The NHS is struggling. Labour must offer a credible health policy

Labour’s attempt to terrify the voters of Copeland with talk of dead babies has failed. Now it needs to get serious about developing a credible health policy.

In north Cumbria the NHS faces difficult choices on maternity care. It has been struggling to maintain the support services and staffing necessary for consultant-led maternity care of acceptable quality in both Whitehaven and Carlisle. This means Whitehaven may lose its maternity service. Both staff and public are anxious about the risks.

Labour’s take during the Copeland byelection was “mothers will die, babies will die, babies will be brain-damaged”, and of course “only a vote for Labour will save our hospital”. Meanwhile, at prime minister’s questions this week, Theresa May easily swatted away Jeremy Corbyn’s latest riff on the theme of Tory NHS cuts.

The manner of Labour’s defeat in Copeland is instructive. It took the most emotionally charged line possible, on an issue of great local sensitivity, on its signature issue of the National Health Service, and lost to the government.

Yet the defeat came as evidence mounts that all three of the drivers of current NHS policy – quality and efficiency improvements under the Five Year Forward View, reconfiguration of local health systems under the Sustainability and Transformation Plan (STP) process, and devolution, are in difficulty.

An analysis of Forward View progress by Kingsley Manning, former chair of what is now NHS Digital, has concluded that “the acceptance of sub-optimal productivity is the default position for the NHS”. The STP plans will not change that, he says, because they do not see productivity as a priority.

This week’s report by the King’s Fund on STP progress highlighted the chasm between aspirations and credible delivery plans. Its authors do not believe that proposed cuts in beds will happen and see the delivery timetable for STP changes as unrealistic.

Crucially, from a Labour party perspective, the King’s Fund provides evidence that some of the current problems can be blamed on the 2012 health reforms. It points out the obsession with market forces is undermining the development of new ways of delivering services, and highlights the obvious but little discussed fact that STPs do not legally exist, so they have no authority to implement the changes they are recommending. They have been stitched together to overcome the structural chaos ushered in by Andrew Lansley.

Meanwhile, a report on health devolution by the Institute for Public Policy Research out next week will highlight the changes in accountability, commissioning, financing and regulation needed to unlock the potential of the devolution strategy.

Labour has to build a credible response to these problems. The Copeland defeat shows “save our NHS” will not be enough to save the Labour party. If it is going to demonstrate it is ready for government it will have to stop writing its health policy on a placard.

It will obviously promise more funding, but to do what? Will it have the courage to stop “saving” services and instead build community-based systems which in the long term will need fewer acute hospital beds? Will it push the NHS to face up to weaknesses in clinical productivity and back-office efficiency?

It needs to construct a proper role for the private sector in providing healthcare, rather than endlessly repeating “public sector good, private sector bad”. Companies, notably SMEs, have a critical role to play if the NHS is ever going to exploit the potential of digital to drive efficiency and quality and improve the lives of patients with long-term conditions.

Health devolution is difficult territory for Labour. Andy Burnham personifies Labour’s conflicting views, having moved from attacking the government’s devolution plans to being Labour’s candidate for Greater Manchester mayor. The party needs to decide how balance the benefits of services built around, and accountable to, local populations with its desire for equitable access across the country.

These are all big questions which the NHS is struggling to answer. Labour needs to offer its solutions.

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