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Blair’s and the current Government’s NHS reforms – is there any continuity?

Filed Under (Coalition Government, Health and Social Care Bill, Health Policy, Tony Blair, Uncategorized) by Paul on 23-01-2012

Last week I posted on the necessity for the Labour opposition to construct a set of medium to long term policies for the NHS which would clearly see them work with it over a period of time that I think of as ‘the long austerity’.

I received a number of comments from people who felt that the reforms in which as special adviser to Alan Milburn, John Reid and Tony Blair I was involved from 2001 – 2007 had laid the ground for the current reforms and that I should take some of the blame for the current Government.

So I thought it important to finish my analysis by examining the current Bill and its reforms in the context of the Blair reforms of the NHS.

The first thing to note about the continuity between the Blair and Cameron reforms is that since the election Lansley and Cameron have – on most occasions – said that what they are doing is different from what Blair did, and that there is no continuity.

On coming into power the new Government could have looked at past reforms and compared them with their own and said theirs were a continuation. They consciously chose not to.

In this area of policy – along with all the others – they declared May 2010 to be ‘year zero’ and said that what they were doing as a Government was new. In the summer of 2010 this looked like a strategic error for two big political reasons.
First there was strong evidence that both at the election and over the months since the public had demonstrated record support for the NHS. Public experience of the NHS was better than ever before.

Therefore if as a Government you are going to say that the last lot messed up the NHS and we are going to do something different, you need to understand that you are taking on the public and their expressed satisfaction with the NHS.
You have to find a delicate way of saying that the public are wrong. You need to persuade them that they are wrong to be satisfied with the NHS. That in fact there are these things (a, b, and c) wrong with it – and our reforms (x, y, and z) will impact upon a, b, and c in this way – and make them better.

So in saying that their reforms were brand new this Government were saying that the public and their satisfaction with the NHS were wrong.

It’s not impossible to develop a political position which starts off by saying that the public are wrong, but you need to be a much better and steadier communicator than this Government has proved to be.

So the Coalition Government chose to say that their reforms were very different and that they needed their own Bill (the biggest in the history of the NHS) to carry out their own reforms.

The second reason (apart from that of not deliberately disagreeing with the public) that it might have been a better strategy not to portray these reforms as departures from Blair’s is that the Conservatives are always going to be seen by the public as having a problematic attitude to the NHS.

A couple of weeks’ ago I posted on the political explanation of how certain formations of the left and right are better positioned to make some reforms and not others precisely because they are left or right wing. (The example I used was Nixon’s recognition of Chairman Mao’s China rather even though he was right wing).

This is also true of the Tories and the NHS. A wise Tory Party would have said we are simply continuing Labour’s reforms and going with the grain of the NHS. They would have hidden behind the Labour Party and its reforms.

But they have not done this. They have said the reforms are clearly theirs and that they take responsibility for their reforms.

So claims made by some of my readers – that these reforms are simply a continuation of the Blair reforms – are not shared by the Government.


One Response to “Blair’s and the current Government’s NHS reforms – is there any continuity?”

  1. Thank You for addressing this issue, Paul. You won’t be surprised that I both agree with you, and disagree with you.

    I can only really comment on the basis of my experience at the hard end of the NHS, a gruelling 10-12 hour day seeing patient after patient and seeing how structural changes affects them and the environment in which I work. I don’t have the time to study policy in great depth; just on how it affects me and my patients.

    I wholeheartedly take the point that the Government wish to take ownership of what they are doing, and – by definition – have distanced themselves from the Labour reforms. This is a conscious plan by them, and also a high risk strategy, as if it fails they will have to take the rap (eventually it will and they will). Therefore your point in what they are doing being distinct from what Labour (and you as Labour’s key adviser) did, I can agree with. That was not the point. The point is by creating an internal market in healthcare (that frankly didn’t work under Labour), with purchaser-provider split and Foundation Hospitals, you created the environment in which the Tories have been able to move to their position quickly. I regret to say that I cannot accept your view that these are not a logical progression from your reforms.

    I say you are culpable by design or culpable by default.

    Which is it to be, Paul?

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