Labour should remember that first and foremost we are all patients and users of the NHS. That means we all have experiences – good and bad – of our health service. How Labour talks about the NHS must resonate with those experiences and reflect how patients interact with the NHS.
For example STPs (sustainability and transformation plans/partnerships) have barely touched public consciousness. But the issues they are dealing with concern patients every day – long waits to see a GP, delays in ambulance responses or A&E treatment, increasing waits for treatment, poor communication and so on. That said, the vast majority of healthcare goes very well, and patients are generally satisfied, indeed very grateful.
Patients also understand the pressures and demands the NHS is facing – an ageing population, people living longer with disabilities and long-term conditions, the financial pressures and stretched staffing, together with rising public expectations. But the public response has been mixed to the overarching solution to these pressures – supporting many more people at or close to home rather than in inappropriate and expensive hospital or residential care. Change is difficult and trust in those proposing change is limited.
So what is Labour vision’s for the NHS in 2020s Britain? Access is crucial – free at the point of need when you need it, and timely in a 24/7 world. Ideally that access has to be as close to home as possible and should reflect patients’ changing lives. So GPs must be the key first point of call and critically they are still trusted. Patients also expect care to be joined up. The other key issue is quality – at some point in the election campaign an example of poor healthcare will hit the headlines.
All of this needs to be properly resourced. The NHS delivers mostly great care on a shoestring compared to other countries. International studies confirm this time and again. The public are sympathetic to more funding going to the NHS – if it’s clearly earmarked and if it’s used well.
On the latter point, better use could be made of existing resources. My experience as chair of finance for a clinical commissioning group (CCG) suggests substantial savings and better care could be delivered by reducing variations across the NHS – between GPs, between hospitals, between different CCGs and local authorities, and on issues like prescribing, referrals for treatment and managing demand. Benchmarking on spending and good practice should be the number one driver for every CCG and every STP across the country – and within the next two years, they should all aim to be performing at the current level of the best 25 per cent of CCGs.
Simply saying that Labour created the NHS is not enough to win public trust. The party must talk about its track record of investment in the NHS and its staff, and how it will manage resources more effectively and deliver a better health service with extra funding where it is needed.
Labour’s vision must be to create better care closer to home; genuinely integrate care with health; and ensure change involves and is driven by patients. Such are the challenges facing the NHS, that without proper patient engagement it will not be possible to sustain the changes needed.
At the moment STPs and the NHS five year forward view are very much top down, savings driven plans. For Labour this engagement should begin during millions of doorstep conversations in the election campaign – what are your concerns about the NHS in your area, how can it be improved and what would you be prepared to do to make it happen? That should also include questions about how you can manage your own care and look after your own health, and how can we help you to do so. The public health agenda needs to be developed, particularly the role of better homes in helping people stay warm, safe and well.
Labour needs to work with patients and staff on turning problems about health and care into sustainable solutions. Perhaps the biggest challenge is making a reality of integrated care and health which everyone seems to support but it still remains elusive. Full integration requires one system, not two separate systems, responsible for planning, commissioning and delivery; and crucially one system of funding health and care, free at the point of need.
In a nutshell, here are four pledges the Labour party could make on health and care:
- we will guarantee that you can see a GP within 24 hours if needed
- we will ensure that funding keeps pace with the country’s health needs
- we will help you to stay healthy in your own home
- we will bring health and care together to meet all your needs