As the Conservatives finalised their plans to bury the most egregious parts of the NHS reforms they forced through in 2012, Labour set out its healthcare policies.
The Tories look set to play it safe on the NHS in the general election, adopting proposals from NHS England to drastically reduce the role of competition, sort out the legal mess around its structures and make it easier for hospitals, GPs and community services to work together.
Labour, meanwhile, is gunning for drug companies and service contractors. Speaking in the wake of drug company Vertex putting a list price of £104,000 per patient per year on the cystic fibrosis treatment Orkambi, Jeremy Corbyn promised compulsory licensing would secure generic versions of expensive patented medicines while a state-owned drug company would manufacture generics.
A pharmaceutical company charging extortionate prices is a familiar story, but usually a pincer movement by regulator Nice and NHS England secures access to innovative treatments at manageable prices. The fact that Donald Trump has railed against national healthcare systems “freeloading” on American drug companies is a measure of the NHS’s success.
The rules set by the World Healthcare Organization allow a government to issue licences for generic versions of over-priced drugs. But any attempt to grab patents routinely would destabilise pharmaceutical research, particularly in the emerging era of personalised treatments and drugs for rare diseases. Companies understanding that exploitative behaviour runs serious risks may well benefit the NHS, but seizing patents should be the exception.
The logic of a state-owned drug company producing generics is hard to fathom. The cost of generics is not a big problem; even if it were, it is difficult to see how this plan would help, considering these drugs are already produced efficiently across the globe. To make this viable, a government would have to establish a company (or nationalise an existing one) and produce drugs so much more cheaply than long-established manufacturers that the marginal savings would significantly outweigh the start-up costs within just a few years. It would be a massively high-risk enterprise for little gain.
Enthusiasm for contracting out is waning across public services. Many councils are bringing services back in-house, confident they can maintain the efficiencies while gaining control and flexibility. In the NHS, court action by private contractors who have lost bids has undermined trust, while sporadic attempts to push hospital staff into arm’s-length companies are resisted.
Labour is committed to bringing privately run services back into the NHS. Routine tendering of service contracts has failed, plaguing the NHS with high legal costs, inflexible contracts and poorly joined up services, while often destabilising NHS organisations who lost the business.
But one dogma should not be replaced by another. If quality will be harmed by bringing a service back in-house, that is a disservice to patients. Similarly, an NHS provider should not have an inalienable right to hang on to a service no matter how poor. And, whatever the initial difficulties, companies will play a key role in making digital access to healthcare part of the everyday NHS experience. Simply put, the NHS staff running local health systems should be free to do what is best for patients.
Labour is on firmer ground in its commitment to fight for a better deal from companies developing products with public money and NHS support. This is a growing issue for drugs and digital technology, and some NHS organisations have been naive in their commercial relationships. NHS England now has a tighter grip on issues such as sharing data – which is of huge value – but there is still further to go in ensuring that state support for product development is fairly rewarded in sharing revenues and giving the NHS a good price.
The relationship between the NHS and the private sector needs to be reset to put power back in the hands of those with the interests of patients at heart. But the private sector still has an important and progressive role to play.
• Richard Vize is a public policy commentator and analyst
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