Reviewing the Principles of the Socialist Health Association

SHA policy

This is a discussion document.  It hasn’t been agreed by anyone.  It is part of an attempt to organise our policies and principles.  It isn’t intended to change the policies we have agreed over the last 86 years, but to find a way of describing them concisely and effectively.  Constructive comments are welcome.

Our statement of principles reflects our beliefs. They are not based on evidence. We believe that all human beings are of equal worth and should be treated equally. Others might not agree.

  1. The claims of the individual should be subordinate to social codes that have collective well-being for their aim, irrespective of the extent to which this frustrates individual greed.

  2. Medical treatment and care is a communal responsibility that should be made available to rich and poor alike in accordance with medical need and by no other criteria.

  3. People should be engaged in their own care, and communities should be engaged in the well being of their locality and in democratic control over services.

  4. We want to see a society that recognises the economic and wider determinants of good health and well being and which acts proactively to promote health and well being and eliminate health inequalities with equality of opportunity, affirmative action, and progressive taxation.

  5. Comprehensive and universal health and social care should meet people’s needs. It should be free at the point of use and funded through taxation to meet the physical, mental health and well-being requirements of the community.

  6. Services should prioritise and focus on patient’s clinical and personal needs including prevention, social action and participation in their own care.

From these principles flow some fundamental policies which are based on evidence and experience. They might play out differently in time and space, but they should be the basis of operational policies.

  1. A free Health Service is a triumphant example of the superiority of collective action and public initiative applied to a segment of society where commercial principles are seen at their worst. Competitive consumer markets in health and care do not generally deliver better quality or reduced cost. Individual payment at the time of need leads to over treatment of the rich and under treatment of the poor. Means testing does not get round this problem. Payment systems need to be designed to incentivise benefits to the users of the service, not the delivery of more treatments or services to the benefit of providers.
  2. Health and social care is rationed everywhere and at all times. We want a system where resources are used to their best effect, based on evidence of cost effectiveness. The National Institute for Health and Care Excellence and the sharing of data across the NHS gives us excellent opportunities to assess evidence of effectiveness and to base the direction of services on robust evidence. We need a clinical and allied workforce that fully meets clinical and patients’ needs, with national pay and conditions, engaged, as far as possible, in research and professional development so that the latest evidence and technology is implemented rapidly and threats to health are assessed and dealt with appropriately. Research should be an integral part of service delivery.

  3. The level of resource, both money and staffing, is the responsibility of national government and should be delivered from general taxation. When services are restricted because of lack of resources decisions about the way in which restrictions should be applied are the responsibility of national government and must take into account evidence about different levels of need and different costs in different communities.

  4. The National Health Service has national standards for service delivery quality and outcomes measurement and information about the delivery of these standards should always be freely and transparently available.

  5. Planning and managing the delivery of services should be the responsibility of local communities with democratic involvement. Different services have different catchment areas and different arrangements must be made as a result.

  6. Services for the poor tend to be poor services. We want to see rich and powerful people using the same services as those who are not, so that we all have an incentive to ensure that the services are as good as they can be.

  7. Health and social care systems should be integrated around the people who need them with continuity between different providers linked by shared records. Competition between different service providers is usually an obstacle to this. Prevention should be incentivised above treatment and co-operation above competition.

  8. Danger of abuse in the Health Service is always at the point where private commercialism impinges. We recognise that the NHS has always been a mixture of public and private provision and that this balance generates conflicts of interest which needs to be managed carefully and transparently. Commercial providers may sometimes be able to offer new or better services, or to meet service pressures when there is pressure on capacity, but use of private services should be a local decision made democratically. We oppose any general requirement for the tendering of services. We are happy to see local community based organisations supported to provide services where they are best able to do so. Any provider of services which are publicly funded should be obliged to provide information about the delivery and costs just as public providers have to. Commercial confidentiality has no place in a publicly funded service.