National Policy Forum Interim Document February 2003

Membership 2002/03

Government: Rt Hon John Reid MP (Co-convenor)*, Rt Hon John Hutton MP, Melanie Johnson MP

National Executive Committee: Margaret Wall (Co-convenor), Nancy Coull, Shahid Malik

National Policy Forum: George Brumwell, Sandra Samuels, Sue Stirling, Lesley Hinds

*John Reid replaces Alan Milburn upon his resignation in June 2003.

Policy development

Commission members met regularly after Annual Conference 2002 to draft their second-year consultation document, Improving health and social care. In writing the document members read through and weighed up the broad thrust of the more than 400 submissions they received in response to their first-year document. We also had extensive group discussions with the National Policy Forum in February. When there was consensus on issues of substance, this then informed the document’s shape.

The new document, now open for consultation until mid-November 2003, looks forward to after the next general election and sets out some of the main challenges for Labour, if we win a third term, in improving the National Health Service as well as the health of the people who use it. It reaffirms Labour’s belief in the fundamental principles of the NHS – that care should be high quality, free at the point of use, available to all, irrespective of ability to pay. In particular the document addresses the challenges of:

  • Cutting smoking still further
  • Recruiting more staff into the NHS and, when from overseas, doing this in a fair and ethical way
  • Getting the right balance between local autonomy for health services and national standards to maintain the quality of those services
  • Reminding patients of their responsibilities to the health service
  • Taking the confidence of the public with us in the genetics revolution

After the document’s publication in May, one of its proposals received particular media scrutiny. As outlined above, the document said one of the future challenges for the NHS would be reminding patients of their own rights and responsibilities in accessing the health service. It suggested a number of policy responses for discussion including the drawing up of agreements between doctors and patients so that each would know what they could expect from the other.

Commission members were dismayed that much of the media comment on this proposal was inaccurate. Some stories claimed that it is Labour’s intention to use doctor-patient “contracts” to deny free NHS care to, for example, smokers who refuse to quit. This is, of course, untrue.

Commission co-convenor Margaret Wall reiterated this point and defended the document in the Observer newspaper saying that it is only right that it should examine new and innovative policy ideas. Its purpose is to kick-start a debate o the health service about one of Labour’s underpinning philosophies of rights and responsibilities. As the NHS gets better, the issue of the patient’s responsibilities in using this free yet finite service becomes starker.

Dialogue on current issues

NHS Foundation Trusts

Most of the submissions the commission received this year were related to the first-year consultation document. The most significant of these highlighted concerns about the creation of new NHS Foundation Trusts, raised in the first-year document under the issue of increased autonomy for hospitals. Submissions revealed worries on several points and a discussion held at Joint Policy Committee level raised issues including whether the policy meant privatisation the NHS, whether Foundation Trusts would have unfair financial advantages over other NHS hospitals, and whether their creation would see the emergence of a two-tier health service.

During discussions with members and others about Foundation Trusts the commission was asked to clarify exactly what they would be. When everything is run from the Health Secretary’s desk in Whitehall it can appear that everything is the same and therefore “fair” but the inconsistency of service provision between one place and another is not acceptable. Foundation Trusts will provide us with the opportunity to address those specific needs.

They are based upon a recognition that a centrally-run, one-size-fits-all approach is no longer the most appropriate way to get the best out of a National Health Service that employs over a million people. Foundation Trusts recognise that frontline health staff and local communities have a unique viewpoint from which to determine local service need. It is for that reason that Labour wants to decentralise the health service, removing central control over local hospitals an creating a new form of local mutual public ownership. And because patients expect and deserve a minimum level of service the government intends to do this within a framework of national standards. It aims to reduce variations in service quality and has said it must be mindful of any perverse effects that could be created locally without adequate oversight. Organisations like NICE and CHAI are establishing, monitoring and delivering standards within the health service.

Foundation hospitals will be NHS hospitals fully part of the NHS but with greater freedom to run their own affairs. Sustained improvement in the NHS can only happen when staff have more control and local communities have a greater over how hospitals are run.

Party members have consistently made clear their keenness for policy commissions to widen their field of contacts with external organisations and parties and with this in mind the Health commission has set about bringing i some outside groups to enrich the quality of its work. At the commission’s June meeting representatives from the Co-operative Party gave their party’s view of the future of mutualism and the NHS and therefore why it was backing the development of Foundation Trusts.

They too believe that the new Trusts will be true to Labour’s traditions of mutualism and co-operation to get local hospitals better focussed on meeting local needs. They will give patients, staff and community groups a constitutional role in the governance of their local hospital. This is the reason why the Cooperative Party backs the creation of Foundation Trusts.

The Private Finance Initiative and the NHS

The commission is aware that there remains an ongoing debate on PFI and that concerns continue to be reflected in submissions received. The May meeting of the commission heard from the IPPR’s Paul Maltby who led commission members’ discussions on the Private Finance Initiative and the NHS. The commission raised concerns over issues such as the involvement of the private sector in the building of NHS hospitals; whether the PFI constituted best value money; and the need to protect NHS staff and their working conditions to guard against the emergence of a two-tier workforce. The government has said all along that PFI should not be delivered at the expense of the pay and conditions of the staff employed in these schemes and, since the 2001 election, has been working hard with unions, NHS Trusts and the private sector to design a solution that achieves this.

The government is committed to the PFI because it helps increase investment tackle the multi-billion pound backlog of underinvestment and neglect in public services which has built up over many years under the Conservatives. It helps manage this increased investment efficiently, and makes the money Labour is investing go further.

Other submissions

The following is a list of issues about which the Health policy commission has received submissions during the year 2002/03.

Many of the submissions have been in response to the commission’s consultation document. All of the submissions have received an acknowledgement letter and a copy of Forum, the Partnership in Power newsletter. The newsletter allows members to keep track of the key debates and issues.

  • Ambulance Trusts
  • Carers
  • Community Health Councils
  • GPs
  • HSE resources
  • Long term care
  • Mental Health Service
  • New consultants contract
  • NHS staff
  • Private provision in the NHS
  • Smoking
  • Tobacco
  • Toxoplasmosis

National Policy Forum Interim Document February 2003


Labour is the party of equality and social justice. It is not enough for us to focus on improving the state of our health service, vital though that is. Our goal must be to work with people to improve their health. The task in hand is one of prevention as well as cure, and we must deliver this for whole of the nation, not just the few.

For over 50 years, the health gap between the better off and the worst off has widened, 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 his or her 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.

And if we are successful at reducing health inequalities within and between our communities, improving the lot of the most vulnerable in Britain, it also means we can achieve more from our finite resources. But improving the nation’s health needs a joined up approach across government. It needs a commitment from the whole government. A commitment to end child poverty, to work towards full employment and to provide decent homes for all.

Labour faces some big challenges in continuing to improve both the health service itself and the health of the people who depend on it. We must find a way to cut smoking further because it kills 120,000 people each year. We must ensure that our strident efforts to recruit more doctors and nurses into the NHS are fair and ethical and do not imperil the health systems of other, less developed countries. We must enlist patients in sharing responsibility for their own care, clearly explaining the necessity of the reciprocal nature of their relationship with the NHS, possibly by drawing up formal contracts between doctors and patients. And 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.


1. Cutting smoking – the leading cause of preventable death We know that smoking is our single greatest cause of preventable illness and early death, with 120,000 deaths a year. Currently about 13 million adults in this country smoke – 70 per cent of whom say they want to quit. Passive smoking kills hundreds every year and causes misery for many. Smoking costs the NHS almost £2 billion each year. It is a public health disaster, it kills, and we are determined to defeat it.

Smoking widens health inequalities and hits poorer people harder. Quite simply this is an affront to Labour values. Labour has already taken action to reduce smoking:

  • We negotiated an EU-wide ban on tobacco advertising.
  • ·In the UK tobacco advertising on billboards and in press and magazines is now banned across the UK.
  • Our tobacco strategy seeks to reduce the number of under-:16s who smoke, help adults – especially the disadvantaged – to stop smoking and give special support for pregnant women.
  • We made it illegal to promote tobacco to children and toughened enforcement on under age sales.

But we will do more:

  • We will require the tobacco industry to come clean on the additives they put in cigarettes.
  • From autumn 2003 the front and back of all cigarette packets will, by law, have to include graphic new health warnings.
  • The misleading double-speak on cigarette packets, such as “mild” and “light”, designed to pretend some kinds of smoking can be safe, will be banned altogether.

We all accept that reducing smoking – both the number of people who smoke and the amount of tobacco smoked by those who choose not to quit smoking – is essential to improving the health of the nation. But it is not the role of government to ban individuals from exercising their freedom of choice to smoke if that is their decision. It is the job of government to educate and to properly inform people as to the risks of smoking. Our challenge then is to take every reasonable step to discourage smokers, reduce smoking and tackle the hazard of passive smoking at the same time as respecting people’s right to choose how they live their own lives.

Is this the right way forward to tackle smoking, one of the most pressing public health problems the UK faces? Have we got the balance right between personal liberty and social responsibility? What future measures should we consider to reduce smoking yet further?

2. Ensuring a fair system of International recruitment

The NHS is now getting the substantial investment it needs to expand and modernise its services. It is now the fastest growing health service of any major European country. We want it to be one of the best.

That requires us to increase the number of doctors, nurses and other key professionals as fast as possible. More staff are being trained and recruited within Britain. But that takes time. So we are now working with other nations to welcome well-qualified health professionals from other countries to work in the NHS – whether it be for a short stay or an extended period.

This can be a mutually beneficial arrangement: work experience, travel and continuing education benefiting the individual, whilst the NHS can fill its vacancies and increase productivity. But those countries who can least afford to lose their health professionals must be protected. While some countries are happy to export staff on a short-term basis the N HS, others see the ‘brain-drain’ of qualified nurses and doctors from their own health services as a significant problem.

he government is acutely aware of the ethical issues involved in recruiting nurses and doctors from overseas and has issued guidance to NHS employers to ensure that international recruitment does not damage health care in developing countries who can ill afford to lose domestic medical expertise. Not only this, but the guidance is also designed to prevent unscrupulous recruitment agencies from exploiting foreign workers coming into the country.

International recruitment is highly beneficial to the NHS. It also provides an excellent earning opportunity for overseas health professionals which in turn can enhance the provision of treatment and care in their home countries.

The challenge for us is to recruit more nurses and doctors – often from overseas – so hat we can expand the NHS, delivering faster treatment to more patients, but to do this responsibly and with due regard to the domestic health service needs of other countries. The guidance the government has issued to NHS employers already means that the NHS does not actively recruit staff from developing countries, either directly or through commercial agencies, unless the country is in agreement. Of course, individuals may still choose to come to the UK from Europe or developing countries independently on a voluntary basis.

Is this the right approach? Are the principles we are applying to international recruitment the right ones? What more can we do that would underline our commitment in this area?

3. Formalizing the rights and responsibilities between doctor and patient

The concept of formalising the relationship between doctor and patient, between the NHS and those in the communities it serves, is one we want to take forward. It also underlines our vision of a society where our duty, collectively, is to provide for all and our duty, individually, is to show responsibility to all. When it comes to the health service patients will be able to expect greater rights – increased choice, faster service, higher standards of care. But they must also recognise the duty they owe in return.

Not only could this new ‘contract’ set out clearly the standard of care the patient can expect to receive, but it would also bring to the attention of the patient the reciprocal nature of their relationship with their doctor. It would involve people in their own care, asking them to share the responsibility for their own health care and well being. Contracts could be drawn up to help people to cut down or quit smoking, to lose weight, to take more exercise or to eat a more nutritious diet. The contract could provide a formal channel of redress should the level of service fall below an acceptable standard. But it could also bind the patient into honouring their duty to the health service, putting the relationship onto a statutory footing.

Of course asking people to sign up to a novel type of agreement in this way may present challenge, especially if we require patients to actively participate in the relationship. To win support for this we need to be clear about what it is that we are trying to do – we must emphasise that in return for free, convenient, high quality care the patient is being asked to use this resource responsibly.

Is this approach a sensible way to formalise the two-way relationship between the patient and their doctor in which rights are expected and responsibilities are owed How far should the health service develop specific contracts with members of the public which lay responsibilities on them for improving their own chances of good health? What principles should form the basis for such a contract?

4. Building a consensus for harnessing the potential of the genetics revolution

It is the government’s job to help prepare Britain to harness the benefits of genetic advances and to avoid its dangers. That can only be done in 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.

We believe there are huge potential health gains in genetic advances. The government respects the need for science to stretch the boundaries of human knowledge and understanding in this field in the interests of human health but will draw those boundaries with care in order to gain public consent to realise the full benefits of genetic science.

With the pace of scientific discovery and innovation surging forward at such a rate it is not surprising that public opinion and political debate are finding it a challenge to keep up. The genetics revolution is opening up a whole new area of debate, introducing us to a number of profound issues we will need to address: the treatment of life-threatening diseases, the screening of unborn children, the commercialization of genetic techniques, the exploitation of embryos, the cloning of human beings.

People had some understandable concerns about the use to which genetic tests would be put by insurance companies. And it was the perceived threat that any advance in genetic science must necessarily herald a further step towards human reproductive cloning which was so corrosive of public support. That is why the Health Secretary acted to ban such human cloning and to put in place protections for the public over misuse of genetic test materials in insurance. The way is now open to us to have a more rational debate about how best our country can be at the leading edge of advances in genetics technologies.

The challenge for us now is to chart a path for the future that allows us to reap the great health benefits that the genetics revolution will undoubtedly generate. And we must maintain Britain’s place in the front rank of the world’s scientific and research community. But we recognise also the potential for misuse and misunderstanding of this new technology. We will take time to examine the ethical issues involved with great care, educating the public about both sides of the debate and legislating where necessary.

Do these principles form an appropriate basis for moving forward? How can we take the confidence of the public with us?