National Policy Forum document on Health July 2005

This is a draft document and does not represent government or Labour Party policy

Challenges in health: keeping our NHS free to all, personal to each

Better, faster healthcare

As a direct result of long-term Tory neglect, over the next few years a core challenge for the NHS will remain one of capacity. That’s why Labour will continue to build capacity, especially in primary care, and why since 1997 the Labour government has so far given the go-ahead for 68 major new hospital schemes (24 of which are now fully operational), the UK’s biggest-ever hospital building programme. By building new hospitals and modernising primary care facilities, the NHS will be in a better position to improve treatment and reduce waiting times further.

Improving public health

For over 50 years, although health generally has improved, the health gap between the better off and the least well off has widened in some communities, not narrowed. Labour exists to create a society based on fairness and on justice, in which each citizen gets the opportunity to fulfil the potential of their talents. It is simply unacceptable to us that the opportunity for a long and healthy life today is still linked to social circumstances, childhood poverty, where you live, how much your parents earned, how much you earn yourself, your race and your gender. Many more people are now making healthier choices when it comes to smoking, drinking, sexual health, eating and exercising sensibly. But there is still much further to go.

Shifting the emphasis from secondary to primary care

We are not relying simply on building more hospitals. We are also ensuring that, wherever appropriate, healthcare takes place not in the hospital (secondary care) but out in the local community (primary care). We have now passed the halfway point of the ten-year NHS Plan (July 2000), part of the focus of which is shifting much of the emphasis from the national to the local to make the system more responsive and patient-centred. Making clear improvements to primary care services will help us to work with people not only to treat ill health but also to prevent it.

Community and social care

Social services are one of the major public services. Services that interface smoothly with the NHS and other services create an altogether better patient experience. Putting the patient first is as relevant to our agenda for modernising social services as it is to our programme for personalising the National Health Service. If patients are to receive the best care, then the old divisions between health and social care need to be overcome. Despite the best efforts of dedicated and professional staff, the NHS and social services have not always worked effectively together as partners in care, so denying patients access to seamless services that are tailored to their particular needs.

Mental health services

Mental health is a top clinical priority for Labour. But for years, mental health services were the Cinderella of the NHS, despite the fact that millions of people – perhaps as many as one in four of the population – face a problem at some point in their lives. This situation has been exacerbated by a system too focused on acute cases. Each year, 600,000 adults with serious mental health problems are cared for by specialist mental health services. Thousands more young people and tens of thousands of elderly people also receive care. Mental health services in England are experiencing a period of unprecedented change. It is our job not only to manage this change effectively, but to do so in a manner that is in the best interests of patients.

Ethical International recruitment

Our efforts to recruit more doctors and nurses should be fair and ethical and should not imperil the health systems of other less developed countries. Labour will introduce measures to ensure that the same standards of ethical recruitment apply to all NHS bodies and to independent sector organisations working for the NHS. We will use the UK’s role in various international bodies to raise the issue of ethical recruitment of health workers from developing countries.

Harnessing the genetics revolution

When we look to the future, eager to harness the great potential benefits of technology and the genetics revolution, we must do so by taking an informed and consenting public with us. It is the government’s job to help prepare Britain to reap the benefits of genetic advances. But that can only be achieved if scientific breakthroughs are matched by public support and understanding. It can only happen if we are open and honest about the potential and the pitfalls which the genetics revolution presents.

Health: taking Britain forward to personalised healthcare for all of us, not back to two-tier healthcare

Better, faster healthcare

Labour promised to revive the National Health Service, and we have done so. We now promise to make the NHS safe for a generation. We are investing and reforming to increase capacity, to speed up and improve treatment and care and to empower patients by giving them more choice. Today’s health service is putting the patient at its centre.

Lower waits

The National Policy Forum’s final report to Conference 2004 acknowledged the very real progress that has already been made in bringing down waits but looked forward to an even greater determination by government to bear down on both waiting times and lists.

In our April 2005 campaign policy document, NHS waiting times, forward not back and again in the manifesto – we set out in greater detail our commitment to reduce waits in the NHS. We said then that we would deliver the shortest waiting times for hospital treatment the NHS has ever seen. When we came to office in 1997, many NHS patients were waiting up to 18 months – after an outpatient appointment – for a hospital operation. Since then we have halved that maximum waiting time. Now we have pledged to reduce the overall wait – from GP referral to hospital treatment – to a guaranteed maximum of just 18 weeks by 2008. This formed the centrepiece of our health offer to the electorate. We also pledged faster test results for cervical smears and said we would go even further in improving cancer waiting times.

An end to the two-tier workforce

An issue of longstanding debate and discussion within the party, the trade unions and the National Policy Forum has been the so-called two-tier workforce which can result in poorer pay and conditions for some health related workers such as hospital cleaners who find their jobs contracted out. The NPF report was explicit on this point, and made clear the importance of ensuring that reform does not happen at the expense of the workforce. In local government Labour has already acted to deal with the “two-tier” workforces and the report said we would now be addressing the two-tier issue more widely in the public sector. Government, it said, would work with employers and trade union organisations to discuss the details of the implementation in line with the Best Value code of practice.

In March 2005, the Prime Minister fulfilled the commitments made in the NPF report and that he himself made in the autumn of 2004 by announcing a major extension of the Code of Practice on Workforce Matters which at the time operated in local government. With immediate effect the code was extended to the wider public sector – including the civil service, NHS and maintained schools.

The code prevents the emergence of a two-tier workforce in cases where public sector employees are contracted out to a service provider, ensuring that new recruits receive comparable treatment to the transferred staff.

Better, fairer access to NHS dentists

The National Policy Forum report made clear that labour recognises there are areas of the country where there are problems accessing an NHS dentist. labour has already taken steps to tackle this problem.

We are investing £368 million in dental services in England, recruiting 1,000 more dentists by October 2005 and funding new training places for dental students. We have also opened 53 Dental Access Centres to provide services to people experiencing problems obtaining NHS dental treatment.

In July 2005, the Department of Health published a consultation on new dental charges for NHS patients. The aim of the new system is to make charges for NHS dental care fairer, simpler and clearer. The maximum cost of NHS dental treatment will be more than halved from £384 to £183 and children, new mothers and those on low incomes will remain exempt from all charges. The number of charges will be reduced from 400 to three simple price bands. Patients will in future know exactly how much they are being charged for NHS dental care and what treatment they will get for their money.

Alongside these proposals, the Government also published the outline of a new contract for NHS dentists. This will encourage the promotion of good oral health and pay dentists for the overall service they provide to patients, helping to take dentists ‘off the treadmill’ of providing care on a fee for service basis, which is one of the main cause of dissatisfaction amongst NHS dentists.

More patient choice

One principle underpins our reforms: putting patients centre stage. Extending patient power and choice is crucial to achieving this and we shall embed both throughout the NHS. The NPF report noted that, in health, increased capacity and personal empowerment are the keys to world class services and during the campaign we gave more details on this. As part of our drive to build up capacity, to increase productivity and encourage innovation in the NHS we shall be developing more areas for the exercise of patient choice, together with more contestability and diversity of supply.

In addition to the 100 major new hospital schemes we have promised by 2010, the manifesto announced a new generation of modern community hospitals. These will, over the next five years, help create an even greater range of provision and further improve convenience for patients. These state-of-the-art centres will provide diagnostics, day surgery and outpatients facilities closer to where people live and work.

At a campaign press conference, the Prime Minister and Health Secretary gave more details and announced that, through an initial £100 million investment, 50 of these new, state of the art community hospitals will be established.

The manifesto set out our plans to further empower patients so that, for instance:

  • by the end of 2008, patients will be able to choose from any hospital that can provide their operation to NHS medical and financial standards
  • by 2009 all women will have a choice over where and how they have their baby and what pain relief to use
  • the investment going into palliative care services will be doubled, giving more cancer patients the choice to be treated at home
  • more information will be provided to patients including the performance of doctors and hospitals.

Cleaner hospitals

An issue of concern to party members throughout the last round of Partnership in Power and to the wider public throughout the Big Conversation process was hospital cleanliness and reducing the spread of infection. Indeed, the final National Policy Forum report noted the unprecedented public concern over hospital acquired infections in general and MRSA in particular. It went on to say that we need to ensure that adequate provision and financing is made for cleaning services and that, specifically, contracting-out of services does not become a vehicle for substituting cheapness for cleanliness.

The Department of Health has since taken a number of crucial steps to address the problem of hospital acquired infection rates. In November 2004, the Health Secretary set a tough new target to reduce by half MRSA bloodstream infection rates in our hospitals by 2008. In December, the Department issued new cleaning contract guidance to help ensure hospitals have clear and binding contracts to deliver high and improving cleaning standards. It set out clearly how often different areas of a hospital should be cleaned and what level of cleanliness is required.

The annual mandatory surveillance figures released in March 2005 showed that the new measures, in compact with those that have been put in place by Labour over the last few years, are having an encouraging effect. There is a long way to go but the government is taking action, and latest figures published in March 2005 show MRSA infection rates are now coming down.

To entrench the progress we have made so far and to move forward to ever lower rates of infection, the manifesto pledged to consult on new laws to enforce higher hygiene standards in hospitals. The first Queen’s Speech of the new Parliament announced the Health Improvement and Protection Bill to, among other things, introduce a new hygiene Code of Practice for all NHS bodies, independent healthcare providers and care homes, subject all health and social care bodies to improved inspection arrangements, and to establish a new range of sanctions for bodies which fail to meet hygiene standards. Consultation has just started on the key provisions of this bill.

Improving public health.

The NPF report acknowledged the need for us to now take bolder steps to improve the health of Britain and so guard against the demands that an increasingly unhealthy population could put on the health service. Many of the issues discussed also arose from Big Conversation events and submissions. One common theme was that although people wanted government to take action they were also clear that government alone could not solve our public health problems and that a greater degree of personal responsibility needed to be a part of whatever plans emerged.

Exposure to second-hand smoke

One of the most positive contributions to improving public health in Britain would be to reduce the amount of tobacco smoked and to reduce the number of people who smoke tobacco products. One of the clearest messages from the National Policy Forum was that party members wanted to see further radical action by government to reduce people’s exposure to second-hand smoke and to do this by restricting smoking in public places.

The Public Health White Paper, Choosing Health, published in November 2004, proposed the most far-reaching restrictions on smoking yet seen in Britain. It committed us to banning smoking in all government departments by 2006, and by 2008 to ending smoking in all enclosed public places and workplaces, the majority of pubs and all restaurants. This commitment was repeated in the manifesto (along with a pledge to expand NHS stop-smoking services), and it will be translated into legislation after appropriate consultation by the Department of Health on the practicalities of implementation.

This Bill will help reduce the harmful effects of second hand smoke, saving thousands of lives in England by reducing deaths from cancer, heart disease and all other diseases caused by smoking. It will also provide smokers who are trying to quit with an environment where it is easier to do so.

In June 2005 the Department of Health published a consultation on how the bill would work in practice. The legislation, which will be introduced in the autumn, will bring into effect proposals which mean that 99 per cent of workplaces will be smoke free by the end of 2008.

Childhood nutrition and tackling obesity

The current public health debate has not been limited to restrictions on smoking. In the context of a growing realisation of the need to reduce obesity levels, many people now recognise that to stand a better chance of a happy and healthy adult life, much more needs to be done to protect and improve the health of our children. The NPF report reflected the concerns of party members and the wider public by including a section on Healthy Schools and Lives. This discussed the importance of children’s nutrition both inside and outside school, and various suggestions for enhancing it.

Our campaign policy document, Children forward not back, launched in March 2005, gave firmer commitments. It said that we would work to achieve a ‘step change’ in the quality of school meals, introducing a variety of measures including a new vocational qualification for school caterers and new minimum health specifications for processed. The document also pledged a new School Food Trust to help empower parents to work with schools to raise standards. And we said we would further improve kitchens.

Furthermore, we are setting a national target that by 2010 we will have halted the year-on-year increase in obesity among under-11s, in the context of a broader strategy to tackle obesity in the population as a whole. This is on top of our existing teaching as part of the National Curriculum and support provided through our healthy schools programme.

Labour in government said we would work with Ofcom to tighten the rules on broadcast advertising, and sponsorship and promotion of food and drink.

All these commitments were repeated in the manifesto, where we also said Labour would invest an extra £210 million for school meals, so that at least 50p per meal is spent in primary schools, rising to at least 60p per meal in secondary schools. The manifesto contained a pledge to ban certain products that are high in fat and salt content from school meals and ensure that fresh fruit and vegetables are part of every school meal. And we said we would bring in simple labelling so shoppers can see the health benefits of individual foods, and would restrict further the advertising and promotion to children of fatty, salty and sugary food and drink.

All the public health measures mentioned above are designed to work with people at the personal level to improve their health – it is not enough for us as the party of social justice to concentrate solely on reforming and improving our national health institutions, vital though that is. We must redouble our efforts in a third term to reduce the stubborn health inequalities that do so much to undermine the quality of people’s lives in communities throughout Britain. To that end, the manifesto pledged that we would also establish health trainers around the country who will by 2010 have helped to cut the health inequalities that exist between rich and poor.

Shifting the emphasis from secondary to primary care

Refocusing health services around the patient rather than the provider requires us where possible to base care and treatment outside of hospitals and in people’s communities.

The National Policy Forum’s final report emphasised the importance of increasing the amount of activity taking place in primary and community settings through renewing GP surgeries, new NHS Walk-in Centres and the introduction of 3,000 new community matrons to assist those living with long-term conditions.

An April campaign press conference announced more details of our plans to modernise further the services provided by GPs. We said we would enable family doctors to develop services at the centre of their community, particularly in areas where there is currently limited GP availability. Go-getting GPs will be able to add a range of services to their current work including some outpatient services, diagnostics like tests and scans, and certain clinical assessments. These could include asthma and diabetes clinics, out-of-hours services, and services such as physiotherapy, chiropody, and speech and language therapy.

The manifesto contained more on the measures we will take to bolster and expand the primary care sector. Following on from the mid-campaign announcement, the manifesto committed us to developing practice-based commissioning, and so ensuring that family doctors have more power over their budgets. In addition, more GPs will be delivering more advanced services more locally; specialised diagnostic and testing services; comprehensive out-of-hours services; high-street drop-in centres for chiropody, physiotherapy and check-ups.

We said that we would develop the new freedom for GPs to expand provision and, where GPs’ lists are full, we will expand provision by encouraging entrepreneurial GPs and other providers to expand into that location.

The next step for the Department of Health will be to launch a major public engagement exercise involving patients, the public and staff to help us design the future of health care services outside hospitals and this will lead to a white paper.

Community and social care

The NPF report identified various steps that needed to be taken in order to improve social care provision. These included overcoming the old divisions between health and social care, creating services that are person-centred, seamless and pro-active, and the creation of choices for patients that create independence not dependence.

In March 2005 the Department of Health set out the government’s vision for the future of social care for adults when it published its green paper, Independence, wellbeing and choice. It sought responses from the public on a number of issues including on how more control, more choice and high-quality support can be offered for those who use care services. Key proposals included the piloting of individual care budgets to stimulate the development of modern services delivered in the way people want, and a greater focus on preventative services to allow for early targeted interventions.

The manifesto built on this work and reiterated that we will develop personalised budgets in social care. It also echoed the wording agreed by the NPF that emphasised the importance of avoiding the creation of a culture of dependence, saying we will promote the integration of health and social care at the local level, so that older people and those with long-term conditions can retain their independence. A key part of our plans to assist those with severe or long-term conditions is to create 3,000 new community matrons, and this pledge was also repeated as a manifesto commitment.

Mental health services

The National Policy Forum report identified as a problem the long-term neglect of our mental health services and it is this neglect that the Labour Government is addressing.

The National Service Framework for mental health has generated a huge amount of activity since it was introduced five years ago and, in his progress report published in December 2004, the National Director for Mental Health said that an impressive range of mental health policy initiatives have been triggered in an area of health care that was previously neglected. Services have become increasingly responsive to the needs and wishes of the people who use them.

There has been a record of progress and achievement. Specialist community mental health teams have been set up across the country, offering home treatment, early intervention or intensive support for people with complex needs. Staff numbers have substantially increased. Modern treatments are in widespread use. Most users of services report that their experience of mental health care has been positive. Suicide rates are at their lowest recorded level.

Of course more is needed and some changes – improvements in the experience of patients from ethnic minorities, for instance – are needed urgently. Moving forward, services will increasingly focus on patient choice, the care of long-term conditions and improved access to services. We need to broaden our focus from specialist mental health services to the mental health needs of the community as a whole.

Ethical International recruitment

The National Policy Forum’s final report was very clear that, although Labour’s efforts to increase the number of nurses and doctors working in the NHS, recruitment from overseas should not be carried out in an unethical way which may adversely affect the healthcare systems of developing countries by draining them of domestic medical expertise.

This is an issue which Labour takes extremely seriously and the government has taken steps in recent years to stop the unethical poaching of staff from abroad. Following the agreement of the NPF’s final report and its subsequent adoption by Labour’s Annual Conference, in December 2004 the Department of Health issued a strengthened code of practice preventing hospitals from actively recruiting nurses and other healthcare professionals from developing countries. Crucially the code also applies to the independent sector following the pledge by the Independent Healthcare Forum – the representative organisation of UK independent healthcare providers – to sign up.

The UK now leads the way in terms of ethical recruitment practices, being the first country to produce guidance on international recruitment based on ethical principles, the first to develop a robust code of practice for employers and the only country to publish an approved list of agencies.

Harnessing the genetics revolution

Genetics, the National Policy Forum report said, is changing the world in which we live, offering the potential for new treatments and a means of predicting and preventing ill health. The report drew several conclusions. Firstly, that there are great potential benefits to be reaped from the technological and genetic revolutions taking place. Secondly and crucially, it is Labour’s conviction, because of our central belief in fairness for all, that the National Health Service is best place to harness these advances. The values on which the NHS is based – providing care on the basis of need rather than ability to pay – are a protection against the inequalities of an insurance-based health system. If you have to rely on private insurance, those with genes that could predict bad health will either get no health insurance or it will be very expensive. But with the NHS, people will be able to take genetic tests free from fear that, should they test positive, they face an enormous bill for insurance or treatment, or become priced out of care or cover.

Thirdly, in order to take the British people with us in looking to a future where genetics play an increasingly important role we must at every stage work hard to retain their confidence and consent. Finally, this will be an ongoing challenge for government – as new developments appear, so new efforts will have to be made to ensure we move forward on the basis of consensus.

As part of this attempt to foster public confidence in the system, in March 2005 the Health Secretary announced that genetic test results used to predict possible future illness will not be used to deny people insurance. Labour has negotiated an agreement with the Association of British Insurers (ABI) to extend the current restrictions on the use of predictive genetic tests result by insurers to November 2011.

Evidence of the positive benefits of genetics technology and of the leading position of the UK on gene therapy trials in Europe was highlighted with the publication of the Gene Therapy Advisory Committee’s report in April. The report showed that 40 per cent of European gene therapy clinical trials, the majority focusing on cancer, are being carried out in Britain.

Making a difference…

Labour has an election winning programme for government. Together we must put this programme into action and ensure our local communities are involved as we develop our policies. Government alone cannot do this. Building a consensus for change takes the whole party and effective implementation of our policies requires the effort of us all.

Already Labour works at every level to improve the lives of hardworking families but as we go forward we must take shared responsibility for delivering our manifesto.

Below are some indicative ideas which help show how this could be done.

… in health

Engaging local communities.

Policies which are created in a vacuum run the risk of being underdeveloped and out of touch. Conversely, those policies which have been subjected to extensive consultation are far more likely to succeed in their objectives, if only because potential pitfalls can be ironed out. Local Labour Party members are well-placed to lead local public debates and to take the process of engagement on health policy forward and out into their communities. They are already quite used to organising forums and meetings of various kinds and might call open meetings or set up public debates to discuss forthcoming policy proposals with comparative ease. These forums could take the format of Big Conversation style events and would provide ideal opportunities to discuss, for instance, the upcoming health White Paper on improving primary care services, to feed back’ findings to the party and to government and it would also have the benefit of linking in the public’s mind the Labour Government and improving health.

Local health networks

A similar type of discussion and consultation forum could be established using virtual means. To make the job of communicating with key stakeholder audiences easier and to bring together people with similar interests in health policy and care, local health networks could be formed, using emaillists and simple yet interactive websites. Networks could comprise any interested members of the public or they could involve solely those working as health professionals or even patients.

Not only could these networks contribute to the formulation of forthcoming Labour policy but could also put forward ideas for making their local communities healthier to local authorities, voluntary sector and non-governmental organisations. Health professionals’ networks might also identify problems and propose solutions to issues of concern in the healthcare related workplace. Patients’ networks would provide another important contribution to any debate but from the more personal angle of the service user.