Editorial Wednesday 24 September 2014: Some reflections on Labour's election health policy
Mascara Kid Andy Burnham's speech to the Labour Party conference today told us little that had not been extensively trailed in his previous speeches and in the party's policy review led by Sir John Oldham.
It allowed delegates to show how much they love the NHS, which they enjoyed. There was a splendid opening contribution from 91-year-old RAF veteran and historian Harry Arthur Smith. That was probably the high point of the conference, in terms of genuine enthusiasm from delegates.
It was also interesting to see that for his forceful and passionate speech, Burnham was allowed a degree of latitude in terms of time and room for manoeuvre that almost no other shadow cabinet minister was granted.
1. The NHS will be a key battleground
2015 has been viewed as an economy election since about May 2010, but with the economic recovery not turning into wage growth for most people, and the problems with NHS performance - both financial and activity gaining mainstream media attention, it is clear that the NHS will be a major campaign issue for Labour in the run-up to May 2015.
(We should also remember that battlefields are often not very nice places to be after the conflict ends.)
This is politically sensible for Labour, provided they do not make too many rods for their own back to be beaten with should they win. Their perceived weakness on economic policy will be ruthlessly exploited by their opponents. The announcement of an extra £2.5 billion a year is a start in acknowledging that the funding of the service is going to have to rise if it is to continue to meet demands. But it is unlikely to be enough, most experts suggest.
2. Integrating social care won't be easy or cheap
The recent report of the Barker Commission for the Kings Fund probably gives us the best guide for the complexity and cost of integrating social care fully into the NHS.
It may well be the right thing to do. It won't be easy, and it won't be cheap.
Economically, there is a huge danger of its appearing to be a means of safely passing on property assets from relatively wealthy parents to their children. Property wealth is a disproportionately huge part of the UK economy. The funding will have to be designed so as to get a reasonable contribution from those with significant assets.
It's worth remembering Frank Leutz's laws on healthcare integration. Can't integrate all of the services all of the time; costs before it pays; who pays the money calls the tune; can't integrate a square peg into a round hole; your integration is my fragmentation; all integration is local: it all applies.
3. If integrated care organisations are to take over the world, we need to know how
With the line ”we will ask hospital trusts and other NHS bodies to evolve into NHS integrated care organisations, working from home to hospital coordinating all care - physical, mental and social.”, the speech seemed to imply hospitals as the hubs of new integrated care organisations.
That sounds suspiciously like a top-down reorganisation of management structures, does it not? Oh good. They always work well.
There are implications all over the place if this is to be Labour's fixed strategy. We might have hoped that wise reflection on NHS redisorganisations past would have led Labour's health team to setting integrated health economies as an objective, but with a permissive approach to allow local health economies to decide how to get there.
It was great to hear that parity of esteem for mental health is a key aim. We need to understand how it will happen.
But primary care is the key tool to making affordable, preventative healthcare the driver of the NHCS system. And most of primary care is still delivered by independent contractor GPs.
Now the independent contractor movement appears to be doing badly at replicating itself for the next generation of GPs. There are many reasons for this: rising property prices play a part (much general practice still works from converted residential property), as does a more female workforce.
Primary care funding has suffered in recent years from 'generosity remorse' over the contract renegotiations in the last decade.
It is also doing more as a sector. Care that was formerly delivered in acute settings is now often delivered in primary care. Access to see a GP is becoming an issue.
Is independent contractor status compatible with a hospital-as-hub ICO model? Remember that Kaiser Permanente talks of 'Kaiserising' its clinicians to work to agreed standards. Will GPs go for this?
Burnham also promised to reinstate his NHS preferred provider policy.
There is another fundamental challenge to the integrated system model: what will we do if local providers are bad? Will we be able to assume that all current social and community care providers are high-quality and safe?
Measuring the quality of healthcare is in its infancy. Social care, probably even more so. This is going to matter.
4. FOI for private and third sector providers of public services
One of the genuinely new announcements came from the following speaker, shadow justice minister Sadiq Khan, who announced that Labour will legislate to make private and third sector providers subject to the Freedom Of Information Act. It’s a good move.