Jeremy Hunt and Andy Burnham both have clear ideas about what they want for health policy but, both are being constrained by their party leaders
There are plenty of stories on health but both the Conservatives and Labour are failing to tell their story on the NHS.
Given the media interest in the issue this seems bizarre, but it is the case. How has it happened?
‘Hunt has hardly been kept out of the headlines but his ability to make them has been constrained’
Those on the receiving end of the secretary of state’s weekly stocktakes on his priority issues would doubtless argue that the pace has hardly slowed. Yet we hear less about it in public; announcements are rationed.
Govern in prose
Hunt has hardly been kept out of the headlines but his ability to make them has been constrained.
This is not an approach of his choosing. It is a consequence of Number 10’s desire to focus on key issues where it feels it has an electoral advantage, notably the economy and education.
The approach of not giving airtime to your weaknesses (and Downing Street knows that health is one of them) may work in the heat of an election campaign but is much harder to pull off during the normal process of governing.
Issues not of your choosing mean that it is very difficult to keep areas of public service delivery quiet for prolonged periods of time.
In the US, Democrat Mario Cuomo once said that although politicians campaign in poetry they must govern in prose.
The noisy NHS
The problem in health is that it generates an awful lot of prose, much of it not too complimentary. The public craves health stories and there are plenty of tales out there.
If the government doesn’t want to tell its own story on health then plenty of other organisations will happily do so. Recent weeks have seen different health issues on the front pages two or three times a week.
If the strategy is to not speak about health in the hope that no one will notice it, it is failing.
Part of Hunt’s appeal to David Cameron when he was appointed as health secretary was his ability to communicate. Yet the Conservatives’ strategy is limiting his ability to do so.
Far from reducing the salience of health, the NHS is a noisy as ever. The difference is that the papers are full of stories that are not of the government’s choosing.
‘If the strategy is to not speak about health in the hope that no one will notice, it is failing’
Labour faces a similar problem, albeit for very different reasons. Andy Burnham has forsaken some of the usual tactics of opposition in favour of making the case for big picture reform.
He has passed up opportunities to match and neutralise the government’s “retail” health policies and has been curiously reticent to announce his own populist measures.
His pledge to repeal the Health and Social Care Act might play well with activists but it means less on the doorstep.
With the NHS still recovering from the last structural upheaval, promising an even bigger one is quite a gamble. It is made even bigger given that neither his leader nor the shadow chancellor has signed off the policy.
The storytelling challenge
If Burnham bet the manifesto on “whole person care” then every indication is that the gamble has not paid off.
Judging by recent briefings to the media, Ed Miliband has not been persuaded either. Labour’s public debate over the issue has resulted in a very public disavowal of one of the two policies Burnham is most closely identified with.
What is more Miliband’s recent remarks – about how vested interests in the public sector must be attacked in the same way as those in the private sector – hardly sound like a ringing endorsement of the other policy Burnham is best known for: that the NHS should be the preferred provider.
‘An absence of stories on the NHS will not be an issue in the run-up to the election, but an absence of clear narrative from both parties may be’
Whatever you think of Burnham’s ideas, it hardly leaves him in a strong position to tell a clear Labour story on the NHS when two of his central ideas appear to have been challenged in such a clear way by his own leadership.
Of course the publication of the proposals from Sir John Oldham’s integration commission – which is imminent – may result in fresh ideas but, even if it does, it will leave a diminished secretary of state to communicate them.
Both the Conservatives and Labour face a challenge in telling their story on the NHS. Unusual bedfellows Hunt and Burnham find themselves in a similar position.
Both have clear ideas about how they want to set out their stall on health but both are being constrained by their party leadership.
An absence of stories on the NHS will not be an issue in the run-up to the general election, but an absence of clear narrative from both parties may be.
Mike Birtwistle is a health policy consultant and founding partner of Incisive Health