Resolutions on health:

NEC STATEMENT – rejected

The starting point for all that we want to achieve in improving health is our belief in a publicly funded National Health Service, free at the point of need with equal access for all, irrespective of their wealth, the fairest system of health care in the world.

It is a Labour government that is today rebuilding and renewing the health service, it is vital that we succeed in this process of renewal and that we do it in a way that remains true to Labour values. If we fail the alternative is no reform at all. It is reform according to the values of our political opponents – with little regard to the value of equal access to health care free at the point of need.

Our Manifesto in 2005 that the electorate gave us our mandate on, just 18 months ago, was clear.

“One principle underpins our reforms – putting patients centre stage. And extending patient power and choice is crucial to achieving this. To achieve our goals we need to expand and develop different types of provision. Expansion in NHS capacity will come both from within the National Health Service where we will develop the NHS Foundation Trust model and the new freedom for GPs to expand provision – as well as from the independent and voluntary sector, where specialist services are available at NHS standards to meet NHS need. Whenever patients need new capacity for their health care, we will ensure that it is provided from whatever source. ”

As the British people recognised when they endorsed this policy, this is a policy of expanding the NHS by treating more people in better ways, all free at the point of need. As the Prime Minister has said, we accept that there are limits to the role of the market in the NHS.

The NEC notes workforce concerns over the outsourcing of NHS Logistics and welcomes the reassurances given by ministers that legally binding clauses in the contract guarantee: Agenda for Change pay rates for current staff; comparable terms and conditions to current staff for new staff; the provision of a pension that is at least comparable to their NHS or civil service pension scheme; and collective bargaining and union recognition rights for transferring and newly recruited staff.

To ensure that Manifesto policy is fully implemented, Ministers should discuss its execution with the health policy commission. Conference has agreed that the commission is the place where problems of the operation of Manifesto policy needs to be discussed. The NPF consultation document ‘Securing Britain’s Future’ asks ‘What are the different criteria that we should use to establish the extent and balance of diverse providers in order to achieve the best care for NHS patients?’ – we recommend the Health Policy Commission consider this as a matter of priority.

More needs to be done to work with staff on the issues that reform, including a diversity of suppliers, payment by results and achieving financial balance, raises with them, particularly in employment issues – including the transfer of staff to different employers. We need to pay much greater attention to staff concerns about the way in which our manifesto policy is being implemented.

We call on the Health Policy Commission to take evidence and consider in depth and these issues and the impact of Payment by Results on local health economies.

We further call on the Department of Health to set up a stakeholder forum to discuss speedy progress in tackling these issues.

We welcome the new emphasis on prevention and the shift in resources to primary care and recognize the need to give more power to PCTs to commission new services.

The NEC recognises that there are serious financial problems being faced in some parts of the NHS and that Strategic Health Authorities have flexibility to offer more time to Trusts and PCTs to achieve financial balance to ensure damaging cuts are not made, but also recognises the need to be fair to other parts of the NHS.

In carrying out this manifesto our NHS is succeeding in empowering patients. We need to ensure that we empower NHS staff.

More needs to be done to support staff who are affected by redundancies caused by remodelling services, as well as newly qualified staff who are finding it difficult to get a job. The NEC recognises the Department of Health is already discussing with staff and their representatives how these issues are tackled and urges the Government to make this a priority. The Department of Health Stakeholder Forum should discuss ways of minimising redundancies, offering staff affected priority access to vacancies in other NHS organisations or retraining where appropriate, for example in supporting staff to move into the community.

Looking at the way in which the Party’s NHS policy is being developed up to the Manifesto for the next General election we need new initiatives to involve more people in our Health policy commission. Our policy making must be much more inclusive. The NHS matters to the British people. Many more of them should be involved with us in making policy for our fourth term.

The NEC further calls on the Government to ensure that structures for patient and public involvement, and Oversight and Scrutiny Committees in local government, work effectively and that the public have a genuine say over commissioning and configuration decisions.

The National Policy Forum should urgently develop ways of widening participation in policy making for the next Labour Manifesto.

Composite 7 – remitted

Conference believes that Labour has transformed the NHS. Conference notes that with Labour investment in the NHS has trebled since 1997 and staff are now working in modern buildings with decent pay.

Conference believes Labour’s approach to the NHS should always be guided by what is best for patients. Conference notes the statement in our manifesto in 2005 to this effect: “One principle underpins our reforms – putting patients centre stage. And extending patient power and choice is crucial to achieving this”.

Conference notes that NHS Trusts across the country have been reporting job cuts.

Across the country, NHS staff and patients are finding themselves facing cuts in valued local services and staffing levels as some local Trusts struggle to balance their books.

This conference reaffirms its commitment to the founding principles and values of the NHS and our commitment to a universal, tax-funded service, with equal access for all, free at the point of need/use and provided according to clinical need and not the ability to pay.

Conference notes the project board set up to review hospital services across north London.

In the past local deficits have been concealed as funding from poorer areas was utilised to bail out wealthier areas.

Conference believes this is utterly unfair and undermines our efforts to reduce health inequalities.

Conference believes our investment in the NHS must be linked to reform as more money and centrally driven targets cannot change a massive organisation like the National Health Service. Conference welcomes the commitment in the White Paper Our Health, Our Care, Our Say to give patients real choice over where they access NHS treatments and services and a choice not just around planned operations and their GP, but also over maternity services, end of life care, cancer, mental health and long terms conditions.

Conference welcomes the new emphasis on prevention and the shift of resources to primary care.

Conference believes that primary care services are the most important service the NHS provides, they are the first point of contact for most NHS patients and should provide an easily accessible service which is targeted at the needs of the communities they serve. Conference believes that if we are to improve services for all patients, especially those in poorer communities where healthcare needs are higher and standards are too often lower, we need to give more power to Primary Care Trusts to commission new services where services are currently of a poor standard.

Conference notes the announcement by the Department of Health on 5 September to outsource NHS logistics to DHL. Conference notes the estimated £1 billion savings that will be made through this move, but believes savings should not be made at the expense of staff terms and conditions.

Conference welcomes the commitment given by the government that staff terms and conditions will not be affected by this move and that staff will be guaranteed comparable pension entitlements. Conference believes that this defence of staff rights is a direct result of the Two Tier agreements reached between unions and the government.

Conference calls for:

  • The Labour Party to have a full debate around the extent and balance of diverse providers in the NHS.
  • The Health Policy Commission to lead this debate within the party, involving all party stakeholders.
  • The Health Policy Commission to invite the leaders of the TUC campaign ‘NHS together’ to give evidence
  • The Health Policy Commission to present evidence from these meetings to the next meeting of the National Policy Forum.

Conference notes the annual report of the Chief Medical Officer in July 2006 which challenged doctors and managers to put an end to unacceptable variations in healthcare provision across the country. The annual report on the state of public health showed that there are still wide ranging variations in healthcare across the country which goes against the founding principles of the National Health Service since its creation in 1948.

Conference believes that in order to defend the founding principles of the NHS – that healthcare should be free at the point of use and universally available to all regardless of wealth – then reform is necessary to ensure that everyone receives a world-class service not just the wealthy few. Conference believes Labour’s health reforms will improve standards for patients and ensure NHS meets its founding principles and provides services equitably and according to clinical need.

Tamworth CLP Waveney CLP

Composite 8 – carried

Conference notes with concern the Government’s announcement on September 5th that NHS Logistics, an award winning service, will be outsourced to DHL and its Texas-based partner Novation and the ballot decision on 11th September of NHS Logistics staff to take industrial action against this step. NHSL has won numerous awards for efficiency and service excellence and its dedicated and committed staff wish to remain part of the NHS public service family.

Conference also notes the appeal court decision of 23rd August 2006 regarding the awarding of a contract for GP services in Cresswell and Langwith in Derbyshire by the North East Derbyshire PCT to United Health Group Ltd.

Despite the fact that investment in the NHS has increased substantially and will continue to increase under a Labour Government, immense damage is being done to some local services because of deficits and the breakneck speed of change. Private Finance Initiative projects, of which a fresh wave was announced on 18 August 2006, lock hospitals into long-term financial commitments and leave them unable to adapt to changing needs

Across the country, patients are finding themselves facing cuts in valued local services and in staffing levels as some local Trusts struggle to balance their books.

Clearly, where such cuts are being made, local services are suffering. Moreover, staff morale across the NHS is being damaged as they feel their views are not being listened to and there is growing public concern that the NHS is once again in crisis. The party needs to listen to the concerns of those communities.

Conference recognises the widespread and spontaneous reaction of local communities as they respond to news about their local NHS with protests and demonstrations. In Cornwall 400 Royal Cornwall Hospital staff have received redundancy “at risk” letters, and services at the Royal Cornwall Hospitals Trust’s two smaller hospitals are being curtailed (with possibilities of outright closure not excluded). A resolution of the South West Regional Labour Party for an independent review of the RCHT’s affairs, promoted by this CLP last March, when the Trust’s declared deficit stood at barely a quarter of its present level, has received no response from the Secretary of State.

Compulsory payments to independent treatment centres can impoverish local NHS facilities; in Oxfordshire, NHS trusts were forced to pay Netcare hundreds of thousands of pounds for cataract operations which were never carried out because local hospitals could already cope, driving them further into deficit. “Cinderella” services such as mental health are particularly hard hit, and though the south-east is considered affluent, there are pockets of deprivation and disadvantaged individuals who are suffering and who look to Labour for support.

Conference understands that the issues underlying some of these problems are complex, varied and often long-standing. But the major cause of the current crisis is a direct consequence of the move to a competitive, market-based system, the continued use of PFI and payment by results.

The paper issued by the Department of Health on July 13, “Health reform in England: Update and Commissioning Framework” defines the key drivers for improvement through commissioning to be “contracting, contestability and service redesign.” (para 2.4). This flatly contradicts Labour’s policy agreed at the end of the last round of Partnership in Power (Britain is Working, 2004, p117) which stated “Labour will develop an approach that builds on collaboration, not competition.”

The Health Select Committee report in July into independent sector treatment centres has demonstrated that the NHS is not benefiting from the involvement of the private sector and that cuts in hospital services may come about as a result. The recent decision to freeze the expansion of payment by results is welcome, but many areas already covered by the national tariff have seen their finances destabilised by the system.

It is the rapid move from collaboration to competition which is forcing individual accounting units within the system to have to achieve “financial balance” in unrealistic timescales. Moreover, this is being demanded at the same time as other substantial changes are being introduced, some very welcome such as the new emphasis on prevention and the shift of resources to primary care.

Conference believes that the sheer pace and weight of change is in itself causing damage, and that such major changes should be carefully trialled and evaluated before considered for wider application.

Conference therefore calls on the Government to rethink the headlong rush to a competitive system. There will inevitably be outcomes and consequences which the Government has not foreseen and will be unwelcome. There will also be serious political consequences for labour and could jeopardise our hopes for a fourth term.

Conference therefore calls for:

1. More time and flexibility be offered to Trusts and PCTs to achieve financial balance, to ensure that cuts are not made which damage local health provision and will incur wider costs later;

2. No further extension of payment by results until a full assessment of the consequences for the local health economy has been carried out;

3. The further outsourcing of services to the private sector, such as NHS Logistics, to be subject to review with full consultation throughout the Party and the NHS to consider the impact on trust budgets and the co-ordinated provision of services;

4. All NHS stakeholders, including patient groups and trade unions, to be fully consulted and included in policy discussions.

5. The Government to ensure that structures for patient and public involvement work effectively and that the public have a genuine say over commissioning and configuration decisions.

Furthermore, this conference reaffirms its commitment to the founding principles and values of the NHS and our commitment to a universal, tax-funded service, with equal access for all, free at the point of need/use and provided according to clinical need and not the ability to pay.

UNISON

Oxford West And Abingdon CLP

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