Labour always has an in-built advantage on the NHS. It founded the institution. Its core instincts are collectivist and are bound up in the notion of “solidarity”. As far as many voters who cherish the NHS are concerned, Labour starts with the benefit of the doubt.
But what Cameron did with the NHS issue in opposition made him difficult to attack. Labour strategists admired the way in which the Tory leader used a combination of direct experience of the health service and calm rhetoric about trusting professionals to neutralise a traditional Tory negative.
It didn’t satisfy pro-reform types like me, but I could see why the Conservative leader was doing it. Now Labour senses that Cameron – with Lansley’s botched bill – is in the process of throwing his gains away.
At PMQs Ed Miliband had a win by going on the NHS, painting Cameron as the man who had claimed he could be trusted who has since let patients down. Incidentally, it wasn’t a knock-out win. There’s something not yet quite right about Mili E’s despatch box demeanour, even when he’s winning. He isn’t petrified, or useless. But it just doesn’t quite gel for some reason.
Anway, Janan Ganesh of the Economist tweeted that Miliband winning on health doesn’t matter, as it is an issue where people expect Labour to be ahead. To really have an impact Labour needs to be making the running where the party is traditionally weak. I know what Janan means, but I’m not sure that he’s right on this one.
This NHS row is fast becoming a quite basic argument about competence, or government incompetence. That has broader potential significance because in time it could erode Cameron’s reputation.
Few people will follow the details of the bill. Even those who do are totally confused about what Cameron and Lansley are now trying to acheive. But voters who care about the subject are likely to have a vague sense that Cameron said before he became Prime Minister that he would look after the NHS. Now his handling of it seems chaotic and confused, with lots of doctors complaining and the government incapable of explaining what it’s up to.
Cameron was very tetchy at PMQs today. I suspect he realises what a mess it all is. He’s presumably rather annoyed with himself.
I have long believed that the most politically astute policy on the NHS is to do nothing. Demand exceeds supply, and the gap is growing as we live longer and die of ever more expensive diseases. No matter how successful, there will always be negative stories. This only gets worse if you are actively trying to improve it.
Of course, the policy of doing nothing isn’t morally right, but is probably the best outcome electorally.
I do have some idea of what Andrew Lansley is trying to achieve. I would also add that he is the most knowledgeble Health Secretary we have had since the departure of Alan Milburn.
I think the government is right to try and reduce the many layers of management oversight which is costing us a fortune and utterly bewildering for those of us who rely on the system. It seems that the current bill is relatively new in terms of healthcare in that legislation is being introduced to ensure that patients must be involved (get away from the paternalistic NHS), integrating services which are currently so fragmented that it is difficult to know who is reponsible. It is also hoped to reduce the massive inequalities which exist throughout the country. The last government introduced many changes but by SI only. Sadly, depite their efforts to place patients in the decision making process by the setting up of Patient and Public Involvement panels I can assure you having joined the panel, it was a tick box exercise with my County not interested in what I or anyone else could offer. Similarly, choice in healthcare provision was sporadic throughout the country and again Andrew Lansley is trying to change this. If I try and book an appointment my local hospitals do not have this online. That is why a Statutory bill is necessary as no health care professional wants to change practice.
The last government introduced a mixed provision with contracts going to companies for some procedures. My husband travelled some 40 miles away to have a hernia repair undertaken by a private facility and paid for by the NHS. This was an excellent experience which should be extended. The last government also set up the privatisation of one failing hospital. I note this as it seems that in the current debate ie three months to save the NHS, all of this has been forgotten. I believe the Bill will encourage more competition for local hospitals which will be superb. I say this as my own local hospital rates poorly in mortality rates (Dr Foster Intelligence) and a recent report by the CGC makes frightening reading. This is the inequality of care which the Bill will address. We all do not live in London where choice is easy to exercise and where there are many highly rated hospitals. I have a cottage hospital some 12 miles away but my nearest main hospital is over 20 miles from my home. I am very frightened of ever requiring in patient treatment given the mortality rates and poor level of care provided.
Regrettably, the orginal bill has been tinkered with to please various constituents. Neverthless, it is worthy of being placed on the Statue book. I feel that by permitting more competition my local hospital will improve clinical outcomes and care to remain in business.
Ian, it isn’t really correct to say that Labour founded the NHS. The idea of a public health service available to all with Government funding was in fact devised and implemented by Churchill’s Government during the War. Most MPs in that Government were Conservative. Beveridge (Beveridge was a Liberal – a real one not a Lib Dem) envisaged that these arrangements would continue once peace came and that the UK would have a comprehensive system very similar to the social insurance systems of post-war France and Germany. Labour’s sole contribution was the dogmatic Stalinist, Aneurin Bevan’s insistence that the health service had to be run on centralised hyper-bureaucratic collectivist lines. This had nothing to do with patient welfare and everything to do with Bevan’s political prejudice.
There’s a further twist to the story of the founding of the health service. The ideology had it that centralised planning was so good that it would become cheaper to run as time went on (because everyone would be healthier!). “It was a long-standing socialist belief that a state medical service would save money. In 1911 Lawson Dodd wrote:
The economy of organisation, the greatly lessened cost of illness due to the increase in sanitary control, and the immense amount saved in the reduced number of working days lost through illness, would make the health tax seem light, and it would be regarded as a profitable form of insurance. ” Once started, it immediately became clear that the costs were increasing, but successive committees and governments either decided there was no straightforward way to improve it, that any change would initially cost money, or that there was too much political capital at stake. [http://goo.gl/SiZLf has a good summary] Evidently we still pay our politicians not to deal with things.