Report on the event we held in Bristol on 8th January:
This was the first of a series of meetings to discuss health policy in public. The aim is to explore and fill gaps in SHA and Labour Party health policies.
This meeting explored Devolution and its stated aim – integration. In essence it looked at the process of devolution represented by Devo-Manc and the Local Authorities. It did not discuss the pros and cons of devolution of countries, such as Wales or Scotland. It did address the Cities and Local Government Bill.
ESSENTIALS
Eliminate privatization and the market in the NHS
Halt the shrinking of the state
Respect and expand the state
RECOMMENDATIONS
Devolution
Devolution has more risks than benefits, particularly in this Tory-controlled austerity, although it may be a pragmatic way for a local health economy to stay in control.
The risks of devolution include:
- Privatisation
- Beginning charging for NHS services, in line with means-tested social care
- Rampant cuts
- Tory controlled local health service
- Deregulation – a reduction in national standards and rates of pay.
The NHS Reinstatement Bill was seen as a way of raising issues nationally.
There was strong representation from Martin that the actual process in DevoManc was not heading into these risks at all. On the contrary, it looks as though developments in Manchester make it more difficult for privatisation to occur.
Integration
Integration has many meanings:
- Across sectors (NHS/SC)
- Across disciplines (MH/Physical health)
- Across NHS organisations (primary/secondary care)
Integrative powers exist now to do all the good things that devolution aims to achieve. There are many other ways of improving integration which in general we agree is a good thing. Experience suggests that it is relationships that make the difference, not structures.
However, despite powers being in place, there is often a lack of integration. How can more integration be achieved without complex structural change? Recent NHS Guidance orders people to work together – will that work?
The Cities and Local Government Bill.
This will enable LAs to take over health functions from CCGs. The meeting agreed that this could be dangerous for the reasons given above. It however, seems unlikely that these powers will actually be used.
Democracy
Very weak in the NHS. We all want more democracy and for local communities to have a say. Although involving LAs in commissioning would be the obvious way to improve democracy, the meeting did not seem to think that LAs could adequately commission health services. How can we improve democratic control?
Local services within a national framework
There was concern over a post-code lottery, but also a recognition that local services have to be tailored to local need. Overarching national standards are essential, and local variation in provision is a good thing.
Redundant NHS land should not be sold off
It can be reused for instance to build care homes or other facilities, perhaps through Housing Associations. This would not lose the land and provide long-term income to the Trust.
The real issue is funding
We need to make it clear that Labour will invest in the NHS. This makes sound economic sense. There is an estimated 4x financial multiplier to NHS investment and the majority of the money is spent locally, not in tax havens.
Social Care needs to be free at the point of use.
That should be the direction of travel.
POLICY RECOMMENDATIONS IN SUMMARY
Basic cross-cutting policies
- Eliminate privatization and the market in the NHS
- Halt the shrinking of the state
- Respect and expand the state
- Invest in the NHS
Devolution in the form of DevoManc has more risks than benefits. It should be opposed. However, current experience in Manchester suggests that devolution is avoiding those risks at the moment. The risks include:
- Privatisation
- Beginning charging for NHS services, in line with means-tested social care
- Rampant cuts
- Tory controlled local health service
- Deregulation – a reduction in national standards and rates of pay.
One argument is that devolution is unnecessary. All that needs to be done can be done with current powers.
Overarching national standards are essential, and local variation in provision is a good thing.
Redundant NHS land should not be sold off
Social Care needs to be free at the point of use.
We should oppose the Cities and Local Government Bill
QUESTIONS
How can we improve democratic control?
How can more integration be achieved without complex structural change?