You know Save Our Thing. It happens every other year in every British community. Some sort of public service is moving, or closing, or reorganising, and someone is agin it, and we are all asked to roll out, get fell in, and demand that they Save Our Thing. Some people, reliably, are convinced that if we all Saved Our Thing at once, this would add up to a movement that would topple the government. Depending on the style you wish to adopt, you can say this in terms of “building the movement”, or else talk about “emergent”, “networks”, all that stuff.
But this is wrong. Saving Our Thing, as a political program, is seriously flawed or at least misdirected, and I think that it is especially flawed in the context of the NHS at the moment.
Here’s my first criticism. I don’t know what the optimal distribution of A&E departments in London is, or of sub-post offices in Rutland, and I would have to work very hard to even start identifying what information I would need to start answering the question. Also, I’m not actually very curious about this and it’s the kind of thing I would rather leave to experts. However, I am fairly confident that the answer is not “they should be distributed according to the presence of shouty middle-class people”. Further, I do know that a lot of complicated questions have counter-intuitive answers, and for example, that ambulance crews do actually take patients directly to hospitals with the speciality they need rather than going to the nearest one.
Here’s my second criticism. The Health & Social Care Act is not about hospitals. Neither is the NHS. Consider the Americans, the official providers of Awful Warning on this subject. They do not, I submit, have a shortage of hospitals. What they lack is, well, a national health service. The bureaucracy everyone loves to hate is, to a first approximation, the NHS. The system could work as well, or possibly better, if all the existing buildings were demolished today and replaced. It would still be the NHS. It is a service, not a large quantity of bricks, girders, and precast panels. It is defined by its organisation, its employees, its standard operating procedures, and increasingly, by software, both literally and metaphorically.
It is precisely the software that the Tories and the Liberals have attacked – the boring bureaucratic important stuff, the PCTs and SHAs, which are to be replaced by CCGs and CSOs and the NCB and if you’re canny you’ll want to watch the CSOs…oh, where did she go? The evil genius of the Act is precisely that its targets are invisible and its proposals, incomprehensible.
Save Our Thing campaigns respond only to large blocks of real estate. They remind me of the ecologists’ despair at the public’s obsession with charismatic megafauna and the resulting impossibility of getting their attention about boring and ugly creatures that are actually important to the survival of the whole thing. Control, power, responsibility, quality; none of this is visible. Bricks and mortar; these are.
The Health & Social Care Act is crafted, I suspect deliberately, to clear-fell the rainforest while carefully driving the bulldozer around the pandas. It destroys the ecosystem while keeping the crowd-pleasers alive in the zoo, for the time being. It is entirely possible to get to full privatisation and install credit-card terminals on the wards without closing even one building.
This strategy also speaks to another flaw in Save Our Thing politics. The worst thing that can happen is that they might actually save your thing, at least in the sense that the building is standing and the lights are on, by finding some sort of cynical fudge. The answer to a Save Our Thing campaign is to hush it with a sop. Very often, the campaign leaders will be all too aware that it’s nowhere near good enough, but will find that their followers presume that it’s all over and go home. I distinctly remember all three political parties promising to save our thing in Islington, including the party that was then proposing to cut it, the party that was secretly planning to cut it, and the party, of which I was then a member, that was secretly planning to put the party that was secretly planning to cut it into government.
Of course, how much sop you get is defined by how much pull you have, which is generally a force in favour of bullshit swing-wanker tudor-Tesco fuckery. This, in general, makes for horrible politics – cynical horse-trading over porkbarrel spending, cap-badge tribalism, vacuous centrist clientele-parties. Chris Huhne burning through a traffic light, forever. Some fields of policy act as a preview of this shit; defence is really bad, and the location of EU institutions is fabulously dreadful.
Now, control of public spending and employment is no small thing. In the 2000s, all the bits of the UK with an autonomous regional government managed to have higher real median wage growth than average, and three out of four of them actually saw positive territory. It can be a redistributive force. But I suspect that Save Our Thing politics is actually the opposite. And in the aggregate, it makes for a greater degree of cynicism, rejection of the public sphere, and supports the general tendency to move towards a low-trust society. And it is not going to save the NHS.
I’m afraid that the only way to do that will be to vote Labour, and keep on doing so. It is, in fact, true that you just can’t trust the other mob with the NHS. Meanwhile, how can we bring forward a general election?