Blueprint for NHS sell-off

What will the Tories do to the NHS? I am returning to this question because it says a lot about where the two parties stand in the forthcoming election. It tells us Cameron is standing on policies as airbrushed as his face. And Labour is sitting on its hands because a proper punch at Cameron might also biff some of its chums on the chin. Both Labour and the Tories know the NHS is sensitive for Cameron - the Tory leader works hard to shake off popular suspicions that his party is anti-NHS. This is why he plastered up posters promising not to cut the health service. It is why he was desperate to distance himself from MEP Dan Hannan when the latter called the NHS a "mistake." And it is why Labour MPs have highlighted Cameron's pre-Christmas meeting with a group called Nurses for Reform. Nurses for Reform is a hard-right group which argues that the "NHS is no longer a dearly loved British institution. It is a Stalinist nationalised embarrassment that should now be quietly and deftly consigned to the dustbin of history." So Cameron was keen to play down the significance of the time he spent with it. I am going to agree with Cameron - slightly.

Nurses for Reform does not represent his most significant adviser. It is a bit more libertarian than purely Tory and more ultra in the free-market freakiness than he is. But a group called Doctors for Reform is much closer to the Tory centre. It is part of a think tank called Reform which has many strong Conservative connections. Tory shadow minister Ed Vaizey sits on the Reform advisory board. So does Christopher Gent, the ex-Lehman Brothers banker who funds the Tories and sits on Cameron's "recovery committee." Adrian Bull, boss of NHS privatisation firm Carillion Health, also sits on Reform's "advisory council." Doctors for Reform's policies are bound to please the think tank's advisers. They square the circle between "backing" the NHS and wanting to let free-market dogma and private health profiteering run riot in the health service. Doctors for Reform says that if "the founding principles of the NHS are to be preserved the following changes need to be adopted and implemented." Its changes preserve the NHS in the same way a butcher preserves a pig. They include: "Supply competition. Patients should be allowed to exercise real, informed choice about where, how and by whom they are treated." Instead of NHS hospitals treating NHS patients, the health service would dole out cash to private companies like Carillion. The health service would stop being a system of hospitals and clinics and become a big money tap pouring cash into the mouths of contractors.

The second change is "Topping up the basic level of care. The NHS should allow patients to spend their own money on treatment provided by either the independent sector or the NHS, where it might make a charge for treatments not normally available." So posh people could take their NHS money out of the health service, add a bit of their own cash and spend it at luxury hospitals. The third change is "Universal coverage with an insurance element. Our current system provides universal coverage but would benefit from having an insurance element." By raising NHS money through insurance schemes rather than tax, the burden of payment would be shifted away from the better off. This would lay the ground to opening up the NHS to the insurance industry. Now, I have gone to the trouble of looking at Doctors for Reform's proposals to dig out this plan to cut the NHS as a provider and shift it towards a voucher system funding the private health sector. But are these plans really secret? No - most of them are already in or compatible with the Tory draft health manifesto. In his manifesto Cameron promises to "open up the NHS to include new independent and voluntary sector providers." So when his billboards say that he will not cut the NHS, he means that he will.

He won't cut government spending on health, but he won't give the money to the NHS hospitals and clinics. Instead he will give the cash to his private health firm pals. Cameron's promise not to cut the NHS rests on a division between the NHS as a funder and as a provider. This arbitrary division is quite common in the minds of MPs, ministers, policy wonks and other Westminster folk, even though it is pretty much unknown in the wider world. And this will be done through a great big marketing drive, because Cameron says: "The next step is to create an NHS where patients are in the driving seat. We will give everyone the power to choose any health-care provider that meets NHS standards." So Carillion Health, for example, could grab the NHS cash from as many patients as it could persuade through its doors. It could use advertising drives, loss leaders and other tricks to starve local NHS hospitals. This would open the door to non-NHS health firms taking both NHS "voucher" payments and extra top-up fees for a little luxury. The only element of the Doctors for Reform plan not in Cameron's draft is the top-up insurance funding. So there is a lot of room to attack Cameron as wanting to take cash from the NHS and give it to his business pals. But Labour will not launch this attack because it did it first.

After years of campaigning by unions and activists, Health Secretary Andy Burnham finally stalled the handover of NHS money to private contractors. Because Labour has its own friends in the private health industry you get the feeling that it would want to restart the scheme as soon as possible if it was re-elected anyway. Essentially Labour is slow to attack Cameron's unpopular policies because they are too popular among its own team.