Health Policy Commission draft
Draft statement of the Left Unity Health Policy Commission – February 2014
This is the latest draft document produced by the Health Policy Commission.
Our aim has been to produce a statement which begins to address the social determinants of health as well as beginning to outline the necessary principles for our health system. We also sought to provide some policy proposals for putting these principles into practice, reversing the destructive attacks upon the NHS, improving the services it provides and making them more democratic and accountable to workers and service users.
These services should be free for all and the profit motive must be removed from the medical world.
The NHS has been continually shown to be at the top of the world’s health systems in terms of outcomes and patient satisfaction. It has achieved this on the basis of lower levels of funding than other developed countries.
This government is the first since the NHS was set up to work to systematically wreck it. The government aims to privatise most of the service, leaving a loss making residue to cover unprofitable areas. Left Unity is essential to promote the values and practical policies needed to defend and advance the NHS.
This document is being published so it can be circulated to all Left Unity groups, to facilitate further discussion and debate and allow input from local groups and members. We welcome feedback, amendments and any discussion documents produced by groups or individuals relating to the document.
The Health Policy Commission remains active to facilitate further work and also to serve as a source of advice and guidance for Left Unity activists campaigning around the NHS or wider health-related issues.
E-mail: HealthPolicy@leftunity.org
Draft statement of the Left Unity Health Policy CommissionPolicies to improve health
Move to minimise social and economic inequality. Every step that reduces inequality can be shown to improve the health of all parts of society. All Left Unity policies should consider their impact on the social determinants of health.
The development of new, and improvement of existing, social factors on health such as improved social housing, access to good education, healthy food, healthy environment, exercise facilities etc.
Healthcare planning and provision should include a focus on the social determinants of health as a means of preventing ill health. This means that resources should be distributed across the country according to the pattern of need.
Defence of the environment to minimise any health impacts.
Healthcare Policies
The NHS is central to healthcare provision. The following policies are vital to defend and improve it:
The Secretary of State for Health should be responsible for all NHS healthcare provision.
Every part of the NHS should be defended as a publicly run, publicly owned system providing free care. Where this is not the case it should be reversed.
Access to health care should be universal and equitable.
Health care should be funded out of taxation (and borrowing where necessary – e.g. as GDP fluctuates annually).
Market forces have no place in state healthcare provision.
Better ways of integrating the provision of healthcare and social care should be investigated and implemented.
Health education ties the health system to the education system and should be developed as a form of co-operation between the two.
Healthcare provision and planning should be based on evidence and outcomes and excellence should be the norm.
Mental health services have been shamefully neglected over decades and need to be expanded and integrated into the broader NHS.
Workforce planning and training of staff should be dependent upon the needs of the NHS.
Health care planning and provision should include a focus on workplace health and ensuring that the physical, chemical, biological and psychological risks in all workplaces are aggressively minimised.
A real weakness of the original NHS is that of poor democratic accountability. We need a modern system in which employees, councillors, patients and carers are represented on all appropriate health bodies. This should help to ensure that the NHS has the flexibility to ensure that local and regional needs are catered for.
In accordance with Left Unity policy, members must consider joining Keep Our NHS Public and other relevant bodies. They should also consider involvement in public health bodies like Clinical Commissioning Groups, Healthwatch and Hospital and other Trusts. The purpose being to defend the remains of an integrated service and resist commodification and especially privatisation at every opportunity.
As a long-term goal, we need to work towards a single integrated NHS. An integrated NHS would eliminate the so-called purchaser/provider split. This is a costly way to create an internal market. It sets parts of the NHS against each other to no good purpose and costs up to 14% of the entire NHS budget annually just to maintain.
A genuine NHS could control the behaviour of the drug companies. This would mean ensuring that fair prices are paid for drugs. It would also mean that the excessive use of drugs would be ended. Once drug companies cannot promote their products directly to doctors the unnecessary reliance on pharmaceuticals can be ended. A unitary NHS would be in a powerful position to deal with global businesses. The possibility of pharmaceutical production within the NHS must be considered.
Health research is essential and the intense competition for funds should be scaled back. The money saved on sterile bidding for funding could be used to expand the total amount of research. Research has to be encouraged at all levels of provision and aimed where the NHS requires it. This goes from work on genetics to the study of the daily practice of GPs and community health workers.
Immediate Demands for discussion at Policy Conference:
The 10 point plan to re-instate, protect, and improve the NHS:
1. Repeal the Health and Social Care Act to restore the NHS as a publicly delivered, publicly funded and publicly accountable healthcare system, and re-establish the position of the Health Secretary as fully accountable for providing comprehensive health care. The most practical solution is to back Lord Owen’s NHS re-instatement bill, which we fully support. (http://www.opendemocracy.net/ournhs/david-owen/nhs-reinstatement-bill-and-explanatory-notes-updated)
2. Re-instate the NHS as the preferred provider of healthcare. This will protect the NHS as a public service by minimising private sector takeover of NHS services
3. Abolish the Private Finance Initiative (PFI). Renegotiate and buy out contracts at realistic value.
Any publicly owned banks must cancel PFI contracts before re-privatisation. Stop and reverse the outsourcing of clinical and support services related to PFI projects.
4. Moratorium on A+E and hospital closures. Any reconfigurations must be clinically, not financially driven, and must show they have won public and professional support for alternative, improved services.
5. Reduce the Department of Health’s reliance on expensive external management consultants who have too much influence on health policy. Instead the DH should re-engage with the representative bodies of frontline NHS professionals, as well as patient groups, to develop and plan future NHS policy in the most clinically effective and sustainable manner
6. Ensure evidenced-based adequate staff to patient ratios and bed numbers in order to maintain safe, effective, and high quality patient care.
7. Improve accountability and transparency of the NHS by empowering community health bodies and combining them with external peer review of hospitals and GP practices. Reviewing and strengthening the NHS complaints process and improving the ease of access, and protection for whistle blowers will also contribute to patient trust and confidence.
8. Use the purchasing power (monopoly status) of the NHS to improve NHS procurement practices in order to reduce costs of drugs, medical devices and general supplies.
9. Strongly focus on dealing with the social determinants of health, such as poverty, income inequalities, unemployment, poor housing, social exclusion, lack of child care etc. Prioritise public health and social care.
10. Exempt the NHS from the EU/US Free Trade Agreement, which otherwise threatens to open up our healthcare system to irreversible privatisation
2 comments
2 responses to “Health Policy Commission draft”
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Many thanks to the Health Policy Commission for producing this. Here are a few suggestions for further development.
It’s implicit throughout the document but needs, I think, to be stated up-front that we would end cuts and privatisation in the health service. We need a formula to flesh-out our commitment to a fully-funded NHS: what that means and how we would act to make it a reality. This would include reversing the ongoing cuts in real pay for NHS staff.
On PFI, the phrasing seems a little unclear. I hope we can campaign on a pledge to “cancel the PFI debt” – to rid the NHS once and for all of a burden that will only grow more onerous in the future. The PFI deals were nearly all made before the financial crisis / recession, but unlike many other forms of debt have not been renegotiated since then. We bailed out the banks, so why not the hospitals?
On drugs and Big Pharma, Ben Goldacre’s book ‘Bad Pharma’ is loaded with specific proposals for reining in the industry and getting better value for patients and the NHS. He proposes that pharma industry representatives (sales people) should be banned from NHS premises, where they currently wander freely, using their personal presence to induce doctors to prescribe or use their preferred drug or treatment. All the information doctors need to make decisions about treatment is available to them online and in print; the pharma reps serve only to bias that process. For Left Unity, this demand could be a strong campaigning point.
Another important point that Goldacre makes is about continuing medical education (CME), i.e. updating knowledge for qualified, practising doctors, made indispensable by the pace of scientific advance. At the moment, Big Pharma and its allies provide nearly all CME. Specialist medical conferences and symposia and publications are all funded by the industry – obviously because of the advantages this gives them in promoting their own products, influencing prescriptions, treatments, avenues of research and development, etc. So we need state-funded CME alternatives.
Beyond regulating and restricting the powers of Big Pharma, we should, I think, be proposing a more comprehensive alternative: licensing and encouraging generic production and building a publicly-owned pharmaceutical industry. This would involve a radical challenge to the ‘intellectual property rights’ regime that underpins neo-liberalism. But that doesn’t make it hopelessly utopian. Governments in India, South Africa and elsewhere have made inroads on global corporate drug monopolies. A left government here would need to work with other governments to roll back the tyranny of IPR and construct an alternative where the benefits of scientific advance belong to the community as a whole.
I’m not sure exactly how we would link or coordinate the specific proposals to curtail the power of Big Pharma (of the sort Goldacre makes) with the broader aim of replacing it altogether, through public ownership of both production and “intellectual property” (patents and licenses). But in general we should aim to put Big Pharma in the firing line of popular opinion, along with the banks and utilities.
Finally, a few miscellaneous suggestions for further development. How does legalisation / decriminalisation of drugs fit in with our health policy? What can we learn from recent developments on this in other countries? How can we bring out the link between health policy, the future of the NHS, etc. and the current struggle to defend disability rights against state-corporate-media attack?
Hope this assists the discussion.
Mike Marqusee
Comrades
Thanks for work on this document which is an excellent statement of principles and general direction. I also support much of what Mike suggests above.
Without getting into too much detail, it important to take account that health policy is a devolved responsibility to Wales and Scotland and this requires taking account of. In Wales – where I am – for example, PFI has been ruled out and where it exists it is being phased out. There is no privatisation and a system of local health boards continues to exist with an oversight remit of the Welsh Government Minister.
However, financial cuts are taking their toll and between 2009/10 – 2015/2016 it is projected that spending will fall around 20% in real terms. The consequences of this are difficult to identify other than where closures take place as local boards have been bailed out in crisis situations and it is suspected that re-organisations mask some of the consequences.
This is just a taste and I’d like to suggest that space is allowed in the document for development of LU policy in Wales and Scotland which we can feed in after proper consideration by us, through the LU constitutional processes agreed last November.