The Labour approach to developing the NHS after 2015 will be limited by major constraints; no growth in funding, no top-down reorganisation and repeal of the Health and Social Care Act. It marks the end of the period when reform was to be driven by competition and markets. It replaces new public management based strategy with public value theory and marks the beginning of a return to faith in the value of democracy, public service and public servants and in ourselves – as public and patients. It brings a decade of stability from redisorganisation and “reform” and looks for incremental evidence supported change which can progress at different rates in different places without endless dictates from the centre.
Compared to 1997 the Party has two major advantages. The resource base of our NHS has been dramatically increased And our collective voice has been augmented by the availability of huge amounts of data and information and an unstoppable trend to make public bodies more open and transparent. Our ability to communicate, share ideas and plan activities has been transformed by social media in ways we are only just beginning to appreciate. Shared decision making, community development, participative and representative democracy have new opportunities if we dump the ideology of markets.
How does the approach to Health and indeed care translate to Labour’s position on education and housing? The key policy themes are examined.
Role of Secretary of State
Labour portrays the NHS as a single system with a Secretary of State legally and politically responsible for the provision of comprehensive universal health care and with the powers to ensure that provision. We know who is accountable.
Role of Public Services
For both health and social care the state (us collectively) pools the risks we face from poor health; risks which have their basis in the determinants of poor health. Risk is pooled over the entire population and over our entire lives. Collective provision is part of our belief that inequality is usually socially unjust and that redistribution of wealth and power is part of the role for the state. Fortunately collective risk pooling can be economically efficient.
National and Local
Our entitlement to healthcare is defined as unambiguously as possible nationally, but some flexibility is left to local agents (mostly local authorities) to ensure that it is provided in the most effective way appropriate to local circumstances. We have no post code lottery on entitlement.
Shared Decision Making and Community Development
Our knowledge and experience is regarded as an asset, both as individuals and communities; we are regarded by the professionals as a resource to support. The Labour Party commits to systematically supporting self-care and shared decision-making at the individual consultation, and community development in localities.
Democracy and Allocation
Decisions about how large amounts of public money are allocated and what priorities are set (what rationing applies) must be taken by those we elect to represent us – that is how our democracy works. Throughout the history of the NHS resource allocation has been carried out by unelected and largely unaccountable processes mostly based on the power of the various vested interests. Our healthcare is not a commodity to be traded and we are no longer passive recipients of professional largess. We can increase non monetary resources during austerity.
Strategic Commissioning
Local authorities form part of the allocation mechanism for most of our public services, usually as local agents of the national government – but health has always been outside and separate. Bringing health into the same framework as social care, housing, education and especially public health gives the opportunity to understand needs better and to meet those needs more effectively. One budget, one system could be the longer term goal.
Whole Person Care
Judged from the standpoint of the recipient of care it is irrelevant which organisation(s) provide the care they need. A definition of what this means in practice for patients and their relatives, carers and advocates and so what expectations we are entitled to have, are set out in the NHS Constitution (National Voices have provided an example). To complete this process, we need mental health care better integrated with physical health provision.
Patient and Public Involvement
Making all commissioners/planners and providers of public services accountable requires that they meet the highest standards of openness and transparency so we all know what they are doing and why. Making information freely available and allowing the many analysis tools to access that information brings a new kind of accountability but it sits alongside the direct involvement of patients and public around any table where decisions are being made. Policy will shift from listening to responding – providers and commissioners will need to show how they have changed provision and planning in response to proactive work with local people. In addition, community development will be a key approach for involving communities in planning provision.
Providing Services – Public Service
Private good – public bad has long since lost its appeal. Years of denigrating public services and public servants could be replaced by years of denigration of corporate tax dodgers, greedy fund managers, incompetent bankers, utility companies and loan sharks. The value of the public sector extends beyond rule setting, risk mitigation and safety net provision – it is seen as a positive force in creating public value and shaping the public sphere – making us happier. The public sector can also be the provider of public services – acting as an exemplar of good practice as well as provider of last resort. In health (given that we have great problems in constructing the right arrangements for effective contracting with private providers) the role of non-public provision is limited to circumstances where public providers are unable to deliver what is required.
How does this framework then apply to a Labour policy for education and housing?