News roundup

Monday 21st March 2022

Health Campaigns Together Monthly Bulletin #17

• Birmingham waiting lists worst in England
  
  Labour MPs got no useful answers when they challenged ministers to explain how they would cut massive waiting lists in the Midlands, with NHS data showing Birmingham with the worst waiting lists in the country.

  Shadow Health Minister Andrew Gwynne highlighted the disastrous performance of the University Hospitals Birmingham NHS Trust (UHB), running major hospitals across Birmingham, Solihull and Sutton Coldfield, where the latest figures show 183,000 patients were waiting for treatment in December, of whom only 38% had been waiting less than 18 weeks.

  Health minister Maria Caulfield claimed Covid was to blame, and that the Government had committed funding for elective recovery.

  However NHS England’s recent Delivery Plan, constrained by the limits of last autumn’s spending review, accepts that waiting lists will continue to go up until 2024 – perhaps as high as nine million – and numbers waiting over a year will not be reduced until 2025.

  More than a million people,  around one in ten of the population, are waiting for care in the Midlands, the highest number in any region.

  Four other major hospital trusts (University Hospitals North Midlands, United Hospitals Lincolnshire, University Hospitals Leicester, and Worcestershire Acute Hospitals) have more than 40% of their total list waiting longer than 18 weeks (University Hospital Coventry & Warwickshire has not published full figures). 

  However UHB’s performance is by far the worst. 

  A staggering 31,000 UHB patients had waited over a year in December, 17% of the total waiting, compared with 15,877 in Leicester (14.5% of the total of 108,365). By contrast in Barts Health in London, with 103,000 waiting, 8,244 (8%) were waiting over a year.

  Pressures on midlands hospitals have been worsened by high levels of unfilled vacancies, with almost 15,000 vacant posts in acute hospitals, a third of them for nurses, leaving one in ten acute nursing posts unfilled, and almost one in six mental health nursing posts.

  Read more ...
  

HCT News Bulletin #17

• Centene mulls pull-out from UK and Spain
  
  There was little public attention paid to the decision last year by US health corporation Centene to spend a reported $700 million in cash to buy out the remaining 60% it didn’t already own of Circle Health and take complete control.

  Circle itself, with increased resources from private equity investors, had in 2020 taken over England’s largest private hospitals chain, BMI, with 47 hospitals, 2,400 beds and turnover in excess of £900m.

  This enabled Circle to pick up the biggest slice of the £2bn-plus NHS contract effectively block-booking almost 8,000 private hospital beds in the first year of the Covid pandemic: Circle’s share of that contract, £468m, boosted the company’s revenue in 2020 by more than 50%.

  So, with just this one major investment, Centene/Operose had leapt into pole position to exploit the turn by the NHS since the Covid pandemic struck to long-term reliance on private hospital beds to compensate for severely restricted numbers of beds available to treat waiting list patients.

  American takeover

  It appeared that a major American takeover of health care in England – long feared by many campaigners – may finally be seriously under way, although the lack of any Centene press release boasting of the Circle takeover did seem uncharacteristic for a company seeking expansion of markets and profits.

  Instead, just months after forking out big bucks to take over Circle, Centene in December revealed that it was reviewing its strategy, focusing on maximising its profits per share.

  As part of this, they are considering the possibility of “divesting” the corporation of all its “non-core” business, including international businesses worth around $2 billion per year out of the corporation’s $126bn turnover.

  Ribera Salud

  Selling off the international operations would mean disposing of both Circle in the UK and Centene’s 90% share of Ribera Salud (which owns and manages the largest private hospital in Spain and has controlling and noncontrolling interests in primary care, outpatient, hospital and diagnostic centres in Spain, Central Europe, and Latin America.)

  However Centene’s core business remains very much in US insurance, where it covers 26.5 million people, primarily in U.S. government-sponsored programs including Medicaid, Medicare and Affordable Care Act marketplaces.

  Its core interest is simple: profit. So now it is looking to slim down its workforce and focus on achieving 2024 earnings per share of between $7.50 and $7.75 – around 50% up on 2021.

  Hence its willingness to explore options to “offload its international operations, including a U.K. hospital operator.”

  Sarah London, vice chairman of Centene’s board and president of the company’s health care enterprises business told Bloomberg:

  “We are committed to a compre-hensive portfolio review, beginning with non-core assets. Let me say it simply: if it doesn’t fit, it doesn’t stay.” The review may not conclude until the middle of this year.

  At the end of the review Centene may, of course, decide to stay and seek ways to maximise what profits it can extract from NHS contracts.

  If, as seems to be expected, they do decide to pull out, their departure from England would no doubt be linked with selling on their assets to another grasping private operator, who would also need to be fought all the way. 

  Read more ...
  

• Cleveland Clinic's £1 billion gamble
  
  The new £1 billion private hospital being opened in London by the American-owned Cleveland Clinic has set a new benchmark for extravagance, coming in at a whopping £5.4 million for each of its 184 beds.

  Almost five times larger than the average British private hospital, it will increase private in-patient bed capacity in the capital by 14 per cent, according to LaingBuisson, and provide 9 per cent extra operating theatre capacity.

  And with plans to pay its medical staff up to £350,000 per year, it will need to be charging sky high fees that place it well out of the reach of any average British punters – and out of the league of almost all but the most elite private hospitals in the capital.

  The Guardian claims Cleveland Clinic London is “in talks about providing complex procedures for NHS patients to help reduce waiting lists”.

  The most recent 3-month NHS England contract to put private hospital beds on standby recognised that the NHS would have to pay above normal tariff rates for any NHS patients who might be treated – because otherwise the private hospitals could make more money from providing private care to “self-pay” patients.

  NHS consultants

  The new Cleveland can no doubt count on support from the ‘vast majority’ of the 270 consultants who will be working at the new site, who also work for the NHS, and will be keen to make sure the flow of highly lucrative work is maintained.

  But whether the NHS, under the cosh to deliver large-scale efficiency savings, could justify or contemplate paying hugely above normal rates to the Cleveland Clinic seems doubtful.

  And treating NHS payments would be little more than a sideline for a hospital that seems to have been put in place in anticipation of the return to London of the wealthy overseas patients who have over the years been the main customers of top London private hospitals. The Guardian reports that they have been slow to come back since the pandemic, but “travel restrictions to the UK have now been relaxed by Abu Dhabi, Dubai and Qatar – all leading sources of private patients.”

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Health Campaigns Together Monthly Bulletin #17

• Emergency care and waiting lists worsen
  
  The pressure is still on emergency services even as the weather improves and we move in to spring.

  In December 2021, there were just under 1.92 million patients seen in A&E departments, representing a 27.3% year-on-year increase. Ambulance services responded to just under 1 million 999 calls in December 2021 including 82,000 of the most serious Category 1 calls – higher than any other month on record.

  In 2011/12, one in 20 patients attending major hospital A&E (type 1) spent longer than 4 hours in the department. In 2019/20, this had risen to almost one in four (24.7%).

  A&E figures for February show 16 trusts failing even to treat or discharge 50% of the most serious Type 1 patients within 4 hours – with by far the worst offenders yet again being Barking, Havering and Redbridge (27.3%) with West Hertfordshire not doing much better at 34.4%.

  The other 14 trusts all achieved between 40 and 50%: East and North Hertfordshire; Norfolk and Norwich; North West Anglia; Shrewsbury and Telford; United Lincolnshire Hospitals; University Hospitals of Derby and Burton; University Hospitals of North Midlands; County Durham and Darlington; York and Scarborough; Mid Cheshire Hospitals; St Helens and Knowsley; Royal Cornwall Hospitals; Torbay and South Devon and Sheffield Teaching Hospitals.

  Twelve hour waits

  Patients waiting 12 hours for admission after a decision to admit were once rare occurrences. Between 2011 and 2014 (inclusive) there were a total of 915 such cases in England. 

  However in the single month of January 2022 there were 16,558 such waits – eighteen times more than the total for the four years spanning 2011-2014. In the whole of 2014, there were 489 twelve-hour waits for admission: but in January 2022, there was an average of 534 such waits every day. 

  Beds occupied

  The most recent daily situation reports for urgent and emergency care (March 13) show 56 of the 138 trusts reporting figures running at more than 95% bed occupancy, with three running at 100% full.

  Another 42 trusts had more than 90% of beds occupied.

  Almost 11,600 front line beds were occupied by patients who had been there for more than three weeks but “no longer meet the criteria to reside”, slightly fewer than the 12,160 on February 13 and 12,007 on January 13, but significantly more than the 10,474 on December 13 .

  This indicates NHS England has had little or no success over the winter in demanding more rapid discharge to free up beds – and that social care and health services outside hospital are still not able to cope with any increased numbers.

  Waiting lists

  Waiting list statistics for January show a total of 6.1 million waiting for treatment, of whom just under two thirds had been waiting less than 18 weeks, with 311,000 waiting over a year, and almost 24,000 waiting over two years.

  Waiting for cancer care

  A new round up from the House of Commons Library notes the continued deterioration in Cancer waiting times:

  “The 62-day waiting time standard for cancer (measured from urgent GP referral to treatment) has not been met in recent years. Performance declined between 2013 and 2018.

  “Since the pandemic it has fallen further, with 67.0% of patients waiting under 62 days in December 2021 (target: 85%).”

  This understates the scale of the problem, since the 67% figure is an average that conceals desperately poor performance.

  University Hospitals Birmingham is by far the worst major trust delivering just 27.7% of cancer patients waiting less than 62 days to start treatment, and three others (Leeds (30%); Manchester (33.7%) and Leicester (37.4%) fell short of 40%.

  It’s hard to correlate this with the complacent report to NHS England’s January Board meeting that claimed

  “Cancer has been a priority throughout the pandemic and between March 2020 and November 2021, GPs referred over 4 million people with suspected cancer and over 514,000 people started cancer treatment, 95% of whom started treatment within a month of a decision to treat.”

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• Health unions link up fight for pay rise
  
  With the prospect of double digit inflation slashing back on living standards, and more than 110,000 NHS posts vacant, the big question is whether or not ministers can be persuaded to agree – and fund – a significant pay increase this year that can begin to reverse a decade of decline in real earnings.

  But the government’s priorities are very different. In its submission to the pay review body for senior salaries, the Department of Health and Social Care (DHSC) argues that – far from rewarding staff for all of the effort they put in to cope with the pandemic, the focus should be on screwing more effort from them, to balance the books: “There is an expectation that the NHS can catch up on some of the lost efficiency and make productivity savings in 2022 to 2023 in order to return to financial balance.”

  For the bulk of staff covered by the Agenda for Change terms and conditions the health unions will need to fight hard to secure any more than a 3 per cent increase.

  The DHSC submission to the Pay Review Body even argues that it had been planning for a 2 per cent pay increase for the 2022-23 financial year, but “the Department has an additional 1 per cent ‘contingency’ which it is choosing to make available for AfC pay, providing an overall affordable headline pay award of up to 3 per cent”.

  When this was written inflation was at 5.5 per cent: since then the gap between the proposed increase and the soaring cost of living has widened, not least because of the impact on NHS staff of the 1.25% increase in national insurance payments, which will cost nurses £275 per year, more than £5 per week.

  UNISON head of health Sara Gorton said: “This tight-fisted proposal ​falls well short of rising costs and staff hopes​. It’s barely half the rate of inflation, which is far from peaking and won’t for many more months. This will go down like a lead balloon with health workers struggling to fill up at the pump, buy groceries and pay bills.

  “It would be a wage cut in all but name.”

  Since 2010 real terms pay for nurses and health visitors has fallen by £1,600 per year, midwives have lost £1,800 and scientific and technical staff almost £3,000.

  All of the unions representing health workers initially recognised the need to act together if they are to win their demand for an “inflation-busting” pay rise.

  In January all 14 health unions jointly called for an NHS pay award large enough to stop more nurses and other health staff from quitting and to attract new recruits.

  This forms part of an “emergency retention package” , which also includes calls for extra shifts to be rewarded fairly, for limits on excessive hours, and for the lowest paid workers to receive a pay increase that puts them above living wage rates.

  However in March the Royal College of Nursing broke ranks, with its ruling Council dumping a plan developed and signed-off by the organisation’s elected Trade Union Committee, and deciding to deviate from other unions by tabling a unilateral demand for at least 5% above inflation.

  Disappointing ballots last year showed that the biggest challenge for all of the unions is not so much the formulation of a big enough claim but successfully mobilising enough of the membership to vote to back it.

  The prospect of united action by all unions offers the best hope of instilling the confidence that strike action can be successful.

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• Javid's three 'Ps' - discredited, impractical, or both
  
  Sajid Javid’s boring and interminable (8,600 word, 16-page) speech on “reforms” on March 8 rehashed a handful of old ideas that were best forgotten.

  But none of the ‘reforms’ he proposes are new, and none address any of the big problems facing the NHS. 

  He argued the government was at a crossroads: “a point where we must choose between endlessly putting in more money, or reforming how we do healthcare.”

  It’s no surprise that he should opt for more of what he calls ‘reforms,’ – even though his ideas won’t be any more successful now than they were when they were first tried out.

  He talks about three Ps: prevention, performance, and personalised care.

  Prevention has been undermined by a decade of austerity that has deepened the health divide between rich and poor, ended improvements in life expectancy, and slashed public health budgets.

  Performance cannot be improved without extra funding and a plan to solve the shortage of staff. Javid pins his hopes on an expansion of digital systems: but these require more cash to put in place – and staff to monitor and respond to the information that is produced.

  Current digital systems offer profitable contracts to private companies, but threaten to further isolate the millions of people who have significant health needs but remain “digitally excluded”.

  Javid also wants electronic patient records rolled out to 90% of trusts by December 2023 and 80% of social care providers by March 2024 – but there is nowhere near enough money in the system for this.

  Digital = DIY health care

  “Personalised care” without additional staff and services just amounts to more online “do it yourself” manuals in the form of apps and websites, and leaves millions of digitally excluded people on the outside looking in.

  ‘Personal health budgets,’ another old idea which Javid has revived, could only work with more funds, more staff to support patients, and ensuring suitable services are available and accessible for people to buy.

  We know this idea doesn’t work because back in 2014 NHS England CEO Simon Stevens suggested “north of five million” people might have personal budgets by 2018, sharing £5 billion between them (i.e. average payments of just £20 per week). But almost nobody really wanted them, and by 2021 the number of people receiving them had only reached 100,000.

  Right to choose

  Javid has also dredged up Tony Blair’s big idea of the “right to choose” which hospital to go to for elective care, which has for years been in the NHS Constitution. This policy doesn’t increase numbers of beds available or find extra staff to look after patients.

  He had earlier told the (£)Times of his ambition to offer more NHS waiting list patients ‘choice’ including treatment in private hospitals.

  Javid plan is to encourage patients to search for NHS or private hospitals elsewhere in the country with shorter waiting times for the operations they need – even offering funding to cover “travel costs, maybe accommodation costs, including maybe for someone to go with them to support them.”

  This bizarre notion of how to use a chaotic and under-funded market system to reduce waiting times is reminiscent of the first shambolic days of the “internal market” system under John Major’s Tory government in 1991. That saw a minority of patients dispatched long distances for surgery while their local NHS waiting lists continued to grow.

  If this ever happens it will inevitably increase costs, create organisational nightmares for pre-operative tests and discharge arrangements – and pile more work onto hard-pressed GPs, while demoralising NHS staff, while of course offering no relief or hope to under-resourced NHS hospitals with long waiting times.

  It’s worth noting that private hospitals have already shown they are unwilling to take large numbers of NHS-funded patients at the basic tariff cost – and demanded payment above the odds for the most recent 3-month contract with NHS England.

  And of course private hospitals are not available in many parts of the country: two thirds of them are in London and the south east.

  Poaching staff

  They also rely on the limited pool of staff trained by the NHS, and sessional staff employed by the NHS.

  So if the private hospitals do take on more NHS work, the NHS will face greater staff shortages – and see more of its budget leeched out to the private sector.

  These “reforms” recycle old ideas that are discredited, or impractical, or both. In the midst of 15 years of brutal austerity funding they are a poor substitute for investment in health and social care.

  Offered the choice between ‘reforms’ and more money, the NHS has to demand the money. Now.

  Read more ...
  

• Lords force amendments to Health & Care Bill
  
  As expected, the Tories have been suffering some defeats in the House of Lords report stage of the Health and Care Bill, losing ten of the first twelve votes on amendments, and then another four.

  It’s possible more amendments could be moved and carried in the Third Lords Reading of the Bill, which coincides with the Spring Budget on March 23.

  Among the amendments that have been passed and will now have to go back to the Commons some are more significant than others for campaigners.

  One is to delete the clause that would abolish the duty of hospital staff to ensure patients can be safely discharged from hospital. This amendment limits the roll-out of the controversial “discharge to assess” policy, and is driven by the growing numbers of patients still waiting for proper assessment of their needs and for assessed needs to be met after rapid discharge from hospital care.

  Also deleted was the clause added last autumn to impose a ‘cap’ on care costs – at £86,000 – which will be of greatest benefit to the wealthiest families, and little or no benefit in many parts of the country where house prices are lowest.

  Another successful amendment, repeatedly opposed by the government in the Commons and the Lords, requires more regular reports on the NHS and social care workforce – but does not address the continued failure to develop any serious workforce strategy.

  And another ensures that conflict of interest rules that apply to an Integrated Care Board (ICB) also apply to commissioning sub-committees.

  It’s not clear how many of these Lords amendments – which also take up issues including abortion, patient data and tobacco regulation -- ministers will seek to overturn when the Bill returns to the Commons, where of course the Johnson government has a hefty majority.

  Those who oppose the Bill on principle, and view Integrated Care Systems as a major threat to the NHS will clearly not be satisfied by any of the amendments that have been passed, or by the concessions made by the government amendment that excludes private sector representatives from ICBs. Labour has previously committeed to vote against the Bill.

  However it is also necessary to start preparing now to scrutinise and challenge the 42 ICBs that will be established with statutory powers from July, and will be the “local” bodies driving through the new austerity.

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• Why the NHS needs an extra £20bn
  
  £14 billion is needed now to repair and rebuild crumbling infrastructure and reopen beds left empty since Covid-19 struck.

  This includes:

  £5bn to tackle the most urgent of the backlog maintenance issues, for which the total bill has soared to £9.2 billion: repair crumbling buildings and replace clapped-out equipment.

  Up to £6bn needed sooner rather than later to rebuild hospitals built in the 1970s using aerated concrete planks, which are in imminent danger of collapse, and costly even to prop up.

  And £3bn is needed to reorganise, rebuild and in some cases refurbish hospital buildings to enable them to reopen around 5,000 beds which were closed in 2020 to allow for social distancing and infection control. They remain unused today.

  NHS capital is also needed so new community diagnostic hubs and surgical centres can be built without depending on private sector involvement.

  On top of this the Royal College of Psychiatrists has called for £3bn capital, and £5bn in additional recovery revenue over 3 years to equip mental health services to cope with the increased demands since the pandemic and expand services for adults and children.

  Rebuild public health: The Health Foundation has calculated that an extra £1.4bn a year by 2024/25 is now needed to reverse years of cuts in public health, which should be leading a locally- based test and trace system and preventive work to reduce ill health.

  Invest in fair pay: this is essential to help restore morale. Each 1% increase in England is estimated to cost £340m, so even to match inflation rising towards 8% needs an extra £2.7bn. The long-promised promised additional 50,000 nurses will cost at least another £1.7bn – plus a pay award for all staff to help recruit, retain and grow the workforce.

  And this list has not even mentioned 48 new hospitals. So £20bn is just a down payment.

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• As 175,000-plus sign SOSNHS petition -- £20 billion NOW!
  
  As Chancellor Rishi Sunak prepares his Spring Budget statement, the NHS is now being plunged another massive period of austerity.

  Hospital trusts, still struggling to cope with 110,000 vacancies, soaring numbers of staff off sick, over 5,000 beds still out of action since they were closed for infection control in March 2020, as well as continued massive delays in emergency admissions, are now being told to generate impossible levels of “efficiency savings”.

  Mental health services, with at least 1.4 million people needing treatment but not getting it, also face the real threat of further cuts in real terms spending.

  Some hospital trusts, according to the Health Service Journal, are staring down the barrel of unprecedented targets of 5% “efficiency” savings in a year, compared with NHS England’s Long Term Plan annual target of 1.1%.

  Such levels of savings have never been achieved before, except by brutal cuts in staffing in the disastrous Mid Staffordshire Hospitals in the mid-2000s, where the resulting collapse of care created a national scandal.

  The reality is the whole NHS has been increasingly under-funded since George Osborne first slammed the brakes on spending back in 2010.

  £35 billion gap

  Each year since then the cash increase has lagged behind the real costs. By 2019 NHS spending in England was £35 billion per year (28%) below what it would have been if pre-2010 average increases had continued.

  Covid has distorted all figures from 2020: but from April all extra funding for Covid ceases – leaving the NHS to carry the costs, including 11,000 beds and rising filled with Covid patients (on March 16), and with all public health precautions scrapped.

  Ministers no longer even talk about protecting the NHS.

  Rishi Sunak’s spending review last October boasted of an increase in funding averaging 3.8 percent in the next three years: but this is barely the amount needed for services just to keep pace with rising costs and increased demand, and does nothing to address the backlog of under-funding.

  Much of the increase is already being wiped out by soaring energy bills and cost inflation. Even more would be eaten up by any significant pay award to one million-plus NHS staff, since even the miserly 2-3% proposed for 2022 by the government is not fully funded, and inflation is expected to hit 8%.

  Sunak even told health secretary Sajid Javid that any decision to tackle Covid with a further round of booster jabs would mean cuts in other services, and has made clear there is little or nothing extra coming for the NHS in the spring budget.

  But in return for the ‘extra’ money it has been given the NHS is somehow also expected to deliver 30% more elective treatment by 2024-25 than before the pandemic.

  Last autumn, just after Sunak had announced the “settlement,” an NHS Confederation survey found almost 90% of trust bosses already believed the pressures on their organisation had become ‘unsustainable,’ putting patient safety at risk, and that the NHS was at a “tipping point.” Since then it’s all got much worse.

  Cancer targets missed

  A new report from the Commons Public Accounts Committee on NHS backlogs and waiting times in England notes that the NHS has not met all of the eight key standards for cancer care since 2014.

  It accuses the Department of Health and Social Care of overseeing “years of decline in the NHS’s cancer and elective care waiting time performance,” and failing to “increase capacity sufficiently to meet growing demand.”

  Privatisation

  The lack of capacity has been used, during the peak of the pandemic and now in all recent plans, as a pretext for striking deals with the private hospital sector to use their beds for NHS patients – even while thousands of NHS beds remain closed.

  In 2020 alone spending on private providers of clinical care went up by a massive 26% in England, almost all of this down to a woefully poor contract that lined the pockets of private hospital shareholders but actually resulted in the hospitals delivering fewer operations to NHS patients.

  At least the same high level of spending is likely to continue until 2025.

  Indeed, if the latest NHS England plans are implemented, this new, expanded role of the private sector will continue for years into the future.

  The NHS would be reduced to handling the emergencies and complex cases the private sector doesn’t want – and paying the bills for routine elective care in private hospitals.

  The only way to prevent this is to reverse the decline.

  Break from the policy of disinvestment – and pump new funds in to repair and rebuild the NHS, reopen the 5,000 unused beds, and invest in new buildings and staff for mental health.

  Begin with £20bn. Now.

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Friday 18th February 2022

HCT News Bulletin #16

• The £200bn spending gap since 2010 - revised text
  
  New figures from the King’s Fund, calculating the progress of funding for the NHS and social care since the banking crash of 2007-8 indicate how dramatically the brakes were applied from 2010 when David Cameron’s government embarked on a decade of austerity.

  But it’s widely accepted that to cope with inflation, demographic change (a rising population and an increasing proportion of it in the more costly older age groups), technological change and other cost pressures real spending needs to increase by around 4% each year: and from 1958 to 2010 that was more or less the average (3.9%).

  Since the Tory-led coalition took office in 2010, however, the rate of increase has remained consistently below this level, leading to a growing shortfall in funding, and this is set to continue.

  Calculating from the King’s Fund figures we can see that had the Department of Health and Social Care received an annual increase of 4% from 2010, by 2021-22 – even allowing for inflation – its core budget would have been £180bn – £35bn higher than the actual figure, and just £11bn below the total spending including the £47bn Covid spending.

  HCT calculations show the cumulative gap between pre-2010 average levels of increase and the austerity levels of actual funding reached £202bn this year: and if Rishi Sunak’s spending review allocations remain unchanged the gap will widen by another £84bn, to create a near-£300 billion shortfall in the 15 years to 2025.

  By contrast when retired banker Sir Derek Wanless examined the long term funding of the NHS for the New Labour government in 2002, he found that by comparison with the European average UK health spending had fallen behind by £267bn – over the previous 25 years.

  The current financial squeeze has made all the difference between an NHS that can sustain sufficient beds and staff, keep up with maintenance and invest in precautionary stocks of PPE – and today’s conditions of constant crisis.

  That’s why the SOSNHS call for emergency funding of £20bn is a modest call for a down-payment to the full investment needed to restore NHS performance, increase its capacity, reopen unused beds, and increase pay and expand the workforce.

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Thursday 10th February 2022

Health Campaigns Together Monthly Bulletin #16

• 128 bids to be one of eight new hospital projects
  
  The delays and confusion surrounding the initial “fake 40” new hospital projects and the promised upgrade of another 70 hospitals has brought a decline in the construction sector, with a 47% drop in the number of healthcare projects beginning on site in the last quarter of 2021 compared with 2020. 

  Building Better Healthcare reports that “no major projects reached the contract awarded stage” in the final quarter, and “Hospitals, in particular, experienced their weakest period, with the value of work starting onsite in the last quarter of the year falling 62% against the previous year.”

  Two thirds of trusts

  But the confusion and certainty of widespread disappointment will have now grown even further with the revelation in the HSJ that a staggering 128 trusts – almost two thirds of all trusts in England – have submitted bids to be one of just eight additional promised projects, to bring the total of new hospitals to 48.

  Nine out of ten of these trusts will inevitably see their hopes dashed and bids rejected – with no foreseeable prospect under a Tory government of another funding round this decade.

  Collapsing

  This Bulletin has consistently highlighted the urgent need for new hospitals to replace those built in the 1970s with defective structural planks.

  Several of these are now either included in larger schemes or submitted separately among the bids that have flooded in as trusts recognise the danger of missing the boat on funding.

  One of these, Frimley Health Foundation Trust in Surrey has set out plans for a complete £1.26bn rebuild to transform it into a state-of-the-art net-zero hospital.

  Grandiose plans not linked to collapsing buildings include the trusts in Lincolnshire integrated care system, which the HSJ reports have together submitted bids with a total value of £1.2bn.

  In London, Imperial College Healthcare has optimistically submitted its Strategic Outline Case for rebuilding St Mary’s Hospital in Paddington, including 840 beds, at an estimated “£1.2-1.7 billion net, once receipts from the sale of surplus land are taken into account.” 

  Even some smaller plans are still coming in above £400m, including the £500m plan to replace Stockport’s Stepping Hill Hospital, which has a £95m backlog maintenance bill.

  The £400m limit is also likely to be a problem for Shropshire’s much-delayed ‘Future Fit’ plan to centralise acute services on a rebuilt Shrewsbury Hospital – for which £312m in capital funding was potentially promised, but the cost of which has now reportedly exceeded £500m.

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• Dudley trust seeks charity hand-out to fund wellbeing
  
  Diane Wake, chief executive of the Dudley Group NHS Foundation Trust, which runs Russells Hall Hospital resorted to crowd funding and the hospital’s charity to finance what should be basic wellbeing measures.

  The Birmingham Mail reports the charity has been seeking donations through justgiving.com. The suggestions on how the money might be spent show the Trust want charitable funds to do the sort of things a caring NHS management wanting to retain valued staff should itself be doing. The appeal states:

  n £5 could cover a hot meal for a frontline staff member who is unable to leave the ward on a twelve-hour shift.

  n £15 could fund a wellness pack for one of our extremely stretched staff members, particularly those in financial hardship.

  n £50 could help provide emotional support for a nurse at the end of a gruelling shift.

  n  £10,000 to 20,000 could refurbish a staff room into a wellbeing space where staff can relax, refuel, and recharge as they spend some much-needed time away from clinical areas.

  The appeal has so far raised over £210,000 of the £300,000 target. We have no information on whether and how it has been spent.

  These desperate measure to fund what should be the basic work of the NHS as an employer, echoes the desperate Thatcher years in the 1980s in which hospitals were forced to divert management time and effort to “income generation” schemes – and even jumble sales – to keep services going.

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• GPs to be 'nationalised'
  
  The primary care sector is set for a major upheaval under new plans to improve patient access, according to a recent ministerial briefing to the (£) Times. 

  Details of funding and a timetable for the move are hazy, but it appears to revolve around a ‘vertical integration’ model which would see GPs widely employed directly by the NHS via hospital trusts – an idea already piloted in Birmingham, Cheshire and Wolverhampton.

  This would effectively abandon the independent contractor model that has been in place since 1948.

  A second element of the restructure – the establishment of a ‘national vaccination service’ to take over the administration of health campaigns such as the annual flu inoculation drive (which GP practices are currently paid to manage) could further undermine the role (and finances) of existing local surgeries.

  The new initiative from health secretary Sajid Javid follows on from his comments last autumn blaming overloaded and under-resourced A&Es on a perceived lack of GP appointments.

  This argument was embraced by various right-leaning media outlets and led to doctors being subjected to physical and verbal abuse from patients.

  Javid’s latest plan has managed to annoy both GPs (with the BMA describing it as a “kick in the teeth”) and hospital bosses, who through the NHS Confederation warned that putting primary care under the management of hospitals “will not fix the workforce shortages or underinvestment.”

  The Times’ attempts to brand Javid’s plan as a form of ‘nationalisation’ that will complement the government’s much-hyped ‘levelling up’ agenda.

  However the report offered no evidence that the restructure will address the main issues facing the sector: declining GP numbers and the poor provision of general practice in deprived areas. 

  The government has a lamentable record of delivery on its pledges relating to general practice.

  The health secretary admitted in November that it would not be able to boost GP numbers by the promised figure of 6,000 by 2025.

  Only last month research by the Royal College of GPs showed that less than 10,000 of the 26,000 extra health professionals pledged three years ago by the government had actually been hired by surgeries. 

  Increasing numbers of newly trained doctors are happier to become salaried GPs working for others, instead of running what is in effect a small business. 

  The past decade has seen the number of salaried GPs in England rise by 65 per cent, while the figures for independent GP contractors fell almost 30 per cent – and around 800 practices pulled down the shutters, with rural areas particularly badly affected.

  More worryingly, the overall size of the GP workforce has fallen more than 5 per cent since 2015, but patient numbers have risen. As a result, the number of patients per GP has increased by more than 10 per cent in the past half-decade, a particular problem in more deprived areas that are underserved by primary care.

  From The Lowdown

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• Huge increase in 12 hour A&E waits
  
  The most recent urgent and emergency care situation report shows 93% of the 89,736 beds dealing with the most serious Type 1 emergency admissions were occupied on February 6. 11,500 of these are Covid patients.

  Figures for January show a massive 27% increase compared with December in the numbers of patients waiting over 12 hours on trolleys after a decision to admit – up from just under 13,000 to 16,500.

  The Royal College of Emergency Medicine, which is campaigning for this measure to be replaced by 0-12 hour measure, logging from time of arrival in A&E to time of patient reaching a bed, suggests the real picture could be up to twenty times worse.

  The RCEM’s most recent “Winter Flow” survey of 40 trusts and some ambulance trusts has found a slight improvement in numbers waiting less than 4 hours to be seen – but only by 0.32 percentage points, to a still dismal 63.2%, meaning well over a third of patients are waiting longer even to be assessed.

  The RCEM points out that this still poor performance comes despite relatively low numbers of A&E attendances, and a reduction of the most recent peak of Covid admissions.

  And numbers of patients staying more than 7 days in hospital had increased by 15% in the previous month despite NHS England efforts to reduce them.

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• More millions wasted on useless 'Nightingale' hubs
  
  As this bulletin is completed the latest figures show almost 11,500 Covid patients were occupying NHS beds in England, with numbers reducing in almost every region.

  This plus the 5,000 or so beds that have not been used since the pandemic preparations in March 2020 represents a very significant loss of NHS capacity.

  But instead of prioritising moves to reopen the unused beds, the Department of Health and Social care has repeated its errors of 2020, and opted to throw even more money into temporary “mini Nightingale” surge hubs.

  The first eight of these were announced by the DHSC on December 30: the new units were to be located at Royal Preston Hospital; Leeds, St James’ site; Solihull Hospital; University Hospitals Leicester; Lister Hospital, Stevenage; St George’s Hospital, south west london; William Harvey Hospital, Ashford, and north Bristol.

  By January 13 the Bristol unit had been erected in the car park of Southmead Hospital, and was ready to be kitted out – while NHS bosses dodged hard questions on where the staff were to be found to run it. The one thing they seemed willing to say was that they hoped the new facility would “never be needed.”

  Of course that turned out to a common factor in almost all of the Nightingale hospitals, which were constructed at the start of the pandemic back in the spring of 2020.

  Unused

  Hardly any of them properly opened, and few of their beds were ever used – because – as The Lowdown warned from the outset – any hospital sending covid patients to them had to also send the staff to look after them, and none of the hospitals under the greatest pressure had any staff to spare.

  It gets worse: it has since been revealed that hundreds of the beds procured for the first round of Nightingales were of inferior specification – and are not suitable for use on regular NHS wards, with £13m having been wasted buying them and storing them.

  Safety risks

  Now the HSJ reports bosses at East Kent Hospitals are flagging up safety concerns about the surge hub constructed in the car park of William Harvey Hospital, and questioning “whether and how” the temporary facility can be used for anything.

  The Trust’s board papers include a recommendation that the hub should be included on the trust’s risk register, on the basis of concerns including “inability to comply with building and IPC [infection prevention and control] regulations; digital services unavailability; and staffing requirements.”

  The chair’s report also recognised that the new hub had also “created additional problems for parking at the hospital for both patients and staff,” and concluded: “At the time of writing this report we are still considering whether and how the building could be used.”

  The one bright side for the Trust is that the £2.7m-£3.5m cost of the project has not been dumped on to the Trust but covered by NHS England. It’s not yet clear who will pay to have it taken away, or when this decision will be taken.

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• No extra promised for staff wellbeing
  
  Resolving the staffing crisis is not all about pay. With pay in some supermarkets and service industries now outstripping NHS rates, a combination of investment in staff, a zero tolerance crackdown on bullying and harassment and all forms of discrimination, and an investment in staff welfare and wellbeing are also necessary to make the NHS an employer of choice.

  Andy Cowper last year rightly called for a renewed effort by trusts to look after their staff as well as possible. “If organisations have been foolish enough to take out obvious pandemic improvements like free car parking and provision of good access to food, then put them back immediately.”

  But the government has offered only complacency and warm words. Last month Lord Kamall claimed that NHS England had an “intensive retention support programme” in place since 2017, offering “emotional, psychological and practical support for NHS and care staff.”

  Former Chief Nursing Officer Dame Sarah Mullally boasted that in 2020 £15m funding had pledged to strengthen mental health support for NHS England’s (1 million) staff.

  But despite a further £37m for 2021-22 to enable the continuation of this offer in the pandemic, staff wellbeing remains a serious concern, and the Nursing Times reports many nurses are angry that national support has not been good enough.

  No commitment

  Despite being pressed on the point Lord Kamall made no commitment to any additional funding for staff wellbeing.

  The practical point about availability of food, especially for hard-pressed staff on 12-hour night shifts, is underlined by recent shocking findings of a survey by the Institute of Health and Social Care Management, which found that less than 10% of 250 responses reported that freshly-made hot food was available 24/7 in their trusts, while 38% reported “no food of any type (hot or cold) was available at all.”

  As a result “streams of fast food delivery companies” mean security staff on nights and weekends were being diverted from their normal duties “to act as concierge for deliveries and contacting ward staff who had placed the orders.”

  The IHSCM reiterating its support for 24/7 provision of hot food for staff in health and social care, comments:

  “Whilst the NHS and social care experience severe and consistent workforce recruitment and retention issues it is strange that the issue of hot food availability for staff who may be working long shifts is not taken more seriously.”

  Attention to staff wellbeing can help increase staffing levels, improve the quality of patient care, and in so doing improve the morale and job satisfaction of staff, win back the confidence of some patients, and begin to clear waiting lists and rebuild the performance of the NHS after the long dark decade of decline since 2010.

  The continued failure to devote serious resources to staff wellbeing especially in such stressful times heads in precisely the opposite direction.

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• 'Not so fast' say Lords as NHS England pre-empts the Bill
  
  The government’s Health and Care Bill has run in to more challenges as it continues its committee stage in the House of Lords.

  Critical voices have been raised about the way so-called ‘integrated care systems” (ICSs) are being established on the ground, and the extent to which these are pre-empting the parliamentary debate. 

  One main focus of criticism of the way the machinery of local integrated care boards has already been put in place – five months ahead of the postponed July implementation date – has been the guidelines issued by NHS England that have been used in some areas to exclude elected councillors from representing local government on Integrated Care Boards (ICBs). 

  The insistence that only unelected council officials should be the voice of their authorities has been forcibly challenged from various benches, not least Lord Scriven from the Liberal Democrats, who complained: 

  “We are living in a parallel universe. We are discussing the legislative framework for this new system while, out in the real world, the foundations and the bricks are being built.  

  “People are in place. Dates are being set. People are being told that they cannot be on boards. This Parliament has not decided. Under what legislative framework are these organisations working?   

  “They have no legitimate powers or approval from Parliament, yet they are being set up. People are being put in place. Chairs are being appointed. Councillors are being told that they cannot sit on ICBs.” 

  The strong protest at the way this was being done forced Lord Kamall from the government to promise to “go back and have a stronger conversation with, in effect, my boss” Sajid Javid, as well as NHS England, whose guidance on the constitution and composition of ICBs, he insisted, was “not statutory”. 

  However some of the amendments proposed could have the effect of forcing NHS England and local ICSs to reopen the appointments process which they began prior to any parliamentary approval of the legislation. 

  Meanwhile the hugely uneven way in which ICSs have been constituted and begun to function in advance of statutory powers (which has been previously highlighted in this Bulletin and The Lowdown), is underlined again by an HSJ analysis that shows just half of the 42 ICSs published board papers in 2021, and 16 ICSs have never published any papers to indicate what they have been planning or discussing. 

  In Norfolk and Waveney ICS, the chair of one of the acute trusts has broken the usual polite silence by declaring that the proposed structure of the ICS, involving no less than twelve separate bodies, is “absolutely daft,” and she was “struggling to navigate what each group does”. 

  A look at the document from the “interim partnership board” confirms her view, explaining the complex network of bodies beneath the ICB: 

  “We are creating five local health and care alliances (‘Alliances’) based on our current health localities. … They will be accountable to our Integrated Care Board (‘ICB’).  

  “We are also creating 7 local health and wellbeing partnerships (‘Partnerships’) alongside our Integrated Care Partnership (‘ICP’) to progress our work on addressing the wider determinants of health, improving upstream prevention of avoidable crises, reducing health inequalities, and aligning NHS and local government services and commissioning. These partnerships will be based on district footprints.” 

  It’s as simple as that!

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• Plan? What Plan?
  
  The new government ‘plan’ to tackle the growing backlog of waiting list treatment, announced on February 8, is not a plan at all. It lacks sufficient investment and – most important of all – a workforce plan, without which none of the promised improvements will happen.

  The 50-page document admits it doesn’t cover mental health, GP services or urgent and emergency care – all of which are facing dire and worsening problems after a decade of underfunding compounded by the 2-year pandemic.

  It offers is neither a plan nor the resources to reopen the 5,000 NHS beds which closed in March 2020 as part of the pandemic preparation – and are still not being used: instead the “plan” proposes to funnel even more NHS cash into private hospitals and private sector providers.

  A whole section of the document is focused on “Making effective use of independent sector capacity.”  This is after recent figures confirmed a huge 25% increase in NHS spending on private providers in 2020 (see page 3).

  Meagre

  Meanwhile the promises are meagre; cancer patients are promised that numbers waiting over 62 days from an urgent referral will be reduced “to pre-pandemic levels by March 2023” (by which time many will have died waiting).

  But even before the pandemic the 62-day target to start cancer treatment had only been met once in five years, and more than one in five waited more than two months for their first treatment.

  Waits of over a year for non-cancer treatment won’t be eliminated until 2025– after the next election.

  Numbers waiting are expected to rise – perhaps as high as 9 million – until 2024.

  This plan offers no real hope to patients or stressed out NHS staff.

  It underlines the need for the £20 billion extra emergency funding demanded by SOSNHS, the new campaign backed by health unions and campaign groups, which is staging a Day of Action on February 26.

  For details, see panel above.

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• Staffing - the elephant in the room
  
  The key issue in expanding NHS capacity is staff, and the need for a long-term workforce strategy. Without significant investment, and a willingness to change the way staff are treated and managed, the chronic shortages are only likely to grow – putting patient safety and quality of care at risk.

  The government’s Red Book last October declared that the Spending Review settlement “will keep building a bigger, better trained NHS workforce,” and reaffirmed “the government’s existing commitments for 50,000 more nurses.”

  “On target” claim

  On January 24 Lord Kamall tried to reassure the Lords debate that the government was “on target” to recruit the promised 50,000 nurses.

  The facts are very different. No funding has been allocated to pay the £1.5bn per year minimum cost of an additional 50,000 staff.

  That 50,000 target also included an ambitious number of overseas recruits – and retention of 19,000 existing staff – while anecdotal evidence suggests demoralised and burned-out staff are leaving and overseas recruitment has stalled.

  The ridiculous decision of Tory MPs to vote down Jeremy Hunt’s proposal for two-yearly reviews of staffing levels and workforce plans serves only to underline the yawning gap where there should be a workforce strategy.

  This is compounded by the lack of realism in ministers’ attempts to hold down NHS pay.

  A substantial across the board fully-funded pay increase for all NHS staff – over and above the 3% 2021 ‘increase’ that has already been swallowed by inflation and increased national insurance payments – is also needed to show hard-pressed and demoralised staff, who are beginning to leave, that they are valued.

  It would help retain them, recruit new staff – and make it more attractive for qualified staff who have left already to come back and work for the NHS.

  Win back retirees

  Last October Andy Cowper in Health Policy Insight urged an immediate resumption of the work that had been done to get retired clinicians to return to practice, which had been halted “once the first wave of infections in 2020 was not believed to have demonstrably overwhelmed the NHS. That decision was a big and foolish error, and it should be fixed.”

  And to tackle the dwindling recruitment of EU and other overseas qualified staff to strengthen NHS and social care teams the government has to scrap all limits on overseas recruitment and the counterproductive migrant surcharge and visa fees which spell out a message that foreigners are no longer welcome. The cost of these measures in lost revenue would be minimal and the potential benefits very substantial.

  While the extra spending required to resource a serious workforce plan is substantial, it will, as health spending always does, generate other benefits, helping to expand the economy as well as the NHS.

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HCT News Bulletin #16

• The chronology of failure on workforce planning
  
  Lord Stevens of Birmingham, aka Simon Stevens, no longer constrained by his seven years in charge of NHS England, spelled out the repeated refusal of government to confront the NHS workforce crisis in a heavy-hitting speech last month in the Lords.

  He blamed the Treasury for time and again blocking the development of any serious workforce plan by failing to guarantee the necessary funding, and preventing discussion of any plans that might cost more.

  Tracing this right back to his own first year in post, he said:

  “It was back in 2014 that the NHS Five Year Forward View talked about the service changes that were required, but it was not permitted to talk about future capital investment, social care or workforce training, since they were being kept separate.”

  Two years later, “in summer 2016, the Department of Health and Social Care was going to produce this detailed quantified workforce plan ….” But that didn’t happen:

  “instead, in December 2017– three years after the Five Year Forward View – Health Education England launched a consultation document which said: ‘Your responses will be used to inform the full strategy to be published in July 2018 to coincide with the NHS’s 70th birthday.’

  “Twenty-eighteen came and went, and answers saw we none. Then in June 2019, we got another, in this case interim people plan, with lots of excellent content but unfortunately no actual numbers and no new pound notes.” 

  A full, costed five-year Plan was promised “later this year” but nothing was heard until, in July 2020, “we had a one-year people plan which, at that point, was covering just the next eight months,” and promising “Further action … to be set out later in the year … “once funding arrangements have been confirmed by the Government.”

  But instead, “in July 2021, last summer, the Department of Health and Social Care again commissioned Health Education England to start from scratch.” 

  Whether or not the Lords amend the Health and Care Bill to include a requirement for regular updates and planning of workforce, and whether ministers accept it in the Commons remains to be seen: but there is no evidence in recent statements that ministers have grasped the need for more than empty promises.

  On 25 January Sajid Javid told MPs he had “recently” commissioned an NHS workforce strategy: but in the same meeting of the Health and Social Care Committee, its chair Jeremy Hunt reminded Javid that Health Education England, the body charged with deciding how many doctors and health professionals are trained, still does not know how much money they will have from April, as it goes in to a merger with NHS England.

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• The pandemic of privatisation
  
  NHS England spending on Independent Sector Providers rocketed upwards by almost £2.5bn  in 2020-21, a massive 25.6% increase on the previous year, according to the latest Department for Health and Social Care Annual Report.

  The major factor in this has to be the massive contract signed in 2020 with private hospitals – which indicates that this higher level of spending is likely to continue for some time to come.

  Spending on services from local authorities – largely social care (itself almost exclusively provided by for-profit companies) rose by a staggering 44.5%, from £2,984m to £4,312m.

  By contrast the spending with the voluntary sector and non profits rose a mere 9.4% to just under £1.9billion.

  The combined picture shows spending on all non-NHS bodies rose by £3.9bn – 27.4% in the year.

  However because the total budget of the DHSC rose in the year by 34%, the private sector share of total DHSC spending actually fell, from 7.2% in 2019/20 to 6.75% in 2020/21.

  Given the amount of extra money that has changed hands and the promise of increasing NHS dependence on private providers until at least 2025 it’s hardly surprising that the private sector are not complaining at this apparent setback.

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Health Campaigns Together Monthly Bulletin #16

• Big dog's big gamble
  
  As PM Johnson continued the barrage of new policy initiatives aimed at appeasing his most right wing back benchers, announcing plans to lift all precautionary measures to limit the spread of Covid, there were still 11,500 Covid patients in NHS beds.

  Hospitals therefore face the continued need for infection control measures that have limited the numbers of NHS beds in use.

  Figures also show more than 1,500 deaths per week – equivalent to more than seven major air crashes – and 67,000 infections per day -- still well above the rate during 2021.

  The announcement was made as a throwaway gesture with no reference to the science and no attempt to consult Chris Whitty or other scientific advisors.

  Opinion polls showed a staggering 76% of the general public cautious about lifting restrictions – but Johnson’s focus is the campaign to “save big dog” as the partygate fiasco refuses to go away.

  With experts warning that an increase in infection is more or less inevitable once the restrictions are lifted the question is for how long life will get back to “normal” – before the NHS is overwhelmed.

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Tuesday 25th January 2022

Dr Louise Irvine

• NHS Patients Want Centene Out of GP surgeries: London High Courts Judicial Review 1st and 2nd Feb, 2022
  
  On February 1st a Judicial Review in the London High Courts will challenge NHS Commissioners’ decision to allow Centene Corporation’s take-over of dozens of London GP Surgeries, via its UK subsidiaries MH Services International Holdings (UK) and Operose Health Ltd.

  The Judicial Review is being brought by Anjna Khurana, an NHS Patient and Islington councillor. Ms Khurana is one of around 375,000 patients across London who were told nothing about this takeover of their GP surgeries until after the event. She said:

  “Like everyone else, I want to feel I can rely on my GP to be on my side. That is what we get with the NHS. But without my knowledge, my surgery has been sold to a giant American healthcare company, one with a very poor reputation. How can that be right? I needed to stand up and make my voice heard. So many people have been in touch to let me know they support me that I know I am not alone. We cannot allow this stealth privatisation of the NHS to carry on.”

  The Court will rule whether, in making their decision, the NHS Commissioners acted unlawfully in three respects –

  ● Misdirection - they failed to consider all the implications of the take-over because they assumed they had no choice but to accept and approve the proposal

  ● Lack of due diligence - they failed to give due consideration to the risk to patients, if the GP contracts they agreed to transfer to Operose Health turned out not to meet its parent company Centene’s profitability targets.

  ● Lack of consultation/involvement. 

  The Judicial Review will ask the London High Courts to quash the decision by North Central London Clinical Commissioning Group to approve the Centene takeover.

  Since the news broke a year ago, hundreds of patients, councillors and members of the public have written letters, protested outside surgeries and have made their feelings clear.

  London GP Louise Irvine understands:

   “Of course patients are worried. When a large American corporation like Centene takes over this many GP practices we have to question their motive. In America they are sued regularly for fraud and malpractice and we do not need their profit seeking behaviour dictating the quality of healthcare for patients and the working conditions for staff. It’s a deeply worrying situation and I am delighted that the High Court has seen the important public interest in this case”.

  Steven Carne, Chair of 999 Call for the NHS, is concerned about the wider implications of the take-over:

  “London NHS Commissioners have allowed Operose/Centene to become one of the largest NHS Primary Care Providers in England. They could become major players in the new NHS ‘Integrated Care Boards’ that the Government are trying to create with their Health and Care Bill. Having American companies making key commissioning decisions about our NHS is not acceptable."

  
  

  • Anjna’s Judicial Review is supported by a team of NHS campaigners from Keep our NHS Public, 999 Call for the NHS and Doctors in Unite, and has been made possible thanks to funding from members of the public, crowdsourced via the CrowdJustice website.
  • Anjna’s legal team is the public law firm Leigh Day, Adam Straw QC from Doughty St Chambers and Leon Glenister from Landmark Chambers.

   

  For more information contact the support team - challengeohl@gmail.com

   

  Or contact

   

  Dr Louise Irvine - 07922 277395

  Professor Sue Richards – 07407 379194

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Wednesday 12th January 2022

HCT News Bulletin #15

• A&E performance slumps as capacity hit by staff sickness
  
  Increasing numbers of ambulances are being delayed outside hospitals waiting to hand over emergency patients: the most recent figures (January 2) show one in eight emergency ambulances were delayed between 30 and 60 minutes, and one in twelve by over an hour. This is despite NHS England instructions last October to end all such delays.

  This performance of some A&E departments has plunged to record lows as a result of shortages of beds and staff.

  The most recent Urgent and Emergency Care statistics only go up to November, but show that in that month almost a quarter (24%) of over 500,000 patients admitted as emergencies were waiting over 4 hours on trolleys for beds to become available, while almost 11,000 were stuck on trolleys for over 12 hours.

  But more shocking is the number of A&E departments taking the most serious Type 1 patients that not only failed to hit the NHS Constitution target of treating and discharging or admitting 95% patients within 4 hours, but failed massively.

  The England average in November for Type 1 patients within 4 hours was just 62%, and 13 trusts fell below 50% -- with the worst of all being Barking Havering and Redbridge with just 29.5% within 4 hours.

  The next worst was Torbay and South Devon at 41%, followed by Norfolk & Norwich on 44.7% and Royal Cornwall Hospitals on 44.9%.

  Nine other trusts: Wirral, County Durham & Darlington, Derby & Burton, University Hospital North Midlands, West Hertfordshire, North West Anglia, York and Scarborough, Sheffield Teaching Hospitals and East & North Hertfordshire all came in between 46% and 49.4%.

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• Experts denounce Sunak's sale of vital vaccine centre
  
  Over the Christmas-New Year break more scientists have joined a growing outcry against the Tory government plan to sell off the Vaccine Manufacturing and Innovation Centre UK (VMIC), which was first revealed by the Financial Times at the end of November.

  The FT reports that at least four companies have tabled bids for the VMIC, including UK biotechnology company Oxford BioMedica, Swiss healthcare manufacturer Lonza, and Japanese conglomerate Fujifilm.

  The “offloading” of the Centre marks a major about-turn by government. Back in May 2020, then chief executive of UK Research and Innovation Professor Sir Mark Walport, welcoming fresh government investment to expand VMIC’s capacity, said it was “an essential new weapon in the UK’s arsenal against diseases and other biological threats.”

  In December 2020 the UK Vaccine Taskforce’s document ‘2020 Achievements and Future Strategy’ also insisted on its long term importance: “We have worked with VMIC to increase VMIC’s delivery capability … to 70m doses of pandemic vaccine. … This is a permanent facility, with government step-in rights during a crisis.”

  Immediate criticism of the planned sell-off came from experts working with VMIC. Sandy Douglas, a vaccine research leader at Oxford University, told the FT it had “accelerated Oxford’s vaccine programme by months” and “saved many lives”.

  VMIC was first set up in 2018, as a not-for-profit company with no shareholders, by the University of Oxford, Imperial College, and London School of Hygiene and Tropical Medicine, with support from vaccine industry experts MSD, Johnson and Johnson, and Cytiva and £66m of government funds.

  Unique facility

  It was initially envisaged as a way to break from the long history of UK vaccine research, which had “not always had a clear pathway for new vaccines to move from discovery to licensed product.”

  For the first time “Under one roof this unique facility, operated by our experts, will promote, develop and accelerate the growth of the vaccine industry.”

  VMIC experts set up the first UK consortium which drove the process and manufacturing scale-up of the Oxford vaccine through to 2021, when the work was handed over to AstraZeneca.

  For this leading role VMIC won an industry award in December 2020, and as recently as March this year VMIC’s role was praised in an Industrial Strategy Council Research Paper, which described in as “a cornerstone” of strategy for vaccine supplies “in the long term.”

  However the subsequent large scale production of successful vaccines by big pharma corporations, meant ministers and hawkish Treasury chiefs are now trying to recoup as much as possible of the money invested.

  Their argument that VMIC’s crucial role as a state-backed vaccine manufacturing centre is no longer necessary has been strongly refuted by a previous leader of the government’s own Vaccines Task Force, Clive Dix, who told the Observer in November:

  “If we leave it to the industry to do, they’re going to go to the highest bidder, and the UK won’t be at the front of that queue any more, because it’s not a big market. Whereas if you act as a partner, you get things done.”

  Now it seems VMIC is set to be another victim of Chancellor Rishi Sunak’s tightening austerity cap on NHS funding, which has already led to him warning Health Secretary Sajid Javid that the extra costs of the booster jabs will have to mean cutbacks elsewhere in the NHS.

  This short-sighted decision to prioritise cash, profits and corporations over health is consistent with the Johnson government’s instinctive turn to the private sector rather than invest in the NHS or other public services.

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• Health Committee says staffing key to recovery of elective care
  
  Workforce shortages are the “key limiting factor” on success in tackling the backlog, according to the latest report of the Commons Health Committee, whose chair Jeremy Hunt has become a specialist in recommending far-sighted policies he failed to adopt while he was health secretary.

  Now the Committee takes a firm line: “Without better short and long term workforce planning, we do not believe the 9 million additional checks, tests and treatments will be deliverable. …

  “We note there are currently 93,000 vacancies for NHS positions and shortages in nearly every specialty.  We remain unconvinced there are sufficient plans for recruitment and retention of staff ahead of April when the funding from the new Levy begins. Our concerns also extend to the social care workforce, ….”

  The Committee argues that “giving hope to NHS staff that the appropriate number of new staff will be trained in the future is the biggest single measure the Government can take to gain the confidence of frontline staff that it has a grip of this problem.”

  It refers to its previous recommendation that Health Education England should be required to publish “objective, transparent and independently-audited annual reports” on workforce projections that cover the next five, ten and twenty years, and adds: “We note the Government decided to vote down an amendment to make this law in the Health and Care Act.”

  But without an independent forecast of future workforce needs, “it remains impossible for anyone - including this committee - to know whether enough doctors, nurses or care staff are being trained.”

  Given the reluctance of the government to make such a commitment, it seems obvious to most observers that no such plan is in place.

  And given the miserly new austerity regime imposed on the NHS by Rishi Sunak it is also clear the funding is not there to pay for the extra staff that are needed.

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• Mental health delays and shortages
  
  A shocking report in the Independent last month revealed the “desperate” situation facing mental health services after more than a decade of austerity: the NHS has once again turned to the private sector, commissioning an extra 40 beds.

  But the HSJ also has recently flagged up fears that mental health budgets could fall next year as a share of NHS spending, triggering a round of cutbacks.

  Based on leaked data, Rebecca Thomas in the Independent reports hundreds of patientswith seroius mental health problems are winding up in A&E, with many waiting over 12 hours for treatment, because mental health hospitals across the country are full to overflowing.

  Almost all mental health hospitals in London were at “black alert” during October and November, meaning their beds were nearly 100 per cent full.

  Central and North West London Hospital was forced to close three of its wards in December following a Covid outbreak, taking 17 adult mental health beds out of circulation.

  More referrals

  Referrals to mental health crisis services have increased by 75 per cent since Spring 2020, but research by the House of Commons Library found the number of people in contact with services in 2020/21 was 75,000 lower in than the previous year – a fall of 2.7%.

  It also reveals a big increase in probable mental disorder among children, up from 11.6% in 2017 to 17.4% of children aged 6-16 in 2021.

   The proportion of 17-19 year olds with a probable mental disorder also rose from 10.1% in 2017 to 17.4% in 2021.

  Children in White ethnic groups were twice as likely (20.1%) to have a probable mental disorder than those in minority ethnic groups (9.7%) in 2021.

  In May 2021 84% of trust leaders told NHS Providers the amount of time children and young people are currently having to wait to access treatment for services was increasing compared to waiting times six months ago.

  78% of trust bosses said they were extremely (47%) or moderately (31%) concerned about their ability to meet the level of anticipated demand for mental health care amongst children and young people for the next 12-18 months.

  Now leaked data showing bed availability in London reveals just 10 children’s beds out of 140 available in mid-October, and sources in the east of England told The Independent that almost 150 children’s mental health beds were closed, causing huge pressures.

  Psychosis

  The Commons Library also revealed that while 60% of people experiencing a first episode of psychosis should have access to early intervention care within two weeks of referral, the national average has fallen back from 75% two years ago to 62%, and the target is not being met in 20 of the 95 CCGs for whom data was available.

  Performance was as low as 12% in Cambridgeshire and Peterborough, with a five North Western CCGs also below 20%: St Helens, Knowsley, East Lancashire, Warrington and Morecambe Bay.

  The Independent quotes Paul Farmer, chief executive for mental health charity Mind, who was “deeply concerned” over the scale of unmet need in mental health services and called for the government to commit new funding to services.

  Read more ...
  

• NHS England abandons strategy of reopening beds.rtf
  
  Back in the summer of 2020 Simon Corben, Director of NHS Estates at NHS England and Improvement gave a speech to a webinar for Public Policy Projects, a “subscription-based public policy institute” which boldly set out the agenda for remodelling NHS hospitals to restore the clinical capacity that had been lost in the pandemic.

  He proposed the NHS should halve its non-clinical space to free up extra capacity in preparation for the coming winter and further potential waves of covid-19, and “push again” at administrative space, which he argued should be “repurposed [as] surge capacity”.

  That surge capacity could be “used for backlog maintenance repair work,” suggested Mr Corben. And there could be a lot of extra space: a million square feet of administrative space – currently around 30 per cent of NHS estate – should be scaled back down to “something like 20 or even 15 per cent”.

  Of course we know that nothing of the kind happened.

  Indeed when Mr Corben appeared last month at another PPP webinar, talking about strategy for “Reconfiguring the NHS estate,” there was not even a mention of investing to restore the lost acute capacity, or any action to tackle the growing backlog of maintenance.

  Instead he wittered on about “working alongside the newly formed ICS’s and ICBs to produce credible infrastructure strategies over the next couple of years” to “deliver world-class health and care infrastructure that is fit for purpose and fit for the future.”

  He went on to claim that:

  “We’re in a fortunate position where the government has set a clear direction of travel for the NHS estate and infrastructure over the next decade in the form of the health infrastructure plan, the new hospital program as well as others, along with capital funding for investment in the NHS estate infrastructure so that we can look strategically at what we need to get our estate fit for the future.”

  Far from addressing the problem of reconfiguring hospitals (which are struggling through this winter with 16,000 acute beds filled with Covid patients while acute capacity has been slashed) this kind of speech simply denies there is even a problem, while confirming that NHS England has no strategy to solve it.

  Read more ...
  

• NHSE's latest Xmas list of impossible things to do
  
  The White Queen in Alice Through the Looking Glass boasted of being able to believe “six impossible things before breakfast”: but she would have a job competing with NHS England, whose 40-page list of TEN implausible “priorities” for 2022-23 were as usual sent out to health bosses on Christmas Eve.

  The air of unreality was underlined by NHS England boss Amanda Pritchard who, in the midst of the surge of Omicron told an exhausted NHS their objectives are:

  “based on a scenario where COVID-19 returns to a low level and we are able to make significant progress in the first part of next year as we continue to rise to the challenge of restoring services and reducing the COVID backlogs.”

  And with 5,000 beds still out of action since the spring of 2020 Ms Pritchard went on to add

   “… when the context allows it, we will need to find ways to eliminate the loss in non-COVID output caused by the pandemic.”

  Elective backlog

  The priorities for 2022-23 include rising “to the challenge of addressing the elective backlogs that have grown during the pandemic through a combination of expanding capacity, prioritising treatment and transforming delivery of services,” although how this can be done without either a plan or the capital to implement it is not explained.

  Managers already struggling to cope will have been overjoyed to read that “every system is required to develop an elective care recovery plan for 2022/23, setting out how the first full year of longer term recovery plans will be achieved.”

  Wherever possible over winter, systems and providers should:

  “continue to separate services and to maintain maximum possible levels of inpatient, day case, outpatient and diagnostic activity” …

  “This should include the independent sector as separate green pathway capacity.”

  Later NHS England instructs that “local independent sector capacity is incorporated as a core element to deliver improved outcomes for patients and reduce waiting times sustainably.”

  Increase activity by 10%

  NHS England’s ambition is for depleted systems somehow to deliver over 10% more elective activity in 2022/23 than before the pandemic.

  It boasts that “£2.3 billion of elective recovery funding has been allocated to systems to support the recovery of elective services in 2022/23,” but NHS Providers and the NHS Confederation called for £10bn extra for 2022-3 to cover ongoing COVID-19 costs (£4.6 billion); recover care backlogs (£3.5-4.5bn); and compensate for lost ‘efficiency savings’.

  The Health Foundation estimated last autumn that an extra £17bn is needed by 2024 just to shrink waiting times to 18-week target levels.

  Far from reopening the empty beds, NHS England is looking instead to increase the capacity of the NHS “by the equivalent of at least 5,000 G&A beds” including increased use of “virtual wards (including hospital at home)”.

  Virtual wards

  By December 2023, NHSE expects systems to have completed the comprehensive development of virtual wards towards a national ambition of 40–50 virtual wards per 100,000 population.

  However it’s clear that not all professionals are huge fans of ‘virtual wards’: the HSJ reports both Society for Acute Medicine and the Royal College of Physicians have raised concerns about the huge increase in the use of the virtual wards model, under which patients can be remotely monitored by clinical staff.

  Doctors are worried about the speed and timing of the rollout, and argue there is a lack of evidence the approach was safe.

  Ambulance delays

  NHS England goes on to repeat its unachievable autumn instruction to minimise handover delays between ambulance and hospital, as well as reduce 12-hour waits in EDs towards zero and no more than 2% and improve against all Ambulance Response Standards

  Systems are also asked to support GP practices to ensure every patient has “the right to be offered digital-first primary care (“a full primary care service that patients can access easily and consistently online”) by 2023/24.”

  Surely GPs have already had enough aggro from the far right and media over face to face appointments in the past year?

  They have relied on telephone consultations to increase the total appointments above 2019 – while demand for online consultations has been next to zero.

  It’s hard to imagine many GPs will hurry to implement this unpopular “priority”.

  Read more ...
  

• Private hospitals set to profit again from new contract
  
  Yet again ministers and NHS England have opted to sink millions into paying private hospitals to treat NHS elective patients rather than invest in reopening the beds that remain unused in the NHS.

  An NHS England press release on January 10 announced that NHSE had been directed by Sajid Javid to sign a “three-month agreement with multiple independent healthcare organisations.”

  No details are given on how, if at all, the contract was advertised, how much above the NHS tariff it is costing to persuade private hospitals to treat NHS patients rather than lucrative “self-pay” private patients, or how the ten private hospital firms were selected.

  It appears that the new contract is in addition to the £10bn 4-year “framework contract” through which the NHS has planned to use private hospitals as additional capacity to help clear the 6m and rising waiting list for elective care.

  The contract will put the private hospitals’ staff and facilities “on standby to support the NHS” should the Omicron variant lead to “unsustainable levels of hospitalisations or staff absences.”

  This short term and unsatisfactory “fix” proves clearly that ministers and NHS England have learned no lessons from the huge sums of money wasted on unused private hospital capacity in 2020 – as we reported in the last issue (No.14).

  Poaching staff

  And they still have not recognised that private hospitals can only take on additional NHS patients by poaching additional staff trained -- and employed -- by the NHS.

  The real problem is lack of NHS capacity, after a decade of austerity and real terms cuts in NHS spending has reduced the NHS to fewer beds, doctors and nursing staff than almost any comparable European country, and the privatised dysfunctional social care system has also been run down.

  Unavailable

  With latest figures showing over 16,000 Covid patients, and almost 10,000 patients fit for discharge stuck in NHS front line beds, and another 5,500 beds unoccupied on January 4, over 35% of an already inadequate number of beds are unavailable for emergencies and normal winter pressures.

  Diverting some of the least complex caseload, and even some NHS cancer patients to private hospitals is a much less efficient way of working than reopening and expanding capacity in NHS hospitals.

  It may mean a few patients get their operation more quickly – but in the long run it leaves the NHS weakened and chronically dependent on the private sector, putting more patients at risk.

  It will delight private hospital bosses and line the pockets of their shareholders, but does nothing to repair the consequences of over a decade of chronic under-funding since 2010 or equip NHS for the next decade. 

  Read more ...
  

• 'Spend what you need' promise -- in secret
  
  Back in December NHS England chief financial officer Julian Kelly have NHS finance directors licence to implement any ‘sensible’ measures to free up beds this winter.

  However the announcement, to the annual conference of the Healthcare Financial Management Association, has been kept securely behind wraps, and only recently leaked to HCT.

  Mr Kelly warned that winter held many uncertainties, and that “remaining flexible, prepared to respond, to change plans at short notice, and to flex resources is going to be as critical as it was last year.”

  He argued that one way for acute trusts to reduce ambulance handover delays would be to increase the flow of patients through the hospital – as if trust bosses had not already thought of that.

  More bed capacity was needed, Mr Kelly admitted – but instead urged finance directors to look at other ways of increasing capacity by taking a more flexible approach, making use of social care, and even working with local authorities to set up “care hotels”.

  Some trusts have agreed funding with the voluntary sector and local authorities to get people back to their homes – or into a care home.

  Ongoing costs

  However he admitted some of these measures would have ongoing costs, and urged finance chiefs:

  “If there are things you can do, get on with it – and talk to my regional teams about the cost of that. If there are sensible things to do with cost consequences [beyond this winter], flag it, and we will deal with it.

  “Pull every lever you can. I am giving you licence to act here today.”

  He also urged trusts to ‘go further’ on the hospital at home models, and said he would “make sure of the funding to see that through to next year.”

  Whether these assurances were worth anything, however, seems open to doubt given that they were made behind closed doors, and have only been reported on the HFMA’s own members’ website.

  Mr Kelly also admitted that despite the apparent extra cash allocated to the NHS in the recent spending review “for the acute sector, funding ‘will feel more like flat cash’ next year.”

  Read more ...
  

• Sunak warns 'booster jabs will mean cuts'
  
  Rishi Sunak, the Tory chancellor whose 2021 Spending Review in November set the NHS on course for a second decade of decline, is now warning that the limited NHS budget will not cover the extra costs of booster jabs for the latest variant of Coronavirus.

  He has begun further tightening the financial straitjacket on the NHS that has effectively frozen real terms funding since 2010 while the population, its health needs and cost pressures have grown.

  And Sunak is, according to a recent Spectator article, also leading a cabal of cabinet ministers who are critical of the NHS itself – and, according to the Financial Times, involved in meetings with US health corporation bosses.

  Systematically starving the NHS of the revenue it needs to sustain services and the capital it needs to repair and renew hospitals and equipment has emerged as the main driver of privatisation.

  Desperate NHS bosses lacking the capacity they need to cope with rising demand have been forced to turn to private hospitals to supply extra beds, contractors to supply cataract and other routine operations, imaging services, laboratory services and mental health care.

  The extra costs and inefficiencies of this fragmented system pile further pressures back on the NHS – while the private sector, which trains no staff, can only expand by recruiting from the limited pool of NHS-trained staff.

  Now Sunak has reportedly warned Health Secretary Sajid Javid that additional spending on vaccination – the government’s preferred and only strategy to combat the virus – will have to be paid for, either by cutting spending elsewhere or by raising taxes.

  The recent socially regressive “levy,” raising National Insurance payments on even the lowest-paid to raise £36bn for health and care services over 3 years, has already made it clear that Sunak has no intention of taxing the rich to raise any additional funds.  

  According to a Daily Mail report, the Chancellor warned Javid and health officials that “people would feel the effects of [any additional extra] spending in NHS and household budgets.” 

  Estimates suggest that six-monthly vaccinations could cost an extra £5bn a year; but no such extra cost has been factored in to Sunak’s tight-fisted allocations to the NHS up to 2025.

  Indeed it appears that Sunak and the Treasury, eager to recoup its £200m investment in the Vaccine Manufacturing Innovation Centre at Harwell near Oxford, is the force behind the efforts to sell it off to a private corporation, jeopardising its potential future role in pioneering new vaccines and saving lives.

  The Chancellor that previously promised the NHS would get “whatever it needs” to fight Covid-19 is now apparently consorting with US health bosses and seeking any avenue to undermine and carve up the NHS and public sector.

  This is happening in the midst of a pandemic that has exposed to all the abject failure of private contractors, most notably in test and trace and in PPE procurement, and the inadequacy of private hospitals to fill in for lack of NHS provision.

  Read more ...
  

• Why the NHS needs another £20bn now
  
  £14bn needed now to repair and rebuild crumbling infrastructure & reopen beds left empty since Covid-19 struck:

  The bill for backlog maintenance to repair crumbling buildings and replace clapped-out equipment has soared to £9.2 billion. To tackle the most urgent of these issues will cost around £5bn.

  In addition up to £6bn needs to be made available sooner rather than later to rebuild a dozen or so hospitals built in the 1970s using aerated concrete planks, which are in danger of collapse.

  A further £3bn is needed to reorganise, rebuild and in some cases refurbish hospital buildings to enable them to reopen almost 5,000 beds that were closed in 2020 to allow for social distancing and infection control, and remain unused today; and to build new community diagnostic hubs and surgical centres without any private sector involvement.

  Invest in mental health: £3bn capital, and £5bn in additional recovery revenue over 3 years to equip mental health services to cope with the increased demands since the pandemic and expand services for adults and children, as called for by the Royal College of Psychiatrists.

  Rebuild public health: More investment is also urgently needed to reverse years of cuts and rebuild public health services.

  Fund a fair pay deal: NHS and care staff need pay justice; pay that keeps pace with inflation, and restores lost wage value, not the insulting 3% pay award. This is essential to help restore morale.

  Each 1% increase in England costs an estimated £340m – but increased tax and economic activity means over 80% of any increase flows back to the Treasury: Rishi Sunak must be told to pay up now!

  Read more ...
  

• NHS on the brink as spin doctors bully crisis trusts
  
  On January 4, as the country emerged from the Christmas and new year break, Prime Minister Johnson admitted that the NHS was under “huge pressure” – and that the government would do nothing else to help.

  “There are not as many Covid patients in the NHS now as there were in the January peak, not be a long way, but sadly the numbers are likely to grow ... I’ve just got to say to people, as I said yesterday, there will be a difficult period for our wonderful NHS for the next few weeks because of Omicron. I just think we have to get through it as best as we possibly can.”

  His half-hearted assurance that “We will give the NHS all the support that we can” fell well short of early (empty) promises by Chancellor Rishi Sunak to “give the NHS whatever it needs.”

  As he spoke, heart attack patients calling 999 in parts of northern England were being asked to get a lift to hospital instead of waiting for an ambulance; a massive 120,000 NHS staff were off work sick, half of them infected with Covid or isolating, with hundreds of military (40 defence medics and 160 general duty personnel) drafted in to plug just a few of the gaps; and the RCN was warning that with many departments running with only half the number of staff that are needed many nurses were being “reduced to tears because they are not able to deliver the care to their patients.”

  Just before Christmas NHS bosses had been contemplating desperate plans for to use hospital canteens, car parks and meeting rooms as makeshift space for “mini-Nightingale” field hospital-style wards to be run by admin staff or non-hospital staff, as the tide of Covid patients filled more front line beds.

  During the first week of January at least 24 trusts declared critical incidents as staff sickness left some services unsafe, despite behind the scenes bullying from NHS England spin doctors, warning that their public announcement of a crisis would likely result in “additional enquiries” by senior managers.

  One trust chief executive told the Independent:

   “The emergency command and control position [from NHS England], is more about managing the message rather than actually providing practical support.”

  But no amount of spin can hide the fact that NHS capacity has been massively reduced since the pandemic struck in 2020. On January 2 just under 84,000 general and acute beds were occupied by Covid and non-Covid patients, compared with 92,495 on the same day in 2020: a continued lack of capacity since the pandemic.

  Worse, on January 4, 23 trusts in England had not a single unoccupied bed for non-Covid patients, and 19 trusts had fewer than 10 beds available to cope with the normal winter caseload.

  Staff continue to hold services together somehow and put in the extra effort to keep patients safe: but a over decade of real terms cuts has reduced the NHS to the brink of disaster.

  That’s why Health Campaigns Together has helped launch the SOSNHS campaign – pressing for immediate government action to increase funding. It’s urgent: please lend your support and join the online rally on January 19.

  Read more ...
  

Sunday 12th December 2021

Health Campaigns Together Monthly Bulletin #14

• US doctors fight to stop attack on Medicare
  
  Campaigning US doctors, members of Physicians for a National Health Program, are fighting moves by the Biden administration that would effectively put profit-seeking private companies in charge of most of the publicly-funded Medicare system that covers senior citizens.

  Most seniors are enrolled in Traditional Medicare, which gives them free choice of any doctor or hospital and reimburses providers directly at a set rate. Because of its simplicity, it spends 98% of its funds on patient care, with only 2% spent on administration. 

  In contrast, Medicare Advantage (MA) is run mainly by commercial insurers for profit. Medicare pays MA insurers a set amount per enrollee per month; then, MA insurers pay providers for enrollees’ care – and keep what they don’t spend on care.

  In 2020, MA plans spent just 82% of their revenues on care, keeping 18% as overhead and profit.

  The Centre for Medicare and Medicaid Services (CMS) recently announced a plan to move everyone enrolled in Traditional Medicare into a “care relationship” with a third party “Direct Contracting Entity” (DCE), as initially proposed by the Trump administration – effectively replicating the flawed MA system, and opening the prospect of increased fraud and denial of care.

  Virtually any type of company can apply to be a DCE, including commercial insurers and venture capital investors. DCEs are profitable because Medicare pays them more money for sicker patients, giving DCEs a strong incentive to engage in a type of fraud called “upcoding,” meaning they exaggerate — or falsify — seniors’ diagnoses, as happens widely in Medicare Advantage.

  DCEs are also allowed to keep as profit and overhead what they don’t pay for in health services, a dangerous financial incentive for them to restrict seniors’ care.

  The plan is being driven through without seniors’ knowledge or consent, and without Congressional oversight. Campaigners have launched a petition calling on Department of Health and Human Services Secretary Xavier Becerra to halt the DC program, provide real oversight and accountability, and protect traditional Medicare. 

  Read more ...
  

• Unite lists key topics for amendment
  
  Unite has written to all Peers urging them to oppose the Health and Care Bill, which had its second reading in the House of Lords on December 7.

  The letter focuses on the issues of privatisation, accountability and transparency, and concludes by advocating that “Amendments to address some of the worst aspects of the Bill should be pursued, but nonetheless the Bill should be opposed in its entirety.”

  It adds a commendably brief list of issues on which Unite would welcome and support amendments:

   1. Ensure NHS suppliers/providers are default providers of NHS services

  2. Ensure ICBs and ICPs are made up wholly of representatives of public sector organisations, with the exception of GPs

  3. Ensure ICBs can only delegate functions to statutory NHS bodies

  4. Ensure NHS professions cannot be removed from regulation and that regulatory bodies cannot be abolished

  5. Ensure people receive their social care needs assessments before they leave hospital

  6. Address the regressive impact of the social care cap

  7. Ensure people in England can receive treatment in any part of the country, ensuring no postcode lottery and that any suggestions of A&Es turning people away because they live in the ‘wrong’ postcode are removed

  8. Ensure this Bill does not undermine the scope of national collective bargaining and health workers‘ access to Agenda for Change rates of pay, T&Cs and NHS Pensions.

  Read more ...
  

• Trust bosses overwhelmingly fear the worst
  
  NHS Providers’ latest State of the provider sector report shows that, while COVID-19 cases are well below their January 2021 peak, with 5,800 Covid patients in English hospital beds on December 3, trusts are “beyond full stretch” as they deal with current pressures and prepare for winter.

  Trust leaders are particularly concerned about the scale of pressure they are already under before the NHS has reached its traditional peak of winter demand which usually runs from mid-November to end-February, with pressure often greatest in January.

  * 87% said they are extremely concerned about the impact of winter on their trust and local area, (compared with 56% when asked the same question last year, ahead of what proved to be one of the toughest winters in the history of the NHS.)

  * 84% are very worried/worried about their trusts having the capacity to meet demand for services.

  * 85% are very worried/worried that insufficient investment was being made in social care in their area.

  * 94% are extremely/moderately concerned about staff burnout.

  The trust bosses want the government to provide emergency help to enable the social care sector to keep its existing workforce in place over the next few months.

  Retention bonus

  Chris Hopson, chief executive of NHS Providers, said:

  “If we want to keep hold of the staff that we’ve got, the government should seriously consider introducing some kind of emergency support for the social care workforce.

  “One option is a retention bonus of a minimum of £500 each for the 1.5 million social care staff in England, similar to the schemes now operating in Scotland and Wales.

  “ This would add up to a £750m bill, most of which would have to be a draw on the government reserve.”

  Over half (57%) of trust leaders were very worried or worried about whether sufficient investment is being made in public health and prevention in their local area.

  Hopson’s blog concludes:

  “Longer term, trust leaders are clear that this is a completely unsustainable position for the NHS and social care to be in and we have to address the underlying causes – a broken workforce model, insufficient capacity to match growing demand, inadequate funding and a social care system in crisis – which COVID-19 has significantly exacerbated.”

  Read more ...
  

• Trust bosses: no confidence in ICSs
  
  Confidence in the new system being legislated through the Health and Care Bill is strikingly lacking amongst trust bosses according to the latest NHS Providers’ survey.

  It shows that

  * Less than half (43%) of trust leaders were confident or very confident that plans to embed system working, via statutory ICSs, will support better collaboration between local partners and improve mutual aid,

  * Even fewer (41%) were confident or very confident that these plans will support better outcomes for patients.

  And amid all of the rhetoric of “Integrated Care Systems” just 22% of trust leaders were confident or very confident that support and infrastructure is in place locally to enable a more integrated service between primary care and secondary care. 

  Read more ...
  

• SOS NHS - new campaign launching
  
  From best to worst since 2010

  In 2010, after a decade of investment, our NHS was delivering its best-ever performance: by 2021 after more than a decade of austerity – despite heroic efforts by staff to keep services afloat – it has sunk to the worst-ever.

   The problems were growing before the Covid pandemic, but have been deepened by the sudden and continued loss of capacity and continued high level of Covid infections.

  * Waiting lists at a record high – close to 6 million and rising.

  * Record delays in emergency care – patients dying in ambulances queuing outside A&E, or waiting hours in pain for ambulances to arrive

  * Record delays in cancer care – performance targets missed for 5 years and getting worse

  * Record gaps in mental health, with 1.4 million people needing treatment and not getting it

  * 100,000 vacancies and staff burnt out and demoralised by years of relentless pressures and year after year of falling real terms pay, and increasingly frustrated that the quality of care they want to provide is being compromised.

  * A “tsunami of unmet need” in social care – over a million people not getting the care they need.

  More decades of decline?

  Ministers keep arguing that spending is at “record levels”: but it’s clear to all that the NHS lacks staff, beds and resources – as a result of ten years of frozen funding while the population has grown by 5 million.

  The level of ‘record spending’ is still not enough to restore 2010 performance or meet demand.

  The recent Spending Review locked in the freeze on funding to 2025, and gives no extra capital to repair and remodel hospitals to reopen lost capacity.

  This threatens us with another deadly decade of declining NHS – and soaring private sector profits, both as contractors to the NHS, and as private providers of elective care to desperate self-pay patients facing agonising waiting times for NHS care.

  The Health and Care Bill addresses none of these problems, but reduces any local scrutiny and accountability: it will not put an end to contracts going to the private sector, draining resources from the NHS.

  No solutions without more money

  If all this is not to go from bad to worse we need a massive public campaign now, to make Rishi Sunak see sense, and force the government to make a major U-turn, to review and revise the Spending Review:

  * No more wasted billions on private contracts: invest in our NHS

  * Restore and expand NHS capacity, to eliminate private providers

  * Build back bigger: repair or rebuild crumbing hospitals and reopen the unused NHS beds

  * Invest in staff, with new targets for recruitment, training, and levels of pay that would prevent the service losing experienced staff

  * Build a properly resourced, publicly run national care and support service

  * Invest in public health and policies to close the health divide

  Stop the Rot!

  Act now to save health and care

  This government has shown it won’t change course without pressure from below: but U-turns have occurred.

  That's why Health Campaigns Together has linked up in a powerful new SOS NHS campaign with Keep Our NHS Public, NHS Support Federation, the major health unions and other campaigners.

  The campaign will lift off in the next few days, and run into the new year with social media messaging, a major online rally and local and regional events to pile maximum and broadest-possible pressure on MPs.

  It’s a campaign in solidarity with all NHS staff battling to keep services afloat, to give them hope: join us in this fight.

  * More details, info and resources as the campaign develops from SOS NHS web pages at sosnhs.uk.

  Read more ...
  

• Private hospitals coining in cash from NHS and self pay
  
  The staggering £2.15 billion paid out by the NHS to private hospitals since the Covid pandemic, to cover their costs and ensure capacity would be available, have been broken down by Private Eye (issue 1561). 

  It found £468m (boosting its revenue by more than 50%) had been paid to the largest hospital chain Circle Health Holdings, with 54 hospitals and over 2500 beds, which has now been acquired by grasping US health corporation Centene. The NHS payments effectively trebled the value of the company.

  £430m was paid out to Spire, with 39 hospitals and 1,870 beds, helping to almost double the company’s share price.

  And Australian-owned Ramsay Health Care UK picked up a cool £385m (equivalent to 76% of its revenue) in the first 13 months of the pandemic for providing capacity in its 29 hospitals with 892 beds. 

  Both Spire and Ramsay have bragged that the increased NHS waiting list offers them even more lucrative possibilities with self-pay patients. Spire’s 2020 Report notes that they were able to keep back beds from the NHS deal to ensure they could continue to treat private patients, and that some of this was exceptionally profitable:

  “Q4 saw exceptionally strong growth in self-pay revenue with priority given to more clinically urgent complex cases, which carry a greater average revenue per case.” 

  Spire’s Strategic Report notes: 

  “our self-pay admissions were broadly in line with the same period in 2019. This wave of activity, following the pause between March and August, was largely due to pent up demand and a desire by people to avoid a lengthy wait for treatment in the NHS at a time of increasing NHS waiting lists and times;”

  NHS England’s eagerness to strengthen its ties with Ramsay was underlined in October when NHS England’s Director of Clinical Improvement turned up to cut the ceremonial ribbon, opening a new Ramsay Hospital in Chorley – where the future of NHS acute services remains uncertain.

  The private hospitals have obviously been happy to accept NHS subsidies to cover their costs during the Covid lockdown, and to fill their otherwise under-used beds with NHS patients as part of the 4-year £10bn “framework” deal announced last autumn.

  But it’s clear that, despite the lavish payments, nowhere near the full 8,000 private sector acute beds have been made available to the NHS, and fewer still have been used.

  If they can choose, the hospitals themselves would clearly rather treat their more profitable self-pay and privately insured patients than fill beds with NHS patients at the lower NHS tariff cost.

  But even utilising ALL of the private acute beds would still leave the NHS still facing a drastic loss of capacity in four years time, compared with 2019 – and leave the capacity gap unresolved, with the NHS more chronically dependent on the private sector.

  As private hospitals increase their caseload, they poach more staff from the same limited pool of NHS-trained staff – increasing the pressures on front-line NHS services – with NHS teams split up and vital staff redirected to work away from main sites in small private hospitals. 

  Any benefit in access to additional beds for elective work would be offset by the greater problems maintaining adequate staffing of emergency services. 

  Read more ...
  

• North Tynesider still Livid as Livi gains new contract
  
  Jude Letham (Co-ordinator), Keep Our NHS Public North East

  Most North Tyneside residents knew nothing of Livi before they received a leaflet in August 2020. North Tyneside CCG (NTCCG) commissioned this private, Swedish company to provide 21,000 on-line GP video appointments on a 12-month pilot scheme, in addition to standard primary care services. 

  The NTCCG website implies that Livi was brought in to help with the pandemic:

  “At the start of the Covid-19 pandemic the CCG recognised that a different complementary digital solution with additional GP capacity may help to improve access across 7 days a week, and release time for practices to focus on patients who need face to face appointments.”

  However, minutes from a Patient Forum meeting on 14th November 2019, record that funding for the Livi pilot had already been approved.

  Rather than improving access to GPs, Keep Our NHS Public North East (KONPNE) see the Livi service as exclusive. Patients require access to and proficiency in the use of smart phones/laptops, as well as adequate data and broadband.

  Privatisation

  Not surprisingly, KONPNE’s main objection is that this is privatisation of the NHS. A private company should not be used to address shortfalls in GP provision and the fundamental problem that must be addressed is the underfunding of primary care services.

  North Tyneside Council have made clear their opposition to NHS privatisation. Councillor Margaret Hall (Chair of the North Tyneside Health & Well-Being Board) stated in a North Tyneside Council Meeting on 26th November 2020 that, “North Tyneside Council is 100% opposed to any privatisation of the NHS.”

  Perhaps this is why the NTCCG did not consult with the local authority scrutiny committee before commissioning Livi. 

  They claim, on their website, that consultation was not necessary because: “This is an additional new service.”

  In our experience the vast majority of the public are also opposed to this private contract. People queued in the street to sign our petition opposing Livi and the service has not been widely used.

  Only 45% of the commissioned appointments were taken up. Indeed, Livi resorted to hiring advertising billboard vans to drive around North Tyneside to promote their service.

  Figures provided by NTCCG indicate that, on average, the uptake of Livi appointments is one per day, per practice (N.B. not per GP). 

  However despite the lack of enthusiasm from the public and the lack of evidence that one-to-one GP appointments are now easier to book, NTCCG produced an evaluation report with gushing praise for Livi.

  They have decided to extend the pilot while a new 5 year contract is procured. 

  n More details on this, and other campaigns by KONP North East at https://konpnortheast.com/

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• NHS funding has been kept unsustainably low - FT
  
  “We must accept higher taxes to fund health and social care” is the headline on an important Opinion piece by veteran Financial Times journalist Martin Wolf on November 29.

  It quotes the Institute for Fiscal Studies’ comment in its recent Green Budget that “between 2009−10 and 2019−20 UK government health spending grew at an average real-terms rate of 1.6 per cent per year — lower than any previous decade in NHS history.”

  Fewer doctors, beds and scanners

  It also notes that “The waiting list for elective treatment had grown by 50 per cent from 2015. The NHS entered the pandemic with fewer doctors, hospital beds and CAT scanners per person than in most similar countries.

  “The system was creaking. Then came the pandemic. Rescue funding had become vital.”

  Wolf goes on to cite the Office for Budget Responsibility analysis showing the most recent increase in spending on health and social care as around £15bn a year, but notes that:

  “Given the ageing of the population, new treatments, growing demand and the inescapable rise in costs of labour-intensive services, the share of spending on health in national income will continue to rise.”

  Looking at ways of responding to rising costs of health and social care, Wolf dismisses austerity, which in the end “blows up,” and hypothecated tax.

  He also dismisses the claim that an insurance based system is any solution: “quite apart from the upheaval, compulsory insurance is just another tax.”

  He attacks the levy on national insurance payments as “a disgrace” and “unjustifiable,” and the new “cap” on social care costs as massively penalising those with small wealth in favour of those with much more.

  And the conclusion? “The country has still not recognised the long-term need to accept rising taxation in order to deliver the services people will demand. There is no realistic alternative.”

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• New owners seek big profits from Virgin Care
  
  Virgin Care no longer exists: Richard Branson’s company which set out from 2008 to compete for NHS and social care contracts all over the country, especially in primary care, community health care, children’s services, sexual health and urgent care, has been handed over to venture capitalists Twenty20 Capital, and rebranded as HCRG Care Group.

  Virgin Care at one point seemed to be one of the most successful private firms in scooping up contracts after the 2012 Health & Social Care Act, and won £2 billion of contracts in five years from 2013-2018. It even felt bold enough to sue and win £2m in damages from a group of Surrey NHS commissioners who had dared to terminate a contract.

  Virgin Care is Twenty20 Capital’s seventh transaction in 2021, and its fourth acquisition in the health and social services sector. The company’s website boasts that it looks for “significant returns in 2-5 years.”

  Not all of Virgin Care’s contracts will necessarily be transferred to Twenty20. Bath and North East Somerset council and CCG, for example, awarded Virgin a 7-year £54m per year contract for health and care services in 2017 – and controversially agreed last month to extend it for another five years.

  Virgin Care’s local managing director had as a result of this contract even more controversially been listed as a member of the ‘Partnership Board’ running the ‘Integrated Care System’ that will be in charge of the NHS across Bath, North East Somerset, Swindon and Wiltshire from next April.

  But now council leader Kevin Guy has warned that the November deal has not been fully signed off, and might not be: the impending sale of Virgin Care to a firm of venture capitalists was not disclosed to council officers during the negotiations.

  Virgin Care’s boss Dr Vivienne McVey, staying on as chief executive under HCRG, insists only the owner and name of the company have changed, and “everything else remains the same.” But it’s not clear how many commissioners will accept health and care services being taken over by Twenty20 Capital.

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• MPs nod through Bill with few changes -- fight starts in the Lords
  
  Tory MPs have rubber stamped a deeply flawed Health and Care Bill with no opposition amendments passed and minimal changes conceded by ministers, and the focus for opposition to it has shifted to the House of Lords.

  Continuing to fight over the controversial issues is important, both to expose as widely as possible (and warn a wider public and the NHS staff) what new problems are coming down the line, and to make it absolutely clear that each and every negative consequence that flows from the Bill is down to ministers and the Tory MPs that vote it through, and nobody else.

  According to a document leaked to the HSJ, it appears that NHS England is concerned that the tight schedule to launch Integrated Care Boards by April next year, when legislation may not have been finalised until late February or March could force a delayed launch of the new system.

  But even if this happens, at the end of the process a government with a majority of 80 will get the core elements of its Bill through.

  So whatever is passed we will have to find ways to fight on to repair and restore our battered NHS – just as we had to do back in 1991 as John Major’s government first broke the NHS into an “internal market” of purchasers and providers, and in 2012 after Andrew Lansley’s wide-ranging and fundamental Health and Social Care Act was forced through by the Tories, propped up only by the spineless LibDems.

  Entrenched privatisation

  That legislation set out to entrench privatisation and outsourcing, a competitive market system in which local commissioning groups were forced to put an ever-growing range of clinical services out to competitive tender. Lansley’s fundamentalist neoliberal supporters gleefully hailed it as the start of the “denationalisation” of the NHS. Happily they were subsequently disappointed.

  The 2012 Act ended the direct accountability of the Secretary of State for the promotion and provision of health services in England, which was transferred to an ‘arm’s length’ body, NHS England – although in practice Health Secretaries have continued to behave as if they were still in charge.

  The new Bill does end the requirement for some tendering (for clinical services (of which only an estimated 2 percent have been going through with tender processes anyway). But it does not roll back any existing contracts and pulls up well short of abolishing outsourcing and privatisation, or making the NHS the default provider, as proposed by the unions.

  An amendment reinserting regulations to limit the danger of a new round of shameless crony contracts has been rejected.

  New powers

  Numerous controversial proposals would extend and add new powers of the Secretary of State on a wide range of issues, including intervention in local hospital closures and reconfiguration of services.

  The Bill scraps the legal right in the Care Act (suspended last year during the Covid peak) for vulnerable patients to have their needs fully assessed before they are discharged from hospital, posing real dangers of patients being left stranded at home by inadequate social care, community and primary care services.

  Ministers have responded to criticism that the Bill is a ‘corporate takeover bill’ by tabling an amendment to prohibit anyone “involved with the private sector or otherwise” from taking a seat on an Integrated Care Board if this could be “reasonably regarded as undermining the independence of the health service”.

  But the private sector voice remains strong at every level, and an amendment to similarly keep private sector representation out of all ICB decision-making bodies has been rejected, and an amendment to exclude GP employees of private corporations also failed.

  Less accountable

  With just 42 ICBs as “local” bodies, some spanning large areas and populations as large as 3 million, and no explicit requirement to establish more local “place based” structures, England’s NHS will be less locally accountable and less open to scrutiny than it has been since the early 1970s.

  The Bill reorganises the NHS – but it does not fundamentally change the system established in 2012.

  It does not “sell off” the NHS, although many services will still be contracted out, not least where capital investment is required to develop new centres or services. Private hospitals and contractors do not seek to own, but feed off and profit from the NHS.

  The fight goes on, through the Lords – and beyond. There’s still a lot of NHS to defend – and far too much to lose if we don’t.

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• Misconduct in public office -- findings of KONP's People's Covid Inquiry
  
  Tony O’Sullivan,     co-chair KONP

  The report into the handling of the coronavirus pandemic was published on Wednesday 1 December, two years on from the emergence of the novel virus and COVID-19, the deadly disease that has killed over 5.2 million people – 167,000 of them in Britain. Keep Our NHS Public organised the inquiry which has filled the deafening silence from Government.

  The Prime Minister had steadfastly refused to organise an inquiry even when it was obvious to all that a rapid-learning inquiry was needed to save lives and halt the tragic repetition of government mistakes and misjudgements.

  In the absence of a formal public inquiry into the pandemic, The People’s Covid Inquiry began in February 2021 and concluded its hearings in the summer.

  The purpose was in the title: ‘Learn lessons – save lives’. It covered all aspects of the Government’s handling of the pandemic and heard testimony from a wide range of individuals and organisations.

  These included previous government advisors and key academics, as well as frontline workers and bereaved family members. 

  The Inquiry was chaired by world renowned human rights barrister Michael Mansfield QC who, together with a panel of experts, has now delivered their findings and recommendations on all main aspects of the pandemic to date:

  “This Inquiry performed a much-needed and urgent public service when the nation was hit by a catastrophic pandemic coincident with an unprecedented period of democratic deficiency.

  “It afforded an opportunity for the beleaguered citizen to be heard; for the victims to be addressed; for the frontline workers to be recognised; and for independent experts to be respected.

  “When it mattered most and when lives could have been saved, the various postures adopted by government could not sustain scrutiny.”

  
  

  The findings are damning – the recommendations are urgent and potentially life-saving. But the reasons behind why the 6th richest nation in the world, with a proud NHS and public health reputation, has the 27th worst death rate of 190 nations and the worst economic impact of the OECD countries are shocking.

  The joint Health & Social Care and Science & Technology Commons Select Committees’ report in October declared the handling of coronavirus to be the worst public health failure. Our report exposes the failings of the UK response to be the worst political failure. There is a case to answer of gross negligence and misconduct in public office.

  In his damning assessment of the Government’s pandemic handling, Michael Mansfield argued the case for the charge of ‘misconduct in a public office’ by government ministers:

  “This People’s Covid Inquiry report is unequivocal – [there has been a] dismal failure in the face of manifestly obvious risks … It was plain to …[the organisers of the Inquiry] that Government words were bloated hot air, hoping to delay and obfuscate. Within this narrative lies a theme of behaviour amounting to gross negligence by the Government, whether examined singularly or collectively. There were lives lost and lives devastated, which was foreseeable and preventable. From lack of preparation and coherent policy, unconscionable delay, through to preferred and wasteful procurement, to ministers themselves breaking the rules, the misconduct is earth-shattering.”

  Testimony

  The Inquiry heard the sadness and the questions from bereaved families demanding justice.

  It heard the pride of NHS, care and other frontline staff and we heard about their pain, exhaustion and their moral injury.

  The Panel listened to vital expert testimony on failings in public health, on workplace safety, on the impact of inequalities, on the running down of the NHS.

  There was disastrous policy and behaviour in public office at every stage

  Pre-pandemic, 10 years of austerity policy left the NHS exposed and social care in danger of collapse. Pandemic planning exercises, including Exercise Alice in 2016 based on a coronavirus pandemic, gave clear warnings which were ignored – on exactly the dangers exposed: insufficient stocks and qualities of PPE, insufficient hospital beds, ventilators and staff, a lack of capacity and data systems to test, contact trace and isolate, and to regulate borders.

  Delayed response

  Government responses to the pandemic spread, despite the experience of China in December -January and Italy in February-March 2020, were unforgivably delayed. The 2-3 week delay before lockdown in the UK when cases were doubling every 3-4 days caused at least 20-30,000 avoidable deaths. Two further lockdowns were delayed in the face of scientists’ urging action and a tens more thousands of deaths resulted in January-March 2021.

  Running through this whole time from pre-pandemic to initial response and across three lockdowns has been the refusal to accept WHO basic public health policy: ‘test, test, test’; ‘go hard go early’; the essential need for rigorous case finding, testing and tracing, isolation and quarantine with support for those who need it. Never has our Government put this FTTIS system in place.

  The heightened inequalities of the past decade led to brutally discriminate impact on the low-paid, unemployed, women, disabled people (six in every 10 deaths) and on Black, Asian and ethnically diverse communities. People in multi-generational households, more crowded accommodation, working zero-hours and low-paid jobs all were exceptionally at risk.

  We learned to redefine the meaning of ‘key worker’ as frontline staff across sectors went to work unprotected by PPE or any semblance of Health & Safety Executive activity. 1500 health and care workers died. In London alone, dozens of bus drivers died.

  It was unions like the GMB, NEU and ASLEF who were actively protecting their members at work, not Government, not employers. The inquiry heard how employers let down their staff exposing them to avoidable risk.

  Public servants were ignored across the NHS, public health, primary care, care homes, local authorities and schools. Teachers were accused of not caring for children when staff demanded safety in schools. Government redefined and downgraded PPE requirements when supplies were running out, to avoid being accused of breaching employees’ safety, and blamed NHS and care staff for abusing PPE.

  Private contracting was the preferred route to procure supplies and services, from NHS Test and Trace at a cost of £37 billion wasted (run by Serco, Sitel and Deloitte) to setting up private, often unaccredited laboratories, instead of urgently boosting NHS capacity.

   The private hospital sector’s costs were underwritten and no more than 30% of their capacity was used. The level of government cronyism and resultant profiteering has been blatant and in plain sight.

  Breach of public trust

  The Government had no time for a public inquiry but time to rearrange the NHS mid-pandemic, with its dangerous Health and Care Bill. Government treated bereaved families with disrespect and ignored their questions for over a year.

  If and when the Government’s judicial-led public inquiry convenes (no chair or terms of reference at the time of writing), Jo Goodman, Co-Founder of Covid-19 Bereaved Families for Justice (who contributed to the Inquiry) argues:

  “It’s vital that bereaved families are at the heart of the forthcoming inquiry and listened to at every turn, and this report evidences exactly why. The loss of our loved ones should be used to learn lessons and save lives - something the Government should be entirely focused on and dedicated to.”

  Lessons to save lives

  The Inquiry set out to learn the lessons that could save lives in this and future pandemics. The Panel has been shocked at the avoidable loss of tens of thousands of lives through the neglect of pandemic planning, the run-down of the NHS, and the intense inequality in this country and the wider impact this has had.

  All this has left the NHS and Care sectors at existential risk of collapse. Equally shocking has been the breach of all the Nolan Principles of behaviour in public office, including lack of candour, honesty and integrity.

  The overall conclusion of the Inquiry is that there has been misconduct in public office. This has to be addressed: if it is ignored, the country cannot learn the lessons from today to face the challenges of tomorrow.

  If the NHS, Care and support services and inequalities are not addressed the future for the population is bleak. Keep Our NHS Public believes that these findings are an important contribution to what must change and change now.

  The report will be submitted to government and the future public inquiry in the hope that its contents may help inform future policy.

  * Watch the report launch here: https://youtu.be/S56rrfgFWFg

  * Download the report at https://www.peoplescovidinquiry.com/

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• Mental health services face growing crisis
  
  Mental health services remain under increasing strain after the peak of the Covid pandemic: NHS crisis services have seen a 74% increase in referrals post-pandemic. The latest data (Quarter 1 2021/22) shows that crisis lines were managing around 180,000 – 200,000 calls per month.

  NHS England’s latest estimate is that at least 1.4 million people have been accepted for, or are eligible for mental health care but are yet to receive it, with an additional eight million who would benefit from care, if access barriers were reduced.

  Increased acuity of patients attending is causing pressures on the urgent and emergency care pathway and inpatient beds, and adult acute bed occupancy remains above the recommended safe levels of 85%, in a system that is currently operating with reduced bed capacity and that is entering a period of seasonal winter pressures.

  Above the safe levels, surge demand cannot be met, the likelihood of safety incidents increases, as does reliance on Out of Area Placements.

  A&E waits over 12 hours are worsening, and NHS Digital have estimated a 4.5% increase of detentions under the Mental Health Act (1983) between 2019/20 and 2020/21.

  In November the Independent revealed one instance of a mental health patient who had waited 36 hours for a bed in a mental health hospital, having to spend the night on a mattress on the floor in Bolton Hospital for lack of beds.

  The proportion of children and young people (CYP) aged 5-16 years with a probable mental disorder has risen by more than half from 11% in 2017 to 17% in 2021, and CYP mental health services have faced an unprecedented surge in urgent eating disorder cases.

  The HSJ reports national clinical director Professor Tim Kendall telling NHS England that in 2016 teams were seeing only around one in four children with mental health problems: while that measure has now been boosted to around 40 per cent, it was nowhere near good enough.

  “If you said you were only seeing 40 per cent of people with cancer, we’d get lynched, and understandably,” he said. “It just wouldn’t be tolerable.”

  NHS England’s November board meeting heard that “new capital and workforce solutions are required to enable systems to provide care closer to home.”

  One constraint on service expansion is staffing: the latest available data show an increase of more than 18,000 mental health staff since 2016, with an expectation that delivery of HEE’s “Stepping Forward” will be achieved by December 2021.

  However expanding the workforce remains critical to delivering the long term plan and coping with the additional post-pandemic pressures; the LTP alone is estimated to require an additional 27,000 WTE by 2023/24,

  NHS England admits that expansion also requires capital investment to ‘house’ growing community services.

  Meanwhile the Royal College of Psychiatrists’ latest census reveals a shortage, with one in ten posts unfilled and almost a quarter of staff effectively acting as locums without a substantive post, meaning that they cannot offer continuity to patients or feel secure in their own jobs.

  The RCP’s Dean, Professor Subodh Dave told the HSJ current workforce gaps are having a “knock-on effect,” with “inevitable rationing” of patient care to keep services running.

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• 'Extra' £700m was announced in September
  
  “£700 million to support NHS this winter” was the catchy headline of the Department of Health and Social Care Press Release on December 3, picked up and relayed as a lazy good news story by LBC and many local and national newspapers.

  But the money is not new or extra: part way though the press release it states that it is “part of the £5.4bn already announced” … back in September.

  The only new factor is the breakdown of how the money is to be carved up – into a staggering 785 schemes across 187 hospital trusts.

  The six largest schemes add up to £51m, leaving an average of just £800,000 for each of the other schemes, some of which are much smaller than that.

  Handing out such limited sums in the first few days of December seems most unlikely to make any significant difference to capacity or waiting lists this winter, and more aimed at reinforcing the complacent view that “record” funding of the NHS is enough to address the unprecedented crisis it has been plunged into by austerity policies since 2010. 

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• Doubts over recruitment as HEE merged into NHSE
  
  Health Education England, which is the body responsible for recruitment and training of NHS professional staff, is to be ‘merged’ into NHS England by April 2023, according to leaked reports to the HSJ.

  The decision to axe the indepen-dent body follows arguments with the Treasury over funding, and an unsuccessful bid to increase HEE’s £3.96bn annual budget to enable it to increase staff supply.

  While HEE has been far from perfect, once the dedicated body focused on staffing has been scrapped, the battle to get NHS England to prioritise workforce planning will have to be waged internally in a sprawling organisation that is also planning to merge NHSX, NHS Digital and NHS Improvement into one all-embracing bureaucracy.

  There are also fears that an HEE budget for an overseas recruitment campaign could be lost in the process of the merger, further undermining hopes of filling the growing and dangerous gaps in front-line staffing.

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• Deadly toll of A&E delays and overcrowding
  
  A damning report on delays in handing over emergency patients to the care of hospitals published last month by the Association of Ambulance Chief Executives (AACE) has found “unacceptable levels of preventable harm are being caused to patients”.

  Up to 160,000 patients are experiencing harm every year in England as a result of being stuck in the back of ambulances that have rushed them across town to hospitals under blue lights.

  80% of those whose handover took longer than 60 minutes were assessed as potentially suffering some harm, and almost one in 10 of these patients could potentially suffer severe harm, such as a cardiac arrest, loss of a limb or brain damage.

  The post-Covid lockdown situation is more dangerous for patients than the period prior to Covid. Safety incidents reported to NHS England by ambulance trusts have jumped 26 per cent so far in 2021 compared to the whole 12 months of 2019. Deaths as a result of safety incidents in ambulance trusts are up 13 per cent compared to 2019.

  The scale and spread of the problem is underlined by a new report from the Royal College of Emergency Medicine, which warns that nearly two thirds of A&Es across the UK had ambulances waiting to transfer patients every day in the past week.

  The NHS mandates that ambulance handovers ought to be reliably completed within 15 minutes of arrival, but 61% of Emergency Departments in the survey were struggling to meet this standard every day.

  The RCEM survey also found that for lack of adequate numbers of beds for admission of emergency patients over half of Emergency Departments had provided care to patients in non-designated areas such as corridors every day in the previous week.

  The problems are not over when the patient finally gets into the Emergency Department, where a new set of delays and problems of overcrowding again puts them at risk.

  Deaths from crowding

  A separate report by the Royal College of Emergency Medicine, ‘Crowding and its Consequences’, found that at least 4,519 patients have died as a result of dangerous crowding in Emergency Departments in England in 2020-2021.

  The Royal College’s survey also found:

  * 14% of respondents stated that the longest stay they had had in their Emergency Department was between 48 and 72 hours

  * 36% of respondents stated the longest stay in their Emergency Department was 24 to 48 hours

  * 39% of respondents stated the longest stay in their Emergency Department was 12 to 24 hours

  * 50% of respondents stated that Same Day Emergency Care had limited availability, less than 12 hours a day or weekdays only in their Emergency Department

  * 71% of respondents stated that they had been unable to maintain social distancing for patients in their Emergency Department in the past week.

  The RCEM blames the deadly combination of shortages of appropriately trained staff – and the dire shortage of available acute beds for emergency admissions:

  “Across the UK there is a shortfall of 2,000-2,500 WTE Emergency Medicine consultants, and crucially, there are also widespread shortages of Emergency Medicine nurses and both junior and supporting staff.

  “At the same time capacity is severely depleted across the UK.

  “The government must restore bed capacity to pre-pandemic levels, this requires an additional 7,170 beds across the UK.”

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• Dodgy figures wheeled out to attack NHS
  
  Right wing publications are unreliable sources of most information: but Boris Johnson’s old employer The Spectator has gone into overdrive this month, with its editor joining forces with a contributor from the obscurely-funded Institute for Economic Affairs to falsify figures and blame the NHS itself for the crisis created by over a decade of under-funding.

  Kate Andrews’ article picks up on the massive Covid-driven increase in ‘health spending’ in 2019-20 (most of which did not come anywhere near the NHS, and was squandered on private contractors and consultants) to claim that the NHS is awash with cash (“The UK now spends almost 13 per cent of its economic output on healthcare — the highest in Europe”).

  She goes on, apparently unaware of the virtual real terms standstill in health spending as a share of GDP from 2010 to 2019 (see graph) along with a 5 million increase in population, to argue “between 2010 and 2025, the health budget will have increased by 42 per cent — squeezing cash spent elsewhere in government”.

  Andrews claims “The government will soon be pouring almost half of day-to-day public service spending into a system which is falling short of what patients (and tax-payers) deserve.”

  In fact the most recent Red Book on government spending shows the Department of Health and Social Care receiving just a third of the total of Departmental Budgets by 2025 – a lower share than in 2019.

  From this dishonest and deceptive starting point Andrews goes on to ask: “how much respect does the system deserve, given that it is currently preventing the treatment of the sick…?” 

  The article’s opening paragraph, describes a recent “surprisingly frank conversation” in Boris Johnson’s cabinet on the “many shortcomings” of the NHS as argued by Rishi Sunak, Jacob Rees Mogg, Cabinet Secretary Steve Barclay and Business Secretary Kwasi Kwarteng. All apparently agreed it is failing.

  But Andrews does not divulge what alternative system these right wing luminaries would prefer, or spell out any clear alternatives herself. Before discarding the NHS as a model it surely makes sense to look at the cost and disadvantages of any alternatives.

  Instead she suggests a vaguely described shift to a “private and charity sector” system to “work in tandem with the state” to ensure the best outcomes for patients. Clearly Ms Andrews, (an American who is canny enough to distance herself from the ruinously expensive basket case of the US health care system) is arguing for far greater use of market forces and private provision.

  But the examples of ‘failure’ that she quotes are not areas where the private sector has any contribution to offer – or indeed any private insurance or self-pay system could fill in the gaps.

  She attacks poor performance in NHS emergency hospital and ambulance services – which anyone with any sense long ago connected directly to the disastrous decade of frozen real terms funding since 2010.

  But the private sector does not offer emergency hospital care in Britain – and everywhere avoids involvement in it wherever possible.

  She bizarrely blames GPs having limited face to face appointments (a policy imposed upon them by NHS England and by Covid precautions) for patients waiting hours on trolleys in emergency departments – as if all primary care patients need immediate admission to hospital.

  Andrews (and Spectator editor Fraser Nelson, who rallied to her defence on Twitter) seem unaware of the loss of 10,349 front line general and acute beds (almost 10% of capacity) since 2010, or the impact of almost 6,000 Covid patients currently occupying front line beds plus an additional 4,500 beds remaining unoccupied compared with 2019 – a further capacity reduction of over 10% for non Covid-patients.

  Instead they offer partial and inappropriate comparisons with the performance of other systems in which private insurance and private provision play a significant part.

  For example Belgium which spends more than 3.6% more per head on health than the UK and has more than twice as many hospital beds per 1,000 population.

  Germany is mentioned, too, of course, which spends almost 28% more per head on health than the UK, and has more than three times as many beds available as the UK, and six times more acute beds per head than England.

  Andrews goes on to bring in another of her favourites, Switzerland, the highest-spending health care system other than the US, which spends over 35% more than the UK on health, and has almost double the UK provision of beds.

  Sweden, Denmark, Norway Italy and Ireland are also thrown in for good measure: Sweden spends 9.2% more per head than the UK, Denmark 10% more, Norway 28% more and Ireland – whose system is a notorious horror story with extensive private profiteering, spends 6% more: only Italy somehow spends less. And all of these countries except Sweden, which has long had integration of health and social care, also have more beds per head than the UK.

  Andrews’ examples shoot down her own argument: how can the NHS be over-funded, when all her preferred models are more expensive? Why does she never mention user fees and supplementary insurance costs of these systems?

  And why have none of them been ranked as more accessible and equal than the NHS? Because they are quite the opposite.

  The IEA won’t say who funds them, and won’t say what system they really favour: all we know is they really hate the relatively cheap, fair and efficient NHS because it’s not privatised enough.

  And it seems Johnson’s cabinet agree.

  Read more ...
  

Thursday 11th November 2021

HCT News Bulletin #13

• Nuneaton & Warwick IT staff strike to stay 100% NHS
  
  IT staff at Nuneaton’s George Eliot Hospital and South Warwickshire NHS Foundation Trust (SWFT) in Warwick have staged a 2-day strike against plans to transfer them on December 1, against their will and without consultation, to Innovate Healthcare Services, a new private subsidiary company set up by the trusts.

  No concessions

  George Eliot and SWFT share a chief Executive, Glen Burley, who somehow also manages to hold the CEO job at Wye Valley NHS Trust – and is making no concessions as he pushes forward with the project.

  He claims that the new wholly owned subsidiary would provide “protection from external providers” and somehow “keep staff within the NHS family.”

  However even a Warwick Tory councillor has warned that SWFT is being unfair to those staff who have ‘proudly and loyally’ worked for the health service for years, and this could lead to ‘privatisation of part of the NHS by the backdoor’.

  Mr Burley also claims that “Throughout all stages of this process we have worked closely with Union representatives to address their concerns and we are having on-going conversations regarding arrangements with them post transfer.”

  UNISON regional organiser Mike Wilson insists that the only offer to negotiate has been on the TUPE transfer of staff out of the NHS, not on the issue of whether or not the company should be set up.

  “Like many of their colleagues in healthcare, these staff actively chose to work for the NHS to serve the public. And they’ve done so through the toughest of times during the past few months of the pandemic.

  Private contractor

  “Now their employers have turned round to say they don’t want them and are forcing them to become a kind of private contractor.”

  One staff member told the Coventry Telegraph: “We started work in the NHS, and want to continue this. People are just so disappointed, we are not being listened to. We do not want to work for this private company - we want to stay in the NHS, we are proud to be in the NHS.”

  Further action is planned on November 23 and 24.

• Macmillan call for £170m plan to train more cancer nurses
  
  Cancer treatment is not keeping pace with demand, let alone catching up with the pent-up demand from the prolonged Covid-19 lockdown, warns Macmillan Cancer support.

  More than 55,000 people had to wait for more than four weeks to find out whether or not they had cancer from their initial urgent referral, according to the latest NHS England figures, and August 2021 saw another new record-high number of people who had waited for more than two months before they started cancer treatment following an urgent referral from their GP — more than 4,000 people.

  Figures published by NHS England, and analysed by Macmillan for the Guardian, show the number of patients starting treatment in August following a decision to treat fell from above 27,000 in June and July to 25,800.

  The proportion of patients who began treatment within one month of the decision to treat fell to 93.7% – the lowest percentage ever recorded.

  Urgent cancer referrals were made by GPs in England also fell back in August, although the figure was still higher than the equivalent figure for August 2019 before the pandemic.

  Macmillan analysis estimates the NHS in England would need to work at 110% capacity for 17 months to catch up on missing cancer diagnoses xi, and for 13 months to clear the cancer treatment backlog.

  To make matters worse Macmillan’s research has found that more than one in five diagnosed with cancer in the UK was unable to get support from a specialist cancer nurse during their diagnosis or treatment and would have liked to, or said the support they received was not enough.

  Macmillan is calling for Governments across the UK to invest a total of around £170 million to fund the training costs of creating nearly 4,000 additional cancer nurses required by 2030 to provide the care people need.

  If the number of specialist cancer nurses stays at current levels, Macmillan estimates the gap in the number of specialist cancer nurses in each nation by 2030 will be 3,371 in England, 166 in Wales, 100 in Northern Ireland and 348 in Scotland.

• Kent fights on for stroke services
  
  Health campaigners in Kent have declared they will fight “tooth and nail” the government decision to endorse a reconfiguration which will mean halving the number of stroke units in Kent – and lengthening journey times and delays in treatment.

  Campaign group Save Our NHS In Kent (SONIK), which has been campaigning for years to save stroke units in east Kent called an emergency protest outside Margate’s QEQM hospital on November 6 (above).

  60-minute journeys

  The three remaining specialist stroke centres will be in Dartford, Maidstone and Ashford – with units at Margate, Medway and Canterbury closing, leaving much of East Kent with 60 minute journeys to a Hyper Acute Stroke Unit (HASU) – assuming the ambulance services can deliver.

  Large areas would face 45 minute journeys to a HASU: but when stroke services were centralised in London it was specified that all patients had to be within 30 minutes of a HASU.

  Ambulance response times in Kent and elsewhere have worsened dramatically since the initial plan for the service redesign was submitted for ministerial approval over two years ago.

  A spokesperson for SONIK said: “Everyone knows that surviving a stroke is critically dependent on how close you are to an emergency unit. The halving of our stroke units in Kent from six to just three is going to put people’s lives at risk. We have fought this appalling decision every step of the way and we will not give up now. We will fight it tooth and nail.”

  “We’ve had judicial reviews, petitions, debates. We’ve presented local NHS bosses with overwhelming evidence of the lethal dangers of this move. Our only recourse now is protest.”

  Read more ...
  

• 'Jab or no job' threat piles on the agony for social care
  
  Things were bad enough in social care before Sajid Javid chose to ignore the advice of trade unions and employers, and confront tens of thousands of care staff with a ‘jab or no job’ ultimatum.

  As this Bulletin is completed the deadline for staff to be fully vaccinated has now passed, and latest reports suggest over 3% of staff – for whatever reason – have opted to leave the low-paid jobs rather than accept the vaccine.

  This comes on top of the rapid increase of vacancy rates in social care from 6% of the staff to 10%: it will mean even more care homes closing their doors to new admissions and home care services unable to deliver support to frail and vulnerable people – more of whom will wind up in hospital.

  Stuck in hospital

  Last month Age UK warned of the growing numbers of older people getting stuck in hospital when they are fit to be discharged, because there is not enough care to support them at home.

  Of course the crisis is not merely one of staffing: the chronic low pay that makes it so hard to recruit or retain staff is itself linked to the largely privatised provision of social care, and the system in which the poorest patients rely on funding from local government budgets that have been relentlessly slashed back year after year since 2010.

  This in turn has held down the benchmark fees paid to care homes and home care companies that sprang up in place of the previous council-run home help services.

  The Homecare Association has found that many councils are not paying homecare companies a high enough hourly rate to cover basic costs like travel time between clients.

  The average paid by councils in Great Britain and health boards in Northern Ireland is just £18.45 per hour, while the Association calculates the true minimum cost of providing an hour of homecare in the UK is £21.43.

  Care by the minute

  To make matters worse, and underline the way in which any notion of quality of care has been discarded in the pursuit of cheapness, some local authorities still buying homecare by the minute.

  This in turn leads homecare employers to resort to zero hours contracts, and the notorious failure to pay staff for travel time between clients.

  The Association, which represents 2,340 companies, wants central government to “invest properly” in homecare, and raise pay to £11.20 per hour. This would cost £1.6bn a year across the UK.

  They also call for a ban on purchasing homecare by the minute, a professional register for care workers and for social care workers to be added to the Shortage Occupation List to make it easier to hire from overseas.

  But without the funds to pay up, and still no sign of the promised government “reform” of the dysfunctional social care system it seems things can only get worse in the months ahead for those trapped in it, or working for it.

  Read more ...
  

• Health and Care Bill - ministers block all opposition amendments - Justin Madders MP
  
  By Justin Madders, MP for Ellesmere Port and Neston, leading for Labour on the Bill Committee

  A pandemic, a burnt out workforce, record waiting times - pressure in every part of the system. The NHS is stretched to its absolute limit and beyond, yet against this background the Government have put forward the Health and Care Bill which represents yet another reorganisation of the NHS that fails to tackle the underlying causes of the challenges both health and social care face.

  In simple terms, the Bill removes competitive tendering for clinical services (but not all NHS funded services); it replaces Clinical Commissioning Groups with bigger ICBs (which are expected to delegate to ‘place-based’ units of some sort); it replaces market structures with heavy top down management by a much enhanced NHS England. The big winners as always are the large acute trusts.

  No end to privatisation

  The Bill may end the waste and cost of pointless tendering introduced under Andrew Lansley, but it does not end privatisation even of clinical services. 

  The claims about the Bill favouring integration of services are largely rhetorical and clearly even the Government don’t believe they will be delivered as they have already begun to trail another White paper on integration.

  Most worrying was the inadequate response to the issue of workforce planning. The provision was universally criticised – but has still so far remained.

  During consideration in the Commons Public Bill Committee, numerous amendments were proposed but none were carried. 

  Tory MPs voted down our efforts to ensure representation on NHS decision-making boards for mental health, social care, public health, staff and patients, and safeguard near-patient services from further outsourcing.

  They also blocked our attempts to remove controversial powers for the Secretary of State to intervene in local service reconfigurations from the Bill.

  Promises of discussions

  Instead, there were many assurances and promises of further discussions and thought. 

  Some Government amendments are expected before the Bill goes to the next stage and concerns remain, especially about the possibility for private sector interests to influence commissioning of NHS funded services by having a role on ICBs, and for contracts with the private sector to be agreed without any proper oversight. 

  The new organisations are weak on clinical leadership and on staff, public and patient involvement. Who decides what is no clearer.

  There is also the focus on acute care and the big Trusts – potentially leaving primary care, mental health, community care, social care, public health outside the key decision-making bodies.

  The argument often advanced for rejecting Labour amendments that may have dealt with some of the concerns was that local systems should have ‘flexibility’ to shape services, but this argument was totally undermined by the provisions in the Bill giving many further powers for the Secretary of State and for top down intervention.

  The Bill is about reorganising the NHS, not about improving care or the integration of care – and not about improving wellbeing or tackling unacceptable inequalities. It is a huge missed opportunity.

  The structures in the Bill which are already largely in place may not last long, do not do enough to fix the mess made by the Tories’ previous reorganisation, and are frankly a distraction at a time when the NHS is facing the biggest crisis it has had in its proud history.

  Staff and patients deserve better than this.

  Read more ...
  

• Health and Care Bill fight will go on in the Lords
  
  Labour MPs on the Committee tabled a total of 161 amendments to the Bill, 14 from Margaret Greenwood MP and 147 from Justin Madders: but none were carried.

   Health Minister Edward Argar tabled 14 amendments, the most significant of which reinstated deleted wording from the 2006 Act specifying that NHS services must include secondary care and ophthalmic services.

  However Argar’s promised amendment to exclude private health companies from gaining seats on ICBs has still not been tabled.

  Nor has any explicit guarantee of local access to emergency care, as it appears in the current legislation, been reinserted into the Bill, leaving questions over the access and entitlement to emergency care especially for refugees and migrant workers.

  Opposition parties in the Lords, where there is greater scope for votes to be won, will continue to fight for amendments on key issues including the lack of any local accountability, and seeking to define the NHS itself as the default provider both of clinical and of non-clinical services like cleaning, catering and porters.

  There are also likely to be proposals to require a business case to justify any contract in excess of a certain amount being outsourced to a private contractor, and imposing strict conditions.

  As it stands, the Bill has most of its many initial deep flaws, and more organisations are drawing the conclusion that the limited repeal of the 2012 Lansley Act is not enough to justify anything but opposition at 3rd reading.

• 'Extra' spending still leaves NHS poorer
  
  John Lister (abridged from The Lowdown November 1)

  NHS Providers Chief Executive Chris Hopson calculated back in 2019 that if NHS spending since David Cameron first took office had just kept pace with the previous long term average annual increase, spending on health and social care would by then have been £35 billion per year higher than it was.

  Since then it’s fallen further behind, while Tory spin-doctors have successfully fed much of a poorly-informed mainstream news media with the illusion that the NHS has been lavishly funded under Johnson.

  In September came the £36 bn 3-year package of National Insurance tax increases on the lowest-paid workers, allegedly to spend more on the ‘NHS and social care’.

  In fact less than half of the £36bn, just £15.6bn over three years, is earmarked for NHS England. £6bn goes to devolved governments (Wales, Scotland and Northern Ireland), £9bn is simply to be handed to the Department of Health & Social Care – and £5.4bn, again over 3 years, is reserved for social care – too little, too late, and with no reforms of a crisis-ridden largely privatised system.

  Figures in the Treasury’s Red Book show that the new money brings NHS England’s an average increase in funding of just 3.1% per year from 2019-2025 – not enough even to keep pace with cost and demographic pressures.

  The growing gap between resources and demand for health care had already increased England’s NHS waiting list to more than 4 million before the Covid pandemic. It’s now edging up towards 6 million, with over 200,000 waiting over a year – and growing numbers waiting over two years.

  The combination of beds (and staff) tied up treating Covid patients with the reduction in bed numbers to ensure social distancing has cut NHS non-Covid acute capacity by around 15% since 2019.

  NHS England has looked to spend up to £10bn over 3 years on treating NHS patients in private hospital beds – a short-sighted measure that will leave huge unresolved problems and the NHS chronically dependent on private providers.

  No capital

  NHS capital allocations have also been squeezed to unrealistic low levels for a full decade. So there is no capital for trusts to invest in re-planning the use of their hospitals to restore capacity or invest in new and improved diagnostics or other services – let alone provide the extra resources needs for mental health, community services or primary care.

  Trusts can’t even keep up with routine maintenance and the replacement of clapped-out equipment. The backlog maintenance bill has rocketed to £9 billion from an already unmanageable £6bn in 2017/18.

  Despite all this, the Red Book declares that with the minimal increases just announced, the government expects the NHS to deliver a 30% increase in elective treatment by 2024-25. It also lists how the same money is supposed to be spent:

  * £4.2 billion by 2025 “to make progress on building 40 new hospitals by 2030 … and to upgrade more than 70 hospitals”. Everybody knows £4.2bn is nowhere near enough. In fact all of the prioritised new hospital projects are at a standstill, with new limits on spending causing chaos.

  Meanwhile 1970s-built hospitals across the country using concrete planks are increasingly unsafe for patients and staff – and need replacing.

  * £2.3bn by 2025 to “transform diagnostic services, with at least 100 community diagnostic centres …”. However the first such ‘community’ diagnostics centre, recently opened in Somerset, turns out to be yet another project reliant on the private sector. It is being run by Rutherford Diagnostics Limited, in partnership with Somerset NHS Foundation Trust. It’s likely most if not all of the new centres will also rely on private companies.

  * £2.1bn by 2025 for “innovative use of digital technology” – more expensive, chaotic whizz-kiddery, unproven apps and systems.

  * £1.5bn (just over £3m per year per acute trust) by 2025 for “new surgical hubs, increased bed capacity and equipment.” Where will the staff be found?

  * Just £450m by 2025 for projects in England’s 54 mental health trusts – again a pathetically inadequate amount to pay for the changes proposed.

  The key issue for which no real changes are in hand, is the dire workforce shortage.

  The Red Book declares that the Spending Review settlement “will keep building a bigger, better trained NHS workforce,” and reaffirms “the government’s existing commitments for 50,000 more nurses”.

  No funding

  The facts are very different. No funding has been allocated to pay the £1.5bn per year minimum cost of an additional 50,000 staff. The 50,000 target included an ambitious number of overseas recruits – and retention of 19,000 existing staff – while anecdotal evidence suggests demoralised and burned-out staff are leaving and overseas recruitment has stalled.

  The most recent workforce statistics (July 2021) show nurse numbers up overall by 11% since July 2010, and midwife numbers by 13%, but health visitor numbers down by 19%.

  Mental health nurse numbers are down by 2,350 (5.6%), despite the promise by Theresa May’s government in 2017 that 21,000 new posts would enable mental health trusts to treat an extra million patients a year.

  The most recent figures, to June 2021, show 94,000 (7.2%) unfilled posts in England’s NHS of which almost 39,000 are nursing posts, with vacancy rates ranging from 8.4% (South West) to 12.5% in London. Almost 10,000 medical posts are vacant.  

  Read more ...
  

• Crisis point
  
  It’s not normal for a senior hospital chief executive to phone Health Service Journal Editor Alastair McLellan on a Sunday lunchtime to speak out on the massive stress the NHS is under, warn his trust, and probably all trusts, are providing inadequate care – and confess he doesn’t know where to turn.

  It’s most unusual for a chief executive to speak frankly to staff about fears that their trust is facing such pressure that its giant teaching hospital is “ceasing to function as a hospital.” The leaked warnings came from an internal meeting at Cambridge University Hospitals Foundation Trust.

  Both happened within days of each other. Now an NHS Confederation survey has found almost 90% of trust bosses believe the pressures on their organisation have become ‘unsustainable,’ putting patient safety at risk, and the NHS is at a “tipping point,” – directly refuting Health Secretary Sajid Javid’s complacent claims last month.

  This is the utterly unprecedented crisis that almost 12 years of Tory austerity, exacerbated by Covid-19, has brought upon the NHS, while ministers are living in denial.

  The figures tell the stark truth:

  * Almost 6 million people waiting for treatment, 292,000 of them for over a year;

  * Ambulances queuing for hours to hand over emergency patients;

  * A&E and GP services facing record levels of demand for treatment;

  * Mental health services short of beds and staff -- leaving 1.5 million without the care they need;

  * NHS beds are filled with patients who cannot be discharged for lack of social care support outside hospital;

  * Over a million people are not getting the care and support they need: social care faces a “tsunami of unmet need” according to the CQC;

  * Care staff vacancies up from 6% to 10% in a few months, – with potentially tens of thousands more about to lose their jobs because they won’t get vaccinated.

  The situation in the NHS was bad and worsening before Covid.

  But during 2020 hospitals lost around 15% of vital front-line capacity, and Covid-19 is still causing chaos, with 7,000+ Covid patients in English hospitals (Nov 5), and thousands more beds still left closed or empty.

  Capacity is further reduced by chronic staff shortages, with over 94,000 vacancies, 77,000 sickness absences at the last count and NO serious workforce strategy.

  Too many NHS hospitals are literally falling down, or struggling on with clapped out kit and dilapidated buildings – with the backlog maintenance bill now £9.2 billion – and no money to invest in reopening closed or unused beds.

  The danger is that delays, failures and gaps in care will mean growing numbers of patients and the wider public lose confidence in the NHS.

  As long waits increase, more patients in pain who can afford it will opt to ‘self-pay,’ while others consider taking out health insurance to cover elective care.

  This threatens to leave the large majority who can’t afford to do this, and all those needing emergency care or more complex treatment queueing to use an increasingly run-down service.

  Ministers want you to believe that they have given generous funding increases: they were lying before the spending review – and they are still lying now.

  There is no funding to pay for the promised 50,000 additional nurses that we all knew would never be recruited. There is no funding for any big pay increase next year. There’s nowhere near enough money to pay for 40 new hospitals. It’s all lies and distortions.

  Twelve years brutal austerity policies require BIG spending now to repair and restore the NHS.

  The NHS can’t live off empty rhetoric about “record spending” and empty promises of “40 new hospitals by 2030” … any more than health workers could live off the applause they received in place of a pay increase.

  Campaigners urgently need to focus on the bigger picture here: the NHS itself is under threat, and while money alone is not enough, none of the problems can be solved without more cash and capital in the pot to rebuild, repair and reopen our NHS, and recruit, train and retain the staff we need.

  The spending review settlement was not enough: with the government weakened by the corruption scandals, we need a concerted campaign to force a political crisis – and emergency measures to allow sufficient bank and agency staff to keep services open and patients safe, wards to be re-planned to maximise capacity, and give hope to embattled NHS staff that there can be light at the end of a very long tunnel.

• Covid - 'One of the worst ever public health failures
  
  John Puntis, co-chair Keep Our NHS Public

  The response of the Westminster government to the management of the coronavirus pandemic in England has been characterised by inertia, lack of trust in the public, outrageous cronyism and an unwillingness to learn lessons.

  Even now, none of this has changed. The consequences include 139,000 deaths (8.6 million cases), massively increased waiting lists for National Health Service (NHS) treatment, general practice (primary medical care) in crisis, huge numbers of staff vacancies and a burnt out workforce.

  With numbers of infections (particularly among the young) now rocketing, escalating hospital admissions and deaths, there is still a reluctance to implement basic mitigating interventions such as mask wearing and improved ventilation in schools and workplaces.

  The initial rapid roll out of vaccine has now stalled, yet vaccination is still being promoted as the only intervention that is effective, and the only plan there appears to be is waiting for ‘herd immunity’ through a combination of vaccination and natural infection.

  Damning report

  The management of the pandemic has been explored by parliamentary representatives in a report published on 12th October from the House of Commons Health and Social Care, and Science and Technology Committees. 

  The outstanding take home message from this report is summed up in the statement that this was “one of the UK’s worst ever public health failures”.

  Politicians escape blame

  But the discussion is framed in a way that avoids attributing blame to politicians for the effects of their policies or the state of the NHS at the start, and in this sense the report must be considered a whitewash.

  Scathing criticisms are made, however: the initial response was delayed, care homes were abandoned, the ‘world beating’ test and trace system had marginal impact.

  The report describes how comparisons with flu and a fatalistic view of the inevitable spread of infection impeded reaction to the pandemic.

   While clearly condemnatory of the delay in the first lockdown for reasons including lack of testing capacity and doubts about public compliance, ‘groupthink’ and ‘British exceptionalism’ are given the blame.

  Bereaved families excluded

  The report is also notable for the absence of the voices of those who lost loved ones to Covid. A representative of the Covid-19 Bereaved Families for Justice group commented:

  “The report … is laughable and more interested in political arguments about whether you can bring laptops to Cobra meetings than it is in the experiences of those who tragically lost parents, partners or children to Covid-19. This is an attempt to ignore and gaslight bereaved families, who will see it as a slap in the face”.

  Astonishingly, Former Secretary of State for Health Jeremy Hunt claimed to know nothing of Exercise Alice, a pandemic modelling exercise only recently made public.

  Senior health officials who war-gamed the impact of a coronavirus hitting the UK, warned four years before the onset of Covid-19 of the need for stockpiles of Personal Protective Equipment, a computerised contact tracing system and screening for foreign travellers.

  From the one pandemic exercise Hunt does admit to knowing about (Exercise Cygnus), recommendations arising were not implemented.

  Few lessons learned

  Although the title of the Commons report was ‘Coronavirus: lessons learned to date’, very few lessons appear to have been learned.

  Infection rates in the UK are more than 18 times those in Spain and more than nine those in France. The government’s Scientific Advisory Group on Emergencies has warned of the need for a possible winter lockdown if measures are not taken now to tackle rising infections.

  The present pandemic management policy in Westminster is indifferent to the loss of life, the long term complications of Covid in survivors and the impact on NHS staff and other frontline workers.

  This raises the question as to whether this amounts to democide (“the killing of members of a country’s civilian population, as a result of its government’s policy, including by direct action, indifference, and neglect”), “social murder”, gross negligence manslaughter, or misconduct in a public office? 

  Read more ...
  

• Bring Barts services back in house
  
  As multinational outsourcing firm Serco announced a premature end to its 10-year £600m contract for support services covering the five hospital sites run by Barts Health, Unite has called on the Trust to bring these workers back in-house into NHS employment, demanding that there must be “no more contracts for outsourcing privateers that put profit before people.”

  Serco’s ‘Soft Services’ contract with Barts Health NHS Trust, signed in 2016, is now due to end on 30 April 2023. It was controversial at the time and more recently in April this year Unite balloted catering staff for strike action at the trust’s Royal London Hospital in Whitechapel in a dispute over bullying and the imposition of ‘chaotic’ new rotas.

  Now they are preparing for an industrial action ballot over pay: the mainly Black, Asian and ethnic minority (BAEM) staff, which include cleaners and porters, are paid up to 15 per cent less than directly employed NHS staff.

  The workers are now rightly demanding a significant pay increase.

  Serco Group PLC had a turnover of £3.9 billion last year but is offering staff just 1per cent. Unite has branded the offer an “insult” to the workers who risked their lives at the height of the pandemic and continue to put themselves at risk. 

  Staff are also fighting back against the draconian use of the company’s sickness and disciplinary policies, bullying by management and unmanageable workloads.

  Unite is balloting ancillary staff including cleaners and porters across Royal London Hospital, Whipps Cross and St Barts. The ballot opened on Monday 8 November and closes on December 8.

Tuesday 12th October 2021

Keep Our NHS Public

• Commons Covid Report is damning, but a wasted opportunity to learn urgent lessons
  
  The House of Commons Health and Social Care, and Science and Technology Committees joint report Coronavirus: lessons learned to date was published 12 October. Despite outlining some mistakes in the Government’s early response, which will surprise next to no one, the report and the spin on it rests most of the blame on public health bodies rather than the Government, and of course Prime Minister Boris Johnson gets off almost scot-free. 

  While recognising failure on the ‘serious mistake’ of halting mass testing in March 2020 for example, on the fatal error of delaying the first lockdown, the report makes evasions and excuses:

  ‘This slow and gradualist approach was not inadvertent, nor did it reflect bureaucratic delay or disagreement between ministers and their advisers. It was a deliberate policy – proposed by official scientific advisers and adopted by the governments of all of the nations of the UK.’

  Despite being critical of aspects of the Government’s response the report is nonetheless a whitewash covering up the worst political failures of this Government. The two chairs are Conservative MP Jeremy Hunt, who served as Health Secretary from 2012 to 2018, and Conservative MP Greg Clark. As the reports’ co-lead Jeremy Hunt is predictably providing cover for his own role in the years leading up to the pandemic. As Secretary of State for Health, Hunt sank the NHS into a crisis which left it and the population totally exposed when the pandemic arrived – leaving the problems of insufficient staff (100,000 hospital vacancies and a shortage of over 7000 GPs), a lack of hospital beds and equipment, insufficient ventilators, crumbling NHS estate, depleted public health and low morale. He also failed to act on the pandemic planning Exercise Cygnus 2016 and claims not to have even been aware of the Exercise Alice, also in 2016, into coronavirus pandemic planning. All explained away neatly:

  ‘The NHS responded quickly and strongly to the demands of the pandemic, but compared to other health systems it “runs hot”—with little spare capacity built in to cope with sudden and unexpected surges of demand such as in a pandemic.‘ [para 63]

  Being the sugar-coated whitewash of the Government’s historic handling of the NHS it is, this report is a wasted opportunity to learn the essential lessons and save lives. But that’s not the intention here, this is little more than a political manoeuvre by those desperate to cover their tracks. The political failures responsible for 10s of 1000s of avoidable deaths are buried.

  Undeniable failures

  The report only acknowledges what is already undeniable: this has been ‘one of the UK’s worst ever public health failures. It provides partial explanations: ‘Groupthink’ amongst government advisors and ministers, attitudes of ‘British exceptionalism’, a deliberately ‘slow and gradualist’ approach, based on totally inappropriate use of ‘herd immunity’ theory. Fatal inaction and delays meant that the UK fared ‘significantly worse’ than other countries. The report points to ‘major deficiencies in the machinery of government’, with public bodies unable to share vital information and scientific advice impaired by a lack of transparency, input from international experts and meaningful challenge. (Guardian 12 October 2021)

  Hiding political failures behind science and medical successes

  Hunt and the report bend over backwards to say that the problems caused by ‘groupthink’ were balanced by the success of the vaccine and the medical advances developed in Britain. By doing so he provides cover for the political failures of both Johnson’s government and his own tenure as Secretary of State before the hapless Matt Hancock took over in 2018.

  On the Today programme Hunt talks of how ‘groupthink’ assumed that the pandemic was like a flu virus, and makes it almost understandable and forgivable. With this virtual absolution to Government, he conveniently absolves himself too in his previous role as Health Secretary. And he has insulted bereaved families by describing the pandemic as a ‘game of two halves.’

  Ignoring bereaved families’ experience

  Hannah Brady, of the Covid-19 Bereaved Families for Justice group, is completely right to criticise the report. It provides a whitewash for the Government’s culpability. The responsibility for the horrific reality of the deaths of 150,000 people is “redeemed” by the success of the vaccine programme and the medical treatments developed in the UK. As she says: 

  ‘The report … is laughable and more interested in political arguments about whether you can bring laptops to Cobra meetings than it is in the experiences of those who tragically lost parents, partners or children to Covid-19. This is an attempt to ignore and gaslight bereaved families, who will see it as a slap in the face.’

  Lessons still to be learned

  Our People’s Covid Inquiry took the opposite approach and heard testimony from bereaved families, frontline staff and expert scientists and clinicians. By so doing, our inquiry addressed the catastrophic death rate and the disastrous effect on the BAME population, zero hours workers, frontline staff, on children’s education and mental health, and the economy – and the catastrophic policies that had left the NHS, public health, and social care so vulnerable to failure.

  It is unforgivable that the government pursued the herd immunity argument to protect the economy. The Government must be held to account for the combined outcome: one of the worst levels of avoidable deaths, the worst economic impact of the OECD countries, and one of the worst examples of profit-taking as Government cronies and political contacts and hundreds of private companies benefited from the country’s worst public health disaster. 

  On 7^th of July this year, our People’s Covid Inquiry released what we called our ‘Manifestly obvious and requiring urgent action’. In it we outlined 7 urgent recommendations: 

  Recommendation 1

  That established public health measures, supported by the World Health Organisation, and known to be effective in lowering everyday risks, be urgently implemented in the UK, including: 

  (a) effective find, test, tract, isolate services with economic support for isolation and quarantine. 

  (b) based in local public health and local authorities in liaison with an effective national public health system 

  (c) with effective protection against aerosol transmission by the wearing of masks and sensible social distancing in enclosed indoor spaces 

  (d) employment of strict border measures for infection-control purposes

  Recommendation 2

  That medium to long-term health policy addresses social inequality, including overcrowding, poor quality housing, food insecurity, investing in recovery that tackles the root causes of health inequalities including: 

  (a) integrating health considerations into future housing and urban development with healthy housing and equitable access to public spaces for safe physical activity for travel or leisure to build future resilience 

  (b) providing and regulating guidelines to ensure adequate ventilation in enclosed spaces, notably workspaces and schools

  Recommendation 3

  That the UK fulfils its international obligations to prevent the spread of disease by ensuring global distribution of vaccines and support for technology transfer and IP waiver, and by the termination of vaccine nationalism.

  Recommendation 4

  The pandemic provides both rationale and opportunity to invest in the NHS and a public sector health and care service that could once again be the envy of the world; the UK did this in 1948 and can lead the world again now. This investment includes not only hospital beds, but the workforce, primary care, diagnostic labs, social care, and public health). We do not dismiss the private sector, but to promote it in favour of the public sector does the nation a huge disservice and weakens us for the future.

  Recommendation 5

  That it is possible, and urgent, to restore and grow NHS capacity and NHS staff morale with a statement of commitment to public services, backed up by urgent real terms restoration of level of funding to expand the NHS workforce and reinvigorate the publicly provided NHS and its workforce.

  Recommendation 6

  That the previously universally admired performance of the NHS can be restored if the Government ends its policy of bypassing and undermining public services in favour of contracts to the private sector on procurement and to provide clinical services for NHS patients in place of NHS provision.

  Recommendation 7

  An independent public Judicial Inquiry is needed now. 

  The joint House of Commons Health and Social Care, and Science and Technology Committees report still falls staggeringly short of these manifestly obvious recommendations.

  The People’s Covid Inquiry report will be published soon. Meanwhile all our evidence is available here

  Read more ...
  

Monday 11th October 2021

HCT News Bulletin #12

• Safety crisis in maternity services
  
  Queens Hospital in Romford and Walsall’s Manor Hospital have become the latest in a growing list of maternity units to be sharply criticised by the Care Quality Commission over safety issues, often linked with bullying and poor management culture.

  In August the Healthcare Safety Investigation Branch reported that its investigators had started 760 investigations in the year to March 2021 involving incidents at 125 NHS trusts and made more than 1,500 safety recommendations.

  The CQC has previously warned that more than four in ten maternity units in England need to improve their safety.

  Last December the Ockenden report on long-standing failures in maternity care in Shropshire highlighted seven immediate and essential actions:

  * Enhanced safety – increasing partnerships between Trusts and local networks

  * Listening to women and their families

  * Staff training and working together

  * Robust pathways for managing complex pregnancies ensuring an agreed criteria for cases to be discussed/referred to a maternal medicine specialist centre

  * Risk assessment through pregnancy at each contact with services

  * Monitoring foetal wellbeing – Maternity services must appoint a dedicated Lead Midwife and Lead Obstetrician both with expertise to practice best foetal monitoring

  * Trusts must ensure women have easy access to accurate information to enable informed choice.

  The mounting crisis has come as the government is facing mounting calls to invest more money in maternity services. NHS England has increased spending this year by £95m.

  Half of this money (£46.7 million) will go towards creating around 1,000 midwifery posts, £5 million to support recruitment from overseas, £26.5 million towards multidisciplinary training for existing and £10.6 million will go towards increasing the obstetric workforce.

  Royal College of Midwives chief executive Gill Walton welcomed the extra funding while underlining the scale of the problem:

  “This is a substantial investment and something the RCM has been campaigning on for many years. It will be a significant boost for our under-resourced and under-staffed maternity services.

  “It acknowledges that they simply could not have continued ensuring safe, high quality care with the pressures and demands they are facing. Most importantly, it will lead to safer and better care for women, babies, and their families.” 

  Read more ...
  

• Millions missing out on mental health services
  
  Up to 1.5 million people may be waiting for mental health treatment but are yet to receive it as a result of the impact of coronavirus, according to new NHS England Planning Guidance.

  Meanwhile shocking new survey figures from NHS Digital also show there has been a significant deterioration in mental health for children and young people since 2017, with one in six (17.4%) of children aged 6-16 suffering from a mental health disorder in 2021, up from one in nine (11.6%) in 2017.

  17.4% of 17-19-year olds also reported mental health problems in 2021, up from one in ten in 2017. Almost 40% of 6-16s had suffered a drop in their mental health since 2017, compared with 53% of 17 year-olds.

  The proportion of 6-16-year old children with eating disorders almost doubled from 6-13%, while the proportion of 17-19 year olds rose by a third from almost 45% to over 58%.

  Meanwhile a parliamentary question from Labour’s shadow health secretary, Jonathan Ashworth, has extracted figures from the Department of Health and Social Care on the continued level of out of area placements of mental health patients.

  They reveal 7,040 out of area placements (OAPs) in England between April 2020 and this April, with 645 last October – and 695 people in April 2021. 175 of these placements involved patients being sent between 62-125 miles from their home area, 135 involved distances between 125-184 miles and in 45 cases the person ended up 184 miles or more away.

  The OAPs are a reflection of inadequate provision of NHS beds after more than a decade of decline. Just 18,303 mental health beds were available in England in April-June 2021, a reduction of 5,200 (22%) since 2010, while occupancy rates increased sharply from 82% at the beginning of this year to 87% in April-June, close to pre-Covid levels.

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• Javid goes the full Thatcher - threatens to sack NHS bosses
  
  Egged on by the customary extreme prejudices of his audience at the Tory conference in Manchester, Health Secretary Sajid Javid has revived the malignant spirit of Margaret Thatcher, whose picture adorns his office wall.

  At a fringe meeting, after eleven brutal years of real terms cuts in NHS spending, he insisted that governments must stop “throwing cash” at the NHS, and that “there have to be . . . some significant reforms that make that money go a lot further.”

  He followed up by a conference speech echoing Thatcher’s infamous statement that “there is no such thing as society” – arguing that people need to take responsibility for caring for their elderly relatives and “stop looking to the state to provide”. People need to ask “what I can do to help my own family?” before calling on government provision

  And having called in a retired General to conduct a “review” of NHS management, the Times reports he is also preparing new powers to sack managers and seize control of poorly performing hospitals.

  In yet another reincarnation of failed Thatcherite policies from the 1980s he also plans to invite “business people and other outsiders” to run hospitals.

  Read more ...
  

• Health and Care Bill the issues summed up
  
  New legislation to reform the NHS for the second time in a decade is being pushed through Parliament.

  Opposition parties, unions, campaigners and think tanks and some Conservatives continue to express concerns at the Health and Care Bill and its consequences, noting that it will divert NHS management time and energy, and says nothing about the crisis in staffing or the dire state of social care.

  The Bill would give 138 new powers to the Secretary of State, including controversial powers to intervene in local reconfiguration plans, and in the regulation of health professionals – which many fear could result in deregulation and a dilution of the skill mix in the NHS workforce.

  Trade unions have welcomed the Bill’s proposals to repeal the controversial Section 75 of the 2012 Health and Social Care Act (which requires clinical services above an annual cost of £600,000 to be put out to competitive tender) – though the law has been widely ignored, with only 2 percent of clinical contracts tendered this way.

  The unions want to go much further, to end tendering for non-clinical services, and to make the NHS the default provider when contracts expire.

  They also want to ban trusts and ICSs from establishing “subco” companies (whether to dodge tax, escape national pay agreements or avoid scrutiny), and tight regulations on procurement to prevent the award of crony contracts without competition or scrutiny, like too many contracts during the peak of the Covid pandemic.

  NHS England argues that the Bill is about giving legal status to 42 Integrated Care Systems (ICSs) which will replace the Clinical Commissioning Groups established by the 2012 Act. 

  The ICSs are described as “new partnerships between the organisations that meet health and care needs across an area.”

  However, ICSs are far from local: they range in size from 500,000 to 3.2 million population. 26 cover a million or more, and the largest covers a huge coast to coast area in the North of England.

  Such large and remote bodies threaten a drastic reduction in local accountability and reduced ability to defend threatened services, with some ICSs already facing massive financial problems from the outset.

  NHS England guidance emphasises the ‘principle of subsidiarity’, with ‘place-based’ decisions taken “as close to local communities as possible”: but there is no mention of ‘place’ or ‘subsidiarity’ in the Bill, which allows each Integrated Care Board (ICB) to decide its own constitution.

  ICB chairs – appointed from above by NHS England – are not locally accountable at all. With ICB budgets larger than those controlled by most elected Mayors, the argument for ICB chairs to be elected is also a strong one.

  All ICB business should be in public, and subject to the Freedom of Information Act.

  The Bill doesn’t require ICBs to include representation of mental health, public health, patients or public.

  Minister Edward Argar has committed to amend the wording to exclude the possibility of “individuals with significant interests in private healthcare” from sitting on ICBs, although the Bill does not mention committees, and specifically permits private sector involvement in the advisory Integrated Care Partnerships.

  With some concessions made already, and ministers tight on time to get the Bill through and establish ICBs on a statutory footing from April, there may be a chance for MPs and Lords to support many more amendments to address the Bill’s serious flaws.

  These should, above all, seek to:

  n Prioritise fuller representation on ICBs and ‘place-based’ decision making and accountability to local communities, rather than extending new central powers to the Secretary of State.

  n Fully reintegrate the NHS by establishing NHS trusts and FTs as default providers whenever contracts expire, and excluding private sector interests from all NHS decision-making bodies.

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• Fantasy hospital plans compete for imaginary cash
  
  John Lister

  Extravagant schemes are being unveiled in hopes of being selected as one of the additional 8 ‘new hospital’ projects to be announced next spring, even while all eight of the government’s top priority plans for new hospitals at a standstill.

  They are under instruction to submit cheaper plans costing no more than £400m apiece.

  But the ‘Act as One’ health and care partnership that covers Bradford District and Craven has come up with a literally fantastic plan – for THREE new hospitals costing £1.7 bn.

  Their plan includes rebuilding Airedale Hospital in Steeton as Europe’s first carbon neutral hospital; a new mental health facility to replace the Victorian era Lynfield Mount hospital in Bradford; and a new single site hospital bringing together Bradford Royal Infirmary and St. Luke’s Hospital.

  The three schemes have not been costed separately but have each also been put forward individually, in case the whole scheme doesn’t make it onto the list. But remarkably not one of the council or NHS chiefs quoted in the announcement showed any awareness of the tightening financial squeeze on NHS capital.

  Bradford’s monster plan has to compete with a £500m plan to replace Stockport’s Stepping Hill Hospital, which has a £95m backlog maintenance bill, and the £663m plan to replace Leighton Hospital in Crewe, which is run by Mid Cheshire Hospitals Foundation Trust – and in danger of falling down, as another victim of defective concrete planks in its structure.

  Kettering hospital chiefs have boldly submitted the case for investment of “up to £765m” – to fund “the first three phases” of a £1bn-plus 5-phase scheme.

  Bolton Foundation Trust seems to be an exception, having submitted a plan for a £252m first phase rebuild of Bolton General Hospital, citing high and significant risk backlog maintenance bills of £165m.

  Among the prioritised “pathfinder” schemes the dreams are becoming more elaborate, with Barts Health developing plan for “Future Whipps” – a new Whipps Cross “hospital in a garden”, with lovely drawings but absolutely no costings included.

  And from the original “fake forty” Imperial College Healthcare has optimistically submitted its Strategic Outline Case for rebuilding St Mary’s Hospital in Paddington, including 840 and “new, user-centred clinical facilities across three main hospital buildings”. They also want to develop a clinical life sciences cluster on the land freed up, “in partnership with industry and research”.

  The scheme is estimated to cost “£1.2-1.7 billion net, once receipts from the sale of surplus land are taken into account” – in other words 3-4 times more than the £400m limit being imposed on the eight pathfinder schemes.

  While architects are doing very nicely from this boom in fantasy projects it’s not clear how many – if any – of these dreams will come true in the harsh world of Rishi Sunak’s looming spending review.

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• Another redisorganisation under way
  
  Richard Bourne

  The Health and Care Act has begun its parliamentary journey, being examined line by line in a Committee of 10 Conservatives but only 5 Labour members. Some early themes are emerging.

  This is not like 2011 with major lengthy arguments; this is more like the examination of secondary legislation with the Minister outlining things and the opposition raising questions and trying to suggest changes. 

  Although Labour, and others, in the Committee have put down multiple amendments it is obvious that none of these will be passed. But it is likely there will be many government amendments when the Bill passes to the next stage in the Lords.

  In the areas that came from the largely consensual proposals from the NHS itself there have still been attempts to clarify and to strengthen the protections. The Minister has agreed to consider matters and has given some verbal and written assurances. 

  In the areas that came from the attempt at more Hancock (greater powers for Ministers) there is not much enthusiasm and a strong expectation of a retreat from the worst aspects – such as the truly daft idea of the Secretary of State becoming involved in every proposed change to any service anywhere - however minor. 

  Reassurances

  Some reassurances have been given that signal there will be no role for private sector interests in the new NHS commissioning bodies; that the new bodies will be fully open and transparent; that the new structures do not have any impact on the (historic) roles and responsibilities of the Secretary of State as regards the comprehensive NHS; that the new funding and oversight arrangements at local level introduce no new powers or constraints; that there is no intention to vary the national staff agreements, or the already agreed transition arrangements; and there will not be any ability to award contracts without a proper process. Time will tell.

  Contracting out

  Areas of most concern remain over the continuing ability to contract out cleaning, catering, and other similar “non clinical” services which should be central to the NHS itself; about dodgy major national framework contracts for private providers; about who gets to appoint or elect the key Chairs and Board members; and about the actual makeup of the decision making bodies and how they are held accountable – especially ensuring a strong role for staff, patients and public.

  Amendments rather than warm words and reassurance will be required especially in these areas.

  The major contradictions in the Bill between what is flexible and what is imposed; between what decisions are local and what are national; between autonomous bodies like Foundation Trusts and a duty to cooperate; and even who decides what, all remain less than clear. A great deal depends on guidance that will be issued after the Bill goes through.

  The NHS appears to be seeing the end of competitive tendering for most services. This Bill does reverse the Lansley version of markets and competition. Campaigners can rightly say ‘we told you so’ – and take credit that not only were the Lansley ideas never actually fully implemented, they are now being abandoned as counterproductive. However this does not prevent privatisation continuing– and even increasing – by other means.

  Not about integration

  This is a Bill to redisorganise the NHS; it is not about integration, improving services or better accountability. 

  It is not only the wrong Bill at the wrong time it is also a major wasted opportunity. 

  The new Integrated Care Boards are just larger CCGs (without the role for GPs); and the new Integrated Care Partnerships (which will not come into much prominence until long after the ICBs are running) are just bigger Health and Wellbeing Boards – with no powers at all. 

  How any “place based” structures will work is wholly unknown.

  Ending competitive tendering for clinical services must be welcome with or without the explicit statement that the NHS is the default provider – but little else of value is going to come out of this Bill.

  It is just more displacement activity as with the recent attacks on GPs and the suggestion that NHS Leadership is in need of reform. 

  What our care system – including social care – needs is some stability, more funding and long term investment and a focus on the workforce.

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HCT News Bulletin No 12

• £7m in a year wasted on failed Cornish project
  
  Cornwall Partnership Foundation Trust squandered £7 million on just over a year of a consultancy project that was supposed to yield savings by reducing the numbers of older patients (65+) needing hospital care.

  The consultancy firm was Oxfordshire-based Newton Europe, which describes itself as “a specialist in operational improvement, fuelled by a fundamental belief that even the best organisations can be better.”

  The HSJ has revealed that ‘Embrace’ project was launched in the spring of 2019 and suspended in late March 2020 because of the pandemic “but before the implementation phase”. It restarted in September 2020 but was abandoned the following month, when Newton Europe’s role ended.

  The trust board acknowledges that the project has delivered “no tangible savings.”

  Newton Europe’s website boasts “we guarantee our fees against delivering results:” but having trousered a cool £7m they will have been laughing all the way to the bank.

  Read more ...
  

HCT News Bulletin #12

• Boots train up pharmacists to cash in on GP crisis
  
  Readers of the Times, which has criticised GPs for allegedly failing to see sufficient numbers of patients face to face, may have been confused on October 5 to find an article citing research showing evidence of the value of patients having the same GP for years.

  The catch was, of course that the research is from wealthy Norway, where the 4,708 GPs studied had an average of just 1,113 patients on their lists – around half the average list size of the dwindling number of GPs in England.

  GPs driven out

  More hard-working GPs and practice support staff are being pushed towards early retirement or alternative employment by the public abuse and hostility whipped up by the far right using so-called ‘social media’ and coverage in the Times, Telegraph, Daily Mail and other rags that select information to give the impression GP practices have remained under lockdown.

  More fuel to the reactionary fire has been added by comments from Boris Johnson and Sajid Javid, while NHS England has shown no inclination to rally to their defence.

  In fact GPs delivered a near 10% increase in appointments during August this year compared with the same period pre-pandemic in 2019, increasing from 23.3 to 25.5 million.

  And while the proportion of consultations on the phone or online has increased from around 20% in the first week of March 2020 to 42%, many patients have found they can get the response they need from GPs without travelling or waiting in crowded surgeries – and they prefer to do so.

  The pressure on GPs is increased by the lamentable failure of successive health secretaries to make good the promise of 6,000 extra GPs in post by 2024: instead there are 1,904 fewer fully qualified staff in post than there were six years ago, while the pressures on them have increased.

  Profit

  Now Boots, the high street chemist chain owned by US stores giant Walgreen has spotted the chance to profit from the problems of primary care.

  They plan to train up pharmacists to work as PIPs (“pharmacist independent prescribers”) offering appointments for patients with minor conditions who can’t get to see a GP as quickly as they want … and can afford a £15 fee.

  “Rather than wait two weeks to see a GP, people can get immediate diagnosis, treatment and medication for the price of a Nando’s,” Boots chief executive Seb James told The Sun.

  With plans to install a PIP in each of Boots’ 2336 stores across the UK, prescribing and dispensing could be a nice little earner for the company … establishing a 2-tier system in primary care.

  Green light for Torygraph distortions

  Meanwhile the “Independent Press Standards Organisation” (IPSO) has ruled that the Telegraph did not breach the Editor’s Code by publishing anti-GP columns from right wing hack Allison Pearson that presented wilfully distorted information, since the articles were “clearly distinguished as comment pieces by their style and tone and have to be considered in that context.”

  The Doctors’ Association UK (DAUK), which complained in September about the articles, has lodged an appeal against the IPSO decision. Meanwhile right wing rabble rousers have the green light to incite even more ignorant rage against GPs and the NHS as a whole.

  Read more ...
  

Thursday 15th July 2021

Health Campaigns Together Monthly Bulletin #10

• Hobbled NHS and £10bn deal for private hospitals make a nonsense of 'integration'
  
  An explanatory paper from the Royal College of Emergency Medicine notes the continued decline in bed numbers since 2010, that was worsened by measures to address the Covid pandemic, and reminds us that the coming winter and future peaks of demand will require the lost bed to be brought back into use.

  Reopen beds

  The RCEM calculates that over several year the average number of admissions per bed has been 11.7, and from this estimates that depending upon the scale of the winter pressures the NHS needs to reopen between 5,000 and 16,000 of the currently unused beds.

  Of course the extra beds would also raise the need for extra staff – which the RCEM and other professional bodies have been demanding for several years.

  Meanwhile Lowdown has been looking more closely at the uneven level of bed reductions across hospital trusts in England, comparing the most recent figures for occupied beds (Quarter 4 2020-21) with the equivalent pre-Covid figures (Q4 2018-19).

  We calculate that the England average reduction of occupied beds in that time across all trusts is 14.1% – but 79 trusts have lost a higher percentage, and the percentage loss of occupied beds varies sharply.

  Among the acute trusts the reduction varies between just 1.2% (Warrington and Halton Teaching Hospitals and Portsmouth Hospitals) and 30.5% (London North West University Healthcare).

  Nineteen more acute trusts have lost one in five (20%) or more of their occupied beds.

  On numbers of occupied beds lost, the England total is 14,562 since the equivalent period in 2019, but at trust level Manchester University FT tops the list having lost 591, followed by Guy’s & St Thomas’ FT (now merged with the Royal Brompton) with 384, London North West (376) and United Lincolnshire Hospitals (329). Eleven more acute trusts have lost the use of between 200 and 289 beds since 2019 (see table).

  Lack of capital

  Last year NHS England began a debate on the costs of reorganising and refurbishing hospital buildings to restore the lost capacity – but this debate has ground to a halt for lack of capital even for basic maintenance.

  The backlog bill for maintenance is now in excess of £9 billion.

  So while the NHS is unable to use all its own beds to treat waiting list, emergency and Covid patients the private sector is delightedly stepping in to provide capacity to treat NHS funded elective patients under a massive £10bn 4-year “framework agreement.”

  Biggest privatisation

  It should be clear to all that without a major government U-turn, to implement a programme of capital investment to reopen NHS capacity, at the end of this 4-year period the NHS will have become institutionally dependent upon private sector beds to maintain its elective caseload – and the biggest-ever privatisation of clinical services will have been carried through without any systematic protest.

  This also makes a nonsense of any talk of “integrated care.”

  Billions will be flowing out of meagre NHS budgets into the coffers of private hospital corporations, leaving front line services starved of resources.

  Meanwhile scarce NHS nursing and medical staff will have to be split up with teams having to work away from the main hospital sites in small private hospitals – making them unavailable to assist teams coping with emergencies and complex operations. 

  Read more ...
  

• Inquiry reveals scale of harm done by 'hostile environment' charges
  
  Patients have suffered as a result of the charging practices at Lewisham and Greenwich NHS Trust (LGT), a report published Friday 25th June has revealed. It concludes an inquiry set up by the Trust in November 2019 into its arrangements for charging patients who are ruled ineligible for NHS treatment and care at the Trust by law.

  The inquiry was set up in response to public outcry from campaigners and local authorities over the Trust’s practices, and as a result of public revelations in the Health Service Journal of the Trust’s use of credit reporting company Experian.

  Despite the vulnerable status of many patients, the inquiry revealed a lack of compassion and empathy from Trust staff towards their situations, causing significant distress.

  In one case study submitted to the inquiry, a patient retold how they screamed and fell to their knees when they received their invoice for £15,480 for life-saving maternity care. At the time, this patient was living in supported accommodation and had no income.

  Another patient told the inquiry how their blood pressure rose after hearing they were being charged for their stay in hospital.

  The news was delivered just hours after giving birth and they were forced to extend their time in the ward as a direct result of the impact of the £6,000 charge on their stress levels.

  Threats every day

  One patient, interviewed by Lewisham Refugee and Migrant Network, said: “I was charged about £7,000. I was staying in one room accommodation and I couldn’t even afford a payment plan to pay back the debt. There were threats that they were going to report me to the Home Office and I received calls every day. This was at the same time that my child was diagnosed with autism.”

  Some also reported being afraid to pursue healthcare after their experiences, suggesting that the Trust’s practices endangered lives, violating the NHS’ core purpose.

  The report outlined 39 recommendations to improve the Trust’s NHS charging practices, the majority of which were accepted.

  These include reviewing and improving their patient literature to clarify the regulations, writing off debt for people facing destitution, and committing to training on the impact of the charging legislation on patients.

  In a joint statement, Lewisham Refugee and Migrant Network and Save Lewisham Hospital Campaign said:

   “We have participated in the panel in order to reduce the harm of the policy. But we remain completely opposed to the legislation that is part of the continuing Hostile Environment and which we believe will continue to harm patients in the future. Organisations such as ourselves and many others will continue to campaign to end these charges once and for all.”

  “We recognise that NHS staff have to comply with this discriminatory and harmful legislation, targeted at undocumented and vulnerable people, and we welcome measures the Trust has now taken to minimise the damage the policy causes.”

  In the report, the Lewisham and Greenwich NHS Trust said:

   “The Trust sincerely regrets, and apologises for any instances where patients were not treated with compassion, or in a manner consistent with the values of Trust.”

  Read more ...
  

• Who will be next boss of NHS England?
  
  John Lister

  An “overseas healthcare leader” has apparently been added in to the mix as a fifth shortlisted candidate to take over from Lord Stevens of Birmingham as chief executive of NHS England.

  This comes after hotly-tipped but serial incompetent ex-jockey Dido Harding’s chances fell away with the disgraced departure of her buddy and biggest fan Matt Hancock from his post as Health Secretary. His newby replacement, clearly under the thumb of Boris Johnson, is reportedly not close to Harding, and unlike Hancock doesn’t represent a horse racing constituency.

  HSJ reports a potentially strong candidate, Sir Jim Mackey, former chief executive of NHS Improvement has also dropped out of the race. This leaves the most strongly-placed ‘inside’ candidate as Stevens’ virtual deputy at NHS England, Amanda Pritchard.

  She is widely described as an experienced senior manager having been chief executive at Guy’s and St Thomas’s Hospitals FT: however her period at amongst the higher echelons of the NHS seems to have severely limited her communication skills. When she presented a complex framework of more than 70 metrics for assessing Integrated Care Systems to NHS England’s Board, the HSJ reported her speech as follows:

  “This is a really important building block of our kind of architecture as we move towards much more kind of delivery through systems but also brings us right up to date with the priorities we have committed to in the long term plan.”

  This fluency in gobbledygook seems to be a strong basis for suggesting she is ready to step in to Stevens’ shoes.

  Outsiders

  The other three known candidates are all from outside the current NHS, although Mark Britnell, for many years now a senior partner of management consultancy KPMG, was once NHS Director General of Commissioning during the New Labour years.

  He left the NHS as times began to get tough in 2009. He became a “kitchen cabinet” advisor to David Cameron’s government in 2011, but was subsequently revealed to have boasted to a US audience that the Health and Social Care Act would “show no mercy” towards the NHS and offer big profits to the private sector.

  Leeds City Council chief executive Tom Riordan has held that post since 2010, but according to Wikipedia he spent 3 months in 2020 working for the government on the test and trace system – and appears to have liked it.

  The most recent addition to the public list has been Douglas Gurr, a former McKinsey partner who spent four years up to 2020 running Amazon’s operation in the UK, which famously contributes little or no tax revenue towards funding the NHS – although it makes substantial demands on it.

  Mr Gurr will have been the manat the top when according to the GMB union in early 2020 ‘hellish’ working conditions for Amazon’s warehouse employees were so tough that there had been more than 600 ambulance call-outs to Amazon warehouses over the past three years. The GMB is still calling for a parliamentary inquiry into Amazon.

  It’s unlikely that any of Mr Gurr’s expertise in this style of human resources will be of any help to an NHS facing a chronic workforce shortage exacerbated by burn-out and stress after the long battle against Covid-19. The HSJ reports Mr Gurr has been a non-executive on the Department of Health and Social Care’s board since 2018.

  Read more ...
  

Health Campaigns Together

• Wrong Bill at the Wrong Time -- BMA
  
  John Lister

  All but 3 Tory MPs have obediently nodded through the second reading of the Health and Care Bill, most of them clearly having not read it.

  Labour MPs and Shadow Health Secrtary Jon Ashworth spoke and voted against the Bill both because of its timing but also its content, which does potentially open doors for greater private sector involvement and control.

  The BMA Council has also now voted to oppose it on similar grounds.

  However some Tories who have paid more attention are also reportedly uneasy about the sweeping new top-down powers it will give to Health Secretary Sajid Javid and about the boundaries of the 42 “Integrated Care Systems” (ICSs) that are given legal status.

  Delay

  Others, possibly even Javid himself, who wanted to delay the Bill  but was told to push ahead by PM Johnson, may well be wondering why this legislation, which will disrupt the NHS in England for the next 2 years, has to be pushed through now – in the midst of a pandemic and a mounting crisis throughout the NHS.

  The Bill has nothing useful to say about the workforce crisis, nothing at all to say about social care, and brings no extra revenue or capital to help trusts reopen closed beds and get capacity back to pre-covid levels: it will not recruit a single nurse or bring the treatment of one extra patient – or bring any genuine integration of NHS and cash-strapped, privatised social care.

  Diversion

  Instead it will divert management time, effort and attention away from the pressing tasks of the day into yet another top-down reorganisation – and make the service even less accountable to local communities.

  Two thirds (29) of the 42 ICSs have already been given the go-ahead, some even claiming to already be delivering improvements, although none have clearly stated what, with unchanged spending limits, they can achieve as ICSs that they can not do now.

  Worse, the Bill itself with its 138 new powers for the Secretary of State, its vague phrasing and repeated reference to “flexibility”, its omissions of commitments from previous legislation, and dependence on still unpublished guidelines and regulations, leaves scope for potential reductions in services.

  It also creates scope for the private sector, which ministers have consistently favoured during the pandemic, to step in to positions of influence on at least some ICS boards and committees.

  The much-vaunted repeal of Section 75 of the 2012 Act, which requires local CCGs to put services out to competitive tender, will stop little, if any contracting out: only 2% of clinical contracts are subject to competitive tender.

  The change also applies only to clinical services – and is not linked to any proposal to bring privatised services back in-house, or make the NHS the default provider.

  King’s Fund boss Richard Murray, poo-pooing concerns over ongoing privatisation, gives the game away when he admits the Bill would make it easier for services to remain with “existing providers like the NHS” – i.e. NHS or current private contractor.

  The new rules for procurement remain unexplained – and after more than a year of brazen crony contracting for Test and Trace and PPE contracts without competition, critics can be excused for suspecting that the Bill could leave the NHS open to more of the same.

  It will also axe any genuinely local control over services.

  The 42 ICS areas, with populations up to 3.2 million, are much bigger in scope than the CCGs they replace, and their chairs will be appointed top-down by NHS England and signed off by the Secretary of State – whose agreement would be needed to remove them.

  The chairs in turn get to appoint other members of the ICS Boards, with no maximum size, and no bar on private companies taking seats – as Virgin already has in the shadow ICS in Bath, Swindon and Wiltshire.

  Sneering

  Of course it’s possible to exaggerate the extent to which this Bill in itself amounts to or leads to privatisation, and some extreme assessments provide a handy targets for sneering by think tanks that always assume government policies will work out for the best, and journalists who look only at the repeal of Section 75.

  But the overwhelming vote by the BMA Council to oppose the Bill on the day of its second reading is welcome and significant, and lends weight to Labour’s decision to oppose it.

  A BMA press release explains:

  “It is the wrong time to be reorganising the NHS, fails to address chronic workforce shortages or to protect the NHS from further outsourcing and encroachment of large corporate companies in healthcare, and [the Bill] significantly dilutes public accountability.

  “The BMA is also concerned about the wide-ranging excessive powers the Bill would confer on the Health Secretary.”

  Of course there will be those who prefer to take it on trust that the government that has handed out billions in Covid contracts to inept and incompetent PPE suppliers and Test and Trace contractors headed by cronies and donors really wants to limit privatisation and integrate services. They will find a warm reception in the news media.

  There will be others who will insist that we must only focus on trying to “kill the bill,” despite the hefty Tory majority and the fact that the SNP, which opposes the Bill, will not vote on an English policy matter. They will couch their arguments in ever more desperate and hysterical terms that will make it impossible to draw in any broad support.

  For the rest of us the next step must be identifying the key issues on which it will be possible to unite the opposition parties and seek to split off Tory back benchers in support of amendments which limit the damage that can be done by a Bill that offers dangers rather benefits for the future of the NHS.

  Read more ...
  

Monday 14th June 2021

Health Campaigns Together Monthly Bulletin #9

• No extra NHS cash despite beds crunch and soaring waiting list
  
  NHS hospitals are facing a rising tide of emergency attendances with a reduced number of front-line beds available and a significant continuing need for beds to treat Covid-19 patients as infection rates increase.

  NHS figures analysed by the Health Service Journal show a third of acute trusts (49/145) were operating at 95% or higher levels of occupancy last month with numbers of emergency patients higher than any time since the winter before the pandemic.

  Reduced numbers

  However the occupancy rates relate to the reduced numbers of front-line beds, which fell rapidly during 2020 as beds were closed or removed from wards to increase social distancing and reduce dangers of infection.

  The HSJ calculates that the average number of acute beds not reserved or in use for Covid patients fell to 89,339 in May, down by over 12,000 from the numbers that had been available at the same time in the last few years before Covid.

  The most recent published quarterly bed figures for the three months to March 31 show 96,000 beds available in England, of which just under 80,000 were occupied, compared with 102,000 beds open and over 90,000 occupied in the same quarter a year earlier.

  In other words NHS capacity is still hobbled by the aftermath of Covid, the lack of capital to remodel and refurbish hospital buildings to make most effective use of space, and the lack of staff with high post-Covid sickness levels adding to chronically high levels of unfilled posts.

  Meanwhile some of the patients who opted to stay away from seeking hospital treatment during the peak of the pandemic are now being referred by GPs or arriving as serious emergencies.

  The Health Foundation has calculated that to bring down the backlog of cases and meet the target of treating 92% of patients within 18 weeks of referral (which has not been achieved for 5 years) the NHS would need to spend an extra £6bn per year over three years. Its estimates are based on the need to open 5,000 extra beds, and employ 4,100 more consultants and 17,100 more nurses.

  While conjuring up extra staff is a major problem – especially after the government’s derisory offer of a 1% pay increase – the latest figures show that thousands of extra NHS beds already exist – in hospitals that cannot fully use them without investment to reorganise clinical areas.

  (Information from The Lowdown)

  Read more ...
  

• Secretive Leicester NHS chiefs desperate to avoid scrutiny of £450m plan
  
  Leicestershire’s highly secretive NHS leaders have been at it again as they try to force through their flawed and controversial £450m-plus plans.

  On June 8 a joint meeting of CCGs covering Leicester, Leicestershire and Rutland was convened at short notice to nod through a 760-page document analysing the public response to the consultation and a 147-page Decision Making Business Case (DMBC) to kick-start the project.

  But the 760-page document was only released publicly on May 26 – having been kept under wraps for two months: and the DMBC was literally made public one minute before the meeting due to discuss it, even though the text had been in the hands of CCG members for weeks.

  This latest shameless effort to suppress any public scrutiny of the plans that will shape Leicestershire’s hospitals for the next generation, closing acute services at Leicester General and a birthing unit at Melton Mowbray, follows a long and inglorious series of such moves, which have been challenged throughout by Save Our NHS Leicestershire.

  The most recent episode has also drawn public criticism from the chair of the joint scrutiny committee for NHS policy in Leicester and Leicestershire, Patrick Kitterick, who warns that

  “To rush to a decision without the proper opportunity for public scrutiny is a mistake which I would urge the Board Meeting to avoid.”

  There is plenty in the documents for the hospital and CCG bosses to be reticent about – not least the fact that the DMBC admits that the £453m funding that has been promised by the government and from charitable funding will clearly not be enough to complete the project, which was drawn up and costed prior to the pandemic.

  Indeed it states: “because of the uncertainty … it is not currently possible to assess the impact on the capital costs.”

   It later admits that even the amount of Public Dividend Capital available will not be confirmed until next spring.

  The plan will also drain the Trust of capital funding, leaving a £33m bill for chronic backlog maintenance.

  Read more ...
  

• Sussex trust opts to prioritise private patients
  
  East Sussex healthcare has become the latest NHS Trust to shell out taxpayers’ money in the hopes of expanding its private patient income according to the HSJ, while NHS waiting lists and waiting times are on the rise.

  The Trust, which runs hospitals in Eastbourne and Hastings, already reports an almost 50% increase in private patient income in 2019/20 to £3m – although there is no corresponding entry for the expenditure to show whether or not this represents a profit.

  The most recent Annual Report shows Eastbourne Hospital’s Michelham Private Patient Unit delivered a loss of £91,000 on income of £2.3m.

  But in another triumph of hope over experience, the Trust has decided to spend an undisclosed sum buy out the “fixtures and fittings of the 22-bed Spire Sussex Hospital, which is physically linked to the trust’s Conquest Hospital in Hastings.”

  The HSJ reports that Trust intends to keep the mini hospital, leased from the Trust by Spire, mainly for private patients, although it will continue to take some NHS patients. Like so many private hospitals around half its in-patients have been NHS-funded.

  As with other recent moves by foundation trusts to expand their private patient income, it’s questionable whether the acquisition of these 22 beds in Hastings offers any genuine additional income for the Trust – or any benefit to NHS patients stuck on lengthening queues while management energy and scarce resources are so obviously being channelled elsewhere.

  Read more ...
  

• NHS data grab postponed as ministers bend to pressure
  
  Health minister Jo Churchill has attempted to stem the growing tide of opposition to the government’s hugely controversial “data grab,” requiring GPs to hand over data from 55 million patient records to NHS Digital, by announcing on June 8 a two month delay in the deadline for patients individually to opt out.

  The scheme had been initiated by NHS Digital and Health Secretary Matt Hancock back on April 6, and quietly announced by NHS Digital a month later on May 12, hoping as few people as possible would notice that the deadline for opt-outs was June 23. (See an excellent and amusing critique of the plan by comedian Matt Green.)

  Indeed even though patients were assured they could opt out “at any time” they were not told that once their data was on the system it would never be deleted, even if no new information was added.

  While most of the public remain unaware, the opposition demanding at the very least a delay in the plan included a rare alliance of the Royal College of General Practitioners with the BMA, the Chartered Institute for IT, the Information Commissioner, Labour’s Angela Rayner and Jonathan Ashworth, Lib Dem health spokesperson Baroness Brinton and Tory MP David Davis, who joined a coalition of five groups working with Foxglove Solicitors to mount a legal challenge (the groups were Just treatment, Doctors Association UK, The Citizens, openDemocracy, and the National Pensioners Convention).

  A week before the announcement of the delay in implementation even NHS Digital urged ministers to pause the plan, fearing that widespread opt-outs could reduce the value of the data.

  NHSD’s clinical lead told the HSJ GPs were being “eminently reasonable” in raising their concerns, and admitted that:“If we don’t address it then we will lose public and professional trust and that would be intensely damaging.”

  However ministers tried to brush aside NHSD’s concerns, arguing that doctors were simply trying to delay the scheme.

  Key reasons why people might want to opt out of all of their personal medical history being shared not only with the NHS but potentially also with “commercial third parties,” include the fear that individual patients could in future be identified.

  As Foxglove summed up:

  “Your health records being taken are highly sensitive. They include information on things like depression, autism, sexually transmitted infections, erectile dysfunction, and addiction – all to be made available for planning and research, including commercial research.

  “The data is ‘pseudonymous’, but this is quite different from anonymous. It means peoples’ identities will be disguised but could later be re-identified. The government has said little about what safeguards will protect this info – or on what terms corporations will access it.”

  Unsavoury corporations that have already been given access to some potentially valuable NHS data during the pandemic include US tech giants Amazon, Microsoft, and Google – plus two controversial AI films called Faculty and Palantir. In March campaigners succeeded in forcing the government to drop plans to give Palantir a £23m contract without public consultation.

  NHS Digital’s claim that the plan had been cleared with the Information Commissioner’s Office was contradicted by the information Commissioner stating her concerns:

  “It is clear that there remains considerable confusion regarding the scope and nature of the [data-sharing plans], among both healthcare practitioners and the general public . . . It is sensible for NHS Digital to take more time to engage with its stakeholders, and consider the feedback it is receiving about its plans.”

  The Byline Times has warned of the limit to any guarantees given by NHSD:   “NHS Digital does audit some (but not all) of its customers which receive copies of data. Several of these audits have revealed that, not only do organisations break the ‘protections’ in place, but that these do not stop them from getting data once they have been broken.”

  Indeed as Baroness Brinton has pointed out, no data protection impact assessment has yet been published.

  However with the six week school holiday season on the horizon, the two month delay gives just three extra weeks — with no sign so far of any new initiatives to contact patients to ensure they are informed, and a deliberately complex and obscure opt-out procedure – the delay seems to be merely a token gesture to defuse opposition before the plan resumes in earnest.

  For details on how to opt out contact MedConfidential.

  Read more ...
  

• No answers on delayed Leamington mega lab
  
  A total, constipated silence from the NHS and ministers shrouds the long-delayed new “mega lab” that was supposed to have opened in Leamington Spa last January as part of the £37 billion ‘test and trace’ system.

  The Department for Health and Social Care has stonewalled – or given misleading answers to questions from local journalists, and Matt Hancock has flatly refused to answer parliamentary questions raised by local MP Matt Western, who has subsequently raised his concerns in the local press, warning that:

  “This is a scandal waiting to happen. I have heard from distressed residents waiting months to start jobs, many completely without income. I have heard from scientists who fear lack of regulation, poorly qualified staff and mismanagement at the facility.

  “I have heard from NHS groups who are concerned about the undercutting of existing services, ‘stealth privatisation’ and outsourcing of vital healthcare assets. Yet the DHSC has ignored letters, emails and questions from the media – which is unacceptable and keeps the public in the dark.

  Last December then Test and Trace boss Dido Harding let slip that the mega-lab would be run by a private company, Medacs, with no expertise in medical science or laboratories. Medacs is a subsidiary of the multinational Impellam Group, chaired by former Conservative Party deputy chair and tax exile Lord Ashcroft.

  In January The Lowdown reported the lab scientists’ professional body, the Institute of Biomedical Science, warning:

  “It is vital that these labs have an appropriate skill mix and include significant numbers of HCPC registered Biomedical and Clinical Scientists. We would not allow unregistered staff to run care in clinical settings such as medicine, nursing or radiography – why are labs being viewed as “different”? 

  “We have professional registration in place for a reason – to protect the public.” 

  By March it was clear that some staff were also being recruited by Sodexo on fixed term contracts to work in the megalab, making no mention of NHS terms and conditions, NHS Pensions, or UKAS accreditation.

  Nonetheless the Department of Health and Social Care’s response to a question from Matt Western insisted that the “mega-lab” would be “publicly owned and operated,” There was no explanation of why the new lab could not be run, and staff employed, by the neighbouring University Hospital of Coventry and Warwickshire.

  Since then the opening has been postponed to “spring” – or questions of when it might open simply ignored. Dozens of local residents who have signed contracts to begin working at the laboratory have been complaining to Matt Western that they have heard nothing from recruiters – and been left in limbo, without pay. Some say they have been directed to sign non-disclosure agreements.

  Now another local newspaper, the Leamington Courier has interviewed one of these employees, who wishes to remain anonymous but who insists that, contrary to assurances from the DHSC, the lab and its staff will be outside the NHS, and that people on universal credit are being recruited to a specific “trainee lab technician” role. They also now expect not to start work until the autumn “if I even start work at all”.

  "I have confirmation via e-mail from a staff member at Blue Arrow (who along with MEDACS is recruiting the staff) that I will not get an NHS pension or any other benefits relating to working with the NHS.”

  The DHSC in statements to the local press has claimed that 200 staff are employed and working at the lab – and that it will eventually create 1,800 jobs.

  However the secrecy, the obvious role of private contractors in recruiting the staff, the decision to keep the mega-lab separate from the local NHS and the bypassing of the professional body and the trade unions gives real grounds for concern that another privatised fiasco is under way.

  Read more ...
  

• Bath trust buys up first Circle hospital
  
  The Royal United Hospitals Bath Foundation Trust (RUH) has paid an undisclosed sum to buy 100% of the shares in Circle Bath, the lavishly designed 28-bed private hospital that opened in 2010 at a cost of £22m.

  It was supposed to be part of a 25-strong chain of boutique-style Circle Hospitals proposed by Circle’s founder Ali Parsa; but from the outset the problem was insufficient private customers, forcing the hospital to rely increasingly on NHS-funded patients and income from Circle’s NHS-funded “Independent Sector Treatment Centres.”

  Matters got even worse when Parsa managed to blag his way into the contract for Circle to manage Hinchingbrooke Hospital – only for that project to go disastrously pear-shaped, leaving Circle paying £2m to get out of the contract early and the Hinchingbrooke Trust mired in deficits and in disarray.

  In the event the chain of boutique hospitals was never built, Parsa was levered out of the loss-making company, which has since been bought out by venture capitalists to such an extent that it has taken over the UK’s largest private hospital company, BMI. One consequence of this was that the Competition and Markets Authority required Circle to sell off its Bath operation.

  However the HSJ reports that the Trust has not bought the building itself or the land, but the operating company in a deal that commits RUH to maintain 30% private patient activity at the site. One reason for the purchase was RUH fears that a new private company might have reduced the number of beds available to NHS patients.

  Local campaigners told Health Campaigns Together that they believe some of the funding may have come through RUH’s allocation from the “New Hospital Fund” to plan improvements in buildings, and it is believed local CCGs have endorsed the takeover and assured the funding.

  While additional capacity for NHS elective work is obviously a good thing, the secrecy surrounding the price to be paid, and the strings attached in terms of commitment to ongoing private work seem to make this an expensive way of securing 28 beds, and a deal that benefits Circle at least as much as the NHS.

  RUH is one of several NHS trusts seeking ways of expanding their private income, allegedly to plough any profits back in to NHS care – although the extent to which this can be done without impacting on NHS services must be doubtful.

  Read more ...
  

• ICS welcomes Virgin on Board
  
  The concerns of campaigners that the proposals in the NHS White Paper to give statutory powers to “Integrated Care Systems” would lead to private companies sitting on ICS Boards have been proved justified.

  Virgin Care’s local managing director Julia Clarke is already listed as a member of the Partnership Board, the unitary Board which currently runs the ICS covering Bath and North East Somerset, Swindon and Wiltshire (BSW).

  The Board Papers for a meeting on May 28 reveal that the Virgin boss is not only occupying a seat, but actively intervening to protect the company’s interests.

  Minutes of the March meeting reported a discussion on the extent to which private sector “partners” would be required to be financially transparent towards the other providers within the ICS “for purposes of planning the independent/private sector’s NHS related or NHS commissioned work.”

  They noted Virgin’s reluctance to share any information with the public: “Virgin Care were prepared to consider greater transparency where the contract with BaNES and BSW was concerned, but had reservations about sharing information in public.” (page 6)

  In response to this the NHS “partners” tamely rolled over, agreeing to action by Chief Financial Officers to “further discuss how the ‘open book’ approach could be applied to private / independent providers while protecting those providers’ corporate and commercial interests” – in other words how to ensure ‘open books’ were not opened at all, and ICS contracts remain tightly guarded secrets withheld from the local public.

  The HSJ has since also revealed that BSW has been asking private providers to contribute £10,000 per year as a “voluntary” contribution towards the ICS running costs – a move questioned even by the private hospitals’ body the Independent Healthcare Providers Network, whose CEO David Hare told the HSJ it was:

  “Deeply problematic on so many levels. Just one - what happens in the event of a procurement and the winner has paid and a loser hasn’t. Inducement? Reminder to me that lots more work is needed on ICS governance.”

  Nor is it reassuring to find that the Palliative and End of Life Oversight Group includes no less than TWO Virgin nominees, alongside two representatives of Medvivo, the private company supplying out of hours GP services and urgent care, which is also to be brought on to the ICS Partnership Board.

  The ICS leaders’ eagerness to embrace private providers can also be seen on page 29 under Transformation Priorities for BSW, which includes “maximise use of independent sector, working in partnership to target capacity at longest waiters in system”.

  The White Paper leaves room for private companies to be incorporated into ICS Partnership Boards, but also into the main decision-making NHS Boards. Indeed the BSW Minutes from March enthusiastically noted that: “the lack of detail in the White Paper re governance arrangements at system and place levels indicated a level of freedom of design which should be exploited.”

  If the vague proposals wind up entrenching private companies on decision-making boards while excluding any representation for the public or NHS staff, it’s clear that even meeting in public (as BSW does) would not ensure transparency or accountability.

  Read more ...
  

Tuesday 1st June 2021

medConfidential

• Full GP data copy to be taken from Summer 2021
  
  From 1 July 2021, and every day thereafter, the Government has Directed NHS Digital to take from your and your family’s GP records:
  • “data about diagnoses, symptoms, observations, test results, medications, allergies, immunisations, referrals, recalls and appointments, including information about physical, mental and sexual health” (more details)
  • “data on sex, ethnicity and sexual orientation”
  • “data about staff who have treated patients”

  You can opt out if you wish.

  NHS Digital states that: “Data may be shared from the GP medical records about … any living patient registered at a GP practice in England when the collection started – this includes children and adults”.

  It goes on to say the data will be shared “from 1 July 2021”, although NHS Digital says that you only have until 23 June 2021 to opt out – if you haven’t opted out by the time your entire GP history is first sent to NHS Digital this summer, your information will never be deleted.

  From later this year, data collected from your and your family’s GP records will be disseminated dangerously by NHS Digital alongside your other NHS records, including into the secret ‘VIP lanes’ for GP data. 

  Documents about the programme (formally called ‘General Practice Data for Planning and Research’) were published on 12 May 2021 – the morning after the Queen’s Speech (in which none of this was mentioned)…

  • Legal Direction from the Secretary of State to NHS Digital
  • NHS Digital ‘Data Collection’ information
  • NHS Digital ‘Data Provision Notice’ to GPs
  • NHS Digital ‘Transparency Notice’ which YOU are supposed to know about…
  • NHS Digital’s FAQ and our answers
  • ‘Type 1’ opt out form – the only opt out that will stop NHS Digital taking your data
  • National Data Opt-out page – this opt out won’t stop NHS Digital from taking your GP records; it may stop it sharing your NHS data with others. (You will also see that the forms separate you and your children.)
  • Data Protection Impact Assessment – no DPIA has yet been published
  Read more ...
  

Monday 25th January 2021

FBU

• FBU responds to “political and biased” HMICFRS report
  
  Inspectorate doing bidding of government and fire chiefs to attack firefighters, FBU says.

  The government’s fire service inspectorate has made a political attack on firefighters and the Fire Brigades Union (FBU) in an attempt to water down firefighter safety mid-pandemic. 

  Her Majesty’s Inspectorate of Constabulary and Fire and Rescue Services (HMICFRS) claimed the FBU had “prevented” firefighters in England from helping communities during the pandemic, an apparent reference to the union’s refusal to let bosses water down safety measures earlier this month. 

  The FBU has helped firefighters to assist the health and social care sector since March and was in the process of negotiating safety measures for firefighters to be involved in mass-vaccination, when fire service bosses unilaterally collapsed the agreement. 

  But HMICFRS called the safety guarantees in the agreement “more of a hindrance than a help” and advocated for Chief Fire Officers to have the authority to water down safety without negotiation. 

  MPs and trade unions have spoken out in the FBU’s defence, rejecting the “stitch up” and vowing to stand by firefighters. But government minister Stephen Greenhalgh accused the union of preventing firefighters from volunteering, sharing a picture of firefighters during the Blitz to try and suggest firefighters weren’t responding to the coronavirus crisis as they had then. 

  Responding to the report, Matt Wrack, FBU general secretary, said: 

  “This report is a political and biased attack on firefighters. It is neither evidence based nor an independent report and is instead full of untruths and omissions and we totally reject it. While firefighters are out tackling fires, floods and the pandemic, the HMICFRS didn’t even have the courtesy to speak to or provide us in advance with a copy of their report, which was passed to us by a journalist. 

  “The FBU has from the start wholeheartedly supported the response to the pandemic, and as a result of agreements delivered by the union, firefighters have been able to take on significant areas of additional work including driving ambulances, moving the bodies of the deceased and delivering vital supplies to the NHS and care sector and vulnerable people in our communities.  

  “But the message from this report is clear: fire chiefs and the government don’t want workers to have a voice over their own safety or their terms and conditions. That’s why employers, advised by fire chiefs, tore up a national agreement containing vital safety measures. This report is being used to undermine a trade union they consider a nuisance because it wants to keep its members safe. 

  “It is remarkable that in the same breath the inspectorate claims the FBU produced ‘unnecessarily detailed’ safety requirements and also that large staff absences driven by outbreaks ‘didn’t materialise’ in the fire and rescue service. How does the inspectorate think these outbreaks were prevented? It was a direct result of paying serious attention to workplace safety by the FBU and its members. 

  “It is also wrong to say that the FBU asked firefighters not to volunteer to support the vaccination programme. On 9 December, the FBU and employers signed an agreement that said should a request be received for support with vaccinations that both parties ‘will move quickly to support such a request’. 

  “Our priorities throughout this pandemic have been to ensure firefighters can safely support their communities, the NHS, and the care sector. That means protecting their health but also the services they work in which continue to respond to emergencies A service with 11,000 fewer firefighters than a decade ago cannot afford for this virus to run rampant through fire stations. 

  “The FBU wants firefighters to continue supporting the pandemic response but sadly it seems the inspectorate, doing the bidding of the government and fire chiefs, is more intent on attacking our trade union and helping to undermine the terms and conditions of firefighters.” 

  Read more ...
  

Sunday 17th January 2021

HCT circular

• Urgent action needed as Trade Bill comes back to the Commons
  
  The trade deals working party of our sister organisation, Keep Our NHS Public, has received information from the Trade Justice Movement and We Own It that the Trade Bill will come back to the Commons on Tuesday (January 19) and we are jointly asking for a last push to try to persuade all MPs (but especially Conservatives) to support the two important amendments passed by the House of Lords, namely:-

  - to protect the NHS from any future trade deals

  - to ensure that Parliament has the right of scrutiny and voting in any future trade deals.

   If you have the time to contact your MP again, and also put out the message on social media, we would appreciate it very much, but we thank you anyway for all that you have done so far to support this campaign. 

  Please see further details from other relevant organisations below:

  From The Trade Justice Movement (see link below) and We Own It campaigns:

  We Own It (affiliated to HCT) say:

  "We have just received some vital intel from a Conservative MP - the Trade Bill will be voted on in the Commons on TUESDAY 19th or WEDNESDAY 20th January. This gives us just 4 DAYS to make sure the NHS protection amendment passes.

  All the campaigning we've done for the last year on the NHS protection amendment to the Trade Bill comes down to this moment. 

  Whether you've taken every action we've asked you to take or this would be your first time, it's so vital you take THIS action in the next 24-48 hours.

  You can help force Boris Johnson's hand by making a video today that will get this demand spread far and quickly. 

  All you need is to film yourself 1) thanking our wonderful NHS staff 2) Asking Boris Johnson to protect them and the NHS by instructing Conservative MPs to vote for the NHS protection amendment. 

  Will you join the Thank you NHS campaign and make a video right now?

   

  If HUNDREDS of us make videos, the campaign will gather significant momentum, and we can move this back up the agenda, forcing the media to pick it up. We can then force Boris Johnson's and this government to act.

  But we don't have much time at all - this is going back to Parliament next Tuesday!

  Here’s how to make your video in under 5 minutes:

  Record a 30-second video in which you thank the NHS and ask Boris Johnson to instruct Tory MPs to vote for the NHS protection amendment.

  Share your video or picture on social media (Twitter, Facebook or Instagram) and tag Boris Johnson (@BorisJohnson) and nominate two more people to do the same - that way we can get this spreading!

  You can find more details, and what to do if you don’t have social media accounts, or IF YOU CAN'T make a video here: https://weownit.org.uk/we-need-your-help-reach-boris-johnson.

  The NHS protection amendment to the Trade Bill that was passed by the House of Lords, which the House of Commons will vote on next week, does so much to protect our NHS, but with so much happening, it's hard to get this government to listen.

  This is the final push of our trade bill campaign and it is our one opportunity throughout this campaign to speak directly to Boris Johnson before MPs finally vote on the NHS protection amendment. 

  Cat, Pascale, Chris, Alice, Johnbosco - the We Own It team

  Read more ...
  

Thursday 14th January 2021

Oxon Keep Our NHS Public

• Campaigners’ concern over Covid-19 vaccinations delivery
  
  Reports of shortages of supply and logistical chaos in delivery batches of Covid-19 vaccine to GP surgeries in Oxfordshire have led local campaign group Keep Our NHS Public to call for changes.

  The 12 January online meeting of Oxon KONP heard that:

  ·      There are shortages of vaccine supply to GP surgeries

  ·      Deliveries have been cancelled at short notice, disrupting vaccinating

  ·      Surgeries reported they could deliver 6 to 10 times more vaccination doses than they are being supplied

  ·      Some clinical staff in Oxford have received both doses of vaccine, some just one, but others in Banbury have received neither.

  ·      Also in Banbury, one group of 4 GP surgeries has delivered both vaccine doses to patients, while smaller surgeries have not received any vaccine 

  ·      One local group of 11 volunteer vaccinators have been told they have to apply via private company  

  One doctor said: 

  "National vaccination hubs are not the answer.

  A reliable, greatly increased  supply of vaccine to GPs and hospitals is. 

  It is very important to remember that protection from does not kick in until up to three weeks after vaccination, and if  you’ve been vaccinated you still need to distance, wear a mask, and wash hands as before. 

   

  Bill MacKeith, secretary of Oxforshire Keep Our NHS Public ONP said: 

  "We are concerned to hear that the nearest national hub is Epsom Racecourse in Surrey, and that private companies are recruiting vaccinators.

  "We have seen this government-imposed, centralised   drive to privatisation throughout the pandemic.         

  "Our local MPs and councillors must call for  vaccination, like other health service provision, to be delivered locally by trusted practitioners. "

   

  Campaigners agreed to call for all school workers, not only teachers, and in care homes and home visitors to be given the vaccine as priority.

   

  Contact: Bill MacKeith bmackeith@gmail.com 01865 558145

Thursday 7th January 2021

John Lister

• Time running out to respond to consultation on "integrated care"
  
  Tomorrow January 8 is the closing date for responses to NHS England's consultation on potential changes to the law to give statutory powers to "Integrated Care Systems."

  The NHS England proposals would repeal some, but by no means all of the Health and Social Care Act of 2012, and strip away even more local accountability, while opening the possibility of greater private sector involvement in the running of services, and tightening financial controls that are likely to lead to reductions or exclusions of services.

  Keep Our NHS Public has developed some model responses to the consultation:

  1. https://keepournhspublic.com/wp-content/uploads/2021/01/KONP-ICS-consultation-cover-letter-2021-01-03.docx

  2. https://keepournhspublic.com/wp-content/uploads/2021/01/KONP-ICS-consultation-model-responses-2021-01-03.docx

  We urge as many people as possible to submit a response by the deadline

  Read more ...
  

Tuesday 5th January 2021

Charmaine Morgan, Chair SOS Grantham Hospital

• Say No to NHS England plans for "integration"
  
  Press Release 

   

  District Councillor Charmaine Morgan, Chair SOS Grantham Hospital is urging people not to support Government Plans to restructure the NHS currently under Public Consultation. 

  The deadline for the response is 8^th January, and the link to the consultation is https://www.engage.england.nhs.uk/survey/building-a-strong-integrated-care-system/

  Cllr Morgan said:

  Whilst the integration of Health and Social Care is a laudible aim this policy is being used by the Government to restructure decision making within our NHS, further reducing public accountability and further enabling opportunities for the private sector. 

  The new proposal will see the removal of Clinical Commissioning Groups and replacement with 42 new less accountable, tightly funded regulatory Integrated Care Systems. Within the structure the Health Systems Support Framework (HSSFs), private companies are being promoted as 'vendors' by the Government who are specifically instructing NHS decision makers to use them for analytical data.

  Furthermore the 'vendors' will have positions on the new ICS boards. Previously Public Health were able to provide this information and worked with local authorities. 

  The overall objective is to robustly cut our A&E infrastructure and hospital bed time using proactive medical intervention. On the face of it improving public health to reduce the need for medical intervention is a good thing. However, how this is done is extremely important to reduce inequality around access to care, and to ensure there are no gaps in healthcare provision.

  This strategic approach depends on there being an increasingly healthy population. The use of private firms is wholly unnecessary to achieve this aim.

  In the UK this policy has led to a loss of NHS beds and cuts to NHS A&E services nationally. This is before other proactive medical interventions have been put in place, and, before there have been signs of improvement in public health.

  On the contrary the indications are that austerity has led to a reduction in life span for those on low income. Low income men live on average 7 years less than wealthier contemporaries.

  Covid 19 is leaving many with long term medical complications too. Locally NHS Improvement instructed ULHT to review the number of A&Es in Lincolnshire. According to them we have too many. That's why we did not see Grantham A&E reopen 24hrs and why ULHT are pushing for an Urgent Treatment Centre at our local hospital. 

  Long waiting times tell us this is not the time to tighten the squeeze on our A&E or medical treatment network. Covid 19 has highlighted the pressure our NHS hospital staff and beds were already under and worsened the situation. 

  To fully appreciate what less public accountability means in the NHS we need only look at the decisions ULHT have made affecting Grantham Hospital services over 5 years.

  Lincolnshire County Council Health Scrutiny members are only consulted after decisions are made. Only a protracted referral to Sec. of State for Health or legal action can subsequently block or overturn ULHT decisions.

  The existing CCG’s involvement is barely noticeable with the current chair allowing all healthcare providers to do their own thing. There is no elected public representation on the CCG or ULHT. There is a deficit in democracy within NHS decision making now.

  Patients and local businesses, who after all pay for services through taxes, have little or no say on what services are provided. This issue will remain under the new plans but the voice of private health companies will be heard.

  This means £ms more wasted on bureaucracy and profits that could be focused on frontline NHS, Public Health and Social Care services. 

  It is hugely cynical of the Government to be holding such an important consultation over Christmas, and, when eyes are turned towards the pandemic. Nor will most people appreciate its significance. The pandemic is revealing how fragile our NHS is. It needs bolstering not squeezing and help, not undermining, at this critical time. 

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Friday 18th December 2020

John Puntis, Co-chair KONP

• Save lives this Christmas – reverse household mixing advice
  
  COVID-19 will not take a week off. The decision by this government to allow up to three families to mix indoors for 5 days over Christmas will be disastrous and could mean many will die unnecessarily. After our Christmas celebrations are over, we will be counting the cost in our families and communities as the death toll inevitably rises. 

  Cases are already worryingly high, and our hospitals already pushed to the limit on top of the usual winter pressures. Staff on the frontline of this pandemic are struggling to cope with cases now, and if the government does not take swift action we are headed for a catastrophe, the like of which the NHS has never seen.

  I am a recently retired doctor and I’ve witnessed illness and death many times in the course of my working life. I live alone and have a family of four children and their partners, including a new grandchild. Despite this I have made the tough decision not to see any of them this Christmas. We all want to spend time with our loved ones but this is a national emergency, if I can do it, so will many others if given the right advice.

  I would recommend you please show care for your family and loved ones by not meeting inside with vulnerable friends or relatives this Christmas. But the government must also reverse its current household mixing plan now.

  The government’s failure to create an effective ‘test and trace’ system and lack of support for those needing to isolate means that Covid-19 infection is once again on the rise with life threatening implications for many.

  Please sign my petition for the government to be honest with people and do the right thing by giving a clear public health message: “Stay at home this Christmas and save lives - protect your family and all your loved ones.” Thank you.

  Sign the petition at Change.org

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Tuesday 27th October 2020

EPSU

• European mobilization of health and care workers
  
  (Press Release, Brussels, 9 October 2020) Leaders of trade unions representing health and care workers that are affiliates of the European Public Services Union (EPSU) are calling for a European week of action 26-30 October. This call follows a meeting 8 October, in which the union representatives discussed how the pandemic was dealt with.

  The second wave of the pandemic has begun even before the winter has even season started. It once again puts health and care under massive strain. A rapid surge in cases is being witnessed across Europe. Again, unions report a lack of the necessary Personal Protective Equipment (PPE), material and staff to withstand this new rise in infections. And many workers are still feeling exhausted and under stress after having dealt with the first wave.

  Jan willem Groudriaan, EPSU General Secretary says “EPSU and its members urge the European Union and national governments to make PPE for staff available in all hospitals, and health and social service institutions.

  We will stand up for our public health and social care systems so they can respond to the this and future pandemics”.

  A week of action will take place from the 26-30 October across Europe. It will coincide with the call of the International Trade Union Confederation (ITUC) and the global trade union federations for a day of action, “investing in care now”, on the 29 October.

  Nurses, doctors, healthcare assistants, elderly and home care and other frontline workers are mobilising across Europe with these demands:

  - higher wages

  - more staff

  - quality care for all

  We must ensure that the right lessons are learnt from this pandemic and that those at the forefront receive what is necessary to continue the fight against Covid-19. In the next few days, a manifesto explaining our proposals for future reforms of healthcare will be published, outlining the opportunities to transform health and social care in the long term.

  For more info: Pablo Sanchez psanchez@espu.org 0032 (0)474626633

  
  

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Tuesday 29th September 2020

Public service International – People Over Profit

• CUPE lauds decisive win for public health care in BC Supreme Court decision
  
  Canadian public sector union CUPE is applauding the BC Supreme Court’s decision to protect Canada’s universal public health care system in a ruling released today on the Cambie v. British Columbia case. The case was brought by Dr. Brian Day, CEO of Cambie Surgeries Corporation, who is seeking to overturn the ban on for-profit health care and bring a US-style medical system into Canada.

  “Health care in Canada is a right, not a market commodity. This is a decisive win for universal public health care in Canada,” said CUPE National President Mark Hancock.

  “Our health care system doesn’t need more venture capitalists, it needs more funding, beds, and health care workers to help improve quality of care and reduce wait times and backlogs. CUPE will keep up the fight for public solutions to the challenges facing our health care system, along with our allies.”

  In 2012, Dr. Day was found guilty of overcharging patients almost half a million dollars in a 30-day period, but challenged that ruling and filed a Charter challenge, alleging that the Canada Health Act and provincial health legislation violates his freedoms by restricting private, for-profit health care.

  Today’s ruling dismisses Dr. Day’s claims and affirms the deeply-rooted Canadian value that people should receive health care based on what they need, not what they can pay.

  Had the court validated Dr. Day’s claim, it could have opened the door to a two-tier health care system that would have exacerbated wait times and prioritized profits over patient care.

  “Privatization of services, like cataract surgeries in Manitoba and MRIs in Saskatchewan, have already shown us what happens when we privatize health care: even longer wait times and a two-tier system that drains resources from everyone who relies on the public system,” said CUPE National Secretary-Treasurer Charles Fleury.

  CUPE is Canada’s largest union, representing 700,000 workers nationwide, including 158,000 health care workers across the country.

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Saturday 11th April 2020

John Lister

• John Pilger film The Dirty War on the NHS, streaming online
  
  From Monday April 13 for a week Curzon Home Cinema will be streaming John Pilger’s film The Dirty War on the NHS, which was first released just before last year’s election. This could not be more timely. The government is telling us to stay at home and “protect the NHS”.

  John’s film spells out the reason why the NHS might be overwhelmed by the impact of the coronavirus: the lack of resources which are the direct result of the policies of the last ten years and the devastation caused by sustained privatisation.

  At the end of the film Professor Danny Dorling foresaw what we are now going through: "The NHS gave us freedom from fear .... now that fear has returned." This is a film to enrage, but also to inspire: to make sure that when the pandemic is over, the NHS is rebuilt as a properly funded public health system.

  WATCH ONLINE FROM MON 13 APRIL

  On Wednesday 15 April, there will be a live Q&A with two of its main contributors — Professor Allyson Pollock and Dr John Lister at 8.30 pm, which will be beamed live to your homes via Youtube, Twitter, Facebook and Curzon Home Cinema.

  

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Thursday 19th December 2019

John Lister

• After the election – the broken promises
  
  It might take voters who have returned Boris Johnson’s government for a 5-year time with an 80-seat majority a while to catch on – but the promises Johnson made on the NHS, which some clearly believed, are already being diluted and broken – or were simply inadequate in the first place.

  The Queen’s Speech makes this very clear. There is a big gesture of enshrining the promised extra money for the NHS in law: but this also means that there is no immediate prospect of increasing the funding above the level set out in the manifesto – despite all of the evidence that the NHS is now drastically under-funded and failing to deliver performance targets after almost a decade of austerity-driven real-terms cuts.

  NHS Providers, while grateful for any relaxation in the virtual freeze on funding, has pointed out that if NHS spending had increased in line with the previous average prior to 2010, the Department of Health and Social Care budget would by now be £35 billion higher than it is.

  The Johnson government has now promised to increase spending by “£34 billion” over five years – but the government’s own figures show than taking inflation and cost pressures into account that will only be worth £20.5 billion in real terms.

  In other words real NHS budgets in 2024 will still be miles short of the level needed to deal with today’s increased population, a substantially increased older population, and nine years of decline that have left trusts in debt to the tune of £14 billion.

  That’s why hospitals are struggling to deliver A&E performance targets, waiting list targets, cancer treatment targets, and why tens of thousands face trolley waits and delays in ambulance transfers every month this winter – and for the foreseeable future. Similar delays and shortages will continue to impact on mental health services, GP services and community services.

  Social care has again been kicked into the long grass, with vague proposals to seek a “cross party” consensus having failed to make any headway in the past 9 years, while the yawning gaps in services leave over a million vulnerable people without any care at all.

  Staff shortages of course are another major factor, and ministers repeatedly tied themselves in knots trying to explain the promise of an “extra” 50,000 nurses. In fact it’s clear that the plan is for an increase over TEN years, not five. And it hinges on trying to retain over 18,000 nurses who are already working for the NHS: in other words only 32,000 “extra” nurses would be added. To make matters worse, while talking about extra “nurses”, it also relies on using thousands of less qualified nursing assistants to cover for qualified staff.

  The promised restoration of the bursary turns out to be nothing of the sort: those applying for nursing course would get a £5,000 hand-out, but still have to pay the £9,000 per year tuition fees, which David Cameron’s government introduced.

  The plan for extra nurses also relies heavily on further recruitment from overseas. It’s not clear if many of those who see Brexit as a way to reduce immigration were aware of the extent to which the entire NHS depends on migrant workers.

  The Queen’s Speech states that “a new visa will ensure qualified doctors, nurses and health professionals have fast-track entry to the United Kingdom.” But recruitment from the EU has fallen massively since the Brexit vote, and the new £400 visa plus the immigration health surcharge, which ministers have recently pledged to increase to £625 per person, mean that after Brexit EU nationals will face a new £1000-plus up-front cost in coming here – in addition to paying the same taxes that we do: how this is supposed to attract extra recruits is a mystery, especially given the increased incidence of racism towards overseas staff.

  The Conservative manifesto pledge to scrap some hospital car parking charges, for night shift workers and for some severely ill patients, also turns out to be deceptive. Whereas Wales and Scotland have abolished these charges which land unfairly regardless of ability to pay, they remain a major problem in England.

  A large majority of people using hospital car parks – outpatients, visitors and day-shift staff – will still have to fork out hefty sums to park, while the continued centralisation of services and loss of local access in many areas, combined with poor or non-existent public transport, ensure that many have no choice but to travel by car.

  Reduced to a mere heading in the Queen’s Speech, with no further explanation is the proposal for an “NHS Long Term Plan Bill” – to implement a 10-year plan that lacks adequate revenue or capital funding, a coherent workforce plan, or any details on how some of its ideas are to be translated into reality: it also embodies deeply worrying plans to strip away the last vestiges of local accountability and implement so-called “integrated care provider” contracts that carve the NHS up into 44 separate health services, with fears that this could open the way to larger-scale private sector involvement.

  And it’s clear that only six of the promised “40 new hospitals” will even get beyond the drawing board before 2024, while 21 other trusts have been fobbed off with a share of £100m “seed funding” to draw up plans that the next government will have to finance, and over 100 trusts with hefty and rising backlog maintenance bills know they will get no help to repair and upgrade buildings or equipment unless the new government does an abrupt u-turn in the budget.

  To sum up, if anyone really believed that Johnson’s “new” Conservative government, following nine years of Conservative governments, was going to pump big money into the NHS and tackle the problems that are increasingly in the headlines, they will have five miserable years to reflect on how wrong they were.

  Health Campaigns Together, working closely with Keep Our NHS Public, warned of precisely these dangers in our campaign: and we will fight on at local and national level wherever and whenever we need to in our efforts to limit the damage, highlight the problems, and press for a change of course.

  We still have a lot of NHS to defend against cutbacks and privatisation.

  The fight won’t be over until we have won.

  John Lister

  Editor, Health Campaigns Together

  19/12/19

  
  

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Monday 25th November 2019

We Own It

• Hands Off Our NHS week of action kicks off!
  
  We've launched our week of action for the NHS today in Parliament Square, as we showed that the NHS is in fact on the table for a Trump trade deal.

  

  Activists and NHS workers gathered in Westminster from midday to show that we're not fooled by the Conservative's promise that the NHS is 'not for sale'.

  Campaigns Officer for We Own It, Ellen Lees said:

  “The NHS is the most important issue for voters in this election campaign. And the public don’t want to see it sold off as part of a trade deal with Donald Trump. The only we can prevent that is to end privatisation and ensure that the NHS is a fully public institution. Otherwise, the NHS will be automatically on the table in any trade deal with the US. 

  “It’s absolutely vital that Boris Johnson joins other leading politicians - including Jeremy Corbyn, Liz Saville-Roberts and Caroline Lucas - in pledging to take our NHS off the table once and for all by ending privatisation.”

  We heard from inspiring activists including Hosnieh Djafari Marbini, an NHS Doctor and Oxford City Councillor; Gay Lee, from Keep Our NHS Public; Sonia Adesara, who started the incredible change.org petition which now has nearly 1 million signatures, and Heidi Chow from Global Justice Now.

  

  THANK YOU TO EVERYONE WHO TURNED OUT! IF YOU'RE LOOKING FOR WAYS TO GET INVOLVED, YOU CAN:

  1. Ask your candidates to sign up to our pledge to protect the NHS
  2. Be part of our national week of action
  3. Join KONP and their NHS Roadshow
  4. Sign the change.org petition to keep our NHS off the table
  5. Take action with Global Justice Now: Ask the government to publish the full unredacted trade negotiation documents

  
  

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Sunday 20th October 2019

Patients not Passports

• 23rd October 2019 – Counting the Cost of the Hostile Environment in the NHS Vigil & protest for the victims of the Hostile Environment
  
  Please join us on October 23rd for two actions to mark the 2 year anniversary of the expansion of charging and ID checking across the NHS.

  There will be events happening simultaneously across the country – in London, Bristol, Birmingham, and Manchester.

  We will highlight the harm done by racist Hostile Environment policies in our NHS. We will commemorate those who have died and suffered, and those who are currently suffering, as a result of these policies.

  Join us to demand an end to all forms of immigration control in our health service and universal healthcare for all.

  Morning: Direct action at a central London location (we will post further details soon).

  4:30 – 21:00: Vigils

  Vigils outside:

  – A central London Hospital (site to be confirmed)

  – Lewisham Hospital

  London facebook event

  Bristol facebook event (5.30-7.30pm at Bristol Royal Infirmary, hosted by Bristol Patients Not Passports)

  Birmingham facebook event (5.30-7pm at Queen Elizabeth Hospital, hosted by Docs Not Cops Birmingham)

  Manchester facebook event (5.30-6.30pm at St Peters Square, hosted by Docs Not Cops, Unis Resist Border Controls and Greater Manchester Keep Our NHS Public)

  For more information on charging in the NHS and challenging the Hostile Environment, see

  
  

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Wednesday 16th October 2019

PDA Pharmacists Union

• Results of survey on impact of Brexit on supply of medicines
  
  Results of survey of pharmacists about problems with medicines supply and the possible effects of Brexit

  The PDA undertook a survey of pharmacists in August/September and it has received over 1,000 responses.

  Pharmacists who responded said that on average they had already seen shortages affect 21% of prescription drugs in the last 3 months, with over 90% of respondents feeling that the shortages had increased over the last 12 months.

  Dealing with drug shortages is already taking up significant time with 62% of respondents saying they spend an hour or more every day trying to sort out problems caused by medicine shortages.

  25% said that they were aware of patient harm as a result of shortages.

  When asked about the effect of a no-deal Brexit, over 81% of respondents felt that medicines shortages would get worse, with 55% believing they would get ‘much worse’.

  The full survey including numerous comments from concerned pharmacists can be found at the link below.

  
  

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Monday 14th October 2019

United Voices of the World (UVW) Press Release

• Major West London Hospital to be hit by serious disruption as over 170 cleaners and porters walk out
  
  LONDON - - Over 170 cleaners and porters, 150 of them members of the trade union United Voices of the World (UVW), have voted overwhelmingly to take strike action this October at St. Mary’s Hospital in what will be one of the longest strikes in NHS history.

  The striking workers will walk out on the 28th and 31st of October to demand equality in pay and working conditions with directly employed NHS staff. Their union has publicly committed to successive weeks of strike action that will stretch well into December if the demands of its members have not been met.

  Outsourced by Imperial College Healthcare NHS Trust to French multinational Sodexo, the striking workers are paid an hourly rate of £6.16 - £8.21, far below the £11.31 - £12.92 that in-house cleaners and porters receive under the NHS’ Agenda for Change (AfC) pay scale system.

  The striking workers only have Statutory Sick Pay (SSP) and cite this as forcing them to work on wards when ill - sometimes with contagious illnesses such as the flu - as they cannot afford to take time off when sick.

  The workers are also forced to change in mice ridden dimly lit and mixed sex changing rooms located in the hospital basement.

  They are campaigning for better single sex changing facilities as well for an end to discrimination against outsourced staff that has seen Imperial ban them from eating in NHS canteens and resting in NHS staffrooms.

  One striking cleaner said, “I work 55 hours a week just to cover my rent. This [St. Mary’s] is my home, I spend more time here than in my house. Yet I am treated like a dog and made to feel like dirt”.

  Co-Founder of United Voices of the World and organiser of the strikes, Petros Elia, said:

  “In 2018 alone Sodexo turned a profit of 997 million euros, for the last four of the five years that its held a contract with Imperial its now former CEO, Michel Landel enjoyed obscene executive pay totalling nearly a million pounds a year and annual bonuses of up to 200% of his salary. Sodexo can afford to pay our workers in line with NHS rates and we urge them to do so - otherwise the strikes will continue”

  --ENDS--

  Our members demands per strike are as follows:

  * St. Mary’s Hospital – Complete equality in pay and terms of conditions between outsourced facilities staff and in-house NHS staff as set by the Agenda for Change (AfC) payscale system; vaccinations; improved single sex changing facilities and access to NHS staff canteens and staffrooms.

  Strike dates are as follows:

  * St. Mary’s Hospital – Round 1. 28^th, 29^th and 31^st of October. Round 2. 11^th, 12^th and 13^th of November. Round 3. 25^th, 26^th, 27^th and 28^th of November. Round 4. 9^th, 10^th, 11^th, 12^th and 13^th of December.

  About UVW: United Voices of the World (UVW) is a London based trade union. The majority of its members are migrants predominantly from Latin America and the Caribbean, working in the low paid economy. In 2016 the union organised the largest cleaners strike in UK history and became the first trade union to force a UK university to bring the entirety of its outsourced cleaners in-house.

  The striking workers will be joined by over other striking workers and members of UVW in what the union has dubbed an “Autumn of Discontent”. This will include striking café workers from the University of Greenwich, security guards from St. George’s University, security guards from the University of East London, gardeners and cleaners from London’s Royal Parks, cleaners from the headquarters of ITV, Channel 4 and the Ministry of Justice (MoJ).

  
  

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Friday 4th October 2019

The NHS complicit in the exploitation of migrant workers: it has to stop!

• By Petros Elia, Co-founder and organiser, United Voices of the World
  
  This October United Voices of the World (UVW) will coordinate ongoing and indefinite strike action across London. Strike action that will see our members – the majority of whom are migrants – enter into direct conflict with several of the capital’s biggest employers; with the largest strike set to take place at St. Mary’s Hospital where over 170 of our members working as outsourced cleaners and porters will demand that their employer - French multinational Sodexo - grant them parity in pay and working conditions with NHS staff.

  UVW has years of experience in organising low-paid migrant workers, and we have seen just how big the scale of complicity is between outsourcing companies and their clients in propping up what is at its core, a racist economic model.

  Our members are employed by some of the world’s biggest outsourcing companies, companies that report annual profits in hundreds of millions to billions of pounds. Yet these profits are made by paying migrant workers poverty wages and employing them on the worst terms and conditions legally possible.

  In other words, the outsourcing model is inherently predatory and thrives upon creating a racialised two-tier workforce in which ethnic minority workers - and in particular ethnic minority women – are forced to bear the brunt of brazen exploitation. 

  When people read stories of how Harrods, Chanel, Ferrari and Topshop have been complicit in hiring migrant labourers who are paid poverty wages and enjoy little to no job security the majority are, rather cynically not that surprised. Yet what would surprise many, is the degree to which supposedly “socially responsible” employers, such as the University of London - which incidentally will experience strike action at three of its universities this October (Greenwich University, the University of East London and St. George’s University) - have also become complicit in propping up this predatory, and ultimately, racist economic model.

  But nowhere would people be more alarmed to see this than in the National Health Service (NHS). The NHS was originally founded according to the principle that healthcare is a human right and not a privilege. And that as need takes priority over the ability to pay, a healthcare system should be both free at the point of use and publicly owned and funded. So as to ensure that we as a society can mutually insure one another from the risk and certainty of illness.

  But from the infamous “salami slicing” of Thatcher through to the privatisation of the Blair years and the savage onslaught of austerity and privatisation unleashed by successive Conservative led governments, we have seen the erosion of this egalitarian logic.

  The hostile environment policy which brought us the Windrush Scandal and has seen both British citizens, migrants and asylum seekers denied NHS medical treatment - in some cases lifesaving treatment - and is one of the starkest reminders of how the NHS is not immune from wider societal logics of racism, of which the proliferation of the outsourcing model is another symptom.

  It has now become routine for NHS Trusts to outsource entire swathes of their facilities operations to outsourcing companies, meaning that taxpayers’ money is going to companies who make their profits by exploiting and mistreating primarily migrant workers. And French multinational Sodexo who has held a facilities contract with St. Mary’s Hospital since October 2014 is one of the worst offenders.

  Sodexo pays the cleaners and porters who work tirelessly to keep the wards of St. Mary’s Hospital infection free an hourly rate of £6.16 - £8.21 per hour, leaving them £6K - £10K worse off per year than their NHS colleagues of a similar grade. It also employs them on the worst terms and conditions legally possible and has brazenly endangered both their safety and patient safety by refusing to comply with its legal obligation to vaccinate its workers. Yet Sodexo’s disregard for worker and patient safety does not stop there.

  Our members have consistently asked Sodexo to provide them with sufficient spare uniforms so that they can wash their uniforms after a day’s work and still turn up in fresh ones the following morning. Rightly they do not expect that they should have to work in dirty uniforms and increase the risk of spreading infection on the very wards they are trying to keep clean. Nor do they expect to be paid so little and have such little job security that they have to turn up to work when they themselves are ill – and therefore risk spreading flu But in its desire to make a profit, and to pay out obscene executive pay and bonuses, Sodexo has happily endangered the safety of its workers and patients.

  Recently, UVW analysed Sodexo’s Annual Reports from 2014 – 2018 which cover the last four of the five years Sodexo has held a contract with Imperial College Healthcare NHS Trust. What they revealed was a company making staggering yearly profits – in 2018 alone Sodexo made a profit of 994 million euros – and a board of directors enjoying obscenely high annual salaries and bonuses whilst forcing our members to work in dirty uniforms for poverty wages.

  Between 2014 – 2018 the now former CEO of Sodexo, Michel Landel, enjoyed an annual salary of 933,400 euros and annual bonuses equivalent to 200% of his salary. On top of this he annually received 42,000 “performance shares” which between the years 2014 – 2018 were estimated by Sodexo to have a combined value of 10,629,760 euros. And what needs to be understood is that this is not an anomaly with one greedy CEO sat at the top of a company taking more than is his fair share.

  All of Sodexo’s non-executive directors have enjoyed ever increasing annual salaries worth hundreds of thousands of pounds and ever-increasing directors’ fees (in 2013 Sodexo paid out €561,840 in directors’ fees whilst in 2018 the figure stood at €879,000) during the same time in which our members have struggled to scrape a living.

  Ultimately our members are not asking for the earth; they are simply asking to enjoy full equality in pay and working conditions with their NHS colleagues and that Sodexo provide them with sufficient uniforms and adhere to its legal obligation to vaccinate them. As a union we cannot stand by whilst workers are exploited and as a campaigning trade union with anti-racism at our core, we also have a duty to call out the clients of outsourcing companies for propping up a business model that is explicitly predicated upon the exploitation of migrant workers.

  And this is needed now more than ever, given the toxic climate against migrants that has been created by the Brexit referendum. With even some who claim to be on the left parroting the narrative that the decline and stagnation of wages and union density over the past decades is a result of migrant labour pushing wages down. Something which could not be further from the truth: it is companies like Sodexo who push down wages, and the Left’s answer can never be turn amongst ourselves and pit migrant workers against national workers. The answer is to organise and challenge the outsourcing model head on. 

  The public would not take kindly to knowing that the NHS – an institution originally founded upon the principles of social solidarity and equality – is becoming complicit in paying the hardworking staff upon which both it, and patients rely, poverty wages. Our members are not the dirt they clean, they deserve better. And that is why this October they will go on strike. And you can support them by donating to their strike fund at www.uvwunion.org.uk/strikefund  

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Monday 16th September 2019

Irwin Mitchell solicitors

• Court Of Appeal Grants Fresh Challenge Over Closure Of Services At South Tyneside Hospital
  
  Permission Granted To Appeal Judicial Review Decision

  Campaigners battling to prevent the closure of vital services at South Tyneside Hospital have been given a lifeline in their legal challenge, after they were granted permission to appeal the outcome of a judicial review related to the plans.

  The Save South Tyneside Hospital Campaign Group has long-held concerns regarding NHS Sunderland CCG and NHS South Tyneside CCG’s decision to move maternity, women’s healthcare, paediatric and stroke services away from the hospital.

  The campaign group instructed Irwin Mitchell’s specialist Public Law team to help challenge the decision.

  While this led to the group gaining permission for a judicial review at the end of last year, the hearing did not lead to a rethink of the proposals.

  However, the campaigners and legal experts have now been granted permission from the Court of Appeal to appeal the outcome of the judicial review and once again take their concerns about the closure of the hospital services to court.

  Helen Smith, the specialist public lawyer at Irwin Mitchell’s Newcastle office who is representing the Save South Tyneside Hospital Campaign Group, said:

  “Despite the conclusion of the judicial review, we have always remained concerned by the processes used to make this decision regarding absolutely vital hospital services.

  “This is a hugely important issue which affects healthcare access for a great number of people in the region and it is clear that any decision should be taken with the utmost care.

  “It is welcome that the Court of Appeal has allowed us to challenge the original decision and we are determined to once again ensure our clients’ voices are heard on this matter.”

  The Save South Tyneside Hospital Campaign Group had a range of concerns regarding the closure of the services, including that the consultation on the issue in 2017 was not fair. Campaigners also believe that any decision taken by the CCGs involved would be unlawful.

  Irwin Mitchell will argue on behalf of the group in the Court of Appeal that the decision making process was pre-determined against retaining services at South Tyneside Hospital. Campaigners believe that not enough information regarding the various options was included in the public consultation and that not enough consideration was given to the financial, staffing and patient access implications of the decision.

  Roger Nettleship, a spokesperson for the Save South Tyneside Hospital Campaign Group, said: “Everyone involved in the group and others across the local community are devastated by the impact that these closures could have, with them particularly relating to vital services for young children and women.

  “We have always felt that the move would be a disaster for the area and it was hugely disappointing to see the judicial review conclude in the manner that it did.

  “Getting permission to appeal is very welcome and we hope it is another opportunity to highlight just what these changes would mean for our area.

  “It feels like we have been ignored in some respects and I hope now that this appeal is a chance to ensure we have our say on this incredibly serious issue.”

  A hearing in the Court of Appeal is expected to be held in early November.

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Saturday 31st August 2019

Louise Irvine, Save Lewisham Hospital Campaign

• Legal basis for public consultation on CCG mergers.
  
  Across England there are plans for CCG merger. For example in south east London all six CCGs are proposing to merge. This is to carry out the intention of the NHS Long Term Plan which is that there should be one CCG for each "Integrated Care System".

  86 CCGs are planning to apply for merger to take effect from April 2020. To do that they have to get their merger applications to NHS England by September or October at the latest. This process is being rushed through without public consultation.

  Many people are very concerned about this because the new large merged CCGs will cover huge populations of over a million people and be even more remote and less accountable than CCGs are at present.

  With remote centralised CCGs covering very large populations there will be little or no chance in the future of CCGs listening to and acting on the wishes of local people when they are concerned that decisions taken centrally are not in their interests. CCG merger will significantly reduce local NHS democratic accountability.

  We believe the real reason for CCG merger is to confer statutory authority to the ICSs. We believe this is part of Simon Stevens “work around” to reorganise the NHS in a top down fashion while avoiding changes to legislation.

  This is such an important issue that we were surprised there was no requirement for public consultation. We got some legal advice that pointed us to regulations and legislation governing CCG mergers that strongly indicate that public consultation is required.

  I attach the explanation and links to the relevant legislation here.

  Several local campaigns and councils are very interested in using this to challenge their local CCG’s decision not to consult, and to demand public consultation. Public consultation would mean that the applications would not get to NHS England in time for mergers to take effect from April 2020 and they would be put back a year, buying us time for further campaigning on the issue of CCGs and ICSs. By then there might even be a change in government.

  If you think it is relevant to your area then please feel free to use this information and write to your CCG, local Council including the scrutiny committee, and local MPs and demand public consultation on merger plans.

  Legal basis for public consultation on CCG mergers.

  Many CCGs across England are proposing to apply to NHS England to merge. They claim there is no legal requirement to consult the public on this. We believe this is a misinterpretation of the legislation and regulations. The following explains our reasoning. Quotes from legislation are in italics.

  The relevant legislation is contained in the 2006 NHS Act, as amended by the 2012 Health and Social Care Act, which legislated for the creation of CCGs:

  http://www.legislation.gov.uk/ukpga/2006/41

  The relevant regulations are s9(2) and (3) and then Schedule 2(f) and Schedule 3(e) of the National Health Service (Clinical Commissioning Groups) Regulations 2012, which came into force immediately after the commencement of section 25 of the Health and Social Care Act 2012. http://www.legislation.gov.uk/uksi/2012/1631/pdfs/uksi_20121631_en.pdf

  NHS Act 2006

  Section 14G of the NHS Act 2006 says that merger of CCGs entails the dissolution of the pre-existing CCGs and the formation of a new CCG.

    14G Mergers

  (1) Two or more clinical commissioning groups may apply to the Board for—

  (a) those groups to be dissolved, and

  (b) another clinical commissioning group to be established under this section.

  This is followed by section 14H of the Act governing applications to the Board (NHS England) for CCG dissolution. 

  Regulations related to dissolution of CCGs

  Regulations s9(3) and Schedule 3(e) say that if a CCG is applying to the Board for dissolution then the Board has to take into account the extent to which the CCG has sought the views of individuals to whom any relevant health services are being or may be provided, what those views are, and how the CCG has taken them into account. It defines relevant health services as health services pursuant to arrangements made by the CCG in the exercise of its functions. This means the views of the whole population for which the CCG is responsible must be sought, and that would require public consultation.

  In addition, and in case it were to be argued that CCG merger does not entail CCG dissolution, but rather a change to the CCG constitution to vary the area or list of members, then section 14E of the Act (Applications for variation of constitution) and related regulations s9(2) and Schedule 2(f) would apply. This would also require public consultation.

   

Friday 23rd August 2019

Mike Forster, chair Health Campaigns Together

• Bradford NHS Strikes end in Victory!
  
  Having completed three weeks of strike action, the UNISON members at Bradford General Infirmary and St Luke’s Hospitals have chalked up a significant victory having already voted to take indefinite strike action from August 26. 

  In last minute talk brokered by ACAS, the Hospital Trust has agreed not to proceed with its plans to transfer all staff out of the NHS on October 1. UNISON has instead been given the right to address the whole management board on September 12, and the Board will respond to UNISON by the end of the month. If they decide to continue with their plans, the earliest they can now proceed will be February 2020.

  This is an historic and significant victory which has punched a big hole in the Trust’s ambitions and will force the government and NHS England to rethink their whole strategy to farm out NHS services. There is no doubt that once the Trust heard that the strikers had decided to come out on indefinite strike they were taken aback and asked for more talks. 

  The strikers had taken a bold and brave step to stay out and deserve our full solidarity. The Trust had badly miscalculated the mood of their staff and had walked into a dispute they could not win.

  The Hospital Trust’s original proposal was to transfer all the support and ancillary staff, attached to the Estates and Facilities Department, into an arm’s length private company, known as Wholly Owned Subsidiary Companies (WOSC). This would have inevitably resulted in the breaking up of the NHS workforce leading to far worse pay and terms and conditions.

  The WOSC idea is also a tax saving dodge for cash strapped NHS trusts as the new companies are exempt from paying VAT, unlike existing arrangements, so it is yet another bribe to force trusts to go down the privatisation road.

  WOSC’s were of course dreamt up by the Tories and pushed through by NHS England, so far with very little success. For some reason Yorkshire seems to have been chosen as a guinea pig region with Trusts trying to bring them in everywhere.

  They have been met with determined union resistance across the region in Leeds, Wakefield, York, Doncaster where they have largely failed apart from smaller towns where there is scattered union membership.

  Historically, this is a difficult group of workers to organise as it is made up largely of cleaning and domestic staff who tend to work part time and unsocial hours. Tracking them all down and persuading them to join the union is a painstaking and time-consuming task.

  It is to the credit of the two main unions, Unison and Unite, that they have managed to push back management in key Trusts.

  The Bradford Trust has been especially stubborn and were determined to try and drive the transfer through by 1 October 2019. Negotiations got nowhere in the early stages pushing the union down the path of strike action. However, even the most optimistic of activists could not have anticipated the amazing response of the strikers who have been out from day one in droves.

  The picket line was a wonderful sight to behold of colour, singing, noise and chanting, combining all the best of Bradford’s rich multi cultured population. Filipino, Afro-Caribbean, Asian and White British workers have all turned up in force singing and dancing the whole day through. Managers have been out to try and silence the drumming and singing … to no avail.

  As the dispute has progressed, so confidence has grown. Stories of dirty wards, toilets not cleaned, patients not being fed, massive cross contamination events have only stiffened resolve that the strike was having a big impact and punching a hole in the Trust’s finances.

  One day we witnessed a patient, well known to the striking security guards for his alcoholism, being dragged off the hospital grounds by G4S security and dumped on the pavement unconscious!! 

  Management originally held talks but only to try and buy time but they were the first to blink and suggested to the union ACAS was brought in. This actually inflamed matters at the strike rally on 8 August and the common refrain in response was to demand all out action to force the Trust’s hands.

  One striker summed up the entire mood shouting, ‘we have come this far, we can’t go back now’. There was frustration that they had first returned to work before coming out again but likewise there was a determination, which is only learnt through struggle, that there was no going back until victory.

  The vote for action was overwhelming and strikers were all united to ensure the Trust was brought to its knees. It was this spirit and determination which communicated itself to every level of management and they had to climb down from their initial arrogance.

  The UNISON leadership will now need to remain very vigilant and not to let this victory breed any complacency. 

  Lessons will be learnt from this important victory by all sides and activists will continue to maintain links with the strikers to ensure the solidarity support is maintained.

  This strike was of huge national importance and the victory could force NHS England to abandon the whole concept of WOSC’s and will give workers everywhere huge confidence that strikes can win. It will also restore morale to the whole NHS workforce as a result of this breakthrough here in Yorkshire.

  Messages of support and financial donations can still be sent to the branch along with requests for speakers about the important lessons which have been learnt. 

  Donations can be sent to: UNISON Health, UNISON Resource Centre, St Mary’s Hospital, Greenhill Rd, Leeds LS12 3QE

  Pay in donations to the account at Unity, UNISON Health Branch, Acc No 49021215 

  Sort Code 60-83-01

  Tel. No 01274 39683 Email: office.admin@unison-bradfordhealth.org.uk

  
  

  Read more ...
  

Saturday 17th August 2019

Unite Press Release

• Labour’s shadow health secretary Jon Ashworth to address Lincoln rally in support of striking health visitors
  
  Labour’s shadow health and social care secretary Jon Ashworth will give Lincolnshire’s health visitors ‘maximum support’ when he addresses a well-supported rally in Lincoln on Saturday 17 August.

  The dispute centres on the calculation by Unite that its 58 Lincolnshire health visitor members have lost more than £2,000 a year since they were transferred from the NHS to the county council in October 2017.

  The latest round of talks with the county council, under the auspices of the conciliation service Acas, broke down yesterday (Thursday) leading to Unite regional secretary for the East Midlands Paresh Patel to describe the council bosses as ‘turning old-fashioned pig-headedness into an art form’.

  The rally in Lincoln tomorrow will see the protestors meeting in the Minster Yard at 11.00. The march will start at 11.30 going through the city centre and ending with speeches at High Bridge. Lincoln’s Labour MP Karen Lee will also address the rally.

  Labour’s shadow health and social care secretary Jon Ashworth will tell the rally that: “An incoming Labour government will make the restoration of the health visitor service in England a top priority in terms of a major boost in recruitment numbers and the funding to match.

  “We will stop the constant salami slicing of the service witnessed in recent years which has led to the lowest number of health visitors in England since September 2009.

   

  “We will put an end to the grotesque pay anomalies and erosion of professional standards, such as currently exists in Lincolnshire.

  “We recognise the vital work that health visitors do for families and young children during those important early years – and that’s why I am here to give you maximum support.”

  The health visitors have already taken or scheduled 13 days of strike action. Today (Friday 16 August), two further 48 hour strikes were announced starting on 27 August and then on 5 September. Both actions commence at 00.01.

  Unite regional secretary for the East Midlands Paresh Patel said: “Unite will support our health visitors in Lincolnshire for as long as it takes against a council that has turned old-fashioned pig-headedness into an art form.

  “We call on local people to turn out tomorrow to show that their strong support for the health visitors who are the bedrock in local communities delivering a joined-up public health agenda for families, some of whom are in vulnerable circumstances.” 

  The health visitors are on the NHS Agenda for Change pay scales, but have had no increases in pay since being transferred to the local authority which has different pay rates – even though both council and NHS employees have received wage awards, these health visitors have not.

  Unite, which embraces the Community Practitioners’ and Health Visitors’ Association (CPHVA), is also seriously concerned about the downgrading of the health visitors’ professional status, resulting in fewer staff doing the specialist health visitor role.

SONIK Press Release

• COURT WILL REVIEW PLAN TO SLASH STROKE SERVICES IN KENT
  
  Save Our NHS In Kent, 11 Grosvenor Road, Broadstairs, Kent CT10 2BT. 07984 417489 / 07989 070843

  PRESS RELEASE

  It’s been announced that a court will review NHS bosses’ decision to slash the number of hospitals able to offer emergency stroke treatment in Kent. 

  The judicial review, mounted by health campaign group Save Our NHS in Kent, (SONIK) will be heard on the first available court dates from September. 

  Jon Flaig, the SONIK Chairperson said: “This is good news and is down to a great community effort. Ordinary people from across the county raised the £15000 we needed to contribute to the claimant’s legal aid and start the judicial review process.” 

  The spokesperson said the case was a vital one, of huge importance to Kent. The spokesperson said: “NHS bosses intend to close three out of the existing six hospital stroke units

  in Kent, which will greatly increase journey times for the most deprived populations. People in Thanet will be affected the worst. 

  “In Thanet ambulance journey time will go up by a staggering 300%, leaving residents a minimum of one hour away from urgent stroke care. Mortality and disability rates are bound to increase.” But the health campaigners claim NHS plans won’t just affect Thanet.

  “This is a definitely a Kent-wide problem. Medway, also a deprived area, will be badly affected, too, and the rest of Kent is likely to suffer due to the pressure on the whole system,” the spokesperson said. 

  A key part of SONIK’s case is that Kent needs at least four hyper acute stroke units (HASUs) and one must be in Thanet, to ensure that health inequalities are not exacerbated and all patients reach the care they need within approximately 35 minutes, and for a HASU (stroke unit) to be located in Thanet. NHS bosses are planning for only three HASUs in Kent.

  The SONIK spokesperson said: “Among other things we will argue that Kent’s NHS bosses did not properly consider the option of having more than three HASUs and did not consult properly with the public about their proposals. This is a battle we intend to win for the people of this area.”

  Carly Jeffrey, a SONIK spokesperson added: "The evidence suggests the decision to close stroke units in Medway, Thanet and Tunbridge Wells was a foregone conclusion. We believe that the public consultation was a box ticking exercise that was also designed to gloss over the fundamental flaws in the plans. There are councillors and medical professionals that have backed up our assessment. This is a national plan that they want to roll out across even more areas - so what is happening in Kent, with these very long journey times, is essentially an experiment and a forerunner of what could - and will - happen elsewhere".

  Read more ...
  

Wednesday 14th August 2019

Mike Forster, chair Health Campaigns Together

• A call to support striking NHS staff in Bradford
  
  

  After 3 weeks of strike action, the UNISON members at Bradford District Hospital have heroically voted for indefinite strike action in opposition to the Trust's plans to transfer ALL ancillary and support staff into a wholly owned subsidiary company (WOSC). The strike begins on Monday 26th August from 6am onwards.

  This strike has now assumed huge importance. (Read the I report here). The government plan to allow NHS regulators to begin breaking up the NHS workforce into privatised segments is very quickly unravelling. These plans have already been pushed back in most Trusts thanks to determined union resistance. A victory for the Bradford strikers will see the whole mad scheme thrown in the bin.

  The picket lines have been very well supported from Day One. The strikers are united, determined and confident but they need our support for this next critical stage of the dispute. 

  Health Campaigns Together is calling on all our supporters and affiliates to join the solidarity rally on the first day of the strike. We need messages of support and your banners and placards. We are appealing to you all to make the special effort to join us. The NHS is not for sale!

  HCT SOLIDARITY RALLY 

  MONDAY 26TH AUGUST 

  12 NOON

  BRADFORD DISTRICT HOSPITAL 

  Duckworth Lane, Bradford BD9 6RJ

  Please let our chair Mike Forster know if your campaign group, union or Party can provide a speaker, on 07887 668740 

  Email: Mike.forster56@gmail.com 

  Financial support

  Please don't forget you can also donate to the striking workers hardship fund by sending a bank transfer to:

  Name: Unity Trust

  Sort Code: 608301

  Account Number: 49021215

  Or a cheque to:

  Bradford Health Services Branch, Unison Office, Field House

  Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ

  They sincerely thank you in advance for any contribution you can spare.

  In solidarity,

  The Health Campaigns Together team

  Read more ...
  

UNISON Press Release 14 August 2019

• Ambulance staff ‘in tears’ as private company awarded patient contract, says UNISON
  
  Over 80 ambulance service staff have been left fearing for their jobs, after West Midlands Ambulance Service (WMAS) lost the contract for non-emergency patient transport.

  This is a devastating decision for staff after health commissioners in Worcestershire awarded the service to private firm E-zec Medical Transport, says UNISON. This is despite WMAS running it for 30 years and receiving an outstanding Care Quality Commission review. 

  E-zec has not confirmed if it will keep the patient transport service* based at stations in Kidderminster, Bromsgrove and Worcester. Question marks hang over the pensions and terms and conditions, says UNISON. 

  UNISON regional organiser Chanel Willis said: "Staff at West Midlands Ambulance Service have been doing a great job, which is reflected in the service’s ‘outstanding’ rating. We are all deeply shocked at the decision to award the contract to a private company. 

  “Many questions have yet to be answered – primarily where staff will be based. Staff have been in tears since the announcement and are devastated that the decision may affect patient care and their livelihoods.”

Friday 9th August 2019

Mike Forster, chair Health Campaigns Together

• Bradford NHS Strikes, Say NO to backdoor privatisation
  
  The UNISON members at Bradford General Infirmary and St Lukes Hospitals have now completed almost 3 weeks of strike action and although they will return on August 15, they have now voted to come out again indefinitely on a date to be confirmed by their union. 

  This is an historic and significant decision which has wide implications beyond the borders of Yorkshire and will need wider solidarity support.

  The workers are striking against the Hospital Trust’s proposals to transfer all the support and ancillary staff, attached to the Estates and Facilities Department, into an arm’s length private company, known as Wholly Owned Subsidiary Companies (WOSC). 

  This will inevitably result in the breaking up of the NHS workforce and ultimately lead to far worse pay and terms and conditions. The WOSC idea is also a tax saving dodge for cash strapped NHS Trusts as the new companies are exempt from paying VAT unlike existing arrangements, so it is yet another bribe to force Trusts to go down the privatisation road.

  WOSC’s were of course dreamt up by the Tories and pushed through by NHS England, so far with very little success. For some reason Yorkshire seems to have been chosen as a guinea pig region with Trusts trying to bring them in everywhere. 

  They have been met with determined union resistance across the region in Leeds, Wakefield, York, Doncaster where they have largely failed apart from smaller towns where there is scattered union membership.

  Historically, this is a difficult group of workers to organise as it is made up largely of cleaning and domestic staff who tend to work part time and unsocial hours. Tracking them all down and persuading them to join the union is a painstaking and time-consuming task. 

  It is to the credit of the two main unions, Unison and Unite, that they have managed to push back management in key Trusts.

  The Bradford Trust has been especially stubborn and appears determined to try and drive the transfer through by 1^st October 2019. Negotiations got nowhere in the early stages pushing the union down the path of strike action. 

  However, even the most optimistic of activists could not have anticipated the amazing response of the strikers who have been out from Day One in droves. The picket line is a wonderful sight to behold of colour, singing, noise and chanting, combining all the best of Bradford’s rich multi cultured population. Filipinos, Afro Caribbeans, Asian and White British workers have all turned up in force singing and dancing the whole day through. Managers have been out to try and silence the drumming and singing to no avail.

  As the dispute has progressed, so confidence has grown. Stories of dirty wards, uncleaned toilets, patients not being fed, massive cross contamination events have only stiffened resolve that the strike is having a big impact and punching a hole in the Trust’s finances.

  One day we witnessed a patient, well known to the striking security guards for his alcoholism, being dragged off the hospital grounds by G4S security and dumped on the pavement unconscious!! 

  Management have held talks but only to try and buy time and have now suggested to the union ACAS is brought in. This only inflamed matters at the strike rally on 8^th August and the common refrain in response was to demand all out action to force the Trust’s hands. 

  One striker summed up the entire mood shouting, ‘we have come this far, we can’t go back now’. There is frustration that they will first return to work before coming out again but likewise a determination, which is only learnt through struggle, that there will be no going back until victory.

  This strike is now of huge national importance. A victory will force the Tories to abandon the whole concept of WOSC’s and give workers everywhere huge confidence that strikes can win. 

  It will also restore morale to the whole NHS workforce if there is a breakthrough here in Yorkshire. Messages of support and financial donations are urgently required. There are also plans for a major demonstration which will also require support. 

  This is now a strike to the finish and also a war of attrition; we must do all we can to ensure this ends in victory.

  ·       NO to backdoor privatisation; stop the WOSC’s

  ·       Full Support to the Striking Bradford strikers

  ·       Restore a properly publicly funded NHS

  ·       Restore the NHS to full democratic control and accountability to workers, patients and users

  Please send donations to: UNISON Health, UNISON Resource Centre, St Mary’s Hospital, Greenhill Rd, Leeds LS12 3QE

  Pay in donations to the account at Unity, UNISON Health Branch, Acc No 49021215

  Sort Code 60-83-01

  Tel No 01274 39683        Email: office.admin@unison-bradfordhealth.org.uk

Tuesday 6th August 2019

John Lister

• Why the NHS is at risk from a no-deal Brexit
  
  While opinions among campaigners vary on the merits or otherwise of Brexit, there is universal concern at the dangers that would be posed to the NHS by a no-deal Brexit. Jeremy Corbyn has insisted no-deal would be “disastrous” and said Labour will vote against it and call for a referendum. JOHN LISTER looks at the dangers in our Analysis and Debate section.
  Read more ...
  

Monday 5th August 2019

John Lister

• Johnson's "extra" £18 billion - neither new nor enough to repair our NHS
  
  The heavily trailed announcement last weekend by Prime Minister Johnson of an “extra” £1.8 billion for the NHS has swiftly been exposed not only as a blatant effort to win public support prior to an early election, but an equally blatant deception.

  Far from being “new money” as Johnson claimed, more than half of it comes from reversing a previous government demand for trusts to cut back on their capital spending by 20%.

  Shadow Health Secretary Jonathan Ashworth has been relentlessly exposing the weaknesses of Johnson’s plan on Twitter, summing up that “It’s cash hospitals already had, but ministers blocked them from spending; Hancock has failed to deliver on existing promises; Tory smash & grab raids cut over £4bn from NHS budgets, NHS left struggling with £6bn repair backlog.”

  Professor Derek Alderson, President of the Royal College of Surgeons told the Daily Mirror: “We welcome additional investment in hospitals, but today’s announcement is like an absent landlord saying he’ll mend the shower, but the broken toilet, damp walls and dodgy electrics will have to wait.”

  Prior to the “extra” £1.8 billion a massive £4.3 billion since 2013 had been siphoned by the Department of Health and NHS England out of capital funds into reducing trusts’ revenue deficits. So severe has been the squeeze on capital funding that among the urgent backlog maintenance tasks four trusts are under threat of intervention by local fire brigades if they do not urgently take steps to improve safety precautions.

  The remaining £850m has been allocated to 20 specific projects around the country, leaving dozens of hospitals facing bills for backlog maintenance adding up to £6 billion.

  Over two thirds of the “extra” money is predictably flowing to acute hospital services – several of them reversing controversial plans for bed reductions. This leaves just £145m for three schemes to help upgrade neglected and crumbling mental health services and £102m for expanding primary care.

  The new projects are all smaller schemes, below £100m: out of a suggested list of 20 substantial (and sometimes controversial) projects drawn up by the Health Service Journal, adding up to £3.5 billion, only one and a half were included.

  £1.8 billion equates to just over five weeks of the famous “£350m a week” Johnson and other Brexiters famously promised on their bus would flow to the NHS if we leave the EU, and there seems little prospect of any more coming quickly if Johnson proceeds along current lines towards a no-deal Brexit. All reports forecast that would trigger a recession and a big increase in the budget deficit.

  Even if the £1.8 billion is supplemented by a further announcement of a new “technology fund”, expected to be centred on new CT and MRI scanners, it’s clear that the 2016 promise was fraudulent, and that it was cynically used to con voters into believing they were helping the NHS by voting Brexit.

  The HSJ analysis points out that a flurry of news on NHS investment is seen as a way for Johnson and the Tories to win over a sceptical public, and that as a result: “National NHS leaders have been told to provide any and all good ideas that can be announced in the “next 100 days”, as the government gears up for a no-deal Brexit and/or a snap general election.”

  But if the future is a no-deal Brexit the staffing crisis will come immediately to the forefront of the problems, as the flow of EU-trained staff in to the NHS over many years is abruptly reversed, with a currency collapse further slashing the real value of NHS pay: with no staff to work them or in them even shiny new scanners and buildings are of little use to patients or the NHS.

  The HSJ has described the £1.8 billion as 'just a down payment'. It remains to be seen whether any further instalments will be forthcoming.

  Read more ...
  

Sunday 4th August 2019

Unite press release

• Lincolnshire health visitors step up pay campaign with more strikes and rallies planned
  
  Health visitors employed by Lincolnshire county council are stepping up their campaign this week in the dispute over not getting paid the rate for the job and the erosion of their professional responsibilities which could adversely impact vulnerable families.

  Unite, Britain and Ireland’s largest union, said that the 58 health visitors will be holding demonstrations in Gainsborough (Wednesday 7 August), Lincoln (Thursday 8 August) and Louth (Friday 9 August), as well as holding two more 48 hour strikes later this month – on top of the nine days of strike action already taken.

  The two new 48 hour strikes announced are on 15-16 August and 19-20 August. The strikes will start at 00:01.

  The dispute centres on Unite’s calculation that its Lincolnshire health visitor members have lost more than £2,000 a year since they were transferred from the NHS to the county council in October 2017.

  Unite, which embraces the Community Practitioners’ and Health Visitors’ Association (CPHVA), is also seriously concerned about the downgrading of the health visitors’ professional status, resulting in fewer staff doing the specialist health visitor role.

  Unite regional officer Steve Syson said: “Our members have had tremendous support in their local communities by a public that recognises the important work they do for families and children throughout Lincolnshire.

  “However, they have been met by a brick wall in the form of a council that remains intransigent, despite three meetings under the auspices of the conciliation service, Acas. The attitude of the council is immoral as it is denying our members legitimate pay rises.

  “The council has proffered 30 grade 10 jobs, which they have conjured out of nowhere, that may ensure this pay increase. But these contracts are shrouded in secrecy so we don’t know what would be required from our members – it could mean a long-term erosion of employment condition. Also, these contracts are not enough to cover all of our 58 members.

  “Unite remains open for constructive dialogue with the council 24/7 – but until pay parity is guaranteed for all health visitors employed by the county council our campaign for pay justice will continue.”

  Details of the demonstrations taking place:

  7 August - in Gainsborough - demonstration at 10.00 at Marshalls Yard, Beaumont Street, Gainsborough DN21 2NA to be followed by a march through the town.

  8 August - in Lincoln - demonstration at 10.00 at Lincolnshire county council offices, Newland LN1 1Y, also followed by a march through the town.

  9 August - in Louth - the protesters will meet at the Cattle Market car park LN11 9EQ which will be followed by a march through the town.

  There will also be a rally in Lincoln on Saturday 17 August with protestors meeting in the Minster Yard at 11.00. The march will start at 11.30 going through the city centre and ending with speeches at High Bridge.

Thursday 1st August 2019

• June Hautot
  
  For those who knew her for the big personality and great campaigner that she was, June Hautot died last week, very peacefully at a hospice in Clapham, South London. She was a staunch supporter of, and activist in, SW London KONP and she was also on the Steering Group for a time.

  Her funeral will be on Friday 16th Aug at 3.30 at Lambeth Crematorium  Blackshaw Rd, London SW17 0DH and then afterwards at June’s house 72 Glasford St, SW17 9HN

  Wear bright colours! 

  The family want any donations to Royal Trinity Hospice, 29, Clapham Common North Side London SW4 0RN

   John Lister adds:

  “June was already a legend among London campaigners when I first started working for London Health Emergency 35 years ago, in the spring of 1984. She and her husband Arthur had been key activists in the two-year long occupation of St Benedicts Hospital in Tooting (1978-80) to prevent its closure, and June remained a vocal presence in so many campaigns from then onwards.

  "She was listed in the very first issue of Health Emergency newspaper (April 1984) as one of a panel of a speakers willing to help build hospital occupations to prevent the growing round of cutbacks and closures.

  "Although south London was her main stomping ground, and she went on to assist with union organisation in Kingston, St George’s and other hospitals, June popped up at conferences and rallies all over London.

  "There is a black and white picture of her accosting then Tory Health Minister Edwina Currie in much the same way as she later famously tore into Andrew Lansley.

  "June was among the hard core of campaigners who helped Health Emergency and local campaigns keep going during the tough times of the New Labour government, when many others held back from the fight for fear of “rocking the boat”.

  "She was one of the early supporters of Keep Our NHS Public from its formation in 2005, specifically to oppose New Labour’s experiments with privatisation and PFI, and brought her long experience and fearless militancy into the fight against the Cameron government and the hated Health & Social Care Act from 2010.

  "After her celebrated clash with Andrew Lansley I well remember her being in place really early in her seat in the front row of the big rally in Westminster Central Hall in the spring of 2012, at which I was a platform speaker. When I walked onto the stage with Frances O’Grady as the meeting assembled to check on the microphone, June immediately ran up and greeted me: Frances O’Grady recognised the face and asked me who she was – and later name checked June to the near-capacity crowd, winning June a big warm round of applause.

  "June’s passion and commitment were priceless: she cannot be replaced. But there is a need for others to come forward and fight as hard as we can to keep up the fight to defend and reinstate our NHS to reverse the cutbacks, fragmentation and privatisation that have seriously damaged our NHS. In the famous words of Joe Hill: don’t mourn, organise.”

  Read more ...
  

Tuesday 30th July 2019

Pam Kleinot

• New documentary UNDER THE KNIFE
  
  

  A crowdfunding target of £20,000 has been set for a nationwide launch of the feature-length documentary - UNDER THE KNIFE - a film that uncovers the systematic dismantling of the NHS in England through cuts, closures, underfunding and privatisation.

  ‘This is the best film around on the NHS. UNDER THE KNIFE shows the vital importance of the NHS to society and exposes the dark threats facing it. But most important of all, the film gives hope to those who are campaigning to keep the NHS safe for our children. You just have to see it’

  Dr Tony O’Sullivan, Retired consultant paediatrician, co-chair of Keep Our NHS Public

  The film has been produced by Pamela Kleinot, an investigative journalist, who in 2014 started to research into why the NHS services she was familiar with appeared to be underfunded and undermined.

  What started out as a personal project grew into a four-year investigation resulting in a 90-minute documentary film, made with award-winning director Susan Steinberg.

  The film is finished, and we need your support to help launch a series of premiere screenings nationwide during the week of October 14-18 so that as many people as possible can see this film. With your help, UNDER THE KNIFE will raise awareness and be a catalyst for a UK-wide campaign.

  We aim to organise at least 20 FREE screenings.

  26 local 'Keep Our NHS Public' groups have agreed to work with local unions and host screenings in their area; but we need funds to hire the cinema space, promote and co-ordinate the events.

  The more funds we raise, the more places we can screen UNDER THE KNIFE to health workers – doctors, nurses, cleaners, admin teams – and health campaigners, trade unions and members of the public. Apart from cinemas, we are keen to host screenings in community centres, town halls, hospitals, universities and schools. 

  Every penny raised through our crowdfunding campaign will go directly to ensuring that as many people as possible have the chance to see this film for free through nationwide screenings.

  WE NEED YOUR SUPPORT!

  We have a choice: either accept the undermining and privatisation of our healthcare or take up the fight to preserve Britain’s favourite institution.

  Pamela Kleinot, Producer of UNDER THE KNIFE says: 

  "I grew up in Johannesburg, South Africa, where access to health care was not equal. I was a medical journalist and witnessed how the severe inequality for blacks under apartheid impacted every facet of society.

  "My father was a doctor and worked in a state hospital for black people. He always told me how wonderful the NHS was. When it began in 1948, it was revolutionary in providing free healthcare to everyone. It is one of the best institutions that humanity has ever created and was the gold standard for the world.

  "As I became increasingly aware of the crisis in health care, I began to investigate. During my two years of research, I found that the NHS was being undermined through underfunding, cuts and closures. It was also being covertly privatised which heralds the end of universal health care.

  "Do we want to go the route of the American health care system which has bankrupted so many? I was committed to making a film about the NHS to inform the public about how we have got to this place. I have devoted my time and personal money to make this project possible as I think it is vital that we try and save this national institution. 

  "Communities, health care professionals and campaigners have fought to defend hospitals and services threatened with closure through the courts, in council chambers and on the pavements.

  "Campaigners have saved Ealing and Charing Cross hospitals after seven years of struggle. They have followed in the success of the people of Lewisham who won against the government and saved their hospital. The battle rages on as hospitals and GP surgeries around the country close or are at risk and private companies are creeping into the system – most disgracefully in mental health.

  Please donate https://www.crowdfunder.co.uk/nhsundertheknife

  ·   Send this link to others to donate

  ·   Tweet with a photo and tag @UnderTheKnife to say that you have donated and support this action.

  Read more ...
  

Thursday 25th July 2019

Ealing save Our NHS

• Campaigners key to reprieve of orthopaedic services
  
  Ealing Save Our NHS reports in its newsletter:

  Orthopaedic Cuts at Ealing Hospital shelved:

  We recently received disturbing reports from Consultants that there were plans by some managers to move Orthopaedic services from Ealing to Northwick Park Hospital. Initially we were told it would be night-time trauma surgery (emergencies) from 8pm - 8am, but later on, we heard this was to be extended so that all Orthopaedic trauma patients, requiring a stay in hospital would be transferred to Northwick Park (NPH) direct from Ealing’s A&E Department, regardless of what time they arrived. Thus making Ealing Hospital merely a 'stabilise and transfer service' with no Orthopaedic In-Patients at all!

  On 21st June, we had a pre-arranged meeting with the London North West NHS Trust Chief Executive, Jacqueline Docherty & Trust Chair, Peter Worthington, who are responsible for Ealing Hospital. Although we did not know the full extent of the proposed cuts at that time, we were able to raise our concerns about the impact of reducing Orthopaedic surgery at Ealing, in particular, how it would further undermine the A&E and the Hospital and seriously affect local people if forced to travel to Northwick Park.

  The Chief Executive told us they were not aware of these plans, which she said would have to be agreed at Senior Management level. However the plans still seemed to be progressing until last Wednesday when the Consultants, who have been collectively resisting these cuts, were formally told that :-

  "Ealing Save Our NHS (ESON) had gained knowledge of the proposed plan and had raised concerns to the Chief Exec and Chair, who in response had recommended the proposed plans be withdrawn” - It is really nice to know we are seen as a force to be taken seriously!

  Also great that joint action by Hospital Consultants and ESON was so effective - let's keep it up to stop further cuts and hopefully get some of our lost services restored.

  Read more ...
  

Wednesday 5th June 2019

UNISON Eastern region

• Victory for Princess Alexandra domestics on eve of strike
  
  Domestics at Princess Alexandra Hospital in Harlow today called off six days of planned strikes after their employer dropped plans to outsource their jobs.

  The Trust had been market testing its cleaning and catering services with the aim of putting them out to tender, claiming just last week that it would take until at least August to make a decision.

  But following a resolute campaign by the 200 domestics, supported by UNISON, Princess Alexandra backed down, pledging to keep the service in house.

  UNISON warned outsourcing would lead to lower standards of cleanliness and create a two-tier workforce.

  Domestics voted by 99% to strike against the changes and were preparing to take six days of action starting tomorrow (Thursday) before the Trust backed down.

  Read more ...
  

Dr Sonia Adesara, junior doctor and member of Keep Our NHS Public

• Donald Trump: hands off our NHS!
  
  Sonia Adesara started this petition to Liam Fox and 1 other

  As part of his visit to the UK, Donald Trump has just said that the NHS must be on the table as part of any trade deal with the UK after Brexit. This is a serious and direct threat to the NHS that we all know and love - so I’m calling on our government to guarantee that our health service will never form part of trade deal with America.

  As an NHS doctor I know how valuable our health service is. First and foremost I care about my patients, and I’m seriously concerned that this could be the beginning of the end for high quality healthcare for all in the UK.

  Opening up the NHS to US corporations would mean that the profit motive invades our NHS, patient data is up for sale, access to healthcare is rationed and we would be staring at a system, as in the USA, where if you can’t pay you don’t get care.

  Decent healthcare is a human right and should never be a commodity to be bought and sold. Let’s send a message to Donald Trump to keep his hands off our NHS and ask the UK government to explicitly guarantee that it will never form part of a trade deal with America.

  Our NHS is there for all of us at the best and worst times of our lives, it’s part of our identity, and it is not for sale. Please sign my petition to help protect our NHS.

  Dr Sonia Adesara, junior doctor and member of Keep Our NHS Public

  Read more ...
  

Thursday 30th May 2019

GMB and UNISON press releases

• Victory for Liverpool ISS strikers
  
  Hospital staff from all the main unions at Royal Liverpool and Broadgreen Hospitals suspended today’s strike action after a £400 million private outsourcing company agreed to give them a pay rise.

  The low-paid workers – who provide cleaning, porter and catering services – were due to walk out on Thursday May 30 2019.

  But outsourcing giant ISS Mediclean agreed to match the same percentage pay rise other members of staff across the hospitals have received – and back date it to the start of the 2018/19 financial year.

  Michael Evans, GMB Organiser, said:

  “This is a fantastic result for our members

  “Staff working for ISS Mediclean at the Royal Liverpool and Broadgreen Hospitals had sent a clear message to their employer and the trust that they need this pay rise

  “GMB members stood firm and - with the help of members of sister unions and Mayor Joe Anderson – they got the result they deserved. 

  
  

Tuesday 21st May 2019

Nottingham KONP and John Lister

• VICTORY FOR THE NHS OVER CIRCLE HEALTHCARE
  
  Circle Healthcare have failed in their attempt to force local NHS Commissioners to award them the new contract to run the Nottingham Treatment Centre at the QMC. The High Court of Justice in London agreed that the contract should go to the Nottingham University Hospital Trust, as originally proposed.

  This means that all services at the Treatment Centre will now return in-house and the massive profits Circle have enjoyed for the last eleven years will now go towards treating NHS patients. The decision also means that Circle will lose the right to run their exclusive private hospital – from which NHS patients are excluded - in the same building.

  However the legal battle is not yet over: Circle has announced that it still intends to sue the 16 Clinical Commissioning Groups which commissioned the contract (and presumably NHS England, whose regional office supported the plan) for damages as a result of what Circle still calls an "unfair" procurement process. It's not impossible that a different judge on a different day might rule differently. Campaigners -- who mobilised in numbers at short notice to show their support for the NHS outside the High Court last week -- will remain vigilant.

  Mike Scott (Nottingham/Notts KONP Spokesperson) said:

  “This is excellent news for NHS patients and is the commonsense decision we were hoping for. It’s difficult to understand how Circle could even have taken this to Court in the first place. They seem to believe they have some sort of right to suck money out of the NHS for their own profit.

  "And no-one should forget that the Government are to blame for allowing them to do it. Work in all parts of the health service should be done by the NHS. That was the basis it was founded on in 1947, because it obviously made sense. It still does.

  "The whole tendering process is enormously expensive and needs to be scrapped. The NHS is short of money because of this sort of totally unnecessary waste.”

  Contact: Mike Scott (07443-611823)

  Read more ...
  

Saturday 18th May 2019

John Lister

• Princess Alexandra Hospital cleaners 99% vote for action to halt outsourcing from the NHS
  
  Cleaners at the Princess Alexandra Hospital in Harlow have overwhelmingly voted to strike against plans to privatise cleaning services, and have appealed to campaigners in London, Hertfordshire and Essex to support their campaign as they prepare for action.

  170 domestic staff, members of UNISON, voted 98.6% in favour of strike action on an 83.5% turnout.

  UNISON's stand has been welcomed and supported in a statement by the other unions at the hospital.

  The domestic staff warn that if their services were to be transferred into the private sector it would spell ‘disaster’ for their patients, as hospitals with outsourced cleaning have higher rates of infection than those where the service is in-house.

  The in-house service is a modern day reminder of how ward teams used to work before privatisation in the 1980s began to split them apart, and effectively casualised many domestic services with low wages and exploitative conditions.

  As Claire Evans, a Princess Alexandra Hospital domestic, said:

  “We don’t just clean the wards, we bring patients their teas, we make sure they get their dinners, we chat to them. We make sure they feel as safe and comfortable as possible while they’re in the hospital because we care about them.

  “This vote is a clear message to our bosses that we don’t want to work for an outside contractor – we are proud to work for the NHS and serve our communities. Taking strike action is not an easy decision for any of us but we need to stand up for our jobs and our patients.”

  Princess Alexandra Hospital is currently one of the best-cleaned trusts in England, achieving one of the lowest rates of infection, including instances of MRSA.

  By contrast cleaners from the hospital have recalled the brief privatisation of services in the 1990s, when Mediguard had to hand back the contract after just one year because of its failure.

  The staff also warn that their pay and conditions will fall below their NHS colleagues if their services are outsourced, as a private company would not be part of any future NHS pay awards. New starters could also face substantially worse employment terms, with a private contractor facing no obligation to pay any more than the legal minimum.

  The workers will reveal their next steps, including any possible strike dates, next week. UNISON has urged the Princess Alexander Hospital to abandon its privatisation plans to avoid industrial action.

  Please sign the petition against privatising PAH cleaners.

  Read more ...
  

Monday 13th May 2019

Nottingham KONP

• Keep Circle out of NHS! Lobby of High Court May 15
  
  A late notice call for campaigners and union activists who can do so to lobby the High Court, where they are hearing the challenge by Circle Health to a CCG decision to award a Treatment Centre contract to Nottingham University Hospitals Trust.

  Circle previously held the contract, but have a history of NHS contract failures. This is their second attempt to challenge the CCG's decision, which has been backed by NHS England.

  Those protesting against any further contract going to Circle include KONP and UNISON and Unite health branches in Nottingham.

  Lobby 12.30,

  Rolls Building,

  Fetter Lane

  London EC4

  
  

  Read more ...
  

Wednesday 1st May 2019

Nottingham and Nottinghamshire Keep Our NHS Public PRESS RELEASE

• FAILED PRIVATISER IN COURT ACTION AGAINST NHS TO PROTECT PROFITS
  
  Circle Healthcare, the private company currently running the Treatment Centre on Nottingham University Hospitals Trust’s  QMC campus has begun court proceedings against the Rushcliffe Clinical Commissioning Group (CCG) to protect its profits.

  Having lost out twice to the NUH Trust in the new contract to run Treatment Centre services, Circle is now going to court for a second time, claiming the Trust can’t possibly treat NHS patients for less money, and that bringing the contract back in-house would be “unrealistic” and “not in patients’ interests”.

  The controversial company has had a number of major failures in the past, including the collapse of acute dermatology services at the QMC after they took over that contract, and handing back the contract to run Hinchingbrooke Hospital near Cambridge in 2015 only a couple of years into a 10-year contract because they weren’t making enough profit.

  Circle allege that the cost of in-house services would be higher due to staff benefiting from “improved NHS terms” – an admission that they are underpaying staff at present – and fail to mention the extent of the profit they have been taking out of the NHS for the past ten years.

  However both the CCG and NHS Improvement’s Regional Director of Finance have approved the in-house bid.

  Mike Scott (Nottingham/Notts KONP Spokesperson) said:

  “This is completely outrageous. Having been fairly beaten to this contract twice by better value public sector bids, they have gone to court to try to protect their profits.

  “Their past performance should have been enough to bar them from bidding for any NHS contracts. We will not stand by and watch them take urgently-needed money out of the public sector by the back door.

  “These people only care about profit, not patients. This is nothing short of a national scandal.”

  Contact: Mike Scott (07443-611823) nottskonpcampaign@hotmail.co.uk

Tuesday 23rd April 2019

Ontario health Coalition

• Ontario: More than 150,000 hospital and health care staff and patient advocates to join in Action Day to warn against health care privatization
  
  Across Ontario in more than one hundred hospitals and health care facilities, staff and patient advocates are staging an “Health Action Day” today, Tuesday April 23.

  In an unprecedented show of unity, more than 150,000 health professionals and workers and tens of thousands of patient advocates will wear a sticker that says “Stop Health Privatization” and will distribute leaflets warning about the Ford government’s radical health care restructuring plans.

  The Ontario Health Coalition has vowed to fight to protect local health care services from cuts, privatization, and mergers.

  The province's right wing Conservative government led by Doug Ford, which was elected last year, has given itself unprecedented powers to order the privatization of virtually all health care services and leaked documents show that plans are underway to begin privatization of a range of health care services.

  They have rammed a radical health restructuring law through the Legislature in an unprecedented undemocratic process, refusing to hear from thousands who applied for hearings and sent in submissions.

  All amendments prohibiting privatization were voted down by the Conservatives.

  The new law gives Ontario's Minister of Health and the government’s appointees in the new “Super Agency” the ability to force privatization of services as well as to merge, transfer services from town to town and from provider to provider, and close down services including public hospitals, long-term care, home care, community care, mental health, primary care, palliative care, cancer care, eHealth, air ambulance, laboratories and others.

  In addition, the list of health care cuts under the Ford government is mounting:

  ●  Cut OHIP+ (Ontario Health Insurance Plan Plus) forcing families with sick children to pay deductibles and co-payments. (June 2018)

  ●  Cut planned mental health funding by more than $330 million. (July 2018)

  ●  Cancelled all new planned overdose prevention sites. (Autumn 2018)

  ●  Let surge funding for hospitals run out. Surge beds are now closed without replacement, despite overcrowding crisis [Ontario already has the lowest level of beds of any comparable OECD country].

  ●  Cut and restructured autism funding. (Winter 2018/19)

  ●  Set health care funding at less than the rate of inflation and population growth, let alone aging. This means service levels cannot keep up with population need and will force cuts/privatization. (2019 Budget)

  ●  Set public hospital funding at less than the rate of inflation alone. This means real dollar (inflation adjusted dollar) funding cuts and serious service cuts/privatization. (2019 Budget)

  ●  Cut provincial public health funding by 27% and cut public health units from 35 to 10. (2019 Budget)

  ●  Introduced Bill 74 which gives sweeping new powers to the Minister and Super Agency to force privatization and restructuring of the entire health system. (February/March 2019)

  ●  Plan to cut and restructure ambulance services, down from 59 to 10. (April 2019)

  ●  Plan to cut half a billion dollars in OHIP services. (April 2019)

  The Health Coalition is mobilizing for a massive Health Care rally outside the Ontario Legislature next week on Tuesday April 30 at noon.

  The rally is expected to draw thousands concerned about OHIP cuts, hospital cuts, privatization, mergers and centralization of health care services.

  
  

  Read more ...
  

Thursday 28th March 2019

Oxfordshire KONP

• P.E.T. scanners at the Churchill: NHS England and Oxford Hospital Trust’s statements are not a U-turn
  
  This is not a U-turn. Far from it. 

  Even if the staff at Oxford University Hospitals continue to run the service, it looks as if it will be handed over to InHealth.

  The proposed partnership with a private company, outlined in a paper to the county’s Health Overview and Scrutiny Committee (HOSC) to consider on April 4, will be a cuckoo in the nest - with far reaching implications for our NHS.

  The local leadership of OUH has not challenged this ‘in principle’ agreement for a private company to own our precious PET scanning service.

  InHealth, it is proposed, will use OUH as their subcontractor.

  KONP see the so-called ‘partnership’ as pulling the wool over our eyes.

  The detail of the contract with InHealth - and of InHealth with the OUH must be revealed before we can even consult on it. 

  We want HOSC to refer the whole sorry procurement process for our world class PET scanner service to the Secretary of State on the grounds that it was a flawed process, with no proper consultation.

  We believe that the current proposed ‘deal’ will lead to a worsening of service across the region.

  The statement that there will be ’no impact’ for the people of Oxford is not true - there will be serious repercussions.

  This is not ‘outsourcing’ like the Carillion contract. This is direct privatisation of a part of our NHS. We demand a halt to the process.

  Read more ...
  

Wednesday 6th March 2019

Pete Gillard

• NHS Improvement scraps plans to whitewash Shropshire inquiry findings
  
  NHS Improvement have reversed their decision and scrapped the review panel they had set up to “review the findings” of Donna Ockenden’s independent investigation into maternity deaths at Shrewsbury & Telford Hospital Trust (SaTH).

  The review panel was to involve people who had previously given SaTH a clean bill of health and could have been used to bury the results of the Ockenden review. The reversal was a direct result of pressure from campaigning parents who have been fighting for the truth for over a decade.

  Background.

  Donna Ockenden is investigating cases of death and serious harm to babies in SaTH’s maternity service going back well over a decade. We understand that the review is looking at over 250 cases and in “many” there will be evidence of avoidable death or avoidable serious harm.

  If so, this is likely be a much bigger scandal than the Morecambe Bay one, where there were 11 avoidable deaths.

  We had been told that the general problem had been known about for some time but that a senior official in NHSE had helped a cover-up in the past. The suspicion was that this new panel to review the review before publication was part of this same cover up.

  SaTH has continually claimed that there have only been a few cases, and these were aberrations. Apologies were only forthcoming after massive pressure. This article details some of the cases featuring some of those who have been leading the campaign for the truth and a safe maternity service.

  The cover up would be continuing if it were not for campaigners like these.

  It’s not about history. There was a case last year where a mother died during childbirth. The inquest has not yet been held, so we do not have the full facts, but from what we do know, the death may have been avoidable.

  This scandal cannot be blamed on individual staff. Some may have made mistakes, but the problem is systemic.

  The 2018 Staff Survey shows that in 2015, 82.2% of SaTH midwives were satisfied with the quality of care they gave. That has fallen year on year – down to only 56.7% in 2018.

  The maternity service chaos is NOT the fault of midwives, who don’t go to work to provide poor care. “My organisation encourages us to report errors, near misses or incidents”. In 2016, 87.7% of staff agreed. In 2017, 84.3% of staff agreed. By 2018, only 81.2% of staff agreed. This was the WORST result in the country for an acute trust.

  The Trust leadership were directly attacked in a CQC report last year for failing to provide good leadership.

  SaTH was then put into special measures on safety grounds by NHSI.

  But chickens are coming home to roost. Immediately after the CQC report, the Medical Director was downgraded to a less sensitive post.

  In the last couple of weeks, the Directory of Nursing, Midwifery & Quality and the Head of Midwifery have announced they are leaving to take up unspecified posts elsewhere. We are still waiting for an announcement on the future of the Chief Executive.

  This was a team that were more interested in balancing the books that patient safety.

  It is sometimes difficult to talk about failures in the NHS when we are campaigning to save it. But if we don’t others will.

  And these others will blame the NHS as an institution. That’s why we in Shropshire support HCT’s ‘Safe for All’ campaign. Safe for patients, but also importantly for the staff who are usually the one’s to get scapegoated.

  Richard and Rhiannon tweeted this when the news broke last week about the review panel:

  "Kate your daddy & I’ve fought 4 10yrs 2 ensure learning from your avoidable death is embedded in NHS. Unforgivably many don’t want babies to live cos that’s ALL this comes down 2. Evidenced today by NHSI. Love from mummy."

  But their campaigning strength, and that of other parents, has now halted this attempted cover up.

  
  

  Read more ...
  

Wednesday 20th February 2019

Labour Press release

• Labour demands £128 million of new NHS contracts are kept in public hands
  
  Labour is today calling on the Health Secretary to block private companies from securing 26 NHS contracts worth over £128 million that are currently out to tender.

  The 26 contracts, identified by the House of Commons Library for Labour, include a new £91 million contract to run an NHS 111/Clinical Assessment Service in the South East.

  These contracts are tendered on precisely the same regulations and legislation that NHS England's Long Term Plan has just urged the Government to repeal. Labour is demanding ministers step in, follow NHS England and block this competitive tendering which undermines true integration of services in public hands.

  The 2012 Health and Social Care Act obliges NHS CCGs in England to tender out any contract worth over £615,278. This has led to a huge increase in the number of NHS contracts awarded to profit-driven firms such as Virgin Care.

  Speaking last month in front of the Health and Social Care Select Committee, Matt Hancock MP promised there would be “no privatisation of the NHS on my watch.”

  Labour is today demanding the Health Secretary delivers on his promise by ensuring £128 million worth of contracts currently out to tender are kept in public hands.

  In 2017/18, £8.8bn of the health service budget went to independent sector providers- a 50% increase compared with 2009/10.

  Labour is also praying against the Government’s move last week to quietly make changes to existing secondary legislation to speed up the creation of Integrated Care Providers (ICPs), without scrutiny by Members of Parliament. Labour wants to see guarantees that, in the words of the Health Secretary in front of the Health and Social Care Select Committee, “integrated care contracts will go to public sector bodies to deliver the NHS in public hands.”

  It recently emerged that the Health Secretary has endorsed Access MyDentist, a private firm profiting from patients who cannot access an NHS dentist due to cuts.

  This is just the latest in a string of endorsements of private healthcare by Matt Hancock MP.

  In November, Justin Madders MP, Labour’s Shadow Health Minister, wrote to the Prime Minister expressing concerns that the Secretary of State may have breached the Ministerial Code by endorsing Babylon, a private healthcare company, in a paid-for-newspaper supplement.

  Babylon’s GP at Hand, of which Matt Hancock is a patient, has been roundly criticised by doctors’ groups ‘cherry picking’ fit, young and health patients and financially destabilising traditional GP practice.

  Labour has pledged to reverse privatisation of the NHS and return the health service into expert public control, as well as repealing the Health and Social Care Act which puts profits before patients.

  Speaking this afternoon in a General Debate on the NHS Long Term Plan Jonathan Ashworth MP, Labour’s Shadow Health and Social Care Secretary, will say:

  “This Health Secretary’s privatisation credentials become clearer by the day- whether it’s promoting GP at Hand to endorsing private dentistry to now allowing millions of pounds worth of health services contracts to be privatised.

  “But when even NHS bosses are calling for the very worst aspects – the so-called section 75 provisions - of the Tory Health and Social Care Act to be binned surely Mr Hancock should step in, block these tenders and instead guarantee the contracts remains in public hands.

  “Otherwise his promises to the Health Select Committee will be exposed as entirely hollow and it will be clear the Tory NHS privatisation agenda continues to run rampant.”

Sunday 3rd February 2019

John Lister

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

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

  What is the situation?

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

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

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

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

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

  “What are we doing and how can you help?

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

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

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

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

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

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

  Read more ...
  

Sunday 23rd December 2018

John Lister, Editor Health Campaigns Together

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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 70^th “birthday present” to the NHS in Philip Hammond’s latest austerity budget is available until next year, and in many cases last year’s ‘winter crisis’ stretched on deep into the summer or ran unbroken into autumn.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Friday 7th December 2018

Hands off HRI

• Public Statement from Hands Off HRI re CHFT Press Release
  
  “The Calderdale and Huddersfield Trust has now confirmed their intent to use government funding to transfer all acute and emergency care to Halifax.

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

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

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

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

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

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

Thursday 6th December 2018

Richard Bourne

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  If anyone hears the sound of one hand clapping … 

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Tuesday 4th December 2018

PDA Union

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

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

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

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

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

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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 6^th 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.

  
  

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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.

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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).

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Wednesday 7th November 2018

Unite the union

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

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

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

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

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

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

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

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

Tuesday 6th November 2018

Unite the union

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Saturday 3rd November 2018

John Lister

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  2.18

  […] “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)

   

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Saturday 20th October 2018

Bill MacKeith

• Oxon NHS Campaigners call for privatised service to be brought back into the NHS
  
  The report by Oxfordshire Healthwatch rightly points out the distress caused since giving Oxfordshire's NHS muscular skeletal services (Physiotherapy and Podiatry to you and me) to a private contractor to run. 

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

  ·      appointments difficult to make, 

  ·      frustrations with contact (phone lines unmanned), 

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

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

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

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

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

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

  Liz Peretz of Oxon Keep Our NHS Pubic said: 

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

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

Debbie Monkhouse

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

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

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

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

Unite the union

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

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

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

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

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

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

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

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

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

  ENDS

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.

  References

  (1) Mercer, H.and Whitfield, D. Nationalising Special Purpose Vehicles to end PFI” Greenwich University, PSIRU, May 2018. http://gala.gre.ac.uk/20016/1/20016%20MERCER_Nationalising_Special_Purpose_Vehicles_to_End_PFI%20_2018.pdf; http://peoplevspfi.org.uk/2018/05/08/how-much-will-it-cost-to-nationalise-the-special-purpose-vehicles/

  (2) https://www.bbc.co.uk/news/education-45641047

  (3) Mercer, H., The Private Finance Initiative: How come we’re still paying for this?’ People vs PFI (2017). http://peoplevspfi.org.uk/exhibition-how-come-we’re-still-paying-for-this?/ A pdf of this booklet is available on request.

  
  

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Friday 21st September 2018

John Lister

• 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.

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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.

  Reading 

  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:

  
  

  • NHSE consultation document
  • KONP’s guide to completing the NHSE on-line consultation
  • Fill in the NHSE on-line survey  

  
  

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Richard Bourne

• 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

Mike Forster

• 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

Mike Forster

• 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 further

  Read 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

John Lister

• 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 70^th 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: campaigns@keepournhspublic.com

  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."

  References:

  1. 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/
  2. 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/
  3. The People’s Assembly Against Austerity
  4. 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

  
  

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Tuesday 12th June 2018

KONP website

• 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.

  KONP statement:

  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 [3] 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

  
  

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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 70^th birthday of our NHS and demonstrate our demand for proper funding from progressive taxation to keep it free, for all, for ever.”

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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:

  info.handsoffhri@gmail.com    Facebook: HandsoffHRI  Twitter: @HoHRIltd      

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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.

  
  

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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.

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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:

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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:

  info.handsoffhri@gmail.com    Facebook: HandsoffHRI

  www.officialhandsoffhri.org              Twitter: @HoHRIltd

  For more details: Cristina George 07747446005       Mike Forster 07887668740

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Friday 16th March 2018

Dorset KONP

• 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!

  
  

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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.

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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 70^th 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

ESON

• 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 performance

  Read 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.

  
  

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Wednesday 7th February 2018

JR4NHS

• After ministers delay regulations to facilitate ACOs, an update from JR4NHS on Urgent Legal Action for Our NHS - Round 3
  
  Hunt delays

  Dearest supporters,

  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

John Lister

• 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.

  Yours sincerely,

  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

John Lister

• 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 70^th 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 KONP

• 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:

  https://www.crowdjustice.com/case/save-poole-ae-and-maternity-and-nhs-beds 

  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:

  https://www.crowdjustice.com/case/save-poole-ae-and-maternity-and-nhs-beds 

  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:

  https://www.facebook.com/defenddorsetnhs/

  Thank you!

  Debby (Monkhouse)

  Defend Dorset NHS

  Dorset KONP

  
  

  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,                                                                                     14^th 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?

  Will you

  
  

  • 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?

  Yours sincerely

  Pia G Feig

  Old Trafford Resident

PRESS RELEASE

• 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 40^th 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 70^th 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 –

  https://t.co/zbJWPOO53X

   #JR4NHS

  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

John Lister

• 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.

  Background

  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

WestonMercury report

• Hundreds turn out to save Weston Hospital A&E
  
  The event was organised by The Save Weston A&E Campaign, which is a partnership of Protect Our NHS North Somerset, The North Somerset & Weston Trades Council, and Weston Labour Party and an estimated 300 people supported the rally.

  Click on the link to see some fabulous photos.

  Read more ...
  

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 Finsbury

  Read more ...
  

Wednesday 13th September 2017

Oxfordshire KONP

• MORE BED CLOSURES IN OXFORD’S HOSPITALS
  
  In August, Oxfordshire’s Health Overview and Scrutiny Committee voted to accept the permanent closure of 110 beds in the county’s  hospitals.

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

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

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

  We need more hospital beds, not less.

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

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

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

   

Thursday 7th September 2017

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

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

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

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

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

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

  As Caroline Molloy of the Our NHS website says

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

  Read more ...
  

Carol Ackroyd

• Joint councils’ Scrutiny Committee says NO to Single Accountable Officer
  
  Carol Ackroyd from Hackney KONP writes

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

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

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

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

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

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

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

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

  We campaigners have three major concerns about ELHCP:

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

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

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

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

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

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

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

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

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

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

  Read more ...
  

Friday 1st September 2017

John Lister

• Let's mount an autumn offensive to defend #ourNHS
  
  The Tories are weaker than ever and can be put under pressure to reverse their damaging cuts to healthcare, writes JOHN LISTER

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monday 28th August 2017

John Lister

• Tax-payers can’t afford such charity to private sector
  
  Recent revelations on the existence of tax breaks for over a quarter of private hospitals, which benefit from an 80% exemption from business rates, on the spurious grounds that they are “charities,” made headlines even for the BBC: but the insidious process of privatising the provision of NHS-funded services continues largely below the media radar.

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

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

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

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

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

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

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

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

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

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

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

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

   

Saturday 26th August 2017

Shropshire campaigners

• The outrage around Ludlow Hospital
  
  Campaigners respond

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

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

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

  Read more ...
  

Thursday 17th August 2017

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

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

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

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

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

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

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

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

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

   The letter reads:

  17 August 2017

  Dear County Councillor,

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

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

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

  Full minutes of County Council 21 March 2017:

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

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

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

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

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

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

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

   Acceptance of permanent bed closures

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

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

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

   At the full Council meeting in March, councillors

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

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

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

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

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

  Yours sincerely,

   Gus Fagan, acting chair, Oxon Keep Our NHS Public

  Read more ...
  

Sunday 21st May 2017

Mike Fieldhouse

• 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_Roadshow

• NHS frontline staff hit the election campaign trail
  
  NHS Roadshow

  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:

  https://www.facebook.com/groups/433327747027976/?pnref=story

  For more info: info@nhscampaign.co.uk.

   

  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.
   
  Submissions of evidence to challenge theses cuts can be sent by email to; http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/                                                                                                                   or by letter to;  Health Committee, 7 Millbank,  London SW1P 3JA 
  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.
  
  
  Ian Crawford
  
  
  Media Liaison – SOHS
  07917 123 435

Monday 6th March 2017

John Lister

• 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.html
  Read 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,
  
  
  Lesley Carty
  Vice-Chair (Membership)
  South-East Cornwall Constituency Labour Party

Thursday 15th December 2016

Anna Pollert

• 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. 
  Please check the Ealing Council website:​https://www.ealing.gov.uk/news/article/1578/ealing_council_stands_firm_against_hospital_downgrade
  
  
  Read more ...
  

Camden KONP

• 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         
     Resolved 
  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.
  Rik Evans. Rik.evans@btopenworld.com 07899915805
  Stuart Roden.rodenstuart@gmail.com     01872 241079

Monday 14th November 2016

posted by Morning Star in Features

• IT’S ALL kicking off in England’s NHS.
  
  
  JOHN LISTER
   
  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.
  Information packs on STPs and how to challenge them are available from www.healthcampaignstogether.com.

Friday 11th November 2016

Bryn Griffiths

• 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

Camden Council

• 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

Pete Gillard

• 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.
   
  Pete Gillard

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?”
  
  
  
  
  END
  WTUC Chair: Pete McNally Tel .07761-769412 pmcnally@btinternet.com
  WTUC Secretary: Bryn Griffiths Tel.07519-817960 wtuc@btinternet.com
  Notes:
  1. Health Services Journal 6 October 2016
  2. http://www.comfirst.org.uk/stp_slides_opvssn_june_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 others
  Read 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.