Actor Michael Sheen makes a ‘blistering’ speech about the UK National Health Service. Hurrah! If only our milksop politicians would have a bit of that passion and sincerity!
Or not.
It’s a fine example of a good but very bad speech. Rather like the ill-fated Neil Kinnock speech in 1983:
Labour supporters gush that this unambiguously attention-catching oration was one of the finest ever made in British politics: “If Margaret Thatcher is re-elected as Prime Minister on Thursday, I warn you. I warn you that you will have pain – when healing and relief depend upon payment. I warn you that you will have poverty – when pensions slip and benefits are whittled away by a government that won’t pay in an economy that can’t pay… I warn you not to be ordinary. I warn you not to be young. I warn you not to fall ill. I warn you not to get old.”
Well, this scores strongly on thudding rhetoric. But it scores even more strongly on nonsense.
British voters have a keen ear for noisy cant. They know that Labour, Conservative and now coalition governments alike do not – and cannot – bring in apocalyptic changes. For the most part they boss us around and tweak things. Frantic Kinnockite warnings that the End is Nigh make no sense, so anyone proclaiming that comes across as losing the plot (and indeed the election).
Let’s look at this Sheen version from the point of view of technique.
It starts boldly as all speech should:
In 1945 Aneurin Bevan said: ‘We have been the dreamers, we have been the sufferers, and now, we are the builders.’ And my God, how they built. And what they built.
Every bit as much a wonder of the world as any architectural marvel, or any natural miracle … The National Health Service. A truly monumental vision. The result of true representation. Of real advocacy. A symbol of equality, of fairness, and of compassion.
Fine. Snappy short sentences. Not much grammar. They let the speaker add lots of rhetorical pauses for emphasis, or join thoughts together impromptu.
In his book In Place of Fear, Bevan said: ‘The collective principle asserts that no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.’
‘No society can legitimately call itself civilised’: now that begs the question, what sort of society do we want to be?
What is our vision for ourselves? What are the qualities and the principles that we aspire towards, and choose to defend?
Fair enough as an idea. Emphasis/structure through lists/questions.
Because it is a choice. Do we want to be a society that is fractured, divided, disconnected? Do we want to be a society that is suspicious and mistrustful of its own people? A society that is exploitative, that sees people as commodities, as numbers. Mere instruments of profit, to be used while they have use, drained of whatever they can offer, and when they are seen as no longer useful, just abandoned, cut adrift.
Preferably unseen and never again heard from.
Or … or … do we want to be a society where each person is recognised? Where all are equal in worth and value. And where that value is not purely a monetary one.
A society that is supportive, that is inclusive and compassionate. Where it is acknowledged that not all can prosper. Where those who are most vulnerable, most in need of help, are not seen as lazy, or scrounging, or robbing the rest of us for whatever they can get.
Where we … we do not turn our backs on those facing hard times. We do not abandon them or exploit their weakness. Because they are us. If not now, then at some point, and inevitably, they are us.
By now you’re getting the idea. You MUST be compassionate and inclusive. Or else! To be precise, if you don’t accept the Sheen point of view you are treating people as commodities. You’re cruel and heartless!
This is what I believe to be Aneurin Bevan’s vision of a living tapestry of a mixed community, as he said.
What’s a vision of living tapestry? Maybe the person who has such visions is a bit .. dotty? Best avoided?
At a time now, when people mistrust politicians as being too professional, too disconnected, no longer representing the voice of the people they have been elected to serve but more likely to represent the voice of wherever the money is. No longer standing for anything meaningful, or inspired by strongly held beliefs.
At a time like this, a man like Aneurin Bevan seems like a mythical creature.
Like a unicorn perhaps. Or perhaps more fittingly, a dragon.
On the page some of these sentences look confused and incomplete. When delivered they’ll have sounded fine (enough). A good example of how a speech is not a written text. It’s all about spoken words and mood/tone/energy.
This was a man who had no fear in standing up for what he believed in. And he made no bones about how he felt. This was a man who publicly stated: ‘No amount of cajolery, and no attempts at ethical, or social seduction, can eradicate from my heart a deep, burning hatred for the Tory party.’
In today’s political climate, where politicians are careful, tentative, scared of saying what they feel for fear of alienating a part of the electorate; where under the excuse of trying to appear electable, all parties drift into a morass of bland neutrality; and the real deals, the real values we suspect, are kept behind closed doors – is it any wonder that people feel there is very little to choose between?
Bevan said: ‘We know what happens to people who stay in the middle of the road. They get run down.’
A large part of democratic politics is all about building consensus. Saying that you ardently hate another side shows loss of self-control, and insults the middle ground who quite like some of the other side’s ideas.
There is never an excuse to not speak up for what you think is right. You must stand up for what you believe. But first of all – by God, believe in something.
A curiously fascistic idea. Believe! In something! Anything will do! It’s the intensity of your belief that counts, not the substance. See also Islamic State, Al Qaeda, Putin, Hitler and so on.
No one says they want to get rid of the NHS. Everyone praises it, across all parties. It is about as powerful a symbol of goodness that we have, so it would be too dangerous not to. But for decades now, there has nevertheless been a systematic undermining of its core values.
This is beyond party politics. The Labour government arguably did as much damage to the NHS as any Tory or coalition-led one.
Ah. Now you’re actually addressing the issues, not making a loud noise. Why have Labour too undermined the NHS’s supposed core values and all that Symbolic Goodness? Makes no sense, right? Maybe the existing model has, ahem, some significant problems?
This is about who we want to be as a nation, and what we believe is worth fighting for.
Too many people have given too much, and fought too hard, for us to give away what they achieved and to be left with so very little.
Left with so very little? What?
Are we talking about the same NHS? Look at its own website, Michael:
When the NHS was launched in 1948, it had a budget of £437 million (roughly £9 billion at today’s value). For 2015/16, it was around £115.4 billion…
The NHS employs more than 1.6 million people, putting it in the top five of the world’s largest workforces together with the US Department of Defence, McDonalds, Walmart and the Chinese People’s Liberation Army.
The NHS in England is the biggest part of the system by far, catering to a population of 53.9 million and employing more than 1.3 million people. Of those, the clinically qualified staff include 40,236 general practitioners (GPs), 351,446 nurses, 18,576 ambulance staff, and 111,963 hospital and community health service (HCHS) medical and dental staff.
The NHS in Scotland, Wales and Northern Ireland employs 159,748; 84,817 and 62,603 people respectively.
Aaaargh. It’s wasting away! Help!
To those who have discarded all principles, save that of profit before all else; to those who have turned their backs on the very idea of a truly democratic society, and aligned themselves to nothing but self-interest; to those who have betrayed the vision of equality, and justice, and compassion for all – that vision that provided the crucible from which came forth the National Health Service – I say to you, as Aneurin Bevan said in Trafalgar Square in 1956: you have besmirched the name of Britain; you have made us ashamed of the things of which formerly we were proud; you have offended against every principle of decency and there is only way in which you can even begin to restore your tarnished reputation.
Get out. Get out! Get … out!
Haha a rambling sentence of 124 words. But a lively intriguing conclusion.
Verdict?
Just awful.
The reason that even Ed Miliband does not emit something like this is that it is just too stupid. Irresponsible. Essentially dishonest.
Any honest speech about the NHS ought to include some of the practical compromises that were made to set it up. There always were large private enterprise elements in the way it worked. There had to be, if the UK was not to slump into all-out communism. And how did that work out for the health of the Russians?
An honest speech will accept that from those early days the NHS has grown, above all in process and complexity. An honest speech will look at the ratio of doctors/nurses to administrators, and wonder how those relationships are evolving in the wrong direction.
An honest speech will note that other civilised countries do not have an NHS like ours, yet you don’t see people dying like flies in the streets. Why not? Are not other ideas something to consider?
An honest speech will say that if it’s unacceptable that some corporations and banks are ‘too big to fail’, why does that not equally apply to state-funded bureaucracies – don’t huge unwieldy things have lots of negative features in common, wherever they are?
An honest speech will ask why the NHS is killing thousands of people a year through incompetence and neglect. Srebrenica after Srebrenica. Far more people than die in terrorist attacks. Under the evil Precautionary Principle all sorts of items are banned lest they pose the slightest risk. Should this not apply to the NHS too?
Above all, an honest speech will talk about the transformations occurring in technology and how all sorts of investigations and procedures can now be done utterly differently.
Why do we need anything like the heavy, over-centralised, over-processed systems we now have, when new decentralised arrangements will be cheaper and better?
Why go to the doctor when your watch can send the doctor a stream of vital data? Maybe in the future the main role of a doctor will be to tell you that you are getting sick and help you avoid that, not treat you when it happens?
All that could be in a short powerful and thought-provoking speech delivered with passion. Even belief!
But it would mean thinking, not emoting.
Reason, not Noise.
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I entirely agree with your critique of Michael Sheen's rhetoric and have very little time for the Left's use of the NHS as a stick with which to beat the Tories.
However, I'm afraid that I think that your analysis of the current state of the Health Service is as almost flawed as Sheen's.
The first, and biggest problem is not the way that the NHS is organised, but the development of medicine in the context of an aging society: the medical profession is now very good at treating lots of illnesses and the NHS, by and large, delivers treatment fairly well. However, it has largely ceased to provide care, which is the fundamental need of many patients. Many hospitals are in a state of almost perpetual crisis because of the number of patients to whom they can offer very little in the way of 'cure'; they are there because they cannot be safely cared for anywhere else. This was the root cause of scandals such as Mid-Staffs and Royal Tunbridge Wells.
It is utopian to believe that in future doctors will primarily concentrate on helping us prevent illness: paradoxically, as society becomes healthier, our healthcare demands increase. The conditions that the NHS will need to deal with will increasingly be age-related and unavoidable rather than 'lifestyle-related' and preventable. The condition that already costs the NHS more than any other is dementia, and whilst some kinds of dementia can be prevented, the most significant causal factor is age.
I share your view that the NHS spends too much time and money on administration (though actually, the real scandal is as much the amount of time that clinicians are forced to spend on bureaucratic activity as the number of bureaucrats); however, having worked in the healthcare system for several years, this is not simply the result of the NHS being a monolithic state bureaucracy.
Since the 1990s, there has been an appalling proliferation of bureaucratic activity: partly this is a consequence of decentralisation and a commitment to 'localism'. In the 1970s, the NHS in my County was effectively one organisation, with one Health Authority and 2 or 3 of semi-independent structures reporting to it (GP practices were always independent to a much greater degree). During the '90s, the number of separate organisations rose to 13, then reduced through mergers to 5 or 6. Each organisation has its own legal, HR and finance departments, its own board and its own CEO.
This is one reason for the growth of NHS bureaucracy; the other is the consequence of the introduction of market models and 'purchaser/provider splits'. If there is one single activity that accounts for most of the resource used to employ all those administrators (and clinicians doing admin work) it is the transaction of quasi-commercial relationships between commissioners and NHS bodies, Foundation Trusts, private contractors et cetera.
I am not a dogmatic opponent of commercial healthcare: it seems to me that if treatment is free at the point of delivery, it really doesn't matter who is providing it. I have seen some very good treatment provision by the private sector (and indeed experienced it) within the NHS. But I'm afraid that it is simplistic to see the problem as an old-fashioned one of state inefficiency. The pre-1990 NHS was more monolithic and more like a traditional 'socialist' organisation; and, paradoxically, it employed far, far fewer bureaucrats…
The fact is that the NHS is failing in the face of a hige demographic challenge precisely because of the way that it has sought to develop a decentralised, free-market model.
All the Best.
Thanks for these thoughtful replies – are they meant to be complementary?
I'm not analysing the NHS, so much as making ideas for an honest speech about it. Your ideas are strong too, of course
Yes, it was meant to be complementary and complimentary!
I think that you are quite right to point out that purely emotive appeals to 'Defend the NHS' and 'belief' get us nowhere; a lot of the current 'debate' borders on hysteria and makes it more difficult to have a sensible discussion about the real challenges that we face in organising healthcare.
I think your point that other civilised countries appear to have effective healthcare systems that are not organised on the NHS model is one we really should be considering; in fact I think that all your points about an honest speech need to be debated.
However, an honest speech also needs to consider that the problem is as much the way that medicine has developed as the structure for delivering it and that a major part of the challenge is demographic change.
And we need to ask ourselves why, in trying to move away from a monolithic 'command and control' model, we actually seem to have created more bureaucracy.
Anybody who tries to promote a more honest debate deserves credit in my view: though in the current climate I'm afraid that they may find that they're banging their head against a brick wall…. It really is quite shocking how crass and duplicitous much of the political discourse about the NHS is.
I entirely agree with your critique of Michael Sheen's rhetoric and have very little time for the Left's use of the NHS as a stick with which to beat the Tories.
However, I'm afraid that I think that your analysis of the NHS's problems is as much a misdiagnosis as Sheen's.
First, the real cause of the crisis the health service faces is demographic: the NHS is simply failing to cope with an aging society and an increased number of elderly people whose illnesses cannot be prevented (because they are a consequence of age rather than lifestyle), or cured. The NHS delivers treatment rather well on the whole: but it does not provide very good care, which, increasingly, is the real challenge.
Secondly, the reason that the NHS spends too much on administration (and I agree that it is scandalous) is not because it is an old-fashioned monolithic state bureaucracy: the NHS employed far fewer managers and spent much less on administration before the 1990s. Bureaucracy has increased over the last 25 years because of an obsession with decentralisation and localism that has led to a proliferation of supposedly independent organisations within the NHS and because of the transactional costs associated with market models and purchaser/provider splits.
i am not a dogmatic opponent of commercial healthcare provision: I have seen and experienced provision by private companies within the NHS that is excellent, and if treatment is free at the point of delivery, I don't see that it matters who delivers it, or whether someone profits from it.
But the unpalatable truth, in my experience, is that in trying to move away from a 'socialistic' 'command and control' model towards a more localised system in which market forces improve quality and efficiency, successive governments have actually created more bureaucracy and waste.
All the Best
Interesting. Just as Stephen Fry has been described as "the stupid man's clever man", I'd say this is what someone who doens't know about speeches would describe as a good speech.
I wish I were as optimistic as you about our national distrust of cant. Sadly my fear is that we're rapidly losing that power to discriminate. Something two minutes long, full of rhetoric, and eyewateringly simplistic is increasingly the order of the day. People would share this speech on Facebook in a way they wouldn't, say, share Vaclav Havel speaking in 1990 (http://old.hrad.cz/president/Havel/speeches/1990/0101_uk.html).
There is a market out there for honest speaking and honest speeches. The question is who will be the first to seize it…