Hearing Shadow Health Minister Andy Burnham proclaim we should scrap the Health and Social Care Act at Labour conference was, on the face of it at least, appealing. Politically you can see the motivation behind this statement of intent.
The Government has forced though what became a very unpopular Bill, with little or no support from the various colleges and associations of medical professionals. It was a Bill poorly understood by the public (and what they did know, they didn’t seem to like much). Certainly in no way can the Bill be seen as democratic, or the rationale behind it very sound. Very few voters on the doorstep before the 2010 election were calling for commissioning powers to be handed to their GP. In fact, satisfaction with the NHS was at a record high.
Labour in light of this, understandably sees a possible dividing line and wants to exploit the public’s growing distrust of the Tories on the NHS, fuelled by Cameron’s pre-election billboard ads, broken promises, media stories about rising waiting times and the stop-pause-go shambles of the Bill itself.
Despite all this, it may surprise you that I, like many in the Health Sector, don’t think overturning or scrapping the Act is either good politics or policy in the longer-term. There are three reasons for this view.
Firstly, it’s a question of money. One major criticism of the coalition’s NHS reform is, that a time of severe budgetary constraint due to a freeze in spending, in the context of ever increasing demand for healthcare and after a history year-on-year large budget; rather than use every penny possible on the front-line, the Government spent or ‘wasted’ billions on this major top-down reform. Any restructure on this scale is hugely disruptive; the whole service is currently in major flux, with uncertainly about exactly what systems will look like come April next year. Structures are currently shifting, job titles changing and employees made redundant from scrapped bodies looking for jobs elsewhere in the new myriad of emerging structures. This process would only simply be repeated yet again should a future Labour Government look at further root and branch reform. With money tight for the foreseeable future, our message to the public should be that we are the party which ensures every penny possible is spent on the ground, on parents care, not on further changes to structures, renaming of organisations, and on a further game of musical chairs for NHS staff.
Second, is the need to take into account the views of those who know the most about the NHS. These reforms were strong opposed by the BMA, RCN, Unison, Patients Association and other professional associations and patients groups. The Labour front-bench team was completely correct in their approach to highlight the sheer scale of opposition to the Bill. It’s of course right to criticise a Government which chooses to ignore those who work and use a particular service, as these groups are best placed to offer insight into what works on the ground. For a Government such as this, which claims its policies are about evidence of what works and that it is driven by localism, to completely railroad the entirety of the staff and user groups of the NHS is particularly hard to take. Indeed the ‘pause’ and listening phase was largely meaningless. However, now as a party we are close to repeating this same mistake. Many clinicians and patient groups now take the view that, whilst the reforms were not what they would have chosen, they are here and it’s vital we make them work for patients. Equally, having suffered reform-fatigue under this and the last Labour administration, the last thing they want to contend with is further massive changes after 2015.
Lastly, to completely scrap the Act would ignore the fact that there are some positive things which have emerged from the mammoth Bill. For example having one national body (the NHS Commissioning Board) responsible for the commissioning of specialised services is surely a very positive development. Small patient groups, thinly spread with distinct needs and often expensive service requirements, can have their needs marginalised when competing for the attention of commissioners with the wider population. Equally, the transfer of some Public Health responsibilities to Local Authorities is an important and welcome development, as is ensuring that local authorities and other key partners, through Health and Wellbeing boards, are better integrated into health services. Giving Local Authorities a greater role in meeting local health needs and inequalities is long overdue.
Labour needs a policy on the NHS which works for the future, not just for its electoral prospects in 2015. Labour should build on the positives from this Act whilst working with those in the sector to address its flaws, boosting cooperation over competition and reducing private involvement. It’s vital that when developing a policy for the NHS the party doesn’t take what seems like the easy approach in opposition but has instead a realistic, affordable and workable way forward in 2015.