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Interview: Ed Miliband on NHS reorganisation, competition and funding

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A Labour government would not instigate a ‘top-down reorganisation’ of the NHS as there would be no ‘mandated… one size fits all model’ for achieving its plan for integrating health and social care, Ed Miliband has told Nursing Times’ sister title, HSJ.

The Labour leader gave an exclusive one to one interview to HSJ last night ahead of the launch of his party’s pivotal 10 year plan for the NHS. The interview comes 100 days out from May’s general election, in which the NHS is rated by voters as the most important issue.

Mr Miliband outlined key details of his plans including:

  • stating that implementation of his “national vision of integrated health and social care [will be] evolutionary”;
  • endorsing the “NHS preferred provider” policy but also stating there “will be circumstances in which the private sector has a supporting role”;
  • insisting the decision whether to meet NHS England’s £8bn funding requirement for the next Parliament is a “matter for us [when] in government”; and
  • endorsing Andy Burnham as doing a “brilliant job [with] a really important vision” but declining to confirm he would be health secretary in a Labour led government.

Reorganisation

The great fear in the NHS about Labour’s plans as described in recent years has been the threat of a structural reorganisation to shift powers between clinical commissioning groups and local government – a move that has been opposed by many leaders at all levels in the service.

Shadow health secretary Andy Burnham has said health and wellbeing boards will become “accountable” for services under integrated budgets, suggesting some reorganisation, but that the timetable and route to achieve it would be locally decided.

Mr Miliband insisted to HSJ that there would be no “top-down reorganisation which people obviously don’t want to see”, a commitment also made by the Conservatives ahead of the 2010 election.

Mr Miliband explained his approach: “What is important is you combine the national vision of integrated health and social care, you combine that with giving big flexibility locally as to how that vision is implemented. That’s the key thing.

“Because if it’s mandated from the centre - a one size fits all model - that is going to lead to exactly what you and people in the service are seeking to avoid and rightly so.

“It is about setting out that vision, as Andy has said making it evolutionary, and working with the institutions that exist.”

Mr Miliband reiterated why he believes bringing together health and social service budgets is necessary: “If you’re a vulnerable person you want not only a care plan, but it makes sense to have a situation where somebody goes into your home and looks if you need a grab rail, or whether there are other things that can be provided at very small cost relative to you ending up in hospital.”

The Labour leader appointed Sir John Oldham, former GP and Department of Health adviser, in 2013 to report to him on proposals to create integrated “whole person care”.

Mr Miliband revealed that Sir John’s role was important because it had set out how to achieve integration without upheaval.

“There are ways of doing this, and that is what John Oldham set out, that’s why we got John Oldham to do the work, which are evolutionary, and avoid – which we are going to avoid – the top-down reorganisation which people obviously don’t want to see.”

‘Privatisation’

Much of Labour’s campaigning on the NHS has focused on accusing the government of damaging privatisation or marketisation of the health service. Public and media temperature over the issue is high, particularly following the high profile failure earlier this month of Circle’s experiment running an NHS hospital, Hinchingbrooke Health Care Trust, under franchise.

Labour has been questioned about how its “NHS preferred provider” policy would work in practice, and some senior figures in the party believe it is retrograde. Mr Miliband gave strong backing to the policy – but left substantial wriggle room on how far it would go.

“The key thing about this is the private sector should be supplementary not a substitute for the NHS,” he told HSJ. “That is what I believe was the major principle I think that we followed in our time in government.

“Preferred provider is a recognition of that. But there will be circumstances in which the private sector has a role, a supporting role.

“But I think people do value a publically provide National Health Service. Also in an era when what matters is resources [and] integration… fragmentation and the kind of competition and market framework this government has put in place leads to fragmentation and privatisation, and makes it much, much harder to integrate services.”

Pressed on whether he wanted to reverse increases in NHS independent sector spending over the past decade, or only to get rid of current competition rules, he was a little more cautious.

“The first priority is to stop the drive towards privatisation, and then we’re going to judge the circumstances as we find them. People will want to look area by area at specific services. But I think the first priority is to stop this drive towards fragmentation and privatisation.”

Funding

Mr Miliband has recognised the NHS’s money problem – he was the first party leader to make a major health funding commitment last year, announcing a “£2.5bn time to care fund” for 2015-16 at the party’s autumn conference.

Exactly a month later Simon Stevens, NHS England chief executive, published the NHS Five Year Forward View and set a new bar by stating that the health service would need an additional £8bn annually by 2020.

The Liberal Democrats are the only party to so far to state they plan to meet this demand. Mr Miliband, for now, believes his “funded” £2.5bn is a sufficient signal of “commitment”. The party leadership is wary of damaging its reputation on the economy by announcing large spending splurges, or new taxes to fund them.

In that light Mr Miliband told HSJ: “We’ve always said the NHS would be a priority but we’ve also said the right thing to do is to set out how you’re going to raise resources, and that’s what we’ve done,” he explained. “We set out like no other party how we can raise £2.5bn extra… We’ll always make the NHS a priority.

“The forward view is an important document but at this stage what we’re doing is setting out how we can raise extra resources over and above anything the government puts forward. The other matters are a matter for us in government.

“We’re making a funded promise for what we can raise [the £2.5bn], we think that’s an important sign of our commitment to it.”

Andy Burnham

Prior to the 2010 election, Conservative leader David Cameron had stated publically that Andrew Lansley would be health secretary in his government.

Andy Burnham – a former health secretary, health minister and shadow health secretary of several years – is also a prominent and well liked figure inside Labour and with the public.

Asked by HSJ whether he would confirm Mr Burnham was in line for the post under a Labour led government, however, Mr Miliband demurred.

His policy was, he said, “never to nominate anybody for government” because it suggests he is presuming victory or “measuring the curtains”.

He added: “Suffice to say I think Andy’s doing a brilliant job and I think he’s got a really important vision for the way the health service needs to both not just change but become fit for the 21st century.

“I’ve had a clear ordinance that I’m not going to start making appointments to government because I think it looks to the electorate that you’re taking things for granted.”

Mr Miliband’s observation about the mood of NHS staff this week, he told HSJ, was “a sense of fear and fearfulness” about its future.

“What our 10 year plan is designed to do is give people a sense of direction – there is a sense of direction, there is a party with a plan for where the NHS goes,” he said. “We’re not sort of chopping and changing, we’re not doing what this government has done [in beginning], a top-down reorganisation, but are giving a clear sense of direction.”

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