This article appeared in Ceylon Today on Thursday October 20 2016 where it was given the title Saviour or Serpent.
Tony Blair has announced that he may return to British politics. This is somewhat surprising considering the universal loathing that is today felt for the man following the repercussions of the ill-advised invasion of Iraq in 2003 and his more recent sordid quest for riches, a quest which has led him to consort with many dodgy dictators.
An examination of Blair’s rule may be enlightening for those masochistic Sri Lankans who believe that this island nation’s polity is supreme in its incompetence, inefficiency and corruption and its politicians unrivalled in their practice of the dark arts of Machiavellian manipulation.
I for one have not forgotten the euphoria which greeted Blair’s election. On the bright morning of 2 May 1997, I wandered down to the Imperial War Museum. A complete stranger, a very tall man conducting a poll for MORI, embraced me, shouting “Isn’t it great”. I was as enthralled as he was. I even got a job with MORI. This was like a new dawn after 18 years of Tory rule. Blair introduced the longest-lasting non-Tory government since 1762.
In 2006, when Blair made his final speech to a Labour Party conference, a MORI poll put the public’s ‘satisfaction’ rating of Blair at 20 per cent, lower than Thatcher on the eve of her fall. There had been a time during Blair’s premiership when approval ratings surged to levels of surpassing those conjured up in totalitarian regimes.
I voted for Labour in that 1997 election and felt that I had personally achieved something. Many of us were drunk with joy. It was a sobering experience to walk around the Imperial War Museum and to see the remembrance of so many lost lives. My grandfather had fought in the First World War. I wonder if my father’s experience in the Second World War had truncated his life so cruelly. Little did I suspect on that morning at the museum that Blair would be complicit in so many needless deaths.
Dawn and Disillusion
Professor Anthony King described the Labour landslide, as being akin to “an asteroid hitting the planet and destroying practically all life on Earth”. Blair entered Downing Street on a wave of optimism and good will, promising to restore trust in politics and breathe new life into Britain’s tired institutions.
Much of the reason for the voters’ distaste for the Major administration was because of what became known as the “sleaze factor”. There was what seemed like an endless succession of sex scandals. It was later revealed that boring old Major himself had had a four-year affair with health minister Edwina Currie. During Blair’s stewardship sleaze continued and the tired institutions continued to languish.
“Our mission will be the renewal of our public services. There is nothing more important to making Britain a fairer and stronger country.” Did he succeed?
I was working as a management consultant in the NHS when Conservative Health Secretary Kenneth Clarke introduced his “reforms”. The “internal market” introduced in 1991 split health authorities (which commission care for their local population) from hospital trusts (which compete to provide care). GP fundholding gave some family doctors budgets to buy care on their patients’ behalf.
Critics saw this as creeping privatisation but Clarke claimed that his reforms prevented Margaret Thatcher from abandoning the NHS. Nevertheless, he brought in many people from the business world and the giant accountancy firms. My boss was the redoubtable Sheila Masters (now Baroness Noakes), a foul-mouthed gorgon imported from Peat-Marwick. Trade journal Accountancy Age described her as “the country’s most high profile accountant”. I had a report published by HM Stationery Office which showed that the reforms seemed to require an army of accountants and managers to implement them. Doctors and nurses felt that money that should be going towards patient care was being wasted on management.
Old Structures, New Labour Words
The Labour victory encouraged hope that the internal market would be abandoned. However, the key element, the purchaser/provider split – was retained, but, typical of New Labour, words were spun: purchasing became commissioning; contracts became service agreements. GP Fundholders became Primary Care Trusts. Hospital Trusts were allowed to continue.
The public and NHS staff had high expectations that things would improve quickly. When that did not happen there was anger and despair. Blair’s first Health Secretary was Frank Dobson (his successors were Alan Milburn, John Reid, Patricia Hewitt and Alan Johnson). Dobson was allowed to stay in such a high profile job, for which he was poorly qualified, as a sop to old Labour. In those early days, the spin meisters were careful to avoid words like “competition” and “choice”. which might alienate any socialists still lurking in the party, preferring to stick with the vague concept of “modernisation”.
Dobson was eventually forced to become Labour’s candidate for Mayor of London and was replaced at Health by Alan Milburn, an old Trot who became converted to the market in health and today makes a good living from private health care. Initially, Milburn called for extra money to resolve the NHS crisis, but rejected using the private sector. “That”, Milburn declared, “would be a Trojan horse for privatisation.” Later, he resurrected competition and advocated reintroducing the Tories’ internal market. Blair did not understand Milburn’s reorganisation.
The government persisted with PFI (Private Finance Initiative) as a method of financing building in the NHS and other public services despite repeated demonstrations of its costliness and other disadvantages.
Civil servants did not dare mention their foreboding. Milburn’s successor Patricia Hewitt knew that Blair “did not do detail”, but she was unprepared for quite how patchy his knowledge was.
Nigel Crisp was appointed as Chief Executive of the NHS and Permanent Secretary at the Department of Health on 1 November 2000. He was the only person so far to combine these posts. Blair was described as “muddleheaded” – he could not describe a coherent and complete model of what he wanted to achieve. So he could not explicitly tell Nigel Crisp what to do.
Expensive Poor Outcomes
By 2005, the NHS was costing £43 billion a year more than in 1997. The country’s health had improved but, in terms of the number of doctors, the use of technical equipment, the number of patients being treated and the cure rates for cancer and heart disease, Britain still ranked near the bottom of the international league tables. Compared to other European countries, Britain’s premature death rates were higher and clinical outcomes worse. The government was embarrassed when Robert Winston, IVF pioneer, medical doctor, scientist, television presenter, said: “We gave categorical promises that we would abolish the internal market. We have not done that. Our reorganisation of the health service was . . . very bad. We have made medical care deeply unsatisfactory for a lot of people.” Funding, he said, was “not as good as Poland’s”. Note that he said “we”. Winston was a staunch believer in New Labour, a Labour peer and the chair of the Lords’ select committee on science and technology. His This Is Your Life on TV had featured a guest of honour appearance by Tony Blair. At the 2006 BMA conference, not only the nurses but also the doctors damned Labour for causing “a real and imminent danger to the NHS”.
Hyperactive Lack of Substance
The incoming government had made a pledge to stick with Conservative spending plans and not raise income tax levels. Even when large amounts of money were promised, Chancellor Gordon Brown refused to release them because of his feud with Blair. There is no space here to go into the detail of the new government’s twists and turns and changes of mind about what to do about the NHS. There was a plethora of new initiatives, the government appearing hyperactive, unable to allow one new scheme to settle down and produce some results before introducing a new one.
The triumph of style over substance, lack of concentration, poor management of human resources and avoidance of confrontation is common to Blair’s approach to all the major issues that he had intended to tackle. The war between Blair and Brown cast a gloomy cloud over the entire Blair premiership. More on that next week.