Category Archives: Labour Health Policy

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

1 Comment

Tagged | 1 Comment

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

Tagged , | 4 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

First published by the Morning Star

Tagged | Leave a comment

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

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

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

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

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

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

Labour in government: access and accountability

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

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

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

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

 

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

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

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

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

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

Choice and involvement

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

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

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

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

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

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

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

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

Quality and safety

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

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

Healthy lives

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

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

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

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

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

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

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

The future

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This essay first appeared in This Woman Can. 

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

6 Comments

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

Funding pledges

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

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

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

Mental health services

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

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

Health care reorganisation

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

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

Staffing levels

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

Privatisation

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

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

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

1 Comment

The health and care section of Labour’s manifesto.

In the aftermath of war and national bankruptcy, it was a Labour government that found the resources to create a National Health Service – our proudest achievement, providing universal healthcare for all on the basis of need, free at the point of use.

Labour will invest in our NHS, to give patients the modern, well-resourced services they need for the 21st century. Labour will ensure that NHS patients get the world-class quality of care they need and that staff are able to deliver the standards that patients expect.

We will guarantee and uphold the standards of service to which patients are legally entitled under the NHS constitution. By guaranteeing access to treatment within 18 weeks, we will take one million people off NHS waiting lists by the end of the next Parliament.

We will guarantee that patients can be seen in A&E within four hours. By properly resourcing the NHS, Labour will stop the routine breach of safe levels of bed occupancy, and we will end mixed-sex wards. We will deliver the Cancer Strategy for England in full by 2020, helping 2.5 million people living with cancer. And, by properly resourcing ambulance services, we will end the scandal of slowing ambulance-response times.

Labour will focus resources on services to provide care closer to home and deliver a truly 21st century health system. We will work towards a new model of community care that takes into account not only primary care but also social care and mental health. We will increase funding to GP services to ensure patients can access the care they need. And we will halt pharmacy cuts and review provision to ensure all patients have access to pharmacy services, particularly in deprived or remote communities.

Labour will tackle the growing problem of rationing of services and medicines across England, taking action to address ‘postcode lotteries’ and making sure that the quality of care you receive does not depend on which part of the country you live in. We will ensure all NHS patients get fast access to the most effective new drugs and treatments, and insist on value-for-money agreements with pharmaceutical companies.

To make sure that autistic people are able to access the whole of their community and to put an end to social isolation, Labour will set the ambition to make our country autism-friendly. We will ensure that everyone with a long-term condition, such as those with diabetes, will have the right to a specialised care plan, and access to condition-management education. We will ensure highquality, personalised care for people approaching the end of their life, wherever and whenever they need it.

Labour will ensure that NHS England completes the trial programme to provide PrEP (pre-exposure prophylaxis) as quickly as possible, and fully roll out the treatment to high-risk groups to help reduce HIV infection.

Labour will fund free parking in NHS England – for patients, staff and visitors – by increasing the tax on private medical insurance premiums.

Labour's manifesto - NHS Staff

Public health

For our health and care services to be sustainable in the long term, we need a renewed commitment to keeping people fit and well. Labour will focus our efforts on children’s health, protecting the wellbeing of the nation for the decades to come.

We will take action to significantly reduce infant deaths and to ensure all families who lose a baby receive appropriate bereavement support.

Labour will invest in children’s health, bringing in a new government ambition for our children to be the healthiest in the world. We will fight health inequalities to break the scandalous link between child ill-health and poverty. We will introduce a new Index of Child Health to measure progress against international standards, and report annually against four key indicators: obesity, dental health, under-fives and mental health. We will set up a new £250 million Children’s Health Fund to support our ambitions. As part of a preventative healthcare drive, Labour will increase the number of health visitors and school nurses

We will publish a new childhood obesity strategy within the first 100 days, with proposals on advertising and food labelling. We will make a concerted effort to address poor childhood oral health in England. Labour will implement the Soft Drinks Industry Levy, commonly known as the ‘sugar tax’.

We will implement a strategy for the children of alcoholics based on recommendations drawn up by independent experts.

Labour will implement a Tobacco Control Plan, focusing on issues of mental health and young smokers.

Loneliness is an increasing problem for our society, and as Jo Cox put it, “young or old, loneliness doesn’t discriminate”. A Labour government will create a more equal society for the many by working with communities, civil society and business to reduce loneliness.

Labour will address historic public- health injustices. We will hold a public enquiry into contaminated blood. We will also hold a public inquiry into medicines, including Valproate, medical devices and medical products licensing and regulation.

A Labour government would maintain our commitment to improve sexual-health services, especially HIV services which will include reducing the rates of undiagnosed and late- diagnosed HIV, ending the stigma of HIV in society, and promoting the increased availability of testing and treatment.

NHS Staff

To guarantee the best possible services for patients, Labour will invest in our health and care workforce. A Labour government will step in with a long-term workforce plan for our health service that gives staff the support they need to do the best for their patients.

Labour will scrap the NHS pay cap, put pay decisions back into the hands of the independent pay review body and give our NHS workers the pay they deserve. Labour will protect patients and legislate to ensure safe staffing levels in the NHS.

Labour’s long-term ambition is for our health system to have the best trained staff in the world, ready to deal with whatever they have to face in the years to come. Labour will re-introduce bursaries and funding for health-related degrees. Labour will support doctors to deliver the best care possible by investing in the training, education and development of doctors throughout their careers.

Labour will immediately guarantee the rights of EU staff working in our health and care services. Labour will support NHS whistleblowers to make sure health service staff are able to speak up in support of the best possible standards for patients. Labour will make it an aggravated criminal offence to attack NHS staff.

NHS Funding

£30 billion in extra funding over the next Parliament through increasing income tax for the highest 5 per cent of earners and by increasing tax on private medical insurance, and we will free up resources by halving the fees paid to management consultants.

Labour will boost capital funding for the NHS, to ensure that patients are cared for in buildings and using equipment that are fit for the 21st century. And we will introduce a new Office for Budget Responsibility for Health to oversee health spending and scrutinise how it is spent.

Labour will halt and review the NHS ‘Sustainability and Transformation Plans’, which are looking at closing health services across England, and ask local people to participate in the redrawing of plans with a focus on patient need rather than available finances. We will create a new quality, safety and excellence regulator – to be called ‘NHS Excellence’.

The next Labour government will reverse privatisation of our NHS and return our health service into expert public control. Labour will repeal the Health and Social Care Act that puts profits before patients, and make the NHS the preferred provider. We will reinstate the powers of the Secretary of State for Health to have overall responsibility for the NHS.

We will introduce a new legal duty on the Secretary of State and on NHS England to ensure that excess private profits are not made out of the NHS at the expense of patient care.

Towards a National Care Service

Our social care sector is in crisis, with severe consequences for the quality of care, public finances, personal assets, pressures on unpaid carers of family and friends, and delays to discharging patients from hospitals.

Care services have been slowly but relentlessly privatised. In recent years, one in ten people reaching the age of 65 have faced lifetime care costs of over £100,000, with some homeowners paying the entire value of their homes.

The Conservatives’ cuts have led to £4.6 billion lost from social care budgets, despite rising demand. Around 1.2 million older people have care needs that are going unmet. Care in the community has become a cover for unseen neglect.

In our first term, Labour will lay the foundations of a National Care Service for England.

Our first urgent task will be to address the immediate funding crisis. We will increase the social care budgets by a further £8 billion over the lifetime of the next Parliament, including an additional £1 billion for the first year. This will be enough for providers to pay a real living wage without cutting the quality of care they provide. It will allow implementation of the principles of the Ethical Care Charter, already adopted in 28 council areas, ending 15-minute care visits and providing care workers with paid travel time, access to training and an option to choose regular hours.

Labour will also increase the Carer’s Allowance for unpaid full-time carers to align the benefit with rates of the Jobseeker’s Allowance.

Short-term funding solutions will not address the fundamental long-term challenges of our ageing demographics, nor meet the growing demands arising from late-life illnesses.

The National Care Service will be built alongside the NHS, with a shared requirement for single commissioning, partnership arrangements, pooled budgets and joint working arrangements. We will build capacity to move quickly towards a joined-up service that will signpost users to all the appropriate services at the gateway through which they arrive.

In its first years, our service will require an additional £3 billion of public funds every year, enough to place a maximum limit on lifetime personal contributions to care costs, raise the asset threshold below which people are entitled to state support, and provide free end of life care. There are different ways the necessary monies can be raised. We will seek consensus on a cross-party basis about how it should be funded, with options including wealth taxes, an employer care contribution or a new social care levy.

Improving the quality of social care is a vital part of providing dignity in older age and independence and support for people who are vulnerable or have a disability or a mental health condition.

Labour will build a new National Care Service. We will also set out the funding alternatives clearly and honestly, seeking to implement change through consensus. Providing dignity and care in old age should transcend party politics and campaign slogans.

Labour's manifesto

Mental Health

Mental ill-health is the biggest unaddressed health challenge of our age. Around one in four people in the UK will experience a mental health problem each year.

Yet, since 2010 mental health funding has been cut, the number of mental health nurses has fallen by 6,600 and remaining mental health budgets have been raided to plug holes elsewhere in the NHS.

Labour will work to reverse the damage done to mental health services under this Tory government, which is particularly hitting services for LGBT and BAME communities.

In order to protect services, we will ring-fence mental health budgets and ensure funding reaches the frontline.

We will end the scandal of children being treated on adult mental health wards and stop people being sent across the country, away from their support networks, to secure the treatment they need by bringing forward the ending of out-of-area placements to 2019.

Labour will also bring an end to the neglect of children’s mental health. Half of people with mental health problems as adults present with symptoms by the age of 14. Yet, across England only 8 per cent of mental health funding goes to services for children and young people. In recent years, referrals to Child and Adolescent Mental Health Services have increased by two-thirds, and the number of young people presenting to A&E units with psychiatric conditions has doubled. Suicide is now the most common cause of death for boys aged between five and 19.

Labour will invest in early intervention by increasing the proportion of mental health budgets spent on support for children and young people. We will ensure that access to a counselling service is available for all children in secondary schools.

Giving mental health the same priority as physical health means not only ensuring access to services, but also making improvements, to those services. Choice is important in a modern NHS, and patients who receive their therapy of choice have better outcomes. Labour will therefore ask the National Institute for Health and Care Excellence (NICE) to evaluate the potential for increasing the range of evidence- based psychological therapies on offer.

Tagged | 1 Comment

An Effort to Tackle Child Obesity in the UK

With the threat of childhood obesity looming over the UK, the Labour Party proposes a new child health plan that would ban junk food adverts from TV programs aired before the 9pm watershed. This proposal makes up only part of a future child health bill that will be outlined in Labour’s election manifesto.

Campaigners claim that the ban will decrease children’s viewing of junk food adverts by 82%.

While such adverts are already banned from children’s programs, this more extensive ban would block them from popular programs like The X-Factor, Hollyoaks, and Britain’s Got Talent, which children watch though the shows aren’t specifically marketed toward them.
Party aims
In ten years time, the Labour Party hopes to halve the number of obese children in the UK and thus reduce the £6 billion annual cost of obesity to the National Health Service.

The party would also create a £250 million fund by cutting the amount spent by the NHS on management services annually, which would help provide school nurses and counseling services to English primary and secondary schools.

The future Labour government plans to compare child health care to international standards as part of its “ambition to make Britain’s children the healthiest in the world,”.

An Index of Child Health would compare and evaluate body fat percentage, as well as numerous other health factors, in children; their indicators include obesity, dental health, under-fives, and mental health.

Labour’s shadow health secretary Jordan Ashworth observed that many children are obese when they begin school, and that type 2 diabetes in children costs the NHS around £10 billion annually.

“This initiative is good for the children but it is also good for the taxpayer,” Ashworth told BBC.

“We are asking people to think about the impact and asking the advertising industry to recognize by putting their messages into things like Britain’s Got Talent all the time, it is having an effect on children saying they want to eat and drink this stuff.”

At this time, the party would not require food manufacturers to change their salt, fat, and sugar contents, but Ashworth hopes it would encourage a change nonetheless.

Critics
Announced in August, the Conservatives’ childhood obesity plan, which they call “the most ambitious” in the world, is at risk by Labour’s plans. The health select committee and many campaigners complained the Tories’ bill was “weak” and “watered down”. TV chef Jamie Oliver openly criticized the Conservatives for not including an advert ban, which he campaigned to have as part of the Labour plan.
In response, Tory public health spokeswoman Nicola Blackwood defended the plan and expressed economic concerns about the Labour party’s leadership.
“Reducing childhood obesity is vital. That’s why the public health watchdog says that the childhood obesity plan we’ve put in place is the most ambitious in the world, and that’s why we have one of the strictest TV advertising regimes of any country.”
Blackwood went on to claim that these health reform programs “could only be funded by a strong economy which Jeremy Corbyn would risk with his nonsensical economic ideas.”
Meanwhile, the child obesity rate in Britain is expected to reach 30% by the year 2050.
References:

http://www.bbc.com/news/uk-politics-39838028

http://www.ncbi.nlm.nih.gov/books/NBK299573/

Tagged | Leave a comment

It is my pleasure to be here. As a Labour MP, a trade union member. As a member of your shadow Cabinet and – I hope – as the next Labour Secretary of State for Health. And it is a pleasure to be here with UNISON a great trade union led by one of the great General Secretaries Dave Prentis. I congratulate all of you for your campaign on public services and the work of public servants.

Dave spoke with great eloquence earlier this week. And when Dave said that funding’s becoming scarcer – he was right. When Dave said you’re all asked to do more with less – he was right. And when Dave said you cannot trust the Tories with the National Health Service – he was right. And that’s what I want to talk to you about this morning.

But my first duty this morning on behalf of the Labour Party and Jeremy Corbyn is to say thank you to this union and your members and indeed all who work in the NHS. So to the nurses, the midwives and the health care assistants – we say thank you. And because we don’t always remember them but I’ve seen for myself the difference you make when a few years ago I had the honour of shadowing your stewards on facility time at Lewisham hospital. To all your stewards representing you in hospitals we say thank you. To the porters, the cleaners and the IT administrators – we say thank you. To the medical secretaries, therapists, paramedics and managers – we say thank you too. For your care, your dedication, your self-sacrifice, every day, your extraordinary efforts, literally often the difference between life and death.

Friends, we are here today. In our various vocations and in this union because we believe in something bigger than ourselves, because we are driven by solidarity not selfishness and we understand, and indeed value the ethos of public service. An ethos that not only runs deep in our history as a trade union movement but defines the character of our country as well. Because when you look at every stage of life, whether we call it cradle to the grave – or as Shakespeare wrote of the 7 ages of man. At every stage public servants have been there for us, have cared for us, have nurtured us and made us all what we are today. Each and every one of them transforming hopelessness into hope. From the midwives and clinicians who bring us into the world, the teachers who inspire us, the community workers improving our quality of life, to our care workers who look after our frail, weak and vulnerable. All represented across this union, all everyday showing the value of public services at the heart of a civilized society. And nowhere is that clearer, than in the NHS, A National Health Service is truly visionary – a central part of the values we share as a society.

So today in the run up to this General Election I want to talk to you about the attack on our NHS and on our values by this Conservative Government. And in this campaign let’s be resolute to not let any Tory run away from their record on the NHS. Theresa May can insist problems with the NHS are nothing more than a ‘small number of incidents’ but she can’t deny what we see with our eyes to be happening. The winter crisis we’ve just been through, with ambulances backed up outside of hospitals, patients on trolleys in corridors, operations cancelled, elderly people trapped in beds with nowhere to go. Ever lengthening queues of the sick and elderly across the land.

  • Nearly 4 million people waiting for an operation;
  • Over 200,000 people waiting for four hours of more in A&E in February alone;
  • The number of people waiting for 12 hours or more on trolleys doubled in a year. Sometimes patients wait over 30 hours on a trolley.

Call it a ‘humanitarian crisis’ as the Red Cross did. Call it the NHS on a ‘burning platform’ as the CQC Chief Executive did. Call it an ‘existential crisis’ as Sir Robert Francis did. I simply call it what it is – this is a Tory NHS crisis and that’s why the future of the NHS is at stake in this general election.

We have a Prime Minister who even yesterday still refuses to see the truth that the NHS is overstretched, understaffed and under threat. We have a Prime Minister imposing on the NHS the largest financial squeeze in history. Who allows hospital trusts to fall into deficit like never before. We have a Prime Minister who next year will be cutting NHS spending per head. Yesterday we heard that the NHS has a backlog of £5 billion in repairs for crumbling hospitals and out of date equipment. They expect the NHS to find £22 billion of so called efficiency savings which no one believes can be found without cutting frontline care. A health system buckling under the strain of huge financial and operational pressures.

And what does it tell you about the state of 21st century Britain under these Conservatives that the number of hospital beds take by patients being treated for malnutrition – yes malnutrition – has trebled in recent years. Malnutrition on the rise in Tory Britain; isn’t that a national disgrace; isn’t that a badge of shame. And because of the pressures on beds in the last few years a million patients have been discharged in the middle of the night. And the numbers of elderly and vulnerable people trapped in hospital with nowhere to go at record levels.

And why? Because we have a care system that has been savaged by 7 years of spending cuts. We have a care system on the brink of tipping point. We have over a million of the most elderly and vulnerable people denied the care they deserve. Some maybe our own grandparents or parents, our own relatives.

And yet we have a Prime Minister who walks by on the other side, refuses to face up to the problems and says to councils in the most deprived parts of the country: you can raise your council tax even though it will go nowhere near meeting your social care needs. Unless of course it happens to be Surrey County Council where you can get a special secret sweetheart deal with Downing Street. Well I tell you something, under Labour these dodgy deals that demean Downing Street will be gone. We’ll bring back honour and integrity to policy and decision making in No 10. No more special access and mates’ rates but fairness instead for all.

And while this Prime Minister ignores the social care needs of the many she can find millions to build new grammar schools, She can find billions to cuts taxes for the biggest corporations, but she won’t recognise thedemands of the elderly or treatment requirements of the sick. So let us be absolutely clear – what prevents this Prime Minister from acting is not the financial constraints of the economy but the dogmatic constraints of her ideology. Things are so bad that even Andrew Lansley – remember him – even Andrew Lansley has complained it isn’t getting the money it needs. Talking of Lord Lansley, never forget that the priority of these Conservatives – including Theresa May – was always a top down reorganization in the Health and Social Care Act whose very aim was to drive our NHS into the realms of privatisation;  And I can tell you today we will not yield, we will not buckle.

Labour will defend the National Health Service and axe that Health and Social Care legislation that allows the NHS to be fragmented and sold off. Privatisation of the NHS will come to an end.

And I tell you what else we will do: We will reinstate the Secretary of State’s responsibilities. We will reinstate the NHS – publicly funded, publicly administered and yes publicly provided. And I want our NHS staff and patients to be given an actual real genuine voice in the running of our NHS too. So I can announce we will also put healthcare professionals, staff and patients on the Board of any organisation providing NHS care.   And yes this will apply to all private companies currently providing services or we will insist they hand back their contracts.   But we will go further than that too and insist that Board level representation of professionals, staff and patients is on every organisation providing NHS care – including Clinical Commissioning Groups and all NHS Trusts.   So Labour will deliver staff reps on boards with voting rights at the heart of our NHS.

Better services

Over this campaign Labour will be setting out our plans to deliver the improvements that patients need. We want to see hospitals properly staffed, waiting times coming down and emergency care available to those who need it, operating to the standards that patients expect. Under the Conservatives the 18 week target has been dumped for what they call non-urgent operations. 

To paraphrase a famous pre-election speech from time gone by: I warn you that if the Tories win again not to get old, not to get sick. I warn you that the real cost of the Tories winning again will be felt in longer waiting times, and people spending longer in pain and discomfort for knee replacements and hip replacements.

Let’s be clear what’s happening, step by step, bit by bit. The NHS under Tories is being pushed back to the bad old days and it will fall to Labour to save the NHS like we have done throughout our history. So we confirm our commitment to hitting the targets for A&E, We’ll do so by investing in our NHS, in our community services, and renewing the focus on keeping people well and out of hospital, delivering care closer to home at the time when people need it. Because those who have given so much all their life deserve security and dignity in retirement we’ll integrate health and social care. And when it comes to the planning and delivery of local services we will always ask what is in the interest of local needs not what is in the interests of filling financial holes.

And we will deliver long overdue improvements to mental health care as well. We know that mental ill health is the leading cause of sickness absence at work, costing the economy £105bn every year. And that one in four of us in this room will experience a mental health problem this year. And yet all we get from Theresa May is warm words and empty promises, but no real meaningful action. Unlike the Tories, Labour will tackle the underfunded and understaffed mental health system. We want to see mental health services properly resourced and focused on prevention, rather than just asking the NHS to intervene once a person is already in crisis. We will give our mental health services the money they desperately need to look after us all, because there can be no health without mental health. The next Labour government will deliver true parity of esteem between mental and physical health. We won’t just talk about equality – we will deliver it. 

And if we are to deliver these improvements for Britain’s patients, then our starting point will be delivering improvements for our health and care workforce.

Standing up for staff

So today I want to set out Labour’s plans for the staff of our NHS and social care system. You are the lifeblood of the NHS. You have committed your working lives to caring for others in our times of need. You deserve to be cared for yourselves, but for too long this Government has taken you for granted. A pay freeze has seen NHS wages fall 14% below inflation. Cut backs to training places have meant units are even more short-staffed. And now Brexit threatens the ability of our NHS to recruit from abroad, and threatens thousands of good, kind European staff who are working in our country already. So let me make it clear, Labour would make the NHS a priority in the Brexit negotiations, and as Keir Starmer said yesterday we would give an immediate NHS guarantee to all European NHS staff. Let us send a clear message to the thousands of NHS and social care staff from the EU. You are welcome, needed and your rights will be guaranteed in the UK under a Labour government. 

You know because you see it every day that staff are being forced by this Government to do more and more with less and less Giving ever more of your free time to keep the service running – working through your breaks and often long past the end of your shift. It’s why I say that our NHS staff are the pride of Britain. Yet you are ignored, insulted, undervalued, overworked and underpaid by this Tory government. Well not any more. Enough is enough. NHS staff have been taken for granted for too long by the Conservative Government.

Cuts to pay and training mean hard working staff are being forced from NHS professions and young people are being put off before they have even started. What is bad for NHS staff is bad for patients too. Short staffing means reduced services and a threat to patient safety. So I can announce a Labour Government will step in with a long term plan for our NHS which gives NHS staff the support they need to do the best possible job for patients. NHS staff deserve to be rewarded for the complex, difficult and highly specialized professional work that they do. So I can confirm today that a Labour government will scrap the pay cap, put pay decisions back into the hands of the independent pay review body and give our NHS workers the pay they deserve. It’s fair to staff and it’s in the interest of patients too. And it’s also in the interests of patients that we invest in the potential of our staff. My long term ambition is for our NHS staff to have the best trained staff in the world ready to deal with whatever they face in the years to come.

As a first step that means giving those who want to enter nursing, midwifery and allied health profession a step up, not kick the ladder away. So let me commit here today that we will re-introduce bursaries. We will reinstate funding for health related degrees so that people who want to get into health professions – whether they are young people starting out or older students who want a new career after starting a family – don’t feel put off by financial considerations.

Safe Staffing

I know that whenever we need the NHS it’s there for all of us and our families. But all of us are naturally anxious when our loved ones or ourselves need to spend time in hospital. Quite simply Labour will never compromise on patient safety.

After seven years of Tory mismanagement our health services dangerously understaffed. We are thousands short on the numbers of nurses, midwives, and paramedics that we need. And yet the attitude of this Prime Minister remains blinkered in the extreme. Her head buried in the sand. A casual dismissal of the concerns of patients and their families.

So just as I’m passionate about investing in our NHS staff, I will be the real patients’ champion too. Time and again expert reports – including the groundbreaking survey UNISON published this week – have told us that staffing levels are linked to patient safety but this Conservative Government has failed to deliver staffing levels which keep up with demand. So the next Labour government will legislate to ensure safe staffing levels in England’s NHS. We will immediately ask NICE to undertake work to set out how safety can be determined in different settings, including looking at legally enforced staffing ratios. So conference with a Labour government a new law to guarantee safe staffing, so that finances never again take precedent over patient safety.

And unlike the current Secretary of State I don’t make promises on behalf of the NHS while refusing to give the NHS the resources and tools to deliver those promises. The NHS under Labour will get the funding needed. Over the coming days we will outline a long term plans for the NHS; for how we integrate health and social care. 

For too long, NHS staff have been taken for granted by the Conservative Government. Wages falling, workloads rising. Staffing shortages getting worse. So I’m pleased to be able to launch here today Labour’s three point pledge for NHS staff: better pay, safer staffing and fully funded education. So yes this election is about the future of the NHS.

And yes, it falls to this movement as it has throughout our history to make the case with passion and yes pride for a National Health Service – free at the point of need for every man, woman and child. It falls to us again as it has throughout our history to make the argument for collective provision not just for a basic health service but for the very best health service. Throughout our history, we never lost our ideals and we never faltered in our ambitions for the best health care for everyone. Because we know that a National Health Service funded through taxation; with treatment free at the point of delivery; where everyone is treated equally based on clinical need not ability to pay is not only the right thing to do but it’s also the most efficient, effective and safest system of health are across the world.

Friends one of favourites poets WB Yeats wrote ‘in dreams begins responsibility” –

Inspired by the solidarity of the communities of Tredegar and motivated by the dream of a fairer society not just for some but for all Nye Bevan took responsibility to bring it about the Health Service. In doing so we escaped from a world of patch work provision and charges for healthcare. So let’s never forget that in that speech introducing the National Health Service Bill he said the NHS, would “lift the shadow from millions of homes”, “It will keep very many people alive who might otherwise be dead” And: “No society can legitimately call itself civilised” he said, “if a sick person is denied medical aid because of lack of means”

They were words that still inspire And of a cause that still endures; And now the responsibility falls to us.

So the choice in this election on June 8th is clear:

A rebuilt National Health Service and social care service for the millions who depend on it with Labour or cut backs, sell offs and nothing but a rump service under the Tories. A world class NHS providing the best quality of care – 

Or waiting times get longer, staff demoralised, standards of care plummeting

The choice is clear.

Labour’s commitment; that is our purpose. Our Values, Labour Values, Our Policies will protect the future for the NHS and standards of NHS care. Let’s go out and win. Thank you

1 Comment

Jon Ashworth MP Labour Shadow Secretary of State for Health addressed the meeting and took questions. He has been in role for 5 months – shares Bevan’s vision of the NHS. Health Service dominates many issues in British politics. Its not only fair but an efficient service.

NHS is being pushed to the brink of disaster – the Red Cross has spoken of a humanitarian disaster, Sir Robert Francis QC has warned financial and demand pressures on the NHS have created an environment in which a care scandal equal to that at Mid Staffordshire is “inevitable”. Ashworth reports that next years Tory NHS funding will be even tighter. Recent Budget allocations to the NHS health and social care are dwarfed by the scale of cuts these services are undergoing… (with the possible exception of Social Care funding for Surrey!)

He recognises that the NHS needs funding increases of about 4% a year simply to stand still. Previous Labour governments did better. The issue of staffing too is getting desperate – nursing bursary needs to be restored and pay restrictions must be lifted – overseas workers play an indispensible role in the NHS and must be supported.

The Lansley Health and Social Care act needs to be undone – the NHS re-instatement bill is a useful way of challenging it in principle but may not be the best tactic.

The government response is effectively to suspend waiting time targets for a year!

The meeting comprised health campaigners and members who had been involved in running the NHS in Wales who stressed the NHS should not only be free at the point of use but should be publicly provided and that the role of the voluntary sector should not be to provide core health services as part of a competitive tendering process.

Ashworth believes that the scale of the cuts proposed by the Sustainability and Transformation Plans were undeliverable politically and that the most the Tories might achieve is a few pilot STPs or Accountable Care Organisations which might be open to privatisation. He supported campaigners challenging the STPs and appealed for assistance in analysing the proposed impact of STPs on local health systems.

For the future the LP needs to consider resources for expenditure on the NHS and Social Care. This will be an important debate in the labour movement.

The SHA is currently producing a Green Paper (consultation document) on future Labour policy on the NHS which it hopes to use to stimulate debate on the future of the service in the labour movement and among people generally. This will be an important outreach initiative – the SHA plans to build a strong membership base among new LP activists.

ACTIONS – step up campaigning, feedback responses to STPs, lookout for SHA Green Paper and use it to stimulate debate … join the SHA!

Tagged | Leave a comment

Labour’s Vision

policies

Labour believes in a strong and secure NHS, where healthcare is based on need, not the ability to pay. We need to make sure we have a health and social care service that is t for purpose and that can meet the challenges of today. The Labour Party believes in a fully integrated health and social care system which looks after the needs of our ageing population, treats people with dignity and ensures that mental and physical health are treated equally.

The scale of the challenge currently facing our NHS and social care system is huge. Our NHS is going through its biggest financial squeeze in history and the system is struggling to cope. Chronic underfunding of health and social care services, coupled with workforce shortages, is causing increasing stress and anxiety for both staff and the patients that they work so hard to care for.

The Conservative Government has failed to give our health and social care services the resources they need to ensure that patients receive the care they deserve. An increasing number of people are waiting too long for operations, key performance targets, such as the four-hour A&E waiting time target and the 62-day cancer treatment target, are being missed month after month. Older and vulnerable people are being left stranded on hospital wards because there is nowhere safe for them to go. Our social care system is under severe pressure, with increasing numbers of people getting little or no assistance to help them deal with basic daily tasks such as washing and dressing.

Underfunding is also having a negative impact on the ability of local authorities to support preventative public health initiatives such as sexual health programmes, smoking cessation services and measures to reduce obesity. There are real concerns that reductions to funding for prevention are short-sighted and will likely contribute to an increased burden on the health system in the future.

The NHS is Labour’s proudest achievement. We have a duty to protect both patients and sta , and ensure that people can access the care they need, when they need it, through a publicly provided service.

The Issues

Last year the Health and Care Policy Commission looked specifically at the issue of mental health and explored issues surrounding early intervention and prevention in mental health, as well as what steps need to be taken to achieve true equality between physical and mental health.

This year the National Policy Forum (NPF) identified further work on funding, social care and public health.

Funding

As a result of Conservative policies on health and social care, our system is underfunded and overstretched. The Conservative Party has failed to grasp the size of the challenge facing health and social care, and patients are being let down as a result. NHS spending per person will be cut next year and experts have suggested that by 2020 there will be a gap in social care funding of at least £2.6 billion. In addition to this, it is expected that funding for public health will fall by at least £600 million in real terms by 2020/21 and figures also show that mental health funding fell by £600 million over the course of the last Parliament. NHS trusts finished 2015/16 £2.45 billion in deficit, the highest on record.

The period between 2009/10 and 2014/15 saw the lowest five year growth in public spending on health in the UK since the 1950s. Under the last Labour Government, the average annual growth rate was 5.9 per cent, compared to 1.1 per cent under the Coalition Government (2010-2015).

In addition to existing funding pressures across the board, local health communities are being asked to find savings totalling £22 billion, as set out in NHS England’s Five Year Forward View. Finding savings of this level, while at the same time developing and implementing Sustainability and Transformation Plans (STPs), is expected to put huge pressure on local hospital services, and is likely to have a knock-on effect on community and primary care. There are real fears that STPs will lead to the downgrading or closure of some local services (e.g. A&E departments and maternity units).

The demographic of our country is changing. Our population is ageing rapidly, and the number of people living with multiple complex and long term conditions has increased. As a consequence, health and social care services are under immense pressure, sometimes struggling to meet the needs of patients. There has been a 56 per cent increase in the number of days lost to delayed transfers of care since 2011; 1.8 million people waited longer than four hours in A&E departments last year; GPs are struggling to cope with an increasing workload and the 62 day cancer target has not been hit for three years.

Health needs are constantly evolving and demand on the NHS is growing as a result. Patient demand for access to new drugs and treatments is increasing and Clinical Commissioning Groups in England are being forced to make difficult decisions about what treatments and drugs they can o er with reduced budgets.

The health and care system is under enormous financial pressure. There are calls from across the political spectrum, and from health and care experts, to boost funding for services in the immediate term by providing an urgent injection of funding to shore up services under significant strain. However, a more long-term, sustainable solution must be considered if we are to secure the future of our health and social care services.

Questions
  • What steps need to be taken to ensure that a universal health care system, free at the point of need, is maintained?
  • What steps should be taken to ensure long-term, sustainable funding for health and social care?
  • What can be done to ensure that the NHS and social care receives adequate funding in order to meet rising demand?
  • Is there scope for further savings in the NHS, without compromising the quality of patient care?
  • What can be done to mitigate the potential impact of Brexit on our health and social care workforce?

Your opinion matters. To get involved login or register

Social Care

As a result of choices the Conservative Government has made, social care is facing a funding shortfall of £1.9 billion next year, and by 2020 the gap could be as much as £2.6 billion. UK public spending on social care is set to fall to less than one per cent of GDP by 2020, and it has been estimated that as many as 1.2 million people are now living with unmet care needs – this means that they are receiving no help to perform daily tasks such as washing and dressing.

The number of people aged 65 and over is increasing. According to the National Audit Office, the number of older people in England (aged 65 and older) rose by 20 per cent between 2004 and 2014 and this upward trend is set to continue. The impact of a rapidly ageing population will have a significant impact on the health and social care system. Both delayed discharges and emergency admissions to hospital have increased in recent years – between 2010/11 and 2014/15 there has been an 18 per cent increase in emergency admissions of older people to hospital.

The Government has failed to provide the social care system with sufficient funding. The social care precept, which allows local councils to raise council tax to pay for social care, is not a sustainable, long term solution to the financial challenges facing the system. Despite the fact that around 95 per cent of councils decided to use the precept in 2016/17, the amount raised will not even cover costs related to an increase in the National Living Wage.

The Government has neglected to address serious funding issues in health and social care. In last year’s Autumn Statement, the Government failed to provide a single extra penny for social care and this year’s Spring Budget was a missed opportunity to give social care an immediate cash injection to help cope with increasing pressures. The Government’s announcement to provide £2 billion over three years is woefully inadequate, when we take into account that the social care funding gap for next year alone is this amount.

Action needs to be taken to protect older and vulnerable people, who are increasingly being left to fend for themselves. Many are living with unmet care needs, or are being left trapped on hospital wards with nowhere to go. Carers are under increasing pressure to provide care to a growing number of older people, and unpaid carers, for example family members, are being left to cope with little or no extra help.

Questions
  • What steps need to be taken in order to improve our social care system for older people and those with disabilities?
  • What steps need to be taken to join up health and social care?
  • How can care workers and those who care for family members and relatives best be supported?
  • Recognising that a large part of the social care market is currently run by private sector providers, what should the government’s approach be to this part of the sector?

Your opinion matters. To get involved login or register

Public Health

NHS England spent over £5 billion on ill health linked to being overweight or obese in 2014/15, and it is estimated that £14 billion a year is spent on treating diabetes. According to a recent report from the Health Foundation, the Department of Health estimates that 70 per cent of the total health and social care spend in England is for the treatment and care of people with long-term conditions, such as diabetes and heart disease.

Cuts to the public health budget in England are putting prevention of ill health at risk – we have already seen in-year cuts to public health budgets of £200 million, and by the end of this Parliament it is expected that funding for public health will fall by around £600 million. Cuts of this scale could put at risk sexual health services, cancer screening, smoking cessation and measures to reduce obesity. Furthermore, there are concerns that cuts in the number of Sure Start centres will negatively impact people who benefit from the use of these services.

Our public health workforce is also under pressure, faced with cutbacks from local authority budgets. Shortages of both health visitors and school nurses are putting the existing public health workforce under unsustainable pressure. There are concerns that staff are finding it increasingly dfficult to provide much needed advice to children and young people, at a crucial point in their lives, because they are so overstretched. Preventing ill health at an early age is vital for the future health and wellbeing of children and young people. A third of children aged between two and 15 are either overweight or obese, and without rm action to combat childhood obesity, there are real fears that its prevalence will continue to increase. The Government’s much delayed and watered down Childhood Obesity Plan published last summer was a missed opportunity to deal with this issue head on.

We need to be aware of the impact issues such as housing, employment and education can have on people’s health and wellbeing. As a society it is crucial that we identify ways in which to promote preventative measures, in order to improve the quality of people’s lives and to reduce the burden of ill health on our health and social care services. Developing a range of policies to address health inequalities in our society is vital if we are to improve the health of people of all ages, from all parts of the country.

Questions
  • What policies should be put in place to tackle health inequalities in our society?
  • What can be done to support parents in helping to improve their children’s health?
  • What action should be taken to deal with the obesity crisis facing our country?
  • How can people be encouraged to take a greater interest in their own health?
  • Are there particular public health issues that affect specific groups in our society (e.g. LGBT, BAME) and if so, what strategies should be adopted to address these?
  • When looking at public health in devolved countries of the UK, what can we learn from different approaches and policies?

Your opinion matters. To get involved login or register

Tagged | 1 Comment

Six years of Tory Government has been a disaster for our health and care services in Greater Manchester. Instead of focusing on improving the care of older people, or making sure we’re training enough staff, the Tory Government in Westminster has been obsessing over reorganisation and privatisation. As a result our hospitals are facing record deficits, hundreds of thousands of patients are stuck on growing waiting lists and older people are not receiving the care they deserve. Mental health has been neglected, health inequalities continue to worsen, and too many people are dying prematurely from preventable diseases.

Devolution gives us the opportunity to address some of these problems, but it also presents challenges – such as how can we improve services at a time when the NHS and social care is under such intense financial pressure?

Andy’s ideas

A Health and Care Service for Greater Manchester

I want Greater Manchester to have the country’s first fully-integrated National Health and Care Service, building on the work that is already ongoing across our region to bring social care and the NHS together. This will be a big change from the 20th century – when we thought of health in terms of buildings and institutions. In this century the home and not the hospital should be the default setting for care. Wherever possible, people should be supported by a single team providing high quality personalised care with the aim of helping them get the most out of life.

Workforce

Many of the problems facing the NHS and social care services in Greater Manchester are workforce related, ranging from shortages of key and specialist staff to the quality of training for care workers. At the moment workforce policy is determined by the Westminster Government and an organisation called Health Education England. This approach hasn’t been working for Greater Manchester. Our area is overly reliant on recruitment from overseas and on hiring expensive agency staff. At a time when health and care services need every penny possible this approach is unsustainable.

I want Greater Manchester to be able to develop its own workforce plan, and to have more control over the funding held in Westminster. This would allow the Mayor to plan for the workforce needs of Greater Manchester, ensuring we have enough doctors and nurses, developing new career pathways for local people, and looking at how young people can be supported financially throughout their training.

Mental health

Too many people in our region who experience a mental health problem do not get the help they need. The situation is particularly grave for children who have to face long waits to get the right care or are left to struggle without any support at all. I want to make mental health a priority in Greater Manchester, and do everything within my power to ensure that parity of esteem between mental and physical health becomes a reality. We should be doing more to tackle the stigma that prevents so many people from coming forward and getting help. And we should be investing in prevention to make sure problems are spotted early and dealt with before they reach crisis point.

It’s not just mental health services that are often not there when needed. Parents of children with autism often face a monumental battle for support, and there can be long waits for services like speech and language therapy and crucial support like specialist wheelchairs. As Mayor I would have a clear focus on improving the support for children with special needs. I want to return Greater Manchester to an “Every Child Matters” approach and commit to GM-wide strategies on disability and autism.

Health inequalities

Greater Manchester still tops the league table of poor health. High levels of cardiovascular disease and deaths from preventable cancers give our community some of the shortest life expectancies in the country. To tackle these health inequalities, we need to link the NHS with the broader determinants of health – like housing, planning, leisure and education. I want the Mayor to bring all of these functions together across Greater Manchester and take the lead on public health, where the Westminster Government has left a vacuum.

Health and Housing

I want to place a new emphasis on building homes with care and support in mind. With an ageing population, we should be looking at following the lead of countries like Sweden and start building specially-designed ‘dementia friendly’ homes as part of a plan to make Greater Manchester the most dementia friendly city-region in the country.

Questions for consultation

  1. What steps do we need to take to support the integration of health and social care across Greater Manchester?
  2. Hospitals in Greater Manchester are facing record deficits and there is an £81m black hole in social care funding. Should the new Mayor be demanding more resources from Westminster for health and social care?
  3. Should the Mayor be calling for more powers over workforce planning? And if so, what needs to be done to improve the education and training of staff in both the NHS and social care?
  4. How can we improve the mental health support available to children and young people at school? And how do we tackle the stigma associated with mental health?
  5. What more can be done to reduce health inequalities and encourage more people to live a healthier lifestyle?
  6. How do we make Greater Manchester autism and dementia friendly?
Tagged | 3 Comments
%d bloggers like this: