This is a sometimes 'cheesey' blog about British and American politics and anything else which tickles my fancy!

Sunday, 21 February 2010

After the election: what next for Labour's health policy?

A blog post I wrote for work which I thought might be of interest here. It outlines the major challenges and opportunities for Labour in healthcare after the next election.

"The NHS is probably the most important public service institution for the centre-left" - Neal Lawson (Director of Compass)

The reform of public services is the bread and butter of British politics.

The party that positions itself as the champion of reform and the deliverer of quality services usually reaps the electoral rewards.

Over the last ten years this party has been New Labour.

In two important areas, New Labour has made significant advances. One, it has improved health service delivery. This has meant addressing the chronic under-funding of the NHS, modernising ageing hospitals, increasing the numbers of doctors and nurses by 38,000 and 80,000 respectively and significantly reducing long waits for treatment, particularly in areas like cancer care. There is more progress to be made, but much has been accomplished.

Secondly, New Labour has given huge priority to the development of our public services and set the environment for the future development of health services. The fact that the Conservatives now talk of investment in health services before tax cuts, is testament to this. It was a Conservative Chancellor, Nigel Lawson, who once observed that the NHS was as close as Britain came to a national religion. If that was true in the 1980s, an even stronger case can be made for it now. New Labour's achievement has been to put public service reform at the heart of political debate.

But this does not mean that the NHS is inoculated from future spending cuts. The crisis in the public finances will eventually hit the NHS and healthcare hard. All of the political parties will stress value for money and will debate how that money is spent.

The Next Debate

For Labour, the question after the next election is: After reductions in public spending, what will the future shape of the health service be?

Before it can begin to answer that question, New Labour will have to accept that it has not been able to convince a majority of people that its spending on healthcare and reforms have delivered real improvement. For a party that has an ideological commitment to health care free at the point of need and seeks to improve the NHS because the vast majority of people depend on it, this will be a tough debate to have. Pundits and strategists will wonder why Labour spent all that money and why it devoted all that energy and political capital to the NHS and still achieved little political gain.

If Labour loses the next election (and this is a big if judging by the polls) this debate is likely to take place against a background of political division and bitter recrimination. It will make a meaningful debate about the future of Labour's health policy even more difficult. In opposition, there will be a likely shift to the left which will result in a thorough re-examination of the party's policies.

So then, what next?

At the moment, the NHS is in a transition phase. As the former Health Secretary, Alan Milburn, recently told an audience:

"The NHS today is in transition between a 20th century model characterised by state control, monopoly provision and a provider-dominated culture - and a 21st century one where the citizen is in control and there is a mixed economy of provision and a user-led culture".

Although Alan Milburn is standing down at the next election, he is not alone in arguing for greater radicalism.

There are many within the Labour Party who would like to see the party push for more payment by results, more use of individual NHS budgets so that patients can buy their own treatment and more use of the private and third sector in providing healthcare.

On the other side of the argument are those in the party pushing for less privatisation and commercialisation, the end to the 'command and control' culture of centralisation of the NHS and a more democratic, accountable and bottom up organisation.

The two approaches are not mutually exclusive but advocates of each will have to grapple with some serious challenges and pressure points over the next few years.

The Challenges

Firstly, if Labour loses the election, it will inevitably find itself having to react to a more modest funding settlement for the NHS. The party will relish a battle with a Conservative government on the issue but it will also be an opportunity to re-open a debate in the party about ways to bring in new resources to fund some parts of the NHS. There will be an argument about how to get better value for money and what the priorities should be. It is not impossible to imagine left wing Labour MPs suggesting that private health insurance benefits should be taxed at a higher level or that pharmaceutical companies should face a surcharge on their profits.

On the other side, some on the right of the Party will argue for a debate on charging patients for health services. For many in the party, this remains a taboo subject. The party is wedded to the basic principle that healthcare should be free at the point of need and this will not change. After all it was Nye Bevan, the Labour Minister and founder of the NHS, who resigned in 1951 over the Atlee Government's decision to bring in prescription charges. Nevertheless, one idea on the Labour Right is to introduce a charge to see GPs.

Students, the unemployed, the under 16s, the old and the chronically ill would be exempt but a nominal charge would apply for everyone else. It is argued this would force people to think about the best way of using the NHS and it is hoped this would encourage people to seek out alternative assistance eg at pharmacies, walk in clinics or NHS Direct. In the long term, this would prevent the bottle-necking that occurs at the primary care level.

Secondly, the public's expectations and demands of the NHS will only increase in the future. Patients will demand a personal, tailored service. Across the Labour Party, there is a strong belief that the best way of doing this is to democratise the NHS. Labour will pursue policies that it believes will empower the users of healthcare services and give them more choice and power over services. This could mean that GPs will suddenly be made accountable to the local communities in which they operate or hospitals held to account through commissioning or local elections to vote for the Chief Executive of the PCT. This is an approach the Liberal Democrats have long advocated.

Labour modernisers on the left and right argue that genuinely redistributing power throughout the system will transform the culture of the NHS and lead to innovation and experimentation.

The pursuit of democratisation will also bridge the gap within Labour between those who think the market has all the answers and those who do not. Although there are issues regarding who is elected and what they are responsible for, most party members will agree that the democratisation of the NHS chimes with their own values of equality, empowerment and redistribution. It is likely, therefore, to underpin the party's approach to healthcare.

As a result, those that seek to shape public policy in healthcare will quickly realise that the levers of power do not begin and end at the Department of Health. Labour will push for a genuine redistribution of power. This will mean that decisions which are currently made in Whitehall will be passed down to a local level. As a result, charities, patient groups and the commercial sector will have to re-evaluate their public affairs strategies in the future.

Thirdly, Labour will respond to demands by patients for a more personalised service by stressing the benefits of improved technology. As products become cheaper and easier to use, Labour will want to find ways of using technology to improve healthcare, a goal President Obama is also pursing in the United States. For example, it will campaign for health tests and screening to be done at home rather than in the hospital. Pharmaceutical companies and the rest of the commercial sector will have to find ways of responding to Labour's demands that specific drugs are tailored to meet the needs of individual patients.

Finally, Labour will have to find ways of responding to the demographic challenge. People are living longer and leading more active lives. Labour will again stress the importance of preventative healthcare to allow doctors to spend more time treating chronic illnesses. Successful policies like free swimming places for the elderly (keeping the older generation fit and away from hospital) will be pursued more vigorously. We can expect to see Labour campaigning strongly on anti-smoking, anti- obesity and food education platforms. A new generation of school nurses may be advocated to provide healthcare advice and minor treatments for children and families, thus freeing up other healthcare professionals to spend more time treating and caring for the elderly.

Why the Labour Party will still matter

For Labour in opposition, health will be the litmus test of whether Cameron's conservatives stay true to their modernizing beliefs or revert to a more traditional Conservative agenda. Therefore, expect whoever becomes Shadow Secretary of State to assume the position of leading opposition attack dog.

Many of the ideas outlined in this article will assume centre stage in debates about the future direction of the Labour Party.

The Party will also need to reconcile itself to perceived areas of failure over the last ten years.

The debacle over doctor recruitment. The fiasco over the NHS IT project. The failure to stop mixed sex words. The obsession with targets. And worst of all, the demoralisation of staff. Expect all of them to be thrown across the Despatch Box with regular abandon.

Some of Labour's reforms have alienated the very people they were trying to help.

Consultants, doctors, nurses and midwives feel undervalued and underappreciated. Labour has failed to get the best out of people because it has failed to root those reforms in the very values that underpin the public service ethos. After the next election, Labour will have to find a new way of speaking to public sector workers that does not demean or antagonise them.

Even if Labour loses the next election, the party will still remain the second largest in Parliament. It will continue to be an important political stakeholder. Many of its MPs and members will have, at one time or another, worked in the public services. What it does and what it says on the NHS will still matter. How the Labour Party responds to the challenges outlined will determine its ability to get back into power again in the future.

Of course Labour might win the next election (and I hope it does), in which case all of these issues will assume an even greater importance as the Party struggles to stay in power with a much reduced majority.

Saturday, 20 February 2010

James Purnell's resignation is a loss to the Party

I am surprised and disappointed that James Purnell has chosen to resign as a MP. His departure is a blow to the Labour Party. He was one of the few senior figures who understood the Tories and thought about ways we could move on from the New Labour era.

In recent months, he had come up with some interesting ideas about regulating the City and grassroots politics that Labour would do well to listen to. His closeness to Jon Cruddas also suggested that the two might even be a formidable partnership after the next election. The Party can scarcely afford to lose people like this.

But it was his courage in resigning from the Cabinet last June which marked him out. He displayed a backbone that his other colleagues lacked. Not for nothing did people talk about him as a future leader.

It is not hard to believe that he is just fed up with politics - disillusioned with the Party and the system in the same way that many voters are. He is approaching 40. He may have calculated that the election is lost and he doesn't want to spend the best years of his life as an opposition MP.

Either way it is another ominous sign for the Labour Party that its best and its brightest are quitting. As Steve Richards says in today's Independent "Youngish MPs do not leave Parliament when sunny days of stimulating power appear to stretch ahead".

Tuesday, 16 February 2010

Gordon Brown's Appearance on Piers Morgan

Gordon Brown’s interview with Piers Morgan on Sunday night is hardly the stuff of Frost and Nixon but I think it worked very well for the Prime Minister and will cause the Tories a lot of worry.

At its peak, the TV show attracted over 4 million viewers (plus all those who saw the heavy trailing on the news channels and in the papers over the weekend). They saw the prime minister open up in a way he has never done before.

It’s no secret that his personality has often been his Archilles’ Heel but Brown was honest and humorous throughout the interview and I thought came across really well. He was certainly more human (and humane) than we’ve ever seen him before.

Very few people could have failed to have been moved when he talked about the death of his daughter, which was handled sensitively by Morgan, or his son's illness. It is precisely experience like this which helps people empathise with him.

It is only right that we know about the personal motivations and experiences of the man that is leading us. I have no problem with this line of questioning. But, at times, some of it was a bit grating and over familiar. Did we really need to know how he proposed to Sarah on the beach in Fife? I don’t think so.

Still, from a Labour perspective this was good stuff and even if Brown makes only a tentative connection with voters as a result of it, this might open up some space for people to listen to him about Labour's policies.

Cynical metropolitan media hacks may well deride this but the normal person in the street will have seen a different side to Brown. It will be interesting to see whether Cameron is forced to do his own version of this in the next few weeks.

Monday, 8 February 2010

The Would Be Comeback Kids: ex-MPs hoping to return in 2010

Bill Clinton was the original comeback kid.

The former president was first elected as Governor of Arkansas in 1978 but after a series of slip ups he lost the 1980 gubernatorial contest only to come back and win again two years later.

During the Democrat primaries in 1992 when it looked like the Clinton campaign was down and out, a memorable interview with Hillary on 60 Minutes earned him a second place victory in the New Hampshire primary. The “Comeback Kid” was back - and the rest, as they say, is history.

On this side of the Atlantic our most celebrated leader, Winston Churchill, lost two elections, was deselected once and represented five constituencies before he became Prime Minister.

And this year’s General Election in the UK looks like it could have a fair few retreads too (ex-MPs returning to the Commons). With the help of the Mandate Twitter (and thanks to everyone who responded) here is a list of the most eye-catching candidates from the ranks of ex-MPs who might just yet make a return to the green benches:

1) Stephen Twigg

Perhaps the most famous of the 1997 Labour intake, Stephen Twigg sensationally beat Michael Portillo in his Enfield Southgate seat and earned a place in political history. But after 8 years in Parliament and a brief spell as a Minister, Twigg lost the marginal seat in 2005 in a swing to the Tories of over 8%.

He is now standing in Liverpool West Derby after the incumbent Labour MP Bob Wareing was deselected. Politics in Liverpool dictates that nothing ever comes easy but a strong local campaign and Twigg's star quality mean he is likely to return to the Commons.

2) Jonathan Evans

Former Conservative MP for Brecon and Radnor until 1997, Minister in the Major Government and MEP for Wales for ten years, Jonathan Evans is standing in Cardiff North which is 20th on the Tory list of target seats.

The constituency is suburban, affluent and middle class and recently went Conservative at the Assembly level in 2007. The current MP is Julie Morgan (wife of First Minister Rhodri Morgan) but she is highly vulnerable to a challenge. ConservativeHome was cock-a-hoop when Mr Evans was selected claiming his brand of compassionate conservatism meant a win in Cardiff North could be a bridgehead back into Wales for the party.

3) Parmjit Singh Gill

An MP for only one year from 2004-5, Parmjit Singh Gill was the first ethnic minority MP for the Liberal Democrats and was elected to the House of Commons at the Leicester South by-election. However, he lost the General Election a year later and returned to Leicester where he is now a councillor. He will stand again this year.

Despite a Labour majority of only 3,717 Mr Singh Gill may struggle to get re-elected. The Labour victor in 2005 was Peter Soulsby, former leader of Leicester City Council, whose rebellious streak in Parliament and careful wooing of the Asian vote mean he is well liked by his constituents. The Lib Dems may decide to concentrate their resources elsewhere.

4) Sue Doughty

One seat the Liberal Democrats may focus on is Guildford where former Liberal Democrat MP Sue Doughty is standing against Anne Milton (Shadow Health Minister) who defeated her in 2005. Guildford is third on the list of Liberal Democrat target seats and it would take only a swing of 0.1% to overturn Anne Milton's 347 vote majority. Could Sue Doughty follow in her colleague Mike Hancock's footsteps? He lost his Portsmouth South seat in 1987 but regained it in 1997. Only time - and a good campaign - will tell.

5) Peter Duncan

The former MP for Galloway and Upper Nithsdale constituency between 2001 and 2005, Mr Duncan unsuccessfully contested the new seat of Dumfries and Galloway in 2005 when boundary changes altered his constituency. He had been Shadow Secretary of State for Scotland between 2003 and 2005 but this wasn't enough to stop him losing to Labour's Russell Brown in a closely fought campaign.

This is likely to be a tough race but Mr Duncan's work as a local councillor and his grassroots support mean he might just overturn Russell Brown's majority. However, it is not certain and a lot will depend on how the Tories perform in Scotland overall.

6) Phil Sawford

Former Leader of Kettering Borough Council, Phil Sawford was MP for Kettering between 1997 and 2005. He won in 1997 after three recounts and managed to double his majority to 665 in 2001 but this wasn't enough to keep him in power. Four years later he lost to Philip Hollobone, who defeated him with a swing of 3.6 per cent. Hardly the most memorable of the 1997 intake, Phil Sawford nevertheless gained a reputation as a 'champion' of local issues and an inveterate 'left winger'. He is still a member of the 'Campaign Group'.

Kettering is a semi rural seat which is due to undergo significant expansion over the next decade, with new homes and major regeneration planned. It is unclear what affect this will eventually have on the constituency but recent boundary changes favour Labour. If the polls remain tight Phil Sawford might win but it is too soon to tell.

7) Ivan Henderson

"Still here, still working". Ivan Henderson's slogan for the forthcoming campaign in Clacton sums up this popular former MP. He was elected for Harwich in 1997 but lost to Tory right winger Douglas Carswell in the 2005 General Election. Since then, Ivan Henderson has remained involved in local politics but it will be a hard slog to win this seat back. Douglas Carswell's radical views go down well in the constituency - it was his motion of no confidence which removed Speaker Michael Martin.

However, the Tories won't simply be able to assume victory here. And if Labour forces the Conservatives to spread their resources thinly by concentrating on places like Clacton, it might enable Labour to hold onto other seats elsewhere.

Tuesday, 2 February 2010

The Pope is wrong about the Equality Bill

The Pope's intervention over the Government's equality agenda and legislation is unwelcome and unhelpful.

The pontiff said that "the effect of some of the legislation designed to achieve this goal [of equality] has been to impose unjust limitations on the freedom of religious communities to act in accordance with their beliefs". He said that Catholic Bishops must invoke "missionary zeal" to resist it.

Everyone is entitled to express their view and in a secular society the Catholic Church should be treated as one voice amongst many but there is no excuse for the pope to be so badly misinformed.

The new Equality Bill tidies up a whole host of equalities legislation and extends anti-discrimination laws in some areas. But it does not affect Catholic schools which are covered by separate legislation and it certainly does not affect churches' hiring for religious posts. The Church should have nothing to fear from the new Bill.

Therefore, I can't understand his intervention. When church attendances are in decline, I don't think this will win him or the Catholic Church in the UK many new friends. There's also something troubling about a foreign leader telling us to change the laws currently being voted on by our elected representatives. Better for him to stay out of it altogether.