The following table compares extracts on the NHS from the 1997 Labour Party
Manifesto with the position and plans in 2006.
Many of the policies have failed or been
reversed.
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1997 Labour Party Manifesto |
Position and Plans in 2006 |
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In health policy, we will safeguard the basic
principles of the NHS, which we founded, but will not return to the top-down
management of the 1970s. So we will keep the planning and provision of
healthcare separate, but put planning on a longer-term, decentralised and
more co-operative basis. The key is to root out unnecessary administrative
cost, and to spend money on the right things - frontline care. Over the five years of a Labour government: We will
rebuild the NHS, reducing spending on administration and increasing spending
on patient care. We will save the NHS
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Policy failed. Administrative costs have increased. Management
structures are reorganised every few years, so each local body achieves very
little apart from implementing centrally determined policies. Local
accountability of NHS bodies is limited, and there is no local democratic
decision making on decisions like closures of community hospitals.
Complex
financial inter-relationships and centrally imposed contracts and policies
have led to some (possibly a majority) of local NHS bodies being
unable to sustain their
current level of front line services within their budgets, even though
resources allocated have increased substantially. |
|
100,000 people off waiting lists |
Reductions in waiting lists were achieved. In part
this was through creation of surplus capacity in the extremely expensive
Independent Sector
Treatment Centres, some of whose surgeons have botched operations that
have had to be redone or have left patients damaged. In part the
reduction in waiting was by
manipulation of
figures by staff in NHS trusts, with passive acceptance at strategic
health authority level. |
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End the Tory internal market |
Policy
reversed. The internal market has evolved but is
still an expensive bureaucracy distorting decisions at all levels. |
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End waiting for cancer surgery |
Achieved, though there is a risk that progress will be lost
as a result of service
cuts affecting most of the country as a result of misdirected resources. |
|
Tough quality targets for hospitals |
Waiting time targets have in part distorted priorities away
from seriously ill patients and resulted in scarcity of emergency beds and
long ambulance journeys for critically injured patients. See
Routine service failures. |
|
Independent food standards agency |
The Food Standards Agency was established, though it has had
to
resist political pressure to suppress bad news. |
|
New public health drive |
Dangerous when it
has
led to denial of treatment to people with supposedly unhealthy
lifestyles. |
|
Raise spending in real terms every year - and spend the money on patients
not bureaucracy |
Spending has increased, and patients have benefited to some
extent. Some of the extra spending has been on
surplus capacity,
expensive contracts and
increased bureaucracy, while
mainstream services have
been cut because of incompetent budgeting
at national level. |
|
Labour created the NHS 50 years ago. It
is under threat from the Conservatives. We want to save and modernise the
NHS. But if
the Conservatives are elected again there may well not be an NHS in five
years' time - neither national nor comprehensive.
Labour commits
itself anew to the historic principle: that if you are ill or injured there
will be a national health service there to help; and access to it will be
based on need and need alone - not on your ability to pay, or on who your GP
happens to be or on where you live. |
There are contradictions in government policy.
The Choose and Book policy will when
fully developed mean that patients will be able to go to any hospital in the
country, at least for elective surgery.
The National Institute for Health and Clinical Excellence is established to
advise on which
treatments should be used and which should not be used, but its research
capacity was cut in 2005, causing a backlog, and some of its recommendations
appear to be influenced more by the cost of a treatment than by its
efficacy.
Policies of primary care trusts differ, and some limit access to treatments
on arbitrary grounds (such as
unhealthy lifestyles) or
deny
access to expensive new potentially life-saving treatments while they
prioritise cutting waiting times for elective surgery for conditions that
are inconvenient and/or painful but not life-threatening.
Postcode prescribing is still thriving. |
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In 1990 the Conservatives imposed on the
NHS a complex internal market of hospitals competing to win contracts from
health authorities and fundholding GPs. The result is an NHS strangled by
costly red tape, with every individual transaction the subject of a separate
invoice. After six years, bureaucracy swallows an extra £1.5 billion per
year; there are 20,000 more managers and 50,000 fewer nurses on the wards;
and more than one million people are on waiting lists. The government has
consistently failed to meet even its own health targets.
There can be no
return to top-down management, but Labour will end the Conservatives'
internal market in healthcare. The planning and provision of care are
necessary and distinct functions, and will remain so.
But under
the Tories, the administrative costs of purchasing care have undermined
provision and the market system has distorted clinical priorities.
Labour will
cut costs by removing the bureaucratic processes of the internal market.
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The separation of commissioning and provision for acute and
community services is costly and diverts resources from patient care.
Policy reversed. The latest phase of the internal market is
payment by results, with money following
the patients. The system is destabilising (liable to randomly shift
deficits between acute trusts and primary care trusts, so that nobody knows
the consolidated deficit and services to patients will be unnecessarily cut), open
to manipulation and costly to administer. The tariff for
payment by results is substantially
exceeded by contractual payments for Independent
Sector Treatment Centres and unable to support the costs of
hospitals funded through the
private finance initiative, |
|
The savings achieved will go on direct care for patients. As a start, the
first £100 million saved will treat an extra 100,000 patients. |
Policy failed. No significant savings were achieved. Extra
resources have been allocated.
Much of the benefit has
been lost by badly costed changes in
contracts for NHS workers, creation of expensive surplus capacity in the
private sector to reduce
waiting times for elective surgery, and unnecessary changes in the
management structures that can only have increased costs. The effect
on costs of new,
more effective, but much more expensive treatments has been
under-estimated. |
|
We will end waiting for cancer surgery, thereby helping thousands of women
waiting for breast cancer treatment. |
Achieved, though there is a risk that progress will be lost
as a result of service
cuts affecting most of the country as a result of misdirected resources. |
Primary care will play a lead role.
In recent years, GPs have gained power on behalf of
their patients in a changed relationship with consultants, and we support
this. But the development of GP fundholding has also brought
disadvantages. Decision-making has been fragmented. Administrative costs
have grown. And a two-tier service has resulted. Labour
will retain the lead role for primary care but remove the disadvantages that
have come from the present system. GPs and nurses will take
the lead in combining together locally to plan local health services more
efficiently for all the patients in their area. |
Policy failed. The primary care groups foreshadowed here were
short-lived and replaced by larger primary care trusts, which in 2006 are
due to be merged to boundaries similar to the pre-1997 health authorities -
an expensive diversion of effort away from direct patient care. It is
dangerous to give any professional group too much power in the
administration of the NHS. See
Sharon Wilson
for where a primary care trust has colluded in the black-listing of a
seriously ill patient whose complaints against various GPs have not been
mutually resolved. |
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This will enable all GPs in an area to bring their combined
strength to bear upon individual hospitals to secure higher standards of
patient provision. In making this
change, we will build on the existing collaborative schemes which already
serve 14 million people.
The current system of
year-on-year contracts is costly and unstable.
We will
introduce three- to five-year agreements between the local primary care
teams and hospitals. Hospitals will then be better able to plan work at full
capacity and co-operate to enhance patient services. |
Policy
reversed. The Choose
and Book system will give patients choice of which hospitals or private
clinics they use for elective surgery, so there will be no contractual
commitment to send elective surgery patients to the local hospital and
finances of hospital trusts will be destabilised. At least patients
will be able to choose the local hospital, where previous contracts may have
been less convenient for people living in some areas. In the
Choose and Book system, local
commissioning adds cost, complexity and inconsistent policies (postcode
prescribing) to no benefit. |
Higher-quality services for patients.
Hospitals will retain their autonomy
over day-to-day administrative functions, but, as part of the NHS, they will
be required to meet high-quality standards in the provision of care.
Management will be held to account for performance levels. |
The original star ratings ignored hospitals' relative
quality of outcome and concentrated on secondary but more easily measured
issues such as waiting times. The ratings were unstable, and a
hospital or other trust could move up or down the ratings by two stars in a
single year, although it is unlikely that any hospital would improve or
deteriorate so fast. The new 2005 system of self-assessment at least
has the advantage of encouraging hospitals to identify and correct their own
weaknesses rather than dispute a rating by an outside body. |
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Boards will become more representative of the local
communities they serve. |
Policy failed. No progress except in
foundation trusts, which
are inappropriate bodies for direct election because relatively few people
have a long term relationship with an acute hospital. It is the
primary care trusts that should be
directly elected and should control the acute hospitals etc. |
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A new patients' charter will concentrate on the quality and
success of treatment. |
New patients' charter?
The Government has not produced one. The Campaign for Health Service
Democracy has prepared a
statement of
Citizen's rights in the NHS. |
|
The Tories' so-called 'Efficiency Index' counts the number of
patient 'episodes', not the quality or success of treatment.
With Labour, the measure will be quality of outcome, itself
an incentive for effectiveness. |
To measure quality of outcome is difficult because the
figures need to be weighted according to how ill patients were in the first
instance. There have been few official figures, but some weighted
performance figures have been published, mainly in the press. See
Clinical
Outcomes. |
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As part of our concern to ensure quality, we will work
towards the elimination of mixed-sex wards. |
As old large wards are closed and replaced by wards
consisting of smaller bays or single rooms, this will be a natural
consequence. |
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Health authorities will become the guardians of high standards. They will
monitor services, spread best practice and ensure rising standards of care.
|
This role has gone to new bodies such as the Healthcare
Commission.
Commissioning primary care trusts have accountability for
standards with minimal influence to improve them. |
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The Tory attempt to use private money to build hospitals has failed to
deliver.
Labour will overcome the problems that have plagued the
Private Finance Initiative, end the delays, sort out the confusion and
develop new forms of public/private partnership that work better and protect
the interests of the NHS. |
Policy failed. Running costs of new hospitals financed through
the Private Finance
Initiative are unaffordable unless specially subsidised, and some
schemes have been delayed or curtailed at a late stage for reason of
unaffordability.
The Local Improvement Finance Trust (LIFT) has not the
same problem because it is used for primary care, which is not under the
same financial pressure. |
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Labour is opposed to the privatisation of clinical services which is being actively promoted by the
Conservatives. |
Policy
reversed. Elective surgery has been contracted to
multi-national companies through
Independent Sector
Treatment Centres, which are expensive and sometimes incompetent, and
have surplus capacity whose cost has diverted resources from treatments that
are more clinically urgent.
Some primary care has been contracted to
multi-national companies instead of the traditional local professional
practices. |
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Labour will promote new developments in telemedicine - bringing expert
advice from regional centres of excellence to neighbourhood level using new
technology. |
NHS Direct is a quiet success, though under-resourced
and insufficiently publicised.
Patients actually needing to see a doctor
out of hours have a great variety of arrangements across the country. often
involving numerous telephone calls. |
Good health
A new minister for public health will
attack the root causes of ill health, and so improve lives and save the NHS
money. Labour will set new goals for improving the overall health of the
nation which recognise the impact that poverty, poor housing, unemployment
and a polluted environment have on health.
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Partial success. Unhealthy lifestyles have not greatly
changed, and improvement has been hampered by long term contracts to sell
junk food at schools. The impetus to change this was not from
politicians but from a celebrity chef..
A pernicious move
has been the
threat, and sometimes the
reality, of denial of NHS treatment to people with conditions that may
have been caused by unhealthy lifestyles |
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Smoking is the greatest single cause of preventable illness
and premature death in the UK. We will therefore ban tobacco advertising.
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Policy compromised
and delayed.
Tobacco sponsorship of
Formula One motor racing was permitted for several years after lobbying by a
former Labour Party donor. This temporary exemption was extended to
snooker. Subsequently and after a faltering start
legislation was brought forward to ban smoking in enclosed public places. |
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Labour will
establish an independent food standards agency. The £3.5 billion BSE crisis
and the E. coli outbreak which resulted in serious loss of life, have made
unanswerable the case for the independent agency we have proposed.
|
The Food Standards Agency was established, though it has had
to
resist political pressure to suppress bad news regarding the possible
pollution of milk when animal carcases were being cremated out of doors
during the recent outbreak of foot and mouth disease. Progress in
improving food labelling has been slow. |
NHS spending
The
Conservatives have wasted spending on the NHS. We will do better.
We will
raise spending on the NHS in real terms every year and put the money towards
patient care. And a greater proportion of every pound spent will go on
patient care not bureaucracy. |
Policy failed. Extra resources have been allocated, but
much of the benefit has
been lost by badly costed changes in
contracts for NHS workers, creation of expensive surplus capacity in the
private sector to reduce
waiting times for elective surgery, and unnecessary changes in the
management structures that can only have increased costs. The effect
on costs of new,
more effective, but much more expensive treatments has been
under-estimated. |
An NHS for the future
The NHS requires continuity as well as
change, or the system cannot cope. There must be pilots to ensure that
change works. And there must be flexibility, not rigid prescription, if
innovation is to flourish.
Our fundamental
purpose is simple but hugely important: to restore the NHS as a public
service working co-operatively for patients, not a commercial business
driven by competition. |
Policy
reversed. Untried policies that have hastily been imposed
throughout England include:
- Independent Sector
Treatment Centres
- Choose and Book, with
money following the patient according
to an untested tariff, and unpredictable consequences in service cuts in
some areas.
- Primary care trusts replacing larger district health authorities.
- Local medical and dental practices losing responsibility for out of
hours care, with no evaluation of the cost to primary care trusts of
making alternative provision.
- Primary care trusts merged often to previous district health authority
boundaries.
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