Labour’s Policy Dilemma

Labour Health Policy

The election in 2015 will not be like 1945 or 1979 or 1997 which is a pity as our country desperately needs a new direction. Labour has to decide whether to adopt a positive strategy offering something genuinely different or hope the dislike of the coalition is enough to scrape home. A core belief appears to be that winning depends mostly on being accepted by the media as having no policies which cost anything – restoring credibility on managing the economy.

Labour’s big picture messages about integration and whole person care have widespread support – but the opposition easily adopts that approach. There is little yet about how these ends are to be achieved where there will be a clear difference between the parties.

The message that the 1940’s NHS has to be “reformed” is another theme which almost everyone agrees with whilst again the means to reform are either vague or non existent. Reform is hard to do when the consensus appears to be there can be no system wide reorganisation and there is no money; in fact, less than no money as our spending on health as a % of GDP slides downwards.

Labour will run the message that “our NHS is not safe with the Tories” which has the advantage of being true. The twin attacks through privatisation and through cuts in funding are leading to a steady and worrying decline in NHS performance. The Tory solution will be the full blown market as the old style “socialist” NHS has failed. Nobody cares what the damaged LibDems think.

Social care isn’t safe with the Tories either as more and more evidence emerges of the impact of massive funding cuts. There is a genuine scandal as a largely untrained and badly managed (privatised) care workforce struggles to cope on zero hours, minimum wage conditions.

Labour would like to give the electors something worth voting for. A few messages that the electorate will empathise with, which the other parties cannot simply copy and which have some kind of credibility. Credibility is important not just because this policy area is awash with commentators and think tanks. There are millions who work (or are close to someone who works) in the care system and they can separate slogans from policies.

We need some positioning.

  • Restoring the belief that publicly provided services are a good thing, and essential if we believe in social justice and removing inequality by tackling the social determinants of poor health.
  • Ending the pretence that “efficiencies” can close the funding gap. The whole panoply of zombie policies based on care closer to home, using competition better (or not at all), procurement gains, better use of assets, removing overlap between social and healthcare, and many more might be worthy but they are nothing like enough to close the gap. Nor indeed can removing the market. The only plausible message is investment and reform!
  • Restoring the belief that we should have the right to be involved and (through our elected representatives) to make decisions about how care funding is allocated, how care priorities are set and how care services are provided. This puts us in charge rather than allowing the market to blindly arrange the outcomes or for management consultants to tell us how to do things.
  • Removing the barriers between different parts of healthcare and social care and having a model of care that sits within an integrated public sector which has the overall mission to increase wellbeing by reducing inequality.
  • Removing the barriers to collaboration and cooperation so the care system is not driven by market forces or by competition and removing all external restrictions on how parts of the system can merge, form alliances and combine budgets and functions.
  • Introducing throughout the health system some democratic accountability and having proper open and transparent strategic oversight over quality and over decisions about service changes, reconfiguration and major new build.
  • Removing the barriers to better care that arise because of professional boundaries and tribal behaviour; lessening the distorting power in some of the Royal Colleges and professional bodies.

Actually we can do all that if we have the will, because it goes with the grain of what most of the workforce and indeed most of the public believe. But it takes many years and will require investment.

However most of that is of no interest to the voters. So in terms of policies that could get a momentum of support:-

  • Publishing a ten year plan for health with a ten year funding settlement which projects increasing the % of GDP spent (or indeed invested) back to average EU levels. Put pride back into our NHS.
  • Moving progressively to free social care based on the free at point of need model.
  • Introducing whole person care explaining how this transforms the way we will be treated, putting the case for shared decision making, personal care plans and (for some) budgets into language the public can understand.
  • Improving the professional standing of the care workforce giving them the right national framework of terms and conditions.
  • Ensuring that whatever organisational models are used they have to embrace genuine staff engagement. We can appeal to the huge care workforce to support the plan for better care.
  • Taking a strong stance on public health issues (sugar, fat, smoking, alcohol, exercise) guiding and supporting in relation to adults but directing in terms of children.

We must not fall into the trap of being seen as critical of our NHS – we should be its greatest fans. And we should not pretend there are major inefficiencies which can easily be used to bridge an unbridgeable funding gap, let’s agree to invest in wellbeing for all.