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Developing a Labour Party policy for the NHS in the long age of austerity

Filed Under (Health Policy, Labour Party, Reform of the NHS) by Paul on 17-01-2012

If the Health and Social Care Bill passes through Parliament before Easter, it will mark the end of a political period in NHS politics. For the last 18 months it has been possible to define one’s overall political position as being for or against the Bill. This has meant that the Labour Party has been able to define its policy on the NHS through its stance on the Bill. That is perfectly legitimate for an opposition party. The Government proposes and the opposition – usually – opposes.

Given that the election took place in May 2010 it is also legitimate for an opposition to spend some time working through its policy rather than setting out its stall so far in advance of another election.

But in the autumn of 2012 this Parliament will be halfway through its course, and those of us interested in politics will be looking towards the next election rather than back at the last.

So I would hope that with the passage of the Bill the Labour Party will start to develop some of the main lines of its own policy towards the NHS.

Last week’s speech by Ed Milliband set out a crucial set of parameters for developing that policy. He quite rightly pointed out that at the next election the country will still be in financial deficit. Money, public and private, will be very tight and it’s important to frame any policy within those financial parameters.

Some of his shadow cabinet colleagues have begun to follow his lead. The Shadow Secretary of State for Education, Stephen Twigg, has started to develop an approach to education policy that recognises that the cuts in public finance will not be restored.

This is a difficult process for the Labour Party because it has always developed its policy for public services within an overall assumption of a growing economy. On many occasions in the past Labour have argued for an increase in the percentage share of the economy that goes to public services, but even when it was not arguing for that, it could base its policy on there being an increasing amount for public services – because the economy was growing.

Realistically the extent of economic growth in the five years of the next Parliament will be small, and consequently it is difficult in such straitened times to see how a political party could argue for the higher taxation that would be necessary to increase the share of expenditure that goes on public services.

Therefore the Labour Party – as with all centre-left parties in Europe – are going to have to develop a set of politics for public services that, at best, assume level funding.

We know what this will mean for the NHS. Because of an ageing population between 2015 and 2020 demand for health care will increase by about 20%, but there will be no increase in resource. How does Labour develop its NHS policy within these very tight economic constraints?

Whilst it is difficult, the Labour Party carries out this task with one enormous advantage. Both of the other major political parties will have already defined their policy for 2015 through the Health and Social Care Act. Over the next three years leading up to the election they will be defending a set of reforms that will at best work only in some parts of the country, and at worst create real day-to-day problems for the NHS. Both Conservatives and Liberal Democrats will find themselves defending a set of reforms that have ended up being structurally incoherent.

They have had their shot at reform and whilst no one quite knows what it is, they will have to argue for them continuing as they are from 2015. It is therefore difficult to see how – whatever policy Labour comes up with – would not be more popular than the opposing parties’.

There are some parameters for that policy though. No political party could go into the next election arguing for structural upheaval in the NHS. Which means that whatever Labour develops it should probably not suggest that it has a ‘really good idea’ for structural reform. The NHS has really had enough of that.

So Labour needs to describe how it will manage to improve the NHS in the latter half of this decade with increased demand and no increase in resources. It needs to persuade the public that it can do this because it understands the NHS better than the other parties.

It will not persuade the population that this is feasible without a radical policy of change. It will have to set its face against the conservatism that some in the labour movement have about the NHS and champion the radical innovations which can provide significantly better health care outcomes from the same level of resource

Last week the leader of the opposition called for a new realism from his party.

The place to start would be the NHS.


2 Responses to “Developing a Labour Party policy for the NHS in the long age of austerity”

  1. As we see the inevitable passing of one of the worst ever Bills into legislation, the Labour Party and its advisers (past and present) need to have a sustained think about the part they have played in preparing for this legislation.

    The charge sheet for the Labour Party is a damning one, and you will need to take your share of the responsibility, Paul.

    I am not a political person, and I don’t study the details of policy making with the relish of those whose life is spent doing this: after all I am a full-time GP in a deprived part of the country. However, all those on the left need to take a long hard look in the mirror and admit their role in getting to where we are now, and much of the misguided attempts at policy change forced through against professional advice.

    I include in this the 2003 contracts, the disaster of MTAS and MMC, the wanton waste of ISTCs, the foolishness of asking Professor Darzi to advise on primary care (and his foolishness for accepting this brief for which he was clearly out of his depth), the purchaser-provider split, the foundation hospitals, the GMC changes and the skills escalator. All of this has been hugely disrupting, ill-thought out, and have had many unintended consequences, almost all of them negative. They have all resulted in preparing the way for the current imbroglio.

    I see no acceptance or remorse for some of these catastrophes, merely a regular apologia pro vita sua, which depresses me a lot. Why have politicians stopped listening to the professionals? Or even worse listening to advisers who will tell them what they want to hear?

    The person in the CMO role needs to take some of the blame, with the previous CMO being rather a disaster (we always knew he would be) and the current one is rather too silent.

    The Labour Party lost its bearings under Blair and embraced many of the policies of the right wing. That is why this mess has happened (as well as messes in welfare and education for which you have no blame): until Labour returns to its role as a moral crusader for fairness, equity and compassion, we will continue to view the party, its leaders, and rump of supporters as Tory-party-lite.

    I’m sorry to be so scathing, Paul: you seem to be a good man with all the right intentions, but you must accept your part in shepherding in this terrible chimera of a BIll.

  2. @ Jobbing Doctor writes “The Labour Party lost its bearings under Blair and embraced many of the policies of the right wing.”

    If you cast your mind back to 1997, the NHS was on its knees – in terms of standards, staff morale (and pay) and infrastructure.

    Fast forward to 2010 and Dr Foster is praising major reductions in hospital mortality, stroke and cancer care amongst others is transformed, inpatient waiting is massively reduced, infrastructure is modernised, and pay is much improved. More money was spent, of course, but spend is still only at the OECD average.

    Oh yes, and public approval for the NHS is at record levels, says the British Social Attitude survey.

    Of course Labour made some mistakes, but you may look back fondly on that period in a few years time. With the NHS policy agenda being pursued, and believers in a “small state” in No 10 and 11 Downing Street, can we really deny the risk that in 10 years the NHS may be unrecognisable?

    A likely scenario is that it becomes like social care and with severe postcode differentials and top-ups for those who can afford it.

    Who else but Labour are going to lead the fight to stop this?

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