Shadow health secretary Andy Burnham sought to reassure GPs that the party’s plans for full integration of health and social care would not mean practices being forced to merge into hospital-led integrated care organisations (ICOs), despite the fears of GPs.
Labour leaders also unveiled plans for an NHS staff champion who would hold government to account on behalf of all those who work in the service.
Speaking ahead of Tuesday’s NHS policy launch, Mr Miliband said those who work in the NHS were 'fearful' that the service faced a 'perilous moment'. The party also unveiled plans for GPs to run a system of home safety checks for elderly patients.
Vision for NHS future
Labour, he said was offering a ‘vision’ for the future of the service, something the current government had failed to provide.
In a briefing for health reporters on Monday, GP asked Mr Miliband and Mr Burnham to assure GPs they would not lose leadership over general practice to hospital managers.
There would be no top-down mandate on integration, said Mr Burnham, and local areas would decide the best model for them.
But, he added: ‘There will be some GPs who might want to work as part of an integrated care organisation and that is something I think we should encourage.’
At the party’s conference in September the shadow health secretary announced that every hospital and NHS trust would be asked to form ICOs with GPs at the centre, to expand into the community. Practices, he said, could in some places be swallowed up by ICOs.
Plans to fully integrate physical and mental health and social care in a single service with combined budgets would improve care, Labour argues, particularly for elderly and vulnerable patients, as well as making the service affordable by caring for people closer to their homes.
The party’s 10-year plan for the NHS sets out how providers will be incentivised to integrate.
'Year-of-care' capitated budgets, initially for patients at greatest risk of hospitalisation, would be paid to NHS preferred providers to encourage the service to integrate into the community and employ social care staff.
The current system, Mr Burnham said, was ‘financially illiterate’, failing to spend small amounts of money to provide social care in the home, only to spend large sums when those vulnerable people end up in hospital.
But, he added, Labour had heard calls for clarity and stability, so integration would be a ‘10-year journey’.
‘We are not going to impose one model on every health economy. It will be right for people to find their own path to integration,’ said Mr Burnham.
‘This is about a bigger vision, about what the NHS can be in the 21st century, rather than feeling like it is a crisis service on the way out. What we are saying is that the party that created the NHS is ready to reset it for the 21st century.’
GPs at heart of ICOs
Mr Burnham said the aim for ICOs was for a single team of professionals with GPs at the centre, built around the person.
But it was necessary, he argued, for NHS professionals to abandon loyalty to particular sectors of the service. ‘Everyone has to move beyond those divides that see hold us back and embrace integration and what it means,’ he said. ‘So it doesn't mean the hospital wins over general practice.’
‘People will be able to decide at a local level. But let's not have this world where the hospital is the enemy. We have got to move beyond that.’
On the controversial pledge to reinstate guaranteed GP appointments in 48 hours to anyone who wants one, and same day appointments if needed, Mr Miliband said he understood GPs’ anxiety. But experience showed the government’s decision to scrap the previous 48-hour guarantee resulted in longer waiting times for appointment and increased A&E attendance, he argued.
48-hour GP targets
‘I understand why people might be anxious about change, I think this is essential not just to guarantee a good service, but I think it is absolutely essential to take pressure off the system of accident and emergency,’ Mr Miliband said.
Mr Burnham added that providing the earliest possible access to primary care was essential to creating a preventative service.
He said: ‘It needs to be seen in the round, as well, in terms of the other changes we are making. If we care differently, and in a different way for older people with the greatest needs, that could take some of the burden off general practice.’
The party leaders repeated their commitment to recruit an extra 8,000 GPs, which would help take pressure off the system.
New models of care would attract new doctors into to the profession who want to work in ICOs, they said.
‘We understand general practice is under incredible pressure at the moment,’ said Mr Burnham. ‘We know morale is very, very low. We will work at this with the profession.’
Tackle staff bullying
Mr Miliband set out new plans for an NHS staff champion who would tackle bullying and harassment of NHS staff, and ‘hold government to account’.
The party also recommitted itself to the pay review bodies for the NHS as part of the proposed compact with workers in the NHS.
The compact would involve measures to reduce work-related stress and sickness to save the service money and improve care for patients by improving working conditions.
Mr Miliband said: ‘We are not just saying we will work with staff, we are not going to have top-down reorganisation like this government did, we are not going to ignore the staff. In a way we are going to put our money where our mouth is, and say we are going to have staff champion who is going to report on the morale of the service, how the culture is doing, whether people are feeling listened to, worked with, and so on. So, I think it is holding all stakeholders to account on behalf of the staff.’