Jackies Pro Sports News - Rumors - & Scandals: Ed Miliband shouldn't crow. It's time to move closer to Clegg

The NHS cuts fiasco offers an opportunity for the Labour leader. By working with the Lib Dems he can reshape the reforms

Three thoughts. First, the great national health fiasco represents Labour's greatest opportunity since the coalition was formed. Second, it represents Labour's greatest challenge, one the opposition might flunk. Third, this really is about the future of our most loved national institution, and is far more important than ups and downs at Westminster.

First thought, then: the obvious thing about the disintegration of Andrew Lansley's badly designed NHS changes is that from the start they looked unlikely to work. Demolishing every primary care trust (PCT) in the country, opening up far more commercially based competition, and forcing GPs to become the purchasers might have looked good on paper. Doing this in practice, so that PCTs had to act as midwives to yet another new structure, while committing institutional suicide ? and achieving both to a strict timetable ? never seemed sensible.

Obliging every GP practice to buy new administration, offices and software, so they could make essentially commercial decisions, always looked bad for the relationship between patient and doctor, as well as horribly expensive. Doing that while imposing a real terms squeeze on spending ? well, we hardly need to dwell on the problems, so lucidly spelled out by virtually every professional body involved.

Had the Conservatives won an overall parliamentary majority, then the Lansley plan would have been rammed through. It is thanks to the coalition, and the hammering the Liberal Democrats got in the local elections, that we now have this "pause". David Cameron should thank his lucky stars for Nick Clegg. We keep being told about the drawbacks of coalition government; sometimes we should reflect on the advantages.

Labour now has the opportunity in the Commons to start to unpick the bill, using temporary alliances with Lib Dem MPs to destroy the original timetable, insert tougher safeguards against privatisation, and defend some of the earlier structure of the NHS. If it can't win some major victories over this, it barely deserves the title of official opposition.

Second thought: opposition is not nearly enough. Labour poured money into the NHS during its years in office and made some important improvements. Doctors and nurses were better paid. Major new facilities were built. Waiting times came down. New drugs were funded. Some of the old horror stories disappeared from the papers.

Yet there is almost nobody who'd say Labour got what it hoped for from all that extra money. Productivity barely moved. Dirty hospitals, poor cancer survival rates, bad nursing care for chronically ill and elderly patients, and rows about the NHS's inability to afford new and useful ? if pricey ? therapies, abound. Clegg put it well in his speech last week: "We have too many patients, spending too long in hospital, taking too long to get better."

Thanks to the coalition, we also now have PCTs and hospitals that are confused, low in morale and have no clear idea of their future. What may seem a good political win for anti-Tory forces at Westminster feels like mayhem on the ground. No responsible politicians can afford to feel happy about "the pause" and the giant question-mark hanging over the structural future of the NHS. Labour has to have its own plan, which advances its own thinking post-government. Oppositionism, like patriotism ? as a nurse once put it ? is not enough.

So, to my third thought: this is far more important than party politics, and should be approached as far as possible in a non-partisan spirit. Labour will get more credit at the next election for helping guide the NHS through a crisis than for splitting coalition politicians, or winning votes in some committee.

I've had a lot of personal experience of the NHS recently, with family members. And many of the problems are just the ones Clegg has identified: a lack of joined-up care, wasting beds, resources and money, lack of convalescent care, appointments cancelled, endless waiting. A few commonsense changes could cut the number of people who end up back in hospital shortly after being discharged. To achieve this, the people running hospital services should have more accountability and more authority ? and that means more freedom.

Labour has to drop its historic determination that the NHS must be the same everywhere; that one structure, one attitude to buying in services, one set of rules set down by Whitehall, is at the heart of the post-1945 settlement.

Because the truth is that the health service is different in different places. In some south coast towns it is heavily weighted to geriatric care. In rich London boroughs, or the wealthy Wirral ? where a high proportion of people have private healthcare and use it frequently, but where there are many very poor migrant workers ? the challenges are different from those in county towns or, say, Birmingham.

In some places, a single primary care trust may be working very well. In others, it may be right to give more commissioning power to GPs. All the parties talk about listening to patients, and accountability. But how this listening is to be done, and how accountability is achieved for the whole community, hasn't been worked through.

The NHS needs change, always. Patient profiles change, drugs change, expectations change, funding changes. In today's varied country, change needs to be piloted, tried out and copied, rather than being rammed through on a strict political timetable. But it also needs to be protected from profit-hunting private medical corporations. Millions know what happened to their pensions and savings "looked after" by shiny new private providers. They don't want the same to happen to their bodies.

I come back to Clegg's speech. Family doctors should only take on new responsibilities when they are ready and willing. Tiers of NHS management shouldn't be swept away overnight. "There'll be no sudden, top-down opening up of all NHS services ? We should be opening up services that patients and communities want to be opened up ? in a planned, phased way."

This is sensible and realistic. Labour intensely dislikes the Lib Dems for their embrace of the Tories, but the thoughtful thing to do now is to work with the Lib Dem critics to reshape the health reforms. As Cameron, observed by a lip reader, seemed to make clear to Clegg while waiting for President Obama's speech, Lansley is no longer in charge. But rather than crowing about that, Ed Miliband should co-operate with Clegg. When it comes to the NHS, playing clever politics would be stupid.

Jackie Ashley

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