Our Beloved Myth
The newspapers were vertical, as if forming some sort of riot shield of protection between the two seated gentlemen. In fact, there was no threat from each other — only from the world outside those walls. Behind the papers, their readers sat upright and in deep contemplation.
The sedate surroundings maintained a restrained silence broken only by the occasional tinkling of glasses or cups as brandy or tea was imbibed.
“I see they’re at it again” said a voice from behind one paper. “Dreaming up some sort of conspiracy theory about how the NHS is being opened up to Big Business and America. Absurd.”
A cough emanating from behind the other newspaper met the comment and followed it with a chuckle.
“Hardly covert was it? Dear old Johnny Redwood talked about privatisation by stealth back in 77 wasn’t it? He didn’t whisper it either, he published it didn’t he?”
“He did. I believe he said that stealth was better than a full-frontal attack. Can’t argue with that. The lefties make it into some sort of secret plot because they do love playing the victim card.”
Toby and Marcus so enjoyed their little get togethers at the club where they could put the world to rights even though the world looked pretty right to — and for — them anyway. They had enjoyed good careers in the City and were now safely ensconced in a retirement from which the view was pretty (and generally downward.)
“Anyway old chap” said Marcus, leaning forward and gesturing his friend toward him, “do you think someone ought to tell them” he whispered in theatrical confidentiality “that they’re a bit late?” Both men let out a guffaw of laughter that broke into the silence like a celebratory toast.
“Quick — the stable door….” laughed Toby with mock urgency.
“Don’t look at the names on the sides of ambulances…….” chortled Marcus
The mirth lasted a few delicious moments before calm and silence was restored and the men returned to their papers.
With a gesture that suggested an imminent proclamation, Toby crumpled his paper into his lap. When the words came they appeared somewhat cryptic.
“Acronyms are marvellous aren’t they?” he asked
“Sorry?” answered Marcus
“Acronyms — they do such a great job. I mean the US had Accountable Care Organisations but before people here knew what an ACO was, our chaps invented the ICS so we could talk about Integrated Care Systems. We avoided talking about the American model even when we’d adopted it. Clever.” Marcus nodded.
“That must have been, what, four years ago now and I doubt that even now most people know what either are, let alone how they decide who gets what for free” said Marcus.” Back in the 70s the Americans came up with the idea that the less care they give the more money they make. Lovely. We weren’t covert about that either — Jeremy even told the Commons Health Committee that it was the model he was using for his health reforms.”
“Ah Mr Hunt” said Toby. “Splendid fellow. He certainly made some things happen by a little bit of rebranding. Carrying on from where Margaret, John and Oliver started in the mid 80s too.”
“Mr Letwin, he was a Rothschild man you know” said Marcus. “He came up with the idea of NHS independent trusts in ‘joint ventures’ with the private sector. It was genius and yet he was lambasted just because he’d written a book called ‘Privatising the World’ so people saw that in everything he did. I mean is that really privatisation?” Marcus’s approval of the positioning was in the sneer behind the question.
“Not at all. Never.” Toby looked at Marcus with an ‘after you, sir’ expression. For a moment Marcus hesitated before realising the game.
“PFI” he said and the two men excitedly let out a quiet ‘bravo.’ The expression on Marcus’ face portrayed a playful sense of triumphalism. “Tony Blair — you know he was one of us really wasn’t he? Or at least as much as we’d have let him in!” said Marcus and Toby spluttered, his body convulsed in laughter until it almost doubled up.
“Who’d have thought that Ken Clarke’s idea of competition for custom between service purchasers and service providers would be taken on by…………” he coughed
“Yes? Prompted Toby
“Well, by them” said Marcus.
The two friends paused to remember Mr Blair’s role from ostensible adversary to (maybe) willing ally.
“To be fair though” said Toby “they followed their own deeply held ideas. I mean they never talked about ‘consumer choice’ as Margaret did — it was ‘patient choice’ for them.” The smiles were broad and mocking — they were having fun.
Part of the fun was realising how all these things had been happening over decades. The conspiratorial idea that changes had somehow been smuggled in under cover of darkness was so ludicrous that it tickled their sense of the absurd.
The angry voices who preached about the dangers of privatisation right now normally talked about its genesis being in 2012 when the Health & Social Care Act really shook things up but Marcus and Toby had been enjoying themselves long before that.
“Remember when Hospital Trusts were told they could raise 49% of their budgeted income from private patients and other sources?” asked Marcus. “There were screams that this was another attempt at back door privatisation but that’s not privatisation — it’s not even half!!” A celebration of 2012 again — there should have been medals.
“Ooh, ooh” purred Toby. “My turn on the acronyms. I’ll give you CCGs”
“I’ll raise you a CSU” retorted Marcus.
They knew that — even now — most people hadn’t got their head around Clinical Commissioning Groups as the bodies that bought services. Run by GPs and clinicians who naturally had no procurement and commercial skills, they were ‘supported’ by Commissioning Support Units to provide both. Lo and behold the CSUs were often run by the usual suspects of management consultancies.
“To the firms” toasted Toby and the two men raised a glass to them, not only beneficiaries of a role in buying services but also — oddly — the designers of the very structure of CCGs and CSUs in the first place.
The range of acronyms and behind-the-scenes private companies shaping the NHS represented a neat little closed shop. As far as Marcus and Toby were concerned, any lefties seeing threats around every corner would be left to engage in a game of whack-a-mole in which the target did more than disappear, it morphed into something that didn’t even look like a target.
“Room for an STP?” asked Toby.
“Always, always” retorted Marcus. “Ah — Sustainability and Transformation Plans, NHS England’s grand design. Saving money by cutting beds thereby reducing access………….”
“Marcus, Marcus please — surely you mean moderating demand” said Toby, always a stickler for accuracy of language.
“Quite so” said Marcus. “I do apologise. This, er, moderation of demand means making money by renting out hospital floor space to private companies that provide paid care.”
“Or selling buildings and land” said Toby. “A lovely little model and all in the name of prudent financial management.”
The two men were delighted with themselves and hungry to continue. Nobody bothered them — the gentle serenity of their surroundings (far from austerity) remained undisturbed — on what was turning out to be a most pleasant afternoon. Toby’s face however took on a sudden expression of mock concern as he fixed Marcus’s eye.
“Mind you” he said, his tone dropping to a level of grave seriousness, “it’s outrageous that these private companies with their borrowing, management charges and shareholder dividends are costing the NHS hugely. Public money is finding its way to private pockets and some are up in arms about it.”
The two men dissolved into laughter.
“Up in arms!” repeated Marcus, dabbing his eyes as his body convulsed with laughter. Both were reminded that they had invested in just the right sector back in the day and that their little positions on US pharma would be worth a little more if (heaven forbid) it got hold of the NHS drug budget
As the air cleared from the laughter, that sense of ‘all is well’ once again settled.
It didn’t however last very long. Toby’s thoughts had been stirred by the whole discussion. He was irked by the fact that some saw all of this perfectly proper behaviour — indeed its cleverness and ingenuity — as worthy of criticism. A sense of unfairness was creeping up on him and it wounded his sensibilities, made him feel embattled. He took personally the rebukes of those seen to be messing with the NHS. Quite suddenly, he lowered his paper with a violence that took Marcus by surprise.
“I’m fed up with the attacks on our chaps you know. They should read their history books” he said. Marcus looked up. He wasn’t following the outburst and was about to ask its meaning when Toby explained himself. “No one ever acknowledges that the NHS was a cross party idea back in 42. How is it that we are always painted as its enemy?”
“Absolutely” replied Marcus, grasping his friend’s disquiet and picking up the baton, “we were part of the idea.” Almost reluctantly and after a few seconds he continued “I mean, I know that we voted against it once or twice back then…….”
Toby coughed and the two exchanged a little amused smile.
“Well 20 odd times before the act was passed” continued Marcus. “But, I mean to say” he hurriedly added “will they never get past that? We had a damn good reason. As Winston said, it was a first step to turn Britain into a National Socialist economy. We’d just beaten the Nazis so we couldn’t have that. How could we ever have stepped aside when they were going to stop a few chaps making some money? I mean it was socialism.”
Toby seemed calmed and he smiled at his friend. History was so neat in the right people’s hands.
“They’re even quoting Bevan here” said Marcus, jabbing a finger at a column on which he scowled with concentration. “Just because we objected they’re re saying that Bevan expressed a deep burning hatred for the Tory Party that he said was pouring money into propaganda. Propaganda ! I mean really” he exclaimed. “Anyone would think that Bevan was some sort of saint.” Toby shuffled the paper, which was now showing signs of stress in its many creases.
“They’re quoting that?” asked Toby. “Shameful. Typically lefty press, still repeating slander decades later. Incorrigible and disgraceful. Bevan — pah! You never hear them say how he forced perfectly good profit- making Doctors to work for the State — pure evil as the BMA said. Thank goodness it’s just a tiny minority still talking that way.” “
“And an even smaller minority listening” responded Marcus with a smile that acknowledged that the NHS has been co-opted by the Tories as if it had always been close to their heart.
“Hats off to Matt I say.” The two men smiled at the image of Mr Hancock, all urbane and ‘collegiate’, a very modern face of Government. “And yet even he’s under fire” exclaimed Marcus in astonishment.
“What, lovely Matt?” asked Toby.
“Yes. They’re full of all sorts of criticism of him as uncaring. I mean, the man wears a badge with the word Care on it. He talks about our NHS or even our beloved NHS. What more do they want?” It was a rhetorical question of course. Marcus knew that it had no rational answer.
Toby sat upright and fixed Marcus with a worried stare.
“I’ve got to ask you old chap — what on earth are you reading?”
Marcus seemed momentarily wrong footed, as if the easy-going camaraderie that the two had always shared was being questioned. It took him a moment to realise the misunderstanding. When he did, he laughed uproariously.
“Oh no old chap. It’s The Telegraph quoting The Guardian. You surely couldn’t think that I’d be…………….”
“No no no” reassured Toby. “My dear fellow, absolutely not. Wouldn’t dream of it.” The two men smiled, the equilibrium having been reset. Toby gestured to the smartly dressed waiter and ordered refills.
Settling comfortably back into their chairs, they returned to their papers.
“Disgraceful” said Marcus. The word seemed to come from nowhere and hung for a moment before Toby peered from around his paper with a questioning expression unseen by his friend. After a pause that seemed to stretch off into the near distance, Marcus continued. “All sorts of rabid charges are being thrown at Matt just because he didn’t publish details of all the PPE contracts and a few went to party donors and contacts. They should be thanking these chaps for stepping forward in our hour of need not castigating him for missing a bit of admin.”
Their papers now lowered, the two men stared aghast at each other, united in their exasperation at the unfairness of it all. For a good few moments, neither seemed able to find further words.
“Of course you know” said Toby “all this criticism of the past matters far less than the problems of the future.”
“What do you mean old chap?” asked Marcus
“Staff. There are over 100,000 vacant posts apparently and the new migration rules aren’t going to help fill them.”
Toby realised his mistake almost as soon as he had said it — an inferred negative reference to the B word. Had he inadvertently suggested a positive of free movement and the EU — with its appalling anti-tax avoidance initiatives — rather than the overwhelming benefits of taking back sovereign control? He had to think quickly.
“Still” he said hurriedly “with a little training and some clapping from the doorstep there’ll be plenty of chaps ready to step up. Certainly by the time you and I or our families find ourselves in an NHS bed………………” he let the sentence tail off so that the full delicious impact of it would be felt.
The two exploded into the sort of heartfelt guffaw that proved their friendship intact and that all was right with the world.
