Fabian ’13 Conference – ‘Next State’ ‘A New NHS: Repeal The Act, But Then What?’

This Saturday, what felt like a large number of the Fabian Society’s 7000 UK members gathered at London’s Institute Of Education for their 2013 Conference.

Set up in 1884 by Beatrice and Sidney Webb, the Fabians are the left’s oldest think-tank, an ideas forum affiliated to the Labour Party that has previously counted such well-known figures as H.G. Wells, Virginia Woolf and John Maynard Keynes among its acolytes.

Dubbed ‘Next State’, the conference’s focus was on Labour’s 2015 manifesto content and what policy pledges should be made. Ed Miliband made an address and members attended breakouts to discuss a variety of areas of economic and public policy.

Unsurprisingly, one of the most inviting breakouts focussed its attentions on the NHS, taking the repeal of last year’s ‘Health and Social Care Act’ as it’s starting point and asking: “but then what?”

Chaired by Labour List Editor, Mark Ferguson, the panel consisted of Labour MP, Liz Kendall (The Shadow Cabinet’s Minister for Care and Older People), Age UK’s Charity Director-General, Michelle Mitchell and Peter Carter (General Secretary and Chief Executive of The Royal College Of Nursing).

Each panellist had five minutes to set out his or her stall before the discussion was opened to the floor for a Q & A session.

For Liz Kendall, the last Labour regime had been marked by notable achievements in reducing waiting times (down from around 2 years to an average of 9 weeks) but she was also honest about the failure of an attempt to use similar targets to drive down waiting times in A&E. Her strongest criticisms, however, were reserved for the Coalition’s reforms which she felt had done nothing to address the postcode lotteries in local care costs and results, nor had met any of the other huge future challenges posed by an aging population. She also highlighted the impact current cuts to local government funding are likely to have on care provision.

For her, any future Labour Manifesto would have to focus on a four-point plan. Firstly, it should do more to integrate health care services (bringing together a patient’s mental, physical and community situations and support needs). Secondly, A far greater equality of health outcomes across the UK should be achieved. Greater input from and transparency for health professionals, patients and their families should be created, aided and motivated by OFSTED-style tables comparing performances of different health institutions across different health conditions. And finally, a comprehensive plan for funding care should be agreed, setting a cap round personal £75000 for health costs, alongside the Dilnott Commission’s recommendations to massively up the thresholds at which people start paying for personal care.

For The Royal College Of Nursing Peter Carter shared Liz Kendall’s reluctance to see any further top-down reorganisations of the health service, but disagreed on repeal, feeling it would take too long, causing disruptions to planning. Instead he wanted to see amendments removing the marketisation content – feeling such content could only lead to unfair competition on price, not quality. This should occur alongside a levelling of the procurement playing field, currently, he felt, heavily loaded in favour of the private sector. He also stressed the need for a concerted attempt to deal with the inefficiencies seen in the procurement process, where differentials of 185% in costs have been seen between identical deals involving neighbouring departments, and where vast wastage goes on in terms of drugs – problems that are becoming more acute, not less.

For Peter, any future version of the NHS would have to focus far more on prevention of conditions such as liver disease that are on increase in UK even as they’re declining in Europe and, once again, on patient participation.

Michelle Mitchell from Age UK felt Andy Burnham had been really clear on his objections to the Health and Social Care Act but needed to be much clearer on a Labour alternative. She spoke of how health outcomes for pensioners in the UK are far worse than those of their counterparts in the rest of Europe in terms of not being correctly diagnosed, suffering malnutrition in hospitals, dying unnecessarily due to the cold and not being treated appropriately. Again there was a reference to the poorer levels of healthcare in poorer neighbourhoods in the UK where people were less likely to complain. Like Liz she felt as though solutions lay in having greater integration of health care, personalised care plans, a greater focus on prevention and a move towards patients receiving support in their own homes and communities with special support co-ordinators rather than being admitted to hospital.

After a couple of rounds of questions dealing with whether patients should manage their own health budgets; whether it would be possible to repeal the bill without yet another major health service re-structuring, and the need to include housing alongside health services in joined-up conversations about care, Mark Ferguson wrapped up the discussion with a question to the panel about when they felt the tipping point would be reached (or even passed) in terms of dealing with the care issues of our aging population.

For Michelle Mitchell, we’ve already passed it and the public have to put pressure on politicians to make them face up to their responsibilities in finding answers to meeting the costs and improving the quality of social care. Liz Kendall accepted this, revealing at the moment she receives just four or five letters on care compared to 99 on subjects such as the threat to our forests.

On the subject of current care failings, Peter Carter shared the grim anecdote of an elderly couple who had seen 56 different carers in a year including one, a 17 year old girl, who’d been working in ‘Burger King’ the week before and had to ask the 70 year old wife of the patient what she should be doing to assist her elderly, sick husband.

So to sum up, it would seem as though despite the fact everyone wanted to lose the compulsory marketisation components of the Health And Social Care Act (if not the act itself in its entirety), the panel felt some kind of relationship with the private sector would – and should – disappointingly, persist under a future Labour government, albeit probably in a very different form (interestingly PFI didn’t receive a mention!). Health and care services should be better integrated and more community-focussed, there are still major procurement inefficiencies to be dealt with and a huge question mark over how the issue of caring for our ageing population (and meeting its huge costs) will be tackled.

It was left to Leicester West MP, Liz Kendall to sum up our current society and its need to overcome an obsession with youth that has prevented it from facing up to questions about the elderly, shutting them away, keeping them out of the media and out of sight through our fear of what they say about our own mortality. For her, old age should be a great time, but a real cross-party debate about how to make it so has clearly never been so needed.

Posted by Susan Masters: Socialist Health Member, Fabian and Labour Branch Secretary for East Ham South Ward