Response from the Socialist Health Association September 2007
1.The Socialist Health Association was founded in 1930 to campaign for a National Health Service and has been affiliated to the Labour Party for 77 years. We are a membership organisation with members who work in and use the NHS. This includes doctors and other clinicians, managers, board members, carers and patients. Our interest in democracy especially as applied to health policy is long-standing. Our members are involved in health and social care in many different ways. This submission is made on behalf of the Association.
2.We welcome the proposals made by Gordon Brown to renew the Labour Party’s policy making structure. However we do not feel that these proposals will be sufficient to achieve their stated aim. Members of the party, and particularly the members of the National Policy Forum themselves, are deeply disillusioned with a process of policy making which has become increasingly centralised and controlled. This centralisation seems to have been associated with an increasing reliance on paid staff of the party and reluctance to hear the views of unpaid and elected members which is not sustainable. We also feel that talk of extending party democracy at the same time as continuing with the ‘appointment’ of a Party Chair is a little contradictory to say the least.
3.With regard to the Party engaging more with its local communities, we are entirely in favour as long as the process involves genuine discussion within well defined parameters and clear guidelines as to how such opinion feeds into the policy creation and review process. The merit of the approach is to ensure that the Party does not become distant from the aspirations and concerns of the communities in which it exists. There is, however, a concern about the ‘duty’ to consult with ‘local communities’ and the reality of how this is to be put into practice. Whilst there is great merit in looking beyond the confines of the Branch or General Committee meeting, there is a danger of tokenistic and manipulative consultation and a diminution of the idea of the party as an agent of change itself. The injunction to ensure that the ‘views and priorities of local people and organisations are reflected in their policy submissions’ is unclear and potentially embarrassing. The Party is not an opinion survey machine with the required expertise or resources at local levels. We are entirely in favour of the intention to give more support to local Labour Parties holding Policy Forums, but it is not obvious to us where this support will come from. It cannot be achieved by relying on the Party’s paid staff at current levels.
4.We would be very pleased to see members of the NPF consulting more widely and involving party members in policy discussions. We would like to be able to engage NPF members in a dialogue as far as health policy is concerned. No doubt other societies would like to do likewise. We suggest that this would require at least making public of the names of NPF members and their constituencies, and some means whereby lines of communication can be established.
5.The proposals to improve feedback, establish a workplan and dialogue with ministers seem positive. We would suggest that this process should be as open as possible. At present there seem to be efforts to keep draft documents and discussions secret. The effect of these efforts is that the first members know of these documents and discussions is when they read about them in the newspapers. This is counter productive. We have difficulty briefing our elected representatives on the NPF because it is made difficult for us to see the documents which they will be discussing. We know that some matters need to be kept secret, for a variety of reasons, but that is very rarely the case with the sort of policy proposals considered by the NPF. We urge a more serious and consistent response from the NEC and Ministers to resolutions passed by local and regional and national parties and affiliates. The formulation of and voting on resolutions is a part of the tradition of the Party which should not be abandoned or ignored. Such debates concern issues about which people often feel deeply and the sense that their expressed views are ignored does nothing to enthuse party activism or genuine debate.
6.The significance of the proposal to give Conference a more substantial role in the NPF process is unclear to us, but is not unwelcome in principle. Nor is it clear how the election of an extra 12 members from Conference will help. There needs to be clarity in this proposal and the party constituents need to be fairly represented.
7.We do not see how making the final policy documents subject to OMOV ballot can be seen as other than tokenistic. There is at that stage very little likelihood that any of the documents would be rejected, and rejection, or lukewarm support, would be a gift to our opponents.
8.We do not feel that the document goes far enough in addressing the difficulties of formulating policy democratically. Health may be a particularly problematic area because of its complexities and the many professional groups involved. We have participated in many policy discussions in local parties and at regional and national level. Most of them have been unfocused and unproductive. Over the past 10 years the Government have introduced many substantial policy changes in healthcare. Most of them – for good or bad – have not been the subject of any useful discussion within the Party. The policy documents presented to members have often been bland and vague, and the impression has certainly become widespread that focussed discussions are seen as unwelcome and divisive.
9.The introduction of a contemporary issue submission rather than a resolution is treatment of a symptom rather than a cause and has its own difficulties. The perception that the resolution process was used to try to contradict or overturn policy formulated partly via the forum process has some merit but ignores the view that the resolution process did at least allow the party to formulate a response to an issue in a recognisably democratic and manner. Whilst composite resolutions had the demerit of often satisfying no-one completely and lacked precision, it is not clear how the contemporary issue process will solve the dilemma posed by the feeling that attending conference is no longer a facet of policy making but rather, attending a rally of the more or less inspired. How is an issue to be defined? Is there not a danger of the ‘issue submission’ being used not for serious reflection but as little more than a media responsive tool to ensure that the party is perceived as ‘up to date’ and ‘dealing with matters of genuine public interest’. There is nothing particularly wrong with either of these reasons but one may imagine issues such as ‘knife crime’, ‘lawless youth’ or ‘motorway cones’ being submitted and to what end unless a cogent narrative accompanies them? It may well become a reactive and media driven process with little serious policy impact. There is also the danger that in choosing some issues over others the party runs the risk of prioritising where no prioritisation is particularly necessary with its consequent negative publicity. One can imagine the Daily Mail headline: ‘Waiting lists less important than public sector pay!’ It could be argued that resolutions pose a similar danger but they at least have the merit of proposing an opinion and rationale.
10.Our members would like to assist with the policy making process, and we feel we have something to contribute. We imagine that other societies would feel the same. We would be able to facilitate workshops on health related topics and provide expert speakers if necessary. Some of our contacts in health could be drawn closer towards the Party by getting involved in this process, especially if they saw ways in which their voice might be heard.
11.There are some in the party, which started its life as the voice of organised labour, who have become suspicious of what is now called “producer capture”. In the SHA we are comfortable with the idea that the interests of professionals and those they care for do not coincide – but they do usually overlap. The Government has been giving the impression that we think the interests of patients and those of doctors are fundamentally opposed. We need more sophisticated ways of dealing with the views of lay and expert people if we are to avoid making enemies of most of the NHS workforce.