When people come to vote for Labour on May 7th 2015, they’ll possibly be thinking of getting rid of this current government. There are various factors which might be important such as ‘the cost of living crisis’, but it’s quite possible there could be a strong anti-privatisation of the NHS contingent.

Tony Benn was last in office in the Department for Trade in 1979, and strictly speaking another Tony, Tony Blair, was the first elected Labour Prime Minister in the UK since October 1974. Benn does raise an interesting hypothesis of how people vote, in his latest (and last) set of diaries entitled, “An autumn blaze of sunshine”. He feels that people vote Labour when they get fed up of the Tories, to feel ‘less bad’ about voting for Tory policies; and after a while, they revert back to the Conservative Party. Benn’s thesis is that the two main parties are now essentially in the same. And to give him credit, Benn forecast the current Coalition long before it happened. Whilst generally quite critical of Gordon Brown and Tony Blair, there was a glimmer of optimism towards the end.

In a passage where Tony Benn is talking about the public opinion turning against railway privatisation (signposted by how Mandelson had to postponing the privatisation of the post office and pull out of a rail franchise):

“I can see a possibility Labour might win… Public opinion is very volatile… Cameron and Clegg are so ineffective… But when I look at people like John Reid and Patricia Hewitt and others, who held offices in government, and who are now working in companies engaged in government contracts and privatisation, it’s very revolting.”

(Tony Benn, “An autumn blaze of sunshine”)

It’s possible that the differences in approach of two former Secretaries of State for Health for Labour, Alan Milburn and Andy Burnham MP, have been exaggerated. However, it is still easy to underestimate how Burnham’s ‘NHS preferred provider’ places a wedge between him and Milburn, although the general assumption of the market may still be in place due to globalisation and the US-EU free trade treaty. It is likely that the two personalities largely agree on the ‘efficiency savings’, all but cuts in name. But certainly who wins out on the ‘NHS preferred provider’ could be symptomatic of what sort of Labour Party Ed Miliband wishes to lead. Tony Blair was generally considered to have brought Labour much more to the Thatcherite fold on the importance of the market compared to the State.

Ed Miliband, whose mother is well known to be good friends with Tony Benn, thus far has indicated that he wishes to challenge the Hayekian notion of the market being ‘liberalising’. Miliband in his first conference speech which was virtually ubiquitously panned also criticised ‘predators‘, presumably an attack on ‘quick buck’ hedge funds which are known to have lobbied aggressively for the Health and Social Care Act (2012). Miliband likewise in ‘One Nation’ has purported not to give any one ‘vested interest’ undue prominence, but this could mean restoring some value for workers including nurses which form the “backbone” of the NHS. Burnham, to give him credit, has argued that he wishes to move towards a society where carers are valued, rather than promoting the shareholder dividend of the directors of the large corporations than can provide them. You can probably run the NHS without hedge funds (though hedge funds will wish to argue that they play a critical rôle in the ‘sustainability’ of the NHS), but it would be impossible to run the NHS without nurses (whether unionised or not.)

In the 2010/11 Operating Framework, Andy Burnham said that the NHS would have to make the £15-20bn “efficiency savings” over four years. These efficiency savings had been previously identified by McKinsey. When Lansley took over the NHS the “efficiency savings” became £20bn over five years (or £4bn a year for each of the five years).  We happen to know that attempts by government to make “efficiency savings” have always failed to hit their target.

Nick Timmins in October 2009 wrote an article in the BMJ which could turn out to be quite important in the months ahead for Labour.  This was when Andy Burnham proposed that NHS organisations would now be the “preferred provider” of NHS care. Significantly the announcement was welcomed by the health service unions, including Unison, the BMA, and the Royal College of Nursing, in fact generally the same parties which were about to be disenfranchised in the discussions over the Health and Social Care Bill (2011), aka the Lansley Vanity Project (2011). However, it had produced a rather different reaction among private providers of NHS care, whose representatives included the “NHS Partners Network”, described it as “completely irresponsible.”

Burnham’s initial announcement about the “preferred provider” policy came in a speech in 2009 to the healthcare think tank the King’s Fund but fuller details were subsequently out in a letter to Brendan Barber, the then general secretary of the Trades Union Congress. According to the preferred provider guidance, NHS organisations must be given “at least two” formal chances to improve where they are underperforming. Even then, alternative providers should be considered only where the continuing underperformance is “significant.” Where incremental improvements in services are sought, existing staff should be given “at least two” chances to provide an acceptable service plan before any move to put the service out to alternative providers. Even then, clinical or safety issues may warrant an “NHS only” tender. It was hypothesised that staff and existing organisations should be engaged early and should help to design any new or important change of service. The BMA said the change was “a very positive sign” that the government was listening to its concerns about the increasing commercialisation of the NHS. Unison welcomed it as “a significant policy shift”.

Alan Milburn, the former Labour health secretary who introduced independent sector treatment centres and patient choice in the NHS, said, “This is a retrograde step. If you are going to drive productivity and quality on the scale required [given the financial challenge the NHS is about to face], the last thing you do is renew a monopoly and say your existing provider is your preferred one.” He said that the NHS needed “not less competition but more” and that the move signalled that Labour was going soft on NHS reform. And we all know what happened next, with the Government throwing in section 75, the vehicle for outsourcing NHS services, into the mix like a policy hand grenade. He warned that failing to accelerate the pace of NHS reform will put frontline services at risk.

Milburn is of course one of the grand architects of the 2000 NHS Plan, under which private sector providers were welcomed, calling for state control over the NHS to be reined in. He said: “The NHS is in transition between a 20th century model of state control and monopoly provision and…a different model where the citizen has more control. The policy question is whether that journey is going to be finished or truncated. We have to take it to its final destination.” Wind the clock on a few years,  Simon Stevens, a one-time Blairite health advisor and co-architect of this plan, was announced as the new chief executive of NHS England. He himself advised Milburn before leaving England to join US healthcare giant UnitedHealth.

Milburn in December 2011 said “it was depressing to hear Labour people defining themselves not against the government but the previous Labour government“. Speaking to the pro-market thinkthank Reform, Milburn called for “more competition and new entrants into the NHS” and said the two shadow health spokesman since the election defeat – John Healey and Burnham – were making a “fundamental political misjudgement” by attempting to roll back Labour’s previous policy on the NHS.

And it’s impossible to fail to be touched by the hand of the multinational corporations upon us (perhaps.) Earlier last century, amidst an equally disastrous global financial crash, Britain itself followed the depreciation of sterling with higher tariffs. In November 1931, it enacted an Abnormal Importation Duties Act which gave the authorities discretion to impose higher duties on selected goods. In February 1932, Parliament passed the Import Duties Act imposing a 10 percent across-the-board tariff on imports, with additional restrictions on certain imports and exemptions for imports from the empire.

Seventy years later, the collapse of world trade in 2009 was  associated with significant part to a sharp fall in consumer confidence in most western economies. In previous economic downturns, most notably the 1930s Depression, a fall in the level of trade was also related to the use of import tariffs and quotas by many countries. In a situation where the economy remains depressed for a period of time, governments feel that they need to make sure that whatever consumer spending there is goes on domestically produced goods. Several recent reports have however pointed to rise in the use of measures such as import tariffs, exchange controls and import licenses by major trading blocs. Economic history overall perhaps suggests that wholesale recourse to tariffs and quotas is likely to prolong the world economic downturn, however, so while such measures might be politically popular at home, they are unlikely to make much of a positive contribution to economic growth. Labour currently seem to wish to change the narrative away from the macroeconomic issue of growth per se, but for many people the cost of living is the totemic issue of the cost of living, and indeed the economy. And it’s possible that other factors, such as the ‘right’ of the Tory Party and UKIP might be the anti-immigration force leading domestic politics (while Labour wishes to appear to strong on the abuse of multinational-corporations of workers below the national living wage to be enacted.)

Quite on the sly, with all the broohaha about privatisation of the NHS, the US-EU free trade negotiations appear to have gone relatively unnoticed. Not everyone is convinced of the benefits of free-trade, however. The centre-left think-tank, Compass, had argued that the fundamental cause of most of the economic ills in the UK, such as the much discussed squeezed-middle, is in fact globalisation. Although the argument that free-trade increases the overall value of economic output is convincing, economic evidence has revealed relatively little about how the gains from trade are distributed (to governments, corporations, and households, for example). Many economists have argued that globalisation has reduced the demand for labour and wages in in the UK and US, particularly for workers with less specialised skills. This might be directly through immigration or indirectly through trade and capital mobility.

A US/EU Free Trade Agreement, as publicly announced, will “dismantle hurdles to trade in goods, services and investment” and “make regulations and standards compatible on both sides”. The agreement is meant to give transnational corporations a level playing field, both in the trade of goods and in the provision of services. Rules must be the same for everyone, to avoid any extra cost or “import tax” for foreign providers. If a corporation thinks that a government or body is limiting their ability to profit, it can take legal action against them. The idea that the Health and Social Care Act (2012) was developed to allow foreign transnational corporations to profit from NHS privatisation is pretty unpalatable for some; but for others it reinforces the idea that ‘I don’t care who provides high quality care as long as it’s free at the point of need‘. Non-socialists argue that the State should not necessarily have a monopoly on NHS services; socialists will argue that leaving it to a market can only encourage cherrypicking and accelerated rationing, totally defeating the purpose of the NHS as comprehensive and universal.

Earlier this month, it was reported that New Labour “grandees” Alastair Campbell and Alan Milburn, as well as a batch of other advisers from the Blair and Brown eras, were to make a dramatic return to Ed Miliband’s general election team, according to a top-secret memo obtained by the Observer. The document – Proposed General Election 2015 Meeting Structure – drawn up in the office of Douglas Alexander, chair of campaign strategy, will infuriate many on the party’s left, who believed that Miliband had moved on from New Labour’s approaches to campaigning and policy.

It is of course perfectly possible that neither Alan Milburn nor Andy Burnham wish to have a big “bust up” over future Labour policy, arguing that there is much more in common between them. Andy Burnham clearly wants to get on with ‘whole person care’, bringing social care up to standard of what he considers to be reasonable for a social care service. Governments of whatever colour will have to implement coherent policies on patient safety, workforce performance management, financial budgeting and dynamic reconfiguration of primary and secondary care. It’s going to be a tough ask to require Alan Milburn and Andy Burnham to match the titanic reputations of Stafford Cripps, Aneurin Bevan, Clem Attlee and Tony Benn, but they’re going to have to have a go at the very least.