Saturday, March 15, 2014

Labour Policy on Health and Care, by Jon Williams.

This is an initial response from Jon Williams to the Labour Party's consultative document on "Health and Care". The consultative document can be found here.

Overall this is a good document for Labour to promote and to take forward into their 2015 election manifesto. It covers a lot of the points of concern which we considered at our Discussion Meeting at Dronfield about the Coalition Government's and Health and Social Care Act moving us further to the privatisation of the NHS. ( See the presentation Jon made to that meeting here . HB).

The consultative document also says that it will use Sir John Oldham’s report  "One Person, One Team, One System"  which can be found here .  Additionally it proposes to make use of Andrew Dilnot’s social care report, see here .

The theme of the integration of  “whole person care”  is pursued to meet physical, mental and social needs. This involves removing inefficient fragmentation and competition to free up money, as long term care needs are increasing every year. It promises to repeal the  2012 Health and Social Care Act.  Yet I have doubts whether this is possible due to the Transatlantic Trade and Investment Partnership and the European and United States US trade agreement – which, however, is yet to be finalised. However, I attended a Chesterfield and North Derbyshire "Save Our NHS" meeting recently where Derbyshire County Councillor David Allen who is Chair of the Health and Well Being Board and Dr Sally Ruane the Deputy Director of Health Policy Research Unit De Montford University, discussed many of these issues. It was thought the NHS could be made an exemption to this agreement.

In the consultative document, Labour proposes to put patients before competition and get rid of the market system in the NHS. It talks about empowering people to use NHS organisations. It supports the principle of the NHS as the preferred provider and of using other providers in partnership. It is good to see the NHS is codified – I assume that incorporates the NHS founding principles. It also states that the local authority remit will be increased using Health and Well Being Boards. Power will be taken away from NHS commissioners and given to an independent body, such as Health and Well Being Board – again I agree with this approach. I hope “Monitor” (see here ) the current economic regulator will be abolished as the market system is reduced / removed. For line 40 of the Consultative Document quotes UNISON as saying  “Labour should use integrated care to break down the market, basing integration on NHS principles...”

By using preventive care / education Labour will reduce the demand on Accident and Emergency Services and will enable better access to local GP services. This is a key theme where funding will reduce over time, for money has been wasted with unnecessary re-organisation - an estimated £3 billion!

Social care funding has been cut with tighter eligibility criteria, which will me mean that hundreds of thousands fewer people get help. Labour is looking to implement Andrew Dilnot’s recommendations, e.g. with caps on care costs. It seems more discussion is required before definite policies are agreed. A key theme is that “older people should be treated with dignity as a top priority”. Keeping people at home to remain healthy, will reduce demand at hospitals. Also carers are central to "whole person care", including providing respite care, proper support and training with new rights. It mentions tackling the abuse of zero hour contracts, but does this mean not abolishing them!?

Part of the theme to help people stay healthy is to provide decent housing and better employment policies. It quotes Marmot’s report on a “Fair Society, Healthy Lives: Health Inequalities in England”  i.e. that large differences in health is dependent on circumstances. I fully agree with these sentiments. See here.

Labour's consultative document "Health and Care" is brief,  but it contains the major issues. What It lacks in detail is (a) how the process of integrated care will be applied, (b) where funding will be raised (taxation), (c) the issue of private involvement in the NHS,  (d) whether existing PFI contracts can be cancelled and (e) what role existing private companies have, if any, in the NHS.

Recently Clause 119 allowing hospital closures without consultation was carried in the Commons whilst probation privatisation went through the House of Lords.  Seemingly there is no limit to the privatisation ideology!

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