Page 1

Redefining the NHS What Milburn really said……….


n all the furore about Secretary of State Milburn’s speech on

redefining the NHS, a lot of good stuff has been lost. Sadly,

Labour Party publicity for the speech focused on the issue of

“foundation hospitals”, and the media picked this up as presaging the privatisation of the NHS. However, he also highlighted other key issues, some of which are at the forefront of SHA campaigning objectives. For example, patients’ needs will be put first. Health and social care services will work as one for the benefit of the patients and not the service providers. New roles for nurses and new contracts for doctors will provide the necessary flexibility around patients’ requirements. The Secretary of State said “a system of health care that is used by all and financed by all makes for a stronger society for all”. He confirmed that the assets of the NHS will remain in public ownership. He also re-affirmed that the NHS will provide comprehensive services, overwhelmingly free at the point of use, according to need and not the ability to pay. The SHA will continue to campaign against charging wherever it exists. Nevertheless these are important statements More good news is that the NHS will no longer be “a centrally run monolith”. The establishment of the Commission for Health Improvement as an independent inspectorate means the Department of Health will no longer manage the day-to-day operation of the NHS. This will devolve to the 28 new strategic health authorities in England. Instead the Department will concentrate on what it should concentrate on:

setting the strategic direction of the NHS a more explicit focus on improvements in public health securing integrated information systems, staff training and development support developing the values of the NHS through education, training and policy development.

The controversial aspect of his speech, the establishment of “foundation hospitals” is obviously being treated with caution. Some of the more thoughtful chief executives are already saying that they will now aim for two-star status only, rather than risk being pushed to the forefront of yet more upheaval - a perverse incentive against the pursuit of excellence if ever there was one!   For its part, the SHA will continue to oppose the

2 privatisation of the health service. Central Council has spent a long time mulling over its public statement on privatisation, and this is published elsewhere in this edition of Socialism & Health. However, the world goes on, and other issues also demand our attention. One of the key areas where the SHA can influence ministers is public health, where the government seems to be losing the plot.

views on public health by Dr. Tony Jewell, and the text of the SHA response to the government consultation document on tackling health inequalities.

This edition of Socialism & Health therefore also includes some


22 Blair Road Manchester M16 8NS

Involving the private sector in the NHS

Tel: 0870-013-0065

The SHA statement on privatisation …………….2 It’s public health, stupid! ……………..4 SHA response to the government’s Tackling Health Inequalities consultation ……….7 Food for socialist thought The SHA Glasgow conference on food and poverty……..9

Letters page ………10 Members remembered: • •

Herbert Bach…………10 Annie Altschul……….11

Westward Ho! News from the West of England Branch…………11

Help the SHA …….12 Contact your branch Contact details for local branch activists in your area …...12

___________ Socialist Health Association

Involving the private sector in the NHS Statement agreed by the SHA Central Council in September 2001


erious concerns are developing within the Labour movement about the growth and dependency of the NHS on private finance. The private finance

initiative (PFI) and public private partnerships (PPP) in the NHS and in other public services pose a serious risk of developing into full-scale privatisation. When significant amounts of state capital are available to the Treasury, it should not continue to starve the NHS of capital and insist that NHS managers market test every capital building project for PFI before consideration is given to state funding. Government capital attracts much lower interest rates than private capital, and without the need to undergo the PFI process, there is a much shorter lead in time for schemes. The trend over the last 25 years has been to reduce the availability of state funding and encourage private investment, a truly Thatcherite policy that the Labour government should surely have abandoned by now.

Eroding the NHS



t is not simply concerns about delays, profiteering, poor value for money and mortgaging the future that characterise PFI and PPP schemes, but the combination of privatising

the ownership of both NHS stock and its workforce that alarms the SHA. Many PFI schemes include the transfer of key NHS staff, which will erode the essential nature of the NHS: an NHS hospital, owned by the NHS and staffed by NHS workers. There has already been competitive tendering, where poorly paid ancillary staff were further exploited, often by seriously incompetent private contractors. Modern health care is a multidisciplinary endeavour, where porters and ancillary staff are also key members of the team. The resilience of the NHS, with its public sector values during the Thatcher years owed much to this feeling of participation and ownership.

Ownership does matter


he SHA, with its 70 years of support for socialised health care, is opposed to dependency on PFI and PPP as a means of funding NHS


The SHA acknowledges that the NHS needs reform, and that it can be inflexible. The SHA endorses many of the Government’s health policy initiatives and aspirations, including reducing

Some people say it doesn’t matter who owns the building and who employs the staff. However, the Duke of Westminster was not willing to give up the ownership of his estate in response to the suggestion that ownership didn’t matter! Buildings should be owned, and health service staff should be employed, by the NHS. health inequality, and the priorities and a system of modernisation programme. The accountability, inspection, and SHA is not opposed to change. standards across the country. The SHA approves of adopting intervention to maintain basic solutions that work. The SHA wishes the The SHA welcomes government to devolve power the framework of national to front line professionals and

4 set them free to innovate and develop much needed services. Most will only require sufficient resources to do just that. And the SHA welcomes front line staff having proper recognition for the work they do, real incentives for better performance, higher morale and greater fulfilment.

Profiteering doesn’t work


especially experiments that will alienate most of the workforce and mortgage the future. The initiatives that have already been introduced, and the extra funding that accompanies them, need to be given time to work.

A short term expedient


he SHA does not object to

the use of spare capacity in private sector hospitals to


perform operations on NHS


patients where it makes sense


to do so. Acceptable examples

SHA does not understand why

might be to keep elective care

the government continues to

going during a time when

believe that introducing the

emergency admissions are

profit motive will work in

causing cancellations. But this

health and social care. The

must be regarded as a

SHA does not object to more

temporary expedient, to be

use of not-for-profit

utilised only until NHS

organisations as stakeholders,

capacity is increased.

but not as shareholders. Both as the recipients and as providers of health care, people have learned to ask for evidence that a new procedure is safe and effective before it is used. As citizens, they would similarly like to see some evidence before experiments are tried on the NHS,

The reduction in acute hospital beds has gone far enough. Standards of safety in private hospitals are not always as high as in the NHS, and it is not sensible to encourage NHS staff to moonlight, nor to pay private employers to entice NHS staff, trained at public expense for the NHS, away from the NHS to profit from their work.


Stand-alone surgery centres


he SHA does not understa

nd why private sector

managers are considered to be more effective, nor why proposals have been made to employ them to run some of the new stand-alone surgery centres. As these centres have never been run inside the NHS, how can the government conclude that the private sector will run them better? And why does the government wish to develop stand-alone surgery centres? The point of a hospital is to concentrate medical resources in one place in order to deploy them to best

advantage. If patients develop complications in a stand-alone centre they will have to be transferred to an acute hospital. Would it not therefore be more sensible to build these centres on existing hospital sites? The SHA does not object to new ways of working so long as they are appropriate to the service and acceptable to staff, and not just a crude attempt to save money or give the appearance of “modernisation”. New grades of intermediate professionals can and should be introduced. Hospitals can and should work into the evening and over weekends more than they do.

Easy targets


rivate sector managers

have an easy target. They are required to make profits and can choose whom to serve without the need to provide the universal cover that is expected of the NHS. The more profit the better. Public sector managers have a harder task. They have many targets to

meet that are not compatible with each other, and they are required to provide a comprehensive service to the population. So why would private sector managers be more effective? It is proposed to extend PFI beyond the hospital sector into primary care, social services and the provision of equipment, and to employ private sector management expertise to run NHS buildings and IT systems. The SHA’s objection to these developments is profound. What motivates the private sector is profit. It is not established for the public good. The private sector has commercial obligations to shareholders. In the planning process, the interests of the shareholders are put on the same level – or higher – than the needs of the patients. Government contracts are an easy touch, where there is no need to compete for customers.

Spectacular failures



he governm ent

should approach the extension of private involvement with capital projects with great caution until those projects already undertaken have been fully evaluated. There have been some spectacular failures

technology are researched and developed and then sold to the NHS by the private sector. But this international market is quite different from the ownership of NHS buildings and the employment of core staff. And government policy and bulk purchasing by NHS Supplies can mediate the relationship between private sector suppliers and the NHS.

HS man agers

are given little option about

in this area, the

PFI funding of major capital

computerisation of the Passport


Office and the outsourcing of Housing Benefit being just two of the best known. PFI hospitals may equally turn out to be expensive long-term

The SHA would like the government to publish the criteria governing PFI schemes, making it clear to the public, the staff and the management what the advantages of this option are. These should be based around the following questions, which should be answered satisfactorily before more PFI schemes are agreed: •

disasters. The SHA recognises that the private sector supplies much of the goods for the NHS, such as food and medical supplies. Medical instruments, pharmaceuticals and modern

• •

Criteria for PFI schemes


What time frames are built into the planning and tendering phase of PFI schemes? Do PFI hospitals come in more on time and closer to budget than those conventionally

financed? Over the length of the contract, are they cheaper to run and do they provide better value for money? Do they provide greater or lesser flexibility in service provision? In what circumstances do they improve the quality of care? Can they demonstrate accountability to the local population?

People do not want anyone to make a profit out of their illnesses. No one should have an incentive of any kind to prolong anyone’s stay in hospital, nor to subject them to treatment that they do not need.

Sense and nonsense



o where is the sense in employing

private contractors to do for the NHS what could be done better by in-house NHS staff? Competitive tendering led to

Some of the firms involved are unprincipled and unscrupulous. Involving them in the running of the NHS could invite catastrophic failure on the scale of Railtrack into the NHS. PFI contracts are not a good deal for the NHS, because they end up with more profit than is justified by the risk they carry.


he SHA also opposes

the extension of user charges

So the SHA opposes Government policies and proposals that support the expansion of private sector management.

into NHS clinical services that

Charging policies

for non-nursing elements of

allows NHS bodies to charge

the 'hiving off' of cleaning,

care. This could put at risk the

catering, laundry and other

fundamental principles of the

support services and thence to

NHS that everyone has fought

dirty hospitals, poor quality

so hard to retain. There should

food, more hospital acquired

be a very extensive and public

infections, and a breakdown in

debate about what should and

the ability to control essential

should not be provided free as


part of the NHS, and what

Contractors make profits by attacking the terms and conditions of the lowest paid staff, many of whom are black or female, and their health suffers as a result. If the government is introducing contractors because NHS terms and conditions of employment are not flexible enough, then it is the terms and conditions that should be changed.

should be available for an additional charge. The SHA wants to see real and lasting improvements to the nation’s public services. The SHA does not want to see speculators making money out of them. That would not be an improvement. The popular perception that the Labour Government is moving in this

8 direction can only help to undermine belief and confidence in the NHS amongst both the public and NHS staff.

It’s public health, stupid!


dependable White Paper. This programme set out the policy framework that seemed to secure the future of the NHS while proposing an agenda for change – particularly around clinical governance, the creation of PCG/Ts, health improvement programmes and the establishment of NHS Direct.

A holistic approach to health programmes


he Health Improve

ment Programmes were particularly welcomed by the SHA as they set out the duty of

hat has the partnership between the NHS

government neglected at its and Local Government, paving peril but is the key to getting the way for a holistic approach the health service right? What to health programmes by is now the big issue? Public tackling the wider determinants health, of course. of health, such as poverty, Rather than continuing to attack the use of the private sector in the NHS, which both the government and the Labour Party hierarchy have repeatedly said is not negotiable, the SHA is campaigning for a much greater focus on public health. Speaking at the Dr. Cyril Taylor Memorial fringe meeting at last year’s Labour Party conference, Dr. Tony Jewell set out some key principles for the government to adopt. This is an extract from his presentation. When the first Labour Government was elected in 1997 we in the Labour movement gave a collective sigh of relief and welcomed The NHS – modern and

housing and transport as well as dealing with NHS issues. The Saving Lives – Our Healthier Nation public health strategy, although rather slow in moving from Green to White Paper, at least highlighted a commitment to reduce the health inequalities that had increased inexorably throughout the 1980s and 1990s. As part of the drive to achieve a greater uniformity of provision and standards across the NHS, national bodies such as the NICE and CHI were also established, and there was a commitment to develop


National Service Frameworks for the major diseases and service groups. So far, NSFs have been published on Coronary Heart Disease, Mental Health, Cancer and Older People. Diabetes has been in final draft form for months and is not fully released. More recently we have also had a sexual health strategy published that reinforces much of the Teenage Pregnancy Unit work that originated from the Social Exclusion Unit.

Evidence based

T I he key

n the first term of


Government the

about the


NSFs is that they represent

Gordon Brown, agreed to abide

health programmes that are

by Tory spending plans. For

evidence based, professionally

the NHS this was politically ill

agreed, incorporate prevention

judged, because at a time of

and health promotion as well as

rising public and political

treatment services, and seek

expectations, the NHS needed

through setting explicit targets

more investment.

to achieve common standards across the NHS that can be implemented energetically and performance reviewed. This is very welcome, and the four contract areas in Saving Lives – Our Healthier Nation (Cancer, Coronary Heart Disease, Mental Health, Accidents) account for some 75% of NHS activity and costs. Accidents should not be overlooked, as they are the leading cause of death in children and young people.

Investment decisions

This under investment led to increasing concern about the long term future of the NHS, with younger voters being less committed to a system that seemed to be difficult to access and was characterised by traditional and rather old fashioned, inefficient systems - booking GP appointments, joining hospital waiting lists. The subsequent political decision to invest significantly more, up to 8% of GDP and comparable to our European neighbours, was contingent on modernising the NHS as described in The NHS Plan of 2000. Unlike the Royal Commission that Cyril was involved with, this Plan put together by Alan Milburn and a few close advisors, without any SHA advisors!

A good Plan


L HT uckily, it






out to be



a good Plan that has achieved

centralisation of key policies

recent consultation on the

widespread assent across the

involving Tsars and new strategy for reducing health

NHS. Unfortunately, the new

“quangos”, whose members’ inequalities that incorporates a

money has only just begun to

accountability is unclear – basket of health indicators and

flow in, and as the NHS has

Tsars for drugs, NSFs, national targets is very

been chronically starved of

Modernisation Taskforces, new welcome.

both capital and revenue monies for so long, a couple of months produces few results. The ensuing political impatience led to the publication of Shifting the Balance of Power, which was sprung on an unsuspecting NHS at the launch of the Modernisation Agency in April 2001. Shifting the Balance Of Power’s proposals for a root and branch re-structuring of the Department of Health, the Regional Offices, Health Authorities and Primary Care Trusts is a huge diversion from work to deliver The NHS Plan that shows little respect for NHS managers in health authorities and the regions.

A strategy to reduce health inequalities

It is earnestly to be hoped that reducing health inequalities will get as much management time and performance review attention as trolley waits. But there are many issues that remain to be considered and debated.


organisations such as NICE, CHI, the National Clinical Assessment Authority, the National Patient Safety Authority to name but some. This can lead to loss of focus within government, and confusion about accountability and responsibility. Not many of us in the SHA have heard of the people who serve on these bodies. They certainly didn’t attend SHA meetings in the dark days of the 1980s and early 1990s!



T T he fact





to tackle

investment in the NHS has

inequalities in health needs to

been too slow, and many of the

be linked to some fundamental

key investments such as

economic policies – most

capital, workforce, information

notably achieving growth, low

technology, and catching up

unemployment and ending

with revenue against activity

child poverty.

means that the NHS has not been given enough time to deliver success. Secretaries of State are obviously impatient to deliver change to the Prime Minister, but some of it takes time, such as training doctors and nurses, and building hospitals. Some investment, such as paying ancillary workers a fair wage, will not necessarily lead to greater waiting list activity. Mending the NHS takes time.

Links with economic policies

The Joseph Rowntree study of mortality rates by political constituency, testing the explanatory variables for these inequalities – unemployment, child poverty and redistribution of wealth – is a powerful document. This report is highly recommended, and demonstrates how through macroeconomics the inequalities we are scarred with can be substantially reduced. The macro-economic nature of this is important, because inequalities are represented by a gradient, and simply targeting some particularly deprived communities will fail to deliver the change and miss some 60% of poor people who don’t happen to live in a Health Action Zone. Poverty kills wherever it is found – even the elderly woman, living alone, not receiving her entitlements, in a rundown cottage in rural Cambridgeshire.

The fact that “the health of the people is the highest law” (Cicero) means that it is fine for the Prime Minister to take an interest in health – and the government can be judged on how it has improved the health of the population and reduced inequalities. International studies have shown how health indices and inequalities can be reduced by social policies that lead to greater equity and the redistribution of wealth. The gap is important, not just the safety net at the bottom.

A Cabinet Minister for Public Health


We welcome the Treasury’s cross-governmental review on inequalities, and feel that the Minister of Public Health has a


here are a couple of key

public health policies that have

key role and should therefore

stalled and which would do

be in the Cabinet Office

much to reduce inequalities –

helping to orchestrate the

tobacco advertising and

joined up government that is

fluoridation of water.

needed. National accountability in Parliament for reducing inequalities and increasing equity would be significant advance. Such accountability could be through an annual report on the health of the population, compiled by the Chief Medical Officer, and delivered to Parliament by the Prime Minister.

Tobacco and fluoride

Why the government has been so slow to move on these is puzzling, and we do worry about which stakeholders are pulling the strings in the case of tobacco. As for fluoride, this does seem to be an area of political weakness. The evidence for safety is strong. There has been a natural experiment in the Midlands for 30 years now, and this evidence is a lot stronger than that for many other national policy decisions.

The risk of privatisation


We are concerned that NHS capital has been so reduced over the last 25 years that it is now virtually unavailable, and NHS managers are required to undergo prolonged and expensive PFI processes. The poor value for money that these schemes offer over the term of the deal is most puzzling. The SHA believes strongly that NHS facilities should be owned, and the staff employed, by the NHS. This is not antibusiness, but is a way of securing public ownership and control of the NHS. The ownership of assets is important – ask any businessman.

Democratic accountability


n demo cratic

accountability, we feel that greater connections with local government and Primary Care

FI and the Trusts should be a key part of risk of local strategic partnerships. privatisatio

n is something that is also difficult to understand .

We welcome the local authority scrutiny panels, but remain sceptical of some of the structures to replace CHCs – the Patient Advice and Liaison Services and Patients’ Forums are welcome, but we are less sure of the networks of the

13 Commission for Public and Patient Involvement at Strategic Health Authority level and the national Commission itself.

damage good health (such as tobacco and poverty).

We prefer systems that embody more formal democratic accountability.

“Health is a reflection of a society’s commitment to equity and justice. Health and human rights should prevail over economic and political concerns.”

The international dimension


inally, social justice

does not respect national borders – look at Afghanistan, for instance. The inequalities that we observe in this country are marked and unacceptable, but are dwarfed by the inequalities between, for example, the UK and the sub Saharan countries, where HIV has killed over 17m. people, many of them children, and where infant mortality rates are 150 in every 1000, compared to our 6 in every 1000. Fairer societies are healthier societies, which is why we in the SHA along with Labour see the pursuit of equity as a significant part of the struggle for healthy societies across the globe. This requires a rigorous political analysis to ensure that we support positive forces (such as the redistribution of wealth and policies to end child poverty), and reject those forces that

___________________ __


he SHA is very pleased

that the government is

The Peoples Charter for Health 2000

beginning to construct a

___________________ _

strategy to reduce health

SHA response to the Tackling Health Inequalities consultation

inequalities. The SHA is also pleased that, in this as in other areas, there is a well organised public consultation. However, because there are so many consultations on health policy at the moment, it has not been possible to give this document the attention it deserves. The SHA trusts that there will be further opportunities for public involvement and consultation as the strategy develops. The SHA’s main concern is that the demands of running a National Health Service that is concerned mainly with illness, and the political imperatives associated with its various imperfections all divert financial and political resources away from public health measures that would produce a far greater health gain for far less expenditure.

The Inverse Care Law extended



urthermore , the Inverse

Care Law first propounded in 1971 still governs the operation of health care. Those most in need of good health care are the least likely to receive it. Funding of health services appears to follow historic expenditure rather than need. Money is sucked into expensive secondary and tertiary care to the detriment of primary care where it will benefit more people more effectively. The inhabitants of deprived areas are not encouraged to make their careers in the health care institutions that are often sited amongst them. The staff come in from the affluent suburbs. Mental health and other areas, despite public statements to the contrary, are not targeted for special help and are still shamefully neglected. The Inverse Care Law can be extended to other public services. Those parts of the welfare state that are the least effective are those that serve the most disadvantaged sectors of the community. The chaos of the administrative collapses in the Housing Benefits offices and the Home Office systems for

dealing with asylum seekers have exacerbated the problems faced by those impoverished people who depend on them. There is evidence that the health, not only of the poor, but of every other member of society is harmed by the vast inequalities. This was exacerbated by the policies of previous Conservative administrations and has not been much reduced as yet by the present government.

reaching gains can be obtained by improving the health of mothers before they give birth. But little has yet been done to improve the health of young single mothers, despite the clear analysis of the problem produced by the Social Exclusion Unit.

>From poor diet to chronic ill health

S T Where is the joined up government? his

ome pregnant teenagers


have to live on ÂŁ32.25 a week.

ent has

Given the turmoil of their lives,

taken some bold and effective

steps to reduce poverty and the systems that trap and retain poor people in poverty, and these are welcome, but the joined up government that was promised seems to have proved more difficult to deliver than was anticipated. Substantial sums have been directed to the relief of child poverty, but there is good evidence that the most far-

some do not even get that. It may be possible to eradicate the problem of teenage pregnancy, but until it is, the government could at least try to ensure that teenage mothers are able to eat enough to ensure that their baby has a chance in life. Sadly, evidence shows that poor diet at that age has effects on health for the rest of that baby’s life.

Wasted talents



enefits for asylum

seekers and recent arrivals into this country are even more meagre. Single parents from European countries have to exist on £2.50 per child per day. Refugees and asylum

reduce morbidity among poorer children. It is also high time serious enforcement measures are taken against shops that sell cigarettes and alcohol to young children. The SHA welcomes measures to reduce the harm that results from drug taking. The war on drugs has been a complete disaster, and it is time it was abandoned.

Devolving decisions


Given the UK’s demographic profile, they should be welcomed and encouraged to use their talents. In fact, they are treated inhumanely, ordered around the country arbitrarily, and no efforts are made to utilise their skills. If the government is serious about strengthening deprived communities, it is here that it should be starting – using a valuable resource made available to many inner city communities by the accident of political events far away. The SHA would like to see the early introduction of fluoridation as the single most cost effective measure to

are also a key resource in

linking local communities to

therefore be allocated to have a system of specific areas, not to practice central direction

families, form a significant

some of the UK’s cities.


t is not possible to


fraction of the populations of


the NHS. They should

coupled with local decisionseekers, who often have large



If Primary Care Trusts are seen as the key to improving responsiveness and involving the NHS in community regeneration, they cannot at the same time be expected to respond to endless central directions and initiatives, and have all their funds allocated to specific programmes.

Defining health communities

populations. There is also an argument for linking GP lists to specific areas. If PCTs are to make a serious contribution to public health, they should be responsible for a population living in a defined area and not for a registered population who may not necessarily live in the area of the PCT.

Food for Socialist thought Peter Murray reports on the SHA conference Food for Poor People


T T he





ce was

Association has staged a highly

addressed by John Mcallion

effective conference on food

MSP, a well known Scottish

policy which reflected

Labour politician and co-

widespread support for the idea of Universal Free School Meals. It was held in Glasgow on 8 March, and opened with the provision of healthy Scottish foods such as porridge. Around 60 delegates came from as far apart as Bournemouth and Shetland and the event proved an excellent showcase for strategies to improve the health of the Scottish nation. Key SHA activists in Scotland, including Dr Ali Syed, Chair of the Scottish branch of the SHA, and Dr David Player reflected on Scotland's appalling record on heart disease and on recent reports charting big increases in childhood obesity across the UK.

Free school meals for all

sponsor with Tommy Sheridan MSP (SSP) and Alex Neil MSP (SNP) of the Free School Meals (Scotland) Bill. Mr Mcallion argued that the provision of free school meals to all Scotland's children would not only remove social stigma but would be a powerful weapon in improving the long term health of the nation. The so-called 'targeting' of free school meals leaves many other poor children unprovided

for. He reflected on the power of services free at the point of use, such as the NHS, which had been a cornerstone of Labour philosophy. He emphasised that the Bill seeks to secure free school meals of a proper nutritional standard, which would greatly improve the diet of Scottish children and provide enormous benefits to long-term health in Scotland. ''At a cost of only ÂŁ174 million per annum, this represents an excellent investment in our Children's Health'' Tommy Sheridan MSP, leader of the Scottish Socialist Party and co-sponsor of the Bill, spoke from the floor and recounted his recent experience of having to pay 47p in a school canteen for a bottle of water, whilst a sugary drink was only 42p! The Bill calls provision of free water to every child, and was not only warmly commended as the way forward in Scotland, but as a measure which should be adopted in England and Wales.

Debt and food poverty


A T O he

ne of





ce was


take on the values underlying

also addressed by Bill Gray of

s featured a young single man

universal free school meals

the Scottish Diet Action

living on benefits in a bed-

was given by the Reverend

Project, who highlighted the

sitter. He had no cooking

Paul Nicolson of the Zaccheus

key role of food co-operatives

facilities and just ÂŁ8.23 to feed

Trust 2000.

and insisted that the Left needs

himself for three days. It was

''For me this is a faith thing. A vital part of most faiths is the

to put healthy, accessible, and

recognised that this is a

idea of sitting down and taking a meal together. Children should be able to do this without money entering into it.''

affordable food at the centre of

virtually impossible task,

its public health and anti-

especially without cooking

poverty strategies.

facilities. The various case

He presented a session on the relationship of debt to food poverty. As the head of the Zacchaeus Trust he is constantly intervening to support poor people caught up in a debt trap. “Some people are paying huge interest rates to companies such as the Provident and Crazy George. Because they are poor, they fail to service debts and end up making further cuts in their food bill�

Food co-operatives

Recognising the problem of the multiples marketing, fatty, sugary, and unhealthy food, he said that the role of retailers is pivotal in any healthy food strategy. In response to questions about whether Scotland needs a food czar, Bill replied 'where I come from we name our streets after Russian cosmonauts, not Russian oligarchs'. The Conference also featured workshops in which delegates had to seek solutions to real case studies.

Fuel and food poverty

studies demonstrated how housing, fuel and food poverty are interconnected, and could only be solved by raising the incomes of poor people. The conference was also addressed by Scotland's newly appointed Health Minister, Malcolm Chisholm MSP. Malcolm was made welcome by delegates who still remember his principled stand on the cuts to single parent benefits, and he won plaudits

18 for responding to questions rather than making a set piece speech.

Some disappointments


any of the questions

reflected the inherent tensions between those in the labour movement, who want more universal provision (such as free school meals) and those primarily in the Scottish Executive and Westminster government, who favour targeting. The Minister clearly disappointed many attendees when he voiced the Executive’s opposition to the Free School Meals Bill. “This is a matter of targeting limited resources, and we feel this money could be better spent elsewhere.” It was perhaps significant that some of the sharpest comments on government health strategy came from the trades unions.

Unison's Glasgow Hospitals branch secretary Carolyn Leckie, for example, deplored the fact that 'the poor and low waged are really paying the price for any improvements to services, whilst the rich enjoy low taxes and do not pay their fair share.' Another delegate quipped ''we should feed the poor and eat the rich''.


he politics of food

clearly remains central to the

However, the day also saw praise for Glasgow's Labour led council, which has recently introduced universal free breakfasts for Glasgow's school pupils. This was welcomed as another move away from the deserving poor mentality.

socialist discourse. One

Where’s the fish?

the 1930's had lectured the

delegate reminded the conference of how Tories in

poor on how to make cod's head soup. The MP Willie Gallagher asked ''what I want to know is what's happened to the rest of the fish?''

___________________ __

Letter to the Editor



our Sum mer

issue of Socialism & Health contains a report of the debate that took place at the December 2000 SHA Central Council meeting – Does the SHA have a future within the Labour Party? Post general election in June, events have moved on and I would suggest that the governments’ intention stated within their Manifesto that units could be managed by the private sector calls for a clear Statement by the SHA. Taking up spare capacity in the private sector to relieve waiting times has been taking place for some time and makes sense. However, the government seems intent on going way beyond this remit. If the SHA is to retain credibility it should issue a position statement at least expressing its deep concern and seeking discussions with the government to establish just what they have in mind. I look forward to hearing from you.

Lawrie Nerva SHA member and member of Brent Community Health Council _________________________ __ Central Council has been exercised by this matter since the election .We publish in this edition of Socialism & Health the SHA statement Involving the Private Sector in the NHS, which it is hoped meets some of Lawrie’s concern. Prof. Allyson Pollock, who is at the forefront of the campaign against privatisation in the health service, also attended and spoke at the September 2001 meeting of Central Council while it was determining SHA policy on this matter. Contributions to this debate and comments on the SHA’s policies will be very welcome from all members and supporters. _________________________ __


___________________ __

SMA Vice President honoured in Harlow


plaqu e in

memory of Dr. Herbert Bach, a former Vice President of the Socialist Medical Association, the distinguished forerunner of the Socialist Health Association, was re-sited at the new Addison Health Centre, Harlow at a ceremony organised locally on 19 July 2001. Herbert Bach was born in Vienna in 1913 and fled to Britain in 1938, after being active in the Socialist Youth Organisation, which was outlawed by the Nazis. His father Martin and uncle David Bach were both prominent in the Austrian Labour Movement and another uncle, Max Jacob Bach, married a sister of Emmeline Pankhurst, the suffragette. In Britain, after internment, Herbert Bach took up residence in Manchester and began to practise medicine but in the aftermath of the Second World War he came south. Initially he was based in


Hoddesdon in Hertfordshire, but moved into Harlow and in due course established his surgery in the original Addison Health Centre, which has since been replaced. He was an extremely attentive and caring GP, but he also made time to be a dynamo of activity in Harlow Labour Party at both ward and GMC level. He campaigned for the NHS, for an industrial health service, and for the building of a hospital in the town. Founder of the local Fabian Society, he embraced a wide range of political and other voluntary work. His wife Millicent, a former nurse, supported him and was herself a member of Harlow Council from 1963 to 1974. His work led him into active membership of the SMA, and he was elected a Vice President. Sadly he died at 57 years of age in 1971. The plaque was unveiled by Dr. Philip Marriot, who was brought up by Herbert and Millicent Bach, after his parents Lydia and Gordon – a former Harlow Council Chairman – were killed in a car crash on the way to Stavanger, with which Harlow was twinned. Martin Lawn, Chair of Harlow Health Centres Trust and the Princess Alexandra Hospital and former Labour MP Stan Newens both spoke. Stan Newens

Annie Altschul


rof Annie Altschul, CBE,

FRCN, MSc, BA was born on 18 Feb 1919 and died on 24 December 2001. She came to London in 1939 with her mother, sister and a young nephew, fleeing from Austria under the threat of Nazi rule. Annie trained as a general nurse and midwife before specialising in psychiatric nursing. After completing her training at Mill Hill (Army medical hospital) she moved to Maudsley Hospital in 1946. While caring for the 'mentally ill' she was promoted to the post of Sister. Later she came to teaching as a Nurse Tutor. While at Maudsley she took a degree from Birbeck College in Psychology. Subsequently she also took a degree in Mathematics from the Open University. In 1964 she came to Edinburgh to join the Department of Nursing Studies at the University of Edinburgh. Annie had by then already published two books: Psychiatric Nursing (1957) and Psychology for Nurses (1962). In 1976 she became

Chair of Nursing Studies. Annie was later promoted to the post of Head of the Department, and was made Emeritus Professor at the University of Edinburgh. In 1978 she was elected as a Fellow of the Royal College of Nursing, and was awarded a CBE in 1983 on her retirement. Annie was also very passionate about music, particularly opera, and was a keen bridge player. Ali Syed Chair, Scottish SHA.

WESTWARD HO! News from the West of England Branch



he last

support from head office, by


the Branch and held on 12


have been relatively quiet down in the West Country. The highlight was the long awaited Bristol Royal Infirmary Enquiry Report Conference hosted, albeit with substantial

To my surprise, although I went to the meeting in favour of this development, as a result of the very interesting debate I changed my mind and went along with the majority view that social and primary healthcare should remain separately administered, although with strong partnership arrangements to ensure a seamless service at patient/client level. At the time of writing, the 6th edition of our newsletter Western Approaches is about to be circulated. Paul Walker

___________________ _

Help the SHA

October in Bristol. To my certain knowledge this was the first Conference hosted by the Branch during the last ten years, and probably since the Branch’s inception. Locally, we felt that it was important to be seen to be interested in this major local issue, the national and international ramifications of which will be substantial. In September we held a council of war at our Chair’s house to discuss how to improve attendance at our


regular two-monthly meetings. This resulted in an action plan which is now being put into operation, and which hopefully will reap dividends next year. A potentially very positive development in Bristol is that the long inactive local Fabian Branch is being reactivated. Already we have held a joint SHA/Fabian meeting on the topic of Poverty – its determinants and effects in January. Another first was an invitation to present the SHA viewpoint at a local Labour Party Constituency meeting. The topic under discussion was a plan to establish a combined health and social Primary Care Trust in North Somerset.

he SHA would like to mobilise and utilise the skills and experience of all its members.

If you can help in any way, if you are a Trust nonexecutive director, an NHS employee, a CHC member, or just someone who has a point of view, please let us know. The pages of Socialism & Health are open to everyone. All letters and articles will be considered for publication. And the SHA welcomes any other expertise or help that you can offer to ensure that the SHA remains a dynamic and respected campaigning pressure group in the 21st Century. ________________________ The views expressed in this journal are not necessarily  those of the SHA



Current branch contacts are set out below: LONDON Huw Davies 020-8992-5823 MANCHESTER Ruth Pushkin 0161-434-5140 PLYMOUTH Fiona Sheaff 01752-229157 SCOTLAND Ali Ahmed Syed k 0141-942-8804 SWANSEA Julian Tudor Hart 01792-371314 WALES Jeff Baker 01639-888750 WEST MIDLANDS John Charlton 0121-475-7700 WEST OF ENGLAND Paul Walker paul@crawfordwalker.frees 0117-968-2205 WEST YORKSHIRE Mike Young 01274-565468


More good news is that the NHS will no longer be “a centrally run monolith”. The establishment of the Commission for Health Improvement as a...

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