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The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Manifestos this week – First, Labour

Filed Under (Health Policy, Labour Party, Manifestos) by Paul on 12-04-2010

This is the week of the election manifestos. And for the first three days I will give an analysis of what their health policies might add up to. 

Starting with the Labour Party today.

I’ve all but given up reading the Sunday papers but in Sunday 11 April’s Observer there was a very shrewd article by Andrew Rawnsley which outlined the issue about Manifestos.

It’s true that most people don’t bother much with them because there is a simple mistrust of what politicians say. But as he points out the 2001 Labour manifesto written for the June Election of that year did not say anything about a war in Iraq because the whole world changed 3 months after the election when the attack on the twin towers took place. In 2005 no political party promised a bank rate of 0.5% – and they would have liked to – because no body foresaw the international collapse of banking.

So, as he says, manifestos are important but they do not, nor cannot predict the world.

He went on to say that elections are not won by the answers that political parties give in their manifestos. Elections are won by the questions that they pose to the electorate. A political party that ’wins’ the debate about what question the British people want answered, wins the battle for the election.

At the moment Cameron’s question that he wants to dominate the minds of the electorate is “Do you want another 5 years of Gordon Brown?”  Brown’s question for the British people “Given all the economic uncertainty is it not too risky to vote for a Government that you don’t know? “

Health manifestos

Ipsos Mori, the polling firm, have evidence that the NHS is – after the economy – the second most important issue in the public’s mind. So in so far as the electorate pay attention to manifestos the health parts of the manifesto should be important.

 What is interesting is that this will be first time for a while that every single election manifesto will stand by the basic principles of the NHS. Given 85% of the public support those principles this shows that political parties that are democratic are not stupid. Of course, how these principles are applied will be different from different parties, but the fact that we should have a health care system paid for out of national taxation and free at the point of delivery with equal access to all, is agreed by everyone.

As readers of the blog will know I am not only interested in policy and what the political parties say about policy, I am also interested in how that policy interacts with the politics of that political party.

So as Tony Blair pointed out in his speech in Durham last week, it is perfectly OK for David Cameron to say that he will not close a single ward in a single hospital and to run his entire health campaign on that fact. That is good clear politics. But it’s then not OK for George Osborne to say to the Wall Street Journal that if the Tories win the election they will develop the full force of the winds of market forces to blow through English public services in a gale of change. Politics says “no change” and policy says “lots of change”. Problem.

And the same is true for the Labour party and its policy on competition. Blog readers will know that for 8 months I have been banging on about Andy Burnham’s personal preference for NHS providers rather than allowing health care commissioners to get the best deal for patients.  But at the same time the Operating Framework issued under him has been implementing policies which could only work if there was competition.

So my analysis of each of the party manifestos will be based initially upon the extent to which their health care policies are internally coherent. If they did both x and y, would y undermine x?

Secondly I will look at the way in which their Manifesto policies on health care will contradict or supplement their health care politics.         

One last thing. I have helped to write two Manifestos. The Labour Party in 1992 (they lost) and the Labour Party in 2005 (they won) so I know a bit about how these things are put together. They are not policy document from think tanks. They are not policy essays. They are statements of what they see as possible from political parties who think (and hope) they will have to carry them out in the real world of implementation. 

In every sense of the word they are not academic documents. 

The Labour Party Manifesto and the NHS 

One of the main themes of the Manifesto is to enshrine in law the minimum waiting times that have been achieved by the NHS over the past few years. This would underline the patient’s rights to treatment within 18 weeks; seeing a cancer specialist within 2 weeks of referral; a health check for all between 40 and 74 and access to GPs in the evenings an at weekends. Most of these rights are already either taking place or are close to happening and therefore what is being promised is grounding in law a set of patient’s rights.

There are however other legal rights which will mean additional new services. To guarantee the legal right of patients wherever they live to all treatments and drugs approved by NICE for use in the NHS, is one legal right that if it came in tomorrow would lead to a substantial change in practice in parts of England.

Politically and organisationally what these legal rights (if they are enacted) will achieve is to place a block on the NHS from using the lengthening of waiting lists as its main rationing device when there are any problems with resources. This is especially the case with the 18 weeks right to treatment since there is a clear, and for NHS providers, costly sanction here. If the NHS fails to treat the patients in that time then the NHS has the legal duty to pay for them to go private.

Alongside these new legal rights patients are promised further information and choices to use that information with. There are also consequences for hospitals that fail to attract and satisfy patients. 10% of payments will be linked to quality outcomes with again the right in law for NHS patients to choose any provider public or independent.

Whilst patients are allowed to choose from providers, commissioners will have to give NHS providers the chance to improve when they do not meet their requirements. Potentially this could put commissioners in a difficult and expensive position where patients chose to go to a different and better provider, but the commissioner has to keep paying the NHS provider to give them a chance to improve.

Staff will have the right to request that they form mutuals to run their own services in the not for profit sector and Foundation Trusts will be given additional financial freedoms. Successful FTs will be given incentives to take over underperforming trusts. But there is no new clarity about how this will work better than the existing incentives. The fact that failing hospitals will have their management replaced is also not new.

The overall stress on giving legal rights re waiting times makes it clear where the Labour Party wants to battle lines with the Tories to be fought. .

In so far as the Labour Party is trying to set the political question for the British people on the NHS it is “Can you trust the Tories to maintain the progress we have made in abolishing waiting in the NHS?”


One Response to “Manifestos this week – First, Labour”

  1. I want patient safety to be top priority. Irresponsible GPs and hospital doctors keep adding to the already huge numbers of innocent victims of pharmaceutical drugs. Doctors’ freedom to prescribe should be curbed by Law. e.g. The Sunday Telegraph report that prescriptions for diazepam aka Valium are rising dramatically. The benzodiazepine family of drugs, which includes Valium, are extremely addictive yet were heavily over-prescribed in the 1970s, and have destroyed the lives of millions of people, mainly women. Were it not for Esther Rantzen and her investigative television programme “That’s Life” this horrifying damage to innocent people would have continued to escalate, as the drug companies assured their medical dupes that the dreadful symptoms their patients were suffering were not caused by the drugs, but by the putative underlying illness. And that’s just one example.

    In my informed opinion, prescription drugs cause most of the avoidable illness and disability in the UK and in the USA.

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