Labour’s 10 year plan has some laudable aims but leaves many questions unanswered. It is not yet clear how it will follow through on its ambitions
Polls consistently show that the NHS tops the list of issues voters most care about.
History reminds us, of course, that voters don’t always follow.
Nevertheless, the NHS is a high priority for all parties and Labour has set out its stall on what has traditionally been one of its strongest policy suits.
Over the past 18 months, there has been a welcome consensus from all those working in and for the NHS on some of the changes we need to make the health service sustainable, safe and patient centred.
‘There’s broad political agreement that the focus must be patients, quality and integration’
The NHS Five Year Forward View, which incorporates much current thinking, was itself welcomed by all the main Westminster parties.
And there has been broad political agreement that the focus must be patients, quality, integration, efficiency, and parity between mental and physical healthcare.
Many, including NHS Providers in our own Programme for the Next Parliament, have set out what is needed.
Labour’s proposals in its 10 year plan for the health and social care offer further clarity about its intentions to bring the two sectors together, invest in frontline staff and deliver more care at home, underpinned by repealing the Health and Social Care Act 2012.
Some of this had its first outing in Sir John Oldham’s report last year on “whole person care’’.
More coverage and analysis of Labour’s 10 year plan
Sync or swim
Tempering ambition with the realism of a 10 year timescale is laudable, even if a full parliamentary term only takes us halfway there.
This really encapsulates the difficulty NHS system leaders face in planning for changes that require time, stability and consistency, particularly given that a vision such as Labour’s commits strongly to the NHS as preferred provider, in sharp contrast with Conservative and Liberal Democrat approaches.
‘Labour commits strongly to the NHS as preferred provider, in sharp contrast with Conservative and Lib Dem approaches’
Labour wants to change commissioning. Andy Burnham envisages health and wellbeing boards and clinical commissioning groups to “embrace full integration, single budget commissioning”.
Arguments could emerge either way about whether this amounts to reorganisation, top-down or otherwise. It certainly represents a significant change for local health economy partners.
Councils are well placed to support a broad, preventative agenda. However, it is vital that providers of NHS care are fully engaged in emerging plans, and that commissioning decisions must continue to be taken on the basis of expert clinical input.
Accountable care organisations, pooled budgets and new payment mechanisms may well be the way forward, but they bring their own challenges.
We will be looking out for plans to ensure they would be delivered without destabilising or risking the current system, provision and, critically, patient care.
Army of workers
The really striking bit for us is the plans for the “new arm of the NHS”: 5,000 “homecare workers” employed to focus on those with highly complex needs, end of life care and to help people to regain independence after a hospital stay.
Although genuinely innovative, it flags up a couple of obvious questions. How will the homecare workers be employed and deployed to meet local needs?
And how do we establish where the boundaries lie between free NHS “homecare” and means tested social care?
Late 20th century debates over when a bath was a health bath or a social care bath were not enlightening.
The existing community services sector is well placed in this regard. It is experienced in providing NHS services in people’s homes – precisely what is needed. We would expect it to be at the forefront of planning and delivering these services.
It is not yet clear how Labour will deliver its proposals to make savings from “addressing potential duplication of responsibilities and further reducing bureaucracy”.
It is worth noting that chopping bureaucracy is often a favoured consideration of politicians of all colours before they come to rely on it to implement their programmes.
Labour has already announced its plans to repeal the Health and Social Care Act, to reinvent Monitor as a regulator of health economies rather than individual organisations, and to introduce a policy of “NHS preferred provider”.
‘Chopping bureaucracy is often a favoured consideration of politicians of all colours’
National policy is always subject to change, and the need for political parties to make their mark is understandable.
However, we do need to protect the dual elements of provider autonomy and local accountability to communities that have always underpinned the foundation trust model.
Given the unprecedented demands facing providers, this seems to us to be the only means to ensure sufficient local flexibility and responsiveness in the system, both of which are fundamental to delivering new models of care.
No policy delivers quick fixes or overnight transformations. Challenge and aspiration are fundamental to build the NHS we all want.
What NHS leaders need from politicians is courage, stability, political air cover and a sense of realism. Hopefully there’s some of that.
Saffron Cordery is director of policy and strategy of NHS Providers