Although discussion of the NHS has dominated much of the election debate, there has been little scrutiny of how Labour would run the NHS. The party’s focus has been on attacking the Tory record, making spending pledges and raising the existential fear that the service is “for sale” to Donald Trump.
This will not surprise many — there is an election to be won after all. But any government in waiting should be able to set out in some detail how it would run England’s most valued public service.
For at least 18 months, HSJ has sought an in-depth interview with shadow health secretary Jon Ashworth to properly explore how a Labour-run NHS would operate. The answer was always: “Yes, but not just yet.”
HSJ’s coverage of Conservative health policy has been, of course, an ongoing affair, as they have been in government. It has included many interviews with ministers. With the arrival of a general election there are naturally more questions to ask of an opposition.
Some of these questions were answered by the Labour party manifesto, but not all. The document also created some new areas of uncertainty.
On 3 December, we sent Mr Ashworth and the Labour party press office a list of 24 questions we believe NHS leaders need answers to. After an initial “no”, we were told on 6 December that an interview would happen. Radio silence followed.
At 3:03pm on 10 December, HSJ had just finished writing an editorial expressing its alarm at reaching election day without fully understanding what a Labour governement would mean for the NHS. Then — out of the blue — Mr Ashworth rang and said: “Shall we do this interview then?”
We are now a little wiser as to Labour’s plans. Which, lest HSJ be accused of bias, appear to offer the best deal financially to the NHS, and crucially to other public services like housing and welfare which keep people from needing care in the first place.
But why had Mr Ashworth finally chosen to speak to HSJ on the record? He was after all knee deep in a last gasp dash round the radio and TV studios trying to make the most of the belated focus on NHS performance produced by the Daily Mirror’s front page and the prime minister’s strange behaviour.
Might it be because, earlier on Tuesday, a betrayal by a so-called friend had effectively scuppered his chances of being made health secretary in a Labour government? Meaning, in other words, he could finally speak freely.
Mr Ashworth and those around him have known that any answers to HSJ’s questions which might increase his credibility with healthcare leaders, could easily risk a backlash from NHS campaigners, both inside and outside the party, who exercise significant influence on its leadership.
The views which can be expressed by Mr Ashworth and other Labour shadow ministers are also complicated by the role of the party’s annual conference and other policy setting fora in deciding what gets done and when.
This might mean a cabinet minister ending up being tasked with implementing a decision that cuts across their own plans. HSJ readers can no doubt imagine the kind of idea which might win favour amongst the partisan fervour of a party conference but could prove difficult or counter-productive to execute.
In other words, one of the reasons we still do not know a lot about how Labour would run the NHS is because the party itself does not really know, and/or has not fully thought through how its commitment to party democracy can be squared with the day to day endeavours of one and a half million NHS staff.
Mr Ashworth has so far managed the tricky balancing act of not getting into hot water with either the NHS or his own party with some skill, much charm, and a little subterfuge, for example when it came to avoiding difficult situations like an HSJ interview. That balancing act was on Tuesday upset in the cruelest way.
The Labour health shadow is a good man who has won the respect of many NHS leaders. HSJ hopes he keeps his job — whatever the result of the election.
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Nobody really knows how this Labour party would run the NHS