This is a transcript of a speech that I gave at the House of Commons's Grand Committee Room on 24/7/07. This was part of a panel discussion with Frank Dobson, Norman Lamb and Neal Watson...
Thank you for giving me the opportunity to set out the Green perspective of what would be in this 'new prescription for the NHS'. I suspect that you may be asking what the Greens have to say on health care and I hope that I can show you that we have a very clear vision that sets us apart from others, and that we have a deep commitment to the NHS and its principles.
For example, we have been campaigning alongside the Keep Our NHS Public campaign for the past year or so, with many of our members joining local KONP groups, knocking on doors and organising petitions. It is worth remembering that we are the only main party that is fundamentally opposed to private sector involvement in health care.
In defining this new prescription for the NHS and where health care should go over the next 20 years, there are a number of key areas.
Firstly, I think the top priority that we must address is accountability. We currently have a health care system that spends £90 billion of taxpayers money, a system that accounts for about 9% of our GDP, results is 5% of vehicle journeys and therefore 5% of all vehicle pollution [1], yet it is under the dictatorial control of just one person, the secretary of state.
We all know that staff, patients, the public, local councillors, MPs and even ministers, don't get listened to. Last year we had Hazel Blears, John Reid and Jacqui Smith that were among 13 ministers protesting at cuts, including a health minister, Ivan Lewis [2]. We, not only have no accountability to local people for their services, but this lack of accountability exists at every level. We have also witnessed the decline of the Community Health Councils into Patients' fora, and now further decline into something called 'LINKS'. There is only one good solution to freeing the NHS of centralist dictates and for providing true accountability to and involvement with local people and that is to have the NHS accountable to local government.
Of course, if people want to have no say in health care, if people want to have no accountability, if people want the NHS to do its own thing, then we should opt for the arms length quango that seems to be flavour of the month. But if we want to have a real voice in our local health care services then we need to have direct accountability to local people through local government.
But shouldn't the NHS be led by clinicians? Well, we need clinicians to develop new approaches to health care and to develop new healthcare technology. We need clinicians to advise on the best and safest way to provide services. But just because something is deemed to be clinically right, it may not be what local people want or need and we must not forget that the NHS is there to serve them.
Accountability has been reduced further by the purchaser / provider split, the internal market, that the NHS operates. When you subcontract work you reduce your responsibility, it gives you the ability to say, “it wasn't me but I'll get on to them”. But with this reduction in responsibility come less accountability. The NHS tries hard to mitigate this problem with its various service reviews, but sub contracting any service, be it cleaning, independent sector treatments or foundation trust hospitals, brings problems when trying to hold them to account.
I am also sure that we are all well aware of the intensely destructive and expensive nature of the NHS market. We now have Payment by results and practice based commissioning, where 'money follows the patient' and every visit is costed and paid for, but health care is not a object to be bought and sold. In a civilized society health care should be a right not a commodity. 'From each according to his ability, to each according to his needs' - not according his, or his PCT's, ability to pay.
So, what are the alternatives to the internal market? We have already had a far superior model to the purchaser / provider split. Directly funded and managed health care was provided at a fraction of today's costs and at the same time the NHS was seen as the best in the world. Sure, wages were too low and health care technology wasn't as advanced, but we have seen a 50% increase in funding since then much of which is wasted on administering our flawed Americanised model.
We hear from the big corporate proponents of marketisation that markets deliver new ideas and advances in health care. I say that is rubbish - it is clinicians that come up with new ideas and advances and they do this for their patients and because they have a natural desire to improve care. UK clinicians are pushing the frontiers of health care because they feel it is the right thing to do, they don't do it to get a bigger market share. New methods of health care need to be driven by NHS staff as does the weeding out of outdated and unsafe practice. Clinicians need to drive clinical change.
But staff, patients and the public are missing this relentless march towards the US model. Let us not forget, the US model leaves millions with no access to health care yet costs twice as much as much as the UK! So why on earth are we trying to emulate it?
The NHS was founded upon a universal service for all based on clinical need, not ability to pay. It was founded as a health service to be funded by taxation. Rather than continuing in the current direction towards the US model, we must recapture the core values that the NHS was built upon.
Were you aware that the government recently consulted on changing its core principles for the NHS? Previously it had set out 10 principles in the NHS plan, one of which said: “Public funds for healthcare will be devoted solely to NHS patients.”. The new principles, proposed of course by Labour, leave this line out... and how could they leave it in while millions of pounds are going to private companies' shareholders?
We do need to re-examine the core values and ensure that they are fit for the 21st century. For example there is nothing in them which talks of timeliness of access to health care [3]. According to the current set of principles patients could wait years for treatment without going against the values of the NHS. There is also nothing in them about providing services to local people and communities. Putting values at the heart of health care, values at the forefront of any changes, must be paramount. Perhaps we ought to use core values as the key measures of performance rather than some of the weird targets currently in place.
Funding is another of the central themes of health care debates. Currently about one fifth of public spending is on health care - around £90 billion, or about a grand and a half for every citizen. But people don't know what the cost of health care is. On the one hand we have protests against spending cuts, on the other we have complaints about taxation.
It is time to reconcile these. We need to be honest and open about just how much health care costs and the best way to do this is to have an NHS Tax that people can see and relate to. Obviously this would not increase the overall tax burden but would simply re-badge part of our current direct taxes. The implications of this are wide reaching there would be an increased sense of ownership of the service as well as the acknowledgment of just how much health care costs.
Ok, so what does a green health service look like, what is our prescription for a new NHS? I've talked of accountability, principles, values and funding but what model of health care do we think NHS needs?
The principle of localisation not centralisation is one that flows through green philosophy. The arrival of climate change, and the pending arrival of peak oil, serve to increase the importance of making health care as local as possible. We do applaud Labour's polyclinic ideas - these have been Green Party policy for years. Community health centres with a wide range of health care functions serving communities are an excellent model. Cuba adopted the polyclinic model 30 years ago and now has one of the best health care services in the world.
It should be up to local people to decide the set up of health care services for their area, but as a general model / principle we support a four tier system of community services, GPs, polyclinics and hospitals. Polyclinics need to be underpinned by GPs, and polyclinics, in turn, need to support district hospitals.
There is, however, a very real and worrying trend that needs urgent and sensible debate. The increasing centralisation of specialist health care is not a sustainable model. A 'network' approach to specialist services is fine, but the notion that we should only provide high tech health care services on a regional basis needs to be balanced by damage it does to local services, and of course the environment, as well as the difficulties it causes for vulnerable people having to travel great distances.
The argument that a service is not safe unless it is provided centrally can be taken to extreme lengths. At what point will we decide to have just the one full A&E service in the country? It would be very high tech, well staffed and probably tick all the governance boxes, but it would be of no use to most people.
It should be for local people to decide what level of risk that they want to have in their health care services and if people want a local A&E that doesn't see enough people to tick every clinical governance box then so be it - whose risk is it to take? We urgently need a sensible debate on how we can best serve local people.
Finally, I was asked to comment on what I think GB should do in his first 100 days... I'd like to suggest that he starts to buy back the hospitals that he has spent the last 10 years selling off through PFI.
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References
1. http://www.neweconomics.org/gen/nhsclimatechange220607.aspx Report by the NHS Confederation
2. http://politics.guardian.co.uk/publicservices/story/0,,1989410,00.html
3. NHS Plan 2000
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