Taking the nation’s pulse

In a New Statesman and Pfizer debate, the three main political parties clashed over their plans for

"Well I hope the New Statesman have now got their headline," the Conservative shadow health minister Mark Simmonds said at a heated moment in the debate with the Labour Health Secretary, Andy Burnham, and the Liberal Democrats' health spokesman, Norman Lamb. "Which is that the Conservative Party is the only party to maintain and guarantee funding for the National Health Service."

Funding was one of the principal dividing lines in the debate on the NHS that took place a week before the general election on 6 May. All three parties devoted substantial sections of their manifestos to health, and the Tories revealed their commitment to preserving funding for the service in one of their early campaign posters. "I'll cut the deficit, not the NHS," proclaimed an airbrushed David Cameron from billboards around the country. Yet the subject made few headlines and occupied little airtime - especially in the leaders' television debates - during the election campaign.

Given that health commands more of the national budget than any other sector, it is surprising that the party leaders have not done more to divert the public conversation to this policy area. Budgetary concerns preoccupied each of the politicians in our debate, and the Conservatives' pledge to ring-fence the NHS budget was met with opposition.

“A major flaw in Conservative thinking is to see the NHS in isolation from other key public-sector budgets, because the NHS depends on those services for its own ability to function and be productive," said Burnham. Instead of blindly preserving the NHS budget, he argued, efficiencies had to be found.

He added that, while in government, he had been "ahead of the game" in seeking savings, despite the vast challenges involved. "We are entering a new era for the NHS. The era of expansion has come to a close and we now have to get much more for the public from the expanded system."

Lamb broadly agreed, and expressed his astonishment at the Tories' unwillingness to consider making savings in the NHS. "Mark said nothing about this budgetary challenge," said Lamb, "and that really scares me, because there's a real danger that by talking about ring-fencing you take your eye off the ball . . . Even if you have small real-terms increases in funding, the NHS still faces a massive challenge to keep within financial means."

The charge from Labour and the Lib Dems was clear: the Conservatives are unrealistic in their pledge to leave the NHS untouched. However, there was some common ground between the Tory and Lib Dem spokesmen. Simmonds said that he would seek to reduce much of the "central bureaucracy" within the health system, while

Lamb, supporting decentralisation, emphasised the importance of working more closely with local authorities and employers to improve health outcomes. Drawing on the example of the pasty-maker Ginsters, which has successfully reduced sickness absence, he said that encouraging this kind of employer action was essential as health budgets are squeezed.

Mind games

One major budgetary fear expressed by the audience related to mental health care. Representatives from the charities Mind and Sane were anxious that the historical underfunding of mental health services would return. Hasty reassurances followed. Burnham promised to "complete the job" on rolling out psychological therapies, and he and Simmonds agreed on the importance of protecting the mental health research budget. But Burnham took the opportunity to reiterate the difference between Labour and Conservative policy. Pointing out the interdependence of mental health, housing, work and education, he argued again that to separate the health budget from these other sectors simply didn't make sense.

There was also disagreement over the organisation of the health service. The Conservatives said they wanted to avoid another major restructuring. "One of the fundamental things that has gone wrong with the National Health Service in the last decade is constant reorganisation - nine in ten years," Simmonds said. "We need to allow the NHS to bed down so both clinical professionals and management professionals can get on with doing what they want to do, which is to look after patients and improve the quality of patient care."

Lamb outlined the Liberal Democrats' plan to abolish England's NHS strategic health authorities, arguing that "there is nothing sacrosanct about a layer of bureaucracy in the NHS". Burnham took issue with both views. The Tory policy of outsourcing the running of the NHS to an independent board - "making the NHS the biggest quango in the world" - sounded to him like a major organisational change. And he dismissed the Lib Dem idea of scrapping the strategic health authorities as "populist". He defended the job the authorities do at a regional level on jobs, procurement and providing specialist services - though he did note that they would have to face "efficiency changes" along with the rest of the system.

Forever free

The three politicians had a moment of unity when Zack Cooper, a health economist at the London School of Economics, raised the issue of the NHS as a free service.

Cooper asked why the health service had to be free at the point of access, when that only encourages people to use it more. Unless you start charging people for medical care, he asked, how will you give them the incentive to take greater responsibility for their health?

“Look, care free at the point of need is something that I cherish," said Lamb. Simmonds declared his "real belief" that the NHS should be free and available to all: "I think that is something that unifies all of us on this platform." Burnham insisted the NHS was cost-effective compared to systems around the world. "Other, market-based systems often have an incentive to over-treat, over-provide and over-prescribe. We spend per head of population about half of what America spends."

However, Burnham accepted the point about responsibility, saying that the service was sustainable only if people took greater care in their engagement with it. He suggested that people could be made aware of treatment costs - printing the cost of a hip replacement on a patient's letter, for example - as a way of hammering home the value of the service.

Simmonds confirmed that a Tory government would make people pay if they missed dental appointments. Burnham challenged him on whether this would be extended to those who missed GP appointments. Simmonds denied this was the plan.

Towards the end, the debate returned to a question raised at the beginning by a nutritionist in the audience - how to motivate people in the UK to improve their lifestyles. Burnham had earlier stated how "proud" he was that childhood obesity levels had levelled off and that nutritional standards in schools had improved. But he acknowledged the importance of raising the levels of physical activity.

“It's not a good statement about this country that we love sport but are in a relegation place in the physical activity league table," he said. Compared to those in Germany, Scandinavia and the Netherlands, rates of activity across the British population are especially low.

Sporting chance

Burnham reminded the audience that Britain won the 2012 Olympics because the Inter­national Olympic Committee was inspired by proposals in the British bid about increasing the population's activity. Simmonds expressed the hope that, in the run-up to the Olympics, athletes would engage with young people around the country. He also promised to improve sport in schools. "Sadly, competitive sport at a school level has disappeared and we need to bring that back," he said. Burnham shook his head at the implication that Labour had failed to promote sport in schools.

In his closing comments, Simmonds restated the Conservatives' commitment to "patient-centric" care, moving away from the Blair-era focus on targets. Lamb repeated the Lib Dem call for structural reform to liberate resources lost in complex layers of administration, and warned that getting this process right was imperative to maintain public confidence in the health service.

Burnham, however, charted new territory, turning to the previously unmentioned issue of social care. "If returned, I would make the reform of social care the very top priority." As things stand, it's a big if.

Sophie Elmhirst is features editor of the New Statesman

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Why Jeremy Corbyn is a new leader for the New Times

In an inspired election campaign, he confounded his detractors and showed that he was – more than any other leader – in tune with the times.

There have been two great political turning points in postwar Britain. The first was in 1945 with the election of the Attlee government. Driven by a popular wave of determination that peacetime Britain would look very different from the mass unemployment of the 1930s, and built on the foundations of the solidaristic spirit of the war, the Labour government ushered in full employment, the welfare state (including the NHS) and nationalisation of the basic industries, notably coal and the railways. It was a reforming government the like of which Britain had not previously experienced in the first half of the 20th century. The popular support enjoyed by the reforms was such that the ensuing social-democratic consensus was to last until the end of the 1970s, with Tory as well as Labour governments broadly operating within its framework.

During the 1970s, however, opposition to the social-democratic consensus grew steadily, led by the rise of the radical right, which culminated in 1979 in the election of Margaret Thatcher’s first government. In the process, the Thatcherites redefined the political debate, broadening it beyond the rather institutionalised and truncated forms that it had previously taken: they conducted a highly populist campaign that was for individualism and against collectivism; for the market and against the state; for liberty and against trade unionism; for law and order and against crime.

These ideas were dismissed by the left as just an extreme version of the same old Toryism, entirely failing to recognise their novelty and therefore the kind of threat they posed. The 1979 election, followed by Ronald Reagan’s US victory in 1980, began the neoliberal era, which remained hegemonic in Britain, and more widely in the West, for three decades. Tory and Labour governments alike operated within the terms and by the logic of neoliberalism. The only thing new about New Labour was its acquiescence in neoliberalism; even in this sense, it was not new but derivative of Thatcherism.

The financial crisis of 2007-2008 marked the beginning of the end of neoliberalism. Unlike the social-democratic consensus, which was undermined by the ideological challenge posed by Thatcherism, neoliberalism was brought to its knees not by any ideological alternative – such was the hegemonic sway of neoliberalism – but by the biggest financial crisis since 1931. This was the consequence of the fragility of a financial sector left to its own devices as a result of sweeping deregulation, and the corrupt and extreme practices that this encouraged.

The origin of the crisis lay not in the Labour government – complicit though it was in the neoliberal indulgence of the financial sector – but in the deregulation of the banking sector on both sides of the Atlantic in the 1980s. Neoliberalism limped on in the period after 2007-2008 but as real wages stagnated, recovery proved a mirage, and, with the behaviour of the bankers exposed, a deep disillusionment spread across society. During 2015-16, a populist wave of opposition to the establishment engulfed much of Europe and the United States.

Except at the extremes – Greece perhaps being the most notable example – the left was not a beneficiary: on the contrary it, too, was punished by the people in the same manner as the parties of the mainstream right were. The reason was straightforward enough. The left was tarnished with the same brush as the right: almost everywhere social-democratic parties, albeit to varying degrees, had pursued neoliberal policies. Bill Clinton and Tony Blair became – and presented themselves as – leaders of neoliberalism and as enthusiastic advocates of a strategy of hyper-globalisation, which resulted in growing inequality. In this fundamental respect these parties were more or less ­indistinguishable from the right.

***

The first signs of open revolt against New Labour – the representatives and evangelists of neoliberal ideas in the Labour Party – came in the aftermath of the 2015 ­election and the entirely unpredicted and overwhelming victory of Jeremy Corbyn in the leadership election. Something was happening. Yet much of the left, along with the media, summarily dismissed it as a revival of far-left entryism; that these were for the most part no more than a bunch of Trots. There is a powerful, often overwhelming, tendency to see new phenomena in terms of the past. The new and unfamiliar is much more difficult to understand than the old and familiar: it requires serious intellectual effort and an open and inquiring mind. The left is not alone in this syndrome. The right condemned the 2017 Labour Party manifesto as a replica of Labour’s 1983 manifesto. They couldn’t have been more wrong.

That Corbyn had been a veteran of the far left for so long lent credence to the idea that he was merely a retread of a failed past: there was nothing new about him. In a brilliant election campaign, Corbyn not only gave the lie to this but also demonstrated that he, far more than any of the other party leaders, was in tune with the times, the candidate of modernity.

Crises, great turning points, new conjunctures, new forms of consciousness are by definition incubators of the new. That is one of the great sources of their fascination. We can now see the line of linkage between the thousands of young people who gave Corbyn his overwhelming victory in the leadership election in 2015 and the millions of young people who were enthused by his general election campaign in 2017. It is no accident that it was the young rather than the middle-aged or the seniors who were in the vanguard: the young are the bearers and products of the new, they are the lightning conductors of change. Their elders, by contrast, are steeped in old ways of thinking and doing, having lived through and internalised the values and norms of neoliberalism for more than 30 years.

Yet there is another, rather more important aspect to how we identify the new, namely the way we see politics and how politics is conceived. Electoral politics is a highly institutionalised and tribal activity. There have been, as I argued earlier, two great turning points in postwar politics: the social-democratic era ushered in by the 1945 Labour government and the neoliberal era launched by the Tory government in 1979.

The average Tory MP or activist, no doubt, would interpret history primarily in terms of Tory and Labour governments; Labour MPs and activists would do similarly. But this is a superficial reading of politics based on party labels which ignores the deeper forces that shape different eras, generate crises and result in new paradigms.

Alas, most political journalists and columnists are afflicted with the same inability to distinguish the wood (an understanding of the deeper historical forces at work) from the trees (the day-to-day manoeuvring of parties and politicians). In normal times, this may not be so important, because life continues for the most part as before, but at moments of great paradigmatic change it is absolutely critical.

If the political journalists, and indeed the PLP, had understood the deeper forces and profound changes now at work, they would never have failed en masse to rise above the banal and predictable in their assessment of Corbyn. Something deep, indeed, is happening. A historical era – namely, that of neoliberalism – is in its death throes. All the old assumptions can no longer be assumed. We are in new territory: we haven’t been here before. The smart suits long preferred by New Labour wannabes are no longer a symbol of success and ambition but of alienation from, and rejection of, those who have been left behind; who, from being ignored and dismissed, are in the process of moving to the centre of the political stage.

Corbyn, you may recall, was instantly rejected and ridiculed for his sartorial style, and yet we can now see that, with a little smartening, it conveys an authenticity and affinity with the times that made his style of dress more or less immune from criticism during the general election campaign. Yet fashion is only a way to illustrate a much deeper point.

The end of neoliberalism, once so hegemonic, so commanding, is turning Britain on its head. That is why – extraordinary when you think about it – all the attempts by the right to dismiss Corbyn as a far-left extremist failed miserably, even proved counterproductive, because that was not how people saw him, not how they heard him. He was speaking a language and voicing concerns that a broad cross-section of the public could understand and identify with.

***

The reason a large majority of the PLP was opposed to Corbyn, desperate to be rid of him, was because they were still living in the neoliberal era, still slaves to its ideology, still in thrall to its logic. They knew no other way of thinking or political being. They accused Corbyn of being out of time when in fact it was most of the PLP – not to mention the likes of Mandelson and Blair – who were still imprisoned in an earlier historical era. The end of neoliberalism marks the death of New Labour. In contrast, Corbyn is aligned with the world as it is rather than as it was. What a wonderful irony.

Corbyn’s success in the general election requires us to revisit some of the assumptions that have underpinned much political commentary over the past several years. The turmoil in Labour ranks and the ridiculing of Corbyn persuaded many, including on the left, that Labour stood on the edge of the abyss and that the Tories would continue to dominate for long into the future. With Corbyn having seized the political initiative, the Tories are now cast in a new light. With Labour in the process of burying its New Labour legacy and addressing a very new conjuncture, then the end of neoliberalism poses a much more serious challenge to the Tories than it does the Labour Party.

The Cameron/Osborne leadership was still very much of a neoliberal frame of mind, not least in their emphasis on austerity. It would appear that, in the light of the new popular mood, the government will now be forced to abandon austerity. Theresa May, on taking office, talked about a return to One Nation Toryism and the need to help the worst-off, but that has never moved beyond rhetoric: now she is dead in the water.

Meanwhile, the Tories are in fast retreat over Brexit. They held a referendum over the EU for narrowly party reasons which, from a national point of view, was entirely unnecessary. As a result of the Brexit vote, the Cameron leadership was forced to resign and the Brexiteers took de facto command. But now, after the election, the Tories are in headlong retreat from anything like a “hard Brexit”. In short, they have utterly lost control of the political agenda and are being driven by events. Above all, they are frightened of another election from which Corbyn is likely to emerge as leader with a political agenda that will owe nothing to neoliberalism.

Apart from Corbyn’s extraordinary emergence as a leader who understands – and is entirely comfortable with – the imperatives of the new conjuncture and the need for a new political paradigm, the key to Labour’s transformed position in the eyes of the public was its 2017 manifesto, arguably its best and most important since 1945. You may recall that for three decades the dominant themes were marketisation, privatisation, trickle-down economics, the wastefulness and inefficiencies of the state, the incontrovertible case for hyper-globalisation, and bankers and financiers as the New Gods.

Labour’s manifesto offered a very different vision: a fairer society, bearing down on inequality, a more redistributive tax system, the centrality of the social, proper funding of public services, nationalisation of the railways and water industry, and people as the priority rather than business and the City. The title captured the spirit – For the Many Not the Few. Or, to put in another way, After Neoliberalism. The vision is not yet the answer to the latter question, but it represents the beginnings of an answer.

Ever since the late 1970s, Labour has been on the defensive, struggling to deal with a world where the right has been hegemonic. We can now begin to glimpse a different possibility, one in which the left can begin to take ownership – at least in some degree – of a new, post-neoliberal political settlement. But we should not underestimate the enormous problems that lie in wait. The relative economic prospects for the country are far worse than they have been at any time since 1945. As we saw in the Brexit vote, the forces of conservatism, nativism, racism and imperial nostalgia remain hugely powerful. Not only has the country rejected continued membership of the European Union, but, along with the rest of the West, it is far from reconciled with the new world that is in the process of being created before our very eyes, in which the developing world will be paramount and in which China will be the global leader.

Nonetheless, to be able to entertain a sense of optimism about our own country is a novel experience after 30 years of being out in the cold. No wonder so many are feeling energised again.

This article first appeared in the 15 June 2017 issue of the New Statesman, Corbyn: revenge of the rebel

Martin Jacques is the former editor of Marxism Today. 

This article first appeared in the 15 June 2017 issue of the New Statesman, Corbyn: revenge of the rebel

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