Analysis: Labour’s awkward opposition to the NHS reforms
The struggle between government and opposition doesn’t feel like the main event when it comes to the battle for the NHS. Is Labour playing this one right?
You might expect the leader of the opposition to hold a press conference on the NHS on the same day that the Royal College of Nursing conference passes a no confidence motion against health secretary Andrew Lansley. But it was hard, watching Ed Miliband make the case against the government, to avoid the impression that this wasn’t the main event at all. “We cannot simply allow this debate to be conducted between the prime minister and his deputy,” Miliband told journalists at Labour’s party headquarters. Hence, we assume, the painfully well-timed press conference.
Everyone knows the real conflict is taking place within the coalition government’s many committees, as the Liberal Democrats dig their heels in against the reforms. That’s the case across the full scope of British politics, but the problem is especially acute here. “The Liberal Democrats and Nick Clegg are up to their necks in this government’s reorganisation,” Miliband added. “Clegg is a come-lately to concerns about the NHS plans that he personally endorsed when he co-signed the foreword to the NHS white paper.”
These attempts to make this debate about Labour’s opposition are only partially successful, at best. It’s an unwelcome side-effect of the simple fact that everyone is up in arms about the proposals, not just the opposition. Miliband inevitably faces claims of bandwagon-jumping as a result. “We’ve helped set the bandwagon rolling,” he protested this morning. Actually, it’s the way in which Labour has gone about approaching the issue which reveals the party’s real problems undermining its position.
An awkward mismatch exists between the Conservative and Labour parties’ tactical approach to this hydra-headed issue. The Tories issued a briefing note this morning trying to muddy the waters when it comes to complains about ‘political micromanagement’. It asks: “Do they believe in top-down politically motivated targets or does Liz Kendall stand by her assertion that ‘many staff are disillusions and disempowered by the top-down, target-driven approach that has dominated much of the latest decade of health policy’?”
The answer, according to a Labour dossier released at the same time, reciprocates that muddying process. “David Cameron promised to ‘stop the top-down reorganisations of the NHS that have got in the way of patient care’,” the opposition notes. “Less than two months into government he broke that promise, approving Andrew Lansley’s plans for the NHS – the hidden reality of which is a wholesale top-down reorganisation of the NHS.”
Perhaps the best that can be said is that these arguments cancel each other out. Why are they clouding the issue in this way?
One answer might be that they’re trying to avoid the awkward truth that their approaches to the NHS are not so easily distinguishable. Take the Tories’ underlined point that the proposed changes aren’t so radical, after all: “These plans are an evolution of Labour’s policy, not a revolution.” It feels as if they’re taken aback by the extent of the opposition – which, of course, they have been.
Labour supported the policy of ‘any willing provider’ before the election. Tony Blair’s health adviser told the health select committee in January that the changes were what New Labour would have liked to have done, had they not encountered “road blocks”. The Tories feel rather sore that these points are being brushed over. Both they and Labour know that the headline of a no-confidence motion easily trumps this sort of minutiae, though.
Labour’s approach to ignoring this surprising degree of proximity between the two positions has been to present the press with some rather explosive nitty-gritty. The opposition, in particular shadow health minister Liz Kendall, has been extremely active in the committee stage of the health and social care bill in digging these details up. Miliband presented the five top picks this morning. NHS hospitals could go bust, face fines of up to ten per cent of their turnover and face shutdown without any consultation; patients could suffer as hospitals prioritise those who can afford to pay; and, most interestingly, new powers could hand GP the right to charge for services.
These, especially the last one, are exactly the kind of thing which ministers unthinkingly throw in sweeping reforms without realising the trouble they’ll create. They also serve a useful strategic purpose for Labour: delving into the detail very conveniently distracts attention away from the more unclear gaps between Labour and Andrew Lansley.
You don’t need to look far to spot further discrepancies in Labour’s approach. After the general election Andy Burnham, fresh out of his office in the Department of Health, said it would be “irresponsible” to increase NHS spending in real terms. His successor as shadow health secretary, John Healey, contrasted David Cameron’s emphasis on a real rise in NHS funding with the simple fact that it’s down by £1 billion.
Pointing this out to Ed Miliband prompted a short response. “I stick by what our manifesto said,” he told politics.co.uk, “which is that we will protect our NHS frontline spending in real terms. I think that’s the right thing to do. Andy took that position in the leadership campaign, but that’s the position of the party.”
Labour’s 2010 manifesto contains its own headaches, though. As the Tories have pointed out, it also states that “patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs”. We can go on and on, in short, back and forth. Politicians don’t need to try hard to get the public bogged down in detail when it comes to the NHS.
Miliband faces two challenges as the melee of this ongoing tussle continues. He must ensure the public think he’s the one leading the opposition – and not struggling to keep up. And, more fundamentally, he must avoid being dragged down by the surprisingly narrow gap between New Labour’s NHS reform ambitions and the Tories’ ideas it is now fighting its hardest against.
