The time to hesitate is through

A joint Labour Party and Socialist Medical Association conference on Labour health policies was held on Saturday October 18th 1980 in Central Hall, Westminster, with nearly four hundred delegates attending from all over the country. The morning session was addressed by Stan Orme MP, opposition spokesman on health and social security, and Cyril Taylor, president of the SMA. In the afternoon delegates were split into four groups to discuss prevention, reorganisation and democracy in the NHS, NHS financing, and the personal social services. At the end of the session there was time for summaries of the small groups and a wider discussion. Cyril Taylor’s editorial on the front page continues some of the areas he touched on in his speech, while a summary of the day’s conclusions should be appearing in the next issue of Socialism and Health.

In order to see the ways in which a future Labour government might start to tackle the overwhelming problems of health and health care, Alison Hadley and Graham Bickler interviewed Stan Orme during the conference. The article beneath is a compilation of that interview and his opening speech — “Labour and the future of the National Health Service.”

We began by asking Mr Orme what he saw as the health priorities of a future Labour government. Against a backcloth of cuts in services, made by the Tory government he considered there to be three main areas in which Labour energies should be concentrated.

First, the commitment to restore a free health service, fully financed by taxation, and he hoped to see, “within the lifetime of that Labour government, the phasing out of all charges.”

Secondly Mr Orme was concerned with the allocation of resources. “The 2% growth rate which the previous government had endorsed and which is now being cut by this government is not sufficient and I would see as a minimum a 3% growth rate for the health service…..and we may find that 3% is not sufficient.”

The third priority was prevention, with the focus on firm action against smoking, legislation for seat belts, alcohol and its attendant problems and the availability of abortion and family planning on the NHS.

Although Mr Orme listed these as the three main areas for action he mentioned the need for attention to democracy in the health service, our expansion in occupational health and for stricter measures to be taken with the drug industry.

A concern which ran through many of these topics and one which was discussed by everyone during the conference, was the power of the medical profession and the difficulties in involving them in socialist health policies. Mr Orme talked about the “mystical vote of clinical judgment” as a source of reaction amongst doctors. Never the less he felt that many could be won over by providing good pay and working conditions and in particular he was in favour of a salaried service for GPs in inner city areas. However, it was suggested that many doctors would continue to resist, and would escape into the private sector thereby perpetuating private medicine. When asked how a Labour government intended to deal with the private health field, Mr Orme felt the priority was “to put a fence around it,” and to remove pay beds in their entirety from the NHS hospitals. The Labour movement must not be afraid of saying that it is “opposed to the principle of private medicine.”

In the area of prevention Mr Orme had made several comments in his morning speech about the need for stronger action to be taken with the tobacco industry. As these had not been fully outlined, we asked him how he would see a future Labour government implementing policies that would significantly affect the tobacco industry, given that the government is so economically reliant on it.  Did he think there would be something in the manifesto about this?

Mr Orme said he felt there should be something in the manifesto and said: “we have reached the stage now where we need legislation regarding advertising. . .I think sponsoring of sports has gone far too far.”

He mentioned that the loss of revenue if smoking demand was reduced is no reason for not implementing policies to discourage smoking. In addition to this he wanted much more comprehensive education particularly with young people, as he felt they were particularly vulnerable to the images of virility and adulthood portrayed by the media and in advertisements. This “built in advantage” the tobacco industry had, should be stopped.

Given that the hazards of smoking have been widely known for a long time and that the educational approach to the problem has always been the one used, we felt the issue was whether things were going to be any different under the next Labour government.

In reply, Mr Orme said “I think we need to take a much- more aggressive approach” and went on to emphasize the necessity of fully educating the public on the health hazards of smoking and other preventable diseases.  He felt that with proper explanations there would be a large measure of public support for action against smoking.

In response to the point that despite similar arguments when the Labour government was last in office no real change in the industry was made, Mr Orme agreed.

The Labour government had tried to come to a voluntary agreement with the tobacco industry, but he felt that now, “with the breathing space that we’ve got..we must see what methods we can come up with.”

We then asked Mr Orme that since the problem is an economic one, was the tobacco industry likely to be more amenable in the future and if so was it simply going to transfer its market to the third world?

Mr Orme agreed, but pointed out that some parts of the tobacco industry had already diversified and that he hoped by international rulings we could make progress. The time had come to move off the defensive, “I would like to see a section in the Labour manifesto on preventive medicine, spelling out some of these …. you can’t just resolve it by legislation, you’ve got to win the arguments.”

As we felt that the food industry is also important in its effects on health we asked Mr Orme to comment on the fact that despite the Health Education Councils’ views on nutrition successive government had done nothing to legislate in accordance with these proposals.

Mr Orme replied that this was partly a class problem which had been made worse by the destruction of the school meal service. What knowledge there is of “health foods” mainly affects the middle classes. When we suggested that legislation on pricing in the bread industry might be an important contribution to healthier eating habits, Mr Orme said he was in favour of legislation in this area but would like to see it linked to a wider area of prevention. The time to hesitate is through.

While many if not all the points discussed above are true, we felt some concern.

Although it is important to pursue aggressive policies on cuts, to be committed to a free national health service and to oppose private medicine, it is the causes of ill health we must attack.

Until the Labour Party can produce their policies for legislation on the tobacco industry, the food industry, housing, transport and conditions of  work to  name a few influential areas, we will not begin to change the social inequalities or health highlighted by the Black Report.