Not feeling so courageous, eh, minister?

William Hague is not the first MP to put loyalty to a local hospital before government policy, and h

The Sun reports today that William Hague is lined up to speak at a rally in opposition to the downgrading of a maternity unit at a small hospital in his Yorkshire constituency. A spokesman for the Foreign Secretary is quoted as saying this has nothing to do with the health reforms contained in besieged legislation currently causing tumult in parliament.

In technical terms, that might just about be true. The Health and Social Care Bill isn't on the statute books so it cannot directly have led to changes on the ground to which Hague is opposed. But politically the two cannot be separated. Partly, it just looks ridiculous. People conflate 'reform' and 'cuts' (the Sun's copy certainly does) and generally blame the government for everything bad that happens in the NHS so will wonder whose side the Foreign Secretary thinks he's on.

But the Hague conundrum also points to a more subtle, long-term problem. There is something approaching consensus in health policy circles that, eventually, for the sake of cost efficiency and coordination of care, specialist services need to be concentrated in centres of excellence, while routine procedures can be done more locally. What this means in practice is that the medium-sized district general hospital is an endangered species. There will be clinics, often based around GP practices, for the small stuff, and then fancy regional centres for the high-tech, complicated stuff. This dynamic appears to be what is behind the removal of certain services from Hague's constituency. Routine baby deliveries will stay; inpatient paediatric care is moving off 22 miles away to Middlesborough.

The problem with this trajectory - although it might make commercial and clinical sense on paper - is that it makes for atrocious politics. It always means stories of sick patients being forced to travel miles by taxi or ambulance when what they really want is just to stay local. Every constituency has an old-fashioned general hospital and every MP feels obliged to stand by it on the barricades. (Remember Hazel Blears getting into much the same pickle?)

Lansley's reforms are going to replicate this situation in constituencies up and down the country. The new GP-led commissioning structures and enhanced competition to provide care will, it is guaranteed, accelerate the process of 'rationalisation' away from general hospitals. That is partly the point of the reforms, albeit not one the government boasts about. Local surgeries will pick off the work that doesn't need in-patient beds, while specialist hospitals will be the obvious suppliers of more complex procedures. Plenty of Tory and Lib Dem MPs are worried about the dilemma this will create for them. It is a courageous politician indeed who turns up at a local town hall meeting to say 'actually,in the interests of overall NHS efficiency and in support of government policy, I'm here to defend the closure of our casualty/maternity ward.'

Hague isn't planning on doing it. The rest will follow his lead. This is just one of many reasons why Andrew Lansley's reforms are a political disaster. He can't seem to sell them to the public and no one else with a seat to defend containing a cherished local hospital is going to dare do it for him.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

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Slowly but surely, the patriotism question is making its way into Labour

John Denham observes a strange but happy outbreak at Labour party conference.

It’s a measure of Labour’s distress that it managed to settle the leadership while resolving so few of the challenges it faces. Over the past two years, the party’s electoral base has been torn apart by identity politics. Huge numbers of Scottish Labour voters abandoned party loyalty to vote for separation and then to dump the party itself. In England, voters feared SNP support for a minority Labour government; many others turned to Ukip. In the final blow, millions of former Labour voters, particularly those who felt mostly sharply English, backed Brexit. Many of the party’s MPs wonder how many will ever be coming back.

Faced with this tsunami of political rejection, the issue was simply airbrushed out of the leadership campaigns. Over four months neither Jeremy Corbyn nor Owen Smith even acknowledged, let alone addressed, the potent power of identity. Both cleaved to the belief that the complex weave of hope, fear, powerlessness, aspiration, community and security that are bound up in our sense of ‘who we are’ could all be stilled by the promise of ‘anti-austerity’.

One of the left’s less appealing habits is believing that it understands what voters really want better than voters do themselves. (You tell me you are worried about how quickly migration is changing your community, I tell you’re really worried about spending cuts).  Jeremy Corbyn’s statement that “we are not concerned about numbers” is probably enough to lose Labour the 2020 election on its own. No comprise here with voters on the issue that has dominated public concern for 15 years. To be fair, Owen Smith never offered a radically different perspective. It was never part of the debate.

Yet reality has a fortunate habit of intruding into the debate. In early, sometimes stumbling ways, identity politics is beginning to concern people right across the party. At Liverpool, most of the think-tanks held meetings addressing national identity in England, Scotland and the Union. Most attracted healthy audiences who, by and large, did not think identity was the property of the far right. (Declaration of interest: I was a speaker at some of these). Policy Network, IPPR, LabourList and the Fabians were amongst those taking the debate forward. Much of the New Statesman’s “New Times” edition is preoccupied with the same issues. Newer organisations from different parts of the party are engaging. The Red Shift group of Liam Byrne, Shabana Mahmood and Nic Dakin called for an explicitly English Socialism. Veteran Brexiteer John Mills, is supporting a new Labour Future organisation. Both are exploring how radical national policy and national identity fit together.

More surprising was the overt insertion of patriotic themes into the speeches of Corbyn’s front bench and the leadership itself. Military service sits as easily with the socialism of Clive Lewis as it does with Dan Jarvis. Rebecca Long-Bailey told the conference  Patriotism is not just about waving a flag during the World Cup. It is a real, life-long commitment to the people around you….When you pay your taxes, you are investing in the British people..This commitment to British people should be woven into every aspect of the British economy,

This is a potentially powerful and unifying theme for Labour. National identity and patriotism may still be a minority interest, yet it attracts people from all the party’s wings.  Tristram Hunt, Lisa Nandy, Owen Jones and some of Corbyn’s key supporters are all engaged.

These are early days. National identity was hardly the dominant issue of the conference, let alone Momentum’s parallel event. Too often the tone is narrow and defensive, as though people on the left don’t have identities but we need to understand those who do. There’s a temptation to believe that Labour simply needs some St George flags to unveil on council estates and put away elsewhere. At its best, progressive patriotism can uniting disparate interests and communities. It opens up conversations with people who would reject a political label. It can be a foundation for holding the powerful to account.

In his speech, John McDonnell praised Christians on the Left for promoting the hashtag “patriots pay their taxes”; a message that was reinforced in Corbyn’s own speech: “there is nothing more unpatriotic than not paying your taxes”.  As Hillary Clinton exposed this week, patriotism can separate those who accept their obligations to a wider society, and those who think it is clever to avoid them. In English radical history, the notion of the common weal held that the measure of the powerful was how well they looked after the commons. It has a powerful resonance today and Labour needs to mine it more.

John Denham was a Labour MP from 1992 to 2015, and a Secretary of State 2007 to 2010. He is Director of the Centre for English Identity and Politics at Winchester University