Viewpoint: Dr Kailash Chand: Labour needs to work out detail to reassure growing tribe of sceptics

Labour's pledges include integrating care from home to hospital, ending the neglect of mental health, more emphasis on preventing ill health and investing in 20,000 more nurses, 8,000 more GPs, 3,000 more midwives and creating a new arm of the NHS, writes Dr Kailash Chand.

Dr Chand: 'The public and professionals might be concerned about the state of NHS finances.' Pic: Michele Jones
Dr Chand: 'The public and professionals might be concerned about the state of NHS finances.' Pic: Michele Jones

It will be comprised of 5,000 homecare workers employed within the health service. Proposing a long-term plan for the NHS, is a right step in the right direction. In the last few decades the NHS has suffered from reform after reform, partly because of the lack of a longer term vision. The plan certainly is an evolutionary change, and is avoiding that worst of all sins: top-down reorganisation.

Essential that the NHS continues to be funded directly by general taxation

Sure, there will be many challenges on the way. Fully merging health and social care will inevitably have implications for the NHS budget, which will be difficult to manage in the current financial climate. There is a risk that NHS funding would be subject to the cuts that are affecting other public services as local authorities attempt to make significant savings.

Given the backdrop that local authorities will have lost at least a third of their budget during 2015, it is even more essential that the NHS continues to be funded directly by general taxation, pooled centrally and then allocated regionally through a fair and robust allocation formula. This will help to maintain a broadly similar service across the country, fulfilling the fundamental principle that the NHS provides a comprehensive service available to all.

I accept that difficult decisions need to be made about where to direct health spending, but this should be done by clinicians supported by public health specialists. While local authorities will have a valuable contribution to make to the debate, they are not best place to make these decisions.

Practices could form integrated care organisations

If Labour wins the next general election, it should enable integration to become properly established not by reorganising but by creating stability across the NHS and local authorities and allowing integrated care to become a priority. Integration will be better achieved by creating a stable environment, stronger incentives and greater flexibilities for the NHS and local authorities to explore how best to work together for the benefit of the local people. There is welcome change of heart from shadow health secretary Andy Burnham’s originally envisaged idea of only hospitals taking the lead on forming integrated care organisations to a model that could be led by GP practices.

Mr Burnham also suggested that health commissioning responsibilities should be jointly undertaken by CCGs and health and wellbeing boards. As, he would like to develop a social rather than a medical model of commissioning.Whilst this would be perfectly possible and the system certainly needs streamlining, clinical commissioning should remain the responsibility of the CCG in order to ensure it is carried out by expert people with expert and in-depth knowledge of local health services and the health needs of local patients.

High-quality commissioning is essential to improving the standard of health services available to patients and ensuring the best possible use of limited NHS resources. This is best undertaken by clinicians working with patients and so, keeping in mind the need to avoid any further NHS reorganisation, CCGs should be retained as the lead commissioners of health services.

Health and wellbeing boards should play an important role in bringing together the CCG and the local authority as well as other local stakeholders but would not be in a position to take on health service commissioning to the same standard as the CCGs.

What is not yet clear is how the emerging muscle of local authority commissioning will affect the overall ethos of the NHS, and what the role is of NHS England in the long term. The current reforms have created much uncertainty, fragmentation and instability of acute and mental health trusts.

While a 10-year-plan will come with a sigh of relief for some of these organisations, the public and professionals might be concerned about the state of NHS finances over one election cycle year let alone two. The principle is right, but Labour needs to work out an awful lot of detail to reassure the growing tribe of sceptics regarding the NHS.

  • Dr Chand is BMA deputy chairman but is writing in a personal capacity.

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