Despite the significant public debate around the Health and Social Care Act, the government’s radical reforms to the NHS are continuing apace.

Labour’s current position is to reverse the main thrust of the reforms, which is to introduce greater competition in the NHS. Ed Miliband has called on local authorities, who will start taking on health commissioning responsibilities from this autumn, to act as the ‘last line of defence’ against the controversial act, presumably by blocking moves to source services from the private sector. But I believe Labour councils will of necessity have to do the exact opposite, and that this will ultimately lead to a more centrist health policy nationally.

Within the alphabet soup of new bodies created by the Health and Social Care Act, embryonic clinical commissioning groups and health and wellbeing boards are now established in most areas of England, ready to ‘go live’ in shadow format this autumn. While CCGs will chiefly be in charge of buying and organising local care, it is the health and wellbeing boards that will have a critical impact on the shape and provision of services. Local government will have direct representation on these boards, and with major predicted gains for Labour in the 2013 and 2014 local elections, you can reasonably say Labour will have more power over health commissioning than at any time since May 2010.

Will Labour authorities listen to Miliband and use this opportunity to ensure services remain ‘in house’, denying the private sector entry to the NHS market and fulfilling Labour’s pledge to protect the health service for further private sector encroachment? I do not think so.

Despite an apparent watering-down of competition provisions, the Health and Social Care Act confirms that existing competition law has always applied to the NHS. If a Labour council were to deny a contract to a private provider, simple political reasons would not stand up if challenged by that provider in court.

But in the main, cold financial considerations will make a political preference for NHS provision, purely because it is publicly provided, untenable. Councils and, importantly, the CCGs who will hold the purse-strings, will be under pressure to choose the provider who can offer NHS standards of quality and price, most efficiently. As seen already by tenders in Devon and Suffolk, on these business considerations alone, private providers are already winning. While not Labour councils, as Labour do not have overall control of any counties at present, I believe this trend will be followed after likely gains in county elections next year.

So the fiscal situation, even if adjusted in the next spending round, dictates that Labour will need to work more closely with private health providers at a local level. This will have been forged by financial necessity and a realisation that, by the time the party will hopefully regain national power in 2015, many of the Lansley reforms will be very hard to undo in practice.

I believe that this will influence Labour’s national policy on healthcare, from the bottom up, especially if local contracts produce good quality services at NHS prices. Of course, our current leadership continues to hold a deep suspicion of the private sector, as do many Labour activists. But changing councillors’ perceptions may be a good place to start in bringing Labour back to the political centre in health policy.

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Dominic Church is a political consultant and a former Labour councillor. He writes here in a personal capacity.

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Since this article was published the author has requested that we declare his firm advises the private hospitals alliance on a media monitoring brief, but is clear that he writes in a personal capacity as a long-time Labour party member and erstwhile councillor

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Photo: nrares