Labour Party Consultation Document on Health Draft June 2006
NB This document does not represent Labour Party or government policy
How do we do more to empower patients?
The starting point for all that Labour wants to achieve in improving health is our belief in a publicly funded National Health Service, free at the point of need with equal access for all, irrespective of their wealth: the fairest system of healthcare In the world.
In 1997 we started the long process of improving our NHS, and the outlook is good waiting times are down, more staff are now working in modern buildings and more lives are being saved than ever before. But we have further to go. Patients rightly demand a world-class service. That’s why Labour’s investment has been tied to reform which puts control into the hands of patients.
By 2008 spending on the NHS will have trebled with Labour. As a result, waiting times are shorter than ever and lives are being saved through reductions in deaths from cancer, circulatory disease and coronary heart disease.
Deficits. within individual Trusts have led the news recently. But, the 2005/06 net deficit of £512 million needs to be kept in proportion. It is around one per cent of the total NHS income, equivalent to someone on £20,000 per year finishing the year with an overdraft of £200. This is a problem, but a manageable one. The majority of NHS organisations (seven out of 10) are not only employing more staff, treating more patients and meeting all of their targets – they are also in financial balance or surplus. Two out of 10 have small levels of overspending while one in 10 has serious financial problems – and these organisations are receiving support and advice to turn their situation around.
The Labour government is determined to get the NHS back into overall financial balance over the next year. In the past, overspending organisations had no incentive to improve since they knew they would be bailed out by under-spending parts of the NHS. This was utterly unfair, since the over-spenders are mostly in better off areas with fewer health problems, while the under-spenders are mainly in the North and the Midlands, with far greater health needs.
As budgets rise all areas will see increases but poorer areas, where health needs are higher,. will receive the highest increases.
Investment linked to reform
In 1997 we inherited an NHS which was on the point of collapse. The service had been neglected and underfunded for years. Undervalued staff were working to maintain a decent service in buildings which were crumbling while waiting lists rose and we faced a shortage of doctors and nurses.
Since then spending on the NHS has more than doubled. With Labour by 2008 total UK health spending will be 9.4 per cent of national income, well above the current EU average of eight per cent. There are now are over 32,000 more doctors and 85,000 more nurses. Our investment is increasing capacity in the NHS, enabling it to do more and to give patients more choice. We are engaged in the biggest hospital building programme the NHS has ever seen, delivering 100 new hospital schemes by 2010, including 50 new Community Hospitals.
Our investment in the NHS has ensured that the country’s health system remains free at the point of need, with valued staff working in modern buildings. Our investment has transformed the NHS, with shorter waiting times, record numbers of staff and new buildings and infrastructure. But we are not operating under unlimited resources; our investment of tax payers money has to be targeted to ensure that the NHS continues to provide a world class service. Patients in the early years of the NHS, in post war Britain, were grateful simply to have a National Health Service. But today’s patients rightly want choice and flexibility in their NHS, for the system to work for them, not to have to work around a one-size-fits-all approach to provision.
So our investment has been linked to reform. We believe that reform is essential if we are to secure the future of the NHS. Without reform the NHS will not keep up with the changing needs and demands of patients. If the NHS fails we all lose out but the hardest hit will be those who need the service most the poorest communities with the greatest health needs.
At the heart of Labour’s health reforms lies our commitment to give patients more say in how, where and when they are treated. By putting patients in control we are shifting power from providers into the hands of patients. With increased choice patients don’t have to settle for what they are given, and fall into line with what the service decides; instead they can exercise choice over the ‘health care they receive, a choice previously only open to the wealthy.
It is a Labour government that today is rebuilding and renewing the health service. It is vital that we succeed in this process of renewal and that we do it in a way that remains true to Labour values. If we fail, the alternative to reform is not no reform at all. It is reform according to the values of our political opponents. It is reform in which efficiency is valued over and above, not alongside, the value of fairness.
Our commitment to the NHS is undisputed, but working within limited resources we have to be clear about where we want to target resources.
- What are our priorities for the future of health care spending?
- And how do we ensure we deliver the best results for all patients from our investment?
Choice in practice
By moving from the old monolithic NHS, where patients got what they were given, to an NHS which gives patients more choice about when and where to have their operation, and more care in their local communities and homes, we will have shown that collective public services can meet individual needs and aspirations.
In practical terms choice means that an elderly mother would be able to choose to have her operation at the hospital near where her children live – not have to go to the nearby hospital she has always attended.
Choice means that for someone with diabetes their GP would have the incentive to provide much more care in the local community or in the patient’s home – cutting down on emergency unplanned hospital admissions and ensuring patient’s are in control of their condition.
And choice means that there would be clear incentives for diagnostic tests to be provided at a time and a place that suits the particular patient’s work or family commitments and not the organisation of the hospital.
Since January 2006 patients have had the right to be offered the choice of at least four hospitals or clinics when they need to see a specialist for further treatment. This new way of using the NHS means that patients are given the power to choose faster and better treatment – driving up standards across the NHS. During 2006 we will be extending choice further, and by 2008 patients will be able to choose from any hospital or provider which meets NHS standards at NHS costs.
With these reforms the providers of services will be rewarded for delivering good services, providing an incentive for hospitals to change for the better and deliver the services patients want. Patient choice rewards the producers well; but insists in return that it is the user who comes first.
Too often in the past those with the loudest voices have received the best service. Correcting this must be part of our reform programme. We want to extend to all people the privileges current1y enjoyed by the well-off.
- How do we ensure that those who have previously been poorly served by the NHS make full use of the choices that are available?
- How do we do more to empower patients?
- How do we extend choice to other services like primary and maternity care?
Moving healthcare closer to our communities
In the last five years we have focused much of our attention on improving hospitals. But most people’s contact with the NHS takes place outside hospital. Labour wants to improve community based services and give people a real say in how the system will work in future.
The White Paper ‘Our Health, Our Care, Our Say‘ marks a strategic shift in how we provide care, out of acute hospitals into community settings. We aim to move more healthcare services closer to where people live or where is most convenient: in their homes, in local clinics, a new generation of Community Hospitals or new GPs surgeries. We want much better integration between the NHS and social services. And we want to shift the emphasis towards preventing ill health and tackling inequalities.
To improve the services that people access closer to home we need to change the way that family doctors, Primary Care Trusts and Local Authorities plan and buy services for their local community.
Labour believes the best way to do this is to empower those closest to patients – GPs and other professionals in the community. Practice based commissioning (PBC) is an opportunity for the NHS to focus more on prevention, working with social care to meet the needs of individuals and communities.
- How can we further encourage GPs and Primary Care providers to push for the best treatment as champions of their patients?
Tackling health inequalities
To ensure everyone has access to a GP and primary care, regardless of where they live, Labour will establish new primary care services, especially in deprived neighbourhoods. Despite the fact that we have over 4,000 more GPs than in 1997, there remains a shortage of provision in the poorest areas that need them most. Through the Health White Paper Labour aims to ensure that in future care is as closely matched to need as possible.
With Labour, funding allocations are made directly to Primary Care Trusts (PCTs) rather than through Health Authorities. And allocations are made for three-year cycles rather than one single year allowing PCTs to plan for the medium term rather than the short term. And using a new funding formula, which gives a better measure of the health needs of each local community, Labour is ensuring that additional resources are targeted to where they are most needed.
Revenue allocations to Trusts reflect the diverse needs of all of England’s communities including the additional costs of inner cities with high populations and rural areas with higher ambulance costs.
Over the next two years as NHS funding continues to increase across the board, we will ensure additional funding is targeted at traditionally under-funded areas. By 2008, when average NHS funding will be £1,388 per head, Primary Care Trusts in the worst-off areas will be receiving £1,552 per person.
Labour is committed to simplifying the registration system for GPs and giving people more information about the services available in their area. Starting from April this year, the GP contract will link an element of GPs’ pay to patients’ satisfaction with the practice – including the appointments system – providing a real incentive for more convenient opening times.
- What more can we do to ensure GPs are more focused on delivering services tailored to what patients want and need?
Labour’s plans will ensure Primary Care Trusts will bring in additional primary care services where people are dissatisfied with the care they receive and lack choice locally. Whether services are organised by traditional GPs, by nurse practitioners, by independent providers or by social enterprises, mutuals and co-operatives and the not-for-profit sector, the test will be simple: to get the best services for patients, with the best value for money, all free at the point of need in accordance with the founding principles of the NHS.
Expert patients
Around 17.5 million people in the UK are living with long-term illness such as asthma, arthritis or heart disease. And the predominant pattern of disease in this country during the second half of the 20th Century and the beginning of the new century is of chronic rather than acute disease.
As the challenges in health change, so too must the NHS. Labour is committed to providing more help for people with long-term conditions such as diabetes, respiratory diseases, and heart problems by trebling the investment in the expert patient programme Which allows patients to take control of their treatment and lifestyle.
The Expert Patients Programme recognises that with more education and better information patients can learn more about their condition and how to handle it day-today thereby preventing unnecessary and distressing admissions to hospital.
- As more people develop manageable long term illness what support should government offer to ensure people are well looked after while still able to lead a independent and fulfilling lifestyle?
The people who make most use of our health and social care services are those with long-term needs – frail elderly people or those with serious disabilities. Many of these people need the support of several organisations, but are frustrated that too often different agencies seem to work in isolation.
By giving local authorities and the NHS stronger incentives to work together, we have already reduced the number of patients remaining in hospital due to a lack of arrangements in place to support them in the community.
Now we will strengthen this joint working, by introducing a single assessment of health and care needs and a joint care plan for people with the most complex needs. By 2008, we will expect Primary Care Trusts and local authorities to establish joint health and social care teams. A common budgetary and planning system will also support more organisations to jointly commission services.
- What more can we do to offer a joined-up service to patients in most need?
How do we help people lead healthier lives?
Labour recognises that to reduce health Inequalities and tackle the prevailing illnesses of the future, we have to tackle the causes as well as the consequences of ill health. We are taking prevention as seriously as cure and recognise that better health depends as much on the responsible actions of the public as it does on the quality of services.
We believe that modern services should be centred around the individual offering protection and support where necessary but also promoting independence and offering choice to those who have in the past been roundly ignored and neglected.
As individuals and as a nation we need to take our health and fitness more seriously. That is not to say there is no role for government, but a recognition that people need to take responsibility for their own lifestyle choices and the way they live their lives.
The role of government is to create the right conditions for health, and to tackle the factors that increase the likelihood of poor health, poor housing, poverty, unemployment, crime, poor education and family breakdown. But we must also work in partnership with communities and individuals so they can properly take responsibility for improving their own health and wellbeing.
We cannot force people into a healthier lifestyle. The decision to change has to be a personal decision. Our latest public health White Paper ‘Choosing Health‘ recognises that people want to take responsibility for their own health but they want the Government to support them in making healthier choices. They want clear and credible information, and where they want to make a change and find it hard to make a healthy choice they expect to be provided with support in doing so – whether directly or through changes in the environment around them – so that it is easier to do the right thing.
Labour recognises the crucial role that local authorities, working in partnership with the NHS, other public sector bodies and the private, voluntary and community sectors, have in improving the health of their communities and tackling health inequalities. Through Local Strategic Partnerships (LSPs) there is now an expectation that primary care trusts will fully engage community based health and care initiatives. And through Local Area Agreements we are bringing health inequalities and public health into the forefront of local community planning.
Meeting tomorrow’s health challenges
Increasingly the health challenges people are facing are brought on by lifestyle choices – alcohol abuse, promiscuous sexual activity, smoking and poor diet are all contributing to demands on the health service that are otherwise avoidable.
The role of government is not to dictate but to support people to make personal choices that are informed by good information available in the public domain. Our role is to help to make choosing the healthy option the easiest choice.
Obesity almost trebled in the last two decades and now affects 22 per cent of adults. It magnifies the risks of heart disease, diabetes and cancer, and shortens life by as much as nine years. So to make the healthy choice easier we are committed to putting in place a simple system of labelling to make it simpler for busy shoppers to see at a glance how individual foods contribute to a healthy balanced diet.
We have agreed a ban on smoking in all enclosed public places so it will be easier for smokers to give up and resist the temptation of social smoking in pubs and clubs. These restrictions will be accompanied by an expansion of NHS smoking cessation services to encourage and support smokers to improve their own health by giving up smoking.
Sexually transmitted infections, including HIV and chlamydia, are on the increase and we are clear that more needs to be done to improve people’s sexual health.
We have initiated a new £50 million sexual health media campaign targeted at young people and have also pledged that by 2008 Genito-Urinary Medicine (GUM) clinic appointments should be available to patients within 48 hours. We will also be running a new national campaign targeted particularly at younger men and women to ensure that they understand the real risk of unprotected sex and we are working with PCTs to pilot a new resource aimed at delivering health Information for younger men aged 16-30.
Through public consultation we know that people are enthusiastic about the idea of a ‘health MOT’. We have therefore set out in the recent White Paper our proposal for an NHS “Life Check” at key points in people’s lives. The NHS “Life Check” will ask people about their lifestyle and family history, with a follow-up from a health trainer – and if necessary a nurse or GP – for people in high risk categories. We will pilot the new health check, starting with parents of very young children and people in their early 50s and introducing it initially in the areas with the worst health inequalities where we can make the biggest difference. This will be in addition to the free annual health check which the NHS offers to everyone over the age of 75.
- What more can we do to encourage people to take a greater interest in their own health?
- How do we make the healthy choice the easiest choice?
Promoting children’s health
We want our young people to grow up healthy’ and to understand the importance of a balanced diet and regular exercise.
We have already extended the provision of free fruit to all four-to six-year-olds at school and are building on this with improved school meals through extra investment, higher standards and improved school kitchen facilities. And we want to help parents resist ‘pester power’ by restricting further the advertising and promotion to children of those foods and drinks that are high in fat, salt and sugar.
Tackling childhood obesity is a government-wide priority and we have set a target to halt the year-on-year increase in obesity in children under 11 by 2010. We have made huge steps forward already in starting to change attitudes through the Five A Day campaign, the school fruit scheme and more investment in school food. Our public health agenda is the first concerted attempt to seriously tackle rising levels of obesity.
We know that participating in sport and physical activity is crucial in tackling obesity. We are investing over £1 billion in school sport and want young people to have every opportunity to play sport both in school and outside the curriculum. This will ensure a step change in the range and quality of PE and sporting opportunities in schools with 3,000 coaches, 15,000 sports teachers and more than 2,000 new facilities. Our long term ambition is to offer all children at least four hours of sport, two hours of PE within the curriculum and at least two to three additional hours of sport outside of school by 2010. And as we move towards extended schools, which offer access to sports, art, drama and homework clubs among other activities, more young people and their families will be encouraged to get involved in healthier activities.
Participation in sporting activity is important to achieving several of our objectives. It is an important part of education, it is a very good way of ensuring that children live healthy lives and sporting organisations are the largest, and most thriving, part of the voluntary sector. We will be devising a strategy to ensure that all these strands of activity come together, to ensure that physical activity and sport are available to everyone who wants it.
- How can we support parents in improving their children’s health?
- Beyond clearer labelling what more can we do to help busy parents make healthier choices for their children?
And we are committed to a more joined up service for children in vulnerable situations. In recent years we have made big advances in children’s policy through Every Child Matters, the National Service Framework and appointing a Children’s Commissioner.
To realise our ambition to improve the lives of all young people, we need radical change in the whole system of children’s services including shifting from intervention to prevention, and services integrating and working together more effectively. The National Service Framework for Children, Young People and Maternity Services (NSF) is integral to this.
Dentistry
Labour is reforming NHS dentistry to achieve better oral health and to provide a good deal for patients and for dentists. We are continuing to invest more in NHS dentistry and recently announced a new £100 million programme of capital investment over the next two years to modernise dental practices and improve and extend access to NHS dental services.
On April 1 2006, the NHS put into place reforms which provided new contracts for dentists, a simpler system of dental charges and moved commissioning dental services to a local level. These reforms mean:
- a simpler and clearer charging system for treatment
- patient-focused treatment improved access to an NHS dentist
- £80,000 average earnings for an NHS dentist, guaranteed for three years
- a fairer deal for local Primary Care Trusts who are now able to retain finances if a dentist leaves the NHS, and commission replacement NHS dental services.
Compared to three years ago, this Labour government is now spending £400 million more on NHS dentistry each year, part of which was in a capital investment programme of £80 million over four years to support a 25 per cent expansion in the number of training places for dentists.
And we have taken action to improve both the short and long-term supply of NHS dentists. We have recruited an extra 1,459 dentists (whole time equivalents) between April 2004 and October 2005 – far surpassing our original target of an extra 1,000 new dentists. The total number of local NHS dentists has increased from 16,700 in 1997 to over 21,000 by the end of October 2005.
We are also funding 170 extra training places for dentists in England this year a 25 per cent increase compared with 2004/05. And we are speeding up the process for people waiting to take the International Qualifying Exam (lQE) which enables dentists from non-EU countries to practice in England.
To improve access for patients we have set up 53 Dental Access Centres to provide services to people experiencing problems obtaining NHS dental treatment. These centres will allow people who have been unable to obtain routine care, or who prefer not to register with a General Dental Practitioner, to gain access to treatment when they need it.
Building modern social services
Social services are one of the major public services. At anyone time there are up to 1.5 million of the most vulnerable people in England relying on their help. Despite the best efforts of dedicated and professional staff, the NHS and social services have not always worked effectively together as partners in care, so denying patients access to seamless services that are tailored to their particular needs. All patients, but particularly older people, need health and social services to work together. They rely on good integration between the two to deliver the care they need, when they need it.
Labour believes services should be person centred, seamless and proactive. Person centred services will give the individual real options and we expect everyone to have a spectrum of choice available, choices that help maintain independence, not create dependence. This will require more joined-up working between local authorities and Primary Care Trusts (PCTs), which is now improving thanks to increased co-terminosity – councils and PCTs covering the same areas. We recognise that elderly people want to stay in their own home and outside institutions for as long as possible and this will influence our reforms as part of our choice agenda.
- What more needs to be done to join up health and social care?
- Can the public sector make better use of the work being carried out by the voluntary sector in the provision of social care?
- What role do local councillors have in ensuring these services are improved?
Older people
We recognise that elderly people want to stay in their own homes and outside institutions for as long as possible. As part of our choice agenda, we will develop a strategy for long term care that aims to promote independent living for elderly people wherever possible.
Labour is working to improve standards of care and ensure fair access to services for all older people. As they get older, people can require different levels of care. Labour has invested money in a range of new initiatives, including:
- free NHS nursing care in all settings since October 2001
- substantial investment in intermediate care
- property is disregarded from the means test for residential accommodation for the first 12 weeks of a permanent move into a care home
- deferred payments scheme, whereby people can delay selling their homes in order to meet care costs; councils have been given a grant to help them introduce this scheme
- raising the capital limits below which individuals will receive financial assistance to pay towards their care.
Labour has introduced measures to significantly reduce the number of older people delayed in hospital because care facilities in the community are not in place. By placing a financial penalty on local authorities who do not meet the needs of older people moving from hospital, we have significantly improved services and reduced the number of older people detained in hospital unnecessarily.
- What more can we do to encourage local government and the health service to work together for the benefit of vulnerable older people?
In total. we are now spending £1.5 billion on introducing free nursing care in England, expanding services for all older people who need them, enabling them to be more independent and to delay, or even avoid, the need for them to enter residential or nursing home care.
We launched our National Service Framework for Older People in March 2001. This is ensuring that older people who have mental health problems have access to integrated mental health services, provided by the NHS and local councils, to ensure effective treatment and support.
And Labour’s Protection of Vulnerable Adults (POVA) Act came into force in June 2004. This provides an additional safety check for those working with the elderly and other vulnerable adults to help protect against abuse in care homes.
A new focus on improving mental health
We are committed to improving the provision of mental health services and make them more focused on the needs of the individual. We have a three part strategy to help deliver mental health services that serve the interests of patients and society; substantially increasing investment in mental health services, developing new and innovative community services and improving mental health law. The current Mental Health Act is now more than 20 years old. So we will be amending it to bring in a number of changes to help protect patients and the wider public from harm, to strengthen patient safeguards and keep pace with the growth of modern, community based services.
We have recently announced measures to improve mental wellbeing through greater use of psychological therapies, through a focus on mental wellbeing in preventive work with older people and through giving people more information and support on how to stay mentally and emotionally well.
We are expanding access to counselling and talking therapies for people suffering from depression. Clinical evidence shows that better access to therapies such as Cognitive Behavioural Therapy (CBT) can help cure depression and reduce time off work due to ill-health. Patients also prefer to receive talking therapies than medication. So we will run pilot sites in Doncaster and Newham to bring together key programmes in the NHS, voluntary sector and local provide evidence of the effectiveness of investing in talking therapies.
We are working with colleagues across government to ensure that each health and local authority has a clear gateway for prisoners to specialist mental health services, counseling, addiction and other services.
Research shows that people from black and minority ethnic (BME) communities can suffer from inequalities in access to mental health services, in their experience of those services, and in the outcome of those services. For example, BME patients are significantly more likely to be detained compulsorily or diagnosed with schizophrenia. The Department of Health’s Delivering Race Equality programme is a comprehensive action plan for eliminating discrimination and achieving equality in mental health care for all BME patients.
We are reforming mental health services through new national standards and we are putting in the necessary investment to provide the right range of services – whether in community services or acute services. Until 1997, no special funding was available for mental health services. That funding is now there, over the long-term, and will mean that by 2008 every person who needs it will have access to comprehensive community, hospital and primary mental health services with round-the-clock crisis resolution and assertive outreach services available to all who need them.
However we recognise there is still a long way to go to ensure all sections of our community get the mental health services they need.
- What more needs to be done to prevent mental health problems and provide more services in the community?
- How can we improve mental health services for black and minority ethnic communities?
Promoting independent living
For too long social work has been perceived as a gatekeeper or rationer of services and has been accused, sometimes unfairly, of fostering dependence rather than independence. We want to create a different environment, which reinforces the core social work values of supporting individuals to take control of their own lives, and to make the choices which work for them. We want to move to a system where adults are able to take greater control of their lives. We want to provide better information and sign posting to allow people to retain responsibility, and to put people at the centre of assessing their own needs and how those needs can best be met.
We need to provide services with an emphasis on preventing problems and ensure that social care and the NHS work on a shared agenda to help maintain the independence of individuals; and ensure people with the highest needs receive the support and protection needed for their own well-being and the safety of society.
In order to offer more control, more choice and high-quality support for those who use care service, we want to make wider use of direct payments and the piloting of individual budgets. Our reform will provide a greater focus on preventive services to allow for early, targeted interventions and a strong strategic and leadership role for local government, working in partnership with other agencies, including primary care trusts (PCTs) and the independent and voluntary sectors.
People who use social care services say that the service is only as good as the person delivering it. They value social care practitioners who have a combination of the right human qualities as well as the necessary knowledge and skills. The workforce is therefore critical to delivery. We want to support all staff to move to a model which supports and promotes the independence of service users and carers. We are supporting initiatives in improving leadership and modernising the workforce.
- How do we attract the right people to careers in social care?
- And how do we best support those in frontline roles?
Carers
Labour recognises the often unsung role that millions of carers perform every day. Six million people care’ for relatives or friends with long term needs. Many carers have to reduce or give up their own work and their own health suffers.
The national strategy for carers, the first ever by a government in Britain, is one example of Labour’s commitment to the needs of carers as well as the cared for; and means carers will have better information, be better supported and have better access to the health service.
Labour is committed to ensuring that short-term, home-based respite support is established for carers, to deal with emergencies. Labour have dramatically increased the funding for the Carers grant in order to give carers a break or provide direct services to carers to support them in their role. We are currently consulting on extending the right to request flexible working to carers, which would offer carers more opportunity to balance their caring responsibilities with work commitments.
In response to what carers themselves have told us, we will establish an Expert Carers Programme, similar to the Expert Patients Programme, to support carers with the skills they need in looking after their own health and that of the person they care for.
Labour has provided support through the carer’s allowance – £44.35 a week. Today 425,000 people are benefiting from an annual allocation of just over £1 billion and there are on average 8,000 new claimants receiving the benefit every month.
And carers will also have access to other help through the social security system, including the Carer Premium and the additional amount paid in Pension Credit, currently £25.55 a week. The Pensions Reform White Paper will modernise the basic and second state pensions by rewarding social contributions and cash contributions equally
By offering weekly credits for mothers and carers and by reducing to 30 the number of years you need to contribute for a full state pension, we will deliver a fairer system where more carers will qualify for a state pension and will not be punished for their time out of the labour market.
- How do we ensure carers maintain a decent quality of life?
- What can we do for the growing number of young carers?