Mike Birtwistle argues that Labour has yet to seal the deal with the electorate on health.
January saw Labour’s ‘health month.’ Such initiatives are much loved by political tacticians but are frequently derailed by news cycles that do not conform to political grids. For Labour, the month was rather more obliging, starting with a blizzard of headlines about a health service in crisis. Newspaper frontpages like those seen in the first week of 2015 must have made the Government fondly recall the rows over the passage of the Health and Social Care Act as spats from an easier time. Many voters are turned off by the politics of health (or anything), but the performance of their health service is a different matter.
With health jumping to the top of voters’ list of priorities, the NHS looked like an open goal. A&E crises, cancelled operations, Hinchingbrooke and rows over ambulance guidance were all successfully ‘weaponising’ the NHS without too much intervention from Her Majesty’s Opposition. Yet the month ended on a less encouraging note. Labour’s 10-year plan for health and care met with a mixed reception, attacked by some on the right of the Party in what looked like a carefully planned operation and bogged down by rows over the extent to which private sector involvement would be reduced.
A Position not a Plan
In opposition, developing a ‘plan’ is always a risky business. Detailed planning requires heavyweight policy capacity, which tends to reside in the civil service not political parties. The help of a few experts is hardly a substitute. When your mantra is no top down change, with reform instead being locally-led, the task becomes even more challenging (what exactly goes in a plan if you can’t set out how change will occur?). The result is a document that admirably summarises Labour’s view on health but does little to fill in the gaps in policy. At 18 pages (a mere 1.8 pages for each year of the decade), it is more of a position than a plan. The Five Year Forward View was of course also not a detailed plan (but never claimed to be). Given Labour’s public support for this direction of travel, there is a question as to what flesh this puts on the bones of its health policy.
There are undoubtedly interesting and fresh ideas within Labour’s policy. If the Zero-Based Review of spending does indeed focus on how improving outcomes can avert costs on issues such as mental health and cancer (referencing Incisive Health's work on the issue), then it could be truly transformative. But these are announcements for another day, probably long after an election has been fought (and won or lost). They alone give little new material to those who will be seeking to make Labour’s case on the doorstep.
Big Idea
Andy Burnham’s challenge is that his big idea – bringing health and social care closer together – is actually one that his opponents seem to agree with. The very fact that the Plan received a cautiously positive reaction from many health watchers, including the Health Service Journal, is also the reason that it will not get cut-through with the mainstream media (“unglamorous” is usually not newsworthy). Without details on the mechanics of change on integration, there is no story here. Making a virtue of bottom up reform may be one thing, but it does somewhat strip the ‘so what’ from the story.
This is compounded by the fact that most of the doorstep-friendly policy commitments on staffing, cancer waits, mental health and prevention have already been announced, meaning that attention quickly drifts to the big unanswered questions – competition, the role of the private sector, meeting the funding gap.
Labour should not be too dismayed by this. Whenever journalists talk about health this is probably a good thing for Miliband. If, according to Tory strategists, every day the Government doesn’t talk about the economy is a day wasted, then every day the media discusses the NHS is a productive one for Labour, even if not all the coverage is flattering.
Winter
The weather tells us that winter is far from over and there many difficulties the Government will need to navigate this side of May, keeping health in the headlines. From problems with waiting times to cuts to cancer treatments, plenty can still go wrong for the Conservatives on the NHS. Yet relying on events is never a comfortable position for any political party to be in, particularly with Labour staking so much on the NHS.
There is also the challenge that political debate may not match public perception (let alone reality). The King’s Fund has found that public satisfaction (admittedly measured before the onset of winter) is at an all time high. Health may be the public’s number one concern, but it is far from clear that voters believe some of the more extreme rhetoric about the threat facing the NHS.
As the dust settles on Labour’s much vaunted 10 year plan, it is clear that it has not yet sealed the deal with the electorate nor has it plugged the gaps in policy that concern NHS watchers. With three months to go to polling day it was never going to. This all leaves the Opposition with some work to do, both in addressing some of the difficult questions it will face on policy but – more importantly – in capturing the attention of voters.