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Sunday 3rd February 2019

John Lister

  • Staffordshire crowd fund appeal to challenge bed closures

    North Staffs Pensioners' Convention has joined with Save Leek Hospital and Save Bradwell Hospital campaigns, local campaigning group Healthwatch, the local branch of the Green Party, representatives of trade unions, local councillors of all political persuasions and local MPs to form the NHS Care for All campaign.

    Together they are mounting a legal challenge to the NHS Stoke-on-Trent and North Staffordshire Clinical Commissioning Groups (CCGs) plans to permanently halve the number of community hospital beds. They are appealing through crowd-funding for donations to enable them to do so.

    What is the situation?

    The proposals put forward by the CCGs would formalise the ‘temporary’ closure of NHS community hospital beds across north Staffordshire, which began over four years ago. They explain:

    “This policy is putting vulnerable people of all ages at risk and damaging the NHS as a whole. We just need to look at the queues at the A&E departments to see the knock on effect of this policy.

    “Our local Community Hospital teams, several of which have won awards, offered an excellent programme of rehabilitation and reablement to their patients, to allow them to return home safely. 

    “The CCGs plans will see the permanent reduction in the number of such beds from 264 to 132. Of these 132 beds, 55 would be commissioned from the private care home sector, where standards are often inferior to NHS Community Hospital care.

    “The CCGs say that they are providing better services in people’s own homes to replace NHS community hospital care. However, they have failed to provide convincing evidence that they have put quality care services in place in the community. They have ignored all the representations put to them by local communities throughout this process and refused to compromise in any way.

    “What are we doing and how can you help?

    “We have reluctantly decided, with the support of all those within NHS Care for All group, that we need to mount a legal challenge. In particular, we are challenging the assumption underlying the consultation that the CCGs will only require 132 beds.

    “Our solicitors have written a formal letter to the CCGs notifying them of our intention to issue judicial review proceedings against them. For this stage of the process to begin, we need to raise £4,300 to cover the legal costs.

    “Please help us to defend our NHS community hospital care in North Staffordshire. Pledge whatever you can afford, and also share this page with all your contacts on social media.”

    By Feb 3 of the CrowdJustice fundraising campaign they had raised more than half the target, a total of £2,612 pledged from 46 individual pledges. 

    They point out: “Remember, this is an 'all or nothing' fundraising campaign - if we don't reach the target none of the pledges are collected and we will not be able to proceed with the legal challenge against hospital bed closures.”

    You can find the appeal and pledge support at www.crowdjustice.com/case/save-our-community-hospital-beds

    Read more ...

Sunday 23rd December 2018

John Lister, Editor Health Campaigns Together

  • What hope for a ten year plan for the NHS?

    The repeated postponement of the 10-year “long term plan” for the NHS called for during the summer by Theresa May is partly a product of the fixation on Brexit – but partly a reflection of the cleft stick in which NHS England is trapped.

    The NHS is saddled with a massive staff shortage exacerbated by eight years of real terms pay cuts for staff and the increased pressures on front line staff, and a wholly inadequate budget which we now know is set to continue falling behind increased costs for another five years: but it is also lumbered with a fragmented structure and legislation (Lansley’s 2012 Health and Social Care Act) that squanders resources on carving up services and contracting, and blocks any effective strategic planning or collaboration.

    Unless this vicious combination can be broken any new long term plan will be as hopeless and empty as the last attempt has proved to be. 2019 will mark the fifth anniversary of the Five Year Forward View (FYFV), effectively Simon Stevens’ manifesto as the incoming chief executive of NHS England.

    It was uncritically embraced at the time by all main political parties as a visionary effort to modernise the NHS and to bridge the rapidly growing gap between the pressures and demands on the NHS and the post-2010 NHS budget.

    On the other extreme a handful of conspiracy theorists laboured gamely through the largely abstract and waffle-strewn document to prove it was all coded messages pointing to the privatisation of the whole NHS, led by Stevens’ former bosses in the US health corporations.

    Both these views hold up badly now. Looking back at the 44-page FYFV is like stepping into a museum: most of the key commitments have long ago been sidelined or reduced to token gestures. For example the insistence that: “The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

    While the concept of improving public health to reduce demand on the NHS is a good one to which nobody could object, it was hardly new at the time: but since 2014 we have seen year after year of cuts to public health budgets which are supposed to fund schemes to help tackle obesity and reduce consumption of alcohol, drugs, and tobacco.

    Worse still, public health is now run by councils whose core funding has been more than halved since 2010, and which are unable to invest or act in any serious way to address any of the social determinants of ill-health – such as poverty, poor housing, poor environment, and poor diet.

    Many more FYFV ideas have also remained little more than words on a page.

    For instance patients were to be given control over shared budgets for health and social care: Stevens in a July speech in 2014 even suggested “north of 5 million” such personal budgets might be operational by 2018, sharing £5 billion between them.

    This sounds ambitious and generous until you do the sums and realise it would result in average payments of just £1,000 per year, £20 per week – well short of the amount required to secure any meaningful care package for any but the most minor health needs, even if the services required were available and the patient/client was confident enough and able to sort out their own care.

    The latest figures show that the vision was unrealistic on almost every level: the number of personal health budgets has apparently been rising each year since they launched in 2014, but there were fewer than 23,000 people receiving one in the first nine months of 2017/18 – a long way short of 5 million.

    Carers, too, were promised new support by the FYFV (not for the first time, and no doubt not for the last): yet the plight of carers remains desperate, with increased misery for many of them hit by the succession of welfare cuts and the nightmare of universal credit.

    Also, according to the FYFV, barriers between GPs and hospitals, physical and mental health and health and social care were going to be broken down: there was going to be a “Forward View” for GPs and a shift of investment from secondary care into primary care (how many times have governments proposed that since the 1980s?); and there were bold promises to invest in more staff and improved services for mental health.

    Predictably none of these things have happened. Barriers are still intact. Overworked, under-staffed GPs face ever-increasing demands, with no sign of the promised increase in numbers or resources. In mental health there are thousands fewer mental health nursing staff than there were in 2010, and the performance on almost every measure is as bad or worse than 2014.

    The FYFV also looked to technology and new apps as a way to improve the monitoring of the conditions of some patients with long term conditions – a proposal echoed more recently by Matt “The App” Hancock, the current Health Secretary: but five years later the idea that apps could actually replace the need for staff or health care in more than a few cases is still desperately lacking in evidence.

    The FYFV promised that: “Different local health communities will … be supported by the NHS’ national leadership to choose from amongst a small number of radical new care delivery options, and then given the resources and support to implement them where that makes sense.”

    This was the basis on which – almost exactly three years ago – NHS England issued its edict on December 23 2015 that led to the drawn out process of redividing the NHS into 44 “footprints” each of which was to draw up a “Sustainability and Transformation Plan” (STP).

    The chaotic and secretive process that this unleashed during 2016 meant that by the time the half-baked and inadequate ‘plans’ were published at the end of the year the very term STP had become toxic. Since then many if not a majority of the STP proposals for reductions in bed numbers have been abandoned, along with some reconfiguration plans for hospital services, because they were not only unpopular but unworkable.

    This attempt to circumvent the fragmentation of the 2012 Act and force NHS (and even local government) bodies to work together has run alongside a repeated criticism by Simon Stevens of the “purchaser provider split” imposed on the NHS since Thatcher’s ‘internal market’ was introduced in 1990. But despite the efforts to get round or ignore it, the law has remained unchanged: NHS England has now been invited to suggest changes – but the government is poorly placed to deliver them.

    As the STPs became more discredited and irrelevant the focus shifted to another concept from the FYFV, ‘accountable care,’ likened to: “Accountable Care Organisations that are emerging in Spain, the United States, Singapore, and a number of other countries.”

    Within months this terminology, soon linked in the public mind with the disastrous US health system, had also become toxified, and since then the language has focused on “integration” – of health services but also of health and social care.

    This only sounds good in abstract: in practice the idea of linking up the tax-funded, free at point of use and largely publicly provided NHS with the council tax-funded, means-tested and largely privatised and dysfunctional social care system has never been an easy one to sell. Even local government is increasingly cagey about being drawn in to an NHS-led “partnership”.

    The latest notion of ‘Integrated Care Provider’ contracts in the NHS effectively tries to rebrand the concept of ‘accountable care’ – except it does not even offer the verbal promise of accountability let alone any actual accountability to local communities, while still carrying the potential danger of privatisation, despite top-level denials that this is intended.

    After such a comprehensive failure to deliver almost any significant element of the FYFV, the likelihood of making a TEN year plan any more than a wish list or a pious declaration seems to be vanishingly small.

    Five years after promising implausibly high levels of productivity increase and performance based on reducing the pressures on the NHS, a new ten year plan needs to address chronic debts, deficits and rising pressures; lack of capacity to meet key performance targets; soaring levels of occupancy and inadequate numbers of hospital beds; legislation that militates against rational and strategic planning; the chaos of Brexit and the Brexodus of EU nationals further massively compounding staff shortages alongside a complete absence of serious workforce planning; a dysfunctional and chaotic social care system leaving vulnerable people without support, and a government obsessed by its own internal party splits that has shown it will not properly fund the NHS in the short or the longer term.

    The full list is longer still: but it’s already clear the NHS England plan when it emerges can deal with few if any of these questions properly. In my next article I will look at the type of long term plan we need, and the issues campaigners need to address in 2019. Meanwhile please have a happy and peaceful festive season and do what you can to support another year’s work by Health Campaigns Together www.healthcampaignstogether.com.  

    Read more ...

John Lister, editor Health Campaigns Together

  • A winter’s tale – no room on the ward.

    Winter is upon us, as it tends to be at this time of year. It should be no surprise. Yet after two successive increasingly severe winter crises, the NHS is no better resourced and barely better prepared to prevent a third.

    None of the fabled ‘extra funding’ talked up as a 70th “birthday present” to the NHS in Philip Hammond’s latest austerity budget is available until next year, and in many cases last year’s ‘winter crisis’ stretched on deep into the summer or ran unbroken into autumn.

    After 8 brutal years of effectively frozen real terms funding, which has fallen falling ever further behind growing need for treatment for a growing population with a rising proportion of more dependent older people, the NHS has too few beds, too few staff to open more, and too little in the way of community and primary care (GP) services.

    To make matters worse the halving of council budgets since 2010 has brought cash-starved, privatised, under-staffed and often dysfunctional social care services, with “eligibility criteria” designed to limit care to those in most extreme need, and offering no possibility of preventive care to support people and keep them out of hospital.

    Even by November, before the coldest weather, the numbers of emergency patients left waiting over 12 hours for a bed have doubled in England compared with November 2017. Over a third of hospitals were running at 97% occupancy or higher, with ten hospitals running more than 99% full – well above the recommended 85% occupancy target agreed by professionals for safe care, and even above the higher 92% target set by NHS Improvement last winter.

    In dozens of hospitals – many of them in rural counties such as Worcestershire, Shropshire, Norfolk, Cambridgeshire and Warwickshire – emergency ambulances are facing delays in handing over patients who have been rushed in for treatment, only to queue behind other ambulances outside already full hospitals.

    The problems facing acute hospitals are echoed in mental health services, where despite limitless tides of gushing rhetoric for the past 20 years funding has remained inadequate or even fallen in some areas as a share of NHS spending, numbers of nursing staff are still massively lower than they were in 2010, and children and adults with urgent needs for in-patient treatment are transported often hundreds of miles in search of a free bed.

    In primary care, too, where 90% of first contacts are made with the NHS, the pressures have been growing. A survey by the GP magazine Pulse revealed that more than half of GPs said last year’s winter crisis led to avoidable emergency admissions among their patients. 43 of the 750 respondents – almost 6% – said the pressures led to the avoidable death of a patient.

    GPs provided an extra 345,000 appointments last winter above the level they were paid for – but still could not prevent long and frustrating delays in many cases for patients waiting to see their doctor.

    Meanwhile as if to advertise the government’s lack of concern for the longer term health of the population, funding for public health services, which are supposed to help educate, promote healthy living and prevent illness, is once again being cut back, while the long term rise in life expectancy since 1945 has not only halted but started to reverse.

    Underlying all these problems are two fundamental problems, compounded by a third.

    The first – and most intractable – problem is the massive, growing staff shortage, with over 100,000 vacancies including over 40,000 nursing posts across England’s NHS. This has been exacerbated by the Brexit referendum result which brought a collapse in applications from many EU countries along with a shameful increase in insecurity and abuse experienced by tens of thousands of qualified EU nurses and doctors, many of whom have been leaving.

    Add to this the short sighted government decision to save money by axing the bursaries that helped cover the living costs of nursing and other professional courses. This has resulted in a predictable fall of over 30% in applications for courses, but also an increased proportion of students coming from school leavers and younger age groups, more likely to drop out or take other jobs, and missing out on the mature students who have been so valuable to the NHS.

    The difficulty of the staffing crisis is that even if the NHS was given all the money it wanted, and even if the long term pay cuts inflicted on these staff were reversed, it cannot instantly magic up tens of thousands of trained staff, since health professionals take years to train, and inadequate numbers have been trained for many years.

    The bursaries need to be reinstated and training expanded, but there is also an urgent need to sweep away the reactionary barriers that have been created to recruitment of staff from overseas, and especially keep open the free movement of EU health professionals, alongside an urgent, systematic and coherent effort to win back many of the trained staff who have left the NHS burned out or frustrated by pressures and workload.

    The second fundamental problem is the level of funding, which has been barely increasing above inflation since the start of the Tory austerity regime in 2010, and lagged way behind the 3-4% real terms increase each year required to keep pace with population and cost pressures.

    The result is an NHS weighed down by overt or covert debts. Hospital trusts are running an underlying deficit each year of up to £4 billion, and have been propped up in many cases by ‘loans’ which now add up to more than £12 billion. The gap is now so wide that even the “birthday present” of an “extra” £20 billion over five years is barely enough to keep the system afloat, and nowhere near enough to raise pay, restore the bursaries, improve mental health, expand community services, or reopen or build the extra beds needed in many areas to cope with rising demand.

    And without all of these issues being resolved, and radical action to bring social care into public ownership and control, with full funding and services free at point of use in place of the current means tested charges, the aspiration of NHS England for “integration” of health and care services remains a pipedream.

    Both of these fundamental problems have been compounded by the government’s underlying privatisation agenda – not seeking to sell off the whole NHS as Thatcher did with the utilities in the 1980s, but finding ways to carve out profitable opportunities for the private sector to take a share of the public budget. This was the logic behind the disastrous 2012 Health and Social Care Act, which has resulted in a colossal waste of management time and resources in a fragmented, dysfunctional system created to formalise a competitive ‘market’ in health care, and compel local Clinical Commissioning Groups to put services out to tender.

    The contradiction has been that the cash squeeze is now so severe that few if any private companies are now even bidding for the larger contracts put out to tender, since they see no way they can make a profit. But even where NHS trusts win the contracts, the damage is still done: services are fragmented and often cut back to save money, competition prevails while population needs are ignored, strategic planning is excluded, and there is less and less accountability to local communities.

    The legislation makes nonsense of the meaningless mantra of “integration” which is repeated by NHS England. We need action to reverse the reactionary 2012 Act, end the requirement to contract out services, roll back privatisation, make the Secretary of State accountable for the NHS, and ensure local communities have real influence on their health care.

    So what needs to be done to fight back for the NHS? Clearly we cannot win all our demands without a change of government and a concerted drive against all forms of austerity, but there are things we can do, and the main coalition that has emerged to coordinate efforts is Health Campaigns Together, now 3 years old.

    For the last two winters Health Campaigns Together has worked with local campaigners, trade unions and others to build major protests over winter pressures (March 4 2017, February 3 2018). This winter we will instead be encouraging local protests and mobilisations, but also focusing strongly on the fight to Make Services Safe For All (with a strong focus on staffing levels, adequate bed numbers and systems) and developing a new campaign for social care, as well as fighting all forms of privatisation.

    In this time of political instability we need not only a national campaign but organisation in every area to intensify the pressure on local MPs and councillors to stand up for services and put pressure on government to halt threatened closures and downgrading of services. This has already yielded results in many areas, with councils beginning to invoke some of the residual powers they have to block changes through their health scrutiny committees, and MPs clearly forced to lobby behind the scenes to avoid embarrassing cutbacks.

    HCT is not party political, but welcomes affiliations and donations from campaigns, Labour and other political parties, trade unions at national, regional or local level, pensioners groups and any organisation wanting to fight to defend, extend and improve our NHS as a public service: check us out at www.healthcampaignstogether.com. Individual activists can join local branches of Keep Our NHS Public – www.keepournhspublic.com.

    Let’s come out fighting in 2019 for the NHS we all need and deserve. 

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