In a strange way, Tony Blair came to David Cameron’s rescue today. Faced with an unusually impressive rat-a-tat-tat salvo from Ed Miliband as he listed the key groups of clinicians and carers that oppose the NHS reforms, the Prime Minister invoked his idol to explain the truth about reform: nobody likes it.

“It is an object lesson in the progress of reform,” Cameron quoted Blair as saying. “The change is proposed; it is denounced as a disaster; it proceeds with vast chipping away and opposition; it is unpopular; it comes about; within a short space of time, it is as if it has always been so. The lesson is also instructive: if you think a change is right, go with it. The opposition is inevitable, but rarely is it unbeatable.”

The Government’s reforms to the NHS may not be wise (indeed, it is hard to know given how poor a job the coalition has done at explaining them). But this Prime Minister, and Blair before him, is right about reform in general. People rarely relish it.

Planning night-mayor

The enduring resistance to change has even ruined plans to transform the management of entire cities. Under the last Government, a number of senior figures in the Department for Communities and Local Government were mulling over how to improve the management of city areas like Manchester, which are carved into tiny councils with no strategic power. Greater London has its mayor, they argued, why not have a Boris or Ken for Greater Manchester, Greater Newcastle, and so on. Local people can rarely name their councillor – but all manner of exciting and outlandish names emerged as potential candidates for the new super mayors. The late, great Madchester impresario Tony Wilson was one.

The mayoral plan – rarely for something that came from the annals of power – made perfect sense. But there was uproar. Local councillors, as a rule, despised the proposal. This reform would remove power from local communities! (Ourselves). Nobody likes it! (Or, at least, we don’t). So the government, running scared, canned it. I’d tender that, had Wilson have ever come to office, the public would soon forget that there had ever existed any other system. When Cameron invoked Blair today, it was this point which most struck home. “Within a short space of time, it is as if it has always been so.” People hate change before it happens but then accept it very quickly.

‘Velli vidi vici

All senior managers will have, at some point in their careers, have been asked to make a change. In some industries – like publishing – that’s often what they are hired for. But that doesn’t make doing it any easier.

Remember this is not a column about the rights and wrongs of NHS reform. What it is about is that change is often necessary, sometimes exhausting, mostly unpopular. None of those make it wrong. Cameron, through Blair, just articulated wise old thinking.
“It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than a new system. For the initiator has the enmity of all who would profit by the preservation of the old institution and merely lukewarm defenders in those who gain by the new ones.”

That was Niccoló Machiavelli. He died in 1527.

Niccoló Machiavelli image courtesy of Antonio Abrignani / Shutterstock.com