Corbyns’ Health Policy- Problems from a different perspective
I provide some commentary in bold under the details of Jeremy Corbyns’ recently announced health policies. These represent a different perspective from those of most commentators.
Secure our NHS and social care
“We will end health service privatisation and bring services into a secure, publicly-provided NHS. We will integrate the NHS and social care for older and disabled people, funding dignity across the board and ensure parity for mental health services.”
Jeremy Corbyn’s vision for the NHS will reverse the marketisation of health, integrate social care and improve staff morale to build a high quality, public and universal NHS free at the point of delivery.
Comment:Public provision is insufficient in itself if it means the return of underfunding, rationing and top down managerialism. Failing to be responsive to new demands has fuelled pressures to control immigration and resentment at deteriorating services caused by population growth.
Bringing our NHS back into public hands
We will bring our NHS back into public hands. Scotland and Wales have reversed marketisation and restored their NHS without massive upheaval – England can too.
We will introduce legislation to not just repeal the Health and Social Care Act, but that will unpick the 25 years of marketisation, end the purchaser-provider split and return the NHS to an accountable public service run in the public interest.
Comment:This is an insufficient policy. Without a clear commitment to increased funding it will result in continued blockages, staff shortages and may expose the Labour government to a dual pressure – from increased expectations and insufficient income. Returning the NHS to pre purchaser –provider split runs the risk of provider capture, inflexibility and a return to waiting lists. The NHS is returning to top down managerialism which will act to reduce access to care, increase bottlenecks in the system and throttle innovation.
Sustainable funding by tackling the private sector involvement in our NHS
The Government continues to sign off new Private Finance Initiatives which are a large drain on NHS resources and creates financial destabilisation in the system, staff shortages and cutbacks. We must tackle this funding crisis and put the NHS back on a long term sustainable funding basis.
We will use our National Investment Bank to buyout organisations from their PFI schemes, we will not renew PFI contracts and we will investigate establishing a PFI Monitoring Unit to ensure compliance with contracts and to cancel contracts where they are not adhered to.
Comment:This links PFI to sustainable funding. But again this is not sufficient. Without easy access to large capital sums the NHS will wither and die. Will the Investment Bank release such funds at any easier terms than commercial banks? Will the NIB be outside of Treasury control? The Treasury sees health expenditure, including capital as personal consumption, whereas it should be seen as increasing effective demand in the economy, supporting jobs and productivity of the population, extending working lives, reducing dependency and independence , increasing satisfaction and longevity. Without a change in mind-set the NHS will continue to be denied sufficient funding ; undermining the very concept of public provision of services.
Modern, integrated health and social care
Creating a modern, integrated health and social care system not only means bringing our NHS back into public hands and properly funding it, it also means a system that places importance on public health and establishes parity for mental health and delivers responsive, whole person care.
We will reverse the damaging cuts to social care and build a social care system that enables independence and puts dignity and human rights at its heart.
Comment:There is a dangerous element of mission creep and muddled thinking here. At present there is a clear divide between a free at the point of care NHS and a largely private provision of social care.
Is Social care to be nationalised which some will read into the vague concept of integration?. I doubt it and a poorly thought through policy risks inflating expectations and confusing people in difficult situations.
Creating a healthy society
The aging population and increases in complex healthcare needs mean that we require a system that prioritises prevention of ill health and focuses on the whole person rather than a collection of reactive services that focus on treatment and cure.
That means rebuilding our public health system and placing it centre stage. The Health and Social Care Act ended public health as a responsibility of the NHS – as part of bringing our NHS back into public hands we would reintegrate public health as a responsibility of the NHS.
Comment:Again good intentions replace clear thought. Government cannot resolve all health problems but it can arrange for healthcare when needed. Prevention initiatives will never prevent sickness and inequality. The most effective way of increasing general health is to promote equality but this statement fails to be made.
Staff are the service
Morale amongst NHS staff is at rock bottom after six years of chaos and delivering more for less. Staff have experienced real pay cuts – we will abolish the cap on public sector pay increases that has caused this.
We need to work with the health and social care workforce and their trade unions, properly rewarding them for their hard work and engaging with them about how to improve our services.
We will ensure that student bursaries for nursing and allied health professionals continue.
Through our commitment to security at work we will end the use of exploitative zero hours contracts, close the loopholes in the statutory minimum wage rates and lift the statutory minimum wage to the Living Wage
Comment:This reads as though written by trade unions but is insufficient. Doctors and nurses in the UK are amongst the highest paid in the world. Nothing is said about the shortages of doctors; the cuts to training budgets or the contribution of the science and research sector to the Pharmaceutical and allied medical industries.
Conclusion:
It is good that clear health policies are given. But the policies do not communicate grasp of the problems or effectiveness in delivery. The things not said are as important and revealing as the statements made.
Why for example are there no pledges to :
- Restore UK funding of healthcare and social funding care to comparable European levels. This would act as a normative guide for government funding and provide a stable basis for planning.
- Increase doctor numbers and staff in training. The UK government colludes with the medical professions in too low a number of qualified staff in the UK and high earnings. This works against the interest of the patient.
- Celebrate a target of higher healthcare spending as a positive thing and good for the economy and our health science industries rather than as an indulgence to unhealthy life styles.
- Regularise the position of the private sector in health. It is not clear what the future of the private sector in health is to be. Previous Labour Health Secretaries of state gave a target of 15% provision. Does that commitment still apply and if not what is to be the role of the private sector?.
- To clarify how social care will be funded in future. Integration is not a solution to that problem and indeed muddles the issue.
- Seek to promote equality as a policy objective such that the top 1% do not receive more than 10% of national income.
While I sympathise with Jeremy Corbyn there needs to be a sharper edge to his policies.