Public satisfaction with the NHS has never been higher, so says the latest annual British Social Attitudes Survey. It seems New Labour worked after all. Our investment in all those extra doctors and nurses and new buildings and equipment changed the NHS for the better. But it is our reforms which really transformed patients’ experience. Waiting times for hospital surgery fell from 18 months to just 18 weeks. If you have suspected cancer you now get seen by a specialist within a fortnight. Deaths from cancer and heart disease have fallen dramatically. Today’s NHS is not without problems but the New Labour formula of resources plus reforms delivered unprecedented progress.
An odd time, then, for the coalition government to be embarking on its self-proclaimed NHS revolution. Labour’s shadow health secretary, John Healey, cleverly calls it a solution in search of a problem. The politics of the changes mystify me. David Cameron’s project was supposedly about decontaminating the Conservative brand. Playing safe on the NHS was central to that strategy. By bigging up its reforms, the government conflates precisely the four words it was trying to avoid – cuts, privatisation, health and Tory. Even here there is confusion. At the outset the reforms were dubbed a radical departure from all that had gone before. More recently they’ve been repositioned as following in the footsteps of my time as health secretary and Tony Blair’s time as prime minister. It can be either revolution or evolution, but it can’t be both.
There are elements of the reforms which I recognise and think Labour should support. Others are bad for NHS patients and should be opposed.
Giving local services greater freedom through NHS Foundation Trusts was a bitter internal battle during Labour’s time in government. Today they are the most efficient and highest quality NHS hospitals so it’s a good idea to rapidly make them universal. What is a bad idea is to let hospitals off the accountability hook by abolishing the national standards and targets that drove better clinical outcomes and lower waiting times during the last decade.
Of course, cutting waste and bureaucracy is a good idea but it is a bad idea to assume that NHS structural change saves cash – at least in the short term – rather than costing it. Abolishing PCTs and creating many more GP consortia to replace them hardly sounds like a recipe for cutting bureaucracy. And there is a chasm between the cost of making change – £1.4 billion – and the cash available for it. The NHS budget will grow by just 0.1 per cent in the next few years compared to 7.5 per cent growth in New Labour’s prime. In reality it’s worse than that. With demand rising and £1 billion of NHS cash being shifted into social care the NHS budget will fall not rise. The NHS has to make £20 billion efficiency savings to make ends meet. Structural change can only distract the NHS from doing so.
Similarly, it’s a good idea to get politicians out of day-to-day NHS management, but it’s a bad idea to move power sideways to a national commissioning board when it should be moved downwards to where health decisions are actually taken, in local services serving local communities. Labour should be making that argument forcibly, not least because the health bill gives the new board far-reaching powers over the GP consortia that were supposed to be the kingpins of these reforms.
Finding ways to get family doctors to own the financial consequences of their prescribing, treating and referring decisions is a good idea. But it’s a bad idea to assume that GPs can easily do the complex business of commissioning local services – and in the process weaken public accountability over £80 billion of public money. Ironically, the original coalition agreement proposed a bigger role for local authorities in commissioning health services, a policy that at a stroke would have improved local accountability over the NHS and bridged the divide between health and social care. Labour should resurrect and champion that idea.
Then there is the move to an any-willing-provider policy which promotes open competition in the NHS. When I first introduced private sector providers into the NHS, some in the labour movement said it would be the end of the health service as we have known it. In fact it strengthened the NHS. One recent study concluded that in those areas where new providers were brought in to provide local NHS services waiting times and death rates both fell faster than where they weren’t. Labour should be far more assertive in arguing that monopolies in any walk of life – public or private – rarely deliver either operational efficiency or customer responsiveness. There should be no preferred providers, whether public, private or voluntary. Quality is what counts for patients. Efficiency is what counts for taxpayers. Labour should promote a legal level playing field based solely on the interests of patients, not providers. But that requires proper planning, not a free-for-all. Market mechanisms can work in healthcare but only when properly managed and regulated. So while it is a good idea to extend competition in the NHS it is a bad idea to allow it to fragment local services or to be on the basis of price rather than quality.
There are enough nitty-gritty policy issues for Labour to get its teeth into here. The bigger question we should be posing is whether this sort of structural change can possibly meet the challenge the NHS faces from an explosion in chronic diseases like diabetes and obesity. That calls for policies that integrate services – between primary and hospital and health and social care – rather than fragment them. It suggests a bigger focus on prevention, not just treatment. Above all else, it argues for patients being empowered to take greater charge and have more responsibility for their own health. This is the future health policy agenda. Labour should own it.
Opposition to change is always easy. But Labour needs to be clear about what we stand for, not just against. It would be unwise in my view for Labour’s stance on the government’s proposals to suggest we are conceding rather than contesting the reform territory. That might be comfortable for now. But it fails to answer the question voters are bound to ask later – so, what do you stand for? The government’s changes provide an opportunity for Labour to earn its spurs as a sensible and credible opposition. More importantly they allow us to restake our claim to be the party of progressive radical reform. It is only when we are that we win.
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