It is universally accepted that the creation of the National Health Service is the single greatest achievement of the Labour Party. It is a working example of a system that serves the best interests of the people in this country. It is Britain’s most cherished public service and one of the fairest systems of healthcare in the world. It started with the opening of the Park Hospital in Trafford, Manchester on July 5 1948, under the principle that treatment should be “free for all at the point of delivery”. The NHS has been described as one of the greatest social achievements of the 20th century, with its promise to care for the British people from cradle to grave. To date,
the NHS remains the most popular institution in Britain.
The neglect of the NHS was a principal contributor to the downfall of the last Conservative Government and it was a major issue that helped New Labour mobilise mass political support for a landslide general election victory in 1997. Labour’s election manifesto in that year warned that only Labour could “save the NHS”. To its credit, a decade of New Labour in government did result in the largest-ever sustained increase in healthcare spending in the history of the NHS. Significant improvements were made in the quality of care, with “huge progress” in the reduction of waiting times and more and better services.
However, when he was Health Secretary in 1999, Alan Milburn marked the start of the transition of the NHS from the public sector to the private sector under the disguise of choice and competition. By 2004, the private sector had metastasized to virtually every organ of the NHS. A market-based approach became central to healthcare delivery and the role of the private sector kept expanding. New Labour’ s reforms of the NHS proved to be highly unpopular both within and outside the mainstream Labour Party.
Why did New Labour take this controversial and unpopular route to the delivery of public services? After four successive general election defeats, Labour’s social democratic model of Keynesian demand management economics, progressive taxation, extending welfare spending and redistribution was no longer seen as a practicable solution. New Labour essentially raised the white flag and inverted the principle of social democracy: society was no longer to be the master of the market, but its servant. Labour was to offer a more humane version of Thatcherism in that the state would be actively used to help people survive as individuals in the global economy. Nevertheless, economic interests would always call all the shots. Professor Anthony King described Tony Blair’s administration as the “first ever Labour government to be openly, even ostentatiously pro-business”.
Thus, the New Labour leadership had been “converted” from tolerating
private enterprise to actively
promoting it – a significant political
U-turn. Unfortunately, the Blairite model of public sector reform has advocates in all three main political parties.
Since then, the private sector has played an ever-increasing role as ministers took to the mantra of “what matters is what works”. The foundations were laid for the complete transformation of healthcare delivery. Choice, competition and diversity are now creating a patient-led consumerist healthcare market in the English NHS, resulting in the most radical departure from previous Labour policy.
Now the Health and Social Care Bill is the biggest challenge to core NHS values. The bill allows the break-up and commercialisation of NHS services. Tax-based funding is to be undermined and that means an end to universal coverage. The bill paves the way to turn the NHS over to a plethora of private companies which either commission or provide services, or both. Unfortunately, the last Labour Government laid the groundwork for everything that the Tory-led coalition is planning to do to the NHS. Market structures, foundation trusts, GP consortia and the introduction of private corporations into commissioning were all products of the ill-conceived Labour vision of “public service reforms”.
We all know that the British public want the NHS to survive as they know it. The only way forward is for Labour to stick to its 1997 manifesto pledge: “Our fundamental purpose is simple but hugely important: to restore the NHS as a public service working co-operatively for patients, not a commercial business driven by competition.”
Labour must pledge that it believes hospitals and community health services should be publicly owned, publicly run and publicly accountable. We need to integrate all services to work co-operatively to keep people out of hospital. It doesn’t need a market, just leadership (as is the case in Scotland).
Robin Cook summed up this situation, shortly before his untimely death: “The history of social democracy can be expressed as the struggle to set limits to the market and to define those areas where priorities should be set by social policy rather than commercial forces. Yet this Government is dismantling the barriers that its predecessors had erected to keep those commercial forces off the public service turf”.
What is required is a policy review to abolish the purchase-provider split and to reintegrate the health services. Such an initiative will save on transaction costs, marketing, billing and invoicing. At the same time, it will also ensure that patients are not treated as commodities, forced to shop around for care.
We should get rid of the foundation trust status and the independent monitor. This will allow reintegration of the health service and bring it back into direct parliamentary accountability, stop the culture of secrecy, corporatism, bullying and commercial confidentiality that surrounds every transaction.
There is a great need to end the “money follows patients” system of resourcing and bring back needs-based planning for geographic populations.
The NHS should terminate commercial contracting for NHS services and abandon proposals to offer GP services to commercial companies. We must analyse the weaknesses of the NHS and work for improvements, such as the benefits of NHS-salaried GP services in health centres and restriction on private practice for Hospital consultants. We should restore long-term care and mental health services to the NHS and bring for-profit care homes under NHS control. We should end means testing and cost shunting of services, while public accountability must be strengthened and renewed.
We should restore the principle of fairness through national terms and conditions of service for doctors and all NHS staff. We need restoring the trust between profession, patients and politicians. Above all, we must allow professional standards to thrive since these are the basis of public and patient trust.
The founding principles and values of the NHS have stood the test of time. Labour’s health team, headed by Andy Burnham, should formulate the policies to fight for those ideals – for comprehensiveness, universality, access based on need and not on ability to pay, for a service that is free at the point of use, for mutuality in which the public accepts that priority should be given to those in most need and keep markets for profit out of health care delivery. Any adulteration of these principles threatens to cause fragmentation of the NHS with the certainty that never again will such a health service be created.
