The Bedpan: The NHS has been politically neutralised
by Andy CowperThis week: John McTernan
Why he matters: A political strategist, adviser and commentator, Mr McTernan was Tony Blair’s director of political operations from 2005 to 2007. From 2007 to 2010, he was special adviser to three secretaries of state. After New Labour’s defeat, he spent time in Australia where he served as director of communications for Labour prime minister Julia Gillard. He has written political columns for The Scotsman and The Daily Telegraph.
“I think the NHS is traditionally a Labour banker [in a general election], as it exposes the sense that the Tory party may be hard-headed in running the economy but it’s hard-hearted in running public services,” reflects John McTernan.
“But it’s such a long time since the NHS was founded and no Tory government’s launched a convincing assault on it ever. Jeremy Hunt got an extra £20bn for the NHS at the peak of austerity.
“Of course, Simon Stevens had a lot to do with that [as well]. Simon’s ability to lobby successfully for that extra money kept the show on the road for the NHS. And we learned that when push [comes] to shove, the NHS gets what it requests.
“The NHS is not quite as independent as the Bank of England’s Monetary Policy Committee in setting NHS funding rates yet, but we could get there”.
Despite the profile of the NHS in this election, Mr McTernan suggests there has been a lot more heat than light.
“I could not name you one Tory NHS policy. There are big ideas out there on how to change primary, secondary and tertiary care, but the Tories are not touching any of them.” It is not much different with Labour, he adds.
“Both parties are paralysed by their inability to say anything about health policy, when sure, the NHS needs more money but also needs to prioritise how it’s spent differently.”
The NHS, he says, has, “been neutralised for political use, something you can’t criticise. That leaves the Tory record fairly safe. There was a big austerity attack, but now they’re promising to put in large sums of money.
“So, the politicians haven’t a clue, but luckily Simon Stevens knows what to do. He’s almost taken the thing out of politics and created a reform culture where nothing’s put on the agenda to frighten the horses too much, but just quietly allowing regionalism to occur and grow”.
Voters don’t want councils to run the NHS
Mr McTernan says the relentless pressure on social care budgets increases “the logic of a move towards full health and social care integration”.
He adds: “I don’t think voters want local councillors to run the NHS. So, a formal merger would mean losing councils’ control of social care, but it’s too big a change for this electoral cycle.”
If outsourcing were banned from public services as Labour are proposing, what does he think would be lost? “First and foremost, the drive for innovation that competition creates, when services go out to tender. That would be a major loss.
“If councils had never contracted out waste collection, do you think we’d have wheelie bins? It’s an innovation we now take for granted; we don’t put out sacks of refuse any more.
“Secondly, you risk losing the benchmarking of quality. The underlying assumption/assertion underneath the drive to ban outsourcing is that public servants can never be wrong and will always be better than private sector workers. Really? Mid Staffs? Morecambe Bay? Shrewsbury and Telford?
“Regulation, inspection, peer review and [continuing professional development] are all important, but the fact that some services can be put out for tender keeps those services tested for quality as well as for price.”
He also cites the loss of capacity and flexibility, citing the concordat signed while John Reid was health secretary, which saw agreement that private suppliers would be paid at NHS tariff.
“The effect was to drive them down to NHS rate, which benefitted the NHS as an outsourcing customer,” remembers Mr McTernan, “[but] also [for] people using the private sector. The private healthcare market wouldn’t have that pressure either [without NHS commissioning]. So, I think you change the ecology at your peril.”
Be a patriot and defend the NHS
If Mr McTernan were advising the Labour Party, how would he go about the task? He smiles: “I would say firstly, don’t be afraid to be a patriot. By which I mean, look at Tories who understand that need.
“In 2012, Danny Boyle put the NHS at the heart of the London Olympics opening ceremony. Idiot Tory backbenchers were noisily outraged. Dominic Cummings saw that, and thought, ‘OK, we’ll put the NHS as a symbol at the centre of the Leave campaign’.
“If they can do that, you can do that. National pride can help you stand as a defender of the NHS.
“Secondly, underpromise and overdeliver. Our problem with [right-wing] populists is that they promise to change everything and then change nothing. The reaction [to that failure] among the public is not to go ‘OK, thanks, now we’ll vote for a very left-wing party’; the voting public just stop trusting any politicians. Progressives know that government matters, and populists damage the major tool progressives want to use to change the shape of our country.
“Finally, real, deep lasting change takes time, and it’s best when it’s bipartisan. This is not to say ‘scale back your ambitions’ but [do] plan a process to land the change at a point where it becomes irreversible.
“Tony Blair didn’t just reverse Section 28; he brought in civil partnerships and changed the context of debate, and so to prove that they too were modernisers, Tories had to accept it and extend legislation for it.”
How does Mr McTernan read the changing nature of British politics?
“For these past 15 years, the public has been telling us that the political offer is not quite what they want. And the first rules of politics is [the same as] Julian Richer’s first rules of retail: ‘one, the customer is always right; two, if the customer is ever wrong, refer to rule one’.
“In the 21st century, we need parties and leaders to find ways to address the next big set of political questions. Thatcher came in with markets; Blair with a restoration of the public sector.”
Mr McTernan claims that “across those two sets of big political ideas”, factors such as “competition and choice, privatisation, personal pensions” gave people more power over their own lives.
“But clearly, there is still a sense of desire to ‘take back control’. So why are the voters sending us a message about agency? They want to put politicians in (or near) power to think about political problems and come up with solutions.
“The next political leader to succeed will really take that seriously and think hard about what they’re saying. It’s the old line: ‘you’ve got two ears and one mouth, so use them in that proportion’. You have to keep looking for the thing voters are trying to say to you.”
Who’s going to win?
Given his key role in New Labour — one of the UK’s most successful election winning operations — how does Mr McTernan read the 2019 contest?
“Labour is struggling to pull the same trick again as it did in 2017. Mr Corbyn’s learning that you only get one chance to make a first impression. He did that in 2017, and surprised some people positively, but it’s not happening from him or his leadership team now because of Labour’s unresolved internal tension over Europe.
“The Tories, by contrast, have managed to absorb their tensions over Europe, absorbed Brexit and they’re doing well.
“The Lib Dems are being much mocked, because they destroyed their brand in coalition from 2010-15, [but] I’d say they’re on the verge of re-establishing themselves as a relevant centrist voice and place to go”.
He thinks the Lib Dems could double or treble their Commons representation, which “doesn’t make them a numerical threat, but a threat that if Labour remains far-left, there’s a place for centrist voices and activists to go. They’re not playing to win; they’re playing to be relevant.”
What are his reflections on election campaigns that fail?
“If you are at odds with where the public are, they won’t have you under any circumstances.
“And second, are you true to yourself? Authenticity is essential in a leader. Theresa May said in 2017 she’d be ‘strong and steady’; announced the social care reforms in their manifesto; and instantly abandoned them when the 2010 ‘Death Tax’ charge levelled against Andy Burnham’s National Care Service plan was played right back at them.
“That weakness showed the electorate who she really was, and public said, ‘no majority for you’. Authenticity is the crucial thread between parties’ leaders and their success with the public.”
If there is any political or influential figure you would like HSJ to interview, please email alastair.mclellan@wilmingtonhealthcare.com.
The past five Bedpans
Prime minister May and the NHS
Cardiac Arrest and Bodies writer Jed Mercurio
Margaret Thatcher and the birth of the internal market
You can read all 45 Bedpans here