Andrew Lansley is engaged at breakneck speed in a wholesale reform of the NHS which was not in the Conservatives’ manifesto (never mind the Liberal Democrats’), with serious question marks over its potential to improve quality, equity or efficiency. These are even bigger questions (duly raised, we hear, by a sceptical Treasury) over the costs of the associated upheaval at a time when the government’s priority is deficit reduction.
He has offered Ed Miliband and John Healey a prime target for attack. Labour should seize the opportunity, and respond with an aggressive critique of the government’s NHS policy based above all on fiscal irresponsibility – a critique that helps the party regain its economic credibility, that challenges established thinking, and one that is accompanied by an alternative vision which gives reason for the kind of optimism Miliband spoke about in his first leader’s speech.
First, Labour should mount a bold attack on the government’s policy of ringfencing NHS spending. The NHS consumes more than £100 billion a year of public money, and there is patently scope for it to be more efficient and make a significant contribution to reducing the deficit. Ringfencing does not just discourage the achievement of these efficiencies, it also means other public services take a disproportionate hit. It is, in short, fiscally irresponsible – as the Liberal Democrats said before the election and as many Tories will be itching to say now (with a tinge of that peculiar Daniel Hannan-style rabidness Cameron is so keen to keep off the front pages). Arguing that the NHS is different because it is faced with growing demographic pressures, as the government has done, will not wash – the same applies to most public services, from schools to social care. And when exposed to the arguments, the public will see it as fiscally irresponsible too – when PwC convened a citizens’ jury to discuss public spending cuts in detail, they found that the vast majority agreed with ringfencing the NHS before the exercise, but that 91 per cent opposed it by the end of the process.
Second, Labour should attack the government’s economic incompetence on the NHS. At a time when the watchword is costcutting, and just after a manifesto promising an ‘end to top-down reorganisations of the NHS’, the government is undertaking a huge top-down reorganisation at staggering cost. One hundred and fifty-two primary care trusts and 10 strategic health authorities will be wound up and around 500 GP consortia will be created. A new ‘NHS board’ will be established, regulators’ functions changed, new divisions of labour created between local authorities and the NHS. The costs of reorganisation alone have been estimated at anything between £1.2 billion and £3 billion – and this does not take into account the likely dip in performance that the NHS is likely to go through as it adjusts to new ways of working. £80 billion of public money will be passed to GPs to purchase care, when all the signs are they neither know how to nor particularly want to. The Health Service Journal estimates that on the performance of those GPs in practice-based commissioning – those who are already doing some commissioning (namely, the most enthusiastic of the lot) – an NHS with buying in the hands of GPs would be £2 billion in the red each year. This at a time when the existing commissioners of care, PCTs, have been steadily improving in performance. And it’s not just in commissioning that Labour can make hay. On the provider side, many foundation hospitals are likely to be in trouble. It slipped by in the news a few weeks ago that the Department of Health had bailed out one foundation trust to the tune of £18 million. Lansley assures us this is not a case of supporting lame ducks. There is a lot to pick on here.
Third, Labour should not just attack the Tories’ economic incompetence on the NHS. It should also set out how it would do things differently, in so doing challenging established thinking as Miliband has said he intends to do. It should look to make greater use of organisations outside the NHS (including community groups, or peer support groups like those run by third sector organisations) who are able to help people manage their own health. It should be bold on public health measures and the regulation of industry where the Tories will be timid and in hock to business. It should argue clearly for shutting inefficient hospitals.
Basing a critique of government NHS policy on economics (saying that it would not ringfence the NHS, attacking the government’s wastefulness in NHS reform and proposing bold reforms of its own) makes sense in policy terms for Labour. But it also makes sense politically: test a faultline within the coalition and demonstrate that Miliband is indeed prepared to challenge orthodox thinking, regain Labour’s reputation for fiscal responsibility, and lead his party rather than following the public sector unions.
Beyond the economics, Labour should also articulate a vision more inspiring than that set out by Lansley. The National Care Service which Labour started to articulate in government, free at the point of need, could form the basis for such a vision. The way we treat old people in need of care is a palpable disgrace; stripping them of their assets and their dignity in order to provide them with services that too often are not worthy of the name. The government won’t come to a decision on reforming funding of social care until summer 2011 at the earliest – in the meantime cuts of 28 per cent to local authority budgets will make a bad situation worse. If only part of the savings that a more economic NHS delivered were spent on creating something close to a National Care Service of the type Labour talked about in office (whose total costs were estimated at £4.4 billion a year, or less than five per cent of the NHS budget), Labour would be able to offer voters a more optimistic, fairer future than anything the government is currently putting forward.
The government’s NHS and social care policy – fiscally irresponsible, economically incompetent, unfair and uninspiring – is ripe for Labour attack, led by Miliband and Healey. That attack should be built on the foundations Miliband set out in his conference speech: fiscal responsibility and a challenge to established thinking (which here can translate into an aggressive wrong-footing of the government), fairness and optimism. The coalition has a big chink in its armour. Labour should strike at it hard.
I had to check to make sure this was not a posting on Conservative Home. “Labour should mount a bold attack on the government’s policy of ringfencing NHS spending” While I agree that the “ring fence” was political expediency, only Tories (and that would appear to include Ralph Michell) actually believe that any “ring fence” exists. Please, before you spout right wing nonsense can you first look up some of the statistics? The Kings Fund (like, umm, independent experts on the NHS) say that the NHS needs to have a 5% to 6% real terms increase every year to take into account the aging population and healthcare inflation (which is typically TWICE CPI). Therefore any responsible government would agree to real terms increases. As we know from the CSR we do not have a real terms increase because £1bn a year is to be taken from the NHS to pay for social care that has NEVER been their responsibility. Since this social care commitment is being done to make up (only partly) for the massive cuts in local authority funding (and hence their social care funding) it means that it is a real cut in the so-called “ring fenced” budget. The NHS “ring fence” does not exist: does that make you feel happy? “The NHS consumes more than £100 billion a year of public money, and there is patently scope for it to be more efficient and make a significant contribution to reducing the deficit.” Where on earth have you been for the last ten months? In the 2010 NHS Operating Framework, published at the beginning of the year, Andy Burnham, said that the NHS must make £15bn to £20bn “efficiency savings” by 2014. That’s about £5bn of efficiency savings every year. Let’s see: that would be the *entire* public health budget, or most of the NHS training budget, or half of prescribing costs. What would you do, cut public health in the first year, then most of training in the second year, then half of prescribing costs in the third year, and then the remaining prescribing costs in the final year? Oh right, you would actually make the NHS more *efficient*. The evidence is that there is not much fat to be trimmed. Even the Tories admit this, the Guardian reports that a Tory “health insider” says that “a fifth of everything the NHS does today will have to stop”. That means cuts. That means that patients will have to go to the private sector to get the treatment or (I guess your “solution”) beg a charity for it. These “efficiency savings” are wreaking havoc in the service right now. In my county the PCT has stopped all “non-urgent” treatments. (The only treatments that are being done are: cancer – everyone’s favourite disease, it is a pity if you have a non-cancerous heart condition – A&E and fractures. EVERYTHING else is non-urgent!) Do you know what that means? An elderly woman needing a hip replacement will be told that she will have to be in pain and immobile for another 6 months (at least) because first Andy Burnham, then Andrew Lansley (and presumably now Ralph Michell) think that it will be “more efficient” that way. What utter and obscene nonsense! “Arguing that the NHS is different … will not wash”, says who? Someone who knows nothing at all? The fact is that the NHS is the bottom line. It is the last line of defence, there is nothing to protect you after the NHS. The NHS has to pick up the pieces and repair the consequences of failures in every other service. You mention social care, yet the first thing that social care providers do when there are any problems is pass the client on to the NHS. It is frankly disgusting that anyone could argue for a cut to the NHS. “Second, Labour should attack the government’s economic incompetence on the NHS.” I don’t know if you have noticed, but the NHS is currently running under the policies of the last Labour government. Any attack on the NHS now will be an attack on Labour.
“One hundred and fifty-two primary care trusts and 10 strategic health authorities will be wound up” Not an expert on the NHS I see. The SHAs were due to be wound up anyway. When an NHS Trust becomes a Foundation Trust it is take out of SHA control, so under Labour SHAs were getting more and more irrelevant and would have been reformed, or maybe abolished when the NHS Trusts in the SHA’s area became FTs. As to PCTs well Labour’s plans were to hand commissioning over to GPs through Practice Based Commissioning, which is not quite the same as GP commissioning, but not far off. And if you were paying attention you’ll see that the Kings Fund says that consortia need to be at least 500k people and most commentators agree: there will be about 80 consortia. The 500 figure was an initial estimate by some newspapers based on PBC. It is clear that such consortia would be far too small and would not have financial stability. Of course, you may have noticed that 152 PCTs will be replaced with 80 consortia and largely staffed by PCT commissioners. You may also have noticed that the NHS Board cannot do its commissioning work from London, and will need regional officers, and some people (Sir Philip Green, for example) suggest that there should be 10 regional offices. Is this “re-inventing the wheel”? Yes it is. But that has happened frequently in the NHS. You casually mention Foundation Trusts, but this is the main area where Labour can get a popular campaign against the Tories. The problem is that you spoil it by making exactly the same argument as Lansley does. “It should look to make greater use of organisations outside the NHS (including community groups, or peer support groups like those run by third sector organisations)” No! No! No! This is NOT the attitude to take. The reason is quite simple: this is EXACTLY Lansley’s plans (have you actually read the White Paper? it does not appear so). Now let’s see. An elderly woman has ulcers on her legs and needs the dressings changed frequently. So let’s ask a “community group” if they could give it a go, I mean all you have to do is take the old dressing off, throw it away and stick a new one on. What’s difficult about that? No need for a trained nurse, eh? Oh right, it does need a trained nurse, but you don’t want to pay him/her? The fact is that the vast majority of the work being done by the NHS needs highly skilled, trained staff. You simply cannot shunt that work onto untrained volunteers. What about if something goes wrong? Who is responsible? “It should argue clearly for shutting inefficient hospitals.” And who will do the hip operations, cataract replacements, cancer treatments? Oh let me guess, either 1) voluntary “poor house” hospitals paid for by charity contributions by rich people with a conscience (doesn’t it just make your heart sing that there are such lovely people around?) or b) private hospitals where the exorbitant costs are paid using a co-payment by the patient. Nice. Point me to an “inefficient NHS hospital”, then have a look at how much it costs to perform their procedures (say, a diagnostic test, or an operation). I will accept your assertion only if you can find me an alternative that is safe and of equal quality, but costs less. Please do not spout Lansley’s propaganda. I would argue that in some places, for historical reasons, there are too many hospitals and that there is an argument to close the excess hospitals. But equally so, there are some areas with too few hospitals and they need a new one built. Over all, the NHS is very efficient compared to just about any healthcare system you could mention. “The National Care Service which Labour started to articulate in government, free at the point of need, could form the basis for such a vision.” Now we can finally agree on something. But the NCS is NOT and alternative to the NHS. We need BOTH. And the NHS needs new funding, it MUST NOT be funded from NHS funds (like Lansley is trying to do now). In my next comment I will tell you how Labour can effectively fight the Tories, and a policy which Labour will have the majority of the people behind them. Unfortunately I think that Ralph Michell will not agree with me, and he is likely to side with the Tories rather than the majority of people in England.
@Richard Blogger Is it really likely we will end up with half the number of consortia as PCTs? it seems unlikely. GPs can form themselves however they want.
and how much are GP’s a conduit for the Pharmaceutical Industry ? at vast cost . Difficult to asses stats but we all know there’s truth there (all good GP’s please forgive me )