Introduction

With the accession to the premiership of Gordon Brown, the record of New Labour under Tony Blair's premiership from 1997 to 2007 can be viewed in perspective. As regards health and the NHS, Brown has affirmed the importance of services to suit the patient (Labour Party conference speech, 24 September 2007; Speech at King's College London, 7 January 2008), and therefore at one level is continuing the focus on ‘the consumer’. Some of the institutions created by the Blair reforms to the NHS – including foundation trusts, about which Brown was initially sceptical – will continue. But the emphasis has changed slightly, with less ideologically based policy discourse (about ‘markets’ and ‘choice’ as understood by neoliberal economists), although the policy of giving budgets for care directly to individuals in particular areas of health as well as in social care (seen as a totemic Blairite policy) was recently re-emphasised by Brown.

We can put New Labour's health policy – from Blair or Brown – into context by considering what ‘modernisation’ has actually meant. It has been the generic term applied by New Labour to diverse policy areas, where different things have been happening on the ground despite a generic New Labour orientation to applying the tenets of neoliberalism in social policy as well as wider areas. ‘Modernisation’ has had political utility for signalling and symbolic purposes: it is part-technical or a descriptive term and part-ideological or a prescriptive term, and New Labour leaders have been able to shift ground from one to the other as has suited them. Where change is essentially non-ideological, or where New Labour policy varies only incrementally from its predecessors, this prosaic fact can be disguised by the rhetorical poetry of ‘technological modernisation’ (which is essentially as phoney as Harold Wilson's ‘white heat of the technological revolution’ in 1964). And yet where change is ideologically rooted in a manner unappealing to mainstream Labour supporters (as with the neoliberal drift of New Labour's later health policy, towards 2008), the actual ideology can be disguised in the rhetorical gush of ‘necessary modernisation’, thus redefining opponents left and right (but mostly left) as ‘old-fashioned’ or ‘conservative’.