Health Policy InsightEditorial Wednesday 28 September 2011: Miliband's argument will keep the NHS as number two political priority
Much of Labour leader Ed Miliband's argument yesterday wasn't at all bad. He has clearly grasped the extent to which the financial crisis has changed UK politics and economics.
And he is positioning himself to appeal with arguments about fairness to a 'squeezed middle' which is certain to grow in size.
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There were some economic curiosities, such as the hints of what sounded very much like protectionism. The two lines on energy prices contradicted each other. The material about his personal life and heritage was forced and unnecessary.
Unfortunately, yesterday he wasn't giving a seminar, but a leader's speech - and a pitch as PM-in-waiting to a public that generally seems sceptical.
And Mili-E is not one of nature's born orators.
His media training has helped: he is standing straighter and stiller, and keeping his eyes more fixed. He is doing less of the curious shapes with his mouth, too.
He has improved, but needs to keep working on his demeanour and delivery. Presentation is important in the television era (and the role of the leaders' debates in the last election should leave us in no doubt that TV will be influential next time as well). You might disdain the importance of presentation in politics, but you'd better be good at it first.
The economy and the NHS are at the heart of politics
As we discussed on Monday, the two principal political concerns of voters by a significant margin seem to be 1. the economy and 2. the NHS.
The economy looks unlikely to be bouncing back to robust growth any time soon: the yield on gilts indicates that uber-low central bank interest rates will be around for some time.
Rebuilding Labour's reputation for economic credibility is a task for the long haul. The global crash happened on Labour's watch, and the recent party line about Gordon Brown's error in claiming to have abolished the business cycle is a smart line.
Genuine public anger remains over the causes of the economic crisis, and the financial industry's 'heads we win, tails you lose' get-out-of-jail-free card. Mili-E is right to attempt to align himself with that. He must however consider that financial services remain an important contributor to the British economy.
Markets and morality might not have to be oil and water, but have often worked in that way. Any attempt to change that is a political Grand Project.
Reclaiming the NHS
The section of the speech that got the hall going was his passage on the NHS:
"There is no greater public interest than our National Health Service. Cherished by all of us. Founded by Labour. Saved by Labour. Today, defended by Labour once again.
"Why does Britain care so much for the NHS? Because, more than any other institution in our country, the values of the NHS are our values. It doesn’t matter who you are. Or what you earn. The NHS offers the highest quality care when we need it. I saw it this year with the birth of our son, Sam. Like millions of other families, mine had the best of care from doctors, nurses. And nobody asked me for my credit card at the door.
"And when I look at everything this Tory Government is doing, it is the NHS that shocks me most. Why? Because David Cameron told us he was different. You remember. The posters. The soundbites. David Cameron knew the British people did not trust the Tories with our NHS.
"So he told us he wasn’t the usual type of Tory. And he asked for your trust. And then he got into Downing Street.
"And within a year – within a year – he’d gone back on every word he’d said. No more top-down reorganisations? He betrayed your trust. No more hospital closures? He betrayed your trust. No more long waits? He betrayed your trust.
"And the biggest betrayal of all? The values of the NHS. Britain’s values. The values he promised to protect. Betrayed.
"Hospitals to be fined millions of pounds if they break the rules of David Cameron’s free-market healthcare system.
"The old values that have failed our economy now being imported to our most prized institution: the NHS.
"Let me tell David Cameron this. It’s the oldest truth in politics. He knows it and now the public know it.
"You can’t trust the Tories with the NHS".
Miliband and his health spokesman John Healey know that in Andrew Lansley, they face a Health Secretary who is possibly the most technically knowledgable ever about the micro-details of the NHS - and also the worst salesman of his NHS reforms.
Labour will also keep pointing to the Coalition Agreement's explicit and explicitly-broken promise to end top-down reorganisation of the NHS.
The un-made case for change
The public and much of the professions remain unconvinced of the case for change in the NHS. (Which is a problem, because there is one. More spending is not the answer to the NHS's challenges: meaningful reconfiguration and rationalisation, properly explained, is. Grown-up politics would be about making an offer to work on this area - perhaps on a cross-party basis.)
Labour will need to be cautious of their narrative on the NHS: the problems of the £4 billion annual efficiency gains and teething troubles of the transition to GP consortia commissioning have not really yet started. Problems are arising with long waits, but they are likely to get worse. Over-dramatising the NHS's woes now would be unwise.
Andrew Lansley (saviour, liberator) goes to his party conference next week on the horns of a dilemma. The up-sides are there: he is the Secretary Of State For Health. At present, while his reforms (and they are his; to a degree unprecedented in health policy of recent years) will clearly get the Humpty-Dumpty treatment in the House Of Lords, the Coalition's working majority and Lib Dem split on health look set to pass a Bill that will deliver a good two-thirds of what he wanted.
There are three main down-sides for Our Saviour And Liberator.
Firstly, he is seriously short of advocates for his reforms.
Secondly, they are high-risk (in the way that any major structural change of the NHS is high-risk) - and this is not helped by the Tories' witless and style-free attempts to demonise NHS managers as "bureaucrats", with the consequent opportunity cost in good-will.
And thirdly, the public, which reported unprecedented satisfaction with the NHS under Labour (in a poll whose funding the DH has cut), does not see the case for these reforms.
This both retoxifies the Tory's brand on the NHS; and means that Mr Lansley's reforms will also be blamed for things that go wrong but which the reforms did not cause. And in the places where the clinical commissioning reforms start to work well, delivery will take time.
It leaves the NHS as a political open goal for Labour.