In the real world the health agenda is dominated by the huge strains within the care system due to chronic underfunding.  Social care is close to collapse and the health system is running at a significant deficit – with unknown consequences.  On further destabilising factor is the lack of any strategic bodies and the huge gaps in management capacity and capability.  The main task for the party for now could be to hold the government to account for the increasing failings in the system.

Much of what the NHS is trying to do is similar to what we supported as ideas pre-election and the plethora of pathfinders, pilots and schemes shows a general attempt to look for far better longer term whole system solutions.

Before the election there was a high degree of agreement around Labour health policy and Andy led the campaign around health very well but within the party there were some major issues the leadership did not or could not address.  The main examples where there was no agreement were:-

Funding

Some £2.5bn of early increased funding for health was promised although the source of that funding were not fully developed.  Given that social care requires an immediate £5bn and that the NHS needs at least £10bn pa increase over the next 4 years (on highly optimistic assumptions) an injection of £2.5bn may have prevented an NHS meltdown in 15/16 but what happened after that was a mystery.  That made everything we said less credible.

Pooled Budgets

The proposals were for the budgets of social care and health to be brought together but little was said about how that would be implemented and what allocation method in particular would be used.  It would end ring-fencing which appears to be supported elsewhere.  It leaves open the issues around housing, and other public services and how they too would be integrated – into an overall wellbeing approach?

Social Care

There is a major debate over whether or not to commit to a policy of free social care on the same principles as a free NHS (and free education). This costs in the order of £9bn, depending on how the approach to entitlement is determined.  It would have to be phased in over many years but could be set as a goal with some initial changes, such as making all care free for those with a terminal illness or a lifelong disability.

Devolution

There is no coherent position.  The argument from Andy Burnham that there would be a national framework for what had to be provided but local discretion over how it was provided was never really developed or accepted.  It appears implicit we accept a four nation approach – then why not a separate approach for major sub regional areas which could have populations of similar size?  What does the N in NHS stand for?

Local Authorities

The ideas around accountability within the care system are not yet developed.  We know social care is provided through the tier one local authorities and one argument is simply to do the same for health.  The statements from Andy Burnham argued for using Health & Wellbeing Boards as the main integration and decision making body.

As ever the opportunity to reinvigorate local authorities is actually viewed by the leadership with suspicion and in some quarters with contempt.

Provision of Services

The policy around preferred provider lacked explanation. The removal of the market was clear but that is not the same as no private provision of any kind, and not the same as the elimination of any commissioner provider split.  There was no commitment to look at developing again the public provision of social care services.  Some voices looking for changes to the small business model for GPs was also being heard.

Personalisation, whole person care, personal budgets

The concept of whole person care and the need to integrate services around the person was actually well set out but how that would translate into delivery was not.  Personal budgets are contentious and there is little evidence so far about the benefits but there has to be a policy position even if that is to say they will not be used.

Some distractions appear to be likely to confuse matters.

NHS Bill

The private members NHS Bill is sponsored by Jeremy Corbyn.  The goal of a structure of regional and local health boards with elimination of any commissioner/provider split may or may not be desirable.  However the scale and cost of reorganisation would be immense.  If the goal is to remove the market then there are other less disruptive ways to achieve the ends

Opposition to Devo Manc Etc

This is attracting opposition on the grounds that it breaks up the NHS, removing the N.  It is often linked to hostility towards any involvement of local authorities. But Labour leaders in the areas proposed for devolution are mostly enthusiastic.

Savings from Ending the Market Removal

There are frequent claims that some £10bn pa could be saved from removal of the market, perhaps used to justify the expense of the NHS Bill.  These savings are not supported by any evidence and play into an agenda that says the NHS can make savings so does not need more funding.  The promised savings from NHS procurement policy look equally unlikely to materialise.

Costs of PFI

Many PFIs in health were very poorly set up with ridiculous contracts with higher whole life costs than traditional public funding approaches.  But the total cost to the NHS of PFI is around £2bn (or 2% of total) and will only grow slowly. If traditional approaches had been used that cost would have arguably been less but still well in excess of £1bn pa.  Expert aggressive renegotiation and strict contract compliance could offer savings of £100ms but that is against a deficit in funding in £billions.  Central management of all PFIs and fair charges are worth pursuing.

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4 Comments

  1. The private members NHS Bill is sponsored by Jeremy Corbyn. The goal of a structure of regional and local health boards with elimination of any commissioner/provider split may or may not be desirable. However the scale and cost of reorganisation would be immense. If the goal is to remove the market then there are other less disruptive ways to achieve the ends

    The scale and cost of commissioning necessitates the introduction the 2015 Reinstatement Bill.

    From my own FOI on commissioning costs locally we found the (CSU) commissioning service unit, cost over £4 million and additional costs for setting up and consultants took it over £6 million, that is before even one patient receives care. If you care to multiply that up nationally it doesn’t take a rocket scientist to work out the waste of that exercise alone.

    The wealth of evidence that has been ignored by the SHA also shows that the NHS we had before the private sector intervened in our NHS was more efficient, cost less, and was the most comprehensive in the world, only when we return back to that will we be able to concentrate on the real issues of health delivery.

    Isn’t it funny how we can completely re-organise our NHS to be privatised but can’t afford to re-organise it back?

    We can and must, the chaos of the market is already denying people the care they need, that WE IN FACT PREDICTED WOULD BE THE OUTCOME.

    So lets get on with the job of promoting the 2015 Reinstatement Bill and look forward to a real NHS once again.

    1. Martin Rathfelder says:

      You are assuming that the costs presently categorised as commissioning would disappear if there was no market. I think the experience of Scotland and Wales shows this to be a false assumption.

      1. Martin I have provided the evidence for you before, OECD data proved we were the cheapest of all industrial countries in 2001 that was even before New Labour carried out their privatisation setting up trusts which neatly led into the Tories re-organisation.

        When are you going to admit that you want private health and don’t believe in public services, I am a socialist that has worked in the private sector all my life, I know how inefficient they are, even at multi national level, I have had dealings with private and public sector and can tell you quite emphatically, the private sector doesn’t work, where are all the Jobs Thatcher promised?

  2. Martin Rathfelder says:

    The NHS still is, I think, the most cost effective health system in the industrial world. My point is that the savings supposed to be made from abolishing commissioning are probably illusory. Scotland and Wales are not more cost effective, and they don’t have a separate commissioning function. Commissioning is not much different from what used to be called planning. We could, and perhaps should, abolish the internal market, but that won’t save a lot of money.

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