RICHARD BOURNE takes a look at the policies that were announced from the platforms at the Labour Party conference in Liverpool, and notes some progressive commitments that other observers may have missed.
The policy announcements at Labour’s conference all built on the policies agreed by its National Policy Forum. What Labour intends is getting clearer, even if some of the plans are constrained by the discipline that nothing can be promised without identifying where the money comes from.
But there were lots of positives, not least an unequivocal commitment to the core NHS principles, and a declaration of determination to deal early on with the scandal of social care, by ensuring a sector-wide settlement for the workforce.
A commitment to a properly paid, respected, and valued workforce, combined with much better support for informal carers is a big step forward.
This means posing a real threat to force out the worst of the providers. The progressive building of a National Care Service has huge support, and ultimately this may even be free at the point of need.
The determination to settle the workforce issues in the NHS is there, with the constant reminder that from 1997 the Blair government established effective machinery for partnership working. There was an acceptance that the Pay Review Bodies were good in principle, but need some changes – and they were only good if genuinely “independent”.
Recruit, retain, respect. Top of the list is to give all NHS staff improved terms and conditions. Working with them and their representatives to improve retention, support the recruitment announcements but mostly to give them back the sense they are truly valued and have the resources and support to allow them to do the job they love.
Better systems to reduce agency and locum rip offs. Valuing and supporting managers (!) to keep the knowledge and talent within the NHS and avoid wasting more £billions on the large parasitical consultancy companies.
And there will have to be a deal (as there was last time) around pay restoration over several years, but linked to how fast the NHS recovers. The NHS already has some brilliant workforce policies which are not implemented universally or consistently.
How to deliver the workforce plan, such as it is, with its price tag of perhaps £40bn is a problem for later! Labour will develop its own Long Term Plan (again as last time) but only after a major exercise in consensus building. The current workforce planning aspirations from NHS England are not too far off from Labour’s intentions, they are just unachievable!
There was a commitment to reduce the waiting list by 2m a year and tackle the dentistry debacle, but there were few if any details on how. The reliance on overtime and weekends has to be seen as a stop gap until “reforms” (and, inevitably, increased investment) add capacity.
The aims of Labour’s proposed reform are slightly clearer (digital not analogue, prevention not remedial, primary/community more than acute, local as well as national), but the big plan has yet to be revealed. Much of this is very hard to do and the “reform” agenda must start by taking the public with it.
The drive to improve wellbeing and ensure people enjoy longer and healthier lives was supported by all. Achieving that is mostly outside the remit of the NHS, but it does fit with much greater NHS attention to Primary and Community Care and Mental Health, and an NHS that works effectively rather than grudgingly with local authorities, which is a big ask of the ICB/ICPs.
Announcements around procurement and the determination to ensure better use of capital investment lay the foundations to increase NHS capacity, reduce outsourcing and reduce reliance on private providers. Obviously there is and always will be the need for private provision of goods and some services, and the need for partnerships with private sector in areas like the life sciences or high end technology is obvious.
However there was no promise of new money beyond that already announced, and no proposals for reorganisations. Even if some of the recent additional funding has not been well spent, this does not mean no further extra funding is necessary!
How much more money is needed to stabilise and grow the care workforce is a problem for later. So too is where the necessary additional capital investment will come from to rebuild the collapsing RAAC hospitals and tackle the £10.2bn-plus backlog of maintenance as well as replacing other crumbling hospitals.
No new reorganisation from top down means ICBs will have to be adapted to meet the policy requirements – which is feasible. The worst possibilities of the 2012 Act never happened: and the 2022 Act has now effectively reversed much of its main content to focus on collaboration, not competition.
This has now given the NHS a bespoke procurement regime strongly weighted to the NHS as preferred provider, and it actually bans private sector interests from any direct involvement in commissioning – so probably no need for major legislation and costly organisational upheaval.
On balance it could be summed up a glass more than half full, while not brimming over (yet).
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