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Friday 7th December 2018

Hands off HRI

  • Public Statement from Hands Off HRI re CHFT Press Release

    “The Calderdale and Huddersfield Trust has now confirmed their intent to use government funding to transfer all acute and emergency care to Halifax.

    "Hands Off HRI is demanding that the 2017 Final Business Case, which originally planned to close our A & E and Huddersfield Royal Infirmary, is completely withdrawn. It is clearly now dead in the water.

    "The allocation of £196.5 million from the government is to carry out the Trust’s furtive plan to transfer all acute and emergency treatment to Halifax, which will be opposed by our campaign. It is time for the Trust to come out into the open and be honest about its proposals. 

    "They MUST begin a full and open public consultation about the next steps for health provision in Huddersfield. 

    "Experience has taught us we just can’t trust these hospital bosses to be straight with the people of Huddersfield and Halifax.

    "They claim to be saving A & E, but in reality, we would be left with a walk-in centre and a hospital dealing with rehabilitation and non-urgent care. Everything else will be transferred along the Elland By Pass to Halifax, with all the huge problems that will cause.

    "Our fight will go one including and up to a further legal challenge if that is what it takes.”

Thursday 6th December 2018

Richard Bourne

  • Creating Subsidiaries - Be Afraid

    After an amazingly fast analysis of responses to its consultation NHS Improvement have decided on some changes to the way NHS Trusts and NHS Foundation Trusts can set up subsidiary companies or WoCs – Wholly Owned Companies. 

    They offered some dubious justifications about why they might be needed but did not mention that these claims have been disputed.

    It appears that NHS improvement did not carry out this laughably inadequate consultation because of all the concerns about the 35 or so WoCs recently created for tax avoidance and to undermine national terms and conditions. Some of these led to disputes and even industrial action and a great deal of criticism. 

    But what has now been published is actually about clearing the way for more WoCs, expanding the scope into new areas. More fragmentation and more attacks on terms and conditions. A big step backwards. Get ready for the next round.

    Little or no effort was made to reflect the criticisms levelled at the recent WoC formations which were carried out in secret, without consultation, gave dishonest justifications and had the clear aim of gaining tax advantages and the bonus of allowing staff to be employed on worse terms and conditions. 

    These were just nodded through by NHS Improvement who also with their performance role were actively encouraging WoC formations to try to deal with the huge deficits.

    There is no positive side to explore as there should be no circumstances where creation of a WoC is better than in house provision. But it appears that some of the worst excesses of the last 18 months may be tightened up.

    Some Foundation Trusts appear to be very conscious of their “autonomy” and argued that they have the power to set up a WoC whether NHS Improvement like it or not. The claimed autonomy and independence is undermined when they have to rely on public funding to bail out their deficits or subsidise their terrible PFI deal – autonomy goes only so far. 

    In future all proposals to form a WoC will have to be subject to some kind of scrutiny. There must be some evidence of engagement with the workforce which was has been notoriously absent in most WoC set ups so far. 

    Trusts must now actually provide Business Cases, set out what alternatives have been evaluated and look at risks in a structured manner. The benefits cannot depend on tax changes, although in theory that was already supposed to be the case! 

    And there is a need to show how the WoC can attract and retain staff in the longer term – which may bring the divisive two-tier workforce approach into question.

    A few “Business Cases” for previous WoCs have made it into the public domain despite strenuous efforts to keep them confidential. They are very poor and do not actually qualify as any kind of case for change – they argue for business as usual with tax advantages. 

    Around 90% of the benefits they identify are from tax changes. None of this attracted any attention in the review by NHS Improvement.

    Despite some caution there is to be no requirement for any independent expert scrutiny or cases and no publication of any assessment that does get carried out.

    And the major disappointment is that there is not going to be any effort to go back and examine previous WoCs and the extent to which they would have met any reasonable criteria for approval.

    If anyone hears the sound of one hand clapping … 

    Read more ...

Tuesday 4th December 2018

PDA Union

  • Safer Pharmacies

    The latest organisation to join Health Campaigns Together is the PDA Union. PDAU were established by members of the not-for-profit Pharmacists Defence Association just over ten years ago and are now one of the 25 largest independent Trade Unions in the country with over 28,000 pharmacists, pharmacy students and trainees as members. Pharmacists are located in hospitals, primary care, academia, manufacturing and the majority permanently employed or working as locums in community pharmacy.  PDA Union members are spread across the entire sector throughout the UK. 

    Medicines are the second biggest line of NHS expenditure and Community pharmacists are delivering NHS services in almost 15,000 locations across the UK, yet this part of the health system was not nationalised when the NHS was created and the chemist shops on our high streets remain almost entirely private businesses. This means these health professionals find themselves trying to deliver patient care while employed and managed by retailers whose priority is profit. It is a challenging environment. The largest dozen employers own more than half of the sector, and the largest multiple, Boots has around 2,500 pharmacies. The union have a recognition campaign at Boots: https://www.the-pda.org/boots-recognition/ In June 2018, Boots Pharmacists became the only workers to ever remove a sweetheart union deal, when they voted in a derecognition ballot. Now they must vote again to secure PDAU recognition

    One of the PDA Unions’ long standing campaigns is to prevent what is known as “remote supervision” where pharmacists would not be present in the pharmacy and yet medicines would still be dispensed. The union say that treating dispensing as a commercial transaction between customer and retailer, rather than between patient and qualified health professional would end in patient harm.  Last year, leaked papers from a government appointed board revealed that this had been discussed, though denials followed and no such formal proposal has yet been announced. The union have recently given their backing to a petition to oppose such steps: https://petition.parliament.uk/petitions/230192

    Another significant PDA Union initiative is the development of a Safer Pharmacies Charter, which has already been endorsed by the UK Labour Party, USDAW and others. The charter defines basic standards to ensure safe practice wherever pharmacists work, yet there has been some resistance to the charter from the owners of community pharmacies. You can register your support for the charter here: https://www.the-pda.org/safer-pharmacies-charter/

    The PDA Union would welcome support for their campaigns and involvement in any issues that impact on pharmacy. 

    Read more ...

Saturday 1st December 2018

Samantha Wathen, Press and Media Officer, Keep Our NHS Public

  • Hancock risks breaching ministerial code, backs Babylon and rejects science

    The last couple of weeks have not been easy for health secretary Matt Hancock. Last week he included trainees and part time workers in the figures for GP recruitment in an attempt to dress them up as rising. Many publicly called him out on this falsehood – a cursory glance at the available numbers immediately proved him wrong. His assertion was withdrawn, but the distrust from members of the public and those in the NHS going forward will be less easy to repair.

    Breach of ministerial code?

    Earlier this week the health secretary extolled the benefits of technology in the NHS, in an interview published in the London Evening Standard supplement, paid for by private health company Babylon. Hancock’s photograph appeared next to the company’s logo as he maintained:

    “The first thing we’ve got to do is make sure that the basic data and infrastructure for the NHS is so much better. But there is enormous excitement for the long term — if we get those underpinnings right — to use AI and genomics and the increasing amount of data about how people live their lives to learn how people can stay healthier for longer and then also be treated better when they become ill.”

    Hancock has proudly and publicly made known his allegiance to the “brilliant” app GP at Hand, answering some of his first questions in parliament by saying how convenient being signed up was for him. A government minister should not be publicly endorsing a private company in this way and last night the Labour Party wrote to the Prime Minister demanding an investigation into an alleged breach of the ministerial code. It will be very interesting to see how this all plays out.

    It’s all about trust

    After news outlet Buzzfeed asked questions around the Secretary of State’s endorsement of Babylon, the branding was withdrawn from the online news article. This follows the same pattern in that fundamental trust in the health secretary is being eroded. When Hancock replaced Hunt a few months ago many were hopeful of more transparency; yet this minister with links to pro-privatisation lobbyists the Institute for Economic Affairs (IEA) was always going to be a concern, no matter how many night-shifts he shadowed.

    As we have previously reported, private company Babylon’s GP at Hand application has faced fierce criticism from health campaigners and clinicians alike. It’s often-dubious algorithms have been called out as potentially dangerous, and the way it ‘cherry-picks’ the fitter patients away from struggling NHS primary care practices deprives them of much needed funding paid per patient. Signing up to the service also de-registers patients from their regular GP practice. Patients are left in a very vulnerable position without comprehensive access to a physician for more complex cases.

    The Science is clear – GP at Hand is heavily criticised by The Lancet

    Private digital health company Babylon launched its GP at Hand service in partnership with the NHS in November 2017, yet until June there had been no trialling of its effectiveness. Letting a private company seeking to make a profit loose upon vulnerable patients is ill-considered at best, and at worst irresponsible. However, health secretary Matt Hancock has a penchant for digital technologies and seems to regard them as a one-size fits all strategy for the future of the NHS. Now though, respected medical journal The Lancet casts serious doubts upon the validity of this application and potentially raises questions therefore about all technology which operates in a similar vein.

    Babylon’s own trial

    The issue with Babylon’s GP at Hand (aside from the concerns over private companies encroaching into NHS provision) is that their methods had not been independently tested, trialled or researched prior to implementation. In June Babylon conducted its own trial into the reliability of its user interface. The results were positive for the company and they maintained, fair. However, there were a number of flaws to their testing. The trial was conducted internally which left it wide open to an obvious bias and the results were published in a non-peer reviewed journal (arXiv.org) so results are not open to critique. In the journal abstract Babylon maintained that:

     “We found that the triage advice recommended by the AI System was, on average, safer than that of human doctors, when compared to the ranges of acceptable triage provided by independent expert judges, with only a minimal reduction in appropriateness.”

    Babylon tested the app using diagnostic questions from trainee GP exams and reported that its AI scored 81% compared to an average mark for real-life doctors of 72%. The Royal College of General Practitioners (RCGP) said the claims were ‘dubious’.

    The Lancet’s findings

    On 6th of November, The Lancet published its findings on the service – the first peer-reviewed paper on the subject; and they are pretty damning. Authors Hamish Fraser, Enrico Coiera and David Wong maintained of Babylon’s trial:

    “…the results…were met with scepticism because of methodological concerns. In particular, data in the trials were entered by doctors, not the intended lay users, and no statistical significance testing was performed. Comparisons between the Babylon Diagnostic and Triage System and seven doctors were sensitive to outliers; poor performance of just one doctor skewed results in favour of the Babylon Diagnostic and Triage System.”

    For a new service providing access to healthcare to really be credible it must be independently assessed and reviewed. Without such a process it will never be trusted or respected by medics and this trust is crucial to the long-term establishment and survival of such an intervention. Doctors and academics are rightly sceptical of a private company that seeks to make a profit at the expense of established GP practices and is too scared to open themselves to proper scrutiny or trusted academic processes. The Lancet states:

    “Babylon’s study does not offer convincing evidence that its…Diagnostic and Triage System can perform better than doctors in any realistic situation, and there is a possibility that it might perform significantly worse… Further clinical evaluation is necessary to ensure confidence in patient safety.”

    Indeed, as its parting comment The Lancet remarks how, far from being the saviour of the NHS, new technologies which are not first subject to proper and rigorous testing may have the opposite effect in actually becoming a burden on the service through irresponsible practice:

    “There is currently minimal regulatory oversight of these technologies. Without such structure, commercial entities have little incentive to develop a culture that supports peer-reviewed independent evaluation… Symptom checkers have great potential to improve diagnosis, quality of care, and health system performance worldwide. However, systems that are poorly designed or lack rigorous clinical evaluation can put patients at risk and likely increase the load on health systems.”

    Despite these findings in the respected Lancet, there has been no announcement that the application is to be curbed, looked into further or indeed withdrawn. It is clear that apps (and particularly this one powered by Babylon), are in no way the answer to the current crisis caused by underfunding and government neglect, there is no such thing as a quick fix. Their rapid roll-out without due diligence and proper scrutiny sets a worrying precedent in terms of all future technological development that may be planned in the NHS.

    Read more ...

Thursday 29th November 2018

Shropshire Defend Our NHS

  • Shropshire trust rated 'inadequate'

    November 29 at 1:00 AM

    Shrewsbury and Telford Hospitals Trust (SaTH) rated ‘Inadequate’. That’s the conclusion of the Clinical Quality Commission’s report published today.

    ‘Inadequate’ is the CQCs lowest rating which shows just what a crisis SaTH are in. The report lists 164 ‘areas for improvement’ where the Trust must act. The areas where failings have been exposed include urgent & emergency care, medical care, surgery, critical care, maternity, and end of life care.

    But the main failure is that of leadership at all levels. The report does not blame the front-line staff. The overall quality of care that they provide is rated as ‘Good’. It’s just that they are not allowed to work in a safe environment.

    Some of the findings: “Not all trust leaders had the skills and abilities to run a service providing high quality sustainable care”; “Staff reported a culture of bullying… and a culture of defensiveness from the executive team”; Staff “were sometimes fearful to raise issues and concerns.”

    With advance warning of the CQC report, SaTH have managed to remove Edwin Borman as Medical Director before publication, so they can claim changes are being made. But there is one change they haven’t made. The failures of leadership start at the top. Chief Executive Simon Wright needs to go. He needs to be replaced by someone who is less concerned with balancing the books than with improving and safeguarding patient safety.

    And we need to abandon the Future Fit reconfiguration.

    Remember all the talk about it being designed by clinicians. Well it’s the same clinicians who designed Future Fit that are being criticised in this report.

    Remember Mr Mark Cheetham, a Medical Director for Surgery. He was a very visible advocate for Future Fit during the consultation process running, amongst other things, the Twitter Q&A sessions. He was also a member of the original clinical design team for Future Fit. When the CQC asked the question is the Surgery service well led, their answer was No.

    Future Fit is a cuts programme. The concentration on cutting costs has led to this crisis in care. We need a new leadership in the trust. And we need adequate funding. Special measures won’t give us that. We need Government intervention – more funds, additional staff.

    We should see the CQC report as an opportunity for us to take back control – for us to say what we want in local healthcare. And to call on our MPs and elected representatives act on it.

    Read more ...

Monday 19th November 2018

Save Scarborough and District Hospitals

  • Campaign launched to save Scarborough Hospitals

    The Save Scarborough and District Hospitals team held their first public stall today in Scarborough and got a great response from the public.

    Three comrades travelled across from York to support them and were well received. I was there for three hours and well over 300 people signed the petition while I was there.

    The stall was well organised and the conversations with visitors to the stall showed a greater degree of anxiety around treatment than we find in York.

    This is because so many services have already been cut or transferred to York and travelling is a significant burden, but also increases medical complexity.

    The on-line petition against cuts to Scarborough stands at 26,000 and the Facebook page has nearly 13,000 members.

    It is so important that York and Scarborough continue to work together - unity is strength and cuts at Scarborough will negatively affect York. York is already stretched and as new issues emerge it becomes clear that Scarborough is being sold-short by the Trust to the long-term detriment of York.

    If you want to know more call Nigel on 07709684473 or join the Facebook page - Save Scarborough and District Hospitals (link below).

    Read more ...

Wednesday 7th November 2018

Unite the union

  • Vote for Cornwall’s children’s services to remain in-house applauded by Unite

    Cornwall Council’s decision today (Wednesday 7 November)) to keep children’s services in-house, and not to outsource them, has been hailed as ‘a significant victory’ by Unite the union.

    The council’s cabinet voted to adopt the option – outlined in its One Vision blueprint – to keep children’s services in-house from April 2019.

    However, Unite warned that the possibility of parents paying for health visitors to carry out vital health checks on their babies and children still remains as the ‘means tested charging’ wording is in the One Vision document.

    Unite regional officer Deborah Hopkins said: “We welcome the decision of the council’s cabinet to keep children’s services in-house and not outsource them to a separate company.

    “It is a very significant victory for the people of Cornwall and a big set-back for the insidious privatisation agenda.

    “We welcome the council’s announcement that parents won’t be means tested when they require children’s services, such as a visit from a health visitor.

    “However, that possibility is still within the wording of the One Vision framework and until that is finally jettisoned from the document, Unite will be following developments in the weeks and months ahead very closely.

    “Unite is keen to work collaboratively and constructively with the management of children’s services to ensure the best possible outcomes for families and children in Cornwall, which is one of the poorest counties in England.” 

Tuesday 6th November 2018

Unite the union

  • Cornish parents face ‘paying for health visitors’, Unite warns

    A crunch meeting is being held tomorrow (Wednesday 7 November) on the future of children’s services in Cornwall, with the prospect of parents paying for health visitors to carry out vital health checks on their babies and children.

    Unite the union, which has 100,000 members in the health service, said that children’s services will be at a crossroads when Cornwall Council’s cabinet meets tomorrow to discuss it One Vision blueprint. 

    The choice facing the cabinet is between keeping children’s services in-house or a so-called ‘alternative delivery model’ by a company that is separate from the council with the potential to make profits from hard-pressed parents.

    Unite regional officer Deborah Hopkins said: “We are at a crossroads in Cornwall as to how we look after and care for babies and young children. The prospect of means testing for such children’s services, including visits by health visitors, will be an anathema to the vast majority of Cornish people.

    “Even the One Vision framework admits that child poverty is ‘a persistent issue in some areas’.

    “One of the founding principles of the NHS in 1948 is that health services should be free at the point of delivery for all those in need – the proposals in the One Vision document are throwing these principles out the window.

    “We need to have the widest public consultation possible and keep our children’s services in the hands of the taxpaying public and not outsourced to a profit hungry company.”

    The introduction of charging is heralded in the document’s section on Drawing on funding opportunities where one proposal is: ‘Introduce means tested charging for a range of family support services’.

    About 235 health visitors and school nurses are transferring into a Cornwall Council integrated children’s service in April 2019, to work with a multi-disciplinary team, alongside services for families and young people.

    Who runs this service is the crux of tomorrow’s meeting – and Unite is urging councillors to keep the services in-house

    Unite said that managers of children’s services ‘don’t foresee’ families paying for health visitor and school nursing, but there is no guarantee that future charging won’t be introduced.

    The debate about children’s services comes hard on the heels of the recent story of a homeless 17-year-old boy who was bought a tent to live in for five weeks after he appealed to Cornwall Council for help.

    Unite regional officer Deborah Hopkins added: “Cornwall, so reliant on the seasonal tourist trade, is reportedly the second poorest region in northern Europe, so I am not sure where councillors would expect hard-pressed parents to find the cash to pay for a visit from a health visitor.

    “Increasingly, Cornwall Council is relying on private companies to provide services. We believe that the council should jettison these flawed and misguided proposals – our children deserve so much better.

    “We must also ensure that the cabinet makes funds available from copious reserves, to look after our children’s safety and well-being.

    “We are disappointed that no councillor, while facing these decisions, has sought the view of the expert clinical staff providing this care. The council’s cabinet has so much power to improve the life chances of every baby born in Cornwall – that would be best served by the in-house option.

    “It is time that a line in the sand is drawn and the Trojan Horse of children’s services’ privatisation is stopped at the River Tamar.”

    A recent survey revealed that nearly 20 neighbourhoods in Cornwall are among the 10 per cent most deprived in England, according to The Index of Multiple Deprivation.

    In 2006, a Cornish school nurse told a shocked health secretary Patricia Hewitt at the Community Practitioners’ and Health Visitors’ Association conference that she had 9,000 children on her books – today Cornwall is struggling to fill posts in school nursing.

    Unite lead professional officer for the South West Ethel Rodrigues said: “Unfortunately, what is proposed in Cornwall is not unique. Other cash-strapped authorities across England are eroding the provision of children’s services, as they grapple with severe Tory cuts to local government budgets.  

    “The problem is compounded by the dramatic slump in the number of health visitors since the health visitor implementation plan ended in 2015, which we are campaigning to reverse.”

Saturday 3rd November 2018

John Lister

  • A budget for [asset-stripping and forcing savings from] the NHS

    The 2018 budget drew headlines on the "extra" money for the NHS, and especially for mental health (while most other areas of government spending face substantial cutbacks) and the announcement that no further new PFI projects will be signed off by the Treasury.

    Less attention has been paid to the detail of the budget, notably the commitment to raising a massive £3.3 billion from the sale of “surplus“ land and buildings.

    Also contained in the full wording is the warning that funding for NHS pensions is only guaranteed until 2023-4.

    Philip Hammond claimed the cash settlement for the NHS to 2023-4 represents an average real growth rate of 3.4% - 3% when cuts or frozen funding for other parts of health spending (public health, capital costs, education and training etc.) are included.

    This is a further underfunding annually well below the pre-2010 average of 4%. It therefore offers no real relief from the relentless austerity for the past [nine years? if we are going to March 2019] eight years. 

    However the 3.4% figure has already been widely discredited by the analysis of almost every knowledgeable commentator.

    Labour’s Jonathan Ashworth, the BBC and the Health Foundation note that even after the budget, the NHS faces a cut of £1 billion next year, and that funding for public health and the training of doctors and nurses is also set to fall next year.

    The Nuffield Trust’s Sally Gainsbury argues that the total budget for DH will increase by just 2.7% real terms in 2019/20.

    The Royal College of Psychiatrists, while welcoming the positive rhetoric about increased funding for mental health notes that the extra £2 billion over 5 years is well short of the amount needed to increase its share of NHS spending – and actually represents a further reduction:

    “The focus on younger people and crisis services is welcome, but this mustn’t be at the expense of the vital community mental health services which treat so many people with mental illness.”

    New figures for numbers of school nurses who are also key to preventive action on children’s mental health shows a brutal 24.7% cut since the service was transferred to local government in 2010.

    The Labour group on the Local Government Association points out that the extra cash for social care is also a deception :

    “Don't be fooled by the Chancellor's claim of an extra £650m for adult social care - they're also making a £1.3bn CUT to council budgets next year. So overall they're still actually CUTTING £650m! ”

    To make matters worse the budget goes on to spell out the requirements of NHS England’s long term plan, which include restoring NHS providers to financial balance – which means cuts to wipe out £billions in deficits, not to mention £12 billion cumulative backlog of deficits that live on as loans.

    Trusts must also deliver “cash-releasing” efficiency gains of 1.1% a year, despite the fact that the extra money just allocated does not even compensate for 4% annual cost pressures.

    This is a further formula for intensified pressure on all sections of trust staff, and cutbacks in services to deliver cash savings regardless of consequences.

    To quote a memorable statement by Theresa May : “Nothing has changed ”. The austerity squeeze on the NHS and the drive to asset strip and cut back services is unrelenting. 

    Extracts on the NHS from the October 2018 Budget (with emphasis added).


    […] “In the run-up to Spending Review 2019, the BSR [Balance Sheet Review] is similarly looking at how to improve the management of departments’ individual balance sheets.

    For example, the NHS will be generating a £3.3 billion increase in proceeds from selling surplus land and buildings, almost doubling the scale of the investment available to the NHS. 

    DHSC will also publish a cross-government strategy for managing the rising cost of the government’s almost £72 billion of clinical negligence liabilities.“

    2.21 Public service pensions

    Public service pensions were reformed in 2015 and, as part of those reforms, an agreement was reached to maintain their value. Valuations of public service pensions are ongoing, and provisional results indicate that changes will need to be made from 2019-20 to make pension benefits more generous for public servants, including teachers, police, armed forces and NHS staff.

    The Budget confirms a reduction of the discount rate for calculating employer contributions in unfunded public service pension schemes, to 2.4% plus CPI (in line with established methodology to reflect OBR forecasts for long-term GDP growth). The valuations indicate that there will be additional costs to employers in providing public service pensions over the long-term. 

    The government is supporting departments to ensure that recognition of these costs does not jeopardise the delivery of frontline public services or put undue pressure on public employers. For the NHS, as outlined in the five-year health settlement in England in June 2018, the Treasury has made provision for NHS pension costs only until 2023-24.

    [...] The Spending Review next year will settle the funding for costs beyond 2019-20 arising from the valuations.

    6.2 The NHS

    NHS funding – The NHS is the government’s number one spending priority. In June, the government set out an unprecedented multi-year funding plan, with associated cash budgets, for the NHS in England.

    At that time this equated to £20.5 billion more a year in real terms by 2023-24, an average real growth rate in the NHS’s budget of 3.4% a year; taking the NHS budget from £114.6 billion in 2018-19 to £147.8 billion in 2023-24, with a total UK-wide scorecard cost of £83.6 billion.

    The NHS agreed to come forward with a new long-term plan this year, to be agreed with the government. The cash settlement that the government promised in June 2018 is fully funded at this Budget.

    The NHS will deliver its plan by the end of the year, and the government will confirm the final settlement consistent with that plan, and the £20.5 billion real terms increase by 2023-24, by Spending Review 2019. (1)

    This settlement will enable the NHS to plan for its future and support it to deliver the world-class care that people want and expect. It is essential that every pound in the NHS is spent wisely. The government has set five financial tests for the NHS to meet in producing the plan, to ensure that it does its part in putting the health service onto a more sustainable footing. The plan must set out how:

    ·        the NHS (including providers) will return to financial balance

    ·        the NHS will achieve cash-releasing productivity growth of at least 1.1% a year (with a final number to be confirmed in the plan), with all savings reinvested in frontline care

    ·        the NHS will reduce the growth in demand for care through better integration and prevention (with a final number to be confirmed in the plan)

    ·        the NHS will reduce variation across the health system, improving providers’ financial and operational performance

    ·        the NHS will make better use of capital investment and its existing assets to drive transformation

    As also set out in June 2018, the government will consider proposals from the NHS for a multi-year capital plan to support transformation, and a multi-year funding plan for clinical training places.

    The government will also ensure that public health services help people live longer healthier lives. Budgets in these areas will be confirmed at Spending Review 2019.

    Mental health funding – The government is committed to achieving parity of esteem between mental health and physical health services, ensuring that high quality mental health support is available for those that need it, in appropriate, safe settings. Funding for mental health services will grow as a share of the overall NHS budget over the next 5 years.

    These services will take pressure off Accident and Emergency (A&E) departments and other public services such as the police, probation and social services. They will also ensure that people with mental illness can return to, and stay in, work, boosting employment and productivity.

    The NHS will invest up to £250 million a year by 2023-24 into new crisis services, including: 24/7 support via NHS 111; children and young people’s crisis teams in every part of the country; comprehensive mental health support in every major A&E by 2023-24; more mental health specialist ambulances; and more community services such as crisis cafes.

    The NHS will also prioritise services for children and young people, with schools-based mental health support teams and specialist crisis teams for young people across the country. For adults, the NHS will expand access to the Individual Placement Support programme to help those with severe mental illness find and retain employment, benefitting 55,000 people by 2023-24.

    Support for air ambulance trusts – Our air ambulance services work tirelessly 24 hours a day, 365 days a year to get those with life-threatening illnesses and injuries to the expert medical care they need. The government is making available £10 million of capital funding in England to back them in this work.

    Additional social care funding – In the short term, the Budget provides an additional £240 million in 2018-19 and £240 million in 2019-20 for adult social care. This will make sure people can leave hospital when they are ready, into a care setting that best meets their needs. This will help the NHS to free up the beds it needs over winter.

    The Budget provides a further £410 million in 2019-20 for adults and children’s social care. Where necessary, local councils should use this funding to ensure that adult social care pressures do not create additional demand on the NHS. Local councils can also use it to improve their social care offer for older people, people with disabilities and children.

    The Budget provides councils with an additional £55 million in 2018-19 for the Disabled Facilities Grant to provide home aids and adaptations for disabled children and adults on low incomes.

    Children’s social care improvement – The Budget provides £84 million over 5 years for up to 20 local authorities, to help more children to stay at home safely with their families. This investment builds on the lessons learned from successful innovation programmes in Hertfordshire, Leeds and North Yorkshire.

    See also the KONP analysis (link below)


    Read more ...

Saturday 20th October 2018

Bill MacKeith

  • Oxon NHS Campaigners call for privatised service to be brought back into the NHS

    The report by Oxfordshire Healthwatch rightly points out the distress caused since giving Oxfordshire's NHS muscular skeletal services (Physiotherapy and Podiatry to you and me) to a private contractor to run. 

    Very many complaints have been made about Healthshare’s performance: 

    ·      appointments difficult to make, 

    ·      frustrations with contact (phone lines unmanned), 

    ·      letters saying appointments have been missed when patients were not aware they had been given them…,

    The Healthwatch report suggests that Healthshare have learnt from their mistakes and will do better next time. Oxfordshire KONP fears that the very fact that these services have been ‘put out’ to an external contractor increases communication problems and leads overall to a worse service for patients and staff - and for the referring general practitioners (GPs) and hospital consultants. 

    The Healthshare staff are no longer on the same terms and conditions as when the service was NHS provided. Many of the old NHS staff left at the changeover of ownership. 

    The ‘plant’ - equipment and clinic space - has to be rented or borrowed from NHS or GP practices

    The paperwork has to go to and fro over organisational boundaries. 

    And then there are the costs of the ‘contract’ itself - lawyers, procurement offices, performance framework and reporting mechanisms, ‘governance’. All of this leads to less money for patient care, more dissatisfied staff, and longer waiting times.

    Liz Peretz of Oxon Keep Our NHS Pubic said: 

    And yet - surely - physiotherapy - after an accident, a fall, a stay in hospital or a prolonged time in bed at home or away from work - is the backbone of an efficient service. It keeps people on their feet (or helps them back on them) and independent. 

    In our view, MSK in private hands is a mistake. This service really should be brought back in house.

Debbie Monkhouse

  • Dorset campaigners win referral of Poole downgrade to Secretary of State

    On October 17 Dorset County Council Health Scrutiny Committee voted by 6-4 to refer Dorset CCG’s planned reorganisation of emergency services, concentrating services in Bournemouth and downgrading Poole Hospital’s A&E, to the Secretary of State for Health..

    This is massive news, a blow to CCG and a huge victory for campaigners, especially Defend Dorset NHS.

    The decision was greeted by cheers and cries of disbelief all round.

    Well done to the campaigners, whose powerful use of evidence to show the risk to life and safety of emergency patients and maternity services finally tipped the scales to force the referrals.

Unite the union

  • Unite to make ‘vigorous’ case in consultation on ‘tax avoiding’ NHS subsidiary companies

    Unite the union will be making ‘a vigorous and well-argued response’ to the consultation on the future of wholly owned subsidiaries (WOSs) set up by NHS trusts and designed to avoid paying tax.

    NHS Improvement, which oversees trusts, is now consulting on a new regulatory approach for the setting-up of WOSs. The consultation closes on 16 November and updated new guidance is expected to be issued in December.

    Unite national officer for health Colenzo Jarrett-Thorpe said: “We welcome this consultation by NHS Improvement and its recent instruction to pause the creation of new wholly owned subsidiaries while this consultation is taking place.

    “We believe that plans for wholly owned subsidiaries should be abandoned as they are not the best way to maintain patient services and jobs. It is another avenue being used to privatise the NHS by stealth.

    “At the very least, the case for a much tighter regulatory regime for WOSs is overwhelming. We will be consulting our members to hear their views from the frontline over the next month.” 

    Unite has hit back at NHS Providers, representing 227 different trusts, which said that claims of privatisation and tax avoidance were ‘misleading’.

    Colenzo Jarrett-Thorpe commented: “NHS Providers’ allegation that our claims are misleading is a classic case of a pre-emptive strike before all the evidence has been gathered and analysed by NHS Improvement. It is a disruptive intervention designed to muddy the waters.”

    Unite has been concerned that trusts are forming these wholly owned subsidiary companies in England so that they can register for VAT exemption and compete on a level playing field with commercial competitors who register for VAT exemption for their work in the NHS, when NHS trusts can’t.

    A number of trusts have already decided to abandon plans to set up such a subsidiary.


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