For a Labour leadership that wants the NHS to be the most important electoral issue, the publication of the NHS Five Year Forward View plan today is a potentially really important moment.
This document contains the hopes and aspirations of the leadership of all the major NHS institutions in England. It is a sharp challenge to the three political parties that are serious about wanting to run the country because it outlines the scale of the changes that need to happen in if they want to save the NHS.
As with any forward look for such an important organisation, this is a complex document.
But it is summed up by the chief executive of NHS England Simon Stevens in a simple phrase:
To secure the future that we know is possible, the NHS needs to change substantially, and we need the support of future governments and other partners to do so.
While most of the immediate publicity around this challenge has been about the extra £8bn necessary for the NHS by 2020, the challenge of finding the extra money is nothing compared to the challenge of supporting the NHS while it goes through five years of ‘substantial change’.
The NHS leadership is saying to political leaders that if they want to maintain the basic principles of the NHS they are going to have to help change the NHS substantially.
This will be a difficult task. How might Labour respond? Here is a suggestion:
‘The Five Year Forward View is most welcome because it argues, contrary to many commentators and some newspapers, that we can reach the end of this decade with a thriving NHS that has equal access to all with care free at the point of delivery.
‘This was the principle created by the Labour government of 1945 and was saved by the work of the Labour governments of 1997 to 2010. For those 13 years Labour reformed the NHS so that it delivered faster, safer services, which gathered a much stronger and broader public support for those NHS principles than had existed before. Because of Labour’s strong commitment to reforming the NHS those principles were saved for future generations.
‘The NHS was shown to be safe in Labour’s hands because we knew what reforms were necessary to both improve the NHS and improve public support.
‘In recent years the Conservative-led government have demonstrated why the NHS is not safe in their hands. For their first two years their first secretary of state developed and implemented a set of changes that imposed a very weird structure on to the NHS. For their second two years the next secretary of state has further confused the NHS by acting as if their weird reforms never happened. The combination of these two political periods has left the NHS in a crisis that did not need to happen.
‘This confusion has shown that the Conservatives do not know what they are doing and given the substantial change the NHS needs for 2015-2020, the NHS cannot be entrusted to them.
‘The Five Year Forward View returns to the recognition that those of us who want to save the NHS’ basic principles have to commit ourselves to sustained and substantial change.
‘This will not be easy. The NHS leadership argues that over the next five years most members of staff and most patients are going to have to change their behaviour.
‘The Labour party, because of its past success with the NHS, has relationships with both staff and patients that can help the NHS carry out those substantial changes. We will work with the leadership of the NHS to achieve those reforms.
‘The febrile nature of their activities in the last four years has demonstrated that the Conservatives have neither the understanding nor the relationships to help with “the substantial change in the NHS” that is necessary.’
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Paul Corrigan was a health adviser to the last Labour government. He tweets @Paul_Corrigan
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I do not think it is sufficiently convincing to say, as Paul Corrigan does: “We’re Labour so you can trust us with the NHS.”
First because between 1997 and 2010, Labour’s record on the NHS was not perfect. Second, because Labour has not admitted its imperfections fully.
Third because Labour needs to specify positive policy and vision – not just talk of correcting the Tory LibDem mess.
Burnham has started to do that with the health PLUS care vision. But the Tories are not unhappy with this approach. What can make Labour distinctive is an insistence that such reform be democratic and accountable.
Health democracy is not only important because it is “our” NHS. It is also important because improved population health depends on it.
Thus one of the key requirements for advances in population health is recognised nationally and internationally by health scientists as being “public engagement”.
Up till now this public engagement has been largely very skimpy: retired health professionals or researchers sitting on research project management committees or hospital committees.
It needs to go far wider and far deeper if it is to reach those members of the public whose health is worst: the socially excluded and the socially secluded.
Local democratic control over primary and secondary health+care services and research is the bedrock on which we can build wide and deep public engagement.
The other element is “outreach”: health professionals need to get out more.
This has been the way that polio vaccination has been able to include socially secluded groups in developing countries. Absence of outreach leads to misunderstandings and hostility when an epidemic is threatened: that is what has happened in those W African nations at the heart of the Ebola crisis. Health workers have in a number of instances been seen as people who have brought disease – not cure – to communities.
Outreach that is locally-based, democratic and open is needed equally as much today in the UK to reach communities with the poorest health.
All the Tories and LibDems offer are “troubled families” units: patronising attitudes that blame the victims for their poor health and that leave untouched the social fragmentation which excludes millions of the population from improved health.