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What will form the core of Labour’s NHS policy – patients or NHS organisation?

Filed Under (Health Policy, Labour Party) by Paul on 19-09-2012

Some of my friends’ lives revolve around the dates of world, national or European soccer cups. The more normal amongst them organise their time around their jobs or houses. But most of ‘me and mine’ have had their lives organised around the milestones of General Election dates.

For us 1992 was the date of an election which Labour expected to win… but was never going to. 1974 brought two elections, the first of which resulted in a surprise Labour government, and a second which resulted in the surprise that they did not win enough seats for a comfortable majority. Each of the 14 elections – going back to 1959 – has engendered a special set of emotions for me both during but most especially after the event.

I don’t pretend this is normal but it’s how my life has been organised since childhood.  This explains why, whilst on holiday, I remembered that within a couple of months we will be half way between the last General Election and the next one. (For the first time we have a piece of legislation that has set the date of the next General Election as May 2015. So unless Parliament decides otherwise we are in the unfamiliar position of knowing that in November 2012 we will be half way through this Parliament).

Of course that halfway date has no particular meaning for politics. But it does mean that all three political parties are starting to feel as if the sands of time are running out.

Up until now the Government could allow itself to feel that it has had time on its side. Time to get things right. Time to show that they are distinctive. Time, above all, to show that they matter and not the ‘other lot’. After next November there will be only two autumns left to relaunch (as they will try to this year), two autumns to show that the economy has turned around and is back to growth – and for those of us in the NHS two winters to prove that the NHS really is ‘safe in their hands’.

A year ago party politics for the Government looked very different from today. Last year there still felt to be a lot of the precious commodity – time – available. Now there seems to be not much left at all.

The same is true for the Labour Party. The first two years after an electoral defeat are tough. But you get through them and try to improve your position. Now the Labour Party’s big challenge is to demonstrate that when the election comes in 2015 they will be prepared for Government and can be trusted with it.

Once again what last year felt like loads of time will from November feel like time is running out. For oppositions the die will be cast in the autumn of 2014. Can the electorate trust them to take over?

This all means that, whilst they will not fine tune the detail of policy proposals until the 9 months or so before election, for this coming year the Labour Party will have to start painting a picture of the sort of society they want the British electorate to work with them to create.

The economy will be the most important aspect of that picture. Only a very few people believe that the years 2015-2020 will be easy ones economically for Great Britain. Most recognise it will be a hard slog in terms of jobs and the standard of living, and there won’t be much spare money in the electorate’s pocket.  Any increase in taxes would be ruinous to the economy because it will depress consumer spending.

And crucially that in turn means there won’t be much spare money for the NHS. With the central question of economic trust between the Labour Party and the electorate being public expenditure it is clear that if the electorate do not believe that the Labour Party will spend the electorate’s money wisely in 2015, they will not win.

Therefore the traditional Labour NHS policy – promising more taxpayers money – will not in 2015 be believable. What may look like a good vote-winning policy for the NHS will look like a very bad policy with regard to the electorate’s attitude to Labour policy on the economy.

Therefore as someone once famously said, “Now we have run out of money, it’s time to think”.

Let’s be clear if, in 2015, the Labour Party is polling better on the NHS than this Conservative-led Government, this will not be enough. A small lead on the NHS can be discounted. As I have suggested in the last 10 days the new Conservative Secretary of State could radically change the Government narrative on the NHS, but they can’t recoup 30 months of thrashing about trying to find a set of reasons for their NHS upheaval.

But the one thing that looks like a good simple policy for the Labour Party – promising to repeal the Health and Social Care Bill of 2012 – will, in the 6 months before the election, be fraught with danger. A promise to repeal the Act will get cheers at the Labour Party Conference in the autumn, but this will look very different in the 6 months before the 2015 election. Then, day after day, the politics of the NHS could be being portrayed as a contest between a Labour Party in favour of another 3 years of upheaval and the Tories as the party of calm and consolidation.

Even though the Act was unpopular the politics of arguing for another reorganisation of the NHS is unlikely to be at all popular in 2015. The new Secretary of State for Health will be presented with an open goal in which to boot the ball on a daily basis.

A wise Labour front bench will not run on the simple ticket of repealing legislation.

So if it’s not new money and it’s not new repealing legislation, what will it be?

Right now, in September 2012, I don’t know. But, given the electoral timetable outlined above, in the next few months I think we will begin to get a good idea of what to expect.

Historically, since the Labour Party feels the NHS is their creation, their traditional stance towards the NHS is conservative. This sometimes means leaving the NHS alone and being anti-reformist, and sometimes it means being in favour of change that goes back to a former era.

For some in the Labour Party that means going back to 1948 while for others it means going back to 1998.

In the next few months we will see if this traditional view has won.

If there is to be change – moving forward rather than backward – what will be important will be the driving reason for that change. In the last two years, as the coalition has tried to find a rationale for its own reforms, the best it has ever come up with is putting clinicians in charge of commissioning.

But that doesn’t start with patients.

Labour policy will have to clearly demonstrate how their policies are being clearly and practically driven by increasing the power of patients. That doesn’t just mean mentioning them in the first sentence, but demonstrating how each of their proposed changes will practically improve their power over their health and their health service.

Over the next few months I will be using this litmus test to blog on the policy as it develops.


One Response to “What will form the core of Labour’s NHS policy – patients or NHS organisation?”

  1. […] the Conference I commented on the difficulties that the Party front bench had got itself into by saying it would repeal the […]

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