A manifesto for health?

Pauline Bryan

The Scottish labour Party is in the process of preparing its 2007 election manifesto for the Scottish Parliament. The Party has learned from experience and the loss of a seat in the suburbs of Glasgow, that health care is a major issue. Dr Jean Turner stood for the Scottish Parliament and won on a platform of defending one of the hospitals in the North of the city.

The health debate seems to have become focussed on hospital buildings, cleaning and waiting lists. There is a real danger that a manifesto based on these issues will fail to satisfy in a number of ways. Hospital closures, even with the promise of a new build is always going to cause problems. There is no "settled will of the Scottish people" which recognises the priorities of centres of excellence over local provision. Hospital cleaning would be more honestly tackled in a debate about outsourcing and resources than to do with restoring matrons. The discus-sions around waiting lists take no ac-count of the need for preventative interventions.

A radical health manifesto would not start with these issues, but would involve people in a debate about the priorities for a healthy society, rather than simply treating a sick society. The Government White Paper on Public Health makes the statement:
"People make their own health but not under conditions of their own choosing."

Public Health

When discussing public health issues it is very easy to concentrate on life style issues such as diet, alcohol consumption, exercise, smoking and forget that the biggest improvements in public health have come about through political action rather than individual life style change. Clean water, good quality housing, universal education, post natal community care have all done more to bring lasting improvements to the nation's health than could be expected from personal life choices.

Poverty remains the single biggest cause of ill-health in Scotland. The figures for life expectancy clearly reflect this. Even the incidents of childhood accidents reflect class background. A Scottish Executive report on Road Traffic Accidents quotes studies that have demonstrated the higher incidence of child pedestrian accidents in deprived or disadvantaged areas.

"Men in Shettleston die younger than anywhere else in the country. At 63, life expectancy is 14 years less than the national average and comparable with Iraq and some countries in the Third World. It is also nearly 18 months shorter than a decade ago Britain's first reduction in lifespan since the Second World War. "

Ensuring warm, dry, airy homes, clean air, rewarding work, good schools, access to affordable good quality food including free school meals, improve transport services. These would set the foundations for more healthy lifestyles. Treating people with respect rather than as potential problems can result in better all round health

Choice in the NHS

The first draft of the Scottish Policy Forum document stated "More patient focussed care is at the heart of what we are doing. We need to consider how we can increase patient choice in Scotland's NHS..."

The campaign to try to impose the English model of Foundation Hospital on Scotland appears to have lost momentum, but the debate about choice remains in the background and the creation of markets may well re-emerge under other guises.

What we should be arguing for is community choice rather than individual choice. As individuals we may have competing interests to our neighbours. Your children may be your priority, whereas the care of the elderly may be mine. I have a big car and can travel to a centre of excellence 30 miles away. You use public transport and it would take you two hours to travel the same distance. I am happy to pay a contribution to my health care as and when I need it, you can't afford to.

These individual conflicting interests can't be reconciled, but those of society can be. We can as a society prioritise good health and decide that spending the country's significant resources on providing the best for everyone is a good use of money. At a community level there will remain conflicting interests that we need to find a way of resolving.

The first consultation paper asked "How do we get the right balance between centres of health care specialism and expertise and locally delivered care?" In a separate section it goes on to ask "How can we make Health Boards more accountable?" These two questions are linked. We can ask communities to make informed choices about their services. Now these would be real choices not the phoney ones that market led ideas produce (would you like that in pink or blue?). Local people should be involved in decisions based on information and advice involving health care professionals and other experts who can spell out the balance of benefit and risk involved in centres of excellence located in major cities against local provision with less specialist staff. Democracy provides a means of making these decisions and this operates in a far more rational way than the anarchy of markets.

Labour's manifesto should include a clear statement that improving the nation's health through both public health initiatives and the provision of high quality health services will be its main priority in its next term.

It should also say that it will democratise the control of health services and oblige health providers to involve local communities in the decisions about their services. This may, as many of the submission from Party members argued, be by electing the health board members, but most importantly it will involve taking decisions to the people who will use the service. A radical manifesto should then be based around democratic accountability and investment in good health.

1 The Scottish Executive Literature Review Road Accidents and Children Living in Disadvantaged Areas. 2002
2 Sunday Observer 14 March 2004
3 John Hopkins Medicine Patients treated with respect more likely to follow medical advice. September 2005.