Editorial Wednesday 28 September 2011: Labour on health - a Boyle in the bag, and two new policy ideas

At one point, it looked as if Labour's shadow health secretary John Healey might forego his speech for a panel session. Labour had pulled off the coup of getting former coronary and stroke czar Professor Sir Roger Boyle onto a mixed panel of NHS staff.

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Boyle was a catch for Labour: his no-nonsense condemnation of the Lansley reform plans   came with the added credibility from his having been involved as national clinical director of cardiac and stroke.

His blows all connected with force: "the words reorganisation and reform seem muddled up. I think we're heading for burgeoning bureaucracy and chaos - the system was not broken. The NHS has proved one of most efficent health systems of developed nations".

Boyle raised a good laugh with his lines on the misinformation about NHS comparative performance on heart disease: "if you're in Paris and you get heart trouble, the safest thing to do is to get on a Eurostar to London".

Alluding to the infamous intransigence of Andrew Lansley (saviour, liberator), Boyle concluded "staff disapprove of this Bill and they want to stop it ... we may not be able to stop it, but the Lords must modify it".

Shadow health secretary John Healey's speech was solid, and clearly delivered.

Healey emphasised the communitarian theme that seems to be running through Labour's policy review ("the NHS was not built by governments. The NHS was built by nurses and doctors, radiographers and pharmacists, porters and clerks and cleaners ... built by working people, through their taxes, willing in the knowledge that care will be there if they need it, free and equal for all").

Mili-E Labour is going to be tough on non-working people. It remains to be seen whether it can present itself as tough on the cause of non-working people.

A ritual hammering of Conservative broken promises played well in the hall, and will resonate more widely when NHS times get tough (whether the problems in question are Lansley-related or not).

Labour's high-spending, high-target and high-results legacy was also defended ("The Tories and the Lib Dems are throwing away Labour’s golden legacy to NHS patients").

There was one curious section where Healey appeared to be promising to ban private businesses from operating in the NHS and social care: "we will regulate for the best business practices as well as the best care standards". It is unclear whether that would be legal.

Two policy messages
Apart from opposing the Lansley Bill, two clear policy messages emerged.

The first, to would-be investors in NHS hospitals, was simple: 'don't'.

It's a curious message in a way, because the hospitals in question are probably ones with not-insignificant problems. At a Machiavellian level, a future government might just let the private sector have them with minimal fuss, and discover that - surprise! - NHS managers are really not that incompetent and that as the system currently works,  these hospitals just aren't viable.

But there is symbolism at play here. Labour feels a need to step away from its proto-market concordat (under which some truly, horribly bad deals were done, such as Wave One take-or-pay ISTC deal and the commissioning of polyclinics by PCT rather than need).

And pragmatically, if you are wrapping yourself in the NHS flag and wanting to retoxify your opponents on the brand, then you may be going to defend in opposition what you might not do in office (vide Chase Farm).

Hello, HMO
The second policy idea is much more interesting: "Labour will look instead to develop integrated care organisations to allow primary, secondary and social care to work together. And because our values demand we’re not neutral on who provides care, we will look to promote those that share a true social ethos over those driven by narrow commercial interests.

"We make this pledge not because we want no change in the NHS but because we need greater change".

It's unclear where the purchaser-provider split would exist in this, as the commissioners in CCGs are so aligned with primary care provision. Would commissioning exist with such a vertically-integrated provision system, and if so, how?

Still, it is a new and interesting concept. It naturally assumes a revolution in the NHS payment mechanism, and places no small faith in breaking down sectoral barriers that have proven stubbornly enduring in the NHS - perhaps unsurprisingly, given the status of most GP practices as small private businesses.

The idea will repay further explanation - the thinking is clearly influenced by the health maintenance organisation concept from the USA, and by the direction of travel suggested by the Kings Fund and Nuffield Trust .

We should hear more detail - but it is a distinctive policy proposal.

Healey concluded with a line of the old-time religion: "Bevan said 'the NHS will last as long as there are folk with the faith to fight for it'. This is our faith. This is our fight".