As the Coalition Government begins to set out its health reform agenda, it is clear that the NHS is set for a period of significant change. How the NHS adapts to this change at a time when the need to deliver savings has never been clearer, will shape the politics of health in the new Parliament.
In this occasional series of opinion pieces, Health Mandate’s team of expert health policy consultants examine some of the issues which will determine the future shape of the NHS and public attitudes to it. Today’s piece sees Mike Birtwistle examine the challenges facing John Healey, the new Shadow Secretary of State for Health.
The challenge facing John Healey
In many ways, John Healey has landed the plum job in the Shadow Cabinet, a clear reward for polling so strongly in the Shadow Cabinet elections. Historically, Labour does well on health in opposition and the job of Shadow Secretary of State for Health should create plenty of opportunities for the hitherto low profile former minister to establish himself as a darling of the Party. It will also enable him to make his mark on the politics of this parliament whilst avoiding becoming embroiled in the debate about deficit reduction, which lessens the risk of leaving him caricatured as either a growth or a deficit denier.
Yet the job is also fraught with difficulty. Labour has seen its historic lead on the NHS slip. The Party now finds itself with either a small lead or in a statistical dead heat, depending on which poll you read. Andrew Lansley, a man schooled in the detail of health policy and with a very set vision of where he wants to take the health service, knows he has a once in a generation opportunity to take away Labour’s trump electoral card by proving that the Government cannot only be trusted with the NHS, but can also deliver significant improvements in quality.
Lack of experience or lack of baggage?
John Healey has little or no track record in health to fall back on. To date his frontbench career has focused on economic affairs, skills and training and housing, all of which have played on his core political interest of regional development and regeneration. Although he has spent time during the early part of his career as a campaigner on disability and mental health issues, the health brief will provide a steep learning curve as he seeks to shape Labour’s response to a complex and far reaching series of reforms. However, John Healey’s absence of a track record may prove to be an asset. Although he will lack the personal experience of health enjoyed by Andy Burnham, Yvette Cooper or Alan Johnson, John Healey will be less tempted to defend Labour’s record at all costs, helping the Party move to a new position on health rather than simply re-running the battles of the last parliament.
With a relative health novice at the helm, it will be easier for Labour to act as an opposition, rather than a series of ministers in exile. Conservative strategists will also find him a harder target to attribute prior pro or anti reform sentiments to than those members of the frontbench with previous experience on health. Contrast this to Andy Burnham, who was a minister at health both in the Blairite pro-reform heyday and the Brownite period of retrenchment. In this sense, Ed Miliband may have made a shrewd appointment. It is also worth noting that John Healey has time on his side: there is no need for Labour to have a full health policy platform until much nearer the next election.
John Healey’s challenge will be to develop a more nuanced response to the Government’s reform agenda than the outright opposition which has been articulated to date. The trick will be to oppose enough to give Labour backbenchers and activists heart without boxing himself into a corner, so damaging Labour’s longer term electoral chances. The Government has already been made to think again on some high profile issues. Issues such as keeping free school milk, the future of NHS Direct and the decision to retain some waiting time targets should all give Labour activists some heart.
Yet neither these successes, nor the recent murmurings of discontent from health unions and royal colleges, should be mistaken for a signal that opposing every policy or element of the reform agenda will be the right thing to do. Such an approach would leave the Opposition running the risk of looking irrational or – worse – irrelevant when many of the reforms are implemented.
This author has set out his views on the significant opportunities and risks associated with the Government’s health reform programme on previous occasions. This opinion piece is not about arguing what position Labour should take, but instead about how it should set about developing that position.
Many of the reforms being pursued by Andrew Lansley have their origins in the policies of the previous government. The emphasis on commissioning and regulation rather than national command and control can be tracked back to the era of Shifting the Balance of Power. Greater freedom for Foundation Trusts is a policy agenda which has its heritage to the time of Alan Milburn. The focus on measuring and rewarding clinical outcomes owes much to the reforms of the Darzi (and indeed Brown) era. Even GP commissioning can be seen as a logical – if radical – extension of practice based commissioning. Simply opposing the White Paper in its entirety would represent a radical departure from previous Labour policy, potentially leaving a void at the heart of the Party’s own health policy platform.
There will be other elements of Government policy which have previously been opposed by Labour, but which will nonetheless prove popular with the public. Adjusting to and accommodating these policies will be an important part of the process of coming to terms with being in Opposition. For example, the introduction of the Cancer Drugs Fund has proven to be popular with the public. Accepting it and holding the Government to account for its implementation may bear more political fruit than opposing the principles underpinning it. Picking and choosing these issues and bringing the Party with him in articulating a new position will be an important task for Mr Healey.
This is not to say that there will not be areas of Government policy where John Healey will have a clear reason to oppose, either because Labour, in conjunction with others, has a realistic chance of stopping reforms, or because he feels that implementation will be impractical or because it goes to the very core of the political divide between the Government and the Opposition. Selecting these issues, developing a narrative and ensuring that his position leaves Labour enough room to manoeuvre as it develops its own policy platform will be critical to Mr Healey’s success as Shadow Secretary of State.
The adjustment in mindset that will be required to take the Labour team from Government to an effective Opposition should not be understated: government and opposition are very different beasts. Until May, John Healey had spent his entire parliamentary career on the government benches. He will now be expected to hold ministers to account for delivery and seize on examples of perceived government failure. Labour members will expect to see frontbenchers in the media, finding stories and landing political blows. How Mr Healey responds to this change in role will define perceptions of his performance every bit as much as the policy platform he helps his party develop.
The final challenge for John Healey is one that should not be underestimated: Andrew Lansley. A shrewd tactician and a fiercer political opponent than perhaps his mild manner betrays, the Secretary of State will be a difficult opponent. The health reform agenda bears his own personal imprint, although it does enjoy strong backing from the Prime Minister, and he will fiercely defend it. The fact that the Conservatives have ring fenced the NHS budget will be a card which is played again and again in rebutting charges of Government cuts to the health service. The Opposition will need to be tenacious and nimble if it is to land political punches when they most matter.
Making the most of the Yorkshire connection?
John Healey will not have to meet these challenges alone. As well as having a junior shadow team which boasts the big media personality of Diane Abbott and the experience of Richmond House brought by Liz Kendall, he will need to bring the Shadow Cabinet with him, on what is sure to be one of the most scrutinised briefs. In this sense he has the advantage of being well connected to, and trusted by, some of the key decision makers in the Party. Close for many years to Gordon Brown’s inner-circle, he is now part of the ‘Yorkshire mafia’ which dominates the Shadow Cabinet. John Healey is ideologically as well as geographically close to Yvette Cooper, Ed Balls, Jon Trickett, Rosie Winterton and – of course – Ed Miliband. The way in which he uses these close personal ties to position Labour on health in this Parliament, and the decisions he makes about how to respond to the forthcoming Health Bill will in large part shape the extent to which Labour is able to hold on to its cherished position as the ‘party of the NHS.
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