Category Archives: SHA policy

These posts are discussions of policies that have not – or had not when posted – been adopted as our policy.

The Socialist Health Association (SHA) notes the public health green paper – Advancing our health: prevention in the 2020s, which was published on the 22nd July by the Cabinet Office.

 

We believe that this is a missed opportunity, which ignores much of the evidence on what works best to improve people’s health and wellbeing. Doing something at the level of communities, such as changing an ‘obesogenic’ environment, is more effective and much better value for money, than doing something one by one for individuals..  The paper also largely ignores the impact of poverty and the gross and worsening inequalities in health. At a time when the Government wishes to unite the country, this again betrays its inability to put first the health and wellbeing of all communities.

We support the recognition that health is an asset and a composite health index should be used at Cabinet and across government departments in their planning and investment decisions. We also strongly support the goal of a smoke free country by 2030 but believe that this will need strong regulation and taxation policies. We also support the removal of barriers put in place of water fluoridation, which is an effective way of promoting oral health in children and thus their dentition for life. Finally we support the strengthening of food and drink regulations in respect of salt, sugar and fat content but look to committing to specific measures such as the sugar tax for milky drinks and beverages.

40 years after the Black report on ‘Health Inequalities’ (1980), there is still too little commitment to address poverty. Poverty exacerbated by years of austerity, has resulted in reducing life expectancy and increasing infant mortality. There is no shortage of expert evidence and advice such as the Marmot reports which point to investment in the first 1000 days of life, early years education, the need to have a living wage and a society which enables ageing well. We need to see a strategic commitment by government to abolish child poverty, support parents in the early years and ensure that people have access to jobs that provide a living wage for families.

The Green Paper disappoints too in drawing back from a purposeful commitment to regulate and use taxation to shape the powerful commercial determinants of our health, such as the food and drink market.  We do not see the evidence for change unless linked with regulation (salt), taxation (sugar) and pricing (alcohol unit price). Similarly the rapid growth in gambling driven by advertising on television and social media and enabled by the digital world will require urgent legislation to prevent the growth in harm caused by addiction and consequential debt.

The SHA has recently published our own ‘Prevention and Public Health policy’ endorsed by the Central Council (available at www.sochealth.co.uk), which unlike the government’s Green Paper gives priority to the Climate Emergency and Planetary Health as well as prioritising addressing the social determinants of health.

The Green Paper makes individuals responsible for their own health in a way which will exacerbate the health outcome gap between the rich and poor. There is strong evidence for achieving better health outcomes through implementing interventions on the social, economic and environmental determinants of health and wellbeing. The emphasis on genomics, big data and artificial intelligence (AI) is misplaced in population level prevention policies, although we agree that these areas are exciting and need further research and evaluation

More recent evidence over the past 20 years of the Climate Emergency – the 21st century public health challenge – also needs to be a high priority for prevention and public health.

SHA 26th July 2019.

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SHA Central Council unanimously passed this motion at its last meeting. Please circulate and discuss at your CLPs and wards and consider whether you want to choose this as a motion to go to conference. It is an opportunity to shift Labour policy forward. The beginning of the motion succinctly describes the current disastrous situation, deepened by this government:

 

England’s Social Care system is broken. LAs faced £700m cuts in 2018-9 with £7 billion slashed since 2010. 26% fewer elderly receive support, demand grows.

People face isolation, indignity, maltreatment, neglect, barriers to inclusion and independent living.

Most care is privatised, not reflecting user needs/wishes. Public money goes to shareholders and hedge funds as profits.  Service users and families face instability as companies go bust.

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

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

 

The second part of the motion offers a set of solutions that go beyond more funding – we are exploring routes to a socialist approach to social care and support:

 

Conference demands Labour legislates a duty on the SoS to provide a universal system of social care and support acknowledging a right to independent living wherever possible:

  • Based on need and offering choice.
  • Meeting the needs of all disabled, frail and sick throughout life with robust safeguarding procedures.
  • Free at the point of use, universally provided, fully funded through progressive taxation
  • Subject to national standards based on Human Rights, choice, dignity and respect for all, complying with the UN Rights of persons with disabilities, including Articles on Independent Living (19) Highest Attainable Health (25) and Education (24).
  • Democratically run services, delivered through local public bodies working co-productively together with users and carers.
  • Training to nationally agreed qualifications, career structure, pay and conditions.
  • Gives informal carers strong rights and support, including finances and mental health.

 

Labour to establish a taskforce involving users and carers/Trade Unions/relevant organisations to deliver the above, including an independent advocate system, and national independent living support service.

Do contact us if you need any information or advice about submitting or debating this motion. “

Thanks

Brian

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Introduction

 

The  SHA Council agreed to pull together some of the existing policies on prevention and public health, introduce new proposals that have been identified and put them into a policy framework to influence socialist thinking, Labour Party (LP) manifestoes and future policy commitments. The SHA is not funded by the industry, charitable foundations or by governments. We are a socialist society which is affiliated to the Labour Party (LP) and we participate in the LP policy process and promote policies which will help build a healthier and fairer society within the UK and globally. An SHA working group was established to draft papers for the Central Council to consider (Annex 1).

 

The group were asked to provide short statements on the rationale for specific policies (the Why?), reference the evidence base and prioritise specific policies (the What?). Prevention and Public Health are wide areas for cross government policy development so we have tried to selectively choose policies that would build a healthier population with greater equity between social groups especially by social class, ethnicity, gender and geographical localities. We have taken health and wellbeing to be a broad concept with acknowledgement that this must include mental wellbeing, reduce health inequalities as well as being in line with the principles of sustainable health for future generations locally and globally.

 

The sections

 

These documents are divided into five sections to allow focus on specific policy areas as follows:

 

  1. Planetary health, global inequalities and sustainable development
  2. Social and the wider determinants of health
  3. Promoting people’s health and wellbeing
  4. Protecting people’s health
  5. Prevention in health and social care

 

The working group have been succinct and not reiterated what is a given in public health policies and current LP policy. So for example we accept that smoking kills and what we will propose are specific policies that we should advocate to further tackle Big Tobacco globally, prevent the recruitment of children to become new young smokers, protect people from environmental smoke and enable smokers to quit. We look to a tobacco free society in the relatively near future. Whether tobacco, the food and drink industry, car manufacturers or the gambling sector we will emphasise the need to regulate advertising, protecting children and young people especially and make healthy choices easier and cheaper through regulations and taxation policies.

 

Wherever appropriate we take a lifecourse approach looking at planned parenthood, maternity and early years all the way through to ageing well. We recognise the importance of place such as the home environment, schools, communities and workplaces and include occupational health and spatial planning in our deliberations.

 

We discuss the NHS and social care sector and draw out specific priorities for prevention and public health delivery within these services. The vast number and repeated contact that people have with these servces provides opportunities to work with populations across the age groups, deliver specific prevention programmes and use the opportunities for contacts by users as well as carers and friends and relatives to cascade health messages and actions.

 

The priorities and next steps

 

In each section we have identified up to ten priorities in that policy area. In order to provide a holistic selection of the overall top ten priorities we have created  a summary box of ten priorities which identify the goals, the means of achieving them and some success measures.

 

This work takes a broad view of prevention and public health. It starts with considering Planetary Health and the climate emergency, global inequalities and the fact that we and future generations live in One World. A central concern for socialists is building a fairer world and societies with greater equity between different social classes, ethnic groups, gender and locality. We appreciate that the determnants of such inequalities lie principally in social conditions, cultural and economic influences. These so called ‘wider determinants and social influences’ need to be addressed if we are to make progress. The sections on the different domains of public health policy and practice sets out a holistic, ecological and socialist approach to promoting health, preventing disease and injury and providing evidence based quality health and social care services for the population.

 

The work focuses on the Why and What but we recognise the need for further work to support the implementation of these priorities once agreed by the SHA Council. Some will be relatively straightforward but others will be innovative and we need to test them for ease of implementation. A new Public Health Act, as has been established in Wales, but for UK wide policies would make future public health legislation and regulation easier.

 

The SHA now needs to advocate for the strategic approach set out here and the specific priorities identified by us within the LP policy process so they become part of the LP manifesto commitments.

 

Dr Tony Jewell (Convener/Editor)

Central Council

July 2019

The complete policy document is available below for downloading.

Public health and Prevention in Health and Social carefinaljuly2019

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

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

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

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

Motion: Reclaim Social Care

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

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

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

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

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

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

 

  • Free at point of use

 

  • Fully funded through progressive taxation

 

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

 

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

 

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

 

  • Giving informal carers the rights and support they need.

 

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

 

(250 words)

Notes for members

SoS – Secretary of state

Reclaiming Our Futures Alliance (ROFA).

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

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

National independent living service

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

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

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

BBC Panorama – Social care 

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

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

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Chipping Barnet CLP notes that access to contraception is a fundamental human right underpinning equality, impacting on the health, structure and prosperity of both society and families. The 2012 Health and Social Care Act disadvantaged women, separating much of the funding for contraceptive care from the NHS by moving the responsibility for commissioning into Local Authorities, with NHS providers competing for contracts. As a result, the commissioning of contraception is now separate from the commissioning of other aspects of women’s health, including abortion. From both a woman’s and a clinical perspective, this is illogical. Compounding this, the impact of austerity on Local Authorities has led to a reduction in services, reduced access and to a postcode lottery for contraception in England.

Chipping Barnet CLP believes that contraceptive services need to be fully funded and accessible in all areas of the UK, with co-operation replacing competition. It welcomes the commitment of the Shadow Health Department to abolish competitive tendering for these essential services, and to work with clinicians to establish centres of excellence alongside regular accessible clinics to which women have free and easy access to confidential care.

Chipping Barnet CLP calls on the Labour Party to resolve to deliver fully funded contraceptive services in all areas of the UK, setting up a working group whilst still in opposition, composed of experienced clinicians and commissioners, to write a blueprint for delivery which will be implemented within the first year of the Labour Government.

Published by Jean Hardiman Smith with the permission of Sarah Pillai ( Chipping Barnet CLP )

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

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

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

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

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

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

Jean Hardiman Smith Secretary and proud SHA delegate

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Dear member,

As you may know, Central Council has agreed a way forward for continuing our policy development work. There are four policy areas being explored further and these are:

a) Looking at our extant public health policies to see what significant gaps, if any, should be addressed

b) Looking at the needs of carers

c) Adding to / undertaking a critical analysis of the Labour Party NPF paper on Mental Health issued last year

d) Taking further some current ideas for what a new (integrated and English ) health and care system might look like, he basis of its funding, values and governance etc

If any SHA member wishes to be contribute to the work of any of these four groups, please could they contact Vice Chair (Policy) Tony Beddow tonesue@aol.com, outlining their policy interest, location, and any background in their chosen subject.

Thanks

Tony

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The SHA is committed to NHS care, free at the point of use and funded out of general taxation, provided by public bodies. We challenge austerity which we agree is a political choice not an economic necessity.

We recognise that the devolved nations make their own policies. These draft policies apply mainly to England.

A NATIONAL HEALTH AND CARE SERVICE

We call on Labour to bring together our separate health and social care systems to become one unified care system driven by the political values and professional / organisational principles that underpin the NHS. This can be achieved by a gradual, non-disruptive process.

The political values needed are:

  • a system with national standards;

  • funded from progressive taxation;

  • delivered by locally accountable bodies that rely on committed staff many of whom have professional training and professionally established responsibilities;

  • evidence based policies
  • relying on the notion of “co-production” between service users and professional staff – people playing an active role in their care and professionals welcoming, respecting and responding to that role.

We call on Labour to adequately fund the National Health and Care Service, reaching the upper quartile of EU average spend, so that it provides a comprehensive service.

Discussion paper on NHS Governance

AN END TO PRIVATISATION

We call on Labour to restore the duty of the Secretary of State to deliver a comprehensive, universal, publicly provided and managed NHS, meeting clinical need, free at the point of use and funded out of general taxation, provided by public bodies. This needs to be achieved with as little disruption as possible. 

The SHA wants to eliminate the private sector except in exceptional and transient circumstances. This needs to be achieved with as little disruption as possible.

The NHS Bill 2016-17 provides a model for legislation in the first weeks of a Labour Government. Legislation should include the relief of NHS bodies from PFI debt.

Commissioning will be replaced by planning, based on needs and assets assessment.  Wales and Scotland offer excellent examples. Planning must be separate from provision and free of any form of conflict of interest or undue influence. Planning functions must be democratically accountable and cannot be given to the private sector under any circumstances.

The NHS will no longer regard Foundation Trusts as free-standing competitive corporations. Foundation Trusts will be reintegrated into the NHS family.

New Models of Care

The NHS England Accountable Care System has created 44+ local health services to replace England’s NHS, bypassing Parliamentary debate. Accountable Care Systems will provide limited services on restricted budgets. We can already see the effects of such austerity, with the long term increase in life expectancy stalled since 2010.  These New Models of Care and the government’s NHS asset sell-off result directly from the 5 Year Forward View currently being implemented via ‘Sustainability and Transformation Partnerships’. We therefore call on the Party to reject the 5 Year Forward View in its totality.

SHA supports the commitment to restore our NHS by reversing privatisation and halting Sustainability and Transformation Partnerships. This demands more than amending the 2012 Health & Social Care Act; we must restore our fully-funded, comprehensive, universal, publicly-provided and owned NHS without user charges, using the NHS Bill (2016-17) as a legislative starting point.

Discussion document on Enduring Aims and Principles

ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH

Addressing the social determinants of health is the foundation for health and wellbeing. Access to clean water and safe waste disposal; social and affordable housing which provides enough space, affordable and efficient heating; clean air, indoors and outdoors; good education to achieve universal literacy and numeracy; jobs that protect health and ensure adequate income; and an environment which promotes healthy transport, green spaces and public amenities should all become elements in a holistic approach to public health.

We support the child poverty abolition target for 2020.

This has implications for the public health service:

  • Chief Medical Officers and District Directors of Public Health need to be professionally independent, reporting annually on the health and health inequalities of their populations and their recommendations on priorities.

  • Communities and our relationships with them and between them and the statutory sector are key to health protection and resilience. The SHA is committed to creating the conditions whereby communities can increasingly share decisions with the statutory sector, thereby increasing confidence and health.

SOCIAL CARE AND INDEPENDENCE

Savage cuts have resulted in about 40% fewer people receiving social care now than in 2009, with severe cuts in other local support services. The human rights of disabled and older people have been ignored. The current system is out-of-date in its assumptions about what disabled and older people want and need and tends to reinforce negative images. Instead of respecting people as contributing citizens and family members, the system has adopted a wasteful consumerist ideology. Too often, in an over-pressurised service, patients and service users are not being treated with sufficient respect and dignity. This requires an end to the 15 minute social care packages.

We call for a new kind of social care, not more of the same.

The key principles for any future system of long term care must include:

  1. Universal coverage – The need for long-term care is part of the normal public sector services and should be treated just as health and education.

  1. Maximum risk-pooling – The most efficient way of insuring ourselves against the costs of impairment or frailty is to all pool resources in order to cover that risk, as with the NHS.

  2. Equity – The system should be equitable and should not discriminate against people because of condition, age or geography.

  3. Entitlement – All citizens should benefit from the system and should not be disadvantaged by income or ability to pay. The system should be funded from general taxation and be free at the point of use, as with the NHS.

  4. Control – All citizens should be able to get the right flexible support to meet their needs, to be able take the level of control that is right for them and their families.

The three key elements of the proposal are:

  1. Fund a universal system and end means-testing – Social care on the same footing as healthcare, funded from general taxation, with resources distributed on the basis of need, free at the point of need.
  2. Invest in citizenship and community – Social care must offer support that people and families can shape to their circumstances, and that helps people contribute as citizens and strengthens family and community life.

  3. End privatisation and the complexity of the current system – Social care must be integrated into one national system that invests resources locally and ends the wasteful procurement systems that currently undermine human rights.

These principles are in line with current developments across OECD countries.

Discussion document – Policy Proposal for Social Care

PRIMARY AND COMMUNITY CARE

It is still true that the availability of good medical care tends to vary inversely with the population’s need for it and this is particularly true in primary care.

The SHA is concerned that general practice under the Tories may go the way of dentistry, pharmacy and optometry, with co-payments becoming the norm. The SHA wants to eliminate the private sector except in exceptional and transient circumstances.

The SHA does not support GPs being responsible for planning although they must be centrally involved, alongside other key stakeholders.

The SHA wants to see improved access to primary care, with continuing personal care. This will require more clinicians and more and better use of IT. We sympathise with GPs’ frustration and agree that the government’s proposals for primary care are too little too late. We need a comprehensive new set of arrangements to support, incentivise and energise primary care.

Independent Contractor status

There are advantages and disadvantages to the independent contractor status of GPs. The SHA recommends a trial of a mixed economy, where in some areas primary care is salaried and in others as it is now, evaluating comparative benefits and risks.

Planning Primary Care

Primary care must be planned and managed rather than just administered which is the present predominant model. We recommend primary care workforce planning and joint multi-disciplinary training.

Integration

We should have a large-scale trial with a fully integrated provider which covers delivery of all primary, secondary, mental health and social care free at the point of use, for a single County or City.

We also recommend:

  • investment in treatment and prevention of mental health problems in children and young people,
  • a long-term plan for health promotion,
  • community-based home care treatment and prevention. This requires more District Nurses and Health Visitors, better paid and supported ,
  • Informal carers need to be fully supported. We support an increase for all carers’

THE MYTH OF THE DEMOGRAPHIC TIME-BOMB

The SHA rejects the concept that an ageing population results in unacceptably high costs. We are proud to have an increasing number of older people whom we value. Older people have falling mortality, less morbidity, and are more economically active than before. Some forms of disability are postponed to later years. Increased life expectancy means more years lived in good health.

Older people contribute almost £40 billion more to the UK economy annually than they receive in state pensions, welfare and health services. It is not age but nearness to death that accounts for health expenditure. Most acute medical care costs occur in the final months of life, the age at which these occur having little effect. According  to European research, health expenditure on older age groups is high because a larger percentage of people in those age cohorts die within a short period of time.

The SHA therefore wishes to see an evidence-based discussion on policies for a healthy ageing population, as part of developing the National Health and Care Service.

Discussion document on Primary And Community Care And The Myth Of The Demographic Time-Bomb

MENTAL HEALTH

Mental Health services see demand increasing by 5-10% for adults over the last 3-4 years, and by 30-40% for children and young people. There are delays accessing care partly because of worsening shortages of staff.

The SHA recognises that societal factors impact on mental wellbeing and illness. These include social deprivation, debt, poor accommodation and security of tenure, inadequate community and family support networks. Socio-economic inequalities have independent impacts: being judged socially inferior has negative effects on physical and mental health, even for those illnesses with a genetic component. We need to promote a social model of care rather the narrow medical model which is particularly unsuited to mental health and addiction services.

The SHA supports implementation of the Five Year Forward View for Mental Health, including parity of funding for prevention and treatment, research into treatments and alternatives to medication, with funding for related social care. We support the Manifesto’s ring fenced mental health budget.

We also recommend:

  1. A National Service Framework for Mental Health provision, with an emphasis on talking therapies and advocacy.

  2. Enhanced mental health services for children and young people, including school-based prevention with more school nurses and health visitors, ready access to CAMHS and better and more inpatient provision.

  3. A strategy for reduction of excess mortality rates for people with serious mental illness including suicide prevention strategies, with improved provision for acute MH emergencies including supporting friends and families. 

  4. Reducing stigma with more information about mental illness,how to self help and early intervention.

Discussion document on Mental Health Policy

DEMOCRATIC, ACCOUNTABLE AND TRANSPARENT HEALTHCARE

The SHA recommends a commitment to responding not only to needs as defined by clinicians, but needs as defined by users, carers and citizens. We see the process as a meeting of experts: the NHS offers its clinical expertise, while the patient is an expert on their own strengths and the impact of ill-health.

Working with NHS users applies at a macro level (planning local and national NHS services in collaboration with citizens and users) and at an individual level in the consultation between patient and clinician with shared decision-making. The community can, with help, identify key issues that matter to them and work with the statutory sector to address those issues – this process protects health. Community development is one key mechanism.

We would like to see a totally independent patient- and public-led and adequately funded Community Health Council type system.

Discussion document on the Organisation Of Health And Care Services

BREXIT AND THE NHS AND CARE SERVICE

The NHS and social care are dependent on overseas labour. We would like to see recruitment and employment of staff from the EU and other countries allowed. We want Labour’s policy on Brexit to focus on the economy and free movement.

EU law includes measures to achieve equivalence of labour, health and safety standards in its trade agreements with countries such as Vietnam and Peru. The European Court of Justice has consistently emphasised a high level of human health in its judgements and it is notable that in its negotiating position on the Transatlantic Trade and Investment Partnership, the European Union was arguing for a judicial model of dispute resolution. There is a real danger that these protections will be lost through Brexit. Indeed, the main justification for many of those advocating Brexit is to remove these protections.

Discussion document on International Trade

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We call for protection of women’s rights:

  • Guaranteeing family friendly employment terms and conditions affecting morale, recruitment retention of women including Lesbian, Gay, Bisexual and Transgender people.
  • Fertility control In Vitro Fertilisation, contraception and abortion access: thus protecting women’s mental health, finances and family stability
  • Safe childbirth for every woman. Risk assessment for home births (evidence of deaths increasing)
  • Reverse the outsourcing of maternity services.
  • Increased support for carers, to improve health and protect people from poverty.
  • Integrate the care system with the National Health Service to be free at the point of use, paid for by taxation.
  • Employ nurses in care homes and improve training and terms for care workers.

Equality:

We call for protection of women’s rights with respect to equality which addresses:

  • the long-term impact of domestic abuse, in the widest context, on health
  • the impact of gynaecological intervention that harms women internally e.g. mesh implants and externally e.g. Female Genital Mutilation.
  • the impact of caring on mothers of children who have specific and higher needs over their lifetime
  • the effect on women refugees and European Union migrants of the new United Kingdom Comprehensive Sickness Insurance regulations involving healthcare charging
  • the quality of and accessibility to women’s mental health services, including primary post-partum treatments.

This is to be presented to the Labour Party Women’s Conference 2017

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This is a draft programme drawn up by the SHA. It remains under development and does not yet represent our final set of recommendations. However, it follows much work and consultation and we see this as a conversation with our members, the party and the public. We want and expect that such discussions will change aspects of this document and we welcome that debate. We shall be holding a workshop on Public Health which will feed in to this work.

We want to present conference with a challenging set of practical and theoretical ideas. They are summarised here, but there is further detail on our website.

Please respond by commenting below  or contact us directly at Conference:

Alex Scott-Samuel;  Brian Fisher;  Jean Hardiman Smith;  SHA Admin

INTRODUCTION

The SHA is committed to NHS care, free at the point of use and funded out of general taxation, provided by public bodies. We challenge austerity which we agree is a political choice not an economic necessity.

We recognise that the devolved nations make their own policies. These draft policies apply mainly to England.

This summary is divided into the following sections:

A NATIONAL HEALTH AND CARE SERVICE (NHCS)

Bringing together our separate health and social care systems to become one unified care system driven by the political values and professional / organisational principles that underpin the NHS. This can be achieved by a gradual, non-disruptive process.

The political values needed are:

  • a system with national standards;
  • funded from progressive taxation;
  • delivered by locally accountable bodies that rely on committed staff many of whom have professional training and professionally established responsibilities;
  • evidence based; relies on the notion of “co-production” between service users and professional staff – people playing an active role in their care and professionals welcoming, respecting and responding to that role.

We call on Labour to fund the NHCS to enable a comprehensive service, reaching the upper quartile of EU average spend.

More details can be found here

AN END TO PRIVATISATION

We call on Labour to restore the duty of the Secretary of State to deliver a comprehensive, universal, publicly provided and managed NHS, meeting clinical need, free at the point of use and funded out of general taxation, provided by public bodies. This needs to be achieved with as little disruption as possible. The NHS Bill 2016-17 provides a model for legislation in the first weeks of a Labour Government. Legislation should include the relief of NHS bodies from PFI debt.

This has implications for what is currently called commissioning.

Commissioning outside the market is called planning, based on needs and assets assessment. Wales and Scotland offer excellent examples. Commissioning/planning must be separate from provision and free of any form of conflict of interest or undue influence. Planning functions must be democratically accountable and cannot be given to the private sector under any circumstances.

It also has implications for Trust status:

The NHS will no longer regard Foundation Trusts as free-standing competitive corporations. Foundation Trusts will be reintegrated into the NHS family.

New Models of Care

The NHS England Accountable Care System creates 44+ local health services to replace England’s NHS, bypassing Parliamentary debate. Accountable Care Systems will provide limited services on restricted budgets, worsening health indicators like the long term increase in life expectancy, stalled since 2010. These New Models of Care and the government’s NHS asset sell-off result directly from the 5 Year Forward View currently being implemented via ‘Sustainability and Transformation Partnerships’.  

SHA supports the commitment to restore our NHS by reversing privatisation and halting Sustainability and Transformation Partnerships. We therefore call on the Party to reject the 5 Year Forward Viewin its totality. This demands more than amending the 2012 Health & Social Care Act; we must restore our fully-funded, comprehensive, universal, publicly-provided and owned NHS without user charges, as per the NHS Bill (2016-17).

More details can be found here.

ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH

Addressing the social determinants of health is the foundation for health and wellbeing. Access to clean water and safe waste disposal; social and affordable housing which provides enough space, affordable and efficient heating; clean air, indoors and outdoors; good education to achieve universal literacy and numeracy; jobs that protect health and ensure adequate income; and an environment which promotes healthy transport, green spaces and public amenities should all become elements in a holistic approach to public health. We support the child poverty abolition target for 2020.

This has implications for the public health service:

  • Chief Medical Officers and District Directors of Public Health need to be professionally independent, reporting annually on the health and health inequalities of their populations and their recommendations on priorities.
  • Communities and our relationships with them and between them and the statutory sector are key to health protection and resilience. The SHA is committed to creating the conditions whereby communities can increasingly share decisions with the statutory sector, thereby increasing confidence and health.

More detail can be found here

SOCIAL CARE AND INDEPENDENCE

Savage cuts have resulted in about 40% fewer people receiving social care now than in 2009, with severe cuts in other local support services. The human rights of disabled and older people have been ignored. The current system is out-of-date in its assumptions about what disabled and older people want and need and tends to reinforce negative images. Instead of respecting people as contributing citizens and family members, the system has adopted a wasteful consumerist ideology. Too often, in an over-pressurised service, patients and service users are not being treated with sufficient respect and dignity. This should include an end to the 15 minute social care packages.

We call for a new kind of social care, not more of the same.

The key principles for any future system of long term care must include:

  1. Universal coverage – The need for long-term care is part of the normal public sector services and should be treated just as health and education.
  1. Maximum risk-pooling – The most efficient way of insuring ourselves against the costs of impairment or frailty is to all pool resources in order to cover that risk, as with the NHS.
  2. Equity – The system should be equitable and should not discriminate against people because of condition, age or geography.
  3. Entitlement – All citizens should benefit from the system and should not be disadvantaged by income or ability to pay. The system should be funded from general taxation and be free at the point of use, as with the NHS.
  4. Control – All citizens should be able to get the right flexible support to meet their needs, to be able take the level of control that is right for them and their families.

The three key elements of the proposal are:

  1. Fund a universal system and end means-testing – Social care on the same footing as healthcare, funded from general taxation, with resources distributed on the basis of need.
  2. Invest in citizenship and community – Social care must offer support that people and families can shape to their circumstances, and that helps people contribute as citizens and strengthens family and community life.
  3. End privatisation and the complexity of the current system – Social care must be integrated into one national system that invests resources locally and ends the wasteful procurement systems that currently undermine human rights.

These principles are in line with current developments across OECD countries. More detail can be found here.

PRIMARY AND COMMUNITY CARE

The SHA is concerned that general practice under the Tories may go the way of dentistry and optometry. The SHA wants to eliminate the private sector except in exceptional and transient circumstances.

The SHA does not support GPs being responsible for planning although they must be centrally involved, alongside other key stakeholders.

The SHA wants to see improved access to primary care, with continuing personal care. This will require more clinicians and more and better use of IT. We sympathise with GPs’ frustration and agree that the government’s proposals for primary care are too little too late. We need a comprehensive new set of arrangements to support, incentivise and energise primary care.

Independent Contractor status:

There are advantages and disadvantages to the independent contractor status. The SHA recommends a trial of a mixed economy, where in some areas primary care is salaried and in others as it is now, evaluating comparative benefits and risks.

Planning Primary Care

Primary care must be planned and managed rather than just administered which is the present predominant model. We recommend primary care workforce planning and joint multi-disciplinary training.

Integration

We should have a large-scale trial with a fully integrated provider which covers delivery of all primary, secondary, mental health and social care free at the point of use, for a single County or City.

We also recommend Investment in treatment and prevention of mental health problems in children and young people, a long-term plan for health promotion, community-based home care treatment and prevention. More District Nurses and Health Visitors, better paid and supported are essential, with Informal carers to be fully supported. We support an increase for all carers’ benefits.

The Myth Of The Demographic Time-Bomb

The SHA rejects the concept that an ageing population results in unacceptably high costs. We are proud to have an increasing number of older people whom we value. Older people have falling mortality, less morbidity, and are more economically active than before. Some forms of disability are postponed to later years. Increased life expectancy means more years lived in good health.

Older people contribute almost £40 billion more to the UK economy annually than they receive in state pensions, welfare and health services. It is not age but nearness to death that accounts for health expenditure. Most acute medical care costs occur in the final months of life, the age at which these occur having little effect. According to this hypothesis health expenditure on older age groups is high because a larger percentage of people in those age cohorts die within a short period of time.

More detail can be found here 

MENTAL HEALTH

Mental Health (MH) services are “overwhelmed” (NHS Providers July 2017, ref 1), with demand increasing by 5-10% over the last 3-4 years, and by 30-40% for children and young people, with delays accessing MH care, often with inadequate treatment, partly because of worsening shortages of MH staff.

The SHA recognises that societal factors impact on mental wellbeing and illness. These include social deprivation, debt, poor accommodation and security of tenure, community and family support networks. Socio-economic inequalities have independent impacts: being judged socially inferior has negative effects on physical and mental health, even for those illnesses with a genetic component.

We need to promote a social model of care rather the narrow medical model which is particularly unsuited to mental health and addiction services.

The SHA supports implementation of the ‘Five Year Forward View for Mental Health’ (Feb 2017), including parity of funding for prevention and treatment, research into treatments and alternatives to medication, with funding for related social care. We support the Manifesto’s ring fenced mental health budget.

We also recommend:

  1. A National Service Framework for Mental Health provision, with an emphasis on talking therapies and advocacy.
  2. Enhanced MH services for children and young people, including school-based prevention with more school nurses and health visitors, ready access to CAMHS and better and more inpatient provision.
  3. A strategy for reduction of excess mortality rates for people with serious mental illness including suicide prevention strategies, with improved provision for acute MH emergencies including supporting friends and families. 
  4. Reducing stigma with more information about mental illness / how to self help / early intervention.

More detail can be found here 

DEMOCRATIC, ACCOUNTABLE AND TRANSPARENT HEALTHCARE

The SHA recommends a commitment to responding not only to needs as defined by clinicians, but needs as defined by users, carers and citizens. We see the process as a meeting of experts: the NHS offers its clinical expertise, while the patient is an expert on their own strengths and the impact of ill-health.

Working with NHS users applies at a macro level (planning local and national NHS services in collaboration with citizens and users) and at an individual level in the consultation between patient and clinician with shared decision-making.

The community can, with help, identify key issues that matter to them and work with the statutory sector to address those issues – this process protects health. Community development is one key mechanism.

Ensure a totally independent patient and public led and adequately funded Community Health Council type system.

More detail can be found here 

BREXIT AND THE NHS AND CARE SERVICE

The NHS and social care are dependent on overseas labour. We would like to see recruitment and employment of staff from the EU and other countries allowed. We want Labour’s policy on Brexit to focus on the economy and free movement.

EU law includes measures to achieve equivalence of labour, health and safety standards in its trade agreements with countries such as Vietnam and Peru. The European Court of Justice has consistently emphasised a high level of human health in its judgements and it is notable that in its negotiating position on the Transatlantic Trade and Investment Partnership, the European Union was arguing for a judicial model of dispute resolution. There is a real danger that these protections will be lost through Brexit. Indeed, the main justification for many of those advocating Brexit is to remove these protections.

More detail can be found here

Acknowledgements

Thanks to all members of the SHA Policy Commission and many other members of the SHA who have worked so hard to put this document together. We look forward to continued discussion and change.

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This is a discussion document not agreed policy.

All NHS bodies must be under clear obligations and duties:

  • To work to reduce inequality
  • To cooperate with other public bodies
  • To promote shared decision making and community development
  • To be open and transparent and to involve public and patients in all major decisions and plans.
  • Mergers and other organisational changes should be subject only to local agreement.
  • NHS bodies should have boards of directors with a majority of NEDs and governing bodies set up to reflect a balance between patients, public, staff and other local stakeholders.
  • The procurement and contract management of major assets should be the responsibility of the Secretary of State with NHS Bodies subject to an appropriate reasonable internal charge for use.
  • We require national standards, national service frameworks, national outcomes frameworks and inspection and regulation on a national basis; and national terms and conditions to allow staff to move easily within the NHS. We already have national systems for collection of data and an obligation on all providers to supply that information.

Accountability and Transparency

  • The SHA supports patient choice and greater involvement by patients in their own treatment. This is not choice as a market mechanism and there may be some limits in the interest of overall efficiency predicated on patients / citizens / public responsibility.
  • Co-production is the process of working with NHS users. This applies at a macro level, planning local and national NHS services in collaboration with citizens and users; it also applies at an individual level in the consultation between patient and clinician where shared decision-making takes place. Care must be delivered with as much participation in shared decision-making as the patient wishes at the time.
  • The NHS must commit, therefore, to both listening AND RESPONDING to citizens and using adequate mechanisms for this.
  • We therefore commit to responding not only to needs as defined by clinicians, but needs as defined by users and citizens. We see the process as a meeting of experts – the NHS offers its clinical expertise. The patient is an expert on their own strengths – and the impact of ill-health on them. The community can, with help, identify key issues that matter to them and work with the statutory sector to address those issues – evidence shows that this process protects health.
  • Ensure an independent and adequately funded Healthwatch and comparable bodies in Wales, Scotland and NI.
  • Community development and community development workers will be supported and funded to increase communities’ input into planning and to increase the responsiveness of NHS organisations.
  • Such a systematic approach at individual and collective levels will require the development of processes such as:
    • Decision Aids
    • Full Record Access to primary, secondary and social care
    • Group appointments
    • Rapid feedback of users’ views to health and care organisations
    • Community development
    • Patient and community views of responsiveness and experience of services should become routine outcome measures for NHS performance
    • NHS organisations must demonstrate the changes in planning that they have made in response to individual and community recommendations
  • There will be appropriate training and workforce delivery to ensure effective individual and community participation
  • There will be an NHS-wide volunteering policy with appropriate support and payment.
  • Values important to patients like dignity and respect should be demonstrated in every service provided.  This should be informed by widely available and meaningful information about the performance of and outcomes from health care services, local and national.

APPENDIX

The current NHS has three “domains” that have to work together. These are the political domain, the professional domain and the managerial domain. Some writers on management in the public services claim that these three domains are necessarily in a state of conflict with – at any one time – two domains aligned against the third. The political process decides which two challenge the third and on what.

The political domain mediates, through the political process, what the NHS is to deliver (and what is isn’t). It is expected to exercise political oversight of how it performs – both at the national levels (England Scotland and Wales) and at the local level through the Board / Trust machinery acting on behalf of the Minister (or the head of the NHS in England). The political domain is largely driven by a 4-5 year cycle linked to the electoral calendars in the three countries. Devolution has complicated the frequency of elections and hence shortened the time horizons available to politicians in devolved systems. Politicians justify their legitimacy by reference to their mandate. Their aim is usually to deliver what they believe they can persuade enough of the electorate ( sometimes their share of the electorate) to accept. This means they operate to a political rationality.

The professional domain – doctors nurses etc – claim their legitimacy from “their” patients, whose interests they seek to represent. The professional domain can be divided between the different professions and often within professions (e.g. GPs v Consultants, surgeons v physicians). Their time horizon is much longer as often they seek engagement over decades if they are pursuing a career. Their rationality is based on science and experience – that is, they claim to know what “works” – and this is a different approach to that of the politician. The professions guard their professional rights closely in maintaining standards of, and controlling entry to, the profession.

The managerial domain seeks to find a unifying set of aims around which their discrete organisation can gather – using such techniques of short and medium term plans, change management and quality improvement, etc. Often the managerial domain will relate to the public by simply seeking to keep services running in the hope that it will deliver the best it can for the most it can. It’s rationality is the wider public service.

(You will note that the three domains each see “the public” in different ways and there is little agreement as to how the three domains different views of “the public” may be reconciled. Indeed, part of the analysis underpinning domain theory assumes that each domain will seek to get “the public” on its side – e.g as in the junior doctors dispute). How “the public” itself fits into the domains isn’t clear.

Managing the NHS and the wider care system – politically, managerially, and professionally – has been recognised as the most demanding of tasks. The NHS does not conform to the usual management approaches that apply in “normal” businesses – in part because its ownership and the values that drive it are unlike any other, and in part because demand seems infinite and resources are limited. Our political processes have found it difficult to match investment in the NHS with what that process can make available. Evidence of “what works” is frequently contested and good practice is still not regularly and readily imbedded across the organisation.

SHA believes that the political domain has to set out more clearly what it expects the NHS to deliver in terms of volumes and range of services. Moreover, it must make explicit what the service is not able to do. The political choices – once made – have to be defended through the political process, and the expected service levels have to be matched by human and financial resources agreed by the wider service as necessary to deliver the services promised. The political domain must not set targets unilaterally or offer resource levels that are incompatible with wished for outputs / outcomes

Professional domains must update professional standards as new services and care methods become available. They must increase their efforts – jointly – to spread best practice and support professionals who need further training or other help. SHA believes that the professions should play a full part in overseeing the delivery of care, ensuring (again jointly) that poor practice is recognised and steps taken on professional levels to rectify matters. Each profession has a duty to advise managers, politicians and the public on the resources needed to deliver safe services – especially for new and emerging therapies. Such advice should be soundly based and will be open to challenge by competent others.

The managerial domain in the NHS should operate to the highest Nolan standards. It should be placed on a professional basis, with a code of conduct that offers protection to its members should they be instructed to manage the service in an unsafe way. It should have a duty of co-operation placed upon it insofar as working with other managers operating in the public sector is concerned. Recognised management posts, such as Chief Executives, Directors of Nursing, and equivalent posts, should have a legal duty to report to Boards (in public) any concerns that they have about service demands and resources. Such reports should be privileged – i.e. their content shall not give rise to legal action by either their employee or any private party mentioned in such a report. The managerial profession should renew the competence of staff in senior grades on a four-yearly basis.

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This is a draft policy not yet agreed.

Addressing the social determinants of health is an important foundation for the health and wellbeing of our citizens. The fundamentals of life such as access to clean water and safe waste disposal; housing which provides enough space, clean air and efficient heating; education to achieve universal literacy and numeracy; jobs that protect health and ensure adequate income; and an environment which promotes healthy transport, green spaces and public amenities should all be assessed and developed as a holistic approach to public health.

Local and national democratically accountable governments need to hold these strategic responsibilities and be supported by public health officers at Chief Medical Officer level in national governments and District Directors of Public Health at local government level. These officials need to be professionally independent chief officers and be required to report annually on the health of their populations with reference to other populations and assessing health inequalities and their recommendations on priorities.

Communities and our relationships with them and between them and the statutory sector are key to health protection and resilience. The SHA is committed to creating the conditions whereby communities can increasingly share decisions with the statutory sector, thereby increasing confidence and health.

  • The nation’s Chief Medical Officers (CMOs) will be required to report annually on the health of their populations to their governments. The UK CMOs will be required to submit an annual report directly to Parliament charting progress in UK comparative performance in terms of population health, health inputs, care processes and patient outcomes (both patient and clinician reported). Such a report will need to consider the UK health outcomes in an international context.
  • Directors of Public Health within local authorities should be adequately resourced executive directors able to make recommendations which must be integral to decision-making by the council’s chief officers.
  • Social care and other local authority provision and relevant services and proposed developments should be included in public health plans.
  • All local authority policies and plans should be subject to an environmental and health impact assessment.
  • All policies in government will be subject to an assessment of their impact on the public’s health.
  • Strategies and plans for wellbeing should be agreed at local, sub-regional and regional level and should be used to guide decisions about service provision, major investments and reconfigurations.
  • Infectious diseases require attention to high uptakes of vaccination and immunisation and the promotion of hand hygiene and the reduction in the use of antibiotics to help prevent the growth in antimicrobial resistance.
  • The public health remit must include promoting health, protecting health as well as effective (evidence based) health and social care. All these three domains of practice require robust systems of appraisal of evidence, systematically collated knowledge and information.

ENVIRONMENT/CLIMATE CHANGE

  • The NHS must maximise environmental sustainability and engage with the strategy that protects and improves health within environmental and social resources now and for future generations.
  • Such sustainability strategies mean reducing carbon emissions, minimizing waste and pollution, building resilience to climate change and nurturing community strengths. See separate section on sustainability and planetary public health (in preparation with David Pencheon of the NHS Sustainability Unit).

AIR QUALITY

  • We will take urgent steps to reduce the air pollution caused by road traffic, particularly by diesel engines.
  • We will reconsider strengthening the regulation of vehicles, taxation of vehicles and motor fuel in the light of the evidence of damage to health caused by particulates.
  • All this in the context of decreasing coal fired electricity generation and proportionately increasing the use of renewables.

FOOD AND DRINK

  • We will remove the VAT exemption from sugar and raise tax on the simple sugar content of drinks and foods such as breakfast cereals. 
  • We will ensure that the quantity of sugar, salt and fat in manufactured food is easily apparent to customers by standardised information in the form of WHO recommended traffic lights and standard information wherever it is sold.
  • We will ban the use of trans fats in food products and push for the ban to be extended internationally.
  • We will introduce minimum unit pricing for alcohol and encourage lower alcohol products.  We will reduce the hours during which supermarkets are permitted to sell alcohol and make it more difficult to buy dangerous quantities of alcohol.
  • The sale of tobacco and alcohol in supermarkets should be regulated so separate areas are identified to display and pay ensuring better supervision and differentiating alcohol and tobacco from a normal family shopping basket.
  • Tax should be proportionate to alcohol strength

HOUSING

  • We will introduce minimum standards for healthy housing construction to ensure sustainable housing quality and reduce the risk of adverse impacts such as fuel poverty through inefficient heating/insulation.
  • Internal ventilation is also required to reduce the risk of house dust, fumes to ensure clean air.
  • Housing should be located near green spaces and close to play ground amenities for children.

WORKFORCE

  • In conjunction with a strengthened Health and Safety Commission, we will introduce measures to ensure that workers feel more in control of their own work. Workers and their trade unions should be represented on company boards?
  • Occupational health will become a responsibility of the NHS to provide a national service with local generalist and more specialist regional resources.
  • A healthy workplace must be the expectation and employers be held to account on best practice and minimum standards in line with health (both physical and mental) and safety legislation.

DRUGS AND TOBACCO

  • The taxation system will make healthier products like fresh fruit and vegetables more affordable while making less healthy processed food products better regulated and relatively more expensive.
  • We will progressively raise tobacco tax and the age below which it is unlawful to supply tobacco to young people.
  • Personal, social and health education (PSHE) will be compulsory in schools appropriate to the age of the child and directed to inform and empower children to look after themselves. 
  • We will bring forward proposals to reform the law on misuse of drugs to minimise risk which will include alcohol, tobacco and other drugs.

TRANSPORT/ SPORT.

  • The Active Travel (Wales) Act 2013 will be extended to England so every local authority will be required to publish details of expenditure on transport measures divided between walking, cycling, public transport and motor vehicles.  
  • We will rebalance the transport budget so that 10% is spent consistently over the length of the parliament on the needs of pedestrians and cyclists
  • We will remove VAT from bicycles and encourage cycle to work and other workplace incentives.
  • We will progressively ensure access for all to affordable public transport
  • Physical activity should be encouraged in schools with whole school activities, travel to school schemes as well as specialist sports teaching.
  • All local authorities must introduce 20mph speed limits on all residential roads so this speed becomes the urban road norm.
  • Transport policies need to be strengthened so that city centres are largely free of private cars with access ensured by efficient public transport, cycle and pedestrian access.
  • Overall transport policies should be biased towards walking and cycling, bus and trains and vehicles that are increasingly electric or other low carbon fuels.
  • We recommend that transport policy should accept a hierarchy of walking >cycling >public transport, to include good provisions for disabled people
  • Air transport needs to be increasingly regulated and air fuel tax applied. We must actively encourage more use of continental trains as an alternative to short haul flights.

CHILDREN

  • We will ensure children have received high quality PSHE through their school years so they are aware of gender and sexual and interpersonal relationships, understand the distortions of on line pornography and be empowered to say no.
  • We will ensure contraception and sexual health clinics are easily accessible to reduce the risk of sexually transmitted diseases and unwanted pregnancy
  • More investment in the training and employment of midwives and Health Visitorss to ensure that sufficient support from midwives and health visitors is available for women and babies, especially solo parents and young mothers,
  • We will increase benefit rates for pregnant women so that they can afford a healthy diet and suitable accommodation.
  • Every school must have a named school nurse and a school counsellor, for which more funding will be required
  • Children’s mental health services need to be improved and made adequate for the speedy identification and treatment of mental disorders in children in the least stigmatising way.
  • We will ensure that there is parity of treatment in health and social care services in respect of both youth and age. 
  • Services must be improved in transition from child to teenager and teenager to adult

HEALTH INEQUALITIES

  • Improving health requires addressing the social determinants of poor health based on the principle that there is a role for an interventionist state, for redistribution of wealth and power, and a role not just in planning and commissioning but in delivery. 
  • Labour’s long-term goal is to break the link between a person’s social class, their social situation and their health. We will work across government, using the power and influence of all government departments and agencies, to achieve this.
  • We recognize the importance of the early years (pregnancy and first 5 years of life) and there should be workplace benefits to enable generous maternity and paternity leave, state nursery provision and safeguarding along the lines of Scandinavian countries.
  • The establishment of an Office of Health Equity to promote and monitor the application of the Fair Society, Healthy Lives policies of giving every child the best start in life; enable all children, young people and adults to maximize their capabilities and have control over their lives; create fair employment and good work for all; ensure a healthy standard of living for all; create and develop healthy and sustainable places and communities and strengthen the role and impact of ill health prevention.
  • Health impact assessment of all government policy will be used to reduce inequalities in income and wealth and those caused by trade, foreign and defense policy

THE IMPORTANCE OF COMMUNITIES

  • NHS agencies and providers will ensure that every locality has a thriving third sector largely funded by grants rather than contracts.
  • NHS organisations will be expected to take an active part in neighbourhood partnerships and to encourage users and carers groups to do so.
  • Health agencies will play an active part in deploying community development to improve health protection through community empowerment, help tackle health inequalities and encourage responsive statutory agencies.
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