My Manifesto for the UK Post Brexit (part 4 – Health and Social Care)

Health and Social Care

The UK is facing an existential crisis, especially when it comes to healthcare. I think it is part of the reason why the Labour party are in such appalling disarray at the moment. When the nation state as we have known it is beginning to fall apart, what is the role of the state? The question comes into sharp focus when it comes to our beloved NHS. The financial nightmare facing the NHS is in the press everyday. How much of this has been orchestrated by a bureaucratic system that wishes to see its demise we may never know. But the fact remains, there is a whole lot of debt, an ageing population with increasingly complex health and social needs and a significant underspend in terms of GDP on health compared to most of the other ‘developed’ nations.

Although I believe that we will (and need to) see increased localism, especially when it comes to political participation and economic alternatives, discovering together entirely alternative ways of being and organising ourselves, I still believe in a more national approach to health and social care, as for me, one of the roles of leadership is to ensure provision for those most easily forgotten about or marginalised in society.

Obviously this subject matter is far vaster than a short blog can offer, but here is a starter for ten:

I would therefore increase spending on health in line with need and GDP. I would support moves through partnerships between health and education to encourage our children and young people, in particular, to exercise and eat healthily, therefore breaking some of the health inequalities we see presently in the years ahead. I would look to improve the overall wellbeing of society, as we know that both extreme poverty and extreme wealth is bad for our health. We need to talk about physical, mental, social, spiritual and systemic health. We need a 70 year vision for healthcare, not something that changes with the wind of each new parliament. People would be empowered to care for their own wellbeing and look after one another, because where people are connected to one another, they flourish more readily. I would not privatise the NHS, but keep it public, learning lessons from around the world, ensuring our systems are continually improving and accountable but providing kind and compassionate health and social care to everyone in our communities. I would amalgamate the health and social care budgets. I would invest in measures to improve the overall mental health of the nation by looking at the root causes of our unhappiness and disconnectedness, ensuring those who need psychological therapies and psychiatric expertise are able to access this. I would ensure our staff are appropriately paid and would create a culture of participatory leadership, where we care for the health and wellbeing of those who work in the system. I recognise that health is best provided in the local community and will support the growth of integrated care communities, like those in Morecambe Bay. General Practice is the bedrock of such communities and will therefore be funded appropriately. Communication training, led by patient-experience, would be compulsory. All training would be integrative, problem based and solution focussed (that could do with some unpacking – maybe another time!).

I would break the negative cycle caused by the economics of ‘payment by results (PBR)’ and create participatory shared budgets, breaking down the walls of competition between segments of the system that need to collaborate. I would create emergency care hubs, co-locating services that need to work in an integrative manor. We have to face the fact, that it would take an enormous cultural shift to stop people walking through the doors of the ED, so let’s work with it, rather than trying to change the tide. I would want to see the 5 ways to wellbeing as part of every work place environment. In hospitals, there needs to be a focus on faster discharges (something the dreadful cuts to social care budgets across our county councils will only worsen), working with community teams to enable people to be cared for in their own homes. We need a complete overhaul of our residential and nursing home sector, finding areas of best practice and raising the bar significantly in terms of how we honour and care for our elderly citizens. We need to have a philosophical shift in our approach to death – it is an emotive subject and I have vlogged on it previously on my other blog http://www.reimagininghealth.com People need to be able to die well, and far too often they die in the strange surroundings of a hospital, cared for by people they do not know, when they could have died at home or in their nursing home, surrounded by people who love them. If only we could face up to the difficulties of death, we would embrace it in a much more healthy way…..(again I recommend Atul Gawande’s book ‘Being Mortal’).

My Manifesto for the UK Post Brexit (Part 2 – Politics and Economics)

Here are some thoughts on Political Structures and the Economy:

 

Political Organisation

I would want to legislate Proportional Representation for a fairer reflection of the political will of the people, with coalitions becoming the norm, leading to a more collaborative and conciliatory form of politics, involving real engagement with and empowerment of local people in their communities.

Political conversations in local communities will mean that politicians and public servants do not come up with good ideas and “do things to people”, but rather learn to form environments of participatory leadership where co-commissioning becomes the norm. “No decision about me, without me, is for me.” (Leeds Poverty Truth Challenge). This is part of the new politics we need.

Sovereignty can be understood in several ways. From my perspective there are two competing narratives that frame the debate. Sovereignty can be the right to self-govern, to be in charge of our own future and rule in such a way to ensure that this happens – that is to insist that our own freedoms matter the most and we may have to suspend the freedom of others to ensure this happens. The alternative view of freedom is rooted in the idea of ‘essential kenosis’, i.e. that true sovereignty is not the domination of the other, but a self-giving, others-empowering love. I would see this latter definition of Sovereignty to be the basis of a more human kind of leadership. Leadership is something which is from among, rather than something which is lorded over others.

I would continue with town and county councils run on this basis, with two nationally elected houses, one based in the north and the other in the south.

Economy

I would start with the breaking up of banks into smaller, regional units, encouraging a multiplicity of options, especially encouraging credit unions and cooperatives. This is a well thought through idea of what to do with RBS, as championed by the New Economics Foundation. This will ensure local lending for local people, businesses and initiatives which will lead to a more sustainable system, more similar to the German or Danish model, both of which have ridden financial storms more easily than those where larger and centralised banks are allowed to dominate the market.

there needs to be a recognition that in all of economic history that we know of, only 3 countries have ever been in surplus and each case this was in a very unusual circumstance and for a short time. The obsession with balancing the books is a nonsense. (A national economy is nothing at all like a household! For instance, we do not have a bank in our back gardens that can print money, nor do we have rich friends living with us, to whom we give special privileges whilst making others work for very little pay, refusing to help them out, but rather telling them they need to have better aspirations and work harder).

A fair society involves creating local environments in which people can work and work pays well, so that a hard days work does not still leave someone unable to afford food, shelter and warmth. A fair society means that when you are unable to work or go through a time of hardship, you will be cared for appropriately. We would encourage the formation and strengthening of unions on this basis.

We need an economy that does not allow organisations to have their headquarters in the UK, but put their profits into other nations, whilst avoiding their fair share of taxation. The UK has many reasons to attract companies here, other than low tax rates and if companies wish to hold the UK to ransom, they can go elsewhere. Instead we will build relationships with those companies that will pay a fair and living wage, ensuring a fair share of profits and contribute to the wellbeing of the economy. Trickle down neoliberalism is failing the vast majority of people, and so we will develop this new economy together.

My Manifesto for the UK post-Brexit (Part 1 – Immigration)

I was having a conversation with someone recently and they challenged me to write a manifesto for the UK, to help put a bit of substance to my various thoughts. What follows is by no means a finished article, nor am I likely to do much with it, but I have found it helpful as an exercise and it serves as a starter on a few issues to spark discussion and also to help me shape my own thoughts further.

I am also a white, privately-educated, “middle-class”, married with 3-kids, “christian” male and so I recognise an inability to communicate, except from the perspective of power and privilege – I can’t change this, but I just want to say that I know it means I can’t see very well.

I hope what I have written is founded on the values of self-giving, others empowering love, the desire to build with positive peace and with hope for a fairer society for everyone. I will start with the area that caused so much debate over the last few weeks and has opened up some deep wounds – let’s see where this goes!

Immigration

I recognise this is a very real and important issue and it is not one that we should be afraid to face up to. My approach would be five-fold:

  1. Our education system will look at the damaging effects of empire and colonisation. We will look at the issue of white and male supremacy and work together to break down these deep set corporate worldviews that we find hard to name let alone own up to. We will help our children and communities face up to the bias and prejudice we all live with and learn from organisations, like the NHS that have done much to tackle them. We will encourage an understanding of the ‘other’ and the benefits of inter-culturalism. We will also work with charities like “together4peace” in Leeds to encourage intercultural dialogue and relationships.
  2. We will introduce a basic rate of pay, guaranteeing a fair and living wage for all of £10 per hour (see economy section for how this is affordable – austerity is NOT the only option available to us!). This will encourage people into work and we will ensure good support of small businesses to make this attainable i.e. the government will give means tested grants to businesses to support them in this. In this way it pays to work, but we will not have a society in which we punish or vilify those who are unable to do so, for whatever reason (see later policy on welfare). It will be illegal for any individual or business to employ workers from overseas or the UK for less than this. This must be legislated and so breaches of this will ensure a heavy fine and/or community service. A second offence would lead to a prison sentence. We cannot endure a culture of westernized slavery that leaves areas impoverished.
  3. We will create local jobs, especially in the places in the UK which have felt forgotten. This will come through a restructuring of the banking sector to encourage local investment in local businesses, as seen in Germany and Denmark. Our banking system is far too centralised and remote. Job creation will come through the creation of locally and/or publicly owned energy, utility and transport services. These might be structured in several different ways and therefore will not take us ‘back to the 1970s’ but create alternative and better ways ahead for local communities.
  4. We will allow the free movement of people but not the free movement of capital. It is not possible to have both. Money created in the UK will stay in the UK ie companies who do their business in the UK will pay their fair share of tax, rather than ship their profits overseas. This will include open but monitored borders, so we are clear who is in the UK, from a security perspective. But overall, we would seek to be a country that welcomes those who want to come here (it’s really not as many as we have been lead to believe!), especially those who need our help at times of crisis in their own nations.
  5. We will encourage every person who lives in the UK to be a net contributor to society where this is possible. We openly recognise and celebrate how many of our public services have depended on the great diversity brought by migrants and refugees from all over the world. We recognise that migrants make a net contribution to our society and give far more in terms of money, skills and rich diversity of culture into the UK than they take. We will ensure welfare for all those who need it, but our international development work will ensure we are able to work with countries to help people where they are to build a future of peace and prosperity (see later post on this). 

 

Obviously all of this needs a great deal of fleshing out, but these would be my overarching principles as points for discussion at this stage – I’m sure it is terribly lacking, so go easy on me – I’m looking for a conversation not a battle!