Editor’s blog Sunday 26 September 2010: Labour leader Ed Miliband on health policy

Thanks to the Socialist Health Association’s hustings event for the Labour Party leadership candidates, we can bring you the transcript of new Labour leader Ed Miliband’s answers from this event in responses to questions. (You can also find Mili-E's first article as leader here, in the interestingly-chosen pages of the Sunday Telegraph. Tanks on lawns?)

Question - What do you think is the best thing Labour did in health over the last 13 years and the worst thing we did - or possibly something we should have done and didn't do?

ED MILIBAND: “In a way, we saw at the general election (that our) great achievements - whether they are in health or not - seem to be banked and taken for granted and people forget what the world was like.  

“In my own constituency, I would say NHS LIFT (Local Improvement Finance Trust) centres are making a big difference. Having somewhere for primary care which is not a falling-down building - not somewhere which doesn't have disabled access and somewhere which is a clean nice place to go (and maybe has a local library and other facilities there as well) makes an enormous difference and shows what capital spending can do.

’ The biggest mistake … that we didn't take people with us, particularly members of staff with us in the changes we made in the health service’

“The biggest mistake? I think it's that we didn't take people with us, particularly members of staff with us in the changes we made in the health service.

“Andy did a work shadowing thing when he was the health minister, I remember reading at the time, and it showed the way we had alienated a lot of people.

’One of the ways we alienated the people was by sometimes making it appear as though it was ‘public=bad; private=good’ when it came to health and we should have been prouder of a publicly-run NHS as a public service’

“I think one of the ways we alienated the people was by sometimes making it appear as though it was ‘public=bad; private=good’when it came to health and we should have been prouder of a publicly-run NHS as a public service.

’We were right to have entitlements and targets for people … (but) the culture of target and audit went somewhat too far and is one of the reasons people felt “this is a service that or changes that I don't feel part of”.’

It's an important lesson we learn and the only other thing I say is we were right to have entitlements and targets for people. I think like all good ideas they can become a bad idea. My sense is that the culture of target and audit went somewhat too far and is one of the reasons people felt ‘actually this is a service that or changes that I don't feel part of’.”

Question - In the last government at least two cabinet ministers, Peter Mandelson and John Hutton, openly boasted about Labour's success in widening income inequalities. From the work of Richard Wilkinson and Kate Pickett amongst others we know income inequality is the key indicator of health and many other social inequalities. If elected, how would you deal with policy in this area?

EM: “I think this does go to the heart of the challenge we face as a political party going forward, and I think the change we need to make from what we talked about and the way we talk to the government.

’Our whole society is scarred by the fact that the gap between rich and poor is so wide … narrowing the gap has to be a central objective of the policy of the future Labour government’

“I think our whole society is scarred by the fact that the gap between rich and poor is so wide. I think if you look round the world at those countries that are healthiest, happiest, most secure, it is the more equal societies. I think narrowing the gap has to be a central objective of the policy of the future Labour government.

“Under my leadership as to the issues you talk about in relation to health and the specific story there I would say a couple of things.

“First of all, I think that we have to understand that actually the changes we made in the health service and the improvements provided the platform, if we had stayed in government, for a much greater drive on health inequalities.

“Actually it is by stopping the health service being cuts and crisis you can then move on to what people have always talked - about making the National Health Service a health service and not a sickness service but wellness service and reaching out to people in relation to health inequalities.

’You can't divorce issues of health inequality from wider inequality in your society; and of course you need the right health policies to deal with these issues - and also the right policies when it comes to a living wage; housing; people on the top of the society in their responsibilities they owe to the rest ‘

“The second point is this: is that you can't divorce issues of health inequality from wider inequality in your society and of course you need the right health policies to deal with these issues - and also the right policies when it comes to a living wage; housing; people on the top of the society in their responsibilities they owe to the rest.

“So we do need to drive forward back in government on health inequality and a whole range of different ways, whether it's on smoking, nutrition and so on. But we also need to recognise the wider issues in which health inequalities are embedded and we have to deal with those issues if we are to successfully tackle not just health inequality but inequality more generally.

Question - One on public health: should breast feeding be compulsory? Should inflicting cigarette smoke on children be a crime? Put another way, how can we maintain Labour values and avoid paternalism and have people do more for their own health?

EM: “I am certainly not in favour of compulsory breast-feeding (I would be in big trouble if I were, for good reason!).

“The reality here is that you need a combination of things to make a difference.

“You first of all need action by the state because we shouldn't succumb to Daily Mail notions or the idea somehow state action is interference with the individual.

“The reason I voted for the smoking ban? You had two rights colliding. The right of someone to smoke; and the right of employees to work in a safe environment. For me, that (latter) is more important, right, and the smoking ban is now something that's been accepted and it shows the way taking the right action can change people's minds and the culture.

“The second point is about markets. The food labelling ‘traffic light’ system is a good example of the way that actually markets can have a devastating effect on public health.  That traffic light system was a very good system brought in and has now been abandoned and it’s completely wrong it was abandoned. I think we should see as the next Labour government if we can bring it back in. It's a basic fundamental of giving people transparent information on what's healthy or not healthy.

’The best thing we can do as a political party and as a government is offer to have people within communities, some being paid, some not, making a difference to public health.‘

“The final thing is about another newspaper: The Guardian; not the Daily Mail. You know how people say, “oh, well all those Guardian adverts about the 5-a-day co-ordinators or smoking cessation - all non-jobs.” Actually, that is complete nonsense because the best thing we can do as a political party and as a government is offer to have people within communities, some being paid, some not, making a difference to public health.

“I was in Scotland recently with Margaret Curran, one of our new Members of Parliament and a local housing association run the housing and community centre.  I met a guy there, a walking co-ordinator. If you listen to the Daily Mail, they say “oh walking coordinator, ridiculous”. He was making an enormous difference on that estate.  He was leading adults and young people for walks twice a week.

“I think that shows how the combination of action by government and communities have made a difference we need to make to public health in this country”.

Question - PFI debt has dragged down local health economies around England. Moving forward, do you have a policy or potential remedy to secure future costs of PFIs are limited or possibly secure them in shareholdings we have in UK banks; thus achieving practical and workable interest rates?

’My Dad ended his life in a … dilapidated broken-down hospital … my son was born 15 years later in a brand new hospital nearby built under the private finance initiative: UCLH. I know because of demands on the public purse that that hospital wouldn't have been there if we weren't willing to use PFI.’

EM: “Let me put it in personal terms. My Dad ended his life in a hospital in London which was a dilapidated broken-down hospital, bad for patients and bad for staff. My son was born in a hospital nearby 15 years later which was a brand new hospital built under the private finance initiative - UCLH. I know because of demands on the public purse that that hospital wouldn't have been there if we weren't willing to use PFI.

’We have to look how we can better regulate costs going forward and deal with some of those inflexibilities‘.

“I understand the concerns people have in the audience: on the costs of debt that are going to be paid back in the future; about inflexbilities of some of the contracts (which aren't just an issue in PFI hospitals but in PFI schools as well). We have to look how we can better regulate costs going forward and deal with some of those inflexibilities.

’Have we improved people's quality of life - both people who use the health service and work in it - by use of PFI? It's my view (not popular with everyone in this audience) that the answer is unquestionably yes. It's a massive abdication of responsibility if we say we won't use PFI’.

“In the end, you have got to make fundamental choice and answer the fundamental question which is - have we improved people's quality of life - both people who use the Health Service and work in it - by use of PFI?

“It's my view (not popular with everyone in this audience) that the answer is unquestionably yes. It's a massive abdication of responsibility if we say we won't use PFI. My son wouldn't have been born in the new hospital, thousands and millions of people around the country would have still been treated in old, broken-down hospitals which existed under the last Tory government” (Applause).

Question - Would you like your doctor to think about you or his budget when arranging your treatment?

EM: “There is an issue about waste. It will cost £3 billion pounds to do these (White Paper and GP commissioning) changes at a time when the NHS is under massive pressure.

’It's a market philosophy brought to the heart of the NHS with the decision around GPs commissioning. I don't want those decisions to be made on a free market basis. I want some sense of accountability on the way that money is spent’.

“There is an issue of accountability. Whatever problems we had with PCTs, at least public money was in some sense accountable. I don't think it was the greatest form of accountability but people employed by the public sector were responsible for how the money was spent.

“It's a market philosophy brought to the heart of the NHS with the decision around GPs commissioning.  I don't want those decisions to be made on a free market basis. I want some sense of accountability on the way that money is spent.

’Health service re-organisation is a set of words that make most people's eyes glaze over … in every GP surgery, people need to be told, “these are the changes proposed; this is the impact it will have on you. These are the dangers of the changes. You should contact your local MP to fight the changes”.‘

“The question is not are these bad reforms (they obviously are):, but how do we fight them? I make a point to colleagues from the Socialist Health Association and all the health professionals in the room. The way this campaign succeeds is led by health professionals, and we need GPs and nurses and midwives people across NHS to campaign on this issue along with UNISON.

“Actually there is a job of persuading that we have to do to win the argument.  Health service re-organisation is a set of words that make most people's eyes glaze over. For reasons we understand, we have to hone our arguments; and in every GP surgery, people need to be told, ‘these are the changes proposed; this is the impact it will have on you. These are the dangers of the changes. You should contact your local MP to fight the changes’.

“Unless we have that kind of effective campaigning, we will protest and say these changes are bad and make ourselves feel good about opposing the changes and won't defeat them we have got to have a proper mass mobilisation against the changes in order to defeat them”. (applause)

Question - What should we do about the division between health and social care? Should we move to the principle that social care should be free at the point of need and paid for out of general taxation?

EM: “I am very sympathetic to the National Care Service proposal we talked about before the general election. I am afraid we didn't get to including it formally in our proposals at the election

“Let's understand what the injustices are here. I think the biggest and first injustice we have to tackle is the injustice of people in their own home and not getting care they need.  We know that for many people, the best solution is to stay in their own home. It is the situation of people up and down the country finding they are not being properly helped at home that are worst of all.

“In my own constituency, I had a man come to see me in the surgery. He made an appointment, came a couple of weeks later. He said, ‘I came anyway my wife died last week after I made the appointment she waited a year to get a stairlift at home and it never came’.

“Up and down this country, we know there are these stories and the first thing we have to do is improving that care people are getting in the home so people aren't cruelly left without that care as they are at the moment.

’The truth about social care is that it should be following the same principle as the NHS‘.

“Secondly, we have to deal with injustice - because the truth about social care is that it should be following the same principle as the NHS. It's a catastrophic cost over which you have no control as a person, and it's random who it hits. The principle should be that those costs are borne across society and we pool the risk, and that's why we have got to find a funding system. It could be Andy (Burnham)'s; it could be another funding system.

“Thirdly and finally, let me say something about people working in the care sector. It's really important and the workplace and what happened to people at the workplace is something that was left out of what new Labour talked about - and wrongly in my view.

“I was at a care home in Durham, a Southern Cross care home. People doing one of the most important jobs in our society are paid just above £5.80 minimum wage. 15p an hour extra for getting NVQ level 2. I said to a worker in the care home, ‘what do you think is a fair wage?’ She said, ‘I get paid 7 pounds an hour to work at Tesco's’.

“There is a deeper debate we have to have in our society and use the leadership discussion on what our values and priorities are; and if we think what the market will bear is a fair wage for someone working a care home or follow different values? That's why we have to change. Unless we do that, we will find we still leave people doing most important jobs in our society getting paid the least. It's wrong and it has to change”.  (Applause)

Summing up why you should be leader
EM: “You have a heavy responsibility in the coming few days: you get to choose who the next leader of the Labour Party is.  I am standing in this election because I believe I am the person who has the values to take our party forward, and I am also the person I believe can win the next election for us.

“I want to say to you very clearly I am the head and heart candidate at this election.

’Unless we reach out to working-class support as well as middle-class support, we will not win the next election’

“Unless we change from some of the things New Labour got wrong, we are not going to win the next election. Unless we reach out to working-class support as well as middle-class support, we will not win the next election. Unless we are willing to change on issues of privatisation, or ID cards, we won't win the next election. Unless we move forward on Iraq we won’t win the next election. Unless we move our party in a different way, we won't win the next election.  

“The way we win is this. We have a party in Parliament of course and a party in Parliament connected to our party in the country and our Trade Union movement. I am pleased I had the backing of UNISON and a number of other trade unions in this campaign. That's because of my message on the way Labour needs to stand up for working people in this country.

’We did not lose the last general election because we were too left wing. I believe we lost it because too many people thought they didn't know what we stood for and there was no difference between the parties ‘

“Let me end on this point. Some people will tell you when Labour loses an election it always has to move to the right, but we did not lose the last general election because we were too left wing. I believe we lost it because too many people thought they didn't know what we stood for and there was no difference between the parties.

’if we stand up for values we believe in and stand up for a fairer, more equal, just society, we increase our chances of winning the next election.’

“We have got to have confidence that if we stand up for values we believe in and stand up for a fairer, more equal, just society, we increase our chances of winning the next election.  If we speak to our values, we can create a party we are proud of; a movement we are proud of; and a country we are proud of too”. (Applause)