A protest in support of the NHS at last year's Labour conference. Source: Getty
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NHS funding is a taboo topic for all parties

The Tories blew their chance to be trusted on health and Labour doesn't want to talk about where the money will come from.

It is hard to think of a policy that Labour is less likely to adopt for its 2015 manifesto than the flat rate £10-per-month “membership fee” for the NHS proposed by Lord Warner, a Blair-era health minister now sitting in the Lords. Jamie Reed MP, shadow health minister has said “this is not something Labour would ever consider.” He might have added re-introduction of small pox as a health policy  closer to Ed Miliband’s preferred general election offer.

When Labour has a vast lead over the Tories as the party to be trusted with the health service, anything that sounds as if it undermines the founding principle of universal access free at the point of use is out of the question. The problem is that Labour has signed up to tight spending constraint if it forms a government and under those circumstances NHS funding is certain to become a volatile issue. People are living longer, suffering from chronic conditions that are expensive to treat – especially if they result in prolonged hospital stays – and costs in medicine tend to rise faster than inflation. Even without the ongoing fiscal crunch, this would be an issue of existential urgency for the system as it is currently configured.

MPs in all parties know this but it has become hard to say so aloud for fear of facing the follow-up question – what would you do about it? In theory, health spending this parliament has been “ring-fenced” but it doesn’t feel that way in the context of local authority cuts, which have severe consequences for social care, and “efficiency savings” that amount to real terms cuts when imposed in a climate of rising costs. GPs say privately that a growing part of what they do amounts to managing patient expectations downward and rationing.

This model of service erosion is no-one’s preferred policy but it is the inevitable consequence of persistent failure of political courage on all sides. The Tories had their moment to bring public opinion with them in a conversation about reform and they blew it with a vast restructuring that alienated pretty much everyone apart from private healthcare providers. The Lib Dems are desperate to scrub away as much trace of complicity with the Tories’ mangled reforms as they can before polling day, although Nick Clegg was a prominent co-mangler.

Labour, meanwhile, does have a plan to transform the provision of health services – the “whole person care” idea developed by Andy Burnham. This puts the emphasis on public health and investment in prevention to save costs down the line. It also envisages the merger of health and social care.

There are obstacles. First, even if the numbers can be made to add up over the long-term, it looks like a hefty up-front expense and yet another epic re-organisation to boot. Second, Ed Miliband’s office is deeply suspicious of Burnham, believing him to be building a support base in the party machine and manoeuvring into a position to be ready for a leadership contest in the event that Labour loses the next election. With an eye on those ambitions, neither Miliband nor Ed Balls seems in a massive hurry to give the shadow Health Secretary the kind of boost that would come from the adoption of his health plans as a flagship reform proposal going into the general election.

Finally, there is a feeling among some Labour MPs and activists that owning up to the imminent cost crunch in the health service and offering a complicated reform agenda to address it just confuses the message, when all the voters need to know between now and May 2015 is that “you can’t trust the Tories with the NHS.” This school of opposition would gladly build an entire campaign around the anti-Conservative message played on a loop alongside pictures of David Cameron and George Obsorne looking smug interspersed with reminders of their “tax cut for millionaires.”

The reality is that Labour expected problems with the NHS to be more extreme and more salient in political debate than they have proved to be so far. (That isn't meant as a denial of the severity of the problem, only as an observation that they haven't blasted other matters off the front pages.) It is an issue where the opposition has a huge potential advantage but only if voters think it is a matter of such urgency as to trump other questions when weighing up who to vote for – the economy; immigration; crime; education etc. Labour’s dilemma is that the obvious way to make more political noise around the health service is to talk about the funding crisis but doing so invites scrutiny of the opposition’s proposed solution. And that is a conversation the party is not yet ready to have.

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

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Celebrate Labour's electoral success - but don't forget the working class

The shutting down of genuine, constructive debate on the left is the great danger we face. 

In the moment when the exit poll was released on 8 June, after seven weeks of slogging up and down the streets of Britain, dealing with scepticism, doubt and sometimes downright hostility, we felt a combination of relief, optimism, even euphoria.
 
This election broke wide open some assumptions that have constrained us on the left for too long; that the young won’t vote, that any one individual or political party is “unelectable”, that perceptions of both individuals, parties and even policies cannot change suddenly and dramatically. It reminded us that courage, ambition and hope are what’s needed and what have been missing from our politics, too often, for too long.
 
We have learnt to tread carefully and wear our values lightly. But in recent weeks we have remembered that our convictions can, as Jonathan Freedland once wrote, “bring hope flickering back to life” and meet the growing appetite for a politics that doesn’t simply rail against what is but aspires to build a world that is better.
 
In this election at least, it seems the final, anticipated fracture of Labour from its working-class base after Brexit did not materialise. Shortly before the snap election was called I wrote that while Brexit appeared to be Labour’s greatest weakness, it could just be our biggest strength, because: “consider what remain voting Tottenham and leave voting Wigan have in common: Labour… We will succeed if we seek the common ground shared by the decent, sensible majority, and more importantly, so will Britain.”
 
But consider this too. The Tories ran a terrible campaign. It was, without any doubt,the most inept, counter-productive campaign I’ve ever seen in British politics. The day their manifesto hit the headlines, even in our toughest neighbourhoods, we could feel change in the air. Arrogance is never rewarded by the British people and Theresa May has paid a price for it. Yet, despite a Tory manifesto that was a full, square attack on older people, the majority of over 65s still came out for the Tories.
 
And despite the growing relevance of freedom, internationalism and tolerance in an era characterised by Donald Trump and Vladimir Putin, the Liberal Democrats managed to become bystanders in the political debate. They stood on a platform that aimed to capture the support of those remain voters for whom Brexit is the major question, but neglected the rest. And they quite spectacularly failed to foresee that those who were intensely angered by May’s conversion to a little England, hard Brexit stance would vote tactically against the Tories. Over those seven weeks, they all but disappeared as a political force.
 
As Bob Dylan once said, "the times, they are a-changin" – and they will change again. The recent past has moved at extraordinary speed. The Brexit Referendum, the rise and retreat of nationalism, the election of Trump and his crushing unpopularity just a few months later, the reversal in fortunes for May and Jeremy Corbyn, the astonishing phenomenon of Emmanuel Macron and pro-European centrism, and the dramatic rise and sudden collapse of Ukip. Politics, as John Harris wrote last week, is now more fluid than ever. So now is the time, for hope yes, and for conviction too, but not for jubilation. We need some serious thinking. 
 
We should be cautious to rush to judgment. It is only two weeks since the exit poll sent shockwaves across the country. There is no comprehensive explanation for the multitude of motivations that delivered this election result and will not be for some time. But there are some early indictors that must make us think. 
 
After seven years of austerity, as John Curtice observes, the Tories made some of their biggest gains in some of the poorest areas of Britain. It is something I felt in all of the eight constituencies I campaigned in during the election. While the Labour vote rose significantly in towns like Wigan, so too did the Tory vote, despite little or no campaigning activity on the ground. As Rob Ford puts it, “Labour, founded as the party of the working class, and focused on redistributing resources from the rich to the poor, gained the most ground in 2017 in seats with the largest concentrations of middle-class professionals and the rich. The Conservatives, long the party of capital and the middle class, made their largest gains in the poorest seats of England and Wales… Britain’s class politics has been turned completely upside down in 2017”.
 
To acknowledge the growing, longstanding scepticism of many working-class men, and women, towards Labour in towns across England is not to take away from the hard work and drive of the activists, advisers and politicians that helped to fuel such a dramatic turnaround for Labour during the short campaign. To have won considerable gains in wealthier suburbs is no small achievement. 
 
But if the future of Labour lies in a coalition between middle-class young professionals and the working class, what is the glue that binds? While there is shared agreement about investment in public services, how are those interests to be squared on areas like national security and immigration? I believe it can and must be done, but – as I said to conference when I was first elected seven years ago - it will demand that we begin with the difficult questions, not the easy ones.  
 
Just a few days before the election, statistics were released that pointed to a collapse in trade union membership. What does the decline of an organised Labour movement mean for who we are and what we can achieve? These are not new questions. They were posed by Eric Hobsbawm in his brilliant lecture, "The Forward March of Labour Halted" in 1979 - a challenge laid down in the year I was born. Now, 37 years on, we are no further down the road to answering it. 
 
The most dramatic finding from this election was the support Corbyn’s Labour party appears to have won from middle-class, young professionals. They said he couldn’t do it and quite stunningly it seems they were wrong. But a ComRes poll last week caught my eye – by a large margin those 30-44 year olds would favour a new centre-ground political party over the current political settlement. In an election where we returned strongly to two-party politics, it appears they moved to us. But what would a dynamic and renewed Liberal Democrat Party, or a British En Marche do to our support base?
 
After a hellish two years we have learnt in Labour, I hope, that unity matters. The public and private anger directed towards each other, whether the Labour leadership, the parliamentary Labour party or elected councillors, is desperately damaging and its (relative) absence in the campaign was important.
 
But unity is not the same as uniformity, and while two weeks ago I felt there was a real danger of historic fracture, now I believe the shutting down of genuine, constructive debate on the left is the great danger we face, and must avoid. No one person, faction or party has ever had the monopoly on wisdom. The breadth of the Labour movement was and remains our greatest strength. 
 
Consider the Labour manifesto, which drew on every tradition across our movement and demanded that every part of the party had to compromise. Those broad traditions still matter and are still relevant because they hear and are attuned to different parts of Britain. Our country is changing and politics must catch up. The future will be negotiated, not imposed.
 
As we witness the age of "strong man" politics across the world, here in Britain our political culture has become angrier and more illiberal than at any time I can remember. The Brexit debate was characterised by rage, misinformation and a macho political culture that demanded that we abandon nuance and complexity, an understanding of one another and tolerance of different points of view.
 
But this is not where the future of Britain lies: it lies in pluralism. It lies in a politics that is nimbler, more fleet of foot, less constrained; a return to the great tradition of debate, evidence, experience and argument as a way to build broad coalitions and convince people; not shouting one another down, nor believing any of us are always right; an arena in which we listen as much as we speak; a political culture in which we are capable of forming alliances within and across party lines to achieve real, lasting change.
 
And ultimately that’s the prize: not just seek power but, to paraphrase a philosopher whose work inspired millions, in the end “the point is to change it”. We could sit tight in Labour and hope to see the current government fall apart. We might even inherit power, we could temporarily reverse some of the worst of the last seven years, but what then? If we have learnt anything from 13 years of Labour government it should be this: that to build lasting change is the hardest political task of all, and it requires now that we do not turn to the political culture, the tools or even the ideas of the past, but that we think hard about where the future of our movement and our country really lies. Now is not the time to sit back and celebrate. Now is the time to think.

 

Lisa Nandy is the MP for Wigan. She was formerly Shadow Secretary of State for Energy and Climate Change.

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