by Peter Watt
Almost everybody agrees that the NHS bill is dangerous. Except, probably, the health secretary Andrew Lansley. Patients groups, trade unions and most of the royal colleges are seemingly all united in their condemnation. And opinion polls indicate a sceptical public. The legislation is so dangerous that the end of the NHS is apparently nigh if you listen to the most hysterical opponents of the legislation.
And increasing numbers of Tory MPs allegedly think that the bill is bad for their political health. If the economy is Labour’s weakness, then they know that the NHS is theirs. Much of the public may not yet have caught up with the reforms, but they fear that they will soon.
Up until now the government has successfully blamed all of the country’s ills on the last Labour government. It has been easy, and on the whole very successful. But they know that between now and the election, every winter crisis, unclean ward or staff shortage is an opportunity for Labour to blame them and their NHS legislation. And that risks their seats and may just put the outcome of the next election, which up until now they were feeling optimistic about, in some doubt.
So Labour are rightly feeling that the NHS bill may be the government’s first serious tactical error. And one that they can and will exploit all the way to the polling stations. The bill also represents a real risk to Labour. It is a risk that they may very well fail to recognise. But recognise it they must.
Think back to the last Labour government and there is a commonly held view that when it comes to the public sector there is a pretty good story to tell. Services in decline were invested in and turned around, new schools and hospitals were built, more staff were employed and more people were treated, taught or supported. The result was that satisfaction ratings for services went up and the staff working in them were better rewarded.
But there is another commonly held view about the last Labour government; that whilst they invested in public services they didn’t match this with reform. The result was both a missed opportunity and a mistake. Tony Blair acknowledges that he didn’t move fast enough when he was able to and by the time he wanted to, later in his period in office, he was blocked by Gordon Brown.
Many of us remember all too well the battles over the Milburn and Reid health reforms and the rows over education reform. Every inch was keenly fought with many conference votes going to the wire or often as not resulting in a loss for the leadership. Behind the scenes the government in waiting, led by Gordon Brown, was making it clear that they were opposed to much of the reform agenda. They demanded it be stopped as they would soon be in charge. Much of the party faithful and the majority of the trade unions backed this stance. The fact is that the party loved to invest tax payers’ money as that was popular. But when it came to reforms that also delivered greater efficiency or a better service and choices for consumers then they were more squeamish.
So fast forward and the Tories are taking forward many of the very reforms that, back in the day, were opposed by many in the Labour party. Academy schools, choice, competition, welfare reform have all been embraced enthusiastically by this government. It confirms for many in the Labour party that the policies were wrong from the start. They knew it –Tony Blair really was a Tory in social democratic clothing after all.
And then there is the NHS bill itself. It has allowed this anti-reforming zeal to really take hold within the party. Andy Burnham may be a supporter of competition and choice, but many of those rallying to the cause certainly aren’t. The Tories inept handling of a largely unnecessary piece of legislation has given them their chance. This is an opportunity to finally put a nail in the coffin of further reform and they are going for it. You can hear it in the rhetoric, the old cries of the NHS being “the best in the world”, of its great efficiency and how we need more cooperation and not more or any competition. All of which are highly debatable, no matter how much you love the NHS. So all in all, the prevailing mood within the Labour party is for less reform not more.
But more reform is exactly what the NHS needs. The current legislation is clearly ill thought out and is rightly being resisted, but that does not mean that the NHS does not need to change. And if the Labour party really wants to save the NHS, it must aggressively embrace further change, not reject it. Because budgets will continue to be squeezed and efficiencies will still need to be found. At the same time patients will demand greater and greater choices, higher standards of care and service. This simply can’t be achieved without reform, even if money were no issue.
Now it may well be that the legislation passed by Labour already allows much of this to happen, so that there really is no need for any further top down reorganisation. But even so there certainly does need to be a bottom up reorganisation and that will involve choice, rationing and competition. Services will close and other providers may well be better placed to deliver certain services or run hospitals. Established ways of working will be challenged and there will be losers.
The only question is whether Labour is really up for delivering it, or whether it backs away from reform having rediscovered its comfort zone. It is the risk of the latter that makes the row over the current NHS bill most dangerous for Labour.
Peter Watt was general secretary of the Labour party.
Tags: Andrew Lansley, NHS, Peter Watt, reform
Dangerous compared to what?
The NHS currently kills 20-80,000 a year. It’s own figures.
The problem with the NHS is that regulator, supplier and insurer are one of the same, and as a result the conflict of interest to fix the medical needs of the UK is too high.
That’s why it needs breaking up and replacing with a health model such as the Swiss.
What is often forgotten when Eds Milliband and Balls cross swords on the NHS is that Conservative supporters are just as passionate about the NHS as Labour supporters. However as you rightly point out, reform of the NHS has become recognised as an issue for people at large in order to not only improve it but to enable it to cope with future demand.
No government can respond to problems and bottlenecks today by simply throwing more cash at them. From 200 to 2010 NHS government funding increased by an average of 6.7% a year as compared by an average of 3.5% a year (Kings Fund) during the last ten years of the 20th century. As the events of the last three years have shown this was in reality actually financially unsustainable at the time.
So improved productivity must be part of any reform. However factors such as an an aging population and population increase, quite apart from the issue of improvement means that this by itself is not enough. That is why means of raising badly needed extra cash from the private sector (but definitely not through more PFI) is an important option, otherwise the current economic state of this country will result in the most important public service of all going into irreversible decline.
“Competition” and “choice”.
Two totally irrelevant and overblown words when used in context of the NHS.
You talk about efficiency – ignoring the fact the NHS is the most efficient high class health service in the world – then wibble about “choice” and “competition” which both imply massive inefficiency, spare capacity and wasted resources.
The NHS doesn’t need reform.
It was beginning to work perfectly well as it became properly funded towards the end of Labour’s term in office.
I have been keeping abreast of the bill and the numerous changes that have been made. I have read widely on the subject and offer my views!!!
I am going back to 2000 when Alan Milburn (best Health Secretary we have ever had) wanted the NHS to be a market with all services being provided by private providers. We have come a long way since then as NHS work amounts to 25% of the private healthcare sector’s income. Andrew Lansley is following on from what the last government started. Alan Milburn wanted all hospitals to be Foundation Trusts operated as businesses and with no bailout by the taxpayer. This will be achieved this year and all Trusts know that they will not receive taxpayers money. they will receive assistance if they get in a mess and if they cannot cope at all the service will be put out to tender. The Private Sector would pick up weak trusts who failed and we have just had this happen – Hinchbrooke Hospital has been taken over by a private provider – the last government precluded any takeover my any NHS body. It is envisaged that some 20-30 hospitals will also be taken over in the next few years. At the same time some 227 GP practices have been taken over. Patricia Hewitt wanted community health to be removed from PCT’s and backed down after union representation. From April this year all community health workers will be detached from PCT’s. I have just been informed of this happening in my area.
At present 50% of NHS activity is subject to price competition. This will increase. I have no doubt this will result in closures and some staff will lose their jobs. Is this a bad thing? Many senior NHS Medical Staff work for the NHS a few days a week and work privately the rest. Rather nice for them. An NHS consultant only has to work so many sessions a week to have his salary, bonus and rather generous pension provision. At the same time many operate one day a week at private clinics (some take NHS patients). This would stop with staff going to where work is.
All this was started by Labour but undertaken without legislation which means that the public were not aware of the changes. Very underhand way of changing things in my opinion such as by way of Statutory instrument.
I find myself bemused with Labour now opposing the Bill. Andy Burnham was strongly in favour of competition as Health Secretary. Many MPs know (tv documentary) that we have far too many large expensive hospitals when smaller clinics tied to communities would be better and cheaper. It is only doctors who want these large expensive hospitals. In my area, we have saved a small cottage hospital with the whole community involved in fund raising to keep it open. We love it – just a few beds with local people using it after major surgery at our major hospital some 20+ miles away and for routine matters such as blood tests.
So, I am in favour of the Bill as it will actually permit me to have a choice on who provides my healthcare. I live in an area were the local hospital has an appalling mortality rate and a recent CQC report indicates that the quality of care is abysmal. Despite conditions being led down by the Trust (which is some 60 miles away), the Hospital merrily carries on its culture of paternalism, lack of dignity for patients etc etc. No doubt with sufficient oversight it will improve slowly.
The downside of the Bill is that many services that are taken for granted will unlikely to be provided in the future. However, being of mature years I know that services have been withdrawn over my lifetime. I can think of chiropodity for one. I think in the future, cosmetic surgery for psychological reasons (not after an accident), fertility treatment etc etc will not be provided. I personally do not have problems with the removal of such services but no dounbt we will have vested interest groups coming out of the woodwork.
So the Bill is a continuation of what has been happening for the past decade. I can fully understand vested interests complaining about the consequences of the changes for their members. All I know is that we need the vast number of health staff and I as a patient do not care whether they are employed by the State or a private company. They will have to go where the work is like the rest of us. Conditions of service may change particularly for Senior Doctors who at present are able to work for the NHS and private providers. Not a bad thing in my opinion. They are unlikely to move to any other European country as in the case of GPs they would have their salaries reduced by 60% and have to provide 24 hour cover.
Yet another ‘New’ Labour (aka:Tory) Billy Liar-ite trying to convince us that Lansley’s plans for the NHS are really not so bad and insisting that what the NHS really needs is more ‘competition’ and that “other providers may well be better placed to deliver certain services or run hospitals.” (Maybe we could get some brain-surgeons on ‘work-fare’ ?!?!)
Unlike you, MR Watt, REAL democratic socialists are desperately trying to save the NHS from the ravages and deprevations of Lansleys ideologically driven plans which would allow for as much as 49% of NHS capacity to be turned over to private enterprise!
Mr Watt, please leave the NHS out of your efforts to de-stabilise the current leadership of the Labour party! (If I really want your opinion I’ll get it from Conservative HQ !!)
The NHS *always* needs to change, health issues change and the NHS needs to change to address them. To a large extent (and totally unacknowledged by this terrible government) the NHS *does* change. Reform, is a different thing to clinical changes. Sadly reform is too often political: “our ideology is *this* so therefore we have to apply *this* to the public services”. If Labour wants to be responsible when it next gets in government (for the sake of the country – that has to be soon) it must be evidence based.
For example, Lansley’s great “improvement” is getting rid of mixed sex accommodation. This is a huge Daily Mail issue, and hence it is very political. But the problem is that when you have hospitals on 95%+ occupancies it is not easy to prevent mixed sex accommodation, and so to comply with Lansley’s diktat patients are transferred between wards, often being put in inappropriate wards for their condition. Mixed sex breaches have a large financial penalty so for the hospital it becomes more important to avoid those penalties than the patients treatment (in fact, the *same* arguments than Lansley and Cameron used before the election against waiting time targets – remember those? the targets that Lansley abolished and Cameron re-introduced for political reasons?)
A sensible Secretary of State would use evidence and determine which are the most important issues. High occupancy rates lead to high levels of hospital acquired infections so reducing occupancy rates would reduce HAIs *and* reduce mixed sex breaches. Lansley did not target high occupancy rates.
Another example: we have five day working. It is bizarre that an NHS hospital does not do electives at weekends. Labour *should* have reformed this, it should have been part of the new consultant contracts Labour introduced that consultants had more flexible working to enable seven day working. What we have now is clear evidence that mortality is higher at weekends. Lansley could have carried out this reform that Labour did not do. He didn’t. Instead, he is inventing problems to solve (“bureaucracy”) instead of solving an issue that exists.
The only thing which needs to change is the removal of the private sector and the purchaser-provider split, both of which cause unnecessary expense and bureaucracy
Mike Homfray, if we carry on spending money we haven’t got on the NHS,the public will eventually realise, it’s not worth having if we can’t afford it
Having lived in the US, I see “choice” and “competition” in healthcare as a deadly threat to the NHS. You people who are so cavalier about embracing a marketised model will only appreciate what you’ve lost when it’s too late. In a civilised society, competition and profit are ok for consumer goods, but not for matters of life and death. The NHS is one of the most cost-efficient and equitable health services in the world according to the WHO. By comparison, administrative costs in the US are off the scale and profiteering has made doctors and medical corporations the health equivalent of bankers and rip-off financial institutions.
As Peter Watt acknowledges, Tony Blair really was a Tory – though I didn’t notice the social democratic clothes. What I don’t understand is why all those who adulate him don’t just join the Tory Party. You agree with the thrust of their policies. What’s the problem? It would at least be the honest thing to do.
John P Reid
The NHS is the cheapest solution of all: no ludicrous over capacity, billions spent on marketing and admin and so on.
Private model is vastly more expensive and more likely to fail.