In the classic film Butch Cassidy and the Sundance Kid, during one of many brilliant exchanges, Sundance refuses to make a perilous jump from a cliff into a rapidly running river below. His reason for not wanting to do so is that he can’t swim. “Are you crazy?” says Butch, “The fall will probably kill you”. So they jump and survive the fall, only to be swept along, pulling each other under in the treacherous current.
This isn’t a perfect analogy for what’s happened to the government and the Health Bill. For a start, Andrew Lansley is no Paul Newman, and Calamity Clegg sure ain’t Robert Redford. But diving in and hoping the fall won’t kill them is pretty much what the government is doing by passing the Health and Social Care Bill.
Politicians and the people they interact with on a daily basis, the advisors, Whitehall civil servants and political journalists, exist in a world where passing a law is the end of the process. Having forced this shoddy square-peg piece of legislation through the arcane round hole of the parliamentary process, Tories and Lib Dems are now discreetly congratulating each other on their survival and ultimate success. They and their Bill have survived the fall.
But once it became clear that the Lib Dems were going to back the Bill’s passage, it was never going to be the fall that killed them. But they aren’t out of the river yet.
The public aren’t particularly politically engaged. They don’t like the Bill according to the opinion polls, but the effect of the shake-up to services is largely yet to be felt, as is its long term political impact. What it has done is set the context for everything that goes wrong in the NHS from here on in.
There will be human interest stories aplenty. People suffering worsening care out there are ready to be written about every single day, and every one of them will have an added political dimension thanks to this Bill. If I were a political editor, I’d have a journalist permanently camped out in A and E, Oncology and Paediatrics departments in Whitney Community Hospital, Royal Hallamshire Hospital and Addenbrookes Hospital.
Maybe they won’t need to. Passing the Bill won’t change doctors, nurses, lab technicians, porters, ambulance drivers and everyone who works in the NHS. They won’t lose sight of what brought them to the caring professions in the first place. But passing it won’t change their minds either. They will be placed under greater strain, with fewer resources and changes they disagree with to implement on top of the cuts to be made. Given the vast opposition to the Bill from health professionals, they won’t lie down and be beaten just because the government think they’ve won. They will be gathering evidence and continuing to campaign – some even standing in strategically placed seats against Lib Dems.
It is easy in government to lose touch with the everyday experiences of people and to believe that enacting legislation – or even consulting on change – is the same as actually changing something. But it’s not. It will be the real experience of people of the next few years that will determine how people feel about what the government have dome to the NHS. That feeling will not be handed down by government, but understood in GP waiting rooms, the agonising pain of long and growing surgical lists, the postcode lottery and the tales told by the nurse you know from the pub or the radiographer you chat to at Zumba class.
Outside of Westminster, government actions and their effect on the ground are what parties are judged by. Plenty of bad legislation has been passed in Parliament and come to be a millstone around the necks of those who celebrated the night of its passage. From Section 28 and the Poll Tax to the 10p tax rate, those in the Westminster bubble would do well to save their breath rather than sigh with relief. They may not have been killed by the fall, but there’s still every chance they will sink, not swim, in the months ahead. Slowly drowning may take longer, but it’s just as deadly.
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