As someone who believes that a Labour government would be a calamity for Britain, I ought not to mind the recent fuss about NHS Wales. Yes, it is a disaster – as the Daily Mail has been cleverly highlighting. And it has been run by Labour for 15 years, so they’re guilty as charged. Jeremy Hunt, the Health Secretary, makes this point powerfully today. But if the English NHS is much better by comparison to Wales, it’s not because of him, nor because of David Cameron. It’s because of Tony Blair.
The NHS in England was prescribed a heavy dose of market reform by the NHS Plan of 2000. This brilliant, radical and enduring document was written by three people born in the same Birmingham hospital: Alan Milburn, Darren Murphy and Simon Stevens. Milburn was Blair’s Health Secretary, Murphy was his adviser and Stevens was a former NHS manager advising Blair (recently hired by Cameron to become chief executive of NHS England).
Three years into his premiership, Blair had realised that Ken Clarke had been on to something with his internal market. The Blair/Milburn/Stevens reforms expanded it, to a degree that even the Thatcher government did not dare imagine. Competition between hospitals was introduced, and patients were given the choice of going to a private clinic for routine operations. Milburn redefined the NHS as a means of paying for healthcare, not necessarily providing it. It was, in effect, perestroika for the NHS.
But there was none of this reform in Wales. Its new devolved government had control over health, and used its powers to reject the Blair agenda. Welsh Labour would congratulate themselves on their principled opposition, saying that Wales was a smaller country that didn’t need stuff like patient choice or private providers. Gordon Brown, brooding in the Treasury, quite agreed: he hated market reform (and put it into deep freeze when he became Prime Minister) and thought that stuffing the NHS with cash would be quite enough.
So an experiment started. A game of health Pooh-sticks. NHS England and NHS Wales were given the same mammoth funding increases, but NHS England was reformed along Blair’s lines and NHS Wales carried on in the Old Labour style. Such reforms take ten years to bear fruit, so the results can only be seen now. Blair was right, and Brown was wrong.
One of the cleverest moves that David Cameron has made is to poach Simon Stevens back to run NHS England. (I write about this in my Daily Telegraph column today). After spending years in America, Stevens knows more about NHS problems and market solutions than any man alive. He has also learned from mistakes of the Blair era. Merging hospital units, for example, has not helped much. But the market reforms do help. Diversity of providers does help. After sending IDS to welfare and Gove to education, the recruitment of Stevens to the NHS is the third-most important hire that Cameron has made.
No political party has an exclusive claim to the reform agenda. It has been picked up by all parties, in their bolder moments, over the years. You can, if you want, trace the Blair reforms to Ken Baker’s school reform and Ken Clarke’s health reform – and refer to the Clarke/Blair/Milburn/Stevens/Hunt NHS-reform agenda. Or the Baker/Blair/Adonis/Gove school-reform agenda. Success normally has many fathers, but reform is an tough and unpopular business (see, for example, how Gove has been rewarded for his efforts).
If Ed Miliband had any sense, he’d be mocking the Tories for copying successful Labour health reforms, rather than denouncing them for privatisation. But here lies the problem for Labour: its politics are now more Welsh than English. Miliband has disavowed the Blair reforms in health, education and welfare. IDS and Gove have succeeded, mainly, by continuing successful experiments started under Blair. This explains why Lord Freud, a former Labour welfare adviser, is now doing the same job under the Tories. Simon Stevens’s recruitment also embodies the linearity – he’s a Blairite working under the Coalition.
But Ed Miliband has severed these links, divorcing his party from its successes. The Miliband project is about resurrecting Old Labour, about trashing the memory of Blair and rushing forward to embrace the 1970s. That’s why NHS Wales is a fairly accurate indicator of where Miliband would take Britain.
It now suits conservatives to blame NHS Wales on the Labour Party, but the truth is rather more complicated. Lazy, applause-seeking politicians in Cardiff Bay rejected the Blair reforms, and Welsh patients are now paying the price. It (now) doesn’t suit anyone to admit it but if NHS Wales vindicates anything, it vindicates the Blair reforms.
PS. The same is true, alas, for Scotland, whose politicians declared the country too pure to be defiled by private NHS clinics. Such ideology deprived Scots of the reduced waiting times enjoyed by English patients, as this study shows.