Milburn's challenge to Labour on NHS reform

Former health secretary argues that Labour should take up the mantle of radical reform.

The Tories lack the public trust needed to radically reform the NHS, so Labour must. That's the striking message of Alan Milburn's essay in tomorrow's New Statesman. Tony Blair's former health secretary argues that Andrew Lansley's bill, "riddled with complexity and compromise", means the Tories have "forfeited any claim to be the party of NHS reform."

He writes:

Obsessed with policy tinkering, Lansley ignored the politically inconvenient truth that the Conservatives simply did not have enough public trust on the NHS to inflict change within it. The baggage they carried of being ideologically obsessed with privatisation weighed them down once they hit a wave of opposition to their health reforms. They are drowning as a result.

From here, he urges Labour to take up the mantle of reform. The left has the opposite problem to the right, Milburn argues. While it has the permission to make change, it lacks the volition. He writes:

Too often the left in Europe has shied away from such an apporach. It has adopted a protectionist rather than a reformist approach to the public services. The left's default position has been to stand up for producers, not consumers. Defending the status quo in a world of such rapid change has proved to be a recipe for electoral disaster. In France, Germany, Italy, Spain, even Sweden, the left has suffered consecutive election defeats where until recently it could lay claim to be the natural party of government. As New Labour proved, it is not by being protectionist but by being reformist that the left is able to win.

He urges Labour to embrace reforms that "empower patients, financially incentivise outcomes, increase competition, improve transparency and devolve accountability to local care organisations."

If that sounds remarkably similar to Lansley's vision for the NHS, it's because it is. Milburn's objection to the coalition's approach isn't a principled one but a pragmatic one. In his view, only Labour, the party that founded the NHS and restored it to health, has the political trust required to introduce Lansley-style reforms.

It's a message that sits uneasily with Labour's current approach. As David Cameron rightly noted at today's PMQs, it was Ed Miliband's party that first introduced private competition into the NHS in 2008. For now, with Cameron on the ropes, Labour is in no mood to reflect on this fact. But Milburn's essay will reignite the debate about what the party is for, rather than merely against.

George Eaton is political editor of the New Statesman.

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Iain Duncan Smith says what most Brexiters think: economic harm is a price worth paying

The former cabinet minister demonstrated rare candour by dismissing the "risks" of leaving the EU.

Most economists differ only on whether the consequences of Brexit would be terrible or merely bad. For the Leave campaign this presents a problem. Every referendum and general election in recent times has been won by the side most trusted to protect economic growth (a status Remain currently enjoys).

Understandably, then, the Brexiters have either dismissed the forecasters as wrong or impugned their integrity. On Tuesday it was the turn of the Institute for Fiscal Studies (IFS), one of the most revered bodies in Westminster. In response to its warning that Brexit would mean a further two years of austerity (with the hit to GDP wiping out George Osborne's forecast surplus), the Leave campaign derided it as a "paid-up propaganda arm of the European commission" (the IFS has received £5.6m from Brussels since 2009). 

The suggestion that the organisation is corrupt rightly provoked outrage. "The IFS - for whom I used to work - is not a paid up propaganda arm of the EU. I hope that clears that up," tweeted Brexit-supporting economist Andrew Lilico. "Over-simplified messaging, fear-mongering & controversialism are hard-minded campaigning. Accusing folk of corruption & ill intent isn't." The Remain campaign was swift to compile an array of past quotes from EU opponents hailing the IFS. 

But this contretemps distracted from the larger argument. Rather than contesting the claim that Brexit would harm the economy, the Leave campaign increasingly seeks to change the subject: to immigration (which it has vowed to reduce) or the NHS (which it has pledged to spend more on). But at an event last night, Iain Duncan Smith demonstrated rare candour. The former work and pensions secretary, who resigned from the cabinet in protest at welfare cuts, all but conceded that further austerity was a price worth paying for Brexit. 

"Of course there's going to be risks if you leave. There's risks if you get up in the morning ...There are risks in everything you do in life," he said when questioned on the subject. "I would rather have those risks that we are likely to face, headed off by a government elected by the British people [and] governing for the British people, than having a government that is one of 27 others where the decisions you want to take - that you believe are best for the United Kingdom - cannot be taken because the others don't agree with you."

For Duncan Smith, another recession is of nothing compared to the prize of freedom from the Brussels yoke. Voters still reeling from the longest fall in living standards in recent history (and who lack a safe parliamentary seat) may disagree. But Duncan Smith has offered an insight into the mindset of a true ideologue. Remain will hope that many more emulate his honesty. 

George Eaton is political editor of the New Statesman.