by David Talbot
“The NHS is on the ballot paper in May” declared the Labour leader at Prime Minister’s Questions as he sought to solidify his party’s clear advantage on this most important, and emotive, of issues. That the NHS is set to be centre stage at the forthcoming general election is partly due to naked politicking, and partly due to the dire forecasts for our health service. Both main combatants are well aware of the financial and demographic peril the NHS is in, but both continue to besmirch the debate with clichéd attacks on how the Tories can’t be trusted on the NHS or, a new variant of the same line, Labour are ruining the NHS in Wales.
It is essential that politicians are honest with the public about the scale of the challenges facing the NHS. This is particularly true of the Labour party who are prone to nostalgia and playing on sentiment, invoking the spirit of Nye Bevan and having a nonagenarian address party conference, for instance, but specifically because the party is making pledges which, deep down, it must know will be difficult or nigh on impossible to deliver. The NHS matters too much for short term electoral considerations; it is better that the party is frank, and dare say unpopular, with the public now rather than risk alienation, anger and a disintegrating NHS later.
Ed Miliband’s flagship announcement at the party conference last month was an eye-catching commitment to establish a new £2.5 billion ‘Time to Care Fund’. This unravelled not long after some fairly rudimentary scrutiny; it will be not be implemented in full until 2017/18 and Labour would need to first pass a Budget and then enact legislation before the mansion tax, levy on tobacco firms and tax avoidance levies would yield any income. And even then there are serious doubts the revenue raised would come anywhere near the £2.5 billion quoted.
It is not to say that the party is not coming up with a better vision for the NHS. Labour’s plan for a combined health and care service is unquestionably the right direction of travel, but it is not a cost or pain-free option. Andy Burnham may deny that there will be large-scale reorganisation, but unavoidably, and undoubtedly, there would be heavy financial and structural costs. A messy structural reorganisation of the administration of healthcare would clearly get in the way of healthcare delivery. What is important, what the public should not be fed, is the idea that it is not a reorganisation. It is exactly that.
The King’s Fund Barker report estimated that even after introducing a combined health and care service, spending would need to rise to around 11% of GDP to meet demand. This would still leave our health spending trailing the highest European spenders – but it would require double the spending increase that Labour is currently proposing.
Labour also used the conference to amplify its pledge to repeal the Health and Social Act. But it cannot be repealed outright, and Labour knows this. In practice, it means scrapping Part 3 of the Act, which relates to competition, and reducing the amount of income that foundation trusts can earn. Burnham has already said that Labour will keep Health and Wellbeing Board, with Clinical Commissioning Group to be retained but downgraded. His plan to give power over local NHS Commissioning to local government will fragment healthcare around its locality, the exact opposite of what the National, the clue, Health Service was designed for.
Labour needs to think far more carefully about its NHS pledges precisely because it is the party most trusted on the service. People look to it for, and trust its views on, the NHS. When it flounders on such detail it compounds the impression that it is thinking too much about exploiting its reputation as ‘the party of the NHS’, and not enough about the severity of the challenges ahead. In the desperate struggle for votes in the months ahead, clarity and realism should guide Labour’s vision for the NHS.
David Talbot is a political consultant
Tags: Andy Burnham, budget deficit, David Talbot, Ed Miliband, funding, NHS, time to care
I do agree that all parties need to be more honest about either providing more funding for the NHS or cutting the extent of services that it offers. To be fair to Labour (and indeed all non-governmental political parties) it is difficult to put accurate numbers to policy documents without the machinery of government. Research costs money.
I also agree that the proposed local authority oversight is at odds with the National Health Service as propounded by Nye Bevan. Not all people agreed with Bevan’s proposals; indeed Herbert Morrison was in favour of health services being under the control of local government. Bevan was relentless in his pursuit of a national service and he convinced the prime minister of his case. Interestingly, the Tories wanted an insurance based system then and in 1951 Churchill convened a report into the efficacy of the NHS. The report found that the NHS was very effective and would be more effective if it received even more funding, a finding that dismayed the Conservative govt of the day. http://news.bbc.co.uk/1/hi/health/7405526.stm
I happen to think that the original proposal; which was predicated on national funding so therefore national control, with regional planning and local administration, makes the most sense. This system allows for co-operation between hospitals and pooling of resources so that different locations can offer different specialisms and that small rural services can be subsidised by large urban centres (otherwise they will close meaning some people do not have access to local healthcare).
As an aside I don’t agree with the prevailing theory that the management function within the health service is a waste of money. I don’t know enough about it to say that there is no dead wood (I suspect there is some) but I do know that nurses and doctors don’t want to be concerned with paying cleaners, invoicing suppliers, scheduling maintenance and financial planning. They want to spend time caring for patients. Managers facilitate this by taking care of the administration.
Living in Wales I found the revealations of the past few days highly amusing. For months now The Daily Mail et al have been bashing NHS Wales saying how bad it was in comparison to England – the a few days ago it turns out there is a massive and growing shortfall in the NHS budget, nearly exclusively in NHS England, that will cause serious collapse in 8 years time and that to balance the books and avoid this requires increases in spending for NHS England at twice the rate of inflation every year as well as a lump sum, as well as significant cuts to services and staffing>
Whereas we in Wales, Scotland and Northern Ireland have run a near-balanced budget. So there you have it – NHS England is only better because it has been living off the credit card and overdraft. And that is about to stop with a bang.