Tag: 2011

Below is the text of the speech made by John Healey to the National Housing Federation on 8th July 2011.

Introduction

Thank you … I am glad to join you again at a NHF conference.

A couple of years ago I spoke at the Federation’s national conference in Birmingham.

That was almost 9 weeks to the day into my job as Housing Minister; this is now 9 months since I became Labour’s shadow health secretary.

As before, this invitation has been a welcome spur to reflect on how we see and meet important policy challenges.

Then I was able to set out plans for the extra £1.5 billion I’d negotiated for our Labour Housing Pledge to kick start 10 000 new homes on commercial sites stalled in recession and build an extra 20 000 new affordable homes, including the largest council house building programme for two decades.

Now I’m no longer in Government; and no longer in a position to make things happen.

It was Tony Blair who said there’s one essential difference between government and opposition: “In government you wake up each morning and say ‘what can I do today?’ In opposition, you wake up and ask yourself ‘what can I say today?’

But one thing after government in opposition that’s imperative, is to learn the lessons of what worked, what didn’t and why.

You are all housing service and policy experts. More so than I am, or will ever become. So I wanted to contribute to your conference discussion by offering my reflections less on policy debate and more on policy decisions as they are taken in Westminster and Whitehall, as well as reflections on overcoming the flaws.

Health and housing

You’ve brought health and housing together for debate at this conference.

But do you know … in my 10 months as housing minister, I don’t recall a single meeting with health ministers to discuss the essential policy and delivery links.

And in 9 months as shadow health secretary, no doctor, nurse, NHS manager or health policy expert has said to me …’we must do more to get better housing if we want better health’.

It is an evident truth.

You know it as housing experts from the way you run your housing and tenant services. I know it as constituency MP for part of Rotherham and Barnsley.

Poorly heated or insulated homes can lead to hypothermia and preventable deaths.

Overcrowded homes can lead to strains on relationships and infectious diseases spreading more rapidly.

Badly adapted homes can lead to trips, falls, avoidable pain and hospital admissions.

Pressure with rent payments or anti-social behaviour can lead to mental stress and ill health.

So housing does directly affect health. Just as health affects housing.

Addiction or mental health problems can lead to loss or work, financial problems, arrears and eviction.

Physical disability or injury can make an existing home impossible to live in.

The Marmot review into health inequalities, which Labour commissioned and published in government, nailed the problem of separating health and housing policy into the silos of different Whitehall departments: “Many of the difficulties in addressing the issue of cold homes is that the effects of the problem are the responsibility of one government department – the DH – while the responsibility for solutions lies with the CLG and DECC”.

Government has not always been organised or operated like this.

History

When Bevan led the legislation to set up the NHS through Parliament in 1946, he was secretary of state for health and housing.

When he launched the post-war council house building programme in the same year he said: “We must not only build quickly, we must build well. In the next year or so we will be judged by the number of houses we have put up. But in ten years we will be judged by the quality of those homes.”

The twin responsibilities were separated by the new Conservative Government in 1951 into two different departments. And they’ve remained separated at the national level since then.

Housing and public health remained twin responsibilities of local government, however, until 1974 when public health was taken into the NHS as a national responsibility.

We can see both changes, I think, as part of the process of the British state centralising to expand its domestic role as its foreign responsibilities diminished post-empire.

Flaws in system

This is not just a feature of recent years in Whitehall. It is reflected directly in Westminster and in the way policy debate and scrutiny takes place.

Neither the Commons health select committee nor the CLG committee has done a report on health and housing, though from time to time the essential links are raised with both and referenced in their published evidence.

The Marmot report recommended greater integration of policy and delivery: “An important step in tackling the social determinants of health at a local level would be greater integration of health, planning, transport, environment and housing departments and personnel.”

Even when Parliament legislates for the broader view and delivery links, this is no guarantee that it happens in practice.

Directors of Public Health have a statutory duty to assess the health needs of their area. But the Chief Executive of St Mungo’s – London’s largest provider for homeless people – told me recently in the 30 years he’s worked for the charity, not once has a public health director approached them about the health needs of London’s homeless.

The personal consequences of this mean only 1 in 6 homeless people come away with a treatment plan when they are discharged from hospital.

And even when the financial evidence also underlines the imperative to overcome policy and service separations, this is no guarantee that it happens in practice.

The Audit Commission confirm “Every £1 spent on providing housing support for vulnerable people can save nearly £2 in reduced costs of health services, tenancy failure, crime and residential care”.

The Chartered Institute for Environmental Health report health costs of £600 million a year from poor housing; and health, crime and education costs totalling £1.5 billion.

Reflecting on five years as a minister at the Treasury, and two spending reviews, we tried joint PSA targets and jointly-held dual-key budgets between departments in some policy areas.

These worked only up to a point. Neither were strong enough to overcome the force of the single department culture. And neither were underpinned with strong enough financial metrics to support one department spending money that reduced costs or lifted burdens for another.

The row this week over the Government’s cap on and cuts to housing benefit offers an interesting illustration. In this case the DWP wants to cut the benefit bill and, even though the consequences and costs to local government were serious and obvious, they played no part in the decision to press ahead with the policy.

Labour steps 

So the separation of health and housing responsibilities makes sound, sensible policy making much harder.

We took some steps in Government to bridge the gap over the last decade. These were necessary, but not sufficient to overcome the significant policy separation between housing and health.

We started and completed 90% of the massive Decent Homes programme, fitting new boilers, insulation, doors, windows and kitchens for council and housing association tenants in more than 1.4 million homes by last May.

We introduced the supporting people grant specifically to help people stay in their own homes; people who are vulnerable and with complex needs for housing support.

And we encouraged closer local working between housing and health providers. The recent ‘Healthy Homes’ initiative launched jointly by Liverpool Council and Liverpool PCT is an excellent example of integrated, locality based, whole population commissioning.

It targets assessment of the health and the housing needs of families living in 25,000 homes across the city. Where needed they improve properties, make appropriate health referrals and expect to prevent at least 100 premature deaths a year.

One year on – the balance sheet

One year on – where are we now with the new government?

The Liverpool Healthy Homes programme is exactly the type of integrated long-term commissioning at risk in the huge NHS reorganisation.

They – like almost everyone else – are beset by uncertainty, confusion and extra cost as more bodies and bureaucracy are being created by the  upheaval in the health service.

Within the Government’s NHS legislation however, the move to return public health to local authorities is sound in principle, although there are important unanswered questions in practice about the powers and funding that councils will have to do the job; about the retention of skilled public health staff; and about the continuing commitment of the NHS to work on public health improvements.

But it is impossible to ignore the scale of the Government’s cuts, which have gone too far, too fast.

I have mentioned housing benefit already. Age UK report average cuts this year of 8% – with councils reducing care hours and raising eligibility thresholds for help.

These are short-term, budget driven cuts which will have longer-term consequences for many people’s health and welfare, and will inevitably lead to greater cost in other parts of the system, especially for the NHS.

There are still 400,000 non-decent homes left, and the Government will not provide the funding to finish the programme. The benefits go wider even than health – for every one million pounds of public investment in housing refurbishment, 17 jobs are created and the Labour shadow housing team has calculated that completing the programme would support 54,000 jobs.

Finally, the supporting people grant is being squeezed and is set of a 12% real terms cut over the course of the Parliament.

The recommendations by Andrew Dilnot on the funding of social are provide an opportunity to reverse this trend of damaging policies. I have called for, and Ed Miliband has called for, cross-party talks at the highest levels to discuss and agree a new system of funding social care, and how to pay for it.

Opposition and alternatives – proposals

One of the very few advantages of Opposition that you are freer from the Departmental constraints of Government, and free to think more broadly.

So I want to use this period in opposition to look for solutions to the systematic separation of housing and health, solutions that we can push through from the word go when we are in Government.

And today I want to open up this work to you and the NHF.

I would like to invite you and your colleagues in the housing and health fields to let me know:

–    First, what are the best examples of work being done on health and housing together. I mentioned Liverpool – tell me more.

–    Second, where are the problems? Where do Government departments or the policy silos of health and housing get in the way of improving people’s health and their homes?

–    Third, if there are the problems, what are the solutions?

You can help shape this work which I will do alongside my colleagues Caroline Flint and Alison Seabeck in the autumn. We have a firm commitment to finding the housing and health policies that we can put in place once we’re in Government, and to give them the weight they will need to have a real impact to improve people’s health, housing and lives.

Conclusion

I wrote Labour’s housing manifesto for last year’s election. It was the first of the specialist policy manifestos we published.

The first line was: “Labour believes that everyone has the right to a secure, decent and affordable home in a safe community.”

There’s a strong social, moral and economic case for this commitment. What I didn’t properly appreciate then, but I do now, is that there is also a strong health case for that commitment too.

Below is the text of the speech made by John Healey to the 2011 Unison Health Conference.

It’s fully ten days since I was last amongst so many trade unionists.

Last Saturday, with 300 times as many of you marching in London alongside Mums campaigning against closure at their local surestart, kids campaigning to save their their youth club. Grandparents campaigning to stop cuts to their meals on wheels…and everyone, campaigning to safeguard the NHS.

Britain’s mainstream saying the Tories are taking Britain in the wrong direction.

Ed Miliband was right.  David Cameron would have seen the big society in Hyde Park last Saturday.

And he can see the big society everyday in the heart of our British trade unions, convenors and stewards and Health & Safety officers and learning reps and pensions trustees ready to represent and support their colleagues at work.

They put themselves out for others, unpaid and often under pressure because they believe in helping others, they believe no one should deal with the power of employers alone and they believe together we’re always stronger.

I’m proud to have been a trade unionist all my working life.

And as an MP I’m proud of my working links with trade unions, including and especially with UNISON.

So thank you for the work you do to support nearly half a million other UNISON members across every area of our NHS.

Thank you for the work you do to support the NHS and NHS patients.

Thank you for the work you do to support me and colleagues in the Labour Party.

And, to Dave Prentis, a special thanks, you made sure UNISON was out early in opposition to the Tories’ NHS plans with the Judicial Review, and you’ve not let up since.  I worked closely with UNISON as Housing Minister, and I’m glad to be doing the same now on health.

To Karen Jennings, as she moves on to be your AGS, you have been an outstanding advocate for NHS staff and for the NHS itself.  I know Christina McAnea will be just as strong and challenging as your new national officer for health.

And to your President, Angela Lynes, and health chair, Lilian Macer, as you look at what the Tories plan for the NHS in England, I suspect the case for devolution has never seemed stronger, especially this week in Scotland, where Labour’s backing has led to the end of prescription charges on the same day as the Tories in England put them up.

With over 450,000 health members, UNISON has a strength and breadth of membership unmatched in other unions or other parts of the public sector.

Andrew Lansley dismisses trade unions as vested interests fighting the loss of power.  And the Prime Minister dismisses the BMA as just another union.

Of course unions in the NHS have a vested interest what the Tories fail to understand is that it’s precisely because trade unions represent their members, that they believe so passionately in the NHS.

To those of us who care most about the NHS – Labour, unions, patients groups, NHS professionals – falls the heaviest duty.  The duty both to safeguard the NHS, and the duty to change and continuously improve the NHS.

Ed Miliband described this yesterday as part of the British promise, that each generation makes and leaves the NHS better than the last.

Labour is the Party of the NHS.  We are also the Party of NHS reform.  The status quo has never been good enough for Labour.  We have always championed change for patients.

That’s why we set up the NHS, why we led the case for raising National Insurance to invest in the NHS, why we required reform – often in the face of resistance – getting GPs to open out of office hours or introducing the challenge of competition from new providers to help clear waiting lists and improve NHS hospitals for patients.

But don’t fall for propaganda that what the Tories are doing now is an extension of what Labour was doing before.

If the biggest reorganisation in NHS history was simply the evolution of Labour’s policies, the Tories would not need legislation more than three times longer than the Act that set up for NHS in 1948.

We were ready to use competition, we were ready to use private providers.  But always properly planned, managed and publicly accountable, to supplement not substitute for the NHS.  By the Election last year, fewer than one in twenty treatments were carried out by independent health providers.

We are proud of our Labour achievements in the NHS.

Many of you here will remember the NHS of the 80s and 90s.

Trolleys in corridors.  Chronic staff shortages and annual winter crises.

100 hour weeks with exhausted overstretched staff.

The NHS was a service whose staff remained true to its values let down by a government that did not share them.

1997 we set out together – to save the NHS; then to review it.

NHS funding doubled in real terms.

Most NHS buildings have been updated with modern equipment.

Staffing numbers are up by 200,000 extra clinical and support staff.

You have training and development through Agenda for Change. And your national NHS pensions protected under Labour – the country’s recognition of the years of commitment to caring for your community.

Some of the changes I know have not been popular, but looking back I believe that we made many of the right choices for the NHS.

Giving well run hospitals more freedom was challenging for many of us.  But Foundation Trusts are today among the best public sector employers in the country, providing world class services to the public.

Bringing in commercial partners to finance and build new public hospitals helped us achieve the biggest hospital building programme in our country’s history.

Allowing patients to choose to have their operation in independent treatment centres was popular and meant patients waiting less time in pain.

We did make mistakes – every government does.

As I have said, we did not always get the best deals and there were times when we should have been tougher in our negotiations.  We had too many reorganisations and we should have done more to relieve the paperwork and release time to care.

Our Labour – investment and reform – plus the hard work, collaboration and commitment of staff meant real improvements for patients.

MRSA and CDiff – tested the collaborative effort of cleaning staff, healthcare assistants, nurses, managers and pathologists but together we cut the rates three quarters and 30%.

Cancer deaths are down by 20% and improving faster than the rest of Europe.

Heart deaths are down by 50% thanks to paramedics and crash team nurses collaborating to provide life saving treatment after stroke or heart attack.

In 1997 more than a third of a million people were waiting over six months for operations they needed.

Together, by 2010 we were doing 2.5 million more operations and the average waiting time was 4.5 weeks.

The lowest waiting lists in NHS history, alongside the highest patient satisfaction ever.

After the Election, we were ready for further changes.  We were ready to remove back office and bureaucratic costs.  Integrate services and see a significant shift of care, especially for elderly people and those with long term health conditions, from hospitals closer to patients at home and in their community.

We have started fresh work on Labour’s health and care policies for the long term.  And I’m proud to chair our Labour health commission jointly with your UNISON ex President and our current Labour Party chair Norma Stephenson.

And as we listen to the public, to staff and to experts, we’re open to criticism as well as compliments, and above all we’re open to new ideas, so Norma and I invite you, as active members of UNISON, to play your part in shaping the alternative future for the NHS through the union and through the Labour Party.

For now our main job is to oppose reckless and ideological plans.

We’ve been making strong arguments against the NHS reorganisation since the early Autumn, and moving amendments to the legislation since it was introduced in January.

Our arguments are hitting home.  Our criticisms about the Tories NHS plans are now coming from doctors, nurses, patients groups, the health select committee, NHS experts, Lib Dems, Peers on all sides of the House of Lords, and I have to hand it to Andrew Lansley, it takes a special talent to unite opposition from Norman Tebbit and MC NXT GEN.

The Prime Minister is increasingly isolated on his NHS plans.

Only 1 in 4 of the public back him in wanting profit making companies given free access across the NHS.

Two thirds of doctors think the reorganisation will lead to worse – not better – patient care.

And nearly 9 in 10 believe it will lead to the fragmentation of services.

Yesterday, in the middle of confusion, chaos and incompetence, the Prime Minister has pushed the Health Secretary out of the bunker to try and tell people what on earth the Tories are doing with the NHS.

He didn’t want to be there, he had nothing to say.

But he was in the House of Commons, because there’s a growing crisis of confidence over the far reaching changes the Government are making to the NHS.

Because there’s confusion at the heart of Government, with briefings and counter briefings on all sides.

And because patients are starting to see the NHS go backwards again under the Tories, with waiting times rising, frontline staff cut, and services cut back.

That’s why Labour has been saying the reorganisation requires a root and branch rethink and the legislation needs radical surgery.

This Bill is not just about getting GPs to lead commissioning or looking to cut layers of management, one third of the long legislation sets up the NHS as a full scale market ruled by the power of a competition regulator and the force of competition law.

It is designed to:

– break up the NHS

– open up all areas of the NHS to private health companies

– remove all requirements for proper openness, scrutiny and accountability – to the public  and to Parliament

– and to expose the NHS to the full force of both UK and European competition law.

Tories are driving free market political ideology into the heart of the NHS.

Helpfully, the government’s new chair for the new market regulator Monitor confirmed – before he was banned from doing more interviews.

We did it in gas, we did it in power, we did it in telecoms, we’ve done it in rail, we’ve done it in water, so there’s actually 20 years of experience in taking monopolistic, monolithic markets and providers and exposing them to economic regulation.

So what the Tories did to public utilities in the 1980s, they’re doing now to public services, including the NHS.

Whilst I don’t want the power companies collaborating on their services and prices, I certainly do want hospitals, GPs and other parts of the NHS to do so – it’s in the best interests of patients and in the NHS DNA.

They are making fundamental and far reaching changes to our NHS and to its ethos.

So there are fundamental flaws in what the Government is doing, not just what it is saying on the NHS.

The test is whether the Prime Minister will deal with these flaws.

Tests for the Tories on NHS

I have five tests for David Cameron; major changes that must be made to his legislation.

These tests reflect the concerns I have heard from patients groups, experts and NHS staff criticisms.

These tests also reflect Labour’s deeply held concerns.

So, Prime Minister, here’s your starter for five…..

– Keep NHS protections against the full force of UK and competiton law, drop your plan for a free market NHS and delete part 3 of the bill

– Keep the waiting time guarantees for patients, so they’re seen and treated quickly

– Drop plans to break up commissioning into so many small GP consortia, make them involve wider expertise and require them to be open and accountable to local patients and the public.

– Ban GP bonuses, stop conflicts of interest where they can commission from themselves and close the loophole that lets them outsource the commissioning job to the private sector

– Keep the cap on NHS hospitals treating private patients, so they don’t jump the queue on NHS patients and strengthen the safeguards on closing down hospital services.

When the Health Secretary was forced to the House of Commons yesterday.

He said Ministers would now “pause, listen, engage” on the Tories’ NHS plans

Andrew Lansley has not been listening for nine months.  The test is now whether David Cameron will recognise the very wide concerns and respond with radical surgery to his health bill.

They’ve failed to listen to criticisms in 6000 responses to their consultation.

They’ve failed to listen to the same concerns in rejecting 100 Labour amendments to the bill.

So this ‘pause’ looks suspiciously like a PR stunt to quell the coalition of critics.

Labour will look to turn this Tory pause into a problem for David Cameron.

We will encourage patients, staff and the public to challenge the changes, wherever and whenever the Prime Minister, deputy Prime Minister and Health Secretary go through the motions of “listening” in the weeks ahead.

Conclusion

For those of us who care most about the NHS – our job, our duty must be to help people see more clearly and more quickly what the consequences of these changes will be.

This means explaining and exposing the truth at the heart of the Tory plans.

We must together make it impossible for the Prime Minister or Health Secretary to dismiss criticisms as the concerns of vested interests or complaints of the minority.

Nye Bevan:  The NHS “will last as long as there are folk left with the faith to fight for it”

It’s our NHS.  It’s our duty to fight for it now.  And it’s our mission to see the NHS changed and improved in the future.