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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I somehow feel very different this year, waving my teenager off to Pride

I thought times had changed, and was glad – then Orlando hit me like a smack in the face.

When I guest-edited Radio 4’s Today programme a couple of years ago, one of my chosen topics was young people and the internet, and specifically the way in which it can be such a positive force for gay teens who are coming to understand themselves and to find friends and allies. This item was entirely inspired by my own teenager, who came out at the age of 15, and had already found an online community of help, support and friendship.

Back when I was a teenager, I didn’t know anyone who was gay. Well, of course I did, but didn’t know it. My friend had a boyfriend with whom things never quite worked out, and when he came out years later it all made sense. We didn’t talk about it or wonder about it at the time. We sang “Glad to Be Gay” and thought we were cool and we knew nothing.

My kids, on the other hand, know everything, and they’ve taught me so much, mostly in terms of theory and terminology. I’d still thought I was cool but it turned out that in fact I was 53 and out of date, and they dragged me cheerfully into the second decade of the 21st century, blinking, dusting myself down.

The whole experience was a happy one, on both sides. A teenager who came out into a welcoming family. A brief, teary hug, because I hadn’t instinctively known (“God, Mum, your gaydar is crap”), and laughter at the clues I’d missed (“All that watching Eurovision together, Mum – did you still not guess?”). It wasn’t that I didn’t think any of my kids might be gay: just that I was still being a mum and not realising they’d stopped being kids.

Back in 2007 I wrote a song called “A-Z”, about gay teens being bullied at school, a kind of retelling of Bronski Beat’s “Smalltown Boy”, which I’d always adored. But then my own teen wasn’t bullied at school, and was happily out there, and everyone was cool, and I thought, “This is fantastic. What a time to be alive.” A crowd of them – gay, straight, bi – went off to Pride, wrapped in flags and with rainbows painted on their faces, and we took photos and celebrated, and again I thought, “What a time to be alive. Hurrah for Now.”

But then Orlando. Oh God, Orlando, which hit me smack in the face, left me shattered and weeping, feeling stupid for not remembering that there were still people out there who might want to harm my beautiful, clever, funny, science-loving, Ru Paul-loving child. Had we been living in a dream? Were we wrong to do so? We’d just been enjoying the good news, that’s all. The increasing freedom and equal rights. The taking of simple things for granted, like being able to marry and have kids. Just ordinariness – nothing anyone should have to feel grateful for.

How we can both know and not know things. How our longing for change lulls us into believing change has come. Of course I knew there was still a way to go. But there’s knowing and not knowing. There’s knowing something cerebrally, and knowing it viscerally. Love makes you strong and it makes you vulnerable. The people you love are the gap in your armour where the blade gets in, and Orlando was quite some blade.

“Four dead in Ohio,” sang Neil Young, in a plaintive lament for the students killed at Kent State University back in 1970. And the tune keeps coming into my head, with different words. Fifty dead in Orlando. Those text messages sent from the bathroom at the Pulse nightclub, what was it one of them said? “Mommy . . . Trapp in bathroom . . . I’m gonna die.” Mommy. That’s where the blade got in. And I wave my child – 18 now, an adult, but always my child – off to Pride for the third time, but in a different mood this year. Alert. Steely.

I’m reading Maggie Nelson’s The Argonauts, a book about same-sex marriage, non-binary gender identity, family, motherhood and, above all, love, and I come across this line: “Sometimes one has to know something many times over. Sometimes one forgets, and then remembers. And then forgets, and then remembers. And then forgets again.” I promise not to forget again.

Tracey Thorn is a musician and writer, best known as one half of Everything but the Girl. She writes the fortnightly “Off the Record” column for the New Statesman. Her latest book is Naked at the Albert Hall.

This article first appeared in the 30 June 2016 issue of the New Statesman, The Brexit lies