Socialism and Health the magazine of the Socialist Health Association October 2013 Labour’s vision Andy Burnham’s vision for the NHS has become clearer while we watch the Government’s market based reorganisation collapse. Andy wants to see an integrated service across physical, mental and social health. Labour Party Conference endorsed his vision. The Party wants to see social care delivered on the same model as the NHS—free at the point of use. But it will take time to get there. Andrew Lansley’s vision for the NHS (and yes, Labour started this) was for a free market where politicians would not interfere in the competition between health providers. But as events in South London, and in A&E depts. across the country show, health care isn’t like that. The health system needs managing. Organisations do not stand or fall on their own. Changes in one organisation impact across all neighbouring providers.
Our Aims Universal Healthcare meeting patients' needs, free at the point of use, funded by taxation Democracy based on freedom of information, election not selection and local decision making Equality based on equal opportunity, affirmative action, and progressive taxation
Perhaps we should be grateful to Lansley for taking the idea of the market in health to its unpalatable conclusion. So it’s clear Labour is now prepared to move away from markets in health and turn towards an integrated whole person service.
In This Issue
Labour Party Conference resolution
Whole Person Care
NHS and dog whistle politics
Andy Burnham’s conference speech
Keep it Simple
Support those who work in the care system, giving a clear sense of direction Support measures that help to bring beneficial change; accepting setbacks and mistakes along the way without knee jerk reaction Remove legal, structural and financial obstacles to cooperation, collaboration and partnership working Encourage and incentivise innovation in how services are delivered but within a clear national framework which sets out entitlement. Make a few immediate changes, but without any kind of whole system top down reorganisation. Keeping to an absolute minimum changes that are imposed by directives from the centre.
If Labour is elected in 2015 it will inherit a demoralised and financially challenged NHS and a social care system on the edge of collapse, with challenging economic background. What should it do? Two things are clear – the NHS needs a period of stability with clear direction and social care needs more funding. Labour has already set out its vision for whole person care, the principles of which have wide support. It has undertaken to consult widely before it commits to specific policies. When elected in 1997 Labour took some remedial actions to improve the parlous state of the NHS but then consulted before publishing its 10 year plan in 2000 – a plan signed by almost every key stakeholder group. That has to be the right approach. In the run up to the next election and once in power Labour needs to be clear on what it will and will not be doing.
At the earliest opportunity it needs to:
So it needs early on to:
Share a new vision for what a whole person care system should be like – viewed through the eyes of those who will be using it. Publish a 10 year plan to move decisively from where we are to where we wish to be. Restore the emphasis on quality – of outcomes, safety and experience of care
Remove from the NHS the whole paraphernalia of markets and competition; restore the powers and duties of the Secretary of State to ensure we have a universal comprehensive NHS. Increase the funding for social care; moving the workforce onto a proper set of terms and conditions; setting an appropriate national level for entitlement to care; set out a long term approach to social care funding. Shift from commissioning that is used to support a market with competing providers to planning how best to use all the public resources to get the greatest health gains for defined populations.
The NHS and dog whistle politics Dr Kambiz Boomla (first published by Open Democracy) The new Immigration Bill introduces hefty charges for migrants to use the NHS. It is a costly, wrong-headed insult to the migrants on whom the NHS has always relied. My father was an immigrant. He came to London at the age of 10 from Bombay in 1927. Having trained as a doctor at Barts in the years running up to the Second World War, when war broke out, he joined the Royal Army Medical Corps. He spent the rest of his working life as a GP in Plumstead giving back what he had been given by this country.But if he arrived today, if the current Immigration Bill goes through, he would have no entitlement to use the NHS he was going to spent his whole life serving. Home Office ministers are responding to UKIP’s dog whistle. They talk of the UK having “a national health service, not an international health service”. They propose charges of between £200 and £400 a year for all migrant workers, right up until they achieve permanent residence status in the UK. This takes at least five years. Mark Harper writes he will “clamp down on those from overseas who try to abuse our public services”. What is the cost of this abuse of the NHS, this problem that the new Immigration Bill is meant to solve? Last year the NHS says it spent £33 million treating foreign nationals. Migrants form a large proportion of those working in health and social care. Many work at little above the minimum wage. And at the top end of the wage spectrum, one in three hospital consultants was trained overseas. We have a government that is parasitic on medical school training in countries much poorer than ours, but rather than say we are indebted to India, Pakistan, and Egypt, it proposing a double robbery by introducing these charges.
Dr Roointon Boomla
ensure visitors to the UK have paid their health tax, GPs will be forced to check ID and immigration status on all those who register on their lists. Nye Bevan, the architect of the NHS, considered these issues. He named those who called for charges for foreign visitors “ill informed” or “deliberately mischievous”. “How do we distinguish a visitor from a British citizen? Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats, both must be classified. What began as an attempt to keep the Health Service for ourselves would become a nuisance to everybody.” It is GPs who are likely to carry the burden of this policing. For this to work, it is clear there would need to be a link up between NHS computer systems and those of the Home Office. This is sure to undermine confidence in the confidentiality of computerised patient records.
My father is now 96. He worked for the Royal Army Medical Corp and then the NHS from his early 20s till Charges will deter people from seeking treatment. If only those with their papers in order and who have paid the age of 70. What right does immigration minister Mark Harper have to say those following in his foottheir annual fees can register with the NHS, there will be a pool of the impoverished who dare not seek medi- steps do not contribute enough and are out to “abuse our public services”? cal treatment when they are ill. As a GP myself I know that stopping people coming to see me will only result in As Nye Bevan concluded on the same issue: “The those same people presenting in crisis and at greater whole agitation has a nasty taste. Instead of rejoicing at expense in A&E. As Diane Abbott says stigmatising the opportunity to practice a civilized principle, Conforeigners accessing the NHS creates a public health servatives have tried to exploit the most disreputable risk. What price xenophobia? emotions in this among many other attempts to discredBut also we need to think how this will be enforced. To it socialized medicine.”
Resolution on the NHS Conference notes reports on August 15 that waiting lists for operations reached their longest in 5 years and figures published on August 21 that show 5,276 fewer nurses in NHS since May 2010. Conference expresses concern over the recent crisis in A&E under David Cameron. Since the election, people waiting over 4 hours have more than doubled. Ambulance queues have doubled too. Conference believes the Tory-led Government’s cuts to elderly care are a major cause of the A&E crisis
than half of Accident & Emergency expect to meet waiting time targets in the coming months. Conference recognises that hospitals are struggling to cope, as the NHS deals with David Cameron’s cuts and a £3 billion top-down reorganisation. Conference notes concerns raised by experts who say that A&Es don’t have safe staffing levels. And Conference notes the recommendation for the National Institute for Health and Clinical Excellence to develop benchmarks on staffing requirement and notes concerns over some extortionate PFI charges. Conference recognises the high court judgement of 31st July that overturned the Government’s decision to downgrade services at Lewisham Hospital, and congratulates everyone who contributed to the campaign which recognised that real consultation should be guided by clinical consideration, informed by public health knowledge, and include patient and public engagement – a clear rejection of the government’s top-down approach.
Conference notes that in 2013 under the Tory-led coalition government, the A&E winter crisis has become endemic, with half of Trusts in London failing to meet the 4 hour waiting target, with chronic shortages of Emergency Medicine staff. Conference is not surprised that under this government we have had the first summer crisis in the NHS for years. Nearly 1 million people waited more than 4 hours in A&E over the last Conference recognises the people of Lewisham for successfulyear. Jeremy Hunt has spent August looking for people to blame for the unprecedented increase in waiting times in casu- ly challenging the decision to downgrade & close their hospital’s Accident & Emergency, Paediatric and Maternity services alty departments across England Conference notes that: and highlighting broken promises made to Parliament by the Secretary of State and the Prime Minister. The NHS is not safe in the hands of the Conservatives and Liberal Democrats
Professor Don Berwick’s report to the Government published on 6 August makes it clear that NHS staff should not be scapegoated when services are overstretched and that good people can fail to meet patients’ needs when their working conditions do not provide them with the conditions for success; David Cameron’s 8 August announcement of funding for struggling A&E Departments fails to address the fundamental threats to our NHS posed by increasing privatisation and continual cuts to nursing numbers
Conference notes the 11 hospitals placed into special measures In the Keogh report leaving public confidence in the hospitals at an all-time low and hospital staff under huge pressure
The Tory led coalition government has again demonstrated it cannot be trusted with the NHS.
They are creating poorer quality, failing and fragmented services, as demonstrated by the breakdown of parts of the NHS111 service. Conference also recognises that A&E services are stretched as never before. Conference is proud of Labour’s record of investment in the NHS and reaffirms that the NHS should be free at the point of use, for all, based on need and not the ability to pay, that values collaboration over competition and which delivers care according to the needs of the patient and not the market.
Conference notes with concern the research published by the NHS Confederation on 8th September highlighting that less
Conference notes the threatened closures of A&Es and other hospital units. David Cameron promised to protect the NHS; he has broken that promise. Conference recognises that the Government’s botched reorganisation of the health service, especially its impact across South London, is putting intolerable pressures on hard pressed staff who continue to strive to provide high quality care. It was Labour that fought to create the NHS. It is now up to labour to fight to defend it. Conference believes that the Government’s harmful, marketled approach should be replaced with a system driven by responsible, clinically-led choices, where the priority is continuity of care and consideration for the whole person, not competition and fragmentation Welcomes Labour’s commitment to repeal the Health and Social Care Act Reaff irms our urgent call for Labour to work with health unions and other NHS supporters to campaign against privatisation Conference supports Labour’s aim of developing a unified, national system of high quality health and social care based on the values of caring, compassion, fairness and equality. Conference believes that you can’t trust David Cameron with the NHS. Conference calls upon Labour to break down the barriers between health and care, into a single service to meet all of a person’s care needs Conference calls on all those in the Labour movement. To stand united to defend our National Health Service.
Andy Burnham’s Conference speech (continued from back page) Conference, I have never been clearer about any-
This is what becomes possible in a one nation
thing in my life than this: we will never, ever get the
health and care service. People with more rights
care we aspire to for our own parents, or indeed an- over where and how care is delivered. Too many yone’s parents, from a malnourished, minimum-
people, against their wishes, end their life in hospi-
wage social care system dishing out care in 15 mi-
tal. So we work to give people the right to be at
nute slots where there’s barely time to make a cup
home, with family around them and social care free
of tea let alone exchange a meaningful word, where as part of that. And, finally, a service that respects over 300,000 care workers in England are on zero-
those who care for other people’s relatives. Proper
hours contracts.
recognition for their service to society, by asking the NHS to work to lift up employment standards in so-
And it gets worse. Because of this failure to support cial care. people properly at home, older people are being driven towards hospital in ever greater numbers. In
Social care no longer a dead-end job but young
the last two years, a 66 percent increase in the
people given aspirations to advance; cutting out the
number of people aged 90 and over coming in to
cancer of abused zero-hours contracts.
A&E via blue-light ambulance. That’s 100,000 very frail and frightened people in the backs of ambu-
One valued team working around the person. It’s
lances speeding through our cities and towns. And
what clinicians want to do. But, right now, they can’t.
when they arrive, hospitals unable meet all the
In Cameron’s NHS, the competition lawyers call the
needs of people at that age. So they go downhill
shots. They call integration “anti-competitive”. Have
and we hear those stories of older people lost on
you ever heard anything more ridiculous? The
the acute ward, disorientated and dehydrated.
Health & Social Care Act 2012 has placed the NHS on a fast-track to fragmentation and privatisation. It
By uniting social care with the NHS, we take the first has got to go - and it will. In the first Queen’s meaningful step on the road to good care for all
Speech of the next Labour Government, we will re-
people in the 21st century. Labour taking away the
peal the Act.
fear of old age. Whole Person Care - for children and adults with disabilities too.
But we don’t just wait. All over England, people are embracing Labour’s agenda and rejecting Camer-
And at last a service that looks after people who
on’s market. 25 councils of all colours working as
care. For too long, too much has been asked of
our Whole Person Care Innovation areas. A plan to
family carers. Left fending for themselves, ground
restore trust in care of older people. But in politics
down, telling the same story to everyone who
too. The public are looking for answers that modern
comes through the door. So let’s end that scandal.
politics has not been providing.
Give them one named contact for the co-ordination
of all mum or dad’s needs and high-quality, homebased support. And if mum or dad has to go into hospital, let’s give people the peace of mind of known care staff going with them on to the ward.
Andy Burnham’s Conference speech (edited)
Conference, Labour is committed to safe staffing
It was this Conference, eighty years ago, voting to cre-
difference between us and them. Where the NHS
ate a National Health Service. In one day, Labour
falls short, Labour will learn and make it better.
levels, based on expert advice, learning from where things have gone wrong. And this is the big
changed a century.
The Tories exploit failings to undermine the NHS Care of older people is not what anyone would want it to itself. What kind of Government asks for a report be. So today we set Labour’s new mission: to make it
on troubled hospitals only to deliberately exagger-
right. This Conference can complete Bevan’s vision.
ate the findings? What kind of Government spins
Unite the NHS with social care.
against the NHS it is supposed to be responsible for?
Just imagine. One service looking after the whole person - physical, mental and social. A national health and
For too long, market forces have been allowed to
care service, based on people before profits. What a
advance into the NHS. Well no more. We will make
way to mark the 65th anniversary and what a contrast
a clear break with that. If we carry on down this
with this Government.
path, the market will devour everything precious about the NHS - those values the country celebrat-
They have spent all year running it down. Since April, all ed at London 2012. So let’s nail our colours to the NHS services forced out to the market. And look at mast. Giving people a proper choice - Labour for a what’s happened: major contracts for NHS work won by
public NHS against Cameron’s market.
Tory donors. Donors who bankrolled Andrew Lansley when he was planning his bill. And you can see why.
For integration over fragmentation, compassion
Huge private health firms, run by people who have do-
over competition, people before profits. And you
nated £1.5 million to the Tories, winning £1.5 billion in
know what? People will be with us. Because belief
NHS contracts.
in a public NHS runs right across the political spectrum, uniting left, right and centre.
And get ready for the next scandal. NHS hospitals, pushed by Mr Cameron to earn half their income from
I am not neutral about who provides NHS services.
private patients, charging for beds left empty by these
I will never see the NHS as an empty blue-and-
restrictions. Conference, think about that. NHS hospi-
white brand to be used by any qualified provider. I
tals, built with public money, charging people for treat-
believe in the public NHS and what it represents. I
ments that used to be free - and still free to people living know that people who work in it give more of themelsewhere. NHS staff turned over to priority care of
selves because it’s based on people not profits. If
those who can pay or are in such pain they have to dig
politicians can’t see that, they’ll never understand
deep. Suffer or pay - the same old choice in a two-tier
the true value of the NHS and they’ll never under-
Tory NHS.
stand NHS staff.
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