There are some very good ideas and sentiments contained in Labour's Manifesto commitments on Health and Social Care. The trouble is that they are left at the level of generalities.
For example, I have argued for years that the focus of the NHS on the provision of hospitals was misplaced, and that by far the biggest focus should be on primary care. We should seek to prevent people becoming ill in the first place, rather than simply seeking to spend huge sums of money trying to restore them to health. Where people do have illnesses, we should seek to diagnose them early, and provide early intervention to prevent them becoming worse. We should not clog up hospitals and A&E with people who could and should be treated immediately at GP's surgeries, pharmacies or European style clinics.
Labour says,
“Our mission is to create the conditions to prevent illness and enable people to live longer, healthier lives.”
And,
“We will complete the confirmed hospital rebuilds and invest more in primary care settings, modern AI, cyber technology and state-of-the-art medical equipment, including more MRI and CT scanners.”
And,
“We will allocate a greater proportion of overall funding to close-to-home health services and build interdisciplinary, patient-focused services across primary care, mental health and social care. We will ensure patients in deprived and remote communities will have better access to primary care services.”
All great objectives, but left vague in the extreme. What is required is a commitment to ensure that, in every community, there is access to good quality primary care. By every community, I mean that the facilities should be within 10 minutes walking distance. Preferably, the primary care should be in the form of European style polyclinics, which can offer a range of primary care facilities, with a pool of health professionals available to provide treatment for a range of conditions. My preference would be that such clinics be owned and controlled as workers cooperatives, and Labour should encourage such development as an alternative to the current situation of GP's, dentists, opticians etc. operating as self employed private capitalists. In each community, we should also create purchasing/commissioning cooperatives comprising local residents who can act to oversee the provision, and where necessary bring in alternative providers if the service falls below standard. By that means any rent-seeking activity can be minimised, but more importantly, the necessary liaison between the commissioning cooperative and the healthcare cooperative will act to undermine the alienation of labour.
But, its necessary to recognise that things have moved on considerably, in the last 70 years, since the creation of the NHS. Today, it is often more convenient for workers to use a GP, dentist etc. close to their workplace, rather than their home. The fact is that TESCO holds more integrated data on people than the NHS does, in relation to patients. It should be possible for an integrated NHS computer system to allow anyone to go to any NHS facility, and for their records and data to be instantly accessed. Moreover, as my old next door neighbour, who is a consultant, commented on Newsnight, last year, with modern technology it should be possible for everyone to have wearable or implantable technology that constantly monitors the state of our health, and picks up any problems before they occur. After all, we have such technology already built into our cars. It should be possible on that basis to be able to walk into the nearest NHS facility, and the appropriate action be taken.
But, more than that. AI now means that a whole range of conditions can be detected from simple blood samples. We have just had the tragic news of the death of Bob Willis at the age of only 70 from prostate cancer. All the more a tragedy in that prostate cancer can be easily detected, early on, and can be treated with an almost 100% success rate. We should ensure that everyone has annual health checks so as to ensure that any such problems can be detected early. We need commitment to invest a lot more money into the development and extension of the use of AI, to ensure the early diagnosis of such illnesses.
But, we also need the development of AI and technology for health and social care more widely. A major problem with Labour's plans is Brexit. Outside the EU, the UK will not be able to get the health and social care staff it requires to meet even current commitments, let alone any sizeable expansion of health and social care. If Brexit goes ahead, its going to be one of the first things that all those old people who voted for it complain about, and insist that “no one told us this would happen”. There are three possible solutions. Either, the care is not provided, and people just suffer until they have an earlier death than would otherwise have been the case; a huge amount of money is put into training health and social care workers, and having to pay higher wages, to attract and keep them; or alternatively, that technology is introduced to assist and/or replace the current labour.
The first two options would meet large-scale resistance that would lead to governments falling. In agriculture, already, a shortage of migrant labour for fruit picking has resulted in new technologies being developed to replace labour. In industry, already, a series of exoskeletons are in use to assist with manual handling. These can be applied to workers involved in health and social care too, but also the development of this technology, and of AI/robotics means that they can be used to enhance and extend the mobility of patients themselves. We may not yet be at the stage of the kind of domestic robots depicted in “Humans”, but we are already at the stage where a series o dedicated robots can provide personal support and services in specific areas. Especially as we have an ageing population, and the number of young workers in the economy will decline rapidly as a result of Brexit, and its associated demands for harsh restrictions on immigration, the only way that health and social care will be affordable in the longer-term, is via an increasing reliance on such technology, and robots.
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