The full documents – on the Labour Party website

Submissions received by the 8 June will be made available to NPF representatives from the relevant division ahead of the meeting on 16/17 June. Submissions received after this date will go to the relevant policy commission for consideration post-NPF.

These are the questions on health to which the Party is looking for answers:

• How can we ensure a better experience of patient care?
• How can we better extend services to hard to reach families and communities?
• How should the health and social care service be funded in the future?
• How should we best integrate physical, mental and public health services and social care?
• How can the NHS promote better mental health and well-being across the population, for example?
• How can services be made more accountable to patients, public and staff?
• What would you list as the key principles for any health and social care service?
• How do we best put patients back at the heart of the NHS and reintroduce cooperation rather than a market free for all?
• What aspects of your local NHS could be improved upon?
• Are there positive examples in your local NHS that others could learn from?
• How can local and national governments build health into all policies, and what can we learn from health policy in Northern Ireland, Scotland and Wales?
• How do you think the NHS can best work to reduce health inequalities?
• Which services need to work together to tackle health inequalities?
• How can health and social care services be integrated locally to deliver the seamless quality in care service provision that patients have requested?
• What kind of service do we want to see for carers and families are there any examples of local services that are working well?
• What can we learn from the Dilnot Commissions about to how we fund social care?
• What can we learn from the Scottish example of providing free personal care?

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  1. Martin says:

    We want more public health

    1. Jo Jewell says:

      Martin, I absolutely agree with the need to include more of a focus on public health and prevention policies. It’s a concern not to see this as an underlying principle of the whole health chapter, and worse yet that there’s not even a sub-section dedicated to public health. While it is addressed somewhat under health inequalities, even then the first question is on what the NHS can do to tackle health inequalities.

      It would be good for this document to try to tease out the relationship between social inequity and health inequalities – looking at the relationship between health, employment, education, living conditions and the urban environment etc.

      Furthermore, given the focus on healthy ageing and the need to reduce costs of the NHS, the health chapter should explicitly address risk factors for NCDs, including tobacco, alcohol, unhealthy diet and sedentary lifestyles. By putting the most effective policies in place – such as stronger restrictions on marketing and promotion of unhealthy foods – you will reduce the burden of disease.

      Finally, a life course approach that recognises the importance of critical life stages for health, including early infant and childhood settings, would be valuable.

    2. Martin says:

      We need to think more about the links between physical and mental health
      Isn’t that a key to health inequality?

    3. Ken Kirk says:

      I would like to ask the Labour Party, to which I used to belong, whether the introduction of private providers, a process which it started and now as we all know continued by the Coalition, has genuinely brought value for money and a better health outcomes. This would be achieved if the party would ask independent economic advisers, the selection of which must represent a distribution across the spectrum of economic thinking and not weighted to market philosphy, whether the building of hospitals and clinics under PFI, Independent Sector Treatment Centres, Darzi Clinics, the privatising of so many services in hospitals, have been money well spent. Or if these were provided by the public sector or were financed directly by public bodies, whether it would represent a cheaper and effective alternative.
      Labour to gain credibility must start voicing the concerns that the market can not provide all policy solutions, and that it must start this process by admitting that its failure to regulate the financial sector (albeit a process initiated by Thatcher) was to blame for the economic crisis.

      1. socadmin says:

        I don’t think anyone in the labour party would say that the market is the answer to everything. The question is whether it is the answer to anything.

  2. Bob Hudson says:

    The dust has scarcely had time to settle on the NHS and Social Care Act, but already the air is thick with the language of ‘resistance’. Conferences of the cognoscenti are being held, Twitter continues to be awash with expressions of outrage, left-leaning think tanks and bloggers monitor the awarding of NHS contracts to the private sector, and there are moves by clinicians to field ‘Defend the NHS’ candidates at the next general election. At local level, sympathisers are being urged to secure membership of Foundation Trust governing bodies, CCG boards and Local HealthWatch bodies, populate patient participation groups in GP practices and use the new Health and Wellbeing Boards to tone down the market-facing aspects of the Act.
    All of this could certainly have some effect, but whether it will add up to anything more than nuisance value is debatable. The plain fact is that in myriad ways the Act has opened up the NHS to market-facing activity, and a paradigm shift from a public service to a fragmented utility united by little more than a common logo is already underway. The only realistic means of resisting or reversing this lies at the highest political level, and with Labour riding so high in the polls, the party’s messages on the NHS are now taking on huge significance.
    At one level the message seems clear and radical, with both Ed Miliband and Andy Burnham talking of ‘repeal’, but caution and timidity lurk beneath the headline. This is seen most clearly in Ed Miliband’s recent speech to the Royal College of Nursing in which he said he would not seek to repeal the whole Act but would focus on the three ‘biggest concerns’:
     the 49% private patient cap
     ‘reframing’ the role of Monitor
     stopping GPs commissioning from themselves
    In truth, this is very timid stuff. For most FTs the 49% cap will never be a reality anyway, whilst a more radical stance would explore removing the NHS entirely from the effects of competition law, thereby rendering the other two issues redundant. Extrication of the NHS from EU competition legislation would doubtless be legally fraught but it is the sort of commitment that would put clear red water between Coalition and Opposition.
    What seems to be missing so far from Labour’s position is any real feel for the moral argument that healthcare should not be considered a suitable matter for commodification and marketisation. This is precisely the central argument of the popular philosopher Michael Sandel in his new book What Money Can’t Buy: the Moral Limits of Markets, and the Labour leadership would do well to draw upon his ideas. He argues that the financial crisis has done more than cast doubt on the ability of markets to allocate risk efficiently, it has also prompted a widespread sense that markets have become detached from morals. This is as true of healthcare as other spheres, and has been seen starkly with the Southern Cross and PIP breast implant scandals, both of which sent Government into a policy tailspin.
    Sandel’s concern is that we have, without any real debate, drifted from having a market economy to being a market society. Markets and market values have penetrated into spheres in which they do not belong and we need a public debate about the moral limits of markets – not merely about some technical hindrances to market entry such a lower private patient cap in healthcare.
    Another of Sandel’s central arguments is that market values have the power to crowd out non-market values that are worth caring about – ‘the question of markets is really a question about how we want to live together’. The way in which we organise our healthcare is surely a litmus test of the moral limits of markets. Raising the debate in stark moral terms is something we should be able to expect from the Labour Party – after all it was Bevan himself who claimed the party was a moral crusade or it was nothing.
    There may well be more of an appetite for a moral stance amongst voters than has been evident for many decades. The recent massive swing in opinion polls from Conservative to Labour must surely be in good part accounted for by perceptions of unfairness in the distribution of resources and the feeling that a ‘feral elite’ is benefiting at the expense of the mass of the population. Parcelling out the NHS to private sector providers (even if most care for now remains free at the point of use) is not a popular political or moral decision. This is precisely the moment for the Labour Party to stand up for the NHS as one of the last bastions of ‘social solidarity’ – a way of organising crucial resources as an expression of the moral obligations that most citizens feel for each other. It would be the right thing to do – and wonderfully popular!

    1. Fantastic, prescient comments by Bob. Rather than flawed attempts to make a market ‘nicer’ the Labour party needs to demonstrate commitment to politically popular arguments that there are some areas – health being one of the most obvious – where there is no place for an increased role for markets. In terms of the philosophical and moral principles, the kind of society we want to live in, this argument is compellingly presented in the book Bob mentions, the summary of which should be required reading for all policy makers Politically popular? Yes. Fewer than one in 5 people (Ipsos Mori Feb 2012) want any more private sector involvement in the NHS and these attitudes have in fact hardened over the last year, no doubt as a result of Burnham’s more effective campaigning against the Bill, amongst other things.

      As for attempts to remove the NHS from EU Procurement Law, everyone needs to look carefully at what has actually happened since the purchaser provider split, what the law says and doesn’t say (even in light of the bill) and realise that there is clearly no LEGAL requirement to go to tender, that commissioners retain (and exercise) decision making power whatever government says. But that it often suits commisioners (as we saw in Gloucestershire) to infer there is a legal imperitive because they do not want to damage their careers by standing up to central government’s ‘direction of travel’, as they can. Once you go to tender, all bets are off and Vigin et al will inevitably dominate whatever tinkering round the edges you do. But there is no requirement to tender if services are transferred from one state body to another, as indeed has happened in much of the country and continues to happen post Act (see for example Cornwall recently).

    2. Katy Gardner says:

      Although this is a huge and complex area I do agree that now is the right time to at least make some sort of moral stance about the NHS and about what sort of society we want. A book called “Intelligent kindness” recoomended in BMJ by Dr Iona Heath mkes this argument very coherently, linking the changing culture in the NHS towards markets and competition away from a focus on caring and compassion, to our increasingly unequal society. I do think people are ready to ask what kind of society we want and the NHS is a pivotal part of that debate and the Labour Party needs to be brave about it . As for well being this is obvioulsy not something that the NHS can do or at the most make a tiny impact on it. This is the time to really focus on the issues hilighted in the Spirit Level.

  3. David Pavett says:

    I think that there is a real problem with the questions in the Policy Review documents and the one on health is no exception. The first problem is that the one thing the policy review documents do not do is to review policy past or present. They are full of waffle and pious wishes e.g. “Many demands on the NHS cannot be met and tackled by the NHS alone. As demands on the NHS are increasing it is essential that we enhance the NHS for the next generation”.
    Of course, we all know that bad housing and poverty have health consequences but there is no point in a statement intended to develop policy merely to make vague allusions to such facts. There is plenty of research on such things. Policy documents should summarise such material and quantify, at least in approximate terms, their effects. Without that they cannot play a part in the formation of policy and might as well not be mentioned.
    Having failed to review policy and failed to provide crucial data the document also fails to provide Party members with considered alternatives to consider which, as everyone one knows, is a vital part of any process of reaching policy decisions in an area as complex as health.
    In this context the questions posed for consideration to Party members are a real distraction from genuine policy debate. They invite members to draw up wish lists of various services they would like to be satisfied but not based on analysis or data (since none is provided). The result is likely to be a cacophonic list of demands involving many different levels of policy consideration. Given such a response the Party’s policy wonks can carry on as before making up policy just as they see fit irrespective of the whole policy review process.
    Therefore I would caution against merely responding to the questions given. The document is not fit for purpose. Once might be able to provide policy markers in giving answers to some of the questions but it will surely be at least as important to draw up a list of points and problems which are ignored by the document even though they are well known issues.
    I am not a health worker but I was struck by the failure to mention PFI funding and its consequences for the NHS. There is nothing specific on NHS organisation. It should not go that the mantra “With Labour, the NHS will always be a comprehensive universal health service, free at the point of need” is simply untrue – as a visit to the dentist or optician will soon demonstrate. I could go on but I am sure that health workers could do this more easily than me.
    I could make plenty of suggestions as to how patient care could be improved but I am not at all convinced that there is any point in doing so in the context of this document for the reasons given above.

    1. I agree with you on many levels David. However I would encourage people to shoehorn their points into questions which I agree are unhelpfully designed. My understanding of the NPF process is that debate is carefully stage managed and the only opportunity delegates get to raise issues is under these proscribed questions. Anything else will be ignored, I suspect. Of course whether engaging with the NPF process and the extent to which it is a democractic reflection of anything in the current party constitution is debatable, but for those with the time I guess its worth a go, though I would also encourage people to work with their local CLPs and unions to put forward submissions (though again, shoehorned into these questions if possible) and indeed most of all to engage with local media & local grassroots campaigns such as KONP to put maximum pressure on politicians to really listen to us.

      1. socadmin says:

        Caroline is too pessimistic, and also too optimistic. At this stage of the NPF process any kind of comments are allowed. But there is only a week between the 8th June and the NPF weekend on 15th, so if many comments come in they will overwhelm the very small numbers of policy staff who are supposed to read and process them. But if people post stuff here I guarantee at least one member of the policy commission will read them.

  4. socadmin says:

    “Policy is about illustrations of a deeper story, the establishment of a deeper sentiment which Labour had and it lost,” – John Cruddas.

    The points made above are quite valid, but I don’t think they take us forward much. We have an opportunity to respond. We don’t have to answer the questions – we can certainly say they aren’t the right questions, but we need to be more positive than that. And David Pavett is wrong on one point – there aren’t a load of policy works in Labour HQ waiting to progress a secret agenda. The reason these documents are so thin is that there isn’t much behind the scenes.

    1. David Pavett says:

      I said wonks not works!

      I think that as well as pointing out the failure of the documents to deliver what they were supposed to deliver (a policy review) which, I think should be done, I said that definite (“positive”) points should be made. I even suggested a few.

  5. Terry Walters says:

    The reason I left the party back in 2005 was that as a senior manager in the NHS I could see that the party leadership’s rhetoric was totally (and cynically) at odds with the effects of the practical effects of its own policies. Among these was the further development of the NHS internal market. What we have now is hundreds of organisations (hospital Trusts, PCTs – soon CCGs – Foundation Trusts, SHAs) who judge themselves as independent business organisations. While we all have to take responsibility for our own competence, we have a situation that encourages sub-optimal organisational goals at the expense of the common good. Our NHS leaders and our politicians are putting themselves before the population because the system encourages them to do so.

    The sad thing is that, as a result, our old people don’t get the care they need and deserve because we treat the problems as individual failures rather than as failures of the system as a whole.

    The only way to identify the real issues and deal with them is to stop getting distracted by the NHS market. It has not yielded the benefits it was intended to over the last 20 years. Sadly I don’t see the current leadership having the courage to do the right thing (certainly not judging form Andy Burnham’s refusal to recognise Labour’s part in creating the current system). So I won’t be re-joining the party any time soon.

  6. Are you tired of Labour councillors (yes Labour councillors) who complain about the “Tory cuts” then go ahead and vote for them? And the current attack on public sector pensions is spearheaded by Labour Peer Lord Hutton. Labour began the current wave of privatisation and they are hopelessly compromised when it comes to opposing “Tory cuts” and “Tory privatisation”.

    The word “traitors” is a bit strong I suppose? The people who created the NHS must be turning in their graves though.

  7. Trevor Cheeseman says:

    I’m all for a bit of debate but the tone of this one risks becoming quite negative before it has even started. Two (?uncomfortable) truthes:

    1. Labour’s boast to have “saved” the NHS is no idle one, in that the NHS was massivley improved when they left office compared to 1997. Public satisfaction at record highs; waiting times down to just weeks from surgery to theatre; outcomes in terms of stroke, herat disease, cancer care, hospital mortality all significantly improved; an NHS Constituion; infrasturcture renewed (OK with PFI but they are fit for another generation or two at least); NHS staff pay restored to a reasonable level. These, and more, have to be acknowledged, folks.

    2. Labour in 2015 would/will inherit a country (and finances) significantly poorer from 5 years of ConDem austerity. No doubt the NHS will be a funding priority (lets hope social care is too!), but against the usual rising demand from technology/demographics requiring 3% increase to “stand still”, there will be hard choices ahead. In practice, this means that Labout will continue to wrestle with the issue – which it did throughout 13 years of running the NHS: how do you drive service development, innovation and spread of good practice across a £110billion organisation?

    In practice, Labout used, a little competition, significant funding growth, a strong targets/performance management regime, a payment systems squewed to acute providers and GPs, various improvement intitiatives, and professional-led clinical audit processes.

    The key question now is: what mixture of these and other approaches should be used to drive necessary change? The argument that markets are not the way forward has been won for now, thanks to the anit-reform movement, but that in inteslf, though welcome, does not answer the question. It also ignores how to tackle the crisis in social care where the market predominates.

    Personally, I favour a revised tariff system to incentivise progressive care (often in community settings) for long term conditions and elements of elderly care, efforts to enhance self care for long term conditions, selected rationalisation of acute services to improve outcomes, stronger links with medical Royal Colleges to incentivise condition by condition improvement in outcomes, an enhanced set of minimum standards in the NHS constitution, plus additional incentives for more integrated health and social care.

    How would others answer this question?

  8. Steve Iliffe says:

    Here are a few answers to the long list of questions:
    How can we ensure a better experience of patient care?
    New Labour governments did this well, by focusing on two things, timely treatment and forward deployment of expertise. Timely treatment includes reduced waiting lists and times, faster attention in general practice and A&E departments, and fast tracking of patients with suspected cancer. These achievements may be eroded by the current government’s policy, and need to be defended. They show the advantages of central direction of the NHS.

    The best example of forward deployment of expertise is the change in the consultant contract to make senior staff more available, working closer to the front line. This has the potential to make treatment decisions more appropriate to the patient, and to offer better care, provided that a range of services are available to deliver the treatment options. So, for example, an individual seen in the A&E department may need investigation in a 24 hour medical assessment unit, observation and review in a 72 hour ward, admission for therapy to an acute ward, simple treatment that can be given at home, or short-term home-based care by a ‘hospital at home’ service. This planned segmentation and diversification of services is an alternative to a market-driven menu of choices.

    There are two problems with this approach. There is resistance to it amongst hospital doctors, especially those in training, who are uncomfortable with the out-of-hours work that it entails. And we do not yet know how to restore the gatekeeper function of general practitioners, which is being so eroded by consumer pressure that referrals to all specialities are rising.

    How should health and social care services be funded in the future?
    As in the past, with a mixed economy of public sector, public domain, charities and commercial organisations. The NHS has shown how effective franchising can be, with thriving networks of general practitioners, dentists, pharmacists and opticians; this government seems likely to add hearing centres to this list, and possibly physiotherapy. A future government might extend the franchise approach to care homes, which are struggling to provide adequate services for frail older people within an obsolete business model.

    Charities have added hospice care, community-based services for people with dementia, sexual health and abortion services to the NHS, and act as sources of innovation. The commercial sector can supplement the NHS and and also stimulate change, as with day-case surgery, but it is economically vulnerable and can easily loose out in competition with the NHS.

    A mixed economy of the kind we have had in the NHS since 1948 requires some form of provider-purchaser split.

    The policy problem that remains is Wanless’ “full engagement” scenario, in which the NHS remains economically viable only if the population is fully engaged in staying healthy. This is a utopian expectation in one sense, because it emphasises a rational approach to an emotive problem, but it is important because it focuses attention on both lifestyle and environment, and the actions that government can take to make both healthy.

    How should we best integrate physical, mental and public health services and social care?
    By developing vertically integrated structures serving communities, stretching from the GP surgery, social services and the care home to the hospital. There are few reasons for keeping social work within local government, and this discipline should be relocated in the NHS. Hospitals can embed themselves in communities by incorporating community-based services into their organisations, on the US model. Integrated services can compete around their geographical margins, but essentially act as ‘industrial markets’ in which resources are balanced to keep all components of the service in good order.

    In the past this approach to integration has been risky for community services because specialist services use up all the resources they can access; the saying that “nothing grows in the shadow of a teaching hospital” reflects this. This risk may now be less because hospitals are franchisees of the NHS, and therefore obliged to work to contracts determined by commissioners. The problem that remains is that commissioners need to be independent of providers, which they will not be under the Health & Social Care Act.

    How can the NHS promote better mental health and well-being across the population?
    These are two separate questions. Mental health is established in childhood and young adulthood, so resources should be targeted at parents and children to promote mindfulness, self-efficacy and positive coping strategies; New Labour did this well with Sure Start but there needs to be an extension of this thinking into the teenage years, involving Education as well as the NHS.

    Well-being is subjective ‘feel-good’ experience that is distributed across the age span in a U-shaped form, with peaks in childhood and adolescence, and in later life. The trough in well-being is in the 30s and 40s, perhaps earlier for women than men. This is the young parent population, which experiences substantial economic stress and which is also the most critical of the NHS. Rising well-being seems to be associated with consumption (eat, drink and be merry?) that is not necessarily healthy, and with increasing reluctance to prioritise health care. So, at the individual level there is some evidence that those with higher life satisfaction are less likely to act on threatening symptoms, and a social level there may be political resistance to spending on health services.

    How do we best put patients back at the heart of the NHS and re-introduce co-operation rather than a market free-for-all?
    First, by abandoning myths. Patients as individuals were never at the “heart” of the NHS, co-operation has always been difficult to achieve and sustain in the NHS (without forceful management) and we don’t have a “market free-for-all” in health services (which country does?). The NHS is a utilitarian institution concerned with the greatest good for the greatest number, in which rationing can be either implicit or explicit. As a central allocation economy, it defaults to formation of queues, ‘demand management’ and assembly line forms of provision (that is, efficiencies for staff at the expense of patients).

    The levels of collaboration needed to provide patient-centred care are difficult to develop between competing professional interest groups, and require very powerful management with clear perspectives on quality. One of the attractions of market mechanisms is that they promise to apply such management, but they require the same kind of motivated leadership as public-sector style management, and this is not easy to foster. Thinking about the range of ways in which innovation in service provision can be promoted is perhaps a more important theme for Labour to pursue than a naïve focus on cooperation as a mechanism for change. The objective may be to shift the balance from assembly line methods of working to craft-based tailoring of treatments, which professionals prefer. One example of this is discharge planning, which has been promoted with variable success in the NHS for two decades or more, yet still remains a problem. The commercial sector could have positive as well as negative lessons to teach us.

    How can the NHS best work to reduce health inequalities?
    Part of the answer lies in prioritising “deep end” work – deploying the resources needed to work in deprived communities, developing the social marketing methods that reach deprived populations, and establishing an inclusive community orientation within the local NHS. The US experience of working with underserved populations may help us here.

    A problem that is difficult to approach is that of income differentials. Narrowing the income gap is critical to reducing health inequalities, and this is likely to have an impact on the income of highly-paid professionals. For example, we have the highest paid family doctors in the world, who are providing less continuity of care and weaker gate-keeping to specialist services than at any time in their discipline’s history. There is a clear question about value for money in this situation, and the market will ask it. This government’s policies seem likely to bring it into conflict with the medical profession over pensions, but also over erosion of professional income in an increasingly competitive environment.

    A Labour government elected in 2015 could face very hostile professional groups wanting the restoration of their privileged position. This may not be possible and it may not be desirable either, since the professions (medicine in particular) have no given right to salaries in the top 10% of incomes. How this is handled politically may determine whether the rising generation of professionals remain faithful to the NHS. If they do, it will be because they trade income for something else, like more autonomy (control over their work) or more power (control over resources). The discussions about trade-off’s need to begin soon.

  9. Eoin Clarke says:

    On 24 separate occasions since the NHS Bill became law, Andy Burnham and Ed Miliband have said that they will repeal the NHS Bill. Upon closer examination of their detailed comments about what form this will take, we can say that they include:

    1. Awarding the NHS Preferred Bidder Status in the tendering process.
    2. Repealing the 49% Cap of Private Sector Involvement in the NHS.
    3. Preventing CCGs commissioning to themselves.
    4. Reforming MONITOR but in a way that is unclear.

    None of this goes far enough and to me it is no wonder that an NHS party has been formed with a view to contesting seats at the next election. Below, I outline the policies Labour should be embracing on the NHS if we are to present ourselves as a radical alternative to the Tories on Health.

    1. We need to support François Hollande’s attempts to enshrine in EU Law the right of all EU citizens to have access to a publicly funded healthcare system. This important principle if agreed would have the added benefit of reducing health tourism as well as extending the rights we have enjoyed since 1948 to other EU citizens including those in our neighbouring Irish Republic.

    2. We need to seek opt outs of EU regulations 103 & 104 that open up the NHS to EU Competition Law. This can be done by legislation in the sovereign parliament exempting our healthcare from these elements of EU. It could also be further secured by coordinating Hollande’s planned EU law to include protection from public health systems from competition law.

    3. A De-Marketisation Act: We need to commit to de-marketising our health service. The crude image of a la carte menus of operations offered and their prices runs alien to the ethos of our care. I should not know that £107 will get my partner a pregnancy scan. I should not know that £199 gets me an MRI scan. I should not receive brochures and pamphlets inviting me to book special rooms at the Hospital or Hospital hotel for the duration of my operation. A complete an utter de-marketisation of our public healthcare is required, perhaps through a de-marketisation bill. NHS Hospitals should be cashless societies.

    It might also be necessary to explore all of the structures that Lansley’s bill has created. If the CCGs were to remain then the Senate should be given teeth. Monitor could be dramatically downgraded and its powers dispersed to regional NHS Senates. Healthwatch pending its effective functioning should also potentially be retained and given powers to refer matters to the judiciary if need be.

  10. Penny Barber says:

    To improve the patient experience, remind & re-inforce health professionals existing codes if conduct & guidance on consent to treatment & confidentiality. All too often you hear if cases where informed consent was not the approach to offering and selecting treatment. I continue to be shocked by how easily many health professionals just gossip about patients thinking it’s ok if they don’t give the name OR merrily release information to relatives without ensuring there is consent for this, sometimes information will be given to others that has not been given to the patient. So reinforce respect!

    Ensuring any organisation and establishment providing healthcare is brought into the scope if the care quality commission and registered. Ignore the flack they gave taken, the registration proces, the ensuring of best practice & evidence of this are good and sensible and what should be happening anyway. The inspectors are great – practical people who care about patients & are wise to their contradictions. This alone should ensure GP practices and hospitals are welcoming and staff are not permitted to be judgemental.

    Public health moving to local authorities gives all labour authorities the opportunity to continue the good work labour did in government. The teenage pregnancy strategy was an amazing achievement – the lowest rates in 30 years. It’s hard work, it’s well evidenced partnership work and the rates will rise if the work slides. Attractively, Kings Fund figures show every £1 spent on contraceptive services saves £11 – and that’s an in year saving. Ensuring men & women of all ages can have full control if their fertility us something Labour should be wholeheartedly behind.

    Risk taking behaviour more generally should be prioritised & linked to mental health & emotional well being. Labour did great work in schools (I think SEAL was one programme) ensuring children & young people were emotionally literate. Labour very nearly made Sex & Relationship Education compulsory – we should continue to promote this so that children & young people are protected from abuse & equipped to meet puberty and the pressures of later life n our very sexualised society.

    1. socadmin says:

      I though any organisation and establishment providing healthcare is already in the scope of the care quality commission and registered?

      1. Graham Brack says:

        Pharmacies aren’t registered with CQC, Martin.

        1. socadmin says:

          Should they be? Does all this regulation make a difference?

  11. Integrating health and social care without thinking about those they are there to serve is no good. It still leaves them skulking in a ghetto of scary hospitals and clinics and offices. We need person-centred services. And the most acute need, and the greatest expertise to bring it about, is in the world of profound and multiple disabilities, so let’s invest there to learn.

    I’d like Labour to commit to integrate health and social care into the lives of those who require that care. One example is that care for children’s health should be delivered at home and school where children are, not in remote and forbidding medical temples. Sure Start has a lot to teach us I hope. My initial request is simpler than a new service though – a redesign of services for children with complex needs and multiple disabilities, as a start, by reinvesting that part of the NHS which is locked away into services that are strongly bound to the special schools and SEN services those children regularly use. In other words, more school nurses with the power to act as lead professional on behalf of the children in their school, facilities to conduct clinics in school and a mandate to all consultants, however important, to travel to the children not the other way around. Regular reviews are needed with the family at the core and school, health, respite and other services curled supportively and lovingly around the family and the child. I propose heavy fines or replacement for those professionals who don’t attend. Any further ideas about how we can turn the NHS inside out so it becomes centred on the person requiring care, not the institution or professions providing it?

  12. Mark Burton says:

    I’ve tried to answer the questions in the Labour Party doc.
    * How can we ensure a better experience of patient care? •
    Promote cultural change whereby this is put at the centre of health workers’ responsibilities along with safety and effectiveness. Remove barriers to this (e.g. the pressure under which many front line services work, and remove perverse targets. Promote the involvement of patients and their representatives in reviews of services with an obligation on service management to respond with action plans.
    * How can we better extend services to hard to reach families and communities? •
    Promote neighbourhood-based services, integrated with other public agencies – for example based in local libraries. Emphasise the importance of multiple points of entry to episodes of care and support – not just via primary care. Councils to lead joint plans on reducing social exclusion for hard to reach groups jointly with NHS and related agencies. End the discrimination and pauperization of refugees and asylum seekers.
    * How should the health and social care service be funded in the future? •
    The Labour Party needs to bite this bullet – only by basing these essential services on progressive direct taxation (of both corporations and individuals) will coverage and fairness be achieved. This is the principle of risk pooling which is understood (just about) in relation to health care. Why should social care be any different? To fund the system properly will mean higher taxes – let’s go for it and make them fall fairly in relation to wealth and income thus reversing 30 years of disastrous neoliberal policies under Tory and New Labour governments.
    * How should we best integrate physical, mental and public health services and social care?
    Recognise that the Dobson model of PCTs got this partly right- combining public health, primary care and community health services – the opportunities of this innovation were squandered by the neoliberal turn in Labour health policy under Hewitt and Milburn.
    However the innovation only went so far – failing to integrate social care and mental health. This means revisiting Bevan’s original vision of health services coming under local authority leadership (also the Sandinavian model, where it works pretty well) – but this can’t be achieved in one step. First LA’s need their budgets restoring, then they need renovating to combine representative and direct democratic processes. The move of public health to LA’s is one step in the right direction. A bigger challenge is primary care which needs effective strategic management, something the commissioning fixation of recent policy singularly fails to provide.
    To some extent the answer lies in thinking not so much about ‘services’ as in the construction of a different kind of society, one that focuses on human development as its primary end – a socialist society that, inter alia, has effective services. So, for example we could learn from some of the Brazilian experience of community mental health social movements that work to re-integrate people suffering mental distress in not just social groups but in social action t construct a new social reality. The locality focus mentioned above in relation to hard t reach groups is also relevant here.
    * How can the NHS promote better mental health and well-being across the population, for example?
    By having the power to determine policies that affect health – for example alcohol marketing and prices, gambling, employment practices – beyond the traditional sphere of health services.
    Restore effective health screening in schools (currently this is now just in reception and year 6, and then only minimalist), and do away with the pernicious over-emphasis on parental choice, both in terms of school choice and in terms of referral – for example for seriously obese children.
    Again, however, there needs to be a radical rethink of how our society operates – the NHS within the context of a caring, socially inclusive society rather than as a mitigation of a system that exists for the perpetuation of capital. Transformation of this sort would take a generation and requires investment in community development (more singing for example) linked to new democratic and participative processes and structures – sorry but you can’t deal with these big questions with a narrow focus on the NHS.
    * How can services be made more accountable to patients, public and staff?
    1) By introduction of democracy to the NHS – and this needs to be for provider organizations as well as for commissioning ones (if we stick with this wasteful split).
    2) By introducing deliberative democratic processes for policy decisions at local, regional and national level (the Brazilian participatory budgeting process is one viable model of this).
    3) Make very public the expectations of basic courtesy and kindness required of all health staff – I had a hospital appointment yesterday and only one of the two staff who attended me bothered to introduce himself. My mother was in hospital last summer and still staff came and did interventions on the ward without explanation or introduction.
    * What would you list as the key principles for any health and social care service?
    1) Comprehensiveness, universality and equality of access and quality.
    2) Free at the point of delivery and in social ownership.
    3) Responsive to individual and collective need.
    4) Integrated into a social system that prioritises human development and care over commodity and capital.
    5) Stewardship: i.e. efficient and responsible in the use of money and human resources (including the time and emotional capital of those who work in and those who depend on it).
    * How do we best put patients back at the heart of the NHS and reintroduce cooperation rather than a market free for all?
    Answered above
    * What aspects of your local NHS could be improved upon? •
    GP services that provide proactive and responsive primary care – they seem to provide ever less.
    Mental health services that are effective, have a social model of mental distress (while treating biological problems) and are integrated into he wider social and health support systems.
    Proper public dentistry system rather than the anarchic patchwork of profit seeking private contractors.
    * Are there positive examples in your local NHS that others could learn from?
    Collaborative partnerships between health and social care in the areas of learning disability (intellectual disability), rehabilitation of older people; community (salaried) dental service. Walk in clinics (before the PCT axed them!
    * How can local and national governments build health into all policies, and what can we learn from health policy in Northern Ireland, Scotland and Wales?
    Building in was answered above – i.e. a reconstruction of the overall social model. From the other nations we can learn about alternative models to the internal market (Wales), about increasing the range of free-at-the-point-of-delivery services (Wales, Scotland), and integration with social care (6 counties of NI).
    * How do you think the NHS can best work to reduce health inequalities? •
    * Which services need to work together to tackle health inequalities?
    This is basically not an NHS issue, although the NHS is the key stakeholder. It has to do with poverty, inequality and disadvantage and requires a serious effort at social change, not just tinkering with a system that destroys lives and planet.
    * How can health and social care services be integrated locally to deliver the seamless quality in care service provision that patients have requested?
    We achieved this in intellectual disability services in Manchester, since 1994 by creating a virtual partnership between health and social care provision under one management which reports to both parent organizations. As a first step local organizations could be mandated to create such arrangements for all the long-term care groups. But a more fundamental reform would be to put all this under a locally democratically accountable organization – the local authority would be first choice, but as noted above this can’t be done all at once.
    * What kind of service do we want to see for carers and families are there any examples of local services that are working well?
    I don’t think there is perfection anywhere. The key principle is to create channels of communication and the opportunity to challenge what the services do – the major improvements in our experience have all come about as a result of this. Some of this can be mandated via policy but a lot comes from local commitment and hard work – easier if there is an enaling policy context.
    * What can we learn from the Dilnot Commissions about to how we fund •
    social care?
    Not a lot – the only sensible answer is a system based on progressive direct taxation as discussed above. Progressive direct taxation includes a means test of course.
    * What can we learn from the Scottish example of providing free personal care?
    1) that it can be done.
    2) we can learn about the limits of this exercise too in order to do better when we implement free personal care based on taxation funded risk pooling in the UK.

    1. Garry Parvin says:

      Good to hear from you Mark.

    2. Graham Brack says:

      When we talk about public dentistry, I think we need to make clear that providing an emergency dental service is not the kind of comprehensive public health dentistry we have in mind. It’s true that most people can (eventually) access a dentist, but the preventative work is not done.

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