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

European People's Party via Creative Commons
Show Hide image

Ansbach puts Europe's bravest politician under pressure

Angela Merkel must respond to a series of tragedies and criticisms of her refugee policy. 

Angela Merkel, the Chancellor of Germany, is supposed to be on holiday. Two separate attacks have put an end to that. The first, a mass shooting in Munich, was at first widely believed to be a terrorist attack, but later turned out to be the actions of a loner obsessed with US high school shootings. The second, where a man blew himself up in the town of Ansbach, caused less physical damage - three were seriously injured, but none killed. Nevertheless, this event may prove to affect even more people's lives. Because that man had come to Germany claiming to be a Syrian refugee. 

The attack came hours after a Syrian refugee murdered a pregnant Polish woman, a co-woker in a snack bar, in Reutlingen. All eyes will now be on Merkel who, more than any other European politician, is held responsible for Syrian refugees in Europe.

In 2015, when other European states were erecting barriers to keep out the million migrants and refugees marching north, Merkel kept Germany's borders open. The country has resettled 41,899 Syrians since 2013, according to the UNHCR, of which 20,067 came on humanitarian grounds and 21,832 through private sponsorship. That is twice as much as the UK has pledged to resettle by 2020. The actual number of Syrians in Germany is far higher - 90 per cent of the 102,400 Syrians applying for EU asylum in the first quarter of 2016 were registered there. 

Merkel is the bravest of Europe's politicians. Contrary to some assertions on the right, she did not invent the refugee crisis. Five years of brutal war in Syria did that. Merkel was simply the first of the continent's most prominent leaders to stop ignoring it. If Germany had not absorbed so many refugees, they would still be in central Europe and the Balkans, and we would be seeing even more pictures of starved children in informal camps than we do today. 

Equally, the problems facing Merkel now are not hers alone. These are the problems facing all of Europe's major states, whether or not they recognise them. 

Take the failed Syrian asylum seeker of Ansbach (his application was rejected but he could not be deported back to a warzone). In Germany, his application could at least be considered, and rejected. Europe as a whole has not invested in the processing centres required to determine who is a Syrian civilian, who might be a Syrian combatant and who is simply taking advantage of the black market in Syrian passports to masquerade as a refugee. 

Secondly, there is the subject of trauma. The Munich shooter appears to have had no links to Islamic State or Syria, but his act underlines the fact you do not need a grand political narrative to inflict hurt on others. Syrians who have experienced unspeakable violence either in their homeland or en route to Europe are left psychologically damaged. That is not to suggest they will turn to violence. But it is still safer to offer such people therapy than leave them to drift around Europe, unmonitored and unsupported, as other countries seem willing to do. 

Third, there is the question of lawlessness. Syrians have been blamed for everything from the Cologne attacks in January to creeping Islamist radicalisation. But apart from the fact that these reports can turn out to be overblown (two of the 58 men arrested over Cologne were Syrians), it is unclear what the alternative would be. Policies that force Syrians underground have already greatly empowered Europe's network of human traffickers and thugs.

So far, Merkel seems to be standing her ground. Her home affairs spokesman, Stephan Mayer, told the BBC that Germany had room to improve on its asylum policy, but stressed each attack was different. 

He said: "Horrible things take place in Syria. And it is the biggest humanitarian catastrophe, so it is completely wrong to blame Angela Merkel, or her refugee policies, for these incidents." Many will do, all the same.