Authors: Jonathan Coe
It’s just beginning. I can feel it. Can it really have taken so long to get this far?
November 18th 1977
The Party held me down and kept me back for twenty years. Twenty wasted years. Nothing could give me greater pleasure than to see it unravelling before my eyes. The leadership election was a joke, and now we have a new tenant at Number Ten who can only be described as a political dwarf, with no idea how to govern, and no mandate from the people.
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Every vote has to be fought to the death, and he will have to spend most of his time trying to appease the Liberals.
Reg Prentice
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has announced his defection to the Tories. Fool. Real power lies in the media, and in backroom policy-making: if he hasn’t worked that out after all those years in Parliament, he’s more of a sap than I thought he was. It’s perfectly obvious that Margaret is going to be PM in a year or two, and the important thing now is to start getting the legislation in place. They will have to move fast once they get there.
Work on an NHS bill is progressing. I’ve managed to convince them that the first thing to do is reverse the policy of phasing out private beds. More radical measures will have to wait, but not for long. We need to get a few business types in, to do a major report and show that the present system is nothing but a shambles. If someone from a supermarket chain, for instance, were to come in and see how it operates at the moment … he’d probably have a fit.
Here’s a thought: why not suggest Lawrence? I think he’s still got his wits about him (just about), and he could certainly be relied upon to come to the right conclusions. Worth a try, anyway.
I see her now, and talk to her, more than ever before. Such happy days.
June 23rd 1982
Very agreeable lunch with Thomas in the private dining room at Stewards.
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Extremely fine port – must encourage the Club to buy some, to replace the raspberry syrup they serve at the moment. Pheasant a little overcooked. Nearly lost a tooth on the gunshot.
Thomas has agreed to help us out with the flogging-off of Telecom.
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Took a little persuading at first, but I convinced him that if he and the bank were going to prosper under Margaret’s government then they were going to have to be a little more robust in their business practices. It helped, of course, when I told him the kind of fees he could expect to collect. Also predicted that there was going to be any number of these sell-offs over the next few years, and if Stewards wanted a good slice of the action they should get in early. He asked me what else was going to come up in the near future and I told him that it was basically the lot: steel, gas, BP, BR, electricity, water, you name it. Not sure that he believed me about the last two. Just wait and see, I said.
This was the longest chat we’ve had, I think, for about thirty years. Stayed till about 5, talking about this and that. He showed off his new toy, a machine that plays back films on what looks like a silver gramophone record, with which he seemed inordinately pleased. I couldn’t really see it catching on, but didn’t say so. He’d seen my latest appearance on the box, and told me that I’d done very well. Asked him if he’d noticed I hadn’t answered any of the questions, and he said no, not really. Must tell this to the PR people: they’ll be very pleased. They’ve been training us all quite intensively over the last few weeks and I must say it seems to be paying off. I timed the interview on playback last night and was impressed to find that only 23 seconds after being asked about the
Belgrano,
I was already talking about Militant infiltration of the Labour Party. Sometimes I surprise even myself.
June 18th 1984
Reforms progressing, although not as speedily as I’d hoped. Everybody on the committee seems to have a full calendar, and today was only the second time we’d managed to get together since the review was announced. Still, the Griffiths
1
report gives us plenty to go on, and is a firm nudge in the right direction, since it deals something of a death blow to the whole idea of ‘consensus’ management. One lady committee member (of pinkish hue, I suspect) queried this but I shut her up by quoting Margaret’s definition of consensus as ‘the process of abandoning all beliefs, principles, values and policies’ and ‘something in which no one believes and to which no one objects’. Point made, I think.
What we’ll now end up recommending – if I have anything to do with it – is the introduction of general managers at every level on
performance-related pay.
That’s the crucial thing. We’ve got to squash this dewy-eyed belief that people can be motivated by anything other than money. If I’m going to end up running this show, after all, I need people underneath me who I can be sure are going to give of their best.
Went upstairs to the TV room at the Club for the
Nine O’Clock News
this evening and saw extraordinary scenes at some pit or other.
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A whole gang of thuggish-looking miners were mounting a murderous, unprovoked assault – throwing stones, some of them – on policemen who were armed only with truncheons and riot gear. When the police tried to ride through, some of these hooligans blatantly obstructed them, actually trying to trip up the horses by getting in the way. What will Kinnock
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have to say about that, I wonder?
October 29th 1985
Over to Shepherd’s Bush this evening to appear on
Newsnight
, where it turned out that the guest presenter was none other than my old enemy Beamish. Contemplated walking off at that point, since it’s well known that the man is practically a Communist and has no business chairing a supposedly impartial discussion programme. Anyway, I managed to come off very well from the whole thing. To present the ‘other point of view’ they wheeled out some pig-ugly female doctor with NHS specs and a bleeding heart, who whined and moaned a lot about ‘goodwill’ and ‘chronic underfunding’ before I put her in her place by quoting a few simple facts. Thought I’d heard the last of her, after that, but she came up to me afterwards in hospitality and claimed that her father had known me at Oxford. Gillam was the name, apparently. Meant nothing to me, I must say – in fact this sounded suspiciously like a chat-up line, and since she didn’t look quite such a Gorgon away from the studio lights, I asked if she fancied a quick one to show there were no hard feelings. Nothing doing, needless to say. She took the hump and stormed off. (Did look a bit dyke-ish, now I come to think of it. Just my luck.)
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∗
From
A Pox on the Box: Memoirs of a Disillusioned Broadcaster,
by Alan Beamish (Cape, 1993)
… I can even pinpoint the incident which first convinced me that the quality of public debate in this country had entered into precipitous decline. It was in October 1985, during one of my occasional stints as presenter of
Newsnight
: the guest was Henry Winshaw (or Lord Winshaw, as we all had to get used to calling him for a year or two prior to his death) and the subject was the NHS.
This, you will recall, was at the high tide of Thatcherism, and the last few months had seen a series of aggressive measures which had left the more liberal wing of the electorate feeling punch-drunk and disoriented: a radical cutting-back of the Welfare State announced in June, the GLC abolished in July, the BBC forced to abandon a documentary featuring interviews with Sinn Fein leaders, and, most recently, Mrs Thatcher’s implacable opposition to sanctions against South Africa, which left her isolated at the Commonwealth Prime Ministers’ conference. At the same time, the question of the Health Service continued to bubble away in the background. A fundamental policy review had been set in motion, and there was mounting unrest within the medical profession about dwindling resources and ‘privatization by the back door’. We decided it would be instructive to invite one of the architects of the NHS reforms on to the programme and confront him with someone working at the front line of medical practice in a London hospital.
For this purpose we brought in a junior doctor called Jane Gillam, who had recently taken part in a Radio 4 phone-in and impressed everyone with her commitment and grasp of detail. I remember her as a tall woman, whose jet-black hair was cut in a bob and whose small, gold-rimmed glasses framed a pair of striking and combative brown eyes: and yet it was obvious from the beginning that she was going to be no match for Winshaw. Long gone were the days when I had interviewed him for the old ‘Backbencher’ slot and inadvertently exposed his hazy grasp of foreign policy. It was impossible, now, to connect that nervous, fresh-faced MP with the puffy, glowering old firebrand who stared at me across the table, thumping it with his fist and barking like a rabid dog as he answered Dr Gillam’s questions. Or rather, failed to answer them: for Winshaw’s mode of political debate, by this stage in his career, had long since parted company with rational discourse and tended to consist entirely of statistics diluted with the occasional gobbet of scattergun abuse. And so, consulting a transcript of that discussion, I find that when Dr Gillam first raised the subject of deliberate underfunding as a prelude to privatization, his answer was:
‘17,000,000 over 5 years 12.3% of GDP 4% more than the EEC 35% up on the USSR 34,000 GPs for every HAS × 19.24 in real terms 9,586 for every FHSA seasonally adjusted 12,900,000 + 54.67 @ 19% incl VAT rising to 47% depending on IPR by the IHSM £4.52p NHS safe in our hands.’
In response to which, Dr Gillam said:
‘I don’t dispute the truth of your figures, but neither do I dispute the truth of what I see every day with my own eyes. And the problem is that these two truths contradict each other. Every day I see staff working longer hours, under greater stress, for less reward, and I see patients waiting a longer time, for worse treatment, under worse conditions. These are facts, I’m afraid. They can’t be argued away.’
And Winshaw’s second answer to Dr Gillam was:
‘16%! 16.5%! Rising to 17.5% under a DMU with 54,000 extra for PAYE and SERPS! 64% PRP as promised in the CIPs and £38,000 = $45,000 + ¥93,000,000 divided by ✓451 to the power of 68.7 recurring! 45% IPR, 73% NUT, 85.999% CFC and 9½ weeks more than under the last Labour government.’
In response to which, Dr Gillam said:
‘My point really is that you can’t make the NHS more efficient by making it more geared to costs. If you do that, you’re effectively trimming its resources, because the NHS runs on goodwill, on the goodwill of its staff, and under the right conditions, this goodwill is potentially infinite. But if you continue to erode it, as you’re doing at the moment, and replace it with a finite range of financial incentives, then eventually you will end up with a more expensive NHS, a less efficient NHS, an NHS which is always going to be a millstone round the government’s neck.’
And Winshaw’s third and final answer to Dr Gillam was:
‘60 CMOs, 47 DHAs, 32 TQMs, 947 NAHATs, 96% over 4 years, 37.2. in 11 months, 78.224 × 295 ÷ 13¼ + 63.5374628374, leaving £89,000,000 for the DTI, the DMU, the DSS, the KLF, the ERM and the AEGWU’s NHSTA. 43% up, 64% down, 23.6% way over the top and 100–1 bar. And that’s all I have to say on the matter.’
After that, he left the studio with the victorious air of a man who has finally conquered the medium. And I suppose, in a way, that he had.
∗
October 6th 1987
At long last, another full meeting of the Review Board – the first since Margaret’s victory in June.
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The first White Paper
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is finished and work will be starting on a second and third.
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The next reforms will be much further-reaching. We’re getting to the heart of the matter, at last. To remind everyone where our priorities lie, I’ve had a large notice pinned to the wall: it says
FREEDOM
COMPETITION
CHOICE
I’ve also decided to take a strong line with the word ‘hospital’. This word is no longer permitted at discussions: from now on, we call them ‘provider units’. This is because their sole purpose, in future, will be to provide services which will be
purchased
from them by Health Authorities and fundholding GPs through
negotiated contracts.
The hospital becomes a shop, the operation becomes a piece of merchandise, and normal business practices prevail: pile ’em high and sell ’em cheap. The beautiful simplicity of this idea astounds me.
Also on the agenda today was income generation. I see no reason at all why provider units shouldn’t impose car-parking charges, for instance, on visitors. Also, they should be encouraged to rent out their premises for retail developments. There’s no point in all those closed wards standing empty when they could be turned into shops selling flowers, or grapes, or all those other things people feel like buying when visiting a sick relative. Hamburgers, and so on. Little knick-knacks and souvenirs.
Towards the end of the meeting somebody brought up the subject of Quality Adjusted Life Years. This is one of my own personal favourites, I must say. The idea is that you take the cost of an operation and then calculate not just how many years’ life it saves, but what the
quality
of the life is. You simply put a figure on it. Then you can work out the cost-effectiveness of each operation: and so something basic like a hip replacement will come out at around £700 per QALY, while a heart transplant is more like £5,000 and a full hospital haemodialysis will cost a cool £14,000 per QALY.
I’ve been arguing it all my life: quality is quantifiable!
Most of the Board, nevertheless, don’t think the public is ready for this concept just yet, and they may be right. But it can’t be long now. We’re all feeling tremendously buoyant after the election result. The sell-offs have been proceeding at an amazing rate – Aerospace, Sealink, Vickers shipyards, British Gas last year, British Airways in May. Surely the day for the NHS can’t be far off.