The Health Bill could kickstart Labour’s revival
Even prior to the COVID-19 pandemic, when the public are asked to identify their main concern, the NHS consistently ranks highly. Labour has traditionally polled well on the issue. Yet in 2019 a simple message of 40 new hospitals and 50,000 more nurses helped the Conservative Party to overturn their traditional weakness.
By the time of the next election, the issues within the health system created by the pandemic will have been brought to the fore. If Labour wants to reclaim its firm place as the “party of the NHS” it must rebuild support and trust so it can deliver the very best from the system. One route to this is seizing the opportunities to leverage the upcoming Health Bill.
The 2012 Health and Social Care Act, introduced by Andrew Lansley, sought to embed competition and market mechanisms within the health service. It also created a complex and fragmented system of quangos and arm length bodies. The 2021 Health Bill will formalise Integrated Care Systems – partnerships which aim to deliver joined-up health and social care. The Bill undoes many of the most heavily criticised aspects of the 2012 Act. It increases collaboration while reducing competition and, critically, provides closer links between local communities and health decision makers by using a population health approach. These are measures which Labour has continually called for since the 2012 Act was introduced.
Labour’s natural inclination will be to frame this as a “public vs private debate”. However, this road is well trodden and failed to gain traction for Labour during the 2019 General Election. What is more, this Bill proposes the opposite and removes the requirement for competitive tendering for all NHS contracts, giving public health commissioners more flexibility over when they use competitive processes. Under the plans, the NHS will also shift away from payments based on activity which incentivised providers to work to the numbers rather than collaborate for the benefit of patients and local populations.
This puts Labour in a legislative quagmire which requires a more savvy and nuanced response. One such area is the proposed powers of the Secretary of State, which received the bulk of criticism when the initial White Paper was published in February. NHS organisations such as NHS Confederation and NHS Providers expressed concerns about the scope of the Secretary of State’s powers, whilst think tank the Health Foundation outright rejected the plan. Generally, the scepticism was rooted in the wide scope of the new powers and the degree of direct control the Health Secretary will have over the NHS. However, with these increased powers comes greater political accountability. While this may be a boon in certain circumstances, it could prove to be a political albatross around the neck of the Health Secretary. Does any politician really want to contend with countless front pages asking why they are not dealing with crises in local hospitals? The answer is of course no, and so this is the area where Labour may be able to win concessions.
Another opportunity for Labour is highlighting the critical areas which these reforms will not address. The four greatest issues facing the NHS are workforce, social care, sustainable funding and waiting times. None of these issues are mentioned by the Health Bill. However, during the recent Hartlepool by-election, a video went viral of a voter blaming the local Labour Party for the cuts to his local hospital. This lack of mention of years of underfunding by the Conservative Government or the failed promises of what the 2012 reforms would do to improve the health service for patients is, for Labour, a failure of communication.
By the next election in 2024, the Health Foundation predicts that the number of people waiting for operations or other hospital treatment could reach 10 million, double the current number which recently hit 5 million for the first time. As was seen during the John Major-era, Labour should use long NHS waiting lists to hammer home to the public that the Conservative Party cannot be trusted to meet their ambitions on the NHS.
Beyond giving people a reason not to vote Conservative, Labour needs to give voters something to vote for on the NHS. The Health Bill will put into place the structures required to create a population health-based approach to delivering care, but to have any impact on patients, the supporting infrastructure is required. At an absolute minimum, Labour should commit to a National Care Service, similar to that proposed in Scotland, and a long-term sustainable funding settlement for the NHS to provide it with the certainty it needs. This needs to be underpinned by a public campaign to encourage people from home and abroad to take up careers in the NHS, training up the staff who can help clear the backlog of waiting patients. As a party, we need to step out of an Opposition mindset to offer a real alternative, one which is radical, optimistic and embraces the opportunity which new technologies and structures can bring post-pandemic.
As we learnt in 2019, the public debate on the NHS goes beyond “public vs private”. Voters do not resonate with it and are fatigued by political point scoring. What wins on the NHS is a simple message which offers a positive vision for a health system for the future, the type of system which the Health Bill seeks to create. The road back to power will not be an easy one but by playing to its strengths on the NHS, there is an opportunity to cut through. If Labour can reclaim the NHS as its own once more, it can win again in 2024.
Rory Macfarlane and Subodh Tailor
Hanover Communications