Neal Lawson: We should proclaim the moral benefits of the NHS

For the left, choice is a cul-de-sac of insecurity, disillusion and disaffection

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The Budget will help to ensure that New Labour wins the election. But the political hopes of those who are unremittingly New Labour have been scuppered. Despite prudence with a purpose, early election skirmishes have killed off the choice agenda for public service reform, which was to be the central plank of the third term.

The Budget will help to ensure that New Labour wins the election. But the political hopes of those who are unremittingly New Labour have been scuppered. Despite prudence with a purpose, early election skirmishes have killed off the choice agenda for public service reform, which was to be the central plank of the third term.

Choice was killed off by Margaret Dixon's cancelled operations and the bed crisis at Great Ormond Street. To have meaningful choice you must first have excess capacity. If you can't get the basics of routine operations or beds for sick children right, then talk of choice is just that - talk. New Labour's campaign managers must be scratching their heads. It was not meant to be like this. Under Gordon Brown, billions of pounds more have been spent on the NHS, but the re-election team are being rocked back on their heels over accusations of under-funding. Why?

The answer lies in the difference between mechanical and moral reform of public services. New Labour made a virtue out of delivery - what matters is "what works". Service is judged on mechanical terms drawn from the high street. Is it what I want, when I want it and how I want it?

But there is another type of benefit that New Labour ignores: the moral benefit derived from a universally funded health system free at the point of need. It is not just our individual experience of the service that matters, but the very fact that we are all treated the same, have equal worth and equal value. It is the benefit derived from points of common experience, where the values of equality and collectivism take precedent over those of competition and greed.

We feel the benefit when we walk through the doors of our GP or hospital by entering a different world - our hearts lifted by leaving behind the choice, competition and insecurity of increasingly commercialised lives. It is as if the oxygen were different in these truly public spaces. This is the moral benefit we derive from the NHS.

The problem for New Labour is that health services are finite while demand for health resources are infinite. Increasing expectations mean there will always be a Margaret Dixon in the news. The crunch comes when we only promise "what works" - because there always comes a point when it doesn't work. If these are the mechanistic terms of success, they are also the terms of failure.

If the pizza isn't delivered, then you chose another outlet. But if the health service doesn't "deliver", we breed dissatisfaction in collective provision and encourage people to go private. Stripped of the moral case for their existence, public services are left exposed to the withdrawal of our common support every time there is a crisis of funding or a delivery fault.

Sadly, New Labour is repeating the failures of the 1970s, when the post-war settlement broke down because Labour could never deliver on purely mechanical terms. Old Labour's past is defined by this failure to make the moral case for public services. This is not yet a Winter of Discontent, but it is far from a spring of contentment. New Labour set out to save the public sector, but fought on the same mechanical terrain as Old Labour, and is now paying the price.

The moral case for reform can only be made by contesting what it means to be free. The left has failed to offer a rival to the rights definition of freedom for the individual from others. Mimicking the choice agenda of the right was never going to work. The left view of freedom must rest on two compelling beliefs. First, if you cannot afford the bus fare to the job interview, then you are only free in theory to get any job you want. Real freedom demands greater equality. Second, freedom cannot just mean changing ourselves but must also mean changing the world around us. We can't do this alone - only together. So real freedom also demands that we act collectively.

The challenge for a new democratic left in a more ambitious, decentralised, and less deferential world is to come up with imaginative ways in which people want to and can act in concert to change their world - as citizens and empowered co-producers of health and education. This can be the basis of more responsive and accountable public services. Together we should be building hospitals that are cathedrals of collective care - not shopping malls of individualised choice.

The great hope for the democratic left is that, in an age where deference is in decline, people want to take control of their lives. For the left, choice is a cul-de-sac of insecurity, disillusionment and disaffection. The alternative is to manage our lives by doing it together for ourselves. This is what the new social democracy of a third-term Labour government must become. The Tories will always score points on the mechanical delivery of public services; where they can never win is the morality of collectivism and equality, because this is the exclusive space of the left.

neal@compassonline.org.uk

The writer is chair of the democratic left pressure group Compass

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