Health

Partnership in Power

DRAFT - This is a discussion paper only. The content of this document does not necessarily reflect Government or Labour Party policy.

Introduction

The National Health Service is the Labour Party's greatest achievement. We created it, we saved it, we value it and we will always support it. The NHS remains Britain's most cherished public service and the fairest system of healthcare in the world. In 2008, as it celebrates its 60th birthday, the NHS is in good hands, well placed to meet the new demands and challenges which will be placed upon it in the future.

Over Labour's 11 years in government, substantial and sustained investment in the NHS backed by vital reforms have transformed the service. 80,000 more nurses and 38,000 more doctors have helped to drive up standards and drive down waits. Waiting lists, which went up by over 400,000 under the Tories, have fallen by 607,000 and waiting times are now at their lowest level since records began. The premature mortality rate for cancer is the lowest ever recorded, saving nearly 9,000 lives in 2006 compared to 1996. And premature mortality from cardiovascular diseases has dropped by more than 40 per cent since 1996, saving nearly 31,000 lives a year. New services, like NHS direct, commuter walk-in centres and health centres, are making the NHS more accessible to patients.

But the NHS must continue to change and improve, responding to the combined pressures of an ageing population, rising patient expectations and medical advances. We will ensure that the NHS is always clinically driven, patient centred and responsive to local communities. And Labour, true to our values of fairness, will focus particular priority in the years ahead on tackling health inequalities, so that as the health of the whole population rises, people are not left behind. This must involve improving public health and preventative services as well as primary and acute care - supporting people to make healthy choices for themselves and their families, and spotting the most dangerous conditions at an early stage when they can be dealt with most easily. And as demand for social care increases and older and disabled people rightly demand and expect more power and control over the care services they receive, we must review the way social care is funded and delivered to ensure that users and carers have fair access to the support they need and the dignity they deserve.

"We applaud our Labour government's commitment to improving the provision of healthcare in the NHS, with a massive increase in funding and the belief that it should remain free at the point of need, based on requirement, not ability to pay. In particular we applaud the vision that healthcare is as much about preventing problems occurring, including improving lifestyles, early education and community support, as it is about fixing problems in the hospital after they have occurred." Haltemprice and Howden CLP

Promoting good health

Good healthcare isn't just about treating people when they get ill. It's about helping people to avoid getting ill in the first place. Eating well, taking proper exercise, avoiding smoking and excessive drinking, preventing sexually transmitted infections - all of these are about the personal decisions of individuals and families. But these decisions are not purely personal. All of them have major implications for future demand on NHS services, and in all of them the government has a crucial role to play in providing sound advice, making it easier for people to make healthy choices, giving people support to change unhealthy behaviour and creating a healthier environment for everyone.

Public health is an equality issue too. People at the bottom of the income scale, and those with the worst housing and the least education, tend to have the poorest health, and as people climb the income scale they tend to eat more healthily, smoke and drink less and take more exercise. The government's wider efforts to tackle poverty and poor housing and to improve education, while not "health policy" in themselves, can have a substantial impact on long-term health outcomes. Similarly, improving the health of people with disabilities, mental health problems and long-term conditions can help them to find and keep employment, and improve their overall quality of life.

"Usdaw strongly believes that there should be an integrated approach towards healthcare across all government policy and departments. Income levels, educational attainment and provision, housing, diet, crime, environmental standards, transport, etc. all impact on a person's health and well being." Usdaw

Promoting public health matters because as people live longer and our population grows, demand for healthcare will rise, and it will rise faster if people do not do what they can to prevent avoidable illnesses themselves. The long-term capacity of the NHS to treat everyone who needs it will be at risk without a focus on prevention as well as cure. That means expanding screening services to detect major health conditions earlier so we can fight them more effectively, and mainstreaming public health across all policy areas.

Promoting health right from the start

Healthy children are more likely to grow up to be healthy adults, and the case for early intervention is very strong. Parents need to be supported, as habits can persist from childhood into adulthood. There is clear evidence to show that supporting mothers-to-be during pregnancy improves health outcomes for their children later on. The infant mortality rate is significantly higher among groups with low incomes compared with the better off. Low birthweight babies develop higher blood pressure and face an increased risk of coronary heart disease in later life, and are more likely to go on to achieve lower educational qualifications regardless of social background. Babies in low income families are less likely to be breastfed.

Labour already supports children from birth through child benefit and child tax credit, and we are introducing the Health in Pregnancy Grant from April 2009, giving every pregnant woman a tax-free payment of £190 from the 25th week of pregnancy, along with advice from a health professional, to help them with the additional needs they have at this important time. And we are piloting nurse-family partnerships, giving personal support to the poorest young first- time mothers as early as possible in pregnancy right up until the child is aged two.

We are also supporting pregnant women before they give birth by giving them and their partners access to Sure Start children's centres, which provide a wide range of advice and support services from early pregnancy through early childhood. There will be 3,500 Sure Start centres by 2010, where trained healthcare and childcare professionals will help a million young children and their families to tackle problems such as poor nutrition, low birth weight, parents smoking and access to benefits.

"It is our view that the only acceptable way to reduce demand for healthcare services is by the improvement of public health. In terms of our field of expertise, we believe that the way society supports those becoming parents during pregnancy, birth and the first years after birth have major implications for the future health and wellbeing of the population." National Childbirth Trust

By promoting healthy lifestyle choices to families and children at a young age we will ensure our young people grow up understanding the importance of a healthy diet and regular exercise. This matters because there have been clear increases in obesity over the last 20 years in many developed countries, including this one. Obesity magnifies the risk of heart disease, diabetes and cancer, and shortens life by as much as nine years. Tackling childhood obesity is particularly important because excess weight in childhood tends to continue into adulthood. We are already improving school meals and have extended the provision of free fruit and vegetables to school children and increased awareness of healthy eating through the "Five -A-Day" campaign. Labour is now committed to reducing the proportion of overweight and obese children to 2000 levels by 2020.

Reaching this ambitious goal will require a range of actions across government, as set out in our obesity strategy Healthy weight, healthy lives. These include identifying families whose children are most at risk of obesity and giving them targeted support; promoting breastfeeding as the healthiest option for babies; making cooking a compulsory part of the key stage 3 curriculum in schools; ensuring that all children take part in five hours of PE and sport per week; and improving cycling infrastructure and cycling skills to get more children cycling - some of these measures are discussed in the Education and Skills document. And we will encourage people of all ages to take more exercise.

Helping people take care of their own health

The NHS gives everyone a right to good healthcare, but individuals also need to look after their own health and to avoid damaging the health of those around them.

"There should be respect for individual lifestyle choices but the NHS and/or government must do more to promote healthy lifestyle choices. The NHS should work with employers, trade unions and all agencies to promote and develop healthy workplaces and communities. There should be much more effort to provide health education that will inform citizens about the consequences of their choices." Health Policy Forum, Redruth, Cornwall

Smoking tobacco is dangerous to health - the links between smoking and fatal illnesses such as cancer and heart disease are well known. Reducing the number of smokers will have a major impact on public health. The whole of the UK has been smokefree since July 2007, with a ban on smoking in all enclosed public places - both to protect the health of workers and the public and to encourage people to give up smoking. In October 2007, the legal age for buying tobacco was raised from 16 to 18, because the younger a person starts smoking, the more likely they are to be killed by their addiction. And we will consult on placing further restrictions on cigarette vending machines and on displays of tobacco at the point of sale in shops, to discourage sales and make it more difficult for children to buy tobacco. Our expanded NHS Stop Smoking Services have seen unprecedented levels of demand since the introduction of smokefree legislation.

Millions of adults enjoy drinking alcohol with few, if any, ill effects. But alcohol misuse by a small minority is a growing cause of ill health, anti-social behaviour and crime - see the Crime, Justice, Citizenship and Equalities document for more on this. Alcohol misuse is a health inequality issue too - the most deprived fifth of the population have two to five times more admissions to hospital because of alcohol than those in more affluent areas, and alcohol- related death rates are about 45 per cent higher in areas of high deprivation.

For the majority who stay within the law but may be putting their own health at risk, our focus is on ensuring that people know what is a safe level of drinking, that they are aware of the risks associated with excessive drinking, and that they know where to go to get help - with alcohol support services available for those with serious alcohol problems. And we will make sure that NHS professionals have the expertise to provide that help. Over the next ten years, our investment will allow 60,000 new doctors to be specifically trained to identify and treat alcohol abuse.

Teenage pregnancy rates are at their lowest for over 20 years, but sexually transmitted infections are still rising and we are clear that more needs to be done to improve sexual health. Greater use of contraception is important in reducing both STIs and unintended pregnancies, and we are increasing funding to Strategic Health Authorities to propose innovative new ways of helping young people access sexual health advice and contraception. We have already increased investment in modernising sexual health clinics over the past two years, leading to increased access and increased uptake of HIV tests. But increasing availability of contraception also needs to be accompanied by good quality sex education and relationship education in schools and support for parents to talk to their children about these issues.

Drug misuse is a crime, but also a health issue. We have reduced drug-related deaths and overall levels of drug-related crime, and increased investment in drug treatment programmes. More people are entering drug treatment programmes than ever before, waiting less time and staying on programmes for longer. For every £1 spent on treatment £9.50 is saved in crime and health costs. We will encourage more people to come forward for drug treatment, and continue our support for the National Treatment Agency.

There are currently over 8,000 people awaiting an organ transplant in the UK, but the true need is some 50 per cent higher. Only around 3,000 transplants are carried out each year, and only around 25 per cent of the population are on the organ donation register. This proportion needs to rise significantly, and so we have established an Organ Donation Taskforce to look at ways to address the shortage and encourage more people to donate. We are considering moving to a system of presumed consent to organ donation, from "opt-in" to "opt-out". As now, the final decision would remain with the deceased person's family.

The EU is playing an increasing role in disease prevention and helping UK citizens take care of their own health. This has included EU regulation on more effective health warnings on tobacco products as well as a growing programme of research and development and public awareness campaigns, for example on obesity and conditions associated with ageing. Labour MEPs are making this agenda a priority in their work at EU level.

Supporting people with long-term conditions

There are around 15 million people in England who live with long-term health conditions such as asthma, arthritis, diabetes and mental illness. This number is likely to rise, as healthcare improves and diseases which used to kill people quickly, like heart disease and cancer, can often now be managed over long periods. People with chronic diseases often know what they need to do to manage their own condition and, given the necessary skills, can moderate the impact of their disease and improve the quality of their lives. Labour is committed to expanding the Expert Patient Programme, a training programme which supports people with chronic conditions to develop new skills to manage their condition better on a day-to-day basis. And, recognising their expertise and autonomy, we are considering giving personal NHS budgets to patients with chronic conditions, to give them more control over their treatment and to manage their lives in the way they want.

"The MS Society fully agrees with the consultation paper that care should be tailored to individual need, particularly where a person has long term needs or disabilities. The moves towards single assessments of health and care needs and joint health and social care teams are a positive and necessary step in achieving individualised care. Joined up health and social care is vital for people with MS, particularly during a relapse or when the condition is progressive." MS Society

We will make it easier for newly diagnosed patients and new carers to be put in touch with self-help groups and carers' centres. And we will ensure that children with long-term conditions are given the support they need to participate fully in school.

Prevention and early intervention

Many serious diseases and health conditions can be prevented, cured or effectively managed if they are detected at a sufficiently early stage, through screening. This means that screening saves lives - and it also saves money, because early intervention is often cheaper and more successful than major surgery later on. Labour is committed to following the recommendations of the independent National Screening Committee, offering new forms of screening to everyone who can benefit from them on clinical grounds, not on ability to pay.

People who are particularly susceptible to conditions for which effective screening exists are already offered screening. For example, the NHS Breast Screening Programme provides free breast cancer screening every three years for all women aged between 50 and 70.

Around 1.5 million women are screened every year, saving 1,400 lives a year in England. But we are going further. By the end of 2010, we will have extended the ages at which adults are screened so that an additional 450,000 women will be screened for breast cancer, and an additional 300,000 men and women will be screened for bowel cancer. And we will offer men over 65 a simple ultrasound test to detect early abdominal aortic aneurysm, or Triple A, which kills over 3000 men a year - saving around 700 lives per year within the first ten years of the programme. We will also extend the availability of diagnostic procedures in GP surgeries - making blood tests, ECGs and in some cases ultrasound tests available and on offer at the local surgery. Since men are less likely than women to take up screening or attend their GPs, we will encourage men to take advantage of the health checks which are available to them.

"Whilst encouraging people to take responsibility for their own health is important to potentially improve public health and disease prevention, it is also essential that people are encouraged to take advantage of early detection services, such as the NHS Cancer Screening Programmes, and to recognise signs and symptoms of diseases to aid early detection." Breakthrough Breast Cancer

Vascular diseases - heart disease, stroke, diabetes and kidney disease - affect the lives of more than four million people and kill 170,000 every year. They also account for more than half of the mortality gap between rich and poor. So we will introduce a national system of vascular checks, which have the potential to prevent at least 9,500 heart attacks and strokes per year and save 2,000 lives. Everyone between the ages of 40 and 74 will be entitled to the checks, which will assess their personal level of risk and set out the steps they can take to reduce it. The checks will be carried out in a range of convenient places including GP surgeries, pharmacies and other community settings, to ensure that everyone has access to them.

Immunisation is one of the most important weapons for protecting individuals and the community from serious diseases. The NHS provides vaccinations free of charge, from early childhood, when vaccines are given against a wide range of diseases, right through to old age: everyone over 65 is offered a flu jab every year. A high vaccination uptake across the population is vital to prevent outbreaks of infectious disease, so we will continue to encourage vaccination among at-risk groups and provide the public with accurate and reliable information about our vaccination programme. Where cost-effective new vaccines are developed, we will make them available to those who can benefit from them. From September 2008, all 12 and 13 year old girls will be offered a new vaccination against cervical cancer, saving an estimated 400 lives a year.

Health and social inclusion

Keeping healthy is important because it enables people to participate fully in social and community life, and to get into work and hold onto jobs. Long-term sickness costs the economy in lost productivity and in benefit payments, but it also costs individuals and families by denying them work opportunities and income. And just as illness keeps people out of work, so being out of work damages health - and returning to work after a period of unemployment improves it. Ten years ago, just over one third of disabled people were in work; now, almost half have a job.

We are now committed to reducing the number of people claiming incapacity benefit by one million.

Labour's work to reform the welfare system, and to promote good health at work, is discussed in more detail in the Prosperity and Work document. But we are clear that the task of helping people with long-term health conditions and disabilities back into work - or, in many cases, into work for the first time - will need a focus on health, and the involvement of healthcare professionals. This is why we want GPs, whose vocation is about helping people get better not writing people off, to offer fitness-to-work advice to patients and employers, replacing a "sick note" culture with a "well note" culture.

Employers have a role in promoting good health too. Health and safety legislation, and the work of Trade Unions and businesses, have made workplaces safer than ever before, but occupational health is not just about avoiding workplace accidents and ensuring that people use dangerous machinery safely. Back pain costs employers £600 million per year, and around half a million people a year experience work-related stress, depression or anxiety. We want to promote the link between good work and good health, and encourage the NHS to work with business, expanding the occupational health services offered to NHS staff so that small and medium sized businesses can access them for their own employees. Good occupational health is key to helping to prevent people with minor illnesses such as mild mental health issues falling out of work, onto incapacity benefit and into the health service with more serious problems.

Modernising mental health care

Improving mental health is a key public health challenge. Mental health problems are the largest single cause of disability and illness in England - accounting for 40 per cent of all disability, nearly 40 per cent of people on Incapacity Benefit (and a secondary factor for a further 10 per cent), and a third of all GPs' time. Around one in six people will experience mental ill health at some time in their life. Since 1997 Labour has given a much higher priority to mental health services, with significant investment to improve services resulting in a record number of staff working in the mental health sector. Suicide rates are at an all-time low. We are massively increasing the provision of psychological therapies, investing to train 3,600 therapists over the three years from September 2008, enabling an extra 900,000 people with depression and anxiety to be treated in that period and improving their quality of life.

"The government's commitment to improve access to psychological therapies backed by the massive additional investment pledged in last year's Comprehensive Spending Review marks a huge step forward in our response to mental distress." Mind

We have legislated, in the Mental Health Act 2007, to modernise mental health law for the first time in a generation, to benefit patients and the public, to allow some people who need compulsory treatment to get it in the community instead of having to be detained in hospital, to allow a wider group of health professionals to treat patients, and to give people receiving compulsory treatment access to independent advocacy.

Better dental health

Labour is reforming NHS dentistry to achieve better oral health and to provide a good deal for patients and for dentists, but we accept that access to dentistry still needs to improve. Primary Care Trusts are now responsible for commissioning local NHS dental services. Our reforms mean that NHS dentistry is now expanding, with an increase in the number of dentists and dentistry funding ring-fenced until 2011 to ensure that local provision keeps going up. New dentists are coming into the NHS all the time: since 2005 there have been an extra 170 dental student places each year, two new dental schools opened in 2007, and we are making new NHS training places available to dentistry graduates in areas of highest patient need.

To ensure that everyone has access to dental treatment, we have introduced for the first time a duty on local health services to provide urgent dental treatment for those who need it. This applies to everyone, so there is no need for people to allow dental problems to go untreated. We have also improved and simplified the system of charging for dental treatment, replacing the old system of almost 400 different charges with just three charge bands and cutting the maximum possible charge by 50 per cent, which directly benefits those with the worst oral health who are most likely to need complex and expensive treatment. Nearly 50 per cent of NHS dental patients, including all children, pregnant women and those on income support, are exempt from all charges, and there are schemes to help with costs for those on low incomes who do not qualify for full exemption. We will make sure people have accurate information about local NHS dental provision and charges, and about their rights in relation to dental treatment.

Evidence suggests that oral health is better in areas where tap water is fluoridated, which means that widening fluoridation could have an impact on health inequality. For example, children in fluoridated Birmingham have half the cases of tooth decay than children in non-fluoridated Manchester. We have legislated to allow local authorities to add fluoride to their water supply if the local community supports it, but few have so far done so. We are therefore providing extra funding to Strategic Health Authorities which find that their local community is in favour of introducing fluoridation, to help them to do so.

Healthcare accessible to all, personal to you

The Labour Government created the NHS in 1948 to ensure, for the first time, that everyone had access to high quality healthcare, free at the point of need. These principles of equity and accessibility remain at the heart of our NHS, and Labour will uphold them in government. But as well as being free and fair, the NHS must continue to meet the changing needs of individual citizens. That means giving people as much power and control as possible over the health services they use - getting the attention, care and treatment they need in the way they want it and at times convenient to them.

Health inequalities

The creation of the NHS was the biggest ever contribution in Britain's history to tackling health inequalities. But there is still a link between lack of wealth and poor health, and despite the fact that they often have the greatest need for healthcare, the poorest in society often make the least use of the NHS. Tackling health inequalities is a central priority of Labour health policy. We must improve the health of the whole nation, while ensuring that the health of the poorest improves the fastest.

Under Labour, mortality rates have improved across the board - but we need to do more to narrow the gap between rich and poor. That's why we have reformed the funding formula to give a better measure of the health needs of each local community, ensuring that additional resources are targeted to where they are most needed. We are committing new resources to those Primary Care Trusts (PCTs) with the fewest primary care clinicians, lowest patient satisfaction with access and poorest health outcomes. The bottom 25 per cent of PCTs (38 PCTs) have already committed to delivering 100 new GP practices. And we will double the number accessing smoking cessation clinics in the most deprived areas, and increase the coverage of statin therapy for those with high cholesterol levels and hypertensives for those with high blood pressure in those areas.

Health inequality isn't just about income. Race, disability, age, sex and sexual orientation also have an impact on people's health needs and the way in which they access health services. One in five mental health inpatients comes from a black or minority ethnic background, and BME patients are significantly more likely to be detained or diagnosed with schizophrenia. The suicide rate is three times higher for men than for women. The prevalence of a range of health conditions differs between ethnic groups. Disabled women are less likely to access cancer screening than women in general. And people with mental health problems and learning disabilities are more likely to have significant physical health problems which go undiagnosed. We will do more to ensure that care is matched to communities, and that prevention is aimed at groups which are most at risk.

Moving healthcare closer to communities GP services are the first point of contact for most patients in the NHS, and Labour is committed to ensuring that everyone can see their GP at a time and a place convenient to them. Labour understands that hard working families need healthcare to be available close to their homes and workplaces, and open when they need it. That's why we have built over 90 new NHS walk-in centres and over 650 one-stop primary care centres, and are investing £750 million in a new generation of modern, convenient community hospitals. And it's why we have negotiated a new deal with doctors to ensure that more GP surgeries open for longer in the evenings and at weekends.

"We would endorse the call for GPs to open evenings and Saturdays." Bournemouth CLP

We are now opening at least 100 new GP practices in the areas which need them most - the areas with the fewest doctors, poorest health outcomes and lowest patient satisfaction with access to care. We will also establish a further 152 GP-led health centres, one in each PCT, on top of existing services. These centres will be open from 8am to 8pm, seven days a week, and will offer a wide range of health services including pre-bookable GP appointments and walk-in services for registered and non-registered patients. They may also offer other services such as dentistry, podiatry, physiotherapy and community mental health support, and provide services for which patients have previously had to travel to a district hospital: for example blood tests, outpatient clinics and minor surgery. Such services may come from a range of public, private and voluntary sector providers. The commissioning of different services by these clinics will be at the discretion of the local PCT, based on local need.

We are committed to ensuring that all PCTs are world-class commissioners of services for their local communities, focusing on reducing health inequalities, giving people more choice and control over the services they use, and delivering good value for money. The principle is to develop innovative ways of providing a wide range of integrated services to people in a community setting.

As new services are brought closer to communities, some existing services will need to change. More services will be provided in health centres rather than hospitals. Some hospitals will specialise more in particular conditions and types of surgery - evidence from around the world shows that where consultants get regular rather than occasional experience of complex conditions, quality improves and more lives are saved. Any changes to local health services will be made for sound medical reasons to benefit patients, driven by local clinical need and made locally following consultation with communities, not imposed from the centre.

"UNISON welcomes the confirmation that changes to local health services need to be driven by clinical decisions. This should allow for a more pragmatic, evidence-based approach to reconfigurations, rather than a dogmatic attachment to centralising services regardless of the local situation. Crucial to reconfigurations, however they are carried out, is the need to engage staff and local populations from the earliest possible stage in the process." UNISON Labour Link

In order to ensure that the NHS is clinically led, patient centred and locally accountable, Labour has asked Lord Ara Darzi, one of the world's leading surgeons, to carry out a wide-ranging review of the NHS, directly engaging with patients, NHS staff and the public. This will focus on ensuring that clinical decision making is at the heart of the NHS; on improving patient care; on making care more accessible and convenient; and services more responsive to patients and local communities. Lord Darzi's review will report in summer 2008.

Choice, accountability and regulation

The NHS is a universal service with a commitment to maximising quality everywhere, but it should never be rigidly uniform. And different people need and want different things from the NHS, and will respond best to different treatments and environments - mothers choosing to give birth at home or in hospital, people with mental health problems choosing drug treatments or psychological therapies, smokers choosing different techniques to give up, older and disabled people choosing a range of different support services tailored to their individual needs. Some people, particularly those who are better informed, have always been able to make choices about their healthcare by navigating the system. Labour believes that maximum information and choice should be available to everyone. All patients can now choose from any hospital provider in England that meets NHS standards and costs.

At the heart of our patient empowerment agenda is the understanding that choice should be a means of driving improvement and ensuring that the NHS is focused on the needs of patients. NHS providers are more accountable to the public they serve if they have to provide accessible information about their quality and performance, and if patients are empowered to choose the best providers for their needs.

The use of a variety of providers in the NHS has had a significant positive impact on waiting lists and diagnostic services. The independent and third sectors make up only a small percentage of NHS provision, but where they are able to add capacity or promote innovation, delivering services for the NHS at the NHS tariff, we will continue to use them - where that is best for patients, and always following the principle that NHS healthcare is free at the point of use, based on need, not ability to pay. All commissioning should be clinically appropriate and provide value for money, and independent providers should be open to the same level of clinical scrutiny as NHS providers.

We have introduced a number of reforms to ensure members of the public are better involved in shaping local health and social care systems, and will continue to increase the power and control of local people over the services they use, with a new NHS constitution (see below) making clear how the NHS is accountable to local communities. NHS Foundation Trusts have been established as independent, not for profit public benefit corporations, accountable to their local communities rather than being controlled by central government. Their independence has enabled them to make good progress in developing new innovative approaches to healthcare, and to invest their resources in response to local need - but they remain part of the NHS, providing care based on need and not on ability to pay. Local Involvement Networks (LINks) will work with interested individuals and voluntary and community sector groups to promote public and community influence in health and social care.

"The vision of care closer to, or at, home, with an emphasis on prevention and health improvement, is one that we fully support, but is not a vision that the NHS can deliver on its own. Because of their responsibility for the wider determinants of health - such as environment, transport, leisure, planning, economic well-being etc. - local authorities can plan with the NHS to address health improvement and health inequalities, bringing investment to bear on local priorities for health improvement. At a population level, without local government's support on prevention and tackling inequality, the NHS alone will be unable to address the consequences of demographic change." Local Government Association, Labour Group

As we work towards greater integration of health and social care, we need to ensure that providers of services are effectively regulated to guarantee quality and safety. Labour is creating a tough new single regulator for health and social care, the Care Quality Commission, with which all NHS providers will have to register. For the first time, there will be a single coherent set of national safety and quality requirements for all, and a more flexible system so that resources and inspections can be targeted to the areas of greatest risk. The complaints system for health and adult social care will be unified and simplified, too, with an emphasis on fast local resolution and on giving effective support to people who want to make complaints - especially to those who may have difficulty making their voices heard.

Our NHS - skilled staff delivering high standards for patients

Labour's investment since 1997 has transformed the NHS, with shorter waiting times, record numbers of staff and new buildings and infrastructure. But resources are never unlimited: our investment of taxpayers' money must be targeted to make sure it is put to the most effective use. The NHS needs to continue to improve, providing more and better services, giving staff the resources they need, supporting innovation and investing in new life-saving technologies.

"We welcome the massive and sustained investment the Labour government has made in the National Health Service since 1997 and we support future planned increases in NHS spending. Our members have noticed the benefits this investment has delivered: more doctors and nurses; shorter waiting lists; new and refurbished hospitals and other infrastructure; in short a new, modernised NHS." Usdaw

Waiting times and targets

When Labour came into power in 1997, 284,000 patients were waiting for more than six months for admission to hospital - about a quarter of all patients waiting. Now, nobody should wait this long. Most patients are now waiting less than 13 weeks, and by the end of 2008 no patient will have to wait more than 18 weeks from GP referral to the start of treatment, unless it is clinically appropriate for them to do so. This means that the time you have to wait before getting a hospital appointment will be the shortest since the NHS was established. Through the hard work of staff, increased capacity, new technology and patient choice we are now in a position where we will see, in effect, the end of NHS waiting lists. This means that we can now have fewer national targets, and give more freedom and responsibility to staff to respond to local needs.

This progress - and progress in many other areas where standards have been driven up - would not have been achieved without the introduction of national standards and targets, which ensured that resources were focused on identified priorities. Waiting time targets tell patients what standards they should expect, and also help to highlight difficulties in particular hospitals. When hospitals struggle to meet these standards extra support is offered from the centre to help them turn around their performance and improve the way they work.

Cleaner hospitals

The public must be able to trust the NHS to keep them safe from healthcare acquired infections such as MRSA and C. Difficile. And the cleanliness of hospitals is a key factor in whether patients have a positive or negative experience of using the NHS. All hospitals have a duty to employ enough cleaners to deliver the hygiene standards the public rightly demands and expects. We have brought back Matrons with new powers to set and enforce high standards of cleanliness and terminate cleaning contracts where necessary, introduced a new "bare below the elbow" uniform policy and enforced rigorous hand washing for NHS staff. We have ordered that every hospital must be deep cleaned. And we have set tough targets on reducing infection rates. This means that in 2008 we will halve the number of cases of MRSA from 2004 levels, and by March 2011 there will be at least a 30 per cent reduction in the number of C. Difficile cases from current levels.

MRSA can spread after being brought into hospitals from outside by patients, so by March 2009 every non-emergency patient will be screened for MRSA, and by March 2011 we will screen every emergency patient as well. And because overuse of antibiotics damages resistance to some infections, including some healthcare acquired infections, we are encouraging doctors and the public to reduce their use.

"The RCN launched its Wipe it Out campaign in 2005 and since then a number of our solutions for tackling healthcare associated infections have been taken forward. We also welcomed the Government's recent announcements for tackling healthcare associated infections including the deep cleaning of wards and increased number of nurses with the responsibility and authority to make infection control a priority. We also acknowledged that these initiatives need to be part of a long-term package of measures." Royal College of Nurses

Supporting NHS staff

The NHS would be nothing without its staff. It is thanks to the NHS's staff - including the thousands of new staff recruited as a result of our increased and sustained investment - that the NHS has made such dramatic improvements over the last decade. Since 1997 we have worked in partnership with staff and their trade union representatives to improve working conditions, pay and prospects. We will continue to support staff who develop innovative new ways of working which improve healthcare and patients' experience, and help to spread their good ideas across the NHS. And we will ensure that staff are properly protected from anti-social behaviour and abuse on NHS premises.

"GMB calls on the Labour Party/government to ensure that all NHS workers are able to deliver quality health care safely and without having to suffer from violence, abuse, bullying or harassment." GMB

Agenda for Change is now firmly embedded in the NHS. Its reforms mean more patients are treated faster, with pay reform tied to shorter waiting lists, with increased skills development for staff and with better recruitment and retention. We will ensure that the Knowledge and Skills Framework is fully implemented, and ensure the appropriate use of training budgets by strengthening transparency and accountability for their use. Agenda for Change has also made progress in ensuring more flexible deployment of staff and more opportunities for staff, with greater use of systems appraisals. Working with the unions and the private and voluntary sectors, we have brought cleaning, portering, catering and other "soft facilities management" services provided by contractors into line with the Agenda for Change pay deal, benefiting low paid workers.

"The people at the top need to have a bottom up rather than a top down approach: it is often the most junior staff who know best what will work and what won't." Sheffield Heeley CLP

As the NHS moves closer to communities with a greater emphasis on primary care, there will be less reliance on hospital-based staff, and more staff employed in primary and intermediate care.

Staff will need to develop their skills to meet these changes, and we will support staff to retrain for positions in community-based roles. The opportunity to retrain will be made available to staff so that they can take on new roles or develop further in their existing positions. As health and social care become increasingly integrated, a "pension passport" could help ensure that staff can transfer easily between roles without losing pension rights.

Prioritising midwife recruitment

The number of births in England is rising, and maternity services are expanding in response to this change. Labour is giving additional funding to maternity services and introducing a package of measures to recruit an additional 4,000 midwives to the NHS by 2012. As well as training more new midwives, we will give incentives to former midwives, including free training, support with finding childcare and travel costs and a grant of up to £1,500, to encourage them to return to the profession. This will help to give genuine choice to mothers of where and how to give birth, and deliver our commitment for midwives to work with the same mother throughout her pregnancy.

NHS Constitution

The NHS will keep changing, but its fundamental values will stay the same. We will create a new NHS constitution which will set out these unchanging values and establish that current changes and any future reforms must remain rooted in our principles. The constitution will state straightforwardly what patients, citizens and staff have a right to expect from the NHS. It will also lay out what we all have a right to expect from patients, citizens and staff - making fair use of NHS resources, keeping appointments and showing respect towards other users and NHS staff. And it will make clear the lines of accountability between the NHS and the local communities it serves.

"TSSA would support the concept of a constitution for the NHS so that there is no doubt about what the health service is and what it stands for. This would also give Labour the chance to again assert itself as the champion of the NHS and allow Labour to deliver a set of principles that future governments of whatever political persuasion would find difficult to undermine. Such a constitution would be based on principles that confirm that NHS services are free at the point of need, fair to all and publicly funded through direct taxation." TSSA

Transforming social care

Demographic changes and improvements in healthcare mean that the population is ageing, and the demand for social care for older and disabled people is set to keep rising over the coming decades. At the same time, we are determined to improve social care services, to guarantee users and carers a better quality of life. Meeting the demand for a person-centred service for everyone with long- term needs, with a fair balance in funding between the taxpayer and the individual, is one of the biggest public policy challenges facing us. We will lead a major national debate on this issue, consult widely and publish a Green Paper with detailed proposals on the long-term future funding of adult social care.

"This GC recognises the need to raise awareness of the challenge expressed by organisations such as Age Concern, Help the Aged, The Joseph Rowntree Trust and many other leading bodies over the need for government to tackle the way care is funded and paid for and to come up with a sustainable and fairer solution. To this end we urge the government to produce a Green Paper on this subject to initiate a public debate." Brent North CLP

At the heart of our transformation of social care will be the principle that users and carers must be given as much choice and control as they want over the services they receive - choosing the services which are right for them, not being given a choice between inappropriate provision and no care at all. And social care must be about enabling people, not simply looking after them. Disabled people rightly demand and expect to live full and equal lives. People with learning disabilities are no longer expected to spend their lives in long- stay hospitals: we all now recognise that they have the right to fulfil their potential and make the most of their talents and, like everyone, live independently and interdependently. We want to maximise their opportunities to develop skills and find appropriate employment or meaningful activity.

Unlike the care provided by the NHS which is free at the point of delivery to everyone, the cost of social care has always been shared between the individual and local authorities, based on assessments of the person's need for care and the person's financial resources. There is a wide consensus that a means-tested element to social care will continue to be needed. But the eligibility criteria used by social services, which were introduced in order to ensure that resources were targeted towards the people who need them most, have too often been used to deny people help. As well as reviewing the way social care is funded, we are reviewing the eligibility criteria to look at ways of making them fairer. We will also ensure that local authorities provide universal information, advice and advocacy services about social care, so that even where people have the financial resources to pay for their own care, they are not left to arrange that care alone.

As well as making the system fairer, we will make it easier to use. For those who need long-term care the lack of connection between the different care providers is a common frustration. We will encourage every locality to have a single community based support system focussed on the health and wellbeing of the local population, bringing different agencies - the NHS, local government, the voluntary sector, housing, employment and benefit advice services - together to redesign local systems around the needs of citizens.

Giving people more control over their own services

Everyone who needs long-term care is different, and will require a different package of services which suits their needs and is personal to them. The right to self-determination will be at the heart of a reformed social care system. Where people are able to make choices for themselves, and want to do so, the system must put them in charge, and support them to make these decisions. Where they cannot choose or would prefer others to make decisions for them, services must be designed to meet their needs in the best way possible, and be centred around them and the life they want to lead.

"We are cautiously optimistic about providing direct payments and individual budgets to people with mental health problems, as this form of funding may allow people to tailor support to suit their needs. It is necessary, however, to ensure that people with mental health problems are fully supported in commissioning their social care and that they are able to make fully informed choices." Mental Health Foundation

Over time, people who use social care services and their families will take the central role in shaping and commissioning their own services. Personal budgets for everyone eligible for publicly funded adult social care (except where they need emergency access to provision) will ensure that everyone can choose their own support services if they want to - a right previously available only to self-funders. We will consider including NHS resources in personal budgets for people with some long-term conditions, ensuring a joined-up service for people who need healthcare and social care at the same time. The role of the state and statutory agencies will be to support people's choices and enable them to access services - not to control people's access to services.

Supporting carers

Many people with long-term needs are cared for by relatives, friends and neighbours - there are around 6 million carers in the UK. Taking on caring responsibilities has an impact on the carer's health and life chances. Labour recognises carers' contribution and values them highly. That's why it introduced the New Deal for Carers, providing extra support and services for carers. We support carers financially through the Carer's Allowance, and introduced the right to request flexible working for carers to make it easier for them to combine paid work with their caring responsibilities. We have made families with disabled children a priority, with £370 million in new funding to transform short break services, and significant new investment in disabled children's services and children's palliative care, and we are introducing alongside this funding a new legal duty on local authorities to provide short breaks for families with disabled children.

But we are clear that we need to do more to support carers, and that this needs to extend beyond social care. That's why the Prime Minister launched the biggest ever national consultation with carers to find out their priorities, and established a Standing Commission on Carers to address the long-term challenges carers face and oversee the new Carers' Strategy to be published later this year.

Dignity for older and disabled people

All services for older and disabled people, whether provided by the NHS, social services, the voluntary or private sector, should treat them with respect and dignity. This means offering everyone a personalised service, and recognising that most people want to stay in their own homes and outside residential care for as long as possible - focusing on prevention and early intervention, not waiting for a crisis before support begins.

Too many older people are required to stay on in hospital because of a lack of appropriate care facilities in the community. Labour has challenged this by imposing a financial penalty on local authorities which do not meet the needs of older people moving from hospital. Partnership working with local authorities has significantly improved services and reduced the number of older people kept in hospital unnecessarily. We are expanding services such as intermediate care for all older people who need them, enabling them to be more independent and to delay, or avoid, the need for them to enter residential or nursing home care. And to ensure that people in care homes are protected from abuse, we are looking at amending the Health and Social Care Bill to ensure that the Human Rights Act protects people who get local authority funding to live in private care homes, and not just to those living in council-run homes.

Labour is investing £80 million in extra care housing, to avoid forcing older couples apart when one of them needs to enter residential and nursing care, instead allowing them a home of their own where a wide range of care and support services can be provided on site.

To promote dignity in care, Labour has launched the Dignity Challenge, setting out national expectations of what a service that respects dignity consists of, building a network of volunteers working to raise the profile of dignity in care, and providing £67 million for local authorities to improve the physical environment of care homes for older people. The campaign has been extended to cover people with mental health problems, focusing on tackling stigma and improving inpatient mental health settings.

As the population ages, a growing number of older people are developing dementia - around 600,000 people in England now have dementia, and this is set to double over the next 30 years. Labour is developing the first ever National Dementia Strategy, to increase public and professional understanding of the disease, improve early diagnosis and intervention, and improve the quality of dementia care. The focus, as elsewhere in social care, will be on avoiding the need for hospitalisation and maximising choice and control for people with dementia and their families and carers.