“A big banner policy with wonkish nuance”. That was how the Health Service Journal‘s David Williams described the Labour leader’s approach to big policy announcements the evening before his keynote speech on the NHS.
The following day Ed Miliband unveiled his “GP guarantee”, promising all NHS patients a GP appointment within 48 hours if they want one – and on the same day should they need one.
But compared with October’s pledge to overhaul the energy market or May’s promise to cap rent increases, Miliband’s announcement on Monday was far more about focusing on retail politics than spelling out the real ‘banner policy’: integrating health and social care.
Andy Burnham vision for his brief has been one of the most radical to emerge from the shadow cabinet. A vision that brings together NHS and care services to form a system fit for the 21st century. Whole person care – Burnham’s label for his reforms – would mean one person, being cared for by one team, commissioned by one system.
First sketched out last January, Burnham’s plans are bold, ambitious and all the more credible because of his knowledge and experience in the health brief. But one year out from the general election, the offer of an integrated service is not Labour’s alone. All three parties are now promising to make services work around people, rather than institutional silos. In order to be heard and to win this debate, Labour must be able to demonstrate why they are the only party that can achieve this goal.
The NHS is a key strength for Ed Miliband and Andy Burnham. Labour has a 12-point lead on health over the Conservatives. Improving the NHS is also the second most important issues for voters and their families. Electoral success for Labour next year means putting the NHS at the centre of its campaign.
Sir John Oldham’s recent report begins to add the “wonkish nuance” to the principles behind whole-person care. The policy review process must now be used as an opportunity to build on Sir John’s initial ideas, remove the politically sensitive recommendations (such as abolishing clinical networks or debranding the ‘NHS’ from NHS England) and craft an appealing narrative for the electorate.
There are three initial stages to achieving this. Firstly, Labour’s health team should undertake a national review exploring the extent to which the current architecture and the policy levers within it are achieving integrated care across a different spectrum of patients.
Miliband and Burnham’s pledge for no further reorganisation (for the immediate future at least) means the NHS and social care system they inherit next May will be the framework that will be expected to deliver whole person care.
Understanding how well it is (or is not) bringing services closer together for specific cohorts will not only be politically savvy, but will make for smarter policy development. Areas for consideration should include clinical networks (a Labour creation), funding allocated for integration (which is already shown to be in trouble) and health and wellbeing boards (consistently seen, without much evidence, as the golden chalice of the Health and Social Care Act).
Secondly, Labour should begin to lay out what whole-person care means for different people and for people with different conditions. Integrated care for an elderly man with prostate cancer is likely to be entirely different to the young mother living with multiple sclerosis. Moreover, people do not necessarily identify themselves as having multiple long-term conditions but as someone living with disease X and suffering from disease Y.Offering the electorate policies that they can relate to is essentially in an area like health which, ultimately, is so personal.
Finally, Miliband knows at some point he will have to address the issue of funding. A week does not go by when we are not warned about the huge financial challenge facing the NHS, let alone a care system that has been consistently underfunded. Only the other week, it was revealed that just one in four new clinical commissioning groups ended their first year in the black.
Ed Balls’s ‘zero-base’ review is going to mean difficult decisions for Labour and, while we know the NHS is going to protected, an ambitious financial settlement will need to be put on the table if whole person care can be realised. This settlement should be used as the baseline to inform the ‘National Conversation’ recommended by Sir John Oldham about the future funding of NHS and care services in England today.
With opinion polls remaining close, Labour needs an election campaign that plays to its strengths and this means talking about the NHS. Labour needs to have the right answers to what will be (and should be) a critical election issue. Anything less cannot be expected from the party of the NHS.
Ben Nunn is a specialist health policy consultant and has previously written for the Guardian Healthcare Network.