This week: Jonathan Ashworth MP
Why he matters: Jonathan Ashworth is the MP for Leicester South and has been shadow health secretary since 2016. A thoughtful performer, he has won respect across Parliament and the health policy scene for choosing broadly sensible and thoughtful themes for his opposition programme.
Jonathan Ashworth claims his time in frontbench politics has shown him “there are three big challenges facing the country: climate change; the changing nature of the labour market with automation and [artificial intelligence]; and life expectancy and health inequalities.
“That’s why I think any party needs strong health inequalities policies beyond [the NHS]. [We should] invest in early years, poverty and criminal justice and maximise the social value of every pound [spent by the NHS].
“In the ‘red wall’ constituencies, the NHS is often the big skilled employer offering quality jobs with good pay. So, the NHS itself can be a big contributor to dealing with social inequality. If we’d won the general election, we wanted to introduce a Wellbeing Act to put specific health inequalities duties on the NHS.
“I really wanted to get into the idea that the NHS is not just a sickness service but is for health and wellbeing — and remembering that the NHS is (or should be) using its funding to narrow health inequalities.”
Mr Ashworth describes last month’s report from Sir Michael Marmot on the changes in health inequality during the last decade as “shocking and depressing — but in some way unsurprising”.
He observes that health inequalities are rising, particularly in areas which have traditionally supported the Labour Party but who switched allegiance at the last general election.
“We lost North-West Durham, Bolsover, Stoke, Wolverhampton — these have been Labour seats forever and ever. These are the areas where life expectancy has decreased for the poorest and Labour now has much soul searching to do about why they were not convinced to trust us to form a government.
“This election came during [a period in which] the NHS was in one of its worst winters ever. Where we had weekly news headlines of elderly patients on trolleys, and those pictures of the young boy on the floor at Leeds General [Infirmary]. And for those voters, even understanding that this was a real desperate NHS crisis, they couldn’t trust Labour. Whoever leads Labour next, rebuilding that trust must be the number one priority.”
Mr Ashworth notes the Marmot report is very effective in highlighting the “deaths of despair” occuring in some communities. He adds this phenomenon is “all too familiar in the USA healthcare world, [with] increased mortality in people in their 40s, dying from drug overdose, alcohol overdose or suicide.
“The data shows it’s very prevalent in our deprived coastal towns such as Blackpool. This issue should provoke an urgent government response. I’ve put a lot of emphasis on alcohol abuse and harms to health, because of my personal background. One challenge to this government, with an 80-odd Commons majority, is can it be brave on addressing wider determinants of ill-health?
“Fifteen years ago, we could have been sat doing this interview with ashtrays on this table. But the idea that I might light up is now a weird one. Social attitudes to smoking were completely changed by the smoking ban in bars and workplaces, but it was controversial at the time of its introduction: the tabloids criticised it; people asked [if it] would it be a vote-loser.
“But now there’s consensus around the smoking ban. So, the government could be braver on [for example] alcohol pricing and drug misuse.”
Mr Ashworth continues: “As with everything affected by austerity, we can’t get away from the funding issues. Public health doesn’t know what its budget is! [Directors of public health] don’t have their public health funding allocation for April.
“And, of course, I’ll argue the NHS is still not funded properly. Even if you accept the government thinks it’s given the NHS enough, broader child services still do not have proper funding. We’re going to see higher child poverty levels than there were under the Thatcher government. If Matt Hancock and Boris Johnson are serious about levelling up [society], then they must tackle the threats Marmot has (again) identified.”
Social care will be devastated
The Labour health shadow believes the government’s proposed changes to immigration rules will be “absolutely disastrous” for the UK health and social care sector.
“We know the social care sector is teetering as it is; we know it’s hugely reliant on international recruitment; we know there are about 120,000 vacancies in social care, and so we know Priti Patel’s proposed immigration rule changes will absolutely hinder social care providers’ abilities to recruit. It’s all very well her saying that 8 million Britons are economically inactive in the labour market, but these people are mostly pensioners or students!
“Second, the Home Office attitude to calling these people unskilled is deeply offensive. It may be a low waged sector, but people caring for adults with disabilities, or elderly with heartbreaking illnesses like dementia, are certainly not low-skilled.”
Mr Ashworth understands the proposals indicate there will be some NHS exemptions, “but nurses are still expected to pay huge visa charges. Matt Hancock talked of this great NHS international visa, but overseas applicants for NHS jobs still get asked to pay for coming here to care for our sick and elderly, and they’re also being charged for their families’ eligibility for public services. These changes would devastate social care and hinder NHS recruitment, now and for the future.”
My money’s on Simon Stevens
“If they deliver them, absolutely… The test is can they deliver these promises, and get waiting lists down, as Boris Johnson promised recently at the Commons despatch box.
“A lot of people are very sceptical. I’ve seen no serious think tank or expert saying that the government has put in enough extra money for the NHS to be able to deliver on these promises.”
The Times recently reported that Boris Johnson’s chief adviser Dominic Cummings “… believes that at present the law gives Sir Simon Stevens, the head of NHS England, excessive freedom, making it hard for Downing Street to impose its will”.
Mr Ashworth responds: “There needs to be a strong voice on behalf of the NHS to speak truth to power; to advocate and win arguments for the NHS as the secretary of state doesn’t have the expertise to do that.”
However, he admits “Labour would have reinstated the secretary of state’s responsibility for arranging to provide healthcare” which was amended in the Health and Social Care Act 2012. He believes the government “want control as they still feel they’re held to account”.
This debate may come to a head when the government’s proposed legislation for reforming the NHS begins to be drafted.
Mr Ashworth grins: “I’d mischievously suggest Simon Stevens is a far more effective politician than Matt Hancock, so in that situation, my money’s on Simon Stevens.”
In any case, he detects some confusion in the government’s stance.
“The government is trying on the one hand to brief that they need more powers of direction over the NHS; and on the other to say that they’ve given NHS England the money [it] asked for, and that means NHSE [is] the [one] responsible and will be held to account.
“The secretary of state still sets the NHS mandate, and he should report to Parliament if the NHS is meeting constitutional standards, and if not, why not.
“Mr Hancock can’t hope to travel around the country announcing hospital rebuilds with Tory candidates during the general election campaign and expect a political bonus while running away from his proper accountability for the NHS’ performance.”
The public didn’t get what we were talking about
In the aftermath of Labour’s crushing general election defeat, does Mr Ashworth think it was wise for Labour’s campaign to focus on NHS privatisation, when the service was in the middle of a performance and workforce crisis?
The shadow health spokesman’s answer is diplomatic but telling.
“Activists on the ground have legitimate concerns when they see a contract for health visiting, lab tests or cancer scanning going to a private sector firm.
“I don’t think it’s as simple as saying that ‘this should be all about quality of outcomes’. The more I see of competitive tendering, the more I realise that way of working is wasteful and creates more fragmentation, and I believe it is often offering poorer quality service.
“Look at patient transport, with the awful performance of Coperforma on the South Coast, also Private Ambulance Service Ltd and their predecessor firm in Bedfordshire and Hertfordshire, and it’s shambolic. Constant outsourcing or privatisation or competitive tendering hasn’t worked, and we wanted to bring those services back in house.
“In our general election campaign, there was a lot of emphasis on Trump and trade deals. Trade deals do tend to lock in liberalisation of public services, and in a prospective government trade deal with US, we could be locked into the status of a treaty, so a government trying to unpick aspects of liberalisation for the NHS would be liable to be taken to an international tribunal.
“But if I’m honest, the British public didn’t quite get what we were talking about with the focus on Trump, and not on the NHS elective waiting list of 4.5 million, or the 30,000 people waiting beyond two months for their cancer treatment, or the huge child and adolescent mental health pressures.
“I wanted to focus on those and hammer the government, and if you look back on our ‘NHS Rescue Plan’, our announcement of extra funding was linked closely to improving waiting times, cancer and CAMHS. I wanted to campaign on those themes, as they matter most to patients for very understandable reasons.”
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