Column

A little of old Labour does good

While recent cash injections confirm support for the NHS, Labour remains ambivalent on private health care, says Charles Webster

In the early summer the Comprehensive Spending Review understandably released a tide of euphoria within the health service. A Guardian editorial described spending on education and health ‘of socialist proportions’, while Hugo Young described it as evidence of ‘oldness in New Labour’. The spending review provides the main evidence that New Labour is, after all, living up to its pre-election promise to revive the NHS. Frank Dobson seems to have achieved the kind of spending objective that frustrated the efforts of every one of his predecessors, including such illustrious names as Bevan, Crossman and Castle.

This new settlement is important because it provides evidence with respect to the health service at least, that New Labour retains meaningful links with its roots. Glancing back to the 1983 general election manifesto, The New Hope for Britain, can usefully test this conclusion. This notorious and much-maligned document is euphemistically called old Labour’s lengthy ‘suicide note’. However, this manifesto should not be dismissed out of hand. It remains one of the few election manifestos in which Labour paid more than token regard to health. And it provided the framework of policies that guided Frank Dobson as Labour’s front bench health spokesperson from 1983 to 1987.

The 1983 manifesto provides instructive similarities and differences with regard to the current situation. As a general statement of policy, the 1983 manifesto almost reads like a mirror image of the policy statements refined by Labour’s current spin-doctors. Predictably, the NHS is described as ‘one of the greatest achievements of the Labour Party’. The Tories are censured primarily for starving the NHS of resources. The manifesto is most remembered for Labour’s promise that it would increase health service expenditure by 3 per cent per annum in real terms. This attracted ridicule at the time and was taken as conclusive evidence of Labour’s unfitness to govern. But with its new spending plans, the Blair government is set to increase health spending at an average rate of 3.7 per cent over the life of the present parliament. This great boost in health spending is now accepted without demur; neither the political Right nor economists are claiming that the new commitments are beyond the pale of financial rectitude. Among other things, the present settlement provides a degree of retrospective justification for Labour’s 1983 prescription. Had this been followed, the NHS would not have drifted into the state of neglect that has constituted such a national disgrace.

In 1983, Labour also promised to defend the basic principles of the service, promising that it would be free at point of use and funded out of taxation, and that priority would depend on medical need not ability to pay. In the furtherance of these principles, Labour promised to phase out health charges and ensure that existing health inequalities would be erased. New Labour has kept reasonably to these guidelines. The government has dispelled uncertainties by promising not to introduce new charges before the next election, although the only step towards the elimination of direct charges is the token concession of removing the deleterious charge for eye tests for older people.

With respect to such objectives as greater priority to prevention or improvement in the specific service sectors, there is little difference between 1983 and 1998. However there are also some sharp differences in emphasis, two of which are particularly striking. First, the 1983 policy statement gave prominence to the need to ‘ensure that NHS staff receive a fair reward for their work and dedication’. In pursuance of this objective, Labour promised to discuss with the TUC new arrangements for pay determination and the resolution of disputes. The emphasis is now entirely different. Consistent with its public sector incomes policy, the government insists that the extra resources for health care must not be swallowed up by pay. This conclusion is of course most unappealing to the underpaid and demoralised workforces in both education and health, which constitute the greatest asset of the respective services. The government must learn from Old Labour to accept that justice over pay and a proper degree of industrial democracy are absolute requirements for the viability of the health service.

The second difference between 1983 and 1998 relates to the attitude to the private sector. In 1983, a distinctly adversarial attitude was taken against all things private. The manifesto expressed a determination to prevent the advance of privatisation and the development of a two-tier health service. By 1998 privatisation had become an accomplished fact. As indicated by its attitude to the Private Finance Initiative, Labour is entirely ambivalent about its approach to what is now called ‘private-public partnership’. Mr Blair’s government is not falling into line with the previous government’s doctrinaire assault on public sector provision, but Labour’s public service aspirations of 1983 are unlikely to be revived. For instance, in 1983 Labour proposed to take a major public stake in the pharmaceutical industry. Perhaps it was intended to take over Burroughs Wellcome and absorb the notoriously wealthy Wellcome Trust. Such dreams of greater state intervention in the pharmaceutical industry are forgotten, allowing Burroughs Wellcome to be swallowed up by Glaxo, while the Wellcome Trust has come to overshadow the Medical Research Council, placing the state in a poor relation position with respect to medical research. This microcosmic instance is a reminder of the extent to which power in health care has drifted away from public bodies and into the hands of corporations motivated by profit, which is precisely the opposite of what Bevan intended when the health service was established.