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Socialism and Health

PLAN FOR THE YEAR 2000 SHA Officers and Central Council have been reviewing the SHA’s role in the new millennium, and Central Council has now approved a work and action plan for 2000.

INSIDE ASYLUM SEEKERS Dispersal could seriously damage their health

THE HUTTON COMMISSION Who will represent the public interest in the NHS?

DO WE NEED A NATIONAL SERVICE FRAMEWORK FOR CHILDREN? SHIPMAN

Two over-arching aims have been identified:

A minor symptom of a chronic disease

1. To campaign for a comprehensive and accountable health service, fully and adequately funded from taxation, free at the point of use and accessible to all.

BRANCH NEWS

2. To campaign for the improved health of the population as a whole, and in particular for an end to health inequalities.

The Year 2000 must be a year of change. The SHA has to raise its public profile and secure its long-term future.

The Association continues to be financially lean. One-third of its income depends on two corporate funders, and the remainder derives from member subscriptions and organisational affiliations. A key objective, therefore, is to broaden the income base.

• Scotland • Wales • London

STAFFING CHANGES AT THE SHA SHA WORK PLAN 2000 BRANCH CONTACTS NOTICEBOARD

No radical changes are proposed. It will be an evolutionary approach, focused on utilising and developing members’ enthusiasm and skills in pursuit of the over-arching aims. The Year 2000 must be a Year of Delivery, delivering more members, more activities, stronger branches, and some effective special interest groups.

ANNUAL GENERAL MEETING

Details of the Work Plan are set out on pages 6 and 7.

The SHA: campaigning within the Labour Party for the NHS

ASYLUM SEEKERS Dispersal could seriously damage their health For centuries London has been the gateway for migrants, refugees and asylum seekers.

Until recently, the majority of refugees were concentrated in London and the South East. As a result, a sophisticated network of formal and informal support has developed within London’s diverse communities, and London’s statutory agencies have developed services and policies tailored to the needs of asylum seekers.

for refugee health care is therefore needed to ensure that their health needs do not go unmet. Here are some of the issues it should address.

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From the autumn, asylum seekers will be dispersed around the country. Some will go to areas with no experience of providing services for asylum seekers.

Placing asylum seekers in parts of the country without formal and informal support structures will not be easy. If services are inadequate, asylum seekers may move on to London, and the impact on housing, poverty and social exclusion will be profound.

Asylum seekers may also be sent to unsuitable areas just because some housing is available and the local population may not welcome members of ethnic minority groups. However, the likelihood of racist attacks and harassment is not an issue that is considered before identifying a location as suitable for asylum seekers.

Asylum seekers are entitled to NHS health care services, but some GPs may not register them for fear of the complex health and social problems that they may have. A co-ordinated policy

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Interpreting. Access to high quality interpreting services is a basic requirement.

Telephone interpreting can assist, but must be supplemented by face to face assistance. Staff must be trained to use interpreters. GPs and other service providers must not expect asylum seekers to bring their children or a friend to interpret. No one can discuss sensitive health concerns openly in such circumstances.

Information. Asylum seekers must have equal access to health and social services, including complaints procedures.

Information must therefore be provided in relevant languages and a range of formats, including audio and videotapes.

Racism. Asylum seekers are especially vulnerable to racism. Agencies must therefore ensure that effective policies are in place to deal with any incidents.

Communications. The voluntary sector should be included in inter-agency networks. They can develop links with refugee groups and facilitate communication between asylum seekers and the statutory agencies.

Information management.

Quality information is needed to plan and monitor services. The population of asylum seekers is very dynamic, with constant changes in circumstances and flows in and out of the support system, so effective data collection is essential.

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Needs assessment. Many health problems are specific to refugees and asylum seekers. They can have undiagnosed chronic health problems. They may be suffering from post traumatic stress disorder.

Psychological difficulties may be linked to poverty and isolation from friends, family and community.

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Children. The children of asylum seekers may not settle easily into the school environment. Exclusions are common amongst refugee children, and their parents may not understand the system well enough to deal with this. Health and social care providers must be alert to these issues.

Nevertheless, working with refugees and asylum seekers is stimulating and challenging, and GPs should not be afraid to get involved. SHA members in areas where asylum seekers settle must ensure that they get all the services they need, including health and social care.

Directors of public health have recently received two guides from the Kings Fund – The Health of Refugees – a Guide for GPs and The Health of Refugee Children – Guidelines for Paediatricians. All primary care groups should request copies.

Medact, a network of health professionals challenging social and environmental barriers to health world-wide, is bringing together a network of activists concerned about the development of health services for refugees across the UK. They can be contacted on 0207272-2020.

THE HUTTON COMMISSION Who will represent

the public interest in the NHS? At the moment community health councils (CHCs) represent the public interest in the NHS. They were set up by the then Health Secretary Barbara Castle in 1974. They were intended to become a powerful forum where consumer views could influence the NHS and enable local participation in the running of the NHS to become a reality.

Somehow that didn’t quite happen, and the government is now looking again at their role.

The Department of Health says “CHCs will have a positive future in the new NHS”. However, their precise role will not be determined until the independent Commission on Representing the Public Interest in the Health Service chaired by Will Hutton has reported. The report is due to be published on 18 April.

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The NHS is the least accountable of Britain’s major public institutions The Commission’s interim report in July 1999 found the NHS to be the least accountable of Britain’s major public institutions.

There is no local democratic management of the NHS, and CHCs are the only formal mechanism for voicing the concerns of the public.

The Commission identified the need for radical new structural approaches to ensure that the NHS becomes more transparent and accountable to the needs of its users.

The public must have a real voice in the development and delivery of health services, and the Commission will be proposing a new agenda to make the NHS publicly accountable.

The interim report put forward

several suggestions: 1. Health authorities to become locally elected bodies 2. Local authorities to take over responsibility for health 3. Adding health responsibilities to the English regional assemblies – if and when they come into being 4. Removing the NHS Executive from the Department of Health and making it an executive agency with stated objectives that can be publicly scrutinised

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Ensuring that CHCs have the capacity and the right to monitor and scrutinise key local health decision-makers – including PCGs and Primary Care Trusts.

--------------------------------There is a gap between service delivery and users’ needs and expectations The Commission also drew attention to the gap that is opening between what the NHS delivers and the expectations and needs of users.

Commenting on the Report, Will Hutton said “the public must be actively involved in shaping and defining the role of the NHS. Allowing the public to elect their own representatives to manage local health services may be one possible way forward.”

DO WE NEED A NATIONAL SERVICE FRAMEWORK FOR CHILDREN? The NHS spends most money on us when we are born and when we die. Expenditure during the in-between years varies. But should consideration now be given to re-focusing resources

and paying greater attention to children’s health? Clearly, this must be a key priority if we are to reduce the health gap.

A recent survey of Health Improvement Programmes (HImPs) by The Children’s Society, the NSPCC and the National Children’s Bureau (Improving Children’s Health) reveals little strategic thought around children’s health. Few health authorities consider it a priority. Nor is there much evidence of a multi-agency approach.

The report makes some suggestions to address these omissions.

1. The health needs of children and young people should be a key feature in every HImP 2. Children and young people should influence the planning and provision of their own health services 3. Health services for children and young people should be more appropriately targeted 4. Child and adolescent health services should include early detection of and intervention in mental health problems 5. All primary health care staff should be trained in child protection awareness 6. The value of multi-agency working on children’s health should be recognised and prioritised 7. Health authorities and PCG/Ts should have dedicated a child health commissioner 8. And the government should introduce a National Service Framework for the health of children and young people.

The top areas for influencing the health of children and young people in current HImPs are accident prevention and child safety, parenting and family support, substance misuse, healthy schools, and sexual health and teenage pregnancy.

Child and adolescent mental

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The SHA: campaigning within the Labour Party for the NHS

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Infirmary saga.

00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 The dominant force of 00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 Since accident prevention is a For Shipman was clearly conservatism in the NHS is, of 00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 key government priority, abnormal – possibly a course, medical professionalism. however, it is no surprise to see this included. Similarly, parenting and family support are part of the new Sure Start initiative.

Sure Start is a partnership programme to provide support for 0-3 year olds and their families who live in deprived areas.

However, although reducing teenage pregnancy is another government priority, 75% of HImPs have no proposals to address this., And the current furore around Section 28 cannot favour plans to improve young people’s knowledge and understanding of sexual health.

The Children Act Report, published at the end of January, highlights developments in government policies for children.

Minister John Hutton says that “children’s rights and safeguards are being kept clearly and firmly on the collective agenda of the government”.

He says he is satisfied that an intensive programme is in place to protect children and ensure they receive the best standard of care. Ironically, this information arrives at the same time as reports of inquiries into major scandals at children’s homes.

Members of the SHA may like to send their views to the Editor.

SHIPMAN A minor symptom of a chronic disease?

The Shipman case may send shivers down the spine, but it does not have as much meaning for the future of organised healthcare and medicine in Britain as the only marginally less dramatic Bristol Royal

psychopath, albeit an intelligent one - and even in the best of all possible worlds it would not be possible to erect a regulatory framework that could reliably identify and weed out such a person.

A PERSONAL VIEW BY PAUL WALKER For example, no amount of statistical surveillance of Shipman’s patients’ death records would have raised a scintilla of suspicion because the sample size of his practice list was so small. Had he remained in group practice instead of setting himself up as a singlehanded practitioner, his proclivities might have been detected by practice colleagues and some deaths prevented. But probably it would not.

The Bristol trio - one of whom I knew as a work colleague in the late 1980’s - were in contrast neither mad nor bad. However, their work went unchallenged for many years.

At last year’s Labour Party Conference Tony Blair identified the forces of conservatism as the enemy within, the bar to progress. He was, of course, speaking in a political context and the forces of conservatism he had in mind were those of the political right and left. However, he could just as easily have been talking about society in general and its institutions.

And the particular force of conservatism that links the Shipman and Bristol cases with the hundreds of other documented medical scandals and the thousands of undocumented ones is that of institutionalised professionalism.

This is an ubiquitous influence within the UK affecting all aspects of society, but nowhere is it more pervasive than in the National Health Service.

This is institutionalised in a variety of bodies including the Royal Colleges and the British Medical Association but principally in the General Medical Council.

This body was established some 150 years ago by Act of Parliament and, although this was not its main purpose, it did provide some measure of protection for patients against quackery and other forms of exploitation by doctors at a time when few other accessible forms of protection existed.

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The GMC is ideologically and functionally redundant It is arguable that at its inception the Council did in fact do some good for patients. But what it did, that ultimately was bad for patients, was both to create and to institutionalise the profession of medicine as we know it today.

With the introduction of universal socialised healthcare in 1948 the GMC became redundant.

Ideologically redundant because the institutionalised professionalism that it represented and promoted had no place within the socialist ethos of the NHS. And functionally redundant because control of training and practice standards could quite easily have been taken over by the state funded corporation that was now the monopolistic employer of doctors. The outmoded concept of selfregulation could have been buried once and for all.

No doubt Aneurin Bevan had the GMC in his sights, but was unable to take action because he had other things on his mind.

And with the electoral defeat of 1951 and the subsequent long Tory hegemony, the opportunity for action passed and

surprisingly, was seemingly ignored during the short intervening periods of Labour administration, though one senses that Barbara Castle may have considered taking action during her time at the Department of Health in the mid 1970’s.

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It undermines the NHS and breeds distrust among the public ------------------------------------------Instead the Council survives, continuing to promote medical professionalism and thereby undermining the Health Service and breeding distrust among the public.

Fortuitously, while I was writing this piece, I received a communication inviting me to elect a fellow doctor to fill a casual vacancy on the GMC. What was striking about the literature that accompanied this request is that there are literally many tens of doctors avid to occupy the vacant seat. Proof indeed of the perceived role of the Council among doctors as the prestigious high table of medical professionalism.

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Medicine requires a new model of practice ------------------------------------------Professionalism is an anachronism, so what should replace it? Medicine and the other healthcare disciplines require a new model of practice based on an open and equal partnership with the patient; and on the application of state of the art, evidence-based healthcare technology.

Within such a framework there is probably still room for the Royal Colleges to promote training and practice based on these principles among their memberships; and there is still a role for the British Medical Association to represent the interests of doctors as employees.

But there is no place for the GMC in its present form. At the very least, it must be reconstituted with a much smaller membership and with an in-built, substantial lay majority able fully to represent consumer and societal interests.

Rather easier to achieve, perhaps, would be reform of some of the other abiding monuments to institutionalised medical professionalism.

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The small business model of primary care must go ------------------------------------------Firstly, and harking back to Shipman, we have known for over twenty years that single handed general practice is at high risk of quality failure because of the professional and personal isolation that it so often involves. It must go.

And secondly, the small business model for primary care is not, and never has been, appropriate in the NHS. Salaried practice is the only model consistent with socialised healthcare. However, simply allowing it to happen is not enough. Salaried practice must be actively promoted as the norm for the 21st century.

Socialism may be perceived by some as a reactionary force in modern politics. But we know that its full application within the Health Service would result in real progress in providing the sort of Service which our Association’s founding members fought for, and which the general public and most NHS employees seem to want.

If, as Shaw had it, the professions are a conspiracy against the laity, then institutionalised professionalism is truly a conspiracy against an open society and its institutions.

BRANCH NEWS Scotland End Scotland’s glaring health inequalities Early mortality rates and survival outcomes from some treatments in many deprived areas of Scotland are amongst the worse in Britain and the EU. Scottish SHA members have therefore urged the Scottish Labour Party to ensure that the Scottish Executive fully funds the additional resources needed to tackle the underlying causes of ill-health in Scotland.

The recent Arbuthnott Report (Fair Shares for All) into resource allocation for the NHS in Scotland recognises the links between deprivation and ill health, and recommends that greater resources should go to areas of high inequalities and deprivation.

However, SHA members insist that this shall not be at the expense of health care services in other areas. Bob Thomson, SHA delegate to the March Scottish Labour Party Conference, said: “the role of the SHA in Scotland is to be the health conscience of the Labour Party”. Members elsewhere in the UK will surely not demur from this sentiment!

Wales All-Wales Members’ Meeting With devolution in Wales there is a need for the SHA to respond creatively to the opportunities offered by devolution, to think

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The SHA: campaigning within the Labour Party for the NHS

through how the SHA in Wales might best influence the Welsh Assembly on health and health care issues and to offer leadership at a more local level to promote the health debate.

A meeting has therefore been arranged for all SHA members in Wales. It will take place on

Saturday 15 July at Transport House, Cathedral Road, Cardiff. The meeting will start at 10.00 a.m. and finish no later than 1.00 p.m.

London The Mayoral ballot In a ballot run by the Greater London branch, London SHA members voted overwhelmingly in support of Ken Livingstone for their Mayoral candidate. Glenda Jackson was eliminated on the first ballot, and the final result was 71% in favour of Ken Livingstone, and 29% for Frank Dobson.

The SHA vote was included in the trade union and socialist societies section of the electoral college.

Frank Dobson has been selected as Labour’s candidate for Mayor, and Mr. Livingstone is now running as an independent candidate.

made a presentation to him, had he not been out and about on the campaign trail!

NEW ASSISTANT DIRECTOR A new assistant director has been appointed. Judith Blakeman started at the Toynbee Hall office on 24 January.

Judith is a Labour councillor in Kensington & Chelsea, and chair of the Kensington & Chelsea and Westminster community health council. She is also a co-opted member of the Westway primary care group, which serves North Kensington and North Paddington. Judith has previously worked as a trade union official.

Initially she will be responsible for producing Socialism & Health and developing a press and publicity strategy for the Association.

LOCUM IN MANCHESTER In addition, Central Council has appointed Martin Rathfelder to work from Manchester on a locum basis until the end of April.

The officers will then review the SHA’s overall staffing requirements.

STAFFING CHANGES AT THE SHA

SHA WORK PLAN 2000

DIRECTOR MOVES ON

1. To improve the SHA’s organisation

John Biggs, who was Director of the SHA, has now left to concentrate on winning his Greater London Assembly seat for Labour. Members of Central Council wished him well at their last meeting, and would have

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With efficient administrative procedures.

Through an annual assessment of the organisation’s overall objectives.

2. To raise the internal and external profile of the SHA •

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Through targeted strategies for press and media coverage, publications, communications and events.

Through a programme of joint publications and events with other bodies.

3. To increase SHA membership and member activity •

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By halting the decline in individual membership and increasing the number of affiliated and associate members, supported by an efficient membership records system.

By offering an attractive membership package.

Through the development of self-supporting branch activities and special interest groups.

Through membership drives and a focus on retention strategies.

By encouraging strong branches in the three national regions to develop the health agenda of Wales, Scotland and Northern Ireland.

4. To recruit active and challenging Council members • •

By developing clusters of activists and activity within the organisation.

With a programme of attractive Council meetings with stimulating speakers and debate.

5. To liaise regularly with ministers and the Labour Party • •

Through a programme of regular meetings with the health teams.

By participating actively and visibly at Labour Party conferences and events.

6. To secure the longterm financial viability of the SHA • • •

By broadening the SHA’s income base.

By developing robust financial procedures and monitoring systems.

With a budgetary strategy linked to membership, events and an effective fundraising programme.

7. To facilitate campaigning in new directions •

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By organising an attractive programme of events, including conferences and seminars.

By identifying proposals for collaborative work with likeminded bodies.

By preparing a campaign plan to reduce inequalities.

BRANCH CONTACTS Contact your branch secretary for details of local SHA activities:

Greater London Huw Davies 020-8748-7284

Greater Manchester Nathan Lee 0161-367-8962 nathan4janet@hotmail.com

Plymouth Fiona Sheaff 01752-551-526

Scotland Duncan Booker 0141-419-0654

South Yorkshire John Laurent 0114-245-8000

Swansea & District Anthony Phillips

01792-410998

Wales Paul Walker 0117-968-2205

West of England Moyra Evans 0117-956840

West Midlands Paul Castle 0121-765-4222

LONDON OFFICE Toynbee Hall 28 Commercial Street London E1 6LS 020-7227-0403 fax and telephone, e-mail sochealth@fsnet.co.uk

SHA WEBSITE The SHA now has a Website!

You can visit it on www.sochealth.co.uk

SLOGAN COMPETITION The SHA: campaigning within the Labour Party for the NHS may not be everyone’s cup of tea. So now is your chance to devise a new slogan for the SHA. The authors of all published suggestions will receive a free book!

Please send them to The Editor at the London Office address.

AUTUMN CONFERENCE The SHA will be holding a conference in the autumn on how the NHS is organised and run.

Workshops will include: • NHS organisation • Partnerships • Accountability • Funding the NHS Further details will follow shortly.

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The SHA: campaigning within the Labour Party for the NHS

NOTICEBOARD AGM and Central Council CENTRAL COUNCIL: Central Council is the governing body of the Socialist Health Association. It meets on Saturdays, every two months, in London. All members of the SHA are welcome to attend its meetings as observers. The meeting dates for the rest of the year are 22 July, 16 September and 18 October,

ANNUAL GENERAL MEETING: the annual general meeting of the Socialist Health Association will be held on Saturday 20 May 2000, commencing at 11.00 a.m. All members are encouraged to attend. The AGM convening notice is enclosed with this mailing.

Year 2000 Programme of the Greater Manchester SHA Branch 11 April 17 May 6 June 11 July 21 September 12 October 8 November 20 December

Greater Manchester - Too Many Hospitals? Dr. John Ashton, Director of Public Health, NW NHS Management Executive. In committee room 3 at 8 p.m.

A GP Salaried Service – The Answer to the Inner Cities? Dr. Katy Gardner, a salaried GP in Liverpool. In committee room 1 at 8 p.m.

What is Socialism and a Socialist Approach to Health? Hilary Wainwright, Editor of Red Pepper. In committee room 1 at 8 p.m.

Why is Cuba so Healthy? John Waller, NHS Researcher and Cuba Solidarity Campaign activist. In committee room 3 at 8 p.m.

Hospital Access – a Suitable Case for Treatment? Richard Armitage and Kath Tierney, Richard Armitage Transport Consultancy. In committee room 3 at 8 p.m.

NHS Direct – the New Gatekeeper? Sara Holmes, Development Manager, NHS Direct North West. In committee room 3 at 8 p.m.

Can Primary Care Trusts Improve Health? Professor David Wilkin, National Centre for Primary Care Research. In committee room 3 at 8 p.m.

Christmas Quiz and Disco, at 8 p.m. in the Irish Club, High Lane, Chorlton, Manchester.

All meetings and socials are open to the public and are non-smoking. The Town Hall entrance is by the side door. Non members are asked to pay £2 towards meeting costs. For more details, contact Guy Lancaster on 0161-860-5307.

THE VIEWS EXPRESSED IN THIS JOURNAL ARE NOT NECESSARILY THE VIEWS OF THE SOCIALIST HEALTH ASSOCIATION