THE time has come for the party which created the NHS to set out how it can be secured in the 21st century as a public service which puts people before profits.

It is no exaggeration to say that the 2015-20 parliament will determine the future of the NHS.

If the looming funding pressures combine with David Cameron’s ideological prescription, it could create a toxic medicine that may well finish the patient off.

Ed Miliband has pledged to create a national health and care service, backed by new investment in the nurses, doctors, midwives and homecare workers that will ensure the NHS has time to care.

Our plan is based on the simple notion that if we start in the home and make care personal to each family, it is more likely to work for them and cost less for everyone.

We would build a service that takes away the incentive to cut up care into crude 15-minute slots.

After the last election, I warned of the impact that cuts to social care could have on the NHS.

That warning has been borne out by what is unfolding now — the collapse of social care is dragging down the NHS with it.

There are record numbers of frail, elderly people in hospital beds — trapped there because the hospital is last resort in a system where other services can’t meet their needs.

Hospitals are operating at their limits and, with the wards full, pressure is backing up through A&E.

There is a knock-on effect felt by other patients, having operations cancelled at the last minute or waiting longer for cancer treatment to start.

This situation is affecting patients in the community too. As hospitals treat record numbers, so they draw in more resources. This parliament has seen cuts to GP services, community services and mental health.

People struggling to get GP appointments are turning to A&E, as are people with mental health problems who can’t access the crisis support they need.

Unsurprisingly, our hospitals are close to being overwhelmed. This is the vicious circle in which the NHS is now trapped.

It is an appalling state of affairs and no way to run the country’s most valued service.

The NHS has been reduced to such a state that, if things don’t change, it could be about to get a whole lot worse.

The extreme Tory spending plans will see social care further stripped out, pushing hospitals to breaking point.

And, with the Health & Social Care Act still in force, the next parliament could see the NHS sunk by a toxic mix of cuts, crisis and privatisation.

We need a new financial system that makes the home the default setting for care, not the hospital, and prioritises prevention as well as treatment.

Social care is prevention and the key to making that change.

The NHS today is trapped in a financial framework that rewards the treatment of illness and infirmity.

The financial tide drags to the most expensive end of the system — the acute hospital bed — and community services have no incentive to invest in prevention.

This is bad for patients and bad for taxpayers. For the want of spending a few pounds in people’s homes on decent care, we are spending tens of thousands keeping people for months, even up to a year, in hospital beds.

If we take time to ask people what will work for them and their families, then it will be more likely to work.

Labour will give people quality time rather than flying 15-minute visits and it will mean a big shift towards more personalisation.

But if the NHS is to reshape services for the 21st century, it must have full permission to collaborate and integrate without being trapped in the red tape of compulsory tendering.

When the ageing society demands ever greater integration of care, markets deliver the opposite — fragmentation.
We will start by cementing our commitment to repeal the Health and Social Care Act.

Quite simply, the market is not the answer to 21st-century care. All the evidence from around the world tells us that market-based health systems cost more, not less, than the NHS. 

Last month, Miliband launched Labour’s election campaign with a pledge to impose a profit cap when private companies provide NHS services.

We will put the right values back at the heart of the NHS and call time on the market experiment.

It will lay the right foundations for the NHS to build into a national health and care service.

But that journey must be one where everyone is invited to join and everyone has a part to play, where change is not dropped on people from a great height but worked at and built by people in every community.

Unlike the other parties, Labour’s plan is fully funded. We will create a Time to Care fund worth £2.5bn every year that will be focused on building the workforce of the future — including 3,000 more midwives, 5,000 more care workers, 8,000 more GPs and 20,000 more nurses.

There’s no shortage of young people who aspire to work in the NHS — it’s just got harder to do it in recent years.

Courses are heavily oversubscribed and I meet many young people in my constituency who aspire to work for the NHS but struggle to see a route in.

The increase in tuition fees, combined with reductions in places, has left some feeling a nursing or midwifery course is too big a risk, so they turn instead to care work but find themselves stuck in dead-end, zero-hours jobs with little or no training or career prospects.

There are thousands of young people stuck doing these essential but difficult jobs left feeling forgotten and undervalued.

Labour will say that if you want to help build this new NHS and devote yourself to it, we will give you a ladder into it — not just to become a nurse or midwife but any of the disciplines that whole-person care will need in much greater supply — physios, occupational therapists, speech and language therapists, mental health nurses, dieticians, therapists and counsellors.

For young people working as care assistants or healthcare assistants, we will create a specific new route, through an apprenticeship and technical degree to move into nursing or other clinical roles or into the 5,000 new NHS social care roles we will create to deliver our universal reablement service and improvements to end-of-life care.

Sometimes it might seem that the NHS — built by a generation long ago who came back from the war — doesn’t mean as much to today’s young people.

But that’s not the case. Labour’s message to young people is: come and help us build the NHS of the future. It is your NHS too and now your generation must rebuild it for your century.

Labour’s plan offers a positive vision of what the NHS can aspire to be in a century when people’s needs have changed; that answers the question of how it can be afforded; and that, after the divisive change of the past, is something for people to believe in and unite around; that offers something in short supply in the NHS right now — hope.

Hope that the NHS is not on a slow path out but that it can be rebuilt as a 21st-century service.

• Andy Burnham is shadow health secretary.