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The Health Commission Work Programme 2006
1. Introduction
The Health Policy Commission has two main roles. Firstly, its members examine and take evidence on a number of apposite health policy issues throughout the year so that they can draft Labour's policy documents from a knowledge and evidence-based position. Secondly, the commission acts as a conduit between party Members and government ministers, communicating the views of members and details of the actions of Labour in government and the issues our ministers face.
During the previous phase of Partnership in Power the commission proved its worth in developing the partnership between the government and party. Reflecting the views of party members the commission helped to push the issue of smoking in public places up the agenda; helped move the policy agenda from simply funding a sickness service to providing a true health service; it was at the forefront of the successful effort to persuade voters to back record health investment through the rise in National Insurance contributions; it developed and helped shape the party's thinking on choice in health care and also immersed itself in the debate around improving sexual health.
2. Work programme
Improving primary and community care services
The NHS is a touchstone issue for Labour members. It was a Labour government that created it in 1948. It is a Labour government that today is rebuilding and renewing the health service for the modern Britain. It is vital that we succeed in this process of renewal and that we do it in a way that remains true to Labour values. If we fail and our reforms are not fundamentally grounded in our principles, we risk divorcing the NHS from our party, leaving it exposed to the dangerous ideology of our opponents. The Tories voted against all Labour's extra investment in the NHS and are now simply putting a new gloss on the same old policy of cuts to public services. David Cameron's third fiscal rule - the proceeds of growth rule - would mean an immediate cut of £12 billion from public spending, putting Labour's record investment in our NHS at risk.
We are half-way through our ten-year improvement plan for the NHS - a plan based on investment and reform. Pretty much everyone welcomes the investment but not everyone welcomes the reform. And as we get further down that road, people will naturally have more and more questions. It is our job to examine and answer those questions, to state very clearly the reasons behind the steps we are taking and to explain their Labour roots. The next stage of our reforms will be outlined in early 2006 when the Department of Health launches a White Paper on health care outside of hospitals and the measures we want to implement to improve primary and community care services.
In the last five years we have focused much of our attention on improving hospitals. But most people's contact with the NHS takes place outside of hospital. Labour wants to improve such community based services and wants to give people a real say in how the system will work in future. The commission will also consider here the relevant parts of the health contemporary resolution passed by Annual Conference 2005.
There are problem areas we need to address and improvements we need to make. Most people have high regard for the NHS and its staff but sometimes patients feel that the system itself isn't always on their side and that it isn't really designed around them. Sensitive, understanding communication between NHS staff, patients, carers and families can do so much to make, say, a hospital stay or the collection of test results, more bearable. Sadly, situations in too many cases do not meet best practice standards. Some people find the system hard to understand and sometimes can't access the services they need in the most direct or efficient way. Often people can have trouble using services and many people find the nature and location of existing services incompatible with the way they live their lives. Similarly, most people are satisfied with the services provided by their GPs but they want more of a say about their care than they have now. Although more choice would help people to express their preferences, there isn't yet a consistent way to listen and respond to the views of patients/service users and carers across the system.
So the challenge now is to improve primary and community services. Ninety per cent of people's contact with the NHS is in primary care. It is better for patients and carers and for taxpayers if long term conditions like diabetes and heart disease and care for our ageing population - the big challenges facing the NHS in the 21st century - are dealt with in the local community, rather than in hospitals.
We need to shift the focus of services more towards prevention, move more services like diagnostics, minor operations and other treatments out of hospital wherever it's safe and effective, and ensure all our communities get the services they need. We also need to reduce bureaucracy so that more money goes into frontline care.
Increasingly, patients' carers and families also want to be consulted about the care that patients can receive at the end of life and may want to consider the option for palliative care at home, where this is available and family circumstances can support it.
This needs stronger Primary Care Trusts (PCTs) to design and develop better services for patients and carers, to work more closely with local government, and to hold hospitals and GPs to account more effectively.
Our goals are clear. We want to deliver the best possible health, the best possible health care and the best possible value for money. And the commission will continue to monitor issues of public service delivery and performance as they arise.
There are a variety of services models already in operation around the NHS including those run by the voluntary sector and new NHS initiatives like walk-in centres. As part of its work the commission will examine these and other models of care. Labour in government wants to build on the strengths of what is already happening and best practice from around the NHS. The policy framework for developing primary and community services will be set out in the forthcoming White Paper.
District nurses, health visitors and other staff delivering clinical services will continue to be employed by their PCT unless and until the PCT decides otherwise. The terms and conditions of staff will of course be protected. The decision would be driven locally, following our White Paper deliberations, and only be implemented following full local public consultation.
Social care
Social services are one of the major public services. At anyone time there are up to 1.5 million of the most vulnerable people in England relying on their help. Social services that interface smoothly with the NHS and other services create an altogether better patient experience. Putting the patient first is as relevant to our agenda for modernising social services as it is to our programme for personalising the National Health Service. If patients are to receive the best care, then the old divisions between health and social care need to be overcome. Despite the best efforts of dedicated and professional staff, the NHS and social services have not always worked effectively together as partners in care, so denying patients access to seamless services that are tailored to their particular needs. All patients, but particularly older people, need health and social services to work together. They rely on good integration between the two to deliver the care they need, when they need it.
Labour in government believes services should be person-centred, seamless and proactive. Person-centred services will give the individual real options and we expect everyone to have a spectrum of choice available, choices that help maintain independence, not create dependence. We recognise that elderly people want to stay in their own home and outside institutions for as long as possible and as part of our choice agenda Labour will be pursuing this even more strongly.
We need to debate and discuss all these challenges and more over the coming months. But because the stewardship of the NHS and social care is natural Labour territory, party members - locally in their communities and nationally through the institutions of Partnership in Power - can contribute to, influence and help lead the current and coming debates in a way that others cannot.
NHS finances
The importance of our reform programme has been underlined by the failure this year of a minority of NHS Trusts to live within their means at a time when funding growth is at historic levels. Around seven per cent of them are responsible for two-thirds of this year's projected £620 million total deficit (although the majority of NHS organisations are delivering service improvements and living within their budget).
Our reforms will help address this situation they are highlighting historic weaknesses, and making it easier to fix them. Under the old system, financial problems were hidden and hushed up.
It is important to remember (and the policy commission has a crucial role here in communicating this to members) that there isn't a cash crisis in the NHS. As the end of the financial year approaches, there are always scare stories as NHS organisations position themselves in financial negotiations, and deficits are often overstated, especially by those who want to undermine Labour's record on investment. Commission members, particularly in the run-up to the local elections in May 2006, will be instrumental in getting Labour's message across to campaigners, party members and the media in those local areas that appear to have financial problems.
Improving Britain's public health
A public health environment where health inequalities - the health gap between rich and poor - are widening not narrowing is quite simply an affront to Labour values. Labour is the party of equality and social justice which means for us that a situation where poor people are far more likely to suffer poor health is unacceptable.
We now need to take bolder steps to improve the health of the population and reduce demands on the health service. Action to reduce health inequalities goes way beyond health care. It covers the widest spectrum of life experiences that can be influenced by government. It requires joined-up thought and action across the whole of local and central government from the policy areas of health and education to others including culture, housing and transport.
It is not the role of government to force people into a healthier lifestyle. Indeed our latest public health White Paper recognises just this - it acknowledges that people want to take responsibility for their own health but they want the Government to support them in making healthier choices. They want clear and credible information, and where they want to make a change and find it hard to make a healthy choice they expect to be provided with support in doing so - whether directly or through changes in the environment around them - so that it is easier to do the right thing.
Improving Britain's public health is undoubtedly a challenge. Too many people smoke, drink too much and eat too much of the wrong kinds of foods. As a nation we are getting fatter - obesity rates are rising - and 1.3 million people in England suffer from diabetes, and that number too is increasing. But we are making headway. Cancer deaths have fallen by 14 per cent and deaths from heart disease are down by almost a third. There is still much more to do to bear down on the causes of these and other public health problems, including doing more to restrict opportunities for people to smoke and taking action against alcohol abuse and binge drinking. As well as discouraging unhealthy lifestyles we should also encourage healthier life choices. We must harness the obvious health benefits that can be achieved through, for instance, regular exercise, making it easier to choose to buy and eat healthier food and encouraging breastfeeding.
Alcohol abuse and binge drinking have such serious impacts on health that examining the issues on this topic should feature as an element of the commission's work.
Our policies must also sustain and improve people's sexual health. We have initiated a new £50 million sexual health media campaign targeted at young people and have also pledged that by 2008 Genito-Urinary Medicine (GUM) clinic appointments should be available to patients within 48 hours, but we must look at ways to do more.
Labour in government needs now to step up the action being taken across departments and throughout society to tackle the causes of ill-health and reduce inequalities. But Labour members at the grassroots also have a role to play. The extent of the problem is clear - it is deep-rooted and stubborn. We have already done a lot and are doing more to improve Britain's public health. However, we now need to engage more widely to seek more and radical ideas - consulting with our communities, in our professional circles and looking to the experiences of other countries to find examples of best practice. If it is innovative, if it works, we want to hear about it and see how it can be applied.
More choice and a voice to those with long-term conditions
Another change is underway. Traditionally the NHS has focused on treating individual episodes of illness. But unhealthy lifestyles and a~ ageing population mean that in future it is chronic conditions that will become more important. Already 17.5 million people are living with long-term illness such as asthma, arthritis or heart disease. Mental health problems affect around one in four of the population at some time in their lives, and are a growing issue among the young and socially disadvantaged. These trends mean the NHS will increasingly need to move from being a reactive to a proactive care provider.
Alongside this increasing problem of chronic disease, people are taking a greater interest in their own health. Use of alternative and complementary therapies is growing rapidly. Patients are using the internet to research health information and access online support communities. This new environment presents risks - advice and information may not be appropriate or safe.
But it also provides the opportunity to improve the management of chronic diseases by giving patients and carers more choice - through the introduction of new community matrons or through partnership with 'expert patients' empowered to help manage their own care. Of course as well as having greater choice patients and their carers have said that they also want a greater say over the care they receive. Part of the role of the commission might be to determine, firstly, how we properly engage with and listen to people with long-term conditions and their carers and, secondly, how to support them in making health decisions.
Mental health
Mental health is a top clinical priority for Labour. But for years, mental health services didn't have the priority they deserved, despite the fact that millions of people face a problem at some point in their lives. Each year, 600,000 adults with serious mental health problems are cared for by specialist mental health services. Thousands more young people and tens of thousands of elderly people also receive care. Mental health problems in older adults are common and, over the next ten years, as the number of older people grows so too will the incidence of linked mental illness. Mental health and age-inclusivity must be seen as cross-cutting themes across policy development and implementation, not least because effective intervention can improve the quality of life for both the sufferer and their family carers.
Research shows that people from black and minority ethnic (BME) communities can suffer from inequalities in access to mental health services, in their experience of those services, and in the outcome of those services. For example, BME patients are significantly more likely to be detained compulsorily or diagnosed with schizophrenia. The Department of Health's Delivering Race Equality programme is a comprehensive action plan for eliminating discrimination and achieving equality in mental health care for all people of black and minority ethnic status. But we recognise these are issues that are not easily remedied.
To get the range of mental health services and provision right, three changes are necessary. Firstly, we are making changes in the law which as it stands today dates back to the 1950s and does not adequately provide for the public, patients and their carers or staff.
Secondly, we are reforming services through new national standards. The mental health national service framework that the Government published four years ago has been widely welcomed, not just by clinicians and managers, but even more importantly, by carers and users of the services.
And thirdly, underlining our commitment, we are putting in the right investment to provide the right range of services - whether in community services or acute services. Until 1997, no special funding was available for mental health services. That funding is now there, over the long-term, and will mean that by 2008 every person who needs it will have access to comprehensive community, hospital and primary mental health services with round the clock crisis resolution and assertive outreach services available to all who need them.
The Health Policy Commission can play a worthwhile role in expanding the knowledge of the party and its members about mental health issues. In many cases these problems can be dealt with effectively, quickly and compassionately by the health service and its dedicated staff but sadly at times they can be simply overlooked or, worse, they can be the source of stigma, prejudice and inaction.
Health and welfare of prisoners
We owe a duty of care towards everyone in Britain and that includes the health and education of those living in Britain's prisons both for an acceptable standard of life whilst in prison and for improved life and health chances upon release.
For too long prison health care has been separated from the NHS. Prisoners should receive access to good, wide-ranging health care services but the isolation of health professionals and poor communications have, to date, been common, resulting in enormous variations in the standard of care across Britain's prisons. That is why we are putting in place changes, and increasing the involvement of the NHS via primary care trusts. We are starting to see the benefit of this partnership. Where the partnership is strong and the NHS is actively engaged, the isolation is starting to decrease and the standard of care for prisoners is starting to improve. As there has been inadequate provision for prisoners with mental health problems in particular, we have worked hard with colleagues across government to ensure that each health and local authority has a clear gateway to specialist mental health services, counselling and other services. Contributors to the Big Conversation stressed the importance of access to good quality, confidential sexual health services for prisoners, including counselling and other services.
Education can make a difference too, helping to cut re-offending. Both prisoners and prison staff have reported some benefits for prisoners participating in cognitive skills training, such as improved prisoner behaviour; increased self-confidence; enhanced literacy skills and better interpersonal skills. They also said that cognitive skills training helped to prepare prisoners for other offending behaviour programmes.
The Health Policy Commission will link up with the Crime, Justice, Citizenship and Equalities Policy Commission to engage in some joint work around prisons and prisoner health.
Working to improve NHS dentistry provision
We accept that there is a shortage of dentists and this has meant that some surgeries have stopped taking on new NHS patients, contributing to the low numbers of people registered with surgeries. It is not known exactly how many people find it difficult to access NHS dentistry, but it is clear that action is needed to address the problems that do exist. Labour members can usefully feed back their own experiences of the situation on the ground in their communities.
We are making the most far-reaching reforms to the system of dentistry since the inception of the NHS. There are more NHS dentists now and will be in the future thanks to a successful recruitment campaign bringing dentists to the NHS to improve access, and an increase in the number of students able to train as dentists. In November 2005 the Government exceeded, by quite a margin, its target to recruit 1,000 more dentists. In the preceding year the equivalent of 1,453 more dentists were recruited to the NHS, contributing to a net increase of 1,100 dentists.
We are bringing in a new contract for NHS dentists that will be beneficial to both the dentists and their patients. This will mean that for the first time Primary Care Trusts (PCTs) will have local control of budgets for dentistry and that if a dentist leaves the NHS, the PCT can buy in replacement NHS dental services so that patients do not lose access to NHS dentistry.
NHS patients will benefit as dentists are allowed to spend more time with them and to focus on promoting good oral health. Under the new expert guidelines on recall intervals (produced by the National Institute for Clinical Excellence), many patients may no longer need the traditional six-monthly check up. This will free up time that dentists can use to see a greater range of patients and improve access to NHS services.
The proposed new system of patient charges will be simpler and fairer. Instead of over 400 separate charges for different items of treatment, there will be a simple system of three bands. The maximum charge for dental treatment will reduce, and patients will be able to understand more clearly what treatment is proposed and what it will cost.
The Labour case for extending access to NHS dentistry to everyone who needs it is undeniable. And our new reforms will help to make this a reality. The commission will ensure that party members have the facts about dental care and party members can play a real role in engaging voters up and down the country, acting as ambassadors for our policies and as opinion leaders in their local communities. 'Hot spot' areas that are suffering particularly badly from a lack of NHS dentistry cover can be highlighted and brought to the attention of ministers.
3. Next steps
Annual Conference 2005 agreed new proposals Improving Partnership In Power. The Improvements give policy commissions a crucial leadership role In ensuring the success of the next PiP cycle by, for example, providing better engagement on topical Issues, building an ongoing relationship with party stakeholders who have made policy submissions, as well as looking at Innovative ways policy commissions can work to help with their thinking on future policy development.
This work plan outlines the policy challenges and the topical issues facing the Health Policy Commission in the year ahead. They provide a focus for the commission's work and help party members understand the current work of the National Policy Forum.
The policy commission will consider how to manage the engagement on these issues with party stakeholders which will include prioritising the policy areas, putting forward a timeframe and proposing the best method of engagement depending on the policy issue under consideration.