Introduction
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.
The last Labour Government successfully brought UK health spending in line with that of other comparator economies after nearly two decades of neglect. The Government’s 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.
Our NHS
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.
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.
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 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.
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 ensure 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 contractual flexibility to the full and making sure that changes are not at the expense of patient care or appropriate terms and conditions for staff.
Whilst decisions about our National Health Service must continue to be taken wholly at Westminster, Labour recognises the benefit pan-European action has achieved, for example in research to tackle rare diseases and in the necessary collaboration to tackle threats like e-coli and other potential pandemics which cross our borders. We will continue to support European collaboration to promote public health as appropriate.
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.
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. Some studies have shown that marketised healthcare systems have worse health inequalities and higher costs, and in some situations marketisation 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 are 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.
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. 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 on CCGs and Local Authorities to enact the collective commissioning plan.
Whole-person Care
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 wellbeing 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 through both the restoration of a truly national health service by 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. 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.
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. 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 the services they need. As part of our vision for whole-person care, we will explore how the NHS, social care and the Department for Work and Pensions can collaborate to provide more appropriate support for people with long-term conditions and disabilities.
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, prevent them ending up in hospital and recognise that support can be non-medical. 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.
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. 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.
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 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.
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. 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.
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.
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. 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 to 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.
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. 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, and improve access and outcomes. Labour will work with GPs to improve GP registration, including in hard to reach groups.
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, including stepped up and highly trained emergency services, able to treat people at the scene, triage and refer as set out by Sir Bruce Keogh, which will result in reduced hospital admissions. NHS Walk-in Centres have played a vital and successful role in enabling people to access care and relieving 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.
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. 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.
Labour is committed to working in an integrated global context to drive research and advancement for better treatment and cures of conditions and diseases, whilst recognising and supporting Britain’s role as a leader in life sciences research and development. Labour has a record of protecting separate budgets for basic and clinical research and believes we need to continue to support both. Medical and clinical research and development is vital to improving healthcare outcomes and should be an integral part of the NHS mission. Without investment in research and development, health outcomes will stagnate.
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.
Labour will work with unions and professional bodies to develop an enabling strategy to train and support staff to reach the vital standards that the public expect and deserve. An enabling culture for staff will promote best practice and helps create the preventative mechanism to stop standards falling and errors occurring in the first place.
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. 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 postcode lotteries do not dominate.
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.
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.
A One Nation Labour Government will seek to ensure that no one fears their old age or struggles to cope with the care of a loved one. A 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 cannot 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 of the NHS for those who need care, their families and care workers across the country – the majority of whom are women.
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, 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.
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 and properly valued by society, with this reflected in improved conditions as befits the level of work expected of them. This should begin with a whole system approach of proactive challenge to the known risks of National Minimum Wage non-compliance and the failure of employers to pay travel time. Local authority commissioning practices need to be properly regulated, with the aim of halting the race to the bottom; care quality should not be undermined by narrow considerations of price, and in-house provision should no longer be considered untenable.
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 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. 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 unpaid 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 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.
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.
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 protect the NHS 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.
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. Labour will work to eliminate inequalities in providing public health information to ensure improvements in service delivery benefit BAME communities.
Occupational Health
Labour believes that people who have contracted diseases as a result of their work deserve full and proper recompense without delay. Many thousands of employees who developed asbestos-related conditions have been let down by a slow and cumbersome compensation process; indeed many have died as a result of their conditions while waiting for payment. The Government’s compensation scheme is deeply inadequate. It only covers mesothelioma, neglecting the thousands of people each year affected by asbestosis, asbestos-related diseases, and pleural plaques.
The previous Labour Government proposed the establishment of an Employers Liability Insurance Bureau, which would afford compensation regardless whether the liable employer could be traced. The Coalition’s new scheme is heavily watered down, only offering remuneration for mesothelioma sufferers diagnosed after July 2012. It was introduced 26 months after the ELIB consultation closed and during that delay it is estimated that 5,000 people died from mesothelioma. The obfuscation and distraction currently exercised by the insurance companies has been aided and abetted by this Government, allowing them to dictate the terms of the consultations, and refusing to speed-up and extend the compensation process. The Government is committed to getting the best deal for the insurers, not the sufferers.
Labour will introduce legislation for a proper compensation scheme for sufferers of asbestosis and asbestos-related conditions, ensuring they are given the payment they are duly owed without delay, by enshrining the levy on the insurance industry in law. This will secure a sustainable funding stream for compensation for victims and ongoing research into asbestos related diseases and their treatment. The compensation scheme will be extended to include Pleural Plaques should evidence be found to show Pleural Plaques are symptomatic.
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, smoking and sexual health – 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.
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.
Taking part in community activity is a vital way of protecting and improving mental health. The NHS should 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, works councils are common place in businesses
Labour recognises the link between unemployment and mental illnesses, especially depression. Labour will ensure that patients with mental health problems have equal treatment and resources as patients with physical illnesses. To ensure that waiting times patients with mental health problems 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.
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. The needs of children with mental ill health are currently poorly addressed, with limited services provided. A future Labour Government will ensure that this area of child healthcare will be properly resourced and that children needing mental healthcare will have their needs prioritised at the same level as those suffering from physical conditions.
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. Labour recognises that failings in the provision of mental healthcare for BAME communities and that care can often be remain, and that care is too often inadequate. Labour will put in place measures to improve the delivery of mental healthcare for BAME communities and in particular treatment, care and services for patients on psychiatric wards and services for young black males.
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.
Labour strongly believes 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 publicly funded services enforce the Equalities Act 2010.
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. A Labour Government will respect the views of independent pay review bodies rather than brush them aside irresponsibly or renege on the agreed processes. 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. 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.
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.
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 anti-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 document was agreed by Labour’s National Policy Forum in July 2014 and will be presented to the party conference in September 2014. The other sections of the report are available to Labour Party members.