What are Labour’s plans for the NHS?
While Labour has made some positive manifesto commitments to the NHS, there are serious grounds for concern in terms of whether these will ever amount to a restoration of the service based on its founding principles.
The failure to acknowledge that the huge and growing waiting lists, together with difficulty accessing care, causally relate to underfunding is a major worry for campaigners.
So too is the expectation that the private sector is there to help out. Labour Lord Prem Sikka for example has talked of his party’s general election victory being built on corporate patronage.
It remains to be seen if this will translate into a new period of austerity, with inevitable cuts to both public services and welfare payments, as some fear.
The series of articles below from KONP, Greg Dropkin, and three from the KONP Integrated Care System Working Group begins to look at what may lie in store for the NHS under the guiding hands of Secretary of State, Wes Streeting, and Chancellor, Rachel Reeves.
1 Darzi Report – will the Government write the wrong prescription
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KONP responded immediately when, following nine weeks of reviewing data, Lord Darzi published his report ‘Independent Investigation of the National Health Service in England’. His conclusions focused on patient access, quality of care and the overall performance of the health system. Not surprisingly, his findings on the state of the NHS (summarised in our response) reflect those of health campaigners that have persistently highlighted the deteriorating state of the NHS for many years.
2 Darzi report – a fig leaf for Labour by Greg Dropkin
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In this article Greg Dropkin takes a deeper look at Lord Darzi’s ‘Independent Investigation of the National Health Service in England’, calling it ‘a double- edged sword’. Yes, it is a no-holds-barred look at how the NHS is failing to deliver in line with what the public rightly expects from their health service. Darzi’s report provides uncompromising evidence that these problems cannot be resolved without ending Austerity and refunding the NHS to the level required. KONP summarised those aspects, which echo other recent analyses of a NHS under severe stress, when Darzi’s report was published on 11 September.
At the same time, Darzi rewrites NHS history, omits a key founding principle of the NHS, does not oppose privatisation, is silent on a major current controversy, and sets the stage for Labour’s intended “reforms”. For those reasons, Darzi’s approach is both deficient and dangerous.
3 What do we know about Wes Streeting?
This article explores possible influences on Streeting’s thinking by referencing his background in politics and focusing on his registered interests. This includes an investigation into where his donations (mainly, but not exclusively, ‘towards costs of office staff’ – are these not paid by Parliament? – come from.
Under the banner of the Fourth Industrial Revolution (cloud technology, artificial intelligence, automation, advanced engineering, etc.), his enthusiasm for innovation and technology as an answer to the problems of the NHS are also touched upon. One of Streeting’s mentors, Patricia Hewitt, quickly asserted that his claim the NHS is broken was an acknowledgement that both the model of care is broken, and a change to the model of funding is needed. Since he plans to prescribe treatment on the basis of Lord Darzi delivering a diagnosis for the ills of the service, can we expect this to be evidence-based?
4 Using the private sector to help the NHS – is Labour intent on repeating the mistakes of the past
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This article examines Labour’s past experience with using the private sector to support the NHS, to see what lessons should have been learned. Through his ‘concordat’, Alan Milburn first encouraged referral of simple NHS non-urgent cases to the private sector, but went on to oversee outsourcing of diagnostics together with interventions performed in Independent Sector Treatment Centres (ISTC). It was claimed that the latter would increase NHS non-urgent capacity and reduce waiting lists and times, reduce charges in the private sector, increase patient choice within the NHS, encourage best practice and innovation, and stimulate reform within the NHS through competition. In fact, ISTC proved to be expensive, and a subsequent investigation by the Commons Health Select Committee showed little evidence of increased capacity or of overall benefit to patients or the NHS. They did, however, succeed in embedding a number of private companies within the NHS where they remain to this day. Rather than learning from this experience, Streeting seems bent on repeating such mistakes, despite being alerted that growing the private sector might bring about the very thing he has warned against – the NHS becoming ‘a poor service for poor people’.
5 Alan Milburn and the Labour agenda for the NHS
This third paper deals with the re-emergence of Alan Milburn on the health policy scene. Milburn was central to New Labour’s reform of the NHS and now appears to be an influential voice once again. When Secretary of State for Health in the Blair government, Milburn argued that the founding model of the NHS was out of date. He extended the scope of outsourcing and sought to establish a market in health care. The Private Finance Initiative was promoted on the basis it would offer savings and deliver value for money. Foundation Trusts were introduced to give greater independence to hospitals, exposing them to the risk of bankruptcy. After resigning in 2003, Milburn took a post with Bridgepoint Capital before joining the accountancy firm PricewaterhouseCoopers (PwC). He chaired Steering Groups and wrote introductions for PwC reports foreshadowing Integrated Care Systems, redesigning funding flows to benefit “the system”, and increasing reliance on big data and digital techniques provided by US corporations. He continued to advocate for reform of the NHS and shares an enthusiasm with Streeting for technology and innovation, envisaging and welcoming greater reliance on big business.
Judging by the words of their chosen advisors and the Secretary of State, Labour’s agenda for the NHS is to continue the privatisation programme begun by Thatcher and developed further by Blair, and successive Tory governments. All this calls into question whether Labour has the right advisors and the right (evidence-based) policies for the NHS. As John Lister has pointed out: “Rather than repeating the errors of 20 years ago, Labour should show real courage, and follow the examples of Attlee and Bevan who built the NHS – and raised the money to pay for it – rather than Alan Milburn, and Paul Corrigan who wasted millions trying to turn the NHS into a market”.