As your editorial on Labour’s plan for the NHS points out (23 May), health is largely determined by political choices. To restore the NHS, we could learn from its history. The independent contractor model of primary care has been an NHS success story and, arguably, its collapse is at the root of the service’s wider malaise.
Unifying fragmented primary, community and social care staff in independent, wholly subcontracted organisations under one roof, possibly as social enterprises or John Lewis-style partnerships, would improve care, lift staff morale and release funds to address the workforce crisis. Relocating services currently provided in hospitals – such as urgent care, diagnostics and outpatients – into the community would offer the opportunity for care to be delivered using the personalised, relationship-based and cost-effective model traditionally used by family doctors.
Lastly, exchanging the centralised top-down system of governance for bottom-up systems of quality and accountability would reduce bureaucracy, and free clinicians and social care staff to provide the care that patients deserve.
Dr Tim Reed
Woodbridge, Suffolk
• The push to digitise healthcare has benefits, as outlined in Keir Starmer’s article (No more missing records or letters lost in the post – I will bring in a totally digital NHS, 22 May), but comes with side-effects. Many countries have seen serious hacks to medical records systems. The NHS succumbed to one last year, and a hack to a mental health records system in Finland in 2020 saw ransom money demanded from patients. It is hard to hack paper records, and impossible to hack deleted records. Perhaps these old methods should still have a place in a digital NHS.
Dr Andrew Bodey
Oxford
• If Keir Starmer believes a fully digital NHS means no more missing records, he’ll believe anything.
Dr John Doherty
Stratford-upon-Avon, Warwickshire
• Rafael Behr says that it is sensible for Labour “to avoid too much detail about its manifesto” so far away from the next election, presumably on the basis that it might spook the electorate, or that ideas might be pinched by the policy-deficient Tories (Brexit ruined Britain’s appetite for revolution. That makes Starmer’s job harder, 24 May).
The latter can be averted by ensuring policies are radical rather than Tory-lite, and therefore unlikely to appear in the Conservative manifesto. As for spooking voters, assuming Labour policies to be based on fairness, who but the very wealthy, the most unlikely voters of all to support Labour, will be turned off Labour’s revenue-raising schemes?
So why not announce as soon as possible that the NHS reforms will be funded by a 1% tax on wealth over £10m, which, according to Tax Justice UK, would raise £10bn annually, and that extra funds for education will come from the equalisation of capital gains and income tax, likely to raise £14bn a year?
Announcing policies now would give Labour politicians the time they will need to justify and explain them, in the face of massive criticism, exaggeration and scaremongering from the rightwing media.
Bernie Evans
Liverpool
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