Manifesto

These are some quick comments on the Labour manifesto launch on the 13th June. We have focussed particularly on the ‘Build and NHS fit for the future section’ though. of course, health can only be fully understood in a broader social context so more will come.

This manifesto is a very highly polished document. As with all highly polished objects the observer sometimes sees what they want. The background section at the end of this blog gives some useful context.

Manifesto

Its absolutely right to say “We must change the NHS so that it becomes not just a sickness service, but able to prevent ill health in the first place” but this raises the issue of the broader social influences on health – good quality housing, food, and the widespread poverty particularly among children in larger families. A number of crucial issues need to be tackled in conjunction with dealing with the NHS crisis.

The manifesto is not detailed and is, at times, unclear: is the NHS just a commissioning organisation or is it the provider of healthcare? If it buys services from private providers there will be less healthcare to go around because they will take a cut for shareholder profit and they will need to use largely NHS trained staff our fear is that will result in increasing cases of denial of care which is already happening.

And we know that the use of outsourced services deepens inequalities.

There is, understandably, a heavy emphasis on the waiting list crisis; We believe there is little spare capacity in either the public or private sector to cut lists by 40 000 / week. We also need to be sure that these waiting list reductions are not at the expense of acute, intensive and complex care. There is no response to the crisis in emergency care in this manifesto. The priority has to be stopping unnecessary death from treatable causes.

We strongly welcome the manifesto commitments on maternity care and the promise to train thousands more midwives as part of the NHS Workforce Plan. It is essential too to retain current staff. Many experienced midwives are leaving.  Its so important the manifesto sets an explicit target to close the Black and Asian maternal mortality gap. This is a shameful scandal which must be resolved rapidly. It will be crucial to see how this target is actioned.

Good to see 40,000 extra appointments per week. But this may not be achievable by ‘sweating’ the workforce. There will be risks to patient safety. We need to encourage many of those who have left the NHS to return by offering reasonable hours and decent pay. Loading NHS professionals with huge student debt is a recipe for a future pay crisis. This has arrived. This needs to be resolved in ‘resetting relations with NHS staff’. Engagement with NHS unions and pay restoration is essential.

Real concern exists about a two tier health service which is quite correctly highlighted in the manifesto. A further issue is the use of physician associates at a time of unemployment of highly qualified health professionals. There are significant concerns that in future in order to to see a qualified professional patients will need to pay to go private. The NHS needs to deliver high quality healthcare for us all.

The pledge to “guarantee a face-to-face appointment for all those who want one and deliver a modern appointment booking system to end the 8am scramble” fails to recognise that this system is part of the systematic ‘demand management’ measures brought in from the USA. This is about systematic denial of care, not an inadequate telephone system!

We absolutely welcome the commitment to ending the workforce crisis across both health and social care. Independent workforce planning, across health and social care is crucial and of course the plans need to be actioned. Social care is a key part of our system. Its has been privatised and asset stripped. We need to reverse this and commit clearly not to repeat it in the health service.

The SHA strongly supports an NHS innovation and adoption strategy. Public services can and do drive innovation and should become industrial leaders themselves.

The promise of state of the art scanners with embedded AI via the ‘Fit For the Future’ fund to double the number of CT and MRI scanners, allowing earlier diagnosis is to be warmly welcomed. The NHS is significantly under-resourced. These systems work well as a tool in the hands of an experienced  professional not as a substitute, this will need to be just a down payment on future investment.

The manifesto puts some emphasis on the NHS app – for those with access it is exceptionally useful. But in the past it has been suggested it might be a gateway to private healthcare too. As a trusted gateway to health information and treatments we can envisage commercial battles to be listed. For healthcare providers this will be the ‘killer app’ on everyone’s phone. We oppose the suggestion, made elsewhere, that it be a gateway to private healthcare.

The commitment that young people presenting to the NHS with gender dysphoria receive appropriate and high-quality care is positive. The lack of quality research in this area must not be an excuse for inaction.

The promise to take pressures off GPs by creating Community Pharmacist Prescribing Service may give rise to a hollow laugh among our pharmacist members. This service is massively overstretched and largely run for profit.

Again the promise for 700,000 more urgent dental appointments and to recruit new dentists is welcome but it may not have a big impact. NHS dentists see about 9,000,000 adults each year and 6,500,000 children.

The manifesto rightly points to the urgency of dealing with the current social care crisis – it is strong on aspiration but weak on specifics. A National Care Service with appropriately trained and paid workforce is needed now. Not when a consensus emerges!

The commitment to recruit 8,500 new staff over 5 years to treat mental health problems in children and adults seems to be a very modest proposal. The wave of mental illness is a product of a society where huge pressures and stresses are being placed on individuals. Until this is resolved many more resources will need to be directed into this area.

The call for public health measures to tackle smoking, obesity, gambling and online harm is welcome as is the recognition of the huge disparities in life expectancy and healthy life expectancy across Britain and even within cities. It also needs to be said that improvements in life expectancy have stalled – in some cases it is going backwards. 14 years of Tory rule have left us in an unparalleled situation.

Past and ongoing neglect of women’s health is also correcly identified – this injustice needs to be righted. The prospect of ending new cases of HIV by 2030 is hugely welcome.

The NHS needs investment. There is no way around it. The refusal to raise taxes significantly or borrow combined with the continued commitment to outsourcing condemns the NHS to continued fragmentation and decline. It seems from recent research that a high percentage of outsourcing and PFI contracts are due to end during the next 5 years. We need a commitment to bring this back in house. The response to the collapse of NHS infrastructure, a revival of Boris Johnson’s much derided 40 new ‘hospitals’ programme, is simply inadequate.

We are concerned about the lack of detail in this document.

The final sentence of the manifesto in this section may be the most important. Labour will stop the chaos in our health and care services, turn the page, and reform them in line with the principles of the NHS that Labour founded. We hope to see the actions to match this worthy promise.

LABOUR‘s positions below via the NPF process.