At worst, in its final stage in government and early years of opposition Labour looked conservative and swayed by producer interests. With the launch of his policy review last month, shadow health secretary Andy Burnham positioned the party as a powerful agent of change, based on the inspiring vision of ending fear of old age. He also avoided some of the mistakes made by the coalition, producing green paper thinking for consultation not white paper policies for government. Burnham was also clear about the implications for public finances: without change, the NHS will be overwhelmed by demographic demand.
There are some big shifts in policy. Out goes competition, which Labour used to good effect in government. Out too goes the purchaser-provider split, only just implemented. In comes a clear national entitlement to health and social care and integration with single health and social care budgets. This could potentially see the establishment of more integrated health and social care organisations.
Many questions of detail remain, however. Burnham promised not to restructure but to work with the organisations he inherits in 2015. Quite right. Yet repealing the Health and Social Care Act will remove the statutory basis for those organisations, so Labour will be accused of promising another top-down reorganisation anyway. That was certainly the initial response from health secretary Jeremy Hunt.
Health and wellbeing boards will commission health and social care, with GPs in clinical commissioning groups acting as advisers. That would make CCGs some of the most expensive advice in the country – with GPs receiving six-figure salaries without holding any responsibility for results. And it would vest accountability for billions in NHS spending with committees which do not have organisational form or accountable officers. The Treasury is unlikely to allow that: complicated structural changes look inevitable.
There is clearly a risk that such a reorganisation will mirror what Labour accuses the Conservatives of doing over Europe: creating economic uncertainty at a crucial moment of change. For with billions of productivity savings still required we cannot afford any confusion about who is responsible for making them happen.
Nevertheless, it is possible that councillors and GPs will decide to voluntarily share commissioning responsibility in the way Labour hopes.
If Burnham’s new system emerges, will integration deliver? Major questions remain. First, Labour will need to end the longstanding social care funding crisis, without which integration will simply fail. This means going further than introducing the Dilnot proposals for care reform. Labour will also need to fill a gap of several billion pounds in the cost of providing today’s threadbare care system. Merging a marginal system with a bankrupt one will put both into a tailspin.
Second, the party will need to offer more than patient choice as a lever to challenge poor quality monopolistic providers. In government, Labour found that competition – or the threat of competition – encouraged trusts to raise their game. If large, integrated trusts emerge with no commercial incentive to improve Labour could find its intentions frustrated.
Finally, and most seriously, where is the beef in terms of productivity? Integration is a worthy goal but its potential for savings is often considerably overestimated. Research has found that admissions avoidance programmes have not delivered the results that were expected. And several of the examples of preventative care cited by Burnham would seemingly cost more than they save. Expanding hospitals into the community will not on its own realise bankable savings. Health is a policy area requiring hard choices, not wishful thinking.But Burnham rejected the easy and artificial option of framing debate about ‘saving the NHS’ and instead set out the challenges we need politicians to be honest about.
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Neil Churchill is chief executive of Asthma UK. He writes in a personal capacity
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Another thing he could do (which he wont) is to ensure that drugs which are overly prescribed can be used by another patient.
At the moment they just get thrown away.
The savings would be huge.
I’d say, with regards to actual patient care, he needs to look at how the NHS works but, having told him that to his face, at a campaign launch, he in reply asking me to write to him so he would personally act and for him to then not bother replying I feel it would also probably be futile,.