Introduction

If a week is a long time in politics, then 18 years can change politics altogether. When Labour left office in May 1979, the National Health Service was in what the jargon would call a steady state. The Royal Commission on the NHS had basically given it a good report card in terms of financing and structure. In their 1979 election manifesto, the Conservatives did not promise significant change, focusing their energies instead on the economy and related issues such as trade union power.

In their 18 years out of office, Labour's health policy became reactive to Tory policy. The fact that Labour was both ideologically and practically committed to a model for the health service which involved public financing and public provision meant that what had been a radical policy in 1945 was a conservative policy 40 years later (and none the worse for that).

This chapter addresses two main themes:

• • Is New Labour policy different to Old Labour?

• • Has there been a convergence between Labour and Conservative policy?

In the case of health policy, the two questions are arguably even more closely related than in other areas. Hypothetically at least, New Labour policy is different to Old Labour because Labour's new health policy is a direct inheritance from Conservative policy. In that sense, it does not so much mean a convergence between Labour and Conservative policy as either adoption or adaption by Labour of Conservative policy from the outgoing Conservative government. Labour's policy may be conservative as defined by Disraeli – first opposing change, then adapting it. In other areas of social policy, convergence may be a more accurate term as well as a convenient one. New Labour has adopted many of the tenets of the ‘new welfare state’, different objectives and different policies have been articulated, at the level of a different emphasis at least, in areas such as education and employment. However, in health New Labour strategy is to seek to ‘tidy up’ the consequences of the internal market, inherited from the Tories. This chapter first examines Conservative health policy since 1979. It then outlines Labour's evolving policy, including aspects of policy implementation, before moving to assess Labour's new healthcare state.