Over the last few weeks I have occasionally mentioned that I was working in Whitehall in 2002, the last time the NHS received a significant increase in funding. I thought that, now that the publication of the NHS long-term plan is imminent, it might be interesting to share my experience of being a special adviser to Alan Milburn during that winter of 2002 when the government had pledged to increase the NHS budget.
In some respects things in 2002 were very similar to 2018.
In the same way as our current Prime Minister hijacked the Chancellor’s October budget by making an announcement of extra NHS funding in June, Tony Blair announced the 2002 increase on the Marr programme a few months before the budget. Both Chancellors were less than amused.
But really that’s where the similarities end.
In the winter of 2002 we had the enormous advantage of having an NHS plan that had been published about 18 months earlier. It had been endorsed by nearly all organisations that were a part of the NHS and we had, therefore, many policy drivers that had already been agreed. The money was then the last driver to bring about the changes which were built on top of policy agreement. When the document was published in April 2002 – when the money was finally announced – it was called Delivering the NHS Plan. Unlike this time around we didn’t have to announce our policy intentions as they had already been established. All we had to do was announce the plan’s delivery.
This time the plan is being developed in the few months after the extra money has been announced.
In June 2001 New Labour had been returned with a majority of over 140. The size of that majority was significant as it meant that we could plan for the rest of that Parliament with very little chance of political change.
Now what is being called the ‘NHS long-term plan’ is scheduled to be announced in the week before a vote on Brexit that could just result in the fall of the government.
At the 2001 election New Labour had a large mandate to reduce maximum waiting times for patients. Whilst there was a lot of anxiety within the NHS about whether these targets could be achieved, the then government had no doubt about that this was the highest priority which the public expected us to keep. There was a lot of detail in the plan but reducing maximum waiting times was a clear and consistent outcome.
This time around there is no clear mandate from the Government’s 2017 manifesto which it can insist on the NHS meeting.
The 2001 manifesto also gave the then government the drive to start talking about the policy mantra of investment + reform. By the time the investment was actually agreed – in the early winter of 2002 – the public narrative of the government was to link the two issues of investment and reform in the public mind. This didn’t mean that the reforms were as popular as the investment! But it did mean that the two issues were firmly linked.
Now there is no public narrative from the Government other than the money. It is almost certain that the long-term plan will link something to the investment, but the public has not been warned about it with a narrative – in the way they were in 2002.
In June 2001 New Labour set up the Prime Minister’s Delivery Unit which meant that by the spring of 2002 we, in the then DH, had detailed assistance from a number of specialists whose job it was to construct delivery chains to make policy intentions real. So from May 2002 we could walk through these chains to see what might and what might not work.
Since David Cameron (remember him?) abolished the Delivery Unit in 2010 there is no longer any interdepartmental expertise for either turning policy into delivery or monitoring the process on a monthly basis.
And I suppose last, and not at all least, the uplift for the NHS budget in 2002 was much greater and was pledged for 10 years, not 5. I remember attending a meeting in the Treasury in 2002 when a senior civil servant rather plaintively said to me “One day in the future you will need the Treasury again”.
But if a week is a long time in politics,10 years of increased funding was a veritable aeon of certainty with which to plan in 2002.
I don’t know how those creating the NHS long-term plan feel at the moment, but doing anything with the phrase “long-term” in the title seems a bit at odds with the prevailing political atmosphere.