As Andrew Lansley swings in the wind, cast aside by his Prime Minister, his reforms hang in the balance.
In recent months there has been much debate over whether or not the Government’s health plans are a continuation of or a break with the New Labour direction of travel. Ministers are fond of saying that they are the reformers now and casting Labour as being unable to embrace reform now that the responsibilities of office are no longer with us.
Certainly, a small “c” conservatism is something to be wary of in opposition. We should not deny our record of reform in government in health, education or elsewhere in public services. We should embrace and defend it, for through it patients gained more power and more choice and were largely liberated from the old NHS practice of rationing through waiting. More people were treated, they waited less, the quality of treatment increased and by the time of the last election, levels of satisfaction with the NHS were running at a record high level.
That isn’t an excuse to freeze things in time. But it is a reflection of the progress the NHS made under Labour.
The issue now is what effect would the Government’s proposals have? The centrepiece of the proposed changes is to give 80% of the NHS budget to GPs and give them the powers currently to commission and organise care which are currently exercised by Primary Care Trusts. No one is going to rally to a cause named “save the PCT” but New Labour knew better than to give all power to the producers. Instead, New Labour’s reforms were about empowering the patient, getting away from the “take it or leave it” mentality that can colour service provision when there is no right of choice or no control over provision.
Take A&E waiting times. Labour brought in a target for 98% of patients to be seen within a four hour period. Some clinicians protested saying this “top down” target interfered with clinical judgements and the Tories constantly attacked such targets. Others welcomed it saying it helped to prioritise A&E treatment within the NHS. And patients knew where they stood and benefited from the shorter waiting times.
Figures released this week show that since the Government abolished the target, the number of patients waiting more than four hours has increased by over 60%. The bargain between the Tories and NHS practitioners is clear – “we’ll give you the budgets and take away these nasty top down targets, and if you want to make the patients wait longer, we don’t mind”. The abolition of this target has removed a measure to safeguard patients’ interests and the result is they are waiting longer.
This may be welcomed by some clinicians who don’t like the targets. But it can hardly be said to be good for the patients. In a system free at the point of use, there is a temptation to use rationing by waiting when the pressure is on. Labour intervened on the side of patients to stop this happening, demanding clear limits on waiting times and putting in the resources to increase the capacity of the system and the quality of treatment. The government has decried this as “top down” management but in reality it is ensuring that patients come first.
In breaking with treatment targets, and abolishing those parts of the system whose clear job was to speak up for the public, as distinct from the providers of treatment, the Tory plans are not a continuation of New Labour reforms. They are a break with them.
This issue of what really drives the system is more important than an exclusive focus on whether the providers are public or private. Labour brought in private providers to increase the capacity of the system and to get waiting times down for routine operations like hip and knee replacements, again empowering patients by taking away lengthy waits for these procedures, and did it all within the framework of the NHS – treatment free at the point of use based on clinical need.
The Tory pact of no targets and all power to the producers is not the right place to start, particularly when many of the producers are rising up in revolt because they don’t want the powers. Instead, the starting point, and certainly the focus for Labour, should be a programme of NHS reform which puts the patient in the driving seat and offers to those without power and money the kind of choices and quality of treatment that those with power and money have always been able to buy. That is both a radical direction of travel and one in line with the values of the NHS.
Posted on 5 April 2011.