Health and social care after the Covid-19 pandemic

Remitted to the LLA Organising Group by LLA conference
Amended and agreed on September 26 2020

1. This Conference notes that during the COVID-19 pandemic, doctors, nurses, pharmacists, paramedics and other frontline and backroom staff are working all hours to care for us. It is amazing that the Tory Government, when faced with a crisis, could suddenly produce unprecedented funding and resources and cancel NHS debt. However, the NHS continues to be exploited by the private sector in the field of testing, supply and agency staff. It is clear how vital our NHS is to the people of this country and we will work hard to defend it.
2. The whole UK health and care system has been both underfunded and understaffed since 2010, with investment in training a future workforce cut, as a consequence of political decisions by both the Tory and Coalition Governments.
3. The social care sector was even less well prepared for the COVID-19 pandemic, because of neglect and being almost totally privatised. The sector has been continually subjected, in the name of profit, to low pay, poor working conditions, together with elements of inadequate training, staffing levels, leadership and management skills. During the COVID-19 pandemic, social care staff in nursing and care homes, particularly those in adult social care, worked tirelessly for their residents, often in dangerous situations with little or no personal protection. Today they are being lauded as “heroes”, tomorrow they will be forgotten again, if we do not prevent it.
4. Another Tory policy is thatis that is that from October 2020, migrants will have to pay £624 per year to use the NHS. The Prime Minister had to be put under extreme pressure to scrap the surcharge for health and social care workers. This exemption excludes many who are linked to healthcare, such as taxi and delivery drivers, contract staff in hospitals and others who have contributed to the welfare of this country during the COVID-19 pandemic. At the same time, thousands of frontline healthcare workers who have come from overseas, there is the added worry, that when the COVID-19 pandemic is over, they could be asked to leave or deported. The Home Secretary says she is incredibly grateful, but warm words are not enough, not when our NHS and social care workers have no idea if they will be allowed to stay in the UK. They deserve a guarantee.
5. We are deeply concerned that in England, the NHS Five Year Forward Plan, and new NHS Long Term Plan have resulted in a chaotic, total reorganisation of NHS services and introduced a new and expensive management structure, the Integrated Care Systems (ICS), the purpose of which is to rewrite and manage health and care policy, protocols and budgets at a sub-regional system level. These ICSs have no legal status and use this to deny any accountability to Parliament or the people. All the non-legal ICSs are currently writing their own plans for delivering health and social care post COVID-19, to be completed by 1 September 2020 and submitted to NHS England and NHS Improvement by 21 September 2020, thus giving no time, and with no process, for clinicians, support staff, patients or the public to contribute.
6. All of this has got to end and we must secure the provision of whatever financial, bio-medical, technological, and human resources the NHS needs to ensure it is a public service fit for the twenty first century.
7. This Conference demands the following, which also requires a restructuring of long-term health and social care policy centred around social determinants that impact on health, such as improved social housing, access to good education, healthy food and a healthy environment with excellent sport and exercise facilities.

(i) The establishment of an independent public enquiry into the government’s lack of preparation for the COVID-19 pandemic. Specifically, it must include: (a) the appalling neglect of the social care sector; (b) inadequacies in the provision of PPE and testing; (c) the state of preparedness of the NHS and the Social Care sector for a pandemic prior to COVID-19; (d) the government’s response to the recommendations from Exercise Cygnus (2016), presented to the government in July 2017; (e) the government’s response to the recommendations relating to the risk of a pandemic contained in the 2019 National Security Risk Assessment; and (f) the responses of the Department of Health and Social Care, SAGE, COBRA and the four separate national NHS and public health organisations to the COVID-19 pandemic, from the time the epidemic was first known.

(ii) The cancellation by the government of all remaining NHS debt, especially that accrued from private finance initiatives (PFI).

(iii) The future provision of adequate revenue and capital expenditure to ensure that the NHS is equipped to cope with any future public health crisis, as well as to be a first-class healthcare provider, free from the constraints of austerity.

(iv) A pay award for all NHS and social care workers of at least 15% and a commitment to fair and timely pay awards in the future and improved pension rights.

(v) Legal protection for the NHS in all post-Brexit trade deals, particularly if it could force the NHS to pay more for vital pharmaceuticals and force other burdens upon it.

(vi) Repeal of the Health and Social Care Act 2012 (and subsequent supportive legislation), to restore the NHS as a publicly delivered and funded, but a more publicly accountable and transparent healthcare system. The introduction of a new NHS Bill in order to implement policies that will re-instate the NHS as the sole provider of its own healthcare, ending privatisation of any NHS services, including supply and the process of disintegration that it creates; and the return to a single integrated NHS, ending the commissioner/provider split.

(vii) The establishment of a National Care Service, bringing social care wholly into public ownership and fully integrated within the NHS, with its values and leadership skills.

(viii) The institution of the principle that everyone working and living in the UK shall have free and open access to the NHS, not just those who the government decide randomly are deserving. Healthcare is a fundamental right and access to it must be free and universal.

(ix) The giving to all those NHS and social care staff from overseas, the right to remain permanently once the COVID-19 pandemic is over.

(x) That the structures of the NHS and National Care Service need to be democratically controlled and accountable by the communities they serve and management bodies should be elected with representatives of service users, informal carers and the workforce.

8. Without fighting for policies such as these, the government will go ahead with its programme of privatisation, particularly in the field of Information technology, now that some of the NHS’s work will be undertaken by using modes of communication that do not require face to face contact. If we are not careful, the “heroes of the NHS” will soon be forgotten by the government and we will return to austerity and the undermining of the service, with profit and big business interests, not those of the patient, to the fore.
9. We note that nationally and locally people and health and social care workers have campaigned to challenge the continuous and secretive system changes by working as a strong and supportive network. A network that includes: Keep Our NHS Public; Health Campaigns Together; the People’s Assembly; and the TUC. These organisations jointly led and funded many national NHS demonstrations. Other national groups, such as the Socialist Health Association; the Independent SAGE Group; Doctors for the NHS; NHS Staff Voices; Doctors in Unite; 999 Call for the NHS; and Reclaim Social Care, have each challenged the national COVID-19 chaos and have also raised awareness of an increase in private contracts and rationing of health and care services. Many health and social care unions have successfully lobbied to protect workforce safety, pay and conditions and continue to lead on these issues.
10. Conference calls upon LLA to work with the existing national, and local, Health and Care unions and campaign groups who have led demonstrations, lobbies, legal challenges and days of action aiming to reinstate Health and Social Care services as solely public services that are publicly funded, publicly delivered and publicly accountable.