Labour Party plan for the NHS: devil will be in the detail

Wes Streeting, Labour’s Shadow Health and Social Care Secretary laid out plans this week on how the Labour Party intends to get the NHS ‘back on its feet and fit for the future’.

In a speech at the Labour Party Conference, he said that ‘the NHS is no longer the envy of the world’ and needs both investment and reform because pouring ever-increasing amounts of money into a system that isn’t working is a waste of time that is running out.

“Labour will never abandon the founding principles of the NHS as a publicly funded public service, free at the point of use”, he said. “I make the case for reform not in opposition to those principles but in defence of them. I argue that our NHS must modernise or die, not as a threat but a choice. The crisis really is that existential.”

Health leaders, Royal Colleges and numerous health organisations welcomed the plans, but many said they would need more detail on what these reforms might look like in practice.

Waiting lists and preventable illness

Streeting said he would take immediate action to cut the 7.7 million waiting list, but the combined challenges of rising chronic illnesses and an ageing population threaten to bankrupt the NHS.

In addition, the NHS was more like a ‘sickness service, not a health service’ with too many lives hampered by preventable illness and too many lives lost to the biggest killers. Therefore, it needed to prevent ill health and not just treat it with pioneering cutting edge treatment and technology.

This could be achieved with an extra £1.1 billion funding paid for by abolishing the non-dom tax status, which allows “non-domiciled individuals” to avoid paying UK tax on money they made outside the UK.

The Royal College of Physicians said it welcomed this vision for transforming the health of the nation and said it had long called for a focus on reducing avoidable illness and tackling health inequalities.

Dr Sarah Clarke, President of the Royal College of Physicians (RCP), added: “The best way to shape ill health is to focus on the factors that shape it. The RCP and the Inequalities in Health Alliance want to see a cross-government strategy to reduce health inequalities. To reduce avoidable illness action is needed on the root causes of illness like poor housing, employment, air quality and racism and discrimination. The commitment to restrict the advertising of junk food to children is a welcome example of the bold action that is needed on prevention.”

Family medicine and children

Streeting also addressed primary care and said it would be at the heart of Labour’s plan for the NHS. He promised to train thousands more GPs and bring back ‘the family doctor’ by cutting the red tape that ties up their time.

For children, he wanted to ensure that every child struggling with their mental health got the help they needed. He said Labour will put mental health support in every school and hubs in every community, paid for by abolishing tax breaks for private schools.

Other pledges included banning junk food adverts targeted at children, introducing breakfast clubs and supervised toothbrushing to keep children’s teeth clean and keep them out of hospital.

He also delivered a warning to the vaping industry, who have ‘sought to addict a generation of children to nicotine with flavours like rainbow burst and cotton candy ice’, saying a Labour government will come down on them ‘like a ton of bricks’.

The NHS Confederation said leaders will be pleased to hear Labour’s intention to place a greater emphasis on keeping children healthy and out of hospital.

Matthew Taylor, chief executive of the NHS Confederation, added: “Given obesity will be the next big public health issue to tackle after smoking, introducing evidence-based measures such as a possible ban on junk food advertising targeted at children, would be a sensible step as part of a wider prevention agenda.

“Greater prevention and a shift towards community care has been a long-held aim for health service leaders, who will want to see words turned to action were Labour to come to power, particularly around putting primary care at the heart of the health service.”

The Royal College of GPs said that the pledge to recruit more GPs and reduce red tape are important solutions for primary care.

Chair Professor Kamila Hawthorne added: “We need to see commitments to bold action for general practice that addresses the fundamental issues in workload and workforce – keeping GPs in the profession with improved national retention initiatives, greater and sustained recruitment to meet the growing demands for healthcare and reduced bureaucracy to free up GP time to focus on patients. Our patients and primary care services desperately need more GPs.

“Without taking these actions, it’s hard to see how the vision set out for general practice today can be achieved, given the pressures we’re currently buckling under.”

Social care and Labour

The shadow health secretary also acknowledged that there is no solution to the crisis in the NHS that doesn’t include a plan for social care. He said that they will grip the immediate crisis in social care, starting with the workforce with a plan to address recruitment and retention and implement the first ever Fair Pay Agreement for care professionals. He called this the ‘first step on our ten-year plan for a National Care Service’.

Dr Sarah Clarke from the RCP said they looked forward to further detail on Labour’s plans for a national care service and plans that ensure health and social care are funded and staffed to work as equal partners.

She said: “Fixing social care is key to enabling people to live as independently as possible, as well as supporting flow through hospitals. As we’ve said, a national expansion of ‘catch up’ clinics to move through waiting lists would be welcome, but the devil will be in the detail to ensure it is widely and fairly available and that staff can work through lists in a targeted and effective way.

“As ever, workforce is central to the success of the NHS now and in the long-term. Prioritising the retention of existing of staff must be a priority. Being able to work flexibly, not facing discrimination and harassment at work, having efficient IT and equipment, time off for significant events, hot food and drink and time to fulfil their professional duties will all make a difference. We welcome Labour’s commitment to expanding NHS staff – but a focus on improving working conditions alongside is key.”

Affection for NHS hindered improvements to health services

Other promises included in the speech were extra clinics at evenings and weekends, harnessing advances in artificial intelligence and genomics to predict and prevent illness, and paying extra for staff.

Sally Warren, Director of Policy at The King’s Fund, agreed with much of Labour’s plan and said that a change of approach is needed because there are multiple crises across health and care. She said that this is because affection for the NHS has at times hindered improvements to health, particularly when important services such as public health and social care have been overlooked as political energy is expended on acute hospital services.

Warren added: “This refocusing towards community services has been a political ambition for decades, yet the rhetoric has not translated to reality. Making good on the commitment to bolster community services will mean grappling with knotty issues such as making careers in community services more attractive, improving outdated GP and community health buildings, and shifting the balance of investment away from hospitals toward community services.

‘Across its conference, Labour has announced some welcome measures including additional funding to help reduce soaring waiting lists. Some hospitals have made progress in addressing the number of people waiting for care by offering planned treatment and outpatient clinics at evenings and weekends and there are merits to Labour’s plan to scale up this approach. Of course, the policy relies on the willingness of staff to work overtime at a point when many health care professionals are demoralised and burnt-out, but the approach has been shown to work and could help to bring down waiting times in the short term.

“While Labour has committed to boost the pay of social care staff, it has yet to set out how it would introduce long overdue reform of the sector. A lack of action by successive governments has led social care services to spiral into crisis. If Labour is serious about putting social care on a sustainable footing and ensuring people’s care needs are met, then it needs to put more flesh on the bones of its plans for reform.”