This plan is directed to the period up to the next general election. Andy Cowper helped us to work it out and our thanks are due to him, but he is not to be blamed for what we decide to do.
Expectations
- The coalition will survive, but the Lib Dems in particular will come under considerable pressure. They will lose a lot of local council seats, especially in Northern England. The smaller parties in England, except possibly the Greens, will not make much progress.
- There will be considerable turmoil in the NHS across the UK. Small District General Hospitals especially in suburban, often Tory, areas will be under great pressure. It takes quite a while to shut down a hospital, so we can expect quite a lot of campaigns around closures in 2014/5. There will be a lot more talk about rationing, and probably restriction of NHS coverage or charges for fringe areas like IVF and areas where people’s problems can be seen as self-inflicted.
- The expected additional demand on the NHS from increased longevity will probably not be as great as advertised, but extra demand, especially on mental health services, generated by the coalition’s policies may become significant. More demand will be generated from the consumerist orientation of health policies and new expensive drugs. Wider prevalence of drug resistant organisms may make hospitals more dangerous and more expensive to operate. Efforts to reduce attendance at casualty depts will continue to be ineffective. There may be efforts to restrict or charge people who suffer from what are regarded as self-inflicted problems.
Positioning the SHA
- Our core role is championing the interests of patients, supported by a healthcare system that is universal, of high quality and free at the point of use.
- We are not restricted to health or social care. We are interested and knowledgeable about health and what produces and destroys it. We understand both economic and health inequality, occupational health, social security benefits and their relationship with the health of individuals and communities. And if we don’t we will find people who do.
- We should orient ourselves much more closely on the Labour Party than we have for the past 13 years, and in particular the Shadow Health team, Labour members of the Commons Health Committee, Non-execs and Labour councillors involved in health scrutiny, well being boards and the like. We also offer what support we can to constituencies, MPs, peers etc. For councillors that might include training sessions in the basics of how the NHS works.
- What we offer is expertise from the point of view of patients. Involvement, accountability and democracy are key areas for us. Staff are often able to articulate the issues from a patients point of view. Happy staff are more likely to offer their best to patients, but it is not for us to defend the staff interests though we may be able to contribute something to Union campaigning. We don’t accept that the interests of staff and those of patients are always opposed.
- If we produce responses to official consultations the real audience is mostly political activists. They need to be short and to the point. It is not necessary for us to formulate detailed policies on every issue, or for the papers we produce to command agreement from all our members. What is important is that our policies are coherent, well argued, and as far as possible supported by evidence. We may have to produce different material for different audiences. If we need to impress health professionals we may need to produce special material for them, as most politicians don’t speak the same language.
- We need to have a positive vision of health and healthcare, not just to attack the coalition, though at this stage that vision might be quite abstract. But it might also be quite down to earth in practical issues like patient involvement and community development. We will want to welcome some of the measures the coalition proposes.
- We need to reconsider our relationships with the various organisations campaigning to save the NHS or against the coalitions plans, of which there are now quite a few. We are not planning to organize campaigns against every closure, but we will try to make contact with campaigners and to offer constructive support where we can.
- We need to think carefully about how we turn ourselves into a campaigning organisation, as once we were, and what that means now. We need to find people prepared and capable of taking a lead both in policy areas and in geographical areas. We need to be seen to have something to say to the specialist areas of which health has so many, and we need to be able to put people in touch with politicians. We may well need to explain politics to people in health as well as explaining health to politicians. We must encourage more of our members to become more active, to understand what they can contribute and to encourage and support them to do so. We need to recognise that only a few are confident enough to speak and write publicly on behalf of the SHA. We may not find spokespeople for every area. The Director may have to do quite a lot of that work.
- We need to pay more attention to our members and branches in Wales and Scotland. They can offer experience of the effects of a different policy approach. We should be looking for ways to compare experience across the borders.
External relationships
Our name implies a focus exclusively on health, whereas care services have risen up the political agenda recently, and will be a pressing concern for Labour Councils with forthcoming funding cuts. We should be expanding our presence in social care.
Key relationships are with:
Labour in Parliament
- Labour Shadow Team: have lost civil service support so great opportunity for SHA to forge a closer link – eg briefing on forthcoming health bill/White Paper. Noted timetable of next few months: may see a new Shadow Health Minister, with new political advisers/researchers, from October, and the Lansley’s health bill released in November!
- Labour Health Select Committee members ( Rosie Cooper, Valerie Vaz, Fiona Mctaggart, Graham Morris, Virendra Sharma ), Labour MPs and Labour Peers also likely to welcome relevant briefing material. Peers and MPs can submit written questions, so SHA could identify some suggestions here, including those worthy of an oral debate.
- We should try to arrange meetings formally with Labour Shadow Team and Labour Health Select Committee members
- Key message for all these group is that the SHA can produce some specific but not overly detailed analysis to offer them. We can find quotes from practitioners and stories. We can link them to local campaigns
- Media
- Though there may be an opportunity to cultivate individual journalists, the main opportunity here is to identify interesting stories that illustrate our message, including through FOIs. These can then easily be promoted through existing left of centre blogs eg Fabians, Left Foot Forward or Prospect, who national outlets use as a source for their stories, and specialist health press -HPI, HSJ, Health Matters, Healthcare Republic.
- We need to enhance our online presence. Our website needs to be more interactive. People should be able to debate our ideas, not just read them. The website and the Facebook page are useful vehicles for publishing members’ ideas, not necessarily endorsed by us, but worth discussing, and drawing attention to interesting material elsewhere.
- We should identify leads/spokespeople for key issues
- The demand for our printed magazine, Socialism and Health, will shortly fall below 200.
- Professionals working in healthcare
- This is to spread the message/arguments of the SHA, but with a spin-off of enhanced recruitment opportunities to use existing professional journals eg HSJ, doctors journals
- noted that nurses and social workers not well represented in SHA at present
- may also be useful to strengthen relationships with patient organizations eg new National Voices coalition of patient groups
- Trades Unions- Is there are risk any of our messages may clash with theirs? Worth linking with UNISON over their judicial review challenge. Need to find a few key people in Unison, Unite, RCN etc.
Labour Local Authority Councillors
Given the new enhanced role for Local Authritiess under Lansley’s proposals and the anticipated growth in Labour-run councils, this is a key group for the SHA. Identified the potential to organize meeting/training for councilors who are members/chairs of health and social care scrutiny committees – on how NHS works, new role of LAs and political opportunities. Could potentially be income-earning for the SHA. Could persuade Labour Groups to affiliate, individually or collectively.
- Work for the SHA to advise councilors: what questions (eg via Freedom of Information) to ask. Possibly help in interpreting the answers.
- We should organise workshops specifically targeted at councils who are up for election in May. This may mean working with more than one if they share health services or are small
- We should bring together as many members as possible in those areas from both services AND ALSO from local patient groups, charities, LINks and CVSs. We should have key people from Socialist Health Association to talk about the issues and challenges in their areas
- The theme will be to look at the services from the patient, carer, service user perspective rather than as we tend to do it from the policy, political or managerial perspective. The people we need to engage with are not interested in the marketisation/privatisation debate, they are concerned about their services, whether or not they are going to get them, and whether or not they are what they need and are safe, appropriate and they have good outcomes. So our language and our energies must reflect that
- We need to help produce policies for the local elections that are understood by voters, that will ensure we protect the most important services in the cuts, and that we have good arguments to reinforce the damage the cuts will bring. Being totally negative will not work,. People need to know what we propose which will make them want to vote for us again. A lot of people are still very disenchanted with Labour and have swallowed the Condem arguments that it is all Labour’s fault…. that won’t last but in the meantime they will do untold damage and if we are successful cllrs need to understand the benefits of sharing budgets with commissioners and the role that councils can and should play in commissioning and quality controlling services particularly for older and vulnerable people who need services from health, social services, housing, etc, etc,
Lay People in the NHS
We have excellent relationships with most of the organisations in public and patient involvement in the NHS in England. We run training events for LINKs. Many of our members are involved with LINKs, are Governors of Foundation Trusts, Non-executive directors, or lay people in various health organisations. We could do more to pull these people together. They are well informed, understand the NHS, but don’t have an axe to grind. We may want to consider supporting people to stand for election as a Governor of a Foundation Trust on an Socialist Health Association platform.
Patient/carer and pressure groups
We have cordial relationships with most of the health pressure groups, and many of our members are involved with them. The Co-chairs of Keep Our NHS Public are both members. We are often invited to speak at events run by other groups, and we invite them to speak at ours. We have often collaborated in producing reactions to various government proposals. The political organisations mostly want to maintain their independence. The patient and carer groups are generally charities and wary of getting too closely involved in politics. In general these relationships are supportive and informal.
Socialist Health Association Events
We run several sorts of events:
- Policy seminars, usually midweek, day time with 4 or 5 speakers, analysing a particular topic from different points of view (typically a practitioner, an academic, a service user, a politician or manager). Good for raising awareness of issues we think are important, and for bringing our existence to the attention of particular interest groups. Often help us to produce useful policy recommendations. Many of those attending will come in works time and their employer will pay. Some make a profit.
- Campaigning events. Oriented round a policy issue, often with similar speakers to 1., but typically on a Saturday. Most of those attending pay their own way.
- The restaurant offensive. Meet for dinner in the evening in a restaurant with some eminent person who is prepared to give us their perspective on the world (and often their life story) in return for a good dinner. Good for building relationships. Could be expanded into fundraising events if we can recruit sufficiently attractive and well known speakers.
- Training events. We have run quite a few from LINK members and one for NHS Complaints staff. These make money, but it isn’t clear whether in times of economic stringency they are still viable. However we run very downmarket events – the Netto of the conference circuit, and we have quite a good reputation, especially among people who have an interest in politics. More health professionals may be taking an interest in politics over the next few years.