The health and social care bill’s third reading is today and the government has already had to make big changes to it. But this does not mean that reform has come to standstill; indeed, it will have to continue.

Andrew Lansley is right on one level when he points out that the NHS faces ever-increasing cost pressures as people live longer and new treatments are developed. Demand grows by the day and yet there is no evidence that those who use the service, taxpayers up and down the country, believe they should pay more by way of tax for what they get. Indeed, they absorb quite comfortably the argument that the NHS is wasteful and bureaucratic and believe that its problems can be solved by trimming fat from the service.

What should Labour propose as a model for the long-term sustainability of the NHS as a service free at the point of use? 

Our approach has to be based on three principles. First, we need to commit to strategic investment in preventative health strategies. This would involve difficult decisions and potential confrontation with vested interests but the reward would be worth the pain. Why, for instance, do we persist in failing to invest in early detection strategies for rheumatoid arthritis, which save money in the long-term by making helping arrest disease’s development, alongside the use of expensive therapies?  Why do we not seize the initiative on children’s nutrition by making school meals free and using this to supervise the provision of balanced menus in schools? 

Second, we need to involve the public directly in deciding what we want the NHS to do and not do. At the moment, these key clinical decisions are often being made by commissioners, without reference to the public they serve; hence the recent curtailment in some parts of the country of joint replacement surgery. But who would argue that joint replacement is not a priority, given that it offers increased mobility and independent living? This debate belongs with the public, who are more than capable of understanding the complexities of the issue, rather than the pages of the tabloid media. Involving them directly in the commissioning of primary care along the successful foundation trust model used for secondary care.

Finally, we need to make it clear that personal responsibility for healthcare is to be taken seriously. Diet and exercise are key factors in determining how healthy people are, and of course we know the damage that can be done by smoking, drinking and recreational drugs. Should we not build positive incentives into the system into avoid these? Could we, for instance, offer fiscal credits for maintaining reasonable general health, paid at key points in life, on the basis of an initial measurement at 16 of an individual’s physiological profile? Or, if it is right for an employer to be liable for the safety of the workforce, then surely it’s right for a landlord to be responsible for ensuring that property available for rent does not give rise to serious health conditions? 

Key principles combined with concrete proposals for reform are what we need if we are to spell out an alternative set of reforms for our NHS.

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Angela Smith is MP for Penistone and Stocksbridge

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Photo: lucid_nightmare