Labour’s next leader must outline a vision for the NHS that goes beyond distrust of private companies

The four leadership candidates will now spend the next 3 months making their pitch to Labour members.  At its best this will be an informed discussion about the big issues the country faces and the direction of the party; at its worst it will be a protracted insular debate, in which issues that matter to the voters are substituted for issues which appeal to the few and sound bites that appeal to no one.

If the later debate prevails then the leader, whoever he or she is, will exit the selection weakened and mismatched against a Tory party, which has had 3 months to solidify their message that they “are the party of working people” (or whatever vacuous rubbish they decide to peddle this time).

The debate over the 9 weeks needs to be about issues that matter to voters.  It needs to be based in reality and on an accurate understanding of public opinion.  At times in the 2015 campaign Miliband failed on all these points by making the mistake of trying to bring the centre ground to him, rather than going to it.  The subject of health care and the NHS is an area where we have to get this right this time.

Health care frequently polled in the top 3 issues of the 2015 campaign.  Somewhere between 65% and 75% consider the NHS to be one of the UKs greatest achievements.  Almost half believe that it will not survive to the end of the decade in its current form.  This is an issue that matters to voters.

The current reality of health care provision in this country is one of enormous strain and change. By just about every measure the NHS is struggling to cope. Many Trusts are in financial trouble, and this is before they attempt to climb the mountain of efficiency savings recommended by Simon Stevens. Private provision now makes up a notable proportion of the care provided in the NHS. The 6% statistic frequently voiced is an underestimation and hides the fact that in some sectors, such as mental health care, almost a fifth of care is privately provided. The success rate of private firms in the tendering process in the last financial year was somewhere over a third (e.g. they won 1 in every 3 contracts) and some of the contracts being tendered last almost a decade.  Therefore, currently, without the private provision of health care, the NHS would simply not function. This is the reality of the NHS in 2015.

While this prevalence of private provision is uncomfortable for most Labour Party members; this is not the case for most voters.  In 2013, the public were found to favour the private sector involvement in reducing waiting lists, by a margin of 4 to 1.  Over half of people in the UK would pay for private health care if they could afford it.  Many voters view the private provision of health care somewhere on a spectrum between acceptable and preferable and show little appetite for a sizable reduction in private provision or another large shake up of the NHS. This is where public opinion is.

I have focused on private provision as I am sure that this will be a centre piece of the health debate.  What role private companies should have in the NHS is an important question for the candidates to answer. However, the candidates need to construct a narrative based on the current reality which exists in the health service and in light of public opinion.  Repealing the Health and Social Care Act will no doubt be discussed; however this must be done in the context of removing a sizable chunk of provision from an organisation employing 1.3million people, with a budget of over £100billion.  Failing to do this will be a disservice to the NHS and to their electoral chances. 

The Labour Party has a central role in ensuring the continuing viability of the NHS as a model of care. It is viable, it can be more efficient and it can continue provide world class care.  However, it has no automatic right to exist. The NHS needs the next Labour leader and prime minister to articulate a clear vision for the NHS which goes beyond appealing to a distrust of private companies. Their plan for the NHS must focus on the finance and efficiency of health care provision, the integration of health and social care and making the NHS public facing.  Without this we will – again – be talking to an electorate who doesn’t exist, about a false reality, which we have constructed.