Labour’s confused opposition on the NHS

By Tom Keeley

The NHS reforms are not a workable set of proposals – that has been clear for some time now. If
implemented the Tory plans for the health service would likely result in reduced efficiency, increasing cost and an extended period of confusion. This is the result of a government in a hurry, refusing to consult. It is a mess that has only been made worse by alterations announced this week.

However, in opposition to the reforms the left wing press, blogosphere and to a lesser extent the Labour Party itself has promoted a set of health policy values that are in direct contradiction to government policy between 2001 and 2010. The balance of left wing “thought” seems to be settling on a health policy that has strong similarities to our 1997 manifesto. This is a sizable political mistake that would badly damage the NHS. Take the following two areas where the left is increasingly departing from its recent policies.

Private provision

During Labours stewardship of the NHS private companies were increasingly used to provide services, ranging from cleaning to hip replacements. They were controlled – the market place was clearly defined and entry was limited – and they proved able to provide cost-effective services to the taxpayer. This use of private operations was a factor in reducing waiting times for surgical procedures. Furthermore, previously public controlled hospital trusts were given greater independence through the introduction of foundation
status.

Listening to some of the opposition to the Conservative reforms one could be mistaken in thinking that Labour now rejects out of hand the use of private companies in the NHS. That is not what our recent history is, nor is it what our future policy should be. As a party we need to recognise that in some health care situations private provision can increase efficiency and bring benefits to patients quicker than would otherwise be possible. Private provision of services does not mean a privatised health service As a collective voice we need to reject the open market currently proposed, but accept that a limited use of private provision can improve the level of service to patients.

Doctors and commissioning

The commissioning of health care has been an area where numerous generations of health managers have failed harness technology and control cost. The world class commissioning programme, introduced under the last Labour government, is clear – involving doctors in decisions is a positive step towards effective commissioning. Local doctors shouldn’t be responsible for all decisions, as many commissioning decisions need to be regional and some national in scope. But, bringing commissioning decisions closer to doctors was the raison d’être for the practice-based commissioning programme launched by the Labour party in
2004.

A conflict exists in the NHS between what medically we can do and what as a society we are willing to pay for. Decisions on the provision, or not, of health care have to be made. Doctors should be more involved in these decisions than they currently are. They have knowledge and experience that is not held by middle managers in Primary Care Trusts. The idea that if doctors are involved in commissioning they will be checking their balance books before every referral is misguided. It is possible and prudent to involve doctors in the commissioning process and doing so will improve the standard of care.

A nuanced opposition is a hard thing to pull off, particularly in an area as emotive as health care. The current reforms pose a sizable threat to the NHS. Make no mistake this piece is not arguing for any willing provider or GP consortia; both ideas are flawed and David Cameron is wishing he had never heard of either.

However, the NHS needs the Labour party to be practical and at times centrist in its approach to health. If we get caught up in the excited rhetoric of current opposition to these reforms, and forget the past recipes for success, the NHS has a major problem.