The second most important point about democratic elections (the first is, of course, winning them) is that they provide the winners with a democratic mandate which provide them with a set of tools with which they can govern.
A serious manifesto, therefore, does not only win the election, it must also provide the cabinet members with the tools to govern the country in the way in which they want.
It is that reason why a manifesto based upon the policy that the Labour party loves the NHS more than the Tories will not be good enough to save the NHS.
The picture to keep in your mind is the first meeting between the new Labour secretary of state for health and the permanent secretary of the Department for Health sometime in mid-May 2015.
The permanent secretary will have prepared an outline of the problems facing the NHS for the new secretary of state.
In May 2015 this will be a very difficult picture. Over the next five years this picture gets more and more difficult. The rising demand for health services from an aging population will mean that the model of hospital-based healthcare that was suitable in 1948 when the average male life expectancy was 66, will have become unaffordable.
Given this greater demand the only way the basic principle of the NHS – a health service with equal access for all free at the point of need – will be possible will be to have much more care for sicker older people taking place in people’s homes and not emergency beds in hospital.
This is an enormous change which most leaders in the NHS recognise is a bigger change than in the last 60 years. To bring this about over the next five years a new secretary of state will need powerful leaders of reform.
Therefore in May 2015 the new secretary of state when they hear this picture from the permanent secretary, reaches into their manifesto bag of levers for change and finds at the top of that back a pledge for an extra £2.5bn per annum.
They will lay that on the table and say to the permanent secretary ‘This extra £2.5bn will sort it out’. She of course, having read the manifesto, will be ready for this. First she will point out that since this is consequent on passing the mansion tax legislation, this money will not start reaching the Department of Health until the beginning of the financial years 2016-17.
At that time this sum will come in very handy at that time because it will match almost exactly the deficit that the NHS will have in its spending in the year 2015-16.
So the new money will be really useful in going straight into the deficit that an unreformed NHS will be ratcheting up.
Back in our meeting of May 2015 the chastened secretary of state will reach further into their bag of manifesto promises and scrabbling around for further levers for change will come out with a phrase that says ‘We love the NHS more than the Tories’.
The permanent secretary, as a professional, will of course say ‘That’s very good to hear, secretary of state, but what I need to know is how the this love is going to help you radically change the NHS model of care and to help all these sick older people.’
The main job of any Labour secretary of state for health is to ensure that a health service with equal access for all and free at the point of need is safely handed on to the next generation. Over the next few years to safeguard that principle they will need levers of reform of the NHS that go way beyond deep affection and involve very great reform of the way in which the NHS works.
Love can work wonders but to change the world it sometimes needs better politics than itself alone.
Paul Corrigan was a health adviser to the last Labour government. He tweets @Paul_Corrigan
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