policy Insight readers will be aware that both Gordon Brown and Ed Miliband lost the general elections that they fought.

Time and motion
History is not destiny, of course. The legacy of insecurity from the global financial crisis, the march of tax-shy globalisation and technology replacing jobs mean that the world looks different than it did in 2010. Brexit, and its near-certain tailwind recession, mean that the world looks different than it did in 2015.

Politics has been a lot more like comedy than comedy has of late, but one rule remains true for both of these difficult, dirty and necessary trades: timing matters - a lot.

Politics is the twin brother of economics, and those of NHS funding are not looking good. The National Audit Office’s statement on the DH accounts for 2015-16 revealed what everybody expected: the DH actually bust its budget, and was saved only by a technicality on its refusal to penalise DH for its failure to report higher-than-anticipated NI revenue to the Treasury.

NAO head Amysas Morse said ”“The NHS in England remains under significant financial pressure which is demonstrated in its accounts. It has again used a range of short-term measures to manage its budgetary position, but this is not a sustainable answer to the financial problems which it faces.

"The Department and its partners need to create and implement a robust, credible and comprehensive plan to move the NHS to a more sustainable financial footing”.

This came on top of the Health Select Committee’s statement that the much-vaunted £8.5 billion is not real (as many commentators have said): ”Last year's Spending Review announced that the NHS would receive an additional £8.4 billion above inflation by 2020-21. But whilst previous spending reviews define health spending as the whole of the Department of Health's budget, the 2015 Spending review defines it in terms of NHS England's budget, which excludes, for example, spending on public health, education and training.

"Using the original definitions, and taking 2015-16 as the base year, total health spending will increase by £4.5 billion in real terms by 2021”.

Stiffing Simon Steverns
Damningly, the Health Select Committee concludes that ”“In our view, the funding announced in the Spending Review does not meet the Government’s commitment to fund the Five Year Forward View”.

Money bears down on staffing, and staffing mainly means nurses, as the recent controversy over NHS Improvement’s recommendations about staffing levels and allegations of over-recruitment showed.

HSJ patient safety maestro Shaun Lintern’s observations about being through the looking-glass is not unfair.

The evidence on which the Health Select Committee formed its view was taken pre-Brexit and while David Cameron was still Prime Minister, of course.

Theresa May is now Prime Minister. We do not yet know her attitude, or that of new Chancellor Philip Hammond, to increasing plans for public spending in the Autumn Statement.

In NHS politics, the top-team tribulations of Cameron Obscura and May-day mean things for NHS Commissioning Board chief executive Simon Stevens, and thus for the wider NHS.

Cameron had personally lobbied Stevens to take the job (he did love a Blairite), and that plus general post-Lansley trauma over NHS stuff dealt Simon Stevens a good (if not whip) hand.

The Stevens Ask and the Overton Window
While Cameron was still PM, Simon Stevens probably had a decent chance of success in doing the Oliver Twist – ‘please, sir, may I have some more?’ – at the right moment.

Timing, you see.

The right moment for the Stevens Ask probably looked like the 2017 Autumn Statement, because absolutely nobody with the slightest Scooby about NHS finances believes the NHS budgets set for 2018-19 and 2019-20 are doable.

Worrying reports are emerging that the Treasury is a Scooby-free zone on this issue.

Only one person knows whether Simon Stevens has any credit in the political bank with Theresa May, and that’s Theresa May.

But Simon Stevens won’t be failing to think about the Overton Window, and about politics, and about comedy, and about timing.