WANTED: Labour’s NHS Policy

The Labour opposition front bench put up a whimpering resistance to the NHS reforms. As a result we lost the battle to defeat a deeply flawed piece of legislation. The NHS “reforms” will now be passed into law and the effects will be seen throughout the health service. 2011 should be seen as one of the low points in Labours stewardship of the NHS, because we forgot that effective opposition is sometimes as important as effective governance.

Labour lost the fight because of the complete absence of policy and in some cases an unclear position on fundamental points, mainly private companies and NHS funding. The challenge for the newly in place Andy Burnham and his health team is to form and articulate sensible health policy, compatible with the new reality of Lansley’s NHS. At every step the question must be asked “Will this policy improve outcomes for patients?” Waiting time targets are a key area where sensible policy can improve outcomes.

Waiting time targets

While not a panacea, this is an important area for Labour. In 2015, when we have to tidy up the mess the Tories leave behind, waiting times targets will be needed. The government’s plans for the NHS stand no chance of keeping waiting times low and geographically differential performance will become commonplace. Targets will be needed by a new Labour government, first, to exert a downward pressure on waits and second, to equalise waits throughout the country.

The two-week cancer guarantee, the 18-week elective target and the 4-hour breach barrier in A&E are all examples of targets that kept waiting times low, and ensured the NHS responded to patients. They worked because they applied direct pressure on NHS managers and doctors to achieve efficiency within their departments. They built confidence in patients and in doing so empowered them to hold their health service to account. Furthermore, the setting of these targets ensured that politicians were major stakeholders in the drive for shorter waiting times.

Winning the argument

Targets are often attacked as a government interfering in the NHS. The argument can be developed further to say they lack clinical relevance and don’t allow the flexibility to treat the patient and the disease. On these points past attempts at target setting are rightly criticised: The four hour breach barrier in A&E was an arbitrary and inflexible time period. Why not 3 hours? Or 5? Do all ailments, from stomach pain to broken arms, need to be treated the same way? Or are some more urgent than others? The same can be said for the two-week cancer guarantee and the 18-week elective target. While admirable and helpful these targets were not based on clinical science and outcomes, but on political motivations. This reduced their effectiveness and laid them open to critique.

But, these critiques do not mean that targets can’t be clinically relevant and flexible. They can. For example, ischemic stroke victims that receive thrombolytic treatment in the 4 hours after a stroke are much more likely to enjoy disability free survival. The challenge for our front bench will be to develop relevant waiting time targets that doctors and NHS managers recognise as important to the care of their patients.

The Labour health team needs to win the argument in favour of waiting time targets by forming policy showing the potential for success. This won’t be easy. It will require close collaboration with doctors and health professionals. We must learn where targets will be most needed. If they are not needed in areas of national obsessions, like cancer and heart disease, then so be it. If they require the use of private companies to bolster capacity, then so be it.

Good politics

Waiting time targets are no panacea and are an easy target for attacks in the press. But, when linked to the reimbursement of suppliers and as part of a coherent health policy they have the potential to drive down waiting times. If the Labour health manifesto in 2015 includes a number of well thought through, outcome focused waiting time targets, which are supported by the GMC, the BMA and other medical groups then we are onto a winner. We will then have a policy that is good for the NHS and, when packaged as pledges, good for the campaign trail too. Waiting time pledges are messages that resonate with the electorate, much more so than arguing over 0.5% reductions in funding or introspective debates about private influence in “our” NHS.

In 2011 we lost, badly. The key to winning in 2015 is outcome led policy formation.