By Tom Keeley
After the summer recess the Health and Social Care bill is due for its final reading in the House of Commons. For those hoping to see this bill torn up, time is running out. The chance of stopping this version of the reform is looking increasingly unlikely. The question that may soon need answering is why could Labour not defeat such an obviously flawed bill?
As a party, and as a larger political movement, we have failed to agree on a post-recession and post-2010 vision for the NHS, let alone communicate it to the public. In mistakenly thinking that our excellent track record would be enough in itself we have failed to provide an alternative. Subsequently a weak and often hollow opposition has been the best we have managed. If this absence of policy is not quickly addressed we will lose the public’s trust in our ability to run the NHS. As a party we need agreement and clear policy in four main areas, and quickly.
Private companies in the NHS
Since the introduction of the internal market no party can form health policy without an agreed standpoint on private investment in the NHS. Currently we are a long, long way from this. For some in the Labour Party, and in affiliated organisations, a private company being paid from the public purse to provide NHS care is unacceptable. Others say that that the expansion and improvement in the NHS under Labour was possible because we opened the doors wider to such influence. A practical compromise between these two points, which recognises the current reliance of the NHS on private companies, is urgently needed to avoid a policy paralysis.
The role of the doctor
The health reforms have put the issue of the relationship between the doctor and the patient front and centre in the health debate. When the idea of GP consortia was first forwarded the loudest voices shouting against it were those that did not want “their doctor to be looking at her balance sheet before treating them”. This is a widely held view amongst both the party faithful and the wider public. However, removing clinicians from all commissioning decisions would contradict Labour policy between 2005 and 2010 and would go against a global consensus that says that bringing doctors closer to commissioning decisions is an effective way to contain cost. We can oppose GP consortia and provide a constructive vision of clinician participation in commissioning decisions. We are not currently doing this.
Local versus national
The Tories believe that a centralised health system cannot be responsive to local needs and efficient on a national scale; they prefer an ultra-local and largely unaccountable system. So far Labour has not articulated an alternative vision of an NHS structure that would respond to health needs of Sparkbrook in Birmingham and to those of Chipping Norton in Oxfordshire, while at the same time maintaining standards of care nationwide. Until we have this the localism agenda currently being forwarded by the Tories will dominate. Furthermore, the new reality may be that if GP consortia are put into place a return to PCTs and SHAs, in their pre-2010 form, may not be possible or practical. If this is the case we then need a structure that can respond to the new reality of organisational chaos being imposed on the NHS.
In the last decade the amount spent on health care increased rapidly, and subsequently health outcomes in the country improved, but not at the rate they should have. Questions around what the optimal level of spending on the NHS is, where this money should be spent and how to get this money to “work” best for the patient remained unanswered. Solutions to these questions would rapidly improve the credibility of Labour health policy with doctors, health managers and, I would suggest, patients.
The Tories have shown that they can’t be trusted with the NHS. We need to reaffirm that Labour can be. The first step is to agree on a vision.