"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Tuesday, 5 July 2011

A Labour Manifesto on the NHS

Labour have to do something about their policies over the NHS. Here's how I think they should start.

Funding. Labour must do something to stop Cameron's charge that "Labour would have cut the NHS but the Tories are increasing funding". The evidence - from the last Darling budget - was that Labour would have given flat real terms increases (ie increases that match inflation, but no more) for two years, as opposed to Osborne's flat real terms increases for four years. There are other differences (for example, the size of the planned capital budgets) but most of these lacked detail and can be addressed. Labour needs to be clear about what its plans were and what its plans for the future will be. This is a vital issue and too long Cameron has been allowed to avoid answering an NHS policy question by repeating his trite and untrue statement that Labour would have cut whereas the Tories have increased funding.

Blairism. Labour must draw a line under the Blairite reforms. They must spell out once and for all the purpose of introducing ISTCs, the CCP, FTs, PbR etc, and they must point out which of these succeeded and which failed. If Labour does a mea culpa on ISTC funding it would kill the Tory attack that "Labour paid the private sector more than the NHS". Labour did pay ISTCs more than the NHS, and admitting that they did, and importantly, saying that they would not repeat this if re-elected, would make the Tory argument pointless.

What the public want. Labour have to be seen to be ahead of the government on the issues that matter to the public. The three main issues are: access, waiting times and accountability:
  1. Access: the postcode lottery and health inequalities. These will get much worse under the new Bill and Labour must take every opportunity to point this out. While health inequalities are important, it is the postcode lottery that will get the most publicity and so Labour concentrate on this. Every time a Tory NHS policy is discussed, Labour must point out the potential for a postcode lottery. (And any policy that has the word localism in it will be a source of regional variations, and a postcode lottery.) If people think that they will be rationed simply because of where they live, then they are likely to oppose the policy because it is simply unfair. The public have a deep emotional attachment for fairness, Labour have to point out how unfair the Tory policies will be and how Labour will bring fairness back.
  2. Waiting Times. Labour have tried to make an issue of waiting lists, but in my opinion they are looking at the wrong thing. The big scandal in the next few years will be Referral Management Systems, in other words, GPs' referrals rejected by "faceless bureaucrats". In many areas of the country only urgent treatment is offered without review and for non-urgent treatment (like hip replacement or cataract removals) GPs are being told to delay referrals, with the referral management system in place to ensure a GP sticks to the rules. Crucially, since it is the GP referral that is delayed, they do not appear on the RTT waiting times (since the RTT stopwatch only starts once the referral is made). This is why Cameron and Lansley can say waiting times are not affected: if care is denied the patient is not waiting for it. This rationing of healthcare will increase the business of the private sector as people decide to pay for the treatment denied by the NHS. (IMO, this is how the NHS will be "privatised".) Labour must attack this policy on every front. If the government says that GPs are in control of care, then Labour should question why Referral Management Systems (that overturn GP decisions) are needed. Labour should campaign that the Department of Health should publish the numbers of referrals that have been delayed by GPs or rejected by the Referral Management Systems. This is another fairness issue and Labour should show that it is a Conservative government that is being unfair.
  3. Accountability. Labour should campaign that it is our NHS, and as part of this, campaign for more accountability. Labour can latch on the "no decision about me, without me" message by pointing out how the new NHS structures - National Commissioning Board, Monitor, CCP - specifically excludes patients' opinions, so they are making decisions without me. Labour should also point out that private companies, and the new mutuals and social enterprises that Cameron wants created under the Right To provider policy, will not be accountable to the public. Labour should campaign that one of the qualifications of Any Qualified Provider should be to have board meetings in public and that non-executive directors of such organisations should be publicly elected - both of which will be rejected by the government, but it will bring to light the lack of public accountability with these organisations.
Labour Values. After the Blairite reforms the public no longer know what Labour's values are, they do not know what Labour stands for. The next few years must be used to position Labour as the party of the NHS that the public want (and the three aspects above, in my opinion, are what the public want). My feeling from talking to patients is that they assume that the NHS is publicly owned and publicly run. The public do not want the concept of an NHS kitemark on the private companies that do NHS work, a policy that was promoted by New Labour and is now promoted by this Tory government. Labour should position itself so that it promotes what the public want (a publicly owned NHS), rather than telling the public what New Labour thinks the public should want (a largely non-public kite-marked system). A commitment to a public system - and with an attached warning that any NHS service that is privatised, or turned into a social enterprise, will be taken back into public ownership under a Labour government - would severely curtail any Tory policies that would take NHS services out of public ownership.

Creeping privatisation. Labour also must stop flirting with policies involving mutuals and social enterprises. By all means give staff more involvement in how an NHS service is run, but mutuals and social enterprises are not the way to do this because they are not publicly owned (and hence fail the public accountability requirement). Personally I would be happy for a Labour government to mandate that BMI, Spire, Netcare, etc should become social enterprises before they can do NHS work (fat chance!) but that should be the limit of social enterprise in the NHS. Labour should also campaign against Circle which is not a social enterprise (the mutual - profit-share - part of Circle is only 49.9% of the company so they are a majority profit making private company). Circle gives social enterprises a bad name, it is about time this was made abundantly clear by Labour.


  1. I agree completely. If Labour did this I could actually back them again.
    I saw an advert yesterday for Axa healthcare that said 'with the uncertainty of the NHS reforms' then went on to say they were offering 20% off taking out health insurance. I hope Lansley is proud of himself.

  2. Thank you for articulating this, couldn't agree more. The problem with much of the anti-privatisation organising both before and now since the health reforms bill is that little has been put forward in terms of what positively needs to happen with the NHS, and how it might best be structured. Everyone seems to want to ignore what a failure the PCTs in particular were in terms of accountability and management culture, and the insanities brought about by the internal market on its own.

    At the moment the leadership and younger apparatchiks of the LP seem too out of touch with even their own activists, much less anyone else, - and still too afraid/fascinated with market ideology to really accept that a) they made costly mistakes while in power with PFI and ITSCs etc and/or b) that there might be some good non-market based alternatives. The gulf is getting to tragi/comic proportions if their blogs are anything go by.

    Though it would help the LP in the polls hugely if it followed your prescription, I don't hold out much hope.

  3. Thanks for the comments. I am going to the Labour Conference in September and my sole intention is to raise awareness about this. It's my opinion that Labour could win a huge majority at the next election if they campaign on the NHS.

  4. Trevor Cheeseman11 July 2011 at 14:48

    I agree with a lot of this. In addition Labour should highlight the growing number of organisations providing care wihtout "NHS" in theor titel (eg Surrey Community Health), and the associated lack of accountability.

    It must also have a message on improving productivity whilst driving up the quality of care. Labour should highlight its previous record here - thruugh a judicious combination of supporting clincally credible national standards, clinical networks to properly plan care, national clinical audits, tariffs for best practice care, and occasional use of extra capacity from the private sector at the margins - which delivered major improvements overall, including in stroke and cancer care.