The SHA should take the approach taken by its predecessor, the Socialist Medical Association, when it led the fight to create the NHS. We need to re-establish an NHS publicly owned, publicly run and publicly accountable, funded through taxation with services provided according to need.
Of course, we recognise that there are areas of provision that are not fully publicly provided such as work carried out by opticians, pharmacists and dentists. Also, GP practices work in such a way that they have to make a profit. For example, as dental contracts have been tightened more dentists have moved to the private sector. With GPs, whilst we would wish them all to be salaried and expenses paid for buildings and staff etc, this is not feasible in the short term. However, we resist the creation of companies of GP practices designed for shareholder returns.
Our fundamental aim should be the removal of the purchaser/provider split which has been developed from the nineties increasingly up to the present time, most damagingly through the Health & Social Care Act in 2012, particularly by means of the Section 75 regulations in 2013. Removing the purchaser/provider split will enable better integration by managers and clinicians working together as planners and providers. The cost of the present system compared to the purchaser/provider arrangement is huge and has resulted in the NHS costing much more, caused by the costs of staffing as commissioners and finance employees as well as the costs of contracts. We should continue to resist the cuts and closures and privatisations now being implemented by the Coalition Government.
We have to recognise, however, that a Labour government, if elected, will not go that far. We want and expect them to repeal the Health & Social Care Act. In the process we need them to deal with PFIs by a combination of renegotiation and taking their cost centrally off the NHS books. We want all private contracts to be withdrawn as soon as possible.
In this process we need to recognise the dangers of the EU/US treaty, the Transatlantic Trade and Investment Partnership (TTIP), currently being negotiated under the radar. We want health and social services exempted from the treaty together with the removal of the disputes procedure – the ISDS – which gives powers to multinational corporations over individual governments and parliaments.
Payment By Results should be removed as it distorts activity by hospitals against the interest of patients. The ability of hospitals to provide 49% of their activity privately is unacceptable and should be removed. The whole issue of Foundation Trusts should be re-examined to establish a system where hospitals do not compete with each other and are managed solely in the interests of patients.
Specifically, whilst we support moves to develop primary care to reduce pressure on the secondary sector, primary facilities should be built up before making such changes. Such moves include the use of walk-in centres, urgent care clinics, strengthening GP practice including the provision of more health centres staffed by a wide range of practitioners. One other factor should be giving power to patients through a return to the old Community Health Councils or similar arrangement.
The labour party is moving towards a model of care that recognises the important links and relationships between physical health, mental health and social care. Andy Burnham MP spelt this out when he launched this approach. The SHA should give its support to Labour in this matter. The links would be achieved by putting health care fully under local authority control. This has three advantages: the first is that this approach avoids a further top down reorganisation; the second is that it achieves local democratic accountability; and, thirdly, it brings the cultures of health and social care closer together. For this to be effective national government should be required to distribute funding according to the needs of local populations.
Whilst supporting labour the SHA should have the aim of achieving free social care on a similar basis to that of health over a period of time. When the Oldham report, set up by the Labour Party, comes out the SHA should develop policy on this matter.