Sh0404

Socialism and Health Promoting health and well-being through socialism

Spring 2004

SHA Principles The Socialist Health Association promotes health and well-being, social justice, and the eradication of inequalities through the application of socialist principles to society and government.

Underlying these goals are three foundation principles:

DEMOCRACY • informed participation • local decision making • election not selection

EQUALITY • fairness • affirmative action • progressive taxation UNIVERSAL HEALTHCARE • meeting the needs of individuals and communities • promoting health and well-being and preventing disease • free at the point of use and funded by general taxation.

The SHA believes that these objectives can best be achieved through collective rather than

individual action. Its members are committed to a broad public health approach because they consider that the application of medical technology alone will not realise the full potential for health and well-being.

The SHA is affiliated to the Labour Party, and seeks to influence its policies to reflect socialist principles. In pursuit of its objectives the SHA arranges conferences and seminars, publishes reports and provides a platform for debate on health issues to inform SHA contributions to the development of Labour Party health policy.

FROM THE CHAIR SHA Chair Paul Walker poses a challenging question for SHA members Welcome to the first of the new style Socialism and Health.

Central Council has determined that we should produce our Association newsletter at least twice a year but in a new form – electronic, more eclectic and with photos where appropriate. And with hard copy versions available to members without access to e-mail and for special events such as conferences.

So with this launch edition we are trying something else new. We are using it to seek the views of the rank and file membership on an important but insufficiently discussed public health issue of today by asking the question:

Is it now time to legalise - or at least decriminalise - the use and supply of drugs?

It is a fact of life that, in the absence of a strong religious taboo, homo sapiens has recourse to mind altering drugs of one kind or another.

Attempting to prohibit the use of such drugs stands as much chance of success as banning sex.. Probably less chance, in fact!

The only rational response to this evident truth is to provide the requisite drugs within a regulated framework that assures an adequate supply and the purity of the drugs. This should take place within a taxation regime that generates funds to support comprehensive health education programmes aimed at discouraging drug use, and providing specific care and treatment when needed. This is what we do, more or less,

with alcohol, except of course that the revenues generated are not hypothecated to spend on health promotion, treatment and rehabilitation but to swell Treasury coffers.

The net result of such action would be a significant reduction in harm from overdosing and adulteration, a sustainable source of revenue for targeted health education and treatment programmes, and the elimination at a stroke of the crime associated with illicit drug use.

And as a bonus, licit use would allow us to measure more accurately the true extent and nature of the habit, thus giving a better general insight into societal health and well-being. Can we doubt, for example, that the present epidemic of binge drinking is an indicator of some pervasive societal malaise? Though some would argue that if there is such a malaise, it is one that has existed in this country since time immemorial, as we have a long history of binge drinking.

So should the Socialist Health Association out what the government will do to achieve argued that the only way to improve health campaign for the legalisation of drug use change. It will also feed into government is to tackle the social determinants of and supply on the grounds that the direct plans for health service priorities and health and ill-health. Health care alone can impact on health and well-being would be spending for 2005-8; into other only achieve limited improvements in the positive, and that the indirect effect government departmental spending plans; nation’s health and well-being. through reducing crime might be even and into local authority performance greater? And on the ground that it would assessment.

Branches and members are encouraged to have a differential beneficial impact on the meet, discuss and send their views to the socially excluded? Not trivial questions, and The deadline for responses is Friday 28th SHA. The Association’s response will be ones that no government in this country is May 2004. Consultation papers, finalised at the Annual General Meeting on going to take seriously unless substantial background material and more information Saturday 15 May in Birmingham, so please and sustained pressure is applied. are available from the Department of – get those contributions to the office as Health Website: quickly as possible. Send them to Socialist There is of course the small matter of the www.dh.gov.uk/consultations/liveconsultat Health Association, 50 Wesley Square, United Nations resolution to which all ions or by ringing 020 7210 5343. They London W11 1TS or by e-mail to member states are signed up prohibiting include: jm@jblakeman.fsnet.co.uk. such an approach. However, Portugal and other countries seem to be finding ways Here are some of the key questions that round this constraint; so presumably where individuals, groups and communities are  The main consultation document asked to address. there is a will there is a way.

Choosing Health?  A summary of Choosing Health? 1. What you eat, and how you spend  Fact sheets with specific questions your time at home, school, work BUT WHAT DO YOU THINK? on key areas for action including: and leisure health inequalities, alcohol misuse, Please let us know by writing to: diet and nutrition, accidents, What would make most difference about sexual health, mental health, the choices that you make? Do you want The Editor tobacco, obesity, physical activity, more, or different information about what and drug misuse matters?

Socialism & Health  A summary and recommendations 50 Wesley Square from the Wanless Review Securing Where would you like information from?

London W11 1TS Good Health for the Whole Population, Are there choices you would like to make published in February 2004. This which are not available to you now? or by e-mail to: calls for a more systematic jm@jblakeman.fsnet.co.uk evidence-based approach to What would help you make healthier improving health, and a clear choices? In your list of things to be done, framework for using economic what should come first and why? instruments, such as taxes and Choosing Health? public spending, to influence – the consultation we 2. Everyone should be able to make people’s health. their own choices have been waiting for  A template for responses The government has just begun a major There will be national theme-based consultation on how to improve the consultations led by task groups on nation’s health and well-being. It is seeking children and young people, health and views from the general public and from employment, consumers and markets, organisations on the role that government, leisure, maximising the NHS contribution, individuals, the voluntary sector, the health working with and for communities, and service, other parts of the public sector, service delivery. industry - such as food, alcohol and leisure, and the media can play in improving health. Strategic health authorities, primary care This will include the views of people in the trusts, councils and local strategic groups and areas experiencing the worst partnerships are also being encouraged to health. consult as widely as possible.

Responses to the consultation will feed into a new Department of Health white paper The SHA will be taking part in this to be published in summer 2004, setting consultation. The Association has long

What in particular would make a difference to choices that children, young people, pregnant women, disabled people and older people make? What would make most difference, and why?

3. People in some groups and areas experience health that is worse than the average, including some people in black and minority ethnic groups and people living in disadvantaged areas

How are your circumstances affecting your health? What would support you and your community to be healthier? Who could help you? What should they do? What are the barriers to overcome? What could local services and organisations do to support healthier lifestyles? What would be better done by the community itself ? In your list of things to be done, what should come first, and why?

4. One person’s choice may spoil the chances of good health for others

employers, faith communities, health and social care professionals, local government, voluntary and community organisations, retailers, manufacturers, industry, trade unions, the media, leisure organisations, national government? What should be given priority? Where could more be achieved by working together?

The Big Conversation

Have we got the balance right when it comes to smoking in enclosed public places and workplaces; recognising the difference The SHA has taken part in the between fun and antisocial behaviour; government’s Big Conversation. Here is an considering the consequences of edited version of that contribution, unprotected sex? highlighting the SHA’s position on some key health issues for socialists. This also forms the text of the SHA’s new recruitment pamphlet, copies of which can 5. The role of regulation be obtained from the Manchester office at Should central and local government have 22 Blair Road, Manchester M16 8NS; by telephoning 0870-013-0065; or e-mailing more of a role in supporting people to admin@sochealth.co.uk make healthier choices by making it:

 easier to access the things that



would improve people’s health, such as fruit and vegetables, safe walking and cycling, better communal spaces gyms and swimming pools, sun protection, access to contraception? easier to avoid things that are harmful, such as cigarettes, alcohol, food high in salt, sugar and fat?

whole range of government departments responsible, for example, for the economy, housing, education, the arts, the environment, leisure and transport. Each major government department should therefore have its own health champion, and each department’s contribution to public health should be audited annually.

National, regional and local government should undertake health and health inequalities impact assessments of any major new policy that is proposed.

Only a senior politician with Cabinet status will be able successfully to tackle this agenda.

Democracy, accountability and participation The government should enable citizens to participate in NHS governance through regional and local elections. Directly elected regional assemblies throughout the country should plan and commission specialised health care within their area, as happens already in Scotland and Wales, with directly elected Primary Care Organisations commissioning and delivering local services

A public health approach to well- An alternative model would involve directly elected strategic health authorities, and being It is fundamental to achieving the SHA’s objectives that health, health care and wellbeing should all be tackled from a population-based public health approach rather than an individually focused medical one.

responsibility for commissioning local services devolved to democratically accountable local authorities.

Whatever the model, local commitment and energy is vital to making real changes to people’s lives, and greater local autonomy is a precondition for this.

If so, how? Should rules be changed on what gets advertised, availability of Because a public health overview is so tobacco, drugs and alcohol to children, how important, the SHA believes that the Prime Healthier children products are promoted and displayed in Minister should appoint a free standing shops, foods that industry produces? If so, Minister for Public Health to the Cabinet A healthier nation begins with healthier how? with specific responsibility for ensuring that babies. It is known that poor health and all government policies are evaluated for nutrition in pregnancy cause health their impact on health and well-being and problems throughout the lives of the 6. Working together to support on inequalities. resulting children, yet so many young healthy choices women are expected to subsist on benefit Action to reduce health inequalities goes levels that are too low to support a healthy way beyond health care. It covers the diet. There should be an immediate What opportunities are there to influence widest spectrum of life experiences that increase in benefit levels for pregnant healthy choices by action by parents, can be influenced by government. It women. friends, school and higher education, requires joined-up thought and action by a

Free, healthy school meals should be universally available. Many children entitled Healthier lifestyles A healthy income to free school meals don’t take them because of the stigma. Children should be able to drink water throughout the day, and Healthier lifestyle choices must become Most poor people would be able to live free school milk and fruit should be easier choices. Government faces a healthier lives if they had the means to do available to all. Budgeting and shopping for dilemma in striking the right balance so. It is time for the UK to have a proper healthy food, and cooking it, should be a between persuasion and prescription over measure of the income level needed to part of the National Curriculum. individual lifestyles. However, the SHA avoid both absolute and relative poverty believes that at the moment it errs too far and ensure good health, satisfactory child The duty of care owed to children by on the side of persuasion. development and social inclusion. This schools should be extended to their diet. measure should determine benefit, pension Young children should not be given the and minimum wage levels, and it should For example, international evidence freedom to eat too much fat, salt and sugar suggests that banning smoking in public inform the practices of debt collectors and just because the damage done to their the courts. and in the workplace can halve the health is not immediately apparent. There incidence of smoking. UK local authorities should be a total ban on advertising should be encouraged to introduce bans, unhealthy food directed at children, and and pending the introduction of primary Healthier communities machines vending fizzy drinks and legislation they should be supported to do unhealthy foods should be removed what they can now through existing byMany local health services have a poor immediately from all schools. Commercial laws. record of engaging with deprived schemes that encourage children to eat Individuals are often denied the communities. Too often poor people unhealthy food to obtain “benefits” for information they need to make informed receive poor services from unenthusiastic their schools must also be outlawed. choices. Manufacturers do their best to professionals who live elsewhere and do confuse the public about health risks, and not engage with those communities.

Regular sports, dance and other exercise the government does too little to stop must be re-introduced to the school them.

The government must maintain its timetable to tackle the increasing problem commitment to reduce health inequalities of childhood obesity, complemented by a The food industry should be encouraged to over the long term. full arts curriculum that enhances selfreduce the amount of sugar and fat in Some key determinants of ill health, such esteem and mental well-being. prepared foodstuffs, and salt should be as poor educational attainment, income excluded altogether where practicable. The inequality, and child and family poverty are Parents should be actively discouraged addition of salt to any food should be a seldom mentioned in a health context, and from taking their children to school in cars, matter of individual choice. All food and these must be addressed more robustly. The and each school should have a target to drink should be clearly marked with the resource allocation formula should take increase the number of children who walk percentage of salt, fat and sugar contained. better account of economic and social or cycle, where it can be done safely, to disadvantage to produce a more equitable school.

Policies on drugs and alcohol should distribution of the nation’s resources. The concentrate on harm reduction and be many excellent local initiatives to tackle Learning to live healthy lives should have a based on sound evidence, not moral poverty and deprivation must be place in the National Curriculum, where presumptions. Legislation should be accompanied by robust monitoring systems young people discuss their own and their introduced urgently restricting smoking to that can measure progress made in community’s health. Sensitive issues must consenting adults in private. developing healthier communities. be tackled head on. The topics of drug, alcohol and tobacco abuse are avoided in Poor diet and lack of exercise play a major The current political focus on hospitals many schools because they are part in the ill health of poor people. makes no sense, even in health care terms. controversial, yet children respond well to Access to exercise should be made easier, While medical interventions contribute factual information on such matters. and people encouraged to reduce their increasingly to life expectancy and the Education in sexual health and teenage intake of calories. The EU should not quality of life in developed countries like pregnancy issues must also be compulsory subsidise sugar or tobacco production. This the UK, there are still great gains in health and not left to the discretion of heads, gives a mixed message when government is to be made through healthier lifestyles and school governors and parents. exhorting people not to smoke and to primary care. All local directors of public reduce their consumption of sweet foods. health should therefore be joint NHS and The money should be invested instead in local government appointments, and local health promotion messages. government should share with primary care

trusts the statutory responsibility to reduce health inequalities.

Seamless health and social care services

Mental health – room for improvement

Targets for improving the health of Mental health services remain underpopulations should take priority over developed and of low priority. Mental targets for treatments, waiting lists and Social care cannot be considered separately health policy appears to be in the grip of operations and they should be integral to from health care, and greater co-operation the law and order lobby, whose policies are the role of all senior managers in local and between the NHS and social services is misguided, counter productive and regional government as well as in the NHS. essential. Lip service is paid to the idea of a damaging to service users. whole systems approach, but there is no The government's decision to delay evidence yet that this is delivering publication of the new Mental Health Bill is significant change. Much more needs to be a welcome sign that it has heard the Active patients done, although the development of care overwhelming opposition to previous trusts and children’s trusts must not be at proposals. The SHA looks forward to a People are experts in their own health. The the expense of democratic accountability. new draft Bill incorporating the constructive suggestions made by so many clinician/patient interaction should not be defined as a customer/provider relationshipMore resources are needed to keep people mental health organisations. but as a co-production of equal partners. in their own homes. Personal care contributes greatly to keeping people out In particular, the SHA believes that mental health care services should be the place The new statutory rights for patients and of hospital, yet the role of carers is users in the Health & Social Care Act 2001 neglected. They also need proper support where the government first implements its commitment to provide a wider range of and the Race Relations (Amendment) Act to and resources. choice for patients. influence the planning and delivery of Services in the community are rationed in a health care are welcome as a potentially powerful means of achieving the patient- way that would be unacceptable in acute health services. It is as much a priority to centred health service envisaged in The NHS Plan. However, the mechanisms of ensure, for example, that people with The Labour Party’s policy disabilities can function fully in the this influence, such as local authority community as it is to ensure that they do making process overview and scrutiny and patient and not have to wait too long for an operation. public involvement forums, must be properly resourced.

There are differences of opinion within the The poor image of social workers has Labour Party on some important matters become acute, and there should be regular that would be better discussed than buried. campaigns to counter the low morale of Some health policies advocated in social workers and the negative and unfair A healthier workforce manifesto for the last general election bore media coverage they often receive. little relationship to those that came through the national policy forum process, The NHS must engage with its staff, and the government has implemented other develop their vision and utilise their unique Charging controversial policies without discussion experience of delivering health and social within the Party. care. Money on its own will not raise the Prescription charges should be abolished, morale of health workers, but neither is there any sense in contracting out support and all services based on need should be The SHA therefore advocates a reform of the national policy forum process to give free. Particularly perverse are the services to an underpaid workforce.

Securing the lowest tender price at the cost domiciliary and intermediate care charges Party members real opportunities to influence government. that drive people into residential of impoverished workers should be recognised as the poor long-term bargain accommodation rather than remaining in their own homes. that it is.

The NHS could also focus much more on Pending fundamental change, the recruiting and training staff from deprived government should introduce an immediate Promoting difference communities, and paying realistic wages. It flat fee for a whole prescription. must bring its occupational health service There is an increasing divergence between up to the level of good private employers the health and health care policies in to ensure that the health of its own England and those in Scotland and Wales. workforce, long neglected, is assured.

The SHA supports this trend on the basis

that pluralism promotes innovation; and would like to see formal arrangements established so that all home countries can learn from the experience of the others.

intention of improving whole swathes of public services - there is clearly a huge amount of goodwill towards the national health service. Bodies such as leagues of friends, local fundraising charities, patient groups and volunteers demonstrate this.

A holistic approach to health and The structures being prepared for the governance of NHS foundation hospital well-being

As the present Secretary of State for Health, Dr John Reid MP, said in a speech a few weeks ago, the NHS can learn from overseas good practice. Here is an ideal opportunity now that foundation trusts are to be a reality.

Although mutual healthcare is as yet a rare thing in the United Kingdom, there is one trusts have been deliberately modelled on British body that is already a democratically the experience over 150 and more years of controlled mutual. It has been around for The SHA believes that everything that large organisations such as co-operative nearly a century. government, industry, communities and societies, friendly societies and mutual individuals do impacts on health and well- organisations. While most of these do not The Benenden Healthcare Society has as being. And that promoting health and well- operate in healthcare delivery, they are many members as work in the NHS, being must be an objective – not always based on community-based democratic roughly (about 1.2 million). The members necessarily the prime objective – of all control. Leading practitioners from the co- of this friendly society are people who organised activity. operative and mutual sectors (e.g. building work - or have worked - in the public societies) have been giving advice to the sector. It runs a hospital in Kent, and Department of Health (DoH) and the 25 provides access to other healthcare in other first wave of foundation trust applicants on parts of the country for its members. As if how to run community-based to emphasise that its purpose is to be democratically controlled (warts and all!). complementary to - not in competition with - the NHS, people working in the Incidentally, the name foundation almost NHS are not allowed to become members. certainly derives from a name used in the As the first ten foundation trusts go live, SHA member Geraint Day argues Spanish mutual healthcare sector. A visit to There is one part of the recent arguments Spain by UK health officials and the about foundation trusts that should leave a in favour of the changes.

Secretary of State for Health (Alan Milburn nasty taste in the mouth of anybody who purports to be a democratic socialist. At Well, the Bill got through the wrangling in MP at the time) preceded the use of the name in British (or at least English for the least one Labour peer expressed horror at the Palace of Westminster in November. foundation model is as yet confined to the idea of political activists and others That is, the Health and Social Care parts of the NHS in England) circles. getting elected to governing bodies or (Community Health and Standards) Bill. It boards of directors of foundation trusts. covers a host of topics, only one of which And it is from overseas that some of the was NHS foundation trusts. continuing lessons must be learned as Critics who are frightened of elections Not that one would have thought so from foundation trusts come into existence. That need to take comfort that aspiring to an is to say, that in Spain, Brazil, Japan and the active member is one antidote to being the tenor of the debate around that particular part of the Bill. The arguments United States of America - among other taken over by pressure groups. (Anyway, locations - are to be found democratically not one NHS committee member or board around foundation hospital trusts got member can be appointed or removed by increasingly bitter and acrimonious in some controlled mutual healthcare providers, quarters as the time of final parliamentary with millions of members between them. the public now - what sort of One of them - Group Health Cooperative, accountability is that?) decision-making drew near. in Puget Sound, Washington State, was set So what now? NHS foundation trusts are up at around the time of NHS inception, Who do these people think elect or even and was deliberately modelled on the in many ways a logical extension of the become politicians in the Commons and on government's stated intentions in its NHS Rochdale Society of Equitable Pioneers local councils? It is an idea not that opened for trading in December 1844. uncommonly heard from some supposed Plan issued in the year 2000: to extend autonomy and free up the creativity of left-wing think tanks from time to time. dedicated NHS employees and local trust That is, as a consumer co-operative trading The irony there is that hardly any think not in food and other commodities, but in tanks have any sort of membership or boards and management. the provision of healthcare. They learned democratic base to hold them to account. It If one were to rely only on the likes of the the lessons about bad times as well as good, seems that anybody can set up a think tank and it is well that the opportunity exists for and pontificate in a political vacuum. I have Daily Mail one might be forgiven for thinking that the NHS was already in total learning from other healthcare previously dubbed that sort of thinking the meltdown. Yet, whatever the reality - and organisations.

New Elitism - as opposed to the New the Labour government has the avowed Mutualism.

Building on good foundations – or seeking our new mutual friends

group on governance. He has been an advocate of It is around the experience of large mutual mutual healthcare for nearly four years as the concept has developed from concept to reality. organisations that progressive people in that sector have already been bringing expertise to bear to advise the would-be foundation trusts - people from the AGM and Public and consumer co-operative sector, building Patient Involvement societies and other mutuals.

event

The think tank Mutuo (which is at least allied to that democratic set of enterprises, the mutuals) is one of the leading lights here. And its name also derived from Spanish; an unusual coincidence given my earlier remarks about Spain and mutually run healthcare. Co-operativesUK also contributed to the DoH's reference sourcebook on foundation trusts (NHS Foundation Trusts A Guide to the Governance Arrangements).

Saturday May 15th 10 am – 4 pm NEW DIRECTIONS IN PATIENT & PUBLIC INVOLVEMENT Main speakers: • Lord (Philip) Hunt, Chair of National Patient Safety Agency • Prof Jenny Popay, Commission for Public and Patient Involvement • Sally Brearley, Chair of Health Link

As part of putting the foundation concept To be followed at 4 p.m. by the ANNUAL GENERAL MEETING into practice, the "boards of governors" (or of the Socialist Health Association member councils or whatever each trust will call them) would harness some of the local goodwill and energy for the benefit of the NHS trust and for patients. Some of Birmingham and Midland Institute, Margaret Street, the 25 applicants for foundation trust status Birmingham B3 3BS had already wanted to adapt patient groups or create new ways of actively involving Book your place from patients in their NHS trust.

Martin Rathfelder admin@sochealth.co.uk What could be better than truly to involve Socialist Health Association people in their NHS? 22 Blair Road, Manchester M16 8NS Tel: 0870 013 0065 One other question for now, in the wake of the concluded parliamentary debate. Should www.sochealth.co.uk the foundation approach have started with primary care? Probably yes. But even 25 English hospital trusts do not the whole NHS make. So it should be possible - and discussion is already taking place - to introduce similar locally accountable and autonomous units into Primary Care Trusts perhaps, or even around some progressive GP co-operatives. The most important thing is to do it properly, and among the 25 applicant trusts there is some real creativity and enthusiasm coming through. Watch this space.

Geraint Day SHA member, member of the Co-operative Party national executive committee, and member of the DoH's NHS foundation trusts external reference