Public Services – Big Policies

Labour Party

Within the SHA we lobby for health policies within the Labour Party.  We think there are some big ideas already and would like to see the broad themes applied in other policy areas.

The overriding theme is that we have come to the end of the era of markets, competition and the dominance of new public management with its pandering to the supremacy of the private realm.

We emphasise that quality public services are vital for social justice and redistribution. We want policies which recognise the value of public services not as the safety net for the feckless but as a vibrant and necessary part of our social fabric; contributing to economic progress not a constraint on it.

We are clear that decisions about priorities and resource allocation in our public services must be made be those we elect; not arrived at by the invisible hand of market forces or by some opaque formula constructed behind closed doors.

We want public services where policy making and delivery favour integration; breaking down the silos.  We want healthcare in the family of public service not left as some isolated disconnected island.  We want whole person care so that social, mental and physical health delivery comes together.

We want integration of services but not top down system redisorganisations.  In health integration could develop in different ways in different localities and at different pace – so long as national entitlements are preserved and the direction of travel is consistent with the overall policy.

We must stop the rhetoric of public bad – private good, which led to quangos delivering public services and behaving like private businesses (but using public money).  We need to think again about Housing Associations, Foundation Trusts, Arms Length Management Organisations, Academies and Free Schools. In health we need to restore the ultimate intervention power over all bodies.

We have to move away from constant denigration of public servants.  In health we have seen a tide of attacks first of bureaucrats and managers then on the whole system of care – demeaning all.

We have to have a more realistic view about choice. In health choice should be about being better informed about what is available and involved in decisions; it is not about choosing between competing providers allegedly all offering more or less the same. Our healthcare is not a commodity within a market and choice about our own health is not the same as shopping.

We have to restore faith in politicians.  If we believe in democracy then we need to have representatives we respect and trust.  In health the Secretary of State must be politically and legally responsible for a universal and comprehensive service.

And restore faith in local politicians, our Councillors.  We cannot let the few who are corrupt or inept distort what representative democracy is based on.   In health we propose transferring strategic commissioning into local authorities who can plan for public service delivery as a whole.

We must harness the new powers offered by IT and social media.  Openness, transparency and ease of access to information should be fundamental to public services – no matter who delivers them.  In health that means removing any exemptions from FoI and ending the idea of commercial confidentiality.  We must improve and validate the information about what is available from our NHS and give access to our own health information – so we can be informed in making our choices.

We need more faith in ourselves and in our communities.  We must embrace the ideas around shared decision making, supporting those who may find this hard.  And we develop our communities; the payback is worth the investment. In health this means asking the clinical professionals and the commissioners to develop and embed this approach.

We should view public services as ours and so have the right to a say in how they are delivered.  In health we have a form of stakeholder involvement in delivery in FTs but far more has to be done to make  accountability work, and to think through governance of national providers. We also have to have better processes for decisions about reconfiguration of services to avoid instant hostility to any changes.

We have to accept we live in a market economy but reject a market society.  There will be opportunities for public services to be provided by non public bodies but they must be properly accountable.  In health there is acceptance that there can be circumstances where the NHS is unable to provide the services required (to the level of necessary quality) and also areas where the voluntary sector can offer more.

And all of this is possible, we should not adopt the defeatist argument that we have already lost and that trade agreements or conspiring multinationals or European rules on competition and procurement will make change impossible.  We don’t need a revolution we just need the political will and the support of the public.