Martin Rathfelder - "Building a Better NHS"
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This is the text of a talk and discussion lead by Martin Rathfelder of the Socialist Health Association at the Heaton & Lostock Labour Party meeting on 12th November 2003.
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The Chair introduced Martin Rathfelder of the Socialist Health Association who addressed the meeting. He explained the work of the SHA, started in the 1930s to campaign for a free, comprehensive National Health Service. In the 40s and 50s it was quite a large, powerful organisation and used to print leaflets for general elections. It was previously called the Socialist Medical Association with membership being restricted to doctors and nurses working in the NHS. But in the 70s its membership was broadened and its name changed. Their campaigning broadened too, focussing not just on better healthcare but to improvement of those social factors, e.g. housing and nutrition, which often lead to poor health.
The SHA is reviewing its principles on topics such as whether or not all doctors, etc. should be actual employees of the government, voluntary provision and similar issues.
Martin said that the SHA believes democracy within the NHS to be very important but he questioned whether or not the health service is a democratic organisation. It seems that there is a move to increase democracy, e.g. John Reid, the Health Secretary, wants letters from consultants to doctors to also be copied to the patients or their guardians. There is consultation on the question of extending "patient choice" to include those with chronic conditions, e.g. in the mental health field.
However, Martin said that, as the system becomes more democratic, the SHA is concerned that the middle classes will become more empowered and demanding to the detriment of the less well off. Life expectancy of the better off has increased but poorer people have a much smaller increase.
The SHA believes that the NHS should exist with three guiding principles:
The question to be answered is "Do we meet all the needs of all the population?" This a question especially relevant to the establishment of Foundation Hospital Trusts (FHTs). Will they lead to greater differences between hospitals and less universality than the present system? Will they meet the needs of everyone?
Last week the House of Lords voted against the bill to establish FHTs but it will come back to the Commons pretty quickly. He believed that much of the opposition to FHTs comes from MPs who are unlikely to have one in their constituencies!
Martin's introduction was followed by discussion:
Graham: Foundation Hospitals might be a good idea for areas that get them but would increase inequality between them and non-FHT hospitals.
Ian: Bolton is not a three star trust and if it doesn't get the resources to bring it up to that status it could lose doctors, nurses, etc. to nearby FHT hospitals as it might not be able to pay to keep them.
Martin: FHTs won't get extra money but will be allowed to borrow. All Trusts will have to pay the NHS salary rates but the hospitals will be able to "compete for business" from the Primary Care Trusts (PCTs). Foundation Hospitals won't be able to compete for work on price for services because prices they can charge will be fixed. However, it will result in a move back to the "internal; market" supported by the Tories.
Anne: Her experience of different Consultants varied enormously. Her current one doesn't do private work but she has seen some services at Bolton Royal Hospital decline in recent years while others have improved.
Martin: It's not surprising that there will be differences between hospital departments just as there are in schools or any other enterprise. He asked whether or not people actually want the choice that politicians suppose that they do.
Craig: Lifestyle changes will have a greater effect than changes in hospitals.
Sheila: If FHTs are established we might prefer to go to such a hospital. But it all comes down to the quality of the service that is provided.
Anne: The Bolton Breast Clinic already takes referrals from outside the area, e.g. Bury and Oldham. However, the money from the patients' home Health Service Trust doesn't follow them as it should.
Graham: The Government is proposing that the money will follow the patient.
Martin: Pointed out that the Government's slogan at the last election was "better hospitals and better schools", not "better health and better education". He expressed concern that so much money is going into hospitals rather than into primary care.
Pat: Said that a senior NHS employee had said that the so-called "freedoms" that would reputedly come with FHTs were already available to existing Trusts.
Martin: Agreed that this could be correct as there have been changes in the proposals for Foundation Trusts since they were first proposed.
Anne: Does the funding go to the Primary Care Trusts (PCTs) and then hospitals bid for their funding from them?
Martin: Yes, that is the case.
Sheila briefly explained about contracts between PCTs, existing Trusts and the proposed FHTs.
Anne: Has been working with hospitals on the Race Relations Amendments Act and asked whether or not FHTs would be responsible for race relations in the hospitals.
Martin: No, at least not directly. This was confirmed by Graham.
Martin: Also made the point that Health Secretary John Reid wants to see more "providers" supplying care to the NHS and doesn't believe in the "one size fits all" way of doing things.
Graham: This has been seen in the hospice movement. At the previous meeting, Tom Pickering had said that Foundation Hospitals are one of the least concerning changes proposed by the government. He asked if Martin could comment on this.
Martin: Cannot see the point of a market system if it is not going to show up differences between providers. Small units might be friendly but they are often uneconomical and people need information to make choices.
Joyce: Patients need to have more confidence in their GPs. Most of the public is very poorly informed about medical matters and she said that too much choice may not always be the right thing.
Graham: Compared schools and hospitals. The outcome depends very much on the intake. Schools that start with pupils having a lot of problems have to be much better to turn out good students and the same must be the case with hospitals.
Sheila: Agreed - hospitals in deprived areas will have sicker patients and poorer results.
There was discussion on whether or not all would want to go to the "best" hospitals. Resources are finite and, after a while, these would become overstretched.
Anne: Noted that the discussion seemed to have moved away from Socialist to market forces. She wanted to hear the Socialist alternative to what the government are proposing.
Martin: Asked whether or not Socialism is incompatible with the market. He didn't believe this to necessarily be the case.
Simon: The real criterion for the NHS should be that everyone received the treatment they needed, when they needed it. But resources are limited.
Alan: There is pressure for everyone to be given choice in every sphere of government service, whether it is hospitals, schools or other areas and it's not always possible or realistic to give a wide choice. Additionally, people don't like to pay increased taxes to finance it!
Craig: The debate is really between patient choice and the professionalism of the practitioner. He would rather trust the professionals.
The discussion continued on the need for informed choice and how difficult it can be for a patient to make a choice between one course of treatment and another, between one hospital or clinic and another. Craig and Alan agreed that choice is most likely to be exercised by the middle classes.
Anne and Alan pointed out that really ill patients often need to be transferred to the NHS from private hospitals when the latter don't have the facilities, equipment or staff to treat them properly.
Graham thanked Martin for addressing the meeting and declared it officially closed at 21:00, although the discussion continued informally for some time.
Graham and Anne were thanked for the use of their home and for their hospitality.
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