The NHS has been a political issue since its birth – and it should remain so

In many ways, the pleas from influential groups of health professionals to the politicians to stop using the NHS as a political football seem perfectly fair, rational and laudable. Privately, many of those in the political game admit that the NHS is an easy way to win a round of applause at a party conference or on an edition of Any Questions?

Voice cracking, almost tearful, the mention of our wonderful hospital staff and carers – sincerely meant or not – is sufficient to endow even the most unworthy and mercenary politician with a veneer of compassion.

This may be why Boris Johnson chooses to spend quite as much time as he does on the wards, despite the constant heckling from outside and, indeed, inside the buildings as he goes about his photo opportunities, sleeves rolled up and issuing confused figures for the building of new hospitals.

So, yes, NHS Providers, representing every arm of the health service, and the Academy of Medical Royal Colleges are right to object to the weaponisation of the NHS, and the way politicians use and abuse it. They might have added, but chose not to, that many of the criticisms of “NHS failures” that are found in certain sections of the media and politics are motivated purely by the desire to undermine public faith and confidence in it.

As right as they are, however, their solution is both wrong and unrealistic. The NHS was, is, and will for ever be a deeply political project, the one surviving socialist monument created after the Second World War by a Labour government, bitterly opposed by many in the medical profession and above all by the Conservative Party at the time. It has always been a matter of passionate and, at times, vituperative language. Its very founder, Aneurin Bevan, famously remarked that the way he got the general practitioners to agree to being, in effect, nationalised was to “stuff their mouths with gold”.

In the 1970s, the then-Labour health secretary, Barbara Castle, was her usual fiery self when she told the Commons: “We on the government side of the house believe it is an outrage that a patient should go into a private bed in a hospital as a result of crossing a consultant’s palm with money and then get the extra facilities there, for which the only person who gets any financial benefit is the consultant himself.”

Margaret Thatcher, for her part, simply said she rejected the NHS for herself because: “I, along with something like five million other people, insure to enable me to go into hospital on the day I want; at the time I want, and with a doctor I want.” John Major, for a change, praised it for saving his leg after a bad car accident. David Cameron spoke movingly about his son’s heavy use of the service. For that openness, he has been cruelly attacked. The political football has been kicked around for rather a long time.

Even Kenneth Clarke, nowadays a cuddly father figure observing our national nervous breakdown with open bemusement, was, as health secretary in the 1980s, once a hard man of Thatcherite privatisation, blithely telling striking ambulance drivers that they were not gifted paramedics, merely “glorified taxi drivers”.

And now, right on cue, comes the current shadow health secretary, Jonathan Ashworth, making the most lurid claims about the Tory record on cancelled operations, failing to mention that cancellations are a little down in 2018-19 compared to 2017-18. Full disclosure of the data would hardly have weakened his strong and broadly substantiated claims, but he chose not to offer the full statistical picture.

For the sake of balance and fairness, the chaotic spinning by the prime minister and the health secretary, Matt Hancock, about how many “new” hospitals the government proposes to fund, and when, is even more dangerously misleading.

Uninspiring as all of this is, it may be for the best. Only in the crucible of political argument can such claims and promises be tested and found wanting. Such scrutiny is provided by the ministers, their shadows in all opposition parties, backbench MPs, the professional bodies, journalists, think tanks and anyone who takes the time to email their MP or parliamentary candidate. For every NHS figure on waiting times or spending, there is another that will prove or disprove it, or put it into context or take it out of context. The public can make their own minds up about the performance of the NHS from their own experiences of it, and those of their friends, family and colleagues.

Mr Ashworth, then, should make no apology for dramatising the state of things as he sees it, and for caring about what is happening. Mr Hancock is equally committed to doing his best for the NHS, within the constraints of a government that seems to have lost the ability to count money in the way Tory administrations are supposed to be good at.

It would be more than nice if the front benches could agree on reforms to care and pensions, and accept the recommendations made by the learned commission set up to achieve just such a bipartisan approach and consensus. Yet, with rare exceptions, such consensus is as impossible to achieve now as it ever was. Even when some joint agreement has been reached, such as on the basic structures of the NHS, it does not often survive a change of direction in one or the other of the main parties. Where once PFI and PPP were enthusiastically pursued by both parties, now both reject them.

The debate about the involvement of the corporate sector, of the charities and the efficiency of the NHS model as against an insurance-based or means-tested scheme have been argued over, on and off, for the best part of a century. The NHS may or may not be better off depoliticised, but that would not be an ideal way for it to remain subject to criticism and for its financial needs to be made apparent to a sometimes sceptical public. Besides, given that the NHS is usually regarded as a “Labour” cause, and one which the Tories try to avoid talking about, the very act of trying to depoliticise it is something of a political manoeuvre itself. Frank argument can sometimes be the best medicine.