Perspective was one of the great additions in fine art painting. It involved the creation of the horizon line, which is often implicit. Where parallel lines are involved in a depiction, then one or more vanishing points are involved.

Why am I writing about perspective? Due partly the reflection from returning from a good holiday. One thing that a good holiday can provide is enough of a break from routine to give you a sense of perspective.

Another thing s holiday prompts is the unanswered question of whether the real world is that of holiday or that of work. Larkin’s toad.

Of the two-and-a-half main themes during the past couple of weeks, the most interesting one politically has been the row over ‘who is the party of the NHS?’. The future of the NHS IT programme is the other one; and the half-one has been the comedy non-debate over comparisons between the US and UK healthcare systems. The FT’s Nick Timmins makes the most sense about this one.

However, it seems unclear what will now happen regarding any vote on proposed US heathcare reform legislation (which President Obama wanted before Christmas 2009), given that Edward Kennedy’s seat in the senate is now vacant through his death.

It was interesting to note from one of the obituaries that Kennedy refused President Richard Nixon’s offer to roll out a form of universal coverage in 1974 because Kennedy thought it insufficiently generous. Kennedy wrote this interesting article for Newsweek last month.

Kennedy’s death leaves the Democrats temporarily without the 60-seat majority needed to steamroller the legisation through the Senate in the face of the growing Republican opposition, as this article in The Guardian notes.

Kennedy asked the legislature of Massachusetts, the state he represented in Washington, to enable the governor to appoint an inyterim senator to prevent the five-month delay before another (undoubtedly Democrat) senator could be elected. The status of this request remains unclear.

Who is the party of the NHS?
You Tube heroism was bestowed on MEP Daniel Hannan for his excoriating attack on PM Gordon Brown in the European Parliament. However, whatever morale-boost this gave the Conservative Party leadership was blown away by Hannan’s stunning comments on US TV about the NHS being “a 60-year … mistake”.

Interestingly, Hannan’s coments attracted much less notice on 4 April 2009, when they were first broadcast, than in recent days.

However, there has been sufficient concern over the new currency of Hannan’s attack as the Obama reforms hit the deep … mud. It prompted David Cameron to re-announce the Conservatives as the party of the NHS – a bold move, first made in the unpopular returning to financial balance of 2006-7.

Cameron has political reasons (decontamination of the Tory brand) and personal ones (close-up knowledge of NHS strengths and weaknesses in the care of his late son Ivan) for wanting the NHS to be a safe issue for his party.

In the political fight over the issue, Andy Burnham used the line about the Tory proposals for an independent board to run the NHS creating “Britain’s biggest quango”. He also, mischeiviously, asked whether Cameron would remove the Conservative whip from Daniel Hannan. Cameron’s problem in the parliamentary grouping of his Euro MEPs is a public laughing matter.

Nor was this the only source of concern to Mr Cameron and colleagues: a ComRes poll of 150 MPs at Westminster, funded by the BMI Healthcare hospital group (along with NHS-facing unit Netcare, part of the General Healthcare Group), found that the majority of the 45 Conservative respondents see the NHS as unsustainable and want more private insurance and / or tax breaks.

29% of the Conservative MPs who replied to a question whether the NHS should receive guaranteed real-terms spending rises over the next Parliament agreed; 62 per cent disagreed. Only 33 per cent believed the current NHS model, funded from general taxation and free at the point of delivery, was sustainable for the next 60 years; 62 per cent did not.
Now there are more than 45 Conservative MPs on the back benches. More to the point, the August silly season probably gave the story more impact than it might normally have.

Is this a problem for Cameroon Conservatives? Not necessarily. They are in truth a small group, who many Tory traditionalists regards as ‘entryists’, and in many senses are out of sympathy with their party’s traditional lobby fodder – not unlike the New Labour modernisers, though after one less general election defeat to grind the discipline into them.

Hence Cameron’s gleeful haste to dispatch inconvenient, ‘non-U’ expense claim miscreants, creating a vacancy for the generation of bright young things he wants behind him when he crosses the floor next year.

Is Cameron serious in his commitment to the NHS? He seems to be fully sincere. This has been an embarrassment, but given Labour’s sleepy response to the opportunity for some ‘clear red water’, an embarrassment of a low order of magnitude.

Elsewhere, may I direct you to a couple of excellent articles: Nigel Edwards of the NHS Confederation pleading for more sensible derbate about NHS reform in The Independent and Dr Michael Dixon of NHS Alliance suggesting that GP pay should be published on BBC News Online.