WHAT is the main purpose of government? To judge by this week’s media headlines about backbench pressures on Tony Blair to oust Patricia Hewitt, the answer is perfectly clear: the first responsibility of the British Government is to manage healthcare, to finance hospitals and to pay doctors and nurses. And opinion polls show that most people in Britain share this judgment. The NHS consistently comes at the very top of voters’ concerns when pollsters ask them to name the most important issue facing the country or the government.
At first sight, this ranking makes sense. Everyone understands that good health is one of the main prerequisites for a good life. But step back from the parochial perspective of the Westminster village and the British national obsession with medical politics looks decidedly odd.
After all, there isn’t another country in Europe — or indeed the world — that expects ministers to answer for the staffing decisions of hospital administrators, the drugs prescribed by oncologists or the working hours and salaries of GPs.
Contrary to widespread expectations when the NHS was proudly created by Aneurin Bevan, not a single other country, not even in socialist Scandinavia, emulated the British example of establishing a government-run health service. Thus Britain is now the only place in the world where health secretaries are called to account in parliament for the emptying of hospital bedpans, an absurdity that Bevan himself predicted would be an unintended consequence of the nationalisation of health. While the ritual humiliation of health secretaries was just a matter of political knockabout in Parliament, it did not matter very much, but as the health budget keeps growing and the managerial problems of the NHS multiply, the whole of British politics is being distorted by the obsession with health.
Take this week’s big political stories. Are the deficits reported by some 5 per cent of the nation’s hospitals or the shock-horror stories about the sacking of a few thousand doctors and nurses really among the Blair Government’s biggest and most important failures? How are these NHS deficits a bigger indictment of government than the bungled release of almost 1,000 criminals, including numerous murders, rapists and armed robbers? Should the managerial failures of the NHS be considered more damning of the Government than the culture of complacency and incompetence at the Home Office and Probation Service, which has led to a spate of horrifying murders by lethally dangerous prisoners who were released mistakenly and without supervision on parole?
Most British politicians and commentators seem to think so. They see the management of the NHS as one of the core responsibilities of government, while the policy on releasing criminals is a relatively unimportant specialist issue. Nobody would suggest, for example, that Tony Blair’s position might in any way be threatened by the chaos in the Home Office and the near-collapse of criminal law enforcement that is widely attested and documented by lawyers, judges and police officers. By contrast, the Prime Minister’s place in history is seen as largely dependent on the success of NHS reforms.
This may seem so obvious as to be hardly worth noting, but taking another step back for perspective, this time into history, Britain’s present political priorities again start to look very odd. Consider the question I posed at the start: what is the most important responsibility of government? Throughout the 5,000 years of recorded history, if you asked any subject of any civilisation on any continent, from China to Egypt to Peru, to name the one duty which governments must fulfil above all others, you would probably get the same answer. The first responsibility of any government is to protect its subjects from unlawful killing, robbery and violence. While gross inequalities of legal treatment have provoked and justified most of the revolutions and rebellions in human history, almost nobody has ever disputed that a government’s main raison d’être was to deter and punish criminals and to try to maintain the rule of law.
What has this to do with British politics today? The Government is failing in its primary responsibility to protect its citizens by releasing hundreds or even thousands of dangerous criminals into society. But hardly anybody seems to view this as a challenge that ministers can constructively respond to, except with grovelling self-abasement that has absolutely no policy content. Meanwhile, some minor managerial problems emerge in a few hospitals and these are treated as a deadly threat not only to the Health Secretary’s future but also to the Prime Minister’s entire political programme.
But do these contrasting attitudes really represent the priorities of the British people? Perhaps they do, as the opinion polls suggest, but there may be another factor. One of the main reasons why criminal justice is no longer regarded as a serious political issue is that politicians of all parties know there is no hope of providing more funding for Home Office, probation and social services which are chronically short-staffed. It is therefore impossible for Charles Clarke or anyone else to offer a realistic promise of higher conviction rates or better monitoring of prisoners on probation. But why can there be no hope of finding sufficient resources? Because the funding of the NHS has been growing like topsy and in the years ahead, as the overall growth of public spending inevitably dwindles, the share of any increases absorbed by the NHS will be even larger than it has been in the past five years.
The NHS is becoming an incubus steadily eating away at every other responsibility of government. If the nation’s demand for healthcare keeps growing much faster than the economy — and it certainly will — voters and politicians will soon face a choice: do they want a tax-financed health system and a paralysed government or will they start paying for their healthcare and hope to get a government that works?
