The Care system in England

SHA policy

Policy summary 2014

This is not intended to be a new statement of policy.  It draws heavily on the document we agreed in 2012 – Improving the Health of the Nation; a policy for the NHS and its partners. It attempts to draw out some of the unanswered questions, particularly arising from the proposal to integrate health and social care in England, and proposals to devolve decision making in the NHS.

The SHA stands for a care system (for England) which is an integral part of our public services, providing world class care but also helping to reduce inequalities in health, wealth and power.  Policy should be guided by the social determinants of health.

  1. Care should be free at the point of need and funded out of general taxation and should be provided predominantly by public bodies.
  2. Decisions about allocation of resources, priorities and plans and major changes in services should be made through relevant representative and participative democratic structures in each of the four nations in the UK .
  3. Free social care should be introduced progressively starting with those with greatest needs.
  4. Public provision of (social) care services should be greatly increased.
  5. Directors of Public Health within local authorities should be adequately resourced to make recommendations which must be taken into account.
  6. Partnership working at national and Regional level should be established with joint agreements over workforce planning.
  7. A national framework for common terms and conditions covering all care staff should be negotiated. A national framework should be agreed for staff development and training across the care system.
  8. NHS bodies should have boards of directors with a majority of NEDs and governing bodies set up to reflect a balance between patients, public, staff and other local stakeholders. Collaboration rather than competition should be the managerial paradigm.
  9. The NHS will have clear “franchise” arrangements with the four independent contractors (GP’s dentists, pharmacists and opticians) or will directly provide primary care services where necessary. Aspiring GPs and dentists should have a choice of joining locally sensitive independent partnerships, or NHS-run primary care services.
  10. The Secretary of State in England should be legally and politically accountable for the provision of a comprehensive health and social care service with powers of direction over all NHS bodies.
  11. The arrangements made for the provision of NHS services must be through service level agreements, should be subject to best value but not compulsory tendering and not subject to competition law.
  12. Legal contracts for provision of services to the public sector should be fully subject to Freedom of Information and must carry the same obligations as placed on NHS bodies. All potential service providers should be subject to a “fit and proper test”. All contractors should pay the living wage and recognise trade unions
  13. The NHS should treat private patients only where this has direct benefit to NHS patients.
  14. All NHS bodies must be under clear obligations and duties:-
    1. To work to reduce inequality
    2. To cooperate with other public bodies
    3. To promote shared decision making and community development
    4. To be open and transparent and to involve public and patients in all major decisions and plans.
  15. The procurement and contract management of major assets should be the responsibility of the Secretary of State rather than individual NHS organisations. NHS Bodies should be subject to an appropriate reasonable charge for use.
  16. Oversight by regulatory bodies should be much simpler and more co-ordinated.
  17. Patient and public participation in the scrutiny of NHS services will be strengthened