Labour’s NHS plans should reflect real life not vague values

‘The frequency of talk about values is matched by a corresponding vagueness of the concept’ a famous German philosopher once wrote. In the run-up to the election, Labour is in danger of speaking with a tone of vague passion when talking about the NHS. We insist we’re the only party that can save this cherished institution, but sound unclear and woolly when interviewers ask what that means in practice. The polls aren’t necessarily on our side. Yes, the public think we believe in the NHS far more passionately than the Tories, but they don’t trust any group of politicians – us very little more than them – to sort it out.

The problem is the same one I’ve commented on before in this column, the gap between the way politicians imagine the world and how the rest of us experience life. Encouraged by focus groups that test abstract propositions, political leaders imagine our political behaviour is determined by our beliefs. You win elections when the beliefs you espouse align with the electorate. “I care about the NHS”. “So do I”, says the political candidate and bingo, they’re on their way to see the Queen.

The worst recent case of this, sadly, was by the leader of our party. Asked on Radio 4 about the greatest political achievement of the twentieth century, Ed Miliband named the NHS, and called it an idea. It is no such thing, of course. The NHS is institution that organises millions of carers and patients, who each have their own thoughts and own ways of doing things. It’s a good start if politicians care about the Health Service, but the point is what they’re going to do about it.

The philosopher whose work I quoted a moment ago offers a better starting point. Martin Heidegger argued that we are practically involved in the world before we think about it. We experience the world through our emotions and our practical purposes, few of which are based on abstract beliefs. Even when beliefs count, they come from our relationship with people and things.

But we don’t need philosophy to tell us that. Labour’s historic strength came from its creation of a practical world made up of institutions and relationships which supported working people and nurtured a practical sense of dignity and power for many: the co-op, the union, the local party branch, municipal enterprise. With the collapse of industry the conditions of that world collapsed and Labour lost its practical sense of how to act. Instead of developing plans that engaged with the world as it was, we retreated into the idiocy of ‘values’. New Labour began as a movement intent on creating a mass party ‘at the centre of community life, but ended up speaking a vague and abstract vocabulary about social justice that often had little relationship to the real world. Unsurprisingly, the party as a mass campaigning force has badly atrophied. Too few thought Labour connected to the world they knew.

We can recover by changing our way of working. We need to be a party linked to a way of doing things, not just a set of abstract beliefs. Our renewal comes, I’d argue, from creating local institutions that give people a sense of greater power.The PROGRESS pamphlet ‘Let it Go’ published today by Steve Reed and Liz Kendall outlines the right kind of approach.  Rather than making a set of theoretical statements about the way the world should be, they’ve collected cases from public services across the country that have properly listened and made a difference. Their argument is simple – it’s the same case I made a few years ago in a Fabian pamphlet. The role of politicians is to create the conditions for people to solve their own problems. It is to build institutions that enable local collective action. Politicians listen, convene and arbitrate – sometimes they need to act tough, but often they should let go.

There’s an important lesson here for our story on health and social care. The best solutions come when local service providers are free to listen, to innovate and collaborate. Improvements in health and social care come when providers can create strong relationships with their clients. They don’t come from central targets, whether set by big private firms or the state.

The issue is how to ensure continual pressure to ensure service quality. But pressure is far more effective when it comes from irate service users rather than distant bureaucrats. Ed Miliband is relying on anger at Tory NHS plans to drive him to Downing Street. Why, then, can’t our national passion be directed to hold our local hospitals and GP surgeries to account?

I think we need far more radical plans for the NHS. The cases Kendall and Reed examine show how a health service based on the voice of service users can be built. The state’s job is to provide funding, to force institutions to listen, but not decide the detail of how they respond. And as Jim McMahon, Leader of Oldham Council argues, real local accountability means an acceptance of local diversity. We need to be clear. The problem with Conservative approach is not that it introduces choice, but that it enforces a one-size fits all approach in the interest of the profit of big multi-nationals. Our alternative needs to be more than an abstract statement of our values and a few promises on money and waiting times. It should be a health service that listens to the voices of those who need it, so is far more firmly embedded in our lives than it feels now.