Labour"s draft manifesto: key policies analysed

The most eye-catching proposals in Labour’s draft manifesto are the plans to renationalise the railways, the energy market and Royal Mail, and to abolish university tuition fees.

Estimates of costings are difficult at this stage as the leaked draft is a menu without prices, but the party promises they will be fully costed.

Railways

What the draft manifesto says: A Labour government will introduce a public ownership of the railways bill to repeal the Railways Act 1993 under which the Conservatives privatised our railways. In public ownership, we will deliver real improvements for passengers by freezing fares, introducing free wifi across the network, ensuring safe staffing levels and ending driver-only operation, and by improving accessibility for disabled people.

Analysis: Polling shows that more than 20 years after John Major’s Conservative government privatised the old British Rail, many commuters and the public are open to the idea of giving the state another go. Recent polls have shown 58-60% of the public back the idea. Public dissatisfaction with rail privatisation has partly been fuelled by a surge in passengers numbers far outstripping the extra investment in rolling stock, safety and stations.

But as the detail of the Labour’s manifesto pledge shows, this is no policy of 1970s-style state confiscation without compensation. The cautious phrase “as franchises expire” carefully limits the effect of this policy and avoids the problem of the cost of buying out the existing contracts. There are currently 15 rail franchises in place and their length varies from an initial seven to 10 years to longer 15-22-year contracts, so it is going to be a lengthy process.

Rail poll

Energy

What the manifesto says: Energy companies will be taken back into public ownership with central government control of transmission and distribution grids. There will be at least one publicly owned energy company in every region of the UK, that is a locally run, democratically accountable energy supplier, working to tackle fuel poverty and encouragement for community energy cooperatives.

Analysis: Labour promises to “ensure that the average dual fuel household energy bill remains below £1,000 a year”. The energy regulator Ofgem says the current average variable tariff is £1,086, so a cap of £1,000 would not be a big stretch for the providers. But without a fall in costs, the drop of £86 would rob them of their profits, which the regulator said averaged £47 per customer in 2015.

Labour would create a state-run energy supplier for each region to keep private operators honest. It would also take control of National Grid and the regulator to control this natural monopoly. National Grid is a private company and it is unclear how Labour plans to exercise control without nationalising it.

Energy prices

Royal Mail

What the manifesto says: The Conservative government’s privatisation of Royal Mail was a historic mistake, selling off another national asset on the cheap. Labour will reverse this privatisation at the earliest opportunity, because it is a profitable company that should still be giving a return to the many not the few, and because key national infrastructure like a postal system is best delivered in public ownership.

Analysis: A policy even more popular than renationalising the railways, with recent polls showing 67% of voters back the idea. The post office unions say Royal Mail was worth £10bn when it was sold in 2013 for £3.3bn.

Mail decline

Tuition fees

What the manifesto says: Labour believes education should be free, and we will restore this principle … Labour will reintroduce maintenance grants for university students, and we will abolish university tuition fees.

Analysis: Variable university tuition fees were introduced in 2006 under Labour, which argued they were a middle class subsidy paid for by working class voters. The coalition government raised them to £9,000 a year in England. The cost of scrapping tuition fees has been estimated at £8bn, with a further £2bn on top for reintroducing maintenance grants. When the costed manifesto is published, it will be pored over to see whether the pledge is to be funded from reversing the cuts in corporation and capital gains taxes that have already been earmarked elsewhere.

Party strategists hope it will the “big bazooka” that will attract younger voters, especially students and 18- to 24-year-olds who who still strongly support Labour.

Students

Brexit

What the manifesto says: Labour accepts the referendum result. We will scrap the Brexit white paper and make retaining benefits of single market and customs union negotiating priorities. We will guarantee rights of EU nationals living in UK. We will reject any ‘no deal’ position and drop great repeal bill, replacing it with EU rights and protections bill to ensure no diminishing of workers’ rights, equality laws or consumer and environmental rights.

Analysis: It is wrong to say that the Labour manifesto is silent on Brexit. However, it will disappoint Labour remainers looking for a stronger commitment to staying in the single market while not particularly reassuring leave voters that the party is dedicated to delivering Brexit.

Immigration

What the manifesto says: No false promises on immigration numbers as the economy ‘needs migrant workers to keep going’. A desire to see “fair and managed migration”. That means scrapping £18,500 income threshold for UK citizens to bring non-European spouses to Britain that has led to separation of thousands of families. A migrant impact fund will be established to finance public services under additional pressure financed by existing visa levy.

Analysis: The manifesto implies Labour would scrap the Tories’ net migration target without giving any hint of its future approach to European migration post-Brexit, especially whether EU citizens will face a similar skills-based visa system that exists for non-EU citizens. The promise of a migrant impact fund is a long-standing Labour promise which has been matched by the Conservatives.

Migration figures

Business

What the manifesto says: Labour says it wants to discourage rocketing executive pay, short-termism and unscrupulous business behaviour, mentioning the BHS scandal, which it says was a high street shop “sacrificed for the sake of a quick buck”. There will be rewards for firms that pay a fair wage and respect the environment.

Analysis: A new deal for business means a more onerous regime of regulation for large companies and support for small firms and exporters with extra funds for trade promotion and a state-backed insurance that guarantees payment for exports even when foreign buyers go bust. Big firms considered “systemically important” will be shielded from foreign takeovers and protected from foreign firms dumping cheap goods in the UK, but directors will owe a duty to employees, suppliers and the environment and not just to shareholders.

Companies will also need to abide by strict rules when bidding for government contracts: complying with rules on workers’ rights, environmental protection and paying suppliers on time. Controversially, bidding firms will need to show that their highest-paid employee earns no more than 20 times the lowest. This will prevent Serco, Capita, G4S and all the other big outsourcing firms from running Britain’s prisons and IT systems without dramatic reductions in top pay.

National investment bank

What the manifesto says: Labour wants to establish a bank devoted to lending £250bn over 10 years to large-scale investment projects that the private sector cannot fund and make a profit. Regional development banks will be created and a law would be tabled preventing branch closures “where there is a clear local need”. Backing for research and development would also be one of its aims with a target of reaching 3% of GDP – higher than the OECD’s 2.4% average.

Analysis: Many eminent economists, including former Bank of England policymaker Adam Posen, have supported the idea of an investment bank. Initially, funds would come from the public purse. But the bank, which would be underwritten by the state, could keep these funds in reserve and only lend the private funds that will pour in from pension funds and other institutions looking for an ultra-safe home for their cash. With the Treasury cutting back on borrowing, it is the perfect time for an investment fund backed by the state to boost major infrastructure spending

Defence and foreign policy

What the manifesto says: Supports the renewal of the Trident submarine system “but any prime minister should be extremely cautious about the use of weapons of mass destruction”. Suspend any further arms sales to Saudi Arabia. Party remains committed to “a two-state solution” in Israel-Palestine.

Analysis: Appears at first sight to square the circle on an issue that has been one of the most corrosive in Labour’s history. Unlike the 1983 “non-nuclear” manifesto, it is not promising to scrap Britain’s nuclear deterrent, although Jeremy Corbyn’s refusal to guarantee he would press the nuclear button, as expressed in the “extremely cautious” wording, somewhat reduces its value.

Trident spending forecast

Housing

What the manifesto says: Biggest council housebuilding programme for 30 years, with pledge to build “at least 100,000 council and housing association homes a year for genuinely affordable rent or sale”. Building new private sector homes will become a national infrastructure priority, with help to buy funding guaranteed until 2027. A pledge to end rough sleeping within five years includes 4,000 homes reserved for the homeless.

Analysis: Corbyn has pledged 1m new homes over five years. The manifesto does not quite put that figure on it but the scale of ambition is clear. At the 2015 general election, the Conservatives pledged to build a million new homes by 2020, but Labour claims housebuilding has fallen since 2010 to its lowest level since the 1920s. Previous Corbyn papers put a figure of £15bn a year on the cost of Labour’s housebuilding pledge.

housebuilding

Welfare

What the manifesto says: Promises to immediately scrap the bedroom tax, the punitive sanctions regime and reinstate housing benefit for the under-21s. A social security bill would repeal cuts in support to disabled people and adopt a new social model of disability, which means removing the barriers in society that disable people.

Analysis: Labour has promised to reverse the worst elements of Conservative social security policy from the past six years but the manifesto makes no attempt at serious reform of the welfare system.

Health and social care

What the manifesto says: More than £6bn extra in annual funding from increasing income tax on the top 5% of earners and increasing tax on private medical insurance. Guarantee access to NHS treatment within 18 weeks and being seen in A&E within four hours. Scrap NHS pay cap. Suspend planned hospital closures. Will put an extra £8bn into social care, including £1bn in the first year, to address the immediate crisis.

Analysis: This is expensive but is the one area of public life where throwing more money at it really could be the answer. The British Medical Association immediately responded by saying the NHS needed £10bn, not £6bn. All will depend on how the extra funding is raised. Simply focusing on the top 5% of earners is unlikely to yield the kind of sums needed. It will also mean massive expansion of the NHS workforce but there is little acknowledgement of the cost involved.

NHS waiting times

Best of the rest

• Labour will fund child burial fees for parents

• Plant 1m native trees

• Lower the voting age to 16

• Free public wifi in city centres and on public transport

• Inquiries into Orgreave, blacklisting and contaminated blood scandals

• National review of local pubs

• Poor roads – make utilities firms responsible for repairs.

• Ban third-party sale of puppies

• Enforce anti-bots legislation to prevent resale of sports/concert tickets.

Labour"s draft manifesto: key policies analysed

What does Labour"s school meals policy mean for families, teachers and politicians?

Jeremy Corbyn’s announcement of a £1bn plan to introduce a VAT tax on private schools to pay for free school meals for all primary children has divided opinion.

The Labour policy was greeted warmly by many health, welfare and education experts, while others pointed to potential pitfalls in its logic. Politically, it seems the Labour leader may be on to a winner, but how has the plan been greeted by families, teachers and politicians?

Families

The extension of free meals to all primary school pupils would certainly boost attempts to tackle poverty, lifting thousands of children above the breadline, providing financial respite for hard-pressed parents and removing the social stigma endured by many pupils who qualify already.

An estimated 1.2 million children in England living below the poverty line missed out on free school meals in 2013, according to research by the Children’s Society. Half of these were simply not entitled to support under eligibility rules that restricted entitlement to pupils whose parents were unemployed or earning less than £16,200.

The impact of this eligibility “cliff edge” can be dramatic: while 70% of children on free school meals ate a school canteen lunch regularly, take-up slumps to 20% among the children of poorer parents who are in work, suggesting many parents struggle to meet the £450 annual cost per child.

The coalition’s introduction in 2014 of universal free school meals to all children in the first three years of primary school meant an estimated 200,000 children in poor working families qualified for a free lunch. Extending eligibility to all would help even more of the offspring of the “just about managing”.

Interestingly, about 700,000 families who were eligible for free school meals did not claim them, the Children’s Society estimated. This was possibly because of the stigma attached, especially in schools where children who took up the benefit were segregated in separate lunch queues or required to pay with special tokens.

Universalising free school meals will always raise objections among those who believe it is a poor use of public money. Supporters say richer pupils are not expected to pay for books so why are they for school food? Patrick Butler

Children’s health

Anti-obesity campaigners and experts are clear: free school meals are a weapon in the war against ill health. Whether they are from affluent or hard-up families, many children eat packed lunches that are full of saturated fat and sugar, comprising crisps and cake, chocolate bars and cola.

School lunches, however, have to meet government nutritional standards, including one portion of fruit and one of vegetables every day, a dessert containing 50% fruit at least twice a week and a variety of fruit and vegetables – three different types of each in a week.

Other healthy foods must also be on the menu, such as oily fish at least once every three weeks, wholegrain varieties of starchy food once a week and water, low-fat milk and limited amounts of fruit juice to drink.

There are problems, though, that the new policy would have to address. Children already entitled to free school meals do not always get them. There are forms to fill in, which parents may find difficult if English is not their first language, and there are cultural barriers to signing up. Teachers may be charged with following up those who are eligible, but may be short of time. Sarah Boseley

Teachers

The announcement will be met with mixed reactions from the private and state school sector.

Private schools justify their exemption from VAT and other tax breaks by offering scholarships and bursaries to children from disadvantaged backgrounds, and by partnering with state schools to share facilities and teachers. They claim the imposition of a tax would force some independent schools to close, putting pupils back into the already stretched state system.

According to experts, one in five households with privately educated children earn less than £50,000 a year, suggesting some may struggle to meet a 20% price hike. But only 7% of the UK’s schoolchildren are educated privately – one in five of that number is not very high.

Private school fees have also been increasing at a faster rate than inflation, reaching an average cost of £16,119 a year. For boarding schools it’s over £30,000.Some argue middle class parents are already being priced out.

Others, including former Ofsted chief Sir Michael Wilshaw, support the VAT but say the money raised could be better spent because the most disadvantaged children already receive free school meals. Labour and the teachers’ union say at a time when more families are affected by cuts to benefits, and in-work poverty is soaring, the cost of school lunches can be prohibitive.

Were Labour to roll out a universal policy, they would also have to create a benchmark to measure the performance of the most disadvantaged pupils, as free school meals status is used to identify students that require assistance. Nadia Khomami

Politics

Universal free school meals, paid by higher taxes on free schools, has major political advantages as a policy for Labour. First, it’s catchy and easy to understand, crucial for any policy to have cut-through with voters.

Second, it’s hard for Tories to explicitly oppose without looking heartless or out-of-touch, especially when former Tory education secretary Michael Gove has said he supports adding VAT to school fees.

Speaking in Nottinghamshire at the launch of the Conservative local election manifesto, Theresa May was pressed on whether it was a good idea – and she didn’t knock it. Instead, she dodged the question and claimed Labour “would bankrupt Britain … Schools would find themselves in a parlous condition if Labour were in government because of the way they would be running the economy.”

If the prime minister is reticent to directly criticise a policy that quite literally takes from richer parents to pay for the less well-off, that could mean Corbyn is on to a winner.

The main criticism of the policy is that it will help middle-class kids rather than the poorest, who already receive free school meals. That may be true, but that is unlikely to have significant political cost. No party ever lost votes by being too kind to middle-class parents.

When Nick Clegg introduced free school meals for five- and six-year-olds in the coalition government, the government faced criticism for failing to anticipate the extra costs to schools because of the increased demand.

Corbyn will be hoping to head this off with the VAT announcement, but Ed Miliband – who could easily have come up with something similar himself – was relentlessly attacked for policies like the mansion tax, which commentators said were the politics of envy. Whether Corbyn can avoid a similar criticism will become clearer over the next 24 hours. Jessica Elgot

What does Labour"s school meals policy mean for families, teachers and politicians?

Corbyn pins Labour"s local election hopes on NHS and schools

Jeremy Corbyn has pledged to put the NHS crisis and lack of school funding at the heart of Labour’s local election campaign, and blamed the party’s poor polling on the media for failing to give those issues due prominence.

The Labour leader launched the campaign in Newark, Nottinghamshire, against a backdrop of low support in the polls and warnings that his party could lose dozens of seats on 4 May.

His supporters booed when Corbyn was asked whether the local elections would be the ultimate and perhaps final test for his leadership.

“These elections are a chance for us to take our case out to the country about how we want to make a fairer Britain, an investment-led Britain, a Britain that isn’t in health crisis, schools that are not underfunded where they have to collect from the parents, that we don’t have to go around the whole country seeing Sure Start centres closed, libraries closed, all these things,” the Labour leader said.

“We will take the case out there for what Labour councils can do and do their best in a period of austerity but show that a Labour government will invest in the needs of people not in tax giveaways.”

He added: “Our party is very strong and very active on all of the doorsteps.”

During his speech, Corbyn highlighted figures suggesting life expectancy in Britain for pensioners is falling.

When asked why opinion polls show support for the Conservatives is so much higher than for Labour when the NHS is struggling and life expectancy falling for some groups, Corbyn said: “Too often our media do not deal with the issues people face day to day. There are more than a million people waiting for social care in this country and there are many people stuck in hospital who frankly shouldn’t be in hospital but can’t leave … and so I’m not expecting or wanting an easy ride from the media, I don’t care about that.

“But what I do care about is an obsession by so many to ignore the reality of homelessness, of social care … It simply doesn’t have to be the case in modern Britain. So these elections give us an opportunity and I hope all newspapers and radio and TV will at least get involved in the serious debate about health, social care, schools, housing because at the end of the day if people grow up in poverty they tend to underachieve at school and if they underachieve at school, they tend to lead less fulfilling lives. If they lead less fulfilling lives, we all lose.”

The local government elections – including many county council seats – will take place across England, Scotland and Wales, alongside a number of mayoral elections in areas such as Greater Manchester and the West Midlands.

Prof John Curtice, the leading election expert, has warned there could be a 12-point swing from Labour to the Conservatives in May’s contests, with Corbyn’s party at risk of losing control of councils in Nottinghamshire and Derbyshire.

The latest Guardian/ICM poll put Labour at 25%, their lowest support in these polls since the 2015 general election and joint equal to their lowest performance going back to 1983.

Corbyn pins Labour"s local election hopes on NHS and schools

Labour’s failure on the NHS is prolonging this health crisis | Polly Toynbee

Remember Mavis Skeet? In 2000 the 74-year-old led the news for weeks when her operation for cancer of the oesophagus was cancelled four times, until it became inoperable and she died. Liam Fox, then shadow health secretary, exclaimed: “This is not an isolated case. The NHS is not coping!”

When does a rumbling NHS crisis erupt into a volcanic political eruption? Labour’s miserable failure to “weaponise” the NHS into a winner in Copeland makes it worth looking back.

Mrs Skeet was the tipping point for Labour. The worst flu epidemic in a decade blew away Tony Blair’s pre-election “waiting lists cut” pledge. Instead Labour stuck to a draconian Tory budget, but this one case sent Blair into the TV studios promising to match average EU spending – and Labour did. The best NHS decade followed: 7% annual budget increases saw waiting times plummet, as heart and cancer results improved.

Margaret Thatcher’s eruption came in 1987 with the NHS squeezed dry. Babies died waiting for operations at the Birmingham Children’s Heart hospital. Through gritted teeth, the NHS “safe in our hands”, she bunged it £100m and punished it with the internal market.

In this latest seismological era, political vulcanologists can’t predict exactly when the top will blow. With its lowest ever funding rises, its hardest years are still to come, despite soaring numbers of the old, hospital admissions up by 31%, and 22% more A&E patients since 2010. Staff shortages follow cuts in nurse training and worsening GP and specialist recruitment. Even if extra is found for social care, the National Audit Office suggests it won’t stem the flow of patients into hospitals.

Are things bad enough yet? The British Medical Association reports that 15,000 hospital beds have been cut in the past six years. The Royal College of Surgeons protests at cancer operations being cancelled. Ambulances frequently stack up outside hospitals. Look at all that molten lava bubbling away.

Mavis Skeet’s death in 2000 became a tipping point for the NHS under Labour. Her operation for cancer of the oesophagus was cancelled four times. Photograph: PA

Ahead of next week’s budget, Theresa May pretends the NHS has an extra £10bn – at loggerheads with Simon Stevens, the head of NHS England, who publicly disputes it. What forces a U-turn? Before it was deaths, but already two patients have died on Worcester Royal hospital trolleys, one after a 35-hour wait. Coroners have protested to the health secretary, Jeremy Hunt, after two recent deaths due to lack of intensive care beds: the case of Teresa Dennett, who died from a stroke, and Mary Muldowney, who died after a brain haemorrhage.

The war zone of A&E has featured nightly on BBC news, with a graphic documentary series on the controlled mayhem in barely coping hospitals. When is enough enough? Not quite yet, it seems. The government has been lucky, with no flu epidemic in any recent winters or any Arctic freeze-over. With beds at full capacity, it would only take a mild outbreak to tip over the NHS.

The pressure-cooker is finance: monumental debts swell by millions a month as hospitals receive absurdly frantic threats if they don’t cut back. In December they were told to free beds by cancelling operations, causing longer waiting times and lost revenue from missed operations. Look at King’s College hospital, in south London: its chair, Bob Kerslake, calls official finances “kidology”. Ordered to make a surplus this year, King’s can’t avoid a £2m loss – yet the punishment is a cut in funds, sending its deficit to £30m, and an instruction to make a £26m surplus next year: this is mirage accounting, mirrored everywhere.

So far these debts are Hunt’s and chancellor Philip Hammond’s problem: what do patients care? But if the Treasury really means to recoup the money, plus the £22bn in savings it demands of the NHS by 2020, then Vesuvius will blow. Wards and units will close, staff will be laid off, the chaos will be unprecedented. It can’t happen.

When the government is forced, kicking and screaming, to pay up, who will it blame? It will call the NHS “unsustainable” and “a bottomless pit”. (Hammond already has.) Yet more “reforms” and re-disorganisations will be hurled at it: payment for services, top-up insurance and tax rebates for private payers will resurface. The government will ignore the UK’s fall in the EU spending scale since 2010, and is now sixth out of the G7 countries, with fewer beds, doctors and nurses per capita.

Who has the political heft and credibility to defend it? Fear of Labour’s NHS moral hegemony kept Thatcher, John Major and David Cameron in check. No longer. Labour thought the NHS was its big bazooka in Copeland, where a maternity unit is under threat. But the naked desperation of Labour’s “Babies will die!” leaflets shot the very last bolt in Jeremy Corbyn’s arsenal. Each time he raises the NHS at prime minister’s questions his feeble attempt at “weaponising” sounds pathetically opportunist: May bats him away with balderdash statistics he is too incompetent to refute.

This has never happened before: polls find May more trusted than Corbyn to run the NHS by 45% to 35%. Far worse, Labour’s failure to counter the right’s message has left more people blaming the NHS crisis on migrants and patients’ bad lifestyles than Tory underfunding or rising numbers of older people. As ever the Mail and the rest carry endless NHS tourism or obese wastrel stories – but Labour has always had to fight twice as hard to get a hearing for the facts on the NHS.

Whoever follows Corbyn will now find it ferociously hard to regain that lost NHS ground. By 1997, hammering away in opposition, Labour had made the threadbare NHS the top issue and owned it. Hard-won economic credibility earned it the trust to run the NHS better. Now Ben Page of Ipsos Mori finds the NHS the second issue after Brexit, but Labour doesn’t own it, or anything else: Corbyn falls behind on everything, with every demographic, so even Labour voters prefer May.

Because the NHS crisis has so far exploded in debt rather than closures, most people’s experience is not yet bad enough to reach tipping point. Page says satisfaction is down on 2010, but not rock bottom, with always a long lag in perception. A third would pay more tax for the NHS, but the rest want savings by denying obese people and migrants.

Austerity has entered the nation’s blood stream: Page finds most people still think it necessary – despite the reckless tax cuts ahead. Banging on about “austerity” without specifics gets Labour nowhere. May’s own polling and her Copeland result tell her this – but hubris is her greatest peril. There may be no opposition, but if she and her chancellor really try to squeeze the gargantuan debt out of the NHS, all hell will break loose anyway.

Labour’s failure on the NHS is prolonging this health crisis | Polly Toynbee

Labour’s MPs and the urgent need for unity | Letters

On 28 September the Stockport NHS Watch group presented an analytical account of the way in which the Conservative government, starting with the Health and Social Care Act 2012, has been transforming the NHS into a US-style insurance scheme.

The Conservatives have a guarantee of another four years to carry out this programme, another six years if they win a snap election in 2017. John Harris (Opinion, 29 September) writes that a “new modernised movement is taking place” on the left in which a “remodelled Labour party might eventually emerge”.

By 2020? By then it will be too late. By then the degree of damage to the NHS and the extent of transformation of it into private health care will be immense. We will be back to 1947, before the NHS. Harris speaks of “Labour’s predicament”. He can say that again. There is only one solution: it is unity of opposition to the Tories now and defeat of them at the next election whenever it comes. That requires one almighty transformation into cooperation between the PLP and Momentum.

The whole parliamentary Labour party must now pledge support to Corbyn and offer itself entire for places in the shadow cabinet, and Momentum must abandon deselection of MPs. It is the sacrifice by both sides that has to be made.

The 1948 NHS is the jewel in the crown of this country’s achievements. Only unity can save it for the people. What else is the Labour movement in existence for?
Michael Knowles
Congleton, Cheshire

• Mandatory reselection of Labour MPs, abolished under Tony Blair, is simply basic democratic accountability. Trade union general secretaries stand for election every five years and lay union representatives, working hard to represent their members while facing facility time cuts, between one and three years.

The sense of entitlement and concern for their careers that has anti-Corbyn MPs hyperventilating at the prospect of mandatory reselection will not restrain them from colluding with the pro-corporate establishment to conduct smear campaigns or organising coups to ensure their party leader is subjected to yearly mandatory reselection through doomed but divisive leadership challenges.
John McInally
National vice-president, Public and Commercial Services union

• Join the debate – email guardian.letters@theguardian.com

Labour’s MPs and the urgent need for unity | Letters

Where is the men and women power in Labour"s well being policy blueprint?

Ed Miliband has offered Sir John Oldham’s report a warm welcome. Photograph: Christian Sinibaldi for the Guardian

The eagerly awaited Oldham report on entire man or woman care has now been published with the catchy title One Particular person, 1 Crew, 1 System. Commissioned by the shadow well being secretary, Andy Burnham, and led by former Division of Health director Sir John Oldham, the report has been eagerly grasped by Ed Miliband and looks set to kind the basis of future Labour celebration overall health strategy. What lies in keep?

Significantly of the solution is a bundle of existing ideas. The nicely-established situation for integrated care is rehearsed, along with acquainted calls for person-centred care and far better engagement with sufferers and the public. Self-care is to be encouraged, citizen engagement promoted, integrated teams established, info shared and patients allotted a “care co-ordinator”. We have been right here just before with little track record of success, but Oldham does go additional. In particular he proposes:

• A “new compact with citizens” – an “independent national conversation” hunting at the potential of well being and care, to be finished inside of a year of the standard election
• New supplier outcomes-based mostly approaches this kind of as the accountable care organisation model, though this need to be left for regional determination
• Extended primary care services to give far more support for folks in the community and at property
• A reformed “total individual payment technique” to replace the existing payment by outcomes tariff that incentivises fragmentation

With these proposals, Oldham appears to be drawing heavily on current reviews from the King’s Fund, Nuffield Trust and other folks – indeed their influence looms big during the report. People expecting a far more political strategy might be disappointed by the technical tone of the overview.

The process facing Oldham was to come up with a recipe for adjust that did not involve but far more structural upheaval. Accordingly he emphasises that “relationships and culture trump structures”, and laments the current loss of understanding and knowledge in the well being and care program – “a form of organisational dementia” as he puts it. Nonetheless he cannot resist some tinkering with the current structures:

• NHS England ought to be renamed Care England “to reflect the needs of the majority of folks making use of the wellness and care program”
• Clinical senates – barely established – must be abolished
• Check and CQC to merge – a proposal also made in the Francis report
• The strengthening of overall health and wellbeing boards to consider on a more powerful strategic position in nearby well being and care systems

The warm welcome provided to the report by Labour leader, Ed Miliband, is in some measure a rebuff to the ideas of the man or woman behind the establishment of the Oldham commission, Andy Burnham. Two of Burnham’s key suggestions – putting neighborhood government in charge of healthcare commissioning and producing NHS trusts the “preferred provider” – are nowhere to be witnessed. Instead, Oldham puts his faith in overall health and wellbeing boards or, as he strangely puts it, “analogous local arrangements”.

The elevation of these largely invisible boards to this kind of a pivotal position is intriguing, especially given that they had been only dreamed up as a coalition sop to the Liberal Democrats to compensate for the loss of their policy on elected board members on the outdated principal care trusts. We nevertheless know tiny about these boards, and most individuals and members of the public will be absolutely unaware of their existence. Certainly, even Ed Miliband, in a recent speech, mistakenly referred to them as “independent bodies”. Far also significantly is riding on them as the custodians of what Oldham calls “the locality pound”.

Although turgidly technical for the most component, Oldham does acknowledge the incompatibility of collaboration and competition. He urges “considerations of care firmly before people of competitors” and reiterates Burnham’s get in touch with for the repeal of the segment 75 laws on compulsory tendering. However, these are relatively throwaway remarks towards the end of the report, with no exploration of what will be required for the NHS to elude the clutches of domestic and European competition law.

Oddly, for a report commissioned by a left-wing politician to inform a future Labour government, the Oldham report reads apolitically. Much of it is basically lifted from thinktank publications, and the assistance for the work from PwC and KPMG only appears to add to the impression of a relatively “establishment” report. For all the speak of “men and women-powered public companies” there is no indication whatsoever in this report of how the NHS can turn into more accountable to regional populations.

What are we left with? A worthy report but 1 hardly very likely to set political pulses racing in the run-up to the common election, and possibly performing nothing at all to assuage the worries of these opposed to the Overall health and Social Care Act 2012. Two cheers out of three – at best – for Sir John?

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Where is the men and women power in Labour"s well being policy blueprint?

Will Labour"s proposed wellness policy shortchange social care?

Oldham report marks the finish of Andy Burnham’s plan to hand commissioning to regional government and minimize clinical commissioners to advisers. Photograph: Graeme Robertson

The proposals for Labour’s health policy, unveiled this week, open up the prospect of profound changes in the regional and national method of leadership of the NHS.

The report, One particular Person, One particular Team, 1 Method, is the final result of the party’s commission on “entire individual care” led by GP Sir John Oldham. Championing integrated wellness and social care, it is strongly focused on producing the method match round the needs of men and women. It calls for the abolition of the current competitors rules and for the loathed Office of Fair Trading to be stored out of the NHS. Even so, there is no mention of shadow wellness secretary Andy Burnham’s strategy to make NHS services the “favored provider” of healthcare.

Oldham’s report marks the end of Burnham’s grand program to hand commissioning to regional government and lessen clinical commissioners to advisers. But in in search of to integrate overall health and social care provision it pursues two distinct, and arguably contradictory approaches.

Even though clinical commissioning groups will broadly carry on their recent commissioning role, Oldham envisages them ceding their accountability for nearby system leadership to reinvigorated wellness and wellbeing boards. The boards would include supplier and housing representatives and be accountable for creating a collective, end result-targeted commissioning strategy for neighborhood individuals with lengthy-phrase circumstances, disabilities and frailty.

The growth of primary care would be pulled into the neighborhood program by NHS England sharing accountability for commissioning it with CCGs. That package of alterations provides the impression that regional democratic oversight would be strengthened and local autonomy increased.

But the report also suggests that NHS England metamorphoses into Care England, with duty for the delivery of total particular person care. This would include the introduction of non-executive board members from neighborhood government. Care England’s energy would be further strengthened by formally becoming the strategic leader which Keep track of and everyone else has to follow.

Even though lining up the statutory bodies behind Care England would at least go some way to offering clear leadership and minimizing territorial scraps, offering it power over social care could undermine councils’ management of their biggest spending budget just as they are making an attempt to cope with unprecedented cuts.

The anticipated jurisdiction for Care England is poorly defined, but possessing one particular or two regional government reps on the Care England board will supply tiny safeguard towards social care spending getting to be subsumed into the medicalised, hospital dominated model of care that most men and women agree we are making an attempt to change.

The counterbalance may possibly lie in the report’s help for gradually ending the funding of episodic care by means of the Payment by Benefits technique, and replacing it with contracts based mostly on a ‘capitated payment’ which gives for the entire of a person’s care.

But no matter what the public expressions of help for the principle, financially compromised providers will often resist the consequences of moving towards prevention and local community services if they are not working them. With suppliers getting a sturdy voice via the wellness and wellbeing boards, Oldham’s proposals may possibly nicely inspire the development of vertically integrated solutions created about the hospital. This is not what GPs have in thoughts.

What appears to be the report’s most benign recommendation carries significant threat. It calls for a “nationwide conversation” looking at overall health and social care together, with outcomes enshrined in legislation for implementation from 2020. This conversation would seem at overall health and social care funding – and would be an best chance to develop considering all around cost-free, at the level of need, social care, as properly as “how and the place care ought to be carried out”.

Although there is no doubt that such a conversation between politicians and the populus is overdue and holds out the hope of building a shared vision of care outside hospitals, it dangers stalling hard selections.

It is all too effortless to envision Labour ministers hiding behind months of consultations and reports when commissioners want their backing to shut a services. The longer governments avoid challenging selections, the much more NHS finances will deteriorate.

This report is published by Guardian Professional. Join the Healthcare Professionals Network to get typical emails and unique provides.

Will Labour"s proposed wellness policy shortchange social care?