We asked each contender for their ideas about health and healthcare. Their responses are below in the order in which they replied.
All the candidates were invited to our Labour Leadership Health Hustings Liverpool Tuesday 31st August 2010
| Candidate | 1st round | 2nd round | 3rd Round | 4th round |
|---|---|---|---|---|
| Andy Burnham | 22 | 23 | Eliminated | |
| David Miliband | 29 | 30 | 37 | 47 |
| Diane Abbott | 32 | 32 | 34 | Eliminated |
| Ed Balls | 6 | Eliminated | – | |
| Ed Miliband | 38 | 40 | 49 | 70 |
| None of them | 2 | – |
We have therefore voted to support Ed Miliband
David Miliband
There are few better examples of the power of politics to improve people’s lives than the National Health Service. It remains one of Britain’s most popular institutions and an expression of Labour’s enduring commitment to the equal worth of all.
In government, we saved the NHS and renewed its founding principle – universal access to high quality care based on need, not ability to pay. I would defend that principle vigorously as leader of the Labour Party. We are rightly proud of our record in government on health. Waiting times are now at their lowest ever level. The average inpatient wait has fallen from over 13 weeks in 1997 to 4 weeks now. Public satisfaction with the NHS is at its highest level since 1984.
This is Labour’s legacy – made possible by more doctors and nurses, new hospitals and cutting edge treatments and technology. Reforms like Agenda for Change and innovations like the NICE also played an important role.
We’ve forced the Tories to endorse the basic principles of the NHS. That’s good. But their decision to scrap patient guarantees – to see a GP within 48 hours, to wait no more than 18 weeks for hospital treatment and to be seen at A&E inside 4 hours – put our progress at risk. This is a grave mistake that we must oppose and expose.
As we begin the process of rebuilding and renewal, Labour must reflect on lessons learned and challenges ahead. In health, I think we need to focus on three areas in particular – each fundamental to shaping a more equal society where everyone is able to lead healthy and fulfilling lives.
First, we must reignite our mission to reduce health inequalities.
It is a scandal that the life of a baby girl born in Glasgow today is expected to be over 11 years shorter than a girl born in Kensington and Chelsea. While life expectancy across the board rose, we didn’t do enough to reduce that inequality.
As the powerful Marmot Review showed, and the National Audit Office has now reinforced, the solution lies in addressing the social determinates of health inequality – rooted in experiences of childhood, the workplace and quality of life in communities. That means remembering we need more than just a world class NHS for a healthy society.
We need to prevent poor health and promote good health – especially good public health. Cuts to the benefits and public services on which the poorest rely (as the Tory-Lib Dem government are planning) will only widen health inequalities – and ultimately increase the strain on the NHS.
Second, we need a health service where power lies with patients and professionals.
With an aging population and increasing numbers managing long term conditions, we need to find ways to give patients more control over their healthcare that draw on their expertise about their lives and their needs. This is especially true for social care – which needs to become the next frontier of the NHS.
Achieving this goal also means empowering health professionals so as to harness their compassion, expertise and commitment in the service of their patients. The NHS is only as good as the people who work in it – and they must be properly rewarded and properly involved in the management of the health service of which they are experts.
Third, we need to strengthen democratic accountability and control within the health service.
Rather than relying heavily on top down management and central targets, we need Foundation Trusts to be genuine institutions of democratic governance in local areas. Proper accountability is also essential to ensure the highest quality standards and patient experiences are maintained where external providers are used. We must also learn the lesson that repeated structural reorganisations can risk diverting attention from patient care.
With funding tighter in the years ahead, we will need to innovate to deliver health services differently and reduce demand by improving prevention.
Our guiding goals in that task should be reducing health inequalities, empowering patients and professionals and strengthening democratic accountability and control.
That’s the basis on which I believe we should oppose the Tories and set out a radical Labour alternative.
Andy Burnham
Sixty years ago, Labour embarked on a journey to change the lives of generations of people across the UK. The birth of the NHS was a turning point for Britain, improving and saving millions of lives over the decades. Taking on the stewardship of this jewel in the UK crown is a responsibility I haven’t taken lightly.
I am proud of what Labour achieved during 13 years of government. We increased the number of NHS doctors and nurses, cut waiting times for patients, brought in the smoking ban, extended free eye tests for the over 60s: the list goes on. We also made the NHS the most efficient healthcare system in the world. That’s quite a bold statement, but that’s thejudgment of the Commonwealth Fund, a leading US health thinktank.
But there were also areas where we didn’t get it right. We seemed obsessed with policy when we should have focussed on people. That’s why, when I was appointed Health Secretary, I took the time to shadow people within the NHS, from porters to surgeons, to see what life was like on the frontline. Because the NHS’s greatest asset is the 1.3 million people working within it.
Labour also gave the impression that private was good, public bad. As Health Secretary, I wanted to put those impressions to bed, once and for all. That’s why I fought for and established the NHS Constitution and the NHS Preferred Provider scheme, because I’m passionate about the NHS and I wanted to remove any doubt that Labour doesn’t believe in a public NHS.
My personal regret is that we didn’t tackle health inequalities hard enough or early enough. In my own constituency, a combination of blue collar industrial jobs, smoking and poor diet all conspire to pull life expectancy well below the national average. According to the National Audit Office, Labour made some dramatic improvements to life expectancy in England, but the gap between the richest and poorest widened.
We still live in a country where your life chances are dictated by the postcode of the bed you were born in, where children growing up in my constituency face a life far harder and far shorter than those living in David Cameron’s. And let there be no doubt: under this Coalition government, that situation is likely to worsen.
To tackle these inequalities we must be proactive and do more to prevent disease and ill-health: we simply can’t afford not to, either societally or financially. I will pursue a more prevention-led agenda, saving the public purse billions of pounds in healthcare costs and benefits payments, but more importantly, improving life chances for people across the country.
Improving life chances is about more than health interventions. Getting people active is instrumental in keeping them healthy. As Culture Secretary, I introduced free swimming for under-16s and over-60s, one of the first things to be cut by the Coalition. It confirmed to me that they have no understanding of the positive impact these measures have on lower income families – and frankly, they don’t care.
Under my leadership, Labour will do more on mental health. As Health Secretary, I made funding available to tackle untreated and undiagnosed mental health in prisons, aiming to break the reoffending cycle. But we must go further, working with communities and individuals, to provide better support and better access to talking therapies.
And we must also treat our ageing society better and with dignity. Too often people fear getting older, they fear losing everything they’ve worked for just to pay for their care. That is why I will establish a National Care Service, funded by a 10% compulsory levy on estates but limited to £50,000 per couple, to take away that fear and to enable people to enjoy their later years.
That is the vision I will bring as Labour leader, bringing forward bold ideas in the best tradition of our party, tackling the challenges of the 21st century, just as we tackled the challenges of the last.
Diane Abbot
There are many successes Labour has made in the health service. Our ageing population is better looked after than ever; our maternity wards are second to none and people can now rely on a two-week guarantee on cancer referrals.
The improvements are noticeable wherever you look. My local hospital in Hackney, the Homerton where I had my son 18 years ago, has been vastly improved over the years. This is down to Labour funding which was poured into back into the inner cities, after years of being overlooked in favour of Tory shires.
The level of care we have for everyone now is Labour legacy we can be proud of.
But I have never hidden my concerns about the Government’s plans to privatise the NHS and the detrimental effect I believe this will have.
I have met with several people earlier this year to discuss this problem, including Dr Hamish Meldrum, Chair of the BMA council. I am backing their campaign ‘Look after Our NHS’. I am also involved in a local group Hackney ‘Keep our NHS public’, made up of local GP’s who share my concerns about privatisation and the effect on patient care.
The main problem is that choice and competition are being viewed as mechanisms to bring about quality improvement. But evidence shows that this is not the case.
Experience tells us that commercialisation of the NHS leads to the fragmentation of local health services; it risks good providers selling off their services to private companies; it worsens pay and conditions for health service workers; it encourages a loss in transparency and accountability to local people; and it is expensive and wasteful as money is spent on bureaucracy managing commercialisation rather than delivering high-quality care to patients.
By making the health service a business, we take away the duty of personal care and the link between a patient and a GP who knows their medical background.
Encouraging non-NHS providers to compete to provide services puts pressure on local services that must rise to these competitive pressures, often on an uneven playing field, or risk closure.
We have also seen the tendering of electivecare centres and urgent-care centres to private corporations and the reduction of the number of district general hospitals in London by either closing them down or downgrading them. This will mean that local hospitals may not have A&E, acute surgical cover or intensive care units and may not be able to provide the all-round service of the district general hospital.
I held my government to account on these issues. In March, I wrote to Andy Burnham, one of my fellow Leadership contenders, along with fellow MPs Neil Gerrard, John Austin, Kate Hoey, John McDonnell and Jeremy Corbyn, asking for clarification on comments he made last September about how the NHS should be ‘the preferred provider’.
This is a position I think Labour should stick with. The Coalition look geared to open up the market to new providers, despite whatever David Cameron may have said about his love for the NHS. As Labour leader I would support keeping the NHS public.
Another area Labour failed to conquer was the postcode lottery of quality of service based on where you live. We need to even out the inequalities.
But the suggestion that the health service needs to save a fortune by outsourcing hospital services en masse is foolhardy. We must consider what it is we are giving away. It’s not just a matter of handing over the reins and letting someone else get on with it. The successes and progresses Labour made over 13 years are at stake, as are the jobs of those who work in the public sector.”
Ed Miliband
The NHS, Labour’s greatest achievement, reflects a profound commitment to social solidarity and to fairness. It is the best way of guaranteeing the right to healthcare regardless of wealth, status, background or race.
I am proud of so much of what Labour has achieved for the NHS and through it. In 1997 the NHS was crumbling and our action as a party rescued it from years of Tory neglect. We argued, successfully, for the need for tax rises to fund a better NHS for everyone and the public support for the increase in National Insurance to fund better healthcare remains one of the enduring examples of why we can be confident we live in a country with fundamentally progressive values. Investment combined with the hard work of hundreds of thousands of those working in the NHS have transformed the NHS for all of us – the shortest waiting times since records began, high quality medicine, new and innovative services.
However we also have to accept and learn from the things we could have done better. Too often we gave the impression that improving the NHS was a battle with those who work in it when we could have achieved even more had we been better at listening to them. And too often we thought structural reorganisations were alone the answer to a better healthcare system when we should have seen their ability to sap the energy and morale from the workforce on whom all care ultimately depends.
As we think about the future we need to focus on the change which can really make a difference to people. My vision is for a more equal and confident Britain in which everyone is guaranteed not just good quality healthcare but good health. Where your background and income do not determine your quality of life or the years you will live.
To achieve this we need a far more comprehensive approach to tackling the health inequalities which still blight our country. Despite improving life expectancy for everyone the gap between rich and poor continues to widen. The NHS must play its part in reversing this. We need an NHS which looks outwards to local authorities and local partners, which looks to educate and equip patients and public so they can better look after their own health. We know that good health depends as much on good housing, meaningful work, and strong relationships as it does on healthcare services. We need an NHS which recognises this and creates the local partnerships which reflect it. We can build on the examples of local leadership which have seen local, community NHS services working in partnership with local authorities, with community projects to work with people as whole people, not just patients with a particular illness or affliction.
Nowhere is this more important than mental health which has for too long been a Cinderella service when in fact it is critical to helping people achieve good quality, well balanced lives. Programmes like Improving Access to Psychological Therapies are already making a difference, but we are still only at the beginning of finding the ways in which access to mental health services can transform lives, including preventatively by helping people build capability and coping strategies.
We need the NHS to focus far more on prevention and early intervention and we need to better fund these aspects of what the NHS does. The most effective use of NHS resources is often preventing disease, such as with the vaccinations now offered to young women against the cervical cancer causing HPV. We need to find innovative ways to fund and invest in the health and health capabilities of people, young and old, so that invasive and institutionalised healthcare is not a first resort but there when needed.
We need to break down the barriers between healthcare and social care. As a country we are denied the full contribution of those with disabilities as adults or in old age, who want to continue to be active, healthy and involved but who are let down by the failure of our care and health services to work together. That we should, in the 21st century, still live in a country where people are written off not because they are too frail but because they are too old is a scandal. We need a properly funded National Care Service, as we set out in our manifesto, at the heart of our plans for a fairer society in which everyone who is able to is able to contribute and make the most of their talents.
Achieving all this depends on a more democratic and more accountable NHS, retaining national standards but more clearly rooted into local communities and answerable to them. I would like to see the NHS working far more closely with and through local authorities and committed to democratic local decision making about its priorities. Local democracy can free our public services from some of the bureaucracy which frustrates practitioners whilst making them more accountable to local people.
And finally, we need to make our support for global healthcare rights a more central goal of our international development efforts. Britain’s NHS can be an example to the world that it is possible to provide high quality healthcare, free, when it is needed, irrespective of wealth or status. We already have an important tradition of British doctors and nurses working internationally but we can do far more to support their work and to help developing countries build their own universal, tax-funded healthcare systems – making healthcare a right and not a privilege and helping others learn from the experience of the NHS.