With the NHS once again plunged into the scandal of another ‘winter crisis’, it is clear that an emergency injection of cash is desperately needed to keep the service afloat, so Labour’s call last week for an injection of £700m was welcome.
Yet, for all the angry noises we’ve (rightly) been hearing, it is less clear that Labour actually has a plan for the NHS. Simply pumping cash into the NHS in perpetuity is not sustainable and, beyond shouting “NHS” at every election, we know very little about the vision for health and social care policy.
Yes, we know that, alongside a cash injection into the social care sector, Labour wants to integrate health and social care. But all the parties promised this at the last election.
Yes, the competitive market enshrined in the 2012 Act entrenches an organisational ‘fortress’ mentality and places structural barriers to collaboration between healthcare providers that will be needed in the coming decades. But what alternative is being proposed by Labour, and how would the party seek to change it?
And yes, everyone wants to protect the foundational principles that the NHS remains free at the point of use. But again, no serious politician in the UK disagrees.
None of these platitudes constitutes a plan.
How, for example, would Labour integrate an adult social care sector, where most people pay for their services, with an NHS that remains free at the point of use? What is Labour’s plan to streamline movement between the two systems? How will Labour facilitate closer working between Local Authorities and the local NHS?? How will Labour remove the perverse incentives that currently mean there are thousands of people sitting in NHS beds when they could be moved to social care?
On competition in the NHS, Labour has spent much of the last 4 years since the 2012 Health and Social Care Act passed arguing that this reorganisation wasted £3bn. So how does Labour plan to repeal that act without inflicting another round of unwanted reconfiguration on a service already stretched to breaking point?
We can all agree that we don’t want an expansion of the role of the profit motive in the delivery of healthcare. However, as John Rentoul has written, the absurd conspiracy that the Tories are deliberately running the NHS down in order to justify the move to a private insurance-based system is, well, just that – absurd. And Labour needs, frankly, to be a little more grown-up on the issue of private involvement in the NHS, because unless Labour is planning on wholesale nationalisation of GPs, then we’re going to have continue spending a big chunk of NHS funds on private providers of NHS care.
The reactionary attitudes to ‘privatisation’ of the NHS is illustrative of the vacuous rhetoric that has, thus far, constituted Labour’s health policy. In a time of huge demographic pressures and ever-increasing healthcare costs we’re going to have to get inventive about how we deliver the right services at the right time to the right people. If that means NHS Trusts or a groups of GPs setting up private companies to deliver the sort of ‘Accountable Care Organisation’ style providers, of the sort that have been developed in the USA as part of Obama’s healthcare reforms, then we shouldn’t let ideological dogmatism get in the way of what works best for patients.
Instead of merely retreating into slogans and empty rhetoric, Labour needs to engage with the very real need to combine an increased investment in the NHS with a transformational vision necessary of the health system necessary to ensure we have a world class service fit for the 21st Century.
A pledge to invest more in health and, of course, social care, is necessary. Personally, I think an “NHS tax” could, once again, prove to be both a popular policy and provide of much needed funds. But pumping in cash indefinitely won’t be enough to tackle the challenges of an older and fatter population that is experiencing increasingly complex co-morbidities. Up to now, it is not clear that Labour has a credible plan to tackle these challenges.
Labour needs a plan to increase public health funding and an increased focus on preventative measures. Just as importantly, Labour needs to formulate a strategy to sell this investment to the public who, in the face of increasing pressure on the NHS, will inevitably question why preventative measures, rather than treatment of those who are ill now, deserves increased investment.
Labour also needs to look creatively at international examples, for example to innovations in ‘accountable care organisations’ in the USA, which appear to help overcome organisational boundaries and deliver streamlined care for patients across the health service. And closer to home for me, look to Scotland, and the Integration Act, to learn the lessons there about how Local Authorities and the NHS can deliver joined up health and social care.
Furthermore, in a world where patients, aided by apps and other digital tools that monitor their conditions, not doctors, are the experts in their complex co-morbidities; where smartphones and tablets make telehealth and virtual GPs a real possibility; where the human genome can be mapped for individual patients, how would Labour seek to accelerate the adoption of technology, big data and AI in the NHS?
It is not enough for Jeremy Corbyn, though he is not alone in the Labour Party in doing so, to just keep shouting, ‘privatisation’. The NHS is more than a political football to be weaponised by Labour. Yes, more money is necessary, but if Labour is to remain the ‘party of the NHS’, it needs to have a credible vision for the future of health services in England.