A week is certainly a long time in politics, but these days 24 hours can be too. Consequently the Autumn party conference season already seems an age away.
Nevertheless, reviewing the two main parties’ positions on health provides some interesting key takeaways – even in these uncertain times.
Both parties have been subject to substantial change in recent months, but perhaps just leading in the uncertainty stakes is Labour, with its leadership challenges, in-fighting and somewhat fluid shadow cabinet lineup. But consistency was the order of the day at its conference in Liverpool, where the party reiterated its plans to halt any moves towards the privatisation of the National Health Service, which it would ensure through a return to its origins as a wholly publicly-owned, publicly-funded system of care.
In her address to the party’s conference, the then-shadow secretary of state for health Diane Abbott, accused the government of fragmenting the service through the widespread reform programme mandated by the Health and Social Care Act. This, Abbott said, had made it “easier for the private sector to move in”.
“Now we are seeing a rise in the proportion of the NHS budget going to private sector companies. Labour will repeal the Health and Social Care Act as the first step towards undoing the damaging and wasteful marketisation that has been inflicted over many years”.
The pledge is not a new one, having formed a central strand of Labour’s mode of attack before the 2015 general election. Similarly, Abbott took another, familiar shot at the Private Finance Initiative, deeming its £1.8 billion a year cost to the NHS a “huge burden” on the health system.
The somewhat controversial scheme was first dreamed up by the Conservatives in the early 1990s and subsequently taken up by Labour itself in 1997 as a means of securing new hospitals (and schools and roads) without an immediate impact on national debt. The contracts are awarded to private contractors to build and maintain hospitals, which are then effectively leased back to the state. However, critics of the scheme have long argued that debts attached to PFI contracts have hugely increased financial pressures on NHS Trusts and Abbott stressed that, should Labour take the helm at Whitehall in the future, it would not sign anymore PFI contracts.
Elsewhere, the NHS’ current dire financial straits, junior doctors’ strikes and Brexit gave the party new ammunition for its running battles against the Conservatives.
Abbott derided the much touted Sustainability and Transformation Plans (STPs) that form health secretary Jeremy Hunt’s “answer to the £22 billion funding gap” currently facing the service. She told conference delegates that, while some may be a “good idea in principle”, increasingly they are looking “like a vehicle to drive through cuts and closures”, adding: “Where these STPs are purely about cuts Labour will fight them all the way.”
Abbott also called for an end to government attacks on NHS workers. “Tory health secretary Jeremy Hunt has persistently vilified and misrepresented the British Medical Association and the junior doctors themselves. They have been treated like ‘the enemy within’,” she argued.
“Staff need discussion and negotiation, not threats of imposed contracts. They also need to be encouraged to work in the NHS,” she noted, and reiterated the party’s support for junior doctors. She subsequently promised to reverse the government’s move of abolishing bursaries for student nurses, midwives and other professionals. “We will end the scandal that these professionals will incur debt just to work in the NHS,” she recently wrote in The Guardian.
On a Brexit note, Abbott said Labour would be holding the government to account over negotiations and would battle to protect the interests of working people. “We need to remember the 55,000 EU workers in the NHS and the 80,000 EU workers in social care,” she stressed. “Our health and social care system depends on these workers. We need to be clear that an end to freedom of movement could be disaster for the NHS and social care. And we need to demand assurances from government about the EU workers already here”.
Labour’s current mantra is that the NHS is in crisis, with its website calling on the Conservatives to “repair the damage they’ve done” to overcrowded A&E services and under-pressure elderly care services and GP surgeries.
However, the party’s changes continue. Barely a week after setting out Labour’s stall on health, Abbott’s place was taken by Jonathan Ashworth after her promotion to shadow home secretary.
Tackling the Workforce shortfall
Meanwhile, the health focus for the Conservative Party at its conference in Birmingham was on tackling the NHS’ workforce shortfall with a 25 percent hike in medical school places.
Health secretary Jeremy Hunt pledged 1,500 additional medical school training places in the UK every year in a bid to plug the workforce shortfall and reduce the health service’s reliance on overseas staff.
Currently the number of medical places is capped to 6,000 and the Department of Health notes that “universities can only offer places to half of those who apply to study medicine”. Addressing delegates at the conference, Hunt said there would be up to a 25 percent increase on this by 2018, with the Department of Health confirming that the plan is for all “domestic students” with the academic grades, skills and capability who want to train as a doctor to have the chance to do so.
The health secretary also unveiled plans to explore ways to ensure that graduates provide a return on taxpayer investment to the NHS through, for example, a minimum period of NHS service for four years.
“As well as delivering higher standards today, we need to prepare the NHS for the future,” said Hunt.
“Currently, we rely heavily on doctors from overseas – who do a fantastic job but are often taken from developing countries that need them – as well as expensive agency staff. By dramatically expanding our supply of home-grown doctors, we will ensure the NHS always has the doctors it needs,” he noted.
For doctors’ leaders, however, Hunt’s plans do not go far enough. “Jeremy Hunt has been health secretary for four years, and while it is welcome that he has finally admitted the government has failed to train enough doctors to meet rising demand, this announcement falls far short of what is needed,” said British Medical Association council chair Dr Mark Porter.
“We desperately need more doctors, particularly with the government plans for further seven-day services, but it will take a decade for extra places at medical school to produce more doctors.” He also noted that the initiative “will not stop the NHS from needing to recruit overseas staff,” who bring “great skill and expertise to the NHS” and without whom the service would not be able to cope.
The government, Dr Porter argues, must tackle the root causes of the workforce crisis and the reasons UK-trained doctors are leaving the NHS “rather than forcing doctors to stay in a profession in which they can see
no future”.
Dr Taj Hassan, president of the Royal College of Emergency Medicine, added: “With the emergency care system at crisis point, this long-term solution will do nothing to have any beneficial effect on the immediate crippling shortages of doctors in the UK. More urgent action is needed to address the short-term challenges to give time for longer term solutions, such as this one, to deliver.”
Cancer and mental health, but not funding
Hunt also used his conference speech to outline a series of measures to improve the care of cancer, leading with a new cancer plan that will introduce a maximum four-week wait from GP referral to diagnosis.
It also brings in Ofsted-style cancer ratings for CCGs – now published. Hunt admitted that they don’t make for comfortable reading, but said “everyone will now see our commitment to build a safer NHS doing more than ever to fight cancer”. In pursuit of this Hunt added that there would be “more molecular diagnostics and immunotherapy” and that the new measures would save an estimated 30,000 lives a year.
He also outlined a new mental health plan that would see a million more people being treated for mental health conditions by the NHS every year by the end of the parliament and improve services for children, new mothers and the unemployed.
Hunt pointedly dismissed NHS funding concerns, saying “just writing a cheque doesn’t raise standards”. But since then the head of the NHS Simon Stevens has told MPs the health service is getting £2 billion less than it was promised, and reports have emerged that Stevens was told in a private meeting with Theresa May that there would be no extra money for the NHS – so all eyes will be on the chancellor’s Autumn Statement next month.
