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Health Policy Challenges SHA first response to the Labour Party Health Policy consultation In general we are happy with the NPF documents on health – as far as they go. However there are some structural difficulties in the relationship between Government health policy and the Labour Party's health processes. Although the Party aims to produce forward looking policy the pressures on Ministers to develop policy in real time outstrips the ability of the Party to keep up. The SHA – and the Party – would like to see more stress on prevention, on well being, and on quality of life. Ministers share this aspiration but the pressure of events inside the NHS repeatedly diverts them from the difficult job of organising cross cutting action which is essential to the success of most key prevention programmes. Furthermore many programmes require a degree of regulation which is seen as politically dangerous. So we see measures to effectively devolve power and responsibility for NHS services to local communities as essential to make political space in which the more fundamental challenges at national level can be addressed. The four areas which we want to see addressed more effectively in the next Manifesto are these: 1.
Health inequalities
Inequality in health is a symptom of wide inequalities in our society. Despite valiant efforts to address the problems of the poor we have only managed to hold the level of inequality as it was in 1997. We have not been able to reverse the increase in inequality which occurred under Thatcher. As the NPF documents make clear social exclusion is an issue which extends far beyond the
remit of any one department. We would like to see some mechanism for ensuring that measures to address social exclusion – which are often politically and administratively challenging – get the attention they deserve. The reduction in inequalities in health must be a key driver of the NHS and all policies should be evaluated in terms of their impact on inequalities in access and quality of care through the process of health impact assessment. 2. Health and Well-Being There is of course an issue of personal responsibility in many issues of well being, but to stress them to the exclusion of measures which should be taken by Government either locally or nationally is to play into the hands of our opponents. We should strengthen the cross-cutting interDepartmental, inter-agency approach to prevention to tackle the major public health challenges of obesity, alcohol abuse, sexual ill health, and smoking with the application of much stronger gov-
ernment regulation where appropriate. 3. A cooperative health service We have strong reservations about the degree to which the NHS should or could be organised on the basis of competition between different publicly funded organisations, and we want to see greater emphasis on co-operative ways of working as a means of promoting efficiency, innovation and quality of care. We were very pleased to see the Secretary of State announce a moratorium on structural change in the NHS and suggest that this should stay in force for at least 5 years 4. A personalized health service, by which we mean one that responds to: 1. The individual patient at the point of care 2. The collective interests of patients in a locality 3. Diversity in all its forms