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Socialism and Health The journal of the Socialist Health Association Spring 2005

Editorial This edition of Socialism and Health goes to press as the General Election is being announced. The manifestoes have not yet been published but we are assuming that Health will be a major issue in the coming campaign, and we are therefore setting out recent policy statements by the major parties for comparison and reference. The Guardian reports that Health is the number one issue for voters. If we give most space to the Tory proposals that is because realistically these are the only alternatives likely to be adopted if Labour is not re-elected. As explained later in this edition I have replaced Judith Blakeman as Hon Editor. We are all grateful to Judith for the work she has done over the past years, and we expect to receive further contributions from her. Meanwhile please send any contributions to the address below. We intend to publish this newsletter quarterly, with deadlines at the last week of every third month. Gavin Ross, Hon Editor

HEALTH POLICIES FOR THE GENERAL ELECTION The website of the Socialist Health Association, www.sochealth.co.uk gives a detailed and updated analysis of contrasting party policies under the heading 2005 General Election. Here we will summarise some of the main points. An election is not a referendum. The question is not whether you approve of everything the Labour Government has done. The question is whether you think some other party could do better. There are things this government has done about which the Socialist Health Association has reservations, mostly because we want the policy to

Promoting health and well-being through socialism


3 be implemented more thoroughly or more quickly, or we think there will be unintended consequences. But when the opposition is weak their alternative policies are not given much attention. Despite our unhappiness with some aspects of Labour health policy a Labour victory is greatly to be preferred to any other likely alternative. Labour’s Manifesto Commitments The main thrust of Labour’s policy for the NHS is to continue and consolidate the achievements already made. There are also many policies that affect the health of the nation, from tackling poverty and inequalities to protecting the environment and reducing the risk of accidents and disease.  Spending on the NHS to increase by £34 billion by the end of next parliament  Waiting times: no patient to wait longer than 18 weeks by 2008, with an average wait of about nine weeks from GP referral to treatment. Consultations, diagnostic procedures and tests are included in the pledge for the

A Conservative Vision for Health

first time. Patients will see a primary care practitioner within 24 hours when they need to, and a GP within 48 hours  Choice – patients referred to hospital will have the right to choose any healthcare provider in the NHS that can meet the price and 18 weeks waiting time  Hospital Care – mixed sex wards are to go. Matrons are to have powers to fine cleaning contractors as part of a plan to halve the incidence of MRSA superbug infections by 2008. Fewer specific targets are to be imposed on successful three-star hospitals.

From the Health Service Journal 24/2/05

The detail behind the Conservatives' proposed redirection of NHS reform was revealed to the HSJ by health spokesman Andrew Lansley in February. Mr Lansley was speaking after the publication of the Conservative's Action on Health manifesto, which set out over 30 changes in policy that would follow a Conservative general election victory. The manifesto includes action to tackle hospital-acquired infection, reduce waiting lists, improve public health and re-organise the commissioning of care.

Expanding on these proposals Mr Lansley sketched out an NHS in which: 

the number of primary care trusts was reduced to a 'maximum' of 150; central targets were abandoned for acute trusts, but retained for public health and elements of primary care; appropriate waiting times would be set by the National Institute for Clinical Excellence; the Foundation Trust watchdog Monitor would become the regulator for a mixed market of

Promoting health and well-being through socialism


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

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public and private sector secondary care provision; the Healthcare Commission would have to radically reform its proposed approach to assessing NHS performance; primary care trusts would lose the ability to restrict the use of practice-based budgets; national procurement of independent treatment centres would be abandoned.

The Conservatives would abandon all 'centrally set targets on hospitals' and stop the Healthcare Commission inspecting trusts on the basis of core and developmental standards set by government. Mr Lansley claimed these were largely based on the government's planning and priorities framework and contained relatively few clinical standards. However, NICE would take on a much wider role - producing 'clinical standards' on most aspects of healthcare from hospital-acquired infection to cancer care to niche areas of chronic-disease management such as speech therapy after a stroke. Mr Lansley said these standards could include guidelines on the appropriate waiting times for specific types of treatment. These standards would be the basis of the Healthcare Commission's inspection regime, provide the framework for GPs' commissioning decisions and inform patients of what treatment they should expect. Mr Lansley said he recognised the bureaucratic 'risk' posed by a growth in NICE standards, but said this would be obviated by the fact that they would be 'evidence-based', 'produced in part by those who have to implement them' and take into account 'costeffectiveness'.

The opposition health spokesman said a Conservative election victory would see an immediate 'progressive transfer of [commissioning] budgets to practices.' From April practices have a right to an indicative commissioning budget. A Conservative government would remove the ability of PCTs to govern how these were used. Mr Lansley said that, as NICE guidelines were produced for specific conditions, practices would then be given 'specific sums' to spend on the relevant patient population. Patients with long-term conditions would be given choice over treatment specified by NICE, sometimes using direct payment to access independent providers. Mr Lansley said he hoped that a 'significant proportion' of long-term conditions would be covered by NICE standards by the end of the next parliament. Practices' influence would be further strengthened by making the delivery of commissioned services the second and final element of the Healthcare Commission's inspection regime. The increased commissioning role of practices would see a reduction in the number of PCTs that would be responsible for commissioning emergency care and public health. Mr Lansley said it was unclear how far the rationalisation would go: 'There should be a maximum of 150, but there could be considerably fewer.' All strategic health authorities would be abolished, but acute trusts could see significant growth under a Conservative government. With all trusts becoming foundation hospitals by April 2007 and freed from the prudential borrowing

Promoting health and well-being through socialism


5 requirements placed on them under the current administration, Mr Lansley claimed some NHS hospitals would expand. He suggested this was particularly true of specialist hospitals with 'world class brands, like the Marsden'. There was 'very little likelihood of private hospitals setting up in competition' with such centres of excellence, Mr Lansley said. But he said the Conservatives would encourage independent sector growth by giving it the 'right to supply' to the NHS. Mr Lansley said a 10-15 per cent increase in capacity was needed to end waiting lists. But this was on the basis that a large number of those paying for private healthcare did not return to the NHS. He said that Conservatives' plans to pay a contribution to the costs of private healthcare were designed to stop this happening. Patients attending

hospitals which charged above NHS costs would be given a state subsidy of 50 per cent of the NHS cost. In a significant expansion of its role, Monitor would become the regulator of the 'managed market' consisting of both NHS and private hospitals. It would license independent hospitals to supply the NHS if they met the relevant standards. Monitor would also be responsible for 'the structure of the [payment by results] tariff'. With the independent sector given the right to supply the NHS, Mr Lansley said there would be no need for the national procurement of independent treatment centres. However, he made it clear a Conservative government would honour any contracts that had been signed by the time they won power. Martin Rathfelder SHA Director

Newsflash, April 5th: The Conservatives have launched a campaign to shield family doctors running small practices from being forced out of the NHS by Labour Government reforms. An incoming Conservative government would provide special funding to ease pressure on small GP operators now facing the prospect of having to merge into large “super surgeries” planned by Labour throughout Britian. The Harold Shipman defence committee? Martin Rathfelder Liberal Democrat Policies While some Liberal Democrat policies may strike a chord with SHA members there is no likelihood that they would be in a position to implement them, or that they would be able to afford to do so if they achieved power. Liberal Democrats would  abolish Strategic Health Authorities  reform local government with mandate to determine health priorities

provide free personal care for the elderly

integrate health and social care at local level provide more information on treatment options remove central targets for clinicians make the NHS a health service, not a sickness service cut out waste

   

Promoting health and well-being through socialism


6 earmark National Insurance as the NHS contribution Other Parties The Scottish Nationalists emphasize that health policies should be local, not centralised, and that a proportion of health board members should be directly elected. The Scottish Socialists would abolish prescription charges and provide free school meals for all. Plaid Cymru would reduce bureaucracy, deliver services efficiently, and create a fairer society to reduce inequalities of health. 

The Ulster Unionists accept the fundamental principles of the NHS, free at point of use and accessible to all. They would introduce free personal care for the elderly, reduce waiting lists, and reform the present system of administration. Sinn Fein would harmonise health provision with that of the Republic. The SDLP would empower primary health and social care groups.

A VIEW FROM THE CHAIR - SAFEGUARDING TOMORROW TODAY In a long career as a public health specialist I have heard the mantra “ we must do more to prevent disease to reduce the burden on the NHS” or words to this effect, on innumerable occasions. And every few years this mantra gets enshrined in some new policy document or political initiative that ensures that for a period – uncommonly short usually – it is mouthed by all the great and the good in government and the NHS as the path to a New Jerusalem. Wanless and the English Public Health White Paper are just the latest manifestations of this syndrome. But very little happens as a result and sooner or later the mantra gets reinvented and chanted afresh. The explanation for what seems to be an iron law of nature is quite simple; it is that politicians and health service managers are, quite understandably, highly reactive to pressures from the public and staff. And these pressures almost invariably concern here and now problems of patient treatment and care. They rarely relate to preventive services whose impact can only be felt in the future. For, people are not

exercised by the “treatment” to prevent a disease they haven’t got; but the nontreatment, inadequate treatment or delayed treatment of the disease they have today, had yesterday and will still have tomorrow! So in spite of good intentions money and management attention committed to prevention get sucked into the bottomless pit of treatment and care. The solution is for a specific proportion of the health budget to be allocated to prevention and for these funds to be ringfenced, that is, available only for their intended preventive purpose and not to be siphoned off to redeem a waiting list or related treatment or care problem. It sounds fairly easy in theory; but it requires a clear vision at the top about the benefits of prevention and a strong determination not to be knocked off course by public and media pressure. This is very rare in my experience. It is rumoured that the Welsh Assembly Government are going to use the ringfencing gambit to ensure that sexual health

Promoting health and well-being through socialism


7 services are radically expanded and reconfigured to meet the growing epidemic of sexually transmitted infections. For these, like preventive services, have always been starved of funds. So a useful precedent might be being set on which we could build. And for support for the desirability of ring fencing, we need look no further than Professor Chris Drinkwater who was one of the presenters at our recent SHA Conference in Sheffield (see below). Chris recounted how in developing the English Public Health White Paper unambiguous advice was given by him and his primary care practitioner colleagues that commissioning for treatment and care must be kept separate from commissioning for prevention in order to guarantee the integrity of funding for the latter. This advice was ignored of course.

And, as well as courageous and visionary leadership, we need a cross party consensus that preventive services should receive adequate ring fenced funding irrespective of which of them is in power. For such funding must be sustained over the long term for maximum impact and not subjected to the stop/go of the political merry-go-round. The Swedes, always league leaders in doing the right thing, seem to have achieved such a consensus. Come to think of it, we need a cross party consensus on all major policy issues relating to the NHS so that we get some stability in the Service. The continual structural change that it has been subjected to since 1974 has been deeply destructive. Paul Crawford Walker, Chair

REPORT ON THE SHA CONFERENCE ON “IS HEALTH A CONSUMER GOOD?” HELD IN SHEFFIELD ON FRIDAY, 18 FEBRUARY 2005. The programme comprised four presentations followed by a discussion. The main points from the four presentations were as follows:

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1. Geof Rayner, lately chair of UKPHA

1. Surveys show that people are not

2.

very interested in choice of where they are treated and any choices offered must be local choices The person-centred approach of the English Public Health White Paper fails to recognize the clear evidence of the importance of environmental and socio-cultural factors, ie the ecological approach. This feature of the White Paper stems from a paper (from Mulgan

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et al) to the Prime Minister a year ago promoting the importance of focusing on personal behaviour Big business, the CAP and public services including the NHS are working against the health interests of the population in the field of food and nutrition and by analogy almost certainly in lots of other fields too. The change, over the last 30 years, from a producer society – manufacturing important and people did their own cooking and made their own jam and bottled fruit – to a service/consumer society with more cooking on TV than in the home kitchen.

Promoting health and well-being through socialism


8 2. Prof Richard Wilkinson, University

8. The crucial importance for humans

of Nottingham Medical School

1. Inequalities in wealth are widening

2. 3.

4.

5. 6.

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in Britain. Countries with the greatest inequalities in wealth have the greatest inequalities in health and lower overall health than more egalitarian countries Inequalities in wealth are associated with inequalities in every other feature of life In unequal societies only the most advantaged approach the performance of their counterparts in other more egalitarian societies; the disadvantaged perform much worse than their equivalents in egalitarian societies. There is the example of youngsters in US and Sweden in terms of years of education and that of their parents The importance of status and “locus of control” – high status people have internal locus of control whereas low status people have an external locus of control The mediating impact of chronic stress as a cause of poor health and other disadvantages The importance of respect as well as status. The example of Japan was quoted where low status people are accorded respect by higher status people because it is recognized that someone has to do the difficult and dirty jobs in society and they deserve respect for being willing to do these. Japan is the most egalitarian society in terms of distribution of wealth and health. Contrast cooperative societies such as Sweden with essentially competitive ones such as the US and UK. Friendship and positive social relationships and networks are features of cooperative societies rather than cooperative ones

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of being able to read other peoples thoughts and attitudes – for example, the issue of whites of eyes being only found in homo sapiens not other primates Remember the Revolutionary Slogan – Liberty, Fraternity, Equality – or death!! Borne out by recent evidence!

3. Janine Arnott, University of Manchester

1. The MMR Triple Vaccine / Dr. 2. 3.

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Wakefield story Importance of information to enable choice to be made The importance of visual images to people. For example Dr. Wakefield was very visible but D of H only gave quotes – no memorable images Immunisation choices raise the issue of putting the community above the individual. The rationale for this is fairly obvious with a communicable disease but less so with something like choice of hospital. But shouldn’t the same principles apply?

4. Professor Chris Drinkwater, University of Northumbria

1. The Benwell experience. Benwell

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is a health centre in Newcastle where Chris Drinkwater achieved great things Failure of early regeneration programmes such as City Challenge because they focused on physical/environmental regeneration rather than social and community regeneration Operation of the Inverse Care Law in respect of health promotion activities under the 1991 GP contract, which introduced health promotion activities into general

Promoting health and well-being through socialism


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4.

5.

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medical services but failed to reach those most in need, including in Benwell The crucial importance of empowering local communities to enable them to exercise choice – without it they cannot choose Through community development control is handed over to communities. This is uncomfortable for public bodies but is crucial. Also it means that the outcomes of projects (eg funded by NOF) cannot be predicted in advance because they depend on what communities want, which is not known until the project is being implemented. It is important to realize that ordinary people are used to being economical and realistic in the use of their own funds. Experience shows that they are equally economical and sensible in the use of public or other external funds! The importance of separating commissioning for health and commissioning for healthcare; otherwise the latter will always outshout and subvert funds from the former. The importance of the public health function being shared by health and local government The importance of facilities for the community actually belonging to the community through, for example, community based charitable trusts. For it is through having ownership and thus responsibility that communities are empowered and take control .

e

Discussion These talks were followed by a useful discussion session which considered whether “Choice� was an appropriate approach, and what actions the SHA and others should be taking. Conclusions

1) Choice in healthcare is not a big 2) 3)

4)

5) 6)

issue for the public or for professionals The agri-food industry and the CAP are a major anti-health force to be tackled by strong regulation The need to reduce competitiveness and class differences in British society in order to reduce inequalities in status, and thus inequalities in health The crucial role of community development in improving health and well-being in deprived communities The need to ring-fence funding for prevention so that it is not diverted into care and treatment The personal approach promoted by the English White Paper will fail unless accompanied by an ecological approach.

This was an interesting and stimulating conference with excellent speakers. John Lipetz and Alex Wyk

The following article by Martin Rathfelder appeared in Public Health News, 7 February 2005.

PATIENT POWER As national director for patients and the public Harry Cayton reminds us (and who is

going to nominate him to be a people's peer?) - all professions are a conspiracy

Promoting health and well-being through socialism


10 against the laity. He suggests that extending lay involvement in regulation is the way to improve patient safety. He may be right. But if the professions are organised into conspiracies we lay people must also be organised. Perhaps rethinking the Public and Patient Involvement (PPI) structures after the abolition of the Commission for Public and Patient Involvement in Health (CPPIH) will give us the opportunity to produce something better than we have now. Transparency, accountability and democracy are very important, and largely absent from the present arrangements. Structures which are supposed to involve people need to be built from the bottom up, not the other way round. The temptation to pull up the plant to see how the roots are growing must be resisted. Voluntary organisations cannot be summoned into existence or ordered about. They need to develop and evolve. Forums may be created by statute but they behave like voluntary organisations. If the Forums are to be left as they are we need a national organisation, and regional organisations too so that the patients voice can be clearly heard at every level. A democratic national organisation of Public and Patient Involvement Forums would have a far stronger and more independent voice than a Commission of government appointees, however experienced and eminent they may be. There are Community Health Council survivors who think that CHCs were abolished because they were too effective and national surveys like Casualty Watch were embarrassing for the government. The new arrangements which replace CHCs with a multitude of new organisations - do not give much promise so far of being more effective. CPPIH has done its best to talk up their achievements but actually many forum members feel disempowered. The different organisations are hindered, often prevented, from exchanging information because of an obsession with data

protection. Forums do not have offices or telephones or websites. Forum members seem to be discouraged from communicating with each other – on their Knowledge Management System – a glorified chat-room – nobody has a name. They are allocated titles like “East Midlands Region CPPIH - Community Empowerment Lead 1”. This seems a good way of making sure that no one is accountable for anything they do or say. CHCs were by no means perfect but most of them by the end had a good understanding of the importance of publicity. The reporter from our local paper was practically a member of our CHC. And CHCs were in a position to pull together information from different sources in order to build a more complete picture of their local health economy than most mangers could do. Forums are denied any useful information about complaints because complaints go to ICAS. They don't get information about service configuration because that goes to the Scrutiny Committee. They don't manage their own staff or budgets. Instead, the staff work for Forum Support Organisations (FSOs) - voluntary organisations who sometimes have their own interests to look out for, in particular the need to keep their contract with CPPIH. There is supposed to be monitoring of FSO performance, but Forums as such are not asked their views. Instead there are member surveys. CPPIH does not seem to understand the idea of collective responsibility. They never communicate with Forums as organisations. They only do surveys, as if Forums were just a cross section of the public and not organisations at all. That wouldn’t be so bad if Forums were selected at random like juries, but they are self-selected and so despite efforts to recruit more diverse members they are overwhelmingly middleclass, middle aged or older, and white. Some of the FSOs seem to see their job as keeping Forum members in order, and in particular to make sure nothing controversial gets into the press.

Promoting health and well-being through socialism


11 A national association of Patient Forums has much to contribute to supporting an effective National Health Service to all communities in the UK and to good healthcare service delivery at local level. It could organise an effective voice at a regional level, or wherever decisions are made about a particular service. Once there is a national association then all those people who find themselves on the GMC or any other place representing the public as a token lay person can also be

attached to it, so that they too have support and can, for example, arrange a deputy as other members of such bodies do. An organisation which is seen as independent and able to criticise the NHS will be far more credible than the Chief Medical Officer if it announces that things are improving. But it has to be seen to be independent. Allowing John Reid to suggest to Forums that they should go round hospitals looking for MRSA was a bad move. The agenda must be determined by patients, not by the Secretary of State. Martin Rathfelder

DIABETES – THE EPIDEMIC In early March Sue Roberts, the National Clinical Director for Diabetes, talked to the North East Socialist Health Association on diabetes. She began by finding out what aspects members were interested in, including a brief explanation of what diabetes is, and tailored her presentation accordingly. Diabetes has reached epidemic proportions Types I diabetes can occur at any age but occurs mainly in young people. Although diabetes is due to the blood sugar being too high, the problem for people with type I diabetes, on a daily basis, is that the insulin they take makes it possible that the blood glucose will go too low. A person can appear drunk and become unconscious. The main treatment for type I diabetes is to replace insulin to match food intake. Type 2 diabetes is massively inherited. It is very common in first generation South Asians. In the black and minority ethnic population, early kidney complaints are frequent but foot complaints fewer. A ten-year population cohort in North Tyneside showed a 15% per annum increase in type 2 diabetes. In 1986, 550 people were diagnosed; there are now 8500 diagnoses. 60% of the population is

overweight or obese. An obese woman is twelve times more likely to develop diabetes; an obese man is six times more likely. The reason? Food intake and lack of physical exercise. Physical exercise is probably more important in diabetes than food intake! In trials in Finland and China, 5% loss in body weight prevented two-thirds of diabetes. The drug metformin has been found to make insulin work better but lifestyle changes were more effective. An Australian study of first-nation Aboriginals found that the first generation to move into towns were all destined to get diabetes. They were asked to return to their original lifestyle of hunting and within 6 weeks the metabolic and chemical changes were back to normal. Type 2 (maturity onset) diabetes now occurs in younger and younger people. Pregnant women with Type 2 diabetes are five to ten times more likely to have babies with congenital abnormalities. Current emphasis is on individual responsibility. Society’s job is not to create a diabetic environment The York Public Health Observatory has developed a good model to work out the prevalence of diabetes according to GP

Promoting health and well-being through socialism


12 practice profile. There are 80 ‘Spearhead’ PCTs (more money for poorer health); this total includes 15 of the 16 PCTs in the North East. So for example Hartlepool, with an SMR of 124.7, will receive more money because it is further from its targets.

to look for. Older people may need to rely on Community Matrons to gain access to specialist diabetes services.

It is possible to make a difference A project in Slough, based on opening up to the public information which the NHS has previously held, is encouraging. Commercial and hospital databases were used to map postcodes for diabetes - 7% of the entire population. It was possible to pick out individual streets at risk. A community-based programme, with one person per street raising awareness, appears to have made a difference and is being evaluated (Neighbourhood Watch level of activity). 1998 figures showed the cost of diabetes to the individual as between £800 and £1,000 pa.

A lively discussion focussed on food, exercise and raising awareness. Agricultural subsidies could be used to encourage the production of healthy food. In terms of retailing food, corner shops in disadvantaged areas could be subsidised to stock a shelf of healthy food to ensure affordable, healthy choices. A real breakthrough would be to achieve affordable, healthy choices in all food stores.

Selfcare programmes These are structured patient education programmes. ‘Daphne’ for Type 1 would pay for itself in 4 years (York Health Economics Consortium did the economic evaluation). The cost of Daphne is equivalent to the cost of one year’s tablets. ‘Daphne’ and ‘Desmond’ (for Type 2) self care programmes keep people out of hospital. Hospital admissions of the worst cases of diabetes are five times more likely to have a leg amputation. Hospital stays are longer, due to complications. It is imperative to reorganise diabetic services and nurses to reduce the length of stay. In the community, improved education is needed for people with diabetes. People need proper foot services and to know what A

Discussion

Community awareness could lead to local campaigns /action to promote physical activity, perhaps demanding low-cost access to sports facilities and exercise on prescription. We need to encourage people to continue exercise when they give up sport. Raising diabetes awareness in schools could be supported by school nurses, and learning mentors in the extended school model. It is imperative to get messages into the youth culture.

Conclusions Sue left us with a couple of sobering thoughts. Fat in the tummy is nasty stuff! It makes the body resistant to insulin. Fat is genetically determined. The pancreas has to produce more and more insulin and eventually cannot keep up with the needs of the fat. That says something about our body shape. We were very grateful to Sue for raising our awareness and sharing with us her experience, which indicated that all but one person in the room was potential Type2 material, given our various shapes! Rita Stringfellow, NE Branch SH

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HITTING THE TARGETS – MISSING THE POINT Mental health care was the subject Steve Shrubb, Regional Director of NIMHE for the North East, Yorkshire and Humber, talked about to the North East Socialist Health Association. Mental health care is funded at a low level and the policy position is inconsistent. Although this government has invested more than any other, the focus has been on narrow targets to improve mental health delivery. Moves to concentrate on social inclusion, to support people into jobs, citizen status, decent homes and education, have been slow. People need support to improve how they live their lives, with access to jobs, exercise, art and leisure activities. The north of England has the lowest level of direct payments. Capacity in the third sector needs to be increased. People need to be funded in a different way. Government’s process targets to improve service delivery have not affected change on a personal level. Is the preoccupation of psychiatrists in trusts to focus on a medical model, the barrier to psychological help, which is the real need.

In Australia and New Zealand there is a consistent approach to changing public attitudes. Investing in ‘treatment and repair’ is a short-term goal. The current care configuration results in a struggle to increase social inclusion and sustain recovery. 74% of people suffering psychosis make an almost total recovery. ‘Spend’ in mental health trusts is tailored to narrow targets, without access to information on peoples’ needs. Effective commissioning is the key to making a difference. Should mental health commissioning be lifted clear of the stranglehold of health? There is no power to take money out of the existing system, which may be better spent, for example, by local authorities, relevant to the lives of individuals. We should be thinking about mental health systems, rather than primary and secondary care. Members thoroughly enjoyed discussing some controversial ideas!

Rita Stringfellow, NE Branch SHA and ViceChair

CHANGES AT THE SHA Director of Communications Judith Blakeman will be leaving the SHA’s employment at the end of March, although she will continue to be an active member. Martin Rathfelder will continue as part time Director of the Association and Gavin Ross will take over as Hon. Editor of Socialism & Health. Articles, Letters, Announcements and Comments should now be sent to Gavin Ross, 21 Connaught Road, Harpenden, Herts AL5 4TW, Tel/Fax 01582-715399 or by e-mail to gavros.ross@btopenworld.com Deadline for next issue: 23rd June 2005

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RICHARD BENJAMIN 1921-2005 Richard was born in 1921 in Germany, the fourth of five sons of Karl and Klara Benjamin. His early childhood was happy, but in the ‘thirties with the advent of the Third Reich life became more difficult, and in 1938 Richard and his younger brother, Ralph, were sent to school in Switzerland and eventually were helped to come to England in 1939. He spent a year’s internment on the Isle of Man, (along with the Amadeus Quartet and Rawicz & Landauer), and for the rest of the war worked in a factory, and studied for his degree in the evenings at the Northampton Polytechnic (now The City University), gaining his M.Sc. in physics. As he grew older he became more interested in psychology, sociology and eventually politics.

Unlike many people with this background, Richard liked to visit Germany, especially his home town of Darmstadt, making many trips there. He was a regular attendee at S.H.A. meetings and conferences, frequently proposing motions, often asking for a working party or sub-committee to be set up to look into this or that. His interests were wide, as a member of MENSA (at one time international Secretary), The Labour Party, The British Humanist Association, Electoral Reform Society and the Labour Movement for Electoral Reform, The Voluntary Euthanasia Society and the European Movement, He wrote leaflets on many subjects including Socialism & Modern Democratic Techniques and Registration of Psychotherapists.

Promoting health and well-being through socialism


15 He was a kind man, once intervening in a serious fight between two men, resulting in himself becoming quite seriously injured. He will be remembered with affection and missed by all who knew him.

Derek Marcus & Norma Haemmerle.

What do we mean by ‘Socialist’? The late Raymond Williams provided an invaluable guide to political vocabulary in Keywords (Fontana, 1976). The five-page article on the term ‘Socialist’ identified two conflicting themes within one word, and many different traditions emphasising a contrast with other terms. The first theme encapsulates the idea of reform of the social order, political freedom, the ending of privileges and formal inequalities, and social justice, conceived as the equity between different individuals and groups. The second theme sees competitive individualism and industrial capitalism as the enemies of social forms of society, which depend on co-operation and mutuality, and that the latter cannot be achieved while there is private ownership of the means of production. A century and a half of bitter dispute, in which the word ‘Socialist’ has been a label of pride and of abuse, which has been attached to parties with very different s

objectives, has left the position as confused as ever. New Labour is of course wary of using the term at all, but thereby deprives itself of a key concept. It is the contrast with other terms that is important: ‘not-individualist’, ‘notcapitalist’, ‘not-communist’. The founders of the Socialist Medical Association were not ashamed of the word, which was very much concerned with the first theme, the positive, caring theme which aims to improve society by providing health for all irrespective of the ability to pay. They did not wish to become distracted by the ideological arguments of the second meaning. The result was the NHS born not through revolution but brought about by a democratically elected government carrying out its manifesto commitment, and remaining universally popular ever since. Gavin Ros

Index P.1 Health Policies for the General Election P.4 A View from the Chair Paul Crawford Walker P.4 Is Health a Consumer Good? Report of SHA Sheffield Conference John Lipetz et al P.6 Patient Power Martin Rathfelder P.7 Diabetes, the Epidemic NE Branch Conference Report Rita Stringfellow P.8 Hitting the Target – Missing the Point NE Branch Conference Report Rita Stringfellow P.9 Changes at the SHA Obituary of Richard Benjamin P.9 What do we mean by Socialist? Gavin Ross

FORTHCOMING EVENTS Annual General Meeting Promoting health and well-being through socialism


16 The Annual General Meeting will be held on Saturday 19 May at The Radnor Room, Wesley’s Chapel, City Road, London EC1 (nearest station is Old Street, exit no. 4), commencing at 12 noon. All SHA members are welcome to attend. Nominations for Officers and Members of Central Council required by 30th April Manchester Branch AGM, 7.30 pm Wednesday 27th April (with the Politics of Health Group) Dennis Raphael and Toba Bryant York University Toronto Public Policy, Welfare States, Politics and Population Health A conference at Birmingham and Midland Institute is planned for July The proposed topic is the Social Care Green Paper, for which consultation ends at the end of July. 9th September 2005 Black Report Anniversary Conference on Manchester Speakers include Richard Wilkinson, John Ashton, James Munro and Alex Scott-Samuel

SHA BRANCH CONTACTS Greater London: Greater Manchester: North East: Scotland: Wales: West of England: West Midlands: 0

Huw Davies Martin Rathfelder Rita Stringfellow Ali Syed Anthea Symonds Paul Walker John Charlton

020-8748-7284 0161-286-1926 0191-258-3949 0141-942-8804 01792-295313 0117-968-2205 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 E-mail: admin@sochealth.co.uk Website: www:sochealth.co.uk Editor: Gavin Ross Editorial e-mail: gavros.ross@btopenworld.com The views expressed in this journal are not necessarily those of the SHA

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The journal of the Socialist Health Association The website of the Socialist Health Association, www.sochealth.co.uk gives a detailed and up...

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