'If we can’t fund five days, how can we fund seven?'
The (now promoted) shadow health secretary outlines Labour’s priorities for the NHS to Sofia Lind
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Speaking to Pulse last month as Labour’s health spokesperson, Diane Abbott appears to have no idea of her imminent move to shadow one of the great offices of state – home secretary – a week later.
She greets Pulse somewhat late at the House of Commons because she is busy watching the TV broadcast of health secretary Jeremy Hunt’s speech from the Conservative party conference.
As her photographs are taken, she scoffs at Mr Hunt’s repetition of the statistics on weekend deaths that he used to justify his imposition of the junior doctor contract – figures that have since been called into question many times.
It is clear she is no fan of the man she has shadowed for just a few months, after being propelled into the shadow cabinet amid a mass walkout of MPs protesting against the leadership of Jeremy Corbyn, of whom she is a firm ally.
Coming hard on the heels of Mr Corbyn’s re-election as party leader, she offers an insight into what the health service might look like under his leadership.
A lot of GP practices are closing at the moment, especially smaller ones. Do you think it’s OK for GP practices to close or should they be bailed out?
I think it’s a problem that so many smaller practices are closing. Obviously we’re moving from an era where you had a lot of singlehanded GPs to group practices. For older people especially, it’s very difficult when their GP disappears, and they sometimes find it hard to adjust to a group practice. More should be done to help some of the singlehanded practices because they provide a service that particularly older people appreciate.
I know that in Hackney [part of Ms Abbott’s east London constituency] – which is a very diverse community – particular communities can build a relationship with a particular GP, so it’s important to look at it strategically and maybe help some practices.
There is definitely a role for smaller practices. As a patient, a group practice can seem enormous and the thing that people don’t like is when you see a different GP every time. People value knowing they’re going to see the same person with whom they have an established relationship.
The Socialist Health Association told me at the Labour party conference last week that it is pushing for GP practices as businesses to be phased out, and GPs to become employees of NHS bodies. Is there a shadow cabinet policy on this?
No, there isn’t. I don’t think that’s necessary, actually. I think the business model has served us well. I wouldn’t push for them all to become employees.
GPs say they’ve been underfunded for the past decade. What’s your take on that? Should there be more money going towards general practice?
In principle. I can’t promise more money, I have to say. But I think so, because for most people their GP is their main point of contact with the NHS. There’s a generation of singlehanded GPs that are retiring, and if you’re serious about health prevention, then you need to put money in because GPs are best placed to give advice, give support and identify conditions.
There seems to be an increasing use of private hospitals for NHS care. What do you think of this?
Well, people have been in contact expressing their concern about this. Obviously, the use of the private sector to manage demand started under New Labour. But I was not a supporter of that at the time. The idea was that you use the private sector not just to manage demand, but to motivate the NHS itself to do better, to do things faster. And I don’t think it’s worked like that.
I didn’t like it then and it increased under the coalition and now under this Government. I’m concerned because the problem with the 2012 Health and Social Care Act is that it led to fragmentation, and a fragmented NHS is easier to privatise.
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The Government has promised 5,000 more GPs by 2020. Has Labour done any modelling on the future need for GPs?
No, we haven’t at this point. Obviously one of the things we have to look at as a party is how much more money we put into the NHS and how we would fund that. But we haven’t modelled that as yet.
Over the summer we had a little turbulence in the party (laughs), and we’ve kind of had to get past that. And now we’ve got past that, that’s the kind of thing we’ll be looking at.
Pulse’s analysis shows the Government isn’t doing too well on that 5,000 GP target. Where do you think they are going wrong?
You can bring in new GPs but they’re not doing enough about retention and they’re not giving GPs enough support, including financial support. If you want primary care to do more – more minor procedures, more public health work – you do have to make sure you have the funding structure in place for that. GPs are a really important point of intervention, but the Government is not prepared to provide funding.
One solution the Government is pushing is an increase in the number of non-doctors doing consultations. What is your view on that?
The idea of giving pharmacists a greater role isn’t new, and to a degree, it’s a good thing for advice on sexual health and so on. In my GP practice, the practice nurses do things like take your blood pressure.
The problem is people want to see their GP. You’ve already got non-doctors engaging with patients, and I think there’s a limit to how much you can do that.
As an MP, I meet people who come to my advice sessions to talk about their problems. Even over the course of our conversation they have to build a relationship with you. Only then will they really tell you what the problem is.
There’s no getting around the importance of patients being able to see their GP and building a relationship with their GP. This business about seeing non-doctors, that’s already being done and I’m not quite sure how much further we can take it.
Do you think patients are waiting too long to see a GP at the moment?
I hear it from my constituents all the time and have for some time. And it’s hard to intervene in that situation. When there were PCTs you could talk to them. City and Hackney is my health area and the PCT was trying to deal with the waiting times issue. In east London, people have always waited a long time to see a GP and it’s getting worse.
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Do you support the plans to stretch an already-struggling five-day GP service across seven days?
No, no. Look, on the one hand, people do work at weekends. When I was in Liverpool for the Labour party conference, I visited the Royal Liverpool University Hospital and there were consultants and doctors there at the weekend.
But a fully seven-day service? They can’t fund a five-day service, they’re having to close down A&E departments partially, temporarily. If they can’t fund a five-day service how can they fund a seven-day service?
The thing that Jeremy Hunt never says is that you need all the other people: the pathologists, the scientists. At the weekend you don’t even have hot food. If you’re really going to have the seven-day service and you treat staff fairly, you have to look at a whole range of other things, other NHS people, as well as the facilities in the hospital that make it viable. There isn’t the money to do that.
It’s dishonest of Jeremy Hunt to imply the only problem is junior doctors not being prepared to sign a new contract. It will take money to have a genuinely enhanced seven-day service, which there’s no prospect of him providing.
So seven-day GP access is not policy that would survive under a Labour government?
If we had the money. The problem with Jeremy Hunt is he’s trying to do these things but he doesn’t want to fund them. We would not be asking the NHS to do more with less.
How would Labour fill the NHS funding gap? Do you have any plans?
This is something we’re trying to model. You can either take the money [through] general taxation, or you can do something with National Insurance, but we’re committed to filling the funding gap. We haven’t yet announced exactly how we’re going to do it. But as I say, we had a summer of distraction, but now we can get on and look at those things.
Graduated in 1976 from the University of Cambridge in History
- 1982- Elected to Westminster City Council
- 1987- First elected MP for Hackney North and Stoke Newington
- 2010- Stood in the Labour leadership contest, losing to Ed Miliband
- 2010-2013- Shadow public health minister
- 2015-June 2016- Shadow international development minister
- June 2016-October 2016- Shadow health secretary
- October 2016-present- Shadow home secretary