NHS: Cumbrian case study shows Labour, not the Tories, are the reformers.

By Jonathan Todd

Labour’s compassion built the NHS under Attlee and Labour’s investment saved the NHS under Blair and Brown. But it is Labour reform that has kept Cumbria’s community hospitals open and achieved better health outcomes in so doing. These successes are now threatened by Tory incompetence.

Gerry Robinson, the management guru who once tried to “fix the NHS”, bemoaned the lack of piloting contained in Andrew Lansley’s NHS plan on the Today programme last year. The presenter (Evan Davis, as I recall) then misdirected him towards Cumbria. While Cumbria may have much GP commissioning, it has benefitted from Labour reform, not opened a window on Lansley’s future.

The Financial Times reports that Cumbria offers “a glimpse into what the … government’s healthcare revolution could look like”. It may be that Lansley’s spinners have been whispering in the ears of Davis and the Financial Times, but Cumbria isn’t the first domino to fall in Lansley’s revolution. It is benefitting from a flowering of reform championed by Lord Darzi and patiently cultivated by NHS workers. Evolution would have meant more such reform, not a “grenade tossed into the PCTs”.

Six GP consortia cover Cumbria’s 500,000 residents and have had control over about 70 per cent of the local NHS budget in recent years. Over this period, emergency hospital admissions and A&E visits have fallen by 6 percent and 13 percent respectively. This contrasts with rises of 9 percent and 5 percent over the whole of England.

These achievements have been assisted by moving care closer to home. I declare an interest in that the community hospital in which my Mum works, often threatened with closure in the past, has benefitted from additional beds as part of this trend. Such improvements to community hospitals have enabled earlier discharges from acute hospitals, created space within these acute hospitals that commissioning GPs are pushing to have used for specialist care closer to home, and minimised unnecessary admissions that typically cost £3,000 a time.

The need to address significant overspends within the Cumbrian NHS encouraged local health managers to reform their services. In contrast to GPs today who are required to commission or else, the desire for reform in Cumbria led to a positive choice to embrace practice-based commissioning and to work in a collaborative way in the local interest.

High Quality Care for All, published by the department of health under Alan Johnson in 2008, promised to: “re-invigorate practice-based commissioning and give greater freedoms and support to high performing GP practices to develop new services for their patients, working with other primary and community clinicians”. Cumbria has gone as far to realising this part of Lord Darzi’s vision as anywhere else in the country.

Leaders of Cumbrian GP consortia are effusive in their praise for how the PCT has worked with them to improve local services. This is far removed from Cameron’s bullish claims at PMQs last year: “We say that the primary care trusts and the strategic health authorities, all that additional bureaucracy, should go”.

When the Cumbrian NHS was confronted with overspends, it didn’t, pace the prime minister, scrap its PCT. The PCT was a catalyst to improvement, which provides more accountability than seems likely in future. This speaks to a wider political divide. Labour is for an enabling, reforming state. The Conservatives are for rolling back the state in the faith that something superior will fill in the vacuum.

This makes Labour the pragmatists; in favour of what works. GP commissioning in tandem with an innovative PCT has delivered results in Cumbria. Enthusiasm for GP commissioning doesn’t make Lansley reckless. But imposing this practice on GPs – who may be unwilling or unable – at breakneck speed does. While also scrapping the institution that would be best able to support them (PCTs), destabilising hospitals by exposing them to cut-throat competition and asking all these partners – GPs, PCTs, hospitals – to deal with a massive funding crunch. As well as flu vaccinations that ministers have opted-out of sorting.

If this is what the big society means, no wonder Nick Boles anticipates chaos. Given that Labour moved satisfaction with the NHS to unprecedentedly high levels, this would be a needlessly shambolic descent. From which Cumbria’s acute hospitals may not be spared.

The concerns about the future finances of Carlisle’s Cumberland infirmary and the West Cumberland hospital recently expressed by an independent auditor cannot be eased by the possibility that revenues that would otherwise have come to them will be creamed off by profit-seeking and Tory-supporting firms.

Lord Liddle of Carlisle told Uncut:

“My big worry about the Tory plans for the NHS is whether the government’s rigid model of GP commissioning caters for the exceptional needs of counties like Cumbria. In pure population terms we cannot justify the number of hospitals that we have. We are a remote county and people have to travel long distances for treatment. So our NHS is higher cost than elsewhere. Will the GP commissioning model take adequate account of this? I worry about the viability of some NHS services in Cumbria under the new arrangements”.

It would be a hapless cruelty for Labour reform to have saved Cumbria’s community hospitals only for Tory ineptitude to undermine its acute hospitals. The scrapping of the RDAs was “Maoist”. “Cultural revolution” is ripping through our classrooms. But Lansley’s revolution could be the most destructive and scorched earth of all. Their penchant for hyperbole and reformist seal, fired by Blair biographies, has only left them with their own poll tax. As it was in the 1980s, it will be the most vulnerable who will suffer most from this ham-fisted misrule.

Jonathan Todd is Uncut’s economic columnist.

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5 Responses to “NHS: Cumbrian case study shows Labour, not the Tories, are the reformers.”

  1. Thank you. A well argued piece without the head-in-the-sand approach that appears to be coming from the Labour leadership, nor the tub thumping “GP commissioning is bad because Lansley wants it” approach that comes from the remaining Labour activists who have not succumbed to Ed’s stupor.

    The main purpose of Lansley’s plans is to make the secretary of state no longer responsible for healthcare provision (although for the time being the state will still be responsible for paying for the healthcare – for the time being). This means that service re-configuration will be entirely at the mercy of the market. Too many hospitals in your region? One or more will close, but they will close because they go bankrupt: local people will have no say. The government will say that it is not their responsibility. You WILL NOT be able to complain to your local MP because under Lansley the government will not own, nor have any responsibility for hospitals.

    GP taking part in commissioning is a good thing. The problem with Lansley’s plans is that they will not do it. The policy has been designed to make the privatisation of commissioning occur – without the PCT support that Cumbria GPs have had, few GPs elsewhere will want to do commissioning. Indeed, Lansley’s first version of this policy (the NHS Autonomy and Accountability white paper published in 2007) says that PCTs should remain to support GPs. Why the change of heart? Why did Lansley decide that PCTs would have to go? Well, the fact that GP commissioning with PCT support worked in Cumbria, without private hospitals and competition, showed that “any willing provider” cannot be justified. Abolish PCTs and privatise commissioning means that “any willing provider” and hence the greater involvement of private providers starts to be the norm.

    In the next few weeks Cumbria will be wheeled out by Lansley as justification for his policy. Thanks for providing a good article that shows that Cumbria is a reason NOT to accept Lansley’s policies.

  2. Richard says:

    It would have been useful if you had provided a quote or a link to the effusive praise GP consortia leaders have had for PCTs so campaigners around the country can use it for myth-busting purposes.

  3. Elaine says:

    Thanks for this. Very informative and timely. Agree that more links and citation would strengthen this. Hope that you are making sure your article gets wider circulation. I will forward it on to others.

  4. Richard/Elaine,

    Thank you for your comments.

    If you are able to open the FT piece that I link to, which the FT pay wall may prevent you from doing, you will find a quote from one of the GPs who has been most active in taking forward their commissioning role in Cumbria in which he credits the chief executive of the PCT with “inspirational leadership”. As I argue in the piece, practice based commissioning can work but it’s more likely to work with “inspirational leadership” from PCTs; rather than, as per the Lansley plan, with PCTs completely absent.

    Hope this helps, Jonathan

  5. Nick says:

    I chanced on this piece by accident so apologies for the tardy response. I’m afraid you have swallowed the Cumbria PCT commissioning propaganda hook, line and sinker! They claim to have reduced secondary care activity significantly since the introduction of their Closer to Home policy in 2007, when in reality A+E attendances, elective admissions and outpatient attendances have continued to rise (if you don’t believe me look at the annual reports of North Cumbria University Hospitals Trust). Non-elective admissions have levelled out – mainly due to day cases no longer being counted as an admission. During this time the commissioning funding for secondary care in N Cumbria has been reduced by 30%, decimating hospital services to the point where they are utterly broke and can no longer provide safe acute services within the financial contract offered by the GP commissioners. Therefore the acute trust has had to seek a merger with a neighbouring foundation trust so Cumbrian acute services will no longer be managed locally. So those “inspirational” PCT commissioners whom you praise so fullsomely have taken money away from acute services to provide more care closer to home, none of which has materialised, whilst the acute services continue to treat more and more patients but with 30% less income! The money is not being “creamed off by profit seeking and Tory supporting firms” but by the PCT!The Cumbrian success story is in fact a disaster for acute care – there is little point in preserving the small community hospitals if there’s nowhere for the population to go when there are really ill….and that is very rapidly becoming the reality. Next time do your research more thoroughly and try not to be influenced by political ideology.

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