The 1997 Labour party General Election Manifesto included the following commitments.
‘if the Conservatives are elected again there may well not be an NHS in five years’ time – neither national nor comprehensive. Labour commits itself anew to the historic principle: that if you are ill or injured there will be a national health service there to help; and access to it will be based on need and need alone – not on your ability to pay.
In 1990 the Conservatives imposed on the NHS a complex internal market of hospitals competing to win contracts from health authorities and fundholding GPs. The result is an NHS strangled by costly red tape, with every individual transaction the subject of a separate invoice. After six years, bureaucracy swallows an extra £1.5 billion per year; there are 20,000 more managers and 50,000 fewer nurses on the wards; and more than one million people are on waiting lists. The government has consistently failed to meet even its own health targets. There can be no return to top-down management, but Labour will end the Conservatives’ internal market in healthcare.
The Tory attempt to use private money to build hospitals has failed to deliver. Labour will overcome the problems that have plagued the Private Finance Initiative, end the delays, sort out the confusion and develop new forms of public/private partnership that work better and protect the interests of the NHS.
Labour is opposed to the privatisation of clinical services which is being actively promoted by the Conservatives. Our fundamental purpose is simple but hugely important: to restore the NHS as a public service working co-operatively for patients, not a commercial business driven by competition.’
Labour recognised then the wastage involved in any internal market in health care.
The Thatcherite Purchaser/Provider split introduced into the NHS in 1990 if not abolished would, as most commentators predicted, ultimately lead to the extinction of the NHS. The Health and Social Care Act opposed by Labour is merely an extension of this strategy. If there are purchasers then there will need to be providers and that these should be multinational companies will always be a possibility given the nature of the internal market..
The only sure way to safeguard the NHS was, as the 1997 Manifesto recognised,
‘to restore the NHS as a public service working co-operatively for patients, not a commercial business driven by competition.’
Labour also needs to recommit, as a matter of urgency, to its 1997 pledge to
‘overcome the problems that have plagued the Private Finance Initiative’
PFI has already led to a financial disaster for hospitals in South East London and others are likely to follow suit unless Labour acts to renegotiate the terms of the contracts that have proved to be so favourable to private companies , and so costly for the taxpayer.
Submission to the Labour Party policy review by Mike Squires