We need to harness the election defeat. We need to show a new vision for health and compassionate proactive care for the future. We need to focus less on grand structural redisorganisation. We need to build on the changes that are happening around us. The world outside the NHS is online. There is a clear democratic deficit, filled with comment and political action with campaigners and activists from right to left.  Devolution to cities and countries is moving apace.

At the same time, the NHS did not move people in the election as much as the economy. The NHS may no longer be the touchstone it was. The NHS is being torn apart and social and community care is rapidly being gnawed away. NHS workers are stretched to the limit, filling gaps as best they can with reducing resources.

We need to build a vision of an NHS that is personal, proactive, linking in a clear, responsive and effective way with the communities it serves, integrating participatory democracy (or liquid democracy, as Compass calls it) into the workings of the NHS and other statutory sectors. The devolved nations need to learn from each other.

  1. A commitment to Community and Individual Participation – Community Powered Health
    The NHS will harness community building/development approaches, ensuring that local communities work with statutory agencies to set the agenda for change that meets their needs. This, within a national framework of entitlements set by government.

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.

  1. Maximise the benefit of IT.

We can harness IT for more for self-care; for supporting communities; for doing a range of administrative NHS things more easily and quickly; for personalising care; for offering proactive care; for enabling people to take more charge of their own health and more charge of their NHS through record access and many other means.

  1. No marketisation, no privatisation.
    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.
  2. Incentives for cooperation for better outcomes
    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.

  3. Invest in the NHS
    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. Every £1 invested in the NHS offers £4 in return – and that is spent in the UK, not in tax havens elsewhere.

Renegotiate PFIs where necessary – we cannot any longer allow corporations to hold the NHS to ransom.

  1. Invest in community care, including general practice
    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.

General practice is on its knees. We need radical approaches with a new contract with varied employment options, better support for staff, cooperative working between practices and with far closer collaboration between community staff.

  1. Social care free at the point of use
    A long-term goal, but starting with those needing palliative care

  2. 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, working within the secondary sector and within community care.

The organisational redesigns of the 5yfv are a distraction. There are many sound ideas in the document, but we need to go further and not be distracted by integrating through complex structural change.

  1. Public Health that tackles the social determinants of health
  • Improving control at work
  • Enhancing access to public transport
  • Creating healthy places
  • Implementing a minimum unit price for alcohol
  • Reducing ill-health related worklessness
  • A healthy housing policy
  • Making work pay
  • Minimum Income for Healthy Living
  • Decreasing debt
  1. Tackling health inequalities
    Implement Marmot in full.
  2. Support NHS staff

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.

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  1. John Carlisle says:

    You are missing an economic perspective. The NHS is service organisation that needs to run on sound economic principles, the aim of which is good health and patient care. For far too long it has been treated as a cost “centre” and not as a value-producing system.
    Western manufacturing, for example, were shocked by the high quality and efficiency of the Japanese companies in the 1970’s and ’80’s. This is because we treated our production units as a cost while they treated theirs as value producers with a workforce that gave intellectual as well as energy capital. The factory were designed were to maximise this capital. Ours were designed to control the energy/physical capital and to ignore the thinking capability.
    This stupid model has affected the way we look at health, and has to change. The NHS has 1.4 million employees, Social Care has 1.6 million, and there are 3 million volunteers. Imagine what results we would get if we allowed this potential to flourish, by treating them as responsible adults, doing away with the dreadful governance/compliance regime and the overhead that goes with it.
    Persuade these Tories, who understand the cost of everything and the value of nothing, to then also to look at the economic eco-systems that surround the healthcare system, i.e. 3 million salaries being spent in the local area and tens of thousands of SMEs providing services and products to the organisation to the value of tens of billions.
    Then ask two questions: how does putting cost pressures on the acute and social care services add any value? And, why should any of this money leak out of the system and go to private companies and their shareholders?

  2. I think grand strategies are pointless when we consider that the Tories are dismantling the NHS as we write.

    We know exactly what is happening and what has happened over the last thirty years. We had the support institutions, care homes geriatric hospitals etc., but then along came the Neo-Liberals and promptly dismantled them saying the private sector was best placed to deliver.

    The only viable agenda from here on in is to support Dr Allyson Pollock’s reinstatement bill.

    We need to make it quite clear that we are not frightened of large corporations and business interests and that we will take back any sector that is fundamental to the proper function of the NHS.

    In short stop the corporate sector in it’s tracks, it seems to me that governments can ignore it’s electors when they serve capitalist interests, but we must handle them with kid gloves when they operate against the interests of ordinary people.

    Failure to grasp this nettle will mean deprivation and an end to demaocracy as we think we know it.

  3. Patchy, scrappy, incoherent on advancing wellbeing.

    Not remotely impressed.

    ps the horse has bolted on marketisation. SHA miles behind.

  4. Caroline Molloy says:

    This piece is full of contradictions. On the one hand there are crowd-pleasing nods to ending the ‘market’ and restoring the duty to provide a comprehensive NHS (though without any indication of support for the NHS Reinstatement Bill, which is the only serious attempt thus far to set out HOW to do that).
    On the other hand, there is talk of setting out ‘entitlements’ – which suggests a scaling back from a truly ‘comprehensive health service’. (If you doubt this, think about how the language of ‘entitlements’ has played out in social care). The same dangerous language was central to the Oldham policy review, worryingly.
    And there is talk of ‘preferred provider’ which suggests far from ending the market, merely attempts to privilege the NHS within the market – something the kings fund recently said would be ‘impossible’ without biting the bullet and adopting the major market-scapping moves that the SHA (and the Labour leadership) have so far consistently failed to support.
    The SHA needs to get coherent, and and stop pursuing fads and agendas.

  5. John Carlisle says:

    I agree with the Reinstatement Bill being first on the agenda. However, you need to create the conditions/rationale for its likelihood to succeed. For the Tories who, after all, in power this needs an economic as well as social case. For the beleaguered NHS staff they need the the reassurance that it will not be another catastrophic reorganisation. They need to understand that it will be accompanied by a change strategy that engages them all and keeps patient care at the forefront.
    It is axiomatic that improving the quality of patient care (care delivered right at the right place and time) will cost less and take less effort. So, it needs to be (micro) economically optimal as well.

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