Labour plans ‘democratically accountable’ integrated care systems

In a wide-ranging interview ahead of tomorrow’s general election, he also revealed:

• Labour may agree to the abolition of existing waiting time targets if presented with “overwhelming evidence” of better alternatives; 
• Clinical support services and cleaning contracts would be brought back into the NHS as fast as possible under Labour; and
• Plans for the first major NHS “bed review” since the turn of the century.

Labour has said it will use the repeal of the Health and Social Care Act 2012 to prevent private healthcare firms from becoming involved in integrated care systems which are being developed around England.

Asked what other elements of the current integration plans Labour disliked, Mr Ashworth identified the lack of “transparency” and the resulting difficulty for local populations to influence decisions.

He said that, while he agreed with the “principle” of the legislative changes put forward by NHS England to speed the development of integrated care, he criticised it for creating a structure in which many important decisions would be taken in private.

There was a need to give the new organisations a “statutory footing” — something the NHSE proposals arguably do not achieve — and therefore a requirement to act in a transparent way, he said.

Asked if Labour would envisage a greater role for local authorities in integrated care, he said integrated care bodies must be more “democratically accountable” but did not expand on how this might be achieved.

Challenged that such an approach might create a major “top down reorganisation” of the NHS, he replied: “I think there’s one going on now.”

The party’s manifesto commits a Labour government to meeting the waiting time targets in the NHS Constitution. Mr Ashworth said he would be prepared to abandon the current four-hour accident and emergency and 18-week elective target in favour of new metrics if “persuasive and overwhelming evidence” to do so emerged from the ongoing review by NHS England medical director Steve Powis.

However, Mr Ashworth cautioned that any replacement for the existing targets, especially the A&E standard, would have to be a metric which was “easily understood” by the public.

He also indicated that a Labour government would be particularly keen on minimum waiting times for mental health should the review recommend them.

The Labour manifesto sets out the intention to “end privatisation” in the NHS. In an earlier HSJ interview Mr Ashworth said a Labour government would use private healthcare firms in a “pragmatic” way, while reducing the need for its additional capacity by investing in the NHS.

Asked to identify non-clinical areas which Labour would want to bring back in-house as soon as possible he chose to highlight pathology and other clinical support services, facilities and cleaning, and patient transport.

The manifesto also promises “a moratorium on bed cuts”. Mr Ashworth told HSJ that Labour would launch a “proper beds review” similar to that undertaken towards the end of the first term of Tony Blair’s government.

This, he said, would take full account of existing and future demographic changes which he believed were often underplayed in NHS reconfiguration plans.

While he said he recognised some reconfiguration plans correctly proposed the replacement of beds with community services, he claimed there was now widespread recognition that cuts had gone too far, “particularly in the mental health sector”.

Mr Ashworth said a Labour government was likely to seek to make the NHS “carbon neutral” by 2030, and that NHS organisations in deprived communities would increasingly need to act as “anchor” institutions, taking on social and economic responsibilities over and above providing healthcare.

While saying Labour had no plans to challenge the traditional structure of general practice, he added that it was important that “different models of primary care were allowed to flourish”, citing the Royal Wolverhampton’s ownership of GP practices as an example.