Peter Gillard is a member of Keep Our NHS Public's Executive Committee.
There is plenty for health campaigners to welcome in Labour’s Manifesto for the 2019 General Election. The starting points are an ‘immediate task … to repair our health services’ and an ‘urgent priority … to end NHS privatisation.’
The Manifesto commits Labour to ensuring ‘services are delivered in-house’, which hopefully includes services like catering, cleaning and estates not just the clinical ones, and halting ‘the fire sale of NHS land and assets.’ The 2012 Health and Social Care Act will be repealed and ‘we will end the requirement on health authorities to put services out to competitive tender.’ PFI contracts will be terminated, not immediately, but ‘over time’.
What this seems to leave in place is the continuation of the commissioner-provider split which brought the market to the NHS and was a fundamental cause of its fragmentation. This is hinted at when the Manifesto says there will be ‘a presumption in favour of insourcing’ allowing commissioners to continue outsourcing if they choose.
As the Manifesto says services ‘are currently at breaking point’. Since 2010 successive Governments have run down the NHS, reducing its effectiveness for patients, and making it ripe for privatisation initiatives. The Manifesto headlines the fact that there are over 100,000 staff vacancies and 15,000 fewer hospital beds.
No one believes this can be reversed overnight. Staff must be trained, and services revived. Beds cannot simply be reopened without the infrastructure in place to support them. Bursaries for nurses, midwives, and allied health professionals, and investment in training new GPs, will all reduce the staffing shortage in the medium term as will a commitment to remove the obstacles created by the hostile environment and immigration controls to international recruitment.
The Manifesto, unlike the current Government, recognises that in order to provide the best healthcare, the NHS cannot be hospital centric – it must be centred in the community. Labour calls for ‘joined-up community care’ with ‘interdisciplinary, patient-focused services across primary care, mental health and social care.’ Unlike the current plans for Integrated Care Systems that will be open to privatisation, the Manifesto is explicit that the integration will be through public bodies.
The section of the Manifesto on mental health demonstrates that Labour have been thinking about the problem. There is a recognition that the Mental Health Act does not give people the ‘choice, autonomy and the treatment they need’ and will need to be amended. There is a commitment to invest in new facilities and, particularly welcome, in a massive increase in counsellors for young people. In-school health services have been particularly hard hit by spending cuts since 2010, and Child and Adolescent Mental Health Services (CAMHS) so the commitment to ‘guarantee every child access to school counsellors’ is a small step to reversing that.
On medicines, Labour is committed to resisting any trade deal that would impact negatively on the NHS including the forcing up of drug prices that the US pharmaceutical companies so fervently want. Labour plans to establish a public company that will manufacture generic drugs at a low price for the NHS and abolish prescription charges for the small minority that pay them. There appears to be no commitment to reinstatement of treatments that have been removed from the NHS because they were deemed not worthwhile by ‘value-based commissioning policies.’
There is a recognition in the Manifesto that social care is in crisis. The policies recognise that social care is not just about the cost for elderly people. It makes provisions for severely disabled people to have care packages that will allow them to live in their own homes. But by retaining a provision that people will have to pay up to £100,000 for their own social care, they have not established the universal service, free for all, that campaigners had hoped for.
At the heart of Labour’s Manifesto is a recognition that poor health is frequently a reflection of inequality in society. The Manifesto includes some direct provisions to alleviate this including £1bn investment in public health that has been destroyed by Conservative cuts to funding and reinstating the numbers and role of health visitors and school nurses in protecting the health of children and young people. Other measures in the Manifesto on pay, housing, and the environment will all go some way to reducing health inequality. On migrants who face exclusion from the NHS because of charges they cannot hope to afford, the Manifesto is less clear. The 2014 Immigration Act will be repealed, and Labour commits to ‘protecting the rights of … migrants’, but there is no explicit commitment to ending the charging of migrants for their healthcare.
Any Government has a key role to play in ensuring an NHS that meets peoples needs. Labour has committed to reinstating the duty of the Secretary of State to ‘to provide a comprehensive and universal healthcare system.’ In repealing the 2012 Act, Labour will presumably pass legislation to enable its proposals to be implemented. There is no commitment, though, to enact something like the NHS Reinstatement Bill which also would eliminate the internal market. While the manifesto includes a commitment is to a publicly owned NHS, there isn't a commitment to all services being delivered by that NHS.Increasing capital investment to European average levels will allow the NHS to bring back to an acceptable condition the buildings that have been allowed to fall into disrepair under recent Governments.
It is, however, the NHS that will need carry out most of the necessary work to repair our NHS. Apart from the legislative framework, what it will need most is the adequate funding from the Government. Since 2010, the NHS has been consistently underfunded. Before then successive Governments, Conservative and Labour, had increased NHS funding by an average of 4% per year, a figure recognised by all informed commentators as the necessary increase for sustaining the NHS. If that pattern had been continued, this year the NHS would have received 25% more in day-to-day funding than it actually did. That comes to a shortfall of about £40bn.
The results of this shortfall are obvious. Even with massive cuts in services, NHS Trusts this summer were about £5bn in deficit.
When it comes to Labour’s Manifesto, though, the aspirations for change it proposes are not matched by the finance it is making available. The Manifesto includes a commitment to spend, by the end of a five-year term, £5.5bn a year to re-establish a 4.3% growth rate, an additional £1.4bn for specific programs like free prescriptions and car parking, and about a third of the £5.3bn to be made available for a one-off 5% pay rise for all public sector workers. That is a total of £8.7bn, less than a quarter of the shortfall in annual NHS revenue we have suffered since 2010.
The funding shortfall makes it extremely challenging for Labour to meet its own aspirations. And just as important, it will be challenging to meet the expectations of health workers and the public who want to see the ‘repair our health services’ return the NHS same level of service we have historically expected – an end to rationing, an end to waiting lists, A&Es that work, and a GP appointment when you need it.
The Manifesto is a good start, and much better than the alternatives. But there is more work to be done, on funding in particular, before these aspirations can be turned into reality.