Introduction

 The Labour Party Conference have rejected Sustainability and Transformation Partnerships and American style Accountable Care Organisations and John Ashworth has declared his wish to work with campaigners , trade unions and Labour Party members to review the funding of the NHS and to work on a future Labour policy for the NHS.

This paper takes up that challenge and proposes looking at the issues according to these headings:

1. Immediate priorities
2. Provision of funding and funding principles
3. The question of Integration of healthcare and social care.
4. The question of managing complexity and sub-contracting management to the private sector.
5. The question of Brexit, planning for adequate staffing levels and promotion of training.
6. Promoting true professionalism not unrealistic salaries and earnings expectations.

A clear set of policies can be seen to emerge from discussion of these issues and recommendations are set out.

Immediate Priorities

 In order to attract support, Labour Party policies must be seen to address immediate priorities as well as longer term issues. Undue stress on the latter puts the wrong emphasis and distracts from attending to current problems. By contrast talk of whole person integrated care has struck no chords and instead prepared the way for a speculative, unproven and sinister introduction of American style medical management companies into the fabric of the NHS. Accountable Care Organizations are the latest cure all for the NHS but they are copies of arrangements in the USA that prepare  the ground for the contracting out of management functions and back office services as a precursor to future service changes, including privatization.

The immediate operational priority however is to relieve the current bottlenecks to the delivery of services.

Those bottlenecks are :

• Financial resources: modest initial sums could relieve pressures and avoid counterproductive cuts to service capacity. Making sure pay awards are fully funded would help prevent further destabilization.
• Attending to the financial difficulties attending to PFI developments failing to achieve efficiency targets and posing threats to service continuity.
• Failure to support emergency measures to train more staff in shortage areas.
• Lack of clarity over operational priorities. It should be made clear to the frontline staff that the welfare of patients is the priority not financial control.

In addition to these measures further measures should be taken to halt and divert resources that may be about to be committed to the wrong things, for the wrong reasons.

Included in this category must be resources committed to as yet unproven, unneeded and speculative “transformations”.

Whilst the Labour Party supports extensions of primary care and social care this cannot be at the cost of putting front line and last ditch services at peril before alternative models of care are available, proven and delivering suitable alternatives to existing services.

Given the financial context of relatively limited growth funds, limited capital and risky efficiency schemes the Labour Party should be supporting careful prioritization  not excessive risk taking.

An independent check of current STP plans should be conducted and all those failing to show clear and deliverable benefits should be denied approval. The operational priority should be the maintenance of existing services, not delivering unrealistic hopes for the future.

Funding and Funding Principles

 The total resources devoted to healthcare by the UK economy should be maintained at norms established through comparison with comparable countries. What that figure is can be debated but the principle should be fixed that this should be the basis for settling national budgets and longer term funding trajectories.

Although the level of funding of social care should be taken into account in setting the healthcare budget the Labour Party should make it clear that the funding of healthcare and social care are separate questions that can and needs to be financed in different ways.

The Funding of healthcare should come predominantly from taxation. This does not rule out modest user charges e.g. prescription charges, but given the high level of people in receipt of benefits it is likely that the costs and benefits of their application would need careful justification. The success of the Scottish, Welsh and Northern Irish initiatives to abolish prescription charges could be supported unless evidence shows it leads to overmedication.

Partnership with the private sector in the investment in service developments not otherwise achievable directly by the NHS would be considered on a case by case basis , and not ruled out on principle or promoted on principle.

Investment funding decisions should be routed through a national investment bank and be subject to rigorous independent evaluation based on rewarding schemes with proven long term benefits not whether investment fits within a fixed short term and arbitrary capital  budget. PFI debts should be taken onto the balance sheet of the national investment bank and managed appropriately and not be seen as a purely local responsibility.

Above all funding of an expanding and higher quality healthcare service will be applauded as a positive development and not seen as a drain on the national purse. Links with other countries and the private sector will be encouraged so that the UK can share in and participate in expansion and improvement in healthcare worldwide e.g. in training doctors and researchers; and healthcare products and services.

Integration of Healthcare and Social Care

 The Labour Party believes in an adequately funded comprehensive NHS and in a partially funded social care industry for those in greatest need of social care, including by direct provision where appropriate to ensure needs are met.

Wherever benefits can be realized from greater co-operation between the two services then this should be encouraged but limits exist to the level and depth of the “integration” of the two separate services. Experiments into closer integration can be undertaken but results should be independently substantiated , evaluated and agreed prior to any future structural changes.

Managing Complexity and Sub-contracting management to the private sector.

 The Labour Party is skeptical that the claims made for the improvements available by sub-contracting of public management of either commissioning functions or provider responsibilities for and of the NHS. Indeed the ethical and trust issues involved in healthcare delivery make it possible to justify management being firmly under the control of the state. The prevalence of fraud , corruption and waste in the USA underline the risks for the UK in following American hype supporting “new models of care”. Equally the Labour Party is skeptical of the benefits of the full integration of the NHS into a monolithic management structure on a top –down model. Checks and balances need to be incorporated so that the conflicting demands of clinical quality, economic efficiency, effectiveness , local influence on decision making , patient involvement and choice can be balanced appropriately through democratic means ie through the continued separate influence of local government in the purchasing and commissioning of healthcare , in joint planning and by retaining  prime responsibility for social care.

The question of Brexit,  planning for adequate staffing levels and promotion of training.

 The prospect of imminent Brexit is likely to have a negative effect on the NHS in terms of the effect on government financing, availability of investment capital and access to immigrant labour.

This makes it all the more important to focus funding on immediate needs and to radically upgrade the training of staff in numbers and in quality to deal with the pressures anticipated in the future.

The international statistics suggests the UK lags well behind other countries and it has been a scandal that the NHS has looked abroad to recruit and train staff.

It will be good for Universities, good for young (and mature) people previously denied access to professional training  and good for the providers looking for a fresh supply of well-motivated people to fill vacancies.

Promoting true professionalism not unrealistic salaries and earnings expectations.

 The shift in values within the NHS toward commercial values and away from professional and social welfare values impacts on salary expectations, and labour flexibility . The Labour Party support a return to professional values, a turn away from crude managerialism  and to an NHS infused by professionalism , flexibility toward meeting patient needs and respect for its managers, staff and patient alike.

Policy recommendations :

Sustainability and Transformation Partnerships and Accountable Care Systems to be rejected in favour of measures to support and not undermine existing services.

Progress on expansion of preventative medicine, primary and community care should reflect commissioning priorities focused on todays problems not on unproven claims on behalf of “new models of care” ;and , on  a case by case evaluation of compelling business cases not on speculative and risky gambles with people’s lives.

2. Modest additional resources should be made immediately available to offer relief to the NHS otherwise in financial distress. A figure of £4bn has been presented by industry experts as required.

 Future funding should be increased to at least meet real terms increases in demand and in the medium term converge on to international norms for healthcare funding established with comparative nations.

3. The PFI funding issue should be managed in future by a National Investment Bank who would arrange for an orderly transition for existing contracts and who would take responsibility for approval and funding of new investment cases.
4. To relieve a looming staffing crisis an immediate and substantial expansion in training numbers will be undertaken.
5. To avoid any doubt the government would declare to its managers , staff and patients that immediate patient welfare is the overriding priority in delivery of healthcare within parameters set at the national level.

At a national level advice would be provided on the overall funding by professional bodies and industry experts and not rely on Treasury dictat, blind to the operational and human pressures.

6. The Labour Party see no prospect of fully integrating health and social care funding streams and management arrangements whilst being in supportive of looking for operational efficiencies in the management of individual patients. But given that Healthcare is a right and social care a restricted benefit subject to means testing the two services will have different foci.
7. Professionalism and keeping pace with the speed of scientific development in medical techniques should be the basis of changing the NHS not the unproven claims of the commercial health management industry.