We need to harness the election defeat. We need to show a new vision for health and compassionate proactive care for the future. We need to focus less on grand structural redisorganisation. We need to build on the changes that are happening around us. The world outside the NHS is online. There is a clear democratic deficit, filled with comment and political action with campaigners and activists from right to left. Devolution to cities and countries is moving apace.
At the same time, the NHS did not move people in the election as much as the economy. The NHS may no longer be the touchstone it was. The NHS is being torn apart and social and community care is rapidly being gnawed away. NHS workers are stretched to the limit, filling gaps as best they can with reducing resources.
We need to build a vision of an NHS that is personal, proactive, linking in a clear, responsive and effective way with the communities it serves, integrating participatory democracy (or liquid democracy, as Compass calls it) into the workings of the NHS and other statutory sectors. The devolved nations need to learn from each other.
- A commitment to Community and Individual Participation – Community Powered Health
The NHS will harness community building/development approaches, ensuring that local communities work with statutory agencies to set the agenda for change that meets their needs. This, within a national framework of entitlements set by government.
The NHS will ensure that clinicians and patients share decisions to the extent the patient wants to. This will require incentives, training and technical interventions such as online access to records and Decision Aids, as well as strengthening Healthwatch and making it more independent.
- Maximise the benefit of IT.
We can harness IT for more for self-care; for supporting communities; for doing a range of administrative NHS things more easily and quickly; for personalising care; for offering proactive care; for enabling people to take more charge of their own health and more charge of their NHS through record access and many other means.
- No marketisation, no privatisation.
The NHS will no longer have either an internal nor external market. It will no longer pretend that FTs are free-standing competitive corporations. The duty of the SoS to ensure a comprehensive NHS will be restored. The NHS will be the preferred provider. The private sector will only be allowed to offer patient services if the NHS cannot improve or they can show genuine innovation. - Incentives for cooperation for better outcomes
The financial and other incentives within the NHS will promote cooperation between health sectors and between health and local authorities. Intelligent targets will remain where appropriate. - Invest in the NHS
Austerity at the same time as cutting the welfare state kills people. We need to invest more in the NHS which is effectively suffering a cut, not a freeze. Every £1 invested in the NHS offers £4 in return – and that is spent in the UK, not in tax havens elsewhere.
Renegotiate PFIs where necessary – we cannot any longer allow corporations to hold the NHS to ransom.
- Invest in community care, including general practice
90% of NHS work happens in the community which needs more investment, not only to offer a better service but to be able, where appropriate, to offer services that would otherwise have been delivered in hospitals. We make no assumption that community care is always cheaper than hospital care, but it may be in some places for some services.
General practice is on its knees. We need radical approaches with a new contract with varied employment options, better support for staff, cooperative working between practices and with far closer collaboration between community staff.
- Social care free at the point of use
A long-term goal, but starting with those needing palliative care - Integration
- Health and Social Care, either through poling budgets or through better communication and information flows.
- Services around the patient, ensuring shared information, shared services and shared decision-making
- Primary and secondary care, through a new incentive structure and shared services
- Mental and physical health, working within the secondary sector and within community care.
The organisational redesigns of the 5yfv are a distraction. There are many sound ideas in the document, but we need to go further and not be distracted by integrating through complex structural change.
- Public Health that tackles the social determinants of health
- Improving control at work
- Enhancing access to public transport
- Creating healthy places
- Implementing a minimum unit price for alcohol
- Reducing ill-health related worklessness
- A healthy housing policy
- Making work pay
- Minimum Income for Healthy Living
- Decreasing debt
- Tackling health inequalities
Implement Marmot in full. - Support NHS staff
Less insistence on inspection and more on listening to staff and patients. Whistleblowers will be protected. Staff/patient ratios will be adequate for safe care. On the job pastoral and mutual support to help staff deal with the emotional burden of their work – and to encourage compassion and care.