Sunday 3rd February 2019
- 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. Read more ...
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
- 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
- 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
- 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
- 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.
- 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.
Saturday 29th September 2018
People vs PF
- Royal Liverpool Hospital PFI to be scrapped
The Royal Liverpool Hospital PFI is to be scrapped and the investors ‘bailed out’. This is a reward for failure which we have known is coming for years. People vs PFI says that the government must end all PFI deals now before the public purse is burdened any further with extortionate compensation deals.
In May a major academic paper revealed the low cost of nationalising the special purpose vehicles, the companies which sign the private deals with hospitals trusts, local authorities and other public bodies. At the same time the report showed the annual savings each public body could make by bringing the contracts in-house and refinancing the loans.
The Labour Party has already committed to ending PFI contracts with nationalising the SPVs the ‘presumed preferred approach’.
COSTS OF PFI
Not only have PFI deals cost about double what publicly-financed infrastructure would cost, they have produced poor quality buildings, delayed and costly maintenance and service provision. At the Royal Liverpool Hospital we already know that combustible cladding was used by Carillion and a report by construction engineering company Arup is expected to show up more structural problems. Up to a dozen other PFI hospitals are known to have major structural defects
The collapse of Carillion has merely exposed the tip of the PFI iceberg facing public bodies and the devastating effects on public services, not to mention a host of smaller sub-contractors. Other contractors like Carillion are also reported to be in difficulties, while continuing high costs of financing PFI deals is part of the perfect storm of financial constraints facing public authorities. Are bailouts to continue or can we end this now?
On Friday headteachers are staging a march on Westminster protesting about ‘unsustainable’ budget shortfalls. One element of schools budgets now are PFI costs and heads complain about the constant headache of chasing up maintenance contractors. Costs for simple jobs, such as supplying a new key or providing a new washbasin in children’s toilets are astronomical and take constant chasing.
Nationalising the special purpose vehicles would cost £2.6bn and bring immediate savings of about £1.5bn per year. Following that it would be possible to bring the provision of services and maintenance back ‘in-house’ so that it is done by workers employed by public authorities as it used to be, and refinance outstanding loans.
Read more ...
Friday 21st September 2018
- Unions welcome pause in creation of “subco” companies by NHS trusts
A short note buried in the Provider Bulletin published by the regulator NHS Improvement has provided a belated and welcome relief from efforts by trusts across the country to chisel savings at the expense of privatising their support staff by creating “wholly owned companies” – widely known as “subcos.”
The Bulletin instructs trusts throughout England to halt their plans:
“Please pause any current plans to create new subsidiaries or change existing subsidiaries.
“We'll be consulting on a new regulatory approach to this in October and following the consultation we will be issuing new guidance.”
The health unions have been challenging the creation of subcos for the past year, with an intensifying series of confrontations which have seen a subco plan blocked in Bristol, one dropped after repeated strikes at Wrightington, Wigan and Leigh, and another dropped in Mid Yorkshire to avert a 3-day strike. Last week threatened action by UNISON led to Tees, Esk and Wear Valleys NHS Foundation Trust scrapping plans to transfer around 600 staff to private firm Tees, Esk and Wear Valleys Estates FM Ltd.
Further conflicts were taking shape as the NHS Improvement announcement was made.
However in between the successful resistance a number of subcos have been established, in the case of Calderdale and Huddersfield because despite a strong majority ballot vote for strike action insufficient staff had voted to comply with current anti-union laws.
NHS Improvement must tell trusts not only to drop plans still in the pipeline, but must review and reverse the privatisation that has already taken place, that has stripped thousands of staff of their status as NHS employees and opened the danger of a 2-tier workforce with new employees on inferior conditions.
Responding to NHS Improvement’s announcement UNISON head of health Sara Gorton said:
“This whole policy has been a damaging distraction. Valuable resources that could have gone on improving care have been wasted.Saving money has been the sole motive for outsourcing jobs to private companies. Cash-strapped trusts have seen it as an opportunity for solving their financial woes.
“But they didn’t anticipate the outrage among staff and including porters, cleaners and those in catering who want to stay in the NHS. Recent threatened action by UNISON at Tees and industrial action at Wigan successfully stopped subco plans in their tracks.
“The NHS is already set to face another tough winter. Trusts must now plan ahead and work with unions to make the best possible use of resources.”
Unite, too, has hailed ‘a significant victory’ in its campaign to stop NHS trusts in England setting up wholly owned subsidiaries designed to avoid paying tax.
The news came as Unite members at East Kent Hospitals University NHS Foundation Trust and York Teaching Hospital NHS Foundation Trust were gearing up to take strike action in separate disputes about being transferred to a subsidiary company.
Unite is 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.
Unite national officer for health Colenzo Jarrett-Thorpe has written to NHS Improvement chief executive Ian Dalton saying that the creation of these subsidiaries is not ‘the correct prescription for financial efficiency in the NHS’, after years of budgetary constraint which has put the NHS in England ‘under serious and unprecedented pressure’.
Unite is calling for:
- HMRC to close the tax loophole, so NHS trusts are not forced to consider outsourcing NHS services to private limited companies in the form of wholly owned subsidiaries.
- NHS Improvement on behalf health and social care secretary Matt Hancock to immediately call a moratorium on the further establishment of private limited companies by NHS trusts in England, even with trusts that have gained board approval.
In his letter, Colenzo Jarrett-Thorpe added:
“The increasing tendency of NHS trusts to create wholly owned subsidiaries in the form of private limited companies could lead to a flood of dozens of Carillion type situations across England.
“We believe any VAT tax saving could ultimately turn into fool’s gold, if the tax loophole is closed by HMRC.”
Commenting on NHS Improvement’s intervention, Colenzo Jarrett-Thorpe said:
“We regard this as a significant victory in Unite’s long-running campaign to stop the creation of such subsidiaries – and then to reverse them. We believe this is in the best interests of patient safety and our members who wish to remain employed by the NHS and not outsourced to an outfit where their pay and employment conditions could be seriously eroded.
“Clarity is needed from the NHS Improvement statement yesterday on wholly owned subsidiaries since this may be able to help resolve the industrial disputes in East Kent and York regarding employee transfers to wholly owned subsidiaries on 1 October.”
Unite members will be taking industrial action in East Kent between 24-28 September and in York where there is a 48 hour stoppage between 27-29 September.Read more ...
Wednesday 12th September 2018
Respond to NHS England’s consultation on cutting back NHS treatments
- Help from Keep Our NHS Public
NHSE consultation to limit access to 17 procedures and why we should respond
NHSE is going to severely restrict access to 17 procedures on the NHS: four interventions that ‘should not be routinely commissioned, because they are ineffective or have been superseded by a safer alternative; with patients only able to access such treatments where they successfully make an Individual Funding Request’; and 13 interventions that ‘should only be commissioned or performed in specific circumstances where they have been proved to be clinically effective and specific criteria are met’.
Why we should respond NHSE aims to save £200m per year – less than 0.2% of the NHS budget – and plans to build on this with numerous future restrictions to NHS care.
Even if this ‘consultation’ is flawed (the practice is already widespread) and motivation is financially-driven, it is still worth doing the survey – making the political point that the proposals have not gone unopposed.
It would also help if KONP members wrote letters to the press about it. The general public has little or no idea that this is happening.
See KONP co-chair/HCT Editor John Lister’s lead article in July’s HCT paper: NHS England plan to exclude treatments
More in KONP’s guidance
The consultation runs till 28 September 2018 – please complete NHSE’s survey
All you need is here:
Read more ...
- Outbreak of Honesty?
The NHS trade journal HSJ has reported that - Its been a good week for candour. Today, NHS Improvement finally admitted reality on provider deficits.
For the first time the system is now admitting what everyone knew anyway which is that the underlying deficit in the NHS is over £4bn. That means the first £4bn (yes £4,000,000,000) of any new money just vanishes.
Honesty more generally would be good. There is often a sound reason why NHS Bodies make decisions which are controversial – it’s just they always try to avoid the issues rather than deal honestly with them.
Not long ago there was a huge argument about the government exaggerating the true value of their last funding promises; leading to a rebuke from the Health Committee.
The issues around the Boards of NHS Trusts (and FTs) agreeing to sign up to control totals that they knew were impossible has been extensively commented upon also in the HSJ – lying about the control total is an accepted strategy for hard pressed Trusts.
Dishonesty or at least deliberate obscuration was the hallmark of the Sustainability and Transformation Plans (as they were). They should all have started by stating the plans had an outside chance of working but only if there was more money and a repeal of the hated Health & Social Care Act which require competition for everything. Developing these “plans” in secret was bound to make them literally incredible. Many involved admitted privately they just went through the motions and filled out the templates to get the right answers.
More recently we have the outbreak of forming wholly owned companies. Even a cursory examination of the published business cases shows that almost all the benefits of this cunning plan come from tax changes. This has little or nothing to do with improving services for patients or helping with staffing issues – it is tax avoidance. Yet normally sensible sources, like NHS Providers, go out to make claims that this is all very unfair and the tax issues are a sub text.
To make it worse Trusts are refusing to provide information which would allow proper examination of their decisions, for example around forming wholly owned companies. They make claims that information is “commercially confidential” and so exempt from FoI requests. This is public money; no private companies are involved, there is no competition or tendering involved. Yet we are not allowed to know why Boards made the decisions they have – even months or even years after the event. That is dishonesty too.
And to current issues.
We are learning, again only by digging, that there is a long and growing list of NHS owned land and buildings potentially up for sale. To make it worse there are private sector partners there to h”help”, probably led by Carillion and Capita.
Reality tells us that again as a consequence of chronic underfunding there is a huge and worrying backlog of maintenance for existing NHS premises as well as a growing requirement for capital expenditure on new facilities.
In principle selling off unused land and building or making better use of what is there is good. Many local authorities went through this kind of exercise but what they found was it is not as easy as it sounds to get good value for sales; and it takes a lot of time and effort to reconfigure how buildings are used optimally.
But yet again this is all dishonest. The reason why sales are need is to plug the huge black hole in funding – where this article began!! Years of underfunding have meant all the accounting tricks, tax dodges and clever wheezes to balance the books have been used up. Selling off the assets is one of the few options left.
Weak scrutiny by weak directors, dishonesty in reporting, lack of transparency to cover up dishonesty and the bullying of anyone who prefers an honest approach was becoming the norm in our NHS. Let’s hope the HSJ is right and a new era of honest and open communications is upon us.
But, don’t hold your breath.
Wednesday 22nd August 2018
- Green Light For Judicial Review In Fight To Save Local Tyneside NHS Hospital Services in North East
Public Law Experts at Irwin Mitchell instructed to bring a major legal challenge NHS managers’ decision to move Maternity, Womens Healthcare, Paediatric and Stroke services away from South Tyneside under challenge.
Lawyers acting for a local campaign group have been given the green light to pursue their legal challenge against NHS Sunderland CCG and NHS South Tyneside CCG as they continue the fight to save South Tyneside Hospital.
Law firm Irwin Mitchell had previously written to NHS Sunderland CCG and NHS South Tyneside CCG urging them to overturn the decision to move Maternity, Womens Healthcare, Paediatric and Stroke services away from South Tyneside, or potentially face a judicial review in the High Court.
Now, the High Court has confirmed that Irwin Mitchell, acting on behalf of the Save South Tyneside Hospital Campaign Group, can proceed with its legal action after the two CCGs did not agree to reverse their decision.
Granting permission, His Honour Judge Saffman said he believed the grounds put forward by lawyers at Irwin Mitchell were ‘sufficiently arguable such as to justify the granting of permission.’
Yogi Amin, a partner and Head of Public law and Human Rights at Irwin Mitchell, said: “Following our instruction by the South Tyneside Hospital Campaign Group, we argued that there were grounds for a judicial review of the decision taken by NHS managers at South Tyneside CCG and NHS Sunderland CCG on 21 February.
“Unfortunately South Tyneside CCG and NHS Sunderland CCG have not shown a willingness to reconsider the decision, therefore we welcome the High Court’s decision to grant permission to pursue a judicial review. This is the next step in the legal case to save the local NHS Hospital services.”
Following a review by the South Tyneside NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust, a public consultation was held into changes of three key services at South Tyneside Hospital. The consultation closed on 15 October 2017.
A joint decision was then taken in February this year by NHS Sunderland CCG and NHS South Tyneside CCG to approve the proposals put forward by the two NHS Trusts.
The three services included in the public consultation were: urgent and emergency paediatrics, stroke services and maternity and women’s healthcare.
Roger Nettleship, a spokesperson for the Save South Tyneside Hospital Campaign Group, said: “Our stand is to safeguard the future of South Tyneside Hospital and its acute and emergency services. Families are very concerned about their vital NHS children and women’s health hospital services.
“We believe that the proposed changes will be a potential disaster for the people of South Tyneside and Sunderland.
“We are happy that our legal challenge can continue after being granted permission to seek a judicial review of the proposed plans. It is disappointing that after being urged to reconsider its actions, NHS Sunderland CCG and NHS South Tyneside CCG have shown no sign of being willing to do so.”
No date has yet been set for the hearing, following the approval of the judicial review application.
Helen Smith, a Public Law specialist at Irwin Mitchell’s Newcastle office, added: “This is obviously a very important issue and one which affects thousands of people’s access to much needed, potentially life-saving local NHS hospital services. This is why it is crucial that any decision made in respect of those services, is made correctly and lawfully.
“Our legal challenge raises questions around the decisions taken by the CCGs because of a potentially flawed consultation process which breached the principles of procedural fairness and decisions made on the basis of potential flaws in the transport analysis.
“Our clients believe the proposals to transfer the NHS services to Sunderland were based on a flawed assessment of the impact on patients and that the criteria to assess the cost of this was also flawed.”
Monday 13th August 2018
Adrian O'Malley, Mid Yorkshire Hospitals UNISON
- Another victory against Subco privatisation
Congratulations to Mid Yorkshire Hospitals unions, who had called for strike action on August 20 but have now received confirmation that trust will not proceed with Wholly Owned Subsidiary company.
The statement from UNISON on August 13 states:
"WOS STOPPED! STRIKE OFF. WE ARE 100% NHS!
At a meeting this morning UNISON stewards received confirmation from Director Mark Braden that the Trust has stopped all work, both for now and in the future, on forming a Wholly Owned Subsidiary company.
The Trust has recognised the strength of feeling of our members and our determination to fight to keep our NHS contracts.
We responded by calling off the 3 day strike planned for 20th August.
The strike committee meeting planned for this evening has therefore been cancelled.
The Branch Committee thanks all our members who voted and were prepared to strike to remain in the NHS. By standing together we have succeeded in stopping the privatisation of 100s of jobs and services. We have shown that solidarity works!
WE ARE 100% NHS! Read more ...
Saturday 11th August 2018
- Three Submissions to Secretary of State
Hands Off HRI Say NO to CCG plans
On Thursday 9th August, three separate submissions were presented to the Secretary of State for Health in response to the original IRP referral three months ago.
At the time Jeremy Hunt signalled that the existing business plan [for the downgrade and closure of Huddersfield Royal Infirmary] was flawed and expected the NHS regulators (NHS Improvement [NHSI] and NHS England [NHSE]) to work with local providers and stakeholders to come up with a better plan.
Their proposal was submitted late on Thursday night.
The regulators have failed to attend or acknowledge the meetings of the Joint Health Scrutiny Committee, the body which referred the whole issue to the Secretary of State.
They appear to have just endorsed the CCG and Trusts' new proposal without considering any other ideas.
The CCG and Trust Proposals
The CCG and Trusts' plans are a half-baked reworking of the original business case.
They claim to be maintaining two A&E's: but in reality, the Huddersfield Centre will be self referring; all emergencies will be redirected to Halifax and all acute and emergency care will be dealt with at Halifax.
Although they now recognise that PFI money is now no longer appropriate and expect more capital funding, they are in reality proposing an Accident Centre at Huddersfield with all emergencies redirected to Halifax.
This is not enough and our campaign group will oppose them all the way. The proposal does not make reference to the future of the existing hospital at HRI but implies that the building will be demolished and fall back on the Acre Mill site as a planned care centre.
This is totally unacceptable. The CCG and Trusts have ignored our independent surveyor’s report which clearly states the HRI has a long future for at least another 60 years.
In reality the CCG and Trusts have laboured for 3 months and produced a warmed through version of their failed business case. This will strengthen our legal case if it becomes necessary.
NHSI and NHSE have merely endorsed the CCG/Trust proposal and have undertaken no work of their own. This is a derogation of their responsibilities. The CCG and Trust have demonstrated they have little or no idea how to put together a plan which will meet our health needs, but they have decided to take the CCG/Trusts' plans at face value. This is also unacceptable.
The Calderdale Proposal
Calderdale Council has submitted its own proposal in isolation from their Kirklees council colleagues, but they have clearly had prior sight of the Trust/CCG plan. As such they have chosen to endorse its findings, which is disappointing as Calderdale councillors have sat on the Joint Health Scrutiny Committees.
They see some advantage to maintaining full hospital services at Calderdale but this will be at the expense of Huddersfield and will only increase demand on Calderdale Hospital which is already overstretched.
Our campaign has always maintained that both towns require full hospital services to meet all our health needs and this will remain the case. We are therefore disappointed with their submission.
The Kirklees Proposal
Kirklees Council held a press conference to launch their report on 9th August. They are proposing a new hospital with full A & E services to serve all of Kirklees to be built with capital funding partly financed by Council borrowing.
If approved by the Secretary of State, the Council has enhanced powers to prudentially borrow large amounts of capital funding. This a more interesting alternative model which could meet local health needs but requires a lot more detailed consideration e.g. where would such a hospital be located; how would it be staffed; which local Trust would oversee it; how would local health services be maintained whilst the new building was constructed; what consultation do they suggest.
This is the first time any statutory body has proposed an alternative model to the Final Business case and does require serious consideration. We are disappointed it has taken the Council two and a half years to develop such a model but it has the potential to better meet local health needs, dependent on a lot further detail. We trust the Council has the authority and staying power to see this through properly.
The Next Steps
The Secretary of State now has to consider all these reports and make his recommendation. This is a process which cannot be rushed as too much is at stake.
We demand that Mr Hancock come up to the area himself to listen to and meet local health professionals, patients and local people. In the meantime we will consult our legal team and assess what impact these developments have on our ongoing legal challenge.
If Mr Hancock rubber stamps the CCG/Trust proposal, we will have no option but to take the legal option furtherRead more ...
Thursday 9th August 2018
Adrian O'Malley, UNISON Secretary Mid Yorkshire Hospitals
- Mid Yorkshire strike against privatisation is back on!
STRIKE AGAINST THE WOS!
3 DAY STRIKE CALLED FROM 6 AM ON MONDAY 20TH AUGUST
UNISON has informed the Trust that following their refusal to sign a joint statement with the union committing themselves to no transfer of staff out of the NHS and no two tier workforce, we are lifting our suspended strike action and announcing a three day strike starting at 6am on Monday 20th August.
The strike committee meeting held on Tuesday 31st July agreed the date which was supported by the national industrial action committee.
Details of picketing, meetings and strike/hardship pay etc will be given in the next newsletter.
We have given the Trust the legal two weeks notice and remain available for talks at any time.
We have received the support of MPs Tracy Brabin, Yvette Cooper, Mary Creagh, Paula Sherriff and Jon Trickett and thousands of local people.
We call on the Trust Board to listen to the people – and withdraw their plans to form a WOS.
WE ARE 100% NHS!
Read more ...
Monday 6th August 2018
- NHS England choose school holidays to launch consultation
A '3-month' consultation on new contracts for "integrated Care Providers" has been launched on August 3 by NHS England.
For those unfamiliar with this latest new term, ICPs – defined as contracts signed by commissioning groups to avoid any obvious conflict with the Health & Social Care Act 2012 – are the many-times rebranded "Accountable Care Organisations" first referred to in Simon Stevens' Five Year Forward View, and which many campaigners have argued represent a threat of 'Americanisation' of the NHS.
NHS England is at pains to insist that ICPs are completely different from the US ACOs, which are bodies run by health care providers which agree with insurers to provide a range of services for a defiled local population at a fixed, cash limited fee based on the size of population (capitation).
According to NHS England:
"An ICP is not a new type of legal entity and so would not affect the commissioning structure of the NHS. An ICP would simply be the provider organisation which is awarded a contract by commissioners for the services which are within scope. It represents an additional option for the local NHS but is not expected to be used everywhere."
It appears from the phrasing used by NHS England that the ICP concept is actually closer to the US ACO model even though the words used to label it have now twice been changed to avoid this association.
Insisting an ICP is not a "legal entity", while at the same time describing it as a 'provider organisation' leaves little doubt that the ICP would function outside any of the control and accountability mechanisms of the NHS, while the contract for "services which are within scope" is pretty obviously a cash-limited contract to deliver a defined range of services to a defined local population.
NHS England's explanation of how an ICP would work with local commissioners also fails to address any of the concerns of those who sought a judicial review to block ACOs – that the new arrangements would lack any local accountability or transparency, and would in effect take over from statutory bodies with obligations to consult and inform the public.
NHS England argues:
"ICPs are … intended to allow health and care organisations to be funded to provide services for a local population in a coordinated way. Following two recent Judicial Reviews which were dismissed, the High Court has twice now ruled that this proposed contractual approach to developing integrated care is lawful; and in a recent report Parliament’s cross-party Health and Social Care Select Committee said ICPs were part of a ‘pragmatic response’ to pressures in the system. Subject to the outcome of the consultation, the area that is at the forefront and may choose to use a contract of this sort is Dudley. The bid for this proposal is led by an NHS body, and has the support of local GPs."
Whether or not the last sentence proves to be true, the question over the accountability of an ICP to local people revolves around the creation of an over-arching contract that effectively devolves decision-making from the existing CCGs, which, however imperfect, are public bodies required to meet in public and publish Board Papers, to a new provider organisation, that would have no such obligations.
A new democratic deficit would therefore be created – whether or not the contract goes to an "NHS" body or potentially to a private provider if one could be found willing to shoulder the risks involved for the money available.
Up to now NHS England has been forced to retreat repeatedly and delay its various efforts to force through "new models of care" designed to restrict budgets and eliminate local accountability.
Now, with this new consultation, which runs alongside NHS England plans to restrict access to a potentially ever-expanding list of allegedly less effective treatments (see Health campaigns Together #11), we face a concerted autumn offensive designed to push forward with plans that enjoy little if any public support, beginning in the summer "silly season" for news with a low-profile launch of a consultation at a time while many are on holiday.
It is essential to ensure that these challenges meet a response. Health Campaigns Together will be developing materials to highlight concerns and inform campaigners over the next few weeks. The NHS England consultation document can be accessed HERE.
Read more about the JR4NHS judicial review via the link below.Read more ...
Thursday 12th July 2018
Health Campaigns Together
- Wigan victory against subcos must spur on national fight
The battle to prevent nearly 900 staff at the Wrightington, Wigan and Leigh Trust being outsourced to a private limited company (“WWL Solutions”) has been won.
The Trust, like many others exploring similar plans across the country, hoped to save money in part by exploiting a tax loophole that allows them to avoid VAT, but also by planning to employ new staff on non-NHS terms and conditions, creating a 2-tier workforce.
The hiving off of NHS staff into these ‘subcos’ has rightly been branded as privatisation by the back door. Existing staff transferred would be dependent on TUPE protection of their pay and conditions and lose access to the NHS Pension Scheme.
TUPE protection itself could be set aside after the transfer is complete, by a company that would be free to make its own policy.
If it acts like privatisation and stinks like privatisation, it IS privatisation.
Soon after UNISON had given notice of a further seven-day strike beginning on July 17, an intervention from Wigan Council’s leader and deputy led to a £2m financial offer to the Trust to compensate for the savings they expected – on condition the subco plan was permanently ditched. Trust and unions accepted.
Just a week before this retreat the WWLFT Board decided on June 27 to ignore the strikes and press ahead with the plan.
The message must now ring out loud and clear: where these plans are fought early enough, hard enough, and long enough they can be defeated – wherever they appear.
In Bristol prompt, early action by unions quickly forced a subco plan to be dropped.
This latest, hard-won victory only came after three periods of industrial action taken by UNISON, Unite and GMB members, including porters, cleaners, catering staff, electricians and plumbers employed at Wrightington Hospital, Wigan’s Royal Albert Edward Infirmary and Leigh Infirmary.
Strikers have been driven by determination to protect their terms and conditions and the living standards of future generations of hospital staff, and to keep the NHS team together.
They received tremendous support from people who care about the future of the NHS right across the country, as well as senior national and local politicians and union leaders.
However this victory still has not yet won the war: most regions of England still have trusts planning subcos, with particular concerns in the South West and Yorkshire and Humberside where a significant number of trusts are proposing to transfer hundreds of staff outside the NHS.
Campaigns and ballots for action are also in full swing in several trusts.
All will now draw strength from this victory – and step up the fight to keep staff 100% NHS.
n Exactly what has been agreed is still unclear. Wigan council’s chief executive is also the Accountable Officer of Wigan CCG , and an enthusiast for ‘new models of care’.Read more ...
Health Campaigns Together #11
- NHS England plan to exclude treatments
Even before the formal hypocrisy of the official 70th birthday celebrations for the NHS was over, NHS England’s July 4 meeting returned it to business as usual – cuts to balance the books.
NHS England boss Simon Stevens had been obliged – as a condition of Theresa May’s tight-fisted ‘long term settlement’ for the NHS – to express public gratitude for the money.
He must have been well aware from the outset that the additional cash was not sufficient to plug the growing gap between resources and pressures on the NHS – even before National Audit Office Comptroller General Sir Amyas Morse broke from traditional reserve and took to the columns of the Guardian to bang the point home.
Yet Stevens’ various attempts to work around the fragmented structure of the NHS established in the disastrous 2012 Health & Social Care Act have so far managed to change little but the rhetoric.
Over two years on, ‘Sustainability and Transformation Plans’, lacking revenue and capital funding for new services, have neither transformed services nor resolved trust deficits.
Amid growing public awareness and hostility the “Accountable Care” plans which followed ran into legal challenges for their lack of accountability and legitimacy. This forced an inept change of name in February to “Integrated Care,” despite the lack of evidence that new systems would either be integrated or caring.
In many areas the “integration” has been between CCG commissioners on one side, with mergers of providers on the other – deepening rather than bridging the purchaser-provider split.
The grand plan of drawing cash-strapped local government into these “integrated” systems has also run into problems in many areas, offering councils neither cash nor influence.
So on July 4, the day before the 70th Birthday, NHS England discussed a new far-reaching plan to limit access to a growing number of so called “clinically ineffective” treatments.
A “relatively narrow” initial list of 17 treatments to which access would be restricted has been published as the basis for a 3-month public ‘consultation,’ although with a new, more right wing health Secretary, they will press ahead regardless.
And while a few of the treatments are claimed to be ineffective, most of them are still to be available – as long as the CCG gives prior approval.
NHSE hopes to save £200 million by denying access to 100,000 ‘unnecessary’ procedures a year.
But NHSE’s plan now is to “rapidly expand” beyond this list, to a “much wider, ongoing programme” of restricting access.
The initial list appears based on advice drawn up for the Labour government in 2009 by McKinsey: that included hip and knee replacements, hernia and cataract surgery in a list of “procedures of limited clinical benefit”.
We know some treatments are less effective and used too indiscriminately: but we cannot sit back and watch our NHS in its 71st year being transformed through this into a 2-tier system, denying treatments for some – resulting in rich pickings for private hospital chains and eventually health insurance.
So far many key NHSE plans have been halted or forced back by public pressure and campaigning. These latest plans too must be dumped firmly in the dustbin of history.
We need an election now and a change of government: new laws are needed to sweep away the 2012 Act, to keep our NHS free, for all, forever.Read more ...
Wednesday 27th June 2018
John Lister, editor Health Campaigns Together
- Labour commits to legislation to reinstate the NHS
Campaigners are set to play a leading role in shaping Labour legislation to reverse the 2012 Health and Social Care Act and end the fragmentation and privatisation of the NHS.
That was the positive outcome of a constructive meeting called in Westminster by Labour’s Shadow Health and Social Care Secretary Jonathan Ashworth MP earlier today (June 27).
The meeting brought together representatives and advisors from the shadow health team and Labour Leader’s office and health policy advisors, along with Eleanor Smith MP who had planned to move the NHS Reinstatement Bill as a 10 minute Bill on July 11, Allyson Pollock and Peter Roderick the authors of the Bill, the Socialist Health Association, Health Campaigns Together, and Keep Our NHS Public.
It was called as an urgent response to the decision last week by the Labour whips’ office not to support Eleanor Smith’s Bill for parliamentary procedural reasons, and to address the subsequent criticism and fears expressed by campaigners in social media that this decision represented a retreat by the Labour leadership from a full commitment end privatisation in the NHS, reverse the 2012 Act and reinstate the NHS.
Jonathan Ashworth underlined his support for the underlying principles of the NHS Reinstatement Bill, and also stressed the PLP’s record of implementing the various commitments for campaigning as set out in last year’s Labour Conference Composite motion 8. He explained that his intention in calling the meeting had been to find ways in which legislation which all can support could be developed through a process of collaboration and consultation.
Campaigners were repeatedly assured that Labour’s leadership is committed to proposing its own Bill in the first Queen’s Speech of a Labour government that would embody the principles of the NHS Reinstatement Bill. The explanation of the decision to pull support from Eleanor Smith’s Bill was that the level of detail that it included is too great for tabling at this stage as a 10 minute Bill, with some of it potentially controversial within the Party. In particular significant debates need to be had on how Labour wishes to address the crisis of the heavily privatised social care system currently run through local government, and whether the NHS or local government should take charge of public health.
It was agreed that while this work needed to be done, in the short term, as Eleanor Smith and others argued strongly, a declaration of intent and principle is needed from Labour in this 70th anniversary year of the NHS.
With this in mind the meeting agreed:
- Jonathan Ashworth and Eleanor Smith would publicly sign up to show their support for the ‘NHS Takeback’ pledges, based on the Reinstatement Bill, that is promoted by the We Own It campaign https://weownit.org.uk/nhstakeback.
- Labour will seek the earliest opportunity – if possible before the summer recess – to table a shorter version of the Reinstatement Bill as a 10 minute Bill, to be moved by Eleanor Smith. This would echo the Takeback pledges and the NHS Reinstatement Bill as previously tabled.
- Further detailed meetings will take place beginning immediately – between the Leader’s office, the shadow health team and the drafters of the Reinstatement Bill, but also on a wider level to draw in and engage with campaigners, trade unions and other significant stakeholders – to draw up more detailed Labour legislation based on the Reinstatement Bill. Meetings will also take place with other committees as appropriate with the aim of developing an agreed draft Bill by the end of 2018 suitable for inclusion in a Queen’s Speech.
- Campaigners will continue to work with and advise Jon Ashworth and the shadow health team in responding to any NHS England proposals for new legislation or amendments to the Health & Social Care Act that might be tabled by the current government. Joint efforts to expose and challenge privatisation and encourage those such as the Wigan strikers who are actively fighting it will continue.
The unique and historic nature of this meeting and these agreed proposals was stressed by Jon Ashworth and recognised by the meeting. This unprecedented level of collaboration is a result of years of hard work on the ground by campaigners.
The result will be a stronger and broader campaign in Parliament and across the country for legislation that will restore and improve the NHS as a publicly owned, publicly funded, publicly provided and publicly accountable service.
Tuesday 26th June 2018
Peoples assembly and Health Campaigns Together
- Corbyn to join speakers at June 30 demonstration & celebration
To mark 70 years of the NHS, a major demonstration & celebration will take place in Central London this weekend, Saturday 30 June, organised by the People’s Assembly, Health Campaigns Together, the TUC and 11 health trade unions. Tens of thousands are expected to attend what is the only national public event organised to mark the anniversary of our health service.
Organisers say the recent announcement from Theresa May of a 3.4% annual funding boost is “simply not good enough”. The demonstrators will also be demanding an end to all cuts and closures, a stop to the ruinous privatisation policy and better pay and conditions for NHS staff.
Labour Leader Jeremy Corbyn and Shadow Health Secretary Jonathan Ashworth will be among those who will address the crowds as well as appearances from former Coronation Street actors Julie Hesmondhalgh and Sally Lindsey, music from the ska legend Rhoda Dakar who sang on a number of Specials hits, plus actor Ralf Little who recently had a twitter spat with Health Secretary Jeremy Hunt over the NHS funding crisis.
The march will assemble at 12pm at Portland Place, London W1A followed by a procession route to Whitehall.
Participants are invited to bring colourful placards or banners and to dress in bright colours or costumes associated with any of the decades the NHS has been in operation. Sound systems will play music from each decade since the NHS was founded throughout the march route.
Jeremy Corbyn, Labour Leader said ahead of the demonstration:
“This Saturday in London, I will be joining The People’s Assembly Against Austerity, doctors, nurses, health campaigners, unions and tens of thousands of others at Our NHS at 70 march.
"It is almost 70 years since the NHS was founded by a Labour government and it’s still our proudest achievement. It was the first comprehensive health service in the world built on the principle that healthcare should be available to all on the basis of need, not ability to pay .
"What the Conservatives have done to our NHS, first under David Cameron, and then Theresa May, is appalling. Deliberate underfunding of services, and squeezing the pay of our brilliant doctors, nurses and health staff, has pushed our NHS to the brink.
"Every day there are shocking stories of unacceptable waiting times, ambulance delays and patients left on trolleys in corridors. And they’ve spent years selling off and contracting out our NHS bit by bit, leaving the NHS to be sued by private companies, like Virgin. Labour will end privatisation because our NHS should be about healthcare for all, not profits for a few.
"Last week, the government finally announced some more money for our health service. But you know what? It’s simply not enough. Not enough to make up for the last eight years of slashed budgets and worsening standards, falling morale and loss of staff. In fact, it would barely keep the NHS at a standstill.
"A Labour government would give the NHS the money it needs. It would be able to do so because we’re not afraid to ask big business and the richest to pay their fair share of tax.
"I hope you’ll join us on Saturday to stand up for our health service and its incredible staff who have carried our NHS on their shoulders these last eight years, while the Government brought it to its knees.”
Sam Fairbairn, National Secretary for The People’s Assembly Against Austerity says:
“We've had enough lies and spin from this Government. They are responsible for driving our NHS to breaking point with years of underfunding and are deliberately holding back resources our health service desperately needs, the additional funding Theresa May recently announced is simply not enough and she knows it. In one of the richest countries on the planet no one should have to worry about accessing decent, free, publicly provided healthcare which for 70 years our NHS has done. But unless we all do something now to hold this Government to account our NHS as we know it won't last another 5 years let alone another 70.”
Dr Louise Irvine GP and Co-chair of Health Campaigns Together says:
"We are expecting thousands of people to come to London on 30 June to celebrate the 70th anniversary of our wonderful NHS but also to protest about how this government has progressively run it down, understaffed it, underfunded it and privatised it.
"The NHS is struggling to provide safe quality services for everyone - with record waiting times and massive understaffing - so we will be protesting and demanding that the NHS be reinstated as a public service with an end to cuts, closures and privatisation, and that it be properly funded and fully staffed.
"Patients, public, NHS staff, trade unionists, campaigners and many more will be joining us to celebrate this important event as part of our movement to secure the future of the NHS for another 70 years and more. Our NHS: free, for all, forever!"
Dr Tony O’Sullivan retired Consultant Paediatrician and Co-Chair of Keep Our NHS Public says:
“Keep Our NHS Public is 100% behind this march in celebration of the NHS and its founding vision of universal access and freedom from fear of crippling health bills. We stand for a return to a well-funded, fully public national health and social care service and against the policies that undermine the NHS - de-funding, fragmentation and privatisation.
"The Government has ceded ground on NHS funding under the huge public pressure that campaigners have maintained. It is not enough. But we will continue until we have secured for our children Bevan’s NHS that will be celebrated for decades to come.”
Monday 25th June 2018
Health Campaigns Together officers
- Health Campaigns Together statement on NHS Bill
On Saturday June 23rd June, Health Campaigns Together (HCT) had one of our regular affiliates meeting where we discuss national events / actions and our overall direction.
The issue of the withdrawal of the Labour Party MP Eleanor Smith's NHS Bill from the 11th July reading was discussed amongst many other things including the #ourNHS70 demo and plans for future conferences.
Many had strong feelings on this issue and there was much to discuss so please allow us to tell you what came out of that meeting.
The NHS Bill has been the result of a huge amount of hard work by Allyson Pollock and Peter Roderick over the last 6 years since the enactment of the Health and Social Care Act 2012, in collaboration with many campaigners and supporters. HCT fully and actively support this legislation and admire the work of this excellent team. The fact that it has got to the point that a second Labour MP is tabling a bill to renationalise and reinstate the founding principles of the NHS is testament to a great deal of work of NHS campaigners and people like you, changing the narrative and driving through that political pressure. This would have now been the third presentation of this bill in the House of Commons since 2015.
Late last week after discussions with the Labour leader's office we understand that the Leadership team have asked Eleanor Smith to withdraw her 10-minute rule bill and have alternatively stated their intention to consult on a bill incorporating all of the principles of the NHS Bill but which would be 'Labour-led' and have the objective of being Labour's draft legislation in waiting.
To achieve this Labour’s Shadow Health Secretary Jon Ashworth has set up an initial consultation meeting with the authors of the NHS bill, Socialist Health Association and HCT and will seek the input of other campaigners.
Ashworth reaffirmed his commitment to ending privatisation and the market and PFI and told us he will not renege on this. On Friday evening, he requested we publish this statement on our website (see below).
In our discussions on 23rd June many campaigners expressed confusion and disappointment at the lack of transparency and communication on this decision by the Labour Party. As campaigners we are not party to knowledge and cannot know the political machinations motivating the above decisions taken by the Labour Party and can only speculate. Ashworth has stated his commitment to Composite 8 from last year’s Labour conference, and we must hold the Labour Party to this.
HCT is not aligned to any political party and we will continue to lobby, push and drive forward the principles of demanding publicly funded, provided and accountable universal high quality healthcare delivery. We will not compromise on these principles and will do everything in our power to make that happen whatever else occurs.
We believe the enormous democratic pressure exerted by hundreds of thousands of people getting out on the street and the amazing and tireless work of feet on the ground campaigners and trade unionists has been the most important part of affecting political change.
We will be meeting with the Labour Party with other campaigners next week and will ensure the strength of feeling on this issue is known. We will not give up until we get our NHS back.
Please get involved, get out on the streets with us this Saturday and link up with your local groups and lobby your local MP about these issues. Together we can win!
Friday 22nd June 2018
Health Campaigns Together and Peoples assembly
- On Tuesday get your official guide to the #OurNHS70 march - Saturday 30th June!
We are pleased to announce that as part of their ongoing support the Daily Mirror will be publishing the official demonstration guide with timings, route map, itinerary, how to get there, plus helpful tips on making the most of the day on Tuesday 26. Please look out for the paper in your local shop and look out for further information from us about collecting the free #OurNHS70 Demo pull out from us to distribute in your local area.
From cradle to grave the NHS is there for us, and now we need to be there for the NHS. The planned march on Saturday 30th June is expected to see tens of thousands of people take to the streets of London to both celebrate and demonstrate for the NHS.
The demonstration will assemble at 12pm outside the BBC at Portland Place, London W1A and will arrive at Whitehall shortly after 2pm where a stage will then host music and speeches from campaigners, celebrities, union leaders and politicians.
Participants are invited to bring colourful placards or banners and to dress in bright colours or costumes associated with any of the decades the NHS has been in operation. There will then be 8 different sections for people to stand in alongside a mobile sound system with music from that decade. This is very much a family friendly event. The NHS belongs to us all, and all are warmly welcome to attend.
We’ll need as much help as we can on the day, please volunteer to be part of our stewarding team to ensure the event runs smoothly. It’s lots of fun we promise! If you are able to help us please contact today: firstname.lastname@example.org
Find all the demo information here: Facebook Event
Coaches will be coming from all over Britain, find your nearest one here: Transport links
The NHS belongs to the people - not governments and not private enterprises. It's time to stand up and defend what is ours. Get your official guide free with The Daily Mirror and make your voice heard.
Jonathan Ashworth MP
- Jon Ashworth commits to continued fight to restore NHS as per the NHS Bill
Our NHS is in still in danger.
Yes the government have -- in the face of intense pressure from health campaigners, NHS staff, patients, trade unions and the Labour Party -- announced a new funding settlement, but every expert agrees it’s not enough to make up for years of austerity and cuts. This Tory government has presided over thousands of bed cuts, undermined staff, we have 100,000 vacancies, reduced public health budgets and savaged social care provision. The consequence is growing waiting lists and falling standards.
What’s more there is no guarantee that not a penny piece of the cash will find its way into the profiteers winning contracts as part of the ongoing Tory privatisation agenda.
Let’s be clear; Labour and the shadow Health team stand firm against privatisation.
In recent months in the Commons we’ve exposed the extent of privatisation.
We remain opposed to any moves towards so called American style ACOs that risk privatisation and invite big private firms to bid for multi billion pound contracts. Our EDM showed the strength of feeling on so called Accountable Care Organisations forcing the government to delay making arrangements. You can read the EDM here (https://www.parliament.uk/edm/2017-19/660).
A few weeks ago on an opposition supply day we brought a motion to the Commons demanding the government release all internal documents detailing their privatisation plans in the NHS – I’m grateful to those Labour MPs who spoke and reinforced the arguments against privatisation in the debate - Rosie Duffield, Judith Cummins, Liz Twist, Paul Williams, Tracey Brabin, Debbie Abrahams, Preet Gill, Karen Lee, Karin Smyth, Anneliese Dodss, Rachel Maskell, Mohammed Yasin, Emma Hardy, Alex Cunningham, Hugh Gaffney and Justin Madders, Gareth Thomas, Karen Leen, Conor McGinn, Wes Streeting, Jim Cunningham, Yvonne Farvague, Gloria De Piero, Toby Perkins, Vernon Coaker, Vicky Foxcroft, Louise Ellman. All spoke with passion and insight reiterating Labour’s clear commitment to ending privatisation and reversing the Health and Social Care Act.
Sadly Tory MPs voted down that motion, had it been passed it would have been the most significant advance against Tory privatisation in the Commons this summer
Labour in the Commons have raised our objection to the backdoor privatisation going on right now across hospital trusts with the moves to wholly owned subsidiaries. I was proud as Labour’s shadow Health Secretary to express my solidarity and support for those trade union members on strike, fighting to protect their terms and conditions in opposition to transfer to a wholly owned subsidiary.
Labour in the Commons – including Jeremy Corbyn at Prime Minister’s Questions – has raised the scandal of Virgin Care pursuing legal action against the NHS.
Labour in the Commons have exposed the shambles and failings of privatisation after privatisation from the Sussex Patient Transport contract to various failing 111 contracts to the shortcoming of Capita’s GP contract. And we have repeatedly spoken out warning that private providers are offering poor quality in the field of mental health services and drug and alcohol addiction services
Labour in the Commons fought against the proposed privatisation of NHS Professionals.
Labour in the Commons with John McDonnell has committed to bringing PFI contracts in house to ensure a better deal for taxpayers and demanded answers for those NHS services left in limbo following the collapse of Carillion. Shadow Cabinet Office Minister Jon Trickett has confirmed there will be a presumption that outsourced contracts across the public sector come back in house under a Labour government.
Don’t let anyone set false hares running about what’s been ‘vetoed.’
Labour has continually put the Tories under pressure over privatisation in Parliament, and will continue that fight in Parliament. Labour will continue to expose the Tory privatisation plans through the most effective procedures to both challenge and try to block the sell-off of our NHS.
So let no one be in any doubt about our determination to end privatisation. It’s the position Jeremy Corbyn, John McDonnell and I have continued to outline and it was a position endorsed by our Annual Conference 2017, which resolved in Composite 8:
“Conference recognises that reversing this process demands more than amending the 2012 health & Social Care Act and calls for our next manifesto to include existing Party policy to restore our fully-funded, comprehensive, universal, publicly-provided and owned NHS without user charges, as per the NHS Bill (2016-17)”
So reinforced in our determination to banish privatisation, I now want to engage campaigners in a debate about the future as well.
As our Conference recognised and as indeed everyone who works in the NHS knows the current arrangements are not fit for purpose – in fact even the Tories are now suggesting they will unpick parts of the Lansley Act and are asking NHS England to propose legislative changes.
That’s why our commitment to reinstate the NHS remains and takes on even greater importance. We will have to scrutinise carefully whatever is proposed, but it would appear the NHS landscape is potentially set to change again. Furthermore there remain big public policy questions about the future of social care and how we place it on a long term sustainable footing.
But of course we recognise the status quo is not an option. Jeremy Corbyn and the shadow Health team will begin over the coming months to consult on the future of NHS structures, including with relevant professions, trade unions patients and campaigners, about our proposals for the next Labour manifesto. I hope and look forward to important discussions with NHS campaigners about how a Jeremy Corbyn Labour government can restore our NHS for future generations.
Jonathan Ashworth MP, Shadow Secretary for Health & Social Care
Sunday 17th June 2018
KONP and HCT
- Serious questions surround increased NHS funding – inadequate response for cash starved service
Joint press release by Keep Our NHS Public, Health Campaigns Together and The People’s Assembly Against Austerity 17 June 2018
Theresa May has announced today an increase in NHS funding by 3.4% a year for the next 5 years. The headline 3.4% increase only applies to the NHS England budget and not to the whole NHS budget. Importantly, it also excludes medical and nurse training and public health budgets – these are crucial to the delivery of NHS services. The overall increase promised is in fact only 3% a year.
Even this is a reluctant response from the Government to the unrelenting pressure exerted by campaigners, health unions and the electorate – and even health think-tanks and NHS Providers – to provide desperately needed increased funding for the NHS, left in a critical condition after suffering 8 years of virtually flat funding per person.
While any funding increase is to be welcomed, 3% will not be enough to repair the damage already done to the NHS from years of austerity. At least a 5% real uplift next year would be needed to begin to begin to repair the damage done and at least 4% per year is essential after that to ensure the NHS is fit for the future.
As always with the Conservatives, the devil will be in the detail. We don’t know exactly how this money will be allocated and what strings will be attached. In 2016 the government announced a £10bn a year increase. However, due to some accounting tricks involving moving money around within the Department of Health budget, according to the Nuffield Trust it resulted in only £800m in real terms.
This promised increase must be genuine new money and not a repeat of the ‘smoke and mirrors’ designed to appease the public without resulting in any significant benefits. Resurrection of the tarnished claim of a ‘Brexit dividend’ to fund the NHS is political gamesmanship, when most analysts predict a negative fiscal impact, at least in the short term.
Whilst Theresa May talks of extra funding not being wasted, there are no policy measures to ensure that increased funding actually improves health care delivery rather than paying for the private market and wasteful bureaucracy the Government has created.
There must be an end to the fragmentation of the NHS and the enforced contracting out of NHS services to the market. The NHS must be reinstated as a public service. Currently £billions are wasted on market transaction costs and outsourcing to the private sector. NHS efficiency, co-ordination of services and collaborative delivery of care is undermined by competition.
With no promised increase in social care funding any funding increase for the NHS will have limited benefit. Social care has suffered from extremely damaging cuts over the past eight years and this has adversely impacted the NHS. Social care cuts have cause caused real suffering and an increased mortality rate in those who are directly affected. Any new funding settlement for the NHS requires increased funding for social care.
Think-tank estimates argue for a 3.9% annual uplift in real terms for social care. There should be no pretence that “integration” of health and social care, without extra funds for both, will solve the problems of either service. True integration will require social care to be brought into the NHS as a public service and to be properly funded.
Health Campaigns Together (1), Keep Our NHS Public (2) and People’s Assembly (3) join with NHS staff, other campaigners and concerned members of the public in continuing to apply pressure on this government to fund the NHS properly and reinstate it as a public service according to its founding principles as this is the most economical way to run the system and deliver high quality care for all. We will be calling for these demands on 30 June at the celebration and protest in defence of the NHS at its 70th Birthday. (3)
Dr Louise Irvine is a GP in Lewisham, south London and co-chair of Health Campaigns Together says:
"The Conservative government’s promised funding increase for the NHS is too little too late. It is in fact only 3% a year – they’ve done their usual smoke and mirrors to make it appear more by only counting the increase to the NHS England budget and not the overall Department of Health budget. 4% is the minimum increase needed.
"3% won’t be enough to repair the untold damage the Tories have done to the NHS over the past eight years of austerity or secure its future as a high-quality service. I fear that patients will continue to suffer needlessly and staff will continue to leave the profession due to stress and burnout. We’ll see more rationing, cuts and closures and insufficient improvement, if any, in waiting times.
"Any increase in funding is welcome but its a missed opportunity to put the NHS back on its feet. There’s so much more the Government could and should do. It could stop wasting precious NHS resources on the failed experiment of the market and outsourcing and reinstate the NHS as a public service – the only way to ensure effective and efficient joined up services.
"And it needs to increase social care spending by at least 3.9% a year because without decent social care the NHS will continue to pick up the pieces for all the elderly and disabled who are not getting the care they need."
Dr Tony O’Sullivan, retired paediatrician and co-chair of Keep Our NHS Public says:
"The NHS and social care have been severely damaged by the last 8 years of wilful neglect. NHS workforce planning was abandoned leaving 100,000 vacancies and doctors and nurses working in extremes of pressure and ending up in tears of distress.
"They do not need more mischievous statements, previously exposed as lies, about ‘Brexit dividends’ that smack more of electioneering than care for the NHS.
"We need a commitment to respect NHS staff once again, reinstate the NHS student bursary, pay staff properly and to put the NHS back together again alongside a publicly funded social care system."
- Health Campaigns Together is an alliance of over 100 organisations including five national unions and Keep Our NHS Public, formed Autumn 2015 to campaign for a fully funded and fully public NHS: https://healthcampaignstogether.com/
- Keep Our NHS Public was formed in 2005 to campaign for a fully publicly funded, provided and managed universal and comprehensive NHS: https://keepournhspublic.com/
- The People’s Assembly Against Austerity
- Rally and demonstration supported by HCT, KONP, The People’s Assembly Against Austerity and the TUC and 13 health unions: Saturday 30 June 12midday, assembling Portland Place, London and proceeding to Whitehall
Read more ...
Tuesday 12th June 2018
- KONP statement: PUBLICATION OF HEALTH AND SOCIAL CARE COMMITTEE REPORT ON INTEGRATED CARE: ORGANISATIONS, PARTNERSHIPS AND SYSTEMS
The Health and Social Care Committee (HSCC) has published its report on Integrated Care: organisations, partnerships and systems today. Keep Our NHS Public (KONP) contributed written evidence , gave oral evidence 27 February (Dr Tony O’Sullivan, retired paediatrician and co-chair of KONP) and followed this up with supplementary evidence.
While we welcome certain conclusions of the HSCC, the overall message defends NHS England (NHSE) and the Department of Health & Social Care (DHSC) in their policy direction of introducing accountable care organisations that are dangerous in bringing in models of care based on the deskilling of a workforce designed to give cheaper, underfunded care in the community.
We suspect that the report does not convey a single coherent message but reflects the various different positions of committee members, who have reached a compromise to agree a published report.
A key tenet put forward by KONP is that ACOs are illegal under the current legislation and are an unlawful ‘workaround’. The HSCC has accepted this:
The legal barriers and fragmentation that arose out of the Health and Social Care Act 2012 will need to be addressed … ACOs, if introduced, should be NHS bodies and established in primary legislation.
KONP believes that this is a vindication of one of the key bases for the current Judicial Review (JR) heard 23-24 May (ruling by Mr Justice Green expected in the next few weeks) taken against NHSE and Secretary of State Jeremy Hunt. Five individuals (one now deceased, Professor Stephen Hawking) challenged their attempt to introduce ACOs from April 2018 using secondary regulation, originally planned to be laid down in February 2018, and only delayed in the face of a defeat at JR. However, the HSCC gives a green light to further Government attempts to ‘workaround’ primary legislation:
Where barriers are identified and can be removed with secondary legislation, this may represent a less complex way forward.
We reject this concession to Government attempts to totally reconfigure and break up the NHS without the scrutiny that would accompany primary legislation.
We believe that the HSCC, while denying that ACOs facilitate privatisation, has also responded to the public concern over the risk of that privatisation poses through ACOs. It is beyond dispute that the awarding of 10-15 year contracts to manage ACOs with multi-billion pound annual turnover constitutes a risk of privatisation of the NHS of unparalleled scale to date.
Given the risks that would follow any collapse of a private organisation holding such a contract and the public’s preference for the principle of a public ownership model of the NHS, we recommend that ACOs, if introduced, should be NHS bodies and established in primary legislation.
There is also recognition that the timescale of 5 years that Simon Stevens, CEO of NHSE laid down in his Five Year Forward View has been unrealistic within the context of unparalleled underfunding and in our view a total failure of workforce strategy since 2010:
Countries that have made the move to more collaborative, integrated care have done so over 10–15 years and with dedicated upfront investment … A long-term funding settlement and effective workforce strategy are essential not only to alleviate immediate pressures on services, but to facilitate the transition to more integrated models of care.
It is misleading to imply that NHSE and Jeremy Hunt have merely failed to communicate their intentions adequately – a conclusion unmistakeably drawn from the title of the press release: ‘Government and the NHS must improve how they communicate NHS reforms to the public, say MPs.’ There has been no misunderstanding: ACOs and associated policies embodied in the Five Year Forward View and subsequent documents clearly have been in the direction of:
- Delivering healthcare at unprecedentedly lower funding levels (£22bn annual NHS funding below predicted requirement for the NHS to meet needs)
- A break up of the national NHS into 44 or more geographically based non-NHS management bodies called ACOs covering the whole of England
- New cheaper models of health and social care workforce to reduce the level of skills and professional experience and thereby reduce costs
- An opening up of private control, or private-public partnership control of these huge contracts, whilst (unbelievably) denying the risk of privatisation.
KONP and others gave evidence that successful efforts to deliver integrated clinical care have been in existence long before the Five Year Forward View and this Government. The National Audit Office concluded in February 2017  that there is no evidence that organisationally imposed integration delivers better care. We need delivery of coordinated patient care, but formally integrated organisations are not proven to be valuable and require dramatic and damaging widescale reorganisation to achieve.
Dr Tony O’Sullivan, Co-chair of Keep Our NHS Public says:
We welcome that the Select Committee appear to agree with KONP and those who have taken NHSE and Jeremy Hunt to JR, when the HSCC states that ACOs must be subject to primary legislation and should be statutory NHS bodies. We also welcome the conclusions of the Select Committee that ACOs lack evidence that they will deliver better coordinated care; that they are being rushed through and are severely underfunded – massive challenges that are without precedent. We welcome the HSCC’s call for change to be evidence-based and that results of trial areas must be closely evaluated.
We reject the HSCC assertion that competition can be a useful tool, when it has most clearly failed in numerous disasters, not least Carillion and Capita.
We are disappointed that the HSCC paints the abject failures of the Five Year Forward View and NHSE policy as mere misunderstandings. We call for the following further conclusions to be drawn
- privatisation of the NHS in all its forms must be stopped
- safe levels of funding must be restored immediately and must fund a safe and effective workforce strategy
- models of care must be based on clinical evidence and patient outcomes, not on financial restraint imperatives
- the NHS must be restored to a fully public provision, fully funded publicly with restoration of the direct duty of the Secretary of State to provide universal and comprehensive health care to the population
Read more ...
Thursday 24th May 2018
- Make bankers and business foot bill for repairing NHS undermined by austerity cuts
The NHS needs more money now and for years to come: but the bill for putting right 8 years of deliberate under-funding should not fall on working families, say campaigners.
News media have picked up on one figure in the new report from the Institute of Fiscal Studies and the Health Foundation, claiming that the cost of maintaining and restoring the NHS could be a tax grab of “£2,000 per household” over 15 years.
John Lister, Editor of Health Campaigns Together newspaper, said:
“We agree that a big increase of 4% a year above inflation is needed to get our NHS back on track and improve services. But taxing ordinary families is the least fair way of raising the extra money: in fact even floating this suggestion seems designed undermine public affection and support for the NHS,”
The virtual freeze on real terms NHS funding since 2010 has been part of austerity cuts to make working people carry the cost of the massive public sector bail out of the failing banks ten years ago: but while bankers are again coining in bonuses, pay increases are barely keeping pace with inflation, many families are struggling on low pay.
“The tax bill for repairing the damage done to health services should fall on the banks, big business and the wealthy who have prospered, not the millions who have suffered. It’s time to look at a tax on financial transactions and speculation in the City of London, which could easily raise the money needed. Other countries already raise such taxes.
“We also need to stop the haemorrhage of NHS funds to private companies cherry-picking services while NHS trusts face deficits and close beds. Almost 11% of the NHS budget is now going to private providers.
“That’s why we are working with Peoples Assembly and trade unions to build a huge march through London on June 30 to both celebrate the 70th birthday of our NHS and demonstrate our demand for proper funding from progressive taxation to keep it free, for all, for ever.”Read more ...
Monday 14th May 2018
Hands Off HRI
- Public Statement on behalf of Hands Off HRI - The Campaign to save Huddersfield Royal Infirmary
Last Friday's announcement by Mr Jeremy Hunt, Secretary of State for Health in response to the referral made by Joint Health Scrutiny Committee last July 2016 to the Independent Reconfiguration Panel (IRP), has both delighted and surprised local campaigners fighting to save all hospital service in the Huddersfield area. Since the inception of the IRP , there has never been such a strong and unambiguous statement. Mr Hunt has said of the NHS bosses proposals that
· there are a wide variety of failings in their business case
· the proposals lack consistency
· there is widespread scepticism about them being deliverable
· there is no evidence of adequate out of hospital care
· the loss of beds is unjustifiable
· there is no evidence of capital finance being available for their project
Mr Hunt correctly concludes that the proposal to downgrade HRI is 'not in the best interests of the people' of Kirklees and Calderdale and he has ordered the CCG to work with Joint Health Scrutiny alongside NHS Improvement and NHS England to develop new proposals which take into account these misgivings.
This outcome has completely vindicated the long and relentless campaign waged by Hands Off HRI over the last two and a half years, and supports the findings of the courts that will result in the full Judicial Review in June. There is little doubt in campaigners’ minds that the decision at Leeds Crown Court two months ago to order a full Judicial Review into this proposal has concentrated minds in Whitehall.
The Judge has identified five counts of public law which must be tested in a full hearing which is set to go ahead on 12 - 14 June. With this decision by Mr Hunt now also hanging over the local CCG, it is very difficult to see how they can justify continuing with their disgraceful scheme.
Hands Off HRI had commissioned three professional clinical, financial and building experts to scrutinise the proposal in preparation for the court hearing. Their findings completely bear out Mr Hunt's observations, namely that the financial case for closure is not justified; there is no clinical evidence of improved outcome for patients and that HRI has another 100 years life left in it. Faced with this huge weight of evidence, perhaps Mr Hunt has done the CCG a favour by vetoing their plans.
Where does this leave the future of HRI?? Whilst delighted with this decision, Hands Off HRI recognises that this is not the end of the proposal to shut our hospital. It is the same CCG which is being asked to think again.
Whilst we welcome the departure of Mr Alan Brook as Governing Body Chair of NHS Calderdale CCG, Hands off HRI is demanding that the whole board of both Calderdale and Greater Huddersfield CCGs resign and that new appointees take over to look at the genuine health needs of the population.
It has been clear from the outset that this proposal was driven by the disgraceful PFI scheme hanging over Calderdale Hospital in Halifax and that the CCG is attempting to balance the books by closing HRI.
Mr Hunt has ordered the relevant authorities to develop a new plan over the next 3 months. Hands Off HRI will be engaging with this process by submitting further evidence to the IRP and local politicians. We will also be consulting with our legal team about the Judicial Review which is still scheduled to go ahead.
However momentum is now with our campaign and the whole town is lifted by the decision. There is renewed confidence that we can see this through to the end. The Crowd Justice appeal to raise funds for the Judicial Review has already exceeded our target and funds continue to pour in as no stone is left unturned to ensure our war chest is full. The fight will go on and we will be rallying to our campaign themes:
If you stand up and fight , you can win
It's only a done deal, if you do nowt.
For more information, contact Mike Forster 07887668740; Steve Slator 07854358479; Cristina George 07747446005
To contact the campaign: find us on the following:
email@example.com Facebook: HandsoffHRI Twitter: @HoHRIltd Read more ...
Friday 11th May 2018
Hands Off HRI Official Group
- Hunt signals retreat from flawed plan to axe Huddersfield Royal Infirmary
A 2-page letter from Jeremy Hunt to the joint Calderdale and Kirklees Health Oversight and Scrutiny Committee has slammed the brakes on plans to run down the 400-bed Huddersfield Royal Infirmary.
Hunt's bluntly worded letter (see link below) admits that even the Tory-led Independent Reconfiguration Panel was unable to ignore "a wide variety of failings which call into question the benefits of this scheme and the way in which the process has been managed so far".
Hands Off HRI, after a hard slog going back over 4 years, challenging the plan at every stage, was poised for court action in June, seeking a Judicial Review to challenge the deeply flawed plan.
They had assembled evidence to demonstrate the spurious assumptions and assertions of the Full Business Case, which was neither full nor a genuine Business Case, its lack of concern to address equality issues, transport and access issues, the prospect of chronic capacity gaps, the lack of any clinical or other evidence to support the plan and the careless, slipshod drafting of misleading documents that failed to answer any of the key questions.
Congratulations to all those who have fought so hard and all those who have contribute to the crowd-funding appeals for resources to finance the JR process, and congratulations too to the legal team Irwin Mitchell who had assembled such a strong case.
This is just the most recent of a series of retreats that have been forced onto NHS England, local trusts CCGs and STPs by solid, relentless campainging, piling local pressure onto politicians and refusing to accept the bland assurances of managers and their cynical management consultants.
Campaigning can work: if you fail to fight back you guarantee a defeat. That's a vital message as we fight to build the broadest, strongest, biggest, hardest alliance we can to defend the NHS we still have, stem the haemorrhage of money squandered on a destructive market system and contracting out, and bring the clinical and support services that have been privatised back in house.
In six weeks we will stage a massive show of strength as we march through London on June 30 to celebrate the 70th birthday of the NHS and demonstrate demanding it be properly funded and restored as a publicly owned, publicly funded and publicly accountable service guaranteeing health care free for all, free forever.
Join us in this, and join local campaigns in your area fighting this vital fight against irrational, ill-conceived and potentially disastrous schemes to cut costs at the expense of patient care. Leaflets can be downloaded or ordered FREE from us at Health Campaigns Together: see the front page of this website.
Read more ...
Wednesday 28th March 2018
Oxford KONP - Gus Fagan
- The Independent Reconfiguration Panel critical of CCG's handling of the Horton. But has the Horton been saved?
In 2016 Oxfordshire Clinical Commissioning Group announced the planned closure of obstetrics at the Horton Hospital in Banbury and the centralisation of obstetrics at the John Radcliffe Hospital.
The Horton would retain a midwife-led unit.
The closure was part of Phase 1 of the Oxfordshire Transformation Plan. The first of a two-phase
consultation on the Plan was announced in January 2017. This plan included the permanent closure of obstetrics at the Horton.
The consultation was described by Oxford Keep Our NHS Public (KONP) as 'a sham' and there was strong popular opposition to the plan in Banbury, led by the campaign group, Keep the Horton General (KTHG).
As a result of popular opposition across the county, the Health Overview and Scrutiny Committee (HOSC) of Oxfordshire County Council referred the matter to the Secretary of State. HOSC made the referral to the Secretary of State on two grounds – that the consultation undertaken was inadequate and that the proposal would not be in the interests of the health service in its area.
The Secretary of State sent the referral to the Independent Reconfiguration Panel (IRP) for advice.
In February 2018 the IRP delivered its advice. It agreed with campaigners and HOSC that the consultation, especially the way it was split in two
“… has added more to the confusion and suspicion than helped move matters forward. In the Panel’s view, decisions about the future of obstetrics at the Horton must inevitably influence proposals that remain to be consulted on including around the future provision of MLUs in Oxfordshire.”
According to Oxford University Hospital Trust, the unit at the Horton needed to close because it had been unable to recruit obstetricians to work there. The IRP agreed with critics that, since the Trust had already decided it wanted to close the unit,
“… it is not surprising that scepticism exists in some quarters about the extent of the Trust’s efforts to attract the skilled and experienced staff required to reopen the unit.”
The IRP concluded that the CCG needed to look again at its options for the Horton:
“In the Panel’s view, a further, more detailed appraisal of the options, including those put forward through consultation, is required and needs to be reviewed with stakeholders before a final decision is made.”
The MP for North Oxfordshire, Victoria Prentis, said it was a 'huge relief' to hear the IRP's conclusion.
"The IRP’s conclusion that further work needs to be undertaken comes as a huge relief and is recognition of what many of us have been saying repeatedly since the flawed consultation process began.”
But on the heart of the matter, the future of obstetrics at the Horton, the advice from the IRP was anything but a clear victory for the Horton:
“First, that action to consider alternative options is needed because the problems with sustaining the obstetric service at the Horton that led to its temporary closure in 2016 are real and the prospects for returning to the earlier status quo are poor given a national shortage of obstetricians… Secondly, that this consideration must be driven by what is desirable for the future of maternity and related services and all those who need them across the wider area of Oxfordshire and beyond rather than a search for any possible way to retain an obstetric service at the Horton.”
The campaign group, Keep the Horton General, was more critical of the IRP decision:
“The IRP is effectively leaving the CCG to its own devices in terms of the final decision for maternity, in spite of significant evidence that it would be unsafe to leave vast, semi-rural population without reasonable access to obstetric services. … KTHG considers the IRP has missed the opportunity to examine or take into account the national factors that are being used as a justification to downgrade hospitals all over England - e.g hospitals being denied training accreditation at precisely the time when shortages of specialists were anticipated.”
According to Roseanne Edwards of KTHG
“Everyone's talking as though the Horton is reprieved but I see it as a severely weakened hospital that they can see is needed with the extraordinarily dire winter pressures, but it will only, effectively, have an A&Ee and childrenss ward, which will be highly vulnerable. Already they are sending anything that needs a senior consultant down to the JR.”
In March 2018 the Clinical Commissioning Group gave its first response to the IRP proposals. On the core issue of the campaign, it made no commitment to retaining obstetrics at the Horton:
“… the future provision of an obstetric service or change to a permanent freestanding midwife led unit at the Horton General Hospital will be determined by the outcome of the work undertaken to address the recommendations from the Secretary of State."
It also decided that “there will be no phase two consultation". Instead, a new phrase has entered the CCG vocabulary: 'co-production'. Rather than consult the population in the county about a general plan, there will be engagement at
“a more local level in looking at the population’s health and care needs so we may co-produce a health and social care system that is fit for the future”.
In the meantime, the emergency department and paediatric services will be retained at the Horton. The CCG also is making no commitment to retaining community hospitals:
“The community hospitals must be considered within the context of the health and care needs of the local populations they serve, the state of the actual buildings, the rurality and size of the local population (including growth). The CCG and OHFT have agreed that discussions need to be more about what services are required in localities and how best the community hospitals might support, rather than a county-wide consultation on whether they should be removed or remain.”
In general, the initial response of KTHG seems correct:
“The IRP is effectively leaving the CCG to its own devices.”
Tuesday 27th March 2018
Save Our Hospital Services, Devon
- Devon: Victory for democracy at County Hall
Devon County Council’s Health & Adult Care Scrutiny Committee has agreed to defer plans by the county’s two clinical commissioning groups (CCGs) to implement further changes called for by NHS England on the basis that there has not been sufficient information or time to consider the impact on Devon’s residents.
The decision by Devon’s scrutiny councillors is welcomed by campaign group Save Our Hospital Services (SOHS), which has been concerned that NHS England’s planned integrated care system (ICS), proposed to be launched on 1 April, would lead to a postcode lottery on access to NHS provision due to the ongoing cutting of £557 million from Devon’s healthcare budget by 2020/21.
However SOHS is very disappointed that North Devon Councillor Paul Crabb from Ilfracombe moved an amendment which was carried, calling for no consultation involving the public, preventing his and other voters from participating in the democracy process.
Sue Matthews, a retired registered nurse and spokesperson for SOHS said: “ICSs will still have to operate under the conditions of austerity and cost-cutting, but the public have not been given a clue about their legal structure and obligations, about leadership or about how the funding system might work. From what we do know, it is beginning to look as if they could be run along the lines of a private business, protected from public scrutiny and without the accountability to central government which has been a cornerstone of the NHS.”
Campaigners had sent letters to councillors on the Scrutiny Committee, and SOHS speakers from North Devon made representations at last Thursday’s Scrutiny Committee meeting at County Hall in Exeter. The public gallery was packed with campaigners who had travelled from all parts of Devon to oppose further cuts in NHS provision in the county.
SOHS had also put a number of questions to the NEW Devon Clinical Commissioning Group and the South Devon and Torbay Clinical Commissioning Group concerning the planed ICS.
These cover important issues such as governance and accountability, funding, maintenance of consistent health provision regardless of where in the county patients live, and the budgetary implications of yet another restructuring of the NHS in Devon. These questions were taken on board by the Scrutiny Committee in its decision to defer approval of the CCGs’ proposed introduction of the ICS.
A joint meeting of the CCGs’ Governing Bodies took place at County Hall on the same day as the Scrutiny Committee meeting, and the CCGs indicated that they were willing to speak to campaigners about the details of the proposed ICS.Read more ...
Sunday 25th March 2018
KONP North East
- NORTH TYNESIDE COUNCIL: UNANIMOUS CROSS-PARTY VOTE IN FAVOUR OF MOTION OPPOSING ACO/ACSs
“This council agrees that there is a growing body of evidence questioning the wisdom of ….Accountable Care Organisations / Integrated Care Systems (ACO/ICS)….This council agrees to oppose any proposal to implement the delivery of healthcare in North Tyneside via an ACO/ICS, a project which in the North Tyneside CCG’s own report was stated to be high risk”.
Well done Councillors Lesley Spillard, Sarah Day and Wendy Lott who brought the motion to the council, and to Councillors Leslie Miller, Kenneth Barrie, Margaret Hall, Gary Bell and Alison Wagott-Fairley who all spoke in favour of the motion.
In her introductory speech at tonights full Council meeting, Cllr Lesley Spillard stated: “There are huge concerns and objections to the “elephant-in-the-room” which is not being widely promoted by NHSE and local CCG’s. It is not benign.
The NHS England policy is to move STPs through “systems” (whether these be named “Integrated Care” or “Accountable Care”) en route to Accountable Care Organisations, with plans to put ACOs to tender inviting bids from the private sector. This is in conflict with current legislation, and will lead to the large scale privatisation of our NHS”.
All Councillors spoke with great commitment and knowledge about the matter in hand, being clear about what is at stake. Absolutely no-one opposed the motion, and no abstentions – the vote was carried unanimously by North Tyneside Councillors….an example of excellent cross-party work by North Tyneside Councillors.
The agenda from the meeting, and the motion in full is here:Read more ...
Saturday 17th March 2018
Hands Off HRI
- On Thursday March 15th , Hands Off HRI made legal history in the Leeds Crown Court.
Judge Mark Gosnall agreed there were important matters of law which must be tested in a full Judicial Review. We expect the hearing to take place in June. The Hospital Trust has so far considered itself to be beyond reproach but they will now have to account for their proposals in court.
This is a huge blow to the Trust and a massive victory for the people of Huddersfield who have stood shoulder to shoulder with this campaign. It has taken two years of hard work and perseverance to pull this off but we have been rewarded.
The Judge has approved the referral to the High Court on the following grounds:
· A serious matter of public law needs to be tested
· Consideration of the consultation exercise
· Examination of alternative community care provision
· Potential breach of Equality Law
· Lack of Travel and Transport Provision
Our campaign group will now be shifting up a gear to ensure all possible approaches are explored to win this legal case. Of course we still await the outcome of the Independent Reconfiguration Panel which is now with the Secretary of State but undoubtedly this legal case will focus his mind!
Of course this is not the end of the road; we now have to win our Judicial Review but our legal team are up to the challenge and we know we will continue to have your support. This challenge has local and national consequences.
It is the first serious legal challenge of its kind. If we win, it doesn't just help our hospital, it will give encouragement to all campaign groups fighting for their own services. However we will need ongoing public support.
We estimate we need to raise another £10,000 to bring our legal case and that is where you come in. All supporters can help us in our next phase of fund raising.
We have now proved this is not a done deal and that People Power CAN work.
Join our facebook page; organise your own fund raiser or just donate to our legal fund (details below). This is a fight for Huddersfield and the wider NHS and we can win. Let’s do this together. HANDS OFF HRI!!
You can donate directly by bank transfer into the Hands Off HRI account. Sort code: 20-43-04 Account number: 93119130
For local contact details, please email:
firstname.lastname@example.org Facebook: HandsoffHRI
www.officialhandsoffhri.org Twitter: @HoHRIltd
For more details: Cristina George 07747446005 Mike Forster 07887668740 Read more ...
Friday 16th March 2018
- Dorset campaigners win Full Hearing on their Judicial Review
We’re delighted to report that we’ve been granted a Full Hearing for our Judicial Review into Dorset CCG’s plans, which are to downgrade 1 of our 3 A&E’s, close 1 of our 3 Maternity’s with a 2nd under threat, close Community Hospitals and/or beds in 5 of 13 Dorset locations, and close 245 acute beds.
The plans leave the future of Poole General Hospital in doubt. Poole Maternity site appeared in Poole local plan as ‘existing site allocated for development’ in June 2016, 6 months before the ‘Consultation’ on the changes even began.
We now need to raise the £10,000 Community Contribution needed for the final stage costs: https://www.crowdjustice.com/case/save-poole-ae-and-maternity-and-nhs-beds
Our JR could be of benefit to campaigners across the UK as the arguments the Judge has accepted for full hearing are:
1) Unsafe Travel Times: That the plans to downgrade Poole A&E and close Poole Maternity will move emergency and Maternity services out of safe reach for tens of thousands of Dorset residents. We have a Claimant who has been granted legal aid who is severely affected by the loss of Poole A&E, as her condition can deteriorate rapidly, and potentially be fatal. She is blue lighted to Poole regularly (8 times last year).
2) Failure to meet Beds Duty: That it is unlawful for Dorset CCG to close NHS beds without having replacement staffed services in the Community that are proven to reduce the demand for NHS beds.
We are also arguing for a third argument to be heard at Full Hearing
3) That aspects of the Consultation were so misleading as to be unlawful. There are another group in Dorset who are aggrieved about the Local Government Unitary Authority Consultation. This was carried out by the same company, Opinion Research Services, who did the Consultation on the NHS cuts. This group are starting JR proceedings having been advised that it is illegal to create, or use, a Consultation designed to give a defined outcome.
Please support us! https://www.crowdjustice.com/case/save-poole-ae-and-maternity-and-nhs-beds
We also continue to fight for our Dorset NHS at Local Authority Health Scrutiny Meetings. Follow our campaign on our FaceBook page: https://www.facebook.com/defenddorsetnhs/
If you have any evidence that may support our case, for example research references evidencing delays to treatment cause increased mortality and morbidity, or references showing that the benefits claimed for centralisation of services are exaggerated or untrue, please let me know!
Read more ...
Thursday 15th March 2018
KONP North East
- North East March and Rally for the NHS; a loud and clear message to North East CCGs and NHS England
OUR NHS: NO CUTS – NO CLOSURES – NO PRIVATISATION
SATURDAY 10th MARCH 2018
More than 1000 joined the North East March and rally to demand a healthy NHS … and the message has got out to tens of thousands through word of mouth, journalism and social media.
EIGHT North East health campaign groups plus North East Peoples Assembly joined together to call for
- a cash injection to restore the NHS budget, commitment to increased funding each year, and an end to the cap on NHS pay
- abandonment of any plans for further cuts or cash-driven closures of NHS hospitals and services
- a halt to the imposition of “new models of care” and “accountable care”
- repeal of the 2012 Health & Social Care Act and reinstatement of the NHS as a public service, publicly accountable, publicly owned and publicly funded
Check out the pictures and reports by following the link below.Read more ...
Thursday 8th March 2018
RCEM press release
- Royal College of Emergency Medicine urges patients to take action after worst ever 4hr performance figures
The Royal College of Emergency Medicine is calling on patients to write to their Member of Parliament asking for action to address the serious challenges facing Emergency Departments across the country.
The unprecedented move comes after data released today showed the worst ever four-hour emergency care performance at just 76.9% at major emergency departments. Sitrep data also showed that in February bed occupancy was at 95.1%.
Dr Taj Hassan, President of the Royal College of Emergency Medicine, said: “Unfortunately these figures are not surprising and reflect the acute and detrimental effect insufficient resources are having on our health service; patient care will continue to suffer until this changes.
“Performance that once would have been regarded as utterly unacceptable has now become normal and things are seemingly only getting worse for patients. It’s important to remember that while performance issues are more pronounced during the winter, Emergency Departments are now struggling all year round.
“Warnings and pleas for adequate resourcing have repeatedly failed to deliver with both patients and staff suffering as a result. We cannot continue in this situation - which is why we are calling on patients to contact their MP in support of our A&Es and the NHS.
“Let’s be very clear. The current crisis in our Emergency Departments and in the wider NHS is not the fault of patients. It is not because staff aren’t working hard enough, not because of the actions of individual trusts, not because of the weather or norovirus, not purely because of influenza, immigration or inefficiencies and not because performance targets are unfeasible. The current crisis was wholly predictable and is due to a failure to prioritise the need to increase healthcare funding on an urgent basis.
“We need an adequate number of hospital beds, more resources for social care and to fund our staffing strategies that we have previously agreed in order to deliver decent basic dignified care. We would urge our patients to contact their MP to tell them so. We hope that action from patients will ensure that our politicians give the NHS the due care and attention it needs and help them come together to find appropriate long-term solutions for the NHS that are so desperately required.”
Mr Derek Prentice, the College’s lead patient representative and Lay Committee Chair, said: “Yet again patients have had to endure another winter of misery due to inadequate resourcing. Understandably public satisfaction with the health service has fallen. But patients are not blaming individual trusts or staff. They quite rightly understand that this is the fault of our politicians, which is why we are asking for their help to change the situation.
“While the recent budget allocated extra funds to the health service, it was not what was made very clear would be required and was just about enough to stave off complete collapse. Just about enough should not be good enough. Our patients, staff and the NHS – now in its 70th year – deserve better. We need long term solutions, including more beds and more staff, and we would encourage patients to ask their MPs for them.
“Ministers and decision makers must stop burying their heads in the sand and face the reality of the situation; overall performance is in decline due to the under-resourcing of health and social care. The data shows the reality, yet facts are being disregarded and the health sector is not being listened to. We hope that they will listen to the public who voted for them.”
Read more ...
Sunday 4th March 2018
SHA blog: https://www.sochealth.co.uk/2018/02/28/lies-dishonesty-boards-go/
- Lies, Dishonesty and Boards that Should Go
by Richard Bourne
Trusts around the country are setting up wholly owned companies to deliver services so they can take advantage of taxation changes this allows.
This great VAT saga shows the NHS at its very worst. Bullied from above, local managers believe the hype from consultants. They can’t write a proper business case but still launch a project in secret, refuse to consult with staff, totally mislead the staff and public about the real intentions, refuse to give information claiming everything is commercially confidential and plough on regardless – all with the active collusion of a Regulator that is supposed to stop such poor behaviours. Those involved continue to refuse even to respond to FoI requests. Questions in both Commons and Lords get stock answers saying this has nothing to do with Ministers – it’s local decision making – nothing to see here.
Unison has been active in opposing the outbreak of wholly owned companies for 18 months. On the face of it this represents money for nothing – the same staff doing the same job in the same way with the same managers but with “savings” in £millions from tax changes. No increase in productivity, no innovation, no efficiencies at all – just a tax scam. The staff loose out by moving out of the NHS and become collateral damage, but this does not matter as they are not nurses or doctors – that may come later.
Tactically the Trusts also get to break out of the national pay and conditions and can pay new staff and even promoted old staff on worse terms and conditions. This alone should set red lights glowing somewhere.
Oh, and two fingers up to any local plan about working together, collaboration and that guff – this is every Trust for itself – they even all claim that they will be selling services to each other.
And big issues like the consequences of transferring ownership and control over public assets to a private company (even one which for now is wholly owned) have simply been ignored or lied about.
Facts as opposed to the lies, are slowly emerging. To take one well documented example. Late in 2016 a Trust did preliminary work with outside consultants on going down the wholly owned companies route. In December 2016 in secret the Board agreed to go ahead using a particular model solution pitched to them by the consultants.
They did not look at the overall strategy involved and failed to look at other options. This offer was too good to be true and others had done it; so why not? The “Business Case” to the Board was laughable being a few pages of platitudes and 63 pages of tax advice.
The Trust worked on in secret, despite being under a very clear duty to engage with the staff on a decision which affected hundreds of them.
Eventually, late in 2017, they had to come clean and start TUPE consultations, but they consistently refused in every forum to consult or engage with staff on what was being proposed – they would only talk about the consequences. They knew their whole case was entirely bogus.
In public the Trust simply avoided telling the truth. They maintained throughout that what they were doing had to do with somehow professionalising the facilities management services.
Strangely the Trust had never reported its concerns with these services before they were sold the VAT dodge. They never engaged with staff to see how they could improve services at all.
The Trusts maintained the fiction that this was nothing to do with tax as they had been instructed to do. They gave a presentation to staff which had a dozen slides but none of them even mentioned VAT or tax. They signed a secrecy agreement with the consultants they used. But because information was coming out of other Trusts doing the same thing, but slightly more honestly, they were caught out anyway.
After enormous pressure from Unison the Trust finally revealed at least some of its documents but only after it was already implementing its decision.
What the documents showed was what everyone already knew – the savings almost all came from changes in taxation. Savings from other sources such as reducing pension rights or bringing in a two tier workforce were tiny in comparison.
This was and is all about tax. All about a Trust in severe financial straights doing anything to make savings. Doing what it was told. It was more afraid of external intervention for not trying hard enough than it was afraid of the outrage from its own staff.
Utterly dishonest from start to finish. But with active collusion from NHS Improvement – the Regulator which knew exactly what they were doing and why, even if they now refuse to release the information and ignore FoI requests.
We know from parliamentary answers that NHSI signed off the deal. We also know the relevant CCG opposed it and appealed to the Trust not to go ahead – yet again the lie is that everyone was in agreement.
A disgrace from start to finish. Staff disillusioned, staff relations soured for years to come, further fragmentation of the NHS and a wholly uncertain cloud over the future ownership and control of vital NHS assets. And NO SAVINGS. Anything saved in one place is lost to the exchequer in another – it's our money and we get no benefit at all.
No Board that agrees to this kind of subterfuge and secrecy is fit to stay in place. But they will.
NB: See also the piece from Caroline Molloy, link below:Read more ...
Monday 19th February 2018
- Ealing campaigners challenge viability of North West London hospital closure plans
A group of campaigners from Ealing Save Our NHS have written a hard-hitting, factually-based critique of the plans for the closure of acute services at Ealing and Charing Cross Hospitals, which are still being promoted by NW London CCGs despite the very real doubts over the viability of the plans or availability of the capital required.
The letter to NHS Improvement London states:
"We are a group of concerned North West London (NWL) residents, who have invested considerable time and effort in studying regional and local plans for healthcare services in this area.
In November 2017 a letter written by NHSI/NHSE London to NHS NWL CCG Accountable Officers came into our possession.
The letter asks for further evidence based assurances before committing financial resources to the SaHF ImBC SOC1.
At the heart of these concerns is the lack of evidence to support an annual Non–Elective (NEL) admissions reduction of 99,000 by 2025/26 …"
Read the rest of the letter and the letter to Colin Standfield regarding A&E performanceRead more ...
Tuesday 13th February 2018
Ontario Health Coalition
- Ontario Health Coalition Succeeds in Protecting & Strengthening Ontario's Ban on Private Hospitals
Ontario's ban on private clinics was removed in the provincial government's "omnibus health care bill" that was brought to the legislature last autumn.
The government passed the health care omnibus bill -- Bill 160 -- prior to Christmas and it has been promulgated into law.
The three political parties proposed a total of more than 100 amendments to the Bill. Those amendments went to the Standing Committee to to voted on in early December. (Membership in the Standing Committees follows the make-up of the Legislature so the governing party currently has a majority on all Committees.) The Liberals voted down all amendments proposed by the Opposition Parties. The amended Bill then went to the Legislature and was passed.
Our concerns about paramedic services, long-term care, private clinics and retirement homes were not addressed.
The amendments we were seeking in all the other Schedules of the Act were not passed, with the exception of Schedule 9 (the Private Hospitals section) which I will describe below. Thus, our concerns about paramedical services, long-term care, private clinics, private retirement homes etc. still remain. If you want to see what they are, please see our submission on Bill 160 to the Standing Committee on General Government here: http://www.ontariohealthcoalition.ca/wp-content/uploads/submission-to-the-standing-committee-2.pdf
We were, however, able to get Schedule 9 -- the section on Private Hospitals -- amended to meet every one of our concerns.
This is what happened:
Schedule 9 repealed the Private Hospitals Act. This may sound like a good thing, but in fact, it was quite the opposite. The Private Hospitals Act (1971) was passed to limit private hospitals. It was a short Act, and a good one.
Essentially, it banned all future private hospitals (after 1971) and stopped them from expanding, gave the Minister powers to require private hospitals to be licensed annually, to refuse the transfer (sale) of a license in the public interest, and enabled the Minister unfettered powers to revoke a private hospital's license in the public interest.
When the Shouldice Hospital tried to sell out to Centric Health, one of the largest transnational private health companies in the world, we cited the powers in this Act to ask the Minister to stop the sale. We were successful.
Thus the Private Hospitals Act has, by and large, protected Ontario's public non-profit hospital system from incursions by private for-profit hospitals and transnational chain companies for almost two generations.
So when the government introduced Bill 160, we were extremely concerned. We warned that the government was, in Schedule 9, lifting the ban on private hospitals and the powers of the Minister to stop their expansion and control them, without replacing those powers in the new legislation.
We wrote an open letter to all MPPs we organized press conferences, asked the NDP to raise questions in Question Period, and we sought high-level meetings with the Premier's, Government House Leader's and Health Minister's offices.
The Premier & the Health Minister agreed and stepped in to direct the bureaucrats to draft amendments.
The Premier's staff agreed with our analysis and facilitated meetings with the Health Minister's staff and high-level bureaucrats. We brought our lawyers and ultimately key officials from the Premier's and Health Minister's offices agreed with our analysis and worked with us to fix it.
The government delayed the legislation and agreed to make amendments to Schedule 9.
We reviewed the amendments and the Premier's and Health Minister's offices agreed to change the language until we were satisfied. All this to say that the amendments, in the end, met all of the requirements we asked of the government regarding the issue of private hospitals.
This is what we achieved:
- The ban on private hospitals was restored. Only the 5 still-existent private hospitals that were grandfathered in under the 1971 Private Hospitals Act are allowed to continue.
- No private hospital can expand its services or its bed capacity. No private hospital may move its location.
- The Minister's powers to license these facilities is reinstated along with the powers for the Minister to refuse the transfer, suspend, or revoke a private hospital's license in the public interest.
- Only the grandfathered-in private hospitals may accept a patient for inpatient services and provide treatment. No other entity can do that, and no other entity can hold itself out as providing hospital services.
- We also won an improved definition of private hospital (as a facility that provides overnight accommodation and medical and nursing care). This will help to limit private clinics from turning into private hospitals.
- We also won expanded powers for the Ministry to control transfers of licenses among private clinics, and to revoke or suspend those licenses in the public interest.
In the end, we are satisfied that the government heard us and the amendments to Schedule 9 continue and expand the limits on private hospitals.
But private for-profit clinics (not hospitals) can still expand and take over public hospital services unless we stop them.
However, Bill 160 rolled the private clinics providing outpatient diagnostics and procedures (not hospitals) legislation (called the Independent Health Facilities Act) into the new legislation and renamed it, even more euphemistically, the Community Health Facilities Act.
The Act remains the same as it was. It allows the expansion of private clinics by the stroke of a pen of a bureaucrat in the Health Ministry.
It was always a bad Act and remains so. We have successfully fought back every attempt to expand private clinics in recent years.
We will have to continue to do so until we win legislation that rolls the clinics back into public ownership and stops the expansion of private clinics.
Bottom line? The premier and the Health Minister agreed with the protections we were seeking in the public interest. They worked with us to change their own legislation to stop the expansion of private hospitals and expand public control over them. This is a great achievement in the public interest. Now we need to roll the private clinics' services back into public non-profit hospitals....
NB. The government has been stating that the Private Hospitals Act was 'written in the 1930s'. This has sown some confusion. It may well be that there was a private hospitals act passed in the 1930s. But the version that was changed by the Omnibus Bill and Schedule 9 was the version that is listed as the 1971 Private Hospitals Act in the government's own e-laws.
This 1971 version would have been significantly amended from the 1930s version of the Act since there was no public hospital system in the 1930s therefore there would be no ban on private hospitals etc.
While we thank the Premier and Health Minister for their help and for recognizing this issue as a serious one that needed to be addressed, the letters that we have seen from a few local Liberal MPPs are egregiously misleading, and sometimes, outright dishonest about what happened with Bill 160 and the issue of private hospitals.
Thank you to the NDP for helping!
The NDP kept up the pressure in the Legislature while we were negotiating with the Health Minister and Premier's office. NDP Leader Andrea Horwath asked key questions in Question Period for several days in a row to make sure that the government was held accountable to come through with the changes we were seeking to protect against the expansion of private hospitals. You can see the videos of those questions in the Legislature and the answers from the Health Minister here:
Thank you to all of you who contacted your MPPs, came out to the Legislature to help put on the pressure. Thank you to OCHU/CUPE and Unifor for helping to facilitate meetings with the Premier's and Minister's staff. Thank you to lawyers Steven Barrett and Ethan Poskanzer for working day and night to help.
To all the organizations, from nurses to seniors' groups, the Council of Canadians, health care unions for writing and presenting submissions to the Standing Committee pushing for amendments.
To OPSEU for bringing out your members to help fill the Galleries at Queen's Park. It was a team effort and everyone made a real difference.
Read more ...
Wednesday 7th February 2018
- After ministers delay regulations to facilitate ACOs, an update from JR4NHS on Urgent Legal Action for Our NHS - Round 3
We were very pleased this morning to learn that the government will not now be laying the regulations to facilitate accountable care organisations (ACOs) until after NHS England has consulted on ACOs.
This is a major change.
When we launched our judicial review they said that there was no duty to consult the public about ACOs and that the regulations would be laid this month.
But today, in reply to an oral question in the House of Commons from Jonathan Ashworth MP, Labour's health spokesperson, Health Minister Caroline Dinenage MP [NB: at the prompting of Jeremy Hunt sitting next to her – HCT] said that the regulations would not be laid until after the 12-week national consultation, which was promised by NHS England and Jeremy Hunt MP, Secretary of State for Health and Social Care after we had sought our judicial review.
Now we have a consultation, and the regulations will not be laid.
But we still need to make sure that they can't bring in anything like the kind of ACOs they're proposing.
Please do all you can to spread the word – and to let people know that we still need support to reach our Round 3 target of £100,000 to keep the case going. The pledges have been pouring in - we're almost half way there, with 23 days to go.
As updated yesterday, the Secretary of State and NHS England refused our suggestion for each side bear to its own costs whatever the outcome, so we have asked the court to hear our application for cost capping at a short hearing and have revised the application to ask that the amount we would have to pay, should we lose, be capped at £160,000.
Thank you all so much for your fantastic support.Read more ...
Monday 5th February 2018
- Trump triggers near-unanimous rejection by trying to use our march to attack NHS and universal care.
Donald Trump kicked off the war of the Tweets with a predictably ill-informed and ignorant comment on our magnificent demonstrations on February 3:
- “The Democrats are pushing for Universal HealthCare while thousands of people are marching in the UK because their U system is going broke and not working. Dems want to greatly raise taxes for really bad and non-personal medical care. No thanks!”
To his chagrin the short shrift reply from Jeremy Corbyn got more retweets than Trump had managed. But other replies are also interesting. These included:
- Bernie Sanders: "Hey, Mr. President. The only people who love the current system are you, the drug companies and insurance companies. 30 million Americans have no health insurance and we pay the highest prices in the world. We must guarantee health care to all, not take it away."
- Jon Ashworth, shadow health secretary: "Thousands of us marched for a fully funded public universal National Health Service covering all because its the most equitable way and efficient way of delivering healthcare. We’ll take no lessons from someone who seeks to deny healthcare to millions"
- Health Secretary Jeremy Hunt was also quick to distance himself from Trump's position: "I may disagree with claims made on that march but not ONE of them wants to live in a system where 28m people have no cover. NHS may have challenges but I’m proud to be from the country that invented universal coverage - where all get care no matter the size of their bank balance."
- Health Campaigns Together editor John Lister: "Even a drastically run down
#NHS is better, fairer, more accessible and infinitely more efficient than the dysfunctional costly shambles of US healthcare -- made worse still by Trump's intervention. Nobody on our march would swap for US system."
- John Lister: "It takes the US system to spend almost $3 trillion/year, 1/3 of global health spend, equivalent to almost $10k/head -- but still leave 30 million uninsured, worse life expectancy in US cities than Cuba, more $ wasted than health budgets of 64 lowest-spending countries. Sad, sick, pathetic."
- John Lister: "The US health care 'system' is an international laughing stock: 18% of GDP, $800 bn/year lost through fraud and waste, huge inequalities, ranked bottom of 11 countries by Commonwealth Fund, 600k personal bankruptcies/year from medical bills. Who wants that - except D Trump?"
- Keep Our NHS Public tweeted: We know which side of history we'd rather be on: With Bevan's NHS healthcare paid democratically from taxation, supported by 85%+ real people &
@keepnhspublic @nhscampaigns @pplsassembly NOT rapacious US health industry bankrupting 100Ks & @realDonaldTrump
- Peoples Assembly, co-organisers of the February 3 events: "British people want to show their love for the principles of universal & comprehensive care free at the point of use, no one wants a disastrous US system. We don’t agree with your divisive, incorrect rhetoric. No thanks."
- A joint PA/HCT statement went further:
"Dear Donald Trump
The NHS has existed since 1948 in the UK after the devastation of the second world war. The British population demanded the right to have access to healthcare which they deserve as human beings which is absolutely affordable when the right political decisions are made.
It has been a shining example to the world of what can be achieved when we put the needs of the collective good over the interests of a few wealthy individuals.
Unfortunately, our current government have been persuaded to increasingly adopt policies which represent those of your Government, they have decided to move us more to an American-style system which is widely acknowledged to be one of the most expensive, inefficient and unjust healthcare systems in the world.
This is why our NHS is currently struggling and why leading Professors including Professor Stephen Hawking are bravely battling politicians who wish to turn it into a system like yours.
This is what our demonstration was about on Saturday 3rd Feb and tens of thousands of British people want to show their love for the principles of universal and comprehensive care free at the point of use, paid for through general taxation. We don’t agree with your divisive and incorrect rhetoric. No thanks.
The People’s Assembly and Health Campaigns Together"
NOTE: The US Health care system consistently evaluates as the worst (and the UK as the best) of 11 health systems in wealthier capitalist countries, according to the US-based Commonwealth Fund (http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/ )
The most recent comparison (2017) again ranks systems according to set criteria: care process, Access, Administrative efficiency, Equity and Health care outcomes. The US comes in at 10th or 11th out of 11 on all but the care process (5th).
The one area where the US system does lead the world is in wasted resources: back in 2009 a Thomson Reuters report found waste (including fraud and abuse, under-treatment and over-treatment) running at a staggering $700 billion or more each year: https://healthcarereform.procon.org/sourcefiles/thomson_reuters_study_medical_waste_2010.pdf.
The US also features high on any league table of patients who decline treatment or who do not present for treatment for fear of the costs – with often disastrous results. Trump's own latest changes, deliberately undermining even the minimal insurance cover for the poorest provided under Obamacare, have made matters much worse.
Over and above overt waste there are the inflated costs of administering the complex system, and paying sky-high salaries to CEOs and other senior staff in health corporations, as well as the billing, legal, accountancy and marketing/advertising costs of a system run for private profit rather than public health.Read more ...
Sunday 4th February 2018
- Tens of thousands back our Day of Action and Emergency Demonstration to #FundOurNHS
An estimated 60,000 people from all over England braved the weather and thronged the streets of London on the
#FundOurNHS demonstration on Saturday Feb 3, called by Health Campaigns Together and People’s Assembly.
Thousands more joined local protests outside hospitals and in town centres in over 50 more events, and there were supporting demonstrations and protests in Belfast and Enniskillen in Northern Ireland and Glasgow as well as contingents on the march from Aberystwyth and Welshpool in Wales.
In England there were protests from Cornwall to Carlisle, from Hereford to Norwich and from Newcastle to Whitstable: many managed to get local and regional press and TV coverage, and many of these also managed to make clear it was a national day of action on a common theme: our NHS has been desperately and deliberately under-funded by a government more intent on privatisation than maintaining safe services even for people in their own party’s heartland constituencies.
A brilliant panel of speakers at the London rally outside Downing Street managed to retain an audience despite the freezing conditions: speakers included actor Ralf Little, speakers from of UNISON, Unite, RCN, campaigners, junior doctors, nurses, patients – and shadow health secretary Jonathan Ashworth.
We knew there would be a need to display the mounting public anger at the state of our NHS – and this march was successfully mobilised in less than a month.
We also know it has not been enough to shift the course of Theresa May’s government, which keeps hiding behind spurious statistics and claims to have already given the NHS more money – even while hospital Trust deficits are rising towards £2 billion. With Trusts facing additional costs of anything up to £1.3 billion for the cancellation of an estimated 55,000 elective operations in January to free up scarce beds for emergency patients, the NHS is headed into 2018-19 with a millstone of debt hanging heavy on 8 out of 10 trusts.
More action will be needed, at local and national level to keep up the pressure for a change of course – or, if need be, a change of government. And on June 30, a few days in advance of the NHS 70th birthday on July 5, we are committed to build another even more massive protest – coupled with a celebration of the survival of the NHS despite all that has been done to it, and the dedication and skills of our wonderful NHS workforce.
So we are asking you for your support. We have growing commitments for building the campaign, but we have no core funding: we depend on donations and affiliations. Whether you joined us in London or supported local events, or even if you could not get to either, please consider getting your trade union, campaign, Labour Party, pensioners group or other organisation to AFFILIATE to Health Campaigns Together if they have not already done so – and MAKE A DONATION towards campaigning in 2018 if you have.
And if you are a member of a national organisation make sure they also AFFILIATE to Health Campaigns Together. Full details of how much it costs and how to pay can be found HERE, or on the back page of our latest quarterly newspaper, which is also available online HERE – with bundles available for you to use locally in campaigning, at very reasonable prices.
Please help us build the circulation of the newspaper, spreading information on the latest twists and turns of government policy (updated further in our Newsblog, Infolinks, ACO Monitor and calendar of events.
HCT is an alliance – and a very effective one so far, having staged two successful national demonstrations and a major conference last November.
We can and must reach wider, build stronger and do even better: help us do what we need to defend our NHS against cuts and privatisation, and reinstate it as a fully publicly owned, delivered and accountable service free at point of use and available to all.
Sunday 28th January 2018
- Dorset campaigners appeal for crowdfund help to save services
Here in Dorset under our STP we’re losing 1 of our 3 A&E’s, 1 of our 3 Maternity Units with a second Maternity Unit under threat, 245 acute beds and Community Hospitals and/or beds in 5 of 13 Dorset locations.
We’ve started the Judicial Review process, the themes of our Review are:
1) Closure of beds before ‘replacement’ staffed services are fully in place
2) Unsafe travel times as tens of thousands of Dorset residents will be left without access to A&E or Maternity within the ‘golden hour’
3) That some aspects of the Consultation on the changes were so misleading as to render the whole consultation unlawful
Please help! We’re Crowdfunding for the next stage to Merits Hearing:
The beds argument, which Leigh Day think is particularly strong, could help other areas across England to retain beds. You may know that there is a legal duty to have ‘replacement’ staffed services in place ahead of, or alongside, bed closures, and to have some evidence that these replacement staffed services will reduce admissions.
Similarly the travel times argument could support the retention of A&E and Maternity services in other areas.
In Dorset, people living on the Isle of Purbeck are particularly affected by the plans to downgrade Poole A&E and close Poole Maternity. Pubeck is also losing half their Community Beds, while Poole, our nearest Acute Hospital, is losing 407 of it’s 654 beds.
Defend Dorset NHS have a young (well by our standards - she's 30) Purbeck Claimant for our Judicial Review. She is severely affected by the loss of Poole A&E as she attends regularly by blue light ambulance for adrenal crisis. She has been granted legal aid, which has capped the amount that the Community has to raise. We need to raise £5,000 for the next stage to Merits Hearing, where we will ask for a Full Hearing. If we get a Full Hearing, we then expect to have to raise £10,000. These amounts will be matched by legal aid.
Please help! Wages down here are seasonal and low, while rents are some of the highest in the country, and this is still a lot for the Community to raise.
Please support our CrowdFunder by donating and sharing the link:
We have also set up a Defend Dorset NHS FaceBook page. The CrowdJustice appeal is pinned to the top. Please like our FaceBook page, invite friends to like it, and share our posts:
Defend Dorset NHS
Read more ...
Wednesday 24th January 2018
Health Service Journal
- Creation of first ACOs put on pause
"NHS England and the Department of Health have effectively paused the creation of the first accountable care organisations, pending further consultation.
Health secretary Jeremy Hunt said the ACO contract - published by NHS England in draft last year - would not be put in place in any areas until after the national commissioning organisation holds a consultation in coming months.
He wrote to Commons health committee chair Sarah Wollaston on January 22, in response to a letter from her last week requesting that moves to implement ACOs be delayed pending a committee inquiry. "
By Rebecca Thomas, HSJ (£)Read more ...
Tuesday 16th January 2018
PRESS RELEASE – for immediate use
- Wigan, Trafford, Manchester: NHS crisis protests demand “Fix it now”
Protesters around Greater Manchester are organising a series of demonstrations demanding action to fix the NHS crisis now. Lobbies outside meetings this month of politicians at borough and Greater Manchester level will culminate in local campaigners travelling to London to join the “Fix it now” demonstration there on Sat 3 February.
Protesters are demanding an immediate increase in funding together with a reversal of the costly wasteful privatisation and marketisation measures by successive governments that drain NHS funding away from where it should be spent. They are writing to politicians in advance of the protests to demand answers (see for example letter at end sent to Trafford councillors by local campaigners there).
The protests are organised by Greater Manchester Keep Our NHS Public, for which spokesperson Pia Feig said:
Greater Manchester residents have been left to face this winter with an inadequate NHS, which some of its senior practitioners have warned us, is a dangerous service to use. We already know that the welcomed decline in mortality rates in Greater Manchester, between 2001 and 2010, has now been reversed (significantly because of a lack of nurses.)
Long term public service recruitment and incomes policies have left our local hospitals and clinics seriously understaffed, with desperately tired staff trying to cover for vacant posts. GPs and primary care staff are severely overstretched, not being able to keep up with their increasing responsibilities for the health of residents, whilst receiving inadequate funding to do so.
The privatisation of social care has left our elderly population, who need residential support and home care, to the vagaries of the market: many private care homes have been deemed inadequate or in need of improvement, whilst others are closing their doors to those in need. Yet 3.5% of hospital beds in Greater Manchester are needed by people who cannot receive adequate personal care at home.
And now all the thousands of people who were waiting for their operations in early 2018, often in great pain and distress, have been told that they will have to wait even longer. The NHS is not there for them in their time of need-surely a denial of the basic principle of NHS!
This crisis is not the result of a sudden epidemic: it is the result of year on year decisions, to cut the number of hospital beds in the Greater Manchester; to restrict training for nurses, particularly community nursing posts and to make the NHS absorb inflationary pressure – especially from PFI scheme payments for all the new buildings in primary and secondary health care.
So what are Greater Manchester’s politicians going to do about it?
Details of protests:
Wigan: Friday 19 January, Wigan town hall (time TBC)
Trafford: Tuesday, 23rd January 6.30 pm, Trafford Town Hall, Talbot Road Stretford M32 0TH
Manchester: Tuesday 30 January, 10am Manchester town hall
PRESS RELEASE ENDS HERE
LETTER TO TRAFFORD COUNCILLORS FOLLOWS BELOW
NHS in Crisis: Fix It Now!
Councillor Joanne Harding, 14th January 2018
Chair of Trafford Health Scrutiny Committee
You are charged with overseeing the decisions of the bodies that run our health and social care systems, that they are made in the best interests of Trafford residents.
However we in Trafford, along with all other Greater Manchester residents, have been left to face this winter with an inadequate NHS, which some of its senior practitioners have warned us, is a dangerous service to use. We already know that the welcomed decline in mortality rates in Greater Manchester, between 2001 and 2010, has now been reversed (- significantly because of a lack of nurses.)
Long term public service recruitment and incomes policies have left our local hospitals and clinics seriously understaffed, with desperately tired staff trying to cover for vacant posts. GPs and primary care staff are severely overstretched, not being able to keep up with their increasing responsibilities for the health of Trafford residents, whilst receiving inadequate funding to do so.
The privatisation of social care has left our elderly population, who need residential support and home care, to the vagaries of the market: many private care homes in Trafford have been deemed inadequate or in need of improvement, whilst others are closing their doors to those in need. Yet 3.5% of hospital beds in Greater Manchester are needed by people who cannot receive adequate personal care at home.
And now all the thousands of people who were waiting for their operations in early 2018, often in great pain and distress, have been told that they will have to wait even longer. The NHS is not there for them in their time of need-surely a denial of the basic principle of NHS!
This crisis is not the result of a sudden epidemic: it is the result of year on year decisions, to cut the number of hospital beds in the Greater Manchester; to restrict training for nurses, particularly community nursing posts and to make the NHS absorb inflationary pressure – especially from PFI scheme payments for all the new buildings in primary and secondary health care.
We ask you..what are you and your Committee going to do about it?
- make public the cost of the crisis to Trafford residents - in delayed health and social care?
- publicly call on the government to end the winter crisis with a cash injection to restore the NHS budget ?
- support the call on the government to end the cap on NHS pay now?
Pia G Feig
Old Trafford Resident
- NORTHERN “HEALTH CAMPAIGNS TOGETHER” CONFERENCE Sat. 20th January
Health campaigners across the north will be gathering in Leeds on January 20th to discuss how to end the crisis in the NHS – and not just this winter!
11- 4:30pm at St George’s Centre, Great George St, LEEDS, LS1 3BR (next to old LGI)
The current crisis was entirely predictable after eight years of frozen real terms funding given that cost pressures have risen annually by 4%. 8,000 front line beds and 20% of mental health beds have gone, there are 40,000 unfilled nursing posts, increasing problems recruiting and retaining GPs, and staff under huge pressure to fill gaps and make do.
At the new year more than half of acute hospitals had at least 95% of their beds full when a safe level is below 85%.
Ambulances are queuing up outside A&E unable to deliver patients needing treatment and cuts to social care mean beds cannot be freed up by discharging those patients on the road to recovery but not yet able to look after themselves.
We will be hearing from campaigners defending services such as Glenfield Heart Unit, Leicester, Rothbury Hospital in Northumbria, Huddersfield Royal Infirmary, and Liverpool Women’s Hospital, to name a few.
Afternoon workshops will focus on building effective campaigns against cuts and closures, galvanising Labour activists and working with councillors and MPs to challenge government policy, resisting the further fragmentation of services through the implementation of US style accountable care systems, supporting beleaguered and underpaid health workers, and putting a stop to the outsourcing of facilities staff.
As we break for lunch at 12.30 we are planning to go outside with banners and placards for a photograph outside the LGI.
There will then be plenty of opportunity to interview health workers and leading NHS campaigners from across the country.
The news regarding the NHS may be grim but on Saturday there will be huge enthusiasm and fighting spirit in the St. George’s Centre. This is a great opportunity for press and media to show that many people are organising to defend our NHS and demonstrating that change is not only essential but eminently possible.
Dr. John Puntis, from ‘Doctors for the NHS’ T. 07907 089152
Mike Forster, Chair of ‘Hands off HRI’, Huddersfield T. 07887 668740
Gilda Peterson, ‘Leeds Keep our NHS Public’ T. 07419 295754
Thursday 11th January 2018
Alex Scott Samuel
- Liverpool NHS campaigners demo against unAccountable don'tCare System
NHS campaigners will demonstrate at the Liverpool Health and Wellbeing Board today (Thursday 11 January), against moves to establish an Accountable Care System, a model developed in the US and Spain.
The plans have developed in secret, and will be presented to the Board meeting.
“The government is introducing Accountable Care to impose £22 billion in cuts to the NHS annual budget over the next 3 years,” said Public Health academic Dr Alex Scott-Samuel. “Councillors should refuse to co-operate with these plans, which will lead to further NHS cuts, rationing of services and almost certainly to privatisation.”
Health Secretary Jeremy Hunt faces a Judicial Review to stop NHS England from introducing new commercial, non-NHS bodies to run health and social services without proper public consultation and without full Parliamentary scrutiny.
Cosmologist and NHS patient Prof Stephen Hawking is one of the claimants.
A separate JR targets the ACO model contract as unlawful.
Councillors declared opposition to the Cheshire & Merseyside Sustainability and Transformation
Plan, which mentioned Accountable Care repeatedly along with a £1bn reduction in the annual
regional NHS budget, on 1 December 2016.
But last summer, the Council began work on an Integrated Care Partnership Group, designed to develop an Accountable Care System. Planning meetings were not open to the public.
Nine Merseyside Labour MPs are amongst 116 supporting Early Day Motion 660, sponsored by
Jeremy Corbyn, which calls for a Parliamentary debate on Accountable Care.
Labour Party policy, adopted unanimously in September, opposes Accountable Care Systems outright.
Friday 29th December 2017
New Year message
- The fight we must wage for our NHS in 2018
John Lister, Editor, Health Campaigns Together
In 1988, the year of the 40th anniversary of the NHS, the main danger to its future was Margaret Thatcher’s government, driving cuts in spending, closures of beds, privatisation of support services, and smashing up and privatising the social care system.
30 years later, with another right wing Tory Prime Minister, as the NHS heads towards its 70th birthday on July 5, it faces the most deadly combination yet:
- A sustained 7-year freeze on real terms funding as costs rise and the population grows, has brought the closure of 8,000 front line hospital beds and over 20% of mental health beds since 2010. Beds were already running at near 100% occupancy in hospitals 2 weeks into December: waiting lists are the longest-ever, waiting times are increasing and cash-strapped trusts are missing performance targets.
- Massive staff shortages put the quality and safety of services at risk: problems of recruitment and retention have been worsened by scrapping bursaries for training nurses and other professionals, and by the 8-year freeze or below-inflation cap on NHS pay increases.
- The 2012 Health & Social Care Act increased pressure on local Clinical Commissioning Groups to put clinical services out to tender. Private companies like Virgin are willing to sue the NHS if they fail to win contracts.
- Seven years of cuts in council spending since 2010 have reduced vital home care and nursing home services to a skeleton service restricted to those with most serious needs, leaving thousands of patients trapped in hospital beds for lack of support for them to return home.
- NHS England, having given up on legislation to roll back the 2012 Act and allow them to reorganise services into 44 ‘Sustainability and Transformation Partnerships’, are now embarked, supported by Health Secretary Jeremy Hunt, on the imposition of “new models of care” including “Accountable Care Systems” (ACSs) and “Accountable Care Organisations” (ACOs) – modelled on US systems designed to cut spending. Plans are advanced for the establishment of ACSs in the spring of 2018, with no parliamentary debate or public consultation. ACOs allow services to be carved up and contracted out to private sector organisations, which would not be in any way accountable or open to scrutiny from the local public.
In other words services that don’t collapse as a result of cash starvation face the threat of privatisation: the freeze on funding is set to run at least till 2021, effectively reversing New Labour’s decade of investment, slashing spending levels to the lowest of any comparable economy.
Health Campaigns Together – a coalition of campaigners and trade unions, supported by UNISON, Unite, the NEU and FBU – has fought back hard in 2017. In London on March 4, working with Peoples Assembly, we mobilised the biggest-ever demonstration in support of the NHS, tapping in to the anger over the worst winter crisis since Thatcher was in power.
This march, and subsequent campaigning with our Election Special, social media and NHS Roadshow, helped shift the public mood, putting the NHS firmly on the political agenda. It helped to prevent Theresa May from securing the majority she expected in June’s general election.
In November we brought together a massive conference in London, with over 400 activists and campaigners, discussing where we had got to, and how to work together in regions and at local level. In December a follow-up affiliates’ meeting called for three major mobilisations in 2018:
- A day of action – regional and local events – on March 3, responding to the winter crisis and other local cuts, closures and threats of ACOs, and supporting the pay campaign being waged by the health unions.
- Support for the TUC demonstration on workers’ rights on May 12 in London
- A massive event in London on July 7 to celebrate the 70th anniversary of the NHS, but also demand it be fully funded and brought back fully into public ownership and control.
Through these events and in the work for them, building links in every locality across England, Health Campaigns Together aims to build and strengthen a movement big enough and broad enough to shake and dislodge the weak and wobbly government – or at least block its worst policies and prevent damaging cuts.
Against all the odds the NHS is still alive, delivering vital services to save lives and relieve pain, 70 years on: but its future cannot be secure until the cancer of privatisation is killed off, and the NHS is restored to a public service, funded from taxation, publicly provided, publicly accountable and free at point of use.
To all those who share this aim in 2018 we wish you the happiest and most successful year of campaigning.
We urge any who have not yet done so to join us by affiliating the Health Campaigns Together – and also to support the legal challenge to ACOs being mounted by JR4NHS: donate now to help reach the £144,000 target.Read more ...
Saturday 9th December 2017
Hawking joins Judicial Review v Jeremy Hunt
- Tony O'Sullivan co-chair Keep Our NHS Public
Latest news in battle against ‘Accountable Care’ threat to NHS
Urgent: Help fund Round 2
Professor Stephen Hawking has joined Dr Colin Hutchinson, Professor Allyson Pollock (co -author of the NHS Reinstatement Bill), Professor Sue Richards and Dr Graham Winyard in their joint intention to take Jeremy Hunt, secretary of State for Health in England, to judicial review.
This is a critical challenge to the government’s attempt to circumvent Parliament and democratic scrutiny and to allow Accountable Care Organisations to operate in the NHS in England.
Support the five complainants in this important action by donating to Round 2 of their funding appeal at CrowdJustice https://t.co/zbJWPOO53X
With your help they will cover the potential legal costs.
Since Round 1, lawyers for the Secretary of State for Health, and for NHS England (NHSE), have written to their solicitors, rejecting their arguments and stating that they will robustly defend any judicial review.
The four (now five) complainants’ lawyers have studied these replies and have sent a further letter before action to both Hunt and NHSE.
They expect to file proceedings in the court very shortly.
Why Hawking has joined the JR application
“I have been lucky to receive first-rate care from the NHS. It is a national institution, cherished by me and millions of others, and which belongs to all of us.
"I am joining this legal action because the NHS is being taken in a direction which I oppose, as I stated in August, without proper public and parliamentary scrutiny, consultation and debate.
“I am concerned that accountable care organisations are an attack on the fundamental principles of the NHS. They have not been established by statute, and they appear to be being used for reducing public expenditure, for cutting services and for allowing private companies to receive and benefit from significant sums of public money for organising and providing services.
“I want the attention of the people of England to be drawn to what is happening and for those who are entrusted with responsibility for the NHS to account openly for themselves in public, and to be judged accordingly.”
‘What are we seeking and why?’ – team’s motivation for legal challenge
We are seeking a judicial review to stop Secretary of State for Health Jeremy Hunt and NHS England from introducing new commercial, non-NHS bodies to run health and social serviceswithout proper public consultation and without full Parliamentary scrutiny.
These non-NHS bodies would be called “Accountable Care Organisations” (ACOs). They would be governed by company and contract law and can be given “full responsibility” for NHS and adult social services.
ACOs were conceived in the US about twelve years ago. ACOs are being imported into England although they are not recognised in any Act of Parliament.
ACOs would be able to decide on the boundary of what care is free and what has to be paid for. They will be paid more if they save money. They can include private companies (e.g. Virgin in Frimley, Circle in Nottinghamshire), including private insurance and property companies, which can make money from charging.
They could also include GP practices, in which case people on their lists would automatically transfer to the ACO in order to be entitled to services. New patients would also have to register with the ACO. They will be allowed to sub-contract all “their” services.
Support this important challenge by donating at CrowdJustice here –
In Round 1, £26,020 was raised in 26 hours, underpinning their lawyers’ work up to preparing the case for court.
Read more ...
Thursday 7th December 2017
- Please ask your MP to sign this EDM from Jon Ashworth and Jeremy Corbyn
Early day motion 660
That this House notes
- the Department of Health consultation on Accountable Care Organisations which closed on 3 November 2017, which proposes changes to regulations required to facilitate the operation of an NHS Standard Contract (Accountable Care Models);
- further notes that the consultation states that the Government proposes to lay these regulations before Parliament in the New Year with the intention that they have legal effect from February 2018, subject to Parliamentary process;
- notes that these changes will have far reaching implications for commissioning in the NHS, and that concerns have been raised that Accountable Care Organisations will encourage and facilitate further private sector involvement in the NHS, and about how the new organisations will be accountable to the public;
- notes that the Health and Social Care Act 2012 opened up NHS commissioning to private sector interests;
- notes that the NHS is experiencing the largest financial squeeze in its history and there are concerns that Accountable Care Organisations could be used as a vehicle for greater rationing of treatment locally;
- and calls on the Government to provide parliamentary time for hon. Members to debate and vote on these proposed changes on the floor of the House.
Read more ...
Monday 4th December 2017
Press release from Totnes Constituency Labour Party
- 300 march against South Devon cuts
On Saturday 2nd December more than 300 people marched through the streets of Totnes, sang alternative Christmas carols, and delivered a 'thank you' card to NHS staff at Totnes Community Hospital.
The protest, organised by Save our Hospital Services and members of Totnes CLP, was joined by campaigners from across Devon, angry at the loss of 213 acute and community hospital beds in the county since 2015. The rally was the first item on BBC Spotlight's evening news.
Campaigners pushed a hospital bed and carried a coffin to represent the 120,000 lives unnecessarily lost through health service cuts since the Tories came to power.
A petition was carried, signed by over 4000 local residents, calling for a halt to hospital closures and privatization of care services.
MP Sarah Wollaston was invited to receive this at the rally but declined to attend. She will be receiving it instead on Friday 8th December at her constituency office in Totnes.
Saturday’s protest won the support of Jon Ashworth, Shadow Secretary of State for Health, who said in a statement:
"Closing services and cutting beds because of government decisions to underfund the NHS is unacceptable. It's Jeremy Corbyn’s commitment that Devon should have the high quality NHS that patients need."
Speakers included Devon County Councillors, members of Labour and the Green party, healthcare workers and representatives of Save Our Hospital Services and Keep Our NHS Public.
The protest was also supported by Health Campaigns Together, whose co-chair Louise Irvine's statement said:
"Your campaign is an inspiration to all around the country who are involved in similar struggles to defend vital NHS services. It is only when communities come together to defend their treasured NHS services that we have any chance of halting the dismantling and destruction of our NHS."
Similar rallies were taking place at hospitals in four other counties, with messages of support for the Totnes rally arriving from as far afield as West Yorkshire and Essex.
Totnes CLP continues to work with SOHS and other healthcare campaigns to defend NHS services across Devon. Members will be involved in handing over the petition to Sarah Wollaston MP at 2.30pm on Friday 8 December.
Devon is one of 14 areas covered by NHS England's 'Capped Expenditure Programme, meaning it must find additional savings (rumoured to add up to as much as £500 million) over and above the current spending squeeze.
These 14 areas are in the frontline for the new Accountable Care model, with the implication that large parts of our health and social care services could be privatised, and private corporations could for the first time oversee the management and purchasing of NHS services as well as providing them.
Totnes CLP was at the forefront of the fight to save our four local community hospitals and Torbay Women’s ward. Unfortunately these have now closed, and this may be only the start.
A leaked version of the county's Sustainability and Transformation Plan in 2016 included proposals to cut 590 beds overall, and to relocate acute services from Torbay and North Devon hospitals into Exeter and Plymouth.
Despite a clinical review finding that lives would be at risk, and a reprieve for services inb North Devon, those proposals have not gone away.
Totnes CLP helped to draft Composite #8, passed overwhelmingly at the last Labour Conference, committing the Labour party to reinstate the NHS as a public service, free from marketisation, and fully accountable to local communities.
For more information contact: Helen Beetham, SOHS S Devon and Totnes CLP (07866 360329) or Peter McIlvern, Chair Totnes CLP (07955 730372)
Read more ...
Tuesday 14th November 2017
Thursday 12th October 2017
Save Our Hospitals Hammersmith & Charing Cross
- St Mary's Hospital Urgent Care Centre in "Special Measures"
The privatised Urgent Care Centre has been rated "inadequate" by the Care Quality Commission. Until April 2016 it had been run by hospital staff when the Central London Clinical Commissioning Group took the contract away from the NHS and gave it to Vocare Ltd.
Since then staff at Imperial Board meetings have regularly reported poor performance but worryingly no improvements were made.
In July 17 the CQC rated it "Inadequate for being safe, effective and well-led. It was rated Requires Improvement for being caring"
At the time of inspection there was no permanent clinical director, operational service manager or lead nurse in post and ongoing clinical under-staffing.
The inspectors recorded that accessing the UCC on foot once on hospital premises could take up to 30 minutes.
They reported insufficient oversight and monitoring of risks and incidents and insufficient attention to safeguarding children and vulnerable adults.
NW Londoners will rightly question why a reliable NHS service was privatised and why the CCG who commissioned Vocare failed to monitor and improve the situation.
They may also feel that this is more evidence that the plan to close Charing Cross Hospital's blue light A&E and replace it with an urgent care centre is not in patients' best interests. Read more ...
Saturday 7th October 2017
- City & Hackney CCG bows to pressure & votes to hand powers to north east London NHS 'super chief'
This decision for a single accountable officer was made despite lack of evidence, and a strong case made by the councils, CCG and KONP against the proposals, backed by legal advice.
There was laughter in the committee room including from advocates of the plan such as Sam Everington, when someone asked 'is this job do-able?'
Healthwatch Hackney has been fighting the STP from the start.
Now the principle of local accountability has been surrendered by the CCG the battle will have to be taken on through non-NHS bodies.
Read more ...
Wednesday 27th September 2017
- Composite motion on NHS, passed by Labour Conference 26/9
Composite 8: NHS
The NHS Accountable Care System (ACS) contracts announced on 7 August impose a basis for 44+ local health services to replace England’s NHS. This has bypassed Parliamentary debate and due legislative process.
On 9 August, the House of Commons Library revealed a doubling of the number of NHS sites being sold off. 117 of these currently provide clinical services. Like their US templates, ACSs will provide limited services on restricted budgets, replacing NHS hospitals with deskilled community units.
This will worsen health indicators like the long term increase in life expectancy, stalled since 2010.The ACSs and asset sell-off result directly from the 5 Year Forward View (5YFV) currently being implemented via Sustainability and Transformation Partnerships (STPs).
The 5YFV precisely reflects healthcare multinationals’ global policy aims.
Labour opposes ACSs.
New legal opinion finds STPs lack any legal powers or status under the 2012 Act: yet they seek through bureaucratic means to eliminate or override the already minimal remaining level of local accountability and democratic control over NHS commissioning and provision.
They could eliminate remaining statutory powers and rights of local authorities, commissioners and providers.
Many of these also outline plans to establish ‘Accountable Care Systems’.•
Conference condemns the current Tory NHS pay cap for all staff and the scrapping of the university training bursary for health Students as significant contributors to the current staffing crisis.
Conference welcomes the commitments made in the Labour manifesto to scrap the pay cap for NHS staff. This Conference calls on our Party to restore our NHS by reversing all privatisation and permanently halting STPs and ACSs.
Labour is committed to an NHS which is publicly funded, publicly provided and publicly accountable. We therefore call on the Party to oppose and reverse funding cuts meeting Western European levels.
Conference opposes FYFV policy:
- downskilling clinical staff;
- Tory cuts to the NHS including the Capped Expenditure Process;
- the sell-off of NHS sites;
- reclassifying NHS services as means-tested social care;
- cementing the private sector role as ACS partners and as combined health/social care service providers.
- replacing 7500 GP surgeries with 1500 “superhubs”.
Conference recognises that reversing this process demands more than amending the 2012 Health & Social Care Act and calls for our next manifesto to include existing Party policy to restore our fully-funded, comprehensive, universal, publicly-provided and owned NHS without user charges, as per the NHS Bill (2016-17).
Conference opposes the Naylor Report's call for a fire-sale of NHS assets and instead resolves that the next Labour government will invest at least £10 billion in the capital needs of the NHS.
Conference therefore calls on all sections of the Party to join with patients, health-workers, trade unions and all other NHS supporters to campaign for:
- increasing recruitment and training
- an NHS that is publicly owned, funded, provided and accountable;
- urgent reductions in waiting-times;
- adequate funding for all services, including mental health services
- tackling the causes of ill-health, e.g. austerity, poverty and poor housing, via a properly funded public health programme,
- reversing privatisation, PFIs and the debts which they entail;
- reversing private involvement in NHS management and provision;
- recognition of the continuing vital NHS role of EU nationals;· Constructive engagement with NHS staff-organisations
- rejecting the Tories Sustainability & Transformation Plans (STPs) as vehicles for cuts in services;
- urgent reductions in waiting-times;
- scrapping the Tories' austerity cap on pay-levels; restoration of NHS student bursaries;
- excluding NHS from free trade agreements
- and repeal and reverse the 2012 Act, to reinstate and reintegrate the NHS as a public service, publicly provided, and strengthen democratic accountability.
Conference welcomes Labour's commitment to making child health a national priority, including investment in children's and adolescents' mental health services.
Labour created our NHS. Labour must now defend it
Mover: Socialist Heath Association
Seconder: Islington South and FinsburyRead more ...
Wednesday 13th September 2017
- MORE BED CLOSURES IN OXFORD’S HOSPITALS
In August, Oxfordshire’s Health Overview and Scrutiny Committee voted to accept the permanent closure of 110 beds in the county’s hospitals.
Now, papers for the OU Hospitals trust board meeting on 13 September report that a further 92 beds are currently closed because of a ‘safety issue’ (a lack of staff?).
Speaking for HealthWatch in August, its chair George Smith said that bed closures were shortsighted in light of present and future needs.
England and Wales, with some 2.8 hospital beds per 1,000 people is already worse served than many countries (Germany: 8 beds per 1,000).
We need more hospital beds, not less.
Oxon KONP secretary Bill MacKeith said: ‘The hospitals trust chief executive, Bruno Holthof, has a long connection with McKinsey, the pro-privatization consultancy. On taking up his post he said he aimed to cut bed numbers and he has. He has now got a job at the trust for his fellow McKinsey man, John Drew, who starts as Executive Director of Improvement and Culture in October. The signs are not good.’
Quite apart from this, Oxford University hospitals trust has by far the worst delayed transfer of care figures for the whole country (12,799 delayed days for the last reported quarter compared with the next worst’s 5320). This is despite the fact that Mr Holthof made tackling this a priority 18 months ago. There is a crisis in community care: lack of staff, community beds.
The NHS and social services need a massive injection of money and increase in regular budgets.
Thursday 7th September 2017
- NHS professionals reprieved
After weeks of sustained pressure led by the We Own It campaign and others, it appears ministers have finally recognised the folly of privatising NHS Professionals, the organisation set up by the NHS to reduce the costs of filling temporary posts by more costly agency staff.
The plan has now been dropped, to sighs of relief all round, raising even more curiosity as to how it got so far in the first place.
Commenting on the news that the government has backtracked over the selling off of NHS Professionals, UNISON head of health Sara Gorton said:
“The government has at last seen sense. NHS Professionals is an organisation that saves the health service money and ensures there are enough staff on wards.
“But despite many warnings, ministers have once again gone through a pointless exercise, wasting millions of pounds of taxpayers cash. Instead of filling the pockets of management consultants, this money could have been better spent improving services for patients.
“Selling off NHS Professionals would have been completely counterproductive and bad for patients and staff.”
As Caroline Molloy of the Our NHS website says
“We've been raising the alarm on this in articles since 2014 so it's great to see it finally ditched. Well done to all of those who got involved in the campaign! (including, fair play, the official opposition, in the person of Junior Shadow Health Minister with responsibility for workforce, Justin Madders).”Read more ...
- Joint councils’ Scrutiny Committee says NO to Single Accountable Officer
Carol Ackroyd from Hackney KONP writes
On Wednesday 6th Sept, the Inner North East London Joint Health Overview & Scrutiny Commission (INEL JHOSC*) voted by 6 to 1 to reject proposals to appoint a Single Accountable Officer across East London Health & Care Partnership, ELHCP. (The whole STP area is now re-branded as ELHCP, following what even they call ‘a disastrous launch’ for the STP).
Of course, the fact that the JHOSC has rejected the proposals doesn’t mean that the individual councils involved will take the same view – they could still decide to endorse the proposal for an SAO.
Still, the decision represents an important success for campaigners from NELSON (co-ordinating campaigners across the ELHCP area).
We were given the opportunity to address the meeting and table questions, and spoke strongly against the proposals, citing ELHCP complete absence of consultation, the loss of democratic control over NHS services and the context of austerity and huge cuts to NHS budgets.
Local authority members of the JHOSC thanked campaigners for our contributions. They in turn were scathing about ELHCP’s piecemeal and partial approach to consultation: ‘setting out the drawbacks of current arrangements without setting out alternative proposals for how ELHCP will be governed’, and about ELHCP’s lack of consultation.
They expressed concern that campaigners who might express concerns about ELHCP proposals have been excluded from public engagement events, and the fact that ELHCP currently has no live website, and papers are not publicly available and asked that a report addressing these consultation issues be brought to the next meeting.
Hopefully these concerns will translate into council policy, with Hackney perhaps most likely to hold out since City & Hackney have the most to lose in the face of huge financial deficits in other areas.
Here's my take on what we campaigners have achieved and what we haven’t (yet) been able to get across:
We campaigners have three major concerns about ELHCP:
A major aim of ELHCP is to reduce spending. This will impose massive reductions in services in the face of growing costs and population need -
Lack of consultation, participation, transparency. Slavish adherence to NHSE requirements.
ACOs/ACSs will not end the market in NHS services.
Certainly, they end the sharp purchaser-provider split, with its never-ending requirement to ‘market test’ (ie put out to tender) an endless stream of services.
However, the 2012 Health and Social Care Act remains in place, and regardless of all the talk about ‘collaboration’ and ‘joint work’ etc, there is still a requirement to put NHS services out to tender. With an ACO or even an ACS in place, rather than procuring smaller services on a fragmented piecemeal basis, the entire ACO/ACS will be put out to tender.
This brings with it a massive risk of takeover of the entire ACS/ACO by giant healthcare corporates, likely starting initially with joint bids by NHS hospital trusts and major international finance corporations (bringing capital for new buildings).
This would start an inexorable move towards complete takeover of the NHS by major international corporates, rapid degeneration of the NHS into a rump service, and equally rapid growth in private healthcare insurance.
Our scrutiny Councillors appear to have grasped the finance issues, although they are focusing more on how resources are distributed between CCG areas. They understand completely the issues about consultation – and feel very strongly about their own exclusion.
However they don’t seem to have any awareness that the NHS is truly on the brink of extinction through corporate capture of ACOs/ACSs as these are tendered in coming months. We need to make this a focus for future campaigning.
*The INEL JHOSC includes local authority scrutiny members from the inner London areas of ELHCP: Hackney & City, Tower Hamlets, Waltham Forest, Newham. There are separate LA scrutiny arrangements for the Outer London boroughs in the STP – Barking & Dagenham, Redbridge & Havering, and these areas have not yet scrutinized the proposals for an SAO. Read more ...
Friday 1st September 2017
- Let's mount an autumn offensive to defend #ourNHS
The Tories are weaker than ever and can be put under pressure to reverse their damaging cuts to healthcare, writes JOHN LISTER
THE mainstream media recently flagged up the scandalous situation that allows some of the wealthiest private hospitals in England to claim generous tax exemptions on the spurious grounds that they are “charities.”
It’s outrageous; but this taxpayers’ subsidy to private hospitals adds up to around £100 million over five years — a drop in the bucket compared with the brutal impact of the virtual freeze on NHS budgets since 2010 that has reduced the NHS across England to a continuing crisis.
There has been no equivalent press outrage that ministers have ignored the strident “winter warning” of NHS Providers — the body that represents NHS and foundation trusts — that if an extra £350m were not made available to the NHS by August at the latest to put new staff and resources in place, we will face another winter crisis even worse than the situation last year. It’s the end of August, and there’s no extra cash.
Instead of facing these harsh facts from the managers and the health professionals struggling to keep services running, Health Secretary Jeremy Hunt has been daft enough to engage in a futile debate with Professor Stephen Hawking.
Hawking has now repeatedly exposed the selective use of evidence by Hunt and warned that the crisis in the NHS has been caused by political decisions since 2010, including “underfunding and cuts, privatising services, the public-sector pay cap, the new contract imposed on the junior doctors and removal of the student nurses’ bursary.”
Hawking argues that, to make matters worse: “Failures in the system of privatised social care for disabled and elderly people have also placed an additional burden on the NHS.”
Hunt of course has no answer to this, especially as long as the ideologically imposed freeze on spending continues.
He predictably rejects Hawking’s suggestion that some of the other changes taking place could open up a prospect of US corporations moving in.
But even as Hunt has denied the US connection, August opened with the publication of hundreds of complex pages of guidance and draft contracts for accountable care systems (ACSs) and accountable care organisations (ACOs) — explicitly modelled on systems that first emerged in the US, where of course they are led by major healthcare corporations.
This is what NHS England wants to emerge from the 44 Sustainability and Transformation Partnerships that were wrenched into place last year.
Hunt has on several occasions stated: “We need clinical commissioning groups to become accountable care organisations.”
However this rather underlines that Hunt does not fully understand the model himself, since ACOs are arrangements through which providers (ie NHS trusts and GPs — not CCGs) take the risk of delivering a defined range of services to a local population for a cash-limited budget.
A new study from the King’s Fund, looking at what they see as the nearest international equivalent of an ACO, the transformation of services in Canterbury, New Zealand, underlines that positive results can be achieved by developing services outside of hospitals. But it also underlines how completely different the New Zealand context is from the situation in England.
“Unlike in the UK, most social care is paid for by district health boards, and provision of state-funded social care is relatively generous compared with UK standards, meaning that entitlements to health and social care are more closely aligned.
“The New Zealand health system has had no formal purchaser/provider split since 2001, has undergone no significant organisational restructures in recent years and has a far less complex regulatory environment than the NHS.”
In addition the New Zealand system has been brought in without closing beds and has been built up patiently, with sustained investment, engagement with and training of staff in the necessary new skills.
None of these are true of the secretive, top-down panicked attempts in England to force through savings without investment, making it most unlikely that the positive vision of integrated services could be replicated here.
Despite all the pages of documents and the apparent enthusiasm of Hunt and NHS England boss Simon Stevens, it seems that the constrained and inadequate NHS budget after a seven-year freeze is not enough to entice much interest in taking risk on this scale.
Funding per head in England’s NHS is a fraction of the level of funding for the US ACOs.
The unique experiment of the multispeciality community provider (MCP) contract in Dudley, offering a massive £5 billion-plus contract for a wide package of services to be delivered over 15 years, resulted in not a single external bid, from NHS or private sector, and is being awarded to the existing NHS providers and GPs.
Smaller, but ambitious schemes for “lead provider” contracts for care of older people (Cambridgeshire) and cancer services (Staffordshire) have collapsed as a result of inadequate funding, although community health and other services have been contracted out on a smaller scale — many of them to Virgin.
So the main present danger to the NHS is not coming from Donald Trump’s buddies across the Atlantic but from Downing Street.
And the answer to the threats faced by local services as local plans for cutbacks are beefed up this autumn is already clear, especially after the June election weakened the grip of Theresa May’s government.
Campaigning is the key in every area, to challenge every threat to the availability and integrity of local services. Broad campaigns, linked up with health unions, political parties and community organisations, can build a movement strong enough to persuade newly insecure Tory MPs that they cannot afford to allow local services to be cut back.
Tenacious campaigns in Devon and in south Essex have in the last few months managed to force back plans to downgrade or close local A&E services, which were central to STP plans and local “success regimes.”
In each case local Tory MPs were put under sustained pressure and appear to have lobbied behind the scenes to force a retreat.
In Yorkshire, the sustained campaigning efforts against plans to downgrade and close services at Huddersfield Royal Infirmary have finally forced the local Calderdale and Kirklees councils to at least use their power to refer the controversial plans to Hunt.
In Hackney, too, the council has indicated the kind of stance that could be taken by other boroughs and county councils, and challenged the legality of plans to force a merger of seven CCGs in north-east London that would effectively strip away the already limited level of local accountability.
Legal advice quoted by City and Hackney CCG and by the council makes quite clear that STPs lack any legal status as long as the Health and Social Care Act remains in place.
So there are many other opportunities for local councils — as they should be doing in defence of their local communities — to mount a legal challenge to the plans being pushed through by NHS England.
In Nottinghamshire, the Sustainability and Transformation Partnership is to spend millions on failure-ridden consultant Capita, and a US health provider Centene to help shape its STP and set up an ACS, while doing little or nothing to engage with local people, local authorities and NHS staff.
Elsewhere NHS bosses are withholding information on their plans in defiance of the Freedom of Information Act.
In Oxfordshire, CCG bosses are ignoring the rhetoric about integrating services by contracting out musculoskeletal services to a private provider: nationally the NHS is defying all logic by trying to privatise NHS Professionals, the organisation set up to squeeze out extortionate rates charged by private agencies for nursing staff.
In every area the soft spots for campaigners to aim at are elected politicians — MPs and councillors.
They know the government has no mandate for more cuts, closures, contracting out or reorganisation. And they know that they could pay the price at the ballot box if they are seen to connive at cuts.
With enough support, we can win this vital fight for the NHS. Let’s make it happen.
Monday 28th August 2017
- Tax-payers can’t afford such charity to private sector
Recent revelations on the existence of tax breaks for over a quarter of private hospitals, which benefit from an 80% exemption from business rates, on the spurious grounds that they are “charities,” made headlines even for the BBC: but the insidious process of privatising the provision of NHS-funded services continues largely below the media radar.
Anger over the tax-breaks was intensified by the fact that NHS and foundation trusts are denied any such concessions, and in many cases now face steep hikes in local “business rates,” despite the vast bulk of their activity being centred on delivering services without charge or profit to the population as a whole.
By contrast Nuffield Hospitals, the third wealthiest charity in the country, receives a discount on these payments plus reduced payments of corporation tax and VAT.
Wealthy private hospitals charge for the vast majority of their work, and by doing so exclude the majority of the population. And they retain cash surpluses: but a minority opt to include a minor role delivering unpaid services of their choosing, and this perversion of charity law has created a lucrative loophole for them.
This long-standing problem was dodged by Labour’s Charities Act of 2006, and by a tribunal decision in 2011 that proof that a charity delivers any ‘public benefit’ should be regulated only by the “charity’s” own trustees, and not by the Charity Commission.
Now, according to a fresh review by tax specialists CVS, private hospitals will escape more than 20% of their total potential tax bills of over £240m over the next five years, while hospital trusts in England and Wales face a 21% increase in business rates.
Given the current dire financial straits to which the NHS has been reduced by 7 years of real terms frozen spending under George Osborne’s austerity policies, the lack of equivalent exemptions are an additional insult to the NHS. But the tax breaks are a minor factor compared with the many other ways private medicine – much of it undisguised provision of care purely for profit -- leeches off the NHS.
Private hospitals in England – average size just 50 beds –deliver only a niche service, providing low risk uncomplicated elective surgery to a selected population. So they don’t need multi-disciplinary teams of doctors and professionals: most employ medical staff on a sessional base only, and are staffed overnight by nurses. They can therefore make profits even delivering elective treatment at below NHS tariff prices to NHS-funded patients who help fill up their otherwise empty beds.
Private hospitals’ caseload, which includes no emergencies, no maternity services and no complex cases, is completely different from the case mix of even the smallest NHS general hospital, making it impossible for them to train any staff – even if there were any serious aspiration to do so. Private hospitals rely completely therefore on staff trained by and at the expense of the taxpayer – constituting not only a colossal hidden subsidy, but also a problem for hard-pressed NHS hospitals which have to cope with consultants and key staff regularly ‘moonlighting’ in paid work elsewhere, and therefore not available to staff NHS wards and operating theatres.
While NHS staff have suffered 8 years of frozen pay or below inflation rises, private hospitals have been free to offer whatever rates they choose to pay, and much less stressful conditions to attract staff.
To add another costly hidden subsidy, NHS ambulances and emergency services are effectively used in place of many private hospitals having any proper ITU or other facilities to deal with occasional emergencies when private treatment goes wrong.
So no matter what the claims may be of “benefit” to the wider population from exclusive private hospitals, the reality is that they only exist because they can benefit so consistently and in so many ways from the misguided generosity of government and taxpayers.
Once again the private sector is propped up by the public sector, and entirely dependent upon it. How long should we keep them in the style to which they have become accustomed?
Saturday 26th August 2017
- The outrage around Ludlow Hospital
The real scandal around Ludlow Hospital is that an NHS Hospital relies on charitable donations to buy something as basic as an ECG machine.
The decision of the Chief Executive of Shropshire Community NHS, Jan Ditheridge, to refuse to accept a charitable donation to allow Ludlow hospital to get an ECG machine for use by outpatients has been met by outrage. On social media, people from Ludlow are almost unanimous in condemning the decision, and there has been a similar response from the national media.
Shropshire Defend Our NHS has been asked to make a statement on the issue. Read it HERERead more ...
Thursday 17th August 2017
- Campaigners challenge county councillors on NHS cuts
In a letter (below) to party group leaders and individual councilors, the campaign group Oxfordshire Keep Our NHS Public challenges the council to clarify its stance on the permanent closure of beds in Oxfordshire’s hospitals.
Earlier this year, the council’s Cabinet refused to support the proposals for cuts and downgrades. The full Council went further, indicated their strong opposition to the proposals and rejected the consultation.
The letter, from Oxon KONP acting chair Gus Fagan, says in part:
‘Last week, the concerns expressed by the full Council were ignored by the Oxfordshire Clinical Commissioning Group representatives in their contributions at the 7 August Health Overview and Scrutiny Committee meeting. The national funding context has not improved. The suggestions made by the Council were not taken up by the CCG. But the HOSC agreed to accept the permanent closure of 110 beds.
‘Oxon KONP is concerned that the Committee has failed in its duty to defend the interests of the public in the county.
‘Following last week’s decisions of the HOSC and the CCG board, where does that leave the County Council, given its stance of strong opposition to date on the OTP phase 1?’
News of the permanent bed closures has not gone down well. One health worker in accident and emergency at the John Radcliffe, said:
‘This is just awful. Working in A&E is particularly difficult, and has been all year. We often have significant nursing and medical rota gaps, and long waiting times. Despite it being August, every shift has patients on trolleys in the corridor, with the time waiting for a bed over 12 hours. Resus [ward], built for 4 patients regularly has 6-7. For patients requiring level 3 care, mothers and babies requiring obstetric care and stroke patients to have to travel from the Horton will definitely put lives at risk.
‘We are not coping, and when I ask managers about winter planning I get a shrug of the shoulders...’
The letter reads:
17 August 2017
Dear County Councillor,
Oxfordshire Transformation Plan Phase 1: What is County Council’s stance?
In a letter of 3 April to the chair and chief executive of Oxfordshire Clinical Commissioning Group, Cllr Michael Waine, County Council chair, wrote:
As you know, Cabinet were not supportive of the proposals. Full Council went further and indicated their strong opposition to the proposals and rejected the consultation.
Full minutes of County Council 21 March 2017:
However, on 7 August the county’s Health Overview and Scrutiny Committee decided, as we understand it from notes taken at the meeting:
1. To support the proposals on critical care subject to assurances that there will be no knock-on effect at Horton General Hospital
2. To support the permanent closure of 110 beds already but not to support any further closures until they see the impact of these on phase two proposals and impact on all of our community hospitals
3. Not to support the proposals on planned care services at the Horton at present
because there is no detailed plan, there is a vision. The proposals needed to be fully thought out and fully costed. The CCG was invited to come back when they had a fully developed proposal and detailed plan.
4. On maternity services, if the CCG was minded to approve the downgrade recommendation on Thursday, the HSC would refer the matter to the Secretary of State.
Acceptance of permanent bed closures
Referral of the Horton maternity services is in hand. The news of the HOSC’s vote to accept permanent bed closures has not gone down well with the public. One health worker in accident and emergency at the John Radcliffe, said:
‘This is just awful. Working in A&E is particularly difficult, and has been all year. We often have significant nursing and medical rota gaps, and long waiting times. Despite it being August, every shift has patients on trolleys in the corridor, with the time waiting for a bed over 12 hours. Resus [ward], built for 4 patients regularly has 6-7. For patients requiring level 3 care, mothers and babies requiring obstetric care and stroke patients to have to travel from the Horton will definitely put lives at risk.
‘We are not coping, and when I ask managers about winter planning I get a shrug of the shoulders...’
At the full Council meeting in March, councillors
… discussed the Oxfordshire transformation proposals in the wider national context of significant financial challenge for the NHS and social care. They wanted to emphasise that they understood that the situation the CCG is facing is a result of national policy. The rising demand for health services and lack of funding to address this was a huge national issue which was being played out locally to the detriment of services for local people.
Members felt that the consultation did not make clear the impact on social care and there was a lack of modelling to accurately assess this. It was felt that the proposals would benefit from a workforce plan setting out how the impact on carers would be managed. It should not be assumed that county council services would be able to absorb the impact of the changes on social care. It was also noted that the care sector is financially very fragile as recent examples of agencies becoming insolvent shows.
Members expressed frustration that no options for alternative delivery options were presented in the consultation. Some members felt this implied a ‘fait accompli’ as no alternative future arrangements were presented for consideration. It was also unacceptable to expect proposals for substantial bed closures to be agreed without any detail about proposals for the future of services in the community. These would be vital to support changes in the acute system.
The concerns expressed by the full Council were ignored by the CCG representatives in their contributions at the 7 August HOSC meeting. The national funding context has not improved. The suggestions made by the Council were not taken up by the CCG. We are concerned that the Committee has failed in its duty to defend the interests of the public in the county.
Given the stance adopted by HOSC and the go ahead decided by the CCG board, where does that leave the County Council, given its stance to date on the OTP phase 1?
Gus Fagan, acting chair, Oxon Keep Our NHS Public Read more ...
Sunday 21st May 2017
- Save Southend A&E March & Rally
It was an amazing sight to see on Saturday as 100’s of local people marched down Southend High St to demonstrate their opposition to government plans to downgrade Southend’s A&E department. I can’t thank all those 100’s of people enough for making this event such a huge success, and as the secretary of Save Southend A&E campaign I am privileged to work with a fantastic and truly dedicated group of people whom have all worked so hard over the past weeks to make this happen.
When we first discussed the idea of this march, barely six weeks ago, we were concerned we might only get a handful of people attend – some estimates put the number yesterday at 1,000 and the massive response we’ve had to our campaign is testament to the strength of feeling and passion that people have in defending OUR NHS.
Our message is simple – we oppose the restructuring of A&E departments in Mid & South Essex and the downgrading of Southend A&E department to a walk-in centre that will not accept 999 blue-light ambulances (either at night or at all). We oppose this because it is not a clinically-driven plan.
NHS managers and politicians in favour of these plans sidestep questions by saying “Southend A&E will still be open 24/7” – we know that, but it will be not much more than a minor injuries facility and no doctors, nurses or consultants specialising in emergency treatment will want to work there – it would be like Sherlock Holmes working as a traffic cop.
The same people say “It’s clinically driven and patients will benefit – we already by-pass Southend for Basildon with heart attack sufferers.” Top clinicians working on the frontline in Southend A&E tell us these plans are madness but if they speak out their jobs and careers would be finished. One specific type of heart attack patient will go directly to Basildon if it can be diagnosed by the ambulance crew – an ST-elevated myocardial infarction – in a normal week this would account for 1 or 2 patients and we do not dispute that this is the right and clinically proven course of action – for these few of patients.
Remember too that far fewer ambulances have a qualified paramedic on board than there were 20 years ago. Back then most crews had two paramedics, now many do not have even one.
Basildon will NOT BECOME A MAJOR TRAUMA CENTRE. If plans go ahead as they are currently recommended, Basildon will just become a very busy A&E department – possibly the busiest in the whole country. Major trauma cases from road traffic accidents and the like will still be taken to the Major Trauma Centres (MTC) at Addenbrookes or the Royal London as they are done now. To be a MTC a hospital would need a specialist neurosurgery unit which Basildon hasn’t got and isn’t going to get.
The job of our campaign is to raise awareness of what the government is trying to do – to do that we need YOU, the people, to spread the word and tell everyone in Southend and the surrounding area what is really happening.
You can see how Conservative MPs like James Duddridge and David Amess, and Councillors like Leslie Salter (Exec Cllr for Health & Adult Social Care) are trying to fob us off with spin and avoidance. Don’t allow people to believe what they say – tell them the truth. Together we can fight these plans and stand a chance of defeating them and stop the destruction of our health service!
This is just the start of our campaign and there is a very long way to go, but together we can do it.
[A special mention for Tony at Tang’s Oriental Buffet who helped us massively by letting us use their electricity to power our PA when we couldn’t access the to the Council’s power sockets in the street – I’ve eaten at Tang’s several times and it’s great food and amazing value!]
Friday 12th May 2017
- NHS frontline staff hit the election campaign trail
NHS staff are launching a massive general election national roadshow to highlight the plight of the NHS under the Conservative Government and to get the public to vote for the NHS on 8 June.
The NHS roadshow has been set up by a collective of passionate and concerned NHS doctors, nurses, consultants, other staff and NHS campaigners who have decided to speak out about what is really happening in the nation’s hospitals under the Conservatives.
The aim of the roadshows is to help voters make an informed decision about who they put their cross next to in the general election. With the NHS ranked as the number one concern of the public, the roadshows will shed light on what is really going on in their hospitals. The aim is to make it clear that the NHS can only be safeguarded by voting out this Conservative Government.
NHS Roadshow is a national campaign of public events using social media and the power of the public to explain why a vote for the Conservatives is a vote to destroy the NHS. It will highlight the fact that due to Conservative policies NHS hospitals are permanently struggling to deliver the health care that the NHS was set up to deliver. As a consequence the British public are suffering with services being cut back, closed or sold off. The NHS roadshow message is crystal clear – the NHS is at ‘condition critical’ and it can only deteriorate under another five years of Conservative rule.
A key campaign message is that the NHS is not for sale and it shouldn’t be cut back or squeezed in the name of efficiency savings or profit for the private sector. The result will be terrifying with people dying on beds in hospital corridors, rising child mortality deaths, bed blocking, cancelled operations and harmful waits for cancer drugs. Using the personal experiences of frontline NHS professionals, the roadshow will say that all of this is happening now, in 2017, under a Conservative government.
NHS Roadshow campaigners are urging everyone who wants to save the NHS to come along to an event and hear what NHS staff have to say, pass on experiences, and more importantly spread the word.
The NHS Roadshow campaign will launch on Saturday 13 May at 11am with an event in Croydon. NHS staff with the campaign ambulance will be at Croydon Town Hall to speak to the public and then at 12.15pm will join the May Day parade to Ruskin House, 23 Coombe Road, Croydon CR0 1BD.
There are four weeks to reach as many people as possible
There are four weeks to convince everyone to vote for the NHS.
There are four weeks to persuade the public this means a vote to end this Conservative government.
Links to google maps with pins to all of our upcoming NHS roadshow events: https://www.google.com/maps/d/u/0/edit?mid=1fK5KSfuIDhXT5f49BKpFskKLxyQ&ll=52.46441378311348%2C-1.3331630999999788&z=7
Link to NHS roadshow Facebook group:
For more info: email@example.com.
Read more ...
Friday 28th April 2017
- STP in disguise: now you see it, now you don’t
The North East London Sustainability and Transformation Plan (STP) area has decided to change its name to East London Health and Care Partnership.
This became clear in the middle of a presentation to a Hackney Healthwatch meeting in mid February, when the accompanying literature suddenly printed the new name half way through the pack, with no explanation.
The new name has been printed in STP documents prepared for scrutiny, despite the agenda items as prepared by the council still being called NEL STP.
This is a reflection of the fact that people have finally started to hear about STPs and get concerned about them: the Unite ‘Slash Trash Privatise’ label is sticking, so they have changed the name to anodyne sounding 'Health and Care Partnership'.
The councillors did not challenge NHS chiefs on this at the scrutiny meeting: the importance of this manoeuvre probably passed everyone by at the time.
However we should watch out for this elsewhere and challenge it when it happens.
Our NEL Save our NHS group will discuss how to respond, it needs challenging.
SOHS Press release
- SOHS calls on the Devon electorate to Save Our NHS
County Council elections will take place on 4 May. The General Election will take place on 8 June. Save Our Hospital Services Devon (SOHS) urges the public to make hospital services and social care a top priority when considering how to vote. Here are the facts:
- The Wider Devon Sustainability and Transformation Plan (STP) will slash £550m from the county’s health budget by 2020/21. In simple terms, that means cuts. Big cuts. Lots of cuts. And the process is already well under way
- Across Devon, community hospitals have been decimated. The STP target was to close 190 community hospital beds. North Devon is now down to just 12 community hospital beds for a population of 170,000 people. South Devon is facing the closure of four hospitals. East Devon is losing half of all its in-patient beds.
- A mind-boggling 400+ acute beds are being eliminated county-wide. That means beds at Derriford Hospital, Royal Devon and Exeter Hospital, Torbay Hospital and North Devon District Hospital. Many beds have already been removed.
- In place of acute and community hospital beds, the new model of “care closer to home” continues to be rolled out at a pace even though it remains unproven and inadequately scrutinised.
- North Devon District Hospital is facing the potential removal or downgrading of acute services including stroke, maternity, paediatrics, neonatology and urgent & emergency care. Affected patients would have to travel up to two hours to receive vital treatment. Even one of the co-authors of the STP admits that people may die as a result!
It’s a grim picture, but the upcoming elections represent a real opportunity to turn the tide.
Every single voter in Devon needs to be asking tough questions of prospective councillors and MPs of all parties. And then to only vote for those who will actively defend and promote our hospital and social care services. Which essentially means one thing: scrapping the STP.
“I believe the STP programme is destroying our local health services,” says SOHS supporter Ray Ashman. “I’ll be voting for candidates who commit to halting the programme by campaigning with SOHS Devon to stop threatened cuts – nothing more, nothing less. I urge my fellow constituents to do likewise.”
Ultimately, health policy is driven by politicians. Ultimately, it can only be changed by politicians pressurised from below. So the will of the public must prevail at political level. And SOHS passionately believes that the Devon public can make all the difference.
“The level of support for our campaign across Devon is extraordinary,” says SOHS Facebook Group admin Barbara Nicolson-Martin. “We have 11,000 supporters on Facebook alone. I read most of their posts and I can tell you they’re appalled by what’s happening to our hospitals. Not just that, they’re furious. That fury needs to make itself heard in the elections and I believe it will.”
So the message is simple: however you vote, vote to save our hospital services!Read more ...
Monday 17th April 2017
North devon SOHS
- North Devon Residents Invited to Contact Health Select Committee
Campaigners from Save Our Hospital Services (SOHS) are encouraging residents in North Devon to get in touch with the Commons Health Select Committee which is scrutinising the NHS England’s Sustainability & Transformation Plan (STP) which proposes cuts of over £100M each year to the NHS budget in Devon. Devon MPs Ben Bradshaw and Sarah Wollaston sit on this Commons Committee. Sarah Wollaston MP chairs the committee.
and have to arrive before Tuesday 9th May.
Appropriate topics for submission of challenging evidence are as follows;
Cuts to Acute Services at North Devon District Hospital
Cuts to non- acute services
Cuts to 590 acute and community hospital beds across Devon
Cuts to hospital access for palliative care
Cuts to referrals by GPs to consultants
For residents this is an opportunity to register concerns about the proposals to cut over £550M from Devon’s health budget over the next five years.
SOHS spokesperson, Ian Crawford said; ”We now believe that the managers of the Clinical Commissioning Group are ‘rattled’ by the fierce public reaction presented by hundreds of residents attending meetings to hear about the cuts to services proposed by the Government’s Sustainability and Transformation Plan for Devon which will lead to elderly people being shunted out of hospital into the community without sufficient health care. We know from the massive public support on April 1st that there is opposition to STP and call on everyone who is concerned to make submissions of evidence to the Health Select committee before Tuesday 9th May 2017.”
Friday 17th March 2017
Save Our Hospital Services (SOHS)
- Holsworthy Town Council support their community’s campaign against NHS proposals – Patients do not want medical care in their homes
A meeting of some 500 local residents in Holsworthy Memorial Hall on Wednesday night, is clear evidence of the opposition to North Devon Healthcare Trust’s plan to remove beds from the Holsworthy Community Hospital. It took nearly an hour for the Memorial Hall to fill to capacity and residents were in the mood to have their say. No satisfactory answers were given by Alison Diamond, CEO at NDHT to questions from the floor of the meeting – How long will the ward closure last? – What conditions need to be met to allow re-opening? – Why don’t you show leadership and overturn the decision? Her main response was to blame the decision on the shortage of nurses and low bed occupancy.
Ian Crawford, a campaigner from Save Our Hospital Services (SOHS) said “We congratulate Mayor Jon Hutchings and the Town Council for their support of the campaign to oppose the removal of beds from their local community hospital
Cllr. Barry Parsons made a compassionate plea "Why should we be the ones to suffer?" He emphasised the sense of community and said "I'm terribly disappointed at this decision.
A local GP told Alison Diamond that as a doctor he needed beds for his patients and for convalescence on return from treatment at the main hospital.
Contrary to the NHS England view constantly espoused by Alison Diamond that the plan is to provide medical care in the familiar surroundings of home, previous patients confirmed their preference to receive medical care from professional staff in the safe environment of their local hospital.
These closures of hospitals, removal of beds and plans to provide medical care in the home rather than a hospital are all part of NHS Englands strategy to slim the NHS down for privatisation with the use of agencies on lower wages with little union representation- this is the view of of SOHS campaigners.
Media Liaison – SOHS
07917 123 435
Monday 6th March 2017
- Towns in Cornwall march and protest for the NHS
March 4 was also a major day of mobilisation in Penzance, Truro, Falmouth and other parts of Cornwall where local events were staged in solidarity with the big London demonstration. Local bands played and midnight vigils were staged as Cornish people showed their determination to defend Our NHS.
Full report from the excellent Cornwall Live is here
http://www.cornwalllive.com/mass-ournhs-protest-to-support-health-services-taking-place-in-cornwall/story-30179418-detail/story.htmlRead more ...
Tuesday 28th February 2017
SE Cornwall labour Party
- Can't get to London on March 4?
MARCH FOR THE NHS IN TRURO
Saturday 4th March
Assemble 2.15pm at Lemon Quay and march to Truro Cathedral for a rally with speakers
TRANSPORT WILL BE AVAILABLE
Our campaigning has been having an effect. Where Cornwall councillors were refusing to commit even to a proper scrutiny of the Sustainability and Transformation Plan by a vote in full council, that has now been agreed, and many are opposing it outright. NHS funding looks set to be the biggest issue that the local election will be fought on. But we need to keep up the pressure.
Last Friday's Cornish Times reported the 'temporary' closure of St Barnabus' community hospital in Saltash and the transfer of its staff to Liskeard. The closure has not been presented as a cut, but rather a change resulting from a local recruitment crisis in Liskeard. However, the closure is ushering in the STP plans of rationalising and cost-cutting, and may indicate that the community hospital beds in Saltash are earmarked for closure.
Now is the time to stand up for our local health service and act in solidarity with campaigners from all around the country. Health Campaigns and unions in Cornwall have called a march in Truro
to protest about the STP and save our local hospitals; and Labour throughout Cornwall will be supporting the march. It's the same day as the national march in London and saving the NHS will be high on the news agenda. Please come to Truro with us to march behind the SE Cornwall Labour banner!
It's been great to see how many of our members want to show care for our NHS since this campaign began; and we'd like to organise transport to Truro from this area. Can you offer a lift or will you need one? If there is enough interest we may be able to put on a bus... In any case we'll want to organise meeting up in advance so that we can march together. So please reply to this email - or contact your branch secretary - and tell us if you're planning to come.
Look forward to hearing from you,
yours in solidarity,
South-East Cornwall Constituency Labour Party
Thursday 15th December 2016
- SWKONP applauds Warwickshire County Council saying No to Sustainability and Transformation Plan and says government must pay up for health and social care.
Anna Pollert, SWKONP Chair, said
"SWKONP applauds the wise and timely decision of Warwickshire County Council taken Tuesday December 13th declining to sign up to the published 5 Year Sustainability and Transformation Plan for Coventry and Warwickshire.
"We welcome the Council's setting requirements prior to further consideration, including full public engagement, using plain language, an independent chair for the STP, and planning integrated health and care services accessible to all people in Coventry and Warwickshire."
Anna Pollert added
"SWKONP is concerned that NHS England does not try to impose the £267 million which is at the core of the STP, as the contribution of the Coventry and Warwickshire STP ‘Footprint’ (in NHS England jargon) towards the national ‘Five Year Forward View’ target of saving £22 billion by 2020.
"This figure, which is the bulk of so-called £30 billion NHS shortfall by 2020, is a government created shortfall, caused by the underfunding of the NHS. The UK is spending a diminishing percentage of GDP on the NHS, and is now a lowly 13th out of the original 15 EU members in terms of investment.[i]
SWKONP is equally concerned that cuts in social care are scrapped. In September 2016, Warwickshire County Council announced that it had to make cuts of £67 million by 2020, as a result of reductions in government funding, inflation and demographic pressures.[ii]
"Only this week, it was announced that 'Hundreds of jobs could be lost at Warwickshire County Council as part of cuts which will affect some of the most vulnerable across the area...more than 300 people would lose their jobs, including 45 members of staff working in social care and support, 62 people from Warwickshire Fire and Rescue Service along with 54 from community services, 22 from children and family services and 31 from customer services. On top of this, more than £14 million worth of cuts to adult social care have been proposed as part of the authority's new plan to balance its books....' (Leamington Courier, December 9th 2016).
"The government’s starving of social care, as of the NHS, must be challenged. The UK social care system is in deep crisis – a crisis created by the government’s austerity policy, whose failures have been denounced by leading academics.
"Not only is ‘austerity’ a discredited economic strategy' its resulting widening of social inequality in Britain is bad for health and has gone so far that it has prompted the UN to accuse the government of breaching international human rights.[iii]
"£4.6 Billion has been cut from adult social care since 2010, meaning 400,000 fewer people now have publicly funded care.[iv]
"Ministers have been warned they face a "collapse" in social care across the country due to a funding shortfall. While the government offers no more from the budget, it is ‘allowing’ local authorities to find the money by raising council tax. This is not only a cynical ruse, it cannot raise nearly enough.
"The crisis in social care is damaging the NHS as well as society. Patients needing social care cannot be discharged from hospital, leading to delays in admissions and treating other patients. The double crisis in the NHS and social care is bringing both health and social care to breaking point. But it needn’t be so.
"The government has made a political decision to cut public spending, while handing billions to corporations by cutting corporation tax. The UK’s 20% corporation tax is already lower than the average 28.7% of the G20 most powerful economies, yet the government plans to lower this to 17% by 2020. Raising it, closing tax havens, and forcing tax evaders to pay up would easily plug both the NHS and the social care funding shortage.[v]
"Our local councils must demand that the government gives the NHS and social care the funding they so desperately need."
Save Our Hospitals
- Ealing Council stands firm against hospital cuts plan
The NHS has confirmed that despite widespread public opposition, it is pushing ahead with a 10-year plan that will see Ealing and Charing Cross hospitals downgraded.
Last week, the NHS published a £500million business case that sees blue-light ambulances, critical care and potentially all surgery removed from Ealing Hospital by 2022.
After Ealing is downgraded to a ‘local’ hospital, the NHS would then do the same to Charing Cross Hospital – helping it save £1.1billion over the next decade.
Ealing Council has been fervently opposed to hospital reconfiguration plans since they were first announced in June 2012. Under the NHS’ ‘Shaping a Healthier Future’ programme Central Middlesex and Hammersmith hospitals’ A&Es have closed as has maternity and children’s A&E services at Ealing Hospital.
There is widespread public opposition to the plans and numerous protests and marches have taken place across West London.
Ealing Council has confirmed that it will hold a public meeting at Ealing Town Hall on Wednesday, 15 February 2017 at 7pm. Residents are invited to attend to find out more about what it means for local health services including those provided in hospitals as well as planned improvements to primary care. The council will then be responding to the NHS’ public engagement which is starting early in the new year.
Councillor Julian Bell, leader of Ealing Council said: “Despite huge local opposition the NHS is hell bent on carrying out the biggest reconfiguration experiment in its history and using the people of Ealing as its guinea pigs.
“While we want investment in improved out-of-hospital and preventative care, we cannot support the closure of A&Es and the downgrading of Ealing and Charing Cross hospitals. This plan signals the death knell for emergency services in Ealing. It would leave our borough, which has a population the same size as Cardiff, without an A&E. This is not safe.
“To add insult to injury we have also learnt that the investment in the remaining site is being cut with the existing hospital getting a ‘make do and mend’ refurbishment rather than the new hospital being promised.”
Councillor Hitesh Tailor, cabinet member for health and adult services, said: “I would urge as many people as possible to attend our public meeting in February.
“The NHS belongs to all of us and we need to defend vital local health services - once they have gone they will be lost forever.”
Last year Ealing and Hammersmith and Fulham commissioned an independent inquiry led by Michael Mansfield QC that has provided a strong evidence base for why the proposals are wrong.
To find out more about the NHS plans and how you can get involved:
1. Come to the public meeting in Ealing Town Hall on Wednesday, 15 February at 7pm
2. Speak with friends and neighbours to make sure as many people as possible understand what is proposed.
Read more ...
- Camden says no to STP
On December 14 Camden Council refused to endorse the STP (Secret Tory Plan to destroy our NHS) at their cabinet meeting. Well done to everyone who has been campaigning and joined Camden Keep Our NHS Public's lobby and deputation which included Camden Unison and Yannis Gourtsoyannis
from the BMA
Wednesday 14th December 2016
Anna Pollert South Warwickshire KONP
- Warwickshire council rejects STP
Warwickshire County Council at its full council meeting on 13th December passed unanimously a resolution to oppose the Coventry and Warwickshire Sustainability and Transformation Plan.
Councillors are unhappy with the whole approach to develop the STP and won't sign until there has been full public consultation.
The motion was put by Councillor Matt Western (Lab):
Item 4 - Coventry & Warwickshire STP
1. That the Council believes that the approach used to develop the Coventry & Warwickshire Sustainability and Transformation Plan (STP) has been opaque and veiled in secrecy. Given how critical this Plan is to the future provision of Health and Social Care Services and the future of our local hospitals in Warwickshire, the Council urgently requests that more time is allowed for full and proper public consultation and seeks assurances that all plans for the future of the NHS are developed openly and with full involvement of the users of the service.
2. That, consequently, the Council
(i) Agrees that it will not consider signing up to the Coventry and Warwickshire Sustainability and Transformation Plan published on 6th December until:
a) There has been full public engagement
b) It has been co-produced along with the Health and Wellbeing Boards of both Warwickshire CC and Coventry CC
c) It is rewritten in language which is accessible to the public
(ii) Expects that the STP in its next stage moves to a transformational level and that an independent chair is appointed to ensure the necessary challenge.
(iii) Expects that the original intent of the STP around the integration of the health and social care systems is progressed in a way which recognises the crucial role played by social care."
(iv) Expects that the STP workstreams will recognise local and easy access to services by the whole population of Warwickshire and Coventry as a fundamental principle.
(v) Establishes a cross party scrutiny group to consider the STP
Tuesday 29th November 2016
Keep our NHS Public Cornwall
- CORNWALL NHS CHALLENGED OVER “FLAWED” PLAN
“Keep our NHS Public Cornwall” (KONP) a cross-sector campaign group of health professionals, trades unions and community activists/representatives in Cornwall has today challenged Cornwall’s NHS, following the release of the “Sustainability and Transformation Plan” (STP).
KONP has undertaken an initial analysis of the key elements of the proposed plan, released on Monday 28th November. Whilst many of the proposals are desirable, KONP has concluded that it is unrealistic to expect the proposals to be achieved without adequate guaranteed funding. We are also bitterly disappointed that the Chancellor has failed to recognise the crisis in funding of Health and Social Care in his Autumn Statement.
KONP have therefore concluded that without guaranteed funding the proposals are unachievable.
KONP believes that the proposals will inevitably lead to:
· Hospital closures including community beds.
· Further reduction in acute beds
· Inadequate mental health support
· Service cuts
· Outsourcing and privatisation
· Staffing cuts, downgrading and attacks on pay
· Continuing pressure on social care
KONP welcomes proposals to integrate services and to prioritise public health initiatives to improve health and wellbeing. We also support any proposals to pool budgets, to reduce the number of providers and to simplify the commissioning process by reducing the need for competition.
However, KONP maintains that the STP in its current form lacks sufficient practical detail as to how it could work in practice, how any reforms would be funded, and how it would be made sustainable. We believe that the plan lacks credibility and is no more than an idealised wish list.
Rik Evans said following the release of the STP.
“We have grave concerns about this plan. We support many of its aspirations, but without guaranteed funding it is no more than a wish list. Whilst the plan identifies potential underfunding of £264m by 2020, it fails completely to identify what a reformed system would cost.
“The crucial issue is funding .There is currently no evidence that funding will be forthcoming and without it the plan is meaningless”.
Stuart Roden added
“We recognise that there are serious fundamental issues with health and social care in Cornwall that must be tackled urgently. The system is under incredible strain, the fragmentation of the coalition government’s top-down NHS reorganisation and massive funding cuts to Cornwall council have totally failed our local community. The requirements to put services out for competitive bidding have been very costly: increasing privatisation of the NHS and resulting in many expensive failures.
“Having analysed this plan we have come to the conclusion that without a clear financial strategy and guaranteed funding this plan cannot succeed and is fundamentally flawed.”
For further information please contact.
Monday 14th November 2016
posted by Morning Star in Features
- IT’S ALL kicking off in England’s NHS.
It’s not even winter yet, but the squeals of protest are getting louder as the brutal Tory squeeze on NHS spending forces cuts and closures of local services on top of plummeting performance levels and falling quality of care.
What’s new is not the noisy emergence and strengthening of campaigns across the country fighting back, defending rural health services, smaller A&E and other specialist services — although many of these are impressive in size, scope and clout.
The new factor is the squealing from embarrassed, exposed Tory MPs, forced into challenging their own government and the implications of policies many of them have voted unquestioningly to endorse.
In Oxfordshire, Devon, Dorset, Yorkshire, Staffordshire, rural Cambridgeshire, Shropshire and many more areas where local access to services is now at risk, Tory MPs are being forced to challenge Theresa May’s continuation of the austerity policy and her refusal to relax savage spending limits that are forcing the NHS into a monumental crisis.
So serious are the threats to local services that another factor has emerged, undermining NHS England boss Simon Stevens’s drive to force through cuts in hospital services and “reconfiguration” of services through the restructuring of the NHS into 44 “footprint” areas — in which trusts are supposed to collaborate together and with local commissioning groups and local authorities to draw up and implement sustainability and transformation plans (STPs).
This new organisational structure, which seeks to ignore the fragmented market-style system of competition and commissioning imposed by Andrew Lansley’s massive Health and Social Care Act just four years ago, is an attempt to force each “local health economy” to pool resources and share the pain in order to balance the books and deliver a staggering £22 billion in savings by 2020.
But as the public pressure for disclosure of these plans — which have been developed behind closed doors, and were supposed to be kept under wraps until next month — has grown, a succession of council leaders have broken ranks, and published the latest draft of their STP, opening up a new growing storm of protest.
Most of the plans seen so far are two-thirds filled with abstract and hugely optimistic assumptions on the short-term gains from underfunded and endangered public health and community health services, and pages of evasive waffle. But this cannot conceal the fact that many STPs plan to close or downgrade A&E services, maternity services or whole hospitals.
In many cases this poses local communities with journeys of 20 miles or more to access a growing range of hospital care.
In Cumbria and parts of Devon the new journeys could be upwards of 40 miles on twisting rural roads, with little in the way of public transport.
No wonder local politicians, who know they could face the consequences in any future election, are seeking ways to distance themselves from these plans.
Some have gone further. In west London two boroughs, Ealing and Hammersmith & Fulham have defied pressure to sign up in support of an STP which had already been unquestioningly signed off by other north-west London boroughs, in return for vague promises of future funding for social care.
Since then another borough, Sutton, has refused to sign the south-west London STP, while seven West Yorkshire councils have objected to their lack of engagement with the still unpublished STP, and Birmingham has raised major problems with an STP which has been led by its own chief executive.
Stevens has been force to respond to a chorus of legitimate complaints that the STPs are first and foremost about solving NHS problems, with the councils and elected councillors playing second fiddle — and saddled with additional responsibilities.
There is a real problem for the NHS chiefs, whose rhetoric, intended to enable them to skip nimbly around the obstacle to local planning erected by the Lansley Act, includes a notional commitment to “engagement” with local authorities and “stakeholders,” including staff and the local public.
Nothing could be further from the truth of what has been happening as furtive plans (often taking up and pushing forward previous controversial plans for closures under the misleading headings of “centralisation” or “reconfiguration”) have been hatched up under a blanket of secrecy for fear of the anger they will trigger.
The original plan was to leave any pretence of “consultation” or serious “engagement” with staff and the public until after STPs had been vetted and toughened up by NHS England, and binding contracts had been signed: this is now in disarray.
Indeed Health Minister David Mowatt has been reported in the Health Service Journal as effectively giving local councils a veto over STPs in their area, declaring: “STPs should be regarded as incomplete and not go ahead if councils believe they have been marginalised.”
He also promised that STPs which fail “to address the needs of stakeholders, including councils” won’t go ahead.
This promise alone could sound the death knell for a succession of STPs which effectively follow Simon Stevens’s impatient plan to brush aside “local vetoes” — and impose unpopular changes that ignore the needs of local communities.
So the ball is now very much in the councils’ court: some have already stood up and challenged local plans, some, as in west London and Torrington in north Devon, are actively campaigning against local closures.
But most have up to now been tamely roped into signing up for local plans that their voters would not approve — either naively accepting NHS assurances and signing incomplete STP drafts without reading them, or lured in by false promises of partnership working and “integration” of health and social care bringing extra cash in to prop up their services, or bullied by threats that they will be denied any share of the limited pool of “transformation” funding, and left isolated as other boroughs sign up.
Health Campaigns Together meeting at the end of last month identified local government as the weak link of STPs and has urged local campaigners to focus on lobbying council leaders and councillors, as well as MPs, regardless of their party affiliation.
These elected politicians must be called upon to stand up for their local communities, to publish or demand publication of the latest STP Draft in all 44 footprints, to demand a serious period for consultation on every proposed change in the STPs, and to refuse to endorse any STP which threatens local access to services until convincing evidence has been shown that alternative services have been put in place.
This is next to impossible in almost any instance, since the NHS is being starved not only of revenue funding (according to the Nuffield Trust the claimed “extra” £10 billion trumpeted by May turns out to be a miserable £800 million over six years — leaving a growing “gap” between resources and the demands and pressures on the NHS) but also of capital, meaning almost any local plans centred on new buildings are dead in the water.
Campaigners have no interest in drawing up plans for bigger and bigger cuts to bridge a widening gap that has been cynically deepened by six years of frozen funding of the NHS since 2010. We can’t agree to the books being “balanced” in this way at the expense of local services.
Nor can we accept the erosion of the quality and safety of services by the imposition of even more drastic targets for “efficiency savings” by trusts, coupled with limits on nurse staffing levels opening up new dangers of more scandalous failures of care like those in Mid Staffordshire hospitals a decade ago.
Elected politicians of all parties, councillors and MPs, and local newspapers wanting to preserve local services must be called upon in every area to join with campaigners in demanding a change of government policy — a halt to the freeze on funding, a major injection of new money and a return to the growth in spending that saw the NHS transformed and services made sustainable in the decade from 2000.
That, coupled with the NHS Reinstatement Bill to reverse the costly and divisive Health & Social Care Act and renationalise the NHS would be a plan that could win Jeremy Corbyn’s Labour Party support all over the country, while the STPs are emerging as little more than a formula for cuts and chaos.
- John Lister is director of Health Emergency.
Friday 11th November 2016
- Worcestershire's £229 million health funding “black hole” shock
Worcester trade unionists have expressed their horror at a shock £229 million gap in the funding of health services in Herefordshire and Worcestershire. Health chiefs revealed the figure when questioned by Worcester Trades Council secretary Bryn Griffiths at a public meeting in Kidderminster today. To deal with this huge sum, health chiefs have prepared a plan which still they will not make public.
The Sustainability and Transformation Plan has been demanded by the government to “return the system to financial balance”. Mr Griffiths says that health chiefs may be keeping this quiet until Christmas when the public’s attention will be distracted by consultations over changes to the acute hospitals including the planned downgrading of services at Redditch hospital.
“We are fairly sure when the STP plan is published it will be full of cuts dressed up as efficiency savings. In reality hospital services will be diminished and people will have to fend for themselves. The plans will talk grandly about families, neighbours and volunteers looking after the sick but it is really about shifting the costs away from NHS budgets which are massively underfunded.”
The meeting of HealthWatch in Kidderminster heard angry comments from members of the voluntary sector, councillors and campaigners about aspects the plan and the failure to publish it. Plans for Birmingham, Solihull and Shropshire are already in the public domain.
Worcester Trades Union Council calculates the cuts are equivalent to the loss of 6000 health care jobs. Says Mr Griffiths “we do not of course expect the cuts to fall just on jobs but it does show the measure of the problem. The real solution is for our MPs to accept the NHS is massively underfunded and to push the Government to step up to fund it to the level of other European countries.”
Monday 24th October 2016
- NHS plan (STP) submitted - Council Leader's statement
The NHS in the north central London area – which represents Camden, Haringey, Islington, Barnet and Enfield – has submitted a draft Sustainability and Transformation Plan (STP) to NHS England.
This has been developed by a host of NHS organisations with the support of officials from the area’s local authorities to propose changes to the way services are delivered, to make them more effective and efficient.
Councillor Sarah Hayward, Leader of Camden Council, said:
"There is a national crisis in both the health and social care systems - both need to change and we recognise that they could be more efficient. That said, I have serious reservations about the Sustainability and Transformation Plan process so far.
"There has been no political oversight, and minimal public and patient engagement. At present, there is a lack of appropriate focus on adult social care. That lack of public, patient and political involvement is why I am publishing this document on our website
. It is vital that there is full transparency in Camden as this work progresses.
"The next stage is for the bodies involved to respond to this draft plan
and we will be consulting residents and patients on our response over the coming weeks. Local Authorities see first-hand the impact of the profound health inequalities that exist in the north central London area. In the light of this, we’ll be using our role to influence the future quality of local social care and to improve the health and wellbeing of our residents.
"As the provider and commissioner of social care services in Camden we want to be sure that future needs are reflected in this plan. We will be holding a number of public events to gather the views of residents before our response to the draft plan is considered in public by Camden’s cabinet."Read more ...
Sunday 23rd October 2016
Geoff Barr, Exeter
- Barnstaple: Devon's fightback against Transforming Community Services
Saturday 22nd October saw several thousand people march through Barnstaple to protest against plans to downgrade the North Devon District Hospital. The campaign drew in much of the town and people from all around. It felt like a town on the move.
The protester ranged from the left of politics to the Conservative MP, Peter Heaton-Jones. Heaton-Jones’s speech was determined in tone. However, he was followed by a speaker who pointed out that if he meant what he said he was risking the prospect of a ministerial career and indeed much of a future as a Conservative politician.
The pictures show a lot of red clothing. The theme was based on the so-called “Success Regime” telling us that there are no red lines protecting services from cuts.
The town has a population of a little over 24,000. This gives an idea of the degree of anger in the traditionally conservative areas of rural England. We are at the beginning of a major battle here and this is an early warning to our enemies.
A contingent from Exeter was there. We aim to stop all reductions of NHS services wherever they occur. The cuts in North Devon will impact directly on Exeter as more people who would have gone to Barnstaple appear at the Royal Devon and Exeter Hospital (RD&E) needing treatment, when the RD&E is hard pressed.
Wednesday 12th October 2016
- Shropshire campaigners force CCG to open up meetings
Something which might be relevant when CCGs are looking how they will implement STPs.
The two CCGs in our STP had agreed to set up a joint committee to take decisions on the implementation of the major programme in the STP. The agreed to delegate authority from CCG Governing Bodies to the Committee which meant that decisions would not need to come back for ratification at public meetings of the CCG Governing Bodies. It was intended that this committee would not meet in public.
We challenged the terms of reference at the two CCG Board meetings yesterday and today. We argued that the Joint Committee with delegated authority was subject to the Public Bodies (Admission to Meetings) Act 1960 and could only be closed to the public through a section 1(2) resolution that having a meeting in public would be “prejudicial to the public interest.” We also argued that all papers for the meetings should be published under the “National Health Service (Clinical Commissioning Groups) Regulations 2012”, specifically Regulation 16 on Transparency.
We presented the arguments in legalese – and made them concerned that they would be open to a legal challenge. They obviously took advice overnight and today conceded. Committee meetings will be publicised 7 days in advance, held in public, and all papers will be available on the CCG website.
So we now have 7 days’ notice each time they want to make an important decision on STP implementation – time enough to ensure a large public presence….
I suspect other CCGs will try to set up similar structures, so it’s worth being on the lookout and challenging early.
Saturday 8th October 2016
WORCESTER TRADES UNION COUNCIL
- Secret Plans to Decimate Worcestershire's Local Health Services Discovered
A campaigning group of local trade unionist say it is “astounded” to find that local social and community groups are being consulted behind closed doors over ideas which will fundamentally change how local health services are provided.
The STP presentation document suggests people will have to travel further for health services; that friends, families and neighbours should care for the sick rather than hospitals and seems to encourage patients to move away from care by their GP.2
Worcester Trades Union Council say they have been pressing for months to find out what is to be in the Sustainability and Transformation Plan being worked on for Herefordshire and Worcestershire.
The STP requires all local health authorities to work together and to reduce hospital financial deficits; the Health Services Journal has put this at more than £300 million this year and say the Herefordshire and Worcestershire STP area is “one of the most financially troubled” in England. 1
Worcester Trades Union Secretary Bryn Griffiths says “we have been asking local health bodies and even the County Council’s Health and Wellbeing Board for months what is going on but we have been very politely fobbed off at every turn. They keep saying the public will be “engaged” in due course but the dates change and there is never any detail.”
What has provoked the Trades Council’s immediate concern is an official presentation passed to them by Evesham Labour Party who found it on the website of an organisation Community First.
“This is a staggering document as it presupposes the fundamental rundown of the NHS and suggests people in future will have largely to fend for themselves. It is full of leading questions and loaded political rhetoric.
"It advances the idea of organisational change without suggesting for a moment the problem might be gross underfunding of the NHS.
"It rather looks as if community groups are being drawn in here using pseudo management terms like “co-production” adds Mr Griffiths.
“These groups are even being asked to sign up to ideas suggesting it is somehow wrong to die in hospital rather than at home. Shouldn’t such moral choices be discussed publicly first?”
WTUC Chair: Pete McNally Tel .07761-769412 firstname.lastname@example.org
WTUC Secretary: Bryn Griffiths Tel.07519-817960 email@example.com
1. Health Services Journal 6 October 2016
Worcester Trades Union Council is the official local representative body of the TUC. It is an umbrella organisation of trades’ union branches including ASLEF, NUT, Unison, Unite, NAS/UWT, UCU, and othersRead more ...
Sunday 2nd October 2016
Pete Gillard. Shropshire Defend Our NHS
- 500 defy driving rain to back protest in rural Wellington
We broke the story on Monday that the health bosses had decided to close the A&E in Telford, one of the two serving a population of 650K over an area the size of 3.3 Greater London’s. The health bosses wanted to keep the info secret, but we prevented that. It ran as the lead in the Shropshire Star, our local daily and on both ITV and BBC West Midlands TV, plus a number of radio stations.
We called a demo for today – four day notice, and it was torrential rain today. Five hundred came. Importantly Telford & Wrekin Council supported the demo (which means we didn’t need to worry too much about police permission). The T&W Leader (Labour) made a strong speech arguing for keeping open two A&Es. This was an important shift because there previous line had been, if there has to be only one it should be in Telford. We also had the support of Labour, LibDem and Green Shropshire councillors.
Two short videos. The first, a quick cut from us, and the second is tonight’s BBC report of the demo
Read more ...
Thursday 29th September 2016
John Lister via GP Online
- Former NHS England commissioner lifts the lid on "shameful" rushed STPs
STPs are being forced through at impossible speed by NHS England, resulting in vague plans being submitted filled with "lies" and policies without proof, according to this blistering critique by a former NHS England manager.
Thanks to GPonline for flagging this up.Read more ...
Wednesday 28th September 2016
Tony O'Sullivan, co-chair KONP
- Greenwich campaigners prompt Scrutiny Panel challenge to Circle contract
Greenwich KONP and Save Lewisham Hospital Campaign have worked hard together to raise awareness of this case - Greenwich CCG has awarded the MSK contract in Greenwich to Circle despite a very well coordinated bid from the NHS providers. It is a 'prime contractor' situation (like Cambridgeshire and like MSK in Bedford) and Circle would hold all the cards, passing on any risks to the NHS providers. The biggest hit would be on Lewisham & Greenwich NHS Trust.
GCCG have cut 10% off the value of the current work. Circle would of course set out to make a profit, resulting effectively in a further cut, and all penalties would be passed on to the providers.
Our raising of awareness with the scrutiny committee and our presence at the panel tonight was welcomed by the chair who invited some of us to speak after councillors' questions. The councillors seemed shocked at the lack of information in the written and verbal answers from GCCG. I pressed them to use their powers not to endorse the contract and to refer the matter to Council and Secretary of State.
The chair of the scrutiny committee, Cherry Parker summed up saying she had been disappointed by the level of detail offered by the CCG:
"In too many cases the answers don't go deep enough, and we are not in a position to endorse this contract award. We would like to scrutinise further and engage other stakeholders. We want to hold on and want the incoming Chief Officer to be accountable for this contract [when in post from mid-October]"
Greenwich CCG's outgoing chief officer Annabelle Burn, clearly shocked, responded in confrontational vein:
"The new chief officer has had full sight of this contract. We will sign the contract as soon as we are ready to. The contract is awarded. The process is going ahead. Our signature is not subject to this process. We will do this in our time."
This did not go down very well with the Council's Scrutiny chair who replied:
"You and I know we have powers to take this further, and we will execute those powers. I say this more through tears."
We don't know how this will end, but Greenwich KONP and Save Lewisham teams were very pleased with the night's outcome, the result of a lot of background work. We have potentially delayed this contract, due to be implemented from 1st December, and have set back this contract award to Circle - whether temporarily or whether we can go further, we will see.
- Secret plans for Oxfordshire still under wraps
The body that has agreed to cut £9.7 million from local health services, but has yet to admit where the axe will fall, now refuses to reveal its involvement in secret government plans that could see further threats to patient care in Oxfordshire.
Oxfordshire Clinical Commissioning Group (OCCG) continues to stall by not answering direct questions put by campaigners Oxfordshire Keep Our NHS Public, and by its repeated delays in responding to an information request from our local Healthwatch, challenging the secrecy of the plans.
And the local Health Scrutiny Committee, which has a public duty to ask searching questions about significant changes to local health services, has once again failed to see this blueprint, officially known as a Sustainability and Transformation Plan (STP), which will impose further drastic cuts on local health and social care.
Leaks of STPs from other parts of the country reveal planned cuts that will see more GP practices closed, community services reduced or removed altogether, hospital wards and whole departments downgraded or axed, beds permanently lost, A&E threatened, and staff terms and conditions weakened.
The tell-tale signs are already visible throughout Oxfordshire, with the downgrading of maternity services at the Horton, GP practice closures in Witney and Bicester, and hospital and community beds no longer available.
Chair of Oxfordshire Keep Our NHS Public, Dr Ken Williamson, said today:
‘That the public is being prevented from seeing these secret plans until the end of the year is shocking. It isn’t good enough to say that the plans have to have government approval before the public can comment on them.
By Christmas, these plans will be a done deal, and any consultation will be a cynical PR exercise, and totally meaningless.
These plans (STPs) are being imposed by central government as part of a massive de-funding of our National Health Service, deliberately starving it of much-needed investment.
Chomsky said that the standard technique of privatisation was: “defund, make sure things don’t work, people get angry, hand it over to private capital”.
They want the NHS to fail. They want people to get angry. All the easier to introduce co-payments and private health insurance.’
Contact: Dr Ken Williamson, Chair of Oxfordshire Keep Our NHS Public, Mobile: 07831 570936
Bill MacKeith, Secretary of Oxfordshire Keep Our NHS Public 01865 558145
Read more ...
Friday 16th September 2016
- Our Children’s Services in NHS sale: 96% say no
Today we see another GP surgery close, news which comes on top of further disruption and anger in the Patient Transport Service earlier in the week, both the direct effect of the private market in our NHS.
Now it’s the turn of our Children’s Services to be decimated and picked off most likely by a big corporation, further destroying our local NHS and the guarantees that it brings us. The expensive and secretive process to find a new provider has already begun. Brighton people and local campaigners are up in arms about this NHS firesale. A Council meeting on Tuesday will be met by a demonstration against the sale.
The public health commissioners within Brighton Council are in the process of selling off Children’s Services. But nearly 1,000 signatures have already been collected on a petition in only a few weeks by local campaign group Sussex Defend the NHS. They say, “ Giant private companies like Virgin Care (many of them tax-avoiding) are being awarded huge contracts across the country but because they need to make a profit, they reduce their costs by cutting staff and lowering standards and quality of care. We say No to Virgin taking over our Children’s Services. We want to see them properly funded and run, for us, for all of us, by the NHS.”
A team at Brighton University are researching the views of Brighton residents on what they think about who runs our health and social care services. Their current survey has already attracted hundreds of responses including to a question about the current sell-off, Children’s Services. Preliminary analysis of the second survey data shows 96.3% in favour of the services, which include health visiting, school nursing and the Family Nurse Partnership for teenage parents, being retained by the NHS, a mere 0.4% preferring Virgin Care with 3.3% undecided.
Brighton & Hove Council have already this year implemented severe cuts to the service because of the government’s reduction to local funding. Over £1million will be cut over the next 3 years. This has already led to a 10% reduction in health visitor jobs.
Clare Jones, a UNITE the Union representative in Brighton & Hove says, “ Health visitors and school nurses in the city are in shock over the scale of this budget cut and the fact that their services may be provided by a private company like VirginCare. They say there is no place for private profit in children’s health. This decision will have a huge impact on the health and wellbeing of every child in Brighton and Hove – Health Visitors provide the only universal service that visits every family in their home. Health Visitors and school nurses are specialists in children and family health, we are storing up health and social problems for the future, this is such a false economy.”
For further information contact Katrina Miller SDNHS mob 0775 238 0093
Thursday 15th September 2016
- Leading GP warns STPs are little more than “slash and burn”
The last week has seen a flurry of statements and revelations on the state of the NHS and the plans being developed behind closed doors for drastic action to hold back spending and avoid a “gap” of billions of pounds opening up by 2020.
Leading the charge has been Chris Hopson, Chief executive of NHS Providers, representing the trusts and foundation trusts that deliver front line care. He has been writing articles and giving interviews reiterating the point he has made before: that the NHS budget is insufficient to sustain the full range of services in every area.
If there is no relaxation of the rigid freeze in real-terms NHS spending that Tory-led governments have imposed since 2010 while the population increases and costs rise each year, he says, then services will have to be cut back to fit the budget.
Where Hopson’s warnings play into the hands of the right wing is when he calls not for an immediate halt to the spending freeze, but for a public “debate” on the future of the NHS.
We can predict that if any such debate were opened up it would inevitably be hijacked by well-resourced right wing organisations like Reform, and steered by those who seek to undermine the foundations of the NHS and open the way for charging patients for treatment, expansion of private provision and private insurance.
The same danger applies to calls for a parliamentary or other “commission” to debate the future funding of the NHS. For most of us there is no need for a debate, since it’s clear that funding the NHS through general taxation and delivering it free at point of use is the fairest and most efficient way – and this has been repeatedly confirmed by investigations since the 1950s.
But tax funding requires a government that is prepared to raise tax fairly and fund the NHS properly – whereas George Osborne in 2010 used the pretext of the financial crash caused by the bankers to impose a brutal austerity regime of cutting or freezing public spending. This is reversing the ten years of additional investment in the NHS from 2000, and squeezing Britain back down to among the lowest-spending countries on health care.
The problem is not the health care system, but the government and its political choices. And there is no sign Theresa May’s government is taking a different line on the funding of the NHS, although May might prove more reluctant to push through hugely unpopular cuts and closures, especially in key Tory areas, if there is evidence of local resistance.
This is why the plans – many of which include proposals to save money through “reconfiguration” (closing hospitals and ‘centralising’ services) – are being kept so tightly under wraps by NHS England.
Indeed Matthew Swindells, NHS England’s director of for operations and information, has revealed that drafts of all 44 plans were submitted in July, and he has seen them: but up to now only two relatively complete drafts have been published – for NW London and Shropshire.
These plans, along with many of the outline proposals seen by the recent report for 38 Degrees, talk at length about various worthy ambitions to improve public health and tackle inequalities – but in practice centre on achieving drastic efficiency savings, to stave off projected “gaps” between needs and resources, many of them reaching into hundreds of millions of pounds.
While some of these “savings” are expected to flow from a range of “innovative” proposals outlined in Simon Stevens’ 5 Year Forward View, the North West London STP draft makes clear that two thirds of the core savings are to come from old fashioned cuts – closing hospitals, centralising services, squeezing more “productivity” from already hard-pressed hospital staff, and dumping more unpaid tasks onto GPs and primary care services.
In a scathing critique of the emerging plans DrMark Spencer, a Lancashire GP and co-chair of the’ New NHS Alliance’, has argued that the much-vaunted Sustainability and Transformation Plans (STPs) are “more about slash and burn rather than transformation”.
“The more I read about STPs the more it becomes clear to me that many are a mile wide and only an inch deep.” Echoing campaigners’ critiques of plans to make savings by closing hospital wards “or even whole hospitals”, coupled with vague talk of “prevention and self care,” Dr Spencer warns that the plans offer only “sparse detail on the ‘how’ or the ‘who’”.
However he is convinced that the reason for this is “an almost complete lack of primary care input into putting those plans together”.
Again echoing the points made by campaigners, Dr Spencer questions whether huge volumes of additional work can simply be landed onto GPs:
“’GPs will do it’ would seem to be a much-repeated mantra. Really? STPs should be closely examined to determine the extent to which primary care was included.”
He also criticises proposals for new Multi- disciplinary Community Providers:
“Where are they going to come from? Where is the leadership? Where is the local ownership? Where is the buy-in from practices and frontline clinicians? A failure to take the local workforce along this journey will result in stagnation at best and a complete collapse at worst.”
What’s important in Dr Spencer’s partisan rant (as a GP wanting more GP influence over the 5-year plans) is that it emphasises the secrecy and exclusions of the STPs. They don’t just exclude GPs and primary care staff from the process: they also exclude hospital staff, and staff in community health services, and they involve bribing and bullying council leaders to force them into line, and ensure they sign up for plans that pile more pressure on overstretched social care services. And they exclude any engagement at all with affected communities or the wider local public.
Who’s in charge of the STPs? Who are they accountable to? These questions keep coming, as it becomes clear that these new structures have been deliberately created by NHS England to override the complex and fragmented commissioning bodies established by the 2012 Health & Social Care Act, and allow central control to drive through changes.
NHS England boss Simon Stevens has openly talked of STP leaderships as “combined authorities” that will use delegated authority from CCGs, trusts and councils to force through decisions that might otherwise be blocked by one or more of them.
Matthew Swindells has made clear that once the plans have been signed off by NHS England they will be translated into “contracts” and implemented. He makes no mention of any consultation with local communities – indeed he advocates simply ignoring the market system established by the 2012 Act:
“If you have a plan that works, go in it together and don’t let old-style contracting stop you from doing the right thing. We are looking to get all the contracts for the whole of the system signed off by December. …
“…. After that, you have a two-year contract and you have four years’ worth of implementation to deliver the trajectory, during which consultation will need to happen over some of the changes.”
Meanwhile most of the plans remain secret until they have been finalised – meaning that local people will at best be subjected to a pointless token ‘consultation’ on what will be a fait accompli.
That’s why STPs are important, and why they are an urgent issue in every area. That’s why campaigners will be meeting in Birmingham on Saturday at a conference convened by Health Campaigns Together to discuss what we know about STPs, and how best to challenge the process in each of the 44 “footprint” areas they apply.
Among those speaking at the conference will be Shadow Health Secretary Diane Abbott, who has responded to concerns by forcing an opposition debate in the Commons on STPs and the looming cuts. Watch this space: we will be doing everything we can to keep local services and stop short-sighted cuts and privatisation.
Monday 29th August 2016
- NHS bosses tell us things are going to get worse:
Come to our national Conference Challenging the STPs, Birmingham, September 17
A detailed report from NHS Providers, which represents NHS and foundation trusts, has underlined the seriousness of the financial bind that has been created for managers in front-line services by 6 years of virtually frozen funding.
Since 2010, the population has increased rapidly. Falling real-terms pay and tougher working conditions have created predictable staff shortages and forced trusts to use costly agency staff to fill vacancies, and costs have risen as well as demand for emergency and elective care: but real terms funding has barely increased at all. No wonder there is a growing affordability gap, and trusts are running deficits.
Now NHS Providers report that in Quarter 1 of 2016-17:
· the numbers of people waiting for elective treatment has reached a new record of 3.45 million;
· A&E attendances rose to a record 5.34 million, with A&E admissions up 6.4% on the same quarter last year.
· 112,000 patients waited longer than four hours on a trolley for a bed – up over 60% from last year.
· Calls to ambulance services increased by up to 15% -- but ambulance trusts could not meet performance targets for the most serious cases.
. On top of this bed occupancy levels are soaring above 90%: the system is at full stretch.
Trust deficits for Q1 were reduced to £461m, half last year’s record level at this stage – but only after millions were pumped in to the most successful trusts from the £1.8 billion Sustainability and Transformation Fund, which was supposed to pay for investment in longer-term transformation of services.
Once that money is exhausted, the NHS faces the grim reality of even meaner funding in 2017 and 2018, and real-terms cuts until at least 2020.
But NHS Providers warns that the apparent improvement this year is also misleading, since almost half of trust finance directors say they will not be able to keep up the level of savings they achieved in Q1 to meet tough targets and access a share of the £1.8 billion.
Things can only get worse – to reach the worst ever situation. As NHS providers say:
“We anticipate that the level of financial challenge will surpass any that individual providers, and the sector as a whole, has encountered in previous years.”
This results from a political choice, taken initially by George Osborne, and currently enforced by Philip Hammond as Chancellor, to scale down public spending in general, and reverse Labour’s decade of above inflation increases in NHS spending from 2000 that increased health spending towards the EU average.
Six years of avoidable, imposed austerity – along with billions wasted on bureaucracy of a complex and costly competitive market system as a result of Andrew Lansley’s 2012 “reforms” – has left the NHS on its knees. Massive cuts in funding for local government – which through social services is responsible for commissioning social care, from a motley network of under-funded private providers, have also made things massively worse for the NHS.
The key think tanks have been sounding alarms on this, while the right wing fundamentalists of course want charges for care, health insurance and other horrors of a US-style system. Now even prominent Tory MP doctors, Dan Poulter and Sarah Wollaston are urging Theresa May to consider new devices to raise additional tax revenue for the NHS, although any specific “health tax,” especially if raised from National Insurance would begin to undermine the core principle that the NHS is funded in the fairest way, through general taxation.
NHS Providers chief executive Chris Hopson has summed up the situation in stark terms. Even current levels of performance in A&E are now at risk:
“There is now a clear and widening gap between what the NHS is required to deliver and the funding available. There is now a fundamental mismatch between what is being asked of our emergency services and the resources they have at their disposal.”
The same could be said of mental health services, primary care, and community health services: for the NHS to stay within its inadequate budget, something has to give – and NHS England has recognised that to drive this process at local level a further reorganisation has been needed, establishing 44 new local area “footprints”, each of which is required to draw up a 5-year Sustainability and Transformation Plan (STP).
The Nuffield Trust, and now, following a report commissioned by 38 Degrees, the BBC and news media have finally highlighted the importance of this process – which Health Campaigns Together has been flagging up for the last six months. But there is still a lot more to come out: the process has been obsessively secretive.
Even the stolid management voice of the Health Service Journal is now urging NHS England to raise the shutters and publish draft STP plans that have been produced behind locked doors, but it many cases not even shared with the boards of trusts and CCGs or council cabinets.
So far, with speculation rife, only two of the detailed drafts have been published (North West London and Shropshire), while other leaks are either confidential copies, or relatively bland early drafts.
Indeed even the 54-page NW London STP, filled with extensive argument, (much of it in tiny 6-point type), skirts round one of the key proposals to balance the books – cutting beds and services at Ealing and then Charing Cross hospitals, bulldozing the buildings, flogging off part of each site, and replacing each hospital (if funding allows) with a glorified clinic with a few intermediate beds: total loss over 590 beds.
The rapid closure of Ealing is reduced to a footnote, and an added comment, emphasising for the first time that this is a way to save money, not as claimed previously a way of improving services.
All of the STP drafts that have emerged are also remarkably coy about the lack of any capital for investment in alternative services for the hospitals that are to be closed or downgraded; the HSJ recently pointed out this embarrassing weakness undermining the credibility of service “reconfiguration”.
There are plenty more nasty surprises for local people to be revealed as and when NHS England finally relaxes its rigid rule of secrecy. But in many areas it’s already clear that to cover claimed “gaps” between funding and health needs by 2020, STPs are pushing through plans for reconfiguration of hospital services – “centralising” A&Es, reducing local access, putting lives at risk.
Local NHS bosses have been bullied into signing up for cuts, realising they would be sacked if they refused: local councils have been bullied and bribed into compliance by the promise of additional funding for social care – with hefty strings attached – and the threat of losing out on funding if they refuse.
Too few council leaders have been prepared to speak out and stand up for their local communities. Ealing and Hammersmith have been bold exceptions to a miserable rule.
Every part of the country faces a major test this autumn and winter as a result of the ruthless spending squeeze. And with hard information a rare and precious commodity, it’s important for campaigners to collaborate together to build up a clear picture of the state of the NHS, the direction of Tory plans and the best way to fight back.
It’s now less than three weeks to the Health Campaigns Together conference ‘The Challenge of STPs’, in Birmingham on September 17. We called for this in the summer, before many people realised just how big the challenge was going to be.
Now the facts are beginning to emerge, health campaigners wanting to understand what’s involved, compare their problems and share lessons with others, and reach out to trade unions to build more powerful movements in defence of our NHS are urged to join us in Birmingham.
More details and registration HERE.
Wednesday 17th August 2016
Sussex defend the NHS
- ‘Planned failure’ at Royal Sussex claim campaigners
Today’s damning CQC report into standards at the Royal Sussex County Hospital in Brighton, placing the hospital in Special Measures is hardly surprising, say campaigners from Sussex Defend the NHS in Brighton.
The campaign points to years of underfunding, under staffing, low staff morale, cases of racial and sexuality discrimination and serious disconnect between senior staff and front-line clinicians and nurses.
A senior clinician at the Royal Sussex said that staff are working so hard despite government mishandling of reforms which have massively contributed to the crisis, underfunding as well as constant short-term changes at the top of the Trust. The list should include the effects of the government’s refusal to properly and safely modernise the junior doctors’ contract and the lack of effort by hospital management to support them.
Katrina Miller for Sussex Defend the NHS said, ‘Here we are again with a senior manager, Gillian Fairfield, offering heartfelt apologies and little else. Just like with Patient Transport Services, another of these overpaid super managers who should properly acknowledge their own responsibility and the government‘s failure and resign. It’s on her watch we’ve seen a culture of blame, harrassment and bullying develop with understaffing, underpaid and overstretched doctors, nurses and support staff. These are significant failures of management against too high a number of indicators and she should go.
You could think this is planned failure on the part of this government. What’s left of the national health service will be so bad, we’ll all rush off and buy private health insurance. And you can’t help but notice that in the massive and overdue development of the hospital which is being paid for by our taxes, a whole tower of new wards is only going to be available for private patients - Foundation Trusts are going to have to get nearly half of their funding from the private health sector as the government go on reducing their spend.
It’s happening quite stealthily: ‘Special measures‘ means that an ‘Improvement Director’ will be appointed to oversee the required changes to practices in the Trust. Monitor will also appoint one or more appropriate partner organisations to assist with the required planning and actions for improvements.*
We have noticed that even where such appointments appear to be from within the NHS, it turns out that many of these individuals have clear histories and connections with private management corporations, private financial organisations or giant health corporations. You can see which way the winds blowing.’
The campaigners say the crisis comes along with those in GP services, Patient Transport and we are about to see Children’s Services going the same way.
If you’ve had enough of all this and want to join the campaign, Sussex Defend the NHS stall will be at the Brunswick Festival this weekend in Brunswick Square, Brighton.
Monday 15th August 2016
Shropshire Defend Our NHS
- Shropshire’s NHS: Heading for Devastating Cuts
On Wednesday 10th August, the Governing Board of Shropshire Clinical Commissioning Group (CCG) took some shocking decisions. They nodded through NHS cuts that will harm frail elderly people, people with mental health problems, people with profound disabilities, and children with cerebral palsy. They didn’t say ‘cuts’, of course. They’re just ‘realising the potential for disinvestment’.
The planned cuts for this year include:
· axing a voluntary worker who worked on integrating services from health, social care and the voluntary sector;
· closing a crisis house in Ludlow for people with mental health problems;
· withdrawing funding from the handful of children with cerebral palsy who have intensive therapy at the Movement Centre in Oswestry (a recognised centre of excellence);
· closing Enable, a high quality specialist service helping people with mental health problems remain in employment;
· closing beds in a Much Wenlock care home that have been used to avoid hospital admissions;
· ending a service that provides proactive care to frail elderly people in care homes who are most at risk of hospital admission;
· ending a lifestyle physiotherapy service that has run for 8 years, is cost effective and well-used;
· stopping a Home from Hospital service that provides very practical help and personal care for patients following hospital discharge or requiring support to avoid hospital admission;
· ending a Moving and Handling service that provides support to the carers of older people with dementia or mobility problems;
· probably ending most pain management services in Shropshire and hoping that GPs will absorb the work;
· and ending a specialist service at Oak House that provides health assessment and intervention for adults who have profound intellectual and physical disabilities and sensory impairments.
There are also plans to privatise START, a service that provides a short term period of intensive assessment and support to people in their own home thus avoiding residential care.
Several other services associated with the flagship Integrated Community Services (ICS) will end. GP-based counselling services will probably end, although the decision on this has been passed to another committee.
All of these services will now be hastily considered by ‘Task and Finish Groups’, and the CCG wants to bring proposals back for ratification in September if it can. The policy approved by the CCG on Wednesday – a policy being implemented before it was agreed – states that decisions on whether or not there is a need for formal consultation can be made through an informal discussion with the Chair of the Council’s Health Overview and Scrutiny Committee (Councillor Gerald Dakin). Any other ‘engagement’ is deemed non-statutory and a matter for the CCG to determine. They could of course find themselves subject to legal challenge on a failure to consult.
Likely targets for cuts or privatisation next year include community rehabilitation for people who have had a stroke or who have other neurological conditions; the RAID mental health crisis service; and the Bridgnorth and Oswestry provision of DAART, offering multidisciplinary assessment, diagnostic tests and clinical treatments to keep patients out of hospital where possible, with care provided in the community.
The cuts proposed by the CCG are completely at odds with their stated priorities of shifting care out of hospital and providing ‘care closer to home’ instead.
This is crude firefighting, in response to a financial crisis caused by underfunding of our local NHS. Another national priority for the NHS is meant to be that mental health has parity of esteem with physical health – and that’s certainly not happening in Shropshire, given the level of cuts here to mental health provision.
There was almost no discussion in the Board meeting. There was no discussion of the individual services set to be axed, no discussion of the clinical consequences, and no discussion of the impact on the vulnerable people who rely on those services.
The GP members on the Board mostly sat in depressed silence, while senior bureaucrats, few of them with a clinical background, drove forward the cuts agenda. They talked about their deficit – and they forgot about the human beings who will be harmed by their cuts.
A representative of NHS England now attends meetings, because the CCG is one of two in the country under ‘intensive intervention’ because of the scale of its financial deficit. The intensive intervention on Wednesday consisted of telling the Board ‘You have difficult decisions to make over the next few weeks’, and ‘You have got to increase the pace at which you stop spending money’.
The Board members muttered and mumbled their way through the meeting, inaudible much of the time for a meeting that they are required to hold in public. You would think that with 25 or 30 members of the public there, Board members might have had the courtesy to speak up. Sadly not. Repeated reminders from members of the public that we couldn’t hear were simply ignored.
Several members of the public walked out in disgust, seeing little point in remaining. The only possible conclusion is that most Board members didn’t want to be heard.
It’s not possible to know the names of many of those who voted for the cuts, or what their job roles are meant to be. The Shropshire CCG website is hopelessly out of date on Board membership, the Chair is inaudible when he calls people to speak, and Board members don’t bother to introduce themselves (and wouldn’t be audible even if they did).
One member of the public had hoped to at least ask for the website to be updated – but questions from the public were arbitrarily disallowed at the end of the meeting to anyone who had raised earlier concerns on cuts. The grotesque lack of transparency will presumably continue.
The contempt for members of the public was matched only by the contempt for organisations providing the services that will be cut. Astonishingly, there was no advance discussion of cuts with most of these organisations – including Shropshire Community Trust, Shropshire Council, Age UK, and the Movement Centre based at Robert Jones and Agnes Hunt Hospital.
A few had phone calls the day before the meeting. Others found out from Shropshire Defend Our NHS. We’re glad we were able to let them know – but why on earth was the CCG incapable of showing this basic level of decency?
The manager of a threatened GP counselling service attended the meeting. When she spoke as an advocate for her service, her views were dismissed – and she was accused of using ‘emotive language’.
Several organisations, tipped off by us that cuts were on the way, had written to the CCG explaining the impact of proposed cuts on the patients they serve. They asked for the letters to be circulated to Board members, giving them at least some way of being heard. The decision from the Chair? The letters were withheld from the meeting, and will be circulated only with the minutes.
The CCG was already trying to cut services by £12.6m this year. They now want to add an extra £3.6m cuts, and Wednesday’s slash-and-burn exercise amounts to only a small part of this. No NHS service in Shropshire is safe.
The problem is one of funding. The NHS is half way through a decade of the most severe austerity in its existence, receiving far, far less in core funding than it needs. Shropshire faces a triple whammy: our share of national cuts, the discrimination against rural areas that’s built into national funding policy, and the underfunding of areas with an older population. There isn’t enough money coming into Shropshire’s NHS – and that’s why we are now facing devastating cuts.
Whatever the reasons, we can’t allow the most vulnerable members of our community to lose essential services.
Here are three things to do, if you live in Shropshire:
- Email Councillor Gerald Dakin, Chair of the Health and Adult Social Care Committee of Shropshire Council. Ask him to insist on full public consultation on these cuts, rather than letting them go forward unchallenged. His email is: firstname.lastname@example.org
- Email your MP. Point out the impact that these cuts will have on service users. Ask him to insist on proper public consultation – and to take up the catastrophic underfunding of Shropshire’s NHS. You might want to contact your councillor as well. You can find and contact MPs and councillors through the WriteToThem website: writetothem.com
Think about coming along to the next meeting of Shropshire CCG so that these people know that their actions are under scrutiny. We’ll publicise what’s happening in advance. We’re expecting the next meeting to be on the 14th September at the Royal Shrewsbury Hospital; we don’t have a time yet.Read more ...
Wednesday 10th August 2016
- NW London publishes fuller Draft of STP
The most detailed glimpse yet of what a finished Sustainability & Transformation Plan might look like, a recent draft has been unveiled, raising the question of why the other 43 plans are not yet open to any public scrutiny.
Under pressure from campaigners and from Ealing and Hammersmith & Fulham councils, NHS bodies spanning eight boroughs in North West London, claiming the support of six of the eight borough councils, have finally published what must be at least Version 40 of their STP
An earlier, less complete draft at the end of June which was not published was numbered v 39: several pages left blank in that draft have now been filled with new material in a densely-packed, almost illegible 54-page document, much of it in tiny 7-point type or smaller.
Amid many vague aspirations to miracle public health interventions that almost instantly reduce hospital admissions and save tens of millions of pounds a year, the hard edge is the goal of closing upwards of 590 beds, and achieving savings towards a "gap" between resources and costs of health and social care estimated at £1.2 billion by 2021.
The savings now explicitly centre on the closure of the already part-dismembered Ealing Hospital, where maternity and paediatric services have been largely removed, followed by the closure of Charing Cross Hospital. When the Shaping a Healthier Future plans were first outlined to reconfigure hospital services in NW London, Ealing had 327 beds and Charing Cross 496.
Other documents have revealed that plans for expanding community health services, once depicted as the way in which hospital beds could be safely replaced, are no longer ranked as a priority in NW London. Indeed it is clear from statements from Simon Stevens that there is NO capital available for any major developments of alternative services.
This leaves the massive, unanswered question: how do the commissioners imagine the existing hospital services in Ealing and Hammersmith can be shut down to deliver cash savings between now and 2020 without triggering a massive further deterioration in performance in the remaining NW London hospitals, as took place when two smaller A&E units were closed in NW London in the autumn of 2014?
Nowhere in the 54 pages are there any concrete plans for how any alternative services might be provided, where the staff would come from, how they might be organised and managed, and how it could be paid for while delivering savings.
It's all literally fantastic: a work of wishful thinking rather than a plan. But meanwhile the run-down of Ealing Hospital continues.
- The plans may still be fantasy: but NHS cuts are starting to get real
Theresa May’s government is stepping up George Osborne’s programme of relentless real-terms reductions to NHS spending, to reverse Labour’s decade of expansion. And NHS chiefs are raising the pressure on hospital trusts, GPs and Clinical Commissioning Groups, demanding concrete plans for cuts to tackle monster deficits.
The Health & Social Care Act of 2012 made clear that the Secretary of State has no duty to provide health services: so the cuts and privatisation that are taking shape are being done by ‘remote control’, through Simon Stevens and NHS England, under the approving eye of Jeremy Hunt.
This is why since Christmas Stevens and NHS England have carved England into 44 “Footprint” areas in which the “local health economy” of NHS trusts, CCGs and local authorities are required to work together rather than compete.
However this is no enlightened reintegration to scrap the competitive market. It’s a desperate effort to cut the deficit, balance the books and “transform” services – collaborating in secret, to develop Sustainability and Transformation Plans (STPs), which must all be vetted, and may be changed, by NHS England.
It’s NHS England’s way to assert central control, to speed the implementation of the policies outlined in Stevens’ Five Year Forward View. Alongside the rapid development in each “Footprint” of 5-year plans to bring the NHS back within budget, more tangible, painful cuts are already taking shape.
This very quest for “sustainability” is now threatening services. As a recent report by the King’s Fund on trust deficits argues:
“The scale of the aggregate deficit makes it clear that overspending is largely not attributable to mismanagement in individual organisations – instead it signifies a health system buckling under the strain of huge financial and operational pressures. The recent strategy of driving efficiencies by cutting the tariff has placed disproportionate strain on providers and is no longer sustainable.”
The same report goes on to warn that: “cuts in staffing and reductions in quality of care are inevitable if the government’s priority is to restore financial balance”.
Right on cue Stepping Hill Hospital in Stockport, with a deficit of over £40m, is closing 30 beds, cutting 350 staff and selling off part of the site to cut costs and raise short term cash; trust managers argue that this is in line with plans for other similar trusts.
Just down the road East Cheshire NHS Trust, delivering acute and community services, has declared it is not sustainable in its current form.
And in a nasty echo of the bad old Thatcher era of cuts in spending from 1985, the chief executive of the Care Quality Commission has argued that he prefers cash-strapped trusts to let waiting times increase rather than reduce the quality of care. Not long ago long waiting times were themselves a measure of poor quality.
In another blast from the 1980s St Helens CCG has now resorted to a complete 4-month halt to all non-urgent referrals to local hospitals, reducing services to emergencies only.
Across the country trusts are repeatedly missing targets for prompt treatment of A&E patients – with performance often worst for the more serious Type 1 patients, who need admission to a bed.
However the regulator mis-named ‘NHS Improvement,’ now obsessed with the effort to wipe out deficits, has discarded any pretence of concern for quality of care, and announced that staffing wards at more than the bare minimum of 1 nurse per 8 patients is not affordable, warning that trusts with higher staffing levels may have to cut back as a condition of extra funding.
NHS England, meanwhile, has announced a fresh drive to “reset” the finances. The main components of the “reset” are:
- Pumping in £1.8m of additional cash in a one-off effort to clear deficits;
- Setting tight financial cash limits for every trust and CCG;
- Even tighter controls on use of agency staff;
- national action to implement Lord Carter’s recommendations for savings in procurement and “back office” teams;
- Setting up another team within NHS Improvement to promote efficiency improvement
- Programmes in each STP to increase efficiency through “transforming” services.
But big savings require big cuts. Section 4 of NHS England’s Reset plan argues that hospitals and services which now depend on locums and agency staff need to be closed and centralised in “nearby” larger units.
“By the end of July STPs should have reviewed services which are unsustainable for financial, quality or other reasons […]. They should have developed plans to re-provide these services in collaboration with other providers to secure clinically and financially sustainable services, both for 2016/17 and for future years.”
Despite the fine words about “transformational efficiency” it’s plain that NHS England is primarily resorting to old fashioned cuts to balance the books.
Trusts are being squeezed by CCGs, and in turn have to shed staff and squeeze down on prices they pay to suppliers and agencies.
In many areas – Cumbria, Calderdale, Oxfordshire, Lincolnshire, Devon, North West London, Bedfordshire, Essex, and more – the most vulnerable targets are A&E units, or smaller hospitals that are to be sacrificed on the altar of “sustainability.”
However little has so far emerged from the 44 “Footprint” areas: the details of the STPs have so far been kept firmly under wraps.
The completed documents may have little more of substance to offer than early sketchy drafts. They could yet be a diversion from the actual cuts at trust and workplace level.
The recent publication of at least the 40th version of the North West London STP Plan announces a renewed determination to drive through the closure of Ealing and Charing Cross Hospitals, based on plans debated since 2012 – now openly seen as a way to save money.
However the rest of the 54 densely-packed, chaotically-presented pages in tiny type, indicates that while the volume of paper consumed has increased, management thinking remains stuck in the realm of fantasy.
The same old assertions that have been around for well over 20 years are again embraced by desperate NHS managers –despite the absence of evidence that they can deliver the promised results. The STP shows a semi-religious belief in the effectiveness of prevention programmes to produce rapid improvement in public health. Trendy new apps and digital devices are expected miraculously to keep frail older people out of hospital, and the answer to any problem is seen as paying management consultants to draft another document, or strategy.
It’s a wish-list more than a plan.
However amongst the incantations and pious hopes there is also a commitment in the NW London STP to create “Accountable Care Partnerships” along the lines of the US-style Accountable Care Organisations proposed by the Five Year Forward View.
These would be provider organisations which would work for a fixed budget to cover a defined population. It’s a risky business. In the US private health insurers have homed in on with these, but lost money – despite much higher levels of health spending. Similar NHS “lead provider” projects covering older people’s services in Cambridgeshire and cancer care in Staffordshire have seen private sector bids withdrawn, and the Cambridgeshire plan collapsed for lack of adequate funding.
Nonetheless NHS Improvement have clearly declared their intention to push for much more private sector “partnership” and involvement in local “transformation” plans. The STPs are vehicles to open up contracts for possible privatisation or outsourcing as well as cuts.
With Labour largely silent on this, the only questions seem to be coming from a few local authorities. Councils are being roped into STPs, bribed by pitifully small additional sums towards their meagre social care budgets, then bullied by threats that this could be withheld.
Council leaders are being pressured to sign up in support of STPs without seeing or studying the full document – and many are doing so.
However one or two are standing firm: Hammersmith and Ealing councils in North West London have bravely refused to sign up for an STP which threatens hospitals in their boroughs, and saddles them with even more under-funded responsibilities.
Northamptonshire’s Tory-led county council, facing £60m of cuts, has announced it will cut funding for social care, including support for discharging patients from Northampton and Kettering hospitals.
In Warrington, the chief executive of the Labour-led borough council has spoken out against NHS “naïve” attempts to drive through STP plans without proper consultation, describing them as a “recipe for disaster,” and warning that there was little sign of partnership in the relations between NHS and social care.
Whether it’s STPs, old-fashioned cuts, or the privatisation offensive that is the greatest concern, every part of the country faces a major test in the autumn and winter as a result of the ruthless spending squeeze.
Health campaigners wanting to understand what’s involved, compare their problems and share lessons with others, and reach out to trade unions to build more powerful movements in defence of our NHS are urged to join us at the Health Campaigns Together conference ‘The Challenge of STPs’, in Birmingham on September 17. More details and registration here
Tuesday 19th July 2016
In the post Brexit political free-for all it’s a nightmare scenario for the NHS.
Services were already struggling to cope with rising demand on a budget which falls each year to 2020 in real terms value and as a share of national wealth (GDP).
Nonetheless it seems that – however much rhetoric there may be about the importance of public health – there is no imminent prospect of the extra funding that’s needed either for health care or for the "proactive measures" to improve public health that Simon Stevens keeps on talking about, as things get worse.
Instead there’s just huge economic uncertainty ahead.
The financial squeeze on the NHS flows from the decisions of the Cameron government back in 2010: George Osborne chose the path of austerity and cutting all public spending. He opted to cut the NHS covertly through a 10-year virtual freeze, designed to unpick the previous 10 years of increased spending – while claiming NHS spending was “ringfenced” from outright cuts.
There has never been any sign that the new Prime Minister, Theresa May, in any way dissented from this approach. Nor is there any sign that her chosen Chancellor Philip Hammond, who established a brutal reputation when he was a Treasury minister for driving through cuts, will substantially change Osborne’s approach.
To make matters worse, the Brexit vote is already undermining the ability of NHS employers to recruit health professionals from the EU, who fear that they may not be welcome or secure in the UK.
Since the referendum May herself has refused to guarantee that EU nationals working here would be able to stay following the Brexit vote: that potentially includes the 130,000 or more which Simon Stevens estimates are already working in the NHS, as well as many more in other jobs.
May as Home Secretary was an enthusiastic advocate of tighter limits on immigration: her notion of a ‘one nation’ approach appears to mean excluding people with origins in other nations.
In the midst of her major reshuffle, Health Secretary Jeremy Hunt appears to be almost unique in holding on to his post – despite, or perhaps because of his stand-off with the junior doctors. May’s decision to leave him there signals no retreat from the imposition of a contract which the junior doctors have overwhelmingly rejected.
With continuing fears of recession, there had been talk even from Osborne of freeing up infrastructure spending, but no hint of easing spending limits on health or local government, which is responsible for social care. Hammond is likely to be as mean-spirited.
However it’s not just the health budget feeling the squeeze: social care has been slashed year by year since 2010. With more people living longer with more complex needs, they need social care – and councils are running out of ‘efficiencies’.
The latest survey of all councils in England from the Social Services directors (ADASS) says they have to make further reductions of services of £371m for people needing care – and for their carers. This follows five years of funding reductions totalling £4.6bn, almost one third of real terms net budgets.
The proportion of social care savings expected to be raised from efficiencies has fallen from 75% last year to 55% in 2016/17 whilst outright cuts in services have increased from 18% to 39%.
ADASS argues that there are now “next to no further efficiencies to be made from squeezing provider fees paid, or raising income from fees and charges to customers”.
Half the cuts will come from older people and almost 20% from personal budgets – a scheme dear to the heart of NHS England boss Simon Stevens.
Only a third of social services chiefs were confident they will even be able to meet their statutory duties this year.
All this is bad news for the NHS service users, because most NHS new models of care and hopes for savings through ‘integration’ of services depend on social care: but it’s even worse news for service users.
But big savings are still very much on the agenda on NHS budgets too.
Since just before last Christmas the new mechanism to drive cuts has been Sustainability and Transformation Plans (STPs), which have to be drawn up in each of 44 ‘footprint’ areas across England .
Each STP is required to seek new cuts & “savings” to bridge improbably huge gaps between projected needs and available resources by 2020.
Each plan has to be checked by NHS England, whose boss Simon Stevens has initiated this latest top down reorganisation, hoping to ride roughshod over the structures put in place by the 2012 Health & Social Care Act to impose much more centralised control.
Stevens was reportedly planning to invoke David Cameron’s support in pressing for financial discipline had EU referendum gone against Brexit: but since the vote the central pressure for savings is continuing.
This is made more urgent by the latest revelations that despite extensive “creative accounting” reducing overt deficits by £900 million, the underlying deficit of trusts and foundation trusts last year was £3.7 billion.
Despite hugely ambitious savings targets, the most optimistic forecast for this year is a total trust deficit of £500m. NHS Improvement has responded by demanding trusts implement another £250m cuts.
And as this update is drafted NHS England has called for limits on spending on clinical staff – shocking Royal Colleges. NICE guidelines for safe staffing targets have been effectively discarded, with trusts told they need no longer invest to meet CQC or Royal College guidelines. Struggling trusts which have staffing of more than 1 nurse per 8 patients will be told this can no longer be afforded.
Trusts which appear to be making insufficient savings on “back office” services will be forcibly paired up with other trusts by NHS improvement. The heat is on.
So far there is precious little information on the content of many STP plans. First drafts of all 44 plans – drawn up in secret, with only the blandest generalities published – were apparently submitted to NHS England at the end of June, according to the HSJ, which also reports that it is unclear when – or if – all the plans will be made public.
Behind the scenes there are huge efforts to strong-arm and bribe local authorities to sign up to plans that cut local health care, persuaded by the offer of a token handout of NHS cash to social care budgets.
Many STPs have plenty to keep secret about: they centre on significant, controversial service reorganisation. More and more A&E units and other services are again at risk throughout England, threatening local access for communities.
Plans to axe services at Bedford Hospital for example would mean that the nearest hospital would be 19 miles away: patients are being offered the “choice” of providers up to 50 miles away. STPs offer the chance to override local concerns and impose cuts regardless of opposition.
But the cuts will of course run alongside privatisation: an NHS England director has also promised a conference of the right wing Reform think tank that STPs will offer plenty of opportunities for the private sector to get into contracts for estates management and new models of care.
So the Keep Our NHS Public campaigners that have renamed STPs as “Slash, Trash and Plunder” are spot on, and campaigners need to join with trade unions to address the danger of STPs and coordinate a response wherever possible.
That’s why Health Campaigns Together has established an STP Watch page on its busy website, and organised a national conference in Birmingham on September 17, which will bring together information and experience and attempt to map out solutions.
We need to get together to weather the new, dangerous period for the NHS. I hope readers and their organisations will support HCT, come to the conference, share info on STP Watch – and help us build the strongest possible resistance.
Tuesday 31st May 2016
- STP process will "pool sovereignty" to force through unpopular cutbacks.
NHS England has designated 44 “footprint” areas to cover England, in which for the first time since the 1990s commissioners (purchasers) are required to collaborate with the providers – in drawing up 12-month and 5-year “Sustainability and Transformation Plans” (STPs) to “transform” services and balance the books.
However it’s clear that both concepts – collaboration and balancing the books – have largely lost any currency in key areas of the local health economy. According to the Health Service Journal, NHS England Chief Executive Simon Stevens has also now insisted that within each of these areas trusts have to make much bigger “savings” than some have been planning. They will not be able simply to ignore “control totals” set for them by NHS regulators without incurring financial penalties.
But this may not be enough to force through the scale of changes required to balance the books across the NHS, since it’s clear that current plans are headed for a further deficit in 2016-17, despite huge pressure to find ways to break even.
So in addition Stevens has decreed that where there are controversial decisions to be made (notably over “the disposition of hospital services”) there could be a “pooling of sovereignty” between trusts and CCGs, to establish “combined authorities” with powers to overcome any potential “veto” or resistance to planned cuts or closures.
The purpose of this is much more sinister: this is the old technique of taking controversial decisions as far away from local communities as possible, so that there will be little if any accountability or engagement with communities who face the loss of local access to hospital or other services.
The STPs allow for no public consultation, and sideline both the CCGs and the Trusts, which do have an obligation to consult on changes of service.
This is clearly creating a new mechanism to do unpopular things at great speed with NO local accountability or consultation.
STP plans are to be finalised in the summer and implemented from October – whether local people agree or not. The plans for this are being hatched up now behind closed doors. They will be sent to NHS England by June 20.
But in the “footprint” areas they will be taken forward by a closed cabal of senior figures. This can be seen from documents published by Cambridgeshire CCG, the STP Governance Framework at the May meeting of the CCG Governing Body. This reveals the draconian powers being handed to the STP leadership.
The process will be driven by a newly-created Health and Care Executive (the ‘Executive’), to be made up of the ‘partner’ organisations which are jointly responsible for delivery of the Programme – local CCG(s), Trusts, Foundation Trusts and councils with social service responsibilities.
Since legally decision making remains with each organisation until or unless authority is delegated to the Health and Care Executive, all decision-making across the Programme will therefore be taken under a “Scheme of Delegation” in which the various organisations effectively empower individuals in advance to act on their behalf. But the councils will have no vote, despite being tied in to decisions that are taken.
“The partner organisations will participate in the decision making processes of the Executive to the extent that they are delegated authority by their respective organisations. The Councils participate as non-voting members of the Executive.”
Since this is to be an executive body, able to take decisions binding the various “partners”, attendance at the meetings is ‘mandatory’, and any member of the Health and Care Executive who cannot attend may appoint deputies to represent them at Health and Care Executive meetings. But significantly, in the event a deputy is provided,
“The individual(s) must be fully briefed prior to the meeting and would be expected to have the same delegated authority to commit resources on behalf of their organisation as the named committee member would.”
The element clearly lacking from this new structure is any consultation with the local public – or with staff. The legal basis of this has now been challenged by shadow health minister Justin Madders, writing in a blog that:
“I have asked a number of Parliamentary questions about the footprints and some of the few facts these have revealed include that the footprints and leadership teams do not have legal status or legal duties and will not have the ability to borrow.
“This means that if these bodies do come to the conclusion that certain local services will have to go as part of a blueprint, there may be no public consultation on such decisions and no formal mechanism to challenge them."
It seems that in some areas the possibility of a judicial review of the new arrangements is being considered.
The STP process, forcing hospital closures and cutbacks in services, is undemocratic, unscientific and in many areas unsafe. It must be stopped before it’s too late.
Local MPs, and councillors from all parties should be challenged to take a stand on the plans that are being drawn up and implemented: already one Tory MP has organised a (timid) protest demonstration to oppose a threat to a local A&E service.
Local health unions and professional bodies in every area must also demand a voice on what is being done to the services in which their members work.
Local communities must be alerted, and demand their voice be heard, their access to health care protected, and NHS funding increased to the levels needed to meet the demands of the future.
Simon Stevens seems to believe that if the NHS is driven hard enough in ways that ignore and override the Health & Social Care Act, he can pretty well do as he likes. There is no sign of any ministerial challenge to this view. It’s up to campaigners to prove him wrong.
Tuesday 24th May 2016
- STPs mean express NHS cuts with no consultation
The financial stranglehold of George Osborne’s austerity squeeze – designed to reverse all of Labour’s decade of increases in NHS spending by 2020 – is now tightening on the NHS.
We are in the sixth year with a budget virtually frozen in real terms, and falling in relation to rising pressures since 2010. Trusts are expected to reveal a minimum of £2.7bn deficits from last financial year – and must implement measures this year to drastically rein in spending, and establish “financial balance” next year.
With acute trust deficits averaging a staggering £15m, this level of savings cannot be achieved in most areas without painful cuts: and with key performance targets already being missed, longer waiting times, and a worsening crisis in mental health services, any new spending cuts are likely to further undermine the quality and effectiveness of the NHS.
David Bennett, former chief executive of the regulator Monitor, is only the latest leading figure to highlight the fact that NHS spending is “about two thirds of the average of comparable health services elsewhere.” As a result, the ability of the health service to drive through further savings on the level required is in question. Leading US systems advisor Don Berwick has also pointed out that running a universal service on just 7 percent of GDP is an “experiment”.
Chris Hopson, chief of the trusts’ body NHS Providers has warned that without more money up to 50 hospitals could have to close.
The trusts are indeed expected to carry the vast bulk of the burden of achieving the colossal £22 billion of savings which NHS England chief executive Simon Stevens set as a target by 2020.
NHS England has now declared that up to £15.3 billion of that total is to be squeezed from front-line trusts – with £8.6 billion in increased “productivity”, and £5.7 billion from “demand management” measures that aim to cut trusts’ caseload (and income) by restricting use of services.
Most “demand management” policies are notable for the lack of any evidence of their effectiveness so far – with emergency admissions still increasing in number across the country, despite repeated assurances that they would begin to fall.
However the measures that do restrict demand are the explicit rationing measures and exclusions of some specialist services such as IVF treatment, and ever-tightening restrictions on elective treatment including cataract, joint replacements, hernia and other non life-threatening conditions.
This is designed to push some people with the means to do so to pay for private treatment rather than wait until their condition becomes an emergency, or severe enough for the NHS to take action. This in turn undermines the NHS, promotes inequality and leaves many with the greatest needs unable to access care.
Most of a further £6.7 billion “savings” is expected to come from more years of real-terms pay cuts for long-suffering NHS staff. This has been imposed nationally by the decision of George Osborne, and is one of the factors underlying the junior doctors’ dispute – but has an increasing impact on the ability of trusts to recruit and retain medical, nursing and other professional staff.
Of course where they have gaps in key frontline staff, the trusts are then driven to bring in agency staff – even while NHS England is trying to cap their spending on this and squeeze down agency rates. Meanwhile the staffing crisis remains unresolved.
Balance the books
The “savings” required are truly massive. So the immediate agenda in almost every area is cuts to bring spending back into balance – coupled in some cases with the use of skilled external accountants who will advise on how best to cook the books to minimise reported deficits and maximise apparent income.
A new regime is being imposed to drive this increasingly urgent agenda. NHS England has begun overriding the Health & Social Care Act which established over 200 Clinical Commissioning Groups as the main commissioners of care.
Instead NHS England has imposed a new, unilateral and top down reorganisation, carving England into 44 “footprint” areas, in which for the first time since the 1990s commissioners (purchasers) are required to collaborate with the providers – in drawing up 12-month and 5-year Sustainability and Transformation Plans (STPs) to “transform” services and balance the books.
Simon Stevens has also now insisted that within each of these areas trusts have to make much bigger “savings” than some have been planning.
Forcing through unpopular decisions
In addition he has decreed that where there are controversial decisions to be made (notably over “the disposition of hospital services”) there could be a “pooling of sovereignty” between trusts and CCGs, to establish “combined authorities” with powers to overcome any potential “veto” or resistance.
Older observers, perhaps nostalgic for earlier organisational structures, will see the STPs as a resurrection of the old “Area Health Authorities” established in the 1970s, long before the competitive market and putting services out to tender were even thought about.
But these are not going to be kindly, collaborative bodies.
The purpose is much more sinister: this is the old technique of taking controversial decisions as far away from local communities as possible, so that there will be little if any accountability or engagement with communities who face the loss of local access to hospital or other services.
Footprints = cuts
In practice all 44 “Footprints” and their STPs mean cutbacks and bed closures, as shown by the STP planning to cut 500 beds in North West London – equivalent of at least one of the two hospitals (Ealing and Charing Cross) targeted for closure in long-running controversial plans.
Not every Footprint will focus on bed reductions or hospital closures, but many will. Each STP will vary slightly in form, but each of them will need to make significant changes, and make big reductions in services if budgets are to be balanced by the end of next year.
Some of these reductions involve long and painful journeys. Plans have just been published for the merger of Peterborough & Stamford Hospital, floundering in unpayable PFI debts, with Hinchingbrooke Hospital – which is22 miles away, and still reeling from the deficits left behind after its period disastrously managed by Circle.
There’s fresh talk of reconfiguration of services between Bedford and Milton Keynes Hospitals – 18 miles apart – with discussion of using services up to 58 miles away.
Similar plans for long-distance “reconfiguration” and centralisation of A&E services are being drawn up in many other areas. Chris Hopson has queried the need for separate A&Es “as little as 14 miles apart” – but not explained how patients are supposed to access more distant hospitals.
The STPs – which allow for no public consultation, and sideline both the CCGs and the Trusts, which do have an obligation to consult on changes of service are clearly a mechanism to do unpopular things at great speed with NO local accountability or consultation.
They are to be finalised in the summer and implemented from October, whether local people agree or not.
The plans are being hatched up now behind closed doors. They will be sent to NHS England by June 20.
Opposition – at last
At last we have a vocal challenge to this steamroller of cutbacks from Labour’s ranks with junior shadow health minister Justin Madders writing in a powerful blog that:
“I have asked a number of Parliamentary questions about the footprints and some of the few facts these have revealed include that the footprints and leadership teams do not have legal status or legal duties and will not have the ability to borrow.
“This means that if these bodies do come to the conclusion that certain local services will have to go as part of a blueprint, there may be no public consultation on such decisions and no formal mechanism to challenge them."
The gloves are off: straight after the Referendum, the NHS will become embroiled in a cuts and reconfiguration frenzy that will hit almost every part of the country.
Campaigners need to be ready: threatened hospitals and services that are not actively defended could be axed.
Split the Tories
We need to undermine the government will to drive through the austerity agenda. We have to force more splits in the Tory ranks, to pile pressure on Tory MPs whose local hospitals are under threat.
If promising signs of active Labour Party engagement on this bear fruit, it could mean we can build really strong, united local campaigns: we have to stop these cuts, and demand an end to the austerity squeeze on the NHS.
We must insist that any cost savings are based on scrapping the costly and wasteful market system created by Andrew Lansley, which wastes upwards of £5 billion a year – not on bed closures alongside worthless promises of ‘alternative’ services that are unproven and lack any real resources.
A universal health service like the NHS should be cannot be delivered on Osborne’s meagre funding of 7% of national income (GDP) or less: we must demand a reversal of the cuts that have forced us into this situation, and push spending back up as a share of GDP to at least the level achieved in 2010.
A campaign linking campaigners, unions and the Labour Party could build into a mass movement to defend our NHS and roll back privatisation and the wasteful market. It’s a winner: let’s back it!
Read more ...
Sussex health campaigners
- Sussex campaigners join together to challenge new quango on health plans
For the first time in their campaigns to save our NHS, health campaigners from across Sussex have joined together to send an open letter to the Chair of the new Sustainability and Transformation Plan group, Mr. Michael Wilson.
The groups, from Brighton & Hove, Worthing and Crawley are planning as much publicity and information as possible across the whole of Sussex about how these plans effect the end of a national health service in England. They would appreciate wide publication of the letter in full :
Dear Michael Wilson,
We are writing to register our major collective concerns about the Sustainability and Transformation plan and the role you have taken up in implementing it in our region.
As you are no doubt aware there is considerable public concern about this Plan. Campaigners nationally find it highly suspicious that the exercise in most parts of the country is veiled in almost total secrecy. This Plan has been imposed by NHS England at the behest of the government with no parliamentary approval and no national or local consultation whatsoever. In West Sussex the issue has been raised so far with Coastal West Sussex CCG and in East Sussex with the HWB and will be raised with Brighton and Hove CCG on the 24th of this month. However despite attempts to elicit information, general ignorance of the true implications is being professed on all sides, although your report presented to the West Sussex HWB is at least open about possible risks and difficulties.
The major upheaval which will be caused by this Sustainability and Transformation plan will be hitting local populations around England by October this year (with detailed Plans and budgets submitted by the end of June). Local residents must not be kept in the dark by lack of public information; we urge you to make details of this plan, and the consequences thereof, available publicly.
We also have very big questions round the finances of this deal. We understand that within the local “footprint” health and social care budgets have to be brought to “aggregate financial balance”. You have made clear in your report to the West Sussex HWB the almost unimaginable enormity of the shortfalls involved - £580 million – with even that “ likely to be an underestimate of the true gap” due in part to decreases in Local Authority funding with consequent cuts to Social Care and Public Health. We note furthermore there is no mention of the regional portion of the “savings” of £22 billion in the NHS by 2020 required by the Carter report nor the budget surplus which all regions have to demonstrate.
You will not be surprised to learn that we intend to publicise these figures as widely as possible. You will be fully aware, as are we, what this order of budget reduction across the ‘footprint’ will entail for NHS and social care services across our region. An honest response by your Trust and all the other Trusts involved and all STP Boards across England would be to say “this simply cannot be done – it can only result in the catastrophic undermining of the National Health and social care services”.
We have a number of specific questions which as citizens very much affected by the outcomes of STP we ask in the spirit of “open, engaging and iterative processes” of consultation which have thus far been shamefully lacking on the parts of all those involved in developing the regional “footprint”.
What is the membership of Sussex and East Surrey Board? How many lay members are there? How many trade union/staff side health workers?
What is the legal status of the Board? As presumably the constitution is available for public view, please provide the electronic link to it.
What is the chain of accountability?
How often does the Board intend to meet? Can you confirm that the meetings will be publicly advertised in advance and there will be public access to them?
Where will the agenda, board papers and minutes be made available to the public?
As Healthwatch has been invited to put forward patient/public views how have you informed the public of this and what measures have been taken to elicit such views?
What impact assessments have been carried out in relation to the operation of the Plan?
We realise that this Plan is the implementation of the government’s massively accelerated devolution agenda which has been forced on to the whole of England with virtually no negotiation and in what, by any standards, is a ludicrously tight timescale. You will be as aware as we are however of the probable consequences for our national health service and the public outcry when the consequences become evident.
Such massive change with such far-reaching negative consequences cannot be ushered in “on the quiet” in the hope no-one will notice as the government, NHS England and all those doing their bidding appear to intend. We, the public need to know and very quickly what STP truly represents and the long-term consequences for all our and our childrens' lives.
With enormous concern,
Sussex Defend the NHS; Coastal West Sussex 38 degrees NHS Group; Crawley and District Keep Our NHS Public (covering Crawley, Horsham, Redhill and Reigate); Don't Cut Us Out (Worthing); Brighton and Hove Trades Council.
Madeleine Dickens from Sussex Defend said, ‘ You have to look at the bigger picture: the government is breaking up the NHS into these financially self-managing regions with impossible targets on debt so that the only way of financing our health services will be a US-style personal insurance system. All the evidence is clear: the US has one of the worst public health systems in the world. These people are collaborating with the wrecking of our NHS which was the best system in the world. They should be ashamed.’
Sussex Defend the NHS are organising a sustained campaign to publicise and expose the Sustainability and Transformation Plan development. There will be a demonstration tomorrow outside Tuesday’s CCG Governing Body meeting from 1230 at the Brighthelm Centre in North Road Brighton. Everyone is urged to come along to make some noise. Sussex Defend campaigners will be asking some challenging questions of the commissioners about the impact of these NHS break-up plans.
The campaign is part of a nation-wide network of campaigns against STP. 38 Degrees have set up an online petition against this break-up and sell-off of the NHS which you can sign here:
Sussex Defend the NHS can be contacted at:
Finally, early alert to Sussex Defend the NHS’ next Public Meeting, Our NHS ... Going, going .... Thursday June 30th 7pm with national speakers and campaign planning. Details shortly.
Join the demonstration at The Brighthelm Centre outside the CCG Governing Body meeting on Tuesday 24th @ 1230.
For more information and interviews contact
- Katrina Miller mob 0775 238 0093
- Madeleine Dickens mob 07875 892 580
- Jan Birtwell Coastal West Sussex 38 degrees NHS Group 07565348647
Monday 23rd May 2016
Sussex Defend the NHS
- Local health services in Sussex: more devastation to come.
Complete re-organisation of health service on its way
Remember when David Cameron promised ‘no top-down re-organisation of the NHS’? All that was made completely untrue by the present government’s 2012 Health & Social Care Act. In Brighton & Hove since then we’ve seen the effects of the break-up and sell-off of our health services from Substance Misuse to Patient Transport Services, GP surgeries to Audiology.
Now, the ‘national’ is finally to be struck from what’s left of our health services as the government implement the next stage of their privatising plans.
These are Sustainability and Transformation Plans being stealthily drawn up in new regions around the country. Brighton & Hove comes under Sussex and East Surrey STP along with West Sussex Coastal and the other CCGs covering the whole of the two counties.
In his presentation to West Sussex Health & Wellbeing Board’s last meeting, Michael Wilson, the Chair of the new STP group drawing up our Plan, exposed the massive £580m shortfall that they are going to have to ‘balance’ in order to achieve the targets set by the government.
On Tuesday next week, 24th, Brighton & Hove CCG Governing Body will be discussing the same framework. If the commissioners collude with this plan, they will be enforcing even more devastating cuts to our health and social services across the city. And only a few people know about the steamrollering of these plans.
Madeleine Dickens of Sussex Defend the NHS and campaign groups in West Sussex have written to Michael Wilson demanding clear democratic involvement in this planning saying, ‘Such massive change with such far-reaching negative consequences cannot be ushered in “on the quiet” in the hope no-one will notice as the government, NHS England and all those doing their bidding appear to intend. We, the public need to know and very quickly what STP truly represents and the long-term consequences in all our and our children’s lives.’
Sussex Defend the NHS are organising a sustained campaign to publicise and expose the Sustainability and Transformation Plan development.
There will be a demonstration outside Tuesday’s CCG Governing Body meeting from 1230 at the Brighthelm Centre in North Road Brighton. Everyone is urged to come along to make some noise. Sussex Defend campaigners will be asking some challenging questions of the commissioners about the impact of these NHS break-up plans.
The campaign is part of a nationwide network of campaigns against STP. 38 Degrees have set up an online petition against this break-up and sell-off of the NHS which you can sign here:
Sussex Defend the NHS can be contacted at:
Finally, early alert to Sussex Defend the NHS’ next Public Meeting, Our NHS ... Going, going .... Thursday June 30th 7pm with national speakers and campaign planning. Details shortly.
Join the demonstration at The Brighthelm Centre outside the CCG Governing Body meeting on Tuesday May 24th @ 1230.
For more information and interviews contact
Katrina Miller mob 0775 238 0093
Madeleine Dickens mob 07875 892 580
Jan Birtwell Coastal West Sussex 38 degrees NHS Group 07565348647
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Shropshire, Telford and Wrekin Defend Our NHS