In the fifth of our NHS VOICES series in which communist health workers speak up for the future of health provision in Britain, A.N calls for more integration, cooperation and local democratic control. This he says, would "Put the 'Health' back into the NHS!"


The next Labour Government will need to re-unify, re-integrate and re-establish our National Health Service.  We need to put the 'Health' back into the NHS!


We need to end the commissioner-provider split and we need to end the market in healthcare.  We need to end the fragmentation of planning and commissioning which will be associated with multiple GP Commissioning Consortia and we need to end the fragmentation of service provision between independent and competing Foundation Trust and private sector providers.  


We need to end the wasteful and damaging divisions between hospital and social care, acute and community care, physical and mental care. 


We need to end the leaching of public funds into the private sector through competition, PFI charges and excessive drug costs. 


We need to end the 'unfinished business from 1948', and properly integrate primary healthcare within the NHS.


We envisage countywide and metropolitan wide democratic health authorities combining responsibilities for the planning, commissioning and provision of all public health, hospital, community and primary care services for their local population, radically reducing the number of separate NHS organisations and the numbers of people and processes required to run them.  


Democratic health authorities would be run by boards of members elected by local NHS staff, local patients and from the local authorities, to ensure they are properly accountable and responsive to the people and the communities which the NHS serves.


Boards of elected members would have the power to appoint (and dismiss) the chief managerial officer and their senior management team, to ensure local policies are fully reflective of the priorities, wishes and needs of local people, communities, workers and patients.


Democratic health authorities would have statutory responsibilities to promote the public health of the local population and to actively prevent ill-health, as well as to treat those who do become ill.  Representation from local authorities and relationships with local communities, agencies and employers will help democratic health authorities positively impact on the social, economic and environmental determinants of health, and ensure care and treatment is increasingly integrated, joined-up and holistic.


There should be nationally prescribed minimum standards for the clinical and patient quality and outcomes expected for each population, and the evidence-based service models of care, interventions and treatments required to deliver these. Democratic health authorities would be free to improve on these minimum standards.


This new NHS should be comprehensive, integrated and inclusive, and of course free at the point of use.  Services should be available and accessible to all who need them, locally wherever possible, regionally and nationally where specialisation, expertise and experience makes this necessary.  Services should be shaped and joined-up around people's needs, and have a focus on helping people stay well and healthy and free of symptoms.


Clinical and diagnostic appointments should be at times, days of the week and in places which are convenient and accessible for people, and which suit modern lifestyles and patterns of working. The massive reductions in waiting times and waiting lists achieved by the last Labour Government should be maintained and improved across the board, and increasingly informed by best-clinical evidence e.g. a two week maximum wait to see a cancer specialist.  Out of hours GP care should be as comprehensive and as good quality as ‘in-hours’ care.


Democratic public ownership should be used to integrate private sector services and assets (including PFI) back into the NHS, and extended into the pharmaceutical industry to limit excessive drug costs and to encourage the development of medications which are less costly and better meet the current and longer term needs of patients.


Such a leaner, streamlined, integrated NHS, focused on health promotion and illness prevention, will be genuinely more affordable over the medium term and capable of meeting the rising healthcare needs associated with an ageing population.  A thoroughly democratised NHS with power in the hands of those who use and provide it will be much more responsive and shaped around the needs of the people and communities it seeks to serve, and appropriate to the needs and demands of 21st century society.


This vision of a modern NHS is worthy of Aneurin Bevan and should be capable of motivating millions of NHS workers, patients and the working class majority in this country to campaign, fight for and to deliver!