What would you list as the key principles for any health and social care service?

Competition and markets Labour Health Policy SHA policy
Part of our response to the Labour Party Policy consultation June 2012
  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 as democratically determined
  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).
  6. Prevention better than cure
  7. Comprehensiveness should include Occupation Health – and bringing that in should trigger a review of Health and Safety legislation.
  8. Continuity. Not a succession of short term contracts.
  9. NHS preferred provider. Private providers to have a defined role for a defined purpose, e.g. to deal with any peak pressures, or where they have an expertise that the NHS either doesn’t need to develop or can’t develop overnight, or where a non statutory body can get to groups the NHS finds difficult.
  10. A planned service, but may not need the purchaser-provider split.
  11. Health is not a commodity – it can only be produced co-operatively. Minimise the commercialisation of health and healthcare.
  12. The patient is a valued partner at all times. We work with you. Shared decision-making is routine. The patient is the most undervalued resource in the NHS.
  13. Your information is accessible to you. Your information in your hands.
  14.  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.
  15. Put QUALITY as the number one priority for commissioning care.  Access is important but comes behind quality. Doctors can sell this to patients as we are trusted. So now in my area patients travel twice the distance they used to for they heart attack care but receive first class treatment. Politicians can’t sell this but doctors can – this is the key to – clinician led

How do we best put patients back at the heart of the NHS and reintroduce cooperation rather than a market free for all?

  1. 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).
  2. 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.
  3. Responsive to patients (shared decision-making), responsive to communities through community development and other approaches.
  4. Local people involved in commissioning decisions and in provider services.
  5. Your information is accessible to you. Your information in your hands.
  6. Services: Convenient, caring, honest, safe, trustworthy, integrated, efficient.
  7. Scrap Payment by Results – Explore block contracts
  8. Explore cooperative commissioning: commissioning along pathways in such a way that the budget is shared between primary and secondary care. Savings are reinvested in the pathway. This creates an incentive for cooperation, upstream work and efficiency. We are exploring this in Lewisham. http://www.scribd.com/doc/95337680/Cooperative-Commissioning-planning-for-collaboration
  9. Avoiding the purchaser-provider split would help. However, that does not mean abandoning planning. More like the Scottish system.
  10. Local and national govt including health in all policies
  11. Put all health commissioning in the hands of the Local Authority
  12.  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.
  13.  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.

 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?

  1. All policies should be assessed for their impact on health on the basis of evidence, in both the short and long term.
  2. The purchaser-provider split is not essential. Connecting the Planning of a service (often over long lead times) with the delivery (and deliverers) of a service is still preferable and vested interests do not dominate.
  3. Marketisation can be curbed
  4. Commercialisation and marketisation make little difference to quality.
  5. Continuity and slow steady steps make for better planning.
  6. 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).
  7. Wales’ experience of the Planning Forum and its “Strategic Intent and Direction” circa 1987 is still the the best example of anapplied research methodology  showing how best to decide where the best health gain bang for the health care buck can be found.