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Foundation Hospitals or shifting the balance of responsibility organisations. They will be locally from Whitehall and replacing it with owned, but will remain a constituent greater local public ownership and accountability”. (The Guide to NHS The government no longer wants to part of the NHS. They will have a two-tier governance structure – a Foundation Trusts) know every time an NHS bedpan Management Board and a Board of falls. It wishes to get out of direct, day-to-day involvement in running Governors. Membership of the Board They will operate on a not-for-profit of Governors will be drawn from the basis, and will earn most of their every part of the NHS. This, local “membership community” – that income from legally binding according to Health Minister Lord is, a community of residents, staff and agreements with primary care trusts. (Philip) Hunt at a meeting with This income will be based on the new Socialist Health Association officers, service users who have mandatory “national tariff” of is the main driver behind the standard costings of all health care establishment of foundation hospital procedures to ensure that they cannot trusts. actively opted to become members of undercut PCT contracts with other NHS hospitals. The SHA however is critical of the the trust. concept, and this article describes some of those criticisms. The intention is that “NHS foundation Foundation trusts will be able to borrow from both the public and the trusts will be guaranteed, in law, private sector, and will retain any What is a foundation trust? freedom operating surplus they may earn. from Secretary of State powers of Private sector borrowing will be Foundation trusts are modelled on co- direction, removing control operative societies and mutual

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controlled by a new prudential borrowing code,

similar to that being introduced into local government. A proposed cap on existing levels of private work addresses the concern that foundation hospitals would seek to boost their private patient income.

the personal experience of Florence Matthews………….5

The Welsh Peculiar – the local This innovation represents the introduction of more structural Health Alliance or why an Englishman works in Wales…………………………6 OBITUARY

Paul Gorman………………7 Foundation trusts will be able to offer extra rewards to their staff, although poaching staff from other trusts will not be permitted. They will be required under the terms of their foundation trust licence to deliver their existing range of NHS services to national NHS targets and standards.

The Catalyst Forum ……7 2002 LABOUR PARTY CONFERENCE FRINGE MEETINGS: FOOD POVERTY

Dual regulation This service delivery will be monitored by an Independent Regulator as well as the new Commission for Healthcare Audit and Inspection. In extreme circumstances, foundation status can be withdrawn.

GREAT LABOUR PARTY PERSONALITIES The Socialist Societies fringe meeting, supported by Labour Heritage and the Webbs Foundation

All current three-star hospitals are potential foundation trusts, and preliminary applications for foundation status must be in by February 2003. /2…

   

Foundation trusts or shifting the balance of responsibility…………….…1

Government reneges on commitments to patient and public involvement……..….4

Delayed discharge fines won’t work……………….5 To Lille for a total hip replacement

change. It is questionable whether proposing yet more change at this stage is the right way forward for the NHS, particularly as so many doubts are being expressed about the whole idea. Back to the internal market

The SHA, Democratic Health Network and UK Public Health Association fringe meeting………8

CONTENTS

would like at least 50% of all acute care hospitals to become foundation trusts within five years.

The Webbs………………….9 Jennie Lee……………….…10 Peter Shore………………...10 Ernest Bevin…………….....11

VALEDICTORY

Dr. Julian Tudor Hart…...11 Notice of Annual General Meeting………………….11 Forthcoming Events……12 Branch contacts………...12

Having got rid of the debilitating effects of the internal market, the government now proposes to reintroduce competition through the foundation trust concept. This in turn will create a two-tier system of acute health care, and ensure that struggling hospital trusts never get the chance to succeed. The SHA has always believed that public health is the route to improving health and health care, not continual structural change for the sake of structural change. The pursuit of community initiatives that stress a reduction in inequalities, encouraging healthier lifestyles, tackling social and economic exclusion, the importance of preventive work, partnerships particularly with local government and around community safety, and providing more resources for primary care and preventive initiatives should be the government’s priorities, not giving pre-eminence within the NHS to the acute and tertiary sector. The SHA therefore has grave reservations about the foundation trust proposals, and Central Council resolved the following proposition at its meeting on 16 November:

The short list will be announced in “The Central Council of the Socialist March. The first foundation trusts will Health Association believes that the go live in April 2004, subject to the government's proposals for legislation being in place …… and the foundation hospitals as presently set government has privately told three- out appear star trust chief executives that it to re-introduce the internal market

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and competition between NHS hospitals. The SHA is strongly opposed in principle to any measure that does this.”

A hospital is also the wrong unit to empower. It is returning power to the big hospitals when the thrust should be to empower primary care.

The government says the demand for foundation trusts came from high performing chief executives who want more freedom in the way they run their hospitals. However, since the publication of The Guide, many are If the local population is to have a A democratic illusion truly democratic voice, this should be reconsidering their position because A health service that is democratically in its Primary Care Trust, which has so many of the so-called “freedoms” accountable at all levels is a priority an interest in local services and relates will be swamped in a morass of for the SHA, and the foundation trust to a geographical area. Elections to bureaucratic control. concept has been given a superficial the Board would then be a simple attraction through its association with matter, conducted at the same time as For example, the cap on private local government elections and based patients is already causing co-operation, mutualism and local democracy. This, however, is sadly on the same constituency of electors. consternation amongst managers – suggesting that some of them would illusory. The Guide to NHS Foundation Trusts prefer to maximise private patient The proposed system of foundation says that foundation trusts do not need income rather than treat NHS patients. to set up patients’ forums as they will trust membership and the freedom be held to account through the For medical directors, greater clinical given to trusts to run their own commissioning process. However, it freedom was originally attractive. elections as they see fit, are is up to the Commission for Patient However, foundations will not be able concessions granted to chief executives who fear the introduction and Public Involvement in Health to to decide their own local clinical priorities, and will remain bound by of true democratic accountability into establish patients’ forums, and the suggestion that foundation trusts do government imposed national targets. hospital governance. It completely The role of the new Regulator also is undermines the government rhetoric not need these forums seriously undermines the new system of patient controversial, introducing another tier that the trusts will be community and public involvement in health even of regulation, although the owned and locally accountable. before it is introduced. Department of Health claims that it will operate a “light touch”. The perverse nature of the proposal is The role of PCTs in the foundation reflected in the fact that John Increased freedom to borrow is cited Redwood MP was the most vigorous relationship will be complex and proponent of election via the ballot uneasy, especially where several PCTs as another benefit. However, this will mean that borrowing is driven by box in the recent parliamentary debate hold contracts with the same foundation hospital. It is fanciful to hospital status rather than clinical on foundation trusts. believe that foundation trusts can be need. Furthermore, the foundation held to account through the trusts’ pot of capital is likely to be The proposal for “democratic commissioning process. PCTs will be greater than that available to other stakeholders” is unworkable in the hospitals, undermining the access of context of a big hospital because of required to sign long term, binding the lack of a genuine catchment area. contracts with foundation trusts, and more needy hospitals to capital. The interests of the local population, the trusts will be dependent on these often a very deprived population in contracts to allow them to borrow on Foundation trusts with surplus estate in areas with high property values will the case of many teaching hospitals, the open market. have the opportunity for windfalls may well conflict with those of patients attending specialist units who It is therefore unrealistic to suppose denied to the rest of the NHS. Profits that PCTs can then enter into from asset sales should be shared come from further away. expensive legal wrangles with the across the NHS, not retained within trust whenever they feel that one locality. Similarly, the ability of Where local people dominate stakeholder boards, they could quite contractual obligations are not being foundations to invest their own met. Neither would they be able to surpluses independently will result in rationally decide to close down small scale, piecemeal returns and expensive regional services and divert hold the trust to account by taking their contracts elsewhere. So deny the NHS the ability to maximise resources to meet local needs. In other foundation trusts cannot in reality be returns on aggregated investment. instances, small single-issue patient or held to account by any bodies other other groups could quite easily than the Regulator and CHAI. Real dangers capture control of the Board of Governors. Freedoms for whom? The first wave of foundation hospitals in a situation of prolonged staff The wrong unit to empower shortage is likely to boost recruitment

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at a small number of institutions at the expense of the rest of the NHS, Any further reform should offer making it even more difficult for other greater local flexibilities for all, hospitals to succeed. Staff poaching is reinforced with extra support for inevitable. The duty on foundation struggling hospitals, with the hospitals to exercise their freedoms in resources, money and capacity going a way that does not undermine or where they will achieve maximum damage the rest of the NHS is a pious improvements. The government’s and impossible goal. target should be tackle the current multi-tier delivery of acute health Competitive local pay will also care. transfer resources from health care into collective bargaining processes. It It should resist further organisational will become a recipe for divisiveness, change until there is a single-tier of competition and the uniformly excellent health care institutionalisation of a two or multi- matching the national standards to tiered health care service. This, at a which the government is committed. time when the government should be People pay for a National Health seeking to increase capacity across the Service and have the right to receive board, not introducing unfair consistently high standards of care no competition for scarce resources. matter where they live.

one-stop shop in every community to assist people with complaints, to provide

general information on patients’ rights and to help them get involved in patient representation. On 3 February Lord Hunt was obliged to attend the House of Lords to answer these concerns and others put to him by opposition peers. He was able to say only that “the new mechanisms we are putting in place – including Patient Advice and Liaison Services, overview and scrutiny committees of local government and all other mechanisms – will be put in place as quickly as possible.”

In its Guide, the government is careful The SHA is preparing a detailed While many of these mechanisms are to stress that foundation trusts will commentary on the government’s already there, albeit only just finding remain firmly within the NHS. Time proposals in The Guide to Foundation their feet, others are not. In particular, will tell if this status can be sustained. Trusts to submit to the forthcoming independent advocacy services are not If it can be demonstrated that Health Select Committee inquiry. expected until April 2004. foundations are not robustly embedded within the NHS, then they Judith Blakeman Since CHCs are no longer able to act could fall within the terms of the as the patient advocate, this means an _____________________ GATS agreement. unacceptable gap in services for vulnerable individual patients with complaints against the NHS for over a This General Agreement of Trade in year. The seamless transition to the Services, overseen by the World Trade new system that the government Organisation, reaches far into promised is no longer possible. domestic policy making. If foundation trust ownership is unclear, it could Patients’ forums now also look to be blur the boundary between public and at risk. The independent PCT patients’ private services. Public services are forum will no longer be the public’s exempt from the GATS provisions. Community health councils have reacted with shock and dismay to the access to involvement in their local Private services are not. announcement of their abolition date NHS. This role transfers to the trust PALS. If foundation hospitals become free- of 1 September 2003 and the arrangements for the new structures standing entities, they might be More worrying still, the Commission perceived as competing with private that are to replace them. The for Patient and Public Involvement in hospitals, but not on the same level Association of Community Health Health is proposing that local playing field. If that situation arose, Councils for England & Wales Councils for Voluntary Service set up the government would then have to (ACHCEW) argues that patients’ forums. This will recreate remove all subsidies and NHS within the new system one of the key benefits from the foundation trusts.  the new system will be massively shortcomings of the former under-funded; community health council system.  there will be no effective overlap In reality, the foundation trust is at with CHCs, thus leaving patients best a theoretical construct that will and the public without adequate prove disastrous in practice. It will not representation and support from CVS involvement in many CHCs was protect against future Tory unhelpful. It often produced Sept 2003 to April 2004; privatisation proposals. Unpopular representatives who had a oneprivatisations have been achieved  and the government has despite massive opposition in the past. abandoned its commitment to a dimensional view of their local NHS,

Government reneges on commitments to patient and public involvement

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There is an increasing number of of SHA member older people, many of whom live Florence Matthews in areas of multiple deprivation. Social services are increasingly Just before Easter I received a phone call from the East Kent Hospital Trust having to focus on delayed discharge, and make cuts in other offering me a bed for a total hip replacement operation in Lille, essential services to meet this France. government target. Judith Blakeman  There are initiatives to build the I had been waiting for over a year for _____________________________ capacity to meet the needs of older people leaving hospital, and this operation so, after the initial shock and excitement I accepted it to prevent unnecessary admissions. The government has with the proviso that my husband could accompany me. There was no committed a 6% increase in funding for social care resources. difficulty with this stipulation: he As waiting lists for operations grow But the process of modernising would have to pay his own Eurostar and queues on trolleys in A+E hit the return fare and would be charged £20 services takes time, and local headlines, the press has focused on a day for board and lodging. He authorities could lose this increase “older people blocking beds”, would be accommodated in my to fines. conjuring up images of older people private room on a pullout bed, which refusing to move out of hospital when  From the hospital perspective, unsafe (too early) discharge could turned out to be quite satisfactory. they are fit to leave. However, no one increase and cause more patients wants to stay in hospital longer than After some changes in the departure to be readmitted. they need, and a number of factors date, it was at last confirmed for  Nowhere in the government can cause a delayed discharge. proposals is there any reference to Easter Friday. patient choice, or enabling Parliament is currently considering a patients to participate in planning A week before departure, we were bill to introduce a series of fines for examined by the French surgeon and their own care package. This local authorities and hospital trusts if contradicts the philosophy of the the anaesthetist at Horsham Hospital. they do not meet targets to reduce National Service Framework for This was done to ensure that I was fit delayed discharges. If passed, this will to have the operation, to explain the Older People, which requires come into effect from April 2003. older people to be at the centre of procedure to me in detail and to answer any queries I had. the assessment process. Why discharges are delayed can be a complex issue. Some examples may  It is already known that there are recruitment difficulties in health I was advised to accept a spinal be discharge protocols, the availability and social care. A system of fines anaesthetic rather than a general one, of places in residential or nursing explaining that my recovery would be will only increase pressure on homes, inefficient assessment better and quicker. I had had my left already stressed and demoralised systems, or waits for adaptations to a hip replaced ten years ago under a staff. patient’s home. It could also be general anaesthetic so was a bit insufficient resources to meet Initiatives that will improve discharge dubious about the epidural, but agreed demands on social care budgets. and assessment processes, cut down to it eventually. I was most impressed There are also a number of specific waiting lists, and provide continuity with the full explanations of the factors that cause pressures on waiting of care for older people moving from procedures, and the possible hospital back onto the community are complications and their prevention, lists besides delayed discharge, including a shortage of trained nurses welcome. However, this can only be which were spelt out so clearly to me. achieved by collaborative working, and doctors, and the continuing We set off on Easter Friday by taxi to modernising existing services, and growth of emergency admissions. the Eurostar terminal at Ashford, above all ensuring that the service Yet the government is only proposing users’ needs are at the centre of the Kent, which took about two hours. There we met three other patients and process. fines for local authorities and/or another husband. We were escorted _____________________________ hospital trusts to address all these and assisted by two officials from the TO LILLE FOR A problems. Hospital Trust all the way to Lille. or potential conflicts of interest. Many  areas have no CVS, or very inactive CVSs, or CVSs that have little or no contact with hard to reach groups. To  give these organisations the responsibility to establish local patients’ forums is to court disaster.

Delayed discharge fines won’t work

Why fines won’t work

TOTAL HIP REPLACEMENT

The personal experience

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The actual crossing only took about 50 minutes. At Lille we were met by a special ambulance and in five


minutes we were at the Clinique, with a Zimmer and having more hospital by not sending waiting list whose building was set in lawns with vigorous massages. patients there. flowering trees and looked lovely in the glorious sunshine. On the tenth day, 48 staple clips were Moves are now afoot to campaign for removed painlessly and I was ready to it to be taken into the NHS, like the We were served with a delicious meal return home by the fourteenth day. National Heart and the Stamford in our room at 6.30 p.m., even though The journey back was quite tiring and (previously the Royal Masonic) I was due for the operation at 8 a.m. took me two days to recover as we hospitals in London. the next morning. This was because I had a long journey back home. had agreed to the spinal anaesthetic. I Florence feels that it would have been was introduced to my surgeon and the This Clinique was comparable in more economic to send her to procedure for the preparation for the standard to a private Harley Street Midhurst rather than Lille for her hip operation was explained to me in one. The food was exceptionally operation, and she has written to ask detail. They took every precaution to good in variety, in cooking and in the Minister why she was not offered avoid infection, with special showers choice. My husband had three meals a bed at Midhurst. She regrets that she and skin preparations. a day for £20 per day and wine was did not know at the time about the bed included in the menu. facility at Midhurst. Next morning, I was heavily sedated but not asleep during the one-and-a- This was an impressive and rewarding THE WELSH PECULIAR half hours of the operation. I did hear experience for me. I was able to THE LOCAL HEALTH the sawing of the bone and the talking compare it to my Yorkshire hip ALLIANCE of the team, but was so relaxed it did replacement ten years ago. It also not upset me. I had provided myself made me think about the concept of or why an Englishman works with a Sony Walkman and some taped “Europe” and ways in which we can in Wales piano music by Chopin and that help one another. calmed me. The upper part of me was For most of the 35 years that I have enclosed in a sort of tent, the lower I am grateful to the NHS for enabling practised as a public health physician part being invisible to me. me to have this experience and I have worked in England, with a brief hopefully to improve the quality of period in training in Scotland. So why My husband tells me I was away for my life. should I now find myself working in the best part of five hours, as I spent Wales? some time in the recovery room, during which time I can’t remember Of course opportunity is a great thing Postscript anything. For the first 48 hours after and the chance to work for one of the returning to my room, I was in Welsh health authorities came just at considerable discomfort. The pain I am 76 years old and so is Karl. We the time that I was looking for fresh was controlled by a drip and so was both speak some French, but not pastures after losing my seat, or the risk of infection. fluently. The medical staff spoke having it lost for me to be more English, as did some of the nurses. accurate, as a Bristol City Councillor. The nursing procedures were very But that was four years ago. So why exacting, and were performed every This project is being assessed by York am I still working there? four hours on the dot. I was University to see if it is viable to monitored for blood pressure and the extend. I filled in a 14-page The answer is simple. It is because of heart. I was impressed with the questionnaire of the details of my Local Health Alliances and the nursing, and with the fact that the experience. I wonder if their findings platform they provide for doing really surgeons visited me with an attending will become public? innovative and effective work in nurse twice a day every day until I public health, a platform that does not was discharged. It was a comfort that Florence Matthews exist in England or, I believe, in my husband was with me through this Scotland. Wales, partly by luck but difficult time, even though he was not Since Florence had her operation in partly by design, has got three crucial too well himself. Lille, the King Edward VII Hospital, things right that set it apart from the an “independent charitable” hospital rest of the UK. A physiotherapist started to work on in West Sussex has been threatened my leg muscles the very next day.  Firstly, it has clearly identified with closure. It offers the only The muscles were in spasm, so it was radiotherapy service in West Sussex local government rather than the a very gentle massage at first. Later, and has high quality cardiac and NHS as the lead agent for public on the fifth day I was up and walking orthopaedic surgery services, yet the health. As local government wields many of the key levers for NHS has withdrawn support from the

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improving public health, this to work in Wales. Where else would now also incorporates the Full makes sense and reflects the such a person work apart, perhaps, Employment Forum. position prior to 1974. from Scotland?  Secondly, it has understood that Paul Walker The Forum's National Council is the key to public health is chaired by Roy Hattersley, and brings partnership working, and to this together eminent academics, end it has invented the Local journalists and trade unionists. It is to Health Alliance as the vehicle for be, says Hattersley, "a campaigning such working led, importantly, by think tank" for the labour movement the local authority. and the left, committed to imaginative  And thirdly, in Wales all local and forward-looking ideas, rigorous authorities are unitary authorities research and argument, and the widest – no more the two tiers of local Paul Gorman died in August of a possible discussion and debate. government that bedevil England. haematological malignancy. And these local authorities are Catalyst is not aligned to any political coterminous with the main arms Paul was an active member of the party. It is an organisation of of the NHS – the Local Health Groups, soon to become the Local West of England branch who, with his democratic socialists, established to Health Boards. Having the same background in health and social care promote economic and social policies consultancy, was able to make a that are radical and modern but rooted boundaries as your partners, a positive and always insightful in practical experience. nostrum first concocted for the contribution to branch discussions on The Forum aims to provide some of first NHS reorganisation in 1974, a wide range of health and healthcare the intellectual energy and really is important! related topics. He was unfailingly commitment that the government will good humoured and courteous in his need if it is to achieve its ambitious It is this trinity that constitutes what I critique and in his small talk – the objectives. term the Welsh Peculiar. branch will miss him for his Wales has the infrastructure to enable knowledge and for his infectious Contact details are: it rapidly to overtake England in bonhomie. health if it makes full use of the The Catalyst Forum advantages this trinity bestows. It has I discovered about his illness by 150 The Broadway to be admitted, however, that local accident and though he was open and London SW19 1RX government in Wales is not so frank about it when asked he did not Telephone +44 (0)20 7733 2111 different to that in England. dwell on it. Unfortunately, I did not see him during his final year as he catalyst@catalystforum.org.uk And just as when I was a Bristol City was not fit enough to attend branch www.catalystforum.org.uk Councillor and had no success meetings. I did however keep up a whatsoever over four years in desultory email correspondence that persuading my Labour Group The 2002 Labour demonstrated throughout a positive colleagues that their overall objective and un-embittered attitude to the very Party Conference was promoting the public health of the end. citizens of Bristol, so in Wales local Fringe authorities have not yet fully Paul was a nice man, a fount of understood how public health, or knowledge, and a true socialist. health and well-being as we now call it, is central to their agenda. Paul Walker

OBITUARY

Paul Gorman

FOOD POVERTY

But perhaps, more important than Branch Secretary these structural attributes, Wales, like its sister Celtic nation Scotland, has _______________________ the blessing of a predominantly socialist political milieu - a necessary if not sufficient condition, in my view, for public health to thrive. After months of preparation, Catalyst – the left wing think tank - has Thus it is that a seasoned public secured backing for a substantial health specialist and committed expansion of its activities in its new socialist crosses the Bridge daily guise as The Catalyst Forum, which

THE CATALYST FORUM

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The SHA, Democratic Health Network and UK Public Health Association fringe meeting Hazel Blears MP was the keynote speaker at this very successful fringe meeting held on Wednesday 2 October in Blackpool. Dennis Reed, Director of the Local Government Information Unit, chaired it and the other speakers were Sally Kavanagh, the national food policy officer of


Sustain – the alliance for better food to concentrate at school, and Newham, and all the projects reflect and farming, and Eric Samuels, Co- education is a key factor in improving cultural preferences and requirements. ordinator of the Newham Food Access an individual's life chances. Partnership. Many projects are school-based, and All income groups have a clear include schemes to buy and prepare Hazel Blears said that food poverty is understanding of healthy eating fruit and vegetables, eleven breakfast a key issue that is shooting up the messages. However, the impact of clubs that use goods bought from a political agenda. Poor diet, obesity, aggressive advertising of fatty foods local cash and carry, a fruit delivery to and issues around nutrition are joining to children, the 50% premium school scheme, another scheme in the mainstream of concerns for public increase in the price of healthy foods, conjunction with Sure Start, pupil-run services. a lack of cooking skills, misleading fruit tuck shops, and juice bars in food labelling, and the fact that secondary schools. If children are not cookery is no longer taught in schools eating fruit by the end of their primary The core business of the Labour are all felt most keenly in low income school education they probably never government’s health policy in its second term now is to move from a houses. Poverty inevitably squeezes will, so juice bars are a way of encouraging the consumption of fruit. focus on acute care to tackling health the family food budget. inequalities by empowering communities to take action for Sally welcomed the government’s Ten community food co-operatives themselves that will permanently acceptance that food inequalities buy food from a Spitalfields benefit local people. exist, but was concerned at its wholesaler, and four are based in piecemeal attempts to address them. schools so that mothers can buy food when they collect their children. All Poor health has a differential impact The schools fruit and vegetables programme is good, and the co-operatives make a profit, upon poorer people. This is an Neighbourhood Renewal schemes although their stock is 40% cheaper extremely important issue, and than the shops, and they are therefore government-supported initiatives here recognise the problem of access to healthy food, but still the situation is sustainable. include food co-operatives, farmers getting worse. There is no sustained who produce healthy food, and an support for food co-operatives and expansion of the fruit in schools Families on benefits with pre-school luncheon clubs, which must be fully children can also receive a subsidised policy to include carrots and integrated into local regeneration tomatoes. food box through Sure Start. The projects. Primary Care Trust is training volunteer food co-op workers to However, encouraging people to take educate users in healthy food responsibility for their own health is Budgeting, shopping and cooking preparation, and four Healthy Living going to be more difficult than simply should be included in the National Centres have community cafes. The improving health care. Work within Curriculum. The Common Agricultural Policy keeps the prices of PCT and the local authority are key schools is seen as key, through the health food artificially high, and but silent partners in the Food Access Healthy Schools Collaborative and government departments must work Partnership, since without their Sure Start. Children will have cooking together to tackle these problems. support, it would be unable to achieve sessions, so that they can learn to its goals. The Partnership’s popularity prepare meals from raw materials and Sustain has done some work to map is demonstrated by the fact that its learn the skills that have the prevalence of food poverty, and volunteers range from 10 to 73 years overwhelmingly been lost. through its Food Justice Campaign it of age. is pressing the government for a Sally Kavanagh stressed that however food poverty is defined, it is national action plan to eradicate food All the projects are being monitored poverty within five years. and evaluated by the PCT and the very much related to income. The The existence of food poverty within University of East London. Successful benefits system does not provide the UK should be seen for what it is – outcomes include: sufficient funds to enable people to a source of national shame. have a healthy diet, and people on benefits die on average 8 years earlier  Increased consumption of fruit Eric Samuels gave an inspirational than those in work. and vegetables description of the work being done in  Strengthened school and family Newham in London. Newham is a There is also a clear link between links poverty and early death from coronary “food desert”, an area with no food  Community ownership of all the shops. The Newham Food Access heart disease and cancer, and links projects with obesity and diabetes. Poor diet Partnership that Eric co-ordinates is  Outreach work to share made up of 57 separate projects, and leads to disadvantage across the information with other generations. It affects a child’s ability has been running for over two years. organisations Over 140 dialects are spoken in

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 Reduced racial tension and better New Labour, it lacked interest in the race relations within strengthened communities  Less isolation of volunteers and users alike  The heightened self esteem of the volunteers, with many being trained to enter paid employment  And of course, improved access to healthy food.

Party’s history. 1997 was its Year Zero. This was foolish because there are lasting lessons of importance. He hoped that the tide was turning.

Jennie came from a Scottish Independent Labour Party (ILP) family. Her grandfather was a close friend of Keir Hardie. Her father was a Scottish miner.

The picture drawn was of the Webbs, warts and all. It was easy to pick fun She came out of the powerful ILP at them. tradition – leading from the heart and  Beatrice was not good on women: in the tradition of class hatred. She “the screeching sisterhood”. was a direct, sectarian oppositionist, and a rigorous intellectual. She saw  They like to call themselves ‘The Answering the debate, Hazel Blears the labour movement through the Firm’. said that the government recognises that it cannot run local initiatives, and  Their relationship was ‘A Union period of the General Strike and the 1930s. of Work’. will instead be allocating additional  They divided people into As and money to the PCTs. Bs. The As were the anarchists – Jennie Lee was prospective Parliamentary candidate for North people with no idea of There will be a crosscutting Lanark in 1929, gifted, arrogant, and organisation. The Bs were governmental review of health the best platform speaker in Scotland. bureaucrats – organisers. inequalities. She will be involving the She could win and hold a platform Department for Rural Affairs, since Sidney Webb saw democracy as the audience. The two other formidable food policy is key to tackling food process in which the apathetic mass women at that time were Ellen poverty, as well as local government. was non-receptive, while those with Wilkinson and Barbara Castle. an active spirit were held in check by Jennie was MP from 1929 to 1931 – a member of the ILP group led by Hazel agreed that cookery classes the mass. But the masses were form part of an holistic approach to individuals who should have the vote. Jimmy Maxton and increasingly at odds with the Macdonald/Snowden healthy eating, and accepted that free Beatrice’s driving passion was to water should be provided by law in all improve the lot of the bottom 30% of Government. She thought that they were trying to restore rather than educational establishments. society. destroy capitalism. Other points she picked up from the discussion included the need On the other hand, the Webbs had When they cut unemployment benefit, monumental achievements in to make diet and health a target for the the ILP rejected the Parliamentary education and welfare reform and Local Strategic Partnerships, to look through their vast research projects, Labour Party Whip and went into the at the case for allotments and at the wilderness, not rejoining the Labour including those on the trade union argument that health should be movement, industrial democracy and Party until 1945. included within adult literacy local government, in an age when programmes. After Jennie’s lover Frank Wise died, there were no think tanks. _______________________ she married Aneurin Bevan on the rebound. She was not in love with They were an unlikely couple. him, but with his dissent and Beatrice was after Sidney’s mind – oppositionism. The goals she wanted Sidney wanted more. Beatrice laid were pursued by Nye. down conditions for their letter Sean Creighton reports on the writing. Wright recommended people She thought she could best serve the Socialist Societies fringe to read Beatrice’s Diaries and the cause by helping him become leader meeting, supported by Labour Webbs’ published collected letters. Heritage and the Webb Much of what they argued for is at the and was at his side at the creation of the NHS and in the bid for leadership Foundation. centre of current debates. against Gaitskell. Whenever Nye seemed to be reaching an accommodation, Jennie and Michael BEATRICE AND JENNIE LEE Foot pressured him to oppose and SIDNEY WEBB resign, so he lost the confidence of his colleagues when it came to the Patricia Hollis, a Government Before talking about the Webbs, Tony member of the House of Lords, spoke leadership contest. Contemporaries Wright MP, said that while there about Jennie Lee, whose biography saw her as Nye's ’Dark Angel’. were many admirable things about she has written.

Great Party Personalities

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Jennie became an MP again in 1945. view that if the Labour Party was to setting out hours and rates and When Nye died in 1960 she went into change society, it had to re-think. maximum loads for both horse and a deep depression. Wilson rescued her cart. When he was in charge of labour and offered her the health portfolio, At that time there was an large influx in the War Cabinet, he vetoed a which she refused, becoming instead of members into the Party of people proposal to stop horse racing as it Minister of Arts and of the University from the forces, leading the debates would lower morale and detract from about the future – how the Party of the Air (the Open University). the war effort. should meet their needs and use their Bevin was ahead of his time in warning against the appeasement of Jennie had a steely will, and she was talents. Shore was clear about the need to bring them into the Party. Hitler and stressing the need to rearm indifferent to the views of others because of the Nazis’ brutal about her. This enabled her to cut He became a remarkable Minister at suppression of the unions. through the civil service and the Labour government to get what she the Department of Economic Affairs. wanted. Her disciplined personality This was a major and powerful When he was asked to join the War Department, able to argue with the took on the civil service. Cabinet he laid down three Treasury. conditions: the General Council of the TUC, the Labour Party National She mainstreamed the arts, achieving Peter Shore’s life has a relevance to Executive Committee and the TGWU a three-fold increase in the arts budget. She improved access without all our lives today, because he did not all had to agree. Without Bevin, wish to be associated with a political Churchill’s success would not have diluting excellence. She was been possible. He got 4 million people applauded by the theatrical audience. party that lost sight of equality and decency. into uniform, a striking test of the strength of democracy and collective She insisted that the Open University decision making and achieving a should offer degrees from the start, higher mobilisation rate than Nazi and when the contracts were being ERNEST BEVIN Germany. signed for the OU to start after the Tory victory in 1970, it was supported If it had not been for the Labour by Margaret Thatcher, who saw it as Robin Cook MP spoke about the Labour personality he admires most, Party’s role in defeating Hitler, the degrees on the cheap. Ernest Bevin. Born in poverty, his 1945 victory would not have been so mother died when he was 8 and he left high. Both Bevin and Bevan also Jennie lost her seat in 1970 with the school at 11 to work 10 hours a day became the builders of the peace, with biggest swing against an individual in on a Somerset farm. Later he a single minded commitment to the country. In the early 1980s ill campaigned for a school leaving age creating the United Nations – a health set in, and she died in 1888. of 16. principle as valid today as in 1948. Hers was nevertheless one of the Bevin is an example of the Labour lasting achievements of the Harold When Marshall proposed his Plan, Party and movement empowering Wilson period. working class people. He was a giant Bevin took the view that Britain of the trade union movement, and the should tell him what it meant, and not ask him what he meant by it. He founding father of the Transport & PETER SHORE wanted the Soviet Union to be General Workers Union. He had a passionate feeling for the poor, one included in the Plan, and had he reason why he gave up lay preaching. succeeded the Cold War might have Gwyneth Dunwoody MP praised been avoided. His contribution as Peter Shore for his high intellect and Foreign Secretary was immense. his steely commitment. His clarity of Bevin was ahead of his time. He view was matched by his humanity. collected and used evidence to counter the dock employers’ attempt VALEDICTORY When he came out of the RAF at the to argue that dockers’ food was adequate. As a union negotiator he end of the War, Gwyneth’s father was single-minded in his ability to Morgan Phillips, the Party General Secretary, appointed Shore to run the take on tough employers. There were Research Department. He prepared casualties on the way. A Somerset the 1945 election manifesto, and had farmer had to lock himself in a Dr. Julian Tudor Hart, a long time cupboard to get away from Bevin. enormous clarity of view. stalwart of the Socialist Health Association, has resigned from Bevin negotiated the first ever union Peter Shore was very courteous, Central Council. He has recently been agreement for the carters in Bristol charming and polite. He had a clear beset by ill health and is concerned

Dr. Julian Tudor Hart

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that, in his view, the SHA is not being he will recover his health and in due need another member to second sufficiently robust in its opposition to time perhaps return to Central Council them), and they must be received by the present government’s changes to to press the case for a truly socialist the SHA office on behalf of the the NHS. health service. Honorary Secretary not less than three Nevertheless, one of Dr. Tudor Hart’s ____________________________ weeks before the AGM. many achievements – the NOTICE OF ANNUAL identification of the inverse health The office is therefore inviting GENERAL MEETING care law that the greater an resolutions and nominations for SHA individual’s need for health care is, Officers – Chair, two Vice Chairs, This year’s Annual General Meeting the less likely s/he is to receive it - has Secretary and Treasurer, and for will take place on Saturday 17 May finally been accepted by government, Central Council (20 members) 2003 at Wesley’s Chapel, Old Street, and is now enshrined in The NHS between now and Saturday 26 April London EC1, commencing at 11.00 Plan. 2003. a.m. Central Council has placed on record its profound thanks for all the work Dr. Tudor Hart has done on behalf of the SHA over very many years. Council also expressed the hope that

In the event that a ballot is needed for Any member, branch, group, affiliated the Officers and/or Central Council, organisation or committee or Council ballot papers will be sent out by of the Association may move up to second class post not later than four resolutions or make nominations Thursday 1 May 2003. (those moved or made by members

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FORTHCOMING EVENTS

Friday 16 May 2003

Saturday 24 May 2003

Manchester Town Hall

Birmingham Council House

10.00 a.m. to 4.00 p.m.

10.00 a.m. to 4.00 p.m.

Health Inequalities Targets: are they achievable? Hazel Blears MP, Parliamentary Under Secretary of State for Public health Polly Toynbee, The Guardian Cllr. Richard Leese, Leader of Manchester City Council Dr. Alex Scott-Samuel, Director of Equity in Health Research & Development Unit, University of Liverpool Geof Rayner, chair of the UK Public Health Association

Foundation Hospitals: back to the internal market or power to the people? Lord Hunt of King’s Heath, Parliamentary Under Secretary of State Frank Dobson MP Margaret Mythen, New Health Network Prof. Roger Seifert, Keele University A representative of the NHS Consultants’ Association

 £90 statutory and commercial organisations  £50 voluntary organisations and Community Health Councils  £30 SHA members  £20 concessions To include lunch and refreshments. Vegetarian food will be available. The venues are wheelchair accessible. For other dietary or access requirements please advise when booking .To book, send a cheque payable to the Socialist Health Association or an official order to the SHA office.

BRANCH CONTACTS Greater London: Huw Davies 020-8748-7284 Greater Manchester: Martin Rathfelder 0161-286-1926 Plymouth: Fiona Sheaff 01752-229157 0

Scotland: Ali Syed 0141-942-8804 Wales: Anthea Symonds 01792-295313 West of England: Paul Walker 0117-968-2205 West Midlands: John Charlton 0121-475-770

CONTACT THE SHA Do you have a point of view? 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 you can offer to ensure that the SHA remains a dynamic and respected campaigning pressure group in the 21st Century.

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Socialist Health Association 22 Blair Road Manchester M16 8NS Tel: 0870-013-0065 E-mail: admin@sochealth.co.uk Website: www:sochealth.co.uk Editor: Judith Blakeman The views expressed in this journal are not necessarily those of the SHA Socialism & Health is published by the SHA and printed by RAP, Oldham OL9 7LY


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