With 100 days to go before election day, the Labour party’s decision to place the NHS centre stage in its campaign means that both its critique of the current government and its policies for the future will get 100 days of close scrutiny. The Labour party are correct to spend as much time as they can pointing out how in five years waiting times have increased and the service has become so very stretched.
In 1995-7 on a daily basis Alan Milburn picked apart John Major’s government’s record on the NHS culminating in the slogan ’24 hours to save the NHS’. The attacks worked then because Major’s government did not know what to do with the NHS.
The same has been true of the coalition. Most leading members of the coalition would admit that the way that they sleepwalked into the Lansley reforms meant that they have failed to move the NHS in the direction that it needs to go. The coalition’s first three years were spent using up all of its political capital on a reorganisation of the NHS, much of which could have been achieved by consensus, and now as they admit it was ‘the biggest mistake they have made’.
We therefore have the very odd politics of the coalition spending three years bringing in reforms that no one will now explain or defend. It is therefore understandable and effective that we will see many of the next 100 days with Labour pointing this out, and Labour will gain a significant political advantage from this attack.
More problematic will be turning that into a series of manifesto pledges that leaves the electorate feeling that the Labour party will, if they are in power next winter, be any better than this one. What will Labour do to gain the confidence of the electorate that they will have positive actions to improve the NHS?
Firstly, spending more money on the NHS is always good electoral politics and will have an impact upon the electorate and upon delivery. After all, under Tony Blair the amount of money spent on the NHS doubled and played a major part in both winning the 2005 election and in bringing the NHS to a place of safety in 2010. However, over the next 100 days it will be pointed out that it will take a year to get the mansion tax legislation through and a further year to raise the full £2 billion from it. That will take us to May 2017 and presents us with a problem of what to do before then.
The second issue is a promise to reduce the impact of competition. Obviously this is an important ideological plank for the current Labour leadership and they will raise this again and again. During the election campaign there will be much more detail required about how and when this will save money, and also whether any UK government could achieve this without leaving the EU. It would appear that Cameron is committed to reforming the EU by questioning the EU commitment to free movement of labour and Milliband is committed to questioning its commitment to the free movement of goods and services. Both think (and hope) they can do this within current EU structures; both are almost certain to be disappointed.
The third issue is whether a Labour government will create a new top down reorganisation of the NHS. Andy Burnham’s speech today states that he rejects the need for a reorganisation and then goes on to pledge one. Currently the legislation has NHS care commissioned locally by GP led clinical commissioning groups. Local government commissions social care, public health and other services come together in local authority health and wellbeing boards. Burnham has for some time wanted to bring all commissioning under health and wellbeing boards, the problem is this would be a top down reorganisation of the NHS – something he does not want to do.
Today’s speech make it clear that he now pledges to bring in legislation to achieve this:
By legislating for commissioning with this budget – as a partnership between the NHS and councils through the health and wellbeing board – we will finally vest people at local level with real power
This is definitely what he wants to do and he is now committed to legislation to bring this about. But legislation, by its very nature, creates a top down reorganisation across the country moving by law commissioning from CCGs to health and wellbeing boards. This will not be left up to localities – that is the point of national legislation. The worry for the NHS is that we went into the last election with the Tory party saying there would be no top down reorganisation and the coalition then promptly carried one out. We are now going into this election with the Labour party saying they are not going to have a top down reorganisation but with a pledge to bring in legislation that will do just that.
Over the next 100 days the contest and debate about this will be an important part of how Labour gains the trust of the electorate in what is their most important issue.
Paul Corrigan was a health adviser to the Labour government
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