A year ago, the government’s NHS white paper set out bold rhetoric about putting patients in control. In future, they declared, there would be ‘no decision about me, without me’.
Stealing Labour’s mission to put patients at the heart of health service reform, the coalition styled themselves as patients’ champion and liberator.
They said patients would be involved in all choices and have rights to personal budgets, though at the same time they axed many of Labour’s waiting time guarantees for patients.
But Cameron’s first year has been a wasted year for the NHS, and his government has lost its way on reform. Far from a single-minded dedication to the interests of patients, ministers’ one obsession has been total structural change to set up the NHS as a full-scale utility-style market.
They talked about patients but they’re putting power in the hands of one group of producers – the GPs, most of whom don’t back the changes and don’t believe they will improve services for patients.
The confusion in the government’s handling of the health service has been compounded by the prime minister’s unprecedented ‘pause’ before reorganising his reorganisation with plans for still more complex, costly and centralised bureaucratic change. I said in the Commons, this signalled the onset of sclerosis in the NHS, and the King’s Fund has described the latest plans as a ‘traffic jam’.
The best of Labour’s reforms to put patients and quality at the heart of NHS change are being lost in the chaos of the biggest-ever reorganisation.
And meanwhile, last week’s waiting time statistics show more patients left behind in longer queues for tests and treatments as power leeches back into the bureaucratic system.
The frustration for reformers is this flat-out pursuit of institutional reorganisation and market ideology in the NHS has set back patient power by years.
So it must be Labour that has – and is – the alternative.
Reform of the state and public services has been – and always must be – central to Labour values. We established the postwar welfare state to provide – in Nye Bevan’s words – freedom from fear. But we recognised in government that services could be unresponsive to rapidly changing and diverse modern needs, leaving both users and frontline staff feeling disempowered. Our waiting time guarantees and other reforms were a desire to shift control – so that the patient, not the clinical bureaucracy, had the decisive say about when and where they are treated.
We asked patients, carers and professionals how change could be achieved, through regular major consultations like those led by Alan Milburn and Ara Darzi. We established the NHS constitution, with a right to waiting time limits, choice and a joint care plan for all people with long-term conditions. We set up the first ever pilots to explore how the ideas of personal budgets – so powerful for many in social care – could work in health.
In adult social care our personal budgets have become a central pillar of policy, with 250,000 people controlling their care with a personal budget and backed by advisers where they want them.
In health we understood that access to hospital is not sufficient for excellent care for the growing millions of people living with long-term health conditions. Greater partnership and a more equal relationship between patients, carers and professionals leads to better and better value services than traditional medical practice.
There is an evidence base – personalised care plans, good advice and self-management improves health and cuts hospital emergencies for people with asthma, for example. But for Labour, there is also an ethical base. Redistribution of power is a core centre-left mission – in political, economic or public service reform.
Instead of forcing massive internal reorganisation and market ideology throughout the NHS, we would pursue more personalised care and greater control for patients in healthcare. We would embed the right to personal care plans that are still not being delivered for too many people coping for years with chronic illnesses. We would give personal health budget pilots stability and support. And we would begin a deep process of involvement with healthcare professionals and users on how the shift to personalised care can be secured because we know such reform must be a collaborative social movement, not a technical fix or top-down directive.
In just one year the Conservative-led government has squandered the opportunity of such change. They have lost momentum in personal budget pilots with their organisational upheaval. They have lost sight of the aim of personalised care in pursuit of market reform. They have lost the confidence and motivation of professionals for change because of the chaos they’ve created. And they have lost the trust of the public who increasingly believe they want to privatise the NHS.
The public services white paper last week confirmed just how short of new ideas and momentum the government are, in health and in other public services.
Labour has always championed change on behalf of patients, pupils, parents and public service users. We did so in the last decade and the need for greater quality, productivity and personalisation is more imperative still in the decade ahead.
After the failure of the government in its first year, it still falls to Labour to be the party of reform. We are not in power. We cannot act but we can use the months to come to be the advocates and agitators for a radical alternative; to bring patients’ and professional groups together to develop with us a shared Labour vision for more personal and empowering services.
John Healey MP is shadow secretary of state for health