Ian GreenerLabour are attempting to make the NHS a central issue in this election campaign but are unclear about how they would actually go about improving the health service. Meanwhile the Conservatives, wary of having put in place an unpopular and expensive reorganisation that has borne little fruit, would rather talk about something else. What is missing from both parties is a clear strategy for dealing with the nation’s health, writes Ian Greener.

According to polls by ComRes and ITV News (and indeed others), the number one issue amongst the electorate in 2015 is the NHS. Little wonder then, that political parties of all colours are lining up to show their commitment to it, promising extra resources and service improvements. What are the politics of healthcare (and health) as we approach the election? This short piece explores the present situation in terms of both Labour and Conservative policy – I miss off other parties because of space, and because the next government is almost certain to be dominated by one of these two parties.

Traditionally, the NHS has been a vote-winner for Labour – and they have not hesitated in previous elections to attempt to capitalise on this by declaring there to be days left to save the NHS (as in 1997) or pointing to failings by the Conservatives in respect of healthcare (just about every other election).

In 2010, things got rather confused. The Conservatives, with a leader who had announced his personal commitment to the service, promised to ring-fence spending on the NHS, and Labour seemed unwilling or unable to match that commitment. This resulted in a strange impasse in which neither party really wanted to talk about healthcare in the run-up to the election, and the coalition government’s rather protracted, messy and expensive organisation coming as a shock to nearly everyone (perhaps except Andrew Lansley). The delays in getting the legislation through both Houses, the substantial amendments made to Lansley’s original plan, and the bizarre spectacle of former Labour Secretary of State Alan Milburn complaining the reorganisation wasn’t radical enough, while Conservative bloggers complained that it was so radical it risked losing them the next election, all led to a sense that the NHS was now again a toxic area for the Conservatives. Andy Burnham, Labour’s Shadow Secretary of State, announced his intention to repeal the coalition’s legislation, even though much of what it did was arguably an extension of his tenure in office rather than being entirely new.

So where are we now? Well, although the coalition have protected the NHS budget (at least more than most welfare services), the NHS in England is clearly struggling, not least because of the efficiency savings the NHS has been asked to make, the massive cuts to local government budgets, and the huge pressures this has put on social care and community health services. If people can’t get looked after in their own homes, they end up being referred into NHS care, adding pressure onto the service that has become increasingly apparent in the winter of 2014/15. It is also striking that the extended marketplace for healthcare and the changed commissioning arrangements that are at the centre of the coalition’s reorganisation, haven’t generated much in terms of tangible improvements.

In Scotland, where the NHS has not gone down the same market-based reorganisation, improvements are happening that bodies such as the World Health Organisation credit to a continuity of policy and organisation – unlike England they haven’t gone in for massive change every few years. Scotland is still playing catch-up in health terms, but its success in catching up suggests there are grounds for believing that the answers to health improvement don’t lie in either the market-based ethos that has dominated both Conservative and Labour thinking since the early 2000s, or in changing things every few years.

100 days before the election, Ed Miliband made the NHS the centrepiece of Labour’s election campaign, promising to rescue the NHS, promising additional funds and training places, and Andy Burnham promised to merge and health and care services (as well as again to repeal the coalition’s reorganisation). Alan Milburn suggested later in the day that these plans were a mistake – that Labour should not run emotional campaigns about the NHS, make unfunded promises about it, or be unclear about how it would improve healthcare.

This is a bit odd for two reasons. First, Milburn was very much a product of New Labour, and New Labour were famously disciplined in dealing with dissent to announced policy. Milburn may well feel that neither Labour nor the Conservatives are continuing with the changes he introduced as Secretary of State between 1999 and 2003, but, frankly, I’m not sure there is much evidence suggesting his is really the way to go. Second, Milburn is perhaps being unfair to the new plans in suggesting that they are unfunded – they aren’t, as they would be paid for at least in part by the proposed mansion tax. What both Miliband and Milburn are rather less clear about, however, is how they would go about improving the NHS. Merging health and care is long overdue, but will be messy and time-consuming, and that is hardly a recipe for improving things in the short term.

The Conservatives seem reluctant to make the NHS anything like the centrepiece of their election campaigning this time around. They have again promised to ring-fence the NHS budget, with George Osborne already having promised to put £2 billion extra a year into what he calls ‘front-line’ services in the NHS (and which prompted another row about how much of that money is actually new, and how much pre-committed). This promise seems to be funded by fines imposed on banks for, amongst other things, Libor rate-rigging.

So we seem to be left in a situation where Labour are attempting to make the NHS a central issue, but struggling to really drive their message home, especially when one of the their own ex-Secretaries of State (Milburn) is criticising them, and another (Burnham), is fronting a campaign to repeal coalition legislation and make the NHS more ‘public’ again, even though his period in office was one in which Labour extended the non-public market for care. The Conservatives, in contrast, wary of having put in place an unpopular and expensive (in terms of both money and political capital) reorganisation that has borne little fruit, would rather talk about something else, and their plans for the NHS seem to be very similar to what they promised in 2010.

What is missing from both parties is a clear strategy for dealing with the nation’s health. Research published last week suggested nearly a third of our children are obese. Social care continues to rise in cost with no party apparently able to grasp the nettle and deal with the challenge of creating policy for something we all hope to face one day – old age. We are facing a rising problem in terms of long-term conditions and chronic disease. Perhaps it is time the political parties stopped pretending another reorganisation will magically deal with the very real challenges we face in terms of health and started dealing with these challenges head on. Now that really would be worth debating.

Note: this article was originally published on the PSA’s Insight Blog. Featured image credit: Lydia CC BY

About the Author

Ian GreenerIan Greener is Professor in the School of Applied Social Sciences at the University of Durham. He is one of the authors of Reforming healthcare: what’s the evidence?, Policy Press 2014 and tweets @ijgreener.

 

 

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