So whenever possible I try to get there for at least one day, mostly just to walk, look and digest. I can tolerate the headache I invariably have by lunchtime as the price for absorbing the sheer energy of the place. It’s an energy that comes from several hearts – political, commercial, financial and cultural (some of which have multiple centres themselves) – and being a bit of a (lapsed) political geek I usually head for Westminster, to see what’s going on, where the news cameras are pointing, and if the mother of all Parliaments has yet succeeded in ridding its immediate surroundings of any sign of dissent.
This morning was no different, and as I wandered down Whitehall I noticed a few people hanging around outside the Cabinet Office. I paused for literally five seconds until Health Secretary Andrew Lansley emerged and strode off in the direction of Parliament. I sometimes kid myself I know what I’m doing with a camera, so I kept pace on the opposite side of the road to try to get a decent shot.
Well, it’s a picture, anyway. And I was nervous in case an anti-terrorist SWAT team descended from the Ministry of Defence behind me to confiscate my camera, but it seems that only applies to small children eating ice-cream rather than Cabinet Ministers. Unless they were all busy with Adam Werrity.
As Lansley approached Downing Street he disentangled himself from the news crew and started to cross Whitehall. The press photographers opposite the gates, who looked bored enough to have been camped there for some hours, sprang to life and rattled off a few shots as he approached….and then he ended up on the pavement right beside me.
I have a general rule of not pestering well-known people in the street, on the basis that I probably wouldn’t want pestering myself if I were in their position, and anyway I don’t really know them. This was crystallised when I once got off a train immediately behind Sue Nicholls, to be met by excited screams of “AUDREY!”. I suppose it goes with the territory to an extent, but it would do my head in. The advent of Twitter might blur this rule somewhat, of course, because it’s now possible to have a certain element of interaction with those who want it, and get a general idea as to whether they’d be the type to react favourably to a cheery “hello!”.
Politicians are definitely exempt from the rule, though, and it would have seemed a wasted opportunity to not say something given that as far as I know Lansley is engineering the wholesale privatisation of health care provision in the biggest shake-up since 1948. Unfortunately, I had not anticipated having unfettered access to the Health Secretary, otherwise I might have done a bit of research and planned a couple of questions.
As it was – having politely asked if he minded having a chat as he walked – I stuck to the basic theme I’ve been banging on about since the advent of PFI/PPP deals in local councils about a decade ago. If we’re trying to deliver the best possible health service, I asked, was it worth the risk of the worst-case scenario, that services and therefore funding would coalesce in the hands of a very few large companies, who could then basically charge what they liked?
Lansley replied that he didn’t think that that could happen as a result of his proposals, because of the independent nature of the clinical commissioning groups which would take over the Secretary of State’s ultimate function of procuring healthcare. I persisted with a similar line, asking if it wasn’t the case that the lessons of similar previous reforms to other sectors, such as transport and local councils, was that we ended up with something approaching a cartel (the word “monopoly” escaped me in the rush). Again the response was that this simply wasn’t possible.
I wanted to go on to the other point I normally make in these debates, regarding where exactly the risk of failure falls. It seems self-evident to me, both in theory and practice, that in the end the public authority will be left to pick up the pieces if and when the enterprise providing the service fails for whatever reason, or comes back for more money because it has found it so difficult to make double-digit returns under the contract as initially negotiated. But we had reached the entrance to Richmond House, where the Department of Health lives, so I only had time to ask if the bit about not allowing monolithic provision was explicit in the Bill, and Lansley said that it was. I thanked him for his time and refocussed on my original train of thought, which was finding somewhere with an outside table to get a croissant and a coffee.
I have no idea whether what the Health Secretary told me was correct. I was thinking on my feet so much that I have no idea if I even asked a relevant question, let alone the right one. But it just felt, at that moment, that the opportunity to get a point across to him – that a random, slightly scruffy bloke in the street was hugely concerned about the future of the Health Service he had grown up with – was too important to pass up. My guess is that it’s unlikely the House of Lords will delay the Bill for long, and that within five years we’ll be talking about picking up the pieces of the NHS. And that Andrew Lansley won’t be in post to take responsibility.