Focus: Westminster – Labour finds power is heaven on earthBMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7092.1433l (Published 17 May 1997) Cite this as: BMJ 1997;314:1433
“Small earthquake, not many dead” best sums up the British general election of 1997. Although it swept the Conservatives from power and installed a Labour government with an unassailable majority, the political landscape remains remarkably stable.
The outcome has been accepted with equanimity all round. The electorate is quietly pleased. The civil service is revitalised. And the Conservatives have taken their defeat, the worst for 165 years, with stoicism. As Virginia Bottomley, a former health secretary, put it, they are like survivors from the Titanic.
The Labour party, out of office for 18 years, is still dazed by the scale of its achievement. The new government's majority alone, at 179, is larger than the total of 165 Conservative MPs elected. It is in an impregnable position, which one ecstatic minister likened to being in heaven without having to die first.
Nevertheless, they will come down to earth soon enough. And it may be that the cause of the crash landing will be the parlous state of the NHS. The incoming secretary of state, Frank Dobson, whose first surprise was to find himself in the job at all, rapidly experienced two more. The first was that Labour's election pledge to take 100000 patients off hospital waiting lists is a non-starter. The number of patients on waiting lists is rising faster than the number of extra patients he plans to have treated. Don't expect much rhetoric about shorter waiting lists for a while.
The second hole to appear in Labour's manifesto is the black one of NHS funding. This time, it seems, the wolves really are at the door. Officials have warned Mr Dobson of a potential service collapse next winter (p 1433). Their worry is that the new government is committed to work within the departmental spending ceilings set by the Conservatives. These project new funding for the NHS to drop by one third in each of the next two years. The chancellor, Gordon Brown, who has ordered a fundamental review of public spending, has two chances to rescue the NHS: either in the midsummer Budget or in the public spending round which follows.
Mr Dobson, meanwhile, presses on with manifesto commitments. He has signalled an early attack on “two tierism” and means to clip the wings of GP fundholders. A series of pilot projects will explore GP commissioning and how to dismantle the internal market, in advance of legislation. By far the boldest move comes with the appointment of a minister for public health, Tessa Jowell. Allied to this is more clout for the chief medical officer, Sir Kenneth Calman, in determining health policy (BMJ 1996;312:998). A shake up inside the department of health will acknowledge his new independence.
These moves chime in with the manifesto's recognition that poverty, poor housing, unemployment, and pollution have an impact on health. Ms Jowell's public health remit therefore extends over the whole of Whitehall. She carries the prime minister's personal authority that what she says goes (“of course it impacts on health if you sell off school playing fields and there's too little physical education”).
Action has been initiated to ban tobacco advertising. A central role will be found for the health education authority, marginalised under the Tories. Labour is thereby shifting the emphasis on the health of the nation away from reliance on individual responsibility, as advocated by the Conservatives, to collective government action. Under new Labour, the department of health is the last outpost of socialism.
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