May 13, 2014 by Paul Goldsmith
Ed Miliband’s pledge that under a Labour government all patients will get an appointment with their GP within 48 hours is interesting from three angles. The first is that it came during what is supposed to be a European election campaign, the second is that it is a reinstatement of a policy pledge that existed during the last Labour government but was removed by the Tory-led coalition, and the third is how it would be funded and organised.
Let’s start with the timing. We are supposed to be in the middle of a campaign for the European Parliament elections on May 22nd. Yet the NHS is a General Election issue. It has nothing to do with the upcoming election. Does that mean that Labour have decided to de-prioritise the European election? Is it because, given that they are not, like the Liberal Democrats, the party of “In”, and they are not, like UKIP, the party of “out”, and they are not, like the Conservatives, the party offering a referendum in 2017 on EU membership they essentially have nothing really to offer the electorate for that election? Is it because they realise that those who want to do the classic mid-term protest against the incumbent government are going to UKIP so campaigning on EU issues is a waste of their time and money? Or is it because the General Election is the big prize and past voting behaviour suggests that the EU is NOT a “salient” issue (one that changes a vote) in a General Election? Whatever the answer, their opponents are being givern yet another chance to say Labour has nothing to offer on the issue of our relationship with the EU. Ah, you might say, but these are local council elections too. But the NHS is a UK-wide issue, so it really is irrelevant for May 22nd. Thus, the timing is strange.
Then there is the fact that they had this policy before 2010. At the time it was introduced, it was generally considered to be a pledge that was about trying to ensure a minimum service standard on a public service which has no price mechanism nor profit motive so has to be measured on the service it is providing. So on that basis it seemed a sound policy. But the practicalities of it were that if you wanted to see your GP you HAD to see them within 48 hours, and some people didn’t have an urgent need, and wanted to book to see one two weeks later, but couldn’t. The Tories took away the guarantee because they argued that GPs needed to take account of their patients’ needs. Some wanted to be able to book with longer notice, but also, if you think about it, if GPs need to see everyone within 48 hours they are going to at some point be put in a position where they have to ration the time they spend with some patients who need more of it. So it is a policy which can actually reduce the quality of the service provided.
The best analogy for this is the parents’ evenings we have here at school. I have to see all my pupils’ parents by the end of the evening, as do my colleagues, so we have to limit our time with them to a 5 minute appointment, which may not be enough for some issues we might want to deal with. So what we have to do is to arrange a longer meeting at another time or carry on past the end of the parents evening timing – which is why at the end of many parents evenings here you will find teachers still in meetings with parents almost an hour after everyone else has gone home. That’s part of our job – but GPs might not have any more hours in their day, and so you may need more GPs, which is where the funding comes in.
Miliband argues that the policy will cost £100m, which he will get from stopping paying the lawyers and bureaucrats who police the competition within the NHS (between some service providers). There are some problems with this. Firstly, are Labour saying that competition is always wrong within the NHS? What if it is right for certain services? Secondly, they have often criticised any Coalition plans to pay for something by finding “efficiencies” elsewhere, but are saying they will do it themselves. But thirdly, and most importantly, is £100m enough. Watching the response of GPs, and in particular that of Maureen Baker, the Chair of the Royal College of General Practitioners – who said “it must not be another ‘sticking plaster’ solution but part of a broader, long-term, shift in investment”, my fear is that it is not enough. Which means that Labour may have just announced another unfunded policy which sounds good at a basic level, but for which they would have to raise taxes to pay for. When challenged on this, Miliband would only say it was too early to talk about Labour’s tax and spend plans, and he wanted instead to “get the best out of existing budgets”.
The truth is that the principle of the NHS, which is healthcare free at the point of use, necessarily requires rationing. In the absence of a price mechanism, that rationing mechanism is going to be a waiting list. Because it is free, there can be excess demand for the service, and for demand to meet supply policies and ideas ARE needed. ButI fear that Labour may have got both the politics and the economics wrong on this one. Time will tell