Category Archives: Labour Health Policy

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

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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

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an interview with Michael Meacher

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What do you feel about the Griffiths Report?

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

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

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

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

Graham Bickler & Alison Hadley

July / August 1984

 

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

Labour’s vision

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

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

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

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

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

Issues

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

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

Questions:

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

Public health funding

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

Questions:

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

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

Workforce

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

Questions:

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

This is a summary of that interview:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Alison: What about pay beds within the NHS.?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Graham Bickler

Alison Hadley

 

 

 

 

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Introduction

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

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

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

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

Immediate Priorities

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

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

Those bottlenecks are :

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

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

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

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

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

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

Funding and Funding Principles

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

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

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

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

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

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

Integration of Healthcare and Social Care

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

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

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

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

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

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

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

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

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

Promoting true professionalism not unrealistic salaries and earnings expectations.

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

Policy recommendations :

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This was presented at our conference Public Health Priorities for Labour

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

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

Canterbury Tales

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

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

PFI Revisited

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

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

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

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