Brave, unglamorous: a good plan threatened by cultural risk

In the none too glorious litany of healthcare policy announcements made in the run up to a general election, Labour’s 10 year plan for health and social care has the virtue of being relatively brave in content and tone.

The easy wins of “more doctors and nurses” are there, but the plan focuses on the less glamorous aspects of health and social care. Effective home support is prioritised and hospital admission is rejected as an appropriate response to the challenges of an aging population.

‘Labour’s 10 year plan for health and social care has the virtue of being relatively brave in content and tone’

Cancer – the 800lb gorilla of the healthcare world – gets its own section, but mental health and public health also receive greater attention.

Labour’s policy is a well judged rebalancing of the sector’s priorities when the things that happen before and after people come into contact with the NHS have become the greatest threat to its sustainability.

Begs questions

Of course, the document prompts many questions. But critics cannot have it both ways. Labour wants an evolutionary change, to avoid that worst of all sins: “top-down reorganisation”.

That will necessarily create uncertainty. The biggest worry should be how uncomfortable many in the service, press and public may be with progress that is not uniform.

‘Top-down reorganisation will always create uncertainty’

What has become clearer is how the strategy’s spirit and detail is being driven personally by shadow health secretary Andy Burnham. At the same point in the last Parliament, David Cameron had confirmed Andrew Lansley as the Conservatives’ health secretary elect.

In our exclusive interview with the Labour leader, Mr Miliband is unstinting in his praise of his health spokesman, but refused to follow suit. The views of Labour’s care spokeswoman Liz Kendall show how influential the choice will be on what Labour would actually do in power.

Mr Burnham may not have persuaded his leader and shadow chancellor to be as radical as he would like in transferring budgetary control of healthcare to local councils, so he has to contemplate a longer time frame for change, but up to that point he is being given a free run.

The challenge ahead

The shadow health secretary repeated what he revealed to HSJ in October: that he wants clinical commissioning groups to be responsible for providing the “executive” to the increasingly “accountable”, “non-executive” health and wellbeing boards.

However, the NHS pays relatively little attention to “non-executives” for a range of historical and structural reasons.

The sector is not going to change its way of thinking and adopt a “social” rather than a “medical model of commissioning” without a struggle. Cultural differences could, as one HSJ reader put it, result in “a 10 year arm wrestling contest between local authorities and GPs”.

‘Cultural differences could, as one HSJ reader put it, result in “a 10 year arm wrestling contest between local authorities and GPs”’

The perfectly reasonable drive to identify cost savings by removing duplication in NHS organisations could also take a Labour government dangerously close to the reorganisation rocks as it faces the choice of stipulating change or accepting inefficiencies the sector cannot afford.

Then there is the conflict between Mr Burnham’s desire for NHS trusts to be preferred providers of integrated care and wanting fewer patients to be “sucked into hospitals”. He is right to say trusts will be able to take more radical decisions about their future if they feel more secure, but wrong to think that any more than a handful believe the greatest threat to that security is “privatisation”.

His challenge will be how to give trusts a more secure future without encouraging complacency. The special treatment in the policy given to not for profit providers – which have actually done as well out of the drive for competition as private firms and are just as disliked by some within the NHS – suggests they may supply a little grist to the mill.