The News from Nowhere crew followed the debate about the NHS at Labour’s Annual Conference.

 Announcements at Labour’s conference built on the policies agreed by its National Policy Forum. What Labour intends is getting clearer, constrained by the disciple that nothing can be promised without identifying where the money comes from.

There were lots of positives, including an unequivocal commitment to core NHS principles.  Only the wildest conspiracy theory could support the idea that this is all a ruse to cover some other intention.

Determination to deal early on with the scandal of social care by ensuring a sector wide settlement for the workforce; invest in carers and more and better care follows. A properly paid, respected, and valued workforce combined with much better support for informal carers is a big step forward.  Forcing out the worst of the providers is a real threat.  The progressive building of a National Care Service has huge support and ultimately it may even be free at the point of need.

The determination to settle the workforce issues in the NHS is there with the constant reminder that from 1997 there was effective machinery for partnership working.  There was an acceptance that the Pay Review Bodies need some change but that in principle they were good but only if “independent”.

Recruit, retain, respect.  Top of the list is to give all NHS staff improved terms and conditions. Working with them and their representatives to improve retention, support the recruitment announcements but mostly to give them back the sense they are truly valued and have the resources and support to allow them to do the job they love.  Better systems are needed to reduce agency and locum rip offs.  Value and support managers to avoid the £billions wasted with the large parasitical consultancy companies – keep the knowledge and talent within the NHS.

And there will have to be a deal (as there was last time) around pay restoration over several years, but linked to how fast the NHS recovers. Agreement to some changes which tackle the various “isms” and perhaps unpick some of the unacceptable practices of some. The NHS has brilliant workforce policies which are not implemented universally or consistently.

How to deliver the workforce plan such as it is with a price tag of perhaps £40bn is a problem for later!  Labour will have its own Long Term Plan (again as last time) but only after a major exercise in consensus building.  But the current planning aspirations from NHS England are not too far off from Labour’s intentions, they are just unachievable !

The drive to reduce the waiting list by 2m a year, buy more diagnostic equipment, and tackle the dentistry debacle was there.  Details were few.  The reliance on overtime and weekends has to be seen as stop gap until “reforms” add capacity.  But this time there was no reference to the (mythical) extra private sector capacity.

What the aims of reform must be are clearer (digital not analogue, prevention not remedial, primary/community more than acute, local as well as national), but the big plan has to wait.  Much of this is very hard to do and the “reform” agenda must start by taking the public with it.

The drive to improve well being and to have longer and healthier lives was supported by all.  Achieving that is mostly outside the remit of the NHS but it does fit with much greater attention by the NHS to Primary and Community Care and Mental Health that to 40 (or 50) new hospitals does.  And an NHS that works effectively not grudgingly with local authorities, which is a big ask of the ICB/ICPs.

Announcements around procurement and the determination to ensure better use of capital investment lay the foundations to increase NHS capacity and reduce outsourcing and reduce any reliance on private providers. Coupled with acceptance that there is and always will be the need for private provision of goods and services.  The need for partnerships with private sector in areas like the life sciences or high end technology is obvious.

But no promise of new money beyond that already announced and no reorganisations.  The reality that significant recent additional funding has not been well spent does not also imply no more funding is necessary !

The current settlement already has 3.5% for two years so spending that well is crucial.    What may be more important is greater certainty with multiyear settlements not annual settlements three or four months after the year has started.  How much  is needed to stabilise and grow the care workforce is a problem for later.  So too is where the necessary additional capital investment will come from.

No reorganisation from top down means ICBs will have to be adapted to meet the policy requirement – which is feasible.  The worst of the 2012 Act never happened and the 2021 Act has now effectively reversed its intent.  We have collaboration not competition.  Again, those of conspiratorial mind will see this as another plot – but it gives the NHS a bespoke procurement regime strongly weighted to the NHS as preferred provider, and it actually bans private sector interests from commissioning – so a very cunning plot indeed.  So probably no need for major legislation.

The glass is more than half full if not brimming over (yet)