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    ‘A Radical Practice in Liverpool: the rise, fall and rise of the Princes Park Health centre’ Katy Gardner and Susanna Graham-Jones.

    Published by Writing on the Wall. 2021. 268 pages. ISBN 13:9781910580561.

    This book covers 40 years in the life of Princes Park Health Centre (PPHC), a progressive practice serving a diverse and deprived inner city community in Liverpool 8. This area in South Liverpool hit the headlines in 1981 with the so called Toxteth riots which were the result of long term deprivation and racism and were sparked off by incidents of police ‘stop and search’. Such tensions still resonate today in our disadvantaged ethnically diverse inner city communities. The authors are two practice partners during the period up to 2005, both of whom played important medical leadership roles in the practice and further afield. Katy Gardner for example has been a regular contributor to the Morning Star, is a longstanding SHA member and remains active in Doctors in Unite.

    They have drawn on a wide range of other contributors to tell their stories and provide illustrations from patients, staff and people from the local community in Merseyside. Having been an inner city GP in the 1980s and visited Cyril Taylor as a GP trainee, I feel that this account captures the vision, advocacy and commitment required. The national policy and professional influence of PPHC’s work is reflected in the Foreword by Iona Heath, President of the Royal College of GPs between 2009-2012, who worked for 35 years in the Caversham Group practice in London NW5, a health centre also opened in the 1970s under the leadership of a Socialist Medical Association (SMA) member Hugh Faulkner.

    The book provides a wonderful insight into the demands, stresses and strains of idealistic multi professional health workers grappling with the ill health created by socio-economic conditions, problems experienced by homeless people, refugees and asylum seekers and those subject to sexism and racism in all its manifestations. Some of the innovative services offered to their patients were the extended primary care team including social workers, counsellors as well as the more usual teams of district nurses, health visitors and other visiting professionals. The practice projects responded to the local needs in the population such as the Family Health Project for homeless people, the Somali Mental Health project and needs of asylum seekers more generally. A holistic perspective on health and wellbeing, is illustrated by extensive community engagement, patient participation groups and special events such as the 1992 ‘Health thru Arts’ festival. It is a story about a pioneering group practice, embedded in the local community staffed by health and social care workers, volunteers and activists all committed to creating an inclusive health and social service responsive to local needs.

    The PPHC was the brainchild of Dr Cyril Taylor who had been a local GP in the area since 1950. He had served as a local Labour councillor, was Chair of the Liverpool Social Services Committee and President of the Socialist Health Association (SHA). He was politically active locally in Liverpool but also nationally being for example a member of the Royal Commission on the NHS. This Commission was established by the Labour Government in 1975 and reported in 1979 to the new Thatcher Tory Government! It is worth noting the risk of these government reports taking too long given our short electoral cycle. The Black Report on Health Inequalities also established by that Labour Government missed the boat too by being published in 1980.

    There are golden threads that run through the book and provide the political and moral compass to their work. Cyril Taylor would have been aware of the pioneering Peckham Health Centre developed in the 1920s/30s in SE London where a swimming pool, gym and childcare facilities represented their interest in prevention and family health. As an SMA member he would have known about the policy support for health centres and a salaried service. A more contemporary influence manifest in the book is of his comrade Julian Tudor Hart (JTH), another past President of the SHA. The PPHC was attempting to provide a local and practical response to the Inverse Care Law first published by JTH in the Lancet in 1971.

    There is reference in the book to the potential benefit of primary care and public health working more closely together. Another SHA Chair, Alex Scott-Samuel was involved in the early days as a local public health academic in Liverpool University as was John Ashton who worked in public health academia in Liverpool and subsequently within the NHS as a Public Health Director. However the book outlines the serious obstacles that were confronted in making the case for building the Health Centre, staffing it and the ‘powers that be’ resisting the desire of the GPs to be salaried employees.

    The SHA and its predecessor organisation the SMA has promoted policies from before the launch of the NHS in 1948 that GPs and other health professionals such as dentists should be salaried employees and working together from purpose built health centres. The group of ‘independent contractors’ include dentists, pharmacists and optometrists and these professionals were one part of the 1948 tripartite NHS – separated organisationally from the hospitals and local authority services such as environmental health, public health, midwifery and health visiting. The SMA since the inception of the NHS had argued for health centres and salaried GPs. A policy document on health centres published in 1975 identifies the need to build modern purpose built health centres so that they could provide a base for extended primary care teams some 27 years after the NHS was born and a decade after the 1966 GP Charter. Since then we have seen what has happened to this vision with the corporate takeovers of community pharmacy, the extensive privatisation of general dental practice and the corporate takeover of the optometry and audiology services. We are also seeing the historic GP corner shops, merged into group practices and then taken over by unaccountable businesses. The original vision of health centres accommodating multidisciplinary teams located in accessible sites for the population served is vanishing. The story of PPHC takes us through a period of change, highlights the obstacles in bringing the vision into action and the damaging changes in NHS management and policy.

    The authors document the hurdles that they confronted in developing new services and wanting to move away from the independent contractor status of GPs. The frequent NHS disorganisations proved to be deeply frustrating and demoralising and there is a real sense that idealistic health workers were getting stressed and burnt out by trying to serve their patients in great need on a 24/7 seven day per week basis. The PPHC participated in the short-lived Association of GPs in Urban Deprived Areas (AGUDA), which articulated the higher needs and demands for NHS staff in inner city areas and how the pay and conditions did not compensate for the extra work involved. Encouraging primary care based maternity services with home deliveries and end of life care requires a huge personal commitment the timing of events being outside one’s control. The story of author Katy Gardner falling asleep in the early hours of the morning in a patient’s home while waiting to support the home delivery illustrates the willingness, commitment and consequential tiredness. It is good therefore to note the contemporary success of the Deep End project led by Graham Watt, a former Tudor-Hart MRC Registrar, which while based in Glasgow and across Scotland is also seeding a global network. 50 years on from the publication of the Inverse Care Law the structural determinants of ill health remain and it is good that the aspiration for greater equity in primary care is still alive.

    An opportunity for the GPs to become salaried arose in 1998 as part of a Primary Care Act pilot and the PPHC GPs became employees of the North Mersey Community (Mental Health) Trust. From then on however multiple changes were introduced including the creation of PCGs, PCTs, Alternative Provider of Medical Services (APMS) contracts and in 2011 PPHC was put out to tender by Liverpool PCT and awarded to SSP Health Ltd, a GP owned business. This was a very unhappy period and staff had left (Katy herself in 2005) and a poor Care Quality Commission report in 2015 followed. Services remained unsatisfactory and the SSP contract was not renewed. The Liverpool CCG asked the Brownlow Health group to step in and they were more aware of the history of PPHC, with one of Brownlow’s GPs having been a trainee there. This has proved a success with a five year contract awarded to them in 2018. However there remain huge risks as we enter a second decade of Tory government with continuing under investment in primary care with challenges in the recruitment and retention of GPs. Organisationally there are risks of privatisation as the new Integrated Care Systems develop with little in the way of local democratic accountability and assurance about safeguarding NHS provision from national and international ‘for profit’ organisations.

    I recommend this book which provides a history of the PPHC from 1977-2017, explores the vision which drove the pioneer practitioners, includes a realistic description of the work involved and the value that a socialist and culturally radical practice delivered to the people they served. The golden thread is like an Olympic torch handed over from socialists in the pre NHS period and through each decade of its 70year history. Organisations like the SHA and Doctors in Unite need to keep the flame alight to safeguard what we have and enthuse the next generation of radical practitioners.

    Dr. Tony Jewell was President of the UK Association of Directors of Public Health and was the Chief Medical Officer in Wales. He has been a member of the Socialist Health Association for over 40 years.

    Comments Off on Review of ‘A Radical Practice in Liverpool: the rise, fall and rise of the Princes Park Health centre’ Katy Gardner and Susanna Graham-Jones.

    During the COVID19 pandemic, a lot of routine health provision has been suspended or reduced. As we plan to get get these back on track, lets not put prevention at the end of the  list, yet again. The SHA convened a group of its members with relevant expertise , who have developed a briefing on the risks to the public of the temporary reduction of prevention programs.

    Key Messages

    • Childhood vaccination programme: the recent increase in vaccination coverage after a long fall has now been thrown into jeopardy by COVID19, with little resilience in primary care and public health departments to systematically and actively promote catch up programmes.
    • Measles: there would be a significant risk of measles outbreaks because MMR coverage in England among children was well below the threshold required for herd immunity in most areas. Measles is highly infectious with an R0 of 16
    • Influenza vaccination programmes for children and adults will begin in September. It is vital to achieve a much higher uptake, to reduce the risks of having to manage a flu epidemic while COVID19 is still circulating.
    • Screening services should restart as soon as possible, with safety measures in place for patients and staff, and a plan for catching up all who have missed out
    • Sexual health and contraception: there is a serious risk of losing the excellent gains of the last Labour Government’s Sexual Health and Teenage Pregnancy strategies, after major cuts in the public health grant. We need a new sexual health strategy with a return to planning and collaboration rather than tendering of services
    • Prevention spend: The Government should restore public health expenditure in England to at least previous levels

    Prevention is so much better than cure: There are many prevention programmes designed to prevent and detect diseases at an early stage to stop them causing death and illness. These are some of the most highly cost-effective healthcare interventions; a review by NICE found that 85% of 200 case estimates of prevention programmes were cost effective. Vaccination programmes are the most cost-effective healthcare interventions

    Amazing efforts by staff: During the COVID19 pandemic, many services have been impacted through being suspended, or by reducing services. Some may also have been affected by the public reducing their uptake. Staff in public health programmes have been going to heroic lengths to deal with the pandemic while keeping essential preventive services going

    The paltry and reducing investment in prevention and early diagnosis is now under greater threat There is a high risk that prevention programmes will lose out for investment when finances are reduced, as will happen during the coming recession. Many of these programmes have already been deeply affected by austerity, in particular those commissioned by Local Authorities in England.

    Recovery plans: The NHS is attempting to restart, and this must be fully funded and adhere to principles of patient and staff safety and equity.  There has been a lot of great local integration and innovation in the face of a common threat, and this must be nurtured and not used as an excuse for cutting costs. Digital ways of working are not cheaper and not a replacement for face to face in many situations long term

    Emerging public health risks of suspending public health programmes FINAL

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    Boris Johnson’s Queen’s speech includes this statement:

    “New laws will be taken forward to help implement the National Health Service’s Long Term Plan in England.”


    A Camden New Journal article ‘Beware false prophets’ published last month, reports:

    “The most alarming feature of the Long Term Plan, however, is that it completely locks in the contracts on offer through the adoption of Integrated Care Partnerships (ICPs).

    “These ICPs are the planned outcome of NHS England’s Sustainability Transformation Plans and Accountable Care Organisations, and are non-state organisations with a single management structure. Included within them are hospitals as well as primary and commun­ity care services – and possibly social care too.

    “These giant five to 10 year multi-million-pound commercial contracts will be open to bidding, and they will not be subject to public scrutiny (information is routinely withheld on grounds of commercial confidentiality). This will open the way to bids from giant international health corporations that already run similar de-skilling of healthcare in the US and elsewhere.”

     

    Jeremy Corbyn’s Labour speech in Northampton is clear:

    “For a decade our NHS has been run down, carved up, and prepared for privatisation. A Labour government will reverse this. We’ll repeal the Tory-Lib Dem privatisation Act of 2012. We’ll give our NHS the resources, equipment and staff it needs. That means more GPs and nurses and reduced waiting times. And under Labour prescriptions in England will be free.

    “And we’ll make life-saving medicines available to all by ensuring Big Pharma can no longer hold our NHS to ransom. The prices pharmaceutical companies demand don’t reflect the costs of the drugs they make. They simply charge as much as they can get away with.

    “We’ll use compulsory licensing to secure generic versions of patented medicines and create a publicly-owned generic drugs manufacturer to supply cheaper medicines to our NHS, saving our health service money and saving lives.

    “Only Labour can be trusted with the future of our NHS.”


    Please see Mariana Mazzucato’s The Value of Everything, especially Chapter 7 “Extracting Value through the Innovation Economy”. It explains value extraction by Big Pharma.

    Comments Off on New laws to implement NHSE’s Long Term Plan

    You may have seen the Panorama programmes about the shocking crisis in social care. If not, please see links to iPlayer at the end of this post.

    Below is a motion that I’ll present at my local Labour Party branch meeting on 9 July next week.

    The motion has been agreed by the Reclaim Social Care Group (RSCG) with the aim of getting it discussed and accepted as union policy at Labour Party Conference this year.  Although I’m not ‘registered’ disabled, I’m a member of Disabled People Against Cuts (DPAC).

    The RSCG is co-ordinated through the umbrella group, Health Campaigns Together (HCT). It includes representation from Socialist Health Association (SHA), and KONP (Keep Our NHS Public).  Also included in RSCG are the National Pensioners’ Convention (NPC), several unions including Unite and Unison branches, and a wide range of disabled people’s user-led groups, and writers and academics.

    Motion: Reclaim Social Care

    England’s social care system is broken. Local Authorities face £700m cuts in 2018-19. With £7 billion slashed since 2010, 26% fewer older people receive support, while demand grows.

    Most care is privatised, doesn’t reflect users’ needs and wishes; charges are high. Consequences include isolation, indignity, maltreatment. Disabled and elderly people face barriers to inclusion and independent living, thousands feel neglected.

    8 million unpaid, overworked family carers, including children and elderly relatives, provide vital support.

    Public money goes to shareholders and hedge funds as profits. Service users and families face instability as companies go bust.

    Staff wages, training and conditions are slashed. Staff turnover over 30%.

    This branch demands Labour legislates a duty on the SoS to provide a universal social care and support system based on a universal right to independent living: 

     

    • Free at point of use

     

    • Fully funded through progressive taxation

     

    • Subject to national standards based on article 19 of the United Nations Convention on the Rights of Persons with Disabilities addressing people’s aspirations and choices and with robust safeguarding procedures.

     

    • Publicly, democratically run services, designed and delivered locally, co-productively involving local authorities, the NHS and service users, disabled people and carers

     

    • Nationally agreed training, qualifications, career structure, pay and conditions.

     

    • Giving informal carers the rights and support they need.

     

    Labour to establish a taskforce involving user and carers organisations, trade unions, pensioners and disabled people’s organisations to develop proposals for a national independent living support service, free to all on the basis of need.

     

    (250 words)

    Notes for members

    SoS – Secretary of state

    Reclaiming Our Futures Alliance (ROFA).

    This is an alliance of Disabled People and their organisations in England who have joined together to defend disabled people’s rights and campaign for an inclusive society. ROFA fights for equality for disabled people in England and works with sister organisations across the UK in the tradition of the international disability movement. We base our work on the social model of disability, human and civil rights in line with the UN Convention on the Rights of Persons with Disabilities (CRPD).

    We oppose the discriminatory and disproportionate attacks on our rights by past and current Governments. Alliance member organisations have been at the forefront of campaigning against austerity and welfare reform and inequality.

    National independent living service

    The social care element of Disabled people’s right to independent living will be administered through a new national independent living service managed by central government, but delivered locally in co-production with Disabled people. It will be provided on the basis of need, not profit, and will not be means tested. It will be independent of, but sit alongside, the NHS and will be funded from direct taxation.

    The national independent living service will be responsible for supporting disabled people through the self-assessment/assessment process, reviews and administering payments to individual Disabled people. Individuals will not be obliged to manage their support payments themselves if they choose not to.

    The national independent living service will be located in a cross-government body which can ensure awareness of and take responsibility for implementation plans in all areas covered by the UNCRPD’s General Comment on Article 19 and by the twelve pillars of independent living, whether it be in transport, education, employment, housing, or social security. The cross-government body will also be responsible for ensuring that intersectional issues are adequately addressed.

    BBC Panorama – Social care 

    Part 1:  https://www.bbc.co.uk/iplayer/episode/m0005jpf/panorama-crisis-in-care-part-1-who-cares

    Part 2 – https://www.bbc.co.uk/iplayer/episode/m0005qqr/panorama-crisis-in-care-part-2-who-pays

    8 Comments

    The following article was first published in the Camden New Journal on 06 December, 2018

    A private company being promoted
    by government to recruit patients to its doctor service spells ruin for the whole-person integrated care we need from the NHS, argue
    Susanna Mitchell and Roy Trevelion

    The sneaking privatisation of our National Health Service now aggressively threatens our GPs. In Camden and across London, we all need to be aware of the long-term harms this development will cause GPs and primary care NHS services.

    Last year, a global multinational corporation called Babylon Healthcare – owned by a former Goldman Sachs investment banker and Circle Health CEO – established a “digital- first” business called “GP at Hand”.

    Disastrously for the NHS, Babylon Healthcare Services Ltd can be traced back to a holding company in Jersey, the offshore tax haven.

    GP at Hand is contactable through a mobile app which uses standard calculations as a symptom checker. Unfortunately NHS England have not provided our existing practices with this software.

    Instead any patient registering with this commercial enterprise will be deregistered from their normal GPs. And, although the GPs employed by the company can also be accessed by video or phone, this process delivers no continuity of care or whole-patient assessment.

    Continuity of care is a cornerstone of general practices. However, Matt Hancock, the health secretary says, “If we need to change the rules to work with the new technology then change the rules we must.”

    In addition GP at Hand’s own promotion material actively discourages older people from registering. Explicitly these are those who are frail or living with dementia, or in need of end-of-life care. Pregnant women and those it describes as having complex social physical and psychological needs are also discouraged from signing up.

    In other words it is “cherry-picking” young and healthy patients who will be more profitable to its shareholders. Its use of standard practice via information technology, and the easy access it offers, is particularly attractive to the young.

    Of the 31,519 new patients who have signed up with GP at Hand over the past 12 months, 87 per cent are aged between 20 and 39 years, while patients over 65 now make up just 1 per cent of the population registered with the service.

    All this poses serious problems both for patients and general practices. In the first place, our present primary care system consists of GP practices committed to whole-person and integrated care for everyone in their local communities. Healthcare services are organised around geographic areas to enable better co-ordination with hospitals and social services.

    In contrast to this, GP at Hand fractures this fair and impartial community-based model, registering patients who live or work anywhere within 35 to 40 minutes of one of the clinics. In addition, should any of their patients require more complex care, they will no longer have their own GP to turn to.

    Secondly, by picking the most profitable patients, GP at Hand drains money away from ordinary GP surgeries. Normal GPs are funded according to the number of people on their patient list and this funding is combined into a single budget to provide the services they offer. This means that funding from the roughly 80 per cent of patients who remain reasonably well helps to pay for the 20 per cent who are elderly, who are chronically sick, or have multiple illnesses.

    But if the “capitation fee” of the young and healthy is scooped up by a for-profit company like GP at Hand, it will critically undermine the funding available to surgeries. This will leave practices to deal with the sick, the frail and the old on a much reduced budget.

    Shockingly this commercial entity is funded by NHS England. It can be commissioned through our clinical commissioning groups (CCGs).

    It’s expanding fast, and already has over 35,000 patients. Currently the corporation operates out of five clinical locations in London including one in King’s Cross. Plans for rolling it out nationwide are under discussion. It is also advertised widely, with the health secretary Matt Hancock recently announcing that he has registered with the company.

    Future developments in information technology and artificial intelligence that can be useful to our public health systems should be funded directly towards our existing GP surgeries.

    It should not be used as a vehicle for profit-making by private corporations at the expense of our NHS.
    We need to make the dangers of adopting this business model clear to the widest possible public. We must encourage those who care about our publicly-funded NHS to boycott Babylon’s GP at Hand.

    We need to bring public pressure to bear and end this attack on a valued and trusted institution that serves us all.

    The NHS has always been for the benefit of everybody. It must be kept that way.

    • Susanna Mitchell and Roy Trevelion are members of the Holborn & St Pancras Labour Party and of the Socialist Health Association.

    2 Comments

    To all members, comrades and friends on behalf of the Officers and Executive:

    First, I would like to thank Judith Varley for the tremendous support she gave me at the Conference as a disabled companion. It was extra good having an active and interested SHA member as a plus to our usual allocation of 2. Judith was invaluable in discussions, and in looking around the wider fringes and events at conference. I hope she will have her own tale to tell. Thanks also to my SHA fellow delegate, Coral, who was just great to work with. Missing her already.
    SHA had a wonderful presence at the Labour Party Conference this year (2018). There was a slight disappointment from the perspective of the Socialist Health Association in that the Conference focus was on Brexit. In the Women’s Conference our own delegate, Coral Jones, spoke well and persuasively on our motion on the issue of abortion, and how it is still technically a criminal matter. Coral will tell us more about this in her own words. Although the motion was not chosen to go forward, one on Women and the economy being favoured, all was not lost. Coral managed to speak to it eloquently, persuasively, and at some length, at the end of the main Conference, after Central Council member Norma Dudley proposed a reference back to our SHA motion on NHS renationalisation. Norma was speaking on behalf of her CLP, but she mentioned us warmly, and was speaking for us too. I cannot praise her ability highly enough, she is a real asset, like Coral.
    I discovered, if I didn’t already know, that there is a wealth of talent amongst SHA women. Even when they were not speaking on the platform, or chairing sessions, they were showing their understanding and passion on health and care issues from the floor. I will try to remember some names, but everyone I heard was amazing, so if is an oversight if you are not mentioned:
    Saturday/Sunday: Myself and fellow SHA member Felicity Dowling were speaking at The World transformed on the way forward for the NHS on Sunday. I hope I did us proud, Felicity certainly did. I am hoping she will let us have a copy of what she said to put on our website. Jessica Ormerod, and Nicholas Csergo were present to support us, as were other members and friends. If you read this, please add to the debate, and add your name to the people present. As speakers we didn’t get to take part in the round table discussions, and it would be good to hear about them.
    Other members were speaking at, and supporting the Conference fringes and events on Sunday, and I hope Felicity will also let us know about the Women’s March to save the Royal women’s Hospital in Liverpool on Saturday.

    Monday: Our first Fringe event was on Women’s Health and was very ably chaired by Central Council member and Chair of Liverpool SHA, Irene Leonard. It was attended by Alex, me, and Andy Thompson and a lot of other members and supporters. It was great to see Andy, Alex, and Nicholas supporting the session on Women’s Health. Of course, it is not just a women’s issue, and their support and friendship is very much appreciated. Our members Jessica Ormerod, Felicity Dowling and another local activist with a great depth of knowledge (Alex can tell us more about her, and I hope we meet up with her again – and recruit her), spoke so eloquently and passionately on the subject, and members of the audience were able to make very knowledgeable and worthwhile contributions. I hope Irene will say a few more words on this session.
    Tuesday: Coral, myself and Judith mostly stayed in the Conference, but in the afternoon, Brian Fisher our Vice President arranged a meet up to talk about Care in the Community. Judith and I attended, while Coral and Norma both covered the Conference.
    Tuesday Evening: Our second Fringe meeting on care and the renationalisation of the NHS Bill. We were very lucky with this, as MP Emma Dent Coad, who is the MP who ensured Grenfell did not pass unnoticed, and Eleanor Smith, the MP who is supporting the Renationalisation Bill through Parliament were both able to be present for almost the whole of the session. We also had our SHA member Judy Downey, possibly the foremost expert in the country from SHA perspective, and who is honest, and passionate. Last, but not least, Brian Fisher our Vice President spoke well and passionately about the issues, and a truly Socialist solution. I had the honour of chairing, but with a whole roomful of energised, knowledgeable and passionate people, both speakers and audience, it chaired itself. Again, Nicholas and Alex were there to support, as were Norma, Corrie Lowry, another Central council member, and great speaker, and Felicity. Our own Kathrin Thomas was also there in support. We all agreed that we could not let care be relegated to the long grass, as it seems to be in great danger of doing, and I hope we will get the opportunity to work with the MPs again. Gilda Petersen, from HCT, with whom we (SHA via Brian and me) are working on a Conference in November (details to follow) brought leaflets to the meeting room. I hope everyone will support this. It is in Birmingham on the 17th November and will be another chance to hear some wonderful speakers again, meet with new ones, and spend a whole day thinking about these complex issues.

    Judy spoke about the privatisation of Liberty and will do so again in November.

    Today I collected our material from the stall, and listened to a great speech from Jonathan Ashworth, and, to come full circle, the debates to which Coral and Norma made such a great SHA contribution.

    To all members and friends, I won’t know what everyone did, and your contributions are all important. Please send me your information and opinions, so that all voices are heard

    Jean Hardiman Smith Secretary and proud SHA delegate

    Comments Off on Re: The Labour Party Conference 2018, Liverpool

    Following the Judicial Review in London in July, NHS England quietly launched its promised public consultation on the Integrated Care Provider (ICP) Contracts on 4 August. The consultation closes on 26 October.  If the appeal granted at the other Judicial Review called for by 999 Call for the NHS in Leeds is successful, this ICP contract may yet be unlawful, but it is nonetheless essential that we respond to the feedback.

    The ICP consultation document is a daunting read for most of the public. However, Health Campaigns Together (HCT) has provided expert answers to all 12 points in the public feedback document. 

    HCT’s aim in providing these answers is to prevent flawed plans being adopted. They are seeking to prevent long-term contracts being signed that will undermine our NHS. This is in order to preserve any hopes of achieving a genuine integration of health and social care as public services, publicly provided free at point of use – and publicly accountable.

     

    A reminder on what’s happened so far: There have been two judicial reviews on the Accountable Care Organisations and these Integrated Care Provider (ACO/ICP) contracts. And the courts found in favour of the NHS. But one of the campaign groups, 999 Call for the NHS, has now been granted permission to appeal. 

    This is some very good news. But it also means NHS England is consulting on an ACO/ICP contract that may be unlawful. 

    NHS England knew full well that an appeal was a possibility. Although fully aware of this, on Friday 3rd August – the day Parliament and the Courts went on holiday – NHS England started a public consultation on the ACO/ICP contract. The consultation says that the Judicial Reviews had ruled in their favour. This consultation runs until 26 Oct.

     

    We all know that this ICP consultation needs to be combatted and stopped. But in the meantime, here’s all the information you need to fill in the consultation feedback.

    As stated, the judge in the London NHS Judicial Review said that the ACOs (now ICPs) should not be enacted until a lawfully conducted consultation was held, and any eventual ICP contract would have to be lawfully entered into.

    Since then, NHS England have moved swiftly and stealthily into gear, and you will find their monstrous ICP ‘consultation’ document at this link.

    And here is Health Campaigns Together on the subject at this link.

    As you see, the consultation document includes 12 points for feedback and Health Campaigns together has provided suggested responses to these points – very good responses too, I think. You’ll find them at this link.

    When you’re ready here is the direct link for public feedback to the document, just copy and paste from the Health Campaigns Together link above.

    As stated, there is a move afoot to get the consultation suspended until after the appeal granted to the 999 for the NHS has been concluded, but it’s very important to counter what will definitely be lots of responses from the allies of NHS England. Otherwise they will be able to hail the result as a democratic mandate.

    Health Campaigns Together say that it is OK to copy and paste HCT’s responses into the feedback boxes on the questionnaire, although if possible, it would be good if respondents could add a few tweaks of their own.

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    National Health Service

    Dr. D. Stark Murray (Socialist Medical Association) moved the following resolution :—

    In view of the increased number of doctors and other health workers necessary for the successful running of the new National Health Service, this Conference urges the complete democratisation of recruitment to this Service, by providing free education with maintenance for all suitable students irrespective of sex: It also considers that in order that there may be a maximum of democracy within the new National Health Service, provision should be, made for the establishment of Hospital and Health Centre Committees, of which elected representatives of the staffs should, be members.

    He said: Three Conferences ago we brought before you a resolution supporting the White Paper issued by the Coalition Government. We recognised that in supporting that White Paper we were departing to some extent from the ‘previous policy of this Party, but we decided then, and you unanimously agreed, that the correct thing to do at that stage was to support the proposals of the Coalition Govern­ment. No sooner had the Conference passed that resolution than Mr. Willink, the Tory Minister, of Health, attempted, with the help of the B.M.A., completely to change the whole policy which the Coalition Government laid down. At the next Party Conference we had to come before you and ask the Conference to go back to its original policy and pass a resolu­tion in favour of the original proposal of the Labour Party itself. We asked the Conference to pass the composite resolution which con­tained a great many pf the suggestions which have become the policy of the Party, and which we emphasised just before the General Election. They became the Health section of “Let Us Face the Future’

    Mr. Attlee has spoken about the vigorous activity that has taken place in this Government and Parliament, but I do not think that this Conference yet realises quite how vigorous and how important the action of the Government with regard to health legislation has been: The passage of the National Health Service Bill will bring, in due time, to full fruition an ideal that has been in the minds of the Socialist Medical Association for a great many years. We in that Association have always taken a stand for a complete national health service of a particular kind. The particular points which we are placing before the Conference to-day concern a much more distant future than is envisaged in the present Bill. We look forward to a larger health measure in a future time. We should have liked the Minister of Health to have gone further; and we in the Socialist Medical Association still believe that there should be one single standard of medical care for the whole population. While we have accepted a compromise which still allows a certain degree of privilege to remain within this health service, we shall watch the position exceedingly carefully and we shall be prepared to come before you at any given moment if we find that that privilege is being abused, and we shall ask you to reaffirm the basic principles of Socialist policy in this matter, namely, that there shall be no position of privilege for those who can afford to pay for it.

    The motion before you is so simply worded that I may leave you to read it for yourselves and not attempt to elaborate it at all. We feel that in order to democratise the Service we want Staff Committees in every hospital and health centre. The Minister, if he is to provide all the workers necessary for this Service, must see that all forms of education—medical, dental, nursing, auxiliary, and technical—are open to the whole population. As we have drawn a brilliant Cabinet from working-class ranks, so the Minister of Health must begin to draw the doctors for his Service from the ranks of the working-class of this country.

    Mr. J. Wilkinson (Oxford City Labour Party); As I am asked to be very brief I would like to point out that in this particular Bill with regard to the National Health service all the Committees are appointed and not one of them is elected. I think that the Conference will agree that there should be more election from the general body of the public and less appointments than there has been up to the present. I formally second the resolution.

    Dr. Somerville Hastings M.P. (Barking): At an Annual Conference some fourteen years ago I had the honour, of moving, on behalf of the Socialist Medical Association a resolution in favour of a National Health service. Now I want to thank the Party for accepting that resolution, and especially to thank the Labour Government for introducing a Bill to implement the resolutions then passed, but, like Oliver Twist, we are asking for more. Within the framework provided by the Bill for a National Health service, there is room for personnel which must be much better than any personnel previously provided. We want a personnel recruited from not one class only, the better off, but from every class of society. We want a personnel conten: to play its part, realising that its experience and knowledge can be placed at the service of those responsible for the organisation of such a State service as is pro­vided under the Bill.

    We want all youths and girls who have the interest and the capacity to be given the opportunity to join the medical profession. We want selection to be made, not only by a few scholarship tests, but also we want to select those who are desirous of service and those who have the sympathetic temperament which is so necessary. I know some of the best doctors who started as chemists and nurses, and we want to provide for all health workers the possibility of being trained as doctors if they have the capacity and desire.

    In the hospital with which I am connected, at the beginning of the war the Medical Super­intendent called together representatives from all the workers in the hospital—not only the doctors and the nurses, but the engineers, the ward maids, the porters, and so on—and asked them to consider how the hospital service could be made more efficient during the national emergency. That “Soviet,” as they called themselves, met, and it has met at frequent intervals since, and they have been very useful indeed. Matters such as wages and conditions of service, which are much better left to the Trade Unions, have, of course, not been con­sidered. What has been considered is in what way the services of that hospital could be made more easily available to the patients with a view to benefiting them more.

    Dr. Edith Summerskill, M.P. (National Executive): I feel that it is appropriate that I should be a substitute for Mr. Aneurin Bevan, because I represent the Ministry of Food and I feel that the food service is complementary to the health service. After being in practice for twenty years, I would say that in most cases a patient derives more benefit from one good meal than from a whole bottle of medicine. For many years I have sat with Hastings and Stark Murray on the back benches of this Conference and come forward to the rostrum and made my little contribution to the health service debate. Last year I had the honour of expounding the Labour Party’s health policy, from this platform and telling you what we would do if we obtained power. Few of you can realise what a supreme satisfaction it is, to stand here and say that, although the Bill is not yet on the Statute Book, it has already received its second reading, and, in a comparatively short time, this country will enjoy a health service second to none in the world.

    Let us not underestimate the value of this service to the community. Disease is more deadly than war. In the future nobody will be denied, the best specialist service in the world. No mother need look in her purse to see if she has enough money to call in the doctor for her child. No housewife need neglect symptoms or disease until she is past medical aid. Every man, woman and child will qualify for treatment. As for the doctors, I say deliberately that this Bill is a charter of independence for every medical man and woman in the country. In the future no doctor need prostitute his talents by pandering to the hypochondriac. The malingerer will find short shrift in the Health Centres. The doctor of the future will be judged, not by the size of his bank balance, his house and his car, but by his capacity to prevent, and cure disease.

    Our opponents in the House of Commons charged us with denying, both to the doctor and the patient, his freedom. With regard to the doctor, as I have said, for the first time in his life he will enjoy intellectual freedom and for the first time in his life know the meaning of economic security. With regard to the patient, what freedom has the patient in a village, or, in a small town? Those who talk about freedom forget that when a patient goes to the hospital it is quite common for him to have a major operation performed by a man or woman of whose name he is ignorant. It is quite common, in London, for me to send a woman to a hospital for an operation although she does not know who will perform it. What we are going to establish is faith in the new medical service, and then, if a patient has a doctor at night who is a stranger, he or she will have faith in him.

    So far as the voluntary hospitals are con­cerned—I remember that the Mayor of Bourne­mouth mentioned this in his opening remarks— when the nation takes over the voluntary hospitals, the prestige of these hospitals will be enhanced. Their value will be increased. Modern medical science can no longer rely upon charitable contributions. Furthermore, when the all-in insurance contributions come to be paid it will be found that 80 to 90 per cent, of the revenue of the voluntary hospitals comes out of the pockets of the public. Therefore, can anybody logically argue that they should not be controlled by the people?

    The Minister of Health does not under­estimate the magnitude of the task. The machine that he sets up must work efficiently, in the interests of both the patients and the workers, whether they be doctors, nurses or others ancillary to the work of the hospital and health centre. Moreover, it is of primary importance to perfect the machine in order that the principle of one standard of service for all is definitely carried out.

    I come now to education. I agree with Dr. Somerville Hastings that medical education in the past, has been the monopoly of the middle classes. It will now be necessary to encourage more boys and girls to enter the medical profession. The Minister of Education recently made a statement that more scholarships would be available and that a medical education would be brought within the reach of all, whatever the parents’ income may be. There will be free tuition and maintenance for any boy or girl who is anxious to enter the medical profession, and this will be irrespective of sex.

    By a curious coincidence I find that the chairman of the hospital at which I was trained is in the hall to-day. It gives me great satis­faction to learn from him that in the future it is to be the ruling of his hospital to admit 50 per cent of women students. This is a reversal of policy because, soon after I left, women were excluded. The “serious” reason given to me was that we distracted the male students—that, of course was twenty years ago—-and that, therefore, the football of the hospital deteriorated. For the last twenty years I have followed the football scores of my old hospital, and there has been no noticeable improvement.

    On the question of Hospital Committees I want to remind my medical colleagues that these Committees are, of course, functioning in many hospitals throughout the country. They advise, and make very useful recommendations to the Medical Superintendent, and I see no reason why these should not be extended.

    On the question of nurses I want to say a word. We do not, of course try to justify the appalling conditions under which nurses worked in the past, but I must say this to the Conference: the nurses themselves are not entirely blameless. While doctors have formed one of the most powerful professional organisa­tions in the country, the British Medical Association, the nurses have remained un­organised and inarticulate. The time has come when nurses must learn the value of organisation and the power of collective action.

    Finally, let me assure those delegates who have spoken that we shall bear in mind the points they have raised. We are determined to establish a service which will command the respect and trust of the whole nation, and we shall succeed, for it is politically wise, financially sound and morally right.

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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

    2 Comments

    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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