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Wednesday 13th September 2017

Oxfordshire KONP

  • MORE BED CLOSURES IN OXFORD’S HOSPITALS

    In August, Oxfordshire’s Health Overview and Scrutiny Committee voted to accept the permanent closure of 110 beds in the county’s  hospitals.

    Now, papers for the OU Hospitals trust board meeting on 13 September report that a further 92 beds are currently closed because of a ‘safety issue’ (a lack of staff?).

    Speaking for HealthWatch in August, its chair George Smith said that bed closures were shortsighted in light of present and future needs.

    England and Wales, with some 2.8 hospital beds per 1,000 people is already worse served than many countries (Germany: 8 beds per 1,000).

    We need more hospital beds, not less.

    Oxon KONP secretary Bill MacKeith said: ‘The hospitals trust chief executive, Bruno Holthof, has a long connection with McKinsey, the pro-privatization consultancy. On taking up his post he said he aimed to cut bed numbers and he has. He has now got a job at the trust for his fellow McKinsey man, John Drew, who starts as Executive Director of Improvement and Culture in October. The signs are not good.’

    Quite apart from this, Oxford University hospitals trust has by far the worst delayed transfer of care figures for the whole country (12,799 delayed days for the last reported quarter compared with the next worst’s 5320). This is despite the fact that Mr Holthof made tackling this a priority 18 months ago. There is a crisis in community care: lack of staff, community beds.

    The NHS and social services need a massive injection of money and increase in regular budgets.

     

Thursday 7th September 2017

  • NHS professionals reprieved

    After weeks of sustained pressure led by the We Own It campaign and others, it appears ministers have finally recognised the folly of privatising NHS Professionals, the organisation set up by the NHS to reduce the costs of filling temporary posts by more costly agency staff.

    The plan has now been dropped, to sighs of relief all round, raising even more curiosity as to how it got so far in the first place.

    Commenting on the news that the government has backtracked over the selling off of NHS Professionals, UNISON head of health Sara Gorton said:

    “The government has at last seen sense. NHS Professionals is an organisation that saves the health service money and ensures there are enough staff on wards.

    “But despite many warnings, ministers have once again gone through a pointless exercise, wasting millions of pounds of taxpayers cash. Instead of filling the pockets of management consultants, this money could have been better spent improving services for patients.

    “Selling off NHS Professionals would have been completely counterproductive and bad for patients and staff.”

    As Caroline Molloy of the Our NHS website says

    “We've been raising the alarm on this in articles since 2014 so it's great to see it finally ditched. Well done to all of those who got involved in the campaign! (including, fair play, the official opposition, in the person of Junior Shadow Health Minister with responsibility for workforce, Justin Madders).”

    Read more ...


Carol Ackroyd

  • Joint councils’ Scrutiny Committee says NO to Single Accountable Officer

    Carol Ackroyd from Hackney KONP writes

    On Wednesday 6th Sept, the Inner North East London Joint Health Overview & Scrutiny Commission (INEL JHOSC*) voted by 6 to 1 to reject proposals to appoint a Single Accountable Officer across East London Health & Care Partnership, ELHCP. (The whole STP area is now re-branded as ELHCP, following what even they call ‘a disastrous launch’ for the STP).

    Of course, the fact that the JHOSC has rejected the proposals doesn’t mean that the individual councils involved will take the same view – they could still decide to endorse the proposal for an SAO.

    Still, the decision represents an important success for campaigners from NELSON (co-ordinating campaigners across the ELHCP area).

    We were given the opportunity to address the meeting and table questions, and spoke strongly against the proposals, citing ELHCP complete absence of consultation, the loss of democratic control over NHS services and the context of austerity and huge cuts to NHS budgets. 

    Local authority members of the JHOSC thanked campaigners for our contributions. They in turn were scathing about ELHCP’s piecemeal and partial approach to consultation: ‘setting out the drawbacks of current arrangements without setting out alternative proposals for how ELHCP will be governed’, and about ELHCP’s lack of consultation.

    They expressed concern that campaigners who might express concerns about ELHCP proposals have been excluded from public engagement events, and the fact that ELHCP currently has no live website, and papers are not publicly available and asked that a report addressing these consultation issues be brought to the next meeting.

    Hopefully these concerns will translate into council policy, with Hackney perhaps most likely to hold out since City & Hackney have the most to lose in the face of huge financial deficits in other areas.

     Here's my take on what we campaigners have achieved and what we haven’t (yet) been able to get across:

    We campaigners have three major concerns about ELHCP:

    A major aim of ELHCP is to reduce spending. This will impose massive reductions in services in the face of growing costs and population need -

    Lack of consultation, participation, transparency. Slavish adherence to NHSE requirements.

    ACOs/ACSs will not end the market in NHS services. 

    Certainly, they end the sharp purchaser-provider split, with its never-ending requirement to ‘market test’ (ie put out to tender) an endless stream of services. 

    However, the 2012 Health and Social Care Act remains in place, and regardless of all the talk about ‘collaboration’ and ‘joint work’ etc, there is still a requirement to put NHS services out to tender. With an ACO or even an ACS in place, rather than procuring smaller services on a fragmented piecemeal basis, the entire ACO/ACS will be put out to tender.

    This brings with it a massive risk of takeover of the entire ACS/ACO by giant healthcare corporates, likely starting initially with joint bids by NHS hospital trusts and major international finance corporations (bringing capital for new buildings).

    This would start an inexorable move towards complete takeover of the NHS by major international corporates, rapid degeneration of the NHS into a rump service, and equally rapid growth in private healthcare insurance.

    Our scrutiny Councillors appear to have grasped the finance issues, although they are focusing more on how resources are distributed between CCG areas. They understand completely the issues about consultation – and feel very strongly about their own exclusion. 

    However they don’t seem to have any awareness that the NHS is truly on the brink of extinction through corporate capture of ACOs/ACSs as these are tendered in coming months. We need to make this a focus for future campaigning.

     *The INEL JHOSC includes local authority scrutiny members from the inner London areas of ELHCP: Hackney & City, Tower Hamlets, Waltham Forest, Newham. There are separate LA scrutiny arrangements for the Outer London boroughs in the STP – Barking & Dagenham, Redbridge & Havering, and these areas have not yet scrutinized the proposals for an SAO.

    Read more ...

Friday 1st September 2017

John Lister

  • Let's mount an autumn offensive to defend #ourNHS

    The Tories are weaker than ever and can be put under pressure to reverse their damaging cuts to healthcare, writes JOHN LISTER

    THE mainstream media recently flagged up the scandalous situation that allows some of the wealthiest private hospitals in England to claim generous tax exemptions on the spurious grounds that they are “charities.”

    It’s outrageous; but this taxpayers’ subsidy to private hospitals adds up to around £100 million over five years — a drop in the bucket compared with the brutal impact of the virtual freeze on NHS budgets since 2010 that has reduced the NHS across England to a continuing crisis.

    There has been no equivalent press outrage that ministers have ignored the strident “winter warning” of NHS Providers — the body that represents NHS and foundation trusts — that if an extra £350m were not made available to the NHS by August at the latest to put new staff and resources in place, we will face another winter crisis even worse than the situation last year. It’s the end of August, and there’s no extra cash.

    Instead of facing these harsh facts from the managers and the health professionals struggling to keep services running, Health Secretary Jeremy Hunt has been daft enough to engage in a futile debate with Professor Stephen Hawking.

    Hawking has now repeatedly exposed the selective use of evidence by Hunt and warned that the crisis in the NHS has been caused by political decisions since 2010, including “underfunding and cuts, privatising services, the public-sector pay cap, the new contract imposed on the junior doctors and removal of the student nurses’ bursary.”

    Hawking argues that, to make matters worse: “Failures in the system of privatised social care for disabled and elderly people have also placed an additional burden on the NHS.”

    Hunt of course has no answer to this, especially as long as the ideologically imposed freeze on spending continues.

    He predictably rejects Hawking’s suggestion that some of the other changes taking place could open up a prospect of US corporations moving in.

    But even as Hunt has denied the US connection, August opened with the publication of hundreds of complex pages of guidance and draft contracts for accountable care systems (ACSs) and accountable care organisations (ACOs) — explicitly modelled on systems that first emerged in the US, where of course they are led by major healthcare corporations.

    This is what NHS England wants to emerge from the 44 Sustainability and Transformation Partnerships that were wrenched into place last year.

    Hunt has on several occasions stated: “We need clinical commissioning groups to become accountable care organisations.”

    However this rather underlines that Hunt does not fully understand the model himself, since ACOs are arrangements through which providers (ie NHS trusts and GPs — not CCGs) take the risk of delivering a defined range of services to a local population for a cash-limited budget.

    A new study from the King’s Fund, looking at what they see as the nearest international equivalent of an ACO, the transformation of services in Canterbury, New Zealand, underlines that positive results can be achieved by developing services outside of hospitals. But it also underlines how completely different the New Zealand context is from the situation in England.

    “Unlike in the UK, most social care is paid for by district health boards, and provision of state-funded social care is relatively generous compared with UK standards, meaning that entitlements to health and social care are more closely aligned.

    “The New Zealand health system has had no formal purchaser/provider split since 2001, has undergone no significant organisational restructures in recent years and has a far less complex regulatory environment than the NHS.”

    In addition the New Zealand system has been brought in without closing beds and has been built up patiently, with sustained investment, engagement with and training of staff in the necessary new skills.

    None of these are true of the secretive, top-down panicked attempts in England to force through savings without investment, making it most unlikely that the positive vision of integrated services could be replicated here.

    Despite all the pages of documents and the apparent enthusiasm of Hunt and NHS England boss Simon Stevens, it seems that the constrained and inadequate NHS budget after a seven-year freeze is not enough to entice much interest in taking risk on this scale.

    Funding per head in England’s NHS is a fraction of the level of funding for the US ACOs.

    The unique experiment of the multispeciality community provider (MCP) contract in Dudley, offering a massive £5 billion-plus contract for a wide package of services to be delivered over 15 years, resulted in not a single external bid, from NHS or private sector, and is being awarded to the existing NHS providers and GPs.

    Smaller, but ambitious schemes for “lead provider” contracts for care of older people (Cambridgeshire) and cancer services (Staffordshire) have collapsed as a result of inadequate funding, although community health and other services have been contracted out on a smaller scale — many of them to Virgin.

    So the main present danger to the NHS is not coming from Donald Trump’s buddies across the Atlantic but from Downing Street.

    And the answer to the threats faced by local services as local plans for cutbacks are beefed up this autumn is already clear, especially after the June election weakened the grip of Theresa May’s government.

    Campaigning is the key in every area, to challenge every threat to the availability and integrity of local services. Broad campaigns, linked up with health unions, political parties and community organisations, can build a movement strong enough to persuade newly insecure Tory MPs that they cannot afford to allow local services to be cut back.

    Tenacious campaigns in Devon and in south Essex have in the last few months managed to force back plans to downgrade or close local A&E services, which were central to STP plans and local “success regimes.”

    In each case local Tory MPs were put under sustained pressure and appear to have lobbied behind the scenes to force a retreat.

    In Yorkshire, the sustained campaigning efforts against plans to downgrade and close services at Huddersfield Royal Infirmary have finally forced the local Calderdale and Kirklees councils to at least use their power to refer the controversial plans to Hunt.

    In Hackney, too, the council has indicated the kind of stance that could be taken by other boroughs and county councils, and challenged the legality of plans to force a merger of seven CCGs in north-east London that would effectively strip away the already limited level of local accountability.

    Legal advice quoted by City and Hackney CCG and by the council makes quite clear that STPs lack any legal status as long as the Health and Social Care Act remains in place.

    So there are many other opportunities for local councils — as they should be doing in defence of their local communities — to mount a legal challenge to the plans being pushed through by NHS England.

    In Nottinghamshire, the Sustainability and Transformation Partnership is to spend millions on failure-ridden consultant Capita, and a US health provider Centene to help shape its STP and set up an ACS, while doing little or nothing to engage with local people, local authorities and NHS staff.

    Elsewhere NHS bosses are withholding information on their plans in defiance of the Freedom of Information Act.

    In Oxfordshire, CCG bosses are ignoring the rhetoric about integrating services by contracting out musculoskeletal services to a private provider: nationally the NHS is defying all logic by trying to privatise NHS Professionals, the organisation set up to squeeze out extortionate rates charged by private agencies for nursing staff.

    In every area the soft spots for campaigners to aim at are elected politicians — MPs and councillors.

    They know the government has no mandate for more cuts, closures, contracting out or reorganisation. And they know that they could pay the price at the ballot box if they are seen to connive at cuts.

    With enough support, we can win this vital fight for the NHS. Let’s make it happen.

Monday 28th August 2017

John Lister

  • Tax-payers can’t afford such charity to private sector

    Recent revelations on the existence of tax breaks for over a quarter of private hospitals, which benefit from an 80% exemption from business rates, on the spurious grounds that they are “charities,” made headlines even for the BBC: but the insidious process of privatising the provision of NHS-funded services continues largely below the media radar.

    Anger over the tax-breaks was intensified by the fact that NHS and foundation trusts are denied any such concessions, and in many cases now face steep hikes in local “business rates,” despite the vast bulk of their activity being centred on delivering services without charge or profit to the population as a whole.

    By contrast Nuffield Hospitals, the third wealthiest charity in the country, receives a discount on these payments plus reduced payments of corporation tax and VAT.

    Wealthy private hospitals charge for the vast majority of their work, and by doing so exclude the majority of the population. And they retain cash surpluses: but a minority opt to include a minor role delivering unpaid services of their choosing, and this perversion of charity law has created a lucrative loophole for them.

    This long-standing problem was dodged by Labour’s Charities Act of 2006, and by a tribunal decision in 2011 that proof that a charity delivers any ‘public benefit’ should be regulated only by the “charity’s” own trustees, and not by the Charity Commission.

    Now, according to a fresh review by tax specialists CVS, private hospitals will escape more than 20% of their total potential tax bills of over £240m over the next five years, while hospital trusts in England and Wales face a 21% increase in business rates.

    Given the current dire financial straits to which the NHS has been reduced by 7 years of real terms frozen spending under George Osborne’s austerity policies, the lack of equivalent exemptions are an additional insult to the NHS. But the tax breaks are a minor factor compared with the many other ways private medicine – much of it undisguised provision of care purely for profit -- leeches off the NHS.

    Private hospitals in England – average size just 50 beds –deliver only a niche service, providing low risk uncomplicated elective surgery to a selected population. So they don’t need multi-disciplinary teams of doctors and professionals: most employ medical staff on a sessional base only, and are staffed overnight by nurses. They can therefore make profits even delivering elective treatment at below NHS tariff prices to NHS-funded patients who help fill up their otherwise empty beds.

    Private hospitals’ caseload, which includes no emergencies, no maternity services and no complex cases, is completely different from the case mix of even the smallest NHS general hospital, making it impossible for them to train any staff – even if there were any serious aspiration to do so. Private hospitals rely completely therefore on staff trained by and at the expense of the taxpayer – constituting not only a colossal hidden subsidy, but also a problem for hard-pressed NHS hospitals which have to cope with consultants and key staff regularly ‘moonlighting’ in paid work elsewhere, and therefore not available to staff NHS wards and operating theatres.

    While NHS staff have suffered 8 years of frozen pay or below inflation rises, private hospitals have been free to offer whatever rates they choose to pay, and much less stressful conditions to attract staff.

    To add another costly hidden subsidy, NHS ambulances and emergency services are effectively used in place of many private hospitals having any proper ITU or other facilities to deal with occasional emergencies when private treatment goes wrong.

    So no matter what the claims may be of “benefit” to the wider population from exclusive private hospitals, the reality is that they only exist because they can benefit so consistently and in so many ways from the misguided generosity of government and taxpayers.

    Once again the private sector is propped up by the public sector, and entirely dependent upon it. How long should we keep them in the style to which they have become accustomed?

     

Saturday 26th August 2017

Shropshire campaigners

  • The outrage around Ludlow Hospital

    Campaigners respond

    The real scandal around Ludlow Hospital is that an NHS Hospital relies on charitable donations to buy something as basic as an ECG machine.

    The decision of the Chief Executive of Shropshire Community NHS, Jan Ditheridge, to refuse to accept a charitable donation to allow Ludlow hospital to get an ECG machine for use by outpatients has been met by outrage. On social media, people from Ludlow are almost unanimous in condemning the decision, and there has been a similar response from the national media.

    Shropshire Defend Our NHS has been asked to make a statement on the issue. Read it HERE

    Read more ...

Thursday 17th August 2017

  • Campaigners challenge county councillors on NHS cuts

    In a letter (below) to party group leaders and individual councilors, the campaign group Oxfordshire Keep Our NHS Public challenges the council to clarify its stance on the permanent closure of beds in Oxfordshire’s hospitals.

    Earlier this year, the council’s Cabinet refused to support the proposals for cuts and downgrades. The full Council went further, indicated their strong opposition to the proposals and rejected the consultation.

    The letter, from Oxon KONP acting chair Gus Fagan, says in part:

    ‘Last week, the concerns expressed by the full Council were ignored by the Oxfordshire Clinical Commissioning Group representatives in their contributions at the 7 August Health Overview and Scrutiny Committee meeting. The national funding context has not improved. The suggestions made by the Council were not taken up by the CCG. But the HOSC agreed to accept the permanent closure of 110 beds.

    ‘Oxon KONP is concerned that the Committee has failed in its duty to defend the interests of the public in the county.

    ‘Following last week’s decisions of the HOSC and the CCG board, where does that leave the County Council, given its stance of strong opposition to date on the OTP phase 1?’

    News of the permanent bed closures has not gone down well. One health worker in accident and emergency at the John Radcliffe, said:

    ‘This is just awful. Working in A&E is particularly difficult, and has been all year. We often have significant nursing and medical rota gaps, and long waiting times. Despite it being August, every shift has patients on trolleys in the corridor, with the time waiting for a bed over 12 hours. Resus [ward], built for 4 patients regularly has 6-7. For patients requiring level 3 care, mothers and babies requiring obstetric care and stroke patients to have to travel from the Horton will definitely put lives at risk.

    ‘We are not coping, and when I ask managers about winter planning I get a shrug of the shoulders...’

     The letter reads:

    17 August 2017

    Dear County Councillor,

    Oxfordshire Transformation Plan Phase 1: What is County Council’s stance?

    In a letter of 3 April to the chair and chief executive of Oxfordshire Clinical Commissioning Group, Cllr Michael Waine, County Council chair, wrote:

    As you know, Cabinet were not supportive of the proposals. Full Council went further and indicated their strong opposition to the proposals and rejected the consultation.

    Full minutes of County Council 21 March 2017:

    http://mycouncil.oxfordshire.gov.uk/documents/g4819/Printed%20minutes%20Tuesday%2021-Mar-2017%2010.00%20County%20Council.pdf?T=1]

    However, on 7 August the county’s Health Overview and Scrutiny Committee decided, as we understand it from notes taken at the meeting:

    1.   To support the proposals on critical care subject to assurances that there will be no knock-on effect at Horton General Hospital

    2.   To support the permanent closure of 110 beds already but not to support any further closures until they see the impact of these on phase two proposals and impact on all of our community hospitals

    3.   Not to support the proposals on planned care services at the Horton at present

    because there is no detailed plan, there is a vision. The proposals needed to be fully thought out and fully costed. The CCG was invited to come back when they had a fully developed proposal and detailed plan.

    4.   On maternity services, if the CCG was minded to approve the downgrade recommendation on Thursday, the HSC would refer the matter to the Secretary of State.

     Acceptance of permanent bed closures

    Referral of the Horton maternity services is in hand. The news of the HOSC’s vote to accept permanent bed closures has not gone down well with the public. One health worker in accident and emergency at the John Radcliffe, said:

     ‘This is just awful. Working in A&E is particularly difficult, and has been all year. We often have significant nursing and medical rota gaps, and long waiting times. Despite it being August, every shift has patients on trolleys in the corridor, with the time waiting for a bed over 12 hours. Resus [ward], built for 4 patients regularly has 6-7. For patients requiring level 3 care, mothers and babies requiring obstetric care and stroke patients to have to travel from the Horton will definitely put lives at risk.

    ‘We are not coping, and when I ask managers about winter planning I get a shrug of the shoulders...’

     At the full Council meeting in March, councillors

    … discussed the Oxfordshire transformation proposals in the wider national context of significant financial challenge for the NHS and social care. They wanted to emphasise that they understood that the situation the CCG is facing is a result of national policy. The rising demand for health services and lack of funding to address this was a huge national issue which was being played out locally to the detriment of services for local people.

    Members felt that the consultation did not make clear the impact on social care and there was a lack of modelling to accurately assess this. It was felt that the proposals would benefit from a workforce plan setting out how the impact on carers would be managed. It should not be assumed that county council services would be able to absorb the impact of the changes on social care. It was also noted that the care sector is financially very fragile as recent examples of agencies becoming insolvent shows.

    Members expressed frustration that no options for alternative delivery options were presented in the consultation. Some members felt this implied a ‘fait accompli’ as no alternative future arrangements were presented for consideration. It was also unacceptable to expect proposals for substantial bed closures to be agreed without any detail about proposals for the future of services in the community. These would be vital to support changes in the acute system.

    The concerns expressed by the full Council were ignored by the CCG representatives in their contributions at the 7 August HOSC meeting. The national funding context has not improved. The suggestions made by the Council were not taken up by the CCG. We are concerned that the Committee has failed in its duty to defend the interests of the public in the county.

    Given the stance adopted by HOSC and the go ahead decided by the CCG board, where does that leave the County Council, given its stance to date on the OTP phase 1?

    Yours sincerely,

     Gus Fagan, acting chair, Oxon Keep Our NHS Public

    Read more ...

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