Labour warns of huge risks over NHS reform

Shadow minister Liz Kendall says PBC frustrated GPs, but current plans are risky. Susie Sell reports.

Liz Kendall: 'Proposals for such a big restructure of the NHS at a time when it needs to make £15 to £20 billion of efficiency savings are a huge risk' (Photograph: C Schwetz)
Liz Kendall: 'Proposals for such a big restructure of the NHS at a time when it needs to make £15 to £20 billion of efficiency savings are a huge risk' (Photograph: C Schwetz)

When Liz Kendall received a call from Labour leader Ed Miliband inviting her to become shadow health minister responsible for primary care, her first response was: 'Are you serious?'

As a rookie MP with six months' experience, the invitation came as a bit of a surprise.

But the Leicester West MP has a track record in healthcare, notably as a King's Fund public health researcher and special adviser to former health secretary Patricia Hewitt. She is arguably more experienced in the sector than some of her shadow health colleagues.

But starting with a relatively inexperienced health team - former health secretary Andy Burnham is now shadow education secretary - may have been a tactical move by Labour to get fresh eyes on its policies.

'We lost an election only six months ago - to carry on with policy as if nothing had happened I don't think is the right approach,' says Ms Kendall.

'We need to take time to look at what we did when we were in government, what worked, what didn't work and think again about our policy on health and the NHS.'

Formulating a strategy
In taking time to lick its wounds and formulate a strategy, the shadow team is not producing an alternative NHS blueprint until the Health Bill is introduced in parliament later this month.

Ms Kendall cannot outline clear alternatives for some elements of the White Paper - plans to adopt a single GP contract are 'not something I've formulated a position on as of yet'. But she has a number of concerns about the reforms.

One of her main worries is whether this is the right time for a wholesale reorganisation of the NHS, given the financial backdrop. I think the proposals for such a big restructure of the NHS at a time when the NHS needs to make £15 to £20 billion of efficiency savings are a huge risk,' she says.

Patient care may suffer, and scrapping targets could mean patients wait longer for care, tests and diagnoses, she warns.

Ms Kendall is also wary of the lack of information from the government about how much the reorganisation will cost, outlining that, to date, no estimates have been made about the cost of laying off management staff.

'You do not propose a massive reorganisation without thoroughly looking at what the impact will be,' she says. 'None of that has been figured out and to launch that on the NHS without properly thinking through the consequences is a mistake.'

Power and responsibility
But there are parts of the White Paper Ms Kendall backs, including plans to give GPs more power and responsibility.

She says it is 'absolutely right' that GPs are 'better involved' in commissioning services because of the close relationship they have with patients within communities.

But while she supports the sentiment, she has concerns about the plans as they stand.

Commissioning should not be compulsory, Ms Kendall believes, but introduced where it is locally appropriate. She says asking all GPs to take on commissioning responsibility in such a 'tight timescale' and while targeting £20 billion in efficiency savings is a 'real gamble'.

'I think if you believe in a service that is locally led you shouldn't be requiring everybody to be doing things in the same way,' she says.

'If the relationships are there and the skills and experience are there, then that's right. But at the moment it is a top-down restructuring when the government promised it would not do that before the election.'

She also worries that relationships needed for commissioning to work cannot be forced over a short timescale and need time to develop.

'Many GPs felt frustrated by practice-based commissioning (PBC),' she admits. 'They felt they didn't always get the power, responsibility and resources they might have wanted. But I know in other parts of the country it worked well and that over time, because the relationships and trust was built up, the systems started to work.'

Ms Kendall says the shadow health team will hold the government to account, asking 'probing questions' about reforms. 'We don't want to oppose for the sake of it,' she says. 'But if we think something is wrong, we will say it. We want to ask whether that's the best use of taxpayers' money as well as time and effort within the NHS.'

With the reforms proceeding at breakneck speed, Labour's health team will need to find its voice soon.

News blog: Health team in the shadows

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