Thursday 11th November 2021
HCT News Bulletin #13
- Nuneaton & Warwick IT staff strike to stay 100% NHS
IT staff at Nuneaton’s George Eliot Hospital and South Warwickshire NHS Foundation Trust (SWFT) in Warwick have staged a 2-day strike against plans to transfer them on December 1, against their will and without consultation, to Innovate Healthcare Services, a new private subsidiary company set up by the trusts.
George Eliot and SWFT share a chief Executive, Glen Burley, who somehow also manages to hold the CEO job at Wye Valley NHS Trust – and is making no concessions as he pushes forward with the project.
He claims that the new wholly owned subsidiary would provide “protection from external providers” and somehow “keep staff within the NHS family.”
However even a Warwick Tory councillor has warned that SWFT is being unfair to those staff who have ‘proudly and loyally’ worked for the health service for years, and this could lead to ‘privatisation of part of the NHS by the backdoor’.
Mr Burley also claims that “Throughout all stages of this process we have worked closely with Union representatives to address their concerns and we are having on-going conversations regarding arrangements with them post transfer.”
UNISON regional organiser Mike Wilson insists that the only offer to negotiate has been on the TUPE transfer of staff out of the NHS, not on the issue of whether or not the company should be set up.
“Like many of their colleagues in healthcare, these staff actively chose to work for the NHS to serve the public. And they’ve done so through the toughest of times during the past few months of the pandemic.
“Now their employers have turned round to say they don’t want them and are forcing them to become a kind of private contractor.”
One staff member told the Coventry Telegraph: “We started work in the NHS, and want to continue this. People are just so disappointed, we are not being listened to. We do not want to work for this private company - we want to stay in the NHS, we are proud to be in the NHS.”
Further action is planned on November 23 and 24.
- Macmillan call for £170m plan to train more cancer nurses
Cancer treatment is not keeping pace with demand, let alone catching up with the pent-up demand from the prolonged Covid-19 lockdown, warns Macmillan Cancer support.
More than 55,000 people had to wait for more than four weeks to find out whether or not they had cancer from their initial urgent referral, according to the latest NHS England figures, and August 2021 saw another new record-high number of people who had waited for more than two months before they started cancer treatment following an urgent referral from their GP — more than 4,000 people.
Figures published by NHS England, and analysed by Macmillan for the Guardian, show the number of patients starting treatment in August following a decision to treat fell from above 27,000 in June and July to 25,800.
The proportion of patients who began treatment within one month of the decision to treat fell to 93.7% – the lowest percentage ever recorded.
Urgent cancer referrals were made by GPs in England also fell back in August, although the figure was still higher than the equivalent figure for August 2019 before the pandemic.
Macmillan analysis estimates the NHS in England would need to work at 110% capacity for 17 months to catch up on missing cancer diagnoses xi, and for 13 months to clear the cancer treatment backlog.
To make matters worse Macmillan’s research has found that more than one in five diagnosed with cancer in the UK was unable to get support from a specialist cancer nurse during their diagnosis or treatment and would have liked to, or said the support they received was not enough.
Macmillan is calling for Governments across the UK to invest a total of around £170 million to fund the training costs of creating nearly 4,000 additional cancer nurses required by 2030 to provide the care people need.
If the number of specialist cancer nurses stays at current levels, Macmillan estimates the gap in the number of specialist cancer nurses in each nation by 2030 will be 3,371 in England, 166 in Wales, 100 in Northern Ireland and 348 in Scotland.
- Kent fights on for stroke services
Health campaigners in Kent have declared they will fight “tooth and nail” the government decision to endorse a reconfiguration which will mean halving the number of stroke units in Kent – and lengthening journey times and delays in treatment.
Campaign group Save Our NHS In Kent (SONIK), which has been campaigning for years to save stroke units in east Kent called an emergency protest outside Margate’s QEQM hospital on November 6 (above).
The three remaining specialist stroke centres will be in Dartford, Maidstone and Ashford – with units at Margate, Medway and Canterbury closing, leaving much of East Kent with 60 minute journeys to a Hyper Acute Stroke Unit (HASU) – assuming the ambulance services can deliver.
Large areas would face 45 minute journeys to a HASU: but when stroke services were centralised in London it was specified that all patients had to be within 30 minutes of a HASU.
Ambulance response times in Kent and elsewhere have worsened dramatically since the initial plan for the service redesign was submitted for ministerial approval over two years ago.
A spokesperson for SONIK said: “Everyone knows that surviving a stroke is critically dependent on how close you are to an emergency unit. The halving of our stroke units in Kent from six to just three is going to put people’s lives at risk. We have fought this appalling decision every step of the way and we will not give up now. We will fight it tooth and nail.”
“We’ve had judicial reviews, petitions, debates. We’ve presented local NHS bosses with overwhelming evidence of the lethal dangers of this move. Our only recourse now is protest.”Read more ...
- 'Jab or no job' threat piles on the agony for social care
Things were bad enough in social care before Sajid Javid chose to ignore the advice of trade unions and employers, and confront tens of thousands of care staff with a ‘jab or no job’ ultimatum.
As this Bulletin is completed the deadline for staff to be fully vaccinated has now passed, and latest reports suggest over 3% of staff – for whatever reason – have opted to leave the low-paid jobs rather than accept the vaccine.
This comes on top of the rapid increase of vacancy rates in social care from 6% of the staff to 10%: it will mean even more care homes closing their doors to new admissions and home care services unable to deliver support to frail and vulnerable people – more of whom will wind up in hospital.
Stuck in hospital
Last month Age UK warned of the growing numbers of older people getting stuck in hospital when they are fit to be discharged, because there is not enough care to support them at home.
Of course the crisis is not merely one of staffing: the chronic low pay that makes it so hard to recruit or retain staff is itself linked to the largely privatised provision of social care, and the system in which the poorest patients rely on funding from local government budgets that have been relentlessly slashed back year after year since 2010.
This in turn has held down the benchmark fees paid to care homes and home care companies that sprang up in place of the previous council-run home help services.
The Homecare Association has found that many councils are not paying homecare companies a high enough hourly rate to cover basic costs like travel time between clients.
The average paid by councils in Great Britain and health boards in Northern Ireland is just £18.45 per hour, while the Association calculates the true minimum cost of providing an hour of homecare in the UK is £21.43.
Care by the minute
To make matters worse, and underline the way in which any notion of quality of care has been discarded in the pursuit of cheapness, some local authorities still buying homecare by the minute.
This in turn leads homecare employers to resort to zero hours contracts, and the notorious failure to pay staff for travel time between clients.
The Association, which represents 2,340 companies, wants central government to “invest properly” in homecare, and raise pay to £11.20 per hour. This would cost £1.6bn a year across the UK.
They also call for a ban on purchasing homecare by the minute, a professional register for care workers and for social care workers to be added to the Shortage Occupation List to make it easier to hire from overseas.
But without the funds to pay up, and still no sign of the promised government “reform” of the dysfunctional social care system it seems things can only get worse in the months ahead for those trapped in it, or working for it.Read more ...
- Health and Care Bill - ministers block all opposition amendments - Justin Madders MP
By Justin Madders, MP for Ellesmere Port and Neston, leading for Labour on the Bill Committee
A pandemic, a burnt out workforce, record waiting times - pressure in every part of the system. The NHS is stretched to its absolute limit and beyond, yet against this background the Government have put forward the Health and Care Bill which represents yet another reorganisation of the NHS that fails to tackle the underlying causes of the challenges both health and social care face.
In simple terms, the Bill removes competitive tendering for clinical services (but not all NHS funded services); it replaces Clinical Commissioning Groups with bigger ICBs (which are expected to delegate to ‘place-based’ units of some sort); it replaces market structures with heavy top down management by a much enhanced NHS England. The big winners as always are the large acute trusts.
No end to privatisation
The Bill may end the waste and cost of pointless tendering introduced under Andrew Lansley, but it does not end privatisation even of clinical services.
The claims about the Bill favouring integration of services are largely rhetorical and clearly even the Government don’t believe they will be delivered as they have already begun to trail another White paper on integration.
Most worrying was the inadequate response to the issue of workforce planning. The provision was universally criticised – but has still so far remained.
During consideration in the Commons Public Bill Committee, numerous amendments were proposed but none were carried.
Tory MPs voted down our efforts to ensure representation on NHS decision-making boards for mental health, social care, public health, staff and patients, and safeguard near-patient services from further outsourcing.
They also blocked our attempts to remove controversial powers for the Secretary of State to intervene in local service reconfigurations from the Bill.
Promises of discussions
Instead, there were many assurances and promises of further discussions and thought.
Some Government amendments are expected before the Bill goes to the next stage and concerns remain, especially about the possibility for private sector interests to influence commissioning of NHS funded services by having a role on ICBs, and for contracts with the private sector to be agreed without any proper oversight.
The new organisations are weak on clinical leadership and on staff, public and patient involvement. Who decides what is no clearer.
There is also the focus on acute care and the big Trusts – potentially leaving primary care, mental health, community care, social care, public health outside the key decision-making bodies.
The argument often advanced for rejecting Labour amendments that may have dealt with some of the concerns was that local systems should have ‘flexibility’ to shape services, but this argument was totally undermined by the provisions in the Bill giving many further powers for the Secretary of State and for top down intervention.
The Bill is about reorganising the NHS, not about improving care or the integration of care – and not about improving wellbeing or tackling unacceptable inequalities. It is a huge missed opportunity.
The structures in the Bill which are already largely in place may not last long, do not do enough to fix the mess made by the Tories’ previous reorganisation, and are frankly a distraction at a time when the NHS is facing the biggest crisis it has had in its proud history.
Staff and patients deserve better than this.Read more ...
- Health and Care Bill fight will go on in the Lords
Labour MPs on the Committee tabled a total of 161 amendments to the Bill, 14 from Margaret Greenwood MP and 147 from Justin Madders: but none were carried.
Health Minister Edward Argar tabled 14 amendments, the most significant of which reinstated deleted wording from the 2006 Act specifying that NHS services must include secondary care and ophthalmic services.
However Argar’s promised amendment to exclude private health companies from gaining seats on ICBs has still not been tabled.
Nor has any explicit guarantee of local access to emergency care, as it appears in the current legislation, been reinserted into the Bill, leaving questions over the access and entitlement to emergency care especially for refugees and migrant workers.
Opposition parties in the Lords, where there is greater scope for votes to be won, will continue to fight for amendments on key issues including the lack of any local accountability, and seeking to define the NHS itself as the default provider both of clinical and of non-clinical services like cleaning, catering and porters.
There are also likely to be proposals to require a business case to justify any contract in excess of a certain amount being outsourced to a private contractor, and imposing strict conditions.
As it stands, the Bill has most of its many initial deep flaws, and more organisations are drawing the conclusion that the limited repeal of the 2012 Lansley Act is not enough to justify anything but opposition at 3rd reading.
- 'Extra' spending still leaves NHS poorer
John Lister (abridged from The Lowdown November 1)
NHS Providers Chief Executive Chris Hopson calculated back in 2019 that if NHS spending since David Cameron first took office had just kept pace with the previous long term average annual increase, spending on health and social care would by then have been £35 billion per year higher than it was.
Since then it’s fallen further behind, while Tory spin-doctors have successfully fed much of a poorly-informed mainstream news media with the illusion that the NHS has been lavishly funded under Johnson.
In September came the £36 bn 3-year package of National Insurance tax increases on the lowest-paid workers, allegedly to spend more on the ‘NHS and social care’.
In fact less than half of the £36bn, just £15.6bn over three years, is earmarked for NHS England. £6bn goes to devolved governments (Wales, Scotland and Northern Ireland), £9bn is simply to be handed to the Department of Health & Social Care – and £5.4bn, again over 3 years, is reserved for social care – too little, too late, and with no reforms of a crisis-ridden largely privatised system.
Figures in the Treasury’s Red Book show that the new money brings NHS England’s an average increase in funding of just 3.1% per year from 2019-2025 – not enough even to keep pace with cost and demographic pressures.
The growing gap between resources and demand for health care had already increased England’s NHS waiting list to more than 4 million before the Covid pandemic. It’s now edging up towards 6 million, with over 200,000 waiting over a year – and growing numbers waiting over two years.
The combination of beds (and staff) tied up treating Covid patients with the reduction in bed numbers to ensure social distancing has cut NHS non-Covid acute capacity by around 15% since 2019.
NHS England has looked to spend up to £10bn over 3 years on treating NHS patients in private hospital beds – a short-sighted measure that will leave huge unresolved problems and the NHS chronically dependent on private providers.
NHS capital allocations have also been squeezed to unrealistic low levels for a full decade. So there is no capital for trusts to invest in re-planning the use of their hospitals to restore capacity or invest in new and improved diagnostics or other services – let alone provide the extra resources needs for mental health, community services or primary care.
Trusts can’t even keep up with routine maintenance and the replacement of clapped-out equipment. The backlog maintenance bill has rocketed to £9 billion from an already unmanageable £6bn in 2017/18.
Despite all this, the Red Book declares that with the minimal increases just announced, the government expects the NHS to deliver a 30% increase in elective treatment by 2024-25. It also lists how the same money is supposed to be spent:
* £4.2 billion by 2025 “to make progress on building 40 new hospitals by 2030 … and to upgrade more than 70 hospitals”. Everybody knows £4.2bn is nowhere near enough. In fact all of the prioritised new hospital projects are at a standstill, with new limits on spending causing chaos.
Meanwhile 1970s-built hospitals across the country using concrete planks are increasingly unsafe for patients and staff – and need replacing.
* £2.3bn by 2025 to “transform diagnostic services, with at least 100 community diagnostic centres …”. However the first such ‘community’ diagnostics centre, recently opened in Somerset, turns out to be yet another project reliant on the private sector. It is being run by Rutherford Diagnostics Limited, in partnership with Somerset NHS Foundation Trust. It’s likely most if not all of the new centres will also rely on private companies.
* £2.1bn by 2025 for “innovative use of digital technology” – more expensive, chaotic whizz-kiddery, unproven apps and systems.
* £1.5bn (just over £3m per year per acute trust) by 2025 for “new surgical hubs, increased bed capacity and equipment.” Where will the staff be found?
* Just £450m by 2025 for projects in England’s 54 mental health trusts – again a pathetically inadequate amount to pay for the changes proposed.
The key issue for which no real changes are in hand, is the dire workforce shortage.
The Red Book declares that the Spending Review settlement “will keep building a bigger, better trained NHS workforce,” and reaffirms “the government’s existing commitments for 50,000 more nurses”.
The facts are very different. No funding has been allocated to pay the £1.5bn per year minimum cost of an additional 50,000 staff. The 50,000 target included an ambitious number of overseas recruits – and retention of 19,000 existing staff – while anecdotal evidence suggests demoralised and burned-out staff are leaving and overseas recruitment has stalled.
The most recent workforce statistics (July 2021) show nurse numbers up overall by 11% since July 2010, and midwife numbers by 13%, but health visitor numbers down by 19%.
Mental health nurse numbers are down by 2,350 (5.6%), despite the promise by Theresa May’s government in 2017 that 21,000 new posts would enable mental health trusts to treat an extra million patients a year.
The most recent figures, to June 2021, show 94,000 (7.2%) unfilled posts in England’s NHS of which almost 39,000 are nursing posts, with vacancy rates ranging from 8.4% (South West) to 12.5% in London. Almost 10,000 medical posts are vacant. Read more ...
- Crisis point
It’s not normal for a senior hospital chief executive to phone Health Service Journal Editor Alastair McLellan on a Sunday lunchtime to speak out on the massive stress the NHS is under, warn his trust, and probably all trusts, are providing inadequate care – and confess he doesn’t know where to turn.
It’s most unusual for a chief executive to speak frankly to staff about fears that their trust is facing such pressure that its giant teaching hospital is “ceasing to function as a hospital.” The leaked warnings came from an internal meeting at Cambridge University Hospitals Foundation Trust.
Both happened within days of each other. Now an NHS Confederation survey has found almost 90% of trust bosses believe the pressures on their organisation have become ‘unsustainable,’ putting patient safety at risk, and the NHS is at a “tipping point,” – directly refuting Health Secretary Sajid Javid’s complacent claims last month.
This is the utterly unprecedented crisis that almost 12 years of Tory austerity, exacerbated by Covid-19, has brought upon the NHS, while ministers are living in denial.
The figures tell the stark truth:
* Almost 6 million people waiting for treatment, 292,000 of them for over a year;
* Ambulances queuing for hours to hand over emergency patients;
* A&E and GP services facing record levels of demand for treatment;
* Mental health services short of beds and staff -- leaving 1.5 million without the care they need;
* NHS beds are filled with patients who cannot be discharged for lack of social care support outside hospital;
* Over a million people are not getting the care and support they need: social care faces a “tsunami of unmet need” according to the CQC;
* Care staff vacancies up from 6% to 10% in a few months, – with potentially tens of thousands more about to lose their jobs because they won’t get vaccinated.
The situation in the NHS was bad and worsening before Covid.
But during 2020 hospitals lost around 15% of vital front-line capacity, and Covid-19 is still causing chaos, with 7,000+ Covid patients in English hospitals (Nov 5), and thousands more beds still left closed or empty.
Capacity is further reduced by chronic staff shortages, with over 94,000 vacancies, 77,000 sickness absences at the last count and NO serious workforce strategy.
Too many NHS hospitals are literally falling down, or struggling on with clapped out kit and dilapidated buildings – with the backlog maintenance bill now £9.2 billion – and no money to invest in reopening closed or unused beds.
The danger is that delays, failures and gaps in care will mean growing numbers of patients and the wider public lose confidence in the NHS.
As long waits increase, more patients in pain who can afford it will opt to ‘self-pay,’ while others consider taking out health insurance to cover elective care.
This threatens to leave the large majority who can’t afford to do this, and all those needing emergency care or more complex treatment queueing to use an increasingly run-down service.
Ministers want you to believe that they have given generous funding increases: they were lying before the spending review – and they are still lying now.
There is no funding to pay for the promised 50,000 additional nurses that we all knew would never be recruited. There is no funding for any big pay increase next year. There’s nowhere near enough money to pay for 40 new hospitals. It’s all lies and distortions.
Twelve years brutal austerity policies require BIG spending now to repair and restore the NHS.
The NHS can’t live off empty rhetoric about “record spending” and empty promises of “40 new hospitals by 2030” … any more than health workers could live off the applause they received in place of a pay increase.
Campaigners urgently need to focus on the bigger picture here: the NHS itself is under threat, and while money alone is not enough, none of the problems can be solved without more cash and capital in the pot to rebuild, repair and reopen our NHS, and recruit, train and retain the staff we need.
The spending review settlement was not enough: with the government weakened by the corruption scandals, we need a concerted campaign to force a political crisis – and emergency measures to allow sufficient bank and agency staff to keep services open and patients safe, wards to be re-planned to maximise capacity, and give hope to embattled NHS staff that there can be light at the end of a very long tunnel.
- Covid - 'One of the worst ever public health failures
John Puntis, co-chair Keep Our NHS Public
The response of the Westminster government to the management of the coronavirus pandemic in England has been characterised by inertia, lack of trust in the public, outrageous cronyism and an unwillingness to learn lessons.
Even now, none of this has changed. The consequences include 139,000 deaths (8.6 million cases), massively increased waiting lists for National Health Service (NHS) treatment, general practice (primary medical care) in crisis, huge numbers of staff vacancies and a burnt out workforce.
With numbers of infections (particularly among the young) now rocketing, escalating hospital admissions and deaths, there is still a reluctance to implement basic mitigating interventions such as mask wearing and improved ventilation in schools and workplaces.
The initial rapid roll out of vaccine has now stalled, yet vaccination is still being promoted as the only intervention that is effective, and the only plan there appears to be is waiting for ‘herd immunity’ through a combination of vaccination and natural infection.
The management of the pandemic has been explored by parliamentary representatives in a report published on 12th October from the House of Commons Health and Social Care, and Science and Technology Committees.
The outstanding take home message from this report is summed up in the statement that this was “one of the UK’s worst ever public health failures”.
Politicians escape blame
But the discussion is framed in a way that avoids attributing blame to politicians for the effects of their policies or the state of the NHS at the start, and in this sense the report must be considered a whitewash.
Scathing criticisms are made, however: the initial response was delayed, care homes were abandoned, the ‘world beating’ test and trace system had marginal impact.
The report describes how comparisons with flu and a fatalistic view of the inevitable spread of infection impeded reaction to the pandemic.
While clearly condemnatory of the delay in the first lockdown for reasons including lack of testing capacity and doubts about public compliance, ‘groupthink’ and ‘British exceptionalism’ are given the blame.
Bereaved families excluded
The report is also notable for the absence of the voices of those who lost loved ones to Covid. A representative of the Covid-19 Bereaved Families for Justice group commented:
“The report … is laughable and more interested in political arguments about whether you can bring laptops to Cobra meetings than it is in the experiences of those who tragically lost parents, partners or children to Covid-19. This is an attempt to ignore and gaslight bereaved families, who will see it as a slap in the face”.
Astonishingly, Former Secretary of State for Health Jeremy Hunt claimed to know nothing of Exercise Alice, a pandemic modelling exercise only recently made public.
Senior health officials who war-gamed the impact of a coronavirus hitting the UK, warned four years before the onset of Covid-19 of the need for stockpiles of Personal Protective Equipment, a computerised contact tracing system and screening for foreign travellers.
From the one pandemic exercise Hunt does admit to knowing about (Exercise Cygnus), recommendations arising were not implemented.
Few lessons learned
Although the title of the Commons report was ‘Coronavirus: lessons learned to date’, very few lessons appear to have been learned.
Infection rates in the UK are more than 18 times those in Spain and more than nine those in France. The government’s Scientific Advisory Group on Emergencies has warned of the need for a possible winter lockdown if measures are not taken now to tackle rising infections.
The present pandemic management policy in Westminster is indifferent to the loss of life, the long term complications of Covid in survivors and the impact on NHS staff and other frontline workers.
This raises the question as to whether this amounts to democide (“the killing of members of a country’s civilian population, as a result of its government’s policy, including by direct action, indifference, and neglect”), “social murder”, gross negligence manslaughter, or misconduct in a public office? Read more ...
- Bring Barts services back in house
As multinational outsourcing firm Serco announced a premature end to its 10-year £600m contract for support services covering the five hospital sites run by Barts Health, Unite has called on the Trust to bring these workers back in-house into NHS employment, demanding that there must be “no more contracts for outsourcing privateers that put profit before people.”
Serco’s ‘Soft Services’ contract with Barts Health NHS Trust, signed in 2016, is now due to end on 30 April 2023. It was controversial at the time and more recently in April this year Unite balloted catering staff for strike action at the trust’s Royal London Hospital in Whitechapel in a dispute over bullying and the imposition of ‘chaotic’ new rotas.
Now they are preparing for an industrial action ballot over pay: the mainly Black, Asian and ethnic minority (BAEM) staff, which include cleaners and porters, are paid up to 15 per cent less than directly employed NHS staff.
The workers are now rightly demanding a significant pay increase.
Serco Group PLC had a turnover of £3.9 billion last year but is offering staff just 1per cent. Unite has branded the offer an “insult” to the workers who risked their lives at the height of the pandemic and continue to put themselves at risk.
Staff are also fighting back against the draconian use of the company’s sickness and disciplinary policies, bullying by management and unmanageable workloads.
Unite is balloting ancillary staff including cleaners and porters across Royal London Hospital, Whipps Cross and St Barts. The ballot opened on Monday 8 November and closes on December 8.
Tuesday 12th October 2021
Keep Our NHS Public
- Commons Covid Report is damning, but a wasted opportunity to learn urgent lessons
The House of Commons Health and Social Care, and Science and Technology Committees joint report Coronavirus: lessons learned to date was published 12 October. Despite outlining some mistakes in the Government’s early response, which will surprise next to no one, the report and the spin on it rests most of the blame on public health bodies rather than the Government, and of course Prime Minister Boris Johnson gets off almost scot-free.
While recognising failure on the ‘serious mistake’ of halting mass testing in March 2020 for example, on the fatal error of delaying the first lockdown, the report makes evasions and excuses:
‘This slow and gradualist approach was not inadvertent, nor did it reflect bureaucratic delay or disagreement between ministers and their advisers. It was a deliberate policy – proposed by official scientific advisers and adopted by the governments of all of the nations of the UK.’
Despite being critical of aspects of the Government’s response the report is nonetheless a whitewash covering up the worst political failures of this Government. The two chairs are Conservative MP Jeremy Hunt, who served as Health Secretary from 2012 to 2018, and Conservative MP Greg Clark. As the reports’ co-lead Jeremy Hunt is predictably providing cover for his own role in the years leading up to the pandemic. As Secretary of State for Health, Hunt sank the NHS into a crisis which left it and the population totally exposed when the pandemic arrived – leaving the problems of insufficient staff (100,000 hospital vacancies and a shortage of over 7000 GPs), a lack of hospital beds and equipment, insufficient ventilators, crumbling NHS estate, depleted public health and low morale. He also failed to act on the pandemic planning Exercise Cygnus 2016 and claims not to have even been aware of the Exercise Alice, also in 2016, into coronavirus pandemic planning. All explained away neatly:
‘The NHS responded quickly and strongly to the demands of the pandemic, but compared to other health systems it “runs hot”—with little spare capacity built in to cope with sudden and unexpected surges of demand such as in a pandemic.‘ [para 63]
Being the sugar-coated whitewash of the Government’s historic handling of the NHS it is, this report is a wasted opportunity to learn the essential lessons and save lives. But that’s not the intention here, this is little more than a political manoeuvre by those desperate to cover their tracks. The political failures responsible for 10s of 1000s of avoidable deaths are buried.
The report only acknowledges what is already undeniable: this has been ‘one of the UK’s worst ever public health failures. It provides partial explanations: ‘Groupthink’ amongst government advisors and ministers, attitudes of ‘British exceptionalism’, a deliberately ‘slow and gradualist’ approach, based on totally inappropriate use of ‘herd immunity’ theory. Fatal inaction and delays meant that the UK fared ‘significantly worse’ than other countries. The report points to ‘major deficiencies in the machinery of government’, with public bodies unable to share vital information and scientific advice impaired by a lack of transparency, input from international experts and meaningful challenge. (Guardian 12 October 2021)
Hiding political failures behind science and medical successes
Hunt and the report bend over backwards to say that the problems caused by ‘groupthink’ were balanced by the success of the vaccine and the medical advances developed in Britain. By doing so he provides cover for the political failures of both Johnson’s government and his own tenure as Secretary of State before the hapless Matt Hancock took over in 2018.
On the Today programme Hunt talks of how ‘groupthink’ assumed that the pandemic was like a flu virus, and makes it almost understandable and forgivable. With this virtual absolution to Government, he conveniently absolves himself too in his previous role as Health Secretary. And he has insulted bereaved families by describing the pandemic as a ‘game of two halves.’
Ignoring bereaved families’ experience
Hannah Brady, of the Covid-19 Bereaved Families for Justice group, is completely right to criticise the report. It provides a whitewash for the Government’s culpability. The responsibility for the horrific reality of the deaths of 150,000 people is “redeemed” by the success of the vaccine programme and the medical treatments developed in the UK. As she says:
‘The report … is laughable and more interested in political arguments about whether you can bring laptops to Cobra meetings than it is in the experiences of those who tragically lost parents, partners or children to Covid-19. This is an attempt to ignore and gaslight bereaved families, who will see it as a slap in the face.’
Lessons still to be learned
Our People’s Covid Inquiry took the opposite approach and heard testimony from bereaved families, frontline staff and expert scientists and clinicians. By so doing, our inquiry addressed the catastrophic death rate and the disastrous effect on the BAME population, zero hours workers, frontline staff, on children’s education and mental health, and the economy – and the catastrophic policies that had left the NHS, public health, and social care so vulnerable to failure.
It is unforgivable that the government pursued the herd immunity argument to protect the economy. The Government must be held to account for the combined outcome: one of the worst levels of avoidable deaths, the worst economic impact of the OECD countries, and one of the worst examples of profit-taking as Government cronies and political contacts and hundreds of private companies benefited from the country’s worst public health disaster.
On 7th of July this year, our People’s Covid Inquiry released what we called our ‘Manifestly obvious and requiring urgent action’. In it we outlined 7 urgent recommendations:
That established public health measures, supported by the World Health Organisation, and known to be effective in lowering everyday risks, be urgently implemented in the UK, including:
(a) effective find, test, tract, isolate services with economic support for isolation and quarantine.
(b) based in local public health and local authorities in liaison with an effective national public health system
(c) with effective protection against aerosol transmission by the wearing of masks and sensible social distancing in enclosed indoor spaces
(d) employment of strict border measures for infection-control purposes
That medium to long-term health policy addresses social inequality, including overcrowding, poor quality housing, food insecurity, investing in recovery that tackles the root causes of health inequalities including:
(a) integrating health considerations into future housing and urban development with healthy housing and equitable access to public spaces for safe physical activity for travel or leisure to build future resilience
(b) providing and regulating guidelines to ensure adequate ventilation in enclosed spaces, notably workspaces and schools
That the UK fulfils its international obligations to prevent the spread of disease by ensuring global distribution of vaccines and support for technology transfer and IP waiver, and by the termination of vaccine nationalism.
The pandemic provides both rationale and opportunity to invest in the NHS and a public sector health and care service that could once again be the envy of the world; the UK did this in 1948 and can lead the world again now. This investment includes not only hospital beds, but the workforce, primary care, diagnostic labs, social care, and public health). We do not dismiss the private sector, but to promote it in favour of the public sector does the nation a huge disservice and weakens us for the future.
That it is possible, and urgent, to restore and grow NHS capacity and NHS staff morale with a statement of commitment to public services, backed up by urgent real terms restoration of level of funding to expand the NHS workforce and reinvigorate the publicly provided NHS and its workforce.
That the previously universally admired performance of the NHS can be restored if the Government ends its policy of bypassing and undermining public services in favour of contracts to the private sector on procurement and to provide clinical services for NHS patients in place of NHS provision.
An independent public Judicial Inquiry is needed now.
The joint House of Commons Health and Social Care, and Science and Technology Committees report still falls staggeringly short of these manifestly obvious recommendations.
The People’s Covid Inquiry report will be published soon. Meanwhile all our evidence is available hereRead more ...
Monday 11th October 2021
HCT News Bulletin #12
- Safety crisis in maternity services
Queens Hospital in Romford and Walsall’s Manor Hospital have become the latest in a growing list of maternity units to be sharply criticised by the Care Quality Commission over safety issues, often linked with bullying and poor management culture.
In August the Healthcare Safety Investigation Branch reported that its investigators had started 760 investigations in the year to March 2021 involving incidents at 125 NHS trusts and made more than 1,500 safety recommendations.
The CQC has previously warned that more than four in ten maternity units in England need to improve their safety.
Last December the Ockenden report on long-standing failures in maternity care in Shropshire highlighted seven immediate and essential actions:
* Enhanced safety – increasing partnerships between Trusts and local networks
* Listening to women and their families
* Staff training and working together
* Robust pathways for managing complex pregnancies ensuring an agreed criteria for cases to be discussed/referred to a maternal medicine specialist centre
* Risk assessment through pregnancy at each contact with services
* Monitoring foetal wellbeing – Maternity services must appoint a dedicated Lead Midwife and Lead Obstetrician both with expertise to practice best foetal monitoring
* Trusts must ensure women have easy access to accurate information to enable informed choice.
The mounting crisis has come as the government is facing mounting calls to invest more money in maternity services. NHS England has increased spending this year by £95m.
Half of this money (£46.7 million) will go towards creating around 1,000 midwifery posts, £5 million to support recruitment from overseas, £26.5 million towards multidisciplinary training for existing and £10.6 million will go towards increasing the obstetric workforce.
Royal College of Midwives chief executive Gill Walton welcomed the extra funding while underlining the scale of the problem:
“This is a substantial investment and something the RCM has been campaigning on for many years. It will be a significant boost for our under-resourced and under-staffed maternity services.
“It acknowledges that they simply could not have continued ensuring safe, high quality care with the pressures and demands they are facing. Most importantly, it will lead to safer and better care for women, babies, and their families.” Read more ...
- Millions missing out on mental health services
Up to 1.5 million people may be waiting for mental health treatment but are yet to receive it as a result of the impact of coronavirus, according to new NHS England Planning Guidance.
Meanwhile shocking new survey figures from NHS Digital also show there has been a significant deterioration in mental health for children and young people since 2017, with one in six (17.4%) of children aged 6-16 suffering from a mental health disorder in 2021, up from one in nine (11.6%) in 2017.
17.4% of 17-19-year olds also reported mental health problems in 2021, up from one in ten in 2017. Almost 40% of 6-16s had suffered a drop in their mental health since 2017, compared with 53% of 17 year-olds.
The proportion of 6-16-year old children with eating disorders almost doubled from 6-13%, while the proportion of 17-19 year olds rose by a third from almost 45% to over 58%.
Meanwhile a parliamentary question from Labour’s shadow health secretary, Jonathan Ashworth, has extracted figures from the Department of Health and Social Care on the continued level of out of area placements of mental health patients.
They reveal 7,040 out of area placements (OAPs) in England between April 2020 and this April, with 645 last October – and 695 people in April 2021. 175 of these placements involved patients being sent between 62-125 miles from their home area, 135 involved distances between 125-184 miles and in 45 cases the person ended up 184 miles or more away.
The OAPs are a reflection of inadequate provision of NHS beds after more than a decade of decline. Just 18,303 mental health beds were available in England in April-June 2021, a reduction of 5,200 (22%) since 2010, while occupancy rates increased sharply from 82% at the beginning of this year to 87% in April-June, close to pre-Covid levels.Read more ...
- Javid goes the full Thatcher - threatens to sack NHS bosses
Egged on by the customary extreme prejudices of his audience at the Tory conference in Manchester, Health Secretary Sajid Javid has revived the malignant spirit of Margaret Thatcher, whose picture adorns his office wall.
At a fringe meeting, after eleven brutal years of real terms cuts in NHS spending, he insisted that governments must stop “throwing cash” at the NHS, and that “there have to be . . . some significant reforms that make that money go a lot further.”
He followed up by a conference speech echoing Thatcher’s infamous statement that “there is no such thing as society” – arguing that people need to take responsibility for caring for their elderly relatives and “stop looking to the state to provide”. People need to ask “what I can do to help my own family?” before calling on government provision
And having called in a retired General to conduct a “review” of NHS management, the Times reports he is also preparing new powers to sack managers and seize control of poorly performing hospitals.
In yet another reincarnation of failed Thatcherite policies from the 1980s he also plans to invite “business people and other outsiders” to run hospitals.Read more ...
- Health and Care Bill the issues summed up
New legislation to reform the NHS for the second time in a decade is being pushed through Parliament.
Opposition parties, unions, campaigners and think tanks and some Conservatives continue to express concerns at the Health and Care Bill and its consequences, noting that it will divert NHS management time and energy, and says nothing about the crisis in staffing or the dire state of social care.
The Bill would give 138 new powers to the Secretary of State, including controversial powers to intervene in local reconfiguration plans, and in the regulation of health professionals – which many fear could result in deregulation and a dilution of the skill mix in the NHS workforce.
Trade unions have welcomed the Bill’s proposals to repeal the controversial Section 75 of the 2012 Health and Social Care Act (which requires clinical services above an annual cost of £600,000 to be put out to competitive tender) – though the law has been widely ignored, with only 2 percent of clinical contracts tendered this way.
The unions want to go much further, to end tendering for non-clinical services, and to make the NHS the default provider when contracts expire.
They also want to ban trusts and ICSs from establishing “subco” companies (whether to dodge tax, escape national pay agreements or avoid scrutiny), and tight regulations on procurement to prevent the award of crony contracts without competition or scrutiny, like too many contracts during the peak of the Covid pandemic.
NHS England argues that the Bill is about giving legal status to 42 Integrated Care Systems (ICSs) which will replace the Clinical Commissioning Groups established by the 2012 Act.
The ICSs are described as “new partnerships between the organisations that meet health and care needs across an area.”
However, ICSs are far from local: they range in size from 500,000 to 3.2 million population. 26 cover a million or more, and the largest covers a huge coast to coast area in the North of England.
Such large and remote bodies threaten a drastic reduction in local accountability and reduced ability to defend threatened services, with some ICSs already facing massive financial problems from the outset.
NHS England guidance emphasises the ‘principle of subsidiarity’, with ‘place-based’ decisions taken “as close to local communities as possible”: but there is no mention of ‘place’ or ‘subsidiarity’ in the Bill, which allows each Integrated Care Board (ICB) to decide its own constitution.
ICB chairs – appointed from above by NHS England – are not locally accountable at all. With ICB budgets larger than those controlled by most elected Mayors, the argument for ICB chairs to be elected is also a strong one.
All ICB business should be in public, and subject to the Freedom of Information Act.
The Bill doesn’t require ICBs to include representation of mental health, public health, patients or public.
Minister Edward Argar has committed to amend the wording to exclude the possibility of “individuals with significant interests in private healthcare” from sitting on ICBs, although the Bill does not mention committees, and specifically permits private sector involvement in the advisory Integrated Care Partnerships.
With some concessions made already, and ministers tight on time to get the Bill through and establish ICBs on a statutory footing from April, there may be a chance for MPs and Lords to support many more amendments to address the Bill’s serious flaws.
These should, above all, seek to:
n Prioritise fuller representation on ICBs and ‘place-based’ decision making and accountability to local communities, rather than extending new central powers to the Secretary of State.
n Fully reintegrate the NHS by establishing NHS trusts and FTs as default providers whenever contracts expire, and excluding private sector interests from all NHS decision-making bodies.Read more ...
- Fantasy hospital plans compete for imaginary cash
Extravagant schemes are being unveiled in hopes of being selected as one of the additional 8 ‘new hospital’ projects to be announced next spring, even while all eight of the government’s top priority plans for new hospitals at a standstill.
They are under instruction to submit cheaper plans costing no more than £400m apiece.
But the ‘Act as One’ health and care partnership that covers Bradford District and Craven has come up with a literally fantastic plan – for THREE new hospitals costing £1.7 bn.
Their plan includes rebuilding Airedale Hospital in Steeton as Europe’s first carbon neutral hospital; a new mental health facility to replace the Victorian era Lynfield Mount hospital in Bradford; and a new single site hospital bringing together Bradford Royal Infirmary and St. Luke’s Hospital.
The three schemes have not been costed separately but have each also been put forward individually, in case the whole scheme doesn’t make it onto the list. But remarkably not one of the council or NHS chiefs quoted in the announcement showed any awareness of the tightening financial squeeze on NHS capital.
Bradford’s monster plan has to compete with a £500m plan to replace Stockport’s Stepping Hill Hospital, which has a £95m backlog maintenance bill, and the £663m plan to replace Leighton Hospital in Crewe, which is run by Mid Cheshire Hospitals Foundation Trust – and in danger of falling down, as another victim of defective concrete planks in its structure.
Kettering hospital chiefs have boldly submitted the case for investment of “up to £765m” – to fund “the first three phases” of a £1bn-plus 5-phase scheme.
Bolton Foundation Trust seems to be an exception, having submitted a plan for a £252m first phase rebuild of Bolton General Hospital, citing high and significant risk backlog maintenance bills of £165m.
Among the prioritised “pathfinder” schemes the dreams are becoming more elaborate, with Barts Health developing plan for “Future Whipps” – a new Whipps Cross “hospital in a garden”, with lovely drawings but absolutely no costings included.
And from the original “fake forty” Imperial College Healthcare has optimistically submitted its Strategic Outline Case for rebuilding St Mary’s Hospital in Paddington, including 840 and “new, user-centred clinical facilities across three main hospital buildings”. They also want to develop a clinical life sciences cluster on the land freed up, “in partnership with industry and research”.
The scheme is estimated to cost “£1.2-1.7 billion net, once receipts from the sale of surplus land are taken into account” – in other words 3-4 times more than the £400m limit being imposed on the eight pathfinder schemes.
While architects are doing very nicely from this boom in fantasy projects it’s not clear how many – if any – of these dreams will come true in the harsh world of Rishi Sunak’s looming spending review.Read more ...
- Another redisorganisation under way
The Health and Care Act has begun its parliamentary journey, being examined line by line in a Committee of 10 Conservatives but only 5 Labour members. Some early themes are emerging.
This is not like 2011 with major lengthy arguments; this is more like the examination of secondary legislation with the Minister outlining things and the opposition raising questions and trying to suggest changes.
Although Labour, and others, in the Committee have put down multiple amendments it is obvious that none of these will be passed. But it is likely there will be many government amendments when the Bill passes to the next stage in the Lords.
In the areas that came from the largely consensual proposals from the NHS itself there have still been attempts to clarify and to strengthen the protections. The Minister has agreed to consider matters and has given some verbal and written assurances.
In the areas that came from the attempt at more Hancock (greater powers for Ministers) there is not much enthusiasm and a strong expectation of a retreat from the worst aspects – such as the truly daft idea of the Secretary of State becoming involved in every proposed change to any service anywhere - however minor.
Some reassurances have been given that signal there will be no role for private sector interests in the new NHS commissioning bodies; that the new bodies will be fully open and transparent; that the new structures do not have any impact on the (historic) roles and responsibilities of the Secretary of State as regards the comprehensive NHS; that the new funding and oversight arrangements at local level introduce no new powers or constraints; that there is no intention to vary the national staff agreements, or the already agreed transition arrangements; and there will not be any ability to award contracts without a proper process. Time will tell.
Areas of most concern remain over the continuing ability to contract out cleaning, catering, and other similar “non clinical” services which should be central to the NHS itself; about dodgy major national framework contracts for private providers; about who gets to appoint or elect the key Chairs and Board members; and about the actual makeup of the decision making bodies and how they are held accountable – especially ensuring a strong role for staff, patients and public.
Amendments rather than warm words and reassurance will be required especially in these areas.
The major contradictions in the Bill between what is flexible and what is imposed; between what decisions are local and what are national; between autonomous bodies like Foundation Trusts and a duty to cooperate; and even who decides what, all remain less than clear. A great deal depends on guidance that will be issued after the Bill goes through.
The NHS appears to be seeing the end of competitive tendering for most services. This Bill does reverse the Lansley version of markets and competition. Campaigners can rightly say ‘we told you so’ – and take credit that not only were the Lansley ideas never actually fully implemented, they are now being abandoned as counterproductive. However this does not prevent privatisation continuing– and even increasing – by other means.
Not about integration
This is a Bill to redisorganise the NHS; it is not about integration, improving services or better accountability.
It is not only the wrong Bill at the wrong time it is also a major wasted opportunity.
The new Integrated Care Boards are just larger CCGs (without the role for GPs); and the new Integrated Care Partnerships (which will not come into much prominence until long after the ICBs are running) are just bigger Health and Wellbeing Boards – with no powers at all.
How any “place based” structures will work is wholly unknown.
Ending competitive tendering for clinical services must be welcome with or without the explicit statement that the NHS is the default provider – but little else of value is going to come out of this Bill.
It is just more displacement activity as with the recent attacks on GPs and the suggestion that NHS Leadership is in need of reform.
What our care system – including social care – needs is some stability, more funding and long term investment and a focus on the workforce.Read more ...
HCT News Bulletin No 12
- £7m in a year wasted on failed Cornish project
Cornwall Partnership Foundation Trust squandered £7 million on just over a year of a consultancy project that was supposed to yield savings by reducing the numbers of older patients (65+) needing hospital care.
The consultancy firm was Oxfordshire-based Newton Europe, which describes itself as “a specialist in operational improvement, fuelled by a fundamental belief that even the best organisations can be better.”
The HSJ has revealed that ‘Embrace’ project was launched in the spring of 2019 and suspended in late March 2020 because of the pandemic “but before the implementation phase”. It restarted in September 2020 but was abandoned the following month, when Newton Europe’s role ended.
The trust board acknowledges that the project has delivered “no tangible savings.”
Newton Europe’s website boasts “we guarantee our fees against delivering results:” but having trousered a cool £7m they will have been laughing all the way to the bank.Read more ...
HCT News Bulletin #12
- Boots train up pharmacists to cash in on GP crisis
Readers of the Times, which has criticised GPs for allegedly failing to see sufficient numbers of patients face to face, may have been confused on October 5 to find an article citing research showing evidence of the value of patients having the same GP for years.
The catch was, of course that the research is from wealthy Norway, where the 4,708 GPs studied had an average of just 1,113 patients on their lists – around half the average list size of the dwindling number of GPs in England.
GPs driven out
More hard-working GPs and practice support staff are being pushed towards early retirement or alternative employment by the public abuse and hostility whipped up by the far right using so-called ‘social media’ and coverage in the Times, Telegraph, Daily Mail and other rags that select information to give the impression GP practices have remained under lockdown.
More fuel to the reactionary fire has been added by comments from Boris Johnson and Sajid Javid, while NHS England has shown no inclination to rally to their defence.
In fact GPs delivered a near 10% increase in appointments during August this year compared with the same period pre-pandemic in 2019, increasing from 23.3 to 25.5 million.
And while the proportion of consultations on the phone or online has increased from around 20% in the first week of March 2020 to 42%, many patients have found they can get the response they need from GPs without travelling or waiting in crowded surgeries – and they prefer to do so.
The pressure on GPs is increased by the lamentable failure of successive health secretaries to make good the promise of 6,000 extra GPs in post by 2024: instead there are 1,904 fewer fully qualified staff in post than there were six years ago, while the pressures on them have increased.
Now Boots, the high street chemist chain owned by US stores giant Walgreen has spotted the chance to profit from the problems of primary care.
They plan to train up pharmacists to work as PIPs (“pharmacist independent prescribers”) offering appointments for patients with minor conditions who can’t get to see a GP as quickly as they want … and can afford a £15 fee.
“Rather than wait two weeks to see a GP, people can get immediate diagnosis, treatment and medication for the price of a Nando’s,” Boots chief executive Seb James told The Sun.
With plans to install a PIP in each of Boots’ 2336 stores across the UK, prescribing and dispensing could be a nice little earner for the company … establishing a 2-tier system in primary care.
Green light for Torygraph distortions
Meanwhile the “Independent Press Standards Organisation” (IPSO) has ruled that the Telegraph did not breach the Editor’s Code by publishing anti-GP columns from right wing hack Allison Pearson that presented wilfully distorted information, since the articles were “clearly distinguished as comment pieces by their style and tone and have to be considered in that context.”
The Doctors’ Association UK (DAUK), which complained in September about the articles, has lodged an appeal against the IPSO decision. Meanwhile right wing rabble rousers have the green light to incite even more ignorant rage against GPs and the NHS as a whole.Read more ...
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