How can Labour reform the NHS without another top-down reform?

On 6 May, the Young Fabian Health Network hosted an event looking at NHS reform. Debbie Abrahams MP, Private Parliamentary Secretary to Shadow Health Secretary Andy Burnham MP, spoke for Labour, while Jos Bell spoke on behalf of the London Socialist Health Association.

The key question of the event, ‘How can Labour reform the NHS without another top-down reform?’, is a challenging one. In order to meet the resource demands brought about by an ageing population, health problems linked to lifestyle changes and greater public expectations, the NHS will need to be reformed to deliver high quality care with a tighter budget.

This reform can be realised by transforming the NHS from a fragmented, disease-focused and reactive system of care, towards one that is more preventative, holistic and proactive. Central to this reform is encouraging patients to play a central role in managing their own care. Encouraging anticipatory care and prevention, as well as better use of self-management and community assets, could create significantly greater value at lower cost than is possible with the current system of reactive services. The importance of such a reform is highlighted by one estimate that suggests this policy could produce savings of about £4.4 billion per year if properly implemented (The Innovation Unit, 2013).

Reform at the grassroots level is about implementing new ways of working and utilising key resources that are already in place. For example, bottom-up reforms enable the closer integration of teams working across health and social care services, and using current funding systems these teams can create pooled budgets to facilitate coordinated care. Other bottom-up initiatives the NHS could try include reforming training courses for health and care professionals, updating IT systems so that data is shared more effectively across service boundaries, and coordinating metrics for monitoring progress and outcomes across both health and social care services.

Patients can also be empowered to take the lead on reform with incentives for clinicians and commissioning groups to change traditional consulting styles. Making evidence-based patient decision aids available and training clinicians in better risk communication could be a highly cost-effective way to empower patients and encourage evidence-based practice and awareness of critical risks. This is due to the fact that well-informed patients tend to be more risk averse than the clinicians who treat them, often leading to reduced demand for more invasive and expensive procedures when patients have access to good information and seek help early.

Therefore reforms brought about at the grassroots level can bring huge improvements without huge legislative, political or structural measures that consume huge quantities of both time and money. Furthermore, bottom-up reforms, brought about by greater patient empowerment, will mean that patients and communities will become co-producers in health with a greater say in how change can occur, thereby ensuring that reform meets their needs.

Labour must realise that to avoid the mistakes brought about by the chaotic top-down reforms following the passing of the Health and Social Care Act 2012, change can be implemented through good leadership and organisational and cultural change at the local level. Tapping into the resources already in place, and most importantly the knowledge and assets of non-governmental organizations, local communities and patients themselves, will be key to this.

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