Dr Phil Hammond, broadcaster and sessional GP in Bristol

Will a new Government change the NHS again?

Picture this: you’ve finally settled into your clinical commissioning groups (CCGs) and are carefully rebuilding the complex relationships that were washed away with the last set of reforms. You’re getting to grips with joined-up commissioning, competition law, and how to stay on the right side of Monitor and the Care Quality Commission. You’ve had 2 years to make sense of it all and reduce the number of unnecessary hospital admissions by collaborating with hospitals, social care, and local government. Finally, there’s a sense of stability, if not tranquillity, about NHS reform. Then Labour gets in—is it all change again?

Labour has thus far been fairly bullish about repealing the Health and Social Care Act, or at least part 3 with all the competition legislation, but we haven’t heard much about its proposed policies until recently. Step forward Liz Kendall, Shadow Minister for Care and Older People, who gave a talk at the Managers in Partnership conference and posted it online.1

(More) reform, as you might expect, is: ‘a top priority for Labour ... if we’re going to meet the challenges of demographic and social change.’ And, ‘... whichever party is in Government and however much growth we get back into the economy, we’ve got to get far more out of the billions of pounds spent in the NHS into the foreseeable future.1 This sounds not too dissimilar to what the Coalition is telling us now. So could we eventually reach that nirvana where all three parties agree on the direction of travel of the NHS? Some of the signs from Kendall’s speech are encouraging: ‘If Labour wins the next election we will repeal the Act but we will not force the NHS through another major re‑organisation. We don’t need new NHS organisations, we’ll simply ask those we inherit to work differently. We’ll keep Clinical Commissioning Groups and Health and Wellbeing Boards, but ensure they work within a properly accountable national health service.1

And just to get those on side who believe policy should be based on evidence, not ideology, Kendall promises, ‘We will judge every proposal on its merits: whether it saves more lives, reduces disabilities, and improves the quality of care. The clinical case must be made and supported by the evidence, if the public as well as local MPs are to be convinced.1

So what about that thorny issue of using the private sector? Surprisingly, Kendall talks about ‘innovation’ in the health service and the need to take a non-dogmatic view of the role of private and voluntary sector providers: ‘For all the criticism you hear, there’s actually a huge desire and talent for innovation amongst NHS staff. What they need is the encouragement, freedom, and space to innovate. They need backing to experiment and take sensible risks, not rigid performance management from on high. The private and voluntary sectors also have a vital role to play in bringing innovation and challenge into the system.1

The one point of difference seems to be Labour’s view that, ‘... private and voluntary providers must be effectively commissioned and regulated, within a properly managed system—not the free market, free-for-all that this Government is putting in place.’ So you now have 2 years to provide evidence that the Government’s CCG‑commissioned, open market approach works—or not. Good luck and Merry Christmas.

  1. Liz Kendall website. Managers in Partnership conference. Available at: www.lizkendall.org/wp-content/uploads/2012/11/Where-next-for-the-NHS-Labours-vision-for-21st-century-care-Liz-Kendall-MP-23rd-Nov-2012-.pdfG

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