Beyond the Quick Fix – Labour’s Health Manifesto

I initially thought it would be interesting to compare the Tory and Labour health manifestos, but quickly thought what’s the point? Labour will form the next government and the last Tory manifesto didn’t exactly deliver on its underwhelming, limited ambition.

The trouble with health policy is that, all too often, NHS headlines eclipse it. The waiting list of today is offered a quick fix – more beds, staff or corridors. Fixing it is also what so much of the NHS is set up to do.

Health policy is broader, encompassing both responding to health needs but also generating and sustaining good health and wellbeing, and avoiding and preventing their emergence where possible. The NHS doesn’t do much of that and other policies around education, housing, employment and environment can also have a major impact.

That’s why Labour’s health manifesto has really interesting potential. It does cover the sticking plaster approach to NHS demand and capacity but also repeatedly talks about change and reform to what happens outsides hospitals that can avoid, and prevent, needing them.  Yes, we are living longer and therefore are more susceptible to frailty and multiple chronic conditions, but that doesn’t have to translate into hospital beds.

The manifesto states “investment alone won’t be enough to tackle the problems facing the NHS; it must go hand in hand with fundamental reform.  We must change the NHS so that it becomes not just a sickness service, but able to prevent ill heath in the first place. It must also reflect the change in the nature of disease, with a greater focus on the management of chronic, long-term conditions”. It wants to “shift resources to primary and community”.

These are not new ideas, but if fundamental reform is the measure of success, then the test of the next Labour government on health will be not simply how many people are waiting but also how many avoided hospital altogether.

This is where the Labour manifesto offers interesting promise with more emphasis on mental health, public health, community, primary and social care and working conditions.  Broadly speaking, it offers an ambition to build a health and care system that supports people’s wellbeing, living well with frailty, rather than letting it degenerate into crisis, and positioning this close to where people live in neighbourhoods and communities.

It talks about Neighbourhood Health Centres (Ara Darzi will be pleased), a “Neighbourhood Health Service”, a “Community Pharmacist Prescribing Service” and “bringing together existing services such as family doctors, district nurses, care workers, physiotherapists, palliative care, and mental health specialists under one roof”.

This is significant, but there is little detail of when and how it will happen.  To have impact, it will require a massive shift of resources away from the hospital, which will be controversial and need political muscle to achieve. It will also need clear explanation to build consensus and support, because it’s easy to say here’s a new ward, ambulance or scanner, but less easy to say there’s no new wards, ambulances or scanners, but a neighbourhood service instead.  It’s probably the same reason TV shows are made about A&E and ambulances and not about care homes and community workers. Crowd pleasing stuff sells better. An immediate hit and a quick fix.

Underpinning the NHS side of the “fundamental reform” is the promise of “a programme of reform to create a National Care Service, underpinned by national standards”. This too is crucial to move away from our hospital fixation and improve the health and wellbeing of the population.

The manifesto’s approach recognises that hospitals are at the end of a line of care and support that isn’t working.  It recognises a need to fundamentally reform how we keep people, independent, and in good mind and body. Along with the Mental Health Act update, a new Royal College of Clinical Leadership and a new prioritisation of women’s health, this is a huge agenda which will require a whole reform of industry to deliver it.

And that’s just what is in the manifesto. Wes Streeting, Labour’s likely next Secretary of State for Health, told the BBC’s Laura Kuenssberg after the manifesto’s launch that “on social care I would have wanted the manifesto to be more ambitious”. So even more to come, when resources allow.

There is nothing to disagree with here and all to support.  But fundamental reform can generate huge heat and little light if the plans and timing aren’t right. They can also be expensive and consume huge effort.  But most importantly, they need time to build understanding, support and consensus among the communities and staff, who will fear the loss of what they can see in their hospitals, before they can cheer the benefits of what doesn’t currently exist outside them.

At Freshwater, we see the positive difference a substantial and open conversation makes to implementing change to improve services.  Involving people in shaping the services they use, care about and work in is crucial to creating the consensus required for change and getting it right from the get-go. Labour will need to build that consensus and enable the NHS to do so too.

A journalist friend once told me that no one is interested in stories about how the NHS is structured.  Health for most people is not about systematic organisational wiring but about their quality of life and good health. Labour seems to intrinsically understand this, unlike Andrew Lansley, who blew £3bn on restructuring the NHS to no effect.

There’s a lot of heavy lifting to come in ensuring the NHS is fit-for-purpose and supports people’s good health and wellbeing. Neither role is in great shape at the moment but approaching both with equal fervour will be necessary to make real change.

The manifesto’s journey from good content and ambition to deliverable action and measurable impact is no quick fix. But without it, future quick fixes will become futile.

Nick Samuels is Director of Healthcare at Freshwater, leading our team of communications specialists who provide consultancy and support to NHS trusts across the country. Find out more about our healthcare communications services.