A tale of two bills
On health, Labour has opposed well but is yet to present an alternative. The inverse is true on welfare
While neither have yet run their course, the two major political battles that Labour has fought against the coalition so far this year – to defeat the health and welfare reform bills – appear to be heading for different conclusions.
In the case of the former, shadow health secretary Andy Burnham has skilfully tapped into voters’ underlying distrust of the Tories’ commitment to the NHS, and the near-unanimous opposition of the medical profession, to rally the public. In the case of the latter, Labour’s stance on the benefit cap – support ‘in principle’ but opposition in practice – left the party stuck between a rock and a hard place. It adopted neither the position that was politically most expedient – to back the government – nor one which could at least have been presented as principled but unpopular.
However, the apparent conclusion of these early skirmishes is perhaps a poor guide to the underlying strength or otherwise of Labour’s position. On health, Labour is right to do all that it can to defeat Andrew Lansley’s bill. Having promised no top-down reorganisation of the NHS in their manifesto, the Tories have absolutely no mandate to proceed with their costly, damaging and dangerous plans. Nonetheless, Labour must be clearer about the basis upon which it opposes the bill: that it is, in the words of former health secretary Alan Milburn, a ‘roadblock to meaningful reform’. As Neil Churchill, chief executive of Asthma UK, reminds us on page 6, the principles which supposedly underlie the bill – the need for clinical involvement in commissioning, greater patient choice, and competition – met with widespread agreement when the government unveiled them in 2010. They remain key to helping the NHS manage the rising demand and squeezed budgets with which it is confronted.
Burnham made clear on his appointment to the health brief that, if the government dropped the bill, the opposition would discuss giving GPs greater powers over commissioning. But on the principles of choice and competition Labour, despite the success of its own health policies in government, has been more reticent.
This is a pity. As Zack Cooper of the London School of Economics, who has studied Labour’s managed competition policies, argues: ‘Evidence on the benefits of competition is growing rapidly: it suggests that publishing data on how hospitals are performing, and allowing every patient in England to go to the best hospitals in the country, improves standards across the NHS.’ Moreover, separate research by Imperial College and the LSE shows that competition led to improvements in hospital management which resulted in lower death rates, higher patient satisfaction and efficiency gains. And Richard Cookson of the University of York has shown that the competition on the basis of quality not cost which Labour introduced has not harmed the vital principle of equity.
The coalition’s majority makes the defeat of the health bill an uphill struggle. At that point, the party should make clear that it will judge the legislation on those principles which the government claimed informed it. We have no doubt that the legislation will be found lacking on each of those tests, but they must then inform the alternative that Labour presents.
Having surfed a wave of popular opposition to the health bill, Labour still finds itself facing a tide of public anger about the perceived unfairness of welfare payments and the party’s alleged failure to deal with them when it was in office. Take the latest British Social Attitudes survey which shows that over half of people believe unemployment benefit to be too high, while 63 per cent think child poverty stems from parents’ failure to work. The benefits cap exploited such feelings, offering an easily comprehensible solution to them.
While David Cameron may have temporarily wrong-footed the opposition, under shadow work and pensions secretary Liam Byrne, Labour has enunciated clearly the principles which will inform its approach: ‘No one should be able to choose a life on benefits over a life in work. Everyone should feel the system is based on what you put in as well as what you take out.’
From these principles, the outlines of a new approach – one which could re-establish public confidence in welfare – have begun to emerge. First, it is one that will be based upon greater conditionality in return for greater support. This will require Labour to be tough in its insistence that all those who can work must do so. At the same time, requiring people to work places a responsibility on government to ensure that there is the opportunity to do so: that, as a last resort, it will provide jobs for those unable to find them. It also means that Labour will need, as we have argued before, to prioritise the provision of affordable, universal childcare. Second, welfare must, as Byrne has already indicated, return to the social insurance principles which underpinned William Beveridge’s original vision.
Conventional wisdom at this point suggests that Labour has done a better job at opposing the government’s health bill than its welfare reform one. But opposition is also about providing an alternative. On that score, the jury is still out.
Alan Milburn, Andrew Lansley, Andy Burnham, coalition government, Conservatives, health, Labour, Liam Byrne, LSE, NHS, welfare reform, Welfare Reform Bill, William Beveridge