Labour promised much for the NHS at its’ recent Conference. Here are some reactions.

The NHS faces one of the toughest winters in its history. Last year hospitals were already stretched far beyond their capacity, with more than four thousand extra beds having to be opened. Financially, trusts face a £6bn hole in their budgets this year. Add a bad outbreak of flu into the picture, and the outlook is truly grim.  A one-off financial bung (Labour pledges a £500m winter bailout) is not going to solve these problems. The shortages of beds and staff have been years in the making, and cannot simply be reversed in a few months. We need a long term funding settlement for health and social care so that the NHS can actually plan on the basis of having enough resources. All political parties have been avoiding this question for too long. The Nuffield Trust’s 2017 General Election finances paper showed that the pledges of all political parties before the election fell short even of a level which would keep NHS spending at the same proportion of national income as it is today. Their commitments fell far short of even our minimum calculation of what the Health Service would need.

Nigel Edwards, Nuffield Trust Chief Executive

 

Delegates were ecstatic when the party supported an NHS that was universal, comprehensive, free at the time of need and paid for out of taxation – overcoming years of support for an NHS that was universal, comprehensive, free at the time of need and paid for out of taxation and which tried to deliver decent care.

Organised chanting greeted further announcements pledged to end the scandal of PPI, banning further adverts and taking all hospitals in house – a variation on the hospital at home approach.  A guarantee would be given that no hospital or clinic or unit or service or anything would be changed, ever.  And NHS land and derelict buildings are ours to roam over – Not For Sale.

All involvement of the private sector would cease on day one (an amendment that this was too late was lost) with existing contracts torn up before the eyes of Richard Branson.  All GP practices would be taken over and staff TUPEd into the NHS.

In the spirit of integration, social care would be renamed Other NHS care and also be made free and available on prescription from any one of the new professionalised (graduate only) care support workers.  So called informal carers (such as partners) would be rebadged as NHS employees and paid the living wage or as agenda for change determined.

In transforming care, anyone whose role included words like manager or director would be made redundant as workers would coproduce with other consensual adults.  Oversight would be provided by health boards made up of appointed good people who had more than 3 years membership of Keep Our NHS Public.

Market structures like Trusts would be reorganised and brought under workers control.  Arrogant isolated units like Barts. or Great Ormond Street or Papworth would be broken up and dispersed.

Cheering broke out as it was announced that this brighter future would be signalled by returning to the 1970’s; bringing back 2 year minimum waits for treatment, warehousing of the elderly and those with any mental health issues, doing without IT and finance people, and restoring the right of doctors to ensure long waits so their private practice was not threatened.  Modern notions like technology or public and patient involvement and shared decision making were denounced as part of the neo-liberal plot to a standing ovation.

Asked about experts claiming this would all cost a lot of money a spokesperson for Momentum said that this would be achieved by taxing well off people.  They added that the plans for change were being worked out by a panel of non-experts drawn from campaigners, activists and people who had overheard something down the pub. True vison from a government in waiting.

Roger Lyon-Smith, Freelance journalist

 

Appearances of unity over health policy ended at Labour conference with a challenge to the recent Manifesto of Jeremy Corbyn which was agreed just a few months ago.  The gap between ideologues and realists was exposed in the speeches on the composite resolution on the NHS.  This was a resolution so well considered that it began with an opening sentence that was factually untrue, claiming that 44 contracts with accountable care organisations had been signed.  The rationale was based on the view that everything happening in the NHS was part of a plot, led by Simon Stevens, and fuelled by neoliberal forces.  It was so well drafted that it had the same bullet point twice!  Yet somehow reality was parked and votes followed factional position.

For this faction there is only one issue in care policy – the structure of the NHS – or the ownership of the means of production.  The bigger crises in social care and in housing are as nothing.  The almost insoluble crisis around staffing in the NHS and wider care sector post Brexit does not matter.  The future for the NHS is to return to the structures of the 1970’s and in so doing remove every trace of the private sector (except possibly GPs, pharmacists, dentists, opticians, specialist mental health care, etc.).  How this might be achieved and at what cost is irrelevant.  If the ownership is right then the workers’ control that will follow will be enough to overcome all problems.

This position takes them way beyond the 2017 Manifesto and in direct collision with Jeremy Corbyn who signed it off.  It was a Manifesto almost everyone else described as a key part of Labour’s strong election performance.  A Manifesto that had its roots in the party’s policy development process which established a wide consensus and which was agreed by all the party’s key bodies. Labour actually has a faction that does not trust Jeremy Corbyn on the NHS!

The other faction actually thinks about patients and care and what might be good for them – suggesting that no top down reorganisation of structures has ever done much for patient care.  The real issue is how to ensure adequate funding and the investment of money, time and expertise to resolve (over quite a long period) both the short term and the more difficult longer term problems.

Current party policy is built very solidly on keeping the fundamental principles of the NHS – universal, comprehensive, free and funded from taxation, and even beginning to apply these same principles more widely.  And built on reversing the increased role of the private sector in the NHS and the costs associated with tendering and complex procurement – it’s in the Manifesto and was set out in policy documents. The gulf is between those who think the future lies in the past and those who want a future where a Labour government (or perhaps two successive governments) brings improvements across our care system on the same scale and with the same drive that led to the start of the NHS 70 years ago.

With the current state of care a huge reorganisation on a scale never seen before would probably do immense damage to the delivery of care.  For the present, dealing directly with the current crisis,  making what we have work far better and eliminating some of the barriers to better care accompanied by increased funding and greatly improved pay and conditions is a better option. Let us all get behind Jeremy and the Manifesto.

Alan Walters, health policy analyst