Editor's blog Monday 6 June 2011: PM David Cameron's fab five NHS pledges - lipstick on a pig

Today’s Daily Telegraph carries a briefing of the five pledges on the NHS that PM David Cameron is set to make in a speech tomorrow.


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They are:
- to keep waiting lists low
- maintain spending
- not to privatise the NHS
- to keep care integrated
- and to remain committed to the “national” part of the health service.

Taken together with Secretary Of State For The Time Being Andrew Lansley’s Telegraph article last week, whose final paragraph opened with the phrase “We will never privatise our NHS”, these pledges amount to the biggest failure to win the battle for public opinion on public policy since the community charge  - or as it was better-known, the poll tax.

(They also look inspired by New Labour’s 1997 pledge card, which is wildly unsurprising. If David Cameron’s Blair fetish gets any more pronounced, he’ll need to change his name by deed poll, fake-tan himself orange and win three successive general elections.)

The NHS reforms that Andrew Lansley planned (which were endorsed by both leaders of the Coalition Government’s member parties and voted for twice by almost all of both’s MPs) will today have been relaunched almost as often as the Big Society, and to correspondingly slight effect.

This would concern me if I were Mr Cameron, or indeed a Cameroon. (As a proud Burnsite factionalist, I rise serenely above such matters.) Firstly, because the PM’s whole non-political background is about presentation, and selling the case. Either he is not very good, or he consistently backs unpopular ideas.

So, what about Mr Cameron’s fab five pledges?

Keep waiting lists low - means keeping clinicians happy (which means more cash, while the DH wants to cut consultants’ Clinical Excellence Awards), and requiring the goodwill of managers – sorry, “wasteful bureaucrats”. Interesting.


Maintaining spending - already not happening due to inflation, as Professor John Appleby of the Kings Fund and the IFS have shown.

Not to privatise the NHS - it has come to quite something when this needs to be a pledge.

To keep care integrated - Fine. How? Also, it’s worth observing that care is not desperately integrated at the moment. Better IT? Ahem.

To remain committed to the ‘national’ part of NHS - In what way? The essential part of the Lansley reform plans is to accept and admit the reality that parts of the system make money go further than other parts. The national part of NHS has always existed to seek to balance this fact. It's planning, which the Bill's entire philosophy rules out.

It’s obviously exciting for the NHS to be centre-stage in the political limelight. The speech may not give us any more information that we already have, but I’ll look at it when it’s published. The high probability is that we’ll get more “we love the NHS” blah and no detail – another cliche-fest with everything but ‘God Is Love’ and ‘Please Adjust Your Dress Before Leaving’. Watch out for “no change is not an option”, around a third of the way through.

There is an old expression in advertisingland, that "you can't put lipstick on a pig". Actually, you can, but it takes a lot of work and restraint - and the pig ends up looking very silly.

But not as silly as you look doing it.

David Cameron is not a stupid man, and he will very soon realise that unless there are huge changes to the Bill, he is putting lipstick on a pig.