The NHS at the 2015 election

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HEALTH BRIEFING 10 from the West Midlands Socialist Health Association, April 2014

At the WMSHA AGM Lord (Philip) Hunt spoke about current events in the NHS. It was clear from what he said that the NHS faces a crisis, and will not survive if a Conservative or LibDem/Tory coalition takes office in 2015. Because of its professionalism and coherent policy approach, Philip considered that the SHA was well-placed to influence the Labour manifesto, and actions of a future Labour Government. It was agreed that issues and ideas arising from the presentation and subsequent discussion should be circulated as an input to the Party’s policy processes. That is the aim of this paper.

Key points from Philip Hunt’s presentation

  1. The current and prospective finances of the NHS are dire (average 4% real growth since 1948 – now 0%, but at a time of rapidly expanding demand and needs).
  2. Many Trusts were already in debt at start of year, but Francis Report and Care Quality Commission require them to hire more staff and Monitor is seeking 2- and 5-year plans. The dilemma is rapidly becoming impossible.
  3. If every acute Trust cuts beds (as they must), effects will be system-wide. There will be knock-on into Primary care, adult social care, care homes, etc – all also suffering major cuts.
  4. System is not well structured to handle this: eg Birmingham/Solihull comprises 3 CCGs, 2 Health & Well-being Boards and a regional office of NHS England. Other areas similar or worse.
  5. David Nicholson has admitted that NHS is ‘bust’. But competitive tendering is the rule, and collaboration to deal with the problems jointly faced is thus effectively outlawed.
  6. An incoming Labour Government has several serious problems:
    1. Present system not fit for purpose – but no-one wants another major restructuring;
    2. Must therefore change what the present components do;
    3. Sir John Oldham’s report on whole person care may provide a template to use;
    4. Must remove present perverse incentives to shift costs between NHS and Local Authorities;
    5. Need to start with an overall (whole system) amount of money, and secure leadership in how it is used;
    6. Scope for saving ~£1bn by abolishing central NHSE, Monitor, CQC, Development Agency;
    7. Room for further savings from combining/centralising procurement (eg path labs)
  7. Present Government is on a political mission: attacking collective provision by individualising, marketising and cutting public funding. Not just NHS – also pensions, BBC, etc. They would like to abolish NHS altogether, if they could get away with it.
  8. In the prospective economic context future options for Labour are limited:
    1. Further radical change in how services are delivered; AND/OR
    2. Reduce scope of services.

Discussion

The Labour Party Health & Care Policy consultation provides broad pointers on matters of principle, such as a more integrated ‘whole-person‘ approach to care, more emphasis on prevention and greater patient involvement. However, it is more limited in terms of commitments to actions.

It is clear to us that the Government is engaged in a political offensive in favour of market individualism and against collective provision across the board, and not just in the NHS. The Francis report (and others similarly) have been used by Government and media to generate hysteria, drip-feeding bad news to induce public acceptance of service reductions. We believe therefore that the National Policy Forum must move on from a generalised strategic ‘vision’ to a credible plan of action for a Labour Government. The West Midlands branch of SHA includes many experienced NHS professionals, clinicians, managers and Trust Non Executive Directors, and we propose the following ideas for consideration:

  1. With the NHS made responsible to the Secretary of State again, competitive tendering of internal services is no longer necessary, Monitor becomes redundant and OFT’s reach into NHS is reduced
    • Tendering by CCGs is artificial and should be wound down in favour of collaboration with Health & Well-being Boards (HWBs) and NHS Trusts, with NHS England taking responsibility for strategic direction of collaborative effort at wider geographical scales;
    • CCGs could do the quality monitoring job better than CQC (they see their patients). This could be done without legislation and would allow abolition of CQC as well as Monitor;
  2. With real responsibilities being devolved in these ways, comes more scope to generate energy and release resources by radical action within the NHS, such as:
    • Culling the excess ‘plant’ in the NHS to improve quality and release money for system-wide change– tinkering will not do (we may need s119);
    • Major changes will need to be done with a full commitment to public participation, but with openness and honesty about the resources and the real choices available;
    • Prevent GPs from opting out of necessary expansion of primary care (and increasingly going part-time); and stop consultants going back to bad old ways – doing private work in NHS time and premises;
    • Identify ‘luxury’ elements that could be charged for, making sure the money stays in the NHS (such as sports physiotherapy, laser eye surgery).
  3. Labour must create a better correspondence between the health care responsibilities of the NHS and the social care role of Local Authorities, but without another damaging restructuring. Possible ways forward include:
  • Government giving Health & Well-being Boards more authority, and following this up with additional powers;
    • Encouraging CCGs and HWBs to cover compatible areas, creating joint budgets and service planning processes – HWBs and CCGs could collaborate to initiate this;
    • With clearer devolution of operational responsibilities and less micro-management, powers, resources and accountabilities of the national and local components should be brought alignment over time.

All these kinds of measures would be supported by a focus on patient-centred care (pathways and networks) as Labour’s USP. Politically, there is a need to attack the time and money wasting effects of current policies using front line input (eg through Survey Monkey). There is a need to explain Labour’s own past marketization actions as tactical short-term measures necessary to deal with inherited problems, rather than a long-term strategy. For example the Independent Treatment Centres which forced consultants to bring down NHS waiting lists from 18 months to 18 weeks.

Finally, we note that the BBC is recruiting a health correspondent, having for a long time done without. Labour must make a briefing this person a high priority.

Alan Wenban-Smith