Organisation Of Health And Care Services

NHS reorganisation SHA policy

This is a discussion document not agreed policy.

A Health and Care Service

  • The bringing together of our separate health and social care systems so that they become one unified care system driven by the political values and professional / organisational principles that underpin the NHS.
  • Organising resources to meet the medical and social needs of people so that organisational and professional barriers that might hinder the giving of care are kept to a minimum (or even removed totally). It sees the need for care as sitting within the wider social context which individuals and families inhabit.


  • We support an NHS which is integrated, sensitive to patients’ needs and democratically accountable; founded on values of professionalism, cooperation and partnership not on marketisation: financially driven competition.
  • The NHS should be defined as a single national system set up on the basis of social solidarity and all relationships between commissions and NHS providers should be within the NHS and not the subject of legally enforceable contracts but be subject to best value. While there are no contracts there can be no intervention through competition law
  • Labour will restore the duty of the Secretary of State to deliver a comprehensive, universal NHS publicly provided and managed and will give the Secretary of State the power to give directions to any part of the NHS
  • The private sector will only be allowed to offer patient services as an alternative to the NHS by exception, in rare and clearly defined circumstances, for example:
    • with convincing evidence of necessary enhanced care
    • where these offer vital, novel services otherwise as yet unavailable,
    • as a temporary remedy for persisting inadequate standards,
    • or to meet peak service pressures when NHS capacity is not immediately available.
  • All providers to the NHS, including the private sector, must waive any rights to commercial confidentiality and must comply fully with all requirements for provision of information and be covered by NHS complaints procedures including the Ombudsman and regulation.
  • Any private providers should not be subsidised either directly or indirectly, and no NHS funds should be spent on any form of market development as this is a form of subsidy
  • The NHS will no longer pretend that Foundation Trusts are free-standing competitive corporations.


  • Austerity must end and funding increase to at least the EU average.
  • Health, and eventually social care, should be free at the point of need and funded out of general taxation and should be provided by public bodies.

Private practice:

  • We see no place for private practice. That is, people paying clinicians for care and paying for facilities such as private hospital beds.


  • Labour will remove any legal or other barriers which prevent or deter cooperation. We shall create structures that facilitate and promote co-operation and partnership  
  • The SHA supports continuing development of the many non-market mechanisms

Planning/commissioning. Limit vested interests as much as possible

  • The SHA wants to exclude tendering and the private sector, except in very limited circumstances. Commissioning outside the market is called planning.
  • Commissioning/planning functions have to be done somewhere based on needs and assets assessment. 
  • Planning functions must be democratically accountable.
  • Commissioning/planning must be separate from provision and free of any form of conflict of interest such as undue influence by the dominant NHS acute providers.
  • Commissioning responsibility cannot be given to the private sector under any circumstances. Decisions about services and funding must be made through open and transparent democratically accountable processes.
  • Planning, rather than the market, is the basis of the healthcare system in Wales. Health boards, NHS trusts and their partners are required to work together to secure and deliver services for their populations, collaborating with partners at various levels to assess population need and to plan and deliver services, through the local health board, public services boards and 64 primary care clusters. They are expected to have a long-term view and to be clear about the actions they will take in the more immediate future to deliver high quality, accessible and sustainable services within the national policy context. NHS organisations are expected to collaborate in addressing strategic delivery issues that impact on the delivery of services for patients, and are encouraged to explore strategic alliances to resolve consistent challenges. Plans should make clear where issues are beyond the scope of an individual organisation, and should clearly set out an agreed response at an all-Wales, and / or regional and sub regional level. The collaborative arrangements across Wales should support the alignment of actions within individual organisational plans.

Cross-sector planning

The SHA regards it essential to include sectors like housing, education, air pollution, and the fire service which affect health but are not conventionally involved with NHS. good housing and planning are multipliers of health & well-being and significantly assist in improving the environment for people with particular needs, such as the homeless, those with learning difficulties and those with mental illness. Coordinated action with housing could challenge the national housing shortage, could improve hospital discharge and help with the knee-jerk reaction to austerity of many hospitals in selling off land inappropriately.

An example of cross-sector working is the Shepherd Cardiff work where linking data from A+E with policing interventions reduced crime and knife injuries. 

New Models of Care in England

The SHA is open to considering alternative models of organising the relationships between primary and secondary care. But the plans in the FYFV do not represent useful or effective alternative options. In the current climate of austerity, these are luxuries that distract from the real issues of underfunding. We do, however, support the current New Models of Care in respect of care homes where much improvement is needed.

The SHA does not wish to see Accountable Care Organisations. They do not appear to be accountable. It is not clear how they will improve care. They are a precursor to an insurance-based system.

Integration of Health and Social Care

  • Social care, physical and mental health services must work together in the patient’s interest, offering “integrated care”.
  • Tier 1 Local Authorities should have responsibility for the integrated commissioning of all care at least at the strategic level.
  • The SHA is aware of the risk that integration of care could, under a Tory government, lead to an NHS with co-payments, just like social care. The SHA wishes to see social care nationalized, free at the point of use, and would welcome a transitional approach which would take us there over time.
  • In the interim, we advocate close working, shared data with the patient’s consent.
  • Please also see our thinking about social care in section…….


The SHA observes that STPs are being forced as their prime purpose to focus on living within the financial constraints of austerity, almost to the exclusion of anything else. In addition, the financial plans of many of the STPs that we have seen appear to be based on poor evidence and flaky accounting.

The SHA also sees that any reorganisation of services in England, local or national, is likely to have to follow the tendering and privatisation demands of the HASCA. We see this is a real and present danger to the integrity and effectiveness of the NHS. We see a risk in the size of the footprints.

On the other hand, if STPs were to be removed from the demands of austerity, there is merit in bringing sectors together to jointly solve problems.


The “market” approach is fragmenting provision and creating a hugely complex web of organisations linked by legal contracts, adding significantly to transaction costs. We should introduce incentives for joint appointments, joint budgets, collocation, information sharing, and shared services across the NHS and local authorities. An integrated plan for commissioning across all public services.

We should have a large scale trial with a fully integrated provider which covers delivery of all primary, secondary, mental health and social care, for a single County or City.