Category Archives: Labour Health Policy

Jeremy Hunt has considerably heightened expectations for the so called birthday present for the NHS later this month telling us to expect ‘significant’ investment.

We know the NHS is experiencing the biggest financial squeeze in its history and on current projections the Conservatives are breaking their manifesto promise for real terms head for head rises every year of the Parliament.

Public health and training budgets have been cut, and the capital budgets raided with the consequence we have a £5billion backlog for repairs.

NHS Trusts ended 2017/18 with a deficit of £960million; £464million above the plan set for the year and £196million worse than last year.

The NHS has failed to meet its constitutional standards. The 18 week list has grown to four million, and 2.5million have waited longer than 4 hours in an A&E.

It’s clear our NHS and social care sector needs a long term plan – it’s what I’ve been calling for since I became the shadow health secretary in 2016.

We’re told a plan is imminent. But I’m struck by the world of difference between what is happening today and the way a long term plan was last put in place by the Labour government in 2002. Seventeen years ago Gordon Brown tasked Derek Wanless with conducting a comprehensive analysis of the future health needs of the country and the options for funding it. It was a detailed, exacting piece of research conducted over around year.

Based on that in-depth analysis Gordon Brown introduced a specific and sustainable tax increase for the NHS – not hypothecation. That investment was tied to modernisation to tackle waiting lists and rapidly expand NHS capacity.  It culminated in some of the lowest waiting lists and highest satisfaction ratings.

And it all began as a thorough, detailed process ran by the Treasury not hindered by it.

I don’t think the same can be said today.

That legacy has been systematically unravelled since Labour left government beginning with the Lansley reforms which should have been stopped in their tracks by Jeremy Hunt but weren’t with disastrous consequences for all concerned.

So how should we judge what the government propose in the coming weeks? I would like to offer five tests.

First, the funding test. Labour’s commitment is a fully funded NHS and social care service to fulfil the obligations to the public legally enshrined in the NHS Constitution and to improve the quality of care for the future.

Our plan involved nearly £9billion extra for health and social care in the first year of a Labour government paid for by fair increases in taxation – this would amount to more than a 5% increase immediately.

We would ask the top 5% to pay more in income tax, increase taxation on private medical insurance and increase Corporation Tax. Given our long term commitment is to a fully funded NHS and we would establish an OBR-style process to advise us on funding needs for the future.

But how will the government fund its NHS commitments? Will this government increase borrowing, cut more deeply into other areas of public services or propose unfair tax increases?

So our first test is to whether the government are prepared to take fair decisions on taxation to fully fund our NHS and public social care including allocating a 5% increase immediately for the NHS.

Secondly, on staffing. We have a vacancy gap across the NHS of 100,000 including for more than 40,000 nurses and midwives, 11,000 doctors, 12,000 nursing support staff and 11,000 scientific, technical and therapeutic staff. Numbers of community nurses, mental health nurses and learning disability nurses have all fallen since 2010.  And last week Jeremy Hunt conceded he’s failing on GP recruitment too.

The IFS-Health Foundation’s report predict we will be short of 170,000 nurses and 70,000 doctors in the future and with respect to social care the IFS suggests a massive 458,000 additional staff will be needed by 2033-34.

A credible plan to deliver the staff our NHS and social care sector need will be a key test of the government’s plan starting with bringing back the training bursary for nurses and allied health professionals and immediately dropping Theresa May’s restrictive ‘hostile environment’ visa regime, currently denying so many hospitals access to the very best international clinical staff.

Our third test is on the way in which care is delivered. By 2020 the population of over 65s will grow to 15.4million, and the number of over-85s will double.

As we live longer the disease burden changes too and health and care services increasingly must respond to the complexity of conditions we all live with.

And yet the current NHS landscape created by the 2012 Health and Social Care Act has delivered a fragmented wasteful mess – ‘an organisational no man’s land’ with ‘structures not fit for purpose’ as Alan Milburn recently said.

When faced with demographic changes and the need to help people manage long term conditions like diabetes we should consolidate not fragment. Health care should be delivered not on the basis of markets but on partnership and planning. Yet these structures have allowed a situation where NHS expenditure on private health providers now stands at £9billion.

So our third test is as to whether the government will scrap the Health and Social Act, end fragmentation, end privatisation and instead move towards genuine integration, planning and partnership, publicly administered and provided.

This week I revealed our NHS relies on decades old medical equipment, often in use long past its replacement date. In fact our NHS is still using nearly 12,000 fax machines costing thousands to administer every year.  Investment in technology and innovation for the future is desperately needed. But after years of Tory austerity, our NHS is struggling to keep up with the present.

Our NHS faces a repair bill of £5billion and capital budgets have been repeatedly raided to fund day to day spending. What’s more we have some of the lowest numbers of CT and MRI scanners in the world and across the whole NHS we need better digital support too.

Over the coming years Artificial Intelligence, bespoke nutrition, robotics, digital health technologies, the internet of things – where 50billion devices will be connected in the next 25 years – will all offer huge opportunities for improving health outcomes in the future.

On current plans Labour would invest at least an extra £10billion in the infrastructure of our NHS, we would expand R&D investment across the board by £1.3billion during the first two years of the next Labour Government and to support the spread and adoption of innovation we would increase funding for the Academic Health Sciences Network.

So our fourth test is whether the government will sufficiently invest in the infrastructure of our NHS, renew existing equipment and ensure we access the innovative technologies of the future while banning capital to revenue transfers like we have seen in recent years that have led to such an unsustainable backlog of repairs.

Finally on health inequalities it should shame us as a society that advances in life expectancy have begun to stall and in some of the very poorest areas are going backwards.

Child poverty is on the increase and we know there is a correlation between poverty, deprivation and relatively poor child health outcomes.

So an overarching strategy to tackling the wider social determinants of poor health and wellbeing is our final test.

That means measures to improve the quality of air we breathe and the standards of housing many live in.

That means an all-out mission to improve the health and wellbeing of every child, starting with tackling the childhood obesity crisis through bold measures such as banning the advertising of junk food on family TV. And it means expanding not cutting public health and early years provision too.

The NHS and social care stands at a critical juncture.

In this 70th year of the NHS the Health Secretary has a chance to reset the trajectory of the last eight years.

My fear is that the 70th anniversary is being treated by ministers as the next public relations obstacle to be overcome by this troubled government, not as an opportunity for long term sustainable reform.

There has been no equivalent process to the Wanless report.  Instead all we have are reports of a fudge being wearily negotiated between a beleaguered health secretary, an unimaginative chancellor and a powerless prime minister.

First published in the Huffington Post

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Oh no.

In this world nothing can be said to be certain, except death and taxes. And NHS reorganisations.

The next election could be in 2022, unless the current Tory government falls under the sword of Brexit. So, with all of the current government’s efforts being taken up with exiting the European Union, it might seem intuitively odd at Jon Ashworth might want to think the unthinkable – another redisorganisation of the NHS.

By 2022, some of the ‘integrated care organisations’ might be up-and-running. Or, possibly, by that stage, accountable care organisations might have been killed off in the law courts?

We are all Corbynites now, which means we are all singing from the same song sheet. Jon Ashworth MP is likely to, in reality, want to keep his cards very close to his chest before being forced to ‘reveal his hand’. ‘Labour is socialist in that it’s always had socialists in it’, a saying made famous by the late Tony Benn. And one thing that Labour wishes to be seen to be is democratic.

A wholesale reform might be ‘popular’. Whenever Andy Burnham, as Shadow Health Secretary for Labour, promised to repeal at the Labour Party Conference the Health and Social Care Act, there would always be massive applause.

There would always be huge disdain about the cost of the reforms, occasionally estimated at a few billion, but it’s uncertain whether Labour voters feel the need for austerity any more. After all, George Osborne’s policy in ‘paying off the deficit’ put the economy into meltdown.

The narrative from the Conservatives has been ‘you’ve never had it so good’. Except – one commentator remarked at Question Time, some disabled citizens had been propelled into a premature death. Everyone, it seems, was not awarded the personal independence payment. And there’s always money for foreign wars and things like HS2.

Andy Burnham had always maintained that he would use existing structures to do different things. Whilst Ashworth might want to abolish the ‘internal market’, or abolish the purchaser-provider split, the details are unclear. Will Labour wish to ‘buy back’ some PFI contracts? Would Labour wish to ‘take back control’ of outsourced contracts?

I’ve never heard a politician say that he will strip funding of public services, even if (s) he ultimately does that. But will Labour in real terms be able to increase the funding for physical and mental health as well as social care? Will Ashworth make ‘parity a reality’?

Will Ashworth continue with the ‘personalisation’ agenda? If Ashworth wishes to abolish certain parts of the infrastructure, who is going to administer ‘integrated health and care budgets’? Will the replacement of clinical commissioning groups still have to ‘plan’ services, even if not as such ‘commissioning’ them?

How much of the NHS can Ashworth bring under the State’s ownership? Would Ashworth dare to nationalise social care? How will he rationalise “integrating” a universal, comprehensive, free-at-the-point-of-use NHS with a means-test social care system? Is the ‘divide’ between health and social care tenable anyway, for example for people living with long term conditions such as frailty or dementia?

How much can Ashworth do before being set off course from exiting the European Union? Will ‘taking back control’ unleash millions and billions of ‘state aid’ which only Corbynites had previously dared to dream of? Will it mean that the NHS be rid of those dreadful EU competition directives which the Blairites loved so much?

I have absolutely no idea what Jon Ashworth wants – what he really really wants.

But, if it’s any consolation, nor does Jon Ashworth………. yet.

 

@dr_shibley

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an interview with Michael Meacher

Over the last four years Socialism and Health has made a point of interviewing each health spokesperson of the Labour Party to give them a chance to talk about what they see as the priorities in health policy. Our last interview was with Gwyneth Dunwoody who has been succeeded by Michael Meacher. We visited him at the House of Commons in April. This is a summary of that interview.

What do you see as the priorities in health policy for the next Labour government?

Michael Meacher felt it isn’t enough just to talk about how much we spend. In the West we’re getting diminishing returns in terms of age specific mortality and morbidity rates, for increasing expenditure. In such a system there is no point in looking for efficiency by trimming the edges; instead a new approach has to be found. In the area of health the right combination of social and economic policies is crucial. There should be less emphasis on curative technology and more on prevention, health promotion and health education; that is, on changes in our way of life, as the major causes of illness today are all to do with social conditions.

He used the example of an overfed, under exercised person, who smokes and drinks in excess over a prolonged period and is then taken into hospital after a heart attack. Large amounts of money are spent on intensive treatment and care where­upon he or she returns home only to continue the lifestyle which is likely to generate further trouble. “We have got a health service, we’ve got health policies, but we’ve got anti-health social and economic policies.”

Mr. Meacher believed that we will only succeed in producing a significant qualitative improvement in health, and at reducing the incremental costs of doing that, when there is a fundamental change of lifestyle. “It is trying to get across this alternative perspective of health care that I think is our prime task between now and the next election.”

What do you feel the main effects of the last five years of Tory policies have been on the health service, and how do you see it developing in the future?

Michael Meacher focused on two areas. Firstly, the Tories’ claims about their increased  spending on the NHS didn’t stand up when looked at in detail. For example in terms of NHS pay and price increases rather than RPI figures, the increasing numbers of elderly people and the increasing costs of medical technology. He felt that since 1983 there had undoubtedly been a cutback and that this was sure to continue. Secondly, privatisation is going to take a toll. Not only is it ideologically offensive but it also leads to lower standards and lower pay. This is in a service where many people, particularly women, are already paid at exploitative rates. Even discrete medical units may get privatised over the next few years, such as the kidney unit in Wales.

In general Michael Meacher felt that the Tories are using a systematic and comprehensive approach in relation to their objectives and that none of this is good news for patients or the NHS. As a result, the health service is now set for a major fall in standards over the next few years.

How does that tie up with the defensive anti-cuts position that many people are being pushed into?

Michael Meacher felt that these positions weren’t in opposition but rather complementary. While it is essential to oppose the cuts in the context in which they are occurring now — i.e. as part of a general winding down of the NHS — we musn’t assume that what we had in 1979 or 1948 was okay. What is needed is an alternative scenario in which change and renewal of services and hospital stock occurs as part of the development of a better and more appropriate NHS. He reiterated this point by saying “It is not an adequate health policy to simply say that we’re opposed to the cuts and to privatisation and that when we get back in office we’ll restore it all.”

Having mentioned that an alternative perspective is essential in the development of a better health service, what do you see as the ways and means of encouraging prevention and health promotion?

While acknowledging that the opposition of vested interests within industry was fundamentally a power issue, Michael Meacher felt that there was much to be done in arousing public awareness of the issues involved. Dislocation in the food, tobacco and drugs industries would be inevitable if a health perspective was integrated into policies and the immensely powerful capitalist lobbies would indeed be hard to take on. However, if people were aware of the reasons for such a challenge they would be more likely to back policies for change and the chance of success would be much greater.

He felt that people would alter their way of life if they were more informed of the consequences of their lifestyle and knew what changes to make. Taking food as an example, he suggested that the findings of the James Report, which are ex­extremely important but have only really reached health professionals, should be widely advertised to the public on tubes and buses. Effective use of the media and advertising could be useful in spreading such information and keeping people informed about issues which concerned their health.

Michael Meacher has also set up a food policy group, the membership of which includes Professor James, Jeremy Bray, Bob Hughes (from the agricultural side) and himself and Frank Dobson. The aim is to publish a report, within a year, which will state clearly what a food policy intends to do, the reasons why, and good persuasive arguments to influence other people to support it. Such a policy would look for agreement with agriculture and the Treasury and would then be determined to negotiate for change. A Labour Party policy on food is long overdue; once produced, he felt it would be beneficial to liaise with other socialist groups in Europe in order to influence EEC policies.

In addition to the food policy group. Michael Meacher has himself set up seven other working parties. These include an alternative vision of health care, community care — involving prevention and health promotion, democratisation in the NHS, privatisation, health care for women, dentistry and, through the SHA and Harry Daile, he has recently asked a committee to look into ophthalmic services following the recent moves to privatise the optical services.

The formation of these small working partieis is intended to help overcome some of the problems faced by the previous social policy group of the NEC. With a fluctuating membership of between fifty and seventy people, the group spent much of its time making decisions at one meeting only to reverse them again at the next, depending on who turned up. The overall result was that policies were extremely slow to be developed. The new working parties will not be exclusive; papers and oral evidence from nonmembers will be an integral part of their working. Papers will be circulated in the party for modifi­cation and change but will be developed into policy in a far less amateurish and easy going fashion than has hitherto been used.

Why hasn’t the Labour Party had health as a greater priority recently?

Michael Meacher said there had been a bipartisan concensus about the NHS until Thatcher came into office. From now on he assured us it will have a higher profile in the Labour Party.

While admitting that health should have been given more attention in the past, it does now appear from opinion polls that people not only see the health service as an important issue but also as one on which the Labour Party has overwhel­mingly the best policies. Having stumbled on the jewel in our crown again, the Labour Party is going to support it economically and politically.

What do you feel about the Griffiths Report?

Michael Meacher said he felt sceptical to hostile about the report, but thought it had some good bits in it especially in relation to doctors’ power. The main problem is that it will lead to an increased centralisation of power with a much smaller democratic element. Along with plans for the FPCs in which all their members will be appointed, it is going to be much easier for the government to keep the financial lid on the health service by the simple use of administrative power. On the other hand he felt there is something to be said for re­dressing the balance away from the lack of cost and outcome consciousness that can result from unfettered clinical freedom.

How do you feel about the issue of nurses’ pay?

Apart from any other reasons, Michael Meachers sponsorship by COHSE prompted him into enthusiastic support for a fair wage for nurses! Nurses, along with all women workers in the NHS, were paid appallingly low wages and were clearly used to subsidise the health service. He felt that the Pay Review Body should be used to assess and fix nurses pay at a level which would stop them having to fight each year to increase a sub­standard wage. However, Mr. Meacher was realistic in saying that the key factor was finding sufficient funds to make an appropriate pay award. He felt that much could be gained from reducing the rip-offs by the drug companies and the monopoly suppliers, such as BOC and London Rubber Company. Just as important though, he felt there was no way around putting in more resources. The Labour Party was committed at the last election to 3% extra in real terms, but he would like it to be increased to 5%. If were going to put our money where our mouth is, thats the sort of sum its go to be.

During the interview with Michael Meacher, we were impressed by a number of points. First, his ideas seemed very much in line with current ‘progressive thinking about health and health care. Second, unlike many politicians, he welcomed ideas and discussion and was ready to acknowledge his own lack of expertise in specific areas. Third, his response to that was involvement of a wide range of individuals and groups. We felt he was genuinely concerned with the development of alternative perspectives in health care and was keen to work with all those who shared that concern. It seems that Labour Party health policies might in the future be much more respon­sive to the interests and needs of both the users and providers of health care. Hopefully we may now have the opportunity to start bridging the gap which has all too often separated politicians from those they represent.

Graham Bickler & Alison Hadley

July / August 1984

 

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This is the document presented to the Labour Party National Policy Forum in February 2018.

Labour’s vision

This year sees the 70th Birthday of Labour’s National Health Service; a service set up to provide universal healthcare for all, to improve people’s physical and mental health and crucially, to reduce inequality in our society. Over the years, the NHS has been vital in ensuring that everybody is provided with healthcare from cradle to grave, regardless of how much they earn.

Despite this, real health inequalities in our society persist. That’s why the Labour Party is prioritising this issue for wide ranging discussion and consultation this year. Health inequalities can have significant, detrimental impacts on physical health, mental health and life expectancy, and present a significant cost to society as a whole.

Alarmingly, recent research has shown that life expectancy is starting to slow or even stop in England after decades of increase. The research also shows that inequalities in life expectancy between local authorities continue to exist, highlighting the link between social and economic inequality and health outcomes.

Since 2010, funding for health services has been cut back and provision has been reduced. For example, we have seen cuts to public health budgets, a fall in the number of health visitors in England, and cuts to social care budgets are forecast to reach £6.3 billion by the end of this financial year. Sure Start Children’s Centres, a major Labour achievement which have a vital role to play in the promotion of public health and reduction of health inequalities in society, are being put at risk by this Government. Furthermore, cut backs to vital services are having a disproportionate effect on those in our society who are often most at need – for example, older people and those with disabilities, BAME and LGBT communities and women.

Alongside funding cuts to our health services, comes the toxic issue of privatisation within our NHS, being driven by the 2012 Health and Care Act. The expansion of the internal market in the English NHS has led to one third of contracts being awarded to private providers since the Act came into force. There are numerous examples of failed private contracts having was ted millions of pounds worth of public money and in many instances, because of underfunding, some local health bosses feel compelled to turn to the private sector, with serious consequences. Pr ivatisation of our health services is increasingly, and disproportionately, affecting the most vulnerable people using our health service. Labour will take act ion to reverse damaging privatisation in the NHS, by repealing the Health and Social Care Act, and reinstating the powers of the Secretary of State for Health to have overall responsibility for the NHS when in Government.

Issues

Addressing the impact of health inequalities in all parts of our society

Health outcomes and inequality are inextricably linked, with those living in the most deprived areas likely to experience fewer years of good health compared to those living in the least deprived areas. Issues such as poor-quality housing, insecure employment and lower incomes have a detrimental impact on people’s health and wellbeing. There are fears that Sustainability and Transformation Plans, as well as failure in private sector healthcare provision, could lead to increased health inequalities in society. In addition to this, we know that certain groups within our society (e.g. BAM E people, LGBT people, women, older people, those suffering from mental health issues) are more likely to experience health inequalities, and as a part y we need to be aware, and ready to deal with the specific challenges facing particular parts of our society. It is vital that we recognise and address specific challenges facing those who suffer with mental health issues, including the impact on people who are forced to travel outside their local areas to get access to specialist services. In addition to this, Labour is determined to improve prevention and early intervention in mental health provision, with a particular focus on specific groups in our society that are detrimentally affected. Labour is also acutely aware of the impact loneliness can have on people’s health and wellbeing, and has pledged to work with communities, civil society and business to reduce this increasing problem in our society. Furthermore, Labour’s 2017 manifesto focused on a number of issues which aim to reduce inequality in our society such as improving access to sexual health services, increasing the allowance for unpaid carers, and guaranteeing dignity for pensioners through keeping the Winter Fuel Allowance, free bus passes and maintaining the triple lock on pensions.

Questions:

  • What measures should a future Labour Government put in place to help reduce health inequalities across all parts of society?
  • Are there specific measures to help tackle health inequalities that currently work well in your local area?
  • What specific areas of policy (e.g. housing, criminal justice) do you believe we should focus on in order to reduce health inequalities in all parts of society?
  • What plans could a future Labour Government put in place to address health inequalities faced by particular groups in our society?

Public health funding

Labour believes it is vital to ensure that sufficient funding is made available to all health services, particularly those services which play a key role in reducing health inequalities in our society. Labour supports the promotion of prevention and early intervention to help reduce health inequalities, and believes that investing in Sure Start Children’s Centres, smoking cessation and measures to reduce levels of teenage pregnancy is vital. In its 2017 manifesto, Labour pledged to increase funding for health and social care by a total of £45 billion over five years. Looking specifically at public health, the manifesto pledged to invest in children’s health, introducing a new Government ambition to make our children the healthiest in the world. Specifically, the manifesto pledged to break the scandalous link between child ill health and poverty, to introduce a new Index of Child Health to measure progress against international standards, and report annually key indicators and to set up a new £250 million Children’s Health Fund to support our ambitions. Labour believes that it is vital to address health inequalities in society at an early stage, by investing in prevention and early intervention.  Labour’s task now is to build upon pledges made in the manifesto, with a specific focus on how health spending can be used effectively to combat health inequalities in our society.

Questions:

 How best can a future Labour Government ensure that funding to reduce health inequalities in our society reaches those who are most in need?

  • What does Labour need to do in its first term in Government regarding access to services, health outcomes and service quality in order to reduce health inequalities?
  • Building on pledges made in the 2017 manifesto, what more could a future Labour Government do to reduce childhood obesity in society?

Workforce

 Making sure we have highly trained and skilled health professionals working in our NHS is vital if we are to reduce health inequalities in society. Under the Conservatives, and as a result of damaging policies the y have pursued, we are seeing workforce shortages in many areas in the English NHS. For example, we have seen shortages of GPs, psychiatrists, nurses, midwives and crucially for public health, cut backs in the numbers of health visitors and school nurses. Labour’s 2017 Manifesto addressed the issue of the NHS workforce in England in detail, pledging a long-term workforce plan for health and care. Measures in the manifesto included scrapping the NHS pay cap and putting safe staffing levels into law. Labour believes that there needs to be a clear focus on the quality of training staff receive and we support reintroducing bursaries and funding for health-related degrees. Furthermore, our manifesto made clear that we would guarantee the rights of highly valued EU staff working in our health and care services. The manifesto also acknowledged the role carers play in our society, pledging to increase the amount unpaid carers receive and increasing funding to allow providers to pay a real living wage to those caring for the most vulnerable in our society. The Labour Party highly values dedicated, hardworking staff that work in our health and social care sectors, who play an invaluable role in helping to reduce health inequalities in our society and believes that they should be supported with the right policies and planning.

Questions:

  • How can we ensure that all parts of the health and social care workforce are working together to reduce health inequalities?
  • Which other parts of society should health and social care professionals be working with to address issues of inequality in our society?
  • What steps does the Labour Party need to take in order to create a sustainable health & social care workforce strategy that will truly assist in addressing health inequalities?
  • What steps can we take to improve staff retention in the NHS, particularly in areas of the country with a high cost of living?
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In the Nov/Dec ’80 issue of Socialism & Health‘ we published an interview with Stan Orme, who, at the time, was the shadow health minister. Since then Michael Foot has become the party leader and Gwyneth Dunwoody has taken over Stan Orme’s job. We felt that it would be interesting to see what her views were on broadly the same areas as those we asked Stan Orme about, so we interviewed her in early March.

This is a summary of that interview:

Alison: Which Tory policies are you most concerned with, with regard to health?

G.D.:  It’s their general attitude to health care that worries me, their intent to undermine the N.H.S. from the inside & particularly a 75/25 division of health care between the N.H.S. & private medicine.

Graham: What do you see as the next Labour government’s priorities for both reversing changes introduced by the Tories and in other ways?

G.D.:   The economy is going to be in a bad way & we’ll have to fight for spending on the N.H.S.  The particular priorities should be   a) capital expenditure and b) how to restore the personal social services, as community care is a mess at the moment.  This will be made worse by the proposed reorganisation, and the ‘cinderella’ disciplines will need particular help.

Graham: How would you link that with the Royal Commission & the Black Report?

G.D.: I’m wary of stating detailed priorities partly because the Black Report hasn’t been sufficiently analyzed. Doctors must be given incentives to go into neglected areas and an immediate boost should be given to N.H.S. morale. Current management techniques are thirty years out of date. H’s also important to defend existing NHS structures. The Labour Party must work out what it feels priorities are by the next election and give up sloganizing and substitute it with more concrete policies

Alison: How would a Labour Government tackle the tobacco industry?

G.D.: I think there has to be a total ban on advertising. There’s no evidence that the present government is planning to do this. Tobacco industry profits should be creamed off into the NHS.  Stop business practices that British companies practice in the Third World which would not be allowed here.

Alison: The   Black  Report   advocated  ‘phasing  out’  the British tobacco  industry  within  ten  years,  how do you  see that’?

G.D.: Workers in the tobacco industry must be consulted & redeployed, with public money being used to create Jobs.  If the companies  won’t  diversify, they  should   be  told  that  the  state  won’t  tolerate  their activities.

Alison:  The last Labour Government didn’t  do very much..

G.D.: I think there’s been a shift amongst the public in attitudes towards smoking & smokers – the Labour movement has always been aware of the effects. Predictably, it’s the middle classes who are changing their habits & classes IV & V who aren’t. The press don’t campaign against the industry and the Sunday Times appears to have been ‘nobbled’ by a section of it recently.

 Graham: Do you think a Labour Government could stand up to the tobacco industry? that’s what  the  real  issue  is,  it’s  very  different  producing  educational  material from tackling multinationals.

G.D.: “I  think that all governments  are able  to  withstand attacks where the majority of the people actually understand  what  they ‘re  doing  and why. I believe it now is something in which a Labour Government would have to lead.

Graham: The Black Report uses the tobacco industry as an example of how health may be improved by political action & they later suggest  that  we need  a ‘food policy’ in much the same way as we need a tobacco  policy.   This would  presumably involve education, food  subsidies  and  tackling  the  food industry.

G.D.: This  would  be a long  term  proposition.  While   I   feel  that nutrition should be made political and food policy  become   a priority   for   the  Labour  Party whether enough  work has  been  done  or  enough real political thought has been given to that sort of development I doubt . This sort of stuff is not yet a high priority for the party. Rickets may well soon appear, the school meals service is getting worse. This may make nutrition more political.

Alison: Shouldn’t we  be  making  it  political before we get these problems?

G.D.:Yes,  but  I’m  trying  to  avoid  a  commitment  to such policies   when  there will be enormous problems. We should  have   a  limited  set of proposals that you’ve  got to do & can do, & fights that you can defend. Nutrition is well up on my priorities but at the moment is low down on party priorities. That may change.

Alison: How would you   like  to see occupational  health developing?

G.D.: I’m in favour of it developing as part of the N.H.S. Some Trade Unions want it more closely linked  to the Health & Safety Executive.

Alison :How’s about private health care, in particular occupational aspects?

G.D.:I have  always  persuaded  Trade Unions not  to negotiate private healthcare as part of wages deals. Part   of   the   problem is that   many   people have forgotten what private healthcare was like. They don’t realise all its implications in particular the exclusions for long term support.

Graham:  How do you solve that; as part of the  problem of how you project socialist health policies?

G.D.: That’s part of our responsibility in the House of Commons & part yours. Once people see the real cost of private health  care  they’ll swing  back,  but the N.H.S. may be damaged in the interim. What will safeguard the NHS in the long run is people unders tanding the implications of private treatment.

Alison: What about pay beds within the NHS.?

G.D.: I think they should be phased out very y quickly indeed; even if the insurance companies would like this,  the  NHS has  to  be a  fully comprehensive health service & I  think  that private practice should be right outside it. There will be a growth of some kind of private medicine & it should be licensed. Private units use N.H.S. trained staff without any contribution to their training and I don’ t see why you should have, for example, private hospitals operating alongside NHS. hospitals that haven’t got sufficient nurses.   Maybe private units that use N. H.S. trained staff should have to contribute very substantially to the N.H.S.

Graham: In the Black Report the abolition of child poverty is suggested as a means of combating preventable disease.  This  would   involve   taxation policy, child benefits & possibly an incomes policy. What do you feel about this?

G.D.:       Incomes policies are very problematic.  We do need an extended view of health care,  but  the  implications of the Black Report have not  been  fully debated in the  Labour movement.

Graham:   Why   has health had a lowish priority in the Labour Party for some years?  It had always been a central issue for socialists.

G.D.: We’d got complacent ab o u t health care, t he problems were thought to be specific but overall things were O..K. Under this government it ‘s become clear t½h at the service is  not  good  enough  and  the Black Report came at the right time. Michael  Foot feels very strongly that health is one  of  the  most important  things  that  any socialist can ever be concerned about.

Alison: Inequaliti1es in health  have  been   known  for  some time though.

G.D.: Yes but mainly to experts and not  to ordinary Labour Party members. The Black Report was well written, very well argued & very cogently produced.’

Graham:   What two or three areas of legislation would you like to see the next Labour Government enacting?

G .D .:Difficult  because  in  the  past  we’ve  been  bound  to priorities  without  flexibility but

  • Improving management techniques t o get back some sense of purpose about the NHS among staff.
  • Neglected areas like mental health should be given a boost
  • I want to see   the  whole battle of private health care fought very energetically I really think that’ s one where we’ve got to stop pussyfooting about.
  • Lots   of   other things including day care abortion facilities.

The next government must set out a simple set of steps & defend them in agreement with the workers, the party   &  the trade unions.  That   will   mean hospital services & something constructive in relation  to  the personal social  services .  We’ve got to think about how to channel money, how to monitor things, where our priorities lie and other difficult areas.

Graham:    Can health considerations be brought into other areas of policy making?

G.D.:  Inevitably and it’s happening now, because in local authorities, cuts in their revenue has led to worse social services which has produced increased dependence on the NHS which is itself  under attack. The personal social services need protecting.

Throughout the interview, Mrs. Dunwoody emphasised the need   for the next Labour   government   to have a   list of priorities for    health & health-care  legislation  which could  be both fought for & implemented. While those priorities, & the details of policy,  have  not  yet  been formulated, she intends to see  that  they are during the period  before  the  next  election. We felt that she showed a good grasp of the  problems & was fairly   sanguine  about   th e  differences  between  her   views & likely party policy. We left feeling relatively hopeful.

Graham Bickler

Alison Hadley

 

 

 

 

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Introduction

 The Labour Party Conference have rejected Sustainability and Transformation Partnerships and American style Accountable Care Organisations and John Ashworth has declared his wish to work with campaigners , trade unions and Labour Party members to review the funding of the NHS and to work on a future Labour policy for the NHS.

This paper takes up that challenge and proposes looking at the issues according to these headings:

  1. Immediate priorities
  2. Provision of funding and funding principles
  3. The question of Integration of healthcare and social care.
  4. The question of managing complexity and sub-contracting management to the private sector.
  5. The question of Brexit, planning for adequate staffing levels and promotion of training.
  6. Promoting true professionalism not unrealistic salaries and earnings expectations.

A clear set of policies can be seen to emerge from discussion of these issues and recommendations are set out.

Immediate Priorities

 In order to attract support, Labour Party policies must be seen to address immediate priorities as well as longer term issues. Undue stress on the latter puts the wrong emphasis and distracts from attending to current problems. By contrast talk of whole person integrated care has struck no chords and instead prepared the way for a speculative, unproven and sinister introduction of American style medical management companies into the fabric of the NHS. Accountable Care Organizations are the latest cure all for the NHS but they are copies of arrangements in the USA that prepare  the ground for the contracting out of management functions and back office services as a precursor to future service changes, including privatization.

The immediate operational priority however is to relieve the current bottlenecks to the delivery of services.

Those bottlenecks are :

  • Financial resources: modest initial sums could relieve pressures and avoid counterproductive cuts to service capacity. Making sure pay awards are fully funded would help prevent further destabilization.
  • Attending to the financial difficulties attending to PFI developments failing to achieve efficiency targets and posing threats to service continuity.
  • Failure to support emergency measures to train more staff in shortage areas.
  • Lack of clarity over operational priorities. It should be made clear to the frontline staff that the welfare of patients is the priority not financial control.

In addition to these measures further measures should be taken to halt and divert resources that may be about to be committed to the wrong things, for the wrong reasons.

Included in this category must be resources committed to as yet unproven, unneeded and speculative “transformations”.

Whilst the Labour Party supports extensions of primary care and social care this cannot be at the cost of putting front line and last ditch services at peril before alternative models of care are available, proven and delivering suitable alternatives to existing services.

Given the financial context of relatively limited growth funds, limited capital and risky efficiency schemes the Labour Party should be supporting careful prioritization  not excessive risk taking.

An independent check of current STP plans should be conducted and all those failing to show clear and deliverable benefits should be denied approval. The operational priority should be the maintenance of existing services, not delivering unrealistic hopes for the future.

Funding and Funding Principles

 The total resources devoted to healthcare by the UK economy should be maintained at norms established through comparison with comparable countries. What that figure is can be debated but the principle should be fixed that this should be the basis for settling national budgets and longer term funding trajectories.

Although the level of funding of social care should be taken into account in setting the healthcare budget the Labour Party should make it clear that the funding of healthcare and social care are separate questions that can and needs to be financed in different ways.

The Funding of healthcare should come predominantly from taxation. This does not rule out modest user charges e.g. prescription charges, but given the high level of people in receipt of benefits it is likely that the costs and benefits of their application would need careful justification. The success of the Scottish, Welsh and Northern Irish initiatives to abolish prescription charges could be supported unless evidence shows it leads to overmedication.

Partnership with the private sector in the investment in service developments not otherwise achievable directly by the NHS would be considered on a case by case basis , and not ruled out on principle or promoted on principle.

Investment funding decisions should be routed through a national investment bank and be subject to rigorous independent evaluation based on rewarding schemes with proven long term benefits not whether investment fits within a fixed short term and arbitrary capital  budget. PFI debts should be taken onto the balance sheet of the national investment bank and managed appropriately and not be seen as a purely local responsibility.

Above all funding of an expanding and higher quality healthcare service will be applauded as a positive development and not seen as a drain on the national purse. Links with other countries and the private sector will be encouraged so that the UK can share in and participate in expansion and improvement in healthcare worldwide e.g. in training doctors and researchers; and healthcare products and services.

Integration of Healthcare and Social Care

 The Labour Party believes in an adequately funded comprehensive NHS and in a partially funded social care industry for those in greatest need of social care, including by direct provision where appropriate to ensure needs are met.

Wherever benefits can be realized from greater co-operation between the two services then this should be encouraged but limits exist to the level and depth of the “integration” of the two separate services. Experiments into closer integration can be undertaken but results should be independently substantiated , evaluated and agreed prior to any future structural changes.

Managing Complexity and Sub-contracting management to the private sector.

 The Labour Party is skeptical that the claims made for the improvements available by sub-contracting of public management of either commissioning functions or provider responsibilities for and of the NHS. Indeed the ethical and trust issues involved in healthcare delivery make it possible to justify management being firmly under the control of the state. The prevalence of fraud , corruption and waste in the USA underline the risks for the UK in following American hype supporting “new models of care”. Equally the Labour Party is skeptical of the benefits of the full integration of the NHS into a monolithic management structure on a top –down model. Checks and balances need to be incorporated so that the conflicting demands of clinical quality, economic efficiency, effectiveness , local influence on decision making , patient involvement and choice can be balanced appropriately through democratic means ie through the continued separate influence of local government in the purchasing and commissioning of healthcare , in joint planning and by retaining  prime responsibility for social care.

The question of Brexit,  planning for adequate staffing levels and promotion of training.

 The prospect of imminent Brexit is likely to have a negative effect on the NHS in terms of the effect on government financing, availability of investment capital and access to immigrant labour.

This makes it all the more important to focus funding on immediate needs and to radically upgrade the training of staff in numbers and in quality to deal with the pressures anticipated in the future.

The international statistics suggests the UK lags well behind other countries and it has been a scandal that the NHS has looked abroad to recruit and train staff.

It will be good for Universities, good for young (and mature) people previously denied access to professional training  and good for the providers looking for a fresh supply of well-motivated people to fill vacancies.

Promoting true professionalism not unrealistic salaries and earnings expectations.

 The shift in values within the NHS toward commercial values and away from professional and social welfare values impacts on salary expectations, and labour flexibility . The Labour Party support a return to professional values, a turn away from crude managerialism  and to an NHS infused by professionalism , flexibility toward meeting patient needs and respect for its managers, staff and patient alike.

Policy recommendations :

Sustainability and Transformation Partnerships and Accountable Care Systems to be rejected in favour of measures to support and not undermine existing services.

Progress on expansion of preventative medicine, primary and community care should reflect commissioning priorities focused on todays problems not on unproven claims on behalf of “new models of care” ;and , on  a case by case evaluation of compelling business cases not on speculative and risky gambles with people’s lives.

  1. Modest additional resources should be made immediately available to offer relief to the NHS otherwise in financial distress. A figure of £4bn has been presented by industry experts as required.

 Future funding should be increased to at least meet real terms increases in demand and in the medium term converge on to international norms for healthcare funding established with comparative nations.

  1. The PFI funding issue should be managed in future by a National Investment Bank who would arrange for an orderly transition for existing contracts and who would take responsibility for approval and funding of new investment cases.
  2. To relieve a looming staffing crisis an immediate and substantial expansion in training numbers will be undertaken.
  3. To avoid any doubt the government would declare to its managers , staff and patients that immediate patient welfare is the overriding priority in delivery of healthcare within parameters set at the national level.

At a national level advice would be provided on the overall funding by professional bodies and industry experts and not rely on Treasury dictat, blind to the operational and human pressures.

  1. The Labour Party see no prospect of fully integrating health and social care funding streams and management arrangements whilst being in supportive of looking for operational efficiencies in the management of individual patients. But given that Healthcare is a right and social care a restricted benefit subject to means testing the two services will have different foci.
  2. Professionalism and keeping pace with the speed of scientific development in medical techniques should be the basis of changing the NHS not the unproven claims of the commercial health management industry.

 

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It is always an absolute pleasure to speak at a SHA event – this being my third in the year that I have been Labour’s Shadow Minister for Public Health.

It is wonderful to be with so many like-minded people who are committed to improving people’s health and ensuring that prevention is a key cornerstone of our approach to public policy.  I know you have an incredibly packed agenda with many excellent speakers, so I won’t be keeping you for too long. But in my contribution to today’s discussions I want to set out Labour’s approach to public health and how all of you can help shape and contribute to the policy development as we move forward in this Parliament, and to the next General Election – whenever that may be.

That said, Labour are ready to take on the task of addressing the challenges we see when it comes to the public’s health. I can commit to you today that whenever the public give us the opportunity to govern, Labour will be ready to get on with the task at hand of reversing the damage inflicted after seven years of Tory rule.

For Labour, our clear aim is to champion better public health services across the country which tackle the entrenched health inequalities that have been all too often ignored, tackling the permeation of ill-health that cripples our communities and ensuring our NHS has the right level of funding and resources so it is fighting fit for the future. Under the Tories all of this has been ignored and failed. It cannot go on any longer.

Specifically, when it comes to public health, I have identified what I believe to be a “public health crisis”. This is not about scaremongering or blustering; it is seeing what the Tories have done to our NHS and wider health services and having the understanding that their actions have consequences which put our nation’s health in jeopardy. We all know the facts – by 2021, £800 million will have been siphoned away from public health services and this has had an unimaginable impact on services in our local communities which have stalled the improvement of health we so desperately need.

It isn’t just Labour who have recognised these concerns, but the likes of The King’s Fund, who earlier this year, analysed DCLG data on local spending priorities for public health and found that the prognosis was not good. Their analysis identified that local authorities would be spending on average 5% less on public health initiatives than in 2014 with some of the worst hit services being sexual health promotion and prevention along with wider tobacco control which both see devastating cuts of more than 30%.

The King’s Funds’ conclusion is one that I completely agree with. They said:

“… there is little doubt that we are now entering the realms of real reductions in public health services. This is a direct result of the reduced priority that central government gives to public health.”

The idea of reduced priority isn’t one without basis. If we look at NHS England’s Five Year Forward View update report compared to the document published in 2014, public health has seen a clear downgrade from “a radical upgrade” to one deemed to be no more than an efficiency saving exercise in the 10-point efficiency plan. Whilst efficiencies can always be found to improve outcomes and results, they categorically should never be done to the detriment of our health.

Since 2013, when public health was moved from central government to local authorities, it was welcome to see a more localised approach to addressing health needs – as we all too often know that health inequalities can be local and must be addressed by those who know their communities the best rather than faceless civil servants at their Whitehall desks. Yet as the planning, commissioning and procurement of these services was devolved they were met with eye-watering cuts which left them struggling to ensure the new responsibilities they had acquired could be used effectively. The icing on the cake, for those who believe passionately that improving public health should be done at a local level, was scrapped away when central government laid down these short-sighted cuts. This has meant that services have had to fight to survive and maintain the standards that the public have come to expect, which in turn has led to the money needed to oil the wheels of innovation at a local level has not materialised.

It is always important that innovation sits at the heart of public health so we can meet the health challenges of the day and ensure that we continue to move towards a society that is healthier and happier.

Whilst the local level has seen serious problems arise because of the Tories’ failures, there have also been concerns about action at a national population level too. It is safe to say that delay, decisiveness and joining of the dots are lacking when it comes to national policy by Tory ministers.

We have seen an 18-month delayed Tobacco Control Plan finally published which failed to recognise that to provide the vision of smoke-free society set out in the Plan, that the Government must put their money where their mouth is to see it succeed. The same can be said of the Home Office’s Drugs Strategy which failed to move on from its 2010 predecessor and ignored the significantly reduced funding envelope for prevention and treatment services we now have. We also saw the PrEP Impact Trial continually delayed after the evidence has been abundantly clear that providing PrEP can revolutionise our approach to halting the spread of HIV in society. Then there is the failure to address burgeoning issues such as lung diseases with what can only be described as disdain by ministers even considering the idea of a lung diseases strategy which could help co-ordinate action to improve outcomes for those blighted by these diseases, especially those in our most deprived communities.

The most perfect example of these failures by ministers was the Childhood Obesity Plan – published over a year ago now. Though measures announced in the Plan two summers ago were, of course, to be welcomed and it is pleasing to see steady progress has been made when the Government published their update this summer, the Plan and the progress made have left us wanting. We all know that obesity is one of the most burgeoning public health crisis facing our country right now and this Government have done the bare minimum so they can be seen as if they are acting on these worries. Labour won’t let this continue and we set out quite clearly how we would do this in our manifesto in June of this year with a radical approach to childhood health issues.

However, it is not only health issues specific to the brief which I shadow that this Government are failing on, but a whole host of policies which are damaging when it comes to our nation’s health. The clear and most pronounced of these is: the growing prevalence of poverty in our society. Poverty is not an inevitability of society but is in fact an inevitability of a failed society. Through-out my parliamentary career, I have ensured that poverty is one of the key issues that I work on – may this have been through education or health matters. It is what drives me in my work in Parliament as it is a damning indictment of any society to see poverty become so normalised that it is left to be ignored, especially in one of the richest countries in the world. And it is what will drive me if I am ever honoured with the chance to be a minister in Government. Poverty is a multi-faceted issue and realistically one fix will not address all of the causes of poverty, but the fact of the matter is, austerity is exacerbating the problems of poverty we see in our society. Instead of putting their heads in the sand, it is high time that ministers got to task and addressed these issues head on. Poverty has untold consequences on our society – may this be on education, life opportunities or on our health.

These matters cannot be ignored much longer and it is important that governments put the health of our nation first and to do that health must be considered in every action that is taken by a Government. What I have set out is a sorry state of affairs which we find ourselves in due to the crippling policies of the Tories, but Labour is up to the task of reversing them.

We have heard it said often since the snap General Election in June, but Labour is a government-in-waiting and Labour’s Shadow Health team of myself, Jon as our Secretary of State and Barbara, Justin and Julie, are ready to work tirelessly to improving our nation’s health. We have a track record on this. Take our June manifesto, where we set out in a comprehensive fashion a radical programme on public health and wider health and social care services. I, for one, was incredibly proud of what we offered to the country. I may be a bit biased here but we offered hope and a true vision on what government should be doing around health. But, as I said at the outset of my speech, we must continue to look forward – especially with another General Election forever looming over us with this shambolic government in office.

That is why I welcome these opportunities to meet with you all and speak to you about our priorities as a Labour Party. And about what you believe a future Labour Government should prioritise when it comes to our health policy. We have a lot to sort out, so there will be many competing priorities if we are to get into office but I want you to know that I will continue to champion an improved preventative health service and work towards our ambition to be the healthiest society we have ever seen. I can only do that with your support and guidance, but I know for sure that together we can achieve this ambition that I lay before us today.

This was presented at our conference Public Health Priorities for Labour

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Now the Labour Party’s objectives for the NHS are clearer, the real politics begins. If May’s government collapses, as looks increasingly possible, Labour will need to project its tactical policies for the NHS forcefully. The plausibility of how it plans to cope with the winter bed crisis will matter – what will the £500 million promised be spent on? How will a Labour Secretary of State for Health manage delayed transfers of care?

If May’s government survives Labour will have to live with Hunt Supremacy for a while longer, and will need some practical ideas. Two events in the last week offer some possibilities; the King’s Fund report and webinar on the development of an accountable care organisation in the Canterbury region of New Zealand, and John Appleby’s review of PFI in the NHS, published by the Nuffield Foundation.

Canterbury Tales

The Canterbury story was explained in the webinar by two leaders from the District Health Board and a large GP federation. They described the situation a decade ago in terms familiar to anyone in the NHS; clinicians trying to integrate a fragmented system but often inadvertently working against each other; hospital gridlock; and a common feeling that if only other people would sort themselves out, all would be well.

Creating an integrated local health service required investment in general practice, starting with the organisation of out of hours services, and growing collaboration around care pathway developments, not structural changes. Resources were created for GPs to support their patients in the community more easily, and hospital admissions declined. Effort went into relationship building, influencing the private provider organisations (the majority) and letting go of history in which grievances were prized possessions. Making the process of change clinician-led and management- enabled stabilised the primary care workforce, avoiding the problems we currently have. The leadership of the changes avoided consultation, with its undertones of decisions already made elsewhere, and sought dialogue. Likewise, debates about funding and contracts were postponed because early exposure to them demonstrated that nothing could change. Realistic timescales were sought – no quick fixes. The integrated system works on the basis of not wasting people’s time (patients and professionals) and stressing its operational principles of “no wait, no harm, no waste”. The cancellation of a single elective procedure because of emergency care counts as failure.

PFI Revisited

John Appleby dissects the scale, size and costs of NHS PFI schemes, which vary enormously. He concludes that it is not necessarily the case that PFI scheme were poor value for money. Early schemes were not always good deals, but as the NHS gained more experience of PFI it negotiated better terms. Tees, Esk and Wear NHS Trust, which has paid off one PFI scheme, judged that its more recent schemes were good value and has left them in place.

A Labour Government could find ways to end PFI schemes early but the question is at what cost and opportunity cost? Would such repayments be money well spent, or could they provide more benefit if spent on something else? The drive for PFI has weakened. Seventeen new PFI schemes were expected to reach final construction in the NHS between 2011 and 2018, compared with 92 in the nine years from 2002. This may change again. Trusts needing to increase their capital budgets have been encouraged to open new PFI projects rather than borrow money directly. This will create some challenges for Labour, whether in office or in Opposition.

Appleby, J (2017) “Making sense of PFI”. Nuffield Trust explainer. www.nuffieldtrust.org.uk/resource/making-sense-of-pfi

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LAST week’s Labour Party conference saw significant advances in Labour’s policies for the NHS — advances resulting from the collective efforts of health campaigners and the labour movement.

Rather than sitting back and waiting for a general election, these gains now need to be followed up by concerted action to ensure that MPs, councillors, trade unionists and activists work as one to ensure that Labour’s new policies are effectively implemented in every part of the NHS, national and local government.

The week began with a Sussex Defend the NHS march through Brighton to the conference centre.

The speakers at the rally included shadow chancellor John McDonnell, shadow health secretary Jon Ashworth and Professor Allyson Pollock, co-author of the NHS Reinstatement Bill, which has for so long acted as a beacon for campaigners against NHS privatisation.

In a fiery speech McDonnell committed the next Labour government to not just halting but reversing all NHS privatisation and ending the massive debts created by the discredited private finance initiative (PFI), which the Blair government used to build so many hospitals.

For the first time, Ashworth committed Labour to ending the Sustainability and Transformation Plans (STPs) which constitute the Tory strategy for breaking up England’s National Health Service into 44 Americanised and restricted care packages, or Accountable Care Systems (ACS).

Popular though it was, Labour’s election manifesto had merely committed to halting and reviewing the STPs.

Later, in his conference speech, Ashworth committed Labour to scrapping the NHS pay cap, reintroducing health student bursaries, and fully reinstating a publicly provided health service free of privatisation, free at the point of use and accountable to the secretary of state.

These policies are all to be found in the NHS Reinstatement Bill and later Ashworth agreed to meet the academics working on NHS reinstatement.

However, the most important progress on health policy was made in conference’s overwhelming support for the composite motion on the NHS, which I had the privilege to propose on behalf of the Socialist Health Association.

Our motion had also been submitted by 26 constituencies; a further 13 had submitted similar NHS motions mostly drawn up by the Campaign for Labour Party Democracy and by Keep Our NHS Public.

Agreement at conference implies that the motion can be treated as Labour Party policy.

As heralded in McDonnell and Ashworth’s speeches, it firmly commits Labour to reinstating a fully comprehensive service without user charges, provided and funded by the public sector. All NHS privatisation will be reversed and PFI debts paid off centrally.

The views of conference delegates on ending privatisation were further reinforced by the “reference back” to the National Policy Forum of a section of its 2017 report referring to manifesto commitments for the NHS to be the “preferred provider” and to a proposed new legal duty to avoid excess private profits being made out of the NHS; both of these of course imply a continuation of a commercial market within the NHS.

The Five Year Forward View — NHS England’s ruthlessly and undemocratically imposed cuts, rationing and privatisation strategy — will be ditched, along with the STPs and ACSs which are currently taking apart England’s health service.

Research published by SHA has now shown the Five Year Forward View to have directly originated from the corporate health profiteers of the World Economic Forum at Davos.

Scrapping the strategy will be achieved through an NHS Reinstatement Bill along the lines of the one tabled by Margaret Greenwood MP in the last parliament.

But if the Tories hang on for five years, the NHS will have gone by the time prime minister Corbyn takes office.

We must do everything possible for these newly agreed policies to take effect now.

Although Theresa May, Jeremy Hunt and their NHS executive and corporate friends will plough on regardless, they cannot implement the STPs without support and collaboration from Labour local authorities.

It is imperative that Corbyn, McDonnell and Ashworth meet as soon as possible with Labour council leaders — and also with MPs, trade unionists, councillors, health professionals, the voluntary sector and activists — to spell out Labour’s new policies and to emphatically assert the crucial importance of their immediate implementation.

At the same time, Labour members should be submitting motions to their constituencies, to ensure that local pressure is exerted on councils, NHS and care agencies, and trade unionists, health activists, health workers and everyone who cares for the NHS should be organising to press for effective local action to scrap the STPs and ACSs.

Thanks to last week’s conference, Labour has the political leverage to seize the moment.

The conference motion to renationalise the NHS will win Labour the next general election. We must act to save the NHS — and the time is now.

First published by the Morning Star

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Labour created the NHS in 1948 – and in 1997 it expanded it. Now the challenge is to make the case for more investment in both health and social care, so that our NHS can underpin a growing economy.

‘I pushed a box of tissues across the table to the elderly man who cried as he told me that he feared he would die before he got the heart operation his doctors told him he needed.’

Jacqui Smith recalling a constituency surgery appointment soon after she was elected as MP for Redditch in 1997. NHS patients waited and suffered in 1997. There were more than 1 million people waiting for hospital treatment, and delays of up to 18 months before treatment were still common.

People working in today’s NHS say that they haven’t seen such tough times since before 1997. Times when NHS care was rationed by delays in treatment; when, if you could afford it, you paid to have your elderly relatives operated on in private hospitals and when satisfaction with NHS services was low. Today’s Conservative government is reminding us what happens when funding and focus shift from providing timely access to health care. The NHS of all our great national institutions is particularly relevant to this publication. Women are more likely than men to come into contact with it through their caring responsibilities and comprise
more than three-quarters of its workforce.

The last Labour government improved both the quantity and quality of NHS care. Before 1997, data about patient safety incidents in England was not comprehensive. There was little focus on learning from mistakes and too little research to ensure we delivered the best in our system. Access to health care and a healthy life depended too much on where people lived and how much they earned. Whilst some mental health care had modernised, there was no systematic understanding about new ways to treat the many people with mental health problems. Stigma and prejudice against those suffering mental ill-health went unchallenged.

How did a Labour government rescue and reinvigorate the NHS which had been one of our greatest previous achievements in government? As we will see, it needed a considerable increase in investment – in staff, buildings and care. However it also needed reform to drive accountability to patients and a reinvigorated local leadership in the NHS and communities.

Labour in government: access and accountability

Waiting times for hospital care were a key issue in our 1997 election campaign – one of the five pledges on the famous card. On the doorstep, we talked to people about how we could cut NHS waiting lists by 100,000. This was achieved by 2000 – and we then went far further.

There was huge progress in speeding up access to hospital treatment, including for diagnostic tests and surgery, and improved access to GPs and other forms of primary care. By 2010 most people waited no longer than 18 weeks for diagnostics and treatment – down from the 18 months when Labour came into government. There were half as many people on waiting lists and their waits were far shorter. The shift was in part brought about by substantial increases in the number of operations and diagnostic tests carried out. Between 1998/9 and 2007/8, the total number of procedures carried out in hospitals rose from 6.5 million to 8.6 million.

The focus wasn’t only on hospital care. The NHS Plan in 2000 set a target for 2000 more GPs over five years. This ambition was easily met, with numbers increasing by 3,500 in that time. There were also more contacts with other primary care staff like nurses and pharmacists. These services were delivered in newly opened and renovated GP surgeries and increasingly in GP-led health centres.

How spending on health has slowed down Average annual increase in government spending on health

 

The improvements could not have happened without the decision by a Labour government in the early 2000s to increase investment in healthcare to bring us up to the EU average. The difference between the record on health spending of the Labour government and the Conservative governments which went before and came after is stark, as shown in this diagram from the Institute for Fiscal Studies. The size of the respective columns translates into staff, equipment, buildings, access and quality – and the effects of the cuts post-2010 is the pain people are feeling now.

With more money came more accountability. The performance management of acute hospital services of the NHS was rigorous during the Labour years. Arguably stronger targets in community and mental health care could have improved access there too. Targets drive performance, but they are also an instrument of accountability. When Labour ministers translated the needs of people to be able to get their care quickly – regardless of their ability to pay – into targets for the system, they were enforcing the founding values of the NHS.

Too often the system of targets has been characterised by opponents inside and outside the NHS as being about bureaucratic interference with the professionals who know best. In fact, it was about accountability and delivering people’s priorities more effectively. Despite people’s fears at the time, more local accountability was also achieved through foundation trusts, accountable to members and with elected governors.

However there remains a problem at the local level where too often commissioning has neither properly engaged local people nor really driven providers to deliver the health services those people require. In too many cases, commissioning has tended just to administer national priorities through a burdensome local process or even acted as an additional regulator in the system.

The last few years have seen a weakening of the ‘freedoms’ of foundation trusts. Those providing NHS services are not looking outwards to the needs of their local communities and patients, but upwards with trepidation to central government diktats and a range of regulators.

Choice and involvement

Patient satisfaction as measured by the British Social Attitudes Survey was at its lowest point in 1997 and then grew throughout our period in government. Labour also introduced the biggest survey of patient experience in Europe.

From 2001 onwards, it also became a government priority to provide patients with choice over where they received non-urgent elective treatment.

We introduced personal budgets and direct payments in social care. These have given thousands of older and disabled people, and their families, greater control over their care and support.

In 2009, we extended personal budgets in a pilot scheme for people with long-term conditions like stroke, diabetes and mental health problems. The evidence shows personal health budgets improve people’s quality of life, getting better results with the same amount of money. Where people had higher levels of need and larger personal budgets, their use of more expensive hospital services was actually reduced as they considered their options and made their choices.

Personal budgets can also be a powerful way of ensuring services are properly joined-up and keeping people well and living at home. Patients and families care more about getting the right help than which service or organisation provides it, and living day in, day out with a health condition means they often know best how to prevent it from getting worse.

Of course there are many situations where personal health budgets aren’t suitable. In an emergency, few people are in a position to make choices about their treatment.

However for the growing number of people with longterm health conditions, personal budgets – backed up with the right information, advice and support – can help make sure people’s views are taken into account much more than in the past. The shift in purchasing power from institution to individual works for everyone and provides choice for patients.

Choice has proved a controversial topic for some, but we would argue that the system does not yet deliver enough choice in a whole range of issues which affect the quality of care and patients’ experience. Surveys have revealed several weaknesses, including limited progress in delivering greater choice of treatments, especially for mental health patients, and those reaching the end of their lives.

Quality and safety

The focus put on patient safety and quality was an important step forward by the Labour government. Reporting incidents and learning from them is key for today’s successful health care providers even if there’s more to be done to ensure that the system focuses on accountability and learning rather than blame and fault. Initiatives such as the National Patient Safety Agency helped to highlight the need for clinical quality. The focus on getting rid of hospital-acquired infections marked an
end to the fatalistic view that there was not much that could be done, with instead an emphasis at national and trust level on safety.

More rigour was applied to establishing what worked best and should be delivered. With the National Institute for Clinical Excellence, the NHS made clear the criteria for the best medicines and treatments that people could expect across the system. After the NHS Plan in 2000, national service frameworks set out the types of treatment and care that the whole system should deliver. In mental health, for example, the development of new models of early intervention, crisis resolution, outreach and the introduction for the first time of talking therapies, transformed the quality of services.

Healthy lives

International comparisons of our health systems show the NHS performing extremely well on access and efficiency but less well on helping people to live healthy lives. It is a cliché, but nonetheless true, that we have developed an extremely successful national illness service, but have failed really to drive good health.

That’s not to say we didn’t make progress. Our teenage pregnancy strategy helped reduce conception rates among the under-18s to their lowest rates for more than 20 years. According to Cancer UK, Labour’s ban on smoking in public places helped an estimated 400,000 people quit the habit.

As with many public health developments, critics criticised the smoking ban for being part of a ‘nanny state’ and dubbed the women ministers who stewarded it through ‘nannies’. This is a gendered putdown to all those who considered that keeping people healthy was as important as trying to make them well again when they got ill. Perhaps it’s also why governments have made poor progress in reducing obesity or diseases related to alcohol. No targets were set and no serious government action was taken on these – and still hasn’t been.

The smoking ban was legislated and implemented by the Department of Health alone, but action on alcohol and obesity requires a cross-government approach. This has proved far more difficult to motivate and to lead inside government or outside.

Age discrimination was widespread in access to health services, especially to acute health care but this was only one aspect of health inequalities which Labour held to be completely unacceptable. Reducing health inequality became an explicit target for the first time and there was a focus on particularly deprived areas through initiatives such as health action zones.

Labour also took action to improve social care for older and disabled people. We pioneered new services to help older people stay living independently in their own homes, including through extra care housing and the Partnerships for Older People project. We championed more joined up NHS and social care services, introducing new care trusts for the first time. We introduced new rights for carers including the right to request flexible working, and improved information and advice for carers through the expert carers programme.

Closing health inequalities remained unfinished business. While life expectancy is growing across the population, it was and is still growing fastest for the better off, so the gap is widening. The barriers still haven’t been properly broken down between the NHS and the other services that are needed to improve health standards in the most deprived communities. We need a wider approach that looks at economic and other social factors such as housing, and Labour was impatient in government to achieve this.

The future

But that was then. There were of course discordant voices.  Not all of our reforms were welcomed, or went far enough, or were fully implemented or sufficiently funded. However, the commitment of Labour in government was absolute, and the progress in those years was from a much-loved but battered health care system to one that was delivering to the higher expectations and standards of the 21st century.

The Tories’ onslaught on the NHS started immediately after the election. A divisive reorganisation, unprecedented in its scope and scale, drained an estimated £3bn away from frontline services, demoralised staff and diverted attention from the prime purpose of improving health outcomes. That was on top of the cuts in the growth in NHS spending shown above, so that budgets failed to keep pace with population increases, let alone rising costs or public expectations. There was an ideological onslaught on the notion of target-setting, seen as part of a Labour ‘legacy of bureaucracy’: until earlier this year when the King’s Fund warned that after seven years
of Tory and coalition government, a record 4 million people were waiting for operations. Two decades earlier Labour had committed to cut waiting lists – and delivered on that pledge.

In future, the biggest challenge for our health and care system is how we fund it. The NHS is partly the victim of its own success – people survive diseases which would have killed them in previous years, but they live longer with chronic diseases which need managing. We can do more for people when they are sick and they rightly expect that.

Labour must win the argument for more investment in both health and social care: these are not two separate services but are inextricably linked. We must also make the case that the NHS and social care don’t just consume resources – they are vital to underpinning a growing economy. Helping people to stay fit and healthy for longer as our population ages, and providing decent support for carers, many of whom work as well as care for their loved ones, is as essential for our economy as it is for patients, users and families.

We have a unique asset in the NHS. There are few health systems globally in which there is potential access to so much data about the causes and cures of ill health and so much opportunity for trial and research. This government has bungled the issue of how we use patient data. We have a real opportunity to drive research, life sciences investment and jobs using the model of the NHS. Most importantly, this also provides the opportunity to find the personalised, effective treatments and technologies to put the NHS at the forefront of health care in the years to come.

In both health and social care, we need to finish the job of shifting choice and power to people. Giving service users and their families far more say and control should be at the heart of Labour’s future approach to health and social care.

People’s health often improves when they feel they are in control. We believe everyone, regardless of income, should have the same advantages as wealthy people who are able to choose the kind of care and support they need.

The people who know best how to join up their services and support are users and their families, because they don’t see their needs through the prism of separate service silos. Developments in technology can help this to happen. Our best trusts already use technology to enable patients to access their care plans and records – and to share in decisionmaking. We are already developing apps to enable patients to organise their own follow-up treatment and ongoing care. This should be the norm for all who want it across health and care.

Users are often the strongest champions of prevention, because they are the ones who suffer the consequences if services fail to intervene early on.

And it is service users and their families who are frequently the toughest critics of inefficient services because they see the duplication and bureaucracy that wastes public money which would be better spent on improving their lives.

Making ‘people power’ a reality will require a profound change in the culture of our public services. It is not a £10 charge to see a GP which will ensure people take responsibility for their health, it’s real information, choice and power. In future, people can’t be seen either as passive recipients of services, or as purely consumers. Instead, they must become genuine partners in co-designing and co-creating their care and support.

For this to happen, neither the old state-driven nor predominantly market-based approaches to public service reform will work because both can end up disempowering people.

Instead the new state will understand that people are genuine citizens with whom power and responsibility must be individually and collectively shared.

We should look back to 1945 with pride at what we created in the NHS, and to 1997 when we built on that legacy. But we also need to be able to look forward with optimism about what is still to come for this unique Labour achievement.

This essay first appeared in This Woman Can. 

It was written jointly with Liz Kendall, but our software can only cope with one author.

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The NHS is facing persistent rising costs and funding pressures. Health care needs continue to rise as a result both of an ageing population and of a changing profile of morbidity, with increasing numbers of people suffering multiple long-term conditions. Even more cost pressures arise from technology and medical advances, and the labour intensive nature of much health care means that the NHS rate of inflation is significantly higher than the general rate of inflation.

Funding pledges

Yet neither the Labour nor the Conservative manifestos promise adequate funding. While the Conservatives are promising an extra £8bn a year by 2022, and Labour an extra £12bn in comparison with current funding, this represents in both cases a further decline in the proportion of the GDP being allocated to health care (from 7.3% in 2017/18 to 7.0% and 7.2% respectively, according to the Nuffield Trust). This is likely to reflect a commitment by Conservative-led administrations to reduce the share of the national income accruing to the NHS and, perhaps, a view in Labour circles that the NHS has so far got off lightly under austerity, compared to other departments’ cuts.

While the obduracy of the government and its ideological ambivalence concerning the NHS make the Conservative proposal unsurprising, Labour’s stance must be seen as a disappointment. The impact of the financial stress endured by those working in the service, and the mounting scale of cuts and closures to services consequent upon inadequate resourcing are effectively being disregarded.

Labour promises extra capital funding but does not say by how much; the Conservatives promise £10bn of capital expenditure but do not say where the funds will come from. There is of course an irony in borrowing more expensively from the private sector when public borrowing is so cheap.

Mental health services

Commitments to funding are not a minor detail since they point to doubts as to whether the parties’ other health proposals can be achieved – and this is not just the re-pledged commitment by the Conservatives to a ‘truly seven-day NHS’. Labour promises ‘well-resourced services’, ‘safe staffing levels’ and ‘world-class quality of care’ despite the fact that inadequate funding may make these impossible to achieve. Labour will also attempt to ‘tackle’ the rationing of services and will end the ‘routine breach’ of safe bed occupancy levels but as each is likely to entail an expansion in capacity, the party’s stance on funding may impede their achievement.

This will be a source of particular anxiety to those keen to see improved mental health services. Here, Labour promise parity of esteem; ring-fence budgets; increase the proportion of the mental health budget spent on children; and end out-of-area placements. Oblivious to the consequences of their stance on funding, the Conservatives promise that those with mental health problems will get the ‘care and support they deserve’ and that medical training will ensure a deeper understanding of mental health.

Health care reorganisation

The Conservatives remain committed to the contentious Sustainability and Transformation Plans (STPs), drawn up in secret at a local level to reorganise services and simultaneously cut their costs. The privileging of financial sustainability has rather overtaken the promised transformation. But, contrary to government and NHS England assumptions, transferring services out of acute hospitals and into community settings is unlikely to achieve cheaper health care if they are to remain high quality services. Moreover, the transitional period itself requires additional funding. ‘Vanguard projects’ are currently piloting new ways of providing services and local NHS leaders are being expected to implement changes while an evidence base is still to be produced.

Labour does not promise a roll-back of STPs but instead a ‘halt and review’, with local people invited to participate in redrawing them. This feels an ambiguous passage in the manifesto which might reflect the competing pressures of cautious endorsement of STPs from some think-tanks, given the funding constraints and the perceived desirability of making more services available in community settings, on the one hand, and the fierce opposition, on the other, from local people who experience their STP as the vehicle by which large-scale cuts and closures are being implemented.

Staffing levels

Quality services also require adequate staffing levels. Labour has costed its plans to reinstate bursaries for nurses and to lift the pay cap for NHS staff – some of whom have suffered more than a 10% reduction in the real terms value of their pay since the financial crash. Its commitments on NHS staffing – recruitment and retention – differ somewhat from those in the Conservative manifesto. Labour promises an immediate guarantee of the rights of EU staff, lifelong education and development for doctors, and reinstating the role of the independent pay review body. The Conservative Party promises 10,000 extra staff in mental health service, an extra 1500 doctors a year in training, stronger staff entitlement to work flexibly, and the development of new roles in health care. This is perhaps to facilitate the shift to more generic roles heralded in some STPs, and the greater use of unregistered nurse associates and physician associates to supplement (or supplant) the registered professionals. Where all these staff will come from remains unclear. The Conservatives offer EU nationals working in the NHS only the promise that they will do their best for them in the Brexit negotiations.

Privatisation

Those who have been campaigning against privatisation and the use of market forces in the NHS will welcome Labour’s commitment to reversing the privatisation of the NHS. They will also hope that this is compatible with Labour’s promise to introduce a new legal duty on the Secretary of State to ensure ‘excess private profits are not made out of the NHS at the expense of patient care’. They will certainly welcome the repeal of the infamous 2012 Health and Social Care Act.

The Conservative manifesto also points to the prospect of legislative change and indicates that the provisions of the Health and Social Care Act – a highly unpopular piece of legislation among both campaigners and professional associations – may not be sacrosanct where they interfere with the implementation of STPs. This hints at the fact that much STP activity has occurred outside statutory provision and is an implicit acknowledgment by the Conservatives that Accountable Care Organisations (ACOs) offer a better route to commercialisation than a model based on a competitive provider market in a time of financial constraint. Anti-privatisation campaigners, aware that ACOs can be contracted out to non-public organisations and always suspicious of Conservative intentions, will take little comfort from this.

This was first published on the British Politics and Policy blog.

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