The 10 year plan won't win Labour the keys to Number 10

Last week was the culmination of Labour’s “health month”. Such initiatives are much loved by political tacticians but are frequently derailed by news cycles that do not conform to political grids.

For Labour, January was rather more obliging.

The month started with a blizzard of headlines about a health service in crisis. Newspaper front pages like those seen in the first week of 2015 must have made the government fondly recall the rows over the passage of the Health and Social Care Act as spats from an easier time.

‘Detailed planning requires heavyweight policy capacity, which tends to reside in the civil service, not political parties’

Many voters are turned off by the politics of health (or just politics), but the performance of their health service is a different matter.

With health jumping to the top of voters’ list of priorities, the NHS looked like an open goal. Accident and emergency issues, cancelled operations, Hinchingbrooke and rows over ambulance guidance were all successfully “weaponising” the NHS without too much intervention from Her Majesty’s Opposition.

Mixed response

Yet the month ended on a less encouraging note. Labour’s 10 year plan for health and care met with a mixed reception, attacked by some on the right of the party in what looked like a carefully planned operation, and bogged down by rows over the extent to which private sector involvement would be reduced.

‘Labour’s Zero-Based review of spending could be truly transformative’

In opposition, developing a ‘plan’ is always a risky business. Detailed planning requires heavyweight policy capacity, which tends to reside in the civil service, not political parties. The help of a few experts is hardly a substitute.

When your mantra is no top down change, with reform instead being locally led, the task becomes even more challenging (what exactly goes in a plan if you can’t set out how change will occur?)

The result is a document that admirably summarises Labour’s view on health but does little to fill in the gaps in policy.

At 18 pages – a mere 1.8 pages for each year of the decade – it is more of a position than a plan. The NHS Five Year Forward View was, of course, also not a detailed plan (but never claimed to be).

Feeding the electorate

Given Labour’s public support for the view’s direction, there is a question as to what flesh this puts on the bones of its health policy.

There are undoubtedly interesting and fresh ideas within Labour’s policy. If its Zero-Based Review of spending does indeed focus on how improving outcomes can avert costs on issues such as mental health and cancer, then it could be truly transformative.

But these are announcements for another day, probably long after an election has been fought. They alone give little new material to those who will be seeking to make Labour’s case on the doorstep.

‘Without details on the mechanics of change on integration, there is no story here’

Andy Burnham’s challenge is that his big idea – bringing health and social care closer together – is actually one that his opponents seem to agree with.

The very fact that the plan received a cautiously positive reaction from many health watchers, including HSJ, is also the reason that it will not get cut through with the mainstream media; “unglamorous” is usually not newsworthy.

Without details on the mechanics of change on integration, there is no story here. Making a virtue of bottom-up reform may be one thing, but it does somewhat strip the “so what?” from the story.

This is compounded by the fact that most of the doorstep friendly policy commitments on staffing, cancer waits, mental health and prevention have already been announced, meaning attention quickly drifts to the big unanswered questions: competition, the role of the private sector, meeting the funding gap.

Keeping health in the headlines

Labour should not be too dismayed by this. Whenever journalists talk about health, it is probably a good thing for Miliband.

If, according to Tory strategists, every day the government doesn’t talk about the economy is a day wasted, then every day the media discusses the NHS is a productive one for Labour, even if not all the coverage is flattering.

The weather tells us that winter is far from over and the government will need to navigate many difficulties this side of May, keeping health in the headlines.

‘As the dust settles on Labour’s 10 year plan, it is clear that it has not yet sealed the deal with the electorate’

From problems with waiting times to cancer treatment cuts, plenty can still go wrong for the Conservatives when it comes to the NHS. Yet relying on events is never a comfortable position for any political party to be in, particularly with Labour staking so much on the NHS.

There is also the challenge that political debate might not match public perception, let alone reality.

The King’s Fund has found that public satisfaction – admittedly measured before the onset of winter – is at an all time high. Health may be the public’s number one concern, but it is far from clear that voters believe some of the more extreme rhetoric about the threat facing the NHS.

As the dust settles on Labour’s much vaunted 10 year plan, it is clear that it has not yet sealed the deal with the electorate, nor has it plugged the gaps in policy that concern NHS watchers.

With three months to go to polling day, it was never going to.

This all leaves the opposition with some work to do, both in addressing some of the difficult questions it will face on policy but, more importantly, in capturing the attention of voters.

Mike Birtwistle is a founding partner at Incisive Health