This week: Will Hutton
Why he matters: A former editor in chief of The Observer, Mr Hutton is currently principal of Oxford University’s Hertford College, and chair of the Big Innovation Centre. He is best known for his two influential 1990s books on the UK’s political economy, The State We’re In and The State to Come, which correctly predicted the concentration of wealth in corporations and the super-rich, and the growth of inequality driving significant social polarisation. Mr Hutton’s recent books, Them and Us: Changing Britain – Why We Need a Fair Society, and How Good We Can Be: Ending the Mercenary Society and Building a Great Country, continue on this theme.
The infamous cliché is you should never meet your heroes, but there seems to be no hard-and-fast rule when you have to phone them. Will Hutton is one of the shrewdest observers of our political and economic changes, nationally and internationally.
I don’t have many heroes, but he is one and I’m, frankly, more than a bit nervous about whether the questions I’ve prepared will command his attention.
Mr Hutton’s work has placed a great emphasis on the need for greater fairness in our economics and politics. What does he see as the NHS’ role in achieving that goal?
“I always regarded the NHS, which is portrayed by Labour as a great socialist institution that they own politically, and conversely is attacked by the US Republican right as hardcore socialism, as a fairness institution,” he begins.
“Illness is a piece of brute bad luck — you can pre-empt some health risks, with exercise and not smoking, but the big diseases like cancer are really bad accidents which could fall on any of us.
“In this sense, the NHS is a ‘protect me from brute bad luck’ institution. In my view, that is not socialism.”
Mr Hutton argues the NHS’ success derives more from its connection to “fellow human feeling: the idea ‘that an accident or illness that’s happened to you could have happened to me, I’m lucky it hasn’t and I’m glad that this institution is going to bail you out’.
“It’s a ‘we protect you from bad luck’ institution, and that’s why it has such great and merited public affection.
“And it reminds us of who we are. Think of the 2012 Olympics opening ceremony featuring the healthcare system — that is unique.
“To the annoyance of the political right, the NHS has become a sacred cow — efforts to privatise parts of it or to break up always fail.”
He dismisses the idea that shrinking NHS provision will mean fewer claims on the public purse. “It’s an intellectual fantasy. The demand won’t go away. This is an area where the political right is at its very weakest.”
Private is not always best
The NHS is also a fairness institution for Mr Hutton because “in many left-behind parts of the UK it sets a gold standard of professionalism and care”.
I note the NHS is also a big employer providing good jobs with decent pay and conditions in those areas.
He agrees: “Some of our former industrial towns and cities may be down at heel, but their NHS hospital may well be state-of-the-art. The NHS signals by being in those communities that we are one country, with the public sector uniting the privileged and underprivileged parts.”
Mr Hutton argues the NHS also unifies the population “through what it does”, explaining: “Most people in their engagements with the NHS are supremely satisfied. There can be a human instinct to complain, and things go wrong sometimes, but in the main, be you high or low, the NHS treats you same. Pull all those themes together and it’s clear why the NHS is a much-loved institution.”
The State We’re In and The State To Come accurately foresaw the concentration of wealth and the growth of inequality driving significant polarisation. How might the public sector broadly and the NHS in particular contribute to a less unequal society?
“Inequalities arrive from a dysfunctional private sector and the current emergency of a plutocracy-kleptocracy,” he says.
He references the striking recent Financial Times series, titled Time for a reset in British capitalism, as a sign the worm is turning.
“Finger-pointing at public sector inefficiency has stopped, and we increasingly ask the question, ‘Is the private sector delivering as we hope it should in a capitalist society?’”
Mr Hutton is clear reform of the private sector, ownership, and the regulatory framework has to be the heart of change, but he adds: “The public sector obviously has a role, in the sense that what public sector can do (and actually is doing) is to show that, for a well-led police forces or hospital, it [doesn’t] require you to pay leaders 150-200 times average wages to get those outcomes. It shows that people are motivated by more than money.”
NHS and other public sector organisations, he adds, are animated to do public good: “As such, they are a role model for the private sector. From 1980 to 2019, we just heard ‘the public sector needs to learn from the private sector’. But, to a large degree, today the private sector could start to learn from public sector — motivated people, reasonably paid and doing important work. These things matter, and we’ve undervalued and put them to one side for too long.
“Well-run public hospitals and health services are a rebuke to the ‘private is best’ ideologues. And despite all inducements and blandishments, the private health sector has not done very well, and richer people who try to buy better healthcare quite often regret it. I’ve got endless number of friends who know from experience that for big operations, sustained interventions or complex care levels, you simply can’t beat the NHS.
“The fact that NHS care is better than private sector care (other than in niche areas of cosmetic surgery) is a really important exemplar of how work and organisations can be run better and for good.”
The good luck tax
I ask Mr Hutton if he agrees with former Tory cabinet minister David Willetts’ thesis that much current inequality (which impacts on health and education) is down to the Baby Boomers, and if so, what should be done about that.
“I’m a Baby Boomer, and of course it’s nice if you bought a flat or house as I did when I was 35 [and] end up with £1m of assets, for doing nothing.
“I do think the Baby Boomers could accept inheritance tax with more grace. It’s not really earned wealth!”
Maybe we’ll see his generation start to use their houses as a Viking-type funeral pyre to avoid the government getting IHT?
He laughs: “I’ve always thought IHT, which the right call the ‘death tax’, should be rebranded as a ‘we share in your good luck’ tax. And you don’t pay it, your kids pay it. The idea that the only reason people live in a nice house or work hard was to set up a dynasty is absolutely nonsense and drivel. Great companies are built because people want to build great companies. Not to confer money on their kids. That’s not the sole motivation of human conduct.”
As a Baby Boomer, Mr Hutton says he regrets “the fact that my generation is more wealthy compared to the young than previously. That is a source of division, and I don’t like the idea of my kids propping up house prices by paying insanely huge rents.
“We didn’t cause it, though. It was caused by an intersection between fractional reserve banking, tax breaks and government refusal to levy serious tax on inherited estates.”
As a former BBC Newsnight economics correspondent, what does he think of the national debate on economics and public policy?
“A number of journalists are now publicly saying — and I agree — that when presenters chair debates and give equivalence between people [who get] facts wrong and people [who get] facts right, the result is that you don’t meaningfully challenge the former.
“The quality of journalism is poor, and some national newspapers have become nothing but propagandists for Brexit in general.”
He also notes the “right-wing press never miss an opportunity to have a crack at [the NHS].
“The worst bits of the media are becoming mercenaries in a right-wing jihad against [public] institutions. The aim is to rip our civic, political and public culture apart. It’s poisonous and destructive, and it’s got worse.”
If there is any political or influential figure you would like HSJ to interview, please email alastair.mclellan@wilmingtonhealthcare.com.
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Cardiac Arrest and Bodies writer Jed Mercurio
Margaret Thatcher and the birth of the internal market
Doctors for Extinction Rebellion
Mayor of Greater Manchester, Andy Burnham
You can read all 43 Bedpans here
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