By Kieran Lucia, Senior Director, Incisive Health
During elections, the political goal for Labour on the NHS is usually simple: the louder the better. But this election is different. Labour is fighting to win in parts of the country that have been Tory for over 100 years. 2019 Conservative voters need to be wooed who care less about health, and more about the economy, defence and crime.
And so, Sir Keir Starmer’s objective for Labour’s manifesto launch today will be to not spook ‘middle England’: Labour has a plan to drive economic recovery, and it doesn’t involve raising taxes.
This safety-first approach leaves us wondering when we will hear more on health? Labour’s big pledge from earlier in the campaign to recover the 18-week waiting time standard is there, along with older pledges from the Mission and first steps, including doubling the number of CT and MRI scanners, a dentistry recovery plan, additional mental health staff and a return of the family doctor.
Whilst Labour’s focus is understandable (‘It’s the economy, stupid’), there are potentially political as well as governing risks to leaving the NHS in the background today.
Politically, health remains one of the top two issues for every age group of voters. Even for the over 65s – the last bastion of a Conservative demographic lead over Labour – health comes a close second to immigration. Could convincing them of Labour’s plans for NHS recovery be the difference between a Labour majority and a ‘supermajority’?
Politics aside, this manifesto leaves major unanswered questions for a potential Labour government. There is a noticeable absence of policy on NHS revenue funding (compared to “above inflation” from the Conservatives and £8bn – including care – from the Lib Dems). Looking at the current ICS planning round, funding is going to be a day one question.
How to end the junior doctors strike and the broader question of pay settlements are still unanswered. A sustainable deal on pay – ending regular rounds of industrial action – will be crucial to achieving recovery. Keir is willing to talk, but is there a deal to be done within Rachel Reeves’s fiscal rules?
Then there is primary care, capital funding, innovation, life sciences and the shift to prevention. Not to mention social care. There are welcome hints on all of them: bringing together NHS innovation and adoption into a single strategy will be particularly welcome for the life sciences industry. But this is an incremental vision for improvement. There is little to show how Labour will deliver recovery and transformation at the speed or scale that the country – and all those working in the NHS – expect.
Given the state of the polls, the political risk on July 4 may be small, but politicians are always wise to remember that Bill Clinton’s 1992 election campaign had three core messages. Whilst Labour’s campaign has embraced the first two on ‘the economy, stupid’ and ‘… change’. With an eye towards Keir Starmer's "decade of national renewal", is there a risk they have underplayed the third? ‘Don’t forget healthcare’.
1997 and all that
By Mike Birtwistle, Senior Counsel
The parallels with 1997 are irresistible. A party seeking election after a long and painful period in opposition, following bloody battles over internal party management and a shift towards the centre. The polls predicting a landslide…
Yet you’ll also hear plenty of commentary about the differences between 1997 and 2024, focusing on complaints that, as Keir Starmer clutches his Ming vase, he lacks much of the radicalism which infused New Labour and enthused the electorate. This analysis is conducted through red rose-tinted glasses. Commentators detected (and lamented) a similar lack of enthusiasm in the weeks leading up to the 1997 election.
But what about the manifesto? The 1997 version was not a radical blueprint for change in the NHS. It certainly did not presage the health reforms (or spending) that came to define the Blair years. This is what Tony Blair said in his introduction: “we will safeguard the basic principles of the NHS, which we founded, but will not return to the top-down management of the 1970s…The key is to root out unnecessary administrative cost, and to spend money on the right things – frontline care.” It could have been written at any point in the last 40 years (and by any political party).
Only one of Blair’s 10 commitments focused on health: “We will rebuild the NHS, reducing spending on administration and increasing spending on patient care” It was accompanied by 1 of 5 pledges: “100,000 people off waiting lists” In 1997 Labour had 10 commitments and 5 pledges. The 2024 version has 6 first steps and 5 missions. So far, so familiar.
Beyond this, the 97 manifesto included pledges to raise spending on the NHS in real terms every year and to ensure that a “greater proportion of every pound spent will go on patient care not bureaucracy.” There were also vows to end the internal market, make better use of technology and restrict the promotion of tobacco. Times have changed, but not that much.
It will be years before we can judge whether a Starmer-led government proves to be a radical reforming administration when it comes to health. But if we are looking for early clues, history tells us not to read too much into the manifesto.
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