The Socialist Health Association has been developing health policy for some months under the dedicated leadership of Dr Brian Fisher, building on our wide and deep experience of the health system, going well beyond the NHS. We suggest 4 key recommendations for England, recognising that the devolved nations make their own policies. We have also suggested 3 more secondary recommendations which could also be considered.

Four Key Recommendations:

  1. A NATIONAL HEALTH AND CARE SERVICE (NHCS)

Bringing together our separate health and social care systems to become one unified care system driven by the political values and professional / organisational principles that underpin the NHS. This can be achieved by a gradual, non-disruptive process.

The political values are:

  • a system with national standards;
  • funded from progressive taxation;
  • delivered by locally accountable bodies that rely on committed staff many of whom have professional training and professionally established responsibilities;
  • evidence based; relies on the notion of “co-production” between service users and professional staff – people playing an active role in their care and professionals welcoming, respecting and responding to that role.

Funding; At least 10% of GDP should be for health and care funding, and all parts of the system should be appropriately funded.

Mental Health; We support parity of esteem and funding for mental health and the continued development of integrated services which jointly address mental, physical and social needs.

This offers other significant opportunities for improving health and care:

  • Social Care free at point of use, beginning with conditions such as end of life care and extending as the situation permits and in as short a timescale as practicable.
  • There must be a full commitment to the universal right to the support necessary to enable independent living, consistent with the United Nations Convention on the Rights of Persons with Disabilities.
  • Boosting community care and community services for the frail elderly
  • Hospitals should be funded to deliver best care, using the best equipment, medications and methodologies according to the evidence base.
  • Hospitals should be funded to provide sufficient beds and services where the community option is not in the patients’ best interests.
  • New drugs, treatments and methodologies should be appropriately funded for patients according to the evidence base.
  • Research in publicly owned hospitals, universities and laboratories should be appropriately supported and funded.
  • The importance of informal carers to be recognised. They should be fully supported and their sacrifices recognised. We support the recent proposal to increase carers benefits and we support extending them to all carers.
  1. AN END TO PRIVATISATION

Care, free at the point of need and funded out of general taxation, provided by public bodies. Labour will restore the duty of the Secretary of State to deliver a comprehensive, universal NHS publicly provided and managed service, meeting clinical need. This needs to be achieved with as little disruption as possible. The NHS Bill 2016-17 provides a model for legislation in the first weeks of a Labour Government. Legislation should include the relief of NHS bodies from PFI debt.

This has implications for what is currently called commissioning. Commissioning outside the market is called planning which still must be done somewhere based on needs and assets assessment. Wales and Scotland offer excellent examples.

  • Commissioning/planning must be separate from provision and free of any form of conflict of interest or undue influence.
  • Planning functions must be democratically accountable and cannot be given to the private sector under any circumstances.

It also has implications for Trust status:

  • The NHS will no longer regard Foundation Trusts as free-standing competitive corporations. Foundation Trusts will be reintegrated into the NHS family.
  1. A FULLY FUNDED NHS AND CARE SERVICE

Labour will fund the NHCS to enable a comprehensive service which will either mean reaching the EU average, or at least 10% of GDP.

  1. ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH

Addressing the social determinants of health is an important foundation for the health and wellbeing of our citizens. The fundamentals of life such as access to clean water and safe waste disposal; social and affordable housing which provides enough space, good oral health delivered via the NHCS with active interventions, clean air and efficient heating; education to achieve universal literacy and numeracy; jobs that protect health and ensure adequate income; and an environment which promotes healthy transport, green spaces and public amenities should all be assessed and developed as a holistic approach to public health. We support the child poverty abolition target for 2020.

This has implications for the service:

  • Chief Medical Officers and District Directors of Public Health need to be professionally independent.
  • They would be required to report annually on the health and health inequalities of their populations and their recommendations on priorities.
  • Communities and our relationships with them and between them and the statutory sector are key to health protection and resilience. The SHA is committed to creating the conditions whereby communities can increasingly share decisions with the statutory sector, thereby increasing confidence and health.

Three  Secondary Recommendations: 

  1. EXPLORE A MIXED ECONOMY IN PRIMARY CARE

There are advantages and disadvantages to the independent contractor status. The SHA would recommend a trial of a mixed economy, where in some areas, primary care is salaried and in others as it is now, the benefits and risks to be evaluated.

  1. COMMIT TO DEMOCRATIC, ACCOUNTABLE AND TRANSPARENT HEALTHCARE

Co-production is the process of working with NHS users. This applies at a macro level, planning local and national NHS services in collaboration with citizens and users; it also applies at an individual level in the consultation between patient and clinician where shared decision-making takes place.

  • A commitment to responding not only to needs as defined by clinicians, but needs as defined by users, carers and citizens. We see the process as a meeting of experts – the NHS offers its clinical expertise. The patient is an expert on their own strengths – and the impact of ill-health on them.
  • The community can, with help, identify key issues that matter to them and work with the statutory sector to address those issues – evidence shows that this process protects health. Community development is one key mechanism.
  1. BREXIT AND THE NHS AND CARE SERVICE

The NHS and social care are utterly dependent on labour from overseas. Without them the NHS will struggle. We would like to see recruitment and employment of staff from the EU and other countries allowed. We want Labour’s policy on Brexit to focus on the economy and free movement.

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6 Comments

  1. John Wattis says:

    Mostly good stuff. I am not sure about the 10%GDP for health and care funding. I think around 8.6% would take us to the European average of healthcare spend (though Germany and France are, I think over 10% on healthcare alone); but I don’t know how much would be needed to provide truly comprehensive social care. Also I rather like the idea, floated by Roy Lilley amongst others of separating health and social care funding into a new National Insurance scheme. Let’s see what Labour comes up with!

  2. Alan Rogers says:

    John, Why do you fear matching the %GDP spend of France and Germany?
    In fact .. because Germany has a larger GDP their per capita spend should be far higher even if we matched them in %GDP.

  3. Rita O'Brien says:

    I assume you want to end the “marketisation” of the NHS as well as privatisation – no more tendering of services. Need to make this clear – Labour MPs dont always seem to see this.

  4. Adrian Mercer says:

    I support all the recommendations in this proposal. Personally, I’d be a bit stronger on the privatisation agenda, in all its forms, and the need to beef up democracy in more innovative ways using digital techniques, but that aside its all good stuff.

  5. Valerie Mainstone says:

    There needs to be an explicit acknowledgement that attempts to run bits of the NHS for profit have failed, and that the true costs of the NHS are whatever it takes to provide good service for patients, and to provide correct terms and conditions of employment for NHS workers.

  6. Clare Jones says:

    Good as far as it goes. I’d like to see an explicit mention of Public Health funding and commissioning in the social determinants piece, or somewhere. Public Health – for instance Health Visiting, School Nursing and breastfeeding Support – is currently being devastated by the £400m public health allocation cuts.

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