It’s been almost a year since the Conservatives and Liberal Democrats forged their unholy alliance.
And ironically the very service that both parties pledged to protect, the NHS, has become one of the single most heated topics at public protests up and down the country.
Unfortunately for the public the next general election is a long way off, but when it finally comes around there’s a strong chance that current shadow health secretary John Healey will be the one steering NHS health policy – assuming the NHS still exists by then.
Much like a modern-day Dr Frankenstein, Tory Health Secretary Andrew Lansley had years to dream up his creation. He spent six years on the opposition front benches before finally getting the chance to implement his plans in the form of his Health and Social Care Bill.
And likewise Lansley’s brainchild is reviled by all, from nurses and health workers across the board to David Cameron’s own brother-in-law, who is a hospital doctor.
Even some Tories have criticised the NHS reforms, and the Lib Dems, realising by now that they’ve made a truly Faustian pact, almost unanimously voted against introducing them at their recent party conference. Doctors at the British Medical Association weren’t far behind.
But even though Lansley’s Bill has taken flak from all sides, the picture is a complex one.
When I meet Healey at his parliamentary office, I put it to him that it was the legacy left by new Labour that allowed such a Bill to be created.
After all if Thatcher had pushed the door ajar to PFI and NHS privatisation, then new Labour surely flung it wide open as it enthusiastically embraced PFI hospital-building projects at vast cost to the public purse.
“To argue that is to swallow the propaganda of the Tories,” Healey responds with a smile.
“They try to build on an evolution but in fact the Bill is an evolution in the very basis of the NHS.
“In the last 13 years where we’ve used competition and private providers it was to add capacity to the NHS, clear waiting lists or to do things the NHS was not doing well enough.
“But it was always within a system that was publicly accountable and publicly controlled. The Tories’ plans for the NHS are totally different.
“On PFI, in the end there are thousands of staff treating hundreds of thousands of patients. The safe, modern hospitals and health centres we created could not have been built without PFI.”
Healey is obviously a man with a sharp intelligence, but he’s clearly holding back.
A number of experts have said that PFI schemes are nothing but a false economy. Hospitals were constructed with short-term gain in mind, while completely ignoring the long-term public debt to pay off that goes vastly beyond the actual cost of the building itself.
Professor Allyson Pollock, director of Edinburgh University’s centre for international public health policy, has argued that if Tony Blair had not pushed so fervently for PFI, Labour could have doubled the number of hospitals it built.
Healey refuses to be pinned down on whether a future Labour government would consign PFI or NHS privatisation to the past.
“We are less than one year into five years of a Tory-led government so I’m not in a position to rule anything out or in,” he says.
“But the big hospital rebuilding programme, overdue for decades, was done under Labour in the last decade.
“There is definitely a case for saying we were poor at PFI, poor at negotiating PFI contracts from the outset. Some of the later deals were much better value for money and more flexible in their services,” he says.
“But the capital required to rebuild the NHS with two decades of Tory neglect was too big simply for us to look at public sources of investment and that’s where PFI came in. It played a necessary role in that decade.
“Much of the big capital investment for the NHS has now been done so I would see a reduced need for it and a much reduced scope, if any, for PFI.”
At least that’s a bit more positive. But perhaps of greater importance, given Lansley’s proposals, is the future of the NHS as a whole.
Healey himself has admitted that the NHS needs reform, so what does he see on the path ahead?
“The big challenges for the NHS are no longer about new hospitals but about how you can develop the best quality care, particularly for elderly people and for people with multiple health problems that they live with for the rest of their life,” he says.
One of the main problems to solve, he says, is “how you develop that care for them or at home, within their community and therefore are able to shift what historically is provided in hospitals closer to home or their communities.
“In order to do that we have to break down the barriers between primary and secondary care, primary care and community care, public health and community health, social care and health care. The shame of the government’s plans will be they will make that harder not easier.”
While creating better care in the community for the elderly and those with long-term disabilities is a noble cause, it is just one part in the massive health jigsaw.
At the TUC March for the Alternative this coming Saturday those representing laid-off health workers will be protesting about more than just the NHS reforms.
Healey was campaign director at the TUC himself once upon a time, so he must see the importance of the march at a time of such gargantuan cuts.
New Labour’s past mistakes have led to widespread disillusionment, so many voters now expect – and need – real change from the party to the benefit of ordinary people.
I ask Healey what he feels is the biggest mistake that new Labour made on health policy.
“We were too ready to reorganise,” he finally admits after much pondering.
“But it is the same mistake that the Conservatives are now making in spades.
“The most fundamental and far-reaching change in the Bill is the one they talk least about – and that is shifting the basis of the NHS from a central public service run in the public interest to one that will be a full-blown market system.
“We are likely to see commercial incompetence stamped over many of the most important decisions taken over the future of the NHS.
“My experience with this government is that there are big gaps between what they are saying and what they are doing and a series of broken promises.
“Cameron promised to protect the NHS before the election and give it a rise in funding, which is now being cut, to protect front-line staff and jobs, but they are going, and he promised no top-down reorganisation, but it’s the biggest reorganisation in its history.
“But Labour can’t just rely on the old mantra we have to be able to make a case for a real alternative, which is why the march is going to be really important. I see my job at the moment as oppose, oppose, oppose. But I’m also very conscious about developing an alternative that will make people realise that it doesn’t have to be like this.”
If Healey sticks by these words, and they seem sincere, then he could – and that’s a big could – be the best health secretary this country’s had for decades.
Join the TUC March for the Alternative this coming Saturday at London’s Victoria Embankment at 11am.