The Cooperative Party held it’s debate on Health Policy at our Annual Conference on 9th October in the Queens Hotel in Leeds.
The debate at Conference is the end of a long participatory journey. Our policy development process is member-led, and builds on the ideas, priorities and the lived experiences of our members, movement, and communities. Local parties and individual members take part in a consultation over a 6-8 month period and contribute their ideas and priorities for Britain’s health care system.
During this pre-conference consultation there was much said about improving patient voice, creating parity of esteem for mental health services, delivering a better work environment for NHS staff and increasing the range and depth of democratic, co-operative models.
On the day we had a passionate, well informed and wide-ranging debate which led to the development of 7 broad policy statements
Statement One: Empowering Patient Voice
Statement Two: Tackling Health Inequalities
Statement Three: Co-operative Solutions to Healthcare Challenges
Statement Four: A new settlement for NHS staff
Statement Five: Achieving Parity of Esteem for Mental Health Services
Statement Six: Improving preventative care
Statement Seven: Securing the future of the NHS through education
Each of these policy statements says something about how you restore the position of our NHS as one of the great institutions in our Country’s recent history. Our policy debate on social care from last year’s conference also has much to contribute to the place of health and care service provision as a cornerstone of British culture and our way of life.
Both policies can be found on the Cooperative Party’s website.
Since Conference I have been reflecting on the 74 year life of our National Health Service and of the modern Welfare State, it seems to me that in the various phases of the development of health and care services we have tried two of three potential paradigms for the provision of these services. We have applied the state and market paradigms in response to the challenges of the time, but we have not applied ourselves in a serious way to the third paradigm, namely the community or social paradigm.
Co-operatives and the values of common ownership have not yet been attempted at anything other than at a local level where several excellent examples can be found. Yet ii is within those examples and values, I would argue, that the Third Age of health and care provision may be found
The state and market paradigms, which have dominated our models of health and care provision since 1948, were developed to solve the very different health challenges of their time.
Perhaps the state paradigm’s focus on uniformity and the dominance of professionals was (at the time) a rational response to the enormous challenges of setting up a ground-breaking universal system of healthcare. However there have long been clear indicators that this attempt to set uniform provision in all areas has been leading to diminishing marginal returns as we see health inequalities increasingly emerge and widen.
It has also become abundantly clear that there are wider social, economic, cultural, environmental and other determinants that shape health outcomes for people and communities in far more significant ways than the provision of health and care services alone.
We then turned to the market paradigm with its focus on productivity and patient choice. Again, perhaps an apparently rational response to rising demand, escalating costs and the emergence of concepts such as the postcode lottery of service provision.
Unfortunately this model seems to be ill equipped to confront the complexities of the inter-connected health and social issues faced by so many individuals and communities.
It seems clear that neither the state nor the market paradigm has the resilience or responsiveness to respond to demands that arise from a population that is ageing and the issues that arise from normal ageing and the complexities of life in an increasingly fragmented society where the norms of the past may no longer hold true (if indeed they ever held true).
Our current models of provision can, it seems, only respond to rising demand by increasing activity. This is not financially sustainable nor is it necessarily in people’s best interests. Surely the focus should be on keeping people happier and healthier for longer in the places where they live, a community paradigm.
Effectively this must mean recasting the relationship between our health and care systems and our communities. A Third Age for health and care systems which centres on community capacity, assets and networks.
We must move on from seeing people as simply being recipients of care. We must move towards a system which recognises people’s knowledge of their own needs and works with them to co-produce their own health and wellbeing. It could also bring them together in a localised co-operative endeavour to meet the needs of individuals and communities. We saw some of this in the community responses to the impacts of the Covid 19 pandemic
There is a lot of evidence which supports the conclusion that this leads to better experiences and outcomes for people and their carers and has a direct impact in terms of a reduced demand for services.
Many of the problems we now face in health and care, in a system that for many seems to be broken, arise from the way we have been doing things. A return to Business as Usual is surely no longer an option. We must find a new way, a Third Way, if our health and care system is to meet the challenges of the coming years.
Our Conference was called “From Crisis to Co-operation”. This is the journey our health and care services must now make.
Chris Bain 