Dogma in the face of corridor deaths is deeply unattractive

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The NHS crisis has produced a strange consensus. From the Daily Mail to the FT via the Guardian there appears to be agreement that a wise government would agree now that the health service is under-funded.

This consensus appears to be based on three ideas, even if they are not explicitly stated. The first is that those in the health services are genuinely doing their best with the resources available to them. There appears to be an acceptance that the capacity for savings is being reached within the current organisation structure.

Second, although that not stated explicitly as yet in most cases, clear doubts about that structure are emerging. A system that fractures responsibility into as many different areas as seems to be conceivably possible with no budget or care responsibiluty that demands congruence of objectives for overall patient care has led to ambulances being used as A&E waiting rooms because ambulances are run by different organisations to hospitals and patients being forced to stay in hospital by social care organisations unable to cope within their own massively constrained budgets. A structure better designed to fail is hard to imagine.

Third, it is obviously agreed that the people of the UK expect and deserve better than this.

These ideas are, however, indication of other new strands of thinking, even better hidden as yet within the conciousness that recognises there is an NHS crisis but which has yet to come to terms with what it means. Again I suggest there are at least three.

First, there is an acceptance that public servants can and do work incredibly hard to the limits of human efficiency in organisations where profit is not the motive for action.

Second, it is apparent that marketisation hinders their chances of succeeding in supplying the service the public need in these cases.

And third, there are absolute limits to public tolerance for austerity politics and the NHS  crisis is the point where that is being realised.

I suspect those around the prime minister are amongst the few who truly appreciate these points. Attacking an individual, Simon Stevens, is their response to the first. The implication is there is nothing wrong with the team and it is the manager at fault. It seems very likely that this argument has run out of mileage and that, rather surprisingly, Simon Stevens not only knows this but intends to ride out the storm. I hope he does.

That said, the reason why the outright denial of the crisis is so clear from Number 10 is implicit in my second and third points. It's not just they would have to admit Lansley and Osborne were both fundamentally wrong by agreeing to these arguments: I doubt May would have any difficulty doing that. The issue is bigger than these two failed men: the ideas associated with them,which are now so obviously creating the current crisis, are core to Tory belief. If markets can't make the NHS work then the state does, after all, have a purpose. And in that case cutting tax may be destructive. If those last two sentences are true the whole reason for a Tory government is at an end.

Those two realisations are at the heart of May's denial of an NHS crisis and she has virtually no choice if all she and her party stand for are to continue to carry weight  but carry on suggesting that the NHS crisis is indeed the fault of those who are not true believers in the failed ideology that is at the heart of it (hence the treatment of Simon Stevens).

The difficulty for May is, however, that Simon Stevens is a proxy for all those whose pragmatism, empathy and outright concern about very obvious NHS failure over-rides any ideological faith in small state, market driven solutions  to any known problem, which in practice means most of us. Dogma in the face of corridor deaths is deeply unattractive. With a functioning opposition it could be all but politically fatal. Even with Corbyn in place public pressure alone might force a choice from May. Will she decide to declare an end to austerity, or not? And will she concede that NHS reorganisation has, yet again, to be on the cards? If not she will lose the public for good, I think.

It's always events that expose a government's faults. Few events come bigger than a health service melt down. Right now there is no sign May knows what to do about it. And that means it may not be Brexit that will be the undoing of her. Something even closer to people's hearts may be.