To solve the NHS crisis, Labour must offer neo-Attleean reform – not just money

This winter was the worst winter crisis the NHS has yet faced. Elective procedures were cancelled, waiting times soared to the worst on record and both patients and staff have endured tough conditions. A recent history of underfunding the health service has contributed to the current crisis in our NHS, with NHS trusts struggling to stay financially solvent.

We must also acknowledge that the Tories are right when they say NHS funding has increased in real terms, just as Labour is right to say the Tories have underfunded the NHS. The reality is that the supply of care has not been able to keep up with the rapid increase in demand for services driven by demographic change. If Labour is to build on the legacy of Nye Bevan and build an NHS fit for the 21^st--century, we need a bold neo-Attleean reform agenda.

Healthcare needs are changing. After William Beveridge set out his blueprint for a welfare state that would address the five giant wants – disease, ignorance, squalor, want and idleness – the 1945 Labour government built a healthcare system to care for a population with average life expectancy in their 50s. People died young from illness for want of treatment, so a model of care was designed to treat each person’s condition in hospital, then discharge them fit and healthy. This was a centrally-run tripartite system of hospitals, general practice and community care, separated from local government – creating the division in health and social care that still exists today. And the system worked well. Infectious diseases are no longer the killer they once were. People are living longer, with average life expectancy now at 82.

However, the success of the NHS has created new challenges. Higher life expectancy means more people living with conditions such as frailty and dementia. 18 per cent of people in the UK are now aged over 65 or over, compared to 14.2 per cent in 1976. This is set to rise to 24.7 per cent by 2046 according to the ONS. Patients admitted to hospital today are far more likely to have many multiple conditions and/or chronic illness that cannot be cured – these are conditions that cannot be simply treated in hospital before they are discharged fit and healthy.

Academics and policy wonks have declared that we are entering a “third age” of healthcare – the first being the use of preservatives and practice of sterile hospitals to reduce infection, the second being Bevan’s NHS. You may think this just sounds rather Tolkien, but you do not need to look far to see that it is reality. The result is hospital beds full of patients who are still ill or weak but cannot be easily treated; elderly patients with no social provision to allow them to be discharged. Not only is keeping patients in appropriate care setting not good for them, but “bed-blocking”, as it is known, stretches demands on NHS staff and creates more problems at the hospital front door in A&E.

As our healthcare system evolved to meet the health challenges of 1948, so to must it evolve to meet the health challenges of 2018, while staying true to the principle of free healthcare at the point of delivery. The NHS needs to transition from a system designed for treating ill health to one more focused on managing and preventing it. This is a healthcare system that more often keeps patients at home and prevents hospital admissions, with doctors going to patients rather than vice versa. We should seize the opportunities of the digital revolution and put technological innovation at the heart of healthcare delivery, enabling doctors to monitor patients’ conditions remotely, helping them to make better prescriptions and diagnoses.

This should be more bottom-up, seeking to replicate best practice from across the health system, rather than the old command and control approach. NHS staff on the frontline – be it doctors nurses or allied health professionals – have pioneered models of care that have the potential to reduce pressure on hospitals, improving lives and saving money. Evidence shows that patients who get to stay at home have better health outcomes, are happier in familiar surroundings and at reduced risk of contracting healthcare associated infections, such as MRSA and E. Coli.

Oxford University Hospitals has taken on social care provision, breaking down the barriers between health and social care to allow older people to be discharged from wards. Improved data is enabling healthcare leaders to be better able to spot best practice, through analysing unwarranted variations. This approach was central to Lord Carter’s 2016 review of productivity in NHS hospitals. To meet the demographic challenges we face, it is an approach Labour should embrace.

NHS England’s own “five-year forward view” set out to bring this transformation in healthcare services. Yet its delivery has been hindered by a lack of funding to even provide for the healthcare demands of today, let alone deliver the transformation to build the healthcare system of tomorrow.

Transformation budgets from Sustainability and Transformation Funds – funding pots for 44 “footprint” areas across England to make healthcare delivery more efficient and sustainable in the long-term – have been raised to plug funding gaps to sustain existing underfunded services. Whilst the Conservative Health Secretary has acknowledged the need to evolve healthcare, the government has not given it the required funds. Insufficient funding and botched junior doctors’ contracts have undermined the morale of the medical profession.

Increased funding alone with not fix the NHS in the long-term. Labour has rightly committed to giving the NHS the investment it needs, but the party hasn’t faced up to the need to reform to meet changing and escalating demand for services. A radical investment programme must be matched by a radical reform programme. Using data to spot and spread best practice as well as devolving power and integrating care for local populations through integrated care systems will help the NHS meet the challenges it faces.

Without such a reform programme, greater investment will only paper over the cracks and not address the roots of the problem. An immediate cash injection should prevent the next winter crisis in the NHS, but the following winter crisis will be Labour’s if we don’t act properly. It’s time for Labour to develop a neo-Attleean reform agenda to rebuild the NHS for the 21^st-century – to preserve the status-quo would make us the conservatives, not the radicals.

Edward Jones is a Labour activist and political consultant who lives in London.