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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It's time for Jeremy Corbyn's supporters to take on the unions

The union support for expanding Heathrow reflects a certain conservatism. 

The government’s announcement that it will go ahead with a third runway at Heathrow seems to have unlocked an array of demons. It has also created some unlikely alliances. Zac Goldsmith, the pro-Brexit mayoral candidate whose campaign was widely condemned as racist, is seeking to re-invent himself as an environmental champion, campaigning alongside fellow Heathrow MP John McDonnell. And the Richmond byelection which he is triggering could yet become a test case for Labour’s progressive alliance enthusiasts.

But perhaps the most significant position is that of the major unions. To the shock of many less seasoned activists on the left, Unite, the largest trade union in the UK and a consistent supporter of Corbyn’s leadership, has loudly called on the government to “be bold and build” the new runway, even now urging it to accelerate the process. Far from being a revelation, Unite’s position on Heathrow is longstanding – and it points to the lasting power and influence of an establishment trade unionism.

In August, the TUC co-ordinated a joint statement from five unions, urging the government to go ahead with the third runway. Like the rest of the unions’ lobbying efforts, it was coordinated with other pro-expansion stakeholders like the CBI, and it could just as easily have been authored by the business lobby. Heathrow expansion will, it says, “deliver at least £147bn to UK GDP and 70,000 new jobs”. “Trade unions and their members”, said Frances O’Grady, “stand ready to work to help the government successfully deliver this next major national infrastructure project”.

The logic that drives unions to support projects like Heathrow expansion – and which drives the GMB union to support fracking and Trident renewal – is grounded in a model of trade unionism which focuses not on transforming the workplace, but on the narrowly-defined interests of workers – job creation, economic growth and a larger share of the pie. It views the trade union movement not as merely antagonistic to employers, but as a responsible lobbying partner for business and industry, and as a means of mediating workers’ demands in a way that is steady and acceptable to the state and the economic system. This model, and the politics that accompanied it, is why, historically, trade unions were a conservative influence on Labour’s internal politics.

Nothing could be more at odds with the political, environmental and economic realities of the 21st century. It is not in the interests of workers or ordinary people to live on a planet which is slowly becoming uninhabitable. To avoid catastrophic global warming, we need to leave the vast majority of fossil fuels in the ground – that probably means shrinking the aviation industry, not expanding Heathrow’s passenger capacity by 70 per cent. All of this is implicitly recognised by Jeremy Corbyn’s environmental and industrial strategy, which aims to create a million new jobs and build a million new homes while switching to renewables and democratising the energy industry.

The gap between Corbyn’s policies and the policies of many major trade unions tells us something deeper about the challenges facing the left. If Corbynism is an unfinished revolution in the Labour Party machine, it is one which has barely started in the wider labour movement.

The gradual leftward shift in many unions’ political allegiances has broadened the alliance around Corbyn and given him strength in numbers and resources, but it is often as much about internal union politics as it is a deep conviction for what Corbyn represents. Unison general secretary Dave Prentis did back Corbyn’s re-election following a ballot of members, but is hardly a left-winger, and the union’s votes on Labour’s NEC are not safely aligned to the left.

The political radicalisation of the unions has been matched, if anything, by a decline in coordinated industrial action. The national strategy that fuelled the anti-austerity movement in 2011 and 2012 is only a memory. The democratic and organising culture in many unions, too, remains bureaucratic and opaque. Trade unions have played a key role in Corbyn’s coalition, but without a significant shift in their internal culture and a shift away from their role as respectable partners of industry, they could easily scupper the project as well. 

The expansion of Heathrow airport is a step backwards for the future of the planet and the interests of ordinary people – and yet, if it happens at all, it will have been made possible by the concerted efforts of key trade unions. This is not an aberration but a reminder that, despite their rhetorical flourishes in support of Corbyn, Britain’s trade unions are also in need of change. Any project that aims to transform the Labour party and wider society must also aim to transform the whole of the labour movement – from the shop floor to the corridors of power.