Halting the NHS reorganisation is simply not on the cards. Labour needs to turn its mind to boosting productivity
I can see the temptation. As former health secretary Alan Milburn has observed, the politics of NHS reform have given Labour an open target to criticise another distracting reorganisation of the service. But there is a danger that in being against the health and social care bill, Labour looks against reform.
Already, many in the service are questioning where Labour stands on the key issues of the day. And although the reorganisation rightly distresses NHS workers, it is a side issue to voters, who care more about quality and waiting times.
The fight over the bill is a phoney war that sidesteps the real challenges facing reformers. First, the reorganisation is already well advanced. NHS organisations have been clustered and are already relocating staff into nascent clinical commissioning groups. Going back now would be more disruptive than proceeding forwards.
Second, some of the objections to reform have been overstated. There is no threat of an open competitive market in the NHS. Competition in health is governed by the less prescriptive parts of EU competition law. There will be no requirement for competitive tendering unless commissioners want it. In fact, there are real advantages to breaking up the block contracts that impede sensible change.
Third, much of the opposition to the bill is deeply conservative, seeking to defend the status quo rather than advance reform. The British Medical Association has flagged some important policy issues but Labour needs no reminding that it is not a natural ally of reform.
Indeed, the real threat to the future of a progressive NHS comes from the perpetuation of the status quo. That is why many of the ingredients of reform were introduced by Labour: patient choice was a key plank of Labour policy; competition was used by Labour ministers to drive down waiting times; clinical leadership was encouraged by Labour ministers through the Darzi review; and the productivity challenge was first articulated under Labour by the chief executive of the NHS David Nicholson. All of these are levers Labour will want to pull in government.
In essence, the NHS looks unaffordable unless we achieve a massive leap in product-ivity. We simply cannot afford – and voters do not want – a health service which is often excellent at treating episodes of ill health but can be woeful at helping older people or those with chronic conditions to stay well.
The real challenge right now needs to be in holding the government to account for delivering those reforms. And the warning signs are clear. Academics have warned that in the financial squeeze some trusts will soon start running out of money. That could compromise patient safety and will need system-wide change to fix.
The head of the NHS Confederation, which represents the organisations that make up the NHS, has warned that the service is behind the curve in delivering productivity savings. And we are still in the easiest part of a four-year plan, with the hardest productivity gains put off until later in the parliament. Some of the most promising aspects of the government’s reforms, like the information revolution to put patients in control, have stalled and been delayed.
The real battle to save the NHS is the battle for productivity. Which means Labour cannot afford to cede ground as the party of NHS reform.
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Neil Churchill is chief executive of Asthma UK. He writes in a personal capacity
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In England this is an English problems.
I think that this analysis completely underplays the chaos that is out there in NHS land which in turn is having major impacts on quality (in terms of access and waiting times etc) and compromising the real headway that was being made in quality improvement under Labour). On the commissioning side, the scale of the disruption is enormous, very costly in terms of £££, fragmenting networks that had been built up, risking the separation of commissioning from public health ,and hugely wasteful distractions from the real challenges facing the NHS: saving £20bn, chronic disease, improving the uneven quality of primary care and nursing care, etc etc. I think that a campaigning focus on “privatisation” is not the best tactically but Labour absolutely should campaign vigorously against this dog’s dinner of a bill. I agree that doctors have a fine tradition of opposing change: I often profoundly disagree with my medical colleagues but that doesn’t mean that all change is wise.
It’s quite easy to improve productivity… just stop treating patients who require more than standard care or experimental treatments. Deter people for entering the system…. by reducing choice of procedures offered for a given condition..let them live with it……ensure all GP cases are treated by GPs on GP budgets. That is reduce throughput for expensive care (and reduce staffing) Always use generic drugs, advise non exempt patients to purchase off the shelf equivalents. Do not try officiously to keep people alive!
No one will notice this.
Offer ‘choice of ‘waiting times’ including ‘not yet…. ‘….advise non exempt patients to purchase off the shelf drug equivalents .
Declare certain conditions ‘imaginary’
and many more
in other words reduce the service level. (and quality) After all the majority of customers are old and a charge on the ‘squeezed middle’ and ‘hard working families’.
Legalizing ‘voluntary euthanasia’ would probably go to far, but charging for abortions wouldn’t… and join up with ambulance chasers to recover costs from the injured much more than now who can collect NWNP
Avoid all bureaucratic reforms which require charge per case…… etc .ect
But be nice to patients while they are alive. It costs nothing.
All this will happen anyway
Your article could easily have been written by Andrew Lansley. “Fighting against the bill is a waste of time because the reorganisation is already well under way”, “there is no threat of wholesale privatisation in the NHS – the EU forbids it”, “Labour is more interested in keeping the status quo and is against reform”, “the NHS needs a massive leap in productivity”! How pathetically defeatist and ignorant!
Like Lansley, you also distort (abuse?) the meanings of important words. Take, for example, the word ‘reform’: rather than it’s correct meaning as ‘change’, you interpret it as ‘improvement’. If one substitutes ‘reform’ in your article by ‘change’ the result make most of your opinions open to question. Better still, substituting your ‘reform’ with ‘deform’ would make your article more accurate.
Also, your use of the word ‘productivity’ betrays the real purpose of your vision for the NHS – the Private Health Service! Like Lansley, you glibly accept the premiss ‘because the NHS costs a lot of money to run (which increases year on year) and there are failures in management therefore it is ‘unproductive’ and can only become ‘productive’ by implementation of business practices, namely, the subjugation of all other considerations to the whims of laissez-faire.’ No doubt, your financially-centred views extend to all of our Public Services.
At some stage (the sooner the better), Labour has to advocate a moral stance (as did our past fighters for the rights of ALL – including the working class) that defends our Public Services, warts and all, because they are the best chances of achieving equality of service and opportunity. Improve expertise? Adapt to changing societal demands? Be more managerially efficient? Always look to providing value-for-money without compromising excellence of delivery? Absolutely!
What is totally unacceptable is the assumption that all of the above can only be delivered by selling off the country’s assets to companies like KPMG.
I fear that people like you are sleep-walking into a world of ‘private ruling public’, ‘master over servant’, business dominating workers’ and ‘self-interest prevailing over the needs of all’.