The poll tax was famous for bringing down Margaret Thatcher and causing profound long term damage to the reputation of the Conservative Party. It is notable that one of the key players at the time was Oliver Letwin, who in 1986, recommended the poll tax to the Prime Minister after being asked to evaluate its likely impact.
Oliver Letwin is currently Minister of State for Policy and has had a significant influence on Conservative Party health policy. He was recently rated Number 2 out of the top 100 most influential people in the NHS by the HSJ.
According to Nick Seddon of the think tank Reform, Letwin “has been a key driving force behind encouraging greater plurality of provision – from the private and third sectors – and the development of new ownership models”.
He was also recently asked to review Lansley’s reforms and gave a solid thumbs up to plough on. This was in no way surprising, because his own ideology is so similar to Lansley. In 1988, Letwin wrote a paper about the NHS reform for the Centre for Policy Studies called Britain’s Biggest Enterprise. This paper offers a fascinating insight into his thinking and contains many of the current policy proposals.
In his conclusion, he stated: “One could begin with the establishment of the NHS as an independent trust, with increased joint ventures between the private sector; move on next to the use of credits to meet standard charges set by a central NHS funding administration for independently managed hospitals; and only at the last stage create a national insurance scheme separate from the tax system”.
It is therefore no surprise that he was once famously quoted as saying that “the NHS will not exist” within five years of a Tory election victory and there would be “no limits” to NHS privatisation in an interview with The Times.
His 1988 paper could easily be seen as a prototype of the current Health Bill and is a classic example of modern conservatism’s solutions for the public sector i.e. using markets and the private sector to replace any profitable state functions, whilst leaving unprofitable services well alone. The evidence base for these policies is totally lacking, hence the constant references to Lansley’s reforms as being ideologically driven. The editors of the BMJ have gone as far as calling them “mad”.
David Cameron has now placed his full weight and reputation behind the proposals and he therefore cannot “be for turning”. This is an enormous political risk. This is particularly ironic, because by exempting the NHS from the worst of his government’s spending cuts, the level of public suspicion was subsiding that the Tories would dismantle Britain’s best-loved institution. In fact, the NHS was a non issue in the pre-election debates.
Now, the public, the media and the professions have started to cotton on to what the Tories are up to. Whether the Bill passes or falls, this could be Cameron’s very own ‘poll tax’ issue and once again the fingerprints of Oliver Letwin will be there.