Fishburn Hedges

04.04.2011

There is no question the Coalition is in trouble over the NHS.  In the last few weeks, objections to Andrew Lansley’s reforms have been rehearsed by Shirley Williams, Norman Tebbit and a cast of hundreds whose politics lie somewhere in-between. 

With Cameron and Clegg set to announce an unprecedented ‘three month pause’ to the progress of the Health and Social Care Bill, opportunity knocks for Ed Miliband.  In his speech to the RSA today, the Leader of the Opposition had a timely opportunity to present an alternative vision for the NHS.

Miliband’s challenge was twofold, to emphasise what Labour would do differently to the Coalition and counter the attack that his proximity to the unions means he will unthinkingly oppose all NHS reforms.

Starting with the latter, Miliband had a clear message for detractors and supporters alike.  He didn’t say it out loud, but “I’m a reformer, but I don’t support these reforms”, was the theme of the day.  Miliband was careful to defend Labour’s record on the NHS, arguing that improvements to the health service had been delivered by a combination of investment and reform. 

He said that there was a place for competition in the NHS, but not for the ‘chaotic’ free-market model proposed by the Coalition.  He said that accountability had to be strengthened in the NHS, but Lansley’s model of GP commissioning was not the way to achieve it.  The message was clear, Labour identifies with the need to reform the NHS, but the Coalition reforms go too far.

All of the above was designed to meet the challenge of the Prime Minister that there is ‘no choice but to reform the NHS’.  Cameron wants to pitch the debate as being between a reforming government and an opposition wedded to the status quo.  Miliband responded to that challenge today; by branding himself a reformer, the debate must now be about the type of reform, not whether there should be change at all.

The more difficult, and so far unanswered, question for Miliband remains, ‘How would your reforms differ to those of the Coalition?’ 

Miliband spoke of the ‘ethos of the NHS’ and how his party would always look to preserve the values of collaboration and cohesiveness.  The aim was to draw a dividing line between the government focus on the merits of competition. Labour is acutely aware that the issue of allowing ‘any willing provider’ to bid for NHS services has been met with particularly forceful opposition.

Miliband put himself firmly in the reforming camp today, but has yet to carve out his fully-fledged alternative to Lansley’s plans. That may not matter too much, because the Health and Social Care Bill is likely to be amended anyway, as Cameron and Clegg get a grip of Lansley. Miliband will be keen to claim some credit for any change in direction, but the credit will be shared more widely – by Shirley Williams, Norman Tebbit and all those in between.

Posted by Andrew Lewin