Health Matters | Paul Corrigan's blog

I know that not many of you have much respect for elected politicians but unlike most I think it’s hard work winning elections and representing people, and I recognise that without somebody having the nerve to carry out that role, our society would not be the democracy that we all want it to be. (Being married to one does rather impact upon me!).

Therefore I don’t share nearly everyone’s cynicism about the difference between what politicians say when they are in opposition and what they do when they are in Government.  I’ve spent too long working for them to believe that they are all lying through their teeth all the time.

But the difference between the statements of opposition and the actions of Government are interesting.

I am therefore going to run a series of posts on the difference between what Conservative politicians have said in opposition and what they do in Government. Not because they are telling fibs and have been uncovered, but because they will have learnt what all new Governments learn – that running something carries different responsibilities from opposing it.

The title at the head of this post comes from elegant former New York Mayor Mario Cuomo.  It explains the difference between opposition and government not by the fact that people fib but that the two experiences of the different politics creates two different languages to express them. In opposition you have to demonstrate that your politics has a firm link to the concerns of the population and those concerns can best be expressed in poetic style. Some of those concerns are of the higher order of issues and not the smaller day to day wants and needs. In terms of an up to date political phrase the narrative of opposition has to connect with the very big worries of the population.

So David Cameron talked about ‘broken Britain’. A worry that parts of our society and the world was going to the dogs and it wasn’t “what it was in my day”. As a narrative you can link all sorts of issues together into a single concern and then for its politics link Broken Britain to Labour’s Britain. It can and does sound lyrical. It is poetic.

Being in Government is entirely different.  It must involve the day to day grind of administration and attention to, and celebration of, the detail. Famously Mussolini ‘made the trains run on time’ and for the Italians this mattered. The detail of all governments matter to the public.  Do things work? And if they don’t then the Government is not working. So previously opposition politicians have to switch their actions and their language to that of prose.

I am going to give examples of this mainly from the health field and want to start with NICE.

NICE is a device that rations drugs to demonstrate that they are value for money for the NHS. This is not about safety but about value. This means that for some drugs they say, “No this is not value for money”. For the patients that wanted those drugs on the National Health Service this is a tragedy. For the companies that have carried out the research and invested in them it is a disaster. It is not far from those two experiences to a dramatic story appearing in the press.

Over any period of time this means that there are a number of campaigns attacking NICE for not allowing a specific drug to be used by the NHS. The newspapers will be full of specific patients and their families backed by outraged companies who will now not get return on their investment.

For opposition politicians this is a gift. They are given, on a regular basis, powerful emotional causes to back. Each of these causes has a heady mix of human tragedy, blocked scientific advance and rejected entrepreneurialism. This is a powerful brew and it’s hard for opposition politicians not to drink it.

The problem for the opposition spokesperson is that somebody will ask and what would you do? So if you say “we will let this drug through” someone is going to start adding up the costs and asking who is going to pay for it. So the last thing you want to do is deflect your poetic support for the human tragedy with something concrete.

For the most part Andrew Lansley managed this in opposition. Vague support never tied him down to what would he do. But in January this year the Conservative Party needed to up the ante in the election campaign and they produced a number of manifestos – the first of which was on health.

This contained a number of poetic statements one of which was that NICE gave Ministers the opportunity to ‘hide behind it’ with respect to decisions about which drugs are value for money for the NHS and which not. This is a graphic image – Minister refusing to make difficult decisions and giving that job to others and then hiding behind them

But the alternative to ‘not hiding’ is obvious. It is for politicians to make those decisions themselves and to hide behind nobody. A moment’s thought about Government would show that this would be a disaster for a politician since they would be making the day to day decisions about who would live or die. But the poetry of opposition stops you thinking about this and nodding in the direction of undermining NICE is good opposition politics.

Then the same political party is in Government and it needs to worry about money. It needs a rationing organisation to ensure that the NHS does not go bust with buying non value for money drugs and luckily NICE is there. So when a White Paper is written it ends up saying

“We will expand the role of NICE to develop quality standards for social care. The Health Bill will put NICE on a firmer statutory footing securing its independence and core functions and extending its remit to social care”

Not poetic No mention of Ministers hiding behind it. But prosaic – and absolutely necessary.

Incidentally, as NICE has recently shown, three quarters of the cancer drugs they have reviewed have been agreed. But the publicity about NICE is all about an organisation saying no and not NICE saying yes.