The SHA should take the approach taken by its predecessor, the Socialist Medical Association, when it led the fight to create the NHS.  We need to re-establish an NHS publicly owned, publicly run and publicly accountable, funded through taxation with services provided according to need.

Of course, we recognise that there are areas of provision that are not fully publicly provided such as work carried out by opticians, pharmacists and dentists.  Also, GP practices work in such a way that they have to make a profit.  For example, as dental contracts have been tightened more dentists have moved to the private sector.  With GPs, whilst we would wish them all to be salaried and expenses paid for buildings and staff etc, this is not feasible in the short term.  However, we resist the creation of companies of GP practices designed for shareholder returns.

Our fundamental aim should be the removal of the purchaser/provider split which has been developed from the nineties increasingly up to the present time, most damagingly through the Health & Social Care Act in 2012, particularly by means of the Section75 regulations in 2013.  Removing the purchaser/provider split will enable better integration by managers and clinicians working together as planners and providers.  The cost of the present system compared to the purchaser/provider arrangement is huge and has resulted in the NHS costing much more, caused by the costs of staffing as commissioners and finance employees as well as the costs of contracts.  We should continue to resist the cuts and closures and privatisations now being implemented by the Coalition Government.

We have to recognise, however, that a Labour government, if elected, will not go that far.  We want and expect them to repeal the Health & Social Care Act.  In the process we need them to deal with Private Finance Initiatives by a combination of renegotiation and taking their cost centrally off the NHS books.  We want all private contracts to be withdrawn as soon as possible.

In this process we need to recognise the dangers of the EU/US treaty, the Transatlantic Trade and Investment Partnership (TTIP), currently being negotiated under the radar.  We want health and social services exempted from the treaty together with the removal of the disputes procedure – the ISDS – which gives powers to multinational corporations over individual governments and parliaments.

Payment By Results should be removed as it distorts activity by hospitals against the interest of patients.  The ability of hospitals to provide 49% of their activity privately is unacceptable and should be removed. The whole issue of Foundation Trusts should be re-examined to establish a system where hospitals do not compete with each other and are managed solely in the interests of patients.

Specifically, whilst we support moves to develop primary care to reduce pressure on the secondary sector, primary facilities should be built up before making such changes.  Such moves include the use of walk-in centres, urgent care clinics, strengthening GP practice including the provision of more health centres staffed by a wide range of practitioners.  One other factor should be giving power to patients through a return to the old Community Health Councils or similar arrangement.

The Labour party is moving towards a model of care that recognises the important links and relationships between physical health, mental health and social care.  Andy Burnham MP spelt this out when he launched this approach.  The SHA should give its support to Labour in this matter.  The links would be achieved by putting health care fully under local authority control.  This has three advantages: the first is that this approach avoids a further top down reorganisation; the second is that it achieves local democratic accountability; and, thirdly, it brings the cultures of health and social care closer together.  For this to be effective national government should be required to distribute funding according to the needs of local populations.

Whilst supporting labour the SHA should have the aim of achieving free social care on a similar basis to that of health over a period of time.  Now that the Oldham report, set up by the Labour party, has come out the SHA should develop policy on this matter.

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3 Comments

  1. mike roberts says:

    Unfortunately John those running the SHA are hell bent on taking the organisation into commercial activity areas from their own failed previous life or interests which they don’t declare so the real purpose of the NHS will wither as much under Labour as it is under the Coalition.

    However that’s what some people want but need to be honest about it

  2. I agree completely with the opening paragraph about wanting a publicly owned and run NHS free at the point of delivery. Also I recognise the fuzzy boundary described well here for instance in pharmacy and dentistry.

    I have no part in the internal battles of the SHA and I am sorry you feel hurt and excluded Mike.

    What I want to know is how we can get the best outcomes for our communities. I can see how the purchaser provider split introduces inefficiencies but I also remember and can see elsewhere in the world the pitfalls of centralisation and providers having all the power. I am also a democrat anf believe strongly in the right of communities to have authority over public services and the requirement that public servants and their suppliers like GPs and pharma to answer to elected government, probably increasingly local government, for their decisions.

    So how can we replace the current situation with one that injects innovation based on best outcomes and standards of care, using evidence from around the world, with expert and motivated staff in efficient public organisations reporting to elected government and answerable to the people? How can we harness the energy of private enterprise in, for example, pharmacy and medical devices, to develop new treatments without ripping us off? How can the NHS not become the ivory tower of health but instead contribute to a whole country and whole government drive towards healthier lives and greater wellbeing without dominating the debate with resource grabs for the medicalisation of everything?

    Most of all how can we avoid spending all SHA time on questioning motives and debating structures to the exclusion of considering why people are so unhealthy and unhappy and why such gross inequalities exist (and how other societies, across the world and through history have done so much better)?

    1. Mervyn Hyde says:

      DunxE: When you refer to centralised power You are of course forgetting that today power is concentrated far more at the centre than ever before; and that the financial intereststs of a tiny minority are put before those of the bulk of the nation.

      I rather suspect that you are not a socialist and therefore fail to understand the democratic aspirations of those who are.

      Neo-Liberal politics has been the commanding discipline in the political arena now for over forty years, monetarist policies have been used to transfer wealth and power upwards, that of course is centralising power away from people and directly into undemocratic corporate power.

      Politicians preached empowerment of people whilst actively taking that power away from them. The common cry today is that people no longer experience the freedoms they had before and politicians are not listening. The truth of course is they don’t want to hear, they only care about the lobbyists of the corporate sectors, and the Tories are 50% funded by Banks and Hedge Funds.

      New Labour have been complicit in the Neo-Liberal agenda, Ed miliband has actually toyed with the idea calling Labour “Blue Labour,” I really do not think a leader who contemplated using that believed he was appealing to socialists.

      The other side of delivering political promises is how do you achieve them without considering where the money comes from. At present Ed talks in terms of managing the “Deficit,” the deficit being the difference between levels of Taxation raised and the amount of money needed to fund public expenditure. But then the policies of both Labour and Tories have been to reduce Taxation, which should tell any thinking person that flies in the face of defidit reduction, or is deliberate policy to dismantle the state. Which of course is the Neo-Liberal objective that is not only happening here but all over the world, orchestrated for the benefit of a tiny minority of people.

      In the past 10 years the richest minority have seen their wealth increase to obscene levels and still they are not satisfied. 85 people own between them £66.88 Trillion, whilst the money required to eradicate all the poverty in the world runs into billions, not even a trillion.

      Finally the Guardian has exposed the fact that there is no longer a reason to perpetuate the deficit lie and Austerity policies; as the Bank of England has finally admitted that they produce money out of thin air and can meet any financial commitments to fund any level of public expenditure, something MMT Modern Monetary Theory, have been saying since before the financial crash.

      In case you are still unconvinced, why would any sensible government privatise the most efficient,cheapest, most comprehensive health system in the world?

      This link shows a table produced by OECD showing how cost efficient the NHS was compared to all the other countries in the modern world:
      http://content.healthaffairs.org/content/23/3/10/T1.expansion

      Here in Gloucestershire our CCG has notified us that they are now putting our “Out of Hours service” out to tender, when our service was awarded the “National Gold Standard” for OOH services nation wide. People from all over the country and even Europe, visited Gloucestershire to see how they operated. Why would you even consider doing this?

      The real answer is political corruption. Which is why we need to challenge everything that is happening around us.

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