Personal and family survival through medical crises: that’s the pledge Labour made voters in 1945 to win the general election. Aneurin Bevan saw what the rich already enjoyed – good maternity care, vaccinations in children’s early years, doctors and hospitals for life-threatening diseases and accidents. The state would provide the same for the less well-off, he promised. It’s time that Ed Miliband found a similarly clear, but updated vision.
So what should Labour’s new, vote-winning health narrative be? It would seem obvious to Bevan, to whom austerity Britain today might feel much like a 1945 play-back – millions of people, many but not all of them poor, living unhealthy lives, heading for an unnecessarily early grave and the doctors doing little or nothing to help them, in today’s case, with the diet, lifestyle and environmentally-related causes.
Better-off, well-educated people today are doing fine health-wise, just like they were in 1945. At one end of Church St, Westminster, the rich typically live till they are 83, while, at the other end, their poorer neighbours are usually dead by 67. The big difference compared with 1945 is that the well-off and educated largely look after their health themselves, better than any doctor can: they eat well, take exercise, learn the latest from the Internet, manage their health conditions carefully, pay for gyms, psychotherapists, physiotherapists, complementary care, maybe even some private care where needed. Add it all together and they can expect longer, healthier lives than ever before. Meanwhile, their poorer, less-educated contemporaries may face, in health terms, a dismal future, and often shorter lives than their own parents.
Bevan would take one look at what’s happening and know what to do: commit to ensuring, like in 1945, that the disadvantaged have what the better-off already enjoy. Labour’s first radical health policy was a promise of survival through medical crises. The 2014 updated version should be a pledge to deliver not only longer lives but healthier lives for all.
This sounds simple, but what does it mean in practice? A massive shift from the quick-fix-in-a-crisis NHS that Bevan built and which Labour defends. That requires an end to the episodic, fragmented and occasionally chaotic care that often abandons the frail elderly until they pitch up in A&E. The NHS would cease to sit on its hands in the face of its greatest modern challenge, the unfolding obesity crisis. It would do more than simply peddle drugs for those suffering mental health problems. People with chronic conditions would no longer be deprived of the good support needed to manage their illness well and so cut their hospital crises to a minimum.
In place of outdated short-termism there would be a new NHS working in partnership with individuals as might a personal trainer, a therapist or a teacher. That means an NHS focussed not simply on what it can do to patients, but what it can do with them. Instead of trying to fix patients in a 10 minute GP appointment, the NHS would be working alongside 60 million citizens, helping them to do it for themselves. That’s why, in our recent report*, we propose that every citizen should have an annual Health MOT, funded by a new locally-raised tax, that defines goals and tasks for health professionals and the patient through the next year. This model would fit well with the extension of personal budget schemes, pioneered by social care, to the NHS.
This week, leading health experts said in the Times that the status quo is no longer an option. Labour must now set out a positive vision of a new health partnership between the state and citizens because the paternalistic, Bevanite version lets down large swathes of the population. It’s also unaffordable. A public spending squeeze and over-stretched tax base can no longer sanction a health system that turns a blind eye until people get sick and then works exhaustively to cure them in expensive, professionalised environments, such as today’s acute hospitals. That means facing up, for example, to reshaping many acute hospitals to focus on keeping patients out of their beds instead of racking up hospital income by admitting those who would be better cared for elsewhere.
These challenges require the rebuilding of primary and community-based healthcare, including integration with social care. This programme is widely accepted by many experts, just as were plans for the NHS before the end of the Second World War. But, like then, Britain needs political leadership to articulate and commit to delivering the new vision. The future should not be about managing the decline of Britain’s last great and much loved nationalised industry, but transforming it into something that fits today’s health problems.
If Ed Milliband does not present this new vision, he will lose voters who cannot distinguish Labour from the coalition on health. He will also fail to prepare the ground for solving the health funding crisis that will engulf whichever party comes to power. We know from many sources, including Simon Stevens, NHS England’s new chief executive, that the NHS faces a £30bn-plus deficit by 2020. The system, already falling apart, is being patched up to limp through till May 2015. Meeting these shortfalls will require extra funding from sources that no political leader wants to discuss. Suddenly finding this money after the general election will cripple any government’s credibility unless voters understand that their extra payments are funding a much better service.
A new integrated National Health and Care Service, aligned with the real health needs of a participating population, instead of shaped by historic and outdated patterns of care, would be cheaper in the long run than today’s professionally dominated model. It could support a longer and healthier future for the many that is currently enjoyed by the few. This vision can be sold politically now by Labour, the party that the public trusts with their NHS.
Yet, Labour is still not helping people to see that the NHS could be so much better – providing much better value – if its focus was significantly changed. The party scores political points here and there over NHS mismanagement, but is no more imaginative or visionary than the coalition.
In missing the big picture, the party makes its job harder, should victory come in May 2015. By largely ignoring the health challenges that face millions of people as well as the accompanying funding crisis, Labour lacks Bevan’s insights and so misses a political opportunity to re-energise its following. Ed Miliband risks proving to critics that Labour really is out of touch with the needs of those who could bring it back to power.
Norman Warner was minister of state for NHS reform in the Blair government. Jack O’Sullivan leads a consultancy supporting innovation in health and social policy and tweets @ThinkOSullivan. Their book, *Solving the NHS Care and Cash Crisis, is published by Reform www.reform.co.uk