We are concerned that in many areas pressure on the housing stock means that an increasing proportion of council tenants are people who have recently been homeless or are recently arrived refugees. These people need quite significant degrees of support and housing them together in estates does not make for stable and settled communities.
The other end of the housing market – the ridiculous inflation in the price of housing – is a significant problem. A situation where most of the population aspire to own their own homes but quite modest homes sell for between 6 and ten times average earnings is not sustainable. Steadily increasing prices in the housing market may be politically desirable but it will lead to economic disaster. It is also a key driver of inequality.
We would like to see real priority given to walking and cycling and to public transport. At present although lip service is paid to these healthier forms of transport most of the money is spent on provision for cars. We accept that for some people and for some journeys cars are necessary, but excessive reliance on cars damages both the planet and the health of those involved. Spending money on measures to encourage walking and cycling is very cost effective. Spending money on roads is hardly ever cost effective. The idea that the growth in the number and mileage of cars is inevitable is deeply destructive.
We will not get people out of their cars unless we make the alternatives much more attractive. Firstly we should change the tax and insurance systems so that the cost of motoring is much more related to car use. At present the ways the costs of motoring arise mean that the marginal cost of extra mileage is very low, and it makes economic sense, once you have paid your tax and insurance, to use the car as much as possible. Then we need to develop a genuinely integrated public transport system. There are plenty of other measures which can reduce car use:
- Car sharing with financial incentives offered – e.g. companies, through road charging (offer discounts to fully occupied vehicles).
- Extend bicycle lanes and offer safe bicycle lock ups (incentivised through the tax system). Segregated bicycle lanes are needed to get most people to use them. Work places should provide showers
- Road pricing schemes at peak hours.
- More school buses.
- Reward schools that have restricted school run (children using bikes, walking buses, school buses).
- Greater attention paid to designing in walkways and pavements to encourage people to walk to work and education establishments.
- Increase the cost of city centre parking.
- City centre bicycle hire schemes
- Get more freight onto the railway and canal networks.
The experience of London shows us what we need to do encourage more use of public transport:
- Real time information at bus stops.
- Through ticketing.
- Reduced fairs and extensions of concessionary schemes like the under 18 model adopted in London.
- Cleaner buses, better air conditioning and the return of bus conductors to some routes. People with and alternative will not use buses without better security.
- Extend bus lanes and enforce them.
- Improve frequency.
- 24 hour customer service lines widely advertised .
- Buses need to be more punctual.
Local leadership and participation
Developing community/neighbourhood public health
There is a growing realisation in the public health community that local communities and neighbourhoods must play their part in promoting the public health, or as we prefer to call it, the health and wellbeing agenda; and that a key vehicle for this is community development. There are in our view three key platforms for delivering community /neighbourhood health and wellbeing namely:
- general practice
- community schools/colleges working in a coordinated way
- community development
Our proposed model envisages Practice premises or where they exist, Health Centres/ Polyclinics, providing a range of services, in addition to the traditional primary healthcare services, such as Benefits Advice and social services; and acting as a signpost to relevant services such as housing advice and environmental health. At the same time, by working with local community development workers, health protective social networks could be formed.
The local secondary school acting as a community school or college would provide education and lifelong learning opportunities as well as sports facilities and opportunities for social activities of various sorts.
Public health leadership would be provided from the platform of the local General Practice or Health Centre/Polyclinic either by a suitably trained General Practitioner, or more likely, by a health visitor or health promoter working within the primary care team and relating to the local community and its key institutions, often through community development.
This approach to developing community public health harks back to the revolutionary model adopted in the Peckham Pioneer Health Centre in the 1930s.
Creating a truly patient centred NHS
The NHS must be a patient-centred service responsive to users at both an individual and collective levels. Patients should be seen as co-designers, should they so wish, both individually of their own care, and collectively of their local health services. What drives the whole system should be defined by patients to meet their needs and wants. This has significant implications for structure and function.
Patient choice is important at the individual consultation level and is a necessary component of the equal co-producer, partnership relationship between healthcare professional and patient. But, just as important, is public voice whereby the public as citizens can have their say and influence through local representative democracy. Thus patients also have a key role in defining quality in healthcare and commissioning and in developing and monitoring performance measures.
What patient-centredness means in practice at various levels of the Service is set out below:
1. At Individual, consultation level.
- Shared decision making for all patients who want it when they want it.
- Patients to be given full access to their medical records
- Patients to have ready access to Decision Aids to help them participate in clinical decision making.
- The Expert Patient Programme to be expanded outside the current franchise
- Patients and patients to be involved in the training of healthcare professionals at all levels of training. Patients as Teachers is one approach
2.At General Practice level:
Elected Practice boards to work with the partners to run the practice should be offered as an option to practices
- patients are encouraged to work with staff to select new doctors and clinical staff
- every Practice should be encouraged to have a patient participation group or panel.
The Practice is incentivised to become responsive by:
- The HCC demanding evidence that the practice has changed in response to patients’ views
- QOF incentives increased to do the same
- Quality of care is in part defined by patients
- the patient experience part of QOF to take up a larger proportion of the points
- Working with local community development workers
- Community development workers are placed in each group
- Practice participation groups link up to advise the cluster
Patients are involved in:
- 1.Choosing priorities for investment and disinvestment
- 2.Monitoring quality
- 3.Identifying problem areas and successful areas of service provision
- 4.Deciding on how to spend any savings
3. At PCT level :
- PCT Boards are elected and subsumed into Local Authoritiess
- Patients’ views to be incorporated into the commissioning process in the following areas
- Choosing priorities for investment and disinvestment
- Monitoring quality
- Identifying problem areas and successful areas of service provision
- Deciding on how to spend any savings
HCC demands evidence that the local commissioners and providers have taken on board patients’ views in the areas specified above
4. At National level :
- Patient interests should be safeguarded by appropriately funded and supported Local Involvement Networks ( LINKS) with defined rights (including unannounced inspection) and duties
- Community Development will become a significant approach for LINKs.
- A national body comprising LINKS representatives to promote the sharing of experience and good practice and to influence national policy and strategy.
Part of a sustainable community is about diet. Increasing affluence has not meant for many people in the UK, a better diet. There is plenty of evidence to show that eating plenty of fresh fruit and vegetables is important for good health and that eating too much fat, salt and sugar leads to ill health. Most people know this, but they are not given clear information about what they are buying. The Government has been slow to act in an area where decisive leadership is needed. In take away food, the conference and entertainment trade and meals eaten out people are rarely given any information at all about the content of what they eat. This leads to appallingly low nutritional standards in an area where consumers have no choice but to eat what they are given. We think that caterers of all kinds should be required to provide information in a form that people can understand about the amount of fat salt and sugar in the food they provide. The Labour Party itself could give an example by insisting that food provided for conference delegates should include fresh fruit and vegetables.
The increase in obesity is primarily do to a sedentary life style. The amount of food eaten per head has been falling for years, but the amount of exercise taken has been falling faster. It is imperative that measures are taken to increase the levels of activity among those who take least, especially young children and people who are overweight and over fifty. Organised sport does not offer much to these people. What is needed is opportunities to combine exercise with normal activity. Walking and cycling, as discussed above, are the obvious ways of doing this. We need to persuade people to leave their cars behind when they make short journeys. That means making walking and cycling easier and more attractive than using a car. The design of houses, roads and public spaces has a large part to play. People who live in cul de sacs use their cars more and are fatter than people who live in streets with several directions of travel. Exercise for children must not be confined to organised sport – though sport is important -, and we hope that we won’t see any more school playing fields sold.