Ed Miliband MP, Leader of the Opposition’s article for The Times, Monday 27 February 2012:
There is one aspect of the current health debate on which there is agreement: our National Health Service faces huge challenges because of the rise in the age of the population, the number of long-term conditions, expectations and costs.
The NHS will have to change. The question is if the Health and Social Care Bill helps it to meet these challenges. My emphatic answer is that it is does not. People interested in reforming the NHS to help patients should not – must not – support this Bill.
One of the most pressing tasks for our healthcare system over the coming years is to integrate the provision of services so that they are better organised around the needs of patients, to give them more control, and relieve pressure on NHS budgets.
That means greater emphasis on preventing illness and better care in the home for the elderly to avoid the need for hospital visits, as well as tackling mental health problems before they lead to physical ones.
But this challenge of reform will not be met by the structural upheaval in this Bill. Quite the opposite.
When I visited the Homerton Hospital in East London last week, I was told how planning for HIV care, which is at present done by one organisation, will now be split over three – the National Commissioning Board, the Clinical Commissioning Group, and the Health and Wellbeing Board.
Senior staff spoke of their profound worries that this will damage the world-class services they provide. You can see why. Splitting up budgets will create inefficiency and patients will find it harder – not easier – to choose the care they need. Many patients with long-term conditions want the choice of receiving care at home but this requires integration, not fragmentation.
Nor is the cause of integration helped by the Bill’s aim to turn the whole NHS into a commercial market explicitly modelled on the privatisation of the utilities in the 1980s. Introducing a free-market model throughout the healthcare system – quite different from the limited competition currently in place – will have a chilling effect on the behaviour of those trying to co-ordinate and co-operate.
Lawyers will have a field day as private companies challenge “anti- competitive” decisions. The Government has hurriedly paint- sprayed words such as “co-operation” and “integration” into its amendments. But this cannot conceal the real damage that this Bill will do to patient care.
For reforms to work, they must bring greater clarity. Again, the Bill does the opposite. It creates a vast structure of byzantine complexity. Estimates suggest that the number of statutory organisations will rise from 163 to 521. No wonder the NHS Confederation has warned of potential “paralysis in the system”.
In the tightest spending settlement for a generation, when the NHS must make £20 billion of efficiency savings, the focus should be on patient care. Instead, staff are being distracted by a vast top-down bureaucratic reorganisation.
Years of upheaval lie ahead and patients will get a worse service.
And the danger is that NHS hospitals will be tempted to take advantage of the Government’s plan to allow them to raise up to 49 per cent of their income by turning over their beds to private patients. That would return us to a two-tier service: you can pay to jump the queue, but if you want free treatment you have to wait.
Even at this late stage the Government should drop the Bill and adopt an approach that will drive the reforms that the NHS really needs.
First, we should not break up the commissioning of services but integrate them better. We need better co-ordination of the commissioning of physical health, mental health and social care. Labour has consistently said that there can be a greater clinical role in commissioning – but it does not require this Bill to do that.
Second, we should be reshaping services to focus on prevention and treatment at home. But to achieve this and ensure that people can access the very best services, you need be able to plan services strategically with local communities – not simply leave it to a market free-for-all.
Third, we should be putting more power in the hands of patients by strengthening, not weakening, the guarantees to treatment that Labour introduced – such as the guarantee to get your cancer test done in one week, which the Government scrapped, despite everything we know about the importance of early identification.
This Government came to office criticising what it called “Labour’s top-down targets”. But it was these that helped us to cut waiting times, with the help of the private sector where appropriate. At Homerton last week I was told in A&E that our target to ensure that people did not wait more than four hours was the best thing that had happened, because it gave emergency medicine the priority it needed. But under this Government the A&E target is being missed around the country.
In recent weeks, Labour has set out the future of the NHS if David Cameron’s Bill goes through: patients will suffer from fragmented services, an unfair postcode lottery and the risk of longer waits.
Mr Cameron replies that these are necessary reforms. But throwing all the pieces of our NHS up in the air and seeing where they land is not the right way to go about reform. Only political pride is preventing this Prime Minister from dropping his Bill. If he ploughs on, he will not only destroy trust in himself, he will also prevent the real change that the NHS needs.Other news from The Labour Party