Without a cause

It is no exaggeration to say that whatever happens next will shape the future of the NHS for the next 20 years.

In the same way that sea levels are rising, the world is becoming warmer and man stands powerless to cool it down: so the NHS is on an inexorable path to a new future and we are incapable of changing the compass setting.

As I write, workers in the NHS are so exasperated by the direction of travel of the health service that, for the first time in 18 years, they are going on strike.

Their strike will be pointless and there is no victory for them to win. For a strike to work it has to have the effect of the parachute deployed behind Discovery as it touches down on the runway. It has to dissipate momentum and bring the craft to a halt.

The strike by workers in NHS logistics won't bring the health service to a grinding halt. They wouldn't dare.

Strikes have to do damage and cause disruption. They have to be inconvenient. A good strike turns out the lights, creates piles of rubbish and ignites running battles in the street.

Businesses have to close and commuters must be left stranded. A good strike wreaks havoc; but even then, they seldom work.

Policemen and women are able to buy new cars and make down payments on villas in Spain on the proceeds of the overtime they earn, keeping law and order during a strike; but for everyone else, there is no winner.

Mines are still closed down, car factories remain shut and the fire services are re-organised. Strikes almost never work.

For a strike to work in the NHS, treatments would have to be delayed, hospitals would stop admitting patients and there would have to be deaths. There would be public outrage. Strikers would have little public sympathy and newspapers would rail against them. Strikes almost never work and in the NHS would be doomed to failure.

Health unions know this, but still they are going on strike. They are protesting about government health policy. They are objecting to the privatisation of the NHS. Why?

What's the point?
As more private sector capacity has been introduced into the NHS, waiting lists have been shredded.

The public care about waiting lists. Indeed, it is almost all they care about. The public will suffer lumpy hospital custard and fluff under the bed, but they will not put up with waiting.

A sick patient wants five things. They want the five 'gets': they want to 'get in', 'get diagnosed', 'get fixed-up', 'get out' and 'get on with their lives'. That's all, and this government is well on the way to delivering just that.

Who provides the treatment, who delivers it, where it is and what it is called are of no consequence. Treatment - free when and where it is needed - is all there is to running a successful NHS. On that measure, the NHS is as successful as it has even been.

Workers who strike because some services will be provided by the private sector are brain dead. They are striking over a principle that no one but the cloth-cap brigade gives a toss about. The strikers' mindset is stuck in the days of British Leyland.

Paradoxically, they are right to strike. They are striking because they can. A strike is an expression of freedom and a good thing. They are striking because they care. Workers who are passionate about what they do are usually good workers. They are striking because they can see the power and influence of the trades union movement ebbing away and, for working men and women, that is a genuine concern.

That said, this is a strike that will annoy the public, worry patients and make the long-term sick and vulnerable even more anxious. Yet, this is a strike that no one will lose sleep over.

This is a strike that may embolden others. This is a strike that is about the future direction of not just the NHS but of our nation. Life after Blair. Is Brown - if he is to be King - a moderniser? The man who has redistributed our wealth, given tax credits to families and improved the wealth of pensioners is a socialist. An old time socialist. But is he a moderniser?

Patricia Hewitt says there is no limit to the involvement of the private sector in health. Will Brown set limits? Will he say, enough is enough? Will he want every pound spent in the NHS divided between patient-facing care and administration, or will he see it split three ways: patient-facing care, administration and profit?

Who's in charge?
Brown is a moderniser. It is not the Department of Health that runs the NHS, it merely administers it. It is the Treasury that runs the NHS and, for that matter, every other department of state. It is Gordon Brown who runs the Treasury and has done, every day, since 1997; unlike the NHS, which has been run by enough different people to make a crowd scene in a football film.

It is Brown who is the engine-room behind modernising the NHS, Blair is just the driver.

So, the NHS is poised. We've just had the last party conference where the unions had the chance to unpick policy and potentially change its direction. They had to do their work this time. They needed to galvanise opinion. It was a last chance to turn the clock back to the NHS of Doctor Finlay and ambulances with bells.

Despite a small victory at the conference, ultimately, they will fail. They will fail like the man who accumulates his Sunday newspapers and recycles his empty gin bottle in the forlorn hope that it will stop the sea levels rising in the Arctic. The union activists, who stand in the street, shouting and forcing leaflets on bewildered conference delegates, will fail.

The future is out of our hands and in the hands of a public that wants bigger faster cars and quicker local services - within walking distance. The indefatigable logic of the Great British Public!

The author
Roy Lilley is a healthcare author and broadcaster