A special correspondent looks at the weaknesses and strengths of the latest Labour Party policy statement on the NHS. We welcome alternative views and comments.
The aspirations set out in the Labour Mission “NHS Fit for the Future” have widespread support but so far that has not been translated into anything that could be packaged for voters – to give them something credible and exciting to vote positively for.
Saving the NHS, creating an NHS fit for the future, reforming the NHS – none of these resonate. Voters do not want any change to the NHS principles, and they connect talk of “reform” with cuts.
Most voters just want an NHS that works for them and that means ease of access and shorter waits generally with no charges. They are entitled to expect all NHS care to be of high quality and achieving very high levels of patient satisfaction.
Staff want an NHS that works. They also are entitled to one that works for them: with decent terms and conditions that improve retention and reduce absences. And having enough employed staff, with the right skills to deliver what is required appears to be obvious to staff but not to government.
The Mission makes the welcome pledge that there is to be no change in the NHS principles; universal, comprehensive, free and tax funded.
It sets out aspirations to be applauded – reducing health inequality, improving healthy life expectancy and enabling the NHS to meet the key waiting time and other performance targets that were achieved up to 2010, but have not been met for many years.
More controversial, but generally supported is the need for the NHS to adapt – using the words like ‘reform’ puts people off!
The Labour statement argues that the NHS is no longer ‘fit for purpose’ and in very simple terms it has to shift from a sickness service to a health service; from analogue to digital; and from hospital to home (or as near as possible). The NHS has to work collaboratively alongside other services to provide the care and support needed by large populations of people with multiple long term conditions.
These challenges are not new, and have often been championed before but there has been next to no progress on any of them: they are changes that will be very hard to achieve.
The Mission, combined with other stated policies around public procurement generally foresee an increase in NHS capacity over time and a reduction in outsourcing, whilst recognising that some private provision is necessary where there are gaps in public provision, and that some existing private capacity may have a contribution to make in the short term.
But it does not support another reorganisation (as many on the left advocate, generally without any detail as to what it should be ‘restored’ or reorganised into): nor does it propose any move to greater private sector involvement as many on the right advocate.
The ambition is far bigger than is being reported, and the degree of change is far greater than that from 1997 under Labour, or even 2012 under the Tories (Lansley). It is accepted that this challenge extends over more than one parliament.
The problem everyone recognises is that the commitments set out in the Mission cannot be achieved without significant additional funding. But Labour is not willing to set out its spending plans until it publishes a manifesto prior to the general election. So, in the interim nothing can be “policy” unless the source of any necessary funding is identified.
Just to be clear, it is simply not possible to rely on ‘efficiency savings’, productivity gains or even magic sci fi tech – important though these will be.
Recovery, and establishing an NHS fit for the future will have significant additional short term revenue costs, plus additional capital costs, and will require a larger base of funding that grows faster than we have seen in recent years. To pretend otherwise just loses credibility.
Fundamentally a new attitude from the government is necessary; to see good health as vital to the economy, and not see it as a cost to be controlled and cut.
Any idea that growing the private sector is somehow a solution must also be firmly rejected. Use of private provision of NHS funded services should be phased out over time as NHS capacity grows.
For-profit care should remain only as a contingency for those who want to pay for their care.
Change on the scale envisaged will not be easy, even if adequately funded. Some clearer understanding of “how” a more devolved, more patient centred and more self-improving system might emerge would be welcome. What is clear is that collaboration and partnership will be replacing the market and competition model.
And without a long term settlement to the scandal that is social care no real progress on a better NHS is possible.
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