Labour has just published the results of a major Inquiry into the Effectiveness of International Health Systems

The inquiry was commissioned and led by Debbie Abrahams, Andy Burnham’s Parliamentary private secretary and a member of Labour’s Shadow Health team.

Debbie Abrahams
Debbie Abrahams

The major conclusion is that
‘evidence has shown quite conclusively that where there is competition, privatisation or marketisation in a health system, health equity worsens. There is also evidence of a negative impact on staff morale; there may be conflicts in the values and ethos of a health system founded for social good where some workers are financially rewarded for quality improvements and others are not. ‘

The Inquiry also shows that patient choice works much less well for those on low incomes – and there is strong evidence that spending on healthcare by patients themselves reduces access to health care for those that need it most.

The Inquiry was surprised to find that the impact of different systems of funding on the equity of healthcare is too little understood.
But growing evidence suggests that where the NHS is weighting the allocation of its resources to take account of health inequality this is having a real impact – reducing mortality in the most deprived areas.

The Inquiry will provide important evidence and guidance to the Labour party as it shapes policy. As Debbie herself has said

‘The Labour Party has a proud and historic link with the NHS; it reflects and represents our collective spirit, and the values we hold dear. It is fair to say that in most people’s eyes the NHS remains a national treasure. But we know it is not perfect and although the Labour Party has committed to no further top-down structural reorganisation should we be elected into Government in 2015, service change will be needed.’

Labour is committed to NO FURTHER TOP-DOWN REORGANISATION – and to the repeal of the LibDem/Tory Coalition’s 2012 Health Act. Among many other things, that act has opened up the NHS to European competition rules – and thus, in prospect, to the effects of the EU/US Trade agreement, if that goes ahead unchanged.

The party is now busy putting into place the most fully-informed policy for the NHS -as for much other areas. This Inquiry was a major plank in that process.

But of one thing you really can be sure.

The NHS will be safe in our hands.

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The detailed recommendations of the Inquiry to the Labour Party are

On NHS funding, allocating resources and payment models
1. Restore the key principle of NHS resources allocated based on health need (and health inequalities)
2. Develop a ‘Healthcare For All’ funding model: Undertake a review of NHS resource allocation formulae and budgets in order to simplify and develop a new resource allocation model reflecting NHS principles and values
3. Analyse and develop alternative healthcare provider payment models based on quality, equity and capitation rather than activity/utilisation and ‘choice’
4. Review the evolution needed by Health & Well Being Boards (HWBs) and Clinical Commissioning Groups (CCGs) to enable them to integrate budgets and jointly direct spending plans for the NHS and social care

On the Organisation of the NHS
1. Undertake a prospective assessment of the costs and benefits associated with an integrated, collaborative and planned approach to commissioning and providing healthcare in improving quality and equity in healthcare and social care
2. Ensure that privatisation of the NHS is prevented by exempting the NHS from EU/US Transatlantic Trade and Investment Partnership and ensuring corporate healthcare providers’ investment is not protected beyond current contracts
3. Ensure that a duty to ‘co-operate and collaborate’ is placed on CCGs and local authorities, and on NHS Trusts with local authorities including social care providers
4. Define the terms for private healthcare providers’ involvement in the NHS, in particular in the provision of clinical services
5. Review how to strengthen the democratic accountability of the NHS, including, for example, through locally accountable HWBs

On Integration in the NHS
1. Build on and supplement the evidence-base on integration within and between the NHS and social care with particular emphasis on quality and equity, for example through action-research pilots including single budgets for health and social care
2. Develop national standards for integrating the NHS and social care focusing on quality and equity, with local approaches for implementation
3. Develop holistic, ‘whole person care’ approaches to support people with long term conditions, and explore opportunities for NHS and Department for Work and Pensions (DWP) collaboration in this

On Research and Surveillance
1. Restore data collected to monitor health inequalities including the former ‘dicennial supplement’ inequalities data
2. Within existing research budgets, increase the proportion of research into the health system wide effects of interventions such as organisation and resourcing on quality and equity in health and care
3. Implement Health Equity Impact Assessment: assess the effects on health systems, of local and national policies including all sectors of government as part of the Impact Assessment process


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