As we near the 10th anniversary of entering government, Labour can say with confidence and pride that the NHS has been transformed. To symbolise this transformation, we are now within touching-distance of an historic goal: the end of NHS waiting lists as we have known them. By the end of 2008, the NHS’ 60th anniversary, our manifesto commitment to offer a maximum 18-week wait from GP referral to hospital treatment will have been delivered. This represents a huge prize for the NHS as well as the Labour government, as it offers solid ground from which to fight the next general election.
But, while we’re good at proclaiming our achievements, we’re less good at reflecting on the difficulties we’ve encountered in making the changes needed to secure these achievements. The truth is it hasn’t been easy to make change on this scale in an organisation as large as the NHS. It has put staff under pressure and relationships under strain.
The time is now right to look at the next decade of the NHS, and set out a vision that maintains the improvements we have made, while learning from what has been hard. It is clear the next decade will be even more challenging for the NHS: an ageing population; rising levels of obesity; and increasing numbers of people living with a chronic disease will test the system’s ability to deliver. Medical advancements will add pressure to the NHS, as will the rising expectations of a younger generation.
I accept that, at times, it appears that ministers and the Department of Health are obsessed with change for change’s sake. Perhaps we fail to articulate clearly and simply why we propose change and why we are impatient for further improvements in the NHS.
It is for this simple reason: our overriding aim is to show that the NHS model, its fairness never in doubt, is right for Britain’s future. In a fast-moving world, standing still would leave the NHS unable to meet modern expectations and prey to its right-wing critics, who are never far away.
Yet, as we know, changing health services is difficult and unsettling. The great irony is that the process of change necessary to securing long-term public support for the NHS risks driving a wedge between the very people who are its supporters. How should Labour respond to these challenges?
First, if we are to meet the pressures of an ageing society, we need to make real the long-held vision of the NHS working in close partnership with local government. Second, there must be a culture change in how Labour involves staff in making change on a day-to-day basis. The NHS still has far too much of a top-down culture. With the NHS performing at a much higher level, politicians can have the confidence to stand back from the system and allow greater freedom at a local level.
Part of the problem we have faced is the suspicion that ‘reform’ means a back-pocket plan to dismantle the NHS. So third, we need a much firmer and unshifting landscape in which debates about further NHS reform can take place. The lack of a framework at present creates an impression that everything is up for grabs.
One way of doing this would be to create an NHS constitution, as Will Hutton has suggested. It could set out the values and principles we share and which are not up for debate, whilst providing the framework within which any changes could take place. This has the potential to unite the coalition that believes in the NHS. Staff are passionate about the values of the service they work in, so we need to be better at communicating to them our commitment to the same enduring values.
The challenge for all of us is to move away from the centralised system of control, and develop a way to better engage people and staff on the ground. This way, we can ensure the NHS continues to improve, and provides the best service it can to people in the years ahead.