Dr Howard Stoate MP, author of Fabian pamphlet 'Challenging the Citadel: Breaking the hospitals' grip on the NHS', led a discussion on the future of the NHS.

Speakers at the seminar included Dr. Howard Stoate MP (author of Fabian pamphlet 'Challenging the Citadel: Breaking the hospitals' grip on the NHS'), Anna Coote (Healthcare Commission), Professor Celia Davies (LSE), Mary Creagh MP, and Dr. Mark Exworthy (Royal Holloway University).

This event was chaired by Sunder Katwala, General Secretary of the Fabian Society. The seminar was kindly hosted at the offices of Hill and Knowlton. 

The issue of health policy reform has been sparked by the new government, Professor Ara Darzi's health services blueprint, and the approaching 60th anniversary of the NHS in 2008. The goal of the seminar was to discuss how to use this watershed moment in order to extend the debate on health policy and NHS reform.

The Fabian Society's work on life chances and inequality, in general, inspires further understanding of health inequalities. Strategies to prevent such inequalities require linking health policy with other aspects of policy outside of health, raising questions for NHS reform and future health policy and politics.

Panellists discussed reforms outlined in the services blueprint and Fabian pamphlet 'Challenging the Citadel', such as the expansion of primary care polyclinics to enhance health care services by bringing care closer to the patient, rather than through the expansion of hospitals. The blueprint reforms are designed to make better use of human resources by ensuring that the appropriately skilled health care professional provides the individual with the appropriate treatment. The reforms also aim to bring health care closer to communities, providing better equity and making noticeable changes that the public will value.

Speakers suggested their own recommendations for NHS reform to supplement those in the pamphlet. One proposal called for the integration of primary and secondary care.

A citizen, rather than patient, focused NHS was also recommended. This reform proposal suggested the NHS shift away from 'sickness and illness' services towards 'health' services, in order to remain in the long term, through the expansion of prevention services, not just treatment services.

Another proposal called for social justice to be weaved into future NHS reform. It was pointed out that care should focus on aging as the population grows and could improve through better understanding of socio-economic and life experience older. It was also recommended that future reform consider not only economic, but also environmental sustainability.

The final suggestion for health care reform revolved around developing aggressive, prevention-based policies. It was recommended that the government tackle health problems such as obesity and alcohol related diseases through taxes and advertising bans, as was done with smoking. Other measures of prevention relate to compulsory vaccinations for children, as practiced abroad, for MMR, Hepatitis A and B, influenza, rhota virus, and HPV.

Along with reform proposals, the discussion also revolved around the implementation of reforms. All agreed that trust between policy makers, health care professionals, and the public needs to be rebuilt.

Recommendations included opening up policy discussion to achieve true dialogue, allowing the public to influence the debate, rather than 'selling' the public on reforms. Other proposals included engaging health care professionals through the reintroduction of community health councils and having local government commissions engage with primary care trusts in order to see reform come to fruition. It was also suggested that health care professionals may suffer from 'reform fatigue' so the focus should be on explaining reform better through dialogue and maintaining stability for industry professionals.

Report by Nisha Gulati

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