Labour is rightly proud of its legacy in the NHS, and right to be concerned about the effect of ongoing austerity and underinvestment in both health and social care. The central importance of the NHS to Labour's history and values has seen it place increasing emphasis on the NHS in its campaigning in recent years, from Andy Burnham's National Care Service in 2010, to the 'NHS Jarrow March' in 2014, to the by-election campaign in Copeland in 2017, Labour has seen health and care as a policy and political priority.
Labour's rhetoric has warned of impending catastrophe, and framed the electoral choice in the 2017 General Election as a last-minute opportunity to 'save the NHS'. In 2017, as in 2015, this was not enough to win the election. Although insufficient to enable Labour to win, the hung parliament, the Conservatives' dire campaign and continuing infighting, and Labour's strong showing in the polls means that it is possible that Labour may find itself in power before 2022. Given the growing importance of the NHS to voters, and dire warnings of crisis in both the NHS and social care, what is Labour offering in health and care, and how should this be developed?
Save the NHS
Labour's campaigning on the NHS has increasingly focused on the crisis in the NHS posed by the Conservatives. There is undeniably a sense of crisis in both health and social care, with calls for urgent action to help them cope with the additional demands expected over winter. (1)
Labour's rhetoric, however, has focused often on the use of private provision within the NHS alongside funding levels. In his speech to Annual Conference, Jon Ashworth pointed to a failed ambulance contract with a private company, and promised 'we'll...fight fire sales of hospital assets and end Tory privatisations'.
This approach may have successes, but risks overlooking some of the most critical questions about the future of the NHS. Surely, the biggest problem with the ambulance service referenced in the speech, or with any poor service, is just that the service was poor. NHS service can be terrible at times; privately run services can be good. What should matter most to Labour--because it will matter most to the people it wants to represent--is the quality of services.
This is not contrary to the NHS's values: it is precisely the approach taken by Bevan in his deal with GPs. (2) The NHS's founding principles--free at the point of use, paid for collectively through the tax system, to all according to need--remained untouched. Privately owned practices were contracted to provide services to the public that were free at the point of use, collectively funded, and universal. A focus on privatisation as private ownership overlooks a far more sinister form of privatisation: the privatisation (or individualisation) of the risk of ill health. Without an unswerving focus on ensuring that every person has access to the very best healthcare for them, as individuals, people will suffer, unless they are lucky enough to be able to access support through the market.
This does not just mean private health insurance, but the type of support that helps people stay well--a personal trainer or physiotherapist, for example, to help someone stay well, or recover from injury.
This is not a defence of private ownership of services provided through the...