Anthony Painter

There are a couple of strategic points that it is worth making about the opening salvos of the general election campaign over the last couple of days. First let’s start with the Tories.

Their strategy is very clear. There have identified the NHS as a symbol of the new ‘progressive’ Conservative party that they seek to communicate. This makes sense. The NHS is popular, it is seen as fair, and it is seen as part of our essential national institutional architecture. What’s more, in political strategic terms it offers something else. It is of great importance to two key demographics: older voters who are increasing in number and are more likely to vote (they are double in number as twice as likely to vote as younger voters), and young families, who worry about issues such as where they will give birth.

This is all good political strategy and has the added advantage of being clear. The drawback is two-fold. Firstly, there are other public services that people care about as well as the NHS and putting all one’s eggs in a single basket is very high risk. Secondly, it will require the Conservatives to have credible plans for deficit reduction. Just saying that they will do it and do it faster than Labour is not enough. The reforms that have been outlined will be costly- change always is so the benefits may not be felt for a considerable time and the change will be even slower to come through in a very constrained environment.

Labour also has a legitimate claim that much of the Tory manifesto is actually Government policy already: transparency and choice are very much the direction in which the NHS has been heading for a number of years. The major difference is over what the Tories call ‘targets’ and Labour calls ‘standards.’ On this one, Labour is being slightly more frank. The Conservatives propose a regulated system of healthcare. Well, what will the regulators use to assess good or poor performance? It will be standards. So the impact, even in a choice based system is likely to be similar.

The tactical challenge for Labour will be to question the ability of the Conservatives to deliver real change given their broader commitments on public spending. Alistair Darling’s ‘credibility gap’ response is absolutely right in this regard. More broadly, the proximity of the direction Conservatives wish to take the NHS and where Labour is taking it will take it will need to be articulated.

What will be the upshot of this? Labour needs to the close down the NHS to a score-draw or sneak a late winner- Labour has transformed the standard of service in the NHS after all and should get credit for that. The Tories will benefit more broadly from the continuing de-toxification effects of being seen to campaign strongly and genuinely care about the NHS. But the bigger battles- over credibility of the parties’ plans on public spending and the economy- will ultimately prove to be more crucial.

Post script: I was slightly surprised that the Tories didn’t go for personal patient budgets rather than GP-held budgets. Clearly, GPs are the one interest group in the NHS that the Tories are willing to kow-tow to. Surely, if they mean what they say about a completely decentralised (though they carelessly and wrongly use the word ‘democratic’) and patient-focused NHS then personal budgets are the way to go? I’m not arguing one way or the other-just seems strange that they haven’t gone for that given the rhetoric.