The Association is entitled to propose 10 amendments to the Labour Party’s proposed policies.  These are the amendments we are planning to propose after discussion at our Central Council last week. (there are 12 listed as we hope to cooperate with another affiliated society).  Suggestions for improvements are welcome, but each amendment is limited to 200 words, and they have to be submitted by 13th June.

Amendments to Health and Care

1. Social Care

Page 8  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; cover for all, contributed to by all and 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.

Policies which take away the independence of the disabled and cause deteriorating health as a consequence are costly and cruel.  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.”

2. Mental Health

page 10 line 38 add: “ Britain’s mental health is at its worst since 1997 with increasing morbidity and a worsening suicide rate, because of  recession and savage cuts to public services which disproportionately affect the most vulnerable. A clear focus on enhanced well- being and the promotion of mental health within schools, workplaces and general hospitals is needed to reduce the economic and social burden of mental ill health. A new National Service Framework, with a robust set of clinical and social outcomes based on a model of early identification recovery and optimism, delivered in partnership with service users and carers will be established. Labour will instruct the Care Quality Commission to make sure that all providers of mental health and social care services comply with the Equalities Act meeting the access needs of disabled people and the cultural needs of  BAME communities. In addition, Labour will demand that all relevant authorities play an active part in improving the integration between physical and mental health services and deploy community development resources with the clear objective of strengthening the community and voluntary sector to deliver on our aspiration for better mental health and spiritual well-being for all local populations.
Children’s mental health is paramount if psychomorbidity in the adult population is to decrease. CAMH services need to be adequate for the speedy identification and treatment of mental disorders in children in the least stigmatising way.”

3. NHS

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 overwhelmingly publicly provided and entirely publicly managed and will give the Secretary of State the power to give directions to any part of the NHS.
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 drawing on experiences in Scotland (and Wales, where health outcomes on a par with England are delivered for about 10% less cash than comparable English regions).

The NHS will no longer operate as a market or pretend that Foundation Trusts are free-standing competitive corporations.  The private sector will only be allowed to offer patient services as an alternative to the NHS by exception, where it evidences enhanced care and innovation.. ”

4. Accountability

Page 4 line 30 delete sentence beginning “Instead, we need…”  Insert “The health service must ensure collective and individual accountability throughout. Care must be delivered with as much participation in shared decision-making as the patient wishes at the time. 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 important to patients like dignity and respect should be demonstrated in every service provided.  This should be informed by widely available and meaningful information about the performance of and outcomes from health care services.
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 Chief Medical Officer (England) will be required to submit an annual report directly to Parliament charting progress in these areas.”

5.  Public Health

Page 10 Line 15 insert “We will make healthy choices easier by ensuring that the financial incentives and taxation system supports affordable healthy products such as fresh fruit and vegetables while making unhealthy products high in fat, salt and sugar better regulated and relatively more expensive.
We will remove the VAT exemption from sugar, which has little nutritional value.  We will ensure that the quantity of sugar, salt and fat in manufactured food is easily apparent to customers wherever it is sold. We will ban the use of trans fats in food products (as done in Denmark) – and push for the ban to be extended throughout the EU.We will introduce minimum unit pricing and encourage lower alcohol products.  We will reduce the hours during which supermarkets are permitted to sell alcohol and make it more difficult to buy dangerous quantities of alcohol following the successful example of reducing damage caused by paracetamol poisoning. We will progressively raise the age below which it is unlawful to supply tobacco to young people.  We will bring forward proposals to reform the law on misuse of drugs to balance the penalties against the harm done by different drugs including alcohol and tobacco.”

Amendment to  Stability and Prosperity

6. A healthy society

Page 4 line 8 insert “We want to see a community in which power, wealth and opportunity are in the hands of the many not the few and where the rights we enjoy reflect the duties we owe. This will not happen in an unhealthy society where wealth is primarily inherited and the benefits of economic growth go to those who are already rich.  Labour’s long-term goal is to break the link between a person’s social class and their health. We will work across government, using the power and influence of all government departments and agencies, to achieve this. All Labour’s policies in government will be subject to an assessment of their impact on the public’s health.

We will use a new tax on wealth to finance the NHS and social care system to achieve a level of spend as a percentage of GDP on a par with the best in Europe, aided by the removal of tax rules that currently allow tax avoidance by international companies earning  untaxed profits in the UK. We will safeguard the NHS from the TTIP which will otherwise act as a means of a commercial takeover of our healthcare provision. ”

Amendments to Work and Business

7. Health and work

Page 6 line 25 insert: “Employees of all grades with higher levels of control over their work (in terms of content, pacing of tasks, decision-making, etc.) have better health. Low control at work is associated with higher rates of heart disease, musculoskeletal pain, mental ill health and mortality – even when other risk factors (such as smoking) are accounted for. Interventions to improve control at work (for example rotating tasks, flexible working, employee participation in making company decisions, employee ownership/shares) have been found to improve health – with no detrimental effects on productivity. We will introduce measures to ensure that firms are  involving employees in the business so that job control is increased. In other European countries, such as Germany, “workers’ councils” are common place in businesses and they could be introduced here.”

8. Benefits for disabled people

Page 11  line  6 add at end “Labour will ensure there is a non means tested benefit to meet the additional costs faced by disabled people, and place them on a level playing field with non disabled people.  Pending the benefit redesign Labour will immediately revert to the 50-metre distance test in respect of the higher rate mobility component of PIP. There should be a disabled person on each tribunal considering appeals where award of the benefit has been refused.  The assessment must be accessible, fair and transparent, carried out by NHS workers, must use evidence obtained from Occupational Therapists,  doctors and other healthcare professionals, use existing assessment data held for people’s entitlement to disability living allowance where held, entitle a recipient of DLA automatically to PIP and be carried out once to result in a lifetime award unless the impact of a condition can be expected to change. There should be no cap on the budget for the benefit, so that all disabled people who meet the criteria receive the benefit.  We welcome the report of the Disability and Poverty Taskforce and will work with disabled people and their organisations to examine how its recommendations can be taken forward.”

Amendment to Living Standards and Sustainability

9 Transport and health

Page 3  Line 48  Insert new heading “Transport and health ”
Insert “Traffic accidents are higher in more disadvantaged and urban areas (particularly amongst children and outside schools), and are the leading cause of death in children over 5. We will encourage widespread introduction of 20 mph limits in urban areas to encourage the reclaiming of our streets by pedestrians.
The Active Travel (Wales) Act 2013 will be extended to England so every local authority will be required to publish details of expenditure on transport measures divided between walking, cycling, public transport and motor vehicles.   We will rebalance the transport budget so that 10% is spent consistently over the length of the parliament on the needs of pedestrians and cyclists with the aim of building networks of segregated cycle tracks in every major city.  We will remove VAT from bicycles.
We will take urgent steps to reduce the air pollution caused by road traffic, and in particular by diesel engines. We will reconsider the taxation of vehicles and motor fuel in the light of the evidence of damage to health caused by particulates.
We will reduce the level of alcohol which is permitted for motorists”

Amendment to Education and Children

10. Healthy Children

Page 10  Line 4 insert “In 2013 the UK had worse rates than nearly every other Western European nation for early neonatal deaths especially among socially disadvantaged groups. More investment in employing trained midwives to provide one to one care is crucial and shown to be effective in reducing still birth. We will ensure that sufficient support from midwives and health visitors is available for women and babies to tackle the appalling level of death among young children. We will increase benefit rates for pregnant women so that they can afford a healthy diet. All children are vulnerable and schools need to do much more to promote both physical and mental health. Every school must have a school nurse and a school counsellor. Childrens mental health services need to be adequate for the speedy identification and treatment of mental disorders in children in the least stigmatising way.”

Amendments to Better Politics

11. Community Development

Page 4. line 24 insert. “Taking part in community activity is a vital way of protecting and improving mental health. Health providers will be directed to support the growth of local voluntary and community groups as a whole, cooperating with the other services which have a mutual interest in this. We will ensure that health agencies play an active part in deploying community development, with the clear objective of strengthening the constructive role of the community and voluntary sector in relation to health.  NHS agencies and providers will therefore be expected to play their part in ensuring that every locality has a thriving third sector largely funded by grants rather than contracts. NHS organisations will be expected to take an active part in neighbourhood partnerships and to encourage users and carers groups to do so. There needs to be a shift so that we look at the most disadvantaged people regaining a sense of hope control and optimism over their lives, working on the strengths, (assets), of people, their families and the communities in which they live – this will impact positively on mental health and well-being and is evidence based from the recovery framework that is gaining credence in mental health”.

12. Age discrimination

Page 8  line 46  insert new section “Age”…”We will ensure that there is parity of treatment in health and social care services in respect of both youth and  age.  This implies

  • equal access to effective, safe care
  • equal efforts to improve the quality of care
  • the allocation of resources on a basis commensurate with need
  • equal status within healthcare education and practice
  • equally high aspirations for service users
  • equal status to the measurement of health outcomes”
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  1. Alex Scott-Samuel says:

    I propose the following alternative amendments:

    Page 3 Line 37 –
    After ‘free at the point of need and fit for the 21st century’, delete ‘and’, and insert – ‘publicly provided, and adequately funded through progressive taxation, as the proven most efficient and fairest means of funding health services’.

    Page 4 line 8 –
    Delete ‘Repealing the Act will…’ to ‘conflicts of interest the Act created’ and insert:

    ‘Labour will halt NHS privatisation, and reverse it where it has gone too far already. Labour will take all steps in its power to ensure England has a comprehensive NHS provided on the basis of social solidarity, not one run for private profit.

    Labour will review and remove any legal or other barriers which may restrict our collective right to a publicly owned, publicly accountable, publicly provided comprehensive NHS, including direct barriers and those which expose the NHS to international competition and trade laws and treaties.

    The 2012 Act abolished the Secretary of State’s duty to provide and secure a comprehensive health service across England. This has enabled a shift towards a two-tier NHS, which looks much like a state-subsidised insurance-based model. Combined with funding cuts and wastefully expensive commercialisation, this is rapidly moving us to a system where only those living in richer areas, or who can pay extra, will get comprehensive care (such as face to face access to GPs and hospital beds) and where the rest of us will increasingly have to make do with only ‘core’ services (like A&E).’

    P4 Line 20 –
    Delete ‘With the NHS working in partnership…high quality services’. Insert:

    ‘As a first step, in the first Queen’s Speech Labour will pass an NHS Reinstatement Bill which should do two things:

    restore the Secretary of State’s duty to secure and provide all reasonable health services throughout England, for everyone.

    The current shift to a two-tier NHS is dangerous, unfair and inefficient. It must be reversed, and a comprehensive health service reinstated.

    2. halt the rush to markets by repealing the key commercialising aspects of the 2012 Act and subsequent measures. This should include:
    scrapping sections 72-80 of the Act, including Section 75 and associated Regulations (which have become known as ‘NHS Privatisation Regulations’)
    abolishing Monitor, noting its key role in enforcing competition in the new ‘health care market’ and the Francis report recommendation that there should be only one regulator of providers, not two.
    scrapping the duty of autonomy on different parts of the NHS
    repealing the abolition of NHS Trusts and the requirement for them all to become Foundation Trusts
    stopping Foundation Trusts from being allowed to withdraw previously mandatory health services
    re-establishing the limitation of personal health budget direct payments to pilot schemes only, recognising that schemes to date have shown mixed results.’

    Page 6 line 41 –
    After ‘without proper public consultation’ insert:

    ‘Labour will ensure that the organisation or reorganisation of health care services (including but not limited to, any change of provider) be founded upon a solid and transparent evidence base and subject to full debate. In particular, whilst care in the community may desirable for some patients, this should not be seen as an excuse to cut or privatise. The research evidence for moving a lot of services into the community is weak and health service planners should not present all service reorganisations as improving care when they do not. In particular, there is a danger in reducing the number of hospital beds given that hospital beds in England are already lower per head of population than in many other developed countries.’

    1. I endorse Alex Scott-Samuel’s contribution.

      Lets get the private sector out of our public services, the evidence is here as to who is the best provider in the world, lets not be hoodwinked into believing otherwise.

      Only since private sector involvement have we seen the NHS costs skyrocket.

  2. Methusalada says:

    Now let’s get serious now ! Are you supplying me this info as some new Labour Party policy to be considered by people like myself as an expelled Labour Party member . Or do you wish me to write the new socialist policy on how & with whom the Labour Party can survive in 2014 . Sorry to be so pushy , but I don’t think I shall be around in 2015. In the mean time why don’t you get on with giving some of your friends in the Labour Party a self destruct pill or button.

  3. In the Introduction, page 3 line 37 after……bureaucratic silos.

    In order to translate this vision into reality we will reshape NHS management away from political compliance and ‘quick wins’. A Labour Government will enable the NHS to adopt quality management techniques, understand systems, measure patient centred outcomes, share data and encourage professionals to compete on quality.

    1. Martin Rathfelder says:

      Let’s not be too ambitious here!

    2. As an experienced patient of & within the NHS I totally agree with Dr Theresa Eynon’s contribution to this ? discussion ? contribution ? or possibly a real way forward. I do not believe in people or policies without any ambition !

    3. Dr Eynon Competition is the problem not the solution, the NHS does not have to compete with anybody, people have been using this sort of language now for over forty years and the consequence has been failure not success.

      In my comment supporting Alex Scott-Samuels I provide evidence from the OECD which shows prior to the NHS changes i.e. the Trust status; that was the means to introduce competition and private sector involvement, we had the finest health system in the world, since private sector involvement that is now not the case.

      I have worked in the private sector all my life, it is full of deceit and lies, I have also dealt with companies up and down the country and found ineptitude and mismanagement on a massive scale, as an example I worked for a multi-national company that in the mid 80s was the largest ice-cream producer in Europe, with 46,000 people working for it, today that figure has reduced to around 6,000 due to their mismanagement policies. They are also not the largest producer anymore. I could also offer more examples of private sector failure.

      The public sector has nothing to learn from private enterprise except to avoid it’s pitfalls.

  4. The one that is missing, even under the item on work, is attending to the stress of healthcare workers. This is impacting upon patient care to a dangerous degree, both in terms of safety and compassion. We will never eliminate stress or dissatisfaction, but ignoring its more obvious causes is dangerous. One of the most pernicious causes is the amount of form-filling that staff do nowadays. The time this takes is a real threat to patient care; staff are relating more to computers than to each other; and the data are not leading to any beneficial changes, which was the underlying reason to do clinical audit. Staff tell me they fill forms in at random sometimes to save time, but even where they are meticulously completed, the interpretation of the data is sadly missing and the non-involvement of staff in this interpretation leads to more distress, especially as badly interpreted data Are used as a whip by CCGs and by local management desperate to save contracts. And I could go on…

  5. Martin Rathfelder says:

    I’d like a Labour Government – indeed any Government – to do as Dr Eynon proposes, but I don’t see the relation between political action and the desired result.

  6. Martin Rathfelder says:

    Isn’t the answer to the form-filling problem to have properly joined up computerised records, which follow the patient across organisational boundaries?

  7. Eric Watts says:

    5 Public Health – 2nd paragraph; change “sugar, which has no nutritional value” to ” sugar, which is only a source of calories with no additional nutritional value”

  8. Gill Boden says:

    Section 10 states that “In 2013 the UK had worse rates than nearly every other western European nation for early neonatal deaths, due to risky behaviours during pregnancy especially smoking, which is more common among women who are socially disadvantaged.”
    Perinatal mortality has complex causes which are associated with social disadvantage but not necessarily risky behaviour on the part of mothers,please don’t echo the mother-blaming language of government public health messages.

  9. dinah morley says:

    Para 2 Mental Health
    Should conclude with:
    Children’s mental health is paramount if psychomorbidity in the adult population is to decrease. CAMH services need to be adequate for the speedy identification and treatment of mental disorders in children in the least stigmatising way.

    Para 10 Children
    The last sentence should say ‘every school should have a school nurse and a school counsellor.’

  10. Mina Rodgers says:

    Labour should give more funding and powers to our Local Healthwatch to report any wrong doing to the appropriate authority. All NHS Financial Directors to be committed to the Hospital Trust and not to a Management company.

  11. Christopher Birt says:

    There are some really good amendments here, and Alex has strengthened them. I am only sorry that there appears still to be no attempt to align health policy in UK with that sought at EU level. I shall e-mail the “manifesto” produced by North of England EU Health Partnership; we shall be inviting all North MEPs to a meeting in Brussels to discuss the contents of this.

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