Whether you’re a member or not, the Labour Party want your views about how to turn the NHS around. This week they have launched a national conversation to collect views on the big questions facing our overburdened health care system.
Leafing through their consultation document you are immediately struck by the size of the questions being posed, some of which have vexed policy wonks and governments for decades. Their list includes. How should we solve social care? How can we reorganise the NHS without disruption? How can we use technology?
Not to be put off we will breakdown and analyse these issues over the next few months in the Lowdown, but looking at the question’s posed by Labour is a good place to start. So what’s question number one?
What more can Labour do to ensure the NHS is fully funded and able to deliver universal health services?
On day one, a new Labour government will likely be confronted by an NHS still dominated by deficits. They will need to be prepared to give the NHS a financial jolt big enough to lift it out of short term crisis and into a new era of expansion, but how much will Labour need to spend?
The evidence from the IFS and other experts is clear. Changes in population, the cost of new treatments and the impact of technology, mean the NHS needs rises of at least 4% a year for the next 10 years.
Unlike the current government, Labour must take this advice, and crucially take action on social care too. Again, the advice is clear, social care needs annual rises of 4%, but also fundamental reform (which we’ll explore in a future article)
Austerity has already robbed the NHS of the chance to properly plan for some of the major healthcare pressures; the crisis with obesity, the rise of chronic conditions like diabetes – which now costs the NHS 10% of its budget and the rising number of people living with health mental-health problems. These issues were all predicted, but the response was too weak.
So now the NHS has a much steeper hill to climb. New funding will have to be frontloaded to deal with some of the historic debt and an urgent list of ‘must-do’ investments that have been repeatedly put off.
Hospital buildings have been badly neglected. In his report for the government Robert Naylor thought that the service needs around £10 billion for new buildings and to address the backlog of upgrades and repairs needed on existing buildings.
Highest on the priority list for NHS leaders is the workforce crisis. The government has been desperately slow publishing its strategy, probably because the whole thing rests on extra funding. Labour must not make the same mistake.
Prioritise the workforce crisis
Our NHS would be in a far worse condition were it not for the resilience of staff and their willingness to work unpaid beyond that hours – as 2/3 reportedly do. Although many are now leaving the NHS, due to poor morale, early retirement and Brexit.
There is a capacity gap across the NHS. The number of patients has been growing faster than the number of staff. In fact, the number of GPs is falling, as is the number of nurses and health visitors working in community and mental health services. This is at odds with new priority of treating many more patients outside of hospital. To make this work Labour must invest in a new army of community staff; nurses, technicians and medics, especially in mental health.
The NHS has 100,000 vacancies some of which exist because staff no longer want to work under such pressure. By making the workforce a top priority Labour will not only rebuild services but send a message that the NHS values its staff. More will stay, others will join, some will return. A campaign is needed to attract them. It is going to need a serious strategy, worked out with the unions and it will take longer than their first five years in office to bear fruit.
The TUC outlines it in more detail, but here are five thoughts for starters.
Reward staff with fair pay rises and a good pension – it’s a sign that their work is valued and will help retention
Staffing numbers must reflect patient demand – apply safe staffing levels
Make foreign staff welcome, offer grants to help – nurse recruitment has flat-lined since Brexit
Invest in the wider well-being and career development of staff – help provide affordable homes near workplaces
NHS leaders must set out a compassionate culture, no bullying and promote quality, diversity and inclusion
One more thought. Ending privatisation will stop NHS staff being forcibly transferred to new employers and protect pay and conditions. Better still bring staff back in house. Where it has been tried, most noteably in Wales, it has boosted moral and improved the quality of services.
Restore an accountable NHS
Next Labour must put in place some accountable structures that allow for the proper planning of healthcare. It starts at the top by restoring the responsibility of Health Secretary to provide care to all of us, which was removed by the Health and Social Care Act 2012. Simple to rectify, but highly significant.
After u-turning on their experiment with competition the government is advancing plans to integrate services, but they can’t restructure because they lack the muscle to push new legislation through Parliament.
The government is busy bending the existing structure to pull together their new local partnerships (integrated Care Systems). Their governance looks rickety and whatever a Labour government inherits will have to be cleaned up with primary legislation, but not necessarily replaced.
NHS England are installing regional directorates to enforce national policy, but they are not accountable. Local bodies (CCGs and Health and Well Being Boards) are all merging to for make larger areas for planning purposes, but these look too big to act locally and too remote from local people.
The NHS needs more local accountability as the public are losing touch and influence. Who is in charge? How are decisions made? Where is the public voice?
This is not just about a safety valve against bad policy, it’s a way of putting public interests at the heart of decision making. Of course, accountability does offer protection, making it harder to ignore areas of neglect and difficult to force through plans that the public and NHS staff disagree with.
At a recent meeting of MPs, my colleague at the Lowdown, John Lister sketched out how this could work.
“In my opinion we should have the equivalent of one health board per county or unitary authority (giving around 150), and for simplicity the health districts should mostly be coterminous with local government.
These boards must be public bodies, meet in public, publish board papers, and include elected councillors, lay members and trade union reps (as did Health Authorities prior to 1991).
This too will be welcomed by most people who care about the NHS. It is taking forward and seeking to democratise a process by which NHS England has already begun to bypass and neutralise the provisions of the 2012 Act.”
Hold on to the principles of the NHS
Make it fairer, Health inequalities have grown. The Kings fund noted that “Recent data published by the ONS indicates that, for those living in Herefordshire, the average disability-free life expectancy is 71 years. However, if you live in Tower Hamlets in East London, your disability-free life expectancy is 55 years.”
And yet there is a startling false economy at the heart of this issue. Researchers at the University of York tell us that socioeconomic inequality costs the NHS in England £4.8 billion a year, almost a fifth of the total NHS hospital budget.
We must redirect resources, not only to eliminate postcode lotteries and respond to unfair differences in access to care, but also to look at ways to keep people well and prevent sickness.
Public health budgets have been cut year on year. Many reports have been issued by successive governments, but few stick with it. partly because the rewards will not be reaped for decades. but in an era of integration this is an opportunity for Labour to link policies on health, housing, the environment and welfare.
Some communities like Morcombe Bay are already finding answers for themselves by starting to talk about it, and it is having results. Perhaps it is time involve communities in the solutions and bring the debate out of dusty reports.
Keep the service comprehensive.
In 1997 Labour formed a Royal Commission to look at ways to fund long-term care. It recommended that Labour make both healthcare and personal care free at the point of use. The Blair government ignored these recommendations. Meanwhile, in Scotland they forged ahead and personal care, such as feeding, bandaging and giving of medicines, was made free in the way it is that it is in NHS hospitals.
Labour must rectify this mistake. It is more pressing now because the line between healthcare and social care is becoming more blurred as we transfer treatment outside of hospitals into the community. Who will pay? What is free? The danger is clear as charging and top up fees are already well established in social care.
Underfunding has revved up rationing in the NHS. Eligibility criteria tightens more each year. Patients have to be sicker to qualify for the treatment they need. Or wait longer, and some treatments drop off the list altogether, but not for always for clear clinical reasons, as we saw with proposed restrictions on hernia and cataracts.
Dentistry, long term care, personal care, podiatry, physiotherapy, talking therapies are all area where NHS provision has shrunk and if we can afford it, we put our own hands in our own pockets and organise our own care. This can’t go on unwatched, all governments should be committed to keeping the NHS comprehensive in reality, not just repeating their support for it at elections.