This is my last Report as I am standing down after four years in the Chair preceded by a similar period as vice Chair. So, time for new blood and new leadership. I hope to stay on Central Council as a directly elected member and look forward to saying what I really think unconstrained by the convention of chairpersonly even handedness!
The year has again been dominated by the continuing debate over the marketisation
of the NHS in England though with the accession of Gordon Brown in the summer
and the appointment of Alan Johnson as Secretary of State for Health there is
a glimmer of hope that Tony Blair’s evident wish to marketise the NHS to the
hilt is being moderated. We live in hope.
At the 2006/07 AGM we again voted to affiliate to the Keep Our NHS Public Campaign
but only on the basis of my own casting vote. John Lipetz continues to represent
us on the KONP Steering Group and to be influential in its deliberations. My
thanks to John for this.
In the course of the year three of us – Brian Fisher, John Lipetz and myself – have tried to develop an SHA view on what more needs to be done to the NHS and to Public Health to make the former a truer embodiment of feasible socialism and to make the latter better equipped to tackle the major health problems of today. It has to be said that this has been a difficult process and at the time of writing our paper remains to be endorsed by Central Council. Some members clearly think we have been too critical of the Labour government and too radical in our prescription for the future. Others consider we have been lilly-livered and forgotten what socialism is about! I hold the view, shared I am sure by my fellow authors, that it is important for the SHA to provide a route map for the Labour government that we all support, particularly at this time when there seems to be an openness to new thinking.
Scanning the public health horizon, obesity and alcohol misuse remain the two key lifestyle issues though it is important to recognise that the introduction of a ban on smoking in public places last July does not solve the smoking problem. The prevalence of smoking, having declined steadily over the last 10 years, seems to have reached a stubborn plateau in spite of the excellent NHS smoking cessation service. The aim must be to get the prevalence down to the 15% level achieved in California – probably the lowest level achievable short of outright prohibition.
Obesity is without doubt the new public health challenge. The UK is now the fat man of Europe with only the US having a greater problem among developed countries. There is evidence that the size of the challenge is beginning to be understood at government level though we seem to be a long way from the complete ban on junk food advertising save at point of sale and, probably more important, the implementation of an integrated transport policy to support a more physically active lifestyle, which are two necessary, if not sufficient, components of any serious attempt to tackle it. The prospect of a generation of young people dying before their parents because of obesity is a truly horrific and shaming prospect.
And the alcohol misuse problem just continues to get worse, be it binge drinking particularly among the young or hazardous and harmful drinking in the home. Not much evidence here I am afraid that the government is serious about tackling this issue though there is some tinkering round the edges.
In terms of the wider determinants of public health the focus must continue
on improving education and training and on abolishing poverty, particularly
child poverty, and, above all, on reducing inequalities in health. In none of
these areas is there cause for complacency. Inequalities in wealth measured
in terms of the gap between the top and bottom 10% of the population seem to
be increasing so it is no surprise that the associated inequalities in health
remain embarrassingly high.
Looking at the NHS, the key messages must be to release the energy, enthusiasm
and innovation of staff by loosening the reins at the centre and devolving responsibility
and accountability to local level; and to promote more effective patient and
public involvement in the running and direction of the Service. Micromanagement
of the Service via a command and control structure from Richmond Terrace has
been a running sore for many years which shows every sign of getting worse.
The abolition of Community Health Councils in England was a colossal blunder.
None of the replacement mechanisms have worked. We await the impact of LINKS
with interest. And it goes without saying that we need a period of stability
with no structural change. Let us hope that this the 60th anniversary of the
NHS' creation will be a turning point for the better.
Scanning the political horizon, with Labour trailing in the polls behind the
Tories, the challenge is to make the government seem reinvigorated and exciting
once again in spite of its almost 11 years in office. A major challenge indeed
and one that we can but hope does not result in it jettisoning yet more of our
socialist legacy in pursuit of popular support.
Turning to the domestic scene I would like once again to record my thanks to my fellow Executive members, Tina Funnell, Gavin Ross, Huw Davies, David Pickersgill, Mike Roberts and Patrick Vernon, for their continued support and tolerance over the last four years; and to our indefatigable Director who once again has managed to compress 48 hours worth of activity into each 24 for which we pay him a relative pittance. During the time that he has been our Director, initially with Judith Blakeman as co-Director, the face of the SHA has changed out of all recognition; and very much for the better. It has been my good fortune to have been vice Chair and Chair during this period and to have basked in the reflected glory.
It is good to see some new faces on Central Council though it is also good to see familiar ones and know that we have continuity. Among those we will miss is Christine Hay who has indicated her intention to stand down this year. Christine has been a key figure in the recent history of the SHA having served both as Honorary Secretary and more recently as Chair. We owe her a debt of gratitude.
Successes during the year include further regular editions of S&H thanks to our Honorary Treasurer, Gavin Ross; yet another record number of Conference events which Martin has organised; and our ever increasing profile through these events, articles and Press Releases. And our excellent website continues to impress and attract increasing interest.
Our finances are in an even healthier condition than they were last year thanks to good stewardship on the part of our Director and our Honorary Treasurer and to the ever growing programme of income generating activities run by our Director. This happy state is unprecedented in my 14 years as a member of Central Council.
My sense is that even more than last year the Socialist Health Association is thriving when other socialist societies are experiencing difficulties in maintaining interest and momentum. A rather depressing feature of my 8 years as vice Chair and Chair has been the decline in branch activity – not a cause and effect phenomenon I hope! Nevertheless, it is pleasing to note the revival and new activism of SHA Cymru thanks to the continuing efforts of Julian Tudor Hart and Eddie Coyle, the new Secretary of SHA Cymru and the Wales representative on Central Council and the Executive; and the continuing activity of the Scotland, London and West Midland branches.
And finally, looking back over the last 8 years an important development for the SHA has been an increased interest in the broad public health agenda and in the key issue of inequalities in health. My hope for the future is that this development continues and that the SHA actively promotes the new health and wellbeing agenda which opens up new opportunities for activism, campaigning, conferences and leadership, and on which our comrades in Wales can advise on the basis of their experience of the innovative Welsh health, social care and wellbeing agenda. Learning from the increasing diversity in the countries of the Union, as a result of devolution, presents an opportunity which the SHA is well placed to take advantage of.
Paul Walker
March 2008
During 2007 the standing of the Association seemed to improve. While for much of the last ten years it has seemed that no-one really wanted to know us, suddenly we are in demand. We are building strong partnerships with the NHS Alliance, the Race Equality Foundation, Compass, and the other Socialist Societies. We are invited to speak at events and to participate in policy seminars. New people seem to join the Association not merely because they agree with us in principle but because they want to use the Association to achieve something. We even managed to get invited to visit the Secretary of State. It may be that the political difficulties the Government has faced in respect of the NHS has made them more interested in alternative policy proposals. It is also the case that a number of people well disposed to the Association now find themselves in a position to help us. But it is certainly a pleasant change. Whether any policy changes can be attributed to it remains to be seen.
Central Council has spent most of the year wrestling with issues arising from the Government's continuing drive to modernise the NHS and in particular to bring in greater competition and more private providers. The AGM in 2006 decided to affiliate to Keep Our NHS Public, and we have participated in the organisation's national Steering Committee, largely through the efforts of John Lipetz. But it is apparent that members differ in their views on these questions, and it has been difficult, despite the prolonged and heroic efforts of our Chair, Brian Fisher and John Lipetz, to produce a position which commands majority support among Council members.
At the same time we have been wrestling with issues arising from the reorganisation of the regulation system for health professionals and the Patient and Public Involvement system in England. At the end of 2007 many commentators seemed to notice what we have been talking about for some time – the development of different approaches to healthcare in the various parts of the kingdom.
2007 was a pretty good year for public health in the end. The smoking ban in England seems to have had excellent effects and there seems to be a renewed determination across government to tackle at least some of the drivers of ill health. The approach is more individualised than we would like, but there is also progress on some of the wider determinants of health. And it is hard to get politicians to talk seriously about inequality.
2007 saw the eightieth birthday of Dr Julian Tudor Hart, one of our most distinguished members, marked by a celebration in Glasgow. The Inverse Care Law which he first propounded in 1971 is regularly referred to by our new Secretary of State.
During 2007 we organised 14 conferences and seminars, attended by a total of more than 473 people. Our events are quite down market and we structure the fees to ensure that people are not deterred from participating because of cost. We usually invite 3 or 4 speakers to a Quaker Meeting House and invite a wide variety of people to come and participate. We charge a modest fee and we lay on a good lunch. We deliberately organise meetings across the country. Although attendances are better in London we do not subscribe to the notion that London is the only place that matters. Our events work very well when we get a mixed audience, with lay people, academics, councillors, clinicians and managers - usually somewhere between 25 and 75 - and let them talk to each other. It is hard for doctors, or academics, or politicians, to get out of their box and see how ideas play to a different audience. We have made a serious effort to build up our database of contacts, which at the end of the year stood at 18651. Keeping the database up to date is a major piece of work and the point will be reached in the near future where expansion will not be possible within our existing resources because of the burden of maintaining the list.
For the first time in many years we didn't organise a fringe meeting at Labour Party Conference – for reasons connected with the Government reshuffle. We sent three delegates to Conference and arranged to hire a hotel in which a dozen of our members and associates stayed – a very successful arrangement which helped members to get to know each other and which we intend to repeat.
We established a Facebook group which has attracted 100 members – mostly new people. They are not all formally members of the Association, but we can contact people through the group, and it is helpful for people to publicly commit themselves to support what we stand for.
We have again achieved a significant financial surplus and have established a substantial capital reserve. This has been done by continuing to bear down on our expenses, an enlarged programme of events, and taking advantage of various commercial opportunities. During the year we invested in quite a lot of new equipment. We also organised our first training event – for NHS complaints staff.
The Scottish, West Midland, Welsh, Manchester and London branches have continued to meet more or less regularly. We are very pleased to see that John Charlton, branch secretary in the West Midlands was awarded a CBE for services to Healthcare in the birthday honours.
This report would be incomplete if I did not take to opportunity to thank Dr Paul Walker, our Chair for the last 4 years, who has decided to step down, and his predecessor, Christine Hay who has decided to retire from Central Council. They have both been unfailingly helpful, encouraging and and supportive, have given me many good ideas and dissuaded me from pursuing foolish ideas.
Martin Rathfelder
Director
5/03/08