No apologies for a boring bit of health policy
This week we heard the full extent of the crisis in the NHS. Lord Ara Darzi’s report listed in detail the impact of 14 years of Conservative Secretaries of State for Health. Thousands died waiting for treatment as waiting lists rose.
He highlighted lack of money and the disastrous impact of the Lansley “reforms” which cost billions and weakened the service. Vast sums were spent marketing NHS services to private companies, with few taking up the opportunities. Public Health was taken out of the NHS and had it’s budget slashed. This was one of the main reasons why the UK’s death toll was so high from Covid.
In response to Darzi’s report Keir Starmer also laid out Labour’s plans to tackle the crisis, which involved substantial reforms, in particular to Primary Care
This 10-year plan has to be the moment that we change that, the moment we begin to turn our national health service into a neighborhood health service.
That means more tests, scans, healthcare offered on high streets and town centers, improved GP access, bringing back the family doctor, offering digital consultations for those that want them, virtual wards and more patients safely looked after in their own homes, where we can deal with problems early, before people are off work sick, and before they need to go to hospital.
Back when Labour were last in power they were very keen on the idea of polyclinics – centres which brought together GP services, community and specialist care, with social support. The person who pioneered this was a chap called Ara Darzi, who made them part of his plan for NHS London. This included the Hammersmith centre which was actually located in an acute hospital.
When the Tories got in they scrapped the idea as part of cuts to services.
The idea came back again in the last Labour manifesto:
Labour will work with the NHS to bring together services in the community, learning from sites where this is already happening and working well, such as the Bromley-by-Bow Centre (where holistic, one-stop care provided by amulti-disciplinary team in the community has reduced hospital admissions, supported hospital6discharges and improved longer-term health outcomes). Labour will encourage Integrated CareSystems (ICSs) to identify opportunities to join up services, including by co-locating them on asingle site where existing estate capacity allows and capitalising on the opportunity of closer working with voluntary organisations that are embedded in communities. The aim will be for more patients to have one point of contact for appointments with a range of professionals and services working together as part of a neighbourhood team, including their family doctor, carer, health visitor, physiotherapist, dentist, social prescriber or mental health specialist.
This looks an awful lot like Darzi’s polyclinics. What is also notable is that these would be GPs employed by the NHS not independent contractors. This is one of the biggest nationalisations since the 1940s, which hardly anyone has spotted.
It also opens up the potential for acute hospitals to run primary care, and for GPs to have their gatekeeper role removed for particular conditions.
This looks like a long standing agenda to merge and nationalise GP practices, ending independent contractor status for lots of GPs. It will also lead to the retirement of lots of older, non-UK qualifided GPs for whom independent contractor status is an important part of General Practice.
Some will welcome scaling back GP independent contractor status, but whichever side you are on this is a huge change in how Primary Care is delivered.
It also misses the point. The NHS doesn’t exist because politicians will it do, or because middle class lefties share memes on social media. It exists because clinical staff believe in it. Over the last 14 years that faith has been tested to breaking point. The first priority for the new Government should be winning back the trust of clinicians.
The rest can wait.
https://www.theguardian.com/society/2024/sep/11/long-nhs-delays-thousands-unnecessary-deaths-inquiry
https://labour.org.uk/wp-content/uploads/2023/05/Mission-Public-Services.pdf
Well, Jonny. If this comes to pass then I hope there’s enough medics students to keep it going.