Selected health amendments endorsed at Labour’s National Policy Forum in Milton Keynes 18-20 July 2014. This report is not comprehensive. A set of fully amended documents will be available on the Labour Party’s Your Britain website. Each paragraph is a separate amendment. Only the most significant are included. They will be cobbled together into a coherent narrative, but that is not what we have at the moment.
Labour’s commitment to equality
Labour is the Party of equality. We believe that no person should suffer discrimination or a lack of opportunity because of their gender, gender identity, age, disability, race, religion, socio-economic status or sexual orientation. In government, every decision we take will be taken with that in mind. We will ensure the policies across these eight documents and in our manifesto will be implemented ensuring that they further rather than hinder this cause.
Labour has always led the fight for equality, but our fight is not yet won. We will not rest until everyone can live their lives free from hatred, fear and oppression. In government we will work to remove the structural and social barriers that stand in our way.
Car Parking
We also recognise that car parking charges have an impact on people’s ability to access and work in our health service, excessive charges clash with the founding values of the NHS, that the service should be free at the point of need. A survey by Macmillan Cancer Trust showed that the families of cancer victims could face parking charges of more than £400 per year that places real strain on families. Labour notes recent hikes in hospital car parking charges, which have added to the cost of living crisis facing families. Labour will undertake a review with a view to ensure a fair system of charging.
Carers
Across the UK there are 6.5 million unpaid carers of which many receive no financial support of any kind, and this number is expected to rise to 9 million over the next 25 years.
Labour believes that local authorities must be provided with the support required to ensure that carer’s needs are identified and assessed with appropriate assistance provided. In doing so this will help unpaid carers across the country, providing them with support that will in turn increase their quality of life and that of those they care for.
Commissioning
Health and Wellbeing Boards will have a central role in the commissioning process for people with long-term conditions, disability and frailty – people whose care is often most fragmented and who are heavy users of health and care services. The Health and Wellbeing Board would be responsible for creating a local collective commissioning plan for this group of people – within a nationally defined outcome framework for the development of whole-person care – with a duty of CCGs and Local Authorities to enact the collective commissioning plan.
In caring for those with complex needs, where local partners in communities want to move to a single budget for health and social care, or Joint Ventures, and have the capability to do so, the legislative framework should allow this to happen.
Competition and Markets
The NHS is the most important creation of the Labour movement – free at the point of need to embody our collective identity and the duties we owe to one another. We will ensure it remains rooted in the values that underpinned its creation – cooperation not privatisation and fragmentation. In a planned and collaborative system, Labour will reintroduce the NHS as the preferred provider so that NHS services do not needlessly face the threat of competition and destabilisation.
Repealing the Act will ensure that the Secretary of State has a duty to provide a comprehensive national service which is free at the point of need, that private patients are not put before NHS patients, and that the conflicts of interest the Act created are tackled. We will also ensure that the Secretary of State is able to give directions to the NHS. Labour will break down barriers that prevent or deter co-operation. Labour will take competition law out of the NHS by ending Monitor’s role as an economic competition regulator and by scrapping the Section 75 regulations that force services to be put out to tender.
By contrast, the Government’s free market approach has seen competition used to break up successful NHS services. Some studies have shown that marketised healthcare systems have worse health inequalities and higher costs, and in some situations marketization can lead to poorer quality care, for example higher hospitalisation rates. In a planned and collaborative system Labour will reintroduce the NHS as the preferred provider so that NHS services do not needlessly face the threat of competition and destabilisation. Labour’s commitment to the whole person care agenda will progressively reduce the purchaser provider split across the NHS, enabling local providers to determine how quality services should be delivered within the scope of a national framework. All Trusts – Foundation, NHS and Community Trusts – will need to be accountable to the public and operate within a collaborative and integrated system not a free market free for all. To support this, the mixed economy of Trusts and Foundation Trusts will need to be reviewed so that all service providers are fully integrated to deliver the whole-person care agenda in a collaborative, not competitive, way, and fully accountable to the public. Where additional services funded by the NHS (e.g. from the not for profit sector) they must work in close partnership with the NHS and terms and conditions of staff and public accountability must be prioritised to ensure we achieve high standards in care and terms and conditions. As part of this process we will review the effectiveness of the current TUPE legislation and make improvements where necessary. Labour recognises there is a role for the third sector and a limited role for 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.
Meaningful choice is about the type of service that is provided and the way that service is delivered not which organisation is delivering it. As a result a Labour Government will abolish the damaging and overwhelming market system of “any qualified providers” that does nothing to provide real choice to patients. Instead of relying on a narrow form of choice, Labour will create a national entitlement, written into the NHS Constitution, to ensure that patients get legal rights to access to the services they need.
In 2003 the previous Labour government established Foundation Trust Hospitals in England with the aim of making hospital services more accountable to local communities by giving Trust members a real say over their running. Ten years on the consensus is that, whilst more than 2 million people are members of Foundation Trusts, the model has not achieved its full potential and there is a need to re-awaken the original ambition behind it. One Nation Labour believes in more ‘people-powered’ public services and so a future Labour Government will consider ways of strengthening the role of members within Foundation Trusts and work to better engage and involve NHS staff in Trust membership.
Health and Care Workforce Conditions
Labour will restore the collection of Race Equality and ethnicity data as part of the specific duty on employment for public authorities bound by the general Public Sector Equality Duty. |Labour will develop a framework of action to tackle discrimination in the workforce of the NHS; measures to eradicate institutional racism in the workforce and to remove the ‘glass ceiling’ for workers from BAME communities.
Labour will continue to support the excellent work carried out by health unions and strengthen and support the collective bargaining structures in the NHS. As part of this Labour will work towards a fairer system of pay setting that allows all parties a fair and informed process on pay determination. Labour would also commit to better supporting the social care workforce and ensuring that the integration of health and social care services never sees terms and conditions being levelled down, instead spreading the good practice in the NHS to social care; and we will investigate and consider the longer term goal of being able to bring care workers within Agenda for Change in line with the Kingsmill Report
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 social 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. Labour is committed to strengthening the enforcement of the National Minimum Wage and incentivising employers to pay the Living Wage, because we recognise that care workers are playing an invaluable role in meeting one of the greatest challenges we face as a society, and deserve to earn a decent living and be recognised for their work in caring for our most vulnerable loved ones some councils are already commissioning care providers to pay the living wage and this is a model that should be explored more widely. This is why Baroness Kingsmill has carried out a review of how to better understand and tackle exploitation in the care sector.
Integration
Our vision of whole-person care recognises that the integration of services will deepen over time and that through both the restoration of a truly national health service through repealing the Health and Social Care Act and a strengthened national entitlement of services to be provided and patient rights, written into the NHS constitution, the postcode lottery will be minimised. Models of delivery should be developed from a strong evidence base of clinical and social effectiveness. This is about re-shaping the way care is delivered within communities and reducing health inequalities, and not another top-down structural reorganisation.
Local Authority Responsibilities
Greater localism of services should be a priority for future developments of the NHS. The transfer of Public Health responsibilities to Local Authorities has shown that this can have a beneficial impact, helping to deal with local priorities and local problems. There should however be an overarching framework to ensure that issues of post code lotteries do not dominate.
Mental Health and Equalities
Taking part in community activity is a vital way of protecting and improving mental health. The NHS support the growth of local voluntary and community groups as a whole, cooperating with the other services which have a mutual interest in this. We will ensure that health agencies play an active part in community development, with the clear objective of strengthening the role of the community and voluntary sector in relation to health. Labour will ensure all health and social care providers are compliant with the equalities act. It is also important that mental health providers are compliant with the Equalities Act.
NHS agencies and providers will therefore be expected to play their part in ensuring that every locality has a thriving third sector. NHS organisations will be expected to take an active part in neighbourhood partnerships and to encourage users and carers groups to do so. We will encourage firms to involve employees in businesses so that job control is increased. In other countries, such as Germany, workers councils are commons place in businesses.
Labour recognises the link between unemployment and mental illnesses especially depression. Labour will ensure that mental health patients have equal treatment and resources as patients with physical illnesses. To ensure that mental health patient waiting times are reduced and that the distances travelled to access those services should not be excessive, Labour should take steps to introduce waiting time and access standards for mental health services.
Local Authority Health and Wellbeing Boards should be informed by Mental Health and Wellbeing Strategies ensuring preventative as well as curative services and interventions.
The needs of children with mental ill health are currently poorly addressed, with limited services provided. A future Labour Government will ensure that o this area of child health care will be properly resourced and that children needing mental health care will have their needs prioritised at the same level as those suffering from physical conditions.
Labour recognise that failings in the provision of mental health care for BAME communities remain inadequate. Labour will put in place measures to improve the delivery of mental health care for BAME communities and in particular treatment, care and services for patients on psychiatric wards and services for young Black males
NHS Funding
We want to see a community in which power, wealth and opportunity are in the hands of the many not the few and where the rights we enjoy reflect the duties we owe. This will not happen in an unhealthy society where wealth is primarily inherited and the benefits of economic growth go to those who are already rich. Labour’s long-term goal is to break the link between a person’s social class and their health. We will work across government, using the power and influence of all government departments and agencies, to achieve this.
Labour will develop new funding mechanisms for health and social care providers based on delivering quality, equitable and integrated services and incentivising health promotion and preventative care, rather than simply on volumes of episodic treatment. The Government has taken NHS funding away from deprived areas, hitting communities and risking an increase in health inequalities. Labour is committed to investing to improve primary care access, with a particular focus on tackling the health challenges of need and deprivation.
The last Labour Government successfully brought UK health spending in line to that of other comparator economies after nearly two decades of Tory neglect. The Coalition’s ideological cuts agenda is now reversing that trend. This is not acceptable. The next Labour government will guarantee that health care is publicly funded through progressive means at levels that sustain it as a world leading public service. Funding will be redirected into service provision and will build on the last Labour Government’s levels of funding. On social care the starting point is that the status quo, including the government’s version of the Dilnot reforms, is no longer an option. Social care has never benefitted from a universal contributory system of funding and yet is intrinsically linked to health care. Funding within health will be redirected into service provision to ensure that it is spent to maximum effect.
Outsourcing
Alongside changes to protect the NHS from future privatisation, we will ensure all outsourced contracts for services, including under the Health and Social Care Act 2012, are properly managed to ensure they are meeting clinical and financial standards. Where contracted services are failing, we will consider all the options, including bringing them back into the public sector. Future contracting decisions will be based on what contributes to integration through the whole person care agenda.
Labour will also insure that existing and future procurement projects for public infrastructure and services are scrutinised and action taken to ensure they deliver best value for money for the taxpayer and the NHS, learning from past experience, using contractural flexibility to the full and making sure that charges are not at the expense of patient care or appropriate terms and conditions for staff.
PFI
Labour will also ensure that procurement models for public infrastructure and services deliver value for money for the tax payer and the NHS, learning from past experience, using contractual flexibility to the full, and making sure that they are not at the expense of appropriate terms and conditions for staff.
Primary Care
As part of the next Labour Government’s plan to improve services for patients and ease the pressure on hospitals, the next Labour Government will give all NHS patients the right to a same-day consultation with their local GP surgery, the right a GP appointment at their surgery within 48 hours or the right to book an appointment more than 48 hours ahead with the GP of their choice. To help ease pressures and support the delivery of these new standards, we will invest an extra £100 million a year in general practice, funded by savings made from scrapping the Government’s new competition rules which have led to increased costs in the NHS, and from cutting back on the new bureaucracy created in the Government’s NHS reorganisation. The last Labour Government increased GP numbers to record levels, but numbers have fallen since 2009/10 and the Government is far off meeting its stated goal of 3,250 training places a year. So GP recruitment will be a priority for Labour, including through promoting general practice as a career choice, supporting GP returners back to work and encouraging recruitment in under-doctored areas.
General Practice is under pressure through squeezed budgets, falling recruitment and new commitments from greater involvement in commissioning. It is important that General Practice is able to serve patients, improve access and outcomes. Labour will work with GPs to improve GP registration, including in hard to reach groups. NHS Walk-in Centres have played a vital and successful role in enabling people to access care and reliving pressure on A&E. We have been clear that it is short-sighted to close walk in centres. So it is a huge concern that a quarter of walk-in centres have been closed since 2010. Labour continues to support Walk-in centres. Where they are well used and valued, they should be retained. Labour will review the impact that closures of walk-in centres have had on people’s ability to access primary care services.
Public Health
Given that there is public demand for both high standards of health and social care, and for low taxes, governments should take a strong approach in promoting healthy living to reduce NHS expenditure and increase quality of life and healthy life expectancy. To that end, Labour will introduce initiatives and measures to reduce; smoking and excessive alcohol consumption; excessive sugar, salt and fat in food; food fraud, and air pollution.
The Government’s ‘Responsibility Deal’ has lost credibility as professional bodies have withdrawn from it due to the domination of the agenda by commercial interests. Commercial interests are not necessarily aligned with the aim of improving population health, and excessive consumption of foods high in sugar, salt and fat can have a significant negative impact on the health of citizens and consequently create demands on the Health Service. The growth of chronic illness such as Type 2 Diabetes serves to illustrate this point.
We will make healthy choices easier by encouraging affordable healthy products such as fresh fruit and vegetables while taking action to help people avoid the excessive consumption of unhealthy products high in fat (including trans fats), salt and sugar, including through regulation where appropriate. We will ensure that the quantity of sugar, salt and fat in manufactured food is easily apparent to customers wherever it is sold.
We will also take action to tackle supermarkets selling dangerous quantities of low-cost alcohol that fuel binge drinking and harm health, and further action to help young people not take up smoking.
Labour will work to eliminate inequalities in providing public health information to ensure improvements in service delivery benefit BAME communities.
Reconfigurations
We will reverse the introduction in the care Bill of sweeping powers to force changes to services across an entire region without proper public consultation. We will also extend freedom of information legislation to cover all organisations delivering public service contracts, including the private sector. On coming into office, we will be clear that service changes and reconfigurations should be clinically driven, not financially driven.
Regulation of private care agencies
Labour will ensure more effective regulation of public and private health care providers. We will review progress on the ‘certificate of fundamental care’, recommended by the “Review of healthcare assistants and support workers in NHS and Social Care” to see if further steps should be taken.
Regulation of therapists
Labour strongly believe that being LGBT is not an illness and it should never be treated as something which is curable, which is why we believe public money should never be spent on ‘conversion or cure’ therapies. Labour will ensure that existing safeguards are strengthened to prevent this from happening and will examine the effectiveness of the current system of regulation. Labour will work with the professional bodies to ensure that publically funded services enforce the Equalities Act 2010.
Social Care
The current eligibility criteria for social care are often interpreted according to available resources locally, often rendering them meaningless. National minimum eligibility criteria must be used to set a baseline giving everyone the right to be kept safe and well. Beyond this, Labour will work with key interests to agree the standard of wellbeing and independent living for older and disabled people, in line with the UN convention (on the rights of persons with disabilities) that our society should aspire to, and to help inform future spending priorities.
A One Nation Labour government will seek to ensure that no on fears their old age or struggles to cope with the care of a loved orv&.21st century care service that is integrated with the NHS and focused on the person being cared for must be underpinned by professional standards, regulation enshrined in law and a trained and valued workforce on fair pay, terms and conditions, and represented through a sectoral body. We cannott ask our system and workforce to do more for less as our elderly population increases and demand for care rises. Such a system would be as transformative as the introduction if the NHS for those who need care, their families and care workers across the country – that majority of whom are women.
…operating from the starting point that the status quo, including the government’s version of the Dilnot reforms, is no longer an option. Various ways of supporting and funding improved care must be considered. Bureaucratic and misleading Resource Allocation Systems used by councils should be reformed, with personal budgets becoming optional as part of a new focus on making personalisation meaningful
Transatlantic Trade and Investment Partners
Labour share the concerns that have been raised about the impact that TTIP could have on public services. Labour believes that the NHS and all public services need to be more, not less, integrated and we are concerned that including public services in the final TTIP could increase the fragmentation of health services that is already taking place under this Government, That is why we believe that the NHS and public services should not be included in any TTIP agreement.
Labour believes that key to an EU US trade deal that we would encourage the rest of Europe to support, which avoids a race to the bottom and promotes decent jobs and growth would be safeguards and progress on labour, environmental and health and safety standards.
Labour has raised concerns over the inclusion of an ISDS mechanism in TTIP. Labour believes that the right of governments to legislate for legitimate public policy objectives should be protected effectively in any dispute resolution mechanisms.