Category Archives: Labour Health Policy

NOTES FOR DISCUSSION GROUPS ON NATIONAL SERVICE FOR HEALTH

Introductory Note

The Labour Party’s Policy is contained in the official pamphlet, National Service for Health (price 2d). It is set out clearly in chapters with appropriate cross-headings and sub-headings, and is presented in a form that will be found convenient for study and discussion by Local Groups.

The object of these Discussion Notes is to stress main principles, call attention to special points, and provide additional factual matter. They should be taken in conjunction with the pamphlet.


CHAPTER I (Pages 2, 3, 4)

WHAT MEDICAL SERVICES DO WE NEED?

The health of the people is a supreme national concern, and it should be a definite social responsibility. The nation must, therefore, have a Health Policy, and that policy a properly defined and well-understood aim. We have to deal not only with the effects of ill-health; we must also seek to prevent ill-health by a social offensive against its causes.

The aim of the nation’s health policy can be nothing less than the utmost possible fitness of mind and body for all the people.

This aim of Positive Health calls for practical policies of a domestic and international character.

Under the heading Health and Government the Labour Party deals with this important point.

It is recognised by the third of President Roosevelt’s Pour Freedoms—Freedom from Want, giving to every nation “ a healthy peace-time’life for its inhabitants.”

It is also recognised by Article V of the Atlantic Charter, which proclaims the object of “securing for all improved labour standards, economic advancement, and social security.”

United States Vice-President Henry Wallace has called for “freedom from unnecessary worry about sickness and hunger.”

The Beveridge Plan of Social Security is “to make want under any circumstances unnecessary.”

All this is of vital importance because, as Labour points out, “poverty is still the greatest single cause of ill-health.”

Labour calls for a social offensive to lay the social foundations of human security and well-being. But that is not all. We need also the most complete health provision which modern science and national planned organisation can provide: a comprehensive service, by which is meant a service that covers all the people and is capable of meeting all necessary medical requirements.

The Labour Party Policy sets out the essential character of such a service.

It must be Planned as a whole; Preventive as well as curative; Complete, covering all kinds of treatment required; Open to all; Efficient and up to date; Accessible to the public; Preserve confidence between doctor and patient; Equitable for the doctors; and so organised as to enable the medical profession to play its proper part in all the nation’s efforts to promote health.

These principles will be found elaborated on pages 3 and 4 of the pamphlet.

* * * 

CHAPTER II (Pages 4-12)

OUR EXISTING MEDICAL SERVICE

This section of the pamphlet is devoted to a compact and compre­hensive review of Britain’s Health Record and of the health services available. The following information may provide some useful additional facts.

THE CONDITION OF THE PEOPLE

It is an historical truth to say that the Labour Party has made the problem of the condition of the people a “live” issue in our national political life. It is now generally recognised that questions of work and wages, and the standard of life they give, of housing and home conditions, of the conditions of employment and welfare in places of work, the conditions in which children are born and reared, play, and are educated, and kindred social questions have a direct bearing on health, for good or ill.

We have only to think of maternal and infant mortality, the ill- health of mothers and babies, the toll of infectious diseases, the range of industrial diseases, occupational and civil accidents, the lowering of health due to fatigue or overwork, to under-nourishment, to the worry and strain of keeping and running a home bin inadequate resources, and the hundred-and-one other anxieties and fears that can beset a decent working-class household—of the many forms of sickness, disablement, physical or mental unfitness which threaten healthy life—to realise the need for an efficient, modern and comprehensive health and medical service.

Consider a few facts:—

Cost of Ill-health

Before the war the loss resulting from ill-health, together with the cost of the medical services came to over £300,000,000 a year.

Poverty and Ill health

Recently stress has been laid on the national menace of a falling birth-rate. The explanation of this disturbing trend is partly to be found in poverty, the fear of it, and the consequences of it.

Pneumonia, diphtheria, tuberculosis, measles, whooping cough are the diseases of poverty which ravage child life, especially in the overcrowded slum. Bad housing without space, water supply, room for food storage, cooking facilities and private sanitation essential to good home-making are a source of ill-health. Bad feeding, inadequate sleep, insufficient air and lack of healthy exercise and recreation affect mind and body, and undermine health.

Infant mortality has shown a remarkable decline in this country during the past fifty years. Yet Mr. Richard M. Titmuss (Birth, Poverty and Wealth, Hamish Hamilton, 1943, 7s. 6d.) concludes that between the census years of 1911 and 1931 a 50 per cent, reduction of the national average infant death rate was accompanied by a widening of the difference between the economically favoured and the economically handicapped.

He states:

“The fact that for 11 infants of the economically favoured groups who die from preventable causes 90 children of the poor die from similar causes summarises, as a matter of life or death’, the power of environment and economics.’

Dr. Spence, Medical Officer of Health for Newcastle, in a com­parison between a group of children from one to five years of age from the city’s poorest streets and a group of similar age from families of the professional class, found the following facts: —

One hundred and twenty-four children of the professional class had had:—Pneumonia 2; pleurisy 1; chronic and recurrent cough 2; measles 6.

One hundred and twenty-five children from the poorest city streets had had;—Pneumonia 17; chronic or recurring bronchitis 32; measles 46; recurrent chronic diarrhoea 6; abscesses, septic skin infections and otitis media frequent.

It has been rightly said that “Battles are only the most sensa­tional form of human wastage. Year by year, poverty and disease pursue their unremitting campaign against the most defenceless; year by year an army of little soldiers fight and fall almost before they have lived, or limp on enfeebled in body and warped in mind.”

This wastage of Britain’s human capital calls for action inspired by an offensive social spirit.

In “Our Towns—-A Close-up” (Oxford University Press 1943, 5s) a study made during 1939-42, a conversation overheard in a bus is reported. As the vehicle passed down the main street of a prosperous seaside’ town, a group of poverty-striken children was seen standing on the curb. “They don’t look much, do they?” said one housewife,to another. “Well, anyhow,” replied her companion, “that’s what England always falls back on!”

Overcrowding

The density of population for England is the highest among the Western countries. It bears a population of 766 persons per square mile. Belgium comes second with 702, Great Britain third with 518, and the United States, with the largest population and the greatest territory, lowest with 36.

Richard AT. Titmuss in his Poverty and Population (Macmillan, 1938, 10s. 6d) showed that Durham and Northumberland have, as compared with all other regions in England—

  • A very low income level, particularly in Durham, where it appears to be the lowest of any county.
  • The highest overcrowding rate.
  • The highest death rate and infantile mortality rate.
  • The highest death rate for children up to four years of age,
  • with a particularly heavy excess of death from respiratory diseases.
  • The highest death rate for children from 5-14 years, with a heavy excess of death from diphtheria and tuberculosis.
  • The highest maternal mortality rate, more than double that of Greater London.

This dark picture shows the interlinking of poverty and overcrowding on the one hand and ill-health on the other. Underfeeding

Sir John Orr has stated that the diet of, roughly, half the population—the poorer half—is not up to the standard required for health, and the diet of the poorest 5,000,000 is so bad that it is deficient in nearly every respect. This 5,000,000 contains 25 per cent, of the children of the country.

Maternity and Child Welfare

About 600,000 babies are born every year.

Over 30,000 of them die before they are one year old.

About 2,000 mothers die in child-birth every year.

The health of thousands more is seriously injured by causes arising out of child-birth. Expert opinion holds that by far the greater part of the damage and ill-health which follows child-birth could be prevented.

The Pre-School Child

There is a dangerous gap in the medical care of children. The pre-school child, from two to five years, does not come under any health service, except where there are nursery schools.

The result is that the School Medical Service—which at its best is very incomplete—has a heavy task in the first years of children’s school life in dealing with the aftermath of neglected conditions in the pre-school years.

Industrial Diseases and Accidents

Mr. Will Lawther, President of the Mineworkers’ Federation, stated at the recent Annual Conference that “in death and suffering the miners pay a price higher than that in any other industry, and the lists of those crippled and injured grow.”

According to the Minister of Fuel and Power, in any one week there are 60,000 miners who do not work through sickness or injury, and the number of accidents reported each year involving absence for three days or more is between 160,000 and 160,000. This high rate of occupational injury or sickness accounts for 7 per cent of absenteeism out of the total of 11 per cent.

Working Days Lost Through Illness

The loss of working time output and wages due to sickness, disease and accident in industry continues a serious problem both in terms of wealth to the nation and of personal well-being and happiness for the workers and their families.

The latest calculation made (1933) on working time lost through these causes showed that amongst workers covered by National Health Insurance there were 29,000,000 weeks lost.  This was equal to the loss of a whole year’s work of 558,000 persons.

Scope of National Health Insurance

The present system of National Health Insurance is far from being fully national. It covers only the gainfully employed with an income up to £420 a year.

All dependants are excluded.

Out of a population of about 46,000,000 for England, Scotland and Wales, only half are entitled to the benefits of National Health Insurance. Even for the insured the Service is incomplete: it does not provide specialists or hospital treatment.

The other half of the nation is left to make its own arrangements for medical service.

Health Progress

Now let us look at the brighter side of the picture. As the Labour Party pamphlet shows in the section under Britain’s Health Record, “since the beginning of this century the health of Britain as a whole has been substantially improved.”

There has been a general advance in medical science and it has been speeded up during the war years,

Our knowledge of nutrition has been considerably extended by the special investigations made by experts such as Sir John Orr, Mr. Seebohm Rowntree, and many others.

Our Medical Services have been developed and brought within the reach of a substantial portion of our people through National Health Insurance, our Social Services in general have been strengthened and expanded.

Industrial health and safety measures have been increased and welfare services developed,

The issue of free or cheap milk to school children and the pro­vision of meals are making their quota of contribution to better health.

School medical services provide for dental, and other inspections and treatment, and greater attention is given to cleanliness and physical culture in the schools.

We have steadily improved housing, sanitary and ventilation conditions, and are providing other amenities which affect health.

Our industrial health service has been developing on better lines. The modern standard for most well-run factories and works is to have their own works doctor, with first-aid assistants, and a first-aid centre, and a welfare supervisor with a welfare centre. This makes possible a steady oversight regarding the conditions in which the workers carry on their work, hygiene, ventilation, the administration of protective legislation and factory laws relating to dangerous machinery, industrial diseases, women workers and young persons in industry.

This service needs to be expanded and integrated into our national Health Services.

Greater attention is being paid to what are called the Rehabilita­tion services. Impetus has been given as a result of the war. There is a growing recognition of the need to restore as fully as possible both service and industrial casualties. Before the war it was estimated that out of every 100 patients treated for fracture in the ordinary way, 37 were left permanently incapacitated, whereas when such patients were treated in properly organised clinics only one out of 100 was left in this condition.

Chapter II then proceeds to deal in some detail with our present medical service. It finds it “ill-planned” and “far from adequate for the needs of the nation as a whole.” It shows that we are not working to a coherent plan; that -control, direction and func­tions are spread; and that unification and co-ordination are long overdue.

This is now generally recognised. It is not without interest, however, to recall that the Labour Party, (The Labour Movement and Preventive and Curative Medical Service,  1922 ) over twenty years ago, urged that entire reorganisation of the whole mechanism of both public and private medical services, is urgently necessary in order that the greatest possible use may be made of medical science, not merely for the treatment and prevention of disease, but for the inauguration of those systems of living, working and enjoying leisure which experience and scientific research show to be capable of pro­ducing the greatest happiness for all.” The remedy it called for was “a Public Medical ‘Service.” ‘It was a service that “must be free and open to all.”

Chapter II of the present pamphlet points out, among other things—

  • That there is need for more control at the centre vested in the Ministry of Health.
  • That the family doctor’s position is unsatisfactory, and more “teamwork” is needed, and that doctors should have an economic security which the present system cannot give.
  • That the hospital system is an unplanned medley of public and voluntary institutions without any unified control and with many financial difficulties. (The Labour Party put forward a scheme (The Labour Movement and the Hospital Crisis, 1922) 21 years ago for the reorganisation of our Hospitals  and allied institutions as a foundation for a complete hospital system.)
  • That certain important services, such as the provision of care for mothers before, during and after child-birth, and the School Medical Service, are in special need of expansion.

We can be sure that some form of National Service for Health is on the way. The trend of opinion and demand is now strong enough to secure it.

Sir William. Beveridge in his Report has called for “comprehen­sive health and rehabilitation services that will provide that for every citizen there is available whatever medical treatment he requires, in whatever form he requires it, domiciliary or institutional, general, specialist, or consultant, and will ensure also the provision of dental, ophthalmic or surgical appliances, nursing, midwifery, and rehabilita­tion after accident.”

“Restoration of a sick person to health,” he declares, “ is a duty of the State and the sick person, prior to any other consideration.”

The objects of Medical Service have been defined by the Interim Report of the Planning Committee of the British Medical Associ­ation as—

(a) to provide a system of’ medical service directed towards the achievement of positive health, the prevention of disease, and the relief of sickness.

(b) to render available to every individual all necessary medical services, both general and specialist, and both domiciliary and institutional.

Lord Dawson, in a recent statement, said: –

“For 25 years or more the idea has been spreading that the practice of medicine, should be occupied not only with those disabled by sickness or accident, but also, if not primarily, with the building up of health, and that for this extended purpose our medical Services have become too haphazard and inco-ordinate in their arrangement.”

CHAPTER III (Pages 12, Id, 14)

WHY A STATE MEDICAL SERVICE IS NECESSARY

We have asserted that some form of National Health Service will be forthcoming and will be outlined in the promised Government White Paper’.

But we have still to discuss: How best can an efficient, sensibly planned and open-to-all Service be provided?

The Labour Party has faced up to that problem. Its conclusion is that effective action lies through the present Service being developed into a State Medical Service as part of a comprehensive Service for Health.

Chapter III sets out its examination of the problem and the reasons which prompt its conclusion.

Though a good deal pf medical opinion has been organised against a State Service, it is far from being unanimous. The following expressions are typical of a substantial and growing opinion which is in favour of a State Scheme.

Dr. Somerville Hastings has urged that “a new conception demands a new method of application. The health services must be unified, organised and co-ordinated if they are to be effective. The work is too great and too important to be entrusted to anything less than the whole nation.”

Dr. E. H. M. Milligan, of Glossop, has stated that “necessary changes would involve all sections of medicine—medical research, preventive medicine, curative medicine, and rehabilitation, and also our family and industrial life. Everything must be integrated, locally as well as nationally.”

The Report of the Society of Medical Officers of Health declares: —

“Private enterprise cannot provide and maintain complete hospital, medical, health and allied services, and such services conducted on a whole-time salaried basis have the dual advan­tages of administrative efficiency, and the elimination of undesirable competition for patients. Hitherto the doctor has been mainly interested in the illness of his patients, but it is of first importance that his attention should be directed to the maintenance of health.” (February 2, 1943.)

* * * *

CHAPTER IV (Pages 14-22)

A STATE MEDICAL SERVICE

Having satisfied itself that a State Medical Service is what is needed, the Labour Party has worked out a scheme to get it. The Plan shows how the Service should be organised, what services it should render, and how the cost can be met.

A study of Chapter IV will make clear the principles upon which the Plan is based.

Briefly summarised, it provides for a Central Health Authority to plan the best use of the nation’s medical resources, and with power to see that the plan is carried out.

  • Regional authorities for more detailed planning and adminis­tration.
  • Within each Region a series of Divisional Hospitals, associated with Divisional Health Centres.
  • Within each Division, four or more Local Health Centres, each linked with the Divisional Health Centre, and each served by from eight to twelve general practitioners in urban areas but fewer in rural.
  • The general practitioner or home doctor must retain his position as the first line of the nation’s health defences.
  • The medical profession should be organised as a national, full- time, salaried, pensionable service.
  • Free medical service for all school children.
  • Complete National Maternity Service.
  • Ante-natal Clinics, as part of Local Health Centres, to provide ante-natal supervision of all expectant mothers, and, when necessary, treatment.
  • Industrial Health Service, to be co-ordinated with the National Health Service as a whole. More factory Medical Inspectors and. Industrial Medical Officers. A large development of their work and scope. The work of the Industrial Medical Officers to be fitted in with that of the Inspectors, so as to provide a complete service of health, safety and welfare by a team, comprising the Factory Inspector, arid the doctor, industrial nurse, welfare workers, and the workers them­selves.

OPPOSITION TO STATE SERVICE

It will be useful to consider some of the objections which are being raised by members of the medical profession.

There is a great volume of professional and non-professional opinion in favour of a State Medical Service, but there is also a very vocal volume against it.

It has already been announced that the British Medical Association, by 200 votes to 10, opposes the setting up of a “whole-time salaried State Medical Service.” It is quite clear that the B.M.A., while supporting Health Service development, is determined to resist the creation of a State Medical Service at the expense of private practice. It should be borne in mind, however, that the decision mentioned has been taken at a time when a large number of the younger doctors are serving with the Forces, and it seems clear that they have had little opportunity of expressing their views.

The British Medical Association urges the extension of National Health Insurance to include the dependants of the present insured population, thus bringing about 90 per cent, of the nation within the scope of the Scheme.

Of the remaining 10 per cent, it has been said: “This substantial fraction of 4 ½ millions of the community would become the happy hunting-ground of those practitioners fortunate enough not to practise in industrial areas.’

Dr. S. Lipetz, of Edinburgh, has quoted extracts from the Press at the time the National Health Insurance Scheme was being intro­duced in 1911. He has pointed out that they are very reminiscent of many letters, inspired and otherwise, which are to-day appearing in the medical and lay press. Here are some of them:

  • The result must inevitably be absolute ruin to a great number, probably the majority, of general practitioner throughout, the country.
  • The Scheme may perhaps end in reducing doctors to so many machines for attending democracy at so much a head.
  • We stand at the parting of the ways—independence and self-respect on the one hand, and servitude on the other.
  • It is a long step on the downward path towards Socialism. It will tend to destroy individual effort and increase the spirit of dependency which is ever found in degenerate races.

How ill-founded these fears proved to be is now recognised by the Council of the British Medical Association, which is to-day prepared to extend the National Health Insurance Act to embrace 90 per cent, of the population, Yet similar objections are being advanced to-day against the proposed State Medical Service.

Let us consider some of the specific objections which are being raised by members of the medical profession and on which we make brief comments: —

(a) The biggest danger of reorganisation of our Health Services would be the disappearance of the private family doctor. Until the State Medical Service can provide the equivalent of the private doctor, the service will only be used by those who cannot afford private doctors.

Comment: The aim of a State, Medical Service is to make the interest of the patient the first consideration. The objection above is concerned to ensure the retention of private practice side by side with public service. This means a dual system of public and private enterprise in Health Services. Ninety per cent of the people are to be covered by a State scheme, but the remaining 10 per cent, are to be left as a private preserve for the private doctor because they can afford to pay for special attention. What is good enough for the many is, apparently, not good enough for the few. The purpose of the Labour Party’s Policy is to build an efficient State Service of doctors who are economically secure and working on a full-time basis to provide the best medical care and attention for all the people.

 (b) When people are highly individualist, State medicine like State education could never be more than a makeshift.

Comment: This is an example of prejudice and muddled thinking. No citizen in his right mind would seek to abolish our State system of education. On the contrary, all enlightened minds demand its extension and completion; a national system of education, free and open to all, irrespective of the means of parents. The same funda­mental principles of collective effort underlie a State Medical Service.

(c) Every medical man would become a salaried State officer. There would be no buying or selling of practices.

Comment: In a State Service the doctor would be a full-time salaried public servant just as a teacher is a full-time salaried public servant in the State educational system. In other words, he would have security from financial worry and from over-work which at present assail so many doctors. The second part of the complaint underlines the commercial outlook and vested interest inseparable from the private medical service. The buying and selling of “private” or “panel” practices is an evil feature of the present system. The patients are the human element which gives the practice its goodwill value, but they are never consulted about its sale. They just go with the practice to the new doctor.

(d) The only defect of the present system is that the doctor who has a panel-large enough to keep him in comfort and to enable him to educate his children to his own standard is chronically overworked.

Comment: This, unfortunately, is not the only defect; but it is an important one. If, in order to make a decent living in present circumstances, a doctor must have a large panel by which he is “chronically overworked,” it is obvious that he cannot give efficient service to all his patients, and that, therefore, some of them must suffer. In a State Medical Service a doctor would not have to attend more patients than he could properly and effectively deal with, and the present economic pressure to overtax himself would be removed because he would have security of salary and pension. Thus both doctors and patients would mutually benefit.

(e) Successful doctors worked very long hours, and, on the basis of the economic law of supply and demand, were able to command higher fees, and were able to give free advice to the hospitals and clinics.

Comment: It is wrong that the health of the people should be governed by the arbitrary law of supply and demand, providing high incomes to some doctors and inadequate incomes to others; that both classes of doctors should be overworked, and that “free” advice to the poor should depend in part on the humanity of the successful doctor and in part on the high fees which he is able to charge well-to-do private patients;

(f) Hospitals are for those who cannot afford nursing homes, and clinics are for those who cannot afford private doctors.

Comment: Hospitals and clinics for the poor; nursing homes and private doctors for the well-to-do. That is precisely what a State Medical Service is designed to end, so as to ensure that all patients are treated purely from the health standpoint and regardless of whether they happen to be rich or poor.

(g) The free choice of doctors should be  preserved.

Comment: Under a State Medical Service in which doctors are attached to Health Centres and are assured of an adequate salary for full-time, service, as much free choice of doctors will be possible as under the existing service.  The idea that the public have effective free choice to-day is largely illusory for urban patients, and almost wholly so for rural patients. The buying and selling of private and panel practices without the patients having any voice in it is one proof of this. With team work at Health Centres, to which would be attached eight or ten doctors in urban districts and fewer in rural districts, and from which the duties of the family doctor and other health workers would be organised, it should be possible to give a greater measure of satisfaction (a) to the doctors in the exercise of their medical skill, and (b) to the patients in the provision of proper medical care.

(h) The so-called “free choice” of doctors should be accompanied by a method of remuneration related to the amount of work done or to the number of persons for whom medical responsibility is accepted.

Comment: If this were permitted it would defeat one of the central purposes of the State Medical Service. It would leave doctors free to compete for panel patients, since their remuneration would be based on the amount of work done or the number of patients on their panels. This point has been dealt with in (d) above. It would perpetuate some of the worst defects of the present system; it would continue vested interest in panel practices and provide a means for increasing their saleable value, thereby encouraging the commercial element which is a bad feature of our present medical service.

(i) Every member of the community should be free to consult a doctor of his choice, either officially or privately, and private consulting practice should continue as at present for those who wish to be treated in private accommodation.

Comment: This is a plain demand for what has been described above as a “dual system.” It means that the selected few, because they can pay for it, are to have privileged attention. It means that for health we are to perpetuate the “two nations” division—the broad masses to use the public service, while the 10 per cent are to have what is presumably regarded as a superior service. The principle of “the best for the patient” will be attained only when it is provided by a service in which the best resources of medical science and of the medical profession are brought into full play in a community service which excludes any form of social distinction, regards every citizen as having an equal right to good health, and does not allow that right to be circumscribed in any way by ” means ” capacity.

CAN WE AFFORD A STATE MEDICAL SERVICE?

On pages 23 and 24 the Labour Party pamphlet deals with the important question of whether we can afford the Service which it proposes.

This financial aspect is dealt with both as regards methods and costs in a simple and convincing way. This section of the pamphlet should be closely studied. Here it is sufficient to give a brief summary of the proposals.

The Labour Party proposes that the necessary cost of the scheme should be drawn partly from national taxation expended directly by the Ministry of Health; partly from national taxation, allocated by the Ministry to Regional Authorities in the form of percentage grants and partly from rates payable to the Regional Authorities.

The pre-war cost of the existing Medical Service (excluding cash benefits) was in the neighbourhood of £150,000,000.

A carefully worked out estimate for providing a comprehensive service for the treatment of sickness (excluding cash benefits), is given in the Beveridge Report at £170,000,000.

The Report proposes that this cost should he defrayed out of public funds, subject to a grant-in-aid of £40,000,000 from the Social Insurance Fund.

After the war we shall, in any case, be spending something like £170,000,000 a year on the existing services, with all their admitted deficiencies. For about the same money the Labour Party and Sir William Beveridge agree, we could have a comprehensive service, economically planned, efficiently organ­ised, and open to all.

We can afford a National Service of Health on the lines proposed by the Labour Party. We can have such a Service if the citizens of our land want it sufficiently. For they have the power to get it.

Labour’s Task is to Educate the Public in Support of
NATIONAL SERVICE OF HEALTH

FURTHER COPIES OF THE DISCUSSION NOTES from the Labour Publications Dept., Transport House, Smith Square,

S.W.I, 12 copies 1/6.   100 copies 10/-

October, 1943

Printed by the Victoria House Printing Co,, Ltd, (T.U. all Depts.), 14-15, Elm Street, London, W.C.1.

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Presented to the Labour Party Conference 1934

A STATE HEALTH SERVICE

A Sub-Committee appointed by the National Executive Committee has had under consideration recent Annual Conference resolutions relating to a State Medical Service, and has prepared the following Preliminary Report.

Because of the complicated nature of the subject, and in particular the difficult relationship of National Health Insurance, the Approved Societies, the Medical Profession, and the local Public Medical Services, it has been thought desirable to seek the general views of Conference on the proposed lines of policy, before asking the Sub-Committee to proceed to further detail.

PRIMARY CONSIDERATIONS

At the present time, medical care is provided in four main forms—the private practitioner, the voluntary hospitals and other voluntary services, National Health Insurance, and the various Local Authority services, including the Poor Law.

Assuming, for the purpose of this preliminary Report, that the aim should be a State Health Service, the first question to be decided is whether such a Service should be built (a) on National Health Insurance (by its extension to dependants, etc.), or (b) on the Local Authority Health Services.

It is suggested that the proper course is the latter.

NATIONAL HEALTH INSURANCE

If this be accepted, it is difficult to maintain a separate panel system for insured persons, while at the same time uninsured persons and all dependants are provided for by the Local Authorities. Moreover there are very grave deficiencies in the panel system, as regards both the type and standard of medical care provided and the existence of vested property interests in panels as such.

A primary practical requirement, therefore, would be take medical to benefits away from Health Insurance altogether and to confine the Insurance Scheme to cash benefits only.

If Health Insurance were confined to cash benefits, the following changes would have to be considered’ :—

  1. Insurance contributions to be wholly devoted to cash benefits and their administration.
  2. Rates of benefit as far as possible to correspond to the rates of Unemployment Insurance benefit at the time, but maternity cash benefit to continue to be paid.
  3. Benefits to be at national standard rates, which would involve the complete pooling of contributions and of Approved Society funds.
  4. Compulsory insurance to include manual workers as at present, without income limit, and for non-manual workers the maximum limit to be raised from £250 to, say, £500; any uninsured worker within the £500 limit to be eligible to join voluntarily at the ordinary combined rate of employer’s and employee’s contribution.

On any such terms, Health Insurance would become a cash benefit scheme only, the Approved Societies being the agents for paying out standard rates of benefit and receiving appropriate administrative expenses for the work.

Unfortunately, for financial reasons, it would not appear possible to forego contributions; and if this be so, the raising of the income-limit  for compulsory insurance is long overdue.

UNIFIED MEDICAL SERVICE

The ultimate aim of a unified and comprehensive Public Medical Service would be to provide, through the County and County Borough Councils, free domiciliary and medical care to the population as a whole, in the same Way as Primary Education is now provided free.   For financial and other reasons this can only be achieved by stages.

There are three prerequisites to any substantial development of the Public Health Service

  1. The consolidation in each area, under non-Poor Law control. of all existing Local Authority Medical Services should be carried out as soon as possible.
  2. The delegation of Local Authority health functions to volun­tary agencies should rapidly be brought to an end. Efforts should be made to take over voluntary hospitals and other institutions by agreement; and no financial assistance should be given to voluntary agencies or institutions without an appreciable measure of public control. Otherwise the attitude of the Local Authorities should be one of neutrality. The valuable services rendered by voluntary institutions are not unappreciated, but the provision of a funda­mental service such as medical care should not be left to private charity.
  3. The removal of medical benefits from Health Insurance necessitates from the outset the provision, by the Public Health Service, of an equally good service for insured persons—and it should be something very much better.

Bearing these requirements in mind, it is suggested that the first main stage of a developing Public Health Service might be the provision of free domiciliary and institutional medical care to all insured persons, all uninsured persons of similar income, and all dependants of either category. Uninsured persons over the insurance income limit and their dependents  might continue to make their own arrangements for non institutional treatment, but be entitled to institutional treatment on payment of reasonable charges according to means. In certain cases where free treatment is now available irrespective of means, the practice might be continued.

It is not suggested, however, that even this first stage can be achieved right away. The comparatively early provision of free non-institutional treatment is possible, provided the existing Local Authority services are built up as they ought to be and appropriately extended; but much of this preparatory development has yet to be done. Even more has to be done before institutional facilities are adequate.

We are anxious to see the Public Health Service evolving round a system of clinics, particularly in the towns. These would be  in effect well-equipped surgeries where the patient would receive the best examination, diagnosis and treatment—without the interminable of waiting so typical of the average hospital out-patients’ department.

This does not mean that the clinic should replace domiciliary medical attendance, but that it should be the centre round which such attendance and the other facilities of the Public Health Service should evolve.

THE MEDICAL PROFESSION

The panel system has created vested interests, in that panel practices are bought and sold and a de facto transferable property right exists. It is highly undesirable that this should be extended to the Public Health Service, which should not for a moment tolerate a policy of selling appointments to the highest bidder. As soon as possible, therefore, the panel, as such, might be transformed into non-saleable appointments in the public service; and in fairness it would be desirable to give an equivalent advantage to the doctors concerned, whether by way of a public appointment or direct compensation, or partly one and partly the  other. ” Additional ” insurance medical benefits might similarly be absorbed into the public service. Insurance Committees and the existing medical referee machinery would come to an end.

At the outset of the scheme, most of the new, domiciliary and institutional appointments might be apportioned among existing local doctors, mainly on a part-time basis, in a way roughly corresponding to their loss of panel and other patients as a result, of the  scheme. This appears to be a practicable and fair method and the least likely to cause friction, and would avoid heavy compensation claims.  The part time appointments would not be transferable or saleable by the holders; and as the existing doctors went out of practice, for whatever reason the aim would be to amalgamate part-time appointments into full-time public appointments.

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Presented to the Labour Party Conference 1934

Health Services

Labour proposes to utilise medical discovery to the full in the service of the nation. The extension of the maternity and child welfare services, the strict public control of private nursing and maternity homes, the adequate care of children in the pre-school years, the large-scale development of open-air nursery schools, are all urgent matters. The disastrous “economies” in the School Medical Service should be ended, and increased provision made for the  treatment of ailments. The provision of school meals must be greatly developed.

Far more special schools and classes are needed for children with physical or mental defects. All health functions will be taken away from Poor Law control, and the hospital service must be greatly extended.

Labour’s general aim is to provide eventually domiciliary and institutional care to the community as a whole—a State Health Service evolving round a system of up-to-date clinics, with provision for specialist and other forms of treatment. Individual poverty must not be a barrier to the best that medical science can provide.

It would be a mistake, however, if comprehensive health provision were to be built up on the basis of National Health Insurance. What is needed is to take medical benefits entirely away from Health Insurance, and confine insurance to cash benefits only, on a higher scale than at present. The medical benefits (the panel system, “additional” benefits, etc.) would be provided through the Local Authorities. A service far superior to the existing panel system would be essential, and would also apply to non-insured persons and all dependants. That is the aim of Labour policy, and a Labour Government will make rapid progress towards its achievement.

There are, of course, other directions in which Labour will immediately press forward in health matters, notably in the welfare of the blind, of the deaf and dumb, and of the mentally deficient.

 

Only the section on health services is reproduced

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In 1934 the National Executive Policy Sub-committee appointed four Sub-committees.  The Medical Services sub-committee consisted of:

with Miss Mabel Croat, and Messrs. I. J. Hayward, C. W. Key, J. A. Newrick, E. G. Rowlinson, Lewis Silkin, and J. L. Smyth.

The Local Government and Social Services Committee also set up special Sub-Committees to deal with “A State Medical Service,” the “Welfare of the Blind,” and “Water Supply.”

Conference Debate October 1934 in Southport

The CHAIRMAN: The next item is the section on Health Services in “For Socialism and Peace,” together with the Appendix “A State Health Service” in the Executive Report.

Mrs. B. Ayrton Gould (National Execu­tive): The position as regards the pro­posals for a State Health Service is, that a special sub-Committee, appointed by the National Executive, has been sitting throughout the year on the question and has issued this preliminary statement, which appears as an Appendix to the Executive’s Report. No formal decision on it has been taken by the Executive. We are simply putting it before Conference for discussion, before going into further details of policy.

A State Health Service is a very complicated question, because of the large number of interests there are. Before anything could be done, arrangements would have to be made with regard to National Health Insurance, the Approved Societies, the medical profession and the present public medical services. The two main suggestions are these: that Health Insurance should be confined to cash benefits; that the whole of the contributions under Health Insurance should go to cash benefits, which should be as much as possible along the lines of the ordinary Unemployment Insurance benefits; that all medical benefits should be provided under a public medical service, run by the County and County Borough Councils. Instead of insurance being extended to dependents, everything, apart from the cash benefits, should be given along the lines of a public medical service. We should get clinics and hospi­tals, and the whole thing should be carried out in this way under the local authorities —of course, completely removed from the Poor Law. The suggestion is that you should pass this preliminary report before the question is gone into in greater detail, We do not anticipate that there will be any serious objection. We think you will be willing to accept this, which is along the lines we have all been wanting for a long time, and during the coming year it will be possible to issue a report in greater detail for submission to you next year.

Mr. RaysJ. Davies, M.P. (N.U. Distri­butive and Allied Workers): I am very pleased indeed that the Executive has not come to a final decision on this very import­ant question of National Health Insurance and medical benefits in general. I would, however, ask the Executive to take the first step which, in my view, is imperative and which is practicable, and it is this. The Government has brought under the Unem­ployment Insurance scheme all boys and girls of from 14 to 16 years of age, and for every reason you can give for bringing them under the Unemployment Insurance Scheme, I can give ten reasons in favour of including them for National Health Insur­ance purposes. I would, therefore, urge the Executive to include that point in their programme. I understand that every elementary school child is medically examined during school years about four or five times, but when the child leaves school at 14 years of age there is a gulf until he or she enters National Health Insurance at 16 years of age, and no medical attention whatever is given to the child between those ages.

The Executive, in the next stage, are very doubtful as to whether we should extend National Health Insurance and cover the dependents of insured persons for medical benefit purposes. There are in this country about 15 million to 16 million insured persons under the National Health Insurance Scheme.  The vast majority of them are insured under the capitalist Approved Societies, and it has astonished me on many occasions that in view of the fact that practically every insured person is of the working class they are allowed to pass by their ordinary Trade Union Approved Society.   I would therefore say to the Executive that they are confronted with one of the mightiest problems of all when they are faced with the fact that the influence in politics in this country, especially under this Government, is directed in the main through the large and mighty capitalist Approved Societies.  If we are going to secure an adequate medical service in this country outside those who are insured under the  National Health Insurance, I can see no hope whatever through the present Health Insurance scheme.  You must do it by some other means and leave medical benefit within the present scheme.

The anomalies that have cropped up within the National Health Insurance Scheme are indeed extraordinary, and I would ask the Executive to pay attention to one important factor. Take the unem­ployed man. In spite of the promises of this Government when they passed their last amending scheme under the National Health Insurance Act, the situation of the old unemployed fellow to-day under that scheme is absolutely more tragic than ever it was. He goes out of employment ; he is a broken man physically, and just when he requires medical benefit most he is wiped out of the scheme altogether. It seems to me that the report ought to concentrate on those three points.

Dr. SOMERVILLE   HASTINGS,    L.C. C. (Socialist Medical Association):

I should like to congratulate the Executive for having produced this report. I want to stress the point that this is only a first step. I and my Association will not be content until there is provided for every­one who is prepared to accept it, free of charge, the best preventive and curative system that is possible. We want everything necessary for the prevention and cure of disease to be provided, without any consideration of immediate payment. We believe  that this is possible, and we want every doctor, and not only just a few, to be associated with the preventive services. This scheme is only in embryo, and I do want to urge the Executive to carry on with what is admittedly a very difficult task.

We are getting hold of the local authorities. Labour majorities are developing and we, who are concerned with the administration of health committees, want to have before us a picture of the final aim we are trying to reach. In this report we have got some picture of what we are aiming at. There are two points I may very briefly emphasize.

The first is that it stresses the need for medical work to be done from health centres. There records can be kept; there doctors can consult together; there special treatment can be given and people’s minds can be divorced from the supposition that a bottle of medicine will cure all disease.

The second is that we feel that in this scheme people ought to know that the facilities which we have at present will be largely continued. Some people like to choose their own doctor, as far as possible.  That, it seems to me, will be just as possible in such a scheme as is considered in this report as at present. I would suggest that we must not put too much stress on free choice of doctor, because people can have faith in an institution  just as much as in an individual.  People have faith in a hospital although they do not know the name of a single doctor on its staff. There is not so very  much free choice of doctor in country districts at present. Under this scheme there would be considerable freedom of choice.  The popular doctor under this scheme would have his list filled very quickly, and the less popular doctor would have put on his list the people who were too late. We have to remember that unless the doctors under this scheme are over-worked and inefficient, they cannot, just as at present, do more than a certain amount of work, and the less popular doctor will have people put on his list, because many people do not take the trouble to seek out a doctor until they are ill.

I feel that this is a good start and I urge the Executive to continue with the good work.

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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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