Believe hard enough, and you can get what you want. Or at any rate that’s the theory behind the fashionable cult of manifestation, as championed by Oprah; focus on your heart’s desire, tell yourself you’re going to get it, and it’s amazing what positive thinking can achieve. Only now this form of secular prayer seems to be catching on in Downing Street too.
This week Simon Stevens, head of NHS England, became the latest civil servant accused of failing to believe. He is said to be regarded by some within No 10 as “unenthusiastic”, insufficiently on board perhaps with thrilling efforts to solve the NHS crisis by claiming there isn’t one. Think positive, man! Best foot forward! Like Ivan Rogers, the departing ambassador to the EU said to be too gloomy about Brexit, apparently Stevens just needs to jolly well buck his ideas up.
To be fair, a certain cheery confidence may well prove useful in Brexit negotiations if Theresa May’s plan is basically to play chicken with the EU – convincing other member states that Britain is hellbent on extracting itself, regardless of the cost to itself or anyone else – and hope they blink first. That would require a display of gung-ho optimism and Rogers’ true feelings were perhaps too well known in Brussels for him to fake it.
And even our economic performance post-Brexit vote is, in some ways, linked to the power of self-belief. Part of the reason the predicted post-referendum crash hasn’t materialised may simply be that leavers still cheerfully expect Brexit to be a change for the better, and so see no reason to panic and stop spending.
But putting a brave face on what are still, for now, the theoretical risks of Brexit is one thing. Wishing away cancelled operations is another. The pressure on beds is too tangible now for that, the stuff of school-run conversations and everyday life even for people too busy to follow the news.
At the funeral of an old family friend last week, I was shocked to hear how quickly he had been bundled out of hospital after a stroke, despite being unable to speak or fend for himself. Yesterday, I bumped into another friend whose elderly mother needs an operation and has been told she can have it whenever a bed comes free – but nobody could say when that might be, so it’s hard for the family to make plans to look after her when she comes out.
The idea that the NHS isn’t coping is seeping into ordinary lives now, whether or not they heard the surgeon on Thursday morning’s Today programme explaining that the crisis isn’t just affecting A&E – every day she wonders if there will be enough beds available for her to operate on even half the patients on her list. Perhaps she should try to see the sunny side too, of there being no room on the wards for people to recover.
But this is more than just a culture clash between natural Tiggers and suspicious Eeyores. The charge of pessimism is really just code for suggesting that Stevens isn’t really “one of us”; that like Rogers, he was David Cameron’s man and hasn’t adapted yet to regime change in No 10.
And here, perhaps, lies a grain of truth. Simon Stevens is unpartisan enough to have worked perfectly comfortably with everyone from Labour’s then health secretary Frank Dobson (who first hired him as a special adviser two decades ago) through the Lib Dems’ Norman Lamb to Cameron, who originally brought him back in 2014 to run NHS England.
But Stevens has arguably overstepped the mark lately, not so much by making clear that the NHS got less cash than it wanted in the last spending round – although he has been unusually bold for a bureaucrat in contradicting ministers on this – as by suggesting that reform of benefits paid even to the richest pensioners could provide a long-term source of funding for social care. He may be right, but welfare reform is technically beyond his pay grade. For him to be openly discussing it hints at some frustration.
For Stevens is not just any old bureaucrat. He has an unusually shrewd grasp not just of policy but of politics, having started life as a hospital manager before turning Labour special adviser and architect (under Alan Milburn) of New Labour’s biggest NHS reforms. He endured tortuous negotiations with the Treasury in the early 00s over the national insurance rise that unleashed billions for the NHS – the lessons of which he has not forgotten – before moving into Downing Street to advise Tony Blair and then pursuing a successful private sector career. He took some persuading to come back and run the NHS, and friends say he did it only because he thought he could make a difference on something that matters.
Might he be struggling somewhat with taking orders from a new No 10 team whose understanding of the subject is inevitably less deep than his and which, unlike Cameron, is temperamentally opposed to just giving people their heads? Judging by his resignation email, Rogers clearly felt that way. But that’s being a civil servant for you.
As the name suggests, it is the politicians who are the masters, for good or ill. The Whitehall machine works best when civil servants defer to elected politicians and their mandate from the public, while ministers defer in turn to officials’ specific expertise. It seizes up when the servants worry that their masters aren’t acting in the public interest. What happens next depends on whether the public believes that, too.
Nobody serious denies now that the NHS is being squeezed remorselessly by three separate forces: an ageing population, medical advances putting doctors under constant pressure to do more, and a threadbare social care system that stops existing patients leaving hospital and raises the risk of vulnerable people needing to come in. If nothing changes, winter crises will morph into year-round ones. That’s why Stevens has opposed cuts in social care, drily telling the health select committee this week that he had done so “enthusiastically, I might add”.
But he would be the first to concede that money alone can’t cure what ails the NHS, while no political party yet has a compelling prescription for what could. It’s disappointing that Labour has rejected a cross-party coalition to produce lasting answers. But it’s more worrying that Downing Street can’t even admit to the existence of a question.
