Policy Summary June 2016

SHA policy

This paper summarizes the current policy positions held by the Socialist Health Association. They have been derived from decisions by our Central Council. This has been compiled by our vice president Dr Brian Fisher, to whom we are most grateful. It hasn’t been officially endorsed in this form, and it is possible that some words, now taken out of their original context, may not exactly represent our position.

There are more detailed explanations of our policies on our website. 

INTRODUCTION

The SHA stands for a care system which is an integral part of our public services, providing world class care but also helping to reduce inequalities in health, wealth and power.  Policy should be guided by the social determinants of health.

There is little or no evidence to support marketisation as the main route to improving quality.  Use of market forces reduces patients to the role of shoppers when the real need is to engage patients in their own care, engage communities in the wellbeing of their locality and make all key decisions within the system subject to proper public accountability and democratic control.

The Socialist Health Association believes that our model of NHS has to become part of a National Care System in which social care is also free at the point of need funded out of general taxation.

SUMMARY OF SHA POLICIES

WHOLE PERSON CARE

  • Social care, physical and mental health services must work together in the patient’s interest, offering “integrated care”.
  • Care plans for all
  • Personal Health Budgets for those for whom it is suitable
  • Access to all health data about ourselves

MARKETISATION AND PRIVATISATION

  • We oppose the idea that marketisation is necessary to deliver a world class NHS.
  • We support an NHS which is more integrated, sensitive to patients’ needs and democratically accountable; founded on values of professionalism, cooperation and partnership not on financially driven competition.
  • Care should be free at the point of need and funded out of general taxation and should be provided predominantly by public bodies.
  • Reinstating the NHS as a comprehensive, publicly owned, funded and provided service meeting clinical need.
  • The NHS should be defined as a single national system set up on the basis of social solidarity and all relationships between commissions and NHS providers should be within the NHS and not the subject of legally enforceable contracts but be subject to best value.  Where there are no contracts there can be no intervention through competition law.
  • Labour will remove any legal or other barriers which prevent or deter cooperation.  
  • The private sector will only be allowed to offer patient services as an alternative to the NHS by exception, in rare and clearly defined circumstances, for example:
    • With convincing evidence of enhanced care
    • where these offer novel services otherwise unavailable,
    • to remedy persisting inadequate standards,
    • to meet peak service pressures when NHS capacity is not immediately available.
  • All providers to the NHS, including the private sector, must waive any rights to commercial confidentiality and comply with requirements for provision of information.
  • 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
  • The NHS should treat private patients only where this has direct benefit to NHS patients.
  • Any private providers should not be subsidised either directly or indirectly, and no NHS funds should be spent on any form of market development.
  • Commissioning functions have to be done around needs assessment, the planning of services etc. Commissioning must be separate from provision and free of any form of conflict of interest such as undue influence by the dominant NHS acute providers.
  • Commissioning responsibility cannot be given to the private sector under any circumstances. Decisions about services and funding must be made through open and transparent democratically accountable processes.
  • The NHS will no longer pretend that Foundation Trusts are free-standing competitive corporations.
  • The SHA supports patient choice and greater involvement by patients in their own treatment. This is not choice as a market mechanism and there may be limits in the interest of overall efficiency.
  • Tier 1 Local Authorities should have responsibility for the integrated commissioning of all care at least at the strategic level.

PFI

  • An end to the use of PFI and a serious solution to the problem of PFI debts

PUBLIC HEALTH

  • Directors of Public Health within local authorities should be adequately resourced to make recommendations which must be taken into account.
  • Social care and other local authority provision should be included in these plans.
  • The Chief Medical Officer (England) will be required to submit an annual report directly to Parliament charting progress in UK comparative performance in terms of health inputs, care processes and patient outcomes (both patient and clinician reported)
  • The financial incentives and taxation system will support affordable healthy products while making unhealthy products better regulated and relatively more expensive.
  • We will remove the VAT exemption from sugar.
  • The quantity of sugar, salt and fat in manufactured food should be easily apparent to customers wherever it is sold.
  • We will ban the use of trans fats in food products and push for the ban to be extended throughout the EU.
  • We will introduce minimum unit pricing for alcohol 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.
  • 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 including alcohol and tobacco.
  • 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 on the needs of pedestrians and cyclists
  • 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 and reconsider the taxation of vehicles and motor fuel in the light of the evidence of damage to health caused by particulates.
  • All Labour’s policies in government will be subject to an assessment of their impact on the public’s health.

HEALTH AND WELLBEING AND HEALTH INEQUALITIES

  • 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.
  • Improving health requires addressing the social determinants of poor health based on the principle that there is a role for an interventionist state, for redistribution of wealth and power, and a role not just in planning and commissioning but in delivery. 
  • Health agencies will play an active part in deploying community development to improve health protection through community empowerment, help tackle health inequalities and encourage responsive statutory agencies.
  • NHS agencies and providers will ensure that every locality has a thriving third sector largely funded by grants rather than contracts.
  • NHS organisations should take an active part in neighbourhood partnerships and to encourage users and carers groups to do so.
  • We will introduce measures to ensure that workers feel more in control of their own work.
  • There should be an Office of Health Equalities
  • Strategies and plans for wellbeing should be agreed at local, sub-regional and regional level and should be used to guide decisions about service provision, major investments and reconfigurations.
  • Ensure an independent and adequately funded Healthwatch.

TRANSPARENCY AND ACCOUNTABILITY

  • Community development will be supported and funded to increase communities’ input into planning and to increase the responsiveness of NHS organisations.
  • 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.
  • 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, local and national.
  • There must be one single democratic body which oversees the whole of the strategic commissioning of services for a locality – usually a tier one local authority area, although they may delegate to more local bodies.

GOVERNANCE

  • All NHS bodies must be under clear obligations and duties:
  • To work to reduce inequality
  • To cooperate with other public bodies
  • To promote shared decision making and community development
  • To be open and transparent and to involve public and patients in all major decisions and plans.
  • Mergers and other organisational changes should be subject only to local agreement.
  • NHS bodies should have boards of directors with a majority of NEDs and governing bodies set up to reflect a balance between patients, public, staff and other local stakeholders.
  • The procurement and contract management of major assets should be the responsibility of the Secretary of State with NHS Bodies subject to an appropriate reasonable internal charge for use.
  • Oversight by regulatory bodies should be phased out and the money invested in front line staff.

GENERAL PRACTICE

  • GP Practices (as businesses) should be phased out and GPs employed by NHS bodies.
  • Desirable changes to bring care closer to home and to place emphasis on early intervention and prevention require investment and major changes in primary care to make it far more pro-active.
  • The quality of primary care varies inappropriately. There is potential in harnessing IT, in task-shifting and in involving patients in planning and self-care. These need supporting and coproducing.
  • The commissioning and management of primary care services should be undertaken locally and not by a remote national body.
  • The SHA does not support GPs being responsible for commissioning although they must be centrally involved, alongside other key stakeholders, in local commissioning decisions.

AUSTERITY

  • To campaign for Labour to commit clearly to reversing cuts.
  • 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
  • We will safeguard the NHS from the TTIP. 

CHILDREN

  • More investment in employing trained midwives 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.
  • Every school must have a school nurse and a school counsellor.
  • Children’s mental health services need to be adequate for the speedy identification and treatment of mental disorders in children in the least stigmatising way.
  • We will ensure that there is parity of treatment in health and social care services in respect of both youth and age. 

HEALTH WORKERS

  • To campaign for much stronger Labour support for the doctors’ strike, the NHS bursary fight and other health workers’ struggles – including by Labour MPs and Shadow Ministers attending picket lines, and by the party working with the TUC to organise a national demo in support of the BMA.
  • Partnership working at national and regional level should be established with joint agreements over workforce planning.
  • A national framework for common terms and conditions covering all care staff should be negotiated including for staff development and training across the care system.
  • The NHS must work closely with bodies that help educate and train the future NHS workforce to meet the needs of patients efficiently and effectively making sure that the future needs of patients is the sole driver of curriculum and Continuous Professional Development. Lay representation should have a role to contribute to the existing professional inputs.

DISABILITY

  • An incoming Labour Government will initiate a full review of disabled people’s independent living, driving 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.
  • 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 Disability Assessment tribunal considering appeals where award of the benefit has been refused.  The assessment must be accessible, fair and transparent, carried out by NHS workers, use evidence from healthcare professionals, use existing assessment data, 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 benefits, so that all disabled people who meet the criteria receive the benefit.

SOCIAL CARE

  • Free social care should be introduced progressively starting with those with greatest needs, such as those with disabilities.
  • The SHA will campaign against cuts in Social Care.
  • Additional funding for social care is necessary to raise the quality and professionalize the workforce, with decent pay and conditions. 
  • Public provision of (social) care services should be greatly increased.
  • Integration will bring longer term savings, but the initial net additional cost has to be met through progressive taxes.  

INTEGRATION – NHS AND SOCIAL CARE

The “market” approach is fragmenting provision and creating a hugely complex web of organisations linked by legal contracts, adding significantly to transaction costs.

  • We should introduce incentives for joint appointments, joint budgets, collocation, information sharing, and shared services across the NHS and local authorities.
  • An integrated plan for commissioning across all public services
  • We should have a large scale trial with a fully integrated provider which covers delivery of all primary, secondary, mental health and social care, for a single County or City.

MENTAL HEALTH

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
  • A new National Service Framework with service users and carers will be established.
  • All providers of mental health and social care services to comply with the Equalities Act
  • All relevant authorities play an active part in improving the integration between physical and mental health services and deploy community development.
  • Child and Adolescent Mental Health services need to be adequate.

ENVIRONMENTAL SUSTAINABILITY

The NHS must maximise environmental sustainability.

QUALITY

  • Labour believes market-style behaviours and incentives have a limited application in delivering high levels of consistent quality care. Of much more importance are motivated staff, good evidence, engagement of pts, carers and family, a supportive but challenging workplace culture, professional peer review, multi-disciplinary work.
  • Performance Indicators
  • 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.
  • Locally NHS services – both directly provided and franchised – will be compared and reported on a number of key indicators to include timeliness, quality of care, patient experience, resource use, the efficacy of peer-review mechanisms.
  • Local authorities have a key role to play in holding local health care services to account.
  • Users pushing data on their own experience into the NHS will also drive up standards.

MAKING CHANGE HAPPEN 

None of our suggestions implies major structural reorganisation. Any approach to making changes must be evolutionary:-

  • Having a long term Plan for Care built on a wide consensus.
  • Restoring unambiguously the power of the SoS to direct and to intervene in any part of the NHS
  • Convergence of health and social care through:-
    • progressive introduction of free personal social care
    • a single assessment process which is national and portable
    • incentives to share staff, facilities and services between Local Authorities and NHS bodies
  • Using a licensing system to restrict unsuitable providers and enforce the requirement  to supply all necessary monitoring information
  • Move towards a single regulator/licensee for quality and governance
  • Removing any suggestion of promoting competition or compulsory tendering of services and ensuring there is a sector specific set of rules covering the use of cooperation and competition.
  • Moving responsibility for price setting to DH/NHS England with flexible alternatives to a fixed national tariff price.
  • Require Health and Wellbeing Boards to produce an integrated commissioning plan to support the local wellbeing strategy and to sign off commissioning plans.
  • Giving Clinical Commissioning Groups a proper Board with majority of appointed Non-Executive Directors; ensure all have sufficient scale to function independently
  • Moving the commissioning of primary care service to local CCGs
  • Ensure an independent and adequately funded Healthwatch.
  • Encourage convergence of Health and Wellbeing Boards and CCGs into local commissioning authorities (as suggested by Health Committee).
  • Bring back the Private Income Cap, agreed locally by governors and with an overall limit which can only be exceeded with approval from the Secretary of State.
  • Allow Foundation Trusts and commissioners to sign NHS Contracts, which are not legally enforceable and so outside scope of procurement competition law.
  • The SHA believes that using around 10% of GDP to fund care is in line with spending by other developed democracies and is a reasonable charge on public funds. Funding out of progressive general taxation is the fairest and most just method.

You might like to compare this document with the summary we produced in 1988.