This is a draft programme drawn up by the SHA. It remains under development and does not yet represent our final set of recommendations. However, it follows much work and consultation and we see this as a conversation with our members, the party and the public. We want and expect that such discussions will change aspects of this document and we welcome that debate. We shall be holding a workshop on Public Health which will feed in to this work.
We want to present conference with a challenging set of practical and theoretical ideas. They are summarised here, but there is further detail on our website.
Please respond by commenting below or contact us directly at Conference:
Alex Scott-Samuel; Brian Fisher; Jean Hardiman Smith; SHA Admin
INTRODUCTION
The SHA is committed to NHS care, free at the point of use and funded out of general taxation, provided by public bodies. We challenge austerity which we agree is a political choice not an economic necessity.
We recognise that the devolved nations make their own policies. These draft policies apply mainly to England.
This summary is divided into the following sections:
- A National Health and Care Service
- An end to privatisation
- Addressing the social determinants of health
- Social Care and Independence
- Primary and Community Care and The Myth of the Demographic Time Bomb
- Mental Health
- Democratic, Accountable and Transparent health care
- Brexit
A NATIONAL HEALTH AND CARE SERVICE (NHCS)
Bringing together our separate health and social care systems to become one unified care system driven by the political values and professional / organisational principles that underpin the NHS. This can be achieved by a gradual, non-disruptive process.
The political values needed are:
- a system with national standards;
- funded from progressive taxation;
- delivered by locally accountable bodies that rely on committed staff many of whom have professional training and professionally established responsibilities;
- evidence based; relies on the notion of “co-production” between service users and professional staff – people playing an active role in their care and professionals welcoming, respecting and responding to that role.
We call on Labour to fund the NHCS to enable a comprehensive service, reaching the upper quartile of EU average spend.
More details can be found here
AN END TO PRIVATISATION
We call on Labour to restore the duty of the Secretary of State to deliver a comprehensive, universal, publicly provided and managed NHS, meeting clinical need, free at the point of use and funded out of general taxation, provided by public bodies. This needs to be achieved with as little disruption as possible. The NHS Bill 2016-17 provides a model for legislation in the first weeks of a Labour Government. Legislation should include the relief of NHS bodies from PFI debt.
This has implications for what is currently called commissioning.
Commissioning outside the market is called planning, based on needs and assets assessment. Wales and Scotland offer excellent examples. Commissioning/planning must be separate from provision and free of any form of conflict of interest or undue influence. Planning functions must be democratically accountable and cannot be given to the private sector under any circumstances.
It also has implications for Trust status:
The NHS will no longer regard Foundation Trusts as free-standing competitive corporations. Foundation Trusts will be reintegrated into the NHS family.
New Models of Care
The NHS England Accountable Care System creates 44+ local health services to replace England’s NHS, bypassing Parliamentary debate. Accountable Care Systems will provide limited services on restricted budgets, worsening health indicators like the long term increase in life expectancy, stalled since 2010. These New Models of Care and the government’s NHS asset sell-off result directly from the 5 Year Forward View currently being implemented via ‘Sustainability and Transformation Partnerships’.
SHA supports the commitment to restore our NHS by reversing privatisation and halting Sustainability and Transformation Partnerships. We therefore call on the Party to reject the 5 Year Forward Viewin its totality. This demands more than amending the 2012 Health & Social Care Act; we must restore our fully-funded, comprehensive, universal, publicly-provided and owned NHS without user charges, as per the NHS Bill (2016-17).
More details can be found here.
ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH
Addressing the social determinants of health is the foundation for health and wellbeing. Access to clean water and safe waste disposal; social and affordable housing which provides enough space, affordable and efficient heating; clean air, indoors and outdoors; good education to achieve universal literacy and numeracy; jobs that protect health and ensure adequate income; and an environment which promotes healthy transport, green spaces and public amenities should all become elements in a holistic approach to public health. We support the child poverty abolition target for 2020.
This has implications for the public health service:
- Chief Medical Officers and District Directors of Public Health need to be professionally independent, reporting annually on the health and health inequalities of their populations and their recommendations on priorities.
- Communities and our relationships with them and between them and the statutory sector are key to health protection and resilience. The SHA is committed to creating the conditions whereby communities can increasingly share decisions with the statutory sector, thereby increasing confidence and health.
SOCIAL CARE AND INDEPENDENCE
Savage cuts have resulted in about 40% fewer people receiving social care now than in 2009, with severe cuts in other local support services. The human rights of disabled and older people have been ignored. The current system is out-of-date in its assumptions about what disabled and older people want and need and tends to reinforce negative images. Instead of respecting people as contributing citizens and family members, the system has adopted a wasteful consumerist ideology. Too often, in an over-pressurised service, patients and service users are not being treated with sufficient respect and dignity. This should include an end to the 15 minute social care packages.
We call for a new kind of social care, not more of the same.
The key principles for any future system of long term care must include:
- Universal coverage – The need for long-term care is part of the normal public sector services and should be treated just as health and education.
- Maximum risk-pooling – The most efficient way of insuring ourselves against the costs of impairment or frailty is to all pool resources in order to cover that risk, as with the NHS.
- Equity – The system should be equitable and should not discriminate against people because of condition, age or geography.
- Entitlement – All citizens should benefit from the system and should not be disadvantaged by income or ability to pay. The system should be funded from general taxation and be free at the point of use, as with the NHS.
- Control – All citizens should be able to get the right flexible support to meet their needs, to be able take the level of control that is right for them and their families.
The three key elements of the proposal are:
- Fund a universal system and end means-testing – Social care on the same footing as healthcare, funded from general taxation, with resources distributed on the basis of need.
- Invest in citizenship and community – Social care must offer support that people and families can shape to their circumstances, and that helps people contribute as citizens and strengthens family and community life.
- End privatisation and the complexity of the current system – Social care must be integrated into one national system that invests resources locally and ends the wasteful procurement systems that currently undermine human rights.
These principles are in line with current developments across OECD countries. More detail can be found here.
PRIMARY AND COMMUNITY CARE
The SHA is concerned that general practice under the Tories may go the way of dentistry and optometry. The SHA wants to eliminate the private sector except in exceptional and transient circumstances.
The SHA does not support GPs being responsible for planning although they must be centrally involved, alongside other key stakeholders.
The SHA wants to see improved access to primary care, with continuing personal care. This will require more clinicians and more and better use of IT. We sympathise with GPs’ frustration and agree that the government’s proposals for primary care are too little too late. We need a comprehensive new set of arrangements to support, incentivise and energise primary care.
Independent Contractor status:
There are advantages and disadvantages to the independent contractor status. The SHA recommends a trial of a mixed economy, where in some areas primary care is salaried and in others as it is now, evaluating comparative benefits and risks.
Planning Primary Care
Primary care must be planned and managed rather than just administered which is the present predominant model. We recommend primary care workforce planning and joint multi-disciplinary training.
Integration
We should have a large-scale trial with a fully integrated provider which covers delivery of all primary, secondary, mental health and social care free at the point of use, for a single County or City.
We also recommend Investment in treatment and prevention of mental health problems in children and young people, a long-term plan for health promotion, community-based home care treatment and prevention. More District Nurses and Health Visitors, better paid and supported are essential, with Informal carers to be fully supported. We support an increase for all carers’ benefits.
The Myth Of The Demographic Time-Bomb
The SHA rejects the concept that an ageing population results in unacceptably high costs. We are proud to have an increasing number of older people whom we value. Older people have falling mortality, less morbidity, and are more economically active than before. Some forms of disability are postponed to later years. Increased life expectancy means more years lived in good health.
Older people contribute almost £40 billion more to the UK economy annually than they receive in state pensions, welfare and health services. It is not age but nearness to death that accounts for health expenditure. Most acute medical care costs occur in the final months of life, the age at which these occur having little effect. According to this hypothesis health expenditure on older age groups is high because a larger percentage of people in those age cohorts die within a short period of time.
MENTAL HEALTH
Mental Health (MH) services are “overwhelmed” (NHS Providers July 2017, ref 1), with demand increasing by 5-10% over the last 3-4 years, and by 30-40% for children and young people, with delays accessing MH care, often with inadequate treatment, partly because of worsening shortages of MH staff.
The SHA recognises that societal factors impact on mental wellbeing and illness. These include social deprivation, debt, poor accommodation and security of tenure, community and family support networks. Socio-economic inequalities have independent impacts: being judged socially inferior has negative effects on physical and mental health, even for those illnesses with a genetic component.
We need to promote a social model of care rather the narrow medical model which is particularly unsuited to mental health and addiction services.
The SHA supports implementation of the ‘Five Year Forward View for Mental Health’ (Feb 2017), including parity of funding for prevention and treatment, research into treatments and alternatives to medication, with funding for related social care. We support the Manifesto’s ring fenced mental health budget.
We also recommend:
- A National Service Framework for Mental Health provision, with an emphasis on talking therapies and advocacy.
- Enhanced MH services for children and young people, including school-based prevention with more school nurses and health visitors, ready access to CAMHS and better and more inpatient provision.
- A strategy for reduction of excess mortality rates for people with serious mental illness including suicide prevention strategies, with improved provision for acute MH emergencies including supporting friends and families.
- Reducing stigma with more information about mental illness / how to self help / early intervention.
DEMOCRATIC, ACCOUNTABLE AND TRANSPARENT HEALTHCARE
The SHA recommends a commitment to responding not only to needs as defined by clinicians, but needs as defined by users, carers and citizens. We see the process as a meeting of experts: the NHS offers its clinical expertise, while the patient is an expert on their own strengths and the impact of ill-health.
Working with NHS users applies at a macro level (planning local and national NHS services in collaboration with citizens and users) and at an individual level in the consultation between patient and clinician with shared decision-making.
The community can, with help, identify key issues that matter to them and work with the statutory sector to address those issues – this process protects health. Community development is one key mechanism.
Ensure a totally independent patient and public led and adequately funded Community Health Council type system.
BREXIT AND THE NHS AND CARE SERVICE
The NHS and social care are dependent on overseas labour. We would like to see recruitment and employment of staff from the EU and other countries allowed. We want Labour’s policy on Brexit to focus on the economy and free movement.
EU law includes measures to achieve equivalence of labour, health and safety standards in its trade agreements with countries such as Vietnam and Peru. The European Court of Justice has consistently emphasised a high level of human health in its judgements and it is notable that in its negotiating position on the Transatlantic Trade and Investment Partnership, the European Union was arguing for a judicial model of dispute resolution. There is a real danger that these protections will be lost through Brexit. Indeed, the main justification for many of those advocating Brexit is to remove these protections.
Acknowledgements
Thanks to all members of the SHA Policy Commission and many other members of the SHA who have worked so hard to put this document together. We look forward to continued discussion and change.