The Labour Party has now released its consultation documents on policy. They are all on the Your Britain website. Anyone can submit comments on line. The health document is below. The SHA will be considering how to respond. The process from here on is:
- Each Constituency Labour Party and affiliated organisation may submit up to ten amendments in total, and up to four on any one paper. The deadline is 13th June.
- National Policy Forum representatives will meet on a regional or sectional basis to discuss which amendments to bring forward for discussion at the final NPF meeting. Each NPF representative may bring forward six amendments in total, and up to three on any one paper.
- The NPF will meet to debate the papers and amendments brought forward from 27th to 29th June.
- Following debate and a vote at Annual Conference in September the document agreed will be adopted as Labour’s policy programme in the Spring.
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The National Health Service is the Labour Party’s greatest achievement; an institution that embodies the bonds that tie us together and the responsibility we owe to each other as citizens. We created it, we saved it, we value it and we will always support it. A lot has changed since the NHS was first created. Today, we are living 10 years longer than our counterparts back then. That is a cause for celebration, but increased longevity has brought with it new challenges. In 1948, infectious diseases were the biggest challenge; today chronic illnesses such as dementia, diabetes and depression account for 70 per cent of NHS spending. In 21st Century Britain, people rightly want and expect to be active partners in shaping decisions about their healthcare. So 65 years on, our health challenges look very different, and people’s expectations of the NHS do too. People’s needs don’t fit neatly into categories like ‘physical’, ‘mental’ and ‘social’ – they are often a combination of all three. And physical, mental and social needs are also often interconnected. But, despite the NHS’ great achievements, the way services are provided hasn’t kept up with our changing needs. We have a system that too often treats patients as a collection of conditions – the broken hip, the cough, the bad back – but fails to see the whole person behind them. We see families passed from pillar to post by different organisations, having to tell their story over and over again. And too many opportunities are missed to prevent illness and help people stay healthy. This inefficient, fragmented way of working is something the country cannot afford in an era when there is less money around. Labour’s vision for our NHS will bring together physical health, mental health and social care into a single service to meet all of a person’s care needs, with a focus on prevention. It is a true One Nation vision: a health and care system shaped around people, not bureaucratic structures or market dogma. This stands in stark contrast to the Government’s agenda of ever greater privatisation and fragmentation. Rather than facing up to the challenges of the 21st Century, billions have been wasted on a damaging top-down reorganisation that nobody wanted, and nobody voted for. As a result patients are waiting longer, facing a postcode lottery of rationed treatments and asking why the NHS is losing thousands of nurses and health professionals when there is a crisis in Accident and Emergency departments across the country. One Nation Labour is determined to protect and strengthen the NHS, even in an era when money is tight. That means an NHS based on collaboration and integration, not competition and fragmentation. And it means a health care system built around patients , not bureaucratic silos . The next Labour Government will remain true to our values and vision for the NHS: a comprehensive universal health service, free at the point of need, and fit for the 21st Century.
Our NHS
The Government’s top-down reorganisation is damaging the NHS, and the experience of its patients, by putting market competition ahead of patient care. The next Labour Government will deliver on our mission to protect the NHS by repealing the Health and Social Care Act 2012 (England), putting the right values back at the heart of the NHS.
Repealing the Act will ensure that the Secretary of State has a duty to guarantee a national service which is free at the point of need, removes enforced competition, ensures private patients aren’t put before NHS patients, and tackles the conflicts of interest the Act created.
Labour will deliver an NHS that values collaboration over competition, that focuses on integrated care rather than widening the divide between commissioners and providers, and that delivers care according to the needs of patients, and not the market. Labour’s vision for whole person care does not see people merely as recipients or consumers of services. Instead, it sees them as genuine and active partners in designing and shaping their care and support.
By contrast, the Government’s free market approach has seen competition used to break up successful NHS services. In a system of collaboration, Labour supports the principle of NHS preferred provider – that NHS services should not needlessly face the threat of competition and destabilisation – with the NHS working in partnership with other sectors, including the voluntary and third sectors. Labour recognises that there is a role for the third sector and independent sector organisations in providing health and care services where there are gaps in delivery, or where the NHS is unable to provide a high quality service. The third sector often plays a particularly crucial role in providing services through supporting people to live at home, and providing advocacy and rehabilitation services.
Over the last decade, targets played an important part in reducing waiting lists and improving care and access. And a small number of targets, focussed on what matters for people and patients, is still an important aspect of maintaining high standards. But in driving forwards Labour’s vision of whole-person care, a top-down, target driven approach will not deliver the personalised care we want. Instead, we need to look at powerful rights for individuals, codified in the NHS Constitution, along with greater opportunities for patients to be involved in designing and shaping their own care.
Labour recognises the vital work of local authorities across a range of services that impact on health, including social care, housing and their new public health responsibilities. We will strengthen Health and Wellbeing Boards, enabling health and social care to be fully integrated at a local level according to the needs of individuals and the community.
“Labour should use integrated care arrangements as a means for breaking down the market, basing integration on NHS principles and public provision, rather than the government’s approach of market-led integration. The Government’s competition regulator Monitor has stated that “effective regulation of choice and competition issues will also be vital in enabling integrated care to flourish” with an onus on encouraging private providers into the system, as has already been seen with integrated children’s services in Devon and now with integrated older people’s services in Cambridge.” Unison
Whole-person Care
“A more integrated and preventative health system would be one which supports people to live independently as much as possible with access to both the health and care services they need when they need them.” Novo Nordisk
The current health and care system is based on three fragmented services: physical health in the mainstream NHS, mental health on the fringes of the NHS, and social care in council run services. Increasingly, however, people’s needs are a complex mix of the physical, mental and social. This was captured by the 1948 World Health Organisation definition of health as “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity.” However, for all its strengths, the NHS was not designed to fully achieve this.
That is why the next Labour Government will integrate health and social care services into a system of ‘whole person care’. This approach will bring together three separate, fragmented services into a single service coordinating all of a person’s needs – physical, mental and social – with preventing illness and promoting good health at its heart. Whole-person care will enable us to put people of all ages at the centre of the health and care system in a way that has never been done before; seeing the whole person, and organising services around the needs of people and their communities. The concept of whole-person care has relevance across all stages of life, from the child with complex needs, the working-age adult with disabilities through to the older person. For example, from the very start, our maternity services, health visitors and children’s centres can work closely together to improve the outcomes for children and parents, particularly those from disadvantaged groups.
Our vision of whole-person care recognises that the integration of services will deepen over time and that different areas will develop different models. This is about re-shaping the way care is delivered within communities, not another top-down structural reorganisation.
Central to whole-person care is the idea that people with chronic conditions should be empowered to manage their conditions. Labour recognises that better prevention is the key to reducing the burden of chronic illness and that people need support to live independent lives. It will also ensure that the person whose needs are being considered is at the centre of the decision making process and the planning of their care. This is why personalisation, and meaningful control, will be at the heart of Labour’s vision. We want to see more choice for patients over where they receive their treatment and care, for example, through maternity services giving women the option to give birth in their home, and also more opportunities to have treatments like dialysis and chemotherapy in the home.
Bringing healthcare closer to people
A One Nation health service requires organisations involved in providing services to work together to meet the needs of patients, and to empower the people who use them. Labour’s vision will enable people to stay healthy in their homes for longer, including through prevention and early intervention. For example, installing a grab rail in the home may stop somebody falling over, and prevent them ending up in hospital. This kind of preventative approach is not only much better for the person, but can save money in the long run too.
The current fragmented system of health and care can be difficult to navigate, often resulting in a series of encounters with several different professionals. Central to the vision of whole-person care is the idea of a single named contact for the co-ordination of an individual’s care needs.
“Joint finance between health and social care needs to be far more effective and efficient. Pooling more resources and sharing more information would help us move forward. More ‘quick wins’ would generate more confidence in joint working.”Cllr. Vince Maple, Chatham and Aylesford CLP
Key to successful integration is breaking down the organisational and cultural barriers between those involved in providing, commissioning and planning care. This could be achieved in a number of ways, for example by providing incentives for joint working, or through a single budget to fund services through a ‘year of care’ tariff.
In 2013, Labour set up an Independent Commission on Whole-Person Care, chaired by Sir John Oldham OBE. The Commission have produced detailed recommendations on how Labour’s vision can best be implemented, which has been submitted to the Health and Care Policy Commission.
At the end of a person’s life, we want to see care available in the place of their choosing. Having the right end-of-life care package in place would allow families, in those crucial final days and weeks, to focus on each other rather than fighting the system and worrying about finances. At the moment, many people who would like to die at home end up having to stay in hospital. That is why Labour will work towards giving people the right to receive their end-of-life care at a place of their choosing, with family around them.
Making hospitals and services work for patients
Labour acknowledges that there will be occasions where there is a strong clinical case for changes to hospital services that will improve care. What matters is that service reconfigurations, and changes to the way that health services are provided, are evidence-based and clinically led, not purely financially driven, and that the local community is consulted early and frequently.
The next Labour Government will drive a series of step changes in the culture of the NHS, to ensure communities are given a real say in shaping the future of their local services, including hospital reconfigurations.
We will ensure patients have a formal role in drawing up and deciding on proposals for service change before they get to consultation stage. They must be around the table when initial decisions are made. We will give communities more ownership of the consultation process, taking the power to run the consultation off the NHS commissioners who are advocating the changes, and giving it to an independent organisation, such as the Health & Wellbeing Board, with a duty placed on them to secure real public engagement. We oppose the government taking sweeping powers to force changes to services across an entire region without proper public consultation.
Tackling the A&E crisis and improving primary care
One of the most visible failures of the Government’s NHS reorganisation is the current Accident and Emergency crisis. A&E is a barometer of how the health service is performing, and all the indicators are telling us that the service is under severe pressure. The number of people waiting over four hours in A&E has more than doubled since 2010, and trolley waits and ambulance queues have doubled too.
A key cause of the A&E crisis has been the Government’s failure on social care. This has led to fewer older people getting the care they need at home and in the community, resulting in more people ending up having to be admitted into hospital.
The Government has also made it harder for people to access alternatives to A&E. They have made it harder for people to see a GP by scrapping the 48 hour GP appointment guarantee, and removing incentives to extend evening and weekend opening for GPs. We have also seen the closure of NHS Walk-in Centres and the dismantling of NHS Direct. Labour believes that it should be easier for people to see their family doctor or an appropriate health practitioner, and that there should be appropriate alternatives to A&E.
For the majority of people, GP services are the first point of contact in the NHS. Labour is committed to ensuring that everyone has prompt access to their GP or appropriate member of the local primary care team. Labour believes that a greater focus needs to be placed on extending access to primary care, including through a stronger role for community services such as pharmacies, sexual health services and dentists.
Good primary care takes a pro-active approach where the public is supported over a lifetime to make positive health choices, with enabling interventions at the earliest possible stage.
Improving diagnosis and elective care
Many serious conditions and diseases can be prevented, managed effectively or even cured if they are detected early enough; early diagnosis can save lives. That is why the previous Labour Government left clear plans in place to speed up and improve diagnosis, which were scrapped by the current Government. In particular, Labour believes that improving early diagnosis must be the new front in the fight against cancer.
Without investment in medical and clinical research, health outcomes will stagnate. Labour is committed to working in an integrated global context to drive research and advancement to better treat and cure conditions and diseases.
Stronger patient voice and robust inspections
In 2013, Robert Francis published his second report into the Mid Staffordshire NHS Foundation Trust. Labour believes that what happened at Stafford has no place in the NHS and we must ensure that it does not and cannot happen again.
Labour welcomed the Francis recommendations, but regrets that the Government has adopted a selective approach to them, including on issues such as the duty of candour.
As the scandal at Winterbourne View demonstrated, recent care failures have occurred across all sectors. Even though the majority of people receive good care, everyone must be able to expect the highest quality service, whatever sector or setting their care is in, and to be treated with dignity and respect.
It was Labour that introduced independent regulation of the NHS and we support moves to strengthen the system of regulation and inspection. Sadly, the Government’s mismanagement of the NHS – reducing nurses and other vital health professionals by thousands, sucking £3 billion out of frontline care to fund a wasteful reorganisation, and causing a crisis in A&E – risk making care failures more likely in future.
Labour will ensure that the voice of users, their families and the public are at the heart of local health and care services. Personal control over the care received, regular feedback, community involvement, and a strengthened role for Healthwatch are essential to improve quality and increase the accountability of local services, alongside a robust national inspection regime.
The future of social care
To deliver whole person care, Labour will need to transform the care and support system for older and disabled people. Our principles of fairness, security, opportunity, and defending human rights, will underpin our priorities for older and disabled people. We must also ensure that rigorous safeguards are in place to protect the interests of all people. The growing social care crisis is one of the biggest challenges we face as a society. Since 2010, £2.7 billion has been cut from budgets that pay for adult social care, and the system is close to collapse. Tighter eligibility criteria mean that hundreds of thousands fewer people are getting help. And the rising burden of care charges is adding to the cost of living crisis: increases in charges now mean that since 2010, elderly and disabled people are paying almost £740 a year more for vital home care services.
Ensuring a fair care system
Labour believes that people need a fairer deal and protection against the rising costs of care. The current social care system is the worst of all worlds and it needs to change.
The Government commissioned Andrew Dilnot to develop proposals to put social care funding on a sustainable basis, and the Care Bill intends to introduce some of the Dilnot Commission’s recommendations. But Labour believes that the Government has weakened these recommendations, meaning that many older people with modest incomes and assets will not benefit, and most older people receiving care are likely to pass away before the reach the so-called ‘cap’ on care costs.
Labour believes that the solutions put forward by Dilnot, whilst welcome, do not provide all of the answers. We need a far bigger and bolder response to meet the challenges of our ageing population – a genuinely integrated NHS and social care system which helps older people stay healthy and living independently, in their own homes, for as long as possible.
Crucially, the Government has ignored Dilnot’s warnings that changes to long-term social care funding will only work if the current crisis in care is addressed. That is why Labour called on the Government to use £1.2 billion of the 2012/13 Department of Health under spend – that has been clawed back by the Treasury – to support social care in 2013/14 and 2014/15. Beyond this, Labour is seeking to develop a broad consensus on the funding of social care.
Promoting dignity and respect
Whilst the majority of care provided is of good quality there are still too many stories of poor care, especially for elderly people. It is completely unacceptable that any older person in a hospital or care home be denied help with eating, drinking or going to the toilet, or not to have their privacy properly respected. Far too much home care is delivered in 15 minute slots, a practice which doesn’t meet personal care needs. Labour believes that ensuring older people are treated with dignity must be a top priority. Our hospitals and care services need enough staff who are properly trained, particularly in issues like dementia.
“Alzheimer’s Society suggests that more is needed to allow people with dementia to remain included in their communities.” Alzheimer’s Society
Labour recognises that older people don’t want to go into hospital unless it’s absolutely necessary. When they do, they want to be treated with dignity and respect, and then get home and back on their feet as quickly as possible. Labour is committed to ensuring that services are in place which enable elderly people to remain healthy and independent in their homes, including better provision of step-down services from hospitals or step-up services from the home.
Supporting carers
Carers make a vital contribution to our local communities and to our economy. Across the UK there are 6.5 million carers, and this number is expected to rise to 9 million over the next 25 years. If our vision of the future health and care system is to be sustainable, it will mean that the state has to start thinking very differently about informal care and what it does to support carers. For too long, carers have been invisible in the system, and often far too much is left to them. Labour believes that this can’t go on. Assessing and supporting carers’ needs must be a central part of whole-person care, including providing appropriate respite care.
Labour wants to see improved support and recognition for carers. In Government, we introduced new rights for carers, including a right for carers to have their needs assessed independently of the person they care for.
Today, we can and should do more for carers. For example, the current definition of ‘carer’ should be widened so that it specifically includes young carers, and parents caring for disabled children. There should also be greater institutional recognition of the needs and rights of carers including those of young carers and their right to childhood. NHS bodies should have a duty to identify carers, which would help GPs and hospitals signpost carers to the right help and support.
Public Health
Promoting public health and tackling health inequalities are essential to improving health. As people live longer and the population grows, demand for healthcare will rise, and it will rise faster if we don’t help people to live healthier lives. Without a focus on early intervention and prevention, and ongoing support throughout life, the NHS will struggle to cope with the rise in demand.
“Public health must be fully integrated into the ‘whole person care’ agenda as this is the preventative wing of the NHS.”Unite
Tackling health inequalities requires action across government and society
Future policy designed to tackle health inequalities should reflect the fact that 60 per cent of a person’s health is determined by a range of factors beyond the influence or control of the NHS. In 2010, Sir Michael Marmot’s report ‘Fair Society, Healthy Lives: A Strategic Review of Health Inequalities in England Post-2010’, stated that people in different social circumstances experience huge differences in health, well-being and length of life. It argued that reducing health inequalities requires action across all social determinants of health, for example, housing and employment policies.
There is also a need to recognise the impact that regressive policies can have on a population’s heath. For example, the effect that unemployment can have on an individual’s mental health can lead to further demands on the NHS. The role of good quality housing, access to open space and well-designed urban spaces are also important factors in a person’s wellbeing. Labour’s actions to reduce economic inequalities will help to tackle health inequalities too. Recognition also needs to be built into services of the differing needs of communities, such as the higher prevalence of diabetes among some BAME groups, and the differing family and community support systems that exist, to ensure outreach is effective.
“In order to reduce health inequalities, health and care systems may prioritise disadvantaged communities, or those suffering from discrimination. These are also the groups that are most likely to be lonely and isolated.” Campaign to End Loneliness
Taking care of your health
Helping people to take care of their own health isn’t about the state telling people what to do; it is about helping people to make informed choices on issues such as their diet, exercise, alcohol and smoking – choices that enable them to live healthy lives and to avoid getting ill. Individuals need to be supported to look after their own health.
For example, supporting people to be more physically active can make a huge difference to their health. Turning the tide of inactivity is one of the most cost-effective ways of making our public services sustainable.
The level of obesity in today’s school children puts them at a greater risk of developing diseases like diabetes and cancer. That is why Labour is looking at how we can tackle the problem of unhealthy food being marketed to children. We are also looking at what additional steps, including possible regulations such as legal limits on sugar, fat and salt in foods, would be beneficial.
Schools are also important in improving children’s health – this is discussed further in the Education and Children section of the Final Year Policy Consultation.
Despite all the progress made over the last decade, a quarter of all cancer deaths are still linked to tobacco. This is why Labour supports measures on standardised packaging, measures to ban adults purchasing cigarettes or tobacco for children, and a ban on smoking in cars when children are present.
Mental Health
One in six people across Britain are affected by a mental illness, and according to the World Health Organisation one in four of us will have a mental illness at some point in our lifetime.
Prioritising mental health in the NHS
Under this Government, mental health services are under increasing pressure and people are struggling to access the treatment and support they need. Labour has already sought to prioritise mental health in our National Health Service by forcing the Government to write a commitment to “parity of esteem” between mental and physical health into law. Labour also supported the Mental Health (Discrimination) Act 2013.
To ensure that mental illness is treated with the same level of priority as physical illness, the next Labour Government would re-write the NHS Constitution to create a new right to psychological therapies that help people recover from conditions like anxiety and depression – just as people currently have a right to drugs and medical treatments.
Labour also believes that there should be more mental health specialists working in teams with GPs, nurses and carers. We need all health professionals to see the promotion of good mental health, and spotting signs of mental ill-health, as part of what they do. For this to happen we need to ensure that the training of doctors, nurses and all professional staff who work in the NHS includes mental health and that outreach is effective into all our varied communities.
Breaking the mental health taboo
Far too many people still feel as if they have to pretend that they have something else wrong with them, when they are struggling with a mental health problem like depression. If we are to achieve real parity of esteem for mental health, then we need to break the taboo associated with it.
We must recognise that good mental health doesn’t start in the hospital or the treatment room, but in our workplaces, our schools and our communities. Labour has established a Mental Health Taskforce to produce recommendations on how we can improve mental health in society.
Improved inter-agency working around the person is vital to ensure that there is a co-ordinated approach to the individual, including health, education, criminal justice, housing and other services.
The health and care workforce
A well-trained, motivated and well-led workforce is essential to delivering good quality care. This is especially important for the delivery of integrated care, which will rely on staff with the right mix of skills and the ability to work in multidisciplinary teams across boundaries. Labour believes in national pay frameworks and the stability and recognition they give to the health and care workforce. Staff morale and wellbeing are also essential if we are to have a motivated workforce. Too often, this Government appears too willing to ‘talk down’ the NHS in order to hide their own failings. Labour will seek to create a better dialogue with the health and care workforce. We are committed to safe staffing levels, based on expert advice, learning from where things have gone wrong in the past. Labour also supports the better regulation of health and care support workers.
Tackling the exploitation of care workers
Social care workers carry out some of the most important work in society, caring for the sick, elderly and the disabled. Yet the current care crisis is seeing the work they do being increasingly undervalued. As well as the work being physically and emotionally demanding and often undertaken in unsocial hours, there is strong evidence of exploitation in the care sector. This is something which Labour will strive to put right, including by tackling the abuse of zero hours contracts. This is why Baroness Kingsmill is carrying out a review of how to better understand and tackle exploitation in the care sector.
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