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28 January 2015

Labour’s NHS plan: selective rhetoric or socialist principle?

Key details are "thunderingly absent" in Andy Burnham's ten-year plan for the NHS, but his stark anti-market tones are comforting after four-and-a-half years of business talk.

By Benedict Cooper

“Today, Labour calls time on the Tory market experiment in the NHS”. It was a stark statement – one perhaps more fitting for a public sector protest than a shadow health secretary’s speech. But this week is a big moment for Andy Burnham, as he lays out the details of Labour’s ten-year plan for the NHS.

“If we allow market forces to continue to take hold,” he said, “they will eventually break the NHS apart. Our destination is integration. Markets deliver fragmentation. They bring more providers onto the pitch, increasing the cost and complexity of care”.

The near future holds a clash, he continued, between “NHS values” and business values; a pitting of “collaboration with competition and patient care with the profit motive”.

The solution? The repealing, in the first Queen’s Speech of a Labour government, of the Health and Social Care Act. It’s not the first time Burnham has made this promise on record, and as the health think tank King’s Fund chief executive Chris Ham pointed out later, “it is not clear how far Labour intends to go in dismantling the architecture [the Act] established”.

“It also remains to be seen,” Ham continued, “how easily his commitment to roll back competition in the NHS can be squared with EU competition law”. Labour’s stance on the NHS might just swing the election for it; loose ends like these need to be tied up very soon.

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What will certainly have won Burnham more friends on the anti-privatisation side of the political divide, even if it was just words, is his repeated assertion that private healthcare needs to know its place. Private providers, he said, should have a “supporting, not replacement, role”. Of course, there are many who argue that it should have no role at all in the National Health Service, that if he really wants to “strengthen the ‘N’ in NHS” as he says, all current contracts with private providers should be rescinded.

And there were some key details that were thunderingly absent from the big plan: not one mention of the “Wonga-style PFI debts” – as one doctor describes them to me – that I have previously written are crippling some trusts, for which Labour must take some responsibility. No word about what’s going to happen to contracts already in the hands of private companies – the ones that haven’t torn them up and walked away, that is.

Even so, the ten-year plan contains many eminently sensible suggestions for changing the system, and acknowledging the need for change is a useful act in itself given that many still blame New Labour for ramping up John Major’s original marketisation policy.

The vision of integrating health and social care might be shared by all parties, but the plan included some very promising solutions: to expand the remit of the ambulance service, bring more meaning to the roles of local authorities and Health and Wellbeing Boards, reduce competition and fragmentation of care pathways and establish the right of every patient to a personal integrated care plan. These are both hopeful and practical, and deserve to be applauded.

As should Labour’s pledge to set up a £2.5bn fund to invest in staffing and bring in 8,000 more GPs and 5,000 more careworkers; its nod to non-profit organisations working with the NHS that they will be secured “longer and more stable arrangements”; and perhaps most crucially of all, a scrapping of the Section 75 requirements that have made costly competition and fragmentation mandatory in the new NHS.

As Dr David Wrigley, a GP in Carnforth, Lancashire and BMA UK Council member, tells me: “It’s a great start and it deserves serious consideration. It’s far more preferable to the ongoing Tory privatisation plan, which is likely to see an insurance-based health care system by 2020”.

A lot of this may have already been announced, other parts just rhetoric. But for anyone who holds dear the founding principles of the NHS, it is refreshing to hear such stark anti-market, even socialist, tones being used to describe our socialised health system after four-and-a-half years of business talk.