We must restore the NHS as a safe, comprehensive, publicly funded, publicly delivered, and publicly accountable integrated healthcare system. We support the NHS Reinstatement Bill, and wish to take the following actions:
- Restore the duty of the Secretary of State for Health to provide universal and comprehensive healthcare in England. Halt privatisation and scrap the costly, bureaucratic market within the NHS. Reinstate the NHS as the national provider of healthcare and remove the requirement to tender out contracts to the private sector.
- Ensure funding, resources and staffing levels are consistent with maintaining patient safety and high quality care and that the value of staff pay is maintained. Publicly fund the NHS spending gap while multi-billion pound savings from policies removing the market kick in.
- Listen to patients and staff to improve the NHS. Establish a Health Ombudsman at the head of local independent health commissioners acting on concerns expressed by patients and staff to speed up complaint resolution, introduce improvements more swiftly and reduce the growing litigation bill.
- End financially driven A&E and hospital closures. Stop the Sustainability & Transformation Partnerships which are re-designing the NHS on a US ‘Medicare’ model. Changes and closures do happen to services over time, but they must be based on clinical evidence, with the support of the local population and the affected professional staff. Accessible replacement services must always be in place before any closures.
- Oppose international free trade agreements which contain deregulatory elements affecting public service, public health and human rights as they threaten not only the NHS but the health and well-being of the public. Trade is a key element of our society but must be balanced by government responsibility for public well-being.
- Stop further Private Finance Initiative (PFI) deals and remove the PFI repayment burden from individual hospital trusts. The Government should renegotiate on the basis of “fair value”. End the fire sale of public assets and restore the property from NHS Property Services Ltd and other government owned private companies to public ownership. End the imposition by government of commercial rents on public services.
- Urgently repair the damage to our mental health services, strengthen maternity services and address the crisis in General Practice.
- Introduce free personal social care for the elderly and disabled, and create co-operative working arrangements for NHS health provision and local authority social care.
- Prioritise and focus on public health and preventative medicine, including measures to reduce alcohol consumption, smoking and obesity.
- Make the social determinants of health an absolute priority in the design and development of all government policies. Health is affected by our income levels and work, our education, our housing, the environment and more and in turn our health affects our ability to engage in and enjoy life. That is why inter-departmental collaboration is essential to provide excellent public services to underpin our civil society and provide the life blood of a healthy economy.
Restoring the NHS
Health care is a basic human right, not a marketable commodity. The NHS is the world’s best example of the principle of social solidarity, remarkable for having had the support of people from all political persuasions, since its creation. When the country invests in healthcare it not only reduces poor health and extends lives, but also creates a healthier workforce and contributes to economic growth.
The NHS principles have been undermined by a toxic mix of increasing marketisation and chronic underfunding, with an estimated funding gap of £30bn by 2021.
The Coalition government’s £20bn ‘efficiency savings’ programme resulted in falling NHS productivity. The additional £50-60bn programme of savings now envisaged by this Conservative government is unachievable without vast cuts to services. And now we are seeing the Sustainability & Transformation Plans (STP), 44 local plans that use this artificially-created funding gap as a reason to close services and ration healthcare.
We believe that STPs will lead to a fragmented, privatised service incapable of delivering universal healthcare. This would lead to a two tier system as NHS hospitals are forced to take more private work in order to stay open. We say:
- Halt the service closures contained in the 44 STPs. Make funding available where it is needed, and ensure local bodies follow national clinical guidelines.
- Restore the NHS to public ownership: publicly funded, publicly provided and publicly accountable.
- Restore the duties and responsibilities of the Secretary of State for Health to provide universal and comprehensive healthcare in England. But with less political interference in the day-to-day running of the NHS.
- Halt and reverse privatization by abolishing competition and the market in health provision with its associated huge and unnecessary costs and bureaucracy.
- Reinstate the NHS as the national provider of healthcare and remove the requirement to tender out contracts to the private sector.
- Replace the market with a system based on resource allocation, not commissioning. This system would enable effective planning of healthcare according to the needs of the population at local, regional and national level.
- Implement the ‘NHS Reinstatement Bill’ as the best way to achieve this (nhsbill2015.org). The Bill not only repeals the 2012 Health & Social CareeHea Act, but also corrects the previous legislation which created a market within the NHS.
Defending local hospitals and the District General Hospital (DGH) model of care
- We would defend the DGH as a good model of care for the majority of people who need admission to hospital. They provide care close to home, with easier visiting for relatives.
- While it is appropriate to have a Major Trauma Network and similar services when there is evidence that this improves patient outcomes, this should not be allowed to result in the downgrading and closure of DGHs.
- Reconfigurations of services should not proceed without local community and clinician support. A full consultation process must occur and an equality impact assessment should be published before any hospital or service closures.
Funding the NHS
The average annual increase in funding for the NHS since its inception was historically 3-4% a year. This matched the average rate of increase in other developed countries with similar economies. The causes are a combination of the rising costs of medical advances and technology, the rising population, demographic change and changes in the nature of ill health with many people living with long term conditions. Investing in the NHS to meet these ongoing challenges has been shown to stimulate our economy and generate jobs locally.
- We call for investment in the NHS to close the funding gap created by the Conservative government and bring the UK closer to the G7 average spend on healthcare.
- We call for real terms increases in funding for the NHS of 4% per year.
- In the medium term, the savings from ending the market and halting privatisation will pay for a substantial part of the increased funding required to maintain acceptable standards in the NHS.
- The cuts to public health budgets must be reversed and there must be significant investment in public health and prevention.
Abolish prescription charges
- We call for the abolition of prescription charges, which are effectively a tax on people of working age with chronic health problems. This would bring England in line with the policy of the NHS in Wales, Scotland and Northern Ireland.
- No more PFI or PF2 deals should be signed.
- The Treasury should force a full investigation of PFI contracts and renegotiate onerous contracts on the basis of fair value.
- We feel it is reasonable to use eligibility checks prior to scheduled care, but not prior to emergency care. We reject up front checking of passports and utility bills for eligibility at the front door of hospitals, as this could discourage sick people from attending and deprive those who are not able to provide such documents of access to care.
- We should continue to provide emergency health care to anyone who becomes ill while in the UK.
- We should ensure that refugees and asylum seekers have access to essential provision such as emergency and maternity care.
- Support the traditional model of General Practice with primary care teams working in defined areas, distributed fairly, and based on long-term relationships with patients and underpinned by the vital concept of continuity of care.
- Improve access and continuity of care by increasing GP numbers by 10,000, in line with recommendations from the Royal College of GPs.
- Allow GPs to remain free from pressures, particularly financial incentives, which could detrimentally affect clinical decision-making. Their patients’ best interests must be their priority.
- Reverse the cuts to general practice funding of the last 7 years, with greater investment in premises and local GP-led out-of-hours services.
- We endorse the Royal College of Nursing’s 2015 manifesto.
- Improve patient care – safe staffing levels, access to training and environments where staff concerns are listened to.
- Value nursing – provide fair pay for nursing staff, an end to down-banding and for a focus on the future of nursing.
- Invest in health and care – no more cuts to nursing; increased community resources; workforce planning around patient need.
- Ensure a safe and effective service for women and their babies at one of the most vulnerable times in their lives.
- Address midwife shortages and training numbers
- Statutory maternity pay and allowances must at least be the equivalent of a Living Wage.
- Increase support for working parents
- Focus on maternal mental health issues
- Restore the bursary for nursing and health care students
- Invest in safe staff-patient staffing levels and reduce dependency on costly agency staff.
- Increase training places for nurses, medical students and other health professionals.
- Implement a pay structure to reward NHS staff fairly for their skills and their work. Salaries should rise in line with inflation. Terms and conditions of service should be protected.
- The living wage, not the minimum wage, as the lowest rate payable in the NHS.
Supporting Mental Health Services with “parity of esteem”
- Mental health funding to be addressed as a matter of urgency.
- Increase staffing levels and training places for mental healthcare professionals.
- End the privatisation of mental health service provision.
Listening to patients and staff to improve the NHS
- Make the NHS Complaints Process patient-friendly and be used as a means to improve the NHS. Provide an independent ombudsman to review cases.
- Reduce the NHS and Department of Health dependence on management consultants, and increase the influence of healthcare professional bodies, health staff and patient groups.
- Restore responsibility for health planning to public health and clinical leaders.
- Strengthen the whistle blowing system to allow staff to identify and report their concerns about quality of care and patient safety without fear of recrimination.