This week: The Guardian’s Polly Toynbee
Why she matters: The doyenne of liberal-left commentary, whose Guardian column has been required reading for politicians and public service policymakers for more than 20 years. A former BBC social affairs editor, Ms Toynbee is not afraid to question the Labour Party’s approach, while also being one of the most trenchant critics of austerity.
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“It’s impossible. It’s out of the question. The NHS is politics incarnate.”
Thus, does the Guardian’s Polly Toynbee dismiss the idea that the NHS could ever be “depoliticised”.
It is not a desire, she notes, that’s restricted to those working in the NHS, musing that – for example – teachers are forever complaining about government interference in the curriculum.
But she continues: “You are never going to depoliticise anything that is of any interest to the public. You might depoliticise a bit of stuff about IT – which I’ve always regarded as monumentally boring – but even that then suddenly turns out to be a hot potato [because] it’s all about selling our data.”
Object of worship
Ms Toynbee has written about the NHS (and other public services) since the mid-1970s. While the NHS has always been a political issue, she believes the ante was upped at the end of the 1980s with the introduction of the internal market.
“I don’t think there used to be an awful lot of coverage about the precise way the NHS was run, managed, sliced up, etcetera. But [then health secretary Kenneth Clarke’s reforms] began to make people look more closely at how it was actually organised [rather than simply treating it as] an object of worship from afar.”
From that point on, she says the NHS became a “fascinating intellectual conundrum” to “politicians of all parties”. [They think:] ‘It’s so enormous. It’s so powerful. It’s so expensive. There must always be a better way of running it.’ And, of course, there always is.”
The NHS’s enemies are “legion”
Ms Toynbee has little time for the ‘Tories are privatising the NHS’ panic so popular at present on the left – pointing out that the theoretical threats posed by the Lansley reforms or trans-Atlantic trade deals have not been realised because, apart from some niche opportunities, “there’s not much money it”.
She nevertheless claims the NHS’s enemies are “legion” and that “every single right-wing newspaper wants to find ways to pull it down”, while “every Tory leader is infuriated that it’s untouchable”.
She notes that Labour can get away with making noises about “properly funding the NHS and people will believe them” without needing much proof but, should it start seeking to reform the NHS, then it is just as likely to fall foul of the sector’s vested interests.
Hiring and firing managers
Pointing out the expectations of increased resources and wages would rise under a left-wing government, she says: “It’s not that it’s very much easier for Labour to run the NHS than it is for the Tories, [it’s just that the] problems are different.”
“Everybody,” she continues, referring not just to politicians, “who thinks about the NHS – even in a passing way – thinks they have an answer, [usually] by pulling some big lever that is going to transform it in one way or another.”
This approach means the “same old bad ideas” often get recycled. She is struck by how often they hinge on blaming someone, for example those who miss GP appointments, which allows their advocates to feel morally as well as intellectually superior.
One other consequence of this quick fix approach to NHS problems is the hiring and firing of managers.
’There’s too much inspection and imposition from the top, and too little understanding of the very complex local reasons why one hospital is in trouble and the next door one isn’t’
Ms Toynbee has been a fan of NHS managers from her earliest days as a journalist writing about the “powerless” administrators trying to hold the ring between warring consultants in 1970s hospitals. She welcomed the Griffiths’ reforms which increased manager numbers and power but rues the fact that it gave politicians an easy target when things go wrong.
It is not only the endless “cheap points” they make attacking “pen pushers”, despite the evidence of the relative slimness of NHS bureaucracy, but also the desire to pin blame on individuals.
“There’s too much inspection and imposition from the top, and too little understanding of the very complex local reasons why one hospital is in trouble and the next door one isn’t. Health economies are complex animals – so there are some hospitals that are just basket cases and it isn’t because they’ve got bad managers.
“And the [government] keeps throwing out one chair, one chief executive after another, and it doesn’t make any difference because there’s something structurally wrong that nobody ever takes into account.
“[This approach is] insane and very destructive of some of the cleverest people that I know, really good management brains who are often sacked and traduced in a grossly unfair way.”
Writing about CCGs sends people to sleep
Ms Toynbee acknowledges that most ideas on how to run the NHS – good and bad – have an ideology of “one kind or another” behind them.
This, she thinks, is inevitable and not necessarily a bad thing.
Referring to how she chooses a subject for her column, she explains: “You can never write anything about the NHS that doesn’t involve [expressing a] worldview.
“[Writing about] cystic fibrosis drugs and whether they should be prescribed regardless of cost [means expressing] as big a worldview as you can get: is the NHS an infinite good, how much is a healthy year of life worth, how much tax are people really willing to pay for the NHS?”
She does admit that in making issues interesting for her readers she is sometimes guilty of explaining “infinitely complicated” debates in a way which is “grossly oversimplified”. Ms Toynbee adds that it is “the most populist [health] issues” that get talked about in the media – even in the news conferences of “serious newspapers”.
Electric fence
Asked for a subject she personally thinks is significant, but would never attempt to address in the Guardian, she chooses “how [clinical commissioning groups] work and how they’ve changed”.
The questions she longs to explore include: “Why on earth are GPs still sitting there being paid £40,000 a year… for doing nothing very much? Do people really think GPs can manage the health service? But by the time you’ve explained what a CCG is and how they evolved people will have gone to sleep.”
She believes – as some CCG leads have discovered – that the “intersection between the NHS and politics is incredibly dangerous” for both politicians and those in the service. “It’s sort of an electric fence – touch it from either side and you can get very badly shocked.” Best for politicians to “step carefully” and realise that the NHS “is the great golden calf of British politics”.
However, campaigners can overplay this card, she says, and as a result the service can be “injured internally”. The Guardian columnist believes that the British Medical Association “just about backed down in time” on the junior doctors strike, before “people started saying, ‘hang on, all these junior doctors, they’ve got BMWs in the car park’. The heroes of the NHS can become villains if they’re not careful.”
One good idea that gets endlessly talked about but struggles for traction in practice is shifting resources from treatment to prevention.
Ms Toynbee says the failure to tackle the cause of problems is “true of every single social policy”, citing examples from education, crime, and social exclusion which all end up creating more misery and expense.
“That’s madness and everybody knows it…[But] nobody can ever shift money from the front line to the causes. It’s the most difficult thing to do. And you can only ever do it in the context – as they did with Sure Start [during the last decade] – of having lots of money [to spend].”
The Bedpan will (probably) be taking a break next week – as I’m behind with my interview write-ups. It will return in full force on Sunday 24th. I suspect there will be enough politics to keep you entertained.
If there is any political figure you would like me to interview, please email alastair.mclellan@wilmingtonhealthcare.com or if you are reading this on the website leave your suggestions in the comments box.
Past Bedpans
Paul Johnson, director of the Institute of Fiscal Studies
Neil Anderson, director of Migration Watch
Brexit expert Professor Anand Menon
Jeremy Heywood - an appreciation
Resolution Foundation director Torsten Bell
Dr Sarah Wollaston: part two - the role of the Commons’ health committee
Dr Sarah Wollaston MP, part one
Taxpayers’ Alliance chief executive John O’Connell
Spectator editor Fraser Nelson
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