Labour steps cautiously up to difficult truths about the NHS

At last, a shadow minister says budgets would be tight and reform essential regardless of who was in power.

We know Labour loves the NHS. All British political parties are obliged to profess their undying devotion to the health service at routine intervals, but Labour, as the party that oversaw the creation of the NHS (and has, in recent memory, invested the most money in it) claims a special protective monopoly. Voters seem to recognise this and regularly award Ed Miliband’s party robust leads on questions of who is most trusted on the issue.

That advantage is sure to be extended as the government’s NHS reforms, combined with an unprecedented budget squeeze, reinforce the impression that the Tories inevitably succumb to vandalistic urges towards the health service.

Even without the Lansley reforms (now to be implemented by Jeremy Hunt, who has never knowingly inspired confidence in anyone apart, it seems, from the Prime Minister) the NHS would be causing headaches for the coalition.  The health budget may be “ring-fenced” but anything other than a real terms rise in spending feels, over time, like a nasty cut, given inflation in the cost of treatments and the growing demands of caring for an ageing population.

That would be a problem for Labour in government too although you don’t often hear opposition MPs advertise the fact. Why would they? Slamming David Cameron for trashing the NHS is an open goal for Ed Miliband; it would just complicate the goal-scoring manoeuvre to add mealy-mouthed acknowledgements of the immovable budget obstacles on the horizon. That, at least, is one argument and it has generally prevailed at the top of the Labour party.

There is another view, which is that the public are not fools and will, as an election approaches, expect to hear something about the opposition’s intentions towards the NHS other than “we wouldn’t be the Tories”. As I’ve argued (ad nauseam) in the past, a necessary step on Labour’s journey to governing credibility, especially with regard to fiscal responsibility, is being seen and heard to talk about innovation and reform of public services. This doesn’t have to be a macho breast-beating display of willingness to wield the axe. It just means demonstrating, by the deployment of some policy imagination, that Labour recognises the long-term obligation to find ways of getting more for less.

With that in mind, I was heartened to come across a speech yesterday given by Liz Kendall, shadow minister for social care. Not many people spend their weekends catching up on policy interventions by junior ranking shadow cabinet figures, so I suspect you may not have yet got round to reading this particular example of the genre. It is not the Gettysburg address, nor is it a complete exposition of Labour’s policy towards reforming the health service. As with everything else in Labour's agenda for government (with good reason, given the time still to run before an election) health policy is a work in progress.

Nonetheless, for those of us who try to decrypt dull Labour announcements, scouring the formless surface of cosy One Nation reassurance for signs of something that looks like progress towards a governing position, Kendall’s speech is a find.

She states, for example that:

The truth is that far more fundamental reform is vital if we’re going to meet the challenges of demographic and social change.

And that:

.. Whichever party is in Government and however much growth we get back into the economy, we’ve got to get far more out of the billions of pounds spent in the NHS into the foreseeable future.

Obviously true, and a few grades below rocket science, but refreshing to hear said aloud by a shadow cabinet minister.

Kendall clarifies, up to a point, Labour’s view on what would happen to the new NHS architecture currently being put in place by the coalition if Ed Miliband were prime minister.

If Labour wins the next election we will repeal the 2012 Health and Social Care Act but we will not force the NHS through another major re-organisation.

We don’t need new NHS organisations, we’ll simply ask those we inherit to work differently.

We’ll keep Clinical Commissioning Groups and Health and Wellbeing Boards, but ensure they work within a properly accountable national health service.

And what about this for a realistic account of how the opposition should behave towards hospital  reconfigurations (a euphemism for the movement of services out of hospitals, into the community, usually involving ward closures, demonstrations, angry public meetings, bad headlines etc.):

Whilst changes to local hospital services will always be difficult, Labour will not have a policy of blanket opposition to hospital reconfigurations like the Conservatives did at the last election.

That might be easy politics. But it wouldn’t be right in principle or in practice.

We will judge every proposal on its merits: whether it saves more lives, reduces disabilities, and improves the quality of care. The clinical case must be made and supported by the evidence, if the public as well as local MPs are to be convinced.

In other words, yes, sometimes wards and even hospitals will have to close if we’re serious about finding the most effective and efficient way to deliver modern health services. That is because vast old district general hospitals are a desperately outmoded way of looking after people, many of whom have chronic conditions that should be treated not in hospital beds but at home or at local clinics. Better still, such conditions should prevented or kept in check by lifestyle changes. It’s what nearly everyone who has looked at the long-term implications of health policy decides in the end, but you rarely hear opposition politicians say it because joining in the anti-closure demo is so much more rewarding in the political short term.

Kendall even talks about “innovation” in the health service and the need to take a non-dogmatic view of the role of private and voluntary sector providers:

For all the criticism you hear, there’s actually a huge desire and talent for innovation amongst NHS staff.

What they need is the encouragement, freedom and space to innovate. They need backing to experiment and take sensible risks, not rigid performance management from on high.

The private and voluntary sectors also have a vital role to play in bringing innovation and challenge into the system.

Of course private and voluntary providers must be effectively commissioned and regulated, within a properly managed system - not the free market, free-for-all that this Government is putting in place.

But it would be a real mistake to slip back into old ways of thinking, and attempt to block rather than encourage the benefits these services can bring.

To most people who think about the challenge of running a decent public sector on limited budgets, that is all perfectly sensible. It is also, however, by the standards of recent Labour party caution in the discussion of public sector reform and given the reactionary mood in some corners of the wider labour movement, quite a departure. Brave, even. A modest burst of level-headed realism from a shadow minister about the challenge of running services in straightened times, acknowledging the need for innovation and reform that might not always be popular at first - I wonder if it will catch on.

The Olympic opening ceremony celebrating the NHS. Source: Getty Images

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

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Labour must reclaim English patriotism if we are to beat Ukip and the Tories

We can't talk about the future of our country unless we can discuss the past. 

I was a parliamentary candidate for Thurrock, but the place which I currently call home is Hackney, London. This distinction is worth explaining. The questions of Labour and Englishness – what exactly is the English problem that we’re trying to solve, why do we need a progressive patriotism, does it already exist, if not why not and if we had one what would it look like? – are, above all, questions of identity and place. We need to build a patriotism that includes and resonates with residents of both Hackney and Thurrock. Currently they are very far apart. 

I’m the little girl who sat on her dad’s shoulders to wave a flag at Princess Anne’s first wedding. And I was also, like Sadiq Khan, waving a flag at the Silver Jubilee in 1977. I’m an ex-Catholic, I’m a Londoner, I’m English and I’m a woman, and all of those identities are important although not necessarily equally so and not necessarily all of the time.

But I’m also a member of the Labour party, not only as a candidate, but now as an activist in Hackney. And that is where I see the difference very strongly between Hackney and what I experienced in Thurrock. 

Thurrock was Ukip ground zero last year - 12,000 people voted for Ukip in a general election for the first time, on top of the 3,500 that had voted for them before in 2010. Most of those 12,000 people had either not voted before, or had voted Labour. 

This isn’t just about being in two different places. Sometimes it feels like more than being in two different countries, or even like being on two different planets. The reality is that large swathes of Labour’s members and supporters don’t identify as patriotic, fundamentally because patriotism has been seized and colonised by the right. We need to understand that, by allowing them to seize it, we are losing an opportunity to be able to reclaim our past. 

We do not have any legitimacy to talk about the future of our country unless we can talk about our past in a better way. We have tried but our efforts have been half-hearted. Take Ed Miliband's call for One Nation Labour, which ended up amounting to a washed-out Union Jack as a visual for our brand. It could have been so much better – an opportunity for an intellectual rebranding and a seizure of Conservative territory for our own ends. Ultimately One Nation Labour was a slogan and not a project. 

There is a section of the left which has a distinct discomfort with the idea of pride in country. It has swallowed the right-wing myth that England’s successes have all been Conservative ones. This is a lie, but one that has spread very effectively. The left’s willingness to swallow it means that we are still living in a Thatcherite paradigm. It is no wonder progressives revolt at the idea of patriotism, when the right’s ideas of duty and authority quash our ideas of ambitions for equality, opportunity for all and challenging injustice. But we risk denying our successes by allowing the right to define Englishness. It’s England that helped establish the principle of the right to vote, the rule of law, equal suffrage, and the fight against racism. 

If Englishness is going to mean anything in modern England, it needs to be as important for those who feel that perhaps they aren’t English as it is for those who feel that they definitely are. And a place must be reserved for those who, though technically English, don’t see their own story within the Conservative myth of Englishness. 

Although this reclaiming is electorally essential, it is not an electoral gimmick. It is fundamental to who we are. Even if we didn’t need it to win, I would be arguing for it.

We need to make sure that progressive patriotism reclaims the visual language that the Conservatives use to dress up their regressive patriotism. Women need to be as much in the pantheon of the radicals as part of the visual identity of Englishness. Women tend to either be there by birth or by marriage, or we are abstract manifestations of ideals like "justice" or "truth" – as seen on city halls and civic buildings across the country. But English women need to be real, rather than just ideal. Englishness does need to be focused on place and connection, and it should include Mary Wollstonecraft and Sylvia Pankhurst as well as Wat Tyler and Thomas Paine. 

We can’t pretend that we’re always right. The most patriotic thing you can do is to admit sometimes that you’re wrong, so that your country can be better. I love my country, for all its faults. But I do not live with them. I try to make my country better. That is progressive patriotism. And I know all of us who want to be part of this can be part of it. 

This article is based on Polly’s contribution to Who Speaks to England? Labour’s English challenge, a new book published today by the Fabian Society and the Centre for English Identity and Politics at the University of Winchester.