Labour recognises that it could end up closing hospitals too

The party's plan to integrate health and social care makes sense fiscally and clinically but the politics could be more difficult to navigate.

Up to a point, the politics of the NHS are easy for Labour. No one doubts the strength of feeling towards the health service in the party that built it. By contrast, many voters suspect the Tories wish it harm, which is why an oath of allegiance to the NHS was a central part of David Cameron’s attempt to “decontaminate” his party’s brand in opposition.

Specifically, the Conservative leader pledged to protect health spending and avoid “top-down reorganisations.” By 2015 the NHS will be suffering from a funding crisis, exacerbated by a vast reorganisation that smells enough like privatisation by stealth to cause the Conservatives bountiful political harm.

The "safety first" option for Labour is to watch this grizzly spectacle unfold, and march against it under a “Save our NHS” banner. This will certainly be a feature of the 2015 campaign. But it is to the credit of Labour’s shadow health team – Andy Burnham and Liz Kendall – that they are thinking a bit deeper about how their party might run the health service if it actually formed a government.

The NHS is heading towards a financial crunch, driven by the rising cost of treatment and an ageing population, regardless of the immediate fiscal challenge facing the Treasury. In other words, even if George Osborne’s economic plans were working (and they’re not), even if growth and revenues returned to pre-crisis levels, even if every household in Britain urged the government to tax them some more out of sheer love for the NHS, it would need structural reforms to make it financially sustainable. (Of course, the Tories say that is their motive too but they struggle to convince.)

Part of Labour’s answer is the integration of social care with the NHS. Currently the two services rub along in disjointed fashion, with little coordination and no consistency. As a result, the health service ends up picking up the tab for failings in social care services. Hospitals fill up with elderly patients suffering from chronic, long-term conditions, which is neither a good way to look after people nor an efficient use of finite resources. The theory is that integrating the two services could save billions over time by spending smaller sums on the kinds of early interventions that limit hospital admissions and help elderly patients lead healthier, happier lives.

This in turn is part of a more profound transition to what Burnham and Kendall call “whole person care" – re-orienting treatment and NHS institutions to consider the conditions that lead to ill health in the first place. It means concentrating on interventions that protect society (considering, for example, diet, exercise, stress); empowering and encouraging people to look after their own health. (Advocates of this approach often cite diabetes as a classic case of something that will cost the NHS a whole lot more if dealt with only once it is manifest than if investment were put into helping people change their lifestyles.)

Ed Miliband has today announced the creation of a commission to examine how it might be done. Part of the remit is to achieve the integration with a minimum of disruption to existing structures (i.e. not necessitating another great upheaval) and without a great up-front spending commitment. That won't be easy.

A commission to look at ways to implement an idea may not sound like a bold stride towards manifesto clarity but in the context of Labour’s softly-softly approach to policy it is genuine progress. It is a step towards a broader expression of budget priorities – which areas or departments will be favoured and which will suffer if Labour finds itself governing in austerity. The question of when and how to signal those priorities, or indeed whether it needs to be done at all, is one of the thorniest debates that goes on in the shadow cabinet. Ed Balls is said to be reluctant to permit any announcement that might contain the seeds of a fiscal obligation for the future. Shadow ministers who want to develop their portfolios complain that without some fiscal guidelines they can’t credibly develop plans for government. That leaves the front bench stuck in the realm of stating warm but vague intentions or just whingeing about coalition policy.

For people who have followed Labour’s cautious steps towards an NHS policy, Miliband’s announcement today is hardly new. Burnham made a speech on ‘whole person care’ in January. Kendall has been delicately but consistently making the case that Labour cannot sit back and defend the pre-2010 status quo since joining the front bench. Finally, it seems, they have persuaded Miliband to put his personal authority behind their approach. (It is a rule of Westminster politics that no-one believes something will actually happen until they hear it from the leader’s mouth.)

There is a catch. The “whole person care” idea makes sense fiscally over the long term as a way to save money. It makes sense clinically as a way to achieve better outcomes and modernise the way the health service treats patients. It makes sense as political strategy, addressing the concerns of people who fear they will be abandoned in retirement or worry about how they will care for elderly patients. But it scatters a bunch of tactical land mines in the form of hospital closures.

Pretty much any time politicians look hard at NHS reforms they come to the view that the classic jack-of-all-trades district general hospital is a tired and inefficient model for delivering effective care to communities. But whenever anyone tries to rationalise the system and change the structures, they discover it means wards or whole hospitals closing, leading to demonstrations, petitions, town hall meetings and, usually, political retreat.

“Whole person care” is no exception. It implies a re-allocation of resources to treat people at home and a strategy to encourage patients with chronic conditions to get more treatment at clinics and GP surgeries. It recognises what consultants and healthcare experts have been privately complaining about for years: that many hospitals wards are effectively emergency housing for geriatric patients, which is bad for them and a poor use of resources. But a better use of resources might mean, gulp, fewer wards.

Given his predilection for caution on the topic of public sector reform, Ed Miliband went pretty far today in terms of recognising the existence of an NHS budget challenge. He said:

“The NHS will always be a priority for expenditure under a Labour government, but we must make every pound we spend go further at a time when our NHS faces the risk of being overwhelmed by a crisis in funding because of care needs by the end of this decade.

"When the NHS was in crisis in the 1990s, Labour was able to save it by combining reform with unprecedented increases in funding. We know that budgets will be tighter under the next Labour government. But even in these tough times we want the NHS to provide a better service for patients.

"The changes we propose will ensure that – but they do something else too. They will save billions of pounds which can be better spent elsewhere in the NHS."

Buried in that loose expression of good intent is small print so minuscule it is invisible to the naked eye. It says that that a Labour government could end up closing hospitals too.  

Shadow health secretary Andy Burnham with Ed Miliband in 2010. Photograph: Getty Images.

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

Photo: Getty Images/AFP
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Is Yvette Cooper surging?

The bookmakers and Westminster are in a flurry. Is Yvette Cooper going to win after all? I'm not convinced. 

Is Yvette Cooper surging? The bookmakers have cut her odds, making her the second favourite after Jeremy Corbyn, and Westminster – and Labour more generally – is abuzz with chatter that it will be her, not Corbyn, who becomes leader on September 12. Are they right? A couple of thoughts:

I wouldn’t trust the bookmakers’ odds as far as I could throw them

When Jeremy Corbyn first entered the race his odds were at 100 to 1. When he secured the endorsement of Unite, Britain’s trade union, his odds were tied with Liz Kendall, who nobody – not even her closest allies – now believes will win the Labour leadership. When I first tipped the Islington North MP for the top job, his odds were still at 3 to 1.

Remember bookmakers aren’t trying to predict the future, they’re trying to turn a profit. (As are experienced betters – when Cooper’s odds were long, it was good sense to chuck some money on there, just to secure a win-win scenario. I wouldn’t be surprised if Burnham’s odds improve a bit as some people hedge for a surprise win for the shadow health secretary, too.)

I still don’t think that there is a plausible path to victory for Yvette Cooper

There is a lively debate playing out – much of it in on The Staggers – about which one of Cooper or Burnham is best-placed to stop Corbyn. Team Cooper say that their data shows that their candidate is the one to stop Corbyn. Team Burnham, unsurprisingly, say the reverse. But Team Kendall, the mayoral campaigns, and the Corbyn team also believe that it is Burnham, not Cooper, who can stop Corbyn.

They think that the shadow health secretary is a “bad bank”: full of second preferences for Corbyn. One senior Blairite, who loathes Burnham with a passion, told me that “only Andy can stop Corbyn, it’s as simple as that”.

I haven’t seen a complete breakdown of every CLP nomination – but I have seen around 40, and they support that argument. Luke Akehurst, a cheerleader for Cooper, published figures that support the “bad bank” theory as well.   Both YouGov polls show a larger pool of Corbyn second preferences among Burnham’s votes than Cooper’s.

But it doesn’t matter, because Andy Burnham can’t make the final round anyway

The “bad bank” row, while souring relations between Burnhamettes and Cooperinos even further, is interesting but academic.  Either Jeremy Corbyn will win outright or he will face Cooper in the final round. If Liz Kendall is eliminated, her second preferences will go to Cooper by an overwhelming margin.

Yes, large numbers of Kendall-supporting MPs are throwing their weight behind Burnham. But Kendall’s supporters are overwhelmingly giving their second preferences to Cooper regardless. My estimate, from both looking at CLP nominations and speaking to party members, is that around 80 to 90 per cent of Kendall’s second preferences will go to Cooper. Burnham’s gaffes – his “when it’s time” remark about Labour having a woman leader, that he appears to have a clapometer instead of a moral compass – have discredited him in him the eyes of many. While Burnham has shrunk, Cooper has grown. And for others, who can’t distinguish between Burnham and Cooper, they’d prefer to have “a crap woman rather than another crap man” in the words of one.

This holds even for Kendall backers who believe that Burnham is a bad bank. A repeated refrain from her supporters is that they simply couldn’t bring themselves to give Burnham their 2nd preference over Cooper. One senior insider, who has been telling his friends that they have to opt for Burnham over Cooper, told me that “faced with my own paper, I can’t vote for that man”.

Interventions from past leaders fall on deaf ears

A lot has happened to change the Labour party in recent years, but one often neglected aspect is this: the Labour right has lost two elections on the bounce. Yes, Ed Miliband may have rejected most of New Labour’s legacy and approach, but he was still a protégé of Gordon Brown and included figures like Rachel Reeves, Ed Balls and Jim Murphy in his shadow cabinet.  Yvette Cooper and Andy Burnham were senior figures during both defeats. And the same MPs who are now warning that Corbyn will doom the Labour Party to defeat were, just months ago, saying that Miliband was destined for Downing Street and only five years ago were saying that Gordon Brown was going to stay there.

Labour members don’t trust the press

A sizeable number of Labour party activists believe that the media is against them and will always have it in for them. They are not listening to articles about Jeremy Corbyn’s past associations or reading analyses of why Labour lost. Those big, gamechanging moments in the last month? Didn’t change anything.

100,000 people didn’t join the Labour party on deadline day to vote against Jeremy Corbyn

On the last day of registration, so many people tried to register to vote in the Labour leadership election that they broke the website. They weren’t doing so on the off-chance that the day after, Yvette Cooper would deliver the speech of her life. Yes, some of those sign-ups were duplicates, and 3,000 of them have been “purged”.  That still leaves an overwhelmingly large number of sign-ups who are going to go for Corbyn.

It doesn’t look as if anyone is turning off Corbyn

Yes, Sky News’ self-selecting poll is not representative of anything other than enthusiasm. But, equally, if Yvette Cooper is really going to beat Jeremy Corbyn, surely, surely, she wouldn’t be in third place behind Liz Kendall according to Sky’s post-debate poll. Surely she wouldn’t have been the winner according to just 6.1 per cent of viewers against Corbyn’s 80.7 per cent. 

Stephen Bush is editor of the Staggers, the New Statesman’s political blog.