How Scotland rejected NHS marketisation

Given the downward spiral of the NHS in England, we should give full credit to the Scottish Labour administrations who ensured that Scotland exited the road to health marketisation.

A few recent events made me think about the recent history of the NHS in Scotland. Firstly, the announcement that Malcolm Chisholm MSP is to retire at the next election. He was the Labour health minister who abolished NHS trusts in Scotland.

Secondly, an answer Nicola Sturgeon MSP gave at a recent UNISON referendum hustings comparing the NHS in Scotland and England. She didn't quite say that this was entirely down to the SNP, but those not aware of the history might have interpreted it that way. That's not to say that she wasn't a very good health minister herself and strongly opposed to marketisation. However, she was continuing the work of others. It also reflects the fact that there is not an ideological divide between Scottish Labour and the SNP on health.

Thirdly, a trip to our UK health conference reminded me just how bad NHS England is!

Following the 1997 general election Labour came into government and quickly initiated the devolution referendum that resulted in the first devolved administration in 1999. In April 1999 they set the path to reform by halving the number of NHS trusts in Scotland from 47 to 28. Susan Deacon was the first health minister and everyone was left in no doubt that the market was not the future for health care in Scotland. I spent some eighteen months on secondment to the health department during this period and then served on her advisory board. I'll be circumspect, as I am probably still covered by the Official Secrets Act and the key players are still alive, but let's just say there was some institutional resistance to the direction of travel!

None the less important steps were taken to build cooperation in the NHS rather than competition. Market testing was dropped and services started to come back in house. This included a new HR strategy (the primary reason for my secondment) that introduced partnership working into the NHS. A model that survives to this day and has been rated as probably the best of its type in the world.

At the end of 2001, Malcolm Chisholm took over as health minister and he took over the reform process that resulted in the NHS Reform Act of 2004. This Act formally abolished trusts and established a duty of cooperation. We had Community Health Partnerships for primary care and staff governance was given a statutory footing.

It is often said that Scottish Labour is dictated to by 'London Labour' - largely a myth in my extensive experience of the policy making process. However, it is certainly the case that when New Labour in England reintroduced elements of NHS marketisation there was pressure to follow the same model in Scotland. What is less well known is that Scottish Labour ministers resisted that pressure. I remember one Blairite special advisor in the run up to the UK general election complaining, that the Tories said if their reforms were so good why didn't the Scots adopt them - could we not just sound a bit like them? He was firmly told that the answer was, 'it's devolution stupid!'. However, part of the problem was that ministers were told not to highlight differences and as a consequence they have never got the credit they deserve.

The last Labour health minister, Andy Kerr, went against Gordon Brown's decision to defer a PRB award (topical again this month) and bought, what is now the Golden Jubilee Hospital, into public ownership. Even if he didn't appreciate our press release welcoming the hospital's 'nationalisation'!

The one issue that didn't get resolved was stopping the big PFI hospital projects that had been started and some smaller ones that joined the programme. Ministers like Malcolm Chisholm didn't like PFI, but they were told it was 'the only game in town', due to off balance sheet funding. Wrong in principle and practice and sadly a lesson not learnt to this day, as the present Scottish Government has one of the biggest PFI programmes in Europe.

The first two post devolution administrations didn't get everything right and certainly not over PFI. However, they made crucial decisions over a partnership approach to health through cooperation rather than competition. Health ministers like Susan Deacon, Malcolm Chisholm and Andy Kerr, supported by the wider cabinet, made these decisions and kept to this approach despite political pressure from elsewhere. When we see what's happening to the NHS in England, we should remember to say, thanks very much comrades!

Dave Watson

Posted with Blogsy

Together We Can - Care

In addition to the report of the Devolution Commission, Scottish Labour published a policy vision at its conference, 'Together We Can'.

The care section sets out the challenges facing Scotland as summarised in this info graphic.

While the paper makes a number of commitments on the care workforce, waiting lists, bedroom tax and no privatisation, the big idea is a review of the health and care system 'Beveridge 21'. As the paper says: "Just as the first Beveridge Report focused on tackling the five big problems of the time, described as “want, disease, squalor, ignorance and idleness’, so Beveridge 21 will examine the root causes of health inequality, not just the symptoms".

Again these commitments are summarised in this info graphic.

The Shadow Health Secretary, Neil Findlay MSP has established two Commissions. One to look at health inequalities, chaired by our own Dr David Conway - and another to look at social care. The focus is not on further analysis, but rather on solutions.

Scottish Labour's policy process for the 2016 manifesto is now underway. This paper is a good start on the journey towards a radical manifesto to develop a health and care system that is fit for the 21st Century.

SLP Conference Motion 2014 - Time to Care

Scottish Labour Party Conference – March 2014

Socialist Health Association Scotland – Contemporary motion

Time to Care  

Conference believes that a priority of the Scottish Government should be urgent action to maintain and improve the standards of care provision to elderly and vulnerable people.

Conference notes that care services are coming under increasing strain with too few staff being asked to deliver services with insufficient time to care while facing cuts in their pay and conditions of service.

In UNISON’s ‘Scotland it’s Time to Care’ report, care workers explain in their own words the reality of social care in Scotland today. They tell us the service they provide is not sufficient to meet the needs of elderly and vulnerable people they care for. Either in terms of the time they can spend or the quality of care they can provide.

An increasing number of care workers are being placed on zero-hour and nominal-hour contracts, which like blacklisting has serious consequences for service user and staff safety. Conference therefore welcomes the inquiry into zero-hour contracts by the Westminster Scottish Affairs Committee.

Conference also believes that fair pay for care workers, including the Scottish Living Wage, is essential to raise standards, reduce turnover and ensure continuity of care. Conference therefore notes with dismay the rejection by SNP MSPs at the Scottish Parliament Infrastructure and Capital Investment Committee on March 12^th of Labour amendments to the Procurement (Scotland) Bill which would make the payment of the living wage a requirement in public contracts.

Conference believes that care services will be only be of a sufficient standard when they are  designed in conjunction with users, adequately resourced and delivered by adequately paid staff with sufficient time and training to do their jobs. Conference therefore calls on the Scottish Labour party to campaign for:

·         The Scottish Living Wage as a contract requirement to help the recruitment and retention of staff and support continuity of care;

·         Improved training to ensure that care is delivered by properly qualified staff;

·         Proper employment standards including ending the abuse of zero and nominal hour contracts;

·         Adequate time to care in every care visit.

Those who rely on care services deserve nothing less.

Scottish Labour Party Conference 2013

The SHA Scotland fringe meeting at this year's Scottish Labour Party Conference will be held on Friday 19 April 2013 at the Palace Hotel, Inverness, starting at 5:30pm.

The subject is 'Tackling Health Inequality'.

Chair: Gordon McKay - Chair UNISON Labour Link Scotland

Speakers:
Jackie Baillie MSP - Shadow Cabinet Secretary for Health
Dr David Conway - Chair SHA Scotland

SHA Scotland has also submitted a contemporary motion on the same topic.

"This conference recognises that Scotland's major health challenge is health inequality. The Joseph Rowntree Foundation’s, ‘Monitoring poverty and social exclusion in Scotland 2013’, is one of a number of reports that draw attention to this issue. The health section of that report highlights three main points: 

•      Health inequalities in Scotland are not only stark but growing. A boy born in the poorest tenth of areas can expect to live 14 years less than one born in the least deprived tenth. For girls, the difference is eight years.

•      Rates of mortality for heart disease (100 per 100,000 people aged under 75) are twice as high in deprived areas as the Scottish average.

•      Cancer mortality rates in the poorest areas (200 per 100,000) are 50% higher than average, and have not fallen in the last decade, while the average has fallen by one-sixth. 

The Joseph Rowntree report also concludes that the “Labour Government has taken poverty and social exclusion very seriously, marking a clear distinction from recent previous administrations”. Labour's actions are in stark contrast to the actions of the ConDem coalition who through welfare cuts and reductions in public spending are creating even greater health inequality. 

Conference also recognises that the SNP's Ministerial Taskforce on Health Inequalities is an inadequate response to the scale of the challenge facing Scotland. 

Conference welcomes the recent recognition of the role of local government in tackling health inequalities in the form of a new guide for councillors published by CoSLA and NHS Scotland. The guide’s key suggestions for action to address health inequalities include providing services universally, but with scale and intensity that are proportionate to the level of disadvantage. While offering intensive support, it cautions against targeting geographical areas defined as deprived because this means missing the vulnerable who live elsewhere. Particularly rural areas that have people experiencing inequalities that may be harder to identify. The guide also reinforces the Christie Commission recommendation that local agencies work together with common aims and measures to reduce health inequalities. 

Conference therefore calls on the Scottish Policy Forum to ensure that measures to address health inequality are a major element of Scottish Labour's next policy programme. Recognising that this is not a matter for NHS Scotland alone and requires a comprehensive  policy response across all government departments."