The document to which these amendments relate  is on the Your Britain website.  At present these are merely proposals the Association is considering.  They are not yet agreed.

Page 3

Line 40 insert ”

Austerity at the same time as cutting the welfare state kills people. We need to invest more in the NHS which is effectively suffering a cut, not a freeze. Renegotiate PFIs where necessary – we cannot any longer allow corporations to hold the NHS to ransom.  90% of NHS work happens in the community which needs more investment, not only to offer a better service but to be able, where appropriate, to offer services that would otherwise have been delivered in hospitals.We make no assumption that community care is always cheaper than hospital care, but it may be in some places for some services.

Page 4

line 7

Delete second paragraph and replace with:-

Labour will restore the duty of the Secretary of State to deliver a comprehensive, universal NHS and will give the Secretary of State the power to give directions to any part of the NHS.

(This will effectively restore Sections 1, 2, 3 and 8 of the NHS Act 2006 whilst extending the scope of S8 to cover all NHS bodies including Foundation Trusts.)

Insert  “Under Labour there will be no more top-down re-organisation of the NHS during the next Parliament”.

line 12 Delete first sentence of the third paragraph and replace with:-

Labour will deliver an NHS that values and promotes collaboration and cooperation. Labour will remove any legal or other barriers which prevent or deter cooperation including any which seek to require NHS services to be competitively tendered.   Labour will replace the system of procurement through commissioning with a system where publicly funded care services are planned and decisions about services and funding are made through open and transparent democratically accountable processes.

(This would effectively remove the whole of part 3 of the H&SC Act and its consequences; restore the idea of an integrated NHS; and remove barriers to organisations working together or even combining structures.)

add ” The NHS will no longer have either an internal nor external market. It will no longer pretend that FTs are free-standing competitive corporations. The duty of the SoS to ensure a comprehensive NHS will be restored. The NHS will be the preferred provider. The private sector will only be allowed to offer patient services if the NHS cannot improve or they can show genuine innovation. ”

Line 30 delete sentence beginning “Instead, we need…”  Insert “The health service must ensure collective and individual accountability throughout. NHS services must be responsive, working closely with local authorities, to needs and wants of the populations they serve, as part of a long term dialogue. All care must be delivered with as much participation in shared decision-making as the patient wishes at the time. In particular, all planning functions must be democratically accountable.  We will ensure the engagement of patients and family / carers in the care process as co-producers of health outcomes and the provision of good information to patients to enable them to be actively engaged. Values of known importance to patients such as dignity and respect should be fully demonstrated in every service provided for each patient.  This should be informed by widely available and meaningful information about the performance of and outcomes from health care services.

It is essential that the NHS should retain the confidence of the taxpayer and its users. Transparent, accessible and independently validated comparative performance data should be used to indicate the effectiveness of the NHS. This will describe its effectiveness at two levels, national and local.

Nationally, UK comparative performance in terms of health inputs, care processes and patient outcomes (both patient and clinician reported) will be used to ensure the NHS matches the performance of the best European systems. The average length of life both attained and forecast at national and sub national levels, the number of life years lost, and the quality of life in key respects (especially for the last decade of life) will inform these measures. The independence of the public health function is important; the Chief Medical Officer will be required to submit an annual report directly to Parliament charting progress in these areas.

Locally NHS services – both directly provided and franchised – will be compared and reported on a number of key indicators. These will include:

  • Timeliness of access for diagnostic, elective, and emergency care at primary and secondary locations
  • Clinical quality of care in terms of outcomes and adherence to evidence based treatment protocols
  • Patient experience of the whole care process and the extent of “co-production”
  • Utilisation of human, financial, estate and consumable resources
  • The efficacy of local peer review mechanisms

Local authorities have a key role to play in holding local health care services to account for their performance.

Line 24 delete “Making hospitals and”

Page 5

Line 25 insert ” The financial and other incentives within the NHS will promote cooperation between health sectors and between health and local authorities. Intelligent targets will remain where appropriate.  ”

“Integration

  • Health and Social Care, either through poling budgets or through better communication and information flows.
  • Services around the patient, ensuring shared information, shared services and shared decision-making
  • Primary and secondary care, through a new incentive structure and shared services

Mental and physical health, should be working within the secondary sector and within community care.

The third sector often plays a crucial role in providing services through supporting people to live at home, and providing advocacy and rehabilitation services. NHS agencies and commissioned providers will therefore be expected to play their part in ensuring that every locality has a thriving third sector.

Line 41 insert ” They will therefore be expected to take an active part in neighbourhood partnerships with residents alongside other public services. ”

Page 6

Line 12 insert “One of the most effective tools for integration of care is to enable all providers to use a common electronic record, over which the patient controls access.”

Line 32 insert ” We will therefore ensure support to enable all bona fide local resident groups with a health interest to sit round the table with decision makers. ”

Page 7

Line 3 insert ” So we will direct all health agencies and commissioned services to support and assist carers’ groups and other groups dedicated to supporting older people in their own communities. ”

Line 20 insert: ” The NHS will ensure that clinicians and patients share decisions to the extent the patient wants to. This will require incentives, training and technical interventions such as online access to records and Decision Aids, as well as strengthening Healthwatch and making it more independent. ”

Page 8

Line 6 insert ” (In addition to strengthening Healthwatch) we will require health agencies and providers to support and work with the local community and voluntary sector as a whole, since all the issues that they deal with have an impact on health. We will ensure there is less insistence on inspection and more on listening to staff and patients. Whistleblowers will be protected. Staff/patient ratios will be adequate for safe care. On the job pastoral and mutual support to help staff deal with the emotional burden of their work – and to encourage compassion and care.”

line 18  In Section entitled – The future of social care.

After second paragraph add:-

Labour believes that it is time to accept that social care should be placed on the same basis as health care; free at the point of need. The case for all care being free is the same as the original case for free health care.   Labour will work towards delivering on the aspiration of free care building on the Care Bill provisions which extend social free care to some.

(This sets out the aspiration based on our wider vision for a Whole Person Care single system whilst accepting it may take a long time to fully implement the change.)

line 39  in Section entitled – Ensuring a fair care system

Delete last sentence of fourth paragraph and add:-

Labour will deliver a 10 Year Plan for a Modern Care System after consulting widely and seeking to establish a wide consensus. Within the first year Labour will publish its proposals for the long term funding of a modern Care System.

Page 9

Line 21 insert ” We will therefore ensure that health providers give practical support and encouragement to carers’ groups, for example offering them free meeting space in local hospitals.  ”

Page 10

Line 1 insert ” We will therefore direct health commissioners and providers to work closely both with other services and with local residents, to maximise the health benefits of the full spectrum of social issues, for example by ensuring that front line workers participate actively in cross-issue neighbourhood partnerships such as those described in ‘People and Services Partnerships’  ”

Line 13 Delete “your”. Insert “our”.

(see also post on mental health)

 

 

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8 Comments

  1. i note the phrase ‘publicly provided’ doesn’t appear anywhere.

  2. David Lamb says:

    The health policy proposals make a great deal of sense. There are, however, a couple of aspects that require further thinking.

    An integrated health and social care service can only work effectively when it is supported by an efficient and reliable information system. Creating and integrating the datasets that make the service integration possible is not simple. In the past the NHS has, at excessive cost, put this work out to private organisations. Before the election Labour should prepare a strategy on the means of creating and managing an integrated health and social care information system.

    The public health function could be given a much bigger role to play in the revived NHS than the policy is suggesting. Public health practitioners have the expertise to assess and identify need. The needs assessments produced by a public health team can provide the evidence for prevention and treatment strategies. The outcomes of these strategies can be assessed by public health analysts.

    Over the past 20 years public health analysts in health authorities and PCTs developed considerable expertise in needs assessment and monitoring health outcomes. The move by public health from the NHS into local government has seen much of that expertise lost as posts have become disestablished. Labour should consider strengthening the profile of public health within either local government or possibly establishing regional health and social care strategic agencies.

    Many of the social determinants of health and health inequalities operate across city regions or counties. Rather than trying to tackle these inequalities in individual local authorities there would be a more efficient use of public health expertise if action were taking at a city region or county level.

  3. I agree. I do not think transfer to local authorities of this service on its own (without a ring-fenced budget) has been beneficial for health. It should be integrated into a combined health and social care system.

  4. I think we need to seriously consider the proposals of Kate Barker’s Report for the Kings Fund, for ring-fenced joint commissioning of health and social care. We must all face up to the fact that more funding will be required. Since pensioners now have a similar income to the rest of the population and are considerable consumers of health and social care they should be asked to make a larger contribution, possibly through National Insurance

  5. Scott Nicholson says:

    Can we add in something about tackling antibiotic resistance?

  6. Martin Rathfelder says:

    Would someone like to suggest a proposal about anti-biotics?

  7. Martin Rathfelder says:

    Proposal from Labour Party Disabled Members Group:

    Page 8 line 40: Add at the end “An incoming of Labour Government will not implement the current Government’s proposals to end the Independent Living Fund (ILF) in June 2015 and will instead initiate a full review of disabled people’s independent living. As part of that review Labour will look to use National and local government purchasing power to drive down prices of disability related equipment and services, including insurance. Labour will also look at ways of reducing the cost of social care for disabled people and their local authorities without reducing the quality of services delivered.”

  8. Martin Rathfelder says:

    Proposal from the British Acupuncture Federation:
    Page 5 line 30 insert: The use of drug-free treatments such as acupuncture, which has now been approved by NICE as an appropriate and effective treatment to be used in NHS Pain Control Clinics, could reduce the enormous cost of anti-inflammatory drugs currently being prescribed and, for many patients, provide a safer alternative to constant reliance on such drugs with their many unpleasant side effects.

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