Guest editorial Tuesday 5 July 2016: On the political confusion of 'activists' hoping to shape Labour's health policy

'Pierre Poujade' follows on from Health Policy Insight's recent, exclusive and accurate stories about John McDonnell's efforts to subvert Labour Party policymaking process

The arguments about who advises the Labour Party on the NHS, revealed by Health Policy Insight have reopened some of the claims about the passing of the 2012 Health and Social Care Act.  

Two groups are responsible for the failure to stop it becoming an Act: the medical professions and the Liberal Democrats. Alternative histories are sometimes worth considering.

If the majority of GPs at the very start had said 'Andrew, we have more than enough to do, thanks: we will not become commissioners and the managers of commissioning', the Bill and Act would have been doomed from the start.  In reality, a significant minority of GPs were actively promoting the Bill (but have gone very, very quiet about it since).

If the professionals in the Royal Colleges had kept their nerve and agreed a letter produced on behalf of all Colleges opposing the Bill, it would have almost certainly been abandoned.  This was close-run, but vested interests (and concerns about charitable status) overcame reservations.

If the Liberal Democrats had not signed up to the Bill in the first place, it could not have passed. Three Lib Dems signed the Bill, and Lib Dem Health Minister Paul Burstow was the best advocate of the Bill in Committee.

If the Lib Dems in the Lords had not been convinced by Tory Ministers that reassurances were enough, it would have been blocked. This was also close-run.

This reality - that the 2012 Act was politically contested, and could have been stopped - contrasts with the narrative of those 'activists' now looking to take roles in advising the Labour Party.  Their attitude is best summarised by this, from the introduction in the interesting but not well-informed book NHS SOS.

“This is about the betrayal of the NHS – by politicians, journalists, the unions, and perhaps most culpably the leaders of the medical professions. Without the active collusion, acquiescence or incompetence of all these players, it would hardly have been possible for the Tories to have succeeded in getting Andrew Lansley’s nightmare vision enshrined in law.”


This sense that everyone else is ignorant or bad (or both) fits the conspiracy theory to which 'activists' cling, but the assertion that the trade unions were part of the conspiracy shows just how epically daft this position is.

It shows also a serious ignorance of the nature of politics. It appears to be founded on the selective collecting of anecdotes from people who mostly were observers and not actually central to the long and tortuous battles over the White Paper and then the Bill.

It’s plausible that the Bill could have been stopped or significantly watered down.  Ironically, the outcome was the Act would be simply ignored. Despite the many lurid social media offerings, the NHS did not collapse and was not sold off. The NHS of 2016 looks very much like the NHS of 2010 - but whereas the trajectory in 2010 was an improving one, the opposite is now true.

Which takes us to the current absurd situation where Labour was to be advised about the NHS by a group of activists who believe the solution to all the issues in our care system is to return to the structures of the 1970s through the biggest top-down reorganisation ever.

Discussion have to move on not look backwards.  There is a growing consensus that the second era of the NHS, of accountability, scrutiny, measurement, incentives and market mechanisms is over. The smart response is not to return to the first era of noble, beneficent, self-regulating professionalism.

The big issue facing us in 2016 is not the 2012 H&SC Act, but the underfunding of both the NHS and social care.

There is a desperate need for some new but credible policies around funding, integration, devolution, personalisation, variation and much more. Sadly, there is no forum at present to facilitate such development - and a group of randomly-selected activists working for the Shadow Chancellor does not look to be a promising option.

('Pierre Poujade' is a pseudonym)