A one nation Labour policy: one NHS

Andy Burnham

With the NHS set to be at the centre of Ed Miliband’s ‘One Nation Labour’ narrative, maintaining a clear advantage on health will be critical. Yet the polls make both good and bad reading for Labour on health: the party has re-established its large and historic lead on the NHS, but the salience of health as a political issue is relatively low by recent standards. Put simply, the electorate is finding it hard to see past the economy (an issue on which Labour is weaker).

Andy Burnham’s task is two-fold. Firstly, he needs to hammer home Labour’s poll advantage on the NHS, ideally getting the poll lead up to the levels seen in the early Blair years. Secondly, he needs to get the public to attach greater importance to the NHS.

The latter is a tough ask. He will have to hope that the growing feeling of austerity in the NHS, combined with a revitalised Labour policy offer, will do what two years of bloody battles over NHS reform failed to: shift the public’s focus back onto Labour’s strongest issue.

What of Labour’s policy on health? Diverted by the row over the Coalition’s reforms, Labour’s policy has been in a holding pattern for over two years. Yesterday’s speech was Andy Burnham’s big chance to begin to change this.

How did he do? Well, he went down well with delegates who always warm to his personable style and ability to engage in political rough and tumble. The crowd lapped up lines like: “Let me say this to you, Mr Hunt. If you promise to stop privatising the NHS, I promise never to mispronounce your name.” Yet the real audience was beyond the hall – NHS workers (all 1.3 million of them) and the wider electorate.

The will they/won’t they repeal the Act confusion at the start of the week got things off to a shaky start but, since then, a clear message has emerged from Labour’s team, culminating in Burnham’s speech.

Yesterday’s keynote address contained three key themes. Firstly, he would repeal the Act, but not the structures it creates. Secondly, national political accountability will be restored (“The N in NHS under sustained attack”). Thirdly – and potentially most radically – Labour will move towards an integrated system for health and social care (“As we get older, our needs become a mix of the social, mental and physical. But, today, we meet them through three separate, fragmented systems. In this century of the ageing society, that won’t do”).

Quite what this latter point means remains to be seen. Health and social care commissioners already have the power to share budgets, but seldom use it. Andy Burnham was hinting at something stronger on the fringe.

There is a gamble in all this. If repeal occurs, it will in fact be limited and is unlikely to satisfy all anti-reform campaigners. Despite protestations to the contrary, it is hard to see how Burnham’s second and third themes can be made real without at least some structural upheaval – something the NHS is particularly weary of and voters are likely to be less receptive to by 2015, when the new structures will have all been established. Much of the detail remains to be filled in.  A policy review, led by Liz Kendall, is just kicking off. The health community will await the results with interest.

What is clear is that, for Labour to win the next election, the NHS will need to be a dominant political issue in the way it wasn’t in 2010. The stakes are high for Labour.