This is a curious document and it gets a mixed blessing.

First: on the form of the document. It is an 18 pager addressing the priorities of the incoming Labour government for healthcare and health more generally.

Although it references other documents that have clearly influenced it, it remains a surprisingly light read. There is no attempt to compare healthcare provision with the EU or the world in general or to describe the rapidly increasing needs for healthcare as a result of immigration, a baby boom and the needs of a more elderly population. It is not based on an analysis of needs. Rather it seems to be the result of a discussion of the increase in spending the shadow chancellor may be prepared to accept.

It is not a basis for planning the next ten years of the nations’ healthcare. It compares poorly with the level of analysis the NHS itself would put up to justify a small extension to local services.

Second: on the content. There are clear themes:

  • Repealing the Health and Social are Act 2012 to defeat privatisation and restore democratic accountability
  • Increase staffing levels
  • Promoting the integration of care
  • Giving patients more rights to access care
  • A focus on mental health (and Cancer survival!)
  • Preventative medicine

But there is no story beyond Labour will be better than the Tories.

Third: The subtext is that the costs of implementation seem to be  capped at £2.5bn. This is a ludicrously inadequate figure given current spending levels and future pressures over 10 years.

Thus the resultant feeling is that it may encourage many that the Labour Party is more pro-NHS than the Tories but the reality is that the story is still unpersuasive for those that need convincing the next Labour Government will be better than the last one.

Where did it all go wrong last time?

The Labour party still has not come to terms with the problems of the past.

  1. It has been overly enthusiastic about not responding to the needs of patients and demonstrating its fiscal credibility by keeping an overtight grip on NHS Finances. Thus in the early years of the last Labour government spending was supressed as Brown put other priorities before the NHS. Then in the wake of the unexpected surge in tax revenues from the boom years of the early to mid-2000s the money was spent rashly on the GP contract, new PFI hospitals and increased salaries, now being clawed back.

This is not good enough as a basis for long term funding to provide for long term needs.

I would prefer a more binding commitment to match European levels of funding and staffing levels, and with those countries we should be comparing ourselves with.

It is a misplaced source of pride that the UK spends less, employs less doctors, nurses and occupies fewer beds; and its GP’s relish acting as gate keepers rather than appointment givers.

Health care spending graph

CountryPer 1000Per 1000Per 1000Per headper 100000   
NursesTotal bedsAcute bedsDoctor consultationsDischarges
UK8.22.82.3514204
USA11.13.12.6412549
France9.16.33.46.716766
Germany8.38.35.49.725093
Netherlands4.74.73.36.211863

Source : OECD data 2014

2.It is too easily sold ideas that serve vested interests and fails patients.

Hence, will further rationalisation of acute care help ordinary patients or will it serve the interests of powerful consultants looking to enhance their pool of potential private patients?  Or, will integration of social care and healthcare really help patients or just widen the scope of haggling and delay discharges more not less.  And, will expensive whole area reconfigurations and “service transformations” help anyone other than the teams of management consultants required to draw up the plans.

Why the silence on the need to address the consequences of badly advised PFI deals? And whose idea was choice and competition?

The Labour party needs to demonstrate more democracy in the way policy is set rather than give the impression it can be captured by powerful interests.

  1. It oversells initiatives that will not necessarily make much difference. How often have we heard demands for preventative medicine and to such little effect? And what use are rights if they are not matched with resources or claims on resources.

The Labour party should genuinely tackle the food industry which has created the obesity epidemic not help put the blame on patients.

The verdict: It may be enough to win an election but it is not enough as a basis of exercising power. There must be others who could help in that task. Let’s hope they are asked.

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3 Comments

  1. Robert Jones says:

    It’s unfortunately becoming a case of whom do you distrust least so far as the NHS is concerned. We keep being told that the future lies in increased care in the community – but you look, and it isn’t there. We lose hospital beds, and in consequence hospitals run more or less permanently, certainly in winter, on red alert. It’s going to take more than £2.5billion to change that, and in the meantime so far as I can see Labour is still committed to the Foundation Trust route (well it would be: it was Labour’s idea) “arm’s length” commissioning, and presumably the internal market even if the Health and Social Care Act goes, as it should.

    Looks to me as if the best we can hope for is the process of privatization being stalled, if not halted. While I welcome that, it’s not enough.

    And I imagine the grim farce of HealthWatch stays….

    I’m less keen than the author on “democratizing” the NHS: I just want structures that work in the interests of patients – I have little desire to be “involved” in making them work, and I don’t believe there’s the level of knowledge out there to achieve that.

  2. Richard B says:

    A very fair summary. Taking what Andy Burnham has said alongside the published Party stuff gives a better picture but still incomplete.
    But the good news is that it looks as if some key SHA policies are now also Labour policies. Getting rid of the market; ending the division of health from social care; proper role for local authorities; bringing democratic accountability into play and the whole idea of working towards whole person care as opposed to accepting the federation of vested interests.

    1. ” Getting rid of the market; ending the division of health from social care; proper role for local authorities; bringing democratic accountability into play and the whole idea of working towards whole person care as opposed to accepting the federation of vested interests.”

      This is what the Kings Fund says about Labours Ten Year Plan,

      “‘Burnham is right to put integrated care at the heart of this vision. This echoes the prescription for a single budget and single commissioner for health and social care set out by the Barker Commission. His emphasis on mental health was also very welcome.”

      What this actually means is a single outsourcing body with a single budget and means the NHS will become a commissioning body not a provider of health care.

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