In fighting the health and social care act, Labour must reject outmoded marketisation, building a consensus around the NHS’s founding values.

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Andy Pledge and Dave the Sheen both say they are trying their best to look after the NHS. One offers a fast acting superficial shine, the other provides an organic deep wax treatment rather more in tune with the original materials of grandma’s solid oak sideboard. You know the one – built to stand the test of time, yet with the odd creaky hinge and hot teacup mark here and there. Just like the NHS.

Three of my grandparents worked in the medical profession: the fourth was a farmer. Two were Londoners and two were from Merseyside.

Scenes from A Taste of Honey were filmed in the old family fields. Although Grandpa Farmer had a very different daily round from Grandad Pathologist, he valued the tools of his trade just as much, taking the same pride in his work. He had no time for superficiality.

Given the choice, he would undoubtedly have opted for Mr Pledge.

Following a gargantuan effort to prevent the health and social care bill from passing into law, and in the face of constant niggles about Labour’s lack of clarity on its own position – a situation not helped by an added barracking from the former health secretary Alan Milburn – Andy Burnham popped up the Mersey to launch the next phase of the campaign: Labour’s 5 Pledges for the NHS.

Building on his words from last week, when he exposed a list of Cameron’s broken ‘the NHS is safe in our hands’ promises, Burnham said:

“The NHS is heading in the wrong direction. But, rather than sitting on the sidelines waiting for things to go wrong, we will be working in every community to limit the damage. Labour mayors and councils committed to the ‘NHS Pledge’ will be the last line of defence in that fight.”

Once again hooking Labour’s commitment to the NHS into the forthcoming local elections, he reiterated that Labour mayors and councillors will be asked to act as champions for patients and defenders of NHS values, and contact local NHS leaders to request that they adopt the five pledges to protect the service:

1. Protecting an NHS that is free for all: Resisting the encroachment of charges and unwarranted restrictions based on lifestyle choices. 2. Preventing a postcode lottery: Patients in some areas are already being denied routine treatments, such as for varicose veins, that are available on the NHS elsewhere. 3. Maintaining Labour’s waiting standards for cancer care, operations and in A&E. Since the election there’s been a 25% rise in people who waited longer than 18 weeks for operations. 4. Promoting collaboration over competition, preventing the market from destabilising valued NHS services. Labour will call for a “one NHS” approach in every community. 5. Putting patients before profits. There are already signs that financial incentives may mean NHS patients get sub-optimal care. Labour will always be vigilant in protecting patient choice and preventing profiteering.

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To stress the relevance of the local voice, Burnham was joined by Joe Anderson, Labour’s candidate for Liverpool mayor.

Clearly no fan himself of Cameron’s superficial sheen, Anderson pledged to adopt Labour’s five principles to protect the NHS, agreeing with Burnham’s observations:

“David Cameron was explicitly warned by GPs, nurses and midwives about the damage his NHS re-organisation would cause. Sadly, he ploughed on regardless, putting his own political pride before the best interests of the health service. “Patients are beginning to pay the price, as the effects of the Government’s NHS chaos hit the ground. People will not forgive David Cameron for what he’s done to our country’s most-valued institution.”

Meanwhile, it seems that Alan Milburn has shaken off that irritating bout of health and social care bill depression. It’s not hard to imagine why. It could perhaps be expected that the opposite would be said for those who fought the free market onslaught in all the depths of its twisted poison (as Lord Owen so vividly described it) only to see it forced through to Royal Assent.

However, it seems not. While clinical depression manifests itself in sluggish inaction, this is not characteristic of those seeking to rescue the NHS from the avaricious jaws of privatisation.

In December, Milburn accused Andy Burnham and John Healey of “a fundamental political misjudgement” by opposing competition and embracing the founding ethics of the NHS. However it seems that where Burnham and Healey have the confidence and respect of the medical profession, Milburn himself makes the very error of which he accuses them.

A case of transference perhaps? No, nothing so simple – for Milburn is indeed a disciple of competition, although, as Left Foot Forward has previously highlighted, there is little evidence, to date, that competition really produces improved results, and the integrity of the evidence that is out there is dubious.

Milburn seems to be completely oblivious to the basic truth: far from the patient ‘nothing about me without me choice voice’ having a place in his self proclaimed ‘less optimum service’, poor flapping hospital gown wearers are more likely to be mowed down by abandoned trolleys than gain any treatment advantage in his scalpel wielding relay race.

The reality is that there is already an unfortunate tradition of problematic communication between hospital teams. For the patient who comes under more than one team at more than one hospital, the experience can be traumatic.

When doctors or medical institutions are focused on rivalry and competition, key details can be withheld from colleagues, and patients who could be more appropriately referred to another team or hospital are kept back in the hope of proving a point. Administration is not always a medical strong point. So why compound this?

Far from encouraging such an approach, anyone true to the needs of patients should treasure the collaborative rationale and not pooh-pooh it, as Milburn has done. Indeed his scorn for Burnham’s support for collaboration and cooperation exhibits a fundamental lack of understanding for patient needs.

As Martin Rathfelder of the Socialist Health Association points out, Milburn never once gave the Labour Party the opportunity to discuss competition in the first place, which renders his ‘radical reform requires a grown-up conversation with voters… politicians need to be able to explain the rationale for change’ statement little more than a piece of self defensive political prattle.

Given that, just like Lansley, Milburn is visibly entangled with the profit making elements of medical care, advising Bridepoint Capital (with Lord Patten) and the Covidien US healthcare company, as well as being a social mobility advisor to the coalition (again, just like Lansley), his top-down motivation is unlikely to be aimed at patient gain.

Curiously, Milburn also seeks to twist the fundamentals of the market construct to present a quasi-patient oriented rationale:

“The overall direction of travel will need to be away from a top-down system to a bottom-up, where change is driven less by command-and-control and more by managed-market mechanisms in which power is moved from providers to patients.”

If anyone can name a private health provider that prioritises the patient voice over the profit motive, I would be delighted to hear of them. For the moment, the evidence is not promising.

Those in the Labour ranks who, like Milburn, are tempted to see the NHS as a petri dish for yet more experimentation, or yet more reform, would do well to consider the cacophony of the past 18 months. Ignoring the joined up knowledge of expert medical voices and public health economists, as well as patient groups, will only result in a total eclipse of the heart in the NHS.

Balancing the books is the one thing the combination of hijacked budget areas and reduced patient outcomes will never achieve. Patients and their families will only benefit from a cooperative application of treatment protocols and a best value deployment of funding.

As our point of reference, whilst Milburn bemoans Labour’s snubbing of his approach, citing a lack of market initiative and pulling back from further radical reform, we are told by Burnham – the shadow cabinet’s man of the moment – that Monday’s launch of The NHS Pledge is a practical attempt to limit the damage wrought by Cameron’s free market approach.

The more mayors and councils Labour has after May 3rd, he tells us, the stronger that last line of NHS defence in each community will be.

Rather than being diverted by inverted rhetoric, it would be wise for the whole party to make sure that a vote for Labour in May’s elections really is a vote for the NHS. As Irwin Brown writes:

“We need the widest possible consensus about an alternative, like that broad coalition that Labour built prior to the NHS Plan in 2000”.

To offset further concerns on this matter, Labour would do well to ensure that patient democracy, rather than a competitive steal and squeeze, has a central place in the way forward. That is the real choice.

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