Labour have an important battle on their hands. Their opposition to Andrew Lansley’s terrible Health and Social Care Bill (and it is terrible, more of that later) is as much out of a need to defend their very being as it is for any ideological reasons.
The previous Labour government were wrong on the economy. This is now fact. It is irrelevant that Brown and Darling led the way in ensuring a global response to the crisis, stopping a complete meltdown in the financial sector; nor does anyone care that the Tories would have done nothing differently in the lead up to the crisis; the fact that Labour are proving to be right about the desperate need for a plan for growth to go alongside Osborne’s austerity drive is an irrelevance. History is written by the winners and Labour now have a long battle ahead to regain trust from the electorate. Important as the economy is however, nothing stirs a Labour person like the NHS – we created it and we love it as you would love a child. Lose the battle here and there seems little point getting out of bed in the morning.
So to the bill – and it is a shocker. The flagship policy is the creation of GP-led commissioning. Out go Primary Care Trusts and Strategic Health Authorities. In comes a single national health board and hundreds of small GP commissioning consortiums – reducing bureaucracy and making healthcare more responsive to local needs. It is doomed to failure.
GPs have zero track record in commissioning, they do however have a very good track record in clinical care. They also have full to bursting appointment books. Why, when the average consultation is already only just over 10 minutes in length, do we want them to spend less time seeing patients? The reality is they will delegate the commissioning powers to someone else. Who, I hear you ask? The very same people who have just been made redundant from the defunct primary care trusts.
Any suggestion of a cut in bureaucracy is a fallacy, the new structure has just as many levels as the old one, the simple fact is this is a major restructure that will cost billions of pounds and even in the long-term the exercise will cost money rather than save it. That the new system may be more responsive to local needs could well be a fair one, though whether this will come back to haunt the coalition is another matter – people crave consistency and a perception of equality. How long until the phrase ‘postcode lottery’ comes back into fashion and we start to see a re-centralisation of services?
The rest of the bill includes increasing how much private work a trust can carry out and laying out a timetable for all hospital trusts to gain foundation status. The former is there to increase potential revenues (though risks further impacting on waiting times for those who can’t pay), the latter will, in theory, help increase competition and therefore standards. (But also runs the risk of hospital trusts effectively being bankrupted, with all the associated political fallout).
Labour’s response needs to be robust, the NHS is in pretty good shape and they they have much to be proud of from their time in office – increasing spending to be in line with the European average, then using the money to decimate waiting lists, improve survival rates for those suffering from cancer, heart attacks and strokes and created a fairer pay and reward system, allowing the best health professionals to stay treating patients. The much maligned targets helped to ensure all this happened – as soon as the coalition sidelined them waiting times started to increase again.
What Labour didn’t manage to do is carry staff with them. Staff morale is arguably at its lowest ever, and is still falling. This impacts both on clinical care and the public’s perception of the NHS. Secondly, they didn’t make any in-roads into customer service – which, in my experience has tended to be appalling. It sounds a small issue, but most people’s first contact with the NHS is with a non-clinician and, if the quality is poor so is people’s first impression of the whole organisation. Any changes in the above will come, not from legislation, but from a change in culture and leadership. This is what Labour should be calling for.
Ed M and his team have had a good couple of weeks after a pretty disastrous start to the year, but this is yet another big test. Labour cannot afford for their record on the NHS to go the way of their reputation on the economy.