Kevin Lewis reviews the recent leaders debate and what a coalition government could mean for NHS dentistry.
Magnificent may not be quite the word I was looking for. But the ITV leaders debate just before Easter was (for me at least) interesting, as well as being (for me at least) inconclusive.
Within minutes of the debate closing, all parties were rolled out to pronounce their candidate the winner of the debate. For some of the parties this bravado was showing cracks by the following morning, and one senses we were actually witnessing a sigh of relief that their player had not fallen flat on their face. After Natalie Bennett’s painful radio interview back in February, her Green followers must have endured two hours of anxiety that they were one question away from disaster. Infact the makeover and hours of rehearsals seem to have paid off. It may not have been magnificent, but at least it wasn’t quite as memorable this time.
The NHS was one of the central themes for the debate, but it was clear that the NHS they were talking about was not the one that primary care dentistry forms a part of. The NHS in the debate was free at the point of use, populated by doctors and nurses. It was ‘the most precious public service the nation has’ (Nicola Sturgeon). David Cameron went further, describing it as ‘the most important national institution and national public service that we have.’
PFI – TMI
Once the predictable playground exchanges were concluded (‘I love the NHS lots and lots’…and so on) we had a brief interlude of brick-lobbing about NHS privatisation. We learned that Ed Miliband’s two sons were both born in PFI (private finance initiative) funded hospitals and nobody had the courage to ask what conclusions we should be drawing from this. The stage looked like the set from a new game show and I scanned the other contestants to see if anyone had been briefed with the punchline ‘so you managed to find one that was still open then.’
Everyone had a vision for the NHS. David Cameron’s vision was to see GP practices open 24/seven because this would take a load of people out of A&E departments on the night shift. He forgot to mention that A&E departments would soon fill up again, with all the exhausted medics trying to deliver a 24/seven service with eight-five manpower. Leanne Wood from Plaid Cymru just wanted people in Wales to have the same NHS as the rest of the UK – instead of being the only part where the NHS budget had been cut by the Labour-controlled regional administration.
Talk of the NHS also crept into the two other main areas of the debate – the economy and immigration. On the economy, David Cameron stuck to his mantra that nothing is possible in the absence of a strong economy, and a lot more would be possible if we had a strong economy in the absence of a huge national debt. His plan for the NHS started with the dividend from stronger economic growth and a smaller national debt.
Nigel Farage sought to persuade us that the NHS was overstretched because so much of its time is taken providing free medical care to people who shouldn’t be here in the first place (sic). He touched a raw spot and aroused a swift censure from Leanne Wood when he stated more than half of those newly diagnosed in this country as HIV positive, were born outside the UK.
Nigel’s definition of ‘foreigners’ appeared to be something of a moveable feast. It included British citizens who happened to be born abroad. Public Health England (PHE) subsequently confirmed that 54% of HIV diagnoses in 2013 were for patients who were known to have been born overseas, but PHE also estimated that somewhere between a half and three quarters of these were likely to have been acquired here in the UK, irrespective of where the individuals had been born.
Mr Farage was the most animated of the gladiators and seemed to feel that he was ‘on a roll’. However, Natalie Bennett pointed out that the NHS could not function without immigrant workers.
You may be wondering where Nick Clegg was in all of this. In more ways than one, Farage was on his right, Ed Miliband was on his left and he was a mile apart from David Cameron. It was a metaphor for the past five years. But in terms of big hits, one could be forgiven for thinking that Nick had sent his apologies for absence, such was the low key nature of his performance compared to his runaway successes in the 2010 debates. In terms of performance, Sturgeon was swimming strongly in clear water and if Farage was Marmite, Clegg was Vanilla and he didn’t come alive on the night – other than to claim credit for many of the positive things achieved by the coalition government. Cameron accused him of a ‘pick and mix’ approach to defending his decisions, but Nick Clegg repeatedly came back to his central theme of ‘fairness’ and was persuasive that this was a deeply held principle.
Such is the knife-edge state of play as we approach the 2015 General Election, that it has become no longer a question of which of the main parties will prevail, but whether they will need one, two or more in order to form a coalition government. And given NHS dentistry takes four different forms in the four countries that make up the UK, it will be difficult to first-guess what any coalition government will be able to do in order to give NHS dentists the kind of predictable future it needs to succeed in a desperately complex and finely poised economic environment.
Mark Hughes is the manager of Stoke City football club. His team lost to Premier League front-runners Chelsea, but only after a spectacular long-range goal from his own Charlie Adam that we will see many hundreds of times more in the years ahead. Mark had an interesting perspective on his team’s defeat: ‘We lost, but not markedly.’ On reflection, that was probably a fair description of how the leaders debate was viewed by four or five of the participants. The worst scenario will be if our political parties are heard using similar words when we all wake up on 8 May.