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The electoral arithmetic potentially could turn out good for the NHS
Be in no doubt. This is a very complicated UK general election.
It’s pretty likely that the SNP will gain a huge number of seats in the Westminster parliament. Many of us sadly forecast this. Jim Murphy and Kesia Dugdale were not the people to inspire the Scottish electorate to a good representation. At the time, it was pretty clear that many would go back to their constituencies and prepare for a hung parliament.
The situation is this. Ed Miliband wants a coalition with the SNP over his dead body. He has ruled out ‘a deal’, although this does not exclude lots of mini-deals to get a minority Labour government legislation through. A critical test for a Labour minority government will be whether the SNP can support a Labour government on a case-by-case basis. The economy clearly presents a problem, but many people feel that Ed Balls is ‘the weakest link’. Allowing for eased austerity and boosting consumer confidence and demand might be good for a weak recovery in the UK, and certainly the Green Party and the SNP should like to establish this.
The Liberal Democrats clearly fancy themselves as tempering the Government on preventing a lurch to the left or right. However, the credentials of the current Government are not much to brag about. National debt has gone through the roof. With the Coalition’s policies, a ‘fair society’ is not evidenced by the decimation of English law centres (aka access to justice). If Nicola Sturgeon becomes the Deputy Prime Minister of the United Kingdom, she is exercising her democratic right to be a force within UK politics, given that it was also an exercise of democracy that Scotland did not become independent.
Both the Green Party and SNP talk the talk on wanting a public-run NHS, and the proof of the pudding is in the passing of legislation. Both political parties are expected to be keen to reverse the Health and Social Care Act (2012), getting rid of the toxic sections 75 and 76 which makes competitive tendering a must if there’s more than one bidder. Given that Nick Clegg is keen to apologise for tuition fees, it is possible that Norman Lamb, if given a rôle in government as an experienced care minister, might support integration. Integration is a ‘must’ to make Andy Burnham’s “whole person care” work, bringing together a national health and care service, with pooled budgets, integrating physical, mental and social care. There are potential advantages in having a Liberal Democrat influence on health and care policy now, parking aside previous differences, on securing funding for the future for 2015-20 and giving prominence to mental health and parity of esteem.
In terms of personalities, it is going to be incredibly tough. But you can bet your bottom dollar that Nick Clegg will want to leave the scene, as there is animosity between him and Labour, and the feeling’s entirely mutual. Many Labour members also want him to lose his seat in parliament to a very good Labour candidate in Sheffield Hallam. Nick Clegg might not want to be physically there if Ed Miliband is Prime Minister, and Miliband takes the lead in scrapping the Bedroom Tax and the Health and Social Care Act (2012).
The alternative is pretty dreadful – of a Conservative government propped up by any party which wants a referendum on Europe, i.e. UKIP. Another toughie is going to be Trident, but it is likely that the majority of the Conservative Party, Labour Party and Liberal Democrats will vote against others such as the Greens or SNP on such a vote, whipped or not.
The structure and function of a possible Labour minority government is complicated, but there is actually a possibility that the relationship is a more meaningful relationship that the current Coalition. The electorate, strangely enough, might be producing a best possible outcome.
Fighting each other on the left is a waste of resources
We keep on being told that there is a finite amount of resources to share. So why on the left are we not channeling our energy into things we care about?
Among the various things I have been witness to in the last year have been endless discussions on procedure and constitution. Such discussions while possibly well intended by some have virtually ended up being circular and being presented in summary in an incredibly unimpressive manner.
There are serious matters afoot. There was a draft Bill proposed by the Law Commission, which didn’t make it into the Queen’s Speech, on the regulation of clinical professionals. This promises to be a landmark piece of legislation, and has now been bounced into the next parliament’s lifetime. Clearly this Bill will prioritise patient safety, on which there was not a single clause in the Health and Social Care Act (2012) apart from abolition of the National Patient Safety Agency.
Many of us have allowed the narrative to be articulated in terms of ‘sustainability’, in other words we can’t afford the National Health Service – but curiously can afford war, and afford a lengthy inquiry into the legality of it. We have allowed a ‘there is no alternative’ closure of ‘failing’ hospitals, but have not addressed the principal issue of how clinicians and patients can be in charge of their own services without a firestorm by the Trust Special Administrator.
We have lost time on how we can make the health service function nationally, not in a piecemeal fragmented way like the privatised railway industry. We have lost time on implementing serious methods of keeping vulnerable frail patients out of hospital, or people living with dementia, in cases where they’d be better off with some proactive intervention out of hospital.
It is simply impossible to have this sort of discussion of what the left wishes to do in terms of solidarity, justice, equity and equality, while certain people are at each other throats. Whilst I am not a big fan of Tony Blair by any stretch of the imagination, it cannot be said that the previous Labour administrations can be the root of all of the ills of the National Health Service.
Basic things being done well matter a lot to people, like seeing their local GP or being attend an A&E unit in a timely matter. Andy Burnham MP has a golden opportunity to make sure medical records are shared freely between one part of the health and care service with the other, to prevent reduplication and poor medical decision-making based on information asymmetry. There is a key chance to break down barriers between health and social care, so urgently need, for example, in my academic field of living well with dementia.
There are many people who are now publicly concerned about the effect of competition in English health policy. Margaret Heffernan, of ‘wilful blindness’ fame, is just about to have a bestseller on her hands on this subject.
So can we cut the incessant concerns about how the Labour Party is still a cover for corporate Britain? That Labour hasn’t learned anything from the past, which includes John Major activating the private finance initiative initially before badly negotiated contracts under the early years of the Blair administrations?
It is impossible to divorce the needs of physical and mental health of a person from social care needs. So we can we put a sock in the movement that integrated care of any variety can only be a Trojan Horse for privatisation? There is a possibility that a future Labour government might be able to provide a fully funded national care service, if there were a momentum of public support.
Labour’s position on personal health budgets (“PHBs”) for the last few years has been clear. Whilst there are noteworthy successes, there have been a plethora of concerns, including safeguarding issues for people with dementia. It was never intended that they should be compulsory, despite the subject of PHBs at all being promoted previously by some very senior in the Labour Party.
There’s a battle to be fought indeed, but the outcome of that battle should not a Conservative-UKIP coalition. You’ll find that they will not be the answer to all your concerns about the NHS.
That "One Nation" speech by Ed Miliband MP – an opinion from an ordinary Labour member
Bear in mind when reading this I am a nobody – I am not a MP, councillor, journo, wonk, but I am a member! You’d be forgiven for thinking that this speech was only about “one nation”, but Ed first utters the first of his 46 “one nations” 20 minutes in. This was, by far, the best Labour leader’s speech to, and it was only my third conference in total. Ed Miliband spoke passionately, articulately, and convincingly, without notes, for over an hour, and would have been genuinely inspiring for many. If, on the other hand, you were a Scottish voter looking for Scottish independence, you might have been desperately hoping that Ed Miliband would announce a policy for Scottish independence. It is probably at least accurate to form the judgment that Ed Miliband has converted himself from the “Not never” to the “Yeah but” candidate, as proposed by Matthew Taylor today (the CEO of the RSA). Ed Miliband is clearly much better without an autocue, and his delivery was witty, engaging, vibrant and interesting. The jokes were good too. People who saw the Conference were definitely buzzing afterwards, and I was sat around the corner with some of the ‘Labour Left’ contingent, awaiting a fringe session on ethics in media and in business.
It has become known as the ‘One Nation’ speech, because of the use of the phrase ‘one nation’ forty six times. The speech managed to pull off Ed’s pride in the NHS hospital in which he was born, and the Haverstock Hill Comprehensive School in which he was educated prior to Oxford. And yet the speech did not have the jingoism that Disraeli was in fact known for, and Frank Dobson indeed noted that it was any appropriate that the Left should appropriate back a national sense of pride and identity. A clear message, which Ed convincingly explained, that politics was not simply a well-paid job for Ed, but a genuine life motivation, but a “faith” “to leave the world better compared to how we found it”, and “not to shrug our shoulders against injustice”, and “overcome any odds in coming together”. These are not particularly socialist or social democratic ideals, although the ‘coming together’ may be symptomatic of the solidarity inherent in solidarity, or the action against injustice as a social democratic ideal. Whatever the exact etymology of Ed’s beliefs, Miliband is more concerned about the millions of members of the public who have become disconnected with politics, and it happens that the political process is a central third strand of the extensive policy review currently in progress through 37 focus groups being led by Jon Cruddas MP.
Ed discusses individuals ‘brimming with hope’, such as individuals who have sent off hundreds of CVs to potential employers. It is interesting especially how Ed’s “aspiration” is not of the same tone as the Thatcherite individualistic definition, but rather one combined with a notion of insecurity not exclusive to the middle-class. The feeling that people are “at the mercy of forces beyond their control” is certainly one will chime with many of potential voters. His focus on prices in utility bills (and the profits of privatised utilities) is an interesting one, as these represent genuine concerns of Daily Express readers on a regular basis apparently. Interestingly, Ed Miliband stops short of proposing renationalising of the utilities, or introducing a windfall tax for the utilities, which would have been a radical solution (and which indeed could have been shoehorned, just, within the framework of ‘pre-distribution’). This brings Miliband to the notion that people at the very top are still doing well in Tory Britain, and hence his faith of “One Nation”. The line about Cameron writing himself a cheque as a tax-cut is rather misleading, especially given the blurring of the factual difference in tax terms between income and wealth.
In fairness, a sense of shared destiny has been evoked previously by Prof Michael Sandel in his philosophy of ‘equality of opportunity’ for the common good, and Miliband himself has often spoke much about how the economy is a ‘one nation’ economy, not private vs public, north vs south, millionaires vs non-millionaires, or rich vs poor. ‘We need banks that serves the country, not a country which serves the banks” is indeed a convincing slogan, but Miliband stops short of arguing for intensive regulation of the banking industry in the speech (although he threatens it by offering first an opportunity for self-regulation). A problem, which came up as a recurrent theme in this year’s fringe meetings of the Fabians and Labour Left, is that an optional ‘responsible capitalism’ might not be implementable, but that the State might have to legislate for transparent details to be published about sustainability and ethical practices of the banks, if banks decided not to publish such data voluntarily to secure competitive advantage through a strategy of ‘differentiation’. This is a recurrent theme in Miliband’s speeches, and critics have often remarked how it seems rather disingenious that Miliband criticises a lack of ‘one nation’ while waging some sort of class war. Ed Miliband does not feel that the Conservatives can be a ‘one-nation party’, but is less than clear about his reasons for doing so. The economic narrative initially is clear; that the raison d’être, to cut borrowing, has failed, the economy is not growing, fewer people are in work, and borrowing is going up. One of Labour’s criticisms regarding economic competence is of course that Labour recklessly borrows, but Miliband argues that borrowing is going up anyway. However, as usual, the details from Labour as to what it exactly it will commit to in terms of austerity cuts – and critically where – is ambiguous, and it is particularly confusing that Ed Miliband, while appearing to support austerity in the Conference Hall, is simultaneously willing to go on an anti-austerity march soon.
There are noteable absences in themes, such as the green economy or Europe, and even some burning issues are not tackled at all, such as disability. Ed Miliband concludes that ‘one nation’ is a way of making difficult decisions, including ‘compassion and support for those who cannot work, particularly the disabled citizens of our country’. Miliband has thus far avoided the confusion, in much the same way that Byrne has, that the disability living allowance is not an employment benefit, and this myth must be busted by Miliband soon. Disability campaigners therefore, fundamentally, have every right to be skeptical of the ‘one nation’ narrative, having been sidelined as ‘benefit scrounging scum’ (by some) for far too long. The incompetence narrative is convincing, particularly on the eve of the disaster of the West Country Train fiasco: “”Have you ever seen a more incompetent, hopeless, out-of-touch, U-turning, pledge-breaking, make-it-up-as-you-go-along, back-of-the-envelope, miserable shower?”
The clever aspect about ‘One Nation’ is that it appears to be quite a politically framed left-agenda, but sugarcoated in centrist packaging. For example, “there will be tough settlements for the public sector” might send alarm bells ringing for the Unions, but introducing a 50p tax rate for millionaires might offer some balance. Notwithstanding, Maurice Glasman has been eager to propose how collective workers may be beneficiaries of the new ‘One Nation’ project. The usual criticism is that Labour never introduced a 50p tax rate until the very end, and even then it was finally implemented after the Conservatives had come into power. So, if “those with the broadest shoulders take the greatest burden”, before Miliband then criticises Murdoch explicitly, is this genuinely the talk of “one nation”? There are obvious possible contradictions within the text: for example Scottish members cheering on “Team GB” in the Olympics, whereas one of the greatest triumphs of New Labour had been cited as devolution. There are not only contradictions within the text of the speech, but of Labour with its past. There may be a sense that it is better that ‘the sinner does finally repenteth’, and indeed the move towards youth apprenticeships (and youth employment) may be a practical solution as the antithesis to New Labour wishing to send more and more people to University. It is indeed promising that Ed Miliband even proposes that contracts will only be awarded to those private sector companies which implement apprenticeships, but it is somewhat surprising that Miliband does not state explicitly ‘the minimum wage’ as part of the solution for the dodgy employment activities of some multi-national companies.
It is further uncertain whether Ed Miliband’s description of the core values of the NHS as “competition, care and collaboration” was a Freudian slip; when I later attended the Andy Burnham interview with Caroline Crampton of the New Statesman, people I spoke to in the audience queried the inclusion of the word “competition”. It is likely that Miliband did not in fact mean “competition” at all, as he then graphically explains why competition had failed in the privatised utility companies. Indeed, Conference started off with the report that Labour would not be able to reverse the Health and Social Care Act, but later statements from Andy Burnham, Ed Miliband and Jamie Reed later confirmed that the Health and Social Care Act would be repealed, if Labour came into power. Labour still appears to endorse (in some form) GP commissioning and NHS Foundation Trusts, and was indeed responsible for introducing them, but Andy Burnham’s promise to change the narrative, in ‘getting rid of the market’, is still not entirely convincing with existing structures still in place in 2015. Whilst it is true that the Conservatives went much further and faster than the Labour administration had, many feel that the ‘purchaser-provider’ split is still very much at the heart of the problems in the NHS. A truly socialist NHS might get rid of this split? A very good thing that Ed Miliband did to highlight the lack of inclusion was to state that the medical Royal Colleges had not been involved in the dialogue over the NHS reforms, which definitely supports his “one nation” narrative.
Labour has a lot of time on its side, and we do not know how much further the economy will regress between now and then. This certainly gives Jon Cruddas and his colleagues enough time to work out details about how Labour can build on the ‘one nation theme’. Miliband has indeed experienced a ‘bounce’ in the polls, and previous criticisms of Ed’s leadership have for now been muted. The speech had a clear structure and a clear theme, and was genuinely extremely well received by many Labour members; but the danger is that Labour is preaching to the converted, and overestimating its popularity. However, the distinct possibility has now emerged that David Cameron might be in fact be an ‘inglorious leader’ of a one-term government, and Ed Miliband and his shadow cabinet have now suddenly found themselves “back in the race”. This can only be a good thing for democracy.
The problem is brilliantly illustrated by Gary Baker ((c) of Gary Baker therefore) in Tribune in this incredible cartoon!