The battle for control of Labour's election machine

As big a question for Ed Miliband as the matter of who delivers Labour’s economic message is the question of who will run the party’s general election campaign.

The Labour Party is undoubtedly more united now than it has been for at least a generation. That is setting the bar fairly low, since its more recent session in government was characterised by a bitter feud between the Prime Minister and the Chancellor and their respective entourages. And Labour’s last stint in opposition only ended once vicious, factional warfare had been quelled.

Veterans declare that the Blair-Brown civil strife was not a patch on the civil wars of the Eighties and that any current tensions around the shadow cabinet are but a dim echo or mild aftershock from the TB/GB era.

That doesn’t stop the media feeling around for cracks to prise open, nor does it stop mischief makers inside and outside the party drawing attention to any fissures that might appear in the otherwise uniform veneer of message discipline. A rich but irregular supply of Kremlinological data is furnished by David Miliband’s periodic interventions.

Whenever the brother who might have been leader says anything in the House of Commons there is a flurry of speculation about his return to the front line of Labour politics. Most of it is unwelcome in the former foreign secretary's office. What he most wants is to be able contribute without it reviving pop-psychoanalytical chatter about his relationship with his brother and without the media gleefully readying itself for a re-enactment of old Blair-Brown-style strife.

Except the only way to get beyond that kind of chatter is for David’s participation to become a normal, regular part of the official Labour offer to the public. It is a good old-fashioned Catch 22: he can’t join the front line because of the psychodrama, and he can’t get out of the psychodrama without rejoining the front line.

The latest round of speculation began with a peculiar piece in the Times (£) on Monday, suggesting that anonymous senior Labour people want David back and are urging him to decide one way or another. The newspaper gave the story deliberate momentum with a leader, echoing that line.

There has been another spike in chatter levels following David’s speech in Tuesday’s welfare debate. The Guardian’s Nick Watt has blogged an arcane hermeneutic reading of the speech to explain what, in the Westminster imagination, David was really trying to say. In an interview in the Mirror yesterday, Ed was asked about his brother and replies that they are now friends. He was also asked to confirm that Ed Balls will hold the shadow treasury brief until the election and declined to do so. Thus the speculative story is embellished and sustained.

The obvious reason Ed Miliband might want his brother back on the front line is to act as a counter-weight to Balls, the shadow cabinet’s most heavyweight figure and the man many in the parliamentary party believe is putting voters off listening to Labour’s economic message.

There was a rash of anti-Balls briefing towards the end of last summer. That came to a stop at Labour’s annual conference, where the shadow chancellor went out of his way to sound collegiate and loyal to the leader’s official line. Both Eds know any hint of a serious rift between them would quickly swallow both of their ambitions. (As I wrote here.) Their relationship is sustained by residual esprit de corps as veterans of Gordon Brown’s entourage and, more substantially, by the old Cold War doctrine of Mutually Assured Destruction.

That doesn’t stop other Labour people agitating for a change of personnel. To some extent, those MPs and scarred Blairite veterans who were toasting David as a king-over-the-water in the early years of Ed’s leadership, when it all looked a bit shaky, have simply amended their toast to shadow-chancellor-over-the-water.

There isn’t any evidence that Ed Miliband plans to satisfy that appetite. At the same time, he cannot ignore the possibility that Balls – indelibly associated in many minds with Gordon Brown’s legacy – is a drag on Labour’s poll rating and an obstacle to the leader’s aspiration to represent renewal and definitive break from the past. Balls, meanwhile, has let it be known that he would rather retire from the front line altogether than take a more junior shadow cabinet role. Miliband hardly wants to contemplate what potential devilry could busy the hands of Balls if they fell idle on the back benches.

The discussion of whether Miliband should hang on to Balls usually focuses on the economic debate. On the one hand, the shadow chancellor’s prediction of a double-dip recession was vindicated; on the other hand, the voters don’t seem to care. But maybe, with a triple dip, they will ... but what if growth returns? And so on and so on, round and round the argument goes. But there is another factor in play.

Balls has historically commanded the loyalty of powerful players within the Labour Party. He has, by reputation, been assiduous in building a discreet internal power base: a party-within-the-party. As is often the case in politics, this apparatus has acquired mythic proportions in excess of its actual clout.

A lot of day-to-day rebuttal and attack politics on the Labour side is in the hands of Tom Watson, the party’s official campaign coordinator, and his deputy Michael Dugher. They are often presumed to be Balls acolytes, a loyalty legacy from the old Brownite clan. The capacity to call on an internal patronage network within the party has traditionally been seen as one of the shadow chancellor’s great advantages - and something that ultimately makes him indispensible to Miliband.

As one party adviser puts it: “Ed Miliband didn’t have a machine when he became leader and he needed one.” Balls’s machine might not have been the most sophisticated, high-tech Nimbus 2000 of 21st Century political combat. It was nonetheless famously effective.

But the Balls-Watson relationship, I’m told, has soured very dramatically since the shadow chancellor started writing for and courting support from the Sun and the Sun on Sunday, newspapers controlled by Rupert Murdoch. Watson styles himself as Murdoch’s nemesis and his standing in the party has grown in proportion to the ferocity of his battle with News Corp. In that key respect, he has greater loyalty to Miliband, whose political stock is just as heavily invested in the moral crusade against Murdochism and all its nefarious ways.

Increasingly, I hear Labour people question whether the famous Balls machine is the force it once was. (Which probably explains why there is a bit more chatter directed against him, since fear of reprisal would once have kept criticism more muted.) None of this detracts from the essential fact that Balls remains one of the Labour party’s most experienced, intelligent and astute political operators. No-one disputes his formidable and acute grasp of economics and his capacity in politics, as one shadow cabinet colleague puts it, “to always see two moves ahead.” Aside from all the mythology, gossip and neurotic navel-gazing lower down the ranks, the shadow chancellor is someone who must be taken seriously and whose removal from the shadow Treasury portfolio could certainly not be undertaken lightly. That is why Ed Miliband appears not to be in any kind of hurry to do it and very probably won’t do it at all.

But as big a question for Ed Miliband as the matter of who delivers Labour’s economic message is the question of who will run the party’s general election campaign; who will craft the strategy, shape the message and ensure it is delivered in the right way? At the moment, the default would be the Watson-Dugher team. There are plenty of people in the party who think they might not be the ideal candidates. “It would just be ‘Tory tax cuts for millionaires’ on a loop”, says one sceptical party insider.

There is a growing clamour for Miliband to name a high-profile figure who will take strategic control of party’s offer to the country. Ideally, it would be someone of sufficient stature that the appointment would send a frisson of anxiety through the Conservative ranks. Do not be surprised if David Miliband's name soon starts floating around in discussions of this hypothetical vacancy.

The Tories have George Osborne fulfilling the strategic function and have recently put Lynton Crosby in charge at a more operational level. Opinion in Westminster is divided as to whether Crosby is a campaigning mastermind or a massive liability to Downing Street. Even the Tories themselves aren’t sure. But no one doubts that his main skill is in getting people focused and organised. He is a notorious bringer of discipline. (He helped secure Boris Johnson’s mayoral victories partly just by making sure his candidate took the whole process seriously enough and turned up to work on time.)

The Tories are starting to get properly organised for the battle of 2015. Labour needs to get its own machine tuned and oiled for combat. But whose machine will it be?

Labour Party deputy chair and campaign coordinator Tom Watson. Photograph: Getty Images.

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

Photo: Getty Images
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British mental health is in crisis

The headlines about "parity of esteem" between mental and physical health remain just that, warns Benedict Cooper. 

I don’t need to look very far to find the little black marks on this government’s mental health record. Just down the road, in fact. A short bus journey away from my flat in Nottingham is the Queens Medical Centre, once the largest hospital in Europe, now an embattled giant.

Not only has the QMC’s formerly world-renowned dermatology service been reduced to a nub since private provider Circle took over – but that’s for another day – it has lost two whole mental health wards in the past year. Add this to the closure of two more wards on the other side of town at the City Hospital, the closure of the Enright Close rehabilitation centre in Newark, plus two more centres proposed for closure in the imminent future, and you’re left with a city already with half as many inpatient mental health beds as it had a year ago and some very concerned citizens.

Not that Nottingham is alone - anything but. Over 2,100 mental health beds had been closed in England between April 2011 and last summer. Everywhere you go there are wards being shuttered; patients are being forced to travel hundreds of miles to get treatment in wards often well over-capacity, incidents of violence against mental health workers is increasing, police officers are becoming de facto frontline mental health crisis teams, and cuts to community services’ budgets are piling the pressure on sufferers and staff alike.

It’s particularly twisted when you think back to solemn promises from on high to work towards “parity of esteem” for mental health – i.e. that it should be held in equal regard as, say, cancer in terms of seriousness and resources. But that’s becoming one of those useful hollow axioms somehow totally disconnected from reality.

NHS England boss Simon Stevens hails the plan of “injecting purchasing power into mental health services to support the move to parity of esteem”; Jeremy Hunt believes “nothing less than true parity of esteem must be our goal”; and in the House of Commons nearly 18 months ago David Cameron went as far as to say “In terms of whether mental health should have parity of esteem with other forms of health care, yes it should, and we have legislated to make that the case”. 

Odd then, that the president of the British Association of Counselling & Psychotherapy (BACP), Dr Michael Shooter, unveiling a major report, “Psychological therapies and parity of esteem: from commitment to reality” nine months later, should say that the gulf between mental and physical health treatment “must be urgently addressed”.  Could there be some disparity at work, between medical reality and government healthtalk?

One of the rhetorical justifications for closures is the fact that surveys show patients preferring to be treated at home, and that with proper early intervention pressure can be reduced on hospital beds. But with overall bed occupancy rates at their highest ever level and the average occupancy in acute admissions wards at 104 per cent - the RCP’s recommended rate is 85 per cent - somehow these ideas don’t seem as important as straight funding and capacity arguments.

Not to say the home-treatment, early-intervention arguments aren’t valid. Integrated community and hospital care has long been the goal, not least in mental health with its multifarious fragments. Indeed, former senior policy advisor at the Department of Health and founder of the Centre for Applied Research and Evaluation International Foundation (Careif) Dr Albert Persaud tells me as early as 2000 there were policies in place for bringing together the various crisis, home, hospital and community services, but much of that work is now unravelling.

“We were on the right path,” he says. “These are people with complex problems who need complex treatment and there were policies for what this should look like. We were creating a movement in mental health which was going to become as powerful as in cancer. We should be building on that now, not looking at what’s been cut”.

But looking at cuts is an unavoidable fact of life in 2015. After a peak of funding for Child and Adolescent Mental Health Service (CAMHS) in 2010, spending fell in real terms by £50 million in the first three years of the Coalition. And in July this year ITV News and children’s mental health charity YoungMinds revealed a total funding cut of £85 million from trusts’ and local authorities’ mental health budgets for children and teenagers since 2010 - a drop of £35 million last year alone. Is it just me, or given all this, and with 75 per cent of the trusts surveyed revealing they had frozen or cut their mental health budgets between 2013-14 and 2014-15, does Stevens’ talk of purchasing “power” sound like a bit of a sick joke?

Not least when you look at figures uncovered by Labour over the weekend, which show the trend is continuing in all areas of mental health. Responses from 130 CCGs revealed a fall in the average proportion of total budgets allocated to mental health, from 11 per cent last year to 10 per cent in 2015/16. Which might not sound a lot in austerity era Britain, but Dr Persaud says this is a major blow after five years of squeezed budgets. “A change of 1 per cent in mental health is big money,” he says. “We’re into the realms of having less staff and having whole services removed. The more you cut and the longer you cut for, the impact is that it will cost more to reinstate these services”.

Mohsin Khan, trainee psychiatrist and founding member of pressure group NHS Survival, says the disparity in funding is now of critical importance. He says: “As a psychiatrist, I've seen the pressures we face, for instance bed pressures or longer waits for children to be seen in clinic. 92 per cent of people with physical health problems receive the care they need - compared to only 36 per cent of those with mental health problems. Yet there are more people with mental health problems than with heart problems”.

The funding picture in NHS trusts is alarming enough. But it sits in yet a wider context: the drastic belt-tightening local authorities and by extension, community mental health services have endured and will continue to endure. And this certainly cannot be ignored: in its interim report this July, the Commission on acute adult psychiatric care in England cited cuts to community services and discharge delays as the number one debilitating factor in finding beds for mental health patients.

And last but not least, there’s the role of the DWP. First there’s what the Wellcome Trust describes as “humiliating and pointless” - and I’ll add, draconian - psychological conditioning on jobseekers, championed by Iain Duncan Smith, which Wellcome Trusts says far from helping people back to work in fact perpetuate “notions of psychological failure”. Not only have vulnerable people been humiliated into proving their mental health conditions in order to draw benefits, figures released earlier in the year, featured in a Radio 4 File on Four special, show that in the first quarter of 2014 out of 15,955 people sanctioned by the DWP, 9,851 had mental health problems – more than 100 a day. And the mental distress attached to the latest proposals - for a woman who has been raped to then potentially have to prove it at a Jobcentre - is almost too sinister to contemplate.

Precarious times to be mentally ill. I found a post on care feedback site Patient Opinion when I was researching this article, by the daughter of a man being moved on from a Mental Health Services for Older People (MHSOP) centre set for closure, who had no idea what was happening next. Under the ‘Initial feelings’ section she had clicked ‘angry, anxious, disappointed, isolated, let down and worried’. The usual reasons were given for the confusion. “Patients and carers tell us that they would prefer to stay at home rather than come into hospital”, the responder said at one point. After four months of this it fizzled out and the daughter, presumably, gave up. But her final post said it all.

“There is no future for my dad just a slow decline before our eyes. We are without doubt powerless – there is no closure just grief”.

Benedict Cooper is a freelance journalist who covers medical politics and the NHS. He tweets @Ben_JS_Cooper.