Immediately to the left of Jonathan Ashworth’s desk in Portcullis House are a large flipchart and a poster.
The flipchart details the places Ashworth will visit in the coming week, when he tours different towns and cities discussing the NHS with “people who work in the NHS, patient groups, royal colleges, staff groups, people who aren’t part of a group but have an interest in the future of the NHS.”
The poster shows what was known, for a week or so in 2015, as the ‘Maggie Simpson map’: a Britain colour-coded by general election results, with an almost entirely Conservative-blue body and an SNP-yellow head.
In the centre of the coffee table is a copy of The House magazine, with Yvette Cooper on the cover. “That’s a coincidence!” laughs Ashworth, who nominated Cooper in the leadership election in 2015. He didn’t declare support for either Jeremy Corbyn or Owen Smith in last year’s rematch. Though he would reject the comparison, both Ashworth and Theresa May carried off a very successful 2016 by standing back while their parties fought bitterly amongst themselves. Previously a shadow minister without portfolio, Ashworth was promoted in October to one of the biggest roles on the opposition front bench, following in the steps of Andy Burnham and Diane Abbott.
It is a good week to be shadow health secretary. Three days before we meet, Jeremy Hunt was forced to redraw the four-hour waiting threshold for A&E as a target for “urgent health problems… but not all health problems”, while the British Red Cross chief executive described NHS hospital and ambulance services as a “humanitarian crisis.” The following day, Hunt was forced to admit to the Commons that the NHS had failed to provide mental health support to the 18-year-old daughter of one of its own nurses. The day we meet, the National Audit Office have reported that Hunt’s plans for seven-day GP access were made “despite not having evaluated the cost-effectiveness of their proposals and without having consistently provided value for money from the existing services”.But Ashworth says he doesn’t take any satisfaction from his opponent’s tough week.
“I’m not one for demonising Jeremy; I rather like Jeremy. I’ll probably get lots of criticism on social media for saying that. But if we get into a debate about personalities, we’re missing the bigger picture – the systematic underfunding of the NHS, and deep cuts to social care.” Does Ashworth agree with the Red Cross? Is the NHS at breaking point?
“I think we have to be responsible in the language we use. It is certainly a winter crisis. A&E targets have been missed again, 20 hospitals have had to declare black alert. In the last few weeks, 50 trusts have put out messages saying they can’t cope, several hospitals say they don’t think they can offer comprehensive care and 140 hospitals, at least, are effectively turning people away from A&E. It is certainly a crisis this winter. What is outrageous is that the government were continually warned about this. They’ve been consistently warned that unless they do something to solve the social care crisis in this country, it’ll continue to put undue pressures on the wider NHS. And that is what we are seeing now. We’ve had six years of multi-billion pound cuts in social care. If you take £4.5 billion out of the social care sector, that is a lot of elderly and very vulnerable people not getting the support they deserve and need. It’s inevitable that it’s going to impact on the NHS.”
Funding is the primary issue for Ashworth. “The government insists it’s given the NHS an extra £10bn. Those claims have been eviscerated this week by Simon Stevens at the Public Accounts Committee. The reality is that it’s the biggest financial squeeze in its history. It’s effectively flat-lining, and indeed in 2018, as Simon Stevens said, head-for-head expenditure in this country will actually be cut in the NHS. Whenever you put this to Theresa May, she just stubbornly refuses to listen. She keeps saying we’ve had £10bn, even though expert after expert after expert has knocked this down.”
Ashworth says there needs to be “objectivity in the debate about the finances of the NHS” and that a new body, similar to the Office of Budget Responsibility, might offer this. By making reports to the health secretary as the OBR does to the chancellor, such a body would, says Ashworth, “allow parliament to scrutinise the judgements they are making about the allocation of resources. Government ministers have to be answerable to the people, ultimately, for the decisions they make for NHS financing.”
Few would argue that NHS spending is as well-planned as it could be, but the money does have to exist for it to be allocated. Where would Labour find the funds to save the NHS?
“This government has chosen a multi-billion pound tax cut for corporations and a big capital gains tax cut for share transactions. It’s chosen to give the very wealthiest estates in the country a £1bn pound inheritance tax cut. In the most recent Autumn Statement, there was nothing for social care and yet there were millions allocated in capital expenditure for new grammar schools. And yet we have the NHS having to raid its capital budgets. So in the immediate term, I would say they do not need to make that set of decisions.”
So Labour would increase taxes and reduce spending on education? “We don’t know what we would inherit in 2020. These will be the decisions for the chancellor, for his or her first budget. But if we were in government now, we would be making a different set of decisions now, to help the health service.”
Previous Labour governments – for which Ashworth worked as a special advisor and Gordon Brown’s deputy political secretary – found the money for over 100 new hospitals in Private Finance Initiative (PFI) schemes. Many of these schemes involve repaying three to five times the build cost of the hospital – and in some cases, up to seven times the cost – over decades. The last scheme begun by Labour will not be paid off until 2049. Would Ashworth consider using PFI again?
“I think the days of PFI are over,” he says. “I think Jeremy Corbyn has been pretty clear on that.” Does he defend PFI? “The PFI contracts delivered huge numbers of new buildings, and we wanted new buildings. There are a handful of contracts that were not negotiated well. In fairness, a lot of those were inherited from the previous John Major government.But Jeremy Corbyn has said that he would want to have a look at these contracts, if he can, in government. It’s something that I know he and John McDonnell are looking at carefully. But we’re not going to have PFI contracts in the future.”
Opening the NHS up to more outsourcing is also off the table, says Ashworth. “The Health and Social care Act pushed us in the direction of greater fragmentation, of greater outsourcing to private companies. I think it is a damaging piece of legislation, and we are committed to reversing that. “We don’t see why these companies should be able to come in – they try to make a profit, they don’t, and then they leave. And then sometimes they then rely on the public sector to pick up the pieces again.”
Some recent health policy is worth keeping, however. Ashworth says the sustainability and transformation plans (STPs) introduced in 2015 “could mean more planning at a local level. They could mean a more strategic delivery of local health services. That is something we would be in favour of, and it’s why we used to have strategic health authorities. The problem is, what started off as a way to get greater collaboration in the system now increasingly looks like a way of filling financial gaps. If you look at all of the STPs now, and you look at their ‘do-nothing’ proposals – maintaining services as they are now – it adds up to £21.8bn. That is the gap they’ve got to find. So they’re proposing cutting beds, downgrading hospitals or maternity wings or A&E departments, while not explaining how there will be greater provision in the wider community, not explaining what social care provision will be put in place, not explaining what acute sector provision will be in place. It’s a cart-before-the-horse argument.”
Ashworth is at his most emotive when discussing Labour’s electoral ambitions. “I sit on the opposition benches, and you see casual dismissal from the Tories of the condition of Britain. That does make me angry. I make no apologies for wanting Labour to win. It isn’t a game. It is the ultimate betrayal of the people we’re in politics to represent if we’re not completely focused, laser-like, on winning elections.”