An NHS for the Future

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2014 National Delegate Conference
25 February 2014
Carried as Amended

With the NHS having celebrated its 65th birthday in 2013, Conference believes it is necessary to reassert its importance as one of the few remaining symbols of social solidarity left in the UK.

Conference condemns the government for having subjected the NHS to almost constant attack since it took office in 2010 – whether through the Health and Social Care Act, running down funding, or shamelessly seeking to make political capital from the failings in care at Stafford hospital.

Contrary to these deliberate attempts to denigrate the service, Conference believes that the NHS model still represents by far the most equitable and efficient way of providing healthcare in the 21st century.

Conference notes the alarming expansion of privatisation within the English NHS that will continue to fragment services for patients.

Conference believes that the competition provisions of the Health and Social Care Act and the subsequent Section 75 regulations are beginning to have a significant impact; even the outgoing NHS chief executive has pointed to the damage being done to the NHS, with competition lawyers “all over the place”.

Conference asserts that the procurement regime set up by economic regulator Monitor has robbed clinical commissioning groups of the autonomy they were supposed to enjoy, binding their hands with inflexible rules that make it very hard to avoid using competition, and making a mockery of government changes being “clinically-led”.

In addition to these threats, Conference notes that the failed experiment in “franchising” at Hinchingbrooke Hospital is likely to be replicated elsewhere, as trusts that will struggle to attain foundation trust status look to bring in external organisations.

Conference notes that different approaches to NHS reform have been taken in Scotland and Wales that have largely shunned the use of the market. For example, spending by the NHS on private healthcare currently amounts to less than 1% in Scotland, and Conference welcomes the fact that this figure is set to reduce further as new guidance has instructed health boards to clamp down on their use of the private sector. In Wales, Conference welcomes the first minister’s confirmation of his government’s desire to avoid NHS privatisation, as improvements in A&E performance and public satisfaction contrast sharply with England.

Furthermore, Conference notes the increasing financial pressures on the NHS in all countries of the UK. The Prime Minister’s claim to have protected health funding has been increasingly undermined by a swingeing set of “efficiency” cuts in England and by the knock-on effects of Westminster-based austerity for health funding in the devolved nations.

Conference notes that the integration of health and social care has become a key debate in the NHS across the UK over the past year. Although only Northern Ireland has full structural integration, governing parties from all political persuasions are pursuing integration policies in Scotland, Wales and England.

In addition, Conference notes Labour’s plan for “Whole Person Care” that includes a welcome promise to repeal the Health and Social Care Act, alongside a commitment to full integration of health and social care in England.

Conference believes that integration has the potential to bring about benefits for patients and service users, in terms of a more seamless joined-up service across sectoral boundaries. In addition, it may help reduce some of the time and money wasted when responsibility for a patient or service user’s care is transferred, sometimes repeatedly, between the NHS and local authorities.

However, Conference warns that for meaningful integration to take place, staff and patient/user involvement is essential. Moreover, Conference asserts that integration should never be used as a cover for cuts to services; it cannot be done on the cheap and requires decent funding if it is to work properly. Conference believes it is essential that integration is not used to level down staff terms and conditions.

Conference is concerned by the complacent analysis of the Westminster government that integration is fully compatible with competition; this is not the case – integration should proceed on the basis of public sector values and be used as an anti-market tool to reduce fragmentation.

Conference therefore calls upon the National Executive Council to:

1)Continue to support the NHS model as the best way of delivering free health care at the point of delivery and defend it against any government attempts to undermine the service;

2)Continue the union’s strong campaigning against privatisation and cuts at national, regional and local level;

3)Campaign for safe staffing levels to help ensure the best care;

4)Build capacity amongst UNISON members and local communities in responding to privatisation threats;

5)Work with allies to monitor and expose the expansion of privatisation in the run-up to the 2015 general election;

6)Support the integration of health and social care where this is in the interests of patients/users, but on the basis of proper staff/patient/user involvement, and with the provision that integration should never be used as a cover for cuts;

7)Keep branches up to date on the ongoing initiatives on health and social care integration, monitoring the progress of those areas where it has become a reality;

8)Work with UNISON Labour Link to feed the union’s views into Labour’s plans for Whole Person Care.