Before the NHS can be opened up to the market, popular support must be undermined. This is problematic as the defence of established ways naturally appeals to the conservative temperament. To get conservatives on board, the ideological focus initially shifts towards external threats. In other words, the NHS is being battered by forces beyond its control, so we must change it to save it. These external threats include genuine secular trends, such as advances in medical science and demographic change, but with a relentlessly negative spin (too costly, too old). Other threats include the staple of all things "foreign", from incompetent locum doctors to "health tourists". Even government reform is shamelessly held up as a threat, as politicians decry the destabilising effect of yet another restructure before proposing their own bureaucratic cure.
As pessimism becomes entrenched, the narrative gradually shifts towards the claim that the NHS is intrinsically incompetent. A major trope is the idea that hospitals are a danger to our health. Popular anxiety has been fuelled both by legitimate concerns, such as infections and neglect, and by the irresponsible indulgence of quackery, which has an interest in promoting the risks of conventional treatments under the cover of "choice". When the language shifts up another gear, to imply that the NHS is comprehensively rotten (a culture based on the "normalisation of cruelty"), then you know we are fast approaching the end-game. This has been reinforced this week by Jeremy Hunt explicitly claiming that hospitals are "failing" and that they have "betrayed" patients. The rhetorical equivalence of the hospital and the charnel house can't be far off.
The Health Secretary's proposals in response to the Francis report include the usual managerialist mechanisms of ratings and sanctions. These will institutionalise failure as a feature of the health service, much as the same mechanisms have already done in education. Just as "failing" schools have been handed over to the private sector, so failing hospitals will be handed over to private providers. Health care staff are to be inspected as vigilantly as teachers, while professional status is to be eroded at the bottom end of the pay scale. Nurses are to be obliged to spend a year learning how to care (i.e. wash patients and change bedpans), though this appears to be considered unnecessary for doctors and hospital managers. Given that there will be no extra money, this could mean nurses displacing cheaper ancillary workers, leading to either lower wages or fewer staff. In tone, this sounds punitive: teach nurses their place in the class hierarchy of health.
Compare and contrast with the revelation that job centre staff are expected to meet targets for benefit sanctions, and that offices are being judged in league tables, with underachievers threatened with "performance management". Ian Duncan Smith has sought to deny that this is departmental policy, as it clearly shows that failure (i.e. the sanctioning of a set number of claimants) is being deliberately engineered. He doesn't appear to be trying too hard, and I don't get the feeling that Liam Byrne, his Labour shadow and fellow workfare enthusiast, is really as appalled as he claims to be. Before long, we'll simply accept that the arbitrary decimation of benefits is a necessary discipline for the jobless. Having it decided by the drawing of lots will probably be advocated as fairer.
It has been an interesting couple of weeks for Jeremy Hunt. Last Tuesday came the news that the three main political parties had agreed a deal to set up a new independent press watchdog. This brought to a close the political strand of the phone-hacking affair, which blew up on Hunt's watch as Culture and Media Secretary just as he was trying to facilitate News Corp's takeover of BSkyB. It is widely recognised that both the Leveson inquiry and the subsequent political response failed to address the key issue, namely the concentration of media power in the hands of Rupert Murdoch and a few other rich men. Alan Rusbridger, the editor of the Guardian, has produced many bland words advocating reasoned compromise between press and politicians over the issue of regulation, but even he couldn't avoid admitting the stark truth: "The most powerful newspaper group in the country was – on the kindest interpretation – out of control. The police and parliament were cowed". In the case of Jeremy Hunt, "enthusiastically supportive" would be more accurate.
Given the role that the press has played in denigrating and undermining the NHS over the years, it is distasteful to watch their hysterical over-reaction to the supposed threat to free speech represented by the new regulatory regime. Nick Cohen even went so far as to claim that "a great chill will descend on the free republic of online writing, which until now has been a liberating and democratic force in modern British life". While we should never underestimate the ability of the state to blunder into repression, the idea that any regulator would have the resources, let alone the inclination, to proactively monitor the citizens of "the free republic of online writing" (i.e. obscure bloggers) is laughable.
This is the hyperbole of fear. A weak press regulator is decried as the end of 300 years of press freedom, thus avoiding the need to address the odious privilege of newspaper barons, while the NHS is painted as if it were a murderous conspiracy, the better to justify its dismemberment.