ourNHS https://www.opendemocracy.net/taxonomy/term/12254/all cached version 11/09/2018 14:23:21 en NHS charging for overseas visitors – wrong on every level https://www.opendemocracy.net/ournhs/martin-mckee/nhs-charging-for-overseas-visitors-in-nhs-wrong-on-every-level <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Regulations that deny visitors NHS care –&nbsp;except for certain infectious diseases and to relieve death pains - are riven with contradictions. And will hit some unexpected victims as well as the intended scapegoats.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/nhs-poster-not-free-to-all.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/nhs-poster-not-free-to-all.jpg" alt="" title="" width="380" height="214" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Poster in Newham hospital. Rights: <a href="https://newhamsaveournhs.weebly.com/">Newham Save Our NHS.</a></em></p> <p>Given the choice, the British government’s <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/729872/Guidance_on_implementing_the_overseas_visitor_charging_regulations_-_May_2018.pdf">guidelines on implementing their overseas visitor charging regulations</a> would not have been top of my reading list. Especially because I had already read them once – but still had to revisit them to formulate an answer to a question on a list server. The question was, at least superficially, simple. The regulations contain a list of diseases which -&nbsp; for any visitor to the United Kingdom unlucky enough to have one of them – the NHS will still provide free treatment. Is this list appropriate? Is there anything that is missing? As is often the case, an apparently simple question opens up many other less obvious issues. Here are just a few of them.</p> <p>The guidelines were written for health professionals and managers who must decide whether a patient is entitled to free NHS care, in the light of recent regulations restricting access for visitors.</p><p>To make their decision, NHS staff are confronted with a set of guidelines that stretches to 117 pages, which they are expected to understand and apply, even in the midst of working frantically to save a patient’s life.</p><p>It gets worse. NHS organisations “are advised to seek their own legal advice on the extent of their obligations when necessary”. Why? Because the regulations are incredibly complex, and involve balancing requirements under a wide range of other legislation, including data protection, prohibition of discrimination, and much else. Also there are still unresolved ambiguities. As the guidelines note, “’Ordinarily resident’ is not defined in the 2006 Act”, even though it is a key concept in making decisions under the regulations.</p><p>NHS staff really don't need all of this. In a health service that has been starved of resources for almost a decade, health workers are already overstretched. Posts remain unfilled, and rotas have many gaps. In some parts of the country, many of those providing direct patient care are agency staff, who must spend precious time orientating themselves to different settings. The rapidly changing nature of healthcare means that they must constantly update their knowledge, both in relation to clinical matters and to an often bewildering array of statutory requirements.&nbsp;</p><p class="mag-quote-center">“providing timely and effective care to migrants saves money in the long run”</p><p>Leaving aside the morality of the government’s “<a href="https://www.ncbi.nlm.nih.gov/pubmed/29306349">hostile environment</a>” to visitors, these regulations also completely fail to recognise that what is presented as a cost saving measure is anything but. For many hospitals, the cost of complying with the regulations far outweighs any income that they may generate. And&nbsp;<a href="https://www.ncbi.nlm.nih.gov/pubmed/26201017">research from Germany</a>&nbsp;shows clearly that providing timely and effective care to migrants saves money in the long run. But then, as is apparent with the government’s pursuit of Brexit, deterring migrants is much more important than growing the economy.</p> <p>The politics behind the regulations are obvious. The main exemption from charges is for infectious diseases deemed to pose a threat to the resident population. Visitors will be entitled to care in an emergency department, but only until the point where they require admission to hospital. Palliative care is also exempt, presumably because of the media attention that visitors dying in agony might attract.</p> <p class="mag-quote-center">The list gives an impression of having been drafted several decades ago</p> <p>It is the list of infectious diseases that is most intriguing. Some are highly contagious but others are not. Leprosy, for example, is only transmitted when there is prolonged contact between people. Others are included even though they are transmitted by vectors not normally present in the United Kingdom. Yet other vector borne diseases (such as <a href="http://www.who.int/chagas/resources/Eurosurv_art19968/en/">Chagas Disease</a>, increasingly being diagnosed among migrants from South America) are excluded. Smallpox remains on the list, despite having been eradicated globally almost 40 years ago. The list gives an impression of having been drafted several decades ago, with individual diseases being added on an ad hoc basis.</p> <p>There will, however, be an opportunity to update the list. The guidelines are full of references to the European Union and the European Economic Area. Visitors from the countries concerned are, of course, entitled to treatment paid for by their home health authorities. Should British ministers ever manage to agree on a feasible plan to leave the European Union, then this will have to change completely. However, given the many other challenges that they will face, including shortages of staff, medicines, equipment, and above all money, this may be well down the list of priorities.</p> <p class="mag-quote-center">British pensioners who have retired to the Mediterranean…will find, to their surprise, that they are not entitled to NHS treatment under the regulations</p> <p>So it may take some time for them to address one of the more pressing issues. This is the potential return of large numbers of British pensioners who have retired to the Mediterranean. Many of them will find, to their surprise, that they are not entitled to NHS treatment under the regulations as they are not ordinarily resident. Given that many are elderly, with multiple chronic conditions, this will pose a considerable challenge. In some cases, they will have family members who are not British citizens, just to add to the complexity.</p> <p>Postscript: As I was finalising this blog, the Home Office issued its guidance on <a href="https://www.theguardian.com/politics/2018/sep/04/concerns-raised-over-59-page-handbook-on-brexit-settled-status-scheme?CMP=share_btn_tw">applications for settled status for EU citizens post-Brexit</a>. The good news – it is only 59 pages long. Remember that the then Home Secretary said this would be <a href="https://www.theguardian.com/politics/2018/apr/23/amber-rudd-online-eu-registration-system-lk-bennett">as simple as opening an account at a certain upmarket retailer</a>. The bad news – the guide to the process for such applicants is almost as incomprehensible as the guidance for NHS staff outlined above. This time, the government claims the default position will favour the applicant but, given this would be a 180 degree turn by the Home Office, and totally at odds with the culture of xenophobia it has worked so hard to create, no-one believes it.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/ex-boss-of-england-s-nhs-blasts-nhs-migrant-policy-as-national-scandal">Ex-boss of England’s NHS blasts NHS migrant policy as a “national scandal”</a> </div> <div class="field-item even"> <a href="/ournhs/erin-dexter/making-nhs-hostile-environment-for-migrants-demeans-our-country">Making the NHS a “hostile environment” for migrants demeans our country</a> </div> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/dont-invoke-nhs-to-sell-false-idea-of-good-nationalism">Don&#039;t invoke the NHS to sell a false idea of &#039;good nationalism&#039;</a> </div> <div class="field-item even"> <a href="/ournhs/kailash-chand/nhs-passport-proposals-are-just-more-grubby-politics-from-may-and-hunt">NHS passport proposals are just more grubby politics from May and Hunt</a> </div> <div class="field-item odd"> <a href="/ournhs/migrant-activists-disrupt-department-of-health">Migrant activists disrupt the Department of Health </a> </div> <div class="field-item even"> <a href="/ournhs/docs-not-cops/labour-must-tackle-may-s-hostile-environment-for-migrants-in-nhs">Labour must end May’s ‘hostile environment’ for migrants in the NHS</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by 4.0 </div> </div> </div> ourNHS uk ourNHS Martin McKee Wed, 05 Sep 2018 08:55:52 +0000 Martin McKee 119545 at https://www.opendemocracy.net Social activism and the economics of mental health https://www.opendemocracy.net/transformation/john-picton/social-activism-and-economics-of-mental-health <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Apolitical volunteering is ill-equipped to address the structural causes of depression.</p> </div> </div> </div> <p><img src="//cdn.opendemocracy.net/files/John Picton.jpg" alt="" width="460" /></p><p class="image-caption">“Volunteering.” Credit: <a href="https://www.flickr.com/photos/danielthornton/8620041374">Flickr/Daniel Thornton</a>. <a href="https://creativecommons.org/licenses/by/2.0/">CC BY 2.0</a>.</p> <p>‘Social prescribing,’ where patients with depression join in community activities as a part of their treatment, is moving from the fringe of medical practice to the mainstream. Matt Hancock, the new British Minister for Health and Social Care, <a href="https://www.gov.uk/government/news/social-prescribing-schemes-across-england-to-receive-45-million">has pledged £4.5m to promote it</a>, but we should stop to think before we take this medicine: linking patients to their communities is a positive step, but a better move would be for people to get involved in social activism.</p> <p>The Minister probably has one eye on his budget, since social prescribing <a href="https://www.huffingtonpost.co.uk/entry/social-prescribing-health-conditions_uk_5b586a95e4b0de86f4923524">is thought to stop patients coming back to doctor’s surgeries</a>—so saving the state money in the National Health Service (NHS). But this scheme, which normally involves referring the patient to a link worker who then recommends different types of community activity for them, is about more than balancing the books: in fact the NHS is administering a large dose of social theory. </p> <p>Almost 20 years ago, the American Political Scientist <a href="http://robertdputnam.com/">Robert Putnam</a> published <em><a href="https://en.wikipedia.org/wiki/Bowling_Alone">Bowling Alone</a></em>. Since then there has been a groundswell of interest in its central concept of ‘social capital’—the idea that community bonds such as those developed in bowling leagues in the USA make both individuals and societies happier and healthier. </p> <p>Putnam is a nuanced writer, but the core focus of <em>Bowling Alone</em> is on community participation not social activism. He wants to unify us not cause political fights, and hopes to develop a country of association-joiners: religious service attenders, sports club players, park gardeners, members of knitting circles and school governors. In one interview <a href="https://www.theguardian.com/society/2007/jul/18/communities.guardiansocietysupplement">he analogises this to a honeycomb</a>, a social system of welcoming and interlocking groups, each empowered as a part of a greater civic whole.</p> <p>Charismatic, and with the enigmatic appearance of a nineteenth century preacher, Putnam has become an academic celebrity. His ideas on social capital have been met with great enthusiasm by policy makers on both sides of the Atlantic. <a href="https://www.behaviouralinsights.co.uk/north-america/robert-putnam-celebrating-his-incredible-contribution-to-the-study-of-social-capital/">One British policy group</a> working right at the heart of the Cabinet Office has called him the most influential political scientist alive. Before his promotion, Hancock held the British Government’s brief for civil society, and the influence of <em>Bowling Alone</em> can be clearly felt in his new policy on social prescribing. Linking individual depression to a lack of community activity takes a leaf straight out of Putnam’s book. </p> <p>At core the idea is simple: integrating patients into their communities is thought to <a href="https://bmcfampract.biomedcentral.com/articles/10.1186/1471-2296-9-27">develop self-esteem</a> and social support, providing a holistic treatment instead of just prescribing drugs. In turn, the community will also be improved. It would take a hard heart to reject this idea completely; friends and community really are an important element in our lives whether or not we have depression. </p> <p><a href="https://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Health-and-wellbeing/Social_Prescribing_Report.pdf?dtrk=true">One report by the charity Age Concern</a> describes the case of a woman who, having lost her husband to suicide, found solace in volunteering as a befriender and in theatre outings. Another, trapped in a rural community without access to transport, was encouraged to organise a local party. Social prescribing <a href="https://www.kingsfund.org.uk/publications/social-prescribing">is also deployed</a> in support of community gardening, sports and arts and crafts. Although there <a href="https://bmjopen.bmj.com/content/7/4/e013384">is little hard evidence</a> to back this up, strengthening the community links of patients seems likely to have a positive impact on their health.</p> <p>But there is something missing from this picture. Depression is intimately connected with economic structures. Even when we are well paid we might still have a difficult boss. Target-driven work culture <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30176-7/fulltext">is bad for us</a>, leading to intense and demanding jobs in environments over which we have little control. When we are also short of money our situation gets even worse; unemployment impacts negatively on health, and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0001879109000037">the effect is more pronounced</a> in countries with weak social security systems. Discrimination <a href="http://journals.sagepub.com/doi/abs/10.1111/1471-6402.00090">impairs our mental well-being</a>.</p> <p>In their new book <em><a href="https://www.opendemocracy.net/transformation/kate-pickett-richard-wilkinson/enemy-between-us-how-inequality-erodes-our-mental-heal">The Inner Level</a></em>, epidemiologists Kate Pickett and Richard Wilkinson make a data-based case, not only that unequal societies are worse to live in but also that inequality erodes trust and leads to anxiety, causing an arms race in competitive consumption. This animus is good for no one; disparities in wealth connect with the prevalence of mental illness, and so depression is linked to a deep economic ordering which volunteering is ill-equipped to address. No bowling league will work for a fairer society and no gardening club can keep your boss off your back. </p> <p>It’s not that social capital theory is wrong, just incomplete: community networks are an important, perhaps vital, element of our lives. But even combined with medication they are not a truly holistic solution to depression. By emphasising community over political action, social prescribing side-steps the economics of mental illness: a focus on social capital shifts the frame away from the social effects of capitalism. It is <em>economic </em>society that needs a visit to the doctor. </p> <p>Of course we should not abandon hope in voluntary action. In its more radical guise as social activism it focuses attention on the economic context of depression. In this vein, a charity called <a href="https://www.time-to-change.org.uk/get-involved/activity/persuade-your-employer-sign-time-change-pledge">Time to Change</a> encourages its members to meet with their bosses, requesting a pledge to tackle mental health stigma in the workplace. Another charity, <a href="https://www.mind.org.uk/about-us/our-policy-work/benefits/">Mind</a>, works to improve welfare benefits for mental health sufferers, encouraging its members to lobby Parliament. In contrast to much community work, these campaigns put politics at the centre.</p> <p>In the period since Putnam wrote <em>Bowling Alone</em>, it has become obvious that society cannot realistically be theorised as a civic whole of interlocking groups: there is no ‘honeycomb.’ News reports reflect a world of irreconcilable conflict, from Brexit in the UK to the polarising impact of President Trump in the USA. Yet the fact that we can no longer ignore our divisions might lead us to mount a back-to-front argument <em>against</em> politicising volunteering in this way: in a context of strife, non-political community work could be said to provide a neutral space which opens up a civic domain in which we can come together and leave politics at the door; a place where we might give it all a rest and just concentrate on something fun like bowling.</p> <p>There is some mileage in this view. It’s true that not everyone wants to talk politics with their neighbours, but all political silence has a cost. After two years of field work, the American Sociologist <a href="https://www.jstor.org/stable/658024?seq=1#page_scan_tab_contents">Nina Eliasoph concluded</a> that volunteers often work to keep their conversations neutral, taking care not to sour the mood at meetings. Yet to disengage on social questions is to accept a type of disempowerment, a self-removal from the scene. For Eliasoph, social activists have something valuable that community workers do not—a willingness to recognise complexity, challenge authority, and relate deeply with each other. To confront political issues is only to recognise social reality. </p> <p>While a focus on the economics of depression might push some right-leaning volunteers out of the meeting room, single-issue activism can still be reasonably inclusive. In contrast to party membership, which might require the broad embrace of a cluster of divisive policies, social activism hones in on a cause. A single issue can provide a point around which diverse people might coalesce, even when they agree on little else. At best, activists enjoy the community advantages of a cell in Putnam’s honeycomb. They can be tightly bound together as friends, but they also have a critical awareness of cracks in the overall social and political structure.</p> <p>Social activism can mean leafletting, door knocking and collecting signatures, but it is not necessary to get cold outside in order to change the world. Those that prefer the warm might turn to art. <a href="https://www.jstor.org/stable/3653925?seq=1#page_scan_tab_contents">William Morris</a>, the Victorian socialist and designer thought that joy in creativity was nature’s compensation for toil in labour. Depressed in office work, we might still take pleasure in music, dance, film, photography, crafts or ‘<a href="https://www.opendemocracy.net/transformation/kali-swenson/social-justice-with-knitting">craftivism</a>.’ It is even possible to politicise a knitting circle if activists put slogans onto clothes, quilts and samplers, voicing the economics of depression in cross-stitch. Or they might write and blog together, explaining the world in order to change it. What matters is that we do all our work with an awareness of society, politics and economics, combined with a willingness to change all three.</p> <p>The British Minister for Health should be given credit for being innovative, but it is unrealistic to expect him embrace or encourage social activism. No Minister could prescribe social change on the National Health Service; part of the attraction of Putnam’s theory is precisely its political safety. Policy-makers are responsible for steadying the ship of state not rocking it. </p> <p>When Brooks Newmark, a former British Minister for Civil Society <a href="https://www.theguardian.com/society/2014/sep/03/charities-knitting-politics-brook-newmark">said recently</a> that charities should “stick to their knitting,” he meant to imply that they should keep out of political and economic issues. But that is the voice of the <em>status quo</em>. In fact, politics is precisely what volunteers should be doing—not least with their needlework.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/transformation/michael-edwards/when-is-civil-society-force-for-social-transformation">When is civil society a force for social transformation?</a> </div> <div class="field-item even"> <a href="/participation-now/hilde-c-stephansen-leah-lievrouw-nick-mahony/when-is-citizen-participation-transfo">When is citizen participation transformative? </a> </div> <div class="field-item odd"> <a href="/transformation/peroline-ainsworth-kiran-nihalani/five-ways-to-build-solidarity-across-our-difference">Five ways to build solidarity across our differences</a> </div> </div> </div> </fieldset> <div class="field field-topics"> <div class="field-label">Topics:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> Civil society </div> </div> </div> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> Transformation ourNHS Transformation Civil society John Picton The politics of mental health Activism Tue, 21 Aug 2018 20:02:44 +0000 John Picton 119353 at https://www.opendemocracy.net The NHS deal is not an acceptable settlement https://www.opendemocracy.net/ournhs/rachel-harrison/nhs-deal-is-not-acceptable-settlement <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>GMB, the only union to vote against the government's NHS pay deal, pledge to continue fighting it.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/565030/22241083476_458f212dda_z.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/565030/22241083476_458f212dda_z.jpg" alt="Junior doctors protest contract changes in 2015." title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Junior doctors protest contract changes in 2015. Image: <a href="https://www.flickr.com/photos/rohinfrancis/22241083476/in/photostream/" target="_blank">Rohin Francis</a> (CC BY 2.0) </span></span></span>Since our members overwhelmingly rejected Jeremy Hunt’s dodgy three year NHS pay deal earlier this year, we have been consulting them on the next steps.</p><p>During the past few weeks, members have used the <a href="https://opendemocracy.net/ournhs/caroline-molloy/nhs-staff-discover-they-will-get-hundreds-of-pounds-less-than-they-thought" target="_blank">ballot process to tell reps on the ground about their huge disappointment at this pay deal and how let down they feel by it</a>.</p><p>After nearly a decade of wage freezes and caps that have seen our dedicated NHS and ambulance workers’ pay pinched and left them thousands of pounds out of pocket, a below inflation wage increase for some of the longest-serving, most dedicated staff in the health service is not good enough. Our members deserve far more than a real terms pay cut.&nbsp;</p><p>We have said all along that we could not in good conscience recommend Jeremy Hunt’s offer to our members. And so we didn’t.&nbsp;</p><p>GMB was the only union of 14 health service representative bodies to have rejected Jeremy Hunt’s offer for what it was, and our ability to take industrial action this year alone has been limited accordingly. That, coupled with the government’s anti-trade union legislation which makes it extremely difficult to meet legal thresholds for a formal industrial action ballot, are why we are unable to trigger a formal industrial action vote over NHS pay this year.&nbsp;</p><p class="mag-quote-right">Our members deserve far more than a real terms pay cut&nbsp;</p><p>The message from GMB members has been loud and clear throughout our consultation – we must continue to campaign for more funding for NHS pay. This three year deal is not an acceptable settlement for us.</p><p>A joint meeting between GMB National NHS and Ambulance Service reps and officers has overwhelmingly agreed that although we are not in a position to ballot for industrial action, GMB's campaign does not stop here. As we have promised to members, GMB will continue to push the government into increasing funding into the NHS for pay. Anyone who thinks we will lie down and simply accept this pay deal for the next three years is very wrong. It’s not good enough – and this is not the end of the matter. The strength of feeling among GMB members is very clear on that.&nbsp;</p><p>We’re incredibly proud of our members for taking a stand – and grateful to the support and solidarity we have received from workers across the NHS and from the public at large who support our call for properly funded fair pay for the heroes working in our health service.&nbsp;</p><p>Under this government our NHS is under threat. For it to survive, we need to continue to fight for it and the people who keep it going every day. And GMB will.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/nhs-staff-discover-they-will-get-hundreds-of-pounds-less-than-they-thought">NHS staff discover they will get hundreds of pounds less than many thought</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/nhs-pay-deal-row-intensifies-as-nurses-call-for-union-leader-to-quit">NHS pay deal row intensifies as nurses call for union leader to quit</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS ourNHS Rachel Harrison Mon, 13 Aug 2018 15:45:19 +0000 Rachel Harrison 119249 at https://www.opendemocracy.net NHS pay deal row intensifies as nurses call for union leader to quit https://www.opendemocracy.net/ournhs/caroline-molloy/nhs-pay-deal-row-intensifies-as-nurses-call-for-union-leader-to-quit <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Calls for resignations and for NHS pay vote to be rerun as Royal College of Nursing chief admits they gave incorrect pay deal information.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/pay deal story 2.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/pay deal story 2.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Nurses pay protest 2017. Credit: Yui Mok/PA Images, all rights reserved</em></p><p>Furious members of the Royal College of Nursing last night <a href="https://docs.google.com/forms/d/e/1FAIpQLScapLCouL3tNwINQU5MiaJsNatBlaZ39h6IgXP5fjFTBslNbg/viewform">launched a petition calling for the union’s leaders to stand down</a> over their handling of communications about this year’s NHS pay deal in England.</p> <p>OurNHS understands the petition is well over halfway to the required number of signatures to trigger an emergency general meeting, another of its demands. It was started after the head of the RCN, Janet Davies, last night took the unprecedented step of writing to members to apologise that they were given incorrect information about the pay deal that they voted on in the spring. Ms Davies acknowledged that many have received less than the RCN told them they would.</p> <p>Her email comes after <a href="https://opendemocracy.net/ournhs/caroline-molloy/nhs-staff-discover-they-will-get-hundreds-of-pounds-less-than-they-thought">OurNHS exposed last week</a> that many NHS staff felt disappointed and upset&nbsp;as it emerged that many would not immediately get the full pay rise they were expecting.</p> <p>The email, seen by OurNHS, shows that their concerns were justified. In it, Ms Davies says:</p> <p>"I wanted to write to you myself over the recent NHS pay deal.&nbsp;It has come to my attention in the last 24 hours that the deal was not as straightforward as we said and for that I offer you a sincere personal apology.</p> <p>"I’m as dismayed and angry as you are and will fight the corner of members at every turn.&nbsp;In good faith, we told all members that they would receive a 3 per cent uplift this summer. I now find that this is not the case for everyone.”</p> <p>Ms Davies went on, "I can assure you that I am demanding answers for you. In the meantime, I can only apologise for this unnecessary confusion and assure you that I am determined to resolve it.&nbsp;Your elected Council and Trade Union Committee will be meeting in the next few days and I will update you on next steps."</p> <p>Along with the other main unions, apart from the GMB, the RCN had recommended the pay deal to members.</p> <h2>Anger from below</h2> <p>Last night there was renewed fury amongst RCN activists and members. Anthony Johnson, a health visitor, RCN member and former ‘pay champion’ (members who help organise local action around pay) told OurNHS that the RCN “shouldn’t have trusted the government… It seems like they’ve just gone for the deal and been screwed over, but they’ve sold the deal so it’s their fault”. </p> <p>Asked about the assertion by some unions that the deal was understood, Mr Johnson replied, “No way is that true that staff understood. People were still passing around incorrect information right up till the vote.” Many staff have been making similar comments both to OurNHS and on social media in recent days, as payslips land on NHS staff doorsteps this week.</p> <p>Mr Johnson’s views are echoed across social media. Many NHS staff are furious with the government. Lauren Gavaghan, a consultant psychiatrist,&nbsp;<span><a href="https://twitter.com/DancingTheMind/status/1019835168260001798" target="_blank">tweeted</a></span>&nbsp;that the debacle was “Jeremy Hunt’s parting gift to NHS staff”. The anonymous @GPConsortia account <span><a href="https://twitter.com/gpconsortia/status/1019936011416162305" target="_blank">tweeted</a></span>&nbsp;merely, “Swine.” Retired doctor Mark Cheeseman&nbsp;<span><a href="https://twitter.com/stilton54/status/1019674728968196097" target="_blank">tweeted</a></span>,<strong>&nbsp;“</strong>The NHS worries why it’s losing so many staff. And then double-crosses the ones they have got on a pay deal.”</p> <p>Another NHS worker commented on OurNHS’s original story<strong>, “</strong>I'm a band 6 nurse at spine point 27, with incremental date of end of January. I cast my vote based on information given to me from the pay calculator [from unison],&nbsp;which indicates that in year 1 my pay would increase by £1,672. According to these newly released figures from [the nhs employers site] above, my pay will actually increase by £491, and I will have to wait until my next incremental date before I see the pay rise I voted for. Since my pay was always going to increase on my next incremental date, I feel that I was misled.”</p> <p>Another commented, “I work with highly intelligent, analytically astute people who are used to dealing with numbers and figures on a daily basis... and they were inveigled by the purposely Byzantine structure proposed.”</p> <p>Gordon Marsden, a Labour MP and shadow education minister,&nbsp;<span><a href="https://twitter.com/GordonMarsden/status/1022398603971776513" target="_blank">tweeted</a></span>&nbsp;in response to an openDemocracy update last night, “Looks like Jeremy Hunt got out of [Department of] Health just in time ...another 'con' from a discredited 'Con' Govt They’ll sneak things out to dodge scrutiny … &amp; now misrepresent underpar NHS rises.”</p> <p>Many were angry with both the government and the unions who recommended the deal. One NHS scientist&nbsp;<span><a href="https://twitter.com/wakeyrule/status/1022369064184889344" target="_blank">tweeted</a></span>, “The gasps of disbelief from NHS staff as they open their pay packets is reverberating around the Trust where I work. Overwhelming feeling is that the Unions have been hoodwinked by the Govt.”</p> <p>A community health nurse&nbsp;<span><a href="https://twitter.com/IsiSiewruk/status/1022199715587399680" target="_blank">replied</a></span>&nbsp;to a tweet by the RCN that mentioned a 3% pay rise, saying “That’s just not true though is it. It’s around 1.5 percent until increment date, so not 3% for the full year. The NHS Employer tool also shows that will also happen in year 2 and 3 for me. Not how it was sold to staff before the vote.”</p> <p>An advanced nurse practitioner&nbsp;<span><a href="https://twitter.com/scarymonstertwo/status/1022164916432789504" target="_blank">tweeted</a></span>, “Rather than an apology, how about a public denouncement of the deal, an apology and a declaration to fight it and poll members for action?”</p> <h2>Official responses</h2> <p>Danny Mortimer, head of NHS Employers, told OurNHS today that this was “an issue between the RCN and its membership”. He said, “The letter states that the RCN has in error told members in one of its documents that they would all receive ‘a 3 per cent uplift this summer’… This miscommunication is very unfortunate and clearly the RCN will need to review all of its communications to understand the extent of its error.” In response to a specific question NHS Employers confirmed to OurNHS that <a href="https://twitter.com/TweetBails/status/1021707924404662272">a poster showing the apparently higher pay figures</a>&nbsp;(ie, including a full year's increment for those staff not at the top of their bands) was put up on their website 21 March and taken down on 13 June, and told us that “materials explaining are regularly updated in light of feedback and questions".</p> <p>An RCN spokesperson told OurNHS, “This is not about reopening the deal. Despite some delays to payments, over the three years the deal has to run, members will receive the full amount promised. We are sorry for any confusion caused about what members were due to receive this month.” </p> <h2>Trouble for the Tories</h2> <p>The pay offer came at a point when the government was under considerable political pressure. After one of the hardest winters in NHS history, union leaders were loudly pointing out that eight years of zero or 1% pay rises (a real-terms cut of 14% after inflation) was contributing to serious and worsening staff shortages.&nbsp;<a href="https://www.theguardian.com/society/2017/sep/06/enough-is-enough-nurses-protest-against-pay-cap-outside-westminster" target="_blank">For months, nurses had been warning the government</a>&nbsp;that unless pay was addressed properly they would take historically unprecedented strike action.</p> <p><a href="https://www.independent.co.uk/news/uk/home-news/nurses-vote-overwhelmingly-to-strike-for-first-time-ever-over-1-pay-rises-a7735451.html" target="_blank">Four out of five nurses&nbsp;were prepared to strike</a>&nbsp;over pay, according to an initial RCN ballot of its members during the 2017 election campaign. The government’s pay cap was widely seen by commentators to have contributed to the Tories’ poor performance in that election. Asked during the campaign why nurses were having to rely on foodbanks, Theresa May told the BBC that there were “many complex reasons”—a response for which she was widely criticised.</p> <p>In March 2018 Jeremy Hunt, then health secretary, tweeted that he was “Delighted to confirm pay rise of between 6.5 and 29% for NHS staff who have worked so hard over a tough Winter, in a £4.2bn deal.” Hunt told Parliament, “Rarely has a pay rise been so well deserved for NHS staff, who have never worked harder.”</p> <h2>Pensions problem</h2> <p>In further developments, fresh concerns have emerged about the impact of&nbsp;<span><a href="http://campaign.r20.constantcontact.com/render?m=1102665899193&amp;ca=e2244e75-6316-43e3-939c-7792b7a1680b" target="_blank">pensions</a></span>. The leaders of the GMB have expressed disappointment at the actual increase, and both&nbsp;<span><a href="http://www.labournet.net/ukunion/1807/nhspay1.html" target="_blank">activists</a>&nbsp;in other unions</span> and the GMB leadership have reiterated their previous concerns about the deal, including the impact of inflation and changes to&nbsp;payments for unsocial hours. The GMB&nbsp;<span><a href="https://twitter.com/GMB_union/status/1022216933649907715" target="_blank">tweeted</a></span>&nbsp;yesterday, “We couldn’t recommend Jeremy Hunt’s dodgy NHS pay offer to our members. And so we didn’t.”</p> <p>OurNHS has also seen materials that the RCN circulated to its reps and pay champions before the vote on the pay deal, asking them to recommend the deal even if they didn’t fully understand it. One leaflet for reps tells them to “encourage [members] to say yes to the deal”. Another says, “We believe it’s the best deal we can expect in the current climate of austerity and we’re now recommending members accept it. As a pay champion, we expect you to spread the word about the deal.” Inside, the FAQs include: “<strong>The pay deal looks complex, do I need to learn it all?</strong>&nbsp;The short answer is no. We don’t expect you to advise members on the pay deal. You should signpost them to&nbsp;<span><a href="http://www.rcn.org.uk/nursing-pay" target="_blank">www.rcn.org.uk/nursing-pay</a></span>&nbsp;and pay meetings where they can ask questions.&nbsp;<strong>What if I don’t agree with the deal?&nbsp;</strong>… If you strongly disagree with the deal we hope that you will still give out the leaflets and put up the posters…you can also have your say when voting opens on 23 April.”</p> <p>Some staff who did ask questions told OurNHS they got short shrift. Mr Johnson says that when he raised questions about aspects of the pay deal, including unsocial hours payments, he was told “you don’t understand maths”.</p> <p>NHS Employers told the Health Services Journal last night they were “disappointed” at the RCN’s email to its members yesterday, and “surprised as no concerns were raised with us”.</p> <p>In a separate statement NHS Employers focused on a separate issue, which is that whilst the pay deal will be applied to this month’s pay packets, staff won’t get the backdated pay till August rather than July.&nbsp;&nbsp;</p> <p>The RCN represents 435,000 members.</p> <p>This week NHS doctors are also&nbsp;<span>up in arms about their own, separate pay deal,</span>&nbsp;as it emerged on the last day of Parliament that they, like other public-sector workers including police officers, would this year receive a below-inflation rise of 2%. This is less than the independent NHS Pay Review Body recommended, and comes after doctors, like other NHS workers, have endured years of pay austerity.</p> <p>Calls for the vote to be re-run are widespread,&nbsp;with prominent NHS blogger Roy Lilley saying,<strong> “</strong>Tonight the RCN have ‘apologised’ for ‘the dismay’ I think a re-ballot is called for. Only&nbsp;<span><a href="https://twitter.com/GMB_union" target="_blank">@GMB_union</a></span> opposed the award and they are right<strong>.”</strong></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/nhs-staff-discover-they-will-get-hundreds-of-pounds-less-than-they-thought">NHS staff discover they will get hundreds of pounds less than many thought</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Caroline Molloy Thu, 26 Jul 2018 13:14:13 +0000 Caroline Molloy 119029 at https://www.opendemocracy.net NHS staff discover they will get hundreds of pounds less than many thought https://www.opendemocracy.net/ournhs/caroline-molloy/nhs-staff-discover-they-will-get-hundreds-of-pounds-less-than-they-thought <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Nearly a million NHS staff are due to receive a long-awaited pay rise at the end of this month. But new figures released quietly last week have caused fury—and confusion even amongst some unions.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/rcn protest.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/rcn protest.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Nurses protest against the government's pay cap, September 2017. Credit: NurPhoto/SIPA/PA Images</em></p><p><em>BREAKING NEWS: UPDATE 20:15, 25th July 2018:<br /></em></p><p><em>The head of the Royal College of Nursing, Janet Davies, has today taken the unprecedented step of writing to members to apologise that staff were given incorrect information about their pay deal voted on in the Spring, and large numbers have received less than the RCN told them they would receive. The email (seen by OurNHS) confirms OurNHS's revelations last week. In it, Ms Davies says:<br /></em></p><p><em>"I wanted to write to you myself over the recent NHS pay deal.&nbsp;It has come to my attention in the last 24 hours that the deal was not as straightforward as we said and for that I offer you a sincere personal apology.<br /></em></p><p><em>"I’m as dismayed and angry as you are and will fight the corner of members at every turn.&nbsp;In good faith, we told all members that they would receive a 3 per cent uplift this summer. I now find that this is not the case for everyone.<br /></em></p><p><em>"I can assure you that I am demanding answers for you. In the meantime, I can only apologise for this unnecessary confusion and assure you that I am determined to resolve it.&nbsp;Your elected Council and Trade Union Committee will be meeting in the next few days and I will update you on next steps."<br /></em></p><p><em>OurNHS will cover this rapidly developing story as it unfolds tomorrow.</em></p><p><span>NHS staff vented fury yesterday as newly published figures suggested that they may have accepted a pay offer last month on the basis of information that did not mean what they thought it did.</span></p> <p>The three-year deal – trumpeted by Jeremy Hunt as “an incredibly well deserved pay rise for staff who have never worked harder” – came after years of pay freezes and real-terms pay cuts. NHS staff were expecting a nice chunk of back pay for the first year’s rise to be in their pay packets at the end of July (as they’ve been paid at last year’s rate until everything was settled).</p> <p>But many NHS workers could be in for a nasty shock. <a href="http://www.nhsemployers.org/-/media/Employers/Documents/Pay-and-reward/NHS-TCS-2018-Pay-scales-poster-2018-19.pdf">NHS Employers, the official body in charge of NHS staff, has just published the new 2018/9 pay rates</a> – and&nbsp;<span>to many NHS workers they do not appear to be</span>&nbsp;the same as the 2018/9 pay figures staff were pointed to <em>before</em> they voted on the deal.&nbsp;<span>In fact, averaged across all</span><span> pay </span><span>bands and scale</span><span> points</span><span>, they appear to award </span><span>initially </span><span>only</span><span> around half the pay </span><em><span>rise from April 2018 that many staff may have been expecting</span></em><em><span>,</span></em><span> according to OurNHS’s calculations.</span></p> <p><span>Nearly a million staff are covered by the NHS pay deal, though not hospital doctors</span>. Unions thrashed out the deal with the government in March, and balloted their members in the spring, with most union leaderships (except the GMB) recommending support. There were arguments about the headline figures, so most unions strongly advised their members to check out what it meant for them on a ‘<a href="https://www.nhspay.org/pay-calculator/">pay calculator</a>’ before making up their minds. (Unison created its <a href="https://www.unison.org.uk/nhs-pay-calculator">own calculator</a> which drew from and was identical to the NHS Pay one).</p> <p>For example, Unison emailed members in April, saying, “It’s really important that you understand what it would mean for you before you cast your vote. If you haven’t already, you might find trying out our pay calculator useful – just enter your pay point and your pay band to find out exactly how much your salary would change.” </p> <p>Similarly Unite emailed members in March, linking to the calculator - <a href="http://www.nhspay.org/">www.nhspay.org/</a>.</p> <p>However, it now transpires that, when spinning the new deal, the NHS employers jumbled up two different things in the pay calculators. One was the long-awaited (not very big) cost of living increase across the NHS. The other,&nbsp;<span>Often much larger&nbsp;</span>part of the pay rise people were told they would get turns out to be the normal pay increase that most NHS employees receive every year anyway, in recognition of their growing experience. This is known as their ‘increment’. </p> <p><span>A bigger problem arises because the cost-of-living increase and the increment will be received on very different dates</span>. While many staff thought that the whole new salary would be back-dated to the start of the financial year in April, in fact, only the relatively small cost of living increase will be. Their annual increment - usually the bigger part of the increase - will only come in on the anniversary of when they started with the NHS: which could be many months later. The result is that many staff will be earning hundreds - or even thousands - of pounds less this year than they had understood when they voted for the package.&nbsp;<span>The issue potentially affects nearly half of NHS staff, though those on the top of their pay bands are not affected as they were not due an increment anyway, and those on the very lowest levels of pay (the 90,000 staff currently earning under £17,460) are not affected as they will get the full pay rise with effect from 1 April, unlike other staff.&nbsp;</span></p> <p>In fact, it’s not just staff who are confused. I’ve asked NHS Employers and the unions to explain the discrepancy, and have had totally conflicting answers.</p> <p>Today, the Royal College of Nursing press office told me that a typical nurse on point 20 in the middle of Band 5 (for example), previously earning £25,551 a year, would receive the entire rise with effect from the 1st of April, saying “yes, that member of staff will earn £26,963 [the new rate for that point and band] with effect from April 2018”. </p> <p>But both Unison and NHS Employers have today made clear to OurNHS that that member of staff would be paid only £25,934 from the 1 April. That’s only around a <em>quarter</em> of their promised 2018 increase on basic pay (a difference of nearly £100 a month in this typical example)&nbsp;<span>until their increment payment kicks in at their anniversary date at some point over the following 12 months</span>.</p> <p>The RCN also told OurNHS that<strong> </strong>“the original calculator is for existing staff, and the&nbsp;NHS&nbsp;Employers&nbsp;poster sets out what new staff will earn. Two different tools serving different purposes. Existing staff should use the old calculator to work out their pay uplift.” But this is not what other unions and NHS Employers seem to be saying.</p> <p>OurNHS asked the RCN if they understood why staff might feel they had been misled. They replied, “We are working with&nbsp;NHS&nbsp;Employers&nbsp;to produce a simple explanation of the differences between the individual pay journey document, and the pay calculator, pay scales and new web tool, to prevent further confusion and information overload.&nbsp;We are hoping this will be published this Friday 20th July in time for pay day the following week.”</p> <p>OurNHS has approached NHS Employers for comment, but has not received any formal statement at the time of writing.</p> <p>GMB’s National Officer Rachel Harrison commented, “All that glitters is not gold and it's now clear that Jeremy Hunt's last act was to try and mislead NHS workers who have already endured years of real-terms pay cuts. We have always warned that the devil would be in the detail, and so it has proved...That is why GMB is holding an indicative ballot for industrial action over this pay offer."</p> <p>Furthermore, the GMB told OurNHS that under the pay deal, the ‘increment’ is no longer automatic or definite – in future, it will depend on assessment, though there will be a transitional period (though we've been told contradictory infomation about this).</p> <p>A Unison spokesperson told OurNHS that the need to implement the pay offer as soon as possible meant that the existing issue of the split between April part rises and incremental / anniversary rises later in the year, had not been addressed. The union’s deputy head of health, Helga Pile, said “this agreement won’t solve all problems overnight, but it will ease the financial strain suffered by staff over many years. The deal delivers substantial increases to starting salaries, meaningful pay rises on promotion and faster progression through most pay bands”.</p> <p>The small print in the materials promoted to staff <em>did</em> make reference to increment dates, OurNHS has established. But the question remains, were both the employers and the union leaderships (except the GMB) perhaps (after years of bruising battles, and a long strike over separate junior doctors’ negotiations the previous year) perhaps a little too keen on sealing a deal?</p> <p>The confusion is likely to stoke fury, with many staff affected across the board.<strong> </strong>A senior nurse or Occupational Therapist on pay band 6, point 28, was promised an increase of £3,995 in year one – but instead, according to NHS Employers, from April 2018 they’ll get only £508 more until their incremental increase kicks in. At more junior levels an experienced Healthcare Assistant in the middle of Band 3 will have been expecting their pay to rise by £1039, but instead from April 2018&nbsp;<span>until their increment kicks in&nbsp;</span>will get an increase of only £291 a year. Such examples are typical - according to OurNHS’s calculations, on the basis of the pay calculator information, NHS employees (averaged across all grades and pay points) were expecting a pay rise from April 2018 of £2,184.18 a year. To begin with at least, they’ll get less than half that – an average across all grades from April 2018 of £973.16. (Note – all these figures are higher than the actual average across <em>all staff</em>, because they are skewed by the relatively small number of staff on higher grades).</p> <p>The deal also incudes a "no detriment" clause, which means that no one should be worse off. But mmembers of NHS staff Facebook groups were last night saying they felt “shafted”, “screwed over” and that “the government has lied” – with some also criticising unions.&nbsp;<span>All of this gives weight to <a href="https://opendemocracy.net/ournhs/mark-boothroyd/why-nhs-staff-should-ditchthedeal-reject-government-pay-offer">union activists warnings</a> that NHS staff would have been better rejecting the pay deal and taking further industrial action.</span></p><p class="mag-quote-center">we all deserve to be told why the deal being implemented by the Employers is not the deal many members believed they had voted for</p> <p><a href="http://www.labournet.net/ukunion/1807/nhspay1.html">Unison activist Greg Dropkin commented last night</a> that the source of the discrepancy was “unclear” but he suspected there had been “a failure to explain during the vote that the pay table as circulated did not show the rate for each pay point, but the rate which an employee who was on that pay point in 2017/18 could “expect” to receive in each of the following years…we all deserve to be told why the deal being implemented by the Employers is not the deal many members believed they had voted for”.&nbsp;</p> <p>Perhaps it’s just a case of ‘buyer beware’ – or ‘voter beware’ (there’s a lot of that about in Brexit Britain). Should have read the small print. </p> <p>And perhaps it’s just sheer chance that NHS Employers happened to release actual figures last week, when just about everyone’s attention was maxed out with Donald Trump’s visit, the World Cup and the government falling apart.</p> <p>Certainly, our investigation suggests there are serious questions to answer about whether NHS workers were misinformed about the impact on their pay, and if so, what that means for the future.</p><p><em>19 July: This article has been amended to clarify that no staff should be worse off as a result of this deal, and that we've been told contradictory information about the exact timing of changes to the increment process.</em></p><p><em>20 July: this article has been further amended to remove reference to average salary changes while we discuss these with health unions.</em></p><p><span><em>25 July: this article has been amended to reinstate the reference to average changes, and also to further clarify the timing of those changes and that there are some groups of staff not affected by these issues.</em></span></p><div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Caroline Molloy Wed, 18 Jul 2018 16:23:16 +0000 Caroline Molloy 118923 at https://www.opendemocracy.net The NHS proves there’s always been an alternative https://www.opendemocracy.net/ournhs/laurie-laybourn-langton/nhs-proves-there-s-always-been-alternative <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> As Britain’s National Health Service celebrates 70 years today, its troubles expose neoliberalism’s lies. </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/NHS-image-960x605.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/NHS-image-960x605.jpg" alt="" title="" width="460" height="290" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Birmingham Eastside, CC 2.0</em></p><p>Emerging from the ashes of the Second World War, the founding principles of the NHS – free to all, at the point of use, beyond the insurance principle – allowed Britain to win the peace. Universal health coverage - founded across the UK seventy years ago today - gave succour to a sick and dispirited nation, providing the conditions in which Fordist consumer-capitalism could mature by creating a&nbsp;<a href="https://www.gresham.ac.uk/lecture/transcript/download/aneurin-bevan-and-the-socialist-ideal/">“secret, silent column”</a>&nbsp;of healthy and productive citizens who helped usher in the post-war Keynesian boom. For a nation bowed but unbroken, scuttling its empire in a new age of human rights, it may have seemed reasonable for Aneurin Bevan to proclaim that Britain, with its NHS, now had “the moral leadership of the world”.</p> <p>This was an era of rapid and momentous change. Little less than a year before, at the stroke of midnight, the nations of India and Pakistan achieved freedom from a dying empire; in 1948, as 4th&nbsp;July turned to 5th, the British people could dream of freedom from fear.</p><h2>Support for the NHS across the British state</h2> <p>The NHS was the archetypal child of its ideological time. The concept of public healthcare under the NHS model sat atop a new wave of political and economic ideas. Centralised state bureaucracies and Keynesian demand management washed away the failed political economy of the Wall Street Crash and the Great Depression. As Bevan pushed through his plan for a publicly provided rather than ‘publicly organised’ NHS, a former Conservative health secretary&nbsp;<a href="http://news.bbc.co.uk/1/hi/uk_politics/460009.stm">asserted</a>&nbsp;that this “would destroy so much in this country that we value”. Precisely the opposite occurred.</p> <p>However, contrary to some contemporary opinion, this revolutionary turn in the role and functions of government came with broad support from across the British state. This is not to disavow the achievement, merely a reminder that the time for a profound shift in political and economic ideas had come. When it came again, in the late seventies and early eighties, the vanguard of the new order identified themselves almost in direct opposition to what the NHS stood for, the ideas that justified it, and the objective reality it delivered.</p> <p>The NHS has always been the target of opprobrium from the intellectual evangelists of incongruous market liberalism. This is the case whether they are set to gain from outsourcing and privatisation, or are merely captured by the shadows on the collective cave of our economic discourse. In the case of the former, from its&nbsp;inception, health insurance giants watched the NHS and pumped money into proto-neoliberal think tanks that criticised all facets of Britain’s public healthcare model with gleeful abandon.</p><p class="mag-quote-center">proto-neoliberal think tanks that criticised all facets of Britain’s public healthcare model with gleeful abandon</p> <p>It was in reaction to an attack on the principles of non-fee-paying blood donation that the sociologist Richard Titmuss wrote<em>&nbsp;The Gift Relationship</em>, his seminal exploration of the impacts of pecuniary incentives in social policy. Titmuss warned that the unabashed introduction of markets into previously untouched areas of policy would result in a destructive, pervasive “ideology to end all ideologies”. Into what future would we now head if it was this book that British prime ministers pulled from their bags, slammed onto tables, and over which they declared “this is what we believe”?</p><h2>Neoliberal revolution strikes</h2> <p>As the post-war consensus fell, practical men, finding themselves quite exempt from intellectual influence, slaved away to deliver the assertions of defunct economists. The theoretical basis of neoliberal economic ideas considers markets the superior means of coordinating allocation of resources under conditions of scarcity. However, when applied to healthcare, market dynamics are profoundly inappropriate. This is not the case with, say, food, where you, endowed with sufficient information on which apple is appropriate for your own needs, can enjoy the benefits of a plurality of apple vendors, each optimising their products and prices to meet market demand. For serious heart problems, even a world-renowned cardiothoracic&nbsp;surgeon would suffer from incomplete understanding of her condition and treatment, opening up information asymmetries with the consultant sitting opposite.</p> <p>It took until the nineties for the neoliberal revolution to strike the NHS. Market structures were the order of the day as the state sailed heroically into the End of History. The NHS, as with all areas of public provision, was now going to compete – by hell, high-water or penalty imposed from central government. That it has taken until now for the contradictions, inefficiencies and failures of marketisation to be recognised by elements of the political mainstream stands testament to the dangerous paucity of our policy discourse. One cannot look upon the collapse of Carillion and the eye-watering&nbsp;<a href="https://researchbriefings.parliament.uk/ResearchBriefing/Summary/SN06007">cost of the Private Finance Initiative</a>&nbsp;– £310 billion&nbsp;for assets worth around £55 billion – without concluding that something is profoundly wrong with those economic ideas that justify such cruel, inefficient policies. Where does duty of care come in a contract that allows a private company to&nbsp;<a href="https://www.independent.co.uk/news/business/analysis-and-features/pfi-what-private-finance-initiatives-good-bad-carillion-collapse-public-sector-contracts-government-a8165971.html">charge an NHS hospital</a>£333 for a lightbulb?</p><h2>Marketisation brings waste, moral hazard and structural risks</h2> <p>The NHS under neoliberalism has failed on its own terms. Firstly, inappropriate and unnecessary marketisation has delivered waste, moral hazard, and, ultimately, exposed the system to structural risks, imposing large costs on the taxpayer through the socialisation of failure. The Centre for Health and the Public Interest estimates that the annual cost of marketisation in the NHS is in excess of £4.5 billion per year, with additional start-up costs of over&nbsp;<a href="https://chpi.org.uk/wp-content/uploads/2014/02/At-what-cost-paying-the-price-for-the-market-in-the-English-NHS-by-Calum-Paton.pdf">£3 billion per major market reform</a>. Indeed, the benefits of market ‘reforms’ have always been hotly contested, with opposition across academics and health practitioners, who stress a high opportunity cost in forgone patient care and clinical innovation.</p> <p>Secondly, privatisation – distinct to the&nbsp;<a href="https://www.independent.co.uk/news/health/nhs-capita-patient-risk-outsourcing-gp-pharmacy-dentists-privatisation-england-a8354651.html">wasteful outsourcing</a>&nbsp;of healthcare provision to private companies – has seen the loss of assets built up over decades and paid for by generations of taxpayers, a particularly vindictive, socially and economically irrational policy. For example, the coalition government famously sold 80% of the UK’s blood plasma resource company to Bain Capital for £90 million, putting the security of blood supplies at risk. Bain soon&nbsp;<a href="http://www.bpl.co.uk/about-bpl/news/q/date/2016/08/02/press-release-creat-group-corporation-completes-acquisition-of-bio-products-laboratory-ltd/">enjoyed profits</a>&nbsp;in excess of £700 million when the company was subsequently sold to Chinese investors. Into the future, the government is seeking to sell large quantities of NHS land, imposing the&nbsp;<a href="http://www.bmj.com/content/bmj/358/bmj.j4290.full.pdf">opportunity cost</a>&nbsp;of missed public investment in productive assets, such as the construction of much needed hospitals and the installation of renewable energy that could power the NHS and reduce its carbon emissions.</p><p class="mag-quote-center">the loss of assets built up over decades and paid for by generations of taxpayers</p> <p>Thirdly, it has simply been a deliberate political choice to underfund the NHS over a period that now approaches a decade. Over the 2015/16 financial year, NHS trusts and foundation trusts fell into a&nbsp;<a href="https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/trusts-deficit">combined deficit</a>&nbsp;of nearly £2.5 billion, only three years after reporting a surplus of over £500 million. While the changing nature of ill health and demand for services plays a part, this gap has opened up due to a&nbsp;<a href="https://www.opendemocracy.net/neweconomics/why-is-the-nhs-in-crisis/">deliberate policy of underfunding</a>: real terms increases in NHS funding were 0.9% a year between 2010-2015, in contrast to an average of 3.7% over its lifetime. There is now a near universal consensus that the NHS is underfunded and that the lack of resource is the greatest contributor to successive crises – something that even the government has begun recognised. In all, health and social care spending cuts have been linked to&nbsp;<a href="https://bmjopen.bmj.com/content/7/11/e017722">120,000 excess deaths</a>.</p> <p>At best, the justifications for George Osborne’s ‘Age of Austerity’ were the spurious frenzies of a politician appealing to the polluted ideas of a discredited yesteryear to benefit wealthy vested interests. At worst, they have cost lives and halted the inexorable, centuries-long tradition of improvement in public health driven by the noble efforts of British academics and clinicians. Do not forget that life expectancy had been rising continuously for over one hundred years, a trend that has&nbsp;<a href="http://marmot-review.blogspot.co.uk/2017/11/ncds-health-equity-and-social.html">likely faltered</a>&nbsp;because of the political choice to cut public expenditure, with the rate of increase in life expectancy having dropped by almost 50% since austerity began. If medical science has been of the greatest benefit to mankind, uncritical adherence to outworn economic dogma has been of the&nbsp;<a href="https://www.theguardian.com/books/2013/may/27/economic-stuckler-money-king-review">greatest detriment</a>.</p><h2>The human cost</h2> <p>For the neoliberal experiment, as in nearly all areas of policy, has imposed a wicked cost on our health. It has damaged systems that seemed to be working moderately well in the past and eroded the institutional basis upon which we can effectively respond to the challenges of the age. Take the future of the digital technology, which could alter social and economic relations at a pace and scale not seen since the Industrial Revolution. The manner in which digital technology is integrated into healthcare in the UK is and will always be a political choice. Smart phones, ubiquitous data collection and machine learning could be harnessed by the NHS to better realise its founding principles, creating possibilities beyond the wildest imaginings of Bevan, Beveridge et al. Instead, the digital frontier is dominated by multinational monopolists and speculators pumping money into consumerist start-ups that flood markets springing up in anticipation of continued underfunding and privatisation. We can do better.</p> <p>Moreover, the very basis of our healthcare model is being shaken by demographic change and a shift in the nature of ill health. Underfunding is simply unsustainable in the face of these trends. Into the future, environmental change, already described as the greatest threat (<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60931-X/abstract">and opportunity</a>) to public health, will determine the parameters of our healthcare imaginations. There is no room for systemic waste, fragmented private providers, and the inefficient adoption of innovative technologies in a world that has warmed by 1.5C and in which the&nbsp;<a href="https://www.scientificamerican.com/article/only-60-years-of-farming-left-if-soil-degradation-continues/">majority of soil fertility has been lost</a>.</p><h2>What is to be done?</h2> <p>What is to be done? Much of a post-neoliberal approach to the NHS must seek to repair the damage done over the last few decades. Primarily, the NHS needs to be adequately funded as part of a wider move away from the discredited policy of austerity. Ill health over the period of fiscal retrenchment has resulted from damage to the systems of the state, encompassing everything from transport to social care, that provide the foundations upon which good health can spring. It will be a tragedy if the number of lives lost during the application of these failed, pre-Keynesian ideas should not banish them forever.</p> <p>The government’s recent pledge to up NHS spending by an average of&nbsp;<a href="https://www.nuffieldtrust.org.uk/news-item/funding-settlement-a-big-step-forward-but-pm-s-ambition-for-world-class-nhs-difficult-to-achieve">around 3% a year</a>&nbsp;to 2023/24 does not do this. It is below the&nbsp;<a href="https://www.kingsfund.org.uk/press/press-releases/4-billion-needed-next-year-to-stop-nhs-care-deteriorating">4.3% annual growth needed</a>&nbsp;to keep pace with demand and much lower than that needed to recover from the damage wrought by the past eight years of underfunding. What’s more, the funding is delayed until next year, opening up a cavern across which the NHS must jump and into which much of it could fall, particularly if another cold winter pushes the service into collapse. The increase also leaves out public health, staff training and building and other key capital investments. It has nothing to say about the cost of debt repayment.</p> <p>Marketisation can no longer be the first port of call for policymakers, as should be the case across the public sector. This includes needing to handle the growing burden of PFI debts, with options including the centralisation and renegotiation of contracts. Into the future, the social, environmental and economic power of the NHS should be brought to bear, with hospitals acting as ‘<a href="https://www.bmj.com/content/361/bmj.k2101">anchor institutions</a>’ that provide a local basis for everything from the rollout of clean energy through building energy assets on NHS land, to improving employment standards by targeting local recruitment and procurement. These developments are already occurring, with, for example, some hospitals in London&nbsp;<a href="http://www.renewableenergyfocus.com/view/42570/gospel-oak-a-district-heating-success-story/">recycling their heat into local housing</a>. Maximising the local socioeconomic role of the NHS could also present a more meaningfully democratised approach to decision-making.</p> <p>Until then, be wise to what neoliberalism has done and will continue to do to the NHS. Born of war and strife, Britain’s health service celebrates its 70th&nbsp;birthday in a bad way – bowed, nearly broken, ill-prepared to suffer the burden of continued underfunding and held together by the goodwill of staff. All the while, foreign insurance giants watch with patient eyes for opportunities arising from Brexit trade deals. The NHS is about being civilised; as we dismantle it, we become less civilised.</p><p class="mag-quote-center">The NHS is about being civilised; as we dismantle it, we become less civilised.</p> <p>Over the course of the 70th&nbsp;anniversary, the official celebrations shall likely focus on NHS staff. Quite right. But do not forget that the NHS is and has always been about economics, politics and power. It is about multinational corporations getting richer while sick people die in corridors. It is about bright young management consultants repeating failed economic cantations to justify inefficiency. Alone in a society brutalised by years of austerity, the NHS is increasingly the first and last line of care for people up and down the country, and is kept going by the blood, sweat and tears of its staff.</p> <p>The NHS is no longer national. Fragmented and sucked dry of resources, it cannot invest in responding to modern health problems. The NHS is increasingly becoming a logo under which private enterprise may suckle on the teat of the state, growing fat off our taxes. The predicament of the NHS at 70 is the result of a concerted application of failed economic ideology. Neoliberalism’s legacy is the private ambulance provider who bungles an emergency call because their staff are under-trained and poorly equipped; it is the baby who dies in the night, away from their parents, as the private provider of an out-of-hours service fails to adequately respond. Stand this no longer. If the Labour Party are to enter government in the near future, a test of their willingness to deliver a new society will be whether they create a post-neoliberal NHS.</p> <p>The NHS can be all that its staff and its patients believe it to be. A harbour in which fear is kept at bay, in which everyone maintains the right to be relieved of the pressures of ill health. In the final analysis, the crisis of neoliberalism is inherently a political crisis founded on the inadequacy of a certain set of economic ideas. In the same way that the NHS has always proven there is an alternative, the orthodox approach to healthcare policy proves that we need, now more than ever, an alternative to neoliberalism.</p> <p><em>This essay is a modified version of an article&nbsp;<a href="https://www.themintmagazine.com/issue-5-laybourn">published in the Mint</a>.</em></p><div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS ourNHS Laurie Laybourn-Langton Thu, 05 Jul 2018 12:25:00 +0000 Laurie Laybourn-Langton 118724 at https://www.opendemocracy.net Is the government telling us the truth about GDPR and our NHS medical data? https://www.opendemocracy.net/ournhs/phil-booth/is-government-telling-us-truth-about-gdpr-and-your-nhs-medical-data <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>If you want to make sure your medical data isn’t shared with third parties for unknown purposes, you may need to take action now. Here’s why – and how.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/safe_share_padlock.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/safe_share_padlock.jpg" alt="" title="" width="460" height="227" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Yuri Samoilov/Flickr, CCBY licence.</em></p><p>If you happen to visit your doctor in the next few weeks, you may (or may not) spot a new poster or leaflet; they are NHS blue, with a yellow stripe at the bottom, headlined “Your Data Matters to the NHS”. Like all those e-mails you’ve been receiving asking you to opt in to receiving marketing, the poster and leaflet has been prompted by GDPR – but it’s about something rather different, and the choice you are being offered is an opt <em>out</em>, not an opt in.</p> <p>Simply put, if you have concerns about what’s being done with your medical records – who is getting access to them, and how are they being used – you have the right to opt out of uses of your own health information for purposes beyond your individual care.</p> <p>This ‘new’ National Data Opt-out that you may (or may not) hear of is in fact based on one of the old care.data opt-outs, formerly known to doctors and Government as a ‘Type 2’, renamed so that – by 2020, we are told – care providers all across the NHS and care system will be able to see and honour your consent choice about what happens to your medical data.</p> <p>Great, in theory. But in practice?</p> <p>If you do see the poster, and follow the link – it’s <span><a href="https://www.nhs.uk/your-nhs-data-matters/">nhs.uk/your-nhs-data-matters/</a></span> – you’re told you can exercise your right to choose using a new ‘digital’ opt out process. Unfortunately, NHS Digital’s new process ignores the reality of many patients’ lives and – despite Government digital guidelines – fails to serve families, or the most vulnerable. So much for bridging the digital divide, and reaching the ‘furthest first’...</p> <p>Notably, too, if your family has children under the age of 13, or if you look after a dependent older relative, then things are even more complicated. Rather than giving a simple instruction to your doctor, those who would prefer their children’s data <em>wasn’t</em> sold to third parties for unknown purposes, will be required to send to NHS Digital, by post, four pieces of ID and documentation along with a seven-page form. So much for Jeremy Hunt’s much-vaunted commitment to a ‘paperless’ NHS</p> <p>So much for the process – what then happens to your information?</p> <p>The poster and leaflet go on to say:</p> <p>“<em>In May 2018, the strict rules about how this data can and cannot be used were strengthened. The NHS is committed to keeping patient information safe and always being clear about how it is used.”</em></p> <p>You only have to look at (our slightly more readable version of) NHS Digital’s Data Release Register at <span><a href="https://www.theysolditanyway.com/">TheySoldItAnyway.com</a></span> to see that little substantive has changed in practice. </p> <p>NHS patients’ data is still being sold to a variety of customers – including for-profit ‘information intermediaries’ which continue to serve commercial customers of their own, including pharmaceutical marketers and private providers.</p> <p>The law, however, <em>has</em> changed. </p> <p>As of May 23rd, the UK has a new Data Protection Act 2018 – replacing the expired 1998 Act and bringing the provisions of GDPR into UK law.</p> <p>NHS Digital, however, holds itself to the Information Commissioner’s old, pre-GDPR, non-statutory Code of Practice on Anonymisation – claiming this allows it to continue to <span><a href="https://medconfidential.org/2017/your-hospital-data-is-still-being-sold-and-heres-why-it-matters/">ignor</a><a href="https://medconfidential.org/2017/your-hospital-data-is-still-being-sold-and-heres-why-it-matters/">e</a><a href="https://medconfidential.org/2017/your-hospital-data-is-still-being-sold-and-heres-why-it-matters/"> 1.4 million patients’ opt-outs</a></span>, as it carries on selling ‘Hospital Episode Statistics’ data. </p> <p>This approach has passed its sell by date; GDPR provides a wider definition of what is ‘identifiable’ data – i.e. data that can be used, including by combining it with other sources of data, to identify individuals, <a href="https://ico.org.uk/for-organisations/guide-to-the-general-data-protection-regulation-gdpr/what-is-personal-data/what-is-personal-data/">even if supposedly anonymised</a>. UK law agrees with this wider definition, at least in theory – and both GDPR and our new Data Protection Act agree that any information about a person’s physical or mental health is <em>sensitive</em> personal data, and requires additional protections. </p> <p>Given that ‘Hospital Episode Statistics’ (HES) consists of ‘patient-level’ lifelong medical histories – each row in the data referring to a single person, with every individually-dated hospital event they experienced linked together using a ‘pseudonym’, and containing many other items of data that can act as ‘identifiers’ – it can count as ‘identifiable’ data under the new law and therefore also sensitive personal data, as medConfidential and others have been saying for years – although <a href="https://www.hsj.co.uk/technology-and-innovation/patient-data-flow-suspended-amid-11th-hour-gdpr-confusion/7022507.article">confusion over the new laws seems to have stretched to the top of NHS Digital</a>, and discussions are ongoing.</p> <p>Why does this matter? Your medical history is like a fingerprint – unique to you, and identifiable by almost trivial means: a mother with two children is over 99% likely to be identifiable from their children's birth dates alone, and <span><a href="https://www.bbc.co.uk/news/uk-england-suffolk-44155784">a single news report</a></span> could provide the information required to identify the unfortunate subject’s entire hospital history. A single breach of HES could expose millions of patients’ hospital histories, a disaster orders of magnitude greater than the <span><a href="https://www.theguardian.com/politics/2007/nov/21/immigrationpolicy.economy3">loss of the HMRC Child Benefit discs</a></span> in 2009.</p> <p>This also means that, as of May 25th, any <em>customer</em> of NHS Digital receiving full copies of HES is now handling identifiable, sensitive personal data – so if any patient’s opt-out is not being honoured (i.e. if their row of data is not being removed from HES) then, once again, NHS patients are being lied to. You can check for yourself the lists of organisations with projects that ignored opt outs, and those that honoured them, at <span><a href="https://www.theysolditanyway.com/">TheySoldItAnyway.com</a></span>.</p> <p>Aside from the posters and leaflets, some patients are being written to directly. But only those who already opted out – clearly NHS England is content, as it was in 2014, for large parts of the rest of the population to remain in the dark. (While NHS Digital must write to those patients who opted out already, it is NHS England’s responsibility to communicate with everyone else.)</p> <p>Is what patients are told true? The opt-out should apply to all identifiable data; is that what NHS Digital is doing?</p> <p>NHS England is looking to “empower the patient” by giving already empowered patients marginally more, while ensuring it remains accountable to no-one. For example, aside from “research and planning” uses, how does NHS England itself use data? And can a patient see the list?</p> <p>medConfidential works to ensure every use of patients’ data is consensual, safe, and transparent. Unlike NHS Digital, NHS England has largely avoided writing down who does what with patients’ data and why, and because of that has accumulated a massive transparency backlog. Though they go beyond research and planning, NHS England’s current uses are likely (almost) all legal – but it can’t explain how, and some of its proposed future uses are still obscure. </p> <p>medConfidential believes there need be no conflict between good research, good ethics and good medical care; indeed we are enthusiasts of lawful, ethical medical research. By and large, the standards researchers have to meet mean their use of NHS patients’ data already meet GDPR requirements – the paperwork they have to fill in has helped in that.</p> <p><strong>Commercial deals</strong></p> <p>Many people have concerns about private companies doing data processing for the NHS; cases such as the <span><a href="https://medconfidential.org/whats-the-story/health-data-ai-and-google-deepmind/">illegal deal between Google DeepMind and the Royal Free Hospital</a></span> suggest some caution is justified. The most toxic problem, however, remains commercial <em>reuse</em> by ‘information intermediaries’ – some of which appear in the <span><a href="https://www.theysolditanyway.com/">list of organisations that have breached</a></span> not only their contracts with NHS, but existing data protection law.</p> <p>Promises about the NHS “<em>always being clear about how [patient information] is used” </em>(that poster again...) ring somewhat hollow, while for-profit companies continue using contractual agreements with the NHS as a figleaf to do work for commercial customers such as Pharma marketers who – <span><a href="https://www.nhs.uk/your-nhs-data-matters/who-uses-your-data/">despite promises elsewhere</a></span> that patient information <em>won’t</em> be used for “marketing purposes” – use the information to market to doctors. </p> <p>Patients should know how their information is used if they are to make an informed choice. ‘Your NHS Data Matters’ provides <em>some</em> information about this, but omits some of the more unpalatable truths about what is happening – undermining the important promises it makes.</p> <p>If after checking <span><a href="https://www.nhs.uk/your-nhs-data-matters/">what the NHS says</a></span> and <span><a href="https://www.theysolditanyway.com/">what it does</a></span>, you do have concerns, medConfidential suggests you opt out now. Opting out will not affect your individual care, and you can always opt in later – e.g. when you are satisfied proper protections are in place. </p> <p><em>If you use medConfidential’s <span><a href="https://medconfidential.org/how-to-opt-out/">opt-out form</a></span>, your GP data will be covered as well as your hospital data.</em></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/phil-booth/your-medical-data-on-sale-for-pound">Your medical data - on sale for a pound</a> </div> <div class="field-item even"> <a href="/ournhs/jane-fae/sleepwalking-into-information-grab-by-private-health">Sleepwalking into an information grab by private health?</a> </div> <div class="field-item odd"> <a href="/ournhs/phil-booth/caredata-is-dead-long-live-caredata">Care.data is dead - long live care.data?</a> </div> <div class="field-item even"> <a href="/ournhs/tamasin-cave/tim-telstra-and-tech-takeover-of-nhs">Tim, Telstra, and the tech takeover of the NHS</a> </div> <div class="field-item odd"> <a href="/ournhs/jane-fae/your-medical-data-in-their-hands-concerns-mount-over-new-nhs-it-project">Your medical data in their hands - concerns mount over new NHS IT project</a> </div> <div class="field-item even"> <a href="/ournhs/jane-fae/caredata-questions-mount-just-wholl-get-our-medical-data">Care.data questions mount - just who&#039;ll get our medical data?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Phil Booth Mon, 25 Jun 2018 11:47:48 +0000 Phil Booth 118577 at https://www.opendemocracy.net Want better protection for whistleblowers? Your experiences needed! https://www.opendemocracy.net/uk/minh-alexander-clare-sardari/want-better-protection-for-whistleblowers-your-experiences-needed <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p class="p1">From the NHS to rigged elections, care homes to financial fraud - existing UK whistleblowing protection laws are not protecting concerned staff, nor the public. Call for evidence for forthcoming expert event.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/whistleblow.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/whistleblow.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Stephen Depolo/Flickr. Rights: CC 2.0.</em></p><p class="p1">The freedom of ordinary people to look after each other is fundamental to values of decency and fairness.</p> <p class="p1">Whistleblowing is a vital part of this and whether it is hospital workers raising the alarm over unsafe care, care home staff reporting abuse of older people, financial sector staff flagging up fraud or tech workers speaking out about stolen elections, the function of whistleblowing is to uphold the common good and to protect other people’s rights.</p> <p class="p1">Powerful organisations sometimes suppress whistleblowers, quite brutally. In the UK the law which is supposed to protect workers who whistleblow, the Public Interest Disclosure Act 1998 (PIDA), does not actually protect.</p> <p class="p1">PIDA only allows whistleblowers to sue employers for compensation after they have been seriously harmed, for example if they are unfairly dismissed. Compensation is not guaranteed and is not usually enough to reflect loss of livelihood and blacklisting. Neither does it make up for the trauma that many whistleblowers and their families experience.</p> <p class="p1">PIDA does not even ensure that whistleblowers’ concerns are properly investigated. It does not hold the individuals who cover up and victimise whistleblowers to account. PIDA cases are hard to win because of the way the law is structured and because employers usually outgun whistleblowers in court. This particularly happens in the public sector where taxpayers pick up very large legal bills for cases that are in fact fought against their interests.</p> <p class="p1">Far from being protected, whistleblowers are in reality vulnerable to mistreatment by overbearing employers.</p> <p class="p1">The weakness of UK whistleblowing law allows those who speak up in the public interest to be legally mobbed and robbed. Too many end up with broken health and insecure futures.</p> <p class="p1">There is no meaningful deterrence against this. Professor David Lewis of Middlesex University who led the research for the Freedom To Speak Up Review on NHS whistleblowing comments:</p> <p class="p1"><em>"A major problem in relation to reprisals being taken against UK whistleblowers is that retaliators can simply pay compensation in order to get out of trouble. In some countries this matter is taken more seriously and retaliation is treated as criminal offence. While I would not anticipate that many people would be prosecuted if&nbsp;</em><em>criminal sanctions were introduced in the UK, the possibility might deter some inappropriate behaviour and would send out a positive message about the importance of whistleblowing in a democratic society".</em></p> <p class="p1">We and other whistleblowers across all sectors believe that PIDA should be replaced.</p> <p class="p1">We have negotiated <a href="https://minhalexander.com/2018/04/26/a-whistleblower-led-event-on-uk-whistleblowing-law-reform-the-public-interest-disclosure-act-needs-to-be-replaced/">an event sponsored by the NHS National Freedom To Speak Up Guardian </a>, to be held this coming 19 October, which will present expert legal evidence on the need to reform UK whistleblowing law reform.</p> <p class="p1">Ministers and the Law Commission, which has responsibility for reviewing inefficient and flawed law, will be invited.</p> <p class="p1">Eminent specialist speakers on whistleblowing law, <a href="https://www.mdx.ac.uk/about-us/our-people/staff-directory/profile/lewis-dave">Professor David Lewis </a>of Middlesex University, <a href="https://www.liverpool.ac.uk/law/staff/ashley-savage/">Dr Ashley Savage </a>of Liverpool University and Employment Law and Whistleblowing Specialist <a href="https://www.linkedin.com/in/lauren-kierans-1b8a01a0">Lauren Kierans </a></p> <p class="p1">Barrister, will discuss a range of issues, including the need for meaningful penalties for whistleblower reprisal, the need for pro-active (or ‘pre-detriment’) protection starting from the point that workers whistleblow, and the need to compel the proper investigation of whistleblowers’ concerns.</p> <p class="p1">To support the case for law reform, and to inform this event, we will shortly invite whistleblowers from all sectors <span>with experience of using PIDA</span> to submit written evidence. All such first-hand accounts will be very valuable in driving improvements.</p> <p class="p1">Any whistleblowers who want to register interest in the project and to be kept informed about the forthcoming call for evidence can contact us <a href="https://minhalexander.com/contact/">here.</a></p> <p class="p1">Some outline information for whistleblowers about the project can be found <a href="https://minhalexander.files.wordpress.com/2018/03/forthcoming-call-for-evidence-from-whistleblowers-for-a-symposium-on-replacing-the-public-interest-disclosure-act-1998.pdf">here.</a></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/rebecca-sentance/why-whistleblowers-are-essential-to-democracy">Why whistleblowers are essential to democracy</a> </div> <div class="field-item even"> <a href="/ournhs/minh-alexander/no-one-believes-jeremy-hunt-on-patient-safety-and-whistleblowers-not-even-his-">No-one believes Jeremy Hunt on patient safety and whistleblowers – not even his own appointees</a> </div> <div class="field-item odd"> <a href="/uk/brexitinc/peter-geoghegan-adam-ramsay/new-evidence-that-leave-groups-co-ordinated-to-get-round-re">&#039;Crimes&#039; committed by Brexit campaigners? One extraordinary coincidence offers a new clue</a> </div> <div class="field-item even"> <a href="/ournhs/minh-alexander-anonymous-pam-linton-clare-sardari/why-is-cqc-ignoring-or-even-suppressing-pri">Who&#039;s keeping a lid on &quot;priceless&quot; whistleblower information in our health system - and why?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> uk uk ourNHS Clare Sardari Minh Alexander Fri, 01 Jun 2018 11:48:34 +0000 Minh Alexander and Clare Sardari 118197 at https://www.opendemocracy.net The great NHS property sell-off gathers pace https://www.opendemocracy.net/ournhs/jessica-ormerod/great-nhs-property-sell-off-gathers-pace <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>A reliance on firesales of NHS buildings – both unused and currently in use – returns us to the bad old days of a few rich London hospitals and impoverished hospitals everywhere else.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/nhs for sale building.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/nhs for sale building.jpg" alt="" title="" width="460" height="368" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: <a href="https://www.flickr.com/photos/saulalbert/37947961555">Saul Albert/Flickr</a>, CC 2.0.</em></p><p>On 18 May, in its property section, the&nbsp;<a href="https://www.theguardian.com/business/2018/may/18/royal-free-secretly-planning-to-develop-100-year-old-hospital-into-luxury-flats">Guardian ran an article</a>&nbsp;entitled ‘NHS privately planning to develop Royal Free nurses’ home into luxury flats.’</p> <p>A week earlier&nbsp;<a href="https://www.hsj.co.uk/university-college-london-hospitals-nhs-foundation-trust/teaching-trust-boasts-76m-surplus-after-asset-sales-and-stf-bonus/7022345.article?mkt_tok=eyJpIjoiWVdVMk16STFNbUZqTURobSIsInQiOiJrQjZyUVQ5RnVHZWwyQzJtRmRcL1p0bjE1d0tYQ1FoM2YwYVk0NXhZeFBvOFdIalJWdlF4aEZYTUIzZUFGanZjajNURXVjbGx3UEIwUm9EcHNuMmNCV3dLR2lyNzcwXC9sUWZ2UTZCcVR1RlA4U3BUdnBBeFpGa2hUc0szdEczVG8rIn0%3D">the HSJ (paywalled) reported</a>&nbsp;that University College London Hospital Foundation Trust boasted a £76m surplus after asset sales and a Sustainability and Transformation ‘bonus’. </p> <p>Most of&nbsp;the&nbsp;focus on privatisation of the NHS has been on&nbsp;the&nbsp;outsourcing of clinical services to private health providers. More recently the creation of wholly-owned private Subsidiary Companies has attracted attention&nbsp;and they&nbsp;have been&nbsp;<a href="https://hansard.parliament.uk/Commons/2018-03-06/debates/EEF6EE28-8B5F-4A3A-8C07-8DA267FB6805/NHSWhollyOwnedSubsidiaryCompanies">debated in parliament</a>.&nbsp;But there is consistently less attention paid to the extent of the policies in place dedicated to selling NHS land.&nbsp;These policies are shrinking the amount of publicly owned land in the name of providing cash to ‘pump prime’ transformation.</p> <p>In a&nbsp;<a href="https://www.theguardian.com/commentisfree/2018/feb/08/biggest-privatisation-land-margaret-thatcher-britain-housing-crisis">Guardian article 8 February</a>&nbsp;Brett&nbsp;Christophers,&nbsp;Professor&nbsp;of Social and Economic Geography at Uppsala University wrote, “All told, around 2 million hectares of public land have been privatised during the past four decades. This amounts to an eye-watering 10% of the entire British land mass, and about half of all the land that was owned by public bodies when (Mrs) Thatcher assumed power.” </p> <p>Despite all protestations to the contrary the NHS has been increasingly expected to transform to commercial business practice over the last 40 years and the articles above illustrate the effects of those policies. This is a mass transfer of property from public to&nbsp;private ownership. It has affected our utilities, education, the courts, probation and prison service, housing – and the NHS. There are no exceptions. </p> <h2>Reducing the NHS Estate: The 5 Year Forward View and&nbsp;The Naylor review</h2> <p><a href="https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf">The 5 Year Forward View</a>&nbsp;(5YFV)&nbsp;and the&nbsp;<a href="https://www.gov.uk/government/publications/nhs-property-and-estates-naylor-review">Naylor Review</a>&nbsp;are based specifically on the reduction of the number of sites from which the NHS operates: fewer GP family practices, closure and downgrading of hospitals, centralisation of services. The ownership of sections of the NHS is played out in the language of the private sector – mergers and acquisitions, sweating assets – and belongs firmly in the realm of privatisation. Sales, leases with commercial rents for properties that were previously part of a real ‘one public estate’ and the transfer of properties out of the control of local governing bodies and into publicly-owned private companies like NHS Property Services are all part of the process.&nbsp;</p> <p>The Naylor Review was published in March 2017. It examines how the NHS in England can raise cash from its premises. Its findings are in line with the requirements set out in the Sustainability and Transformation Plans (STPs) which were introduced in December 2015 to fast forward NHS England’s 5YFV.</p> <p>The Review emphasises the need to develop out of hospital care and to provide the necessary infrastructure to increase care in the community. It explicitly states that it is the acute division of the service that is to be scaled back and the GP family practice model to be dismantled.</p> <p>Naylor argues that 57% of the cash that can be found from the sales which will pump prime these changes will be found in London. Charing Cross Hospital, for example, may be reduced to just 14% of its existing area and the&nbsp;<a href="https://www.theguardian.com/society/2017/jun/16/most-of-central-london-hospital-to-be-sold-off-secret-plans-reveal">rest sold off for development</a>. He has a second report on London estates unpublished for reasons of commercial confidentiality.</p> <p>The reality for investors looking at development properties is that central London hospitals occupy valuable sites; long-derelict, small town general practice surgeries do not. Naylor’s Review emphasises the combination of sales of existing estates and the introduction of private finance to create newbuilds as key to changing the Estate to meet the New Models of Care set out in the 5YFV.</p> <h2>The danger of taking ‘surplus’ land at face value&nbsp;</h2> <p>Although the NHS land sales are being used as part of a programme for enforced change, they are not unique in the public sector. Across all departments land sales are being promoted as a solution to the housing crisis. Theresa May chose to prioritise this area in her 2017 conference speech. This appears to be evidence of a worrying trend to prioritise land values and property, which give high returns to private investors, over the provision of essential public services. The real risk for the NHS is that the more it moves from its core purpose, the less likely it is to be there to provide a service for future generations.</p> <p>There are a growing number of campaigners, think tanks and housing organisations who support the ‘release’ of land on the basis that it should be re-used for beneficial public purpose of a different kind.</p> <p>For example, New Economics Foundation has&nbsp;<a href="http://neweconomics.org/2017/10/new-map-shows-public-land-sale-brings-people-together-save/">an interactive map</a>&nbsp;which shows a huge amount of public property for sale and proposes that users start to have a say in creating new community developments on those sites. The National Housing Federation produced a briefing,&nbsp;<a href="https://www.housinglin.org.uk/_assets/Resources/Housing/OtherOrganisation/NHF_Releasing_NHS_Estates_Briefing_v3_002.pdf">‘Releasing NHS Estates for Community Benefit’</a>. Its executive summary says:</p> <p>“The National Housing Federation has been working to explore new ways that housing providers and the NHS can work together to use NHS surplus land. NHS trusts often have surplus land, but do not have the skills or resources to develop and manage it. Given that early release housing or key worker housing could provide improved patient outcomes and reduce cost of care there is a strong case for housing providers and NHS trusts to work together in developing surplus land.</p> <p>On this principle three uses have been identified: step down facility, supported housing and key worker housing.&nbsp;</p> <p>The challenge with these proposals are the Treasury targets for income and housing receipts.&nbsp;This paper, including analysis from Frontier Economics seeks to explore the economic benefit and examine some specific case studies for how organisations can work together.”</p> <h2>The Royal Free and the lie of ‘surplus’ land&nbsp;</h2> <p>The clash between rhetoric and reality is illustrated in the case of the Royal Free. In the Guardian article the property for sale is already keyworker accommodation. But because it is a valuable site it is proposed that it should be sold off for development for luxury flats. However, the building itself was gifted to the Royal Free nearly 100 years ago by Lord Leverhulme. That means that its current running cost will be modest and accommodation can be provided at low rents. To buy land at current prices in order to develop new key worker accommodation is likely to be impossible without increasing rental charges.&nbsp;&nbsp;</p> <p>The agents,&nbsp;Frank, Knight and&nbsp;Rutley&nbsp;are advertising the development on a restricted access webpage. The plans have not yet received local authority planning permission, but with everyone from the Prime Minister to local housing campaign groups squarely supporting a policy of surplus land disposal, it is easy to see why the estate agent is behaving as if it is a foregone conclusion. In the article, one current resident said, “the trust has sold several other key worker accommodation blocks in recent years”. “We wouldn’t be the first residential place they’ve sold,” he said. “They seem to be doing quite a lot of selling their affordable properties for development.”&nbsp;</p> <p>Perhaps the resident was referring to The Royal Free Foundation Trust acquisition of Barnet and Chase Farm Hospitals NHS Trust in July 2014. Chase Farm Hospital was the focus of local campaigning over the loss of its A&amp;E but it is now subject to planning permission. Although a downgraded hospital is included in the plans, the key workers’ accommodation there has been lost too and 500 residential homes and a primary school will be built on the site.&nbsp;&nbsp;</p> <h2>Resistance will be met with regulatory power&nbsp;</h2> <p>As well as a push to develop any identified surpluses, Naylor’s recommendations are that GPs must move out of their old properties which they own into new ones which they will not own. Naylor suggests,&nbsp;“GP practices can be given incentives to move into new facilities, supported by substantial private sector investment. NHS commissioners and regulators have considerable latent authority to insist that premises be fit for purpose. These powers could&nbsp;be used far more explicitly to ensure that new investment is in line with the 5YFV and to force the pace of investment in or exit from inadequate premises.”&nbsp;</p> <p>Naylor’s analysis of the GP estate demonstrates a clear preference and expectation of mass transfer from public to private ownership and financing. Naylor himself was reported as being delighted at the £3.3billion of private financing for new primary care facilities. According to the investors, the money could fund up to 750 new primary care centres but this is&nbsp;<a href="https://octopushealthcare.com/news/property-investors-make-3-3billion-commitment-to-kick-start-next-generation-of-nhs-medical-centres/">predicted to cost the NHS up to £200million</a>&nbsp;a year in new rental charges.&nbsp;</p> <p>The Review claims that within each STP those providers that have greater potential to raise money will share the money with those poorer and less well-endowed providers they are partnered with. However, with the bulk of the cash being found from sales in London it is not clear how these benefits will extend to the whole country. And that highlights a problem with the Guardian’s headline: ‘NHS privately planning to develop Royal Free nurses’ home into luxury flats’&nbsp;because it isn’t ‘the NHS’ that is doing this, it is the Foundation Trust, as a business, which will reap the profit itself.&nbsp;</p> <h2>What’s mine is mine: the&nbsp;inexorable&nbsp;rise of the disproportionately wealthy hospital trusts&nbsp;</h2> <p><a href="http://www.shelfordgroup.org/">The Shelford Group</a>, representing some of the richest foundation trusts in the country, raised the issue of cross-subsidy in their&nbsp;<a href="http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/health-and-social-care-committee/integrated-care-organisations-partnerships-and-systems/written/77219.html">written submission to the Health Select Committee</a>&nbsp;on Integrated Care Systems. The&nbsp;<a href="https://www.hsj.co.uk/finance-and-efficiency/exclusive-advanced-health-economies-reject-terms-of-system-control-totals/7022146.article">HSJ 13 April 2018</a>&nbsp;reported that the Integrated Care Systems are under threat from this approach as organisations are unwilling to risk losing their sustainability funding if a neighbouring clinical commissioning group fails to meet its plan.&nbsp;&nbsp;</p> <p>The HSJ article on University College London Hospitals Foundation Trust (UCLH) shows just how much that matters. The Trust has sold The Eastman Dental Hospital site to University College London. It has also sold a subsidiary company it created in 2011 for its radiology services in which it had a 50% share in partnership with Australian firm Everlight Radiology.&nbsp;</p> <p>The HSJ says,&nbsp;‘the&nbsp;trust said it was approached to dispose of its stake as part of a process in which&nbsp;Everlight&nbsp;sold its teleradiology business to an asset management group.’&nbsp;It was sold for £6.1m, generating a profit of £4.8m. Its original stake in the partnership had been £0.75m.&nbsp;&nbsp;</p> <p>These profits will net UCLH additional Sustainability and Transformation Fund payments of £35m on top of its own core allocation of £15m. This is the second year running it has accrued substantial additional payments because of land sales. The extra money comes from awards allocated but not paid to other Trusts either because they failed to meet their financial targets or didn’t agree one.&nbsp;</p> <h2>The&nbsp;PropCo&nbsp;and Commercial Rents&nbsp;</h2> <p>The 5YFV’s New Models of Care, on which all these property deals and ‘re-shaping’ of the estate are based, are experimental. Such a large-scale change without extensive consultation and testing jeopardises the NHS’s ability to provide safe care. Historically the replacement of NHS delivery of mental health care led to disastrous consequences for patients. The 5YFV relies on a similar care-in-the-community model replacing many NHS services with an emphasis on self-care and non-clinical services. Land sales and privatisation must be examined in this context.&nbsp;</p> <p>The Health &amp; Social Care Act (2012) made provision for the creation of the NHS’ own private limited company which was registered with Companies House in 2011 (before the Act was passed), NHS Property Services Ltd (PropCo). It owns the property which was previously under the stewardship of the Strategic Health Authorities and the Primary Care Trusts. Although it is currently wholly-owned by the Secretary of State for Health, it is a private limited company. These properties have passed from public to private ownership.&nbsp;</p> <p>The precipitous creation of the company and its nature caused concern to the House of Commons Health Committee. The&nbsp;<a href="https://www.nao.org.uk/wp-content/uploads/2014/05/Investigation-into-NHS-Property-Services-Limited.pdf">National Audit Office (NAO) investigated</a>&nbsp;and uncovered failures of good practice.&nbsp;It noted that the government had failed to properly consider forms of public ownership and failed to provide detailed operating objectives. The NAO noted that one of the outlined advantages of setting up a company was the possibility of a future complete sale to the private sector. &nbsp;</p> <p>There is precedent for this with the sale of both the Department of Work &amp; Pensions estate and the HMRC estate, so this is not idle speculation.&nbsp;</p> <p>The PropCo announced in April 2016 it was to start charging market rents to its NHS tenants with immediate effect. The company has already commercialised the leases on the properties it acquired. The biggest transfer of properties so far took place in December 2016, when the company completed the acquisition of the freeholds of 12 Community Hospitals in Devon into its ownership, with the last line of their press release stating:&nbsp;<a href="http://www.property.nhs.uk/biggest-transfer-of-properties-to-nhs-property-services/">‘leases to regularise occupation are currently being finalised’</a>.&nbsp;It is clear that in this context ‘regularise’ can only mean ‘commercialise’ and that rent increases will follow.&nbsp;&nbsp;</p> <p>It is estimated that GP surgeries and Community Hospitals owned by the PropCo (which are not already listed or projected for sale) will have to find in the region of £60million a year from their diminishing incomes to pay these rents.  This is another step in aligning the NHS with commercial and market practices. &nbsp;</p> <p>Despite the commercial rents the PropCo is taking from the funding given to NHS bodies by the government to provide frontline services, its Annual Report and Accounts show it is making a loss. Its auditors report that:&nbsp;‘the substantial shortfall between the costs required to provide the company’s services and the income derived through rental is funded through a recharge to NHS England and the Clinical Commissioning Groups. This recharge is&nbsp;in the nature of a&nbsp;grant and does not have any conditions attached to it.’&nbsp;&nbsp;</p> <p>It is a private company whose debts are covered by the Treasury to keep it solvent whilst its charges undermine the solvency of its tenants.&nbsp;</p> <h2>Project Phoenix: private organisations rising from the ashes of public service&nbsp;</h2> <p>The latest private sector creation to be involved with this complex web of sales and public-private partnerships is Project Phoenix. Project Phoenix is the creation of six major regional public/private property deals which could be in place by June 2019. The procurement process is due to start shortly. The Project is described as a venture to attract companies to ‘unlock’ capital funding for the NHS. The companies formed by these six property deals will be known as Regional Health Infrastructure Companies (RHICs). Just like PFI, these infrastructure projects will be ‘off the balance sheet’ and will sell publicly owned property and replace it with private rented. They are described as the “delivery route” for trusts and Sustainability and Transformation Partnerships to transform their estate.&nbsp;</p> <p>Project Phoenix is the realisation of Sir Robert Naylor’s plan in his review of NHS property. He calculated that up to £5.7billion of funds could be ‘accessed’. The RHICs will increase the number of private subsidiary companies already proliferating in the NHS as they will be set up to run the development projects necessary to create the new privatised NHS estate.&nbsp;</p> <h2>Bring it back into public hands&nbsp;&nbsp;</h2> <p>The response from the Department of Health and Social Care to the petitioner who achieved the debate on privatisation which was held in Westminster Hall on 23 April said,&nbsp;“the private sector has always played a vital supporting role in the NHS, for example in building hospitals, in providing facilities management services”. But the pretence that this commercial property and private company development is a normal part of public service delivery must not be allowed to carry on if we are to retain an NHS which is fit for purpose.&nbsp;</p> <p>Private companies can be sold, as the NAO warned about NHS Property Services Ltd and UCLH have demonstrated with their sale of their radio-imaging company. Unless something is done, unless this process is halted, there will be a proliferation of sales and developments of land, and transfers of subsidiary companies into private hands. The need to restore the NHS to public service becomes ever more urgent.</p><p><em>This article is cross-posted with kind permission from&nbsp;<a href="http://publicmatters.org.uk/">Public Matters</a>.</em></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/deborah-harrington/going-going-gone-great-hospital-selloff">Going, going, gone - the great hospital sell-off?</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/jeremy-hunt-considers-banning-patients-from-walking-up-to-aes">Jeremy Hunt considers banning patients from walking up to A&amp;Es</a> </div> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/are-cash-strapped-hospitals-walking-into-trap-that-could-cost-nhs-its-family-">Are cash-strapped hospitals walking into a trap that could cost the NHS its family silver?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Jessica Ormerod Wed, 30 May 2018 11:33:51 +0000 Jessica Ormerod 118140 at https://www.opendemocracy.net Facing legal challenge, Tories hint about scrapping some NHS reforms – but remain wedded to privatising 'solutions' https://www.opendemocracy.net/ournhs/tommy-greene/facing-legal-challenge-tories-hint-about-scrapping-some-nhs-reforms-but-remain-w <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>The effects of the 2012 Health and Social Care Act are now too disastrous to ignore. But Jeremy Hunt’s shift is of rhetoric, not of substance - .and his new “ACO” plans are so dangerous, campaigners this week challenged them in the High Court.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/sue allyson.PNG" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/sue allyson.PNG" alt="" title="" width="460" height="282" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Campaigners in front of the High Court this week as their Judicial Review opened. Credit: Daniel Lucas/Dpict Media</em></p><p>The leader of the Opposition’s opening gambit in <a href="https://www.youtube.com/watch?v=lGFMnZnpTu0&amp;t=318s">PMQs</a> this week was to put Theresa May on the spot over how much of NHS services are currently being outsourced to the private sector. Rather predictably, she had no answer of substance to this question.</p><p>Most people are aware by now that the NHS is at breaking point. But what much of the public are still in the dark about is exactly <em>how</em> this crisis is happening or being navigated.</p> <p>Anyone wanting to find out would be well-advised to take a look at incoming Accountable Care Organisations, which threaten to usher in an ‘Americanisation’ of services and possibly the largest vehicle for future privatisation in the NHS’s history. This week, the High Court heard about the impending introduction of these ACOs from a <a href="https://www.crowdjustice.com/case/jr4nhs-round3/">team of 4 senior health professionals</a> (<a href="https://www.theguardian.com/society/2017/dec/08/stephen-hawking-lawsuit-foiling-jeremy-hunt-nhs-shake-up">previously 5</a>, until the death of the late Professor Stephen Hawking in March). This judicial review looks to ensure that a shake-up as large as this does not occur without the proper public consultation and parliamentary scrutiny such a significant restructuring of public healthcare should entail. </p> <p>Along with legislative efforts to reinstate statutory responsibility for the health of people across England – which was essentially torn away by Andrew Lansley <a href="http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted">in 2012</a> - the case forms part of a several-year-long campaign to restore public healthcare (as set out in the NHS’s founding charter) as well as to uncover what transatlantic interests <a href="https://www.opendemocracy.net/ournhs/stewart-player/accountable-care-american-import-thats-last-thing-englands-nhs-needs">have planned</a> for it.</p> <p><strong>What are ACOs? And why are they such cause for concern?</strong></p> <p>Already piloted quietly across <a href="https://www.bigissuenorth.com/news/2018/04/nhs-plans-court/">10 areas in England</a>, Accountable Care Organisations boil down to a large-scale reorganisation and ‘integration’ of care providers. In theory, ACOs could be owned by NHS hospitals or GPs. But there may be nothing in place to stop them from being controlled by large insurance companies, finance and property firms who could eventually take them over and run them purely for profit. </p> <p>Through these new integrated care systems, the government looks to pool health and social care budgets from NHS England, Clinical Commissioning Groups (CCGs) and General Practice with local authority budgets into contracts to be awarded on a per capita basis. This means that ACOs could be a financial “Special Purpose Vehicle”, a public body or a private company. The longer-term upshot may be that CCGs disappear altogether and ACOs take on commissioning responsibilities, presenting them with the power to alter resources and patient composition.</p> <p>One central concern that has been raised relates to the way ACOs appear to blur the lines between the definition of care that’s ‘free at point of use’, care that’s charged at point of use and care that’s sold off privately. This obviously goes straight to the heart of the NHS’s founding principle of universal public healthcare provision. It is also a partial carry-over from NHS England chief Simon Stevens’ nebulous <a href="https://www.opendemocracy.net/ournhs/shibley-rahman/nhs-five-year-forward-view-wishlist-for-privatisers">promise</a> to “dissolve the classic divide[s]” of healthcare in his 2014 <a href="https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf">Five Year Forward View</a>, which at the same time pledged to reduce tens of billions in expenditure before 2021.</p> <p>During the last two years, some of the <a href="http://www.nhsforsale.info/database/market-failures/stps-and-privatisation.html">largest ever contracts</a> for NHS services have emerged. One of the first of these super contracts was in Dudley, where financial details of the 15-year Multispecialty Community Provider (MCP) agreement are not known. Then, in April 2017, a <a href="https://www.hsj.co.uk/hsj-local/commissioners/nhs-north-manchester-ccg/biggest-ever-nhs-tender-launched-as-6bn-contract-put-on-market/7017156.article?blocktitle=Most-popular&amp;contentID=-1">Manchester commissioning group</a> announced the largest ever tender for NHS services, in a contract worth £6 billion, for a provider of all out-of-hospital care in an area serving around 600,000 patients. Last year was also the advent of the <a href="http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/first-voluntary-contracts-awarded-to-gps-and-trusts/20035000.article">first “voluntary” contracts</a> to be awarded to GPs and Trusts now operating as tender-based, unofficially pro-profit businesses.</p> <p>In February this year, a High Court judge temporarily <a href="https://www.independent.co.uk/news/health/nhs-virgin-care-outsourcing-childrens-health-contract-private-company-judge-court-a8221811.html">blocked</a> Lancashire County Council’s attempt to outsource a £104 million childcare contract to Virgin. This ruling came only weeks after NHS bodies were forced to make an <a href="https://www.independent.co.uk/news/health/nhs-richard-branson-virgin-care-legal-settlement-tendering-contract-a8080961.html">undisclosed settlement</a> to the health branch of Richard Branson’s conglomerate over <a href="https://www.ft.com/content/297e7714-089f-11e7-97d1-5e720a26771b">its loss</a> of a £82 million contract to provide children’s health services across Surrey. </p> <p>ACOs could open the door to a great deal more private US equity firms looking to prise open the <a href="https://www.opendemocracy.net/ournhs/caroline-molloy/it-may-not-look-like-it-but-jeremy-hunt-does-have-plan-for-nhs-0">£120 billion oyster</a> of UK healthcare. Fears of backdoor privatisation have been compounded by indications from an increasingly <a href="https://www.telegraph.co.uk/politics/2018/01/31/embattled-theresa-may-vows-steer-britain-though-brexit-beyond/">embattled</a> May, who is desperately <a href="https://www.opendemocracy.net/ournhs/nhs-theresa-mays-dowry-gift-to-donald-trump">scrambling to secure</a> a future trade deal with the US post-Brexit. </p> <p><strong>Accountable Care?</strong></p> <p>Despite talk of unification, “seamless” integration and the government’s persistent use of ‘local’ areas and populations in its language around ACOs, they will almost certainly fragment, outsource and create an increasingly complex commercial model of healthcare - instead of an open, transparent, directly-accountable model of provision. ‘Accountable care’ couldn’t be any more of a misnomer.</p> <p>ACOs’ taxonomy of “local health systems”, each with their own geographic “footprints”, was inherited from the division of local healthcare in England under <a href="https://www.kingsfund.org.uk/publications/articles/big-election-questions-stps">Sustainability and Transformation Plans</a> (STPs), Stevens’ last grand solution to plug a £22 billion annual funding gap before this latest move. A core problem with STPs was its <a href="https://www.opendemocracy.net/ournhs/colin-leys/sustainability-and-transformation-plans-kill-or-cure-for-nhs">delegation of responsibilities</a> to these new ‘localities’, with no clear statutory rules or external regulation governing the care provision process. This question is one that has not become any clearer during the introduction of ACOs, for all the government’s talk of openness and liability.</p> <p>Jeremy Hunt’s <a href="https://www.theguardian.com/society/2017/sep/11/jeremy-hunt-to-unveil-plans-for-digital-led-nhs-treatment-by-2018">visions</a> of a <a href="https://twitter.com/jeremy_hunt/status/973230153060012033?lang=en">tech panacea</a> have also been part of the push towards ACOs, as well as to square various circles left by Stevens’ glib tracts. Meanwhile, <a href="https://www.theguardian.com/commentisfree/2017/may/13/nhs-computer-systems-insufficient-funding">underfunding</a> of basic <a href="https://www.telegraph.co.uk/news/2017/05/12/nhs-hit-major-cyber-attack-hackers-demanding-ransom/">IT facilities</a> in hospitals has continued – as was made all too clear in last year’s <a href="http://www.bbc.com/news/technology-41753022">WannaCry</a> ransomware attacks. </p> <p>Government officials <a href="https://www.independent.co.uk/news/uk/politics/jeremy-hunt-health-department-nhs-legal-action-americanise-privatisation-customers-id-pay-a8033986.html">maintain</a> that ACOs are not a move towards US-style privatisation, accusing campaigners of generating “pernicious falsehoods” and “irresponsible” alarmism, while insisting the plans “are simply about making care more joined-up between different health and care organisations”. The pro-market King’s Fund has <a href="https://www.newstatesman.com/politics/health/2018/02/accountable-care-doesn-t-mean-we-ll-end-us-style-privatised-health">reiterated</a> this message, arguing that identifications with US healthcare are mistaken and that the NHS needs more integrated care to survive. </p> <p>But, as public health expert&nbsp;<a href="https://en.wikipedia.org/wiki/Allyson_Pollock">Allyson Pollock</a> has pointed out, commercial contracting and subcontracting in the NHS is already happening on a scale and at a duration never considered by the 2012 Health and Social Care Act. This was one of a number of crucial concerns which either weren’t raised or were stamped out during the legislation’s passage through parliament. It’s little surprise, then, that government and pro-market bodies are trying to keep campaigners quiet about ACOs (<a href="http://www.bbc.com/news/uk-politics-14778406">as they did</a> around the time of Lansley’s reforms) especially given these bodies’ cosy ties with US private health.</p> <p>Although May deflected Corbyn’s outsourcing question at this week’s PMQs, Allyson Pollock argues that only 36% of healthcare contracts were won by NHS providers in the financial year 2016-17, compared to 60% in 2014-15. And we also know private providers won £3.1 billion of new contracts in 2016-17, 43% of total advertised value. </p> <p>If anything, ACOs form part of a discursive shift rather than a shift from policy’s direction of travel after the <a href="http://www.bbc.com/news/health-31145600">effects</a> of the <a href="https://www.theguardian.com/politics/2015/jan/31/health-reform-tories-biggest-mistake-parliament-nhs-stephen-dorrell-mp">disastrous</a> 2012 Act became too obvious to ignore – and then needed to be ‘tidied up’. This shift signalled a move away from talk of breaking up public healthcare (remember, Lansley’s <a href="https://www.economist.com/britain/2014/03/29/health-reform-in-a-cold-climate">top-down reforms</a> were a “reorganisation so big you can see it from outer space”) towards a language of “collaboration” into which the term “integration” fits neatly. </p> <p>The truth is there is no real or meaningful local accountability with ACOs: no one knows what will happen if private contractors walk away from their contracts, or if they choose to close services and sell off buildings in search of more lucrative ventures, as has been happening recently with <a href="https://amp.theguardian.com/business/2018/may/18/royal-free-secretly-planning-to-develop-100-year-old-hospital-into-luxury-flats?CMP=Share_iOSApp_Other&amp;__twitter_impression=true">nursing home closures</a>. </p> <p><strong>The JR4NHS case and NHS re-instatement</strong></p> <p>Sometimes the conversation around the protection and the future of the NHS can seem hopelessly bleak. But, although the task can appear insurmountable, there are groups working to combat the corporate divvy-up of UK public healthcare. And they require public support now more than ever before.</p> <p>This judicial review action, for instance, has already prevented swathes of ACOs from being rubber-stamped until the case and consultation reaches a conclusion – they had initially been scheduled to come into effect this April. </p> <p>The case can only go so far, though, due to its necessarily limited remit. Beyond other standalone legal battles like it, what has so far been stripped away can only be rehabilitated and restored by an Act of Parliament – which is why it is essential to support the Private Members’ Bill on 11th July to reclaim and begin to re-instate the NHS. </p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/stewart-player/accountable-care-american-import-thats-last-thing-englands-nhs-needs">&#039;Accountable Care&#039; - the American import that&#039;s the last thing England&#039;s NHS needs</a> </div> <div class="field-item even"> <a href="/ournhs/allyson-pollock/why-next-labour-manifesto-must-pledge-to-legislate-to-reinstate-nhs">Why the next Labour Manifesto must pledge to legislate to reinstate the NHS</a> </div> <div class="field-item odd"> <a href="/ournhs/john-lister/if-our-government-won-t-act-to-save-our-nhs-then-we-must">If our government won’t act to save our NHS this winter, this is what we must do</a> </div> <div class="field-item even"> <a href="/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Taking politics out of the NHS? Or constructing an elitist ‘consensus’?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Tommy Greene Fri, 25 May 2018 15:01:04 +0000 Tommy Greene 118069 at https://www.opendemocracy.net We must protect the lives of people with learning disability https://www.opendemocracy.net/shinealight/deborah-coles/inquest-leder-report-learning-disability <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Time and time again, grieving families are left to fight for accountability and expose systemic failings in the care of learning disabled people.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/connor_bus2_1.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/connor_bus2_1.jpg" alt="" title="" width="460" height="316" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Bus, by Connor Sparrowhawk (#JusticeforLB)</span></span></span></p><p>INQUEST works with an increasing number of families&nbsp;impacted by learning disability deaths. Central to our work is the need to amplify the&nbsp;concerns of families who feel let down&nbsp;by the social care&nbsp;system; to help&nbsp;them establish the truth behind&nbsp;a death; secure justice on behalf of their deceased relative; and prevent future deaths.&nbsp;</p><p>In many cases the&nbsp;circumstances surrounding a death were entirely&nbsp;preventable, had families’ voices and concerns been&nbsp;listened to&nbsp;by those responsible for their relative’s care. The cases of&nbsp;<a href="https://opendemocracy.net/shinealight/shinealight/kate-dolan/small-details-my-sister-life-cut-short">Josanne Wadsworth</a>,&nbsp;<a href="https://www.inquest.org.uk/richard-handley-conclusion">Richard Handley</a>, <a href="https://www.inquest.org.uk/oliver-mcgowan-conclusion">Oliver McGowan</a>,&nbsp;<a href="https://www.inquest.org.uk/danny-tozer-conclusion">Daniel Tozer</a>&nbsp;and <a href="https://opendemocracy.net/shinealight/shinealight/sara-ryan-clare-sambrook/connor-sparrowhawk-justiceforLB">Connor Sparrowhawk</a>— all of whom&nbsp;had a range of complex needs and disabilities — present a picture of missed opportunities and chaotic care that exacerbated their symptoms prior to their death.&nbsp;</p><p><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/DANIEL_TOZER.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/DANIEL_TOZER.jpg" alt="" title="" width="240" height="297" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style="" /></a> <span class='image_meta'><span class='image_title'>Daniel Tozer</span></span></span></p><p><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/JOSANNE3.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/JOSANNE3.jpg" alt="" title="" width="240" height="300" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style="" /></a> <span class='image_meta'><span class='image_title'>Josanne Wadsworth at 15</span></span></span></p><p><span>In the words of Daniel Tozer’s parents, “Danny’s senseless death has devastated his family and friends” and deprived them of the opportunity&nbsp;to spend a life with someone who “lit up our lives”.</span></p><p><a href="https://opendemocracy.net/shinealight/shinealight/kate-dolan/small-details-my-sister-life-cut-short">Kate Dolan</a> has&nbsp;written about the death of her sister of Josanne Wadsworth who had severe learning disabilities and epilepsy. Josanne died aged 31 in hospital in January 2017. <a href="https://opendemocracy.net/shinealight/shinealight/kate-dolan/small-details-my-sister-life-cut-short">In her blog</a>, Kate describes her relief at the hospital’s frank acknowledgement of the failings surrounding Josanne’s death. Sadly, this open approach on behalf of the hospital is not a common feature in most cases.&nbsp;</p><p><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/Richard_Handley-portrait_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/Richard_Handley-portrait_0.jpg" alt="" title="" width="240" height="304" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style="" /></a> <span class='image_meta'><span class='image_title'>Richard Handley</span></span></span><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/Oliver-McGowan-350.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/Oliver-McGowan-350.jpg" alt="" title="" width="240" height="254" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style="" /></a> <span class='image_meta'><span class='image_title'>Oliver McGowan</span></span></span><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/connorsparrowhawk_crop_1.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/connorsparrowhawk_crop_1.jpg" alt="" title="" width="240" height="293" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style="" /></a> <span class='image_meta'><span class='image_title'>Connor Sparrowhawk</span></span></span>Many families are confronted with a culture of denial and defensiveness, where public bodies are more concerned with reputational management. Further still, the majority of learning disability deaths are not independently investigated, and many are not followed by an inquest. In fact, it is often only through families dogged persistence that failings are brought to light.&nbsp;</p><p>Behind a shadow of injustice are the many untold stories of those who have died in care, and an institutional resistance to transparency or learning. This means many more lives are put at risk due to the continuation of unsafe practices. To combat this, INQUEST has long campaigned for a national oversight mechanism to collate, analyse and monitor learning arising from the deaths of learning disabled people.&nbsp;</p><p>We have also called for unexpected and unnatural learning disability deaths to be investigated by an independent body. This would put an end to the current practice of NHS Trusts, which have overall responsibility for the care of those with learning disability, investigating themselves.</p><p><span>Premature deaths precipitated by unacceptable standards of care has prompted mounting concerns, with the mother of 18-year-old Connor Sparrowhawk, Sara Ryan,&nbsp;</span><a href="https://www.inquest.org.uk/inquest-responds-leder-report">describing</a><span>&nbsp;the “label of learning disability” as synonymous with “a diagnosis of a life limiting illness.” Further still, many families are aggrieved to see countless reports referring to dangerous policies and practices, which are not acted upon.</span></p><p>The recently published&nbsp;<a href="https://www.hqip.org.uk/resource/the-learning-disabilities-mortality-review-annual-report-2017/#.Wvq5G2gvyUm">LeDeR report</a>&nbsp;of learning disability deaths, commissioned by NHS England,&nbsp;has flagged instances of abuse, delays or gaps in treatment in 1 of the 8 cases examined. </p><p>What is particularly&nbsp;worrying is that these findings offer a partial account of the systemic problems which plague the care sector. Only 103 out of 1,311 learning disabilities deaths were reviewed by the University of Bristol Learning Disabilities Mortality Review&nbsp;team&nbsp;due to inadequate resources committed by&nbsp;NHS England.</p><p><span class="mag-quote-right">Many families are confronted with a culture of denial and defensiveness.</span>There are patterns of poor care, neglect and abuse of some of the most vulnerable groups in society. This results in poorer health outcomes and shorter life expectancy of those with a learning disability. Evidence from the LeDeR review&nbsp;shows that on average&nbsp;men with learning disabilities die 23 years younger than their non-disabled peers, while&nbsp;women die 29 years younger.&nbsp;</p><p>Learning disabled people are entitled to the same rights and protections that others enjoy. However too often inquests and investigation reveal a systematic disregard for their lives. There needs to be a more focused approach on providing the best care and treatment to those with complex needs and disabilities. This can only happen if policymakers and medical professionals extract lessons from previous deaths and force a cultural change that recognises the rights of the 1.5 million people with a learning disability in the UK.&nbsp;</p><hr /><p>For more information on learning disability deaths you can follows blogs by&nbsp;<a href="https://mydaftlife.com/">Sara Ryan</a>&nbsp;and&nbsp;<a href="http://www.georgejulian.co.uk/blog/">George Julian</a>. If you would like to support INQUEST’s work, please donate to our Family Participation Officer Ayesha’s&nbsp;<a class="OWAAutoLink" href="https://www.justgiving.com/fundraising/ayesha-carmouche1">fundraising page</a>.&nbsp;Ayesha is running a half marathon to raise money to expand INQUEST’s advocacy work with families impacted by a state-related death.</p><p>&nbsp;</p><p>&nbsp;</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/shinealight/kate-dolan/my-sister-life-cut-short">The significance of small details. My sister’s life cut short</a> </div> <div class="field-item even"> <a href="/shinealight/sara-ryan/connor-sparrowhawk-southern-health-fined-2m">&#039;We’ve done you proud&#039; — Families speak after NHS Trust fined £2million over patient deaths</a> </div> <div class="field-item odd"> <a href="/shinealight/imogen-tyler/connor-sparrowhawk-erosion-of-accountability-in-nhs">Connor Sparrowhawk: the erosion of accountability in the NHS</a> </div> <div class="field-item even"> <a href="/shinealight/shinealight/sara-ryan-clare-sambrook/connor-sparrowhawk-justiceforLB">Connor Sparrowhawk: How one boy’s death in NHS care inspired a movement for justice</a> </div> <div class="field-item odd"> <a href="/shinealight/tom-ryan/since-my-brother-s-preventable-death">Since my brother’s preventable death . . .</a> </div> <div class="field-item even"> <a href="/shinealight/deborah-coles-ayesha-carmouche/case-for-independent-investigation-of-deaths-in-mental-he">The case for independent investigation of deaths in mental health institutions</a> </div> <div class="field-item odd"> <a href="/shinealight/sara-ryan/ministry-of-justice-says-you-don-t-need-lawyer-at-inquest-trust-state">Ministry of Justice says you don’t need a lawyer at an Inquest. Trust the State</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> Shinealight ShineALight ourNHS Deborah Coles Wed, 23 May 2018 06:50:00 +0000 Deborah Coles 117921 at https://www.opendemocracy.net The significance of small details. My sister’s life cut short https://www.opendemocracy.net/shinealight/kate-dolan/my-sister-life-cut-short <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Like so many people who have learning disabilities Josanne Wadsworth died an early and preventable death.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/JOSANNE.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Josanne, 29 years old, in 2015, at St Elizabeth&#039;s Centre in Hertfordshire"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/JOSANNE.jpg" alt="" title="Josanne, 29 years old, in 2015, at St Elizabeth&#039;s Centre in Hertfordshire" width="460" height="344" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Josanne, aged 29, embracing life at St Elizabeth's Centre in Hertfordshire, 2015</span></span></span></p><p>Sometimes it’s the little things that make the biggest difference. I once came back from dropping my child at playgroup to find that I couldn’t get into my house. I put the key in the lock but when I tried to turn it it wouldn’t move. Jammed. Stuck. Locked out. After enlisting the help of a locksmith, it transpired that a tiny millimetre length of metal had broken off the mechanism. The littlest thing stopped the whole thing from working. A millimetre away from getting into my house, yet wholly locked out.</p><p>Little things can be so important. Take, for example, the&nbsp;<a href="https://littlebluecup.org/category/about-us/">Little Blue Cup</a>&nbsp;campaign launched in recent months. A 13 year old autistic boy with severe learning disabilities had used a blue sippy cup since he was two, and wouldn’t drink from anything else. His father managed to find a replacement from a friend when the first cup wore out. But as this second cup began deteriorating and efforts to get him to drink from other cups - however similar - failed, they grew increasingly concerned. Without that blue sippy cup he would become dehydrated and had already spent time in hospital.&nbsp;</p><p>The cup was discontinued, so in a desperate plea online via Twitter, his dad asked if anyone could find and send them these little blue cups. The response was unexpected and truly heart-warming: from&nbsp;<a href="http://www.bbc.co.uk/news/uk-england-37988508">viral re-tweets to offers of cups</a>, to the company themselves&nbsp;<a href="http://www.bbc.co.uk/news/uk-england-devon-38141319">successfully finding</a>&nbsp;the old mould and producing a lifetime’s supply of blue sippy cups for him!&nbsp;&nbsp;</p><p>I like this story, not only for its happy ending, but for the success of a parent fighting for their child, understanding him totally, knowing what’s needed and communicating it successfully to people who listen and respond. Little things, perhaps, making a big difference.</p><p class="mag-quote-right">Knowing and being known was important to Josanne.</p><p>Having grown up with my sister, Josanne, who had severe learning disabilities, I can appreciate the fine line between things being alright and things causing distress. Little things made a big difference. Josanne loved the little details. She used to like to know where people were, and would run through the members of the family in turn saying where they should be and what they would be doing. Knowing and being known was important to her. Knowing the little things formed the depth of her relationship with others and enabled the key to turn in the lock.</p><p>Josanne had severe learning disabilities and intractable epilepsy from infancy. She had been admitted to hospital several times in the past when she experienced clusters of seizures that wouldn’t stop. Sadly her time in hospital was often extended because she didn’t get the medications she needed at the correct times, or she wasn’t monitored closely enough, and she deteriorated enough to require intensive care.&nbsp;</p><p>One of these admissions resulted in paralysis, another in transfer to the leading London neurological hospital. It was during the latter crisis that she was prescribed a newly-licensed drug, which wonderfully caused a termination in seizures for the last two years of her life, and we saw her flourish.</p><p>Josanne had a good quality of life, despite her paralysis and learning disabilities. She had moved to St Elizabeth’s Centre in Hertfordshire aged 19, and had lived there happily for 12 years. She was a character and always secured the affections of staff and carers, even if they had heard her loud rendition of “Happy Birthday” for the umpteenth time that day (and it probably wasn’t anybody’s birthday)! There is a nursing unit on site, and specialist epilepsy nurses cared brilliantly for her. Unless she needed treatment that she could only get in hospital, she got all the care she needed there.&nbsp;</p><p>So when Josanne needed to go to hospital in January 2017 for a routine PEG replacement procedure, having removed her old one too many times, we weren’t particularly worried that she would suffer further setbacks; she wasn’t going into hospital ill, she was going in to prevent future illness. The feeding tube known as a PEG (percutaneous endoscopic gastrostomy)&nbsp;was the means of securing her essential medication and nutrition intake. A small thing, perhaps, but it made all the difference.</p><p>Josanne’s history showed that if she didn’t get her medication reliably she was likely to experience seizures and compounding complications if she entered status epilepsy (where epileptic fits follow one another without recovery of consciousness between), but the procedure was repeatedly delayed, which meant she wasn’t getting her essential medications. My Mum and St Elizabeth’s staff raised concerns, emphasising the severity of potential outcomes if the procedure didn’t happen imminently. But the hospital’s realisation came too late. Josanne had missed too many doses of medication, started having seizures, and quickly became too ill to have the procedure. Her seizures worsened in frequency and severity, and, as those who knew her best had warned, she developed aspiration pneumonia, and tragically died. She was 31.</p><p>The coroner concluded at an inquest held in November 2017 that Josanne died of natural causes, contributed to by neglect, with the hospital demonstrating serious failings in her care.</p><p><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/JOSANNE2.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/JOSANNE2.jpg" alt="" title="" width="460" height="588" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>At 15 Josanne lived at home and attended a special school in Cambridge.</span></span></span></p><p>The fact it was so clear cut is a consolation. The hospital didn’t try to hide their failings or apportion blame elsewhere, but instead produced a 22-page Serious Incident Report that gave appalling detail to the circumstances surrounding Josanne’s death. We realise this is rarely the case, and many families supported by INQUEST are not so fortunate and have far bigger battles in their quest for justice.&nbsp;</p><p>There are many factors I could talk about - the high rate of mortality amongst learning disabled patients, poor understanding of and adherence to the Mental Capacity Act, communication issues between those who know the patient best and the medical staff, or, more positively, the difference it makes when an organisation is willing to admit mistakes and make changes to prevent similar tragedies occurring. But these are by no means little things, and deserve a greater depth of discussion than I can give here.</p><p>Perhaps the littlest thing that could have made the biggest difference was in the process of flagging vulnerable patients on admission. When Josanne was admitted to hospital the Learning Disabilities flag on the patient information system wasn’t activated. Normally it would be automatic, but, despite having lived in Hertfordshire for 12 years and having a Hertfordshire GP, Josanne was not registered on the Local Authority’s patient list as having Learning Disabilities because Josanne was originally from Cambridgeshire and her previous hospital admissions had been to the nearby hospital in Essex.</p><p><span class="mag-quote-right">A little thing. Without it the door to essential medical care didn’t open.</span>Why didn’t a Learning Disability flag get passed from one county to the next? Why didn’t a GP’s patient information system link into the hospital’s patient information system? And, given the severity of Josanne’s learning disability, why didn’t it occur to staff to check the flag had been activated? This would have triggered an alert to the specialist Learning Disabilities Nurse, who has greater understanding of the potential issues faced by vulnerable patients and can advocate for them. But the Learning Disabilities Nurse wasn’t even aware that Josanne was in hospital until 13 days into her stay, by which time it was too late.&nbsp;</p><p>It may just have taken a little thing, but without it the mechanism didn’t work properly, the door to essential medical care didn’t open. Josanne was instead locked in a waiting room of neglect until she died.</p><p>Whilst the hospital have frankly examined their failings and have put things in place to prevent it happening again, my concern is that other hospitals could easily make the same mistakes if learning from this incident isn’t shared. If little things like Learning Disabilities flags aren’t activated somewhere else another time, then this could happen again.&nbsp;</p><p>The wonderful story of the Little Blue Cup continues. Requests for little things that make a big difference to learning disabled people’s lives are now shared on a website and items are united with those who need them. How wonderful it would be if little needs in bigger scenarios could also be met! If healthcare professionals could make seemingly small changes to how they treat and assess vulnerable patients, it could make the biggest difference and unlock the door to saving many lives.</p><p>&nbsp;</p><hr /><p><a href="https://www.inquest.org.uk/our-services">The charity INQUEST</a>&nbsp;provides free and independent advice to bereaved people following a death in state care or detention in England and Wales. This piece, edited by Ayesha Carmouche, is the first in a series of collaborations between families, INQUEST and <a href="https://opendemocracy.net/shinealight">Shine A Light</a>.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/shinealight/deborah-coles/inquest-leder-report-learning-disability">We must protect the lives of people with learning disability</a> </div> <div class="field-item even"> <a href="/shinealight/sara-ryan/connor-sparrowhawk-southern-health-fined-2m">&#039;We’ve done you proud&#039; — Families speak after NHS Trust fined £2million over patient deaths</a> </div> <div class="field-item odd"> <a href="/shinealight/imogen-tyler/connor-sparrowhawk-erosion-of-accountability-in-nhs">Connor Sparrowhawk: the erosion of accountability in the NHS</a> </div> <div class="field-item even"> <a href="/shinealight/shinealight/sara-ryan-clare-sambrook/connor-sparrowhawk-justiceforLB">Connor Sparrowhawk: How one boy’s death in NHS care inspired a movement for justice</a> </div> <div class="field-item odd"> <a href="/shinealight/tom-ryan/since-my-brother-s-preventable-death">Since my brother’s preventable death . . .</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> Shinealight ShineALight ourNHS Kate Dolan Wed, 23 May 2018 06:50:00 +0000 Kate Dolan 117795 at https://www.opendemocracy.net NHS data-sharing U-turn is welcome – but more to do to scrap the ‘hostile environment’ https://www.opendemocracy.net/ournhs/peter-pannier/data-sharing-u-turn-is-welcome-but-more-to-do-to-scrap-hostile-environment-in-n <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Recent attention to the Windrush scandal has focused attention on the many ways migrants are deterred from accessing healthcare. This Saturday, join NHS workers protesting that they are not border guards.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/nursenotaborderguard.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/nursenotaborderguard.jpg" alt="" title="" width="460" height="465" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Medact</em></p><p>The government has this week announced it will be <a href="https://www.theguardian.com/society/2018/may/09/government-to-stop-forcing-nhs-to-share-patients-data-with-home-office">suspending “with immediate effect”</a> the controversial memorandum of understanding (MOU) under which NHS Digital<a href="https://www.theguardian.com/uk-news/2017/jan/24/nhs-hands-over-patient-records-to-home-office-for-immigration-crackdown" target="_blank">&nbsp;shared NHS patients’ details with the Home Office</a>.</p> <p>It’s a significant victory for the<a href="https://www.facebook.com/hashtag/stopsharing?source=feed_text" target="_blank"> #StopSharing</a> campaign by Doctors of the World, the National AIDs Trust, and a host of others - including Docs Not Cops. Campaigners have been insisting that patients should not fear immigration enforcement when seeking NHS treatment. The policy – part of the ‘hostile environment’ - has stirred considerable controversy, with a legal challenge from <a href="https://www.crowdjustice.com/case/stopnhsdatasharing/" target="_blank">Migrants’ Rights Network legal challenge</a> due to be heard next month. MPs on the Commons Health Committee also voiced considerable concern after hearing a range of powerful testimony – including from Voices of Domestic Workers, who highlighted a case of a domestic worker who had&nbsp;<a href="https://www.mirror.co.uk/news/politics/domestic-worker-died-too-frightened-11864052" target="_blank">died of pneumonia 'too frightened' to access healthcare</a>.</p> <p>While suspension of this damaging data-sharing provides a rare moment to celebrate, and appreciate the impact campaigning can have, there are caveats and a good deal of context to bear in mind. Firstly, it is essential to emphasise that - thanks to regulations introduced through secondary legislation by Jeremy Hunt in October 2017 - patients will <em>still</em> be required to prove immigration status to&nbsp;access&nbsp;most hospital care. Such a requirement stops people receiving treatment, criminalises patients and makes healthcare workers complicit in racist policy. Further, the NHS is but one arena in which the government’s hostile environment operates - banks will still freeze your account if you're unlucky enough to end up on a Home Office wanted list, and Landlords are still required to check your passport if you're renting from them. The Prevent duty still places students – and patients – under suspicion, as highlighted by the Joint Council for the Welfare of Immigrants,&nbsp;<a href="http://twitter.com/nobankborders" target="_blank">No Borders In Banks</a>, and&nbsp;<a href="https://twitter.com/UnisNotBorders" target="_blank">Unis Not Borders</a>&nbsp;amongst others.</p> <p>Another caveat is that the announcement on NHS data sharing came during a debate on the Data Protection Bill – however during the wider debate on the bill, an amendment which would have definitively scrapped the exemption that allows data protection rules to be broken for immigration purposes was defeated by 18 votes. And the suspension was also announced with a suggestion that in future the Home Office would still be “able to use the data-sharing mechanism to trace people who are being considered for deportation from Britain because they have committed a serious crime”. As Liberty and the National Aids Trust have already noted, the definition of “serious crime” here is vague to say the least.</p> <p>Corey Stoughton, advocacy director at Liberty said: “The government now admits it has been needlessly exploiting NHS patient data on a mass scale for minor immigration enforcement matters. They have undermined the confidentiality and trust at the heart of our healthcare system in the name of pursuing their hostile environment. We welcome the agreement to overhaul its practices and immediately curtail some data-sharing – but its language is worryingly vague. We need a cast-iron commitment that people will no longer have to fear immigration enforcement when seeking urgent medical care.”</p> <p>Any discussion of crime must acknowledge that those who are not white are more likely to be stopped, detained, prosecuted, and receive harsher sentences. Immediately it is clear that not everyone will be safe from data sharing - and instead of protecting people, and ensuring no-one is deterred from seeking treatment, the discussion is once again dragged toward distinctions between ‘good migrants’ and ‘bad migrants’, ‘deserving’ and ‘undeserving’ people.</p> <p>As with much of the recent (and long overdue) media and political attention to the government’s ‘hostile environment’, people who can be deemed 'illegal' are once again dehumanised even by politicians opposing government policy. Labour’s&nbsp;Shadow Secretary of State for International Trade, and for Climate Change,&nbsp;<a href="https://twitter.com/daily_politics/status/990918048633700352" target="_blank">Barry Gardiner recently told the BBC’s Daily Politics</a>&nbsp;"we have to make sure that those people who are in this country illegally are removed from this country... I'm very happy to see a target of the number of those people that we want to remove". When the BBC’s Nick Robinson asked the&nbsp;<a href="https://www.youtube.com/watch?v=gVKs23tCCKU" target="_blank">Shadow Foreign Secretary Emily Thornberry on the Marr Show</a>&nbsp;“Are you saying that you don’t want to see checks when people arrive in hospital for treatment that might cost tens of thousands of pounds – you don’t want to see whether they’re in fact illegal immigrants?”,&nbsp;Emily Thornberry replied “I don’t have a problem with checks being made”. It was disappointing that Thornberry made no attempt to query the premise of the question (where Robinson also suggested&nbsp;illegal migrants "take" jobs and houses from legal residents) or defend the principle that all should be able to access healthcare as a human right. It would have been easy for Thornberry to mention the public health risks entailed when denying people treatment – as&nbsp;<a href="http://politics.co.uk/news/2018/04/19/hostile-environment-government-ignored-warnings-from-public" target="_blank">Public Health England have done</a>.</p> <p>This stance must change - as Luke de Noronha argues, “There are no sharp divisions between ‘legal migrants’ and citizens over here, working hard, paying taxes and playing by the rules, and the ‘illegal immigrants’ over there, sneaking around, stealing jobs and deceiving ordinary Brits. In fact, the law changes around people;&nbsp;<em>illegality is produced</em>&nbsp;in ways which create divisions within our families, communities and classrooms. We can only develop a stronger critique of the UK’s cruel immigration system if&nbsp;<a href="https://www.opendemocracy.net/uk/luke-de-noronha/windrush-generation-and-illegal-immigrants-are-both-our-kin" target="_blank">we see Windrush migrants and ‘illegal immigrants’ as kin</a>, rather than as good and bad migrants to be isolated from one another.” No one should be made to feel undeserving of care.</p> <p>More positively, it is welcome that, responding to the suspension of data-sharing, Shadow Health Secretary Jonathan Ashworth noted yesterday “Theresa May has ignored warnings that the regulations on ID checks at hospitals are also damaging patient care” and added that "<a href="https://www.mirror.co.uk/news/politics/home-office-stop-using-nhs-12508018" target="_blank">The Government must now suspend these regulations while a full review is carried out</a>.” </p> <p>Having been making this case for months - indeed years - we are pleased to hear a senior opposition politician say:</p> <p>“This policy was yet another example of Theresa May’s heartless ‘hostile environment’ which is clearly undermining patient care. This U-turn is a victory for Labour MPs like Paul Williams and Luciana Berger, as well as the Health Select Committee. But the Government needs to go further. Today’s U-turn should only be the start. To protect the best interests of patients the Government must end Theresa May’s hostile environment entirely.”</p> <p>This is a welcome first step - Labour must now commit to scrap these regulations in their entirety, as&nbsp;<a href="https://labourlist.org/2018/03/the-nhs-must-remain-free-at-the-point-of-use-and-based-on-need-not-ability-to-pay/" target="_blank">we've argued on LabourList</a>, and&nbsp;<a href="https://www.opendemocracy.net/ournhs/docs-not-cops/labour-must-tackle-may-s-hostile-environment-for-migrants-in-nhs" target="_blank">ahead of their 2017 conference on OurNHS openDemocracy</a>.</p> <p>Of course, responsibility lies with Jeremy Hunt. That’s why this Saturday 12th May we’re organising a twitter storm for International Nurses Day. This year the International Council of Nurses have chosen “<a href="http://www.icn.ch/publications/2018-nurses-a-voice-to-lead-health-is-a-human-right/" target="_blank">Nurses A Voice to Lead – Health is a Human Right</a>” as their theme. We agree with them that "healthcare should be accessible to all". The government’s ‘hostile environment’ policies go against this principle - making it more and more difficult for people to access the NHS services they need. It is now mandatory for NHS trusts to check people’s immigration status before providing secondary care and to&nbsp;<a href="https://theconversation.com/who-has-to-pay-for-the-nhs-and-when-91344" target="_blank">charge upfront for treatment</a>&nbsp;where people are unable to prove their eligibility. And additionally, the&nbsp;<a href="https://www.theguardian.com/society/2018/feb/05/annual-charge-paid-by-migrants-for-using-the-nhs-to-double" target="_blank">Immigration Health Surcharge is set to be doubled</a>, despite pricing people out of visa applications at the rates introduced in 2014.</p> <p>Already these&nbsp;<a href="https://www.independent.co.uk/news/uk/home-news/nhs-charging-rules-doctors-nurses-government-id-checks-payments-home-office-hospitals-docs-not-cops-a8014966.html" target="_blank">policies are leading to discrimination and racial profiling</a>, to&nbsp;<a href="https://www.independent.co.uk/news/uk/home-news/pregnant-and-ill-migrants-going-without-medical-care-due-to-hardline-government-immigration-policy-a8011351.html" target="_blank">people being too scared to access the care they need</a>, and are&nbsp;<a href="http://www.gal-dem.com/docs-not-cops-new-policy-transforms-nhs-workers-border-guards" target="_blank">turning healthcare workers into border guards</a>.</p> <p>As health workers we are standing up for our patients and advocating for free, universal, non-judgemental healthcare. Ahead of International Nurses Day, a member who is a nurse has written of seeing the <a href="https://www.independent.co.uk/voices/home-office-nhs-doctors-passport-checks-nhs-health-tourism-patients-a8345056.html">fallout of these policies every day in A&amp;E</a>. Join Docs Not Cops in celebrating International Nurses day this Saturday (12 May) by telling Jeremy Hunt it’s time to end prohibitive healthcare charges for migrants, scrap ID checks in hospitals and community care, and time to kick the ‘hostile environment’ out of the NHS. Please tweet a selfie of you and your colleagues (ideally in uniform - but you don’t have to identify anyone) holding a sign saying “We treat patients not passports. I’m a Nurse not a border guard”. For more information go to:<a href="http://www.docsnotcops.co.uk/nursenotaborderguard" target="_blank">&nbsp;docsnotcops.co.uk/nursenotaborderguard</a></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/uk/jess-potter/is-our-personal-data-fair-game-in-drive-to-create-theresa-may-s-hostile-environment-f">Is our personal data fair game in the drive to create Theresa May’s “hostile environment” for migrants?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Peter Pannier Fri, 11 May 2018 06:00:00 +0000 Peter Pannier 117807 at https://www.opendemocracy.net “Simon Jones was 24 when he died, his head crushed by the grab of a crane” https://www.opendemocracy.net/uk/hannah-basson/simon-jones-was-24-when-he-died-his-head-crushed-by-grab-of-crane <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Poor working conditions kill a worker every 11 seconds. All of these deaths are preventable – if the political will is there. An edited version of a speech given on International Workers Day.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/simon jones.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/simon jones.jpg" alt="" title="" width="460" height="421" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Simon Jones's family, pictured 3 years after his death. Credit: Michael Stephens/PA Images.</em></p><p><a href="http://www.simonjones.org.uk/campaign/">Simon Jones was 24 when he died</a>. It was 20 years ago last month.</p> <p>Simon died, his head crushed by the grab of a crane at Shoreham docks. He didn’t know how to do that job. He wasn’t trained for it. But he took a job he was not prepared for and had no experience in, because of the push from the dole office to make him work, and the threat of his benefits being cut.</p> <p>Worldwide, poor working conditions <a href="http://www.hazards.org/wmd/worldoftrouble.htm">kill a worker every 11 seconds</a>. <a href="http://www.hse.gov.uk/statistics/fatals.htm">137 people died at work in the UK in the 2016-17</a>, and in the same year, one and half thousand fatalities arose from work-related incidents.</p> <p>Union health and safety representatives make a difference in the workplace. Yet this government is relentlessly attacking our unions. Workplaces with union representatives and joint safety committees have half the major injury rate of those without. Safety representatives save society up to half billion pounds a year, by reducing time lost through illness and occupational injury. </p> <p>An academic report looked at the construction industry in Northern Ireland and the Irish Republic. It concluded: “<em><a href="https://www.tuc.org.uk/research-analysis/reports/union-effect#_ftn12">the strongest relationship with safety compliance is the presence of a safety representative</a>”.</em> The Health and Safety Executive’s own research has reinforced these conclusions. Other studies have shown that the better an employer consults with reps, the more effective the control measures. </p> <p>And yet, this govt continues its attacks on our unions and our safety.</p> <p>The 1974 Health and Safety at Work Act is our primary piece of legislation covering occupational health and safety in Great Britain. With the hard work, skills, knowledge, and watchful eye of people like our reps and of the Health and Safety Executive, thousands and thousands of lives have been saved. </p> <p>Not only are this government hell bent on destroying the unions, they are attacking the Health and Safety Executive too. <a href="http://www.hazards.org/safetypimp/buyme.htm">By 2020, the HSE budget will have been cut by half</a>. Conservative leaders and a right-wing media, with the approval of sneering government officials, undermine the work of the Health and Safety Executive at every turn, citing any decision as ‘red tape’, the ‘nanny state’, and ‘health and safety gone mad’.</p> <p>The 40-year social partnership between the Health &amp; Safety Executive and the TUC/unions has been scrapped – after talks behind closed doors between the government and lobby groups - and it’s now <em>ministers</em> that decide who represents workers on the HSE board. </p> <p>The need for proper health and safety, the damage that casual labour creates, outsourcing, the demonisation of the sick and disabled – these issues are as important as they ever were. </p> <h2>How outsourcing and privatisation worsen health and safety</h2> <p>Since the last Workers Day, the <a href="http://press.hse.gov.uk/2017/health-care-provider-fined-for-health-and-safety-failures/">Ramsay health group who run the Winfield private hospital in Gloucester were fined</a> for running an insufficiently staffed and managed occupational health service putting staff, as well as public, at risk. </p> <p>Since last Workers Day, Liverpool has held a <a href="http://www.unitetheunion.org/news/vigil-to-remember-liverpool-hospital-worker/">candlelit vigil for an outsourced worker who could not afford adequate time off work to recover</a>, following surgery to have a lung removed in the hospital where she worked. Unfair sick pay meant she lost her home as a result.</p> <p>Here in the NHS in Gloucestershire, <a href="https://opendemocracy.net/ournhs/caroline-molloy/are-cash-strapped-hospitals-walking-into-trap-that-could-cost-nhs-its-family-">hundreds of staff have just been transferred to a new private company, or ‘SubCo’</a> – transferred whilst its owners, Gloucestershire Hospitals NHS Trust, were <em>still discussing</em> what Health and Safety committee provision there would be, whilst they were still tossing ideas around about the occupational health provision that those workers will have access to.</p> <p>Many outsourcings across the NHS and beyond in this last year have led to reductions of sick days for staff. In Gloucestershire, we don’t know yet what several of the policies of the new SubCo will be. We are still waiting to see what new starters terms will be. Our workers in this county in the SubCo, outsourced to save money for the bosses, face many potential sources of injury every hour of the day in the work place. And these are the lowest paid workers in the health service. They are fodder for feeding the bosses’ profits and for feeding the government’s cuts. They are expendable trash, waste products, of a system that favours money over life.</p> <p>Worldwide, working conditions kill a worker every 11 seconds. Every death is avoidable. There is the knowledge, there is the technology, there just isn't the will. </p> <p>Union organisation is proven antidote. Remember Simon, and remember those that die at work everywhere. And think about your friends and family and the people you don’t know personally but greet each day as though they were your friends. Think about their safety, their futures. An injury to one is an injury to all.</p> <p>Simon was an amazing young man who believed in direct action. He knew you couldn’t sit back and wait for politicians to make the changes needed.</p> <p>Before the next government is sworn in, there will more deaths in the workplace. And we can’t wait for the next government. So, for now, we must do all we can to raise awareness of the good that unions do, the need for proper health and safety, the damage that casual labour creates, outsourcing, the demonisation of the employed and the non-employed sick and disabled. And when the next election comes – you know what you have to do. Then, let’s bring in a reversal to union legislation, repeal the vicious trade union legislation – and let’s make the workplace a safer place for everyone</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/opensecurity/henrik-maihack/rana-plaza-bottomup-route-to-workers%E2%80%99-safety">Rana Plaza: the bottom-up route to workers’ safety</a> </div> <div class="field-item even"> <a href="/uk/frances-ogrady/heartunions-why-young-workers-need-trade-unions-more-than-ever">#HeartUnions - why young workers need trade unions more than ever</a> </div> <div class="field-item odd"> <a href="/laurie-macfarlane/precarious-workers-are-organising-trade-unions-need-to-catch-up">Precarious workers are organising - trade unions need to catch up</a> </div> <div class="field-item even"> <a href="/opensecurity/phil-chamberlain/building-blacklist-police-spies-and-trade-unionists">Building the blacklist: police spies and trade unionists</a> </div> <div class="field-item odd"> <a href="/dave-smith/carillion-must-now-face-justice-for-blacklisting-trade-unionists-too">Carillion must now also face justice for blacklisting trade unionists</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> uk uk ourNHS Hannah Basson Thu, 10 May 2018 08:10:57 +0000 Hannah Basson 117786 at https://www.opendemocracy.net To prevent another Alfie Evans case we must reverse cuts to public services https://www.opendemocracy.net/callum-phillips/to-prevent-another-alfie-evans-case-we-must-reverse-cuts-to-public-services <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>The right have used the case as a stick to beat the public services they supported gutted.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/565030/PA-36210904.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/565030/PA-36210904.jpg" alt="Alfie Evans in Alder Hey Children’s Hospital, Liverpool." title="" width="460" height="392" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Alfie Evans in Alder Hey Children’s Hospital, Liverpool. Image: Ropi/Zuma Press/PA Images.</span></span></span></p><p>On April 28th, 23-month-old Alfie Evans died five days after his life support machine was switched off. The entwined web of legal, medical, and ethical issues brought to light by the case has provoked fierce reactions across the globe. On both sides of the Atlantic, the libertarian right have weaponsied Evan’s death to attack the NHS and British legal system, with figures like Nigel Farage branding it “state-sponsored euthanasia”. But contrary to their claims, this tragic story is not the result of government overreach. Rather, it is indicative of the damage being wrought to public services and human lives by the shrinking of the state, a policy that the right has vociferously fought for.&nbsp;</p><div>In the US, commentators such as Liz Wheeler, a host for the ultra conservative news network OAN, have sought to link Evan’s death to the UK’s universal health care system. But even if an American hospital was willing to keep Evans on life support, it would not be able to do so indefinitely given the financial burden on his parents. Regardless, the opinion of the international medical community is that the outcome would have been the same. Impartial medical experts offering opinions, available to read in the court judgements, comprehensively assessed any likelihood of recovery and found none; MRI scans of his brain found the majority of his brain was already crippled beyond repair. They submitted that Evans would never make any developmental progress (motor skills, vision, hearing, social, or emotional) and his illness was irreversible and terminal.</div><div>&nbsp;</div><div>Having already exhausted all their medical knowledge, experience, and options, Alder Hay Hospital continued to keep Evans alive, at no cost to the parents, supporting his failing organs, enabling him to breath, and treating recurrent infections Evans could not fend off himself. Accordingly, Alder Hay provided palliative care to Evans, which some critics have misleadingly tried to equate to euthanasia. It is at this point that a Vatican-run hospital, Bambino Gesú Hospital, and the Pope intervened. Their intentions however have been misreported. The Italian hospital offered no therapeutic benefit, no increased chance of survival. There was no last ditch option maliciously refused to the parents by a child-murdering government. The British government were not a party to any of the legal proceedings, and the constitutionally endorsed independence of the court ensures the government cannot simply dictate their adjudications. To chastise the state is to erroneously conflate the two.</div><div></div><blockquote class="twitter-tweet"><p dir="ltr" lang="en">Moved by the prayers and immense solidarity shown little Alfie Evans, I renew my appeal that the suffering of his parents may be heard and that their desire to seek new forms of treatment may be granted.</p>— Pope Francis (@Pontifex) <a href="https://twitter.com/Pontifex/status/988496588283826177?ref_src=twsrc%5Etfw">23 April 2018</a></blockquote><p><br />Recognising this, the courts and medical specialists at Alder Hay concluded it was in Evans’ best interests to end his suffering by switching off the life support machine keeping him alive. This was against the wishes of his parents, and certainly their opinions were taken into account. However, it is not in their best interests that the courts and doctors are charged with protecting. They are the guardians of a young man unable to communicate his own wishes. It is a wretched decision to have to take, but arguably, those we entrust with such tragedies were in agreement: it was time to let Evans’ life reach a natural conclusion.</p><div>We cannot imagine the suffering which Evans’ parents have gone through. This has been a horrifically sad story from start to finish. However, as a society we must seek to draw beneficial reforms from what has gone before, recognising where we have failed each other.</div><div class="mag-quote-right">Let Evans’ legacy be a call-to-arms to support a health service wishing to protect its citizens</div><div>&nbsp;</div><div>Incorrect legal advice from the Christian Legal Centre prolonged and increased the suffering of the parents and child involved. It gave them a false hope. It misled them as to the actions of the doctors and the position of the law. This cannot be forgotten. Looking forward, we must invest in legal aid access and supporting organisations like Citizens Advice, which have been stretched to breaking point by vicious budget cuts and austerity measures. Hospitals must be enabled to bring in greater specialist grief counselling facilities, to open up a passage of communication between parents and doctors. The adversarial nature of court proceedings should be avoided at all costs, it is to the benefit of neither party. Clinical Ethics Committees are notoriously poorly resourced, resulting in them fighting a battle with one arm tied behind their back. The answer to this case is most certainly not to turn towards a single-payer healthcare system (as seen in America). As former President Obama noted in his 2009 State of the Union, a medical cost induced bankruptcy occurs every 30 seconds due to a system rampantly providing unequal levels of accessibility to care.</div><div>&nbsp;</div><div>The answer is to double-down on our support for universal health care. As citizens touched by Evans’ story, we must come together to fund charities and research into incurable conditions. We must support political parties seeking to empower our NHS and research facilities to provide pioneering treatment and developing those miracle cures we seek. This is clearly not yet the case under our current neoliberal system. Healthcare blind to social class is irrevocably entwined to the very fabric safeguarding British communities, providing protection and care for those other countries would readily leave behind.</div><div>&nbsp;</div><div>Let Evans’ legacy be a call-to-arms to support a health service wishing to protect its citizens, to formulating a legal system accessible by all, and to campaigning for research into conditions not seen as profitable by corporations. It is only through standing up for these notions that we can prevent the suffering of Evans and his family from being in vain.&nbsp;</div><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/5050/lara-whyte/charlie-gard-cause-celebre-us-christian-right">How Charlie Gard became a cause célèbre for the US Christian right </a> </div> <div class="field-item even"> <a href="/5050/lara-whyte/the-rise-of-citizengo">&quot;They are coming for your children&quot; – the rise of CitizenGo</a> </div> </div> </div> </fieldset> <div class="field field-country"> <div class="field-label"> Country or region:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> UK </div> </div> </div> <div class="field field-topics"> <div class="field-label">Topics:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> Civil society </div> </div> </div> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS UK Civil society Callum Phillips Wed, 09 May 2018 12:03:06 +0000 Callum Phillips 117767 at https://www.opendemocracy.net Don't invoke the NHS to sell a false idea of 'good nationalism' https://www.opendemocracy.net/ournhs/caroline-molloy/dont-invoke-nhs-to-sell-false-idea-of-good-nationalism <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>This isn't 'good nationalism'. This is nationalism - as ever, in an English context - as forgetting. A response to Zoe Williams.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/2012 olympics.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/2012 olympics.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: London Olympic games ceremony, 2012. Credit: Julian Behal/PA Images, all rights reserved.</em></p><p>Zoe Williams <a href="https://www.theguardian.com/commentisfree/2018/may/08/nationalism-positive-case-immigration-counter-narrative-nhs">holds up the NHS as an example of ‘good nationalism’ in today’s Guardian</a>, citing Danny Boyle’s 2012 Olympics NHS montage as an example:</p> <p>“Good nationalism is a certain specific solidarity based on the things you have created together, as a nation, and the things you aspire to create: you could call it, for short,&nbsp;<a href="https://www.theguardian.com/sport/2012/jul/27/olympic-opening-ceremony">Danny Boyle nationalism</a>, and it takes in the NHS.”</p> <p>The problem with this kind of narrative is it omits how all English nationalism – even supposedly the ‘good’ kind – allows us all to ignore inconvenient truths.</p> <p>Narratives that sacralise the NHS - or indeed any of our better achievements or virtues - as part of our nationalism, risk making us complacent. We all love the NHS, fair play, queues, warm beer and decency. These things will always be with us, with any temporary lapses promptly corrected. So the story goes.</p> <p>Of course in 2012, just as Boyle’s dancing nurses brought a lump to our throats, the government was enacting the most destructive anti-NHS legislation in history, destroying (in England) its core principle that people got <em>comprehensive</em> healthcare on the basis that they lived here, and needed it, that had endured since 1948.</p> <p>Just a couple of months <em>before</em> the 2012 Olympics, <a href="https://www.telegraph.co.uk/news/uknews/immigration/9291483/Theresa-May-interview-Were-going-to-give-illegal-migrants-a-really-hostile-reception.html">Theresa May also publicly announced the “hostile environment” policy</a>, making it progressively harder over the next few years for migrants to access healthcare or other basic rights, as well as making life progressively more uncomfortable – or impossible – <a href="https://opendemocracy.net/ournhs/ruth-atkinson/brexit-and-nhs-we-need-to-fight-racist-discourse">for migrant workers in the NHS</a>. </p> <p>The Tories genuflect to the NHS as a ‘national religion’ almost as much as Labour - but that hasn’t stopped them disestablishing it and excommunicating large numbers of people from it. </p> <p>And not just migrants, incidentally. Overweight people and smokers are now being banned from <em>all</em> routine NHS procedures <a href="https://www.theguardian.com/society/2017/apr/22/nhs-letter-more-rations-on-operations-obese-smokers">across at least a third of the country</a>, a policy strongly opposed by doctors.</p> <p>Sajid Javid suggested last week that the hostile environment “<a href="https://www.independent.co.uk/news/uk/politics/sajid-javid-theresa-may-new-home-secretary-immigration-rhetoric-hostile-not-british-a8330151.html">did not represent our values as a country</a>”, and <a href="https://www.telegraph.co.uk/politics/2018/05/07/jacob-rees-mogg-amazing-rise-savid-javid-makes-proud-british/">Jacob Rees-Mogg yesterday called the policy “unBritish”.</a> But Eric Pickles called the aforementioned NHS fat bans “<a href="https://www.opendemocracy.net/ournhs/caroline-molloy/dont-want-government-to-let-nhs-die-one-crucial-thing-you-can-do-now">not the kind of Britain I recognise</a>”, too. It seems evoking Britishness doesn’t save us. </p> <h2>&nbsp;‘Good nationalism’ vs ‘bad nationalism’?</h2> <p>Is ‘bad nationalism’ really confined to the Other, to the unashamedly right-wing both here and across the pond? </p> <p>Williams says, “I have no problem with a bordered civic identity: our borders describe the limits of our democratic agency.” She adds, “Good nationalism… includes, by definition, every man, woman and child who contributed to the achievement”. But Williams fails to spell out who this is. Those Caribbean nurses who came here to build the NHS, now finding themselves or their children denied healthcare, and worse? The Commonwealth doctors, routinely discriminated against? The slaves who were forced to help ‘this nation’ establish its wealth? </p> <p>Williams doesn’t say, and such vagueness is not good enough.</p> <p>This isn’t ‘good nationalism’ – this is nationalism (as ever, in the English context) as forgetting. Forgetting that the NHS was not <em>just</em> built “together, as a nation”, as Williams suggests. It was built by a nation that had built its wealth on the back of empire and slavery, by overwriting brown people’s “civic identity”, a nation that had no qualms about interfering in its colonies’ “democratic agency” just long enough to exploit all that could be exploited – and not a moment longer.</p> <p>It’s a message that has been powerfully brought home lately, with the very Commonwealth workers who came over here to help build the NHS, shamefully denied healthcare for themselves or their families. </p> <p>Even now, too many responses to the Windrush scandal fall into <a href="https://www.opendemocracy.net/uk/luke-de-noronha/windrush-generation-and-illegal-immigrants-are-both-our-kin">inherently flawed tropes of ‘good’ and ‘bad’ migrants</a>, with the ‘bad migrants’ category including <a href="https://www.opendemocracy.net/ournhs/juan-camilo/migrants-fairness-and-nhs">children</a>, <a href="https://www.opendemocracy.net/ournhs/rayah-feldman/pregnant-women-bear-brunt-of-government-s-clampdown-on-migrant-nhs-care">pregnant women</a> and <a href="https://www.opendemocracy.net/ournhs/erin-dexter/making-nhs-hostile-environment-for-migrants-demeans-our-country">torture victims and people with infectious diseases</a>, all of whom are still now being refused free healthcare. The former head of the NHS attacked these policies as a “<a href="https://www.opendemocracy.net/ournhs/ex-boss-of-england-s-nhs-blasts-nhs-migrant-policy-as-national-scandal">national scandal” when Jeremy Hunt rolled out upfront passport checks and charges last year</a>. But the <a href="https://www.opendemocracy.net/ournhs/kailash-chand/stop-distracting-us-with-health-tourism-sideshow">grossly exaggerated</a> story of so-called ‘health tourism’ won’t go away, carried by the insidious bleating about ‘an international health service’ that’s travelled from Nick Griffin’s mouth, to Nigel Farage’s, to Jeremy Hunt’s, to even <a href="https://www.youtube.com/watch?v=n9aq47KRrOI">that other bastion of liberal national pride, the BBC</a>.</p> <h2>A little history</h2> <p>A few years after the Windrush generation arrived, <a href="https://www.opendemocracy.net/ournhs/whole-agitation-has-nasty-taste-bevan-on-so-called-health-tourism">Nye Bevan wrote powerfully</a> about the importance of generosity to visitors and of universalism, saying:</p> <p>“it would be&nbsp;unwise as well as mean&nbsp;to withhold the free service from the visitor to Britain. How do we distinguish a visitor from anybody else?&nbsp;Are British citizens to carry means of identification everywhere&nbsp;to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody. Happily, this is one of those occasions when&nbsp;generosity and convenience march together…. The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilized principle, Conservatives have tried to&nbsp;exploit the most disreputable emotions&nbsp;in this among many other&nbsp;attempts to discredit socialized medicine.”</p> <p>Williams writes “Patriotism is democracy, distilled: satisfaction and solidarity rooted in having created the conditions in which generosity and innovation could thrive.”</p> <p>This sounds like a very Blue Labour take (or Blue Corbynism…?).</p> <p>It’s also nonsense. </p> <p>Do we really want to relegate our “generosity” to merely a side-effect of patriotism? Our most generous service – <a href="https://www.newstatesman.com/politics/2013/01/nhs-even-more-cherished-monarchy-and-army">the NHS – has also been our most cherished</a>, for that very reason. The NHS is not a side effect of patriotism. It is, as Bevan himself said, “pure socialism”. </p> <p>And “innovation” in science and medicine has nothing to do with patriotism, either. Our greatest discoveries have been built on cross-border, non-profit collaboration for centuries, and continue to be so – <a href="https://www.opendemocracy.net/ournhs/ted-schrecker/5-reasons-brexit-is-very-bad-for-our-health">though threatened by Brexit</a>. </p> <p>Mangling history to provide comforting myths won’t provide the effective countervailing ‘narrative’ to ‘bad nationalism’ that Williams says the English need. Indeed it just makes ‘bad nationalism’ worse. </p> <p>We need proper history, not more myth making dressed up as ‘narrative’ and ‘framing’.</p> <p>By proper history, I mean a history that acknowledges the role of empire in building our welfare state. A history that doesn’t just portray the NHS as a ‘reward’ for ordinary people that ‘we won’ with our fortitude and sacrifice during our ‘finest hour’, delivered by rulers with an inherent sense of ‘fair play’ and ‘never again’, imbued with the ‘Spirit of 45’ and immediately able to see and embrace the common sense of applying wartime state management to public needs. We also need a history that acknowledges that in fact the NHS’s creation – and that of the rest of the welfare state – was as much to do with elite fears exposed yet again by the demands of war; fears of an enduringly sickly and unproductive workforce, of the pull of communism, and indeed, their fears of a recently demobbed, militarily-trained working class.</p> <h2>Nationalism - same as it ever was</h2> <p>Less than a month after Boyle’s Olympic opening ceremony, the government announced it was setting up ‘Healthcare UK’ to help the <a href="https://www.theguardian.com/society/2012/aug/21/nhs-brand-sold-overseas-hospitals">NHS ‘brand’ to be exported overseas, particularly to the Gulf states, with private firms allowed to “partner with” and benefit from the NHS’s brand recognition</a>. Broadcasting the NHS brand so powerfully to nearly a billion people was undoubtedly useful in helping “<a href="https://healthcareuk.blog.gov.uk/2016/02/23/a-legacy/">public and private sector organisations</a>” build their global healthcare exports. Whatever Boyle’s good intentions – and the government’s <a href="https://www.thetimes.co.uk/article/tories-tried-to-axe-olympic-nhs-celebration-vzc8pmfck">reported initial discomfort</a> – perhaps our desire for a ‘good nationalism’ (<a href="https://www.theguardian.com/sport/2012/jul/28/olympic-games-opening-ceremony-british">gleefully reported at the time</a>) is all too easily hijacked to export (neo)colonialism for the benefit of a few, just as ‘bad nationalism’ was. </p> <p>There is no such thing as ‘good nationalism’, as applied to England, in other words, a nationalism that serves the interests of ordinary people. There is only English nationalism that undermines those interests, that harms our solidarity both in our communities and globally, and that’s a figleaf for pursuing the interests of elites, whilst playing divide and rule amongst the rest of us.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ourkingdom/lara-brearley/exporting-nhs-brand-overseas">Exporting the NHS &#039;brand&#039; overseas?</a> </div> <div class="field-item even"> <a href="/ournhs/why-you-can-t-solve-nhs-s-funding-problems-by-banning-smokers-and-obese-from-treatment">Why you can’t solve the NHS’s problems by banning smokers and the obese from treatment</a> </div> <div class="field-item odd"> <a href="/uk/anthony-barnett/why-brexit-its-english-stupid">Why Brexit? It&#039;s the English, stupid.</a> </div> <div class="field-item even"> <a href="/ournhs/erin-dexter/making-nhs-hostile-environment-for-migrants-demeans-our-country">Making the NHS a “hostile environment” for migrants demeans our country</a> </div> <div class="field-item odd"> <a href="/ournhs/ruth-atkinson/brexit-and-nhs-we-need-to-fight-racist-discourse">Brexit and the NHS - why we all must fight the racist discourse</a> </div> <div class="field-item even"> <a href="/ournhs/greg-dropkin-karen-reissman/healthcare-in-britain-first-they-came-for-immigrants">Healthcare in Britain - first they came for the immigrants</a> </div> <div class="field-item odd"> <a href="/ournhs/juan-camilo/migrants-fairness-and-nhs">Migrants, &quot;fairness&quot; and the NHS</a> </div> <div class="field-item even"> <a href="/ournhs/kailash-chand/stop-distracting-us-with-health-tourism-sideshow">Stop distracting us with the &#039;health tourism&#039; sideshow</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS Can Europe make it? uk ourNHS Caroline Molloy Tue, 08 May 2018 13:00:28 +0000 Caroline Molloy 117743 at https://www.opendemocracy.net Key NHS ‘efficiency’ programme ‘RightCare’ called into question in Liverpool – and elsewhere? https://www.opendemocracy.net/ournhs/greg-dropkin/key-nhs-efficiency-programme-rightcare-called-into-question-in-liverpool-and-els <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>NHS England is promoting ‘RightCare’ as a way for the NHS to deliver still more ‘efficiency savings’. But questions to Liverpool CCG show at least some local NHS managers are well aware of its flaws.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/liverpool.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/liverpool.jpg" alt="" title="" width="460" height="252" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Royal Liverpool University Hospital, PA Images/Peter Byrne, all rights reserved.</em></p><p>RightCare is an NHS England system for encouraging CCGs to compare themselves with other CCGs, with the declared aims of improving performance and reducing costs. When Accountable Care Systems were rebranded as “Integrated Care Systems” in the latest Planning Guidance, NHSE also promoted RightCare. “<a href="https://www.england.nhs.uk/wp-content/uploads/2018/02/planning-guidance-18-19.pdf">Refreshing NHS plans for 2018/19</a>”, which says “In addition to the moderation of emergency demand, the use of RightCare, elective care redesign, urgent and emergency care reform, medicines optimisation, and more integrated primary and community services are also key areas of focus”.</p> <p>Liverpool CCG’s plan for an Integrated Care System was presented on 13 March. It is a 60 page paper “<a href="https://www.liverpoolccg.nhs.uk/media/2943/lccg-gov-body-tuesday-13th-march-18-papers-pack-website-version.pdf">One Liverpool: 2018-2021</a>” written by Healthy Liverpool Integrated Programme Director Carole Hill, with Liverpool CCG Chief Officer Jan Ledward as the Lead Governor. A section on High Impact Priorities waxes lyrical on RightCare.</p> <p>“In support of the work by the Provider Alliance to develop detailed delivery plans, Liverpool CCG has undertaken a review of clinical and non-clinical interventions that have the capacity to deliver high impact change to achieve our outcome ambitions. The review incorporated the Commissioning for Value approach which is embedded in NHS RightCare, the NHS England programme committed to delivering the best care, making the NHS’s money go as far as possible and improving patient outcomes. <a href="https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2017/01/cfv-liverpool-jan17.pdf">Local RightCare data</a> shines a light on variation and performance and supports local health economies to have discussions to agree a starting point for change. NHS RightCare has a three stage, evidence-based methodology, of ‘Where to look’, ‘What to change’ and ‘How to change’ which provides a robust process for service redesign and prioritisation.</p> <h2>Magical Thinking</h2> <p>Describing itself as “a proven approach that delivers better patient outcomes and frees up funds for further innovation”, RightCare turns out to be unproven and based on faulty statistics (<a href="https://blog.oup.com/2017/12/questioning-nhs-rightcare/">Questioning the magical thinking of NHS RightCare</a>). Apparently Liverpool should compare itself with Brighton, Bristol, Sheffield,&nbsp;Newcastle, and Stoke and then save 80 lives per year from lung cancer mortality.</p> <p>Public Health academic Dr Alex Scott-Samuel sent the CCG an FOI request to find out if they’d heard criticism of RightCare.</p> <p>1) Was Liverpool CCG aware of the Journal of Public Health article "<a href="https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdx136/4596536">RightCare: wrong answers</a>", published 3 Nov 2017, when formulating the "One Liverpool" strategy?</p> <p>2) In formulating the "One Liverpool" strategy, how did Liverpool CCG take account of this peer-reviewed criticism of the RightCare methodology?</p> <p>3) Which other specific aspects of Liverpool CCG's work involve RightCare?</p> <p>4) How does Liverpool CCG intend to respond to this peer-reviewed criticism of the RightCare methodology in future? </p> <p>The CCG’s unexpected answer included a less than ringing endorsement:</p> <p>“Liverpool CCG is aware of the article and the conclusions regarding the limitations of the Right Care methodology. The CCG uses the Right Care Methodology as one tool to highlight where there is variation in outcomes and activity, to inform the development of shared priorities for improvement within the Liverpool health and care system. It is not the only method we use and we do acknowledge its limitations. We do not take a literal view of the scale of opportunities set out in our local Right Care data packs... The CCG does not rigidly follow the Right Care methodology to set levels of ambition and does not assume that the efficiencies or outcomes gains published should be modelled in our plans.”</p> <p>Why not ask your CCG about the RightCare magic? Do their Integrated Care plans show the same unbridled enthusiasm for RightCare as “One Liverpool”, or do they take a more sober view?</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Taking politics out of the NHS? Or constructing an elitist ‘consensus’?</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/why-%C2%A38bn-is-zombie-figure-that-won%27t-save-nhs">Why £8bn is a zombie figure that won&#039;t save the NHS </a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS ourNHS Greg Dropkin Mon, 30 Apr 2018 11:50:29 +0000 Greg Dropkin 117572 at https://www.opendemocracy.net GP practices face funding threat as online service ‘targets’ young people https://www.opendemocracy.net/ournhs/david-wrigley/gp-practices-face-funding-threat-as-online-service-targets-young-people <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Doctors and NHS staff raise the alarm as the GP at Hand model threatens the very survival of NHS general practice.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/telephone-mobile-to-call-attainable-40552.jpeg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/telephone-mobile-to-call-attainable-40552.jpeg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Person using mobile, CC0 license.</em></p><p>The traditional GP practice, in place since the NHS’ inception in 1948, is under serious financial threat from a new online service that is draining funding from surgeries.</p> <p>Doctors in Unite (DiU) – part of Unite, the country’s largest union – are warning today that the online NHS&nbsp;GP at Hand&nbsp;service, powered by private digital health provider Babylon, is signing up predominately young people – and putting the future care of vulnerable groups at risk.</p> <p>When patients register with&nbsp;GP at Hand, currently operating just in&nbsp;London,&nbsp;they are ‘de-registered’ from their own surgery with funding being removed from that practice.</p> <p>What’s the problem? Well, losing registration fees for younger, fitter patients who join GP at Hand threatens the model of general practice relied on by so many patients, since the NHS was formed 70 years ago.</p> <p>The scheme is hoovering up the younger, healthier patients and restricts access to those who are pregnant, frail, terminally ill or suffering from multiple health problems. There appears to be an element of cherry picking operating here, which, if true, is to be deplored.</p> <p>In practice, 70 per cent of all patients are reasonably well. Their funding helps surgeries care for the 30 per cent who are sick. It’s a system that works, because it’s fair. We will eventually end up in the 30 per cent - and that’s why we are calling on health and social care secretary Jeremy Hunt to scrap this flawed and misguided model.</p> <p>It is understood that since&nbsp;GP at Hand&nbsp;launched in London in November 2017 about 26,000 patients have registered, most of them being between the ages of 20 and 39.</p> <p>Practices in the capital have seen their list sizes fall for the first time in years due to those patients registering with GP at Hand.</p> <p>There is, no doubt, that GP at Hand&nbsp;will financially destabilise many practices robbing them of the vital risk pooling and cross subsidy which enables them to provide good care to their more complex and unwell patients.</p> <p>GP at Hand targets the most profitable patients – those who are younger and healthier and don’t need extensive care from their GP.</p> <p>Jeremy Hunt has said that general practice is the ‘Jewel in the Crown’ of the NHS. If he truly believes this, he will acknowledge that the GP at Hand model threatens the very survival of NHS general practice.</p> <p>GP at Hand has made it clear it wishes to roll out this model of care across the country, so this scheme will threaten general practice across England.</p> <p>General practice is the cornerstone of the NHS which has provided excellent care with its other community partners for decades.</p> <p>NHS staff who share our concerns can sign the open letter to Jeremy Hunt <a href="https://docs.google.com/forms/d/e/1FAIpQLScDINMclsb7DiYlhq5HwTvr6fg1A-gwRwVhrKooVh5kcdwzIg/viewform">here</a>.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/david-mccoy-lewis-hier-thomas/gp-at-hand-handy-for-whom"> ‘GP at hand’: handy for whom?</a> </div> <div class="field-item even"> <a href="/ournhs/shibley-rahman/247-transparent-nhs-%E2%80%93-or-rise-of-planet-of-apps">A 24/7, transparent NHS – or the rise of the planet of the apps?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS ourNHS David Wrigley Wed, 25 Apr 2018 11:25:28 +0000 David Wrigley 117487 at https://www.opendemocracy.net An 'NHS tax' is perfect for a 'new centrist party'—stale, regressive and technocratic https://www.opendemocracy.net/ournhs/caroline-molloy/nhs-tax-is-stale-regressive-and-technocratic-perfect-for-new-centrist-party <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>National Insurance is regressive. Hypothecating taxes tends to encourage ideas of opt outs &amp; top ups. So why is Liz Kendall promoting these as the 'new consensus' for NHS funding?</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/liz kendall.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/liz kendall.jpg" alt="" title="" width="460" height="286" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Liz Kendall in 2015. Lauren Hurley/PA Images, all rights reserved.</em></p><p>Today, Tory MP Nick Boles, Lib Dem former health minister Norman Lamb and former Blairite health minister Liz Kendall joined forces to promote the idea of a dedicated ‘health and social care tax’, through National Insurance, to replace current NHS funding. Boles grandly proclaimed it “A new Beveridge moment”.</p> <p>The main lesson to be drawn from their interview broadcast on this morning’s BBC Radio Four Today programme, is that it doesn’t take much to excite the media about anything that could be portrayed as - if not the birth pangs, perhaps at least the twinkle in an eye - of <a href="http://www.bbc.co.uk/news/uk-politics-43875246">a ‘new centrist party’</a> run by ‘<a href="https://twitter.com/bbclaurak/status/988724069133619200">grown-ups’</a>. A rehash of an old, bad idea that’s been doing the rounds in right-wing circles for years? That will do just fine. </p> <p>The interview – conducted by the BBC’s political editor Laura Kuenssberg not its health editor Hugh Pym&nbsp;–&nbsp;was notable for its lack of interest in whether such a plan actually had anything useful to offer today’s NHS. Kuenssberg’s line of questioning focused exclusively on the politics: “I mean here we are, an extraordinary degree of consensus…You’re all saying that the parties have to share the political risk… that none of the party leaderships right now are up to this task…”.</p> <p>The stale idea of an ‘NHS tax’ is perfect for those who’ve pinned their hopes on the creation of a ‘new centrist party’. It’s a technocratic issue that’s unlikely to be well understood by most voters, many of whom are under the mistaken impression that National Insurance is what funds the NHS already. The <a href="https://opendemocracy.net/dave-byrne/why-talking-about-nhs-tax-isnt-brave-at-all">history is slightly complicated</a>, but the health service is still overwhelmingly funded as Nye Bevan set out when he <a href="http://www.unitetheunion.org/uploaded/documents/In%20Place%20of%20Fear%20-%20Chapter%205,%20A%20Free%20Health%20Service11-21215.pdf">explicitly rejected the 1911 National Insurance-based system of healthcare</a>&nbsp;as unfair and "peculiarly unsuitable" and instead set up the NHS: </p> <p>“The means of collecting the revenues for the health service are already in the possession of most modern states, and that is the normal system of taxation. This was the course which commended itself to me and it is the basis of the finance of the British Health Service. Its revenues are provided by the Exchequer in the same way as other forms of public expenditure. I am afraid this is not yet fully understood. Many people still think they pay for the National Health Service by way of their contribution to the National Insurance Scheme.”</p> <p>The system Bevan founded continues to enjoy <a href="https://twitter.com/carolinejmolloy/status/914982117305733120">sky-high public support</a>, with <a href="https://www.ipsos.com/ipsos-mori/en-uk/what-do-public-think-about-nhs">nine out of 10 saying its founding principles should still apply today</a>. But being “<a href="https://opendemocracy.net/uk/jeremy-gilbert/antisemitism-cosmopolitanism-and-politics-of-labour-s-old-and-new-right-wings">unencumbered by nostalgia for the 1945 welfare-state settlement</a>” is, as Jeremy Gilbert rightly says, central to the identity of the Blairites and their fellow neoliberal-friendly “centrists” in other parties.</p> <h2>Why ‘comprehensive’ healthcare matters</h2> <p>The ‘NHS tax’ idea is also the antithesis of what campaigning politics is about – focusing, as it does, on inputs rather than outcomes.</p> <p>The public want an NHS that provides the healthcare they need, when they need it – in other words, a comprehensive and timely service. And to the dismay of right-wingers, the public has remained firmly wedded to this outcome that was at the heart of the founding of the NHS. To the idea that it's the state’s duty to provide a comprehensive healthcare service for everyone (though that duty was significantly weakened - <a href="https://www.allysonpollock.com/?p=2270">some say abolished</a> - by the 2012 Health and Social Care Act).</p> <p>The new set of NHS ‘principles’ that Kendall and Boles have produced say nothing about protecting and renewing a ‘comprehensive’ NHS. They will do therefore do nothing to stop people being told – as they are now, increasingly - “not on the NHS” for treatments ranging from <a href="https://www.chesterchronicle.co.uk/news/chester-cheshire-news/cheshire-nhs-plans-sweeping-cuts-12332772">erectile dysfunction</a> and <a href="http://www.bbc.co.uk/news/uk-england-bristol-41913680">vasectomies</a>, to <a href="https://www.thesun.co.uk/news/5436296/hip-and-knee-operations-being-denied/">hip and knee ops</a>, timely <a href="http://www.bbc.co.uk/news/health-18176017">cataract removals</a>&nbsp;and&nbsp;<a href="https://www.theguardian.com/society/2015/jan/03/hearing-aids-supply-cuts-nhs-depression-dementia">hearing aids</a>. Some – like former British Medical Association Deputy Chair <a href="https://www.theguardian.com/society/2016/jun/22/kailash-chand-bma-tory-party-agenda-wash-hands-nhs">Kailash Chand - have already warned</a> that if this trend continues, the NHS is likely to shrink to just an inadequate Medicare style fall-back option for those who can’t afford health insurance. All of the <a href="https://opendemocracy.net/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">many recent attempts to impose a neoliberal-friendly ‘cross party consensus’</a> have <a href="https://opendemocracy.net/ournhs/caroline-lucas/why-i-have-removed-my-backing-for-nhs-commission">failed to incorporate any principled red line about a commitment to comprehensive healthcare</a> – and so all of them have been <a href="https://opendemocracy.net/ournhs/ournhs/nhs-campaigners-say-no-to-nhs-commission">resoundingly rejected by NHS campaigners</a> (as Norman Lamb should know – he’s been involved in most of the recent attempts).</p> <p>The ‘NHS tax’ idea seems unlikely to appeal to any particular demographic of voters. But of course, it could well appeal to a group that most of the ‘centrist party’ fans seem to consider far more important – potential funders. If you look closely at what’s said – and unsaid - in the <a href="https://www.facebook.com/notes/nick-boles-mp/ten-principles-of-long-term-funding-for-nhs-and-social-care/1522885904504144/">Boles/Kendall principles</a>, there’s a lot of music to the ears of corporations and the rich.</p> <h2>The dangers of an “NHS tax”</h2> <p>The most obvious problem in using National Insurance to pay for the NHS is that it is a deeply regressive tax that is capped for the rich. Boles and Kendall nod to this problem, but say only rather vaguely that “higher earners, the self employed, and better off pensioners” will make a “fair” contribution. But if this government is offered a choice between meaningfully reforming a huge loophole that lets them tax poor people more heavily than rich ones – or just loading massive new costs onto an unreformed tax that doesn’t upset the Daily Mail, in the name of ‘saving the NHS’ and ‘a new consensus’ – which do you think Theresa May might pick? </p> <p>Funding through the NHS through the National Insurance system is not just regressive, though. There are other dangers.</p> <p>Firstly, such a plan would probably make it easier – not more difficult&nbsp;–&nbsp;to underfund the NHS, with yet still more quangos and regulators deflecting public concern away from politicians. It would renew the emphasis on the <a href="https://opendemocracy.net/ournhs/richard-murphy/%27nhs-tax%27-is-not-answer">(false) idea that public funds are a simple matter of 'tax in, spending out'</a>, and also the equally false idea that the NHS is somehow separate from the real business of government (a point <a href="https://www.theguardian.com/commentisfree/2018/apr/24/nhs-tax-fragmentation-cross-party-campaign-health-crisis">Caroline Lucas makes excellently in the Guardian today</a>).&nbsp;And whilst Boles and Kendall say the new Fund ought to be “publicly owned”, it’s not hard to imagine the Fund being privatised in the future (right wing Labour MP <a href="https://www.theguardian.com/society/2016/dec/02/run-the-nhs-and-social-care-like-john-lewis-says-frank-field">Frank Field has already called for just such an NI based NHS fund to be run as a ‘mutual’</a> …)</p> <p>Secondly, separating out our payments for the NHS and channelling them through the contributions-based National Insurance system would make it far easier in future to exclude people who – for whatever reason - haven’t earned enough to pay sufficient contributions. </p> <p>Liz Kendall told me in January “<a href="https://twitter.com/carolinejmolloy/status/988712894287237121">I do not support…social insurance</a>”. But the scheme Boles has persuaded her to sign up to looks an awful lot like social insurance in many respects. Admittedly, it does commit to ‘universal’ provision (rather than contributions-based provision) – but how long would such a commitment last, when the mechanism made it so easy to exclude people who could be labelled as ‘less deserving’? (Indeed, we ought to be careful when we’re making the case for the Windrush generation to receive healthcare, that we don’t over-emphasise the fact that they’ve ‘worked and paid taxes’, but rather focus on defending the right to universal, comprehensive healthcare as one of Britain’s highest achievements).</p> <p>Another danger of an ‘NHS tax’ is that such a scheme would also be likely to create pressure to grant an ‘opt out’ for those who pay for private health insurance – much like the NI reforms Thatcher introduced in 1988 which allowed those who signed up to private pensions to opt out of the State Second Pension (with disastrous results). Once an opt-out is allowed, we’re into two-tier healthcare and delivering the insurance firms’ dream.</p> <p>And what of the contributory benefits we currently have? Boles suggests that the entire National Insurance fund be renamed the ‘National Health and Care Fund’. If our healthcare, sick pay and state pensions are all supposedly coming from the same pot, could we in future see them paid out as a merged allowance, from which people can buy their own healthcare from a range of ‘providers’, alongside their fuel bills and weekly shop, topping up from their own money when their 'entitlement' payment runs out? This might sound like a distant Thatcherite dystopia, but it’s a set of ideas some on the right – including the Labour right – have flirted with. Then Chancellor George Osborne <a href="https://www.google.com/url?hl=en-GB&amp;q=https://www.opendemocracy.net/ournhs/caroline-molloy/osborne-lays-out-path-to-broken-nhs-funding-promises&amp;source=gmail&amp;ust=1524673428477000&amp;usg=AFQjCNF7n9gQoaKG1AAAvtlbCMqCZdHXDA">floated the possibility of ‘integrated budgets across health and employment</a>' back in 2014, not long after New Labour think tank DEMOS had laid the groundwork by <a href="https://www.demos.co.uk/project/the-power-of-prepaid-2/">suggesting </a>that benefit and healthcare 'entitlements' could be merged on one ‘entitlement card’. Already the use of fixed ‘entitlement’ sums (known as ‘personal budgets’) is entrenched in social care – and the concept is now being <a href="https://www.theguardian.com/society/2018/apr/16/plans-to-extend-personalised-health-budget-scheme">rolled out with little fanfare into healthcare</a>, enthusiastically promoted by <a href="https://www.ippr.org/news-and-media/press-releases/new-nhs-funding-should-drive-patient-centred-reforms">another Blairite former Health minister Alan Milburn</a>, and by&nbsp;<a href="https://www.theguardian.com/society/2015/apr/28/liz-kendall-shadow-minister-care-health-nhs">Liz Kendall herself</a>.</p> <p>Jeremy Hunt has written to all Tory MPs asking for their ideas for the future of the NHS, and both he and Theresa May have said that they’ll launch a new “long term plan” for the NHS this summer – probably timed to coincide with its 70th birthday. The “centrists” have a truly lousy birthday present up their sleeve. It’s up to the rest of us to keep a close eye on them. </p> <p>Because – as Bevan said, and as we’ve been reminded of in recent weeks:</p> <p>“Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide.”</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/dave-byrne/why-talking-about-nhs-tax-isnt-brave-at-all">Why talking about an &#039;NHS tax&#039; isn&#039;t brave at all</a> </div> <div class="field-item even"> <a href="/ournhs/richard-murphy/%27nhs-tax%27-is-not-answer">An &#039;NHS Tax&#039; is not the answer</a> </div> <div class="field-item odd"> <a href="/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Taking politics out of the NHS? Or constructing an elitist ‘consensus’?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Caroline Molloy Tue, 24 Apr 2018 17:59:05 +0000 Caroline Molloy 117472 at https://www.opendemocracy.net Arron Banks and Brexit’s offshore secrets https://www.opendemocracy.net/uk/brexitinc/marcus-leroux-leigh-baldwin/brexit-s-offshore-secrets-0 <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>In 2015, Arron Banks’s insurance business was bailed out. Where the rescue money came from is unclear—but as the Electoral Commission probes the sources of the Leave donor’s campaign contributions, a group of accountants who specialise in offshore “wealth preservation” may hold the key.</p> </div> </div> </div> <p dir="ltr"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/553846/PA-26717630_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/553846/PA-26717630_0.jpg" alt="" title="" width="460" height="309" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Arron Banks (left) with Nigel Farage (centre), the day after the UK voted to leave the EU. Image, Isabel Infantes/EMPICS Entertainment.</span></span></span></p><p dir="ltr">On 19 October 2017, Alan Kentish was arrested.</p><p dir="ltr">The chief executive officer of STM Group, which specialises in offshore “wealth preservation”, was detained by the Royal Gibraltar Police under the Proceeds of Crime Act. They were investigating whether he had failed to notify the authorities of potential money-laundering by one of STM’s clients. </p><p>Following his arrest, Kentish, who was released on police bail but remains a suspect in Gibraltar, resigned his directorships of two companies linked to multimillionaire Brexit donor Arron Banks.</p><p>Closely associated with Banks for more than a decade, Kentish and STM have drawn attention from authorities in several of the offshore tax havens where they operate. Kentish is appealing a directorship ban in Malta, while regulators in Jersey censured STM after probing its efforts to procure a St Kitts and Nevis passport for a Ukrainian politician on Interpol’s wanted list.</p><p dir="ltr">Now an investigation by SourceMaterial reveals that Kentish and other STM-linked directors were key figures in a bailout of Banks’s Gibraltar-based insurance business Southern Rock that began in 2015, just months before Banks began bankrolling the Leave.EU referendum campaign.</p><p dir="ltr">The mystery cash injection was critical to the survival of Banks’s insurance empire, the foundation of his wealth. Without it, it is hard to see how he could have funded his political donations while keeping the business afloat.</p><p dir="ltr">Banks has declined to answer questions about the origin of the bailout funds, while a spokesman for STM said the company did not supply the money or have any direct connection with the rescue.</p><p dir="ltr">As the Electoral Commission <a href="https://www.electoralcommission.org.uk/i-am-a/journalist/electoral-commission-media-centre/news-releases-donations/electoral-commission-statement-regarding-better-for-the-country-limited-and-mr-arron-banks">examines</a> the source of Banks’s £8.4 million in donations to the Leave campaign, the role of Kentish and other STM-linked figures—who presided over the bailout and were in a position to know where the money came from—may offer new clues to how Brexit was financed.</p><p dir="ltr">Andrew Wigmore, a spokesman for Banks, said our emailed questions were “baseless” and evidence of a “biased hatchet job” but declined to go into further detail. He said in an interview with <a href="https://www.byline.com/column/67/article/2073">Byline</a> in March that Banks paid for his Brexit campaign with proceeds of the sale of NewLaw Group, a law firm Banks partly owned. Wigmore did not elaborate on how Banks was able to bail out Southern Rock.</p><p><a href="https://investegate.co.uk/stm-group-plc--stm-/rns/director-declaration/201711141146274660W/">STM has said</a> the Gibraltar investigation relates to a client company of STM and it expects Kentish to be exonerated.</p><h2>Mister Big</h2><p dir="ltr">Banks, the man behind the GoSkippy car insurance brand, has never been shy about his wealth, often using an internet chatroom to brag about racehorses, diamond mines and jet-setting holidays. His username: Mister Big.</p><blockquote><p dir="ltr">“When I last looked I had”—reads a typical post from April 2014—“a direct insurance group, a gold mining operation in Ghana, four diamond mines in Kimberley (one in Lesotho), a country park complete with beautiful wedding venue, classic car collection, numerous land holdings (including building land acquired at the bottom of the market), a modest art collection and horrendous insomnia brought on by too much port, cigar and a seafood salad last night.”</p></blockquote><p dir="ltr">But much of the image was a mirage. As he lavished cash on Brexit, a series of offshore manoeuvres was underway to save a key company in his empire, Southern Rock Insurance, from bankruptcy.</p><p dir="ltr">In 2014, when a spectacular £1 million pledge to Ukip signalled his arrival in British politics, Banks was already firmly on the radar of authorities in Gibraltar. Finances at his Southern Rock Insurance Company had been shaky for years and now regulators feared a meltdown.</p><p dir="ltr">As the underwriter for policies sold by Banks’s UK insurance broker Eldon, Southern Rock was the cornerstone of his insurance empire. If it folded, Eldon would be crippled too, leaving hundreds of thousands of UK customers with car insurance not worth the paper it was written on. </p><p dir="ltr">Southern Rock’s accounts from as far back as 2011 had warned that it was “<a href="https://www.scribd.com/document/373954159/accounts-2011-technically-insolvent-pdf">technically insolvent</a>” and by the following year it was such dire straits that Banks had <a href="https://www.scribd.com/document/373954218/List-of-assets-assigned-by-Rock-Holdings-to-Southern-Rock">pledged land and sold shares</a> to shore up its capital. The company’s own auditors made clear in 2013 that it was <a href="https://www.scribd.com/document/373954156/auditors-going-concern-12-pdf">dependent on the mercy of the watchdog</a> for survival. &nbsp;</p><p dir="ltr">Meanwhile, the regulators made Southern Rock <a href="https://www.scribd.com/document/373954154/Amendment-to-Southern-Rock-s-articles-of-association">promise not to make any payments</a> to Banks without their prior written consent and hired accountants PwC to assess the company’s vulnerability to shocks.</p><p dir="ltr">When in 2014 PwC’s findings confirmed their fears about Southern Rock’s fragility, Banks was pushed to <a href="https://www.globalreinsurance.com/gibraltar-based-southern-rock-directors-step-down-after-regulatory-probe-/1409043.article">resign</a> as chief executive officer, along with another director and longstanding associate—Alan Kentish.</p><h2>Dramatic rescue</h2><p dir="ltr">By 2015, as the Brexit referendum neared and Banks’ political fortunes went from strength to strength, Southern Rock was teetering on the edge. The rescue, when it came, was dramatic.</p><p dir="ltr">ICS Risk Solutions, a holding company on the Isle of Man, <a href="https://www.scribd.com/document/373714177/Southern-Rock-Insurance-Company-Ltd-2015-accounts">agreed</a> to pump £77.7 million into Southern Rock to save it from collapse. In return, ICS would take a slice of the Gibraltar company’s future income. </p><p>The capital injection allowed the loss-making Southern Rock to meet new EU solvency regulations for insurance companies, described by Banks as “a good example of something no one really wants” being imposed by Brussels.</p><p dir="ltr">Because Banks owned both ICS and Southern Rock, it is not clear where the new money came from. But the arrival of the funds coincided with changes to the management of ICS.</p><p dir="ltr">Corporate records show that in April 2015, the day before the initial rescue deal, Louise Kentish, the wife of STM’s boss, <a href="https://www.scribd.com/document/373717866/ICS-directors-2015">joined the ICS board</a>. On 24 June 2016, the day after the referendum, Alan Kentish <a href="https://www.scribd.com/document/373717784/ICS-directors-2016">followed</a>, along with two other new directors—the former and current chairmen of STM. &nbsp;</p><p dir="ltr">Banks’s ties to Kentish and STM go back to at least 2004, when Kentish became a founding director of Southern Rock. Banks in turn invested in STM and was its largest shareholder before selling his stake in early 2015. More recently, Kentish, Banks and another STM founder co-invested in Legal Protection Group, a broker of insurance for lawyers and doctors that operates from Banks’s Bristol headquarters.</p><p dir="ltr">The arrival of Banks’s longstanding STM contacts at ICS at the time it found the money to save Southern Rock suggests they may hold the secret to the real source of the bailout funds that ensured Bank’s financial survival as he pumped millions into Leave.EU.</p><p dir="ltr">Public records suggest there may be an undeclared shareholder in ICS. Banks has said he owns 90 per cent of the company, with management and staff holding the rest. But the filings state he owns less—between 50 per cent and 75 per cent—with no information on the remainder. Banks declined to answer questions about the holdings.</p><p dir="ltr">SourceMaterial understands that Gibraltar’s Financial Services Commission is closely monitoring the arrangement between ICS and Southern Rock. &nbsp;</p><p dir="ltr">STM’s spokesman, who also responded on behalf of Kentish and the other STM directors, said the rescue “did not involve STM in any way”. He also suggested the bailout was spread over several years to mend the balance sheet without a single large cash injection. He did not address the origin of the funds.</p><h2>Offshore controversies</h2><p dir="ltr"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/553846/Alan Kentish.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/553846/Alan Kentish.jpg" alt="" title="" width="460" height="259" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Alan Kentish with colleague Therese Neish. Image, YouTube, fair use</span></span></span></p><p dir="ltr">Kentish and STM specialise in keeping secrets. A core line of STM’s business is setting up offshore trusts, opaque financial structures that make it difficult to trace who ultimately owns the assets in them.</p><p dir="ltr">In 2002 STM was sued by the UK tax authorities after it set up a trust for an alleged fraudster suspected of masterminding a £100 million VAT scam. Kentish’s arrest in Gibraltar, after which he resigned as a director of Legal Protection Group and ICS, is one of several subsequent brushes with the authorities.&nbsp;</p><p dir="ltr">Early in 2017, STM’s Gibraltar offices received a visit from local regulators, who didn’t like what they saw. Later that year they told STM they were “fundamentally concerned” about its compliance with anti-money-laundering rules, according to Gibraltar court filings. STM tried to block publication of the proceedings, the documents show.</p><p dir="ltr">Particularly worrying to the regulators was the use of STM services to invest pension savings in the Trafalgar Multi Asset Fund, which collapsed in 2016 and is now <a href="https://www.collascrill.com/news/updates/suspicious-minds/">under investigation</a> by the UK’s Serious Fraud Office.</p><p dir="ltr">Angie Brooks, a director of Pension Life, an advocacy group for pension holders, said that STM should have spotted the red flags in the pension debacle. “It was the most toxic mix imaginable. Everything that could go wrong did go wrong and it should have been prevented."</p><p dir="ltr">STM denies any wrongdoing and is not under investigation itself. Liquidators are attempting to salvage the funds but savers have potentially lost millions.&nbsp;</p><h2>Ukrainian politician</h2><p dir="ltr">It wasn’t just Gibraltar. In 2015, STM became the <a href="https://www.collascrill.com/news/updates/suspicious-minds/">first company in Jersey</a> to be prosecuted for money-laundering compliance failures.</p><p dir="ltr">STM was managing operations for Henley &amp; Partners, whose business includes helping rich foreign nationals acquire citizenship of tax havens in return for investment—and whose chairman reportedly has <a href="https://www.thetimes.co.uk/edition/news/cambridge-analytica-british-data-firm-offered-1m-bribe-to-turn-election-psmv359vh">ties to Cambridge Analytica</a>, the election advisor accused of misusing Facebook data and entrapping politicians to skew elections around the world.</p><p dir="ltr">In 2010, STM had used its Henley business to help a Ukrainian politician apply for a passport in St Kitts and Nevis. Viacheslav Suprunenko, son-in-law of the mayor of Kiev and brother of a senior figure in the Moscow-backed Party of Regions, was at the time wanted by Interpol for assault during armed robbery to recover documents in a business dispute. (No charges have been brought.)</p><p dir="ltr">When Suprunenko asked STM to route his payments through offshore vehicles apparently unconnected to him, the company was suspicious enough to refuse the transactions—but failed to report them to the authorities.</p><p dir="ltr">A Henley spokeswoman told SourceMaterial that the company ended its relationship with STM in 2012. “When it comes to politically-exposed figures, we start from the position that any such person automatically requires even greater diligence including a thorough and independent review of friends and family,” she said. “If any criminal activity is suspected, we will immediately decline the applicant.”</p><h2>Money-laundering risks</h2><p dir="ltr">It was just one of a string of incidents in which STM turned a blind eye to money-laundering risks.</p><p dir="ltr">In a period of less than 18 months, junior STM staff filed internal suspicious activity reports on 19 individuals or entities. Only three of these were acknowledged by STM’s compliance officer and none was passed to the island’s financial crimes unit.</p><p dir="ltr">While STM was eventually acquitted in the money-laundering prosecution, it received an<a href="https://www.jerseyfsc.org/media/1101/public-statement-stm-july-2015.pdf"> official order</a> from Jersey’s financial regulator to clean up its behaviour. Its money-laundering compliance officer was banned from holding a regulated position in Jersey.</p><p dir="ltr">In another offshore haven, Malta, the story was much the same.</p><p dir="ltr">Twice in the last two years STM has been fined and officially rebuked, while Kentish was temporarily banned from holding management jobs for failing to inform the regulator when he was forced by the Gibraltar regulator to resign his directorship of Banks’s Southern Rock. STM and Kentish are appealing the sanctions.</p><p dir="ltr">“STM and its officers ensure a strong culture of corporate governance and compliance with industry regulation,” the company’s spokesman said. “This extends across internal and external relationships ensuring that risks to the business are minimised and that products and services are delivered appropriately.”</p><h2>New questions</h2><p dir="ltr">&nbsp;STM also played a cameo in the Brexit movement. Better for the Country Ltd, one of two campaign vehicles that received Banks’ £8.4 million in donations, was <a href="https://s3-eu-west-1.amazonaws.com/document-api-images-prod/docs/J22VO6IwI5BUTD8yGb4wy-KF3yn5SY0450qcd8ARhds/application-pdf?AWSAccessKeyId=ASIAII5UKPTAP7NZOLMA&amp;Expires=1521823382&amp;Signature=JEtO16EHfsJhwujlFMJyHrnhBwM%3D&amp;x-amz-security-token=FQoDYXdzEC4aDFYkZALUJLFVOeYoQCK3A7GnteoYv61JtlQWmCGz%2B%2FEI96CZUpJ0iCpDCCPiz%2F3mpObhoL1ylarxFYeloiSOY%2Bn57bWrzMOSbDCrhn7%2FSo7r7U0SbieK9ivQEf8rmF0hATPk7mAIDw6KcfSJ%2FUR2mGSIF4gKgmhHkhcdEpzl9GocSbLLMMgUasyhOA7B7n6KHSLE4ZXKA4DmvrJ1BfWgiAQfoizNSCYzkaR9PsXO%2F0LLN3PLE9b3Hd0opLO%2BYTBAamY5XOclo0xRCvXtObi7f081%2FMu8WLG%2Bykb0grQdGz6BXlZZpCRYdQoLpjebt9i%2BlbzeMQk9GUps30IC3Xu3v26eYBTJcqdAyagLqjDJgMsBCL25r2GALbpkVL9h4O9d4oggqj5bNXFy%2FzMb%2FhpWaLXLwE%2F3EkHUEqQAa40RZ3Q8wdiP%2FlxIymJXbT4rerHb0qIJYvM83Vk0oE4gsIzYHuwykzPG5ydIRalhR%2Fmg5vuYOoWdUV72aiYnHQ76vs16mdR0IvufkYQNJ0o1yI28ACKRVs3HVM4kXGjr11ky%2B%2F0gW%2FZ4DkxhQkXwwEzFN0WJ7BrIDlHdK0ccE2c5KQry9Zr%2B044ZbPso6vTT1QU%3D">set up</a> by an STM Group company.</p><p dir="ltr">Banks’s links to Alan Kentish and the STM set whose speciality is using offshore havens to guard wealthy clients’ secrets raise new questions about his Brexit campaign.</p><p dir="ltr">The Electoral Commission has set out to trace the ultimate source of the millions Banks put into Leave.EU and Better for the Country, the company STM founded.</p><p dir="ltr">But with cash flowing through island tax havens whose stock in trade is stealth, the answer may prove elusive.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/uk/brexitinc/adam-ramsay/how-did-arron-banks-afford-brexit">How did Arron Banks afford Brexit?</a> </div> <div class="field-item even"> <a href="/uk/brexitinc/leigh-baldwin-marcus-leroux/not-everyone-agrees-with-arron-banks-about-value-of-his-dia">Not everyone agrees with Arron Banks about the value of his diamond mines</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> uk ourNHS DUP Dark Money Brexit Inc. Leigh Baldwin Marcus Leroux Thu, 12 Apr 2018 15:48:29 +0000 Marcus Leroux and Leigh Baldwin 117236 at https://www.opendemocracy.net Has Labour really turned its back on pro-market NHS ‘solutions’? https://www.opendemocracy.net/ournhs/stewart-player/has-labour-really-turned-its-back-on-pro-market-nhs-solutions <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>As the NHS turns 70, just which corporate actors are queuing up to drive ‘consensus’-based reform? And is Labour prepared to sufficiently distance themselves from such ideas?</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/ashworth corbyn.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/ashworth corbyn.jpg" alt="" title="" width="460" height="300" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Jeremy Corbyn, NHS worker Judith Clegg &amp; Shadow Health Secretary Jon Ashworth. Ben Birchall/PA Images. All rights reserved.</em></p><p>The current programme of NHS ‘reform’ currently underway has long been hailed as <a href="https://www.hsj.co.uk/technology-and-innovation/stps-offer-private-sector-enormous-opportunity/7006369.article">giving private firms “enormous opportunity”.</a></p> <p>So – as I suggested in January – <a href="https://opendemocracy.net/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Labour’s new commitment to halt these pro-market Sustainability and Transformation Partnerships (STPs)</a> was both welcome assurance to party members, and a break with a damaging 30 year cross-party ‘consensus’ on healthcare policy. </p> <p>Yet soon after I wrote this, Shadow Health Secretary Jonathan Ashworth joined key architects of the transnational agenda of the global health industry at a conference organised by the Institute of Public Policy Research (IPPR).</p> <p>The IPPR conference at the end of January was set up to preview a report on the NHS co-produced by the IPPR and the former Labour Health Minister Lord Darzi, who stepped down in 2009 and who in 2015 <a href="http://www.bbc.com/news/uk-politics-31052010">criticised Labour for its tentative moves away from a pro-privatisation agenda</a>.</p> <p>The event saw Ashworth sharing a platform with signatories to the above-mentioned consensus, including the Conservative peer Lord David Prior and Lib Dem MP Norman Lamb, plus economists from the Health Foundation and representatives of the health industry and leading consultancies. On the surface the event was largely about the technological drivers of change in healthcare, and how funding mechanisms can be applied to harness these. A closer look however indicates the real intent was to reinforce particular aims and relationships; ones that it would be inconsistent for Mr Ashworth to seem to endorse. </p> <h2>Ten Year Plans and long-term alliances</h2> <p>As I pointed out in January, Lord Darzi has become a key actor in the corporate agenda for health care, having been, for example, a member of both the Steering Groups on the World Economic Forum’s work on sustainable healthcare systems. </p> <p>It was also pointed out that Tom Kibasi, who was then working for McKinsey and is now chief executive of the IPPR, was the lead author of the reports that informed the WEF’s work, and subsequently presented its findings to the World Bank and OECD. Indeed Darzi’s and Kibasi’s recent collaboration may reasonably be seen as the latest expression of a long-term strategic partnership, with the forthcoming IPPR-Darzi report marking the tenth anniversary of Darzi’s comprehensive report on the NHS for the Brown government, called ‘High Quality Care for All’, for which Kibasi wrote the final draft. </p> <p>In that initial collaboration Kibasi was on secondment from McKinsey, serving as Senior Policy Advisor to the NHS Chief Executive, Sir David Nicholson. He also worked with Darzi on the latter’s 2008 report for London, which was supported by McKinsey’s leading European partners, Penny Dash and Nicolaus Henke, as well as by the chief executive for NHS London, Ruth Carnall. </p> <p>Among the Darzi report’s prescriptions for the capital were the development of a system of ‘polyclinics’, or integrated care centres, with a view to transferring 40% of acute sector activity to these clinics, as well as 70% of the primary care workforce. The BMA resisted, amidst concerns that the <a href="https://opendemocracy.net/ourkingdom/colin-leys/plot-against-nhs">centres would likely be owned and run by private healthcare corporations</a> adopting the NHS Lift – a kind of Private Finance Initiative for primary care – approach. The plans were eventually abandoned, partly due to the recession and change of government. The incoming Health Secretary, Andrew Lansley, also needed to keep GPs on board, given that he was presenting his creation of ‘clinical commissioning groups’ as supposedly ‘putting GPs in charge’. </p> <p>This pause in Darzi’s polyclinic agenda has served its purpose. GPs are now firmly on the back foot, with many willing to trade their premises and practice lists – the new currency within health economies - for a semblance of security as salaried employees of the ‘new care models’ that the ‘consensus’ advocates. </p> <p>Similarly, the government has recently announced that NHS Lift scheme will be rolled out to new areas of the country through Project Phoenix. It appears they are attempting to complete the vision of both government and investors for a privately owned, primary care estate.&nbsp; </p> <h2>New ‘partners’ – and old ones</h2> <p>The McKinsey/Darzi/Department of Health project of 2008 was intended to be a ten-year strategy for transforming the NHS, and while some of the details may have been tweaked in the interim, its fundamentally market-oriented goals remain, and campaigners fear they will reappear in the forthcoming IPPR-Darzi report. Such fears are grounded both in the continuity of the participants involved in helping to produce the report, and also in terms of its associated sponsors and partners. </p> <p>These include the US pharma corporations Baxter and MSD as ‘strategic partners’. The report’s ‘founding partners’ include another US pharma company, Gilead, the European manufacturing giant, Siemens, and Carnall Farrar Associates. The latter is a consultancy firm set up by former McKinsey alumni together with the afore-mentioned Ruth Carnall. </p> <p>Similarly, the IPPR’s recent report on STPs, entitled ‘Sustainability and Transformation Plans: What, Why and Where Next’, included the pharmaceutical giant, GSK, as a sponsor. This report fully endorsed the STP model, concluding that the STPs have “correctly identified the most pressing reform solutions, including reconfiguration of the acute sector, movement of care into the community, and delivery of an upswing in prevention, with reform to commissioning, workforce, estates and local innovation infrastructure, all considered key enablers”. The sole caveats were a lack of both leadership and funding with which to fulfil such aims. </p> <p>Since his participation at the IPPR conference, Ashworth has spoken strongly about Labour’s unwillingness to participate in a cross party consensus on the NHS, arguing instead that what’s needed to rescue the health service is “a government with the political will” to end the punishing funding squeeze; whereas at the Labour Party conference last year he took the IPPR line on STPs, arguing only that they need to be properly funded so they can meet the changing demands on NHS services. It’s to be hoped that the unambiguous rejection of the market-oriented consensus in his recent speeches represents a firm crystallisation of his final policy position.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Taking politics out of the NHS? Or constructing an elitist ‘consensus’?</a> </div> <div class="field-item even"> <a href="/ournhs/tamasin-cave/privatising-cabal-at-heart-of-our-nhs">The privatising cabal at the heart of our NHS</a> </div> <div class="field-item odd"> <a href="/ourkingdom/colin-leys/plot-against-nhs">The Plot Against the NHS</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Stewart Player Wed, 11 Apr 2018 13:26:19 +0000 Stewart Player 117178 at https://www.opendemocracy.net Why NHS staff should #DitchTheDeal & reject the government pay offer https://www.opendemocracy.net/ournhs/mark-boothroyd/why-nhs-staff-should-ditchthedeal-reject-government-pay-offer <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p class="Default">Nurses and other NHS workers need to fight for a better pay deal to protect the NHS, with the same dedication they use to keep the NHS working every day of the week.</p> </div> </div> </div> <p class="Default"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/fair nhs pay now.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/fair nhs pay now.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: <a href="https://www.flickr.com/photos/forayinto35mm/15805828755">Chris Marchant/Flickr</a>.</em></p><p class="Default">The government is offering NHS staff a 6.5% pay rise, after almost a decade of pay freezes and 1% pay rises. With an NHS in almost permanent crisis and near collapse, this appears like a good thing, but when compared with the reality of the present state of the NHS, it’s a poisoned chalice that union members should reject.</p> <h2>Is the pay rise really 6.5%?</h2> <p class="Default">The pay rise is nowhere near as good as the media is making it out to be.&nbsp;</p> <p class="Default">It’s a three year pay deal, with the 6.5% being spread over three years; 3% first year, 1.7% second year and 1.67% the third year. </p> <p class="Default">This is still a below inflation pay rise. The Office for Budget Responsibility <a href="http://obr.uk/forecasts-in-depth/the-economy-forecast/inflation/">projects inflation to be 8.8-9.6%</a> over the next three years. So NHS staff are still receiving a real term pay cut over the period, just slightly less than the previous 8 years.</p> <p class="Default">There is also 1.1% unconsolidated rise in the second year, unconsolidated meaning it is not permanently counted in the pay structure, but just given as a one-off lump sum at the start of that year.</p> <p class="Default">The government has offered a few changes to the pay band structure which will lead to immediate rises for the minority of staff currently at the bottom of their pay band, but no benefit to more experienced NHS workers who are further up the pay bands. The government offer also changes the way staff move up a pay band, meaning progression will be in fits and starts, rather than annual.</p> <p class="Default">And there’s another big catch - in future, advancement will be performance related, based on yearly appraisals. </p> <p class="Default">Performance related pay has been shown to be bad for black and ethnic minority staff, and disabled staff, as it creates another area in which they can suffer discrimination. It could be used to penalise outspoken union activists. It may also trap staff in their jobs as they won’t be able to move post during the 2-5-year gap between pay steps for fear of losing out.</p> <p class="Default">At least the ‘living wage’ is being brought in to the NHS. This is partly out of necessity; NHS pay had been frozen for so long that the yearly increase in the national minimum wage has almost overtaken band 1 and 2 pay bands. To avoid the embarrassment of being forced to raise NHS pay by the legal minimum wage, the government has decided to give their pay a much-needed boost.</p> <h2>What do the government want in return?&nbsp;</h2> <p class="Default">The government clearly feels that – as they are not faced with active strike action to force them into a proper offer – they can demand our workplace benefits and pay in return.&nbsp;</p> <p class="Default">The original pay deal wanted to claw back one day’s annual leave from all staff, according to leaks. The outcry from NHS staff, the public and the Labour Party saw this withdrawn.</p> <p class="Default">However the government are still asking for givebacks in return for our meagre rise.</p> <p class="Default">They want bands 1-3 to progressively give up their unsocial hours rates over the three years of the deal. So lower paid staff will get an initial pay boost, but in the long run they will lose out on reduced unsocial hours payments.&nbsp;</p> <p class="Default">The plans also include changes to sick pay, so anyone earning over £18,160 (in other words, all but the very lowest paid NHS employees) does not receive their usual unsocial hour rate when off sick, only their base rate of pay. </p> <h2>Why a pay rise now?</h2> <p class="Default">It’s important to look at the context in which this pay rise is being offered. NHS staff have endured 8 years of pay freeze or 1% pay rises. We only secured the commitment to a 1% rise after <a href="http://www.bbc.com/news/health-29560083">going on strike in 2014</a>.</p> <p class="Default">This pay freeze has caused a 10-14% loss in the real value of our pay over this period, and combined with increasing pressures due to austerity, has caused a recruitment crisis which is pushing the NHS to the point of collapse.&nbsp;</p> <p class="Default">The health service has over <a href="https://www.independent.co.uk/news/health/nhs-posts-staffing-recruitment-official-figures-healthcare-hospitals-a8221961.html">100,000 vacant posts</a>, of which <a href="https://fullfact.org/health/are-we-short-40000-nurses/">40,000 are nurses</a>, <a href="http://www.bbc.com/news/health-43143325">10,000 are doctors</a> and 10,000 are HCAs. The pay freeze and staffing crisis are driving thousands of nurses to flee the unsafe and unhealthy working conditions in the NHS, with more nurses <a href="https://www.nmc.org.uk/news/news-and-updates/increasing-number-nurses-midwives-leaving-profession-major-challenges/">leaving the NMC register</a> than joining for the last two years. Combined with the fact that <a href="https://www.kcl.ac.uk/nursing/research/nnru/policy/Policy-Plus-Issues-by-Theme/Labourmarketdynamics/PolicyIssue2.pdf">100,000 nurses</a> - almost a third of the NHS nursing workforce - are within 10 years of retirement, and the impact of Brexit and visa restrictions driving nurses away, this creates an existential crisis for nursing and the NHS.</p> <p class="Default">In response to this crisis in nursing, the RCN was pushed by its members to campaign on pay. They launched the “Scrap the Cap” campaign and began to hold protests and marches around the country. The campaign culminated in the RCN’s first ever indicative ballot for strike action in <a href="https://nursingnotes.co.uk/rcn-announces-vote-industrial-action-pay/">April 2017</a>. While turnout was poor, the <a href="https://www.theguardian.com/society/2017/may/14/nurses-vote-support-ballot-for-strike-action-low-pay">vote in favour of action was 78%</a>, clearly demonstrating nurses anger and willingness to fight.</p> <p class="Default">Theresa May responded by <a href="https://www.ft.com/content/c1b7187a-97b4-11e7-a652-cde3f882dd7b">declaring the pay cap over</a> in September 2017. At this point, all the NHS unions decided to bypass the Pay Review Body, and instead use the traditional union method of submitting a pay claim to the government. This unity strengthened their hand and allowed them to set out terms for the pay deal they wanted, rather than relying on the deliberations of the Pay Review Body. All <a href="http://www.unitetheunion.org/news/all-nhs-staff-need-a-pay-rise/">14 unions submitted a joint pay claim</a> for inflation (at the Retail Price Index, RPI) plus £800, which started a series of negotiations over pay, which have now concluded with the deal which is on offer.</p> <h2>Is the deal worth it?</h2> <p class="Default">The deal is meagre compared both to what we have lost. The boosts for the lowest paid and people at the bottom of their bands are welcome, but the pay rise does not address the serious staffing crisis facing the NHS, and particularly nursing.</p> <p class="Default">While the RCN trumpets 29% pay rises for some staff, most NHS staff (52%) are at the top of their pay band. For them, there is only 6.5%. Overwhelmingly these staff are also those who are within 10 years of retirement. This deal offers them little reason to stay in post and help stave off the looming staffing crisis.</p> <p class="Default">The figure of a 29% pay rise for some is misleading as it counts incremental rises in with the pay offer and the boost for those at the bottom of their pay band. Unions have always rejected the argument that increments are a pay rise; they are meant to reflect skills and experience developed through time in service. Yet the union pay calculator is <a href="https://www.huffingtonpost.co.uk/entry/nhs-pay-data-headlines_uk_5ab381d2e4b004fe24699846">deliberately misleading staff</a>, representing incremental rises as part of the pay deal to increase its appeal.</p> <h2>What is the alternative?</h2> <p class="Default">While this deal was presented as the best we can achieve without strike action, all that it took to achieve this deal was one indicative ballot for strike action by the RCN, and a joint pay claim by all the unions. No other union has balloted for action yet. Imagine how much more we could win from the government if we threatened them with joint strike action between all NHS unions.</p> <p class="Default">As a member of Unite’s National Industrial Sector Committee for Health, I was privy to details of the pay deal as it was being negotiated. We were told that the government “red lines” were asking for one or two days of annual leave, and bands 1-3 moving to the unsocial hour rates for bands 4-8, in return for any pay rise. Yet the government backed down from these “red lines”, after little more than a social media outcry.</p> <p class="Default">This is a government without an overall majority, unpopular for their treatment of the NHS, and the damage that eight years of austerity have done to society, and facing quite possible collapse due to the failing Brexit negotiations. </p> <p class="Default">In this precarious position the government cannot afford for an industrial dispute to develop in the NHS. A big fight with NHS staff might even bring them down.</p> <p class="Default">They desperately want to lock us in to a three year pay deal right before Brexit, so when Brexit occurs and causes inflation to skyrocket even further, we will be stuck receiving 1.7% pay rises for two years.</p> <p class="Default">For all these reasons, I urge all union members to reject the deal. We deserve and need more after eight years without a pay rise. The NHS desperately needs well paid and highly motivated staff to rescue it from its current crisis. And we can’t waste this chance to win the pay and funding the NHS and its staff need to survive in to the future.</p> <p class="Default">All the major NHS unions <a href="http://www.gmb.org.uk/newsroom/reject-nhs-pay-deal">except for the GMB</a> are recommending this deal to members. This is the wrong stance to take. All the unions ought to have the best interests of the NHS at heart, yet they are recommending a deal which doesn't meet the needs of staff or the service.</p> <p class="Default">This is much bigger issue than securing a little extra money in our members pockets. It’s about securing a future for the NHS. Agreeing to this deal will not alleviate our struggles to pay our bills, it won’t solve the NHS staffing crisis, and could even accelerate it as overworked, underpaid staff leave rather than stay working for a government and health service which doesn’t value them.</p> <p class="Default">The government is threatening that if we don’t agree, they will take the money for funding the pay rise off the table and force us to accept a 1% deal through the Pay Review Body. This is a disgraceful threat and an attempt to blackmail NHS staff. We should call their bluff and campaign to reject the deal. </p> <p class="Default">We can reject the deal, then push for coordinated strike ballots across all NHS unions. Joint coordinated strike action is the biggest threat to the government. Coordinated ballots would maximise turn out and help all unions get past the 50% minimum turnout required for legal strike action.</p> <p class="Default">Strike action is doable. The <a href="https://www.ft.com/content/7e391688-b4c5-11e7-a398-73d59db9e399">university lecturers union won a ballot for strike action</a> over pensions just a couple of months before, and <a href="https://www.theguardian.com/business/2017/oct/03/royal-mail-workers-vote-for-industrial-action">so did postal workers</a>. We can too, we just need to organise ourselves and fight for it with the same dedication we use to keep the NHS working every day of the week. The first step in this is campaigning to reject the deal.</p> <p class="Default"><em>Follow the “</em><em><a href="https://www.facebook.com/ditchthedeal/">Ditch the Deal</a></em><em>” Facebook page for updates and information on the campaign to reject the deal.</em><em></em></p> <p class="Default"><em>Full technical details of the pay agreement can be </em><em><a href="https://static1.squarespace.com/static/5a857514bff200aa36889e06/t/5ab23db803ce64be4f073046/1521630651875/NHS+Staff+Council+Framework+agreement+21+March+2018.pdf">accessed here</a></em><em>.</em><em></em></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/mark-boothroyd/day-in-life-of-nhs-nurse-why-government-must-act-to-reduce-workloads">A day in the life of an NHS nurse - how our government is failing both patients and nurses</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Mark Boothroyd Wed, 28 Mar 2018 07:52:26 +0000 Mark Boothroyd 116915 at https://www.opendemocracy.net 'We’ve done you proud' — Families speak after NHS Trust fined £2million over patient deaths https://www.opendemocracy.net/shinealight/sara-ryan/connor-sparrowhawk-southern-health-fined-2m <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p> <!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG ></o> </o:OfficeDocumentSettings> </xml><![endif]--> <!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves ></w> <w:TrackFormatting ></w> <w:PunctuationKerning ></w> <w:ValidateAgainstSchemas ></w> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> 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</w:LatentStyles> </xml><![endif]--> <!--[if gte mso 10]> <mce:style><! /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-ansi-language:EN-US;} --> <!--[endif] --> <!--StartFragment--> <!--EndFragment--></p><p class="MsoNormal"><span style="font-size: 10.0pt; font-family: Helvetica; mso-fareast-font-family: &amp;amp;amp; mso-bidi-font-family: &amp;amp;amp; color: #333333; background: white; mso-ansi-language: EN-GB;">Today Southern Health was fined £2m over the “entirely preventable” deaths of 18-year-old Connor Sparrowhawk and Teresa Colvin, aged&nbsp;</span><span style="font-family: Helvetica; font-size: 13.333333015441895px;">45</span><span style="font-family: Helvetica; font-size: 10pt;">.</span></p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/SARA_RYAN_26MARCH2.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/SARA_RYAN_26MARCH2.jpg" alt="" title="" width="460" height="299" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Sara Ryan speaking in Oxford on 26 March 2018, after Southern Health was fined £2million (image #JusticeforLB)</span></span></span></p> <h2><strong>Clare Sambrook writes:</strong> </h2><p>Today at Oxford Crown Court, Southern Health NHS Foundation Trust was fined £2m for allowing the “entirely preventable” deaths of 18-year-old Connor Sparrowhawk and Teresa Colvin, who was 45.&nbsp;<span>Passing sentence,&nbsp;</span><a href="https://www.judiciary.gov.uk/wp-content/uploads/2018/03/r-v-southern-nhs-sentencing.pdf">Mr Justice Stuart-Smith </a>spoke of their families’&nbsp;“<span>deep, catastrophic and unspeakable pain, sadness and loss</span><span>”.&nbsp;</span></p> <p>Teresa Colvin’s husband Roger,&nbsp;<a href="http://www.bbc.co.uk/news/uk-england-43542284">speaking outside court today</a>,&nbsp;said Teresa, who was affectionately known as TJ, had been “a vivacious, beautiful, and loving woman” who was dearly loved. In a statement he read to the court Roger Colvin spoke of life’s “what-ifs” and how every day something would trigger a memory, accentuating his terrible loss.&nbsp;TJ’s sister Wendy Andrade spoke of anger and hurt that was still very raw for the family and the massive void that&nbsp;TJ’s&nbsp;death had&nbsp;left.&nbsp;</p> <p>Teresa Colvin was found hanged by a phone cord at Woodhaven Adult Mental Health Hospital, Southampton on 22 April 2012.&nbsp;She died four days later.</p> <p>The court heard that Southern Health had failed to act upon warnings about ligature risks from health and safety expert Mike Holder. He&nbsp;<a href="http://www.dailymail.co.uk/news/article-3783528/Shamed-NHS-boss-Health-chief-told-FIVE-YEARS-ago-patients-risk-failed-follow-advice-240k-job.html">resigned in protest at the Trust’s inaction</a> eight weeks before Teresa Colvin’s death.</p> <p>Between 2007 and 2011 more than 1,700 “ligature incidents” had occurred across the Trust. The very phone cord that TJ would later use had been identified as a risk to patients. The cost of eliminating the risk would have been £53. Nothing was done about it.</p><p>&nbsp;</p> <p>Connor Sparrowhawk,&nbsp;<span>a funny, quirky and beloved young man,</span><span>&nbsp;was just 18 when he died on 4 July 2013 whilst a patient at Slade House, a Short Term Treatment and Assessment Centre at Headington in Oxford.</span></p><p><span>Connor had autism, learning difficulties and epilepsy, but it was the Trust’s neglect that caused his death.</span></p> <p>His mother, Sara Ryan, had warned staff —&nbsp;in writing — that Connor had an injury to his tongue that suggested a recent seizure. Yet he was allowed to bathe unsupervised and behind a locked door, and he drowned in the bath.</p><p>&nbsp;</p> <p><a href="https://www.judiciary.gov.uk/wp-content/uploads/2018/03/r-v-southern-nhs-sentencing.pdf">Mr Justice Stuart-Smith said</a>&nbsp;each death was an “unnecessary human tragedy”, and it was a “regrettable fact” that Sara Ryan and Roger Colvin had had to campaign for justice.&nbsp;</p><p>Connor’s family and friends campaigned under the banner #JusticeforLB — his nickname was Laughing Boy because he laughed so much. Their work provoked the exposure of the Trust’s failure to investigate hundreds of unexpected deaths.&nbsp;</p><p> <span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/DZNZPVJX4AAVflC.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Connor Sparrowhawk (#JusticeforLB)"><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/DZNZPVJX4AAVflC.jpg" alt="" title="Connor Sparrowhawk (#JusticeforLB)" width="240" height="353" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style="" /></a> <span class='image_meta'><span class='image_title'>Connor Sparrowhawk (#JusticeforLB)</span></span></span></p><p><span>While failing to watch over Connor,&nbsp;Southern Health had spent months monitoring his mother’s blog. The morning after his death executives <a href="https://opendemocracy.net/shinealight/clare-sambrook/on-connor-sparrowhawk-s-avoidable-death">turned their attention to reputation management</a>. Through years of lies and obfuscation Southern Health attacked bereaved families and&nbsp;</span><a href="https://mydaftlife.com/2015/04/02/farcical-inaccuracies-2/">persistently tried to shift blame</a><span>&nbsp;for Connor’s death from itself to Sara Ryan. One Trust employee left a message on her voicemail calling her “a vindictive cow”.&nbsp;</span></p> <p>The judge&nbsp;paid tribute to Sara Ryan today: “It is clear on the evidence that Dr Ryan in particular faced not merely resistance but entirely unjustified criticism as she pursued her Justice for LB campaign.”</p> <p>He noted Southern Health’s admission:&nbsp;</p> <p>“The Trust fully acknowledges that Dr Sara Ryan has conducted herself and the Justice for LB campaign in a dignified, fair and reasonable way. To the extent that there have been comments to the contrary by Trust staff and family members of staff, these do not represent the view of the Trust and are expressly disavowed.”</p><p>The judge said that victim impact statements from Sara Ryan and from Connor’s step-father Richard Huggins “make for almost unbearable reading”. </p><p>He said: “Dr Ryan describes how the light went out of her life on 4 July 2013. And in dignified and restrained terms she lays bare how the assertion by the Trust in the early days that Connor had died of natural causes compounded her grief. As did Mr Colvin when referring to the loss of TJ, Dr Huggins refers to their grief being raw. Their lives have become dominated by a deep, catastrophic and unspeakable pain, sadness and loss.”</p><p>&nbsp;</p> <p>Over years we have published&nbsp;<a href="https://opendemocracy.net/shinealight/sara-ryan/ministry-of-justice-says-you-don-t-need-lawyer-at-inquest-trust-state">work by Sara Ryan</a>, by&nbsp;<a href="https://opendemocracy.net/shinealight/tom-ryan/since-my-brother-s-preventable-death">Connor’s brother Tom</a>, and&nbsp;<a href="https://opendemocracy.net/shinealight/clare-sambrook/on-connor-sparrowhawk-s-avoidable-death">disclosure stories</a>&nbsp;about Southern Health’s failure to take action to remedy known problems.</p> <p>Today we pay tribute to bereaved families who fight for truth and accountability, who work to make public services safer for everyone. We thank&nbsp;<a href="https://opendemocracy.net/@GeorgeJulian">George Julian</a>, whose reporting of inquests and tribunals through live-tweeting has shone a light on Connor’s and&nbsp;<a href="http://www.georgejulian.co.uk/2018/03/24/live-tweeting-inquests-and-tribunals-10-top-tips-of-learning-so-far-justiceforlb/">other state-related deaths</a>. </p><p>Mr Justice Stuart-Smith<span>’</span>s judgement can be found <a href="https://www.judiciary.gov.uk/wp-content/uploads/2018/03/r-v-southern-nhs-sentencing.pdf">here</a>. Connor’s family’s statement in response to today’s sentencing follows below.</p><p>&nbsp;</p><p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/buses_line_2bigger5_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/buses_line_2bigger5_0.jpg" alt="" title="" width="460" height="65" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><h2>Family statement on the Health &amp; Safety Executive (HSE) prosecution of Southern Health #JusticeforLB</h2><h2>Sara Ryan writes:</h2><p>Five years ago this month we took our beautiful boy to what we thought was a specialist NHS unit. He drowned in the bath 107 days later.</p><p>No one should die a preventable death in the care of the state. Learning disabled people should not die on average twenty years before their non-disabled peers. Families should not have to fight for answers and accountability. They should not have to raise funds for legal representation at a time of unspeakable grief and pain.</p><p>Southern Health dug deep into publicly funded pockets and armed itself with a range of legal weaponry and dirty tricks.</p><p>The #JusticeforLB campaign has shone a light on systemic failings in the care of learning disabled people. We have collectively and effectively revealed weaknesses in regulatory practices, a disregard for the lives and deaths of certain people and the limitations of work by large established charities in this area.</p><p>We appreciate Dr Nick Broughton’s recognition and acknowledgement of the failings that spread across five years under Katrina Percy’s leadership, and his heartfelt apology for these. [Broughton has been Southern Health chief executive since November 2017].</p><p>We thank the HSE for their meticulous and sensitive investigation and everyone who has stood alongside us fighting for what is right and just.</p><p>I’m left thinking if Connor was here now, in the shadow of Oxford Crown Court and the St Aldates police station, he would repeatedly ask ‘<em>why mum?</em>‘</p><p>I’d reply ‘<em>I don’t know matey but we’ve done you proud</em>’.</p><p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/connor_bus2_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Bus, by Connor Sparrowhawk"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/connor_bus2_0.jpg" alt="" title="Bus, by Connor Sparrowhawk" width="460" height="316" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Bus, by Connor Sparrowhawk (#JusticeforLB)</span></span></span></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/shinealight/shinealight/sara-ryan-clare-sambrook/connor-sparrowhawk-justiceforLB">Connor Sparrowhawk: How one boy’s death in NHS care inspired a movement for justice</a> </div> <div class="field-item even"> <a href="/shinealight/tom-ryan/since-my-brother-s-preventable-death">Since my brother’s preventable death . . .</a> </div> <div class="field-item odd"> <a href="/shinealight/clare-sambrook/190k-payoff-for-ex-chief-of-nhs-trust-that-failed-to-investig">£190K payoff for ex-chief of NHS Trust that failed to investigate hundreds of unexpected deaths</a> </div> <div class="field-item even"> <a href="/shinealight/imogen-tyler/connor-sparrowhawk-erosion-of-accountability-in-nhs">Connor Sparrowhawk: the erosion of accountability in the NHS</a> </div> <div class="field-item odd"> <a href="/shinealight/clare-sambrook/on-connor-sparrowhawk-s-avoidable-death">On Connor Sparrowhawk’s avoidable death</a> </div> <div class="field-item even"> <a href="/shinealight/sara-ryan/ministry-of-justice-says-you-don-t-need-lawyer-at-inquest-trust-state">Ministry of Justice says you don’t need a lawyer at an Inquest. Trust the State</a> </div> <div class="field-item odd"> <a href="/shinealight/ally-rogers/we-apologise-to-anybody-who-feels-let-down">‘We apologise to anybody who feels let down’</a> </div> <div class="field-item even"> <a href="/shinealight/frances-webber/uk-government-s-inversion-of-accountability">The UK government’s inversion of accountability</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> Shinealight ShineALight ourNHS Access to justice Clare Sambrook Sara Ryan Mon, 26 Mar 2018 16:30:34 +0000 Sara Ryan and Clare Sambrook 116882 at https://www.opendemocracy.net Time to halt the NHS gravy train for management consultants https://www.opendemocracy.net/ournhs/jonathan-allsop/time-to-halt-nhs-gravy-train-for-management-consultants <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>New evidence has emerged that management consultants make NHS hospitals <em>less</em>, not more, efficient. Which will be little surprise to the NHS staff who have to deal with them.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/big_4.jpeg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/big_4.jpeg" alt="" title="" width="450" height="299" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>The recent collapse of Carillion not only threw a long overdue spotlight on the billions leached from the NHS and other public services by the Private Finance Initiative but also severely dented the notion that “private knows best” when it comes to running public services. The public sector’s use of management consultants has grown exponentially since the early 1990s to the extent that the use of consultants by the public sector now accounts for over a fifth of the total turnover of management consultancy firms. For as long as I’ve worked in the NHS (I joined as a trainee accountant in 1990) a view has persisted that, whether we’re caring for patients or supporting those who do, no matter how hard we work or how good at our jobs we are we’ll never quite be as efficient as our private sector counterparts; forever the lower league journeymen to their Premier League superstars.</p> <p>I’ve lost count, down the years, of how many times I’ve seen management consultants (more often than not from one of the Big Four accountancy firms) brought in, at considerable expense, to do jobs that people in the NHS with vastly more experience in the relevant area could have done much better for a fraction of the cost. The sums involved, when viewed in isolation, often aren’t headline grabbing but collectively they add up to a substantial flow of money out of the health service and into the coffers of huge multinational corporations. How much exactly? Well, precise figures on how much the NHS as a whole spends on management consultants are difficult to come by but <a href="https://www.theguardian.com/society/2014/dec/09/nhs-management-consultants-bill-doubles-640m">in December 2014 the British Medical Journal reported that NHS spending on management consultants had risen to £640 million per year</a> (compared to £313 million in 2010) as they cashed in on the chaos created by the implementation of the Health and Social Care Act with some consultants charging a whopping £4,000 per day for their services.</p> <p>To illustrate the impact of the health service’s often unnecessary use of management consultants here’s a recent example from my own experience working in an NHS finance department. It comes nowhere close to the scandal of PFI but it’s typical nonetheless of how the NHS has become reliant on the private sector to do work that could quite easily be done in-house. I’ve chosen this particular example as it’s the most recent but, to be honest, there are dozens of others that I could have drawn from - ranging from project managers on eye watering sums per day brought in to lead the implementation of new systems or inject commercial rigour into dull old NHS accounting practices, to poacher-turned-gamekeeper consultants drafted in to advise on the impact of government policy that they’ve already had a hand in writing. (The current work on <a href="https://opendemocracy.net/ournhs/sarah-carpenter/management-consultants-scoop-up-on-secretive-shake-up-of-health-service-in-en">Sustainability and Transformation Plans</a> (STPs) is the latest in a long list of examples of the latter).</p> <p>NHS Improvement, the body responsible for overseeing the financial performance of NHS trusts, is currently driving a move towards trusts identifying the costs of individual patients, rather than averages, under its ‘costing transformation programme’ which is a major focus for me in my role as the costing lead at a mental health trust.&nbsp;One strand of this programme involves independently assessing the accuracy of the costing information that trusts produce. In 2016 <a href="https://improvement.nhs.uk/resources/costing-assurance-programme/">NHS Improvement awarded a three-year contract to perform this work to EY</a> (in previous years the work had been undertaken by PwC and Capita). You might know EY better as Ernst and Young, one of the Big Four multinational accountancy firms who were rebranded in 2013 and are headquartered in smart offices close to Tower Bridge in London. In October of last year <a href="https://www.ft.com/content/540bdc0e-b238-11e7-a398-73d59db9e399">EY were fined £1.8 million</a> by the UK’s financial watchdog the Financial Reporting Council, for “failures to obtain reasonable assurance” about whether the financial statements of global technology company Tech Data “were free from material misstatement”. Not particularly reassuring for the NHS but, hey, away from the beady eyes of the FRC a handy NHS contract like this is money for old rope for the likes of EY. Firms can typically walk away from NHS contracts such as this without any repercussions no matter how shoddy the work.</p> <p>The contract involves auditing the costing information produced by around one-third of NHS trusts each year over the three-year period. In December 2015 NHS Improvement invited tenders to undertake this work and stipulated a maximum price of £3.9 million, but details are sketchy on the actual price agreed with EY. NHS Improvement’s board papers from around the time are rather coy, indicating only that six companies were invited to tender and that EY had won the contract. Later on the&nbsp;<a href="https://improvement.nhs.uk/events/nhs-improvement-board-meeting-28july/"><strong>board papers from its meeting in July 2016</strong></a>&nbsp;referred to a saving of 36% on the contract value after the initial costs and activities within the scope of the audit were challenged. Which represents quite a saving - looking back at footage of the meeting (the public part of NHS Improvement’s board meetings is filmed and available to view on their website) there is more than a little surprise amongst board members as this substantial saving is noted.</p> <p>Such cost cutting is often a false economy though. It usually means cheaper, less experienced members of staff being employed on the contract and this was evidently the case when EY visited our trust in February last year. Very early on in the audit it became apparent that, beyond the basics, the auditor’s knowledge of NHS costing processes and mental health services was scant. In the end, the auditor spent a mere two and a half days on site and this was followed up with a handful of telephone conversations and email queries which barely skimmed the surface of the figures being audited.</p> <p>A first draft of the audit report, when it eventually turned up, after much chasing, over four months later was strewn with errors including reference to “urology IAPT services” which given that IAPT refers to improving access to psychological therapies makes the mind boggle. The errors were eventually corrected, and a second draft was sent out a month later, in the middle of July, requesting our formal management responses to each of their audit recommendations within two working days. That this tends to be the busiest time of the year for anyone involved in NHS costing (the deadline for submitting the annual reference costs return is usually towards the end of July) was seemingly completely lost on EY. The report itself, once published, was lacking in any real insight, full of half-baked recommendations and with the overall feel of a piece of work that had failed to get to grips with the topic that it was meant to be reporting on.</p> <p>It’s staggering that at a time when the health service is enduring the longest squeeze on its finances in its seventy-year history that it can afford to spend a few million pounds on poorly executed work such as this.&nbsp;In the absence of knowing the actual cost of the contract let’s assume, not unreasonably, that EY’s original tender value was close to the maximum price of £3.9 million. In that case a 36% saving would suggest a contract value of around £2.4 million. Now, in the context of an overall budget for the NHS of more than £120 billion that may sound like small beer and indeed when you spread it, rather crudely, across all the trusts that will be audited during the contract period the cost works out at around £10,000 per organisation. Not too bad, you might think, but it’s a frankly ridiculous sum for barely a week’s work and a report that told us nothing about our costing process that we didn’t already know.</p> <p>We have been told repeatedly down the years that the expense of management consultancy is more than off-set by the beneficial effects it has on the efficiency of public sector organisations. However a recent study by a group of academics at Bristol, Seville and Warwick universities on the&nbsp;impact of the use of management consultants on public sector efficiency, perhaps the first of its kind to measure the quantitative impact of using consultants, <a href="http://www.bmj.com/content/360/bmj.k893">concluded that far from boosting efficiency the use of management consultancy actually decreases it</a>. And this didn’t even take account of the, often ignored, demoralising impact on NHS staff of continually seeing management consultants brought in to perform tasks that they could and already are paid to do. One of the authors of the report, Ian Kirkpatrick from Warwick Business School felt that in the current financial climate the NHS must consider “whether it is appropriate to continue using external consulting advice at the current level”.</p> <p>It’s disheartening to say the least to see others brought in, time after time, to work on “exciting” projects and produce work of questionable benefit whilst we get on with our day jobs and are invariably left to pick up the pieces when external consultants depart. Much of this work could be brought in-house and would offer talented, experienced and dedicated NHS staff the chance to look beyond their day jobs to improve the quality of care that patients receive at a fraction of the cost of using the private sector. We might not be as good at spouting the fancy management-speak and preparing the snazzy PowerPoint slides but at least give us a chance. EY’s work on the costing assurance programme could, and should, have been performed by costing leads at other trusts – a form of peer review that would subject the costing processes of each trust to proper scrutiny and offer valuable insights into how those processes might be improved. All this for a mere fraction of the cost of involving the private sector.</p> <p>So it’s refreshing to read the Shadow Chancellor John McDonnell refer to Carillion as a “watershed moment” and promise that a future Labour government would end the “private knows best” rip-off. For too long huge multinational corporations like EY, McKinsey, PwC, KPMG and Capita have been riding this NHS gravy train. Only last week it emerged that&nbsp;<a href="http://www.independent.co.uk/news/health/nhs-spending-kpmg-watchdog-management-consultants-mckinsey-a8253766.html"><strong>NHS Improvement has awarded a £500k contract to McKinsey</strong></a>&nbsp;to apparently help it define its “purpose”. This comes less than two years after a similar deal, worth £1 million, was struck with yet another management consultancy firm KPMG on defining NHS Improvement’s role. Enough is enough, it’s time to bring this nonsense to a halt and&nbsp;let NHS employees get on with what we are paid to do.</p><p><em>This piece is cross-posted from <a href="https://nowtmuchtosay.wordpress.com/2018/03/18/ey-oh-why-oh-why/">Nowt Much to Say</a>&nbsp;with kind permission.</em></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/sarah-carpenter/management-consultants-scoop-up-on-secretive-shake-up-of-health-service-in-en">Management consultants scoop up on the secretive shake-up of the health service in England</a> </div> <div class="field-item even"> <a href="/can-europe-make-it/sol-trumbo-vila/bail-out-industry-finds-its-new-crisis-opportunity-brexit">The bail out industry finds its new crisis opportunity: Brexit</a> </div> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/peterborough-hospital-nhs-and-britains-privatisation-racket">Peterborough Hospital, the NHS and Britain&#039;s privatisation racket</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Jonathan Allsopp Tue, 20 Mar 2018 14:16:42 +0000 Jonathan Allsopp 116771 at https://www.opendemocracy.net Are cash-strapped hospitals walking into a trap that could cost the NHS its family silver? https://www.opendemocracy.net/ournhs/caroline-molloy/are-cash-strapped-hospitals-walking-into-trap-that-could-cost-nhs-its-family- <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Hospitals from Yorkshire to Yeovil are rushing to set up secretive private companies in which to transfer NHS staff and assets. OurNHS looks in depth at the possible impacts – and whether it’s likely to go horribly wrong.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/PA-30392062.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/PA-30392062.jpg" alt="lead " title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: NHS demonstration. PA Images/Victoria Jones.</em></p><p>Dozens of NHS hospital trusts across England are looking at (or already have) set up private companies in which to transfer swathes of vital NHS staff and assets. The moves are, according to Trusts, an attempt to save money through a supposed VAT loophole designed to promote outsourcing, as well as savings on staff pay, terms and conditions. They are also – an aspect overlooked in the <a href="https://amp.theguardian.com/society/2018/feb/14/nhs-trusts-transferring-staff-into-subsidiary-companies-to-cut-vat?__twitter_impression=true">coverage to date</a> – supposed to promote a greater focus on “commercialising” hospital assets. More of that in a bit…</p> <h2>“By the time people realise it’s been a catastrophe, it will be too late to undo”</h2> <p>Unions and staff are up in arms about the damaging impact of these subsidiary companies in creating a <a href="https://southwest.unison.org.uk/campaigns/one-team-one-nhs-subsidiary-companies/">two tier, demoralised workforce</a> whose goodwill and co-operation our doctors and nurses rely on every day to keep hospitals clean, safe, and well-equipped. In Wigan, Harrogate, Bradford, and Calderdale, Unison members are already close to strike action after union ballots overwhelmingly rejected the plans. Gloucestershire – where around 700 staff are affected – is also about to run an indicative ballot, Unison announced at an NHS activists conference in the county on Saturday.</p> <p>Some hospital governors are deeply unhappy too – one in Gloucestershire told OurNHS, “by the time people realise it’s been a catastrophe, it will be too late to undo.”</p> <p>There’s been no public consultation about any of the plans to create private NHS subsidiary companies (known as SubCo’s), it seems. In Gloucestershire, Hospital Chief Executive Deborah Lee told Stroud Labour MP David Drew that “this is not a matter for public consultation as agreed with the Gloucestershire Health Care Overview &amp; Scrutiny Committee (HCOSC)”. However Stroud Council leader Doina Cornell, who sits on the county’s Scrutiny Committee, told OurNHS, “We’ve not been consulted. There’s been a lack of input into it from any councillors.” OurNHS asked Gloucestershire Hospitals about this apparent discrepancy – and about a number of other points in this article. They have so far declined to comment.</p> <p>Cornell adds “Surely this is not the sort of thing we should be doing…. this is a high-risk project.”</p> <h2>“…<strong>a gambit, a pretence, an illusion and make believe…</strong>”</h2> <p>Indeed it is high risk. Whilst staff understandably worry about pay, pensions and conditions cuts – and unions argue that any guarantees from employers are worth little given weak employment law and the various hospital trusts' stated intent to take on new starters on lower conditions – for the <em>public</em>, it gets more worrying still.</p> <p>Many experts suspect the plans could collapse altogether, with the corporates waiting in the wings of course. Respected health commentator Roy Lilley has called the SubCo plans “<strong>a gambit, a pretence, an illusion and make believe</strong>” and on the same subject comments, “<a href="http://campaign.r20.constantcontact.com/render?m=1102665899193&amp;ca=0082c0d7-b2c5-4001-87b1-c74b77a3a566">an astonishing number of Trusts are heading down Carillion Street</a>”. &nbsp;</p> <p>Certainly, it’s worrying that many of the SubCo plans seem to emphasise this VAT “gambit”. Gloucestershire, for example, told staff it would save £35m over 10 years through this ruse, whilst the staff savings were merely “unquantifiable”. But the biggest similar scheme to date, UnitingCare in Cambridgeshire, collapsed spectacularly – and one of the major reasons (according to both <a href="https://www.england.nhs.uk/mids-east/wp-content/uploads/sites/7/2016/04/uniting-care-mar16.pdf">NHS England</a> and the <a href="https://www.nao.org.uk/report/investigation-into-the-collapse-of-the-unitingcare-partnership-contract-in-cambridgeshire-and-peterborough/">National Audit Office report</a>s) was because the NHS signed the contract on the basis of incorrect advice about their VAT position, meaning an unexpected £5m a year was added to the costs and the arrangement collapsed.</p> <h2>Selling off the hospital buildings?</h2> <p>And – perhaps most worryingly of all – now OurNHS openDemocracy has uncovered considerable grounds for concern about what is happening to hospital buildings around the country as part of these plans. We’ve also uncovered a little noted aspect of the Health and Social Care Act 2012 that might partly explain the sudden rush to "commercialise" hospital estates under these new schemes.</p> <p>In existing SubCo’s, tens of millions of pounds of assets appear to have transferred out of the NHS. In Northumberland, Tyne and Wear for example, one of the few SubCo’s where the business case is publicly available, the plan states <a href="https://www.ntw.nhs.uk/content/uploads/2017/04/Agenda-Item-10ii-a-NTW-Solutions-Business-Case.pdf">that £33.5m of land and buildings will be transferred</a> from the NHS to the SubCo. But in most of the plans about to be signed off in the coming weeks and months staff appear to have been given little more than <em>hints</em> of asset transfer (often highly self-contradictory, see for example <a href="https://opendemocracy.net/files/SubCo-QA-A3-D3.pdf">Gloucestershire’s leaked staff Q&amp;A</a>,<strong> </strong>and Airedale’s (which they’ve mostly taken down in the last few days, but you can read the cached link here [editors note - the cached link has <em>also </em>disappeared since this article was published yesterday, <a href="https://opendemocracy.net/files/NHS Airedale Foundation Trust.doc">but here's the page as we downloaded it last week</a>]). </p> <p>Neither staff or public appear to be being told anything about what hospital buildings are involved, and what this means for the future. Whether or not asset transfers are key to the supposed VAT savings in Gloucestershire and elsewhere is one of the unanswered questions put to the Trust. Some of the other SubCo’s appear to anticipate <em>no</em> VAT savings, according to the Health Services Journal (<a href="https://www.hsj.co.uk/finance-and-efficiency/in-full-trusts-with-staff-transfer-plans/7021681.article">paywall</a>). Meanwhile, other established SubCo’s – notably South Warwickshire and East Kent – have been set up to provide clinics and wards for private patients, OurNHS has uncovered. What <em>is</em> going on?</p> <p>The concerns about hospital buildings come in the light of huge pressure on Trusts to sell off or commercialise parts of their estate, under both the Carter Review and <a href="https://www.mirror.co.uk/news/politics/tories-backed-report-recommending-huge-11941502">the Naylor report that Theresa May endorsed last year</a>. Those hawking schemes to encourage sell offs are impatient with the NHS holding on to their assets “<a href="https://www.birminghampost.co.uk/special-features/how-unlock-potential-midlands-nhs-13926365">like the family silver</a>” and preventing housing developers or rival private health companies getting their hands on these ‘strategic locations’. And all the plans – as elsewhere – are clear on one thing – that there will be “new people” with “commercial expertise” running the SubCo’s - perhaps with a different attitude to the family silver?<strong></strong></p> <p>Tax expert Richard Murphy echoes campaigners’ suspicions. Reviewing the <a href="https://www.ntw.nhs.uk/content/uploads/2017/04/Agenda-Item-10ii-a-NTW-Solutions-Business-Case.pdf">Northumberland, Tyne and Wear</a> SubCo business case, he told OurNHS, “Reading between the lines as to the true motive of this&nbsp;arrangement, it looks like a precursor to the sale to commercial third parties of the underlying buildings and the service contracts associated with them". Whether this is the intention – or an unintended consequence, particularly if the financial models don’t otherwise stack up - remains to be seen.</p> <h2>Sneaky legal changes post-2016?</h2> <p>OurNHS has also uncovered that a little spotted legal change seems to be driving the rush to the SubCo model of estates management. In an article written in May 2017 by SubCo advisors DAC Beachcroft (who are advising Gloucestershire amongst others), the solicitors firm describes how “the foundation trust sets up a wholly-owned subsidiary company. The estates workforce works for the company” but they go on to explain that “<a href="https://www.dacbeachcroft.com/en/gb/articles/2017/may/will-this-new-nhs-estates-management-model-improve-trust-efficiency/">the outsourcing involves transferring the estate across into a wholly-owned subsidiary company</a>.” And intriguingly, they add “These are only now possible because of recent changes in legislation that have enabled NHS foundation trusts to transfer their legal rights in operational property”.<strong></strong></p> <p>What “recent changes in legislation” are these? OurNHS has spoken to top NHS campaigning solicitors who are unsure but have suggested it may refer to a change that follows on from the controversial Health and Social Care Act 2012. One little noted aspect of the Act made it easier for the NHS Foundation Trusts to sell off or otherwise dispose of assets, even where those were previously protected because they were used to provide essential healthcare services (known as “Commissioner Requested Services”). There were some transitional arrangements to protect these services and the buildings used to provide them, following the 2012 Act – <a href="http://www.bmj.com/content/349/bmj.g5603">but these arrangements ran out in April 2016</a>.<strong></strong></p> <p>And certainly, the government’s attitude to these SubCo wheezes seems a little slippery. On the one hand, the government’s “NHS Providers Finance Director” Chris Young wrote an apparently strongly worded letter to Trusts last September (and seen by OurNHS), which stated that “HMRC are actively investigating the health sector in relation to tax avoidance schemes” - though perhaps with a chink of a get out clause about such schemes being “acceptable” if there are also “genuine commercial reasons” for pursuing them. Meanwhile numerous parliamentary questions about the SubCo’s have been met with bland indifference from ministers. Whilst some – like Labour’s health spokesman in the Lords, Phil Hunt – have suggested ministers’ relaxed demeanour means any tax savings are likely to be clawed back from the overall NHS budget, NHS insiders have also told OurNHS that their strong impression is the main NHS regulator (NHS Improvement) is quietly promoting these schemes. </p> <h2>So what can campaigners do?</h2> <p>In Gloucestershire, experienced NHS campaigners – who 6 years ago took NHS Gloucestershire to Judicial Review and reversed the planned transfer of nine local hospitals and 4000 staff to a so-called “social enterprise” company - have written today <strong>(<a href="https://opendemocracy.net/files/glos subco letter to board to publish.doc">letter here</a>)</strong> to the local Hospital Trust's Board of Directors. The hospital's directors are due to agree the project on Wednesday (28 February), but campaigners have raised detailed questions regarding all the above issues. The campaigners warn the Directors that the Trust risks being "negligent" with public money and assets if they rubber stamp the plan before they have clear answers to all these questions – which, campaigners point out, should be shared with the public.</p> <h2>So what can Trusts do?</h2> <p>It’s not good enough for Trusts to rely on expensive, unpublished, "commercially confidential" advice from the likes of DAC Beachcroft and KPMG. Gloucestershire for example has set aside £200,000 for this advice, OurNHS has learned. And let’s not forget KPMG’s role in Carillion – a role which prompted Peter Kyle MP to tell them last week in a parliamentary Carillion investigation, <a href="http://www.independent.co.uk/news/business/news/carillion-collapse-kpmg-deloitte-mps-worthless-accounts-business-committee-rachel-reeves-a8223626.html">“I wouldn’t trust you to do an audit of the contents of my fridge”</a>.</p> <p>Nor does it seem wise for the twenty or so Trusts who are relying on advice from QE Facilities Ltd, a SubCo created by Queen Elizabeth Gateshead NHS Foundation Trust. As Unison’s Michael Sweetman drily told OurNHS, “they are selling this deal on the basis that they’ve found it very lucrative – for them – but it’s lucrative for them partly because they’re going around selling their consultancy on how to do it, back to other parts of the NHS.” (Did anyone say “pyramid scheme”?).</p> <p>Of course Trusts are in impossible financial positions, with soaring waiting lists, problems compounded by heavy fines levied if they miss targets, and – as exposed by last week’s BBC File on Four - an <a href="http://www.bbc.co.uk/programmes/b09ry6k8">absurd government fixation on capital controls as hospitals crumble</a>. <a href="https://www.gloucestershirelive.co.uk/news/gloucester-news/how-gloucestershires-hospitals-managed-rack-215076">Gloucestershire is in the same financial black hole as most Trusts – and also in special measures following a recent huge accounting cock-up</a>. </p> <p>Trust Chief Executives have even taken to Twitter to defend their adoption of SubCo’s models, for example Sarah Jane Marsh, CEO of the Birmingham Women and Children’s Hospital Foundation Trust, who also have a SubCo due to go live next month. Marsh&nbsp;<a href="https://twitter.com/BWCHBoss/status/963781922378969088">commented earlier this month</a>, “It’s a real head/heart issue - but the reality is if we don't, we will have to reduce further posts as our CIP [Cost Improvement Plan, ie further 'efficiencies' or cuts needed] for 18/19 is £17 million.” </p> <p>But it’s not good enough for Trusts developing these plans to attempt highly risky ways to wriggle out of government-imposed constraints, remaining tight-lipped about what the plans could really mean. It’s not good enough for Trusts to hope that no-one’s going to weep for the procurement teams, estates managers, cleaners, safety staff and the other workers who keep the NHS show on the road – nor to ignore vital questions about the hospital buildings and financial models, the quality of the advice they’re getting, and the loss of accountability and control these plans entail. Given the secrecy around these SubCo's, it’s particularly unhelpful when Trust Chief Executives <a href="https://www.nhsglos.com/involve/feb2018/">then blame “irresponsible” unions for causing staff anxiety with “political” opposition to the plans, as Gloucestershire’s Chief Executive Deborah Lee was spotted on camera doing last week.</a> </p> <p>Instead, all Trust CEOs should be being as outspoken about the government’s failure to fund the NHS as a few brave ones <em>have</em> been – and as honest about the obscure tricks the government is using to push ever more outsourcing, even as the failures of Carillion, Grenfell and PFI come home to roost. </p> <p>OurNHS openDemocracy will keep investigating. Whatever the intent of Trust directors, the reality is they tend to move on to pastures new within a few years – only one of Gloucestershire’s current directors has been there for any length of time, for example. </p> <p>Meanwhile local people, currently frozen out of decision making, may be left in a few years wondering how our precious hospitals were sold from out under our feet.</p><div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Caroline Molloy Mon, 26 Feb 2018 21:58:53 +0000 Caroline Molloy 116352 at https://www.opendemocracy.net Exposed - the shocking extent of fire risk in our hospitals and mental health trusts https://www.opendemocracy.net/ournhs/minh-alexander/exposed-shocking-extent-of-fire-risk-in-our-hospitals-and-mental-health-trusts <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Even after Grenfell, hospitals are failing to put in place recommended fire safety measures. The UK government passes the buck. Meanwhile, patients have died.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/chase farm hospital.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/chase farm hospital.jpg" alt="" title="" width="460" height="325" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Fire at Chase Farm mental hospital in 2008. Steps have been taken across the NHS since - but are they enough?</em></p><p>Coroners have criticised two recent patient fire deaths at mental health providers <a href="http://www.bbc.co.uk/news/uk-england-cambridgeshire-41916473">Cambridgeshire and Peterborough NHS Foundation Trust</a> and at <a href="http://www.bbc.co.uk/news/uk-england-berkshire-42185454">Berkshire Healthcare NHS Foundation Trust</a>.</p> <p>Fire safety is a concern across the NHS. There are well-known fire safety problems at some PFI hospitals. Investigations after the Grenfell Tower fire exposed <a href="http://www.telegraph.co.uk/news/2017/06/27/nhs-alert-fire-chiefs-warn-38-hospitals-dangerous-grenfell-tower/">the presence of flammable cladding in NHS hospitals. </a>But risk assessment is tangled up with financial imperatives. Some of the flammable cladding in hospitals was <a href="https://www.mirror.co.uk/news/uk-news/hospitals-still-deadly-cladding-similar-11468002">left in situ</a> because it was considered too costly to remove. And such is the general pressure on trusts that <a href="https://www.hsj.co.uk/acute-care/exclusive-more-than-50-trusts-yet-to-carry-out-post-grenfell-fire-checks/7020898.article">some delayed in implementing fire checks</a> ordered by NHS Improvement after the Grenfell fire.</p> <h2>Mental health services are especially vulnerable</h2> <p>Though fire safety is a concern across the NHS, mental health services are especially vulnerable as they must deal with the special risks of fires caused by patients who are disorganised by illness, or people who set fires deliberately. The government acknowledges this risk in its <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/473012/HTM_05-02_2015.pdf">fire safety guidance for the NHS.</a><span></span></p> <p>The <a href="http://www.dailymail.co.uk/news/article-1078080/Patients-flee-ravages-hospital-unit-mentally-ill-criminals.html">2008 Chase Farm Hospital fire of the locked, forensic psychiatric wards</a> was a reminder of the potential lethality of fire in psychiatric hospital settings. Fast staff reaction in the <a href="http://news.bbc.co.uk/1/hi/england/london/7168206.stm">2008 Royal Marsden Hospital fire</a> prevented deaths, but there was major damage. The <a href="https://minhalexander.files.wordpress.com/2018/01/woodlands-unit-fire-investigation-suffolk-fire-and-rescue-2012_12_20-report-of-investigation-final.pdf">damning fire safety report</a> into the <a href="http://www.eadt.co.uk/news/ipswich-suffolk-patient-almost-died-as-fire-alarm-was-ignored-eight-times-1-1748189">2011 fire at Woodlands psychiatric unit at Ipswich Hospital</a> revealed system failures had resulted in the alarm being ignored eight times. Norfolk and Suffolk NHS Foundation trust escaped criminal prosecution only because of a legal loophole. The then Chief Executive of the NHS Trust Development Authority acknowledged this serious mismanagement and <a href="https://www.buildingbetterhealthcare.co.uk/news/article_page/Hospitals_told_to_step_up_fire_security_after_scathing_report_into_Ipswich_blaze/86061">promised that standards would be tightened up</a>. </p> <p>Vigilance and proactive care are needed. But strain on under-funded mental health services result in understaffing, chronic over-occupancy, escalating acuity and failures of clinical observation (<a href="///C:/Users/Caroline/Downloads/cited%20repeatedly%20by%20coroner&#039;s%20warnings%20as%20factors%20in%20avoidable%20deaths">cited repeatedly by coroner's warnings as factors in avoidable deaths).</a> </p> <p>Risk is also posed by an <a href="https://www.theguardian.com/society/2017/oct/03/bill-urgent-repairs-nhs-hospitals">ever-mounting backlog of repairs and maintenance work – including fire prevention work - in our hospitals,</a> as NHS trusts struggle to make ends meet. </p> <p>Worryingly, subsequent enquiries by BBC File on Four revealed that</p> <p><a href="https://minhalexander.files.wordpress.com/2018/01/bbc-file-on-four-29_01_08_fo4_fire.pdf">Fire Services had had to serve enforcement notices against NHS trusts.</a> – and, as a glance at the <a href="http://www.cfoa.org.uk/notices-register">enforcement register</a> shows that this continues despite promises of improvement.</p> <h2>Injuries and deaths in NHS fires</h2> <p>How much fire risk is tolerable, in hospitals with accelerant medical gases and infirm or detained patients? </p> <p>The <a href="https://minhalexander.files.wordpress.com/2017/11/fennell-report-kings-cross-fire-dot_kx1987.pdf">investigation report on the London Underground fire at Kings Cross</a>, which claimed 31 lives, criticised London Underground’s complacent culture and argued:</p> <p><em>“A mass passenger transport service cannot tolerate the concept of an acceptable level of fire hazard”</em></p> <p>Data from routine notification of estate fires by NHS trusts to NHS Digital shows that there were 1701 and 1462 fires in all trusts in <a href="https://minhalexander.files.wordpress.com/2018/02/nhs-digital-eric-2015-2016-data-reps.xlsx">2015/16</a> and <a href="https://digital.nhs.uk/catalogue/PUB30096">2016/17</a> respectively. Mental health trusts accounted for 1138 (67%) fires in 2015/16 and 895 (61%) fires 2016/17 respectively.</p> <p>Over these two years, 88 people were injured in all NHS trust fires, with 64 of these people being injured in fires related to mental health trusts. There were four deaths in trusts fires, three accounted for by mental health trusts.</p><p class="mag-quote-center">There were four deaths in trusts fires, three accounted for by mental health trusts.</p> <h2>Suicides by burning</h2> <p>There were a total of <a href="https://minhalexander.files.wordpress.com/2018/02/ncish-foi-suicide-by-burning-response-5-02-2018.pdf">259 patient suicides and 14 inpatient suicides by burning</a> over the ten years between 2005 and 2015, a request to National Confidential Inquiry into Suicide and Homicide (NCISH) under the Freedom of Information Act has revealed.</p> <p>FOI data from NCISH also suggests that <a href="https://minhalexander.files.wordpress.com/2018/02/ncish-foi-response-suicide-by-burning-9-01-2018.pdf">roughly a fifth of suicides by burning are due to patient suicides by burning.</a></p> <p>Underlying these deaths will be many more injuries and near misses.<strong></strong></p> <h2>Many hospitals do not have sprinkler systems, even now</h2> <p>The Chief Fire Officers Association <a href="https://minhalexander.files.wordpress.com/2018/02/cfoa-statement-130301-sprinklers.pdf">promotes the use of sprinklers.</a> The London Fire Brigade has advocated for the use of <a href="https://minhalexander.files.wordpress.com/2018/02/london-fire-brigade-2016-07-nickcoleshill.pdf">sprinklers in healthcare premises.</a> As the London Fire Commissioner has explained, </p> <p><a href="http://www.london-fire.gov.uk/news/LatestNewsReleases_Sprinklers-13-Sep-2017.asp#.WnUwhZOFigR"><em>"Sprinklers are the only fire safety system that detects a fire, suppresses a fire and raises the alarm. They save lives and protect property and they are especially important where there are vulnerable residents who would find it difficult to escape"</em></a><em></em></p> <p>The government’s fire standards for the NHS briefly mention but do not commit to installation of sprinklers. The guidance also repeatedly states that where sprinklers are used, other fire prevention measures may be reduced for cost-effectiveness.</p> <p>Since Grenfell, the government has been pressed on the <a href="http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2017-09-08/9666/">adequacy of its regulations</a> for sprinklers in hospitals, and <a href="http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2017-12-20/120648">whether sprinklers are required in all hospitals.</a> Last month, the Minister of State advised that all guidance was under review.</p> <p>Many hospitals do not have sprinkler systems. The exact distribution of sprinklers across the NHS estate is uncertain. The data is not collected centrally by NHS Digital. Expectations do not appear high. A fire safety policy by Northumberland Tyne and Wear NHS Foundation Trust states:</p> <p class="p1"><a href="https://minhalexander.files.wordpress.com/2018/02/northumberland-tyne-and-wear-1475659231fp-pgn-11-actfireprecau-v02-iss3-ermar17-issoct16.pdf"><em>"Healthcare premises do not normally have water delivery systems fitted."</em></a></p><p class="p1"><em><span class="mag-quote-center">"Healthcare premises do not normally have water delivery systems fitted."</span></em></p> <p>Recent FOI data reportedly showed that <a href="https://inews.co.uk/news/uk/revaled-thousands-multi-storey-buildings-lack-fire-sprinklers/">thousands of multi-storey buildings, including hospitals, do not have sprinklers.</a></p> <p>Even some new builds such as <a href="https://www.falkirkherald.co.uk/news/hospital-sprinkler-decision-slammed-1-289846">Forth Valley Royal Hospital</a> have not included sprinklers. The troubled Cumberland Infirmary PFI development <a href="http://www.newsandstar.co.uk/news/Carlisle-hospitals-fire-safety-sprinklers-will-not-be-fully-installed-until-2020-3e1e3656-a8ae-474a-8d18-b6b92c08663d-ds">will not have sprinklers fully installed until 2020.</a> Corporate documents and FOI releases by some NHS organisations, for example by <a href="https://minhalexander.files.wordpress.com/2018/02/sheffield-teaching-hospitals-governors-meeting-partial-sprinklers-cog170627_minutes.pdf">Sheffield Teaching Hospitals NHS Foundation Trust</a>, <a href="https://minhalexander.files.wordpress.com/2018/02/nhs-grampian-fire-prevention-foi-responseletter215-2014red.pdf">NHS Grampian</a> and <a href="https://minhalexander.files.wordpress.com/2018/02/nhs-lothian-fire-prevention-foi-4548.pdf">NHS Lothian</a> show patchy sprinkler coverage. </p> <p>Moreover, working on the ‘acceptable hazard’ principle, where one safety precaution is installed, others may be trimmed. For example, one architect reported that on one Scottish NHS PFI project, because sprinklers were specified, there was corner cutting on other safety features:</p> <p><a href="https://www.ifsecglobal.com/architect-says-corners-cut-fire-safety-glasgow-hospital-sprinklers-fitted/"><em>"...lacks exit stairways and exceeds size limits on fire compartments, while a hose-reel for firefighters is too short and some fire doors open in the wrong direction"</em></a><em></em></p> <p><span>Almost no mental health trusts have sprinkler systems</span></p> <p><a href="https://minhalexander.files.wordpress.com/2018/02/mental-health-trusts-and-fires-1-april-2015-to-31-march-20174.xlsx">I sent a Freedom of Information request to 51 mental health trusts. 49 trusts responded.</a></p> <p>The responses revealed that almost no mental health trusts have sprinklers. Three trusts had sprinklers in 10% of their inpatient areas, and in one of these trusts this was only because a <a href="http://www.sthelensstar.co.uk/news/15788041.sprinklers-installed-at-peasley-cross-hospital-wards/">retrofit took place after a contribution by the local fire service.</a> Two other trusts trust leased four community properties equipped with sprinklers, but none of their own properties had sprinklers.</p> <p>Some trusts stressed that installing sprinklers was “not a requirement under current legislation”. However, legality is a moot point after Grenfell and given the controversy about UK fire safety standards.</p> <p>Cambridgeshire and Peterborough NHS Foundation, one of the trusts criticised over a recent fire death, claimed that it could not say how many sprinklers it had, because responsibility for this was outsourced. However, the trust admitted there were no sprinklers in inpatient areas.</p><p class="mag-quote-center">One of the trusts criticised over a recent fire death claimed that it could not say how many sprinklers it had, because responsibility for this was outsourced.</p> <p>South West London and St. Georges Mental Health NHS Trust and Dudley and Walsall Mental Health Partnership NHS Trust refused to answer the question on sprinklers on the grounds that it would endanger safety. After challenge, St Georges admitted that it had no sprinklers.</p> <p>East London NHS Foundation Trust, rated ‘Outstanding’ and praised the Care Quality Commission for its learning culture was one of the trusts which failed to respond to the FOI at all. NHS Digital data shows that there was a fire related death at East London NHS Foundation Trust in 2016/17 and that a total of seven people were injured in fires in 2015/16 and 2016/17.</p> <p>The 49 trusts which responded to the FOI request accounted for a total of 1800 fires over 2015/16 and 2016/17, at least 790 of which were deliberately caused and at least 801 of which were caused by patients (2).</p> <p>Conservatively, at least 1000 of the fires occurred on inpatient units, some in rooms that might potentially be locked or barricaded such as patients’ bedrooms and bathrooms.</p> <p>One mental health trust acknowledged that there is risk inherent in all fires: “they all carry a potential risk of harm”, whereas another claimed that all fires on its wards were “minor in the sense that items burnt were limited to paper and clothing”. Better data is needed on the seriousness of the fires.</p> <p>Questions arise about whether this level of risk management in mental health trusts is acceptable, and whether it is valid to trim back on failsafes. For example, relying on fire alarms instead of sprinklers. This was a justification given by Mersey Care NHS Foundation Trust for not having sprinklers.</p> <p>In particular, the absence of sprinklers in patients’ bedrooms and bathrooms bears further debate, because such areas may not be accessible quickly enough in an emergency. <a href="http://www.bbc.co.uk/news/uk-england-cambridgeshire-41916473">Heather Loveridge died as a result of a fire in a ward toilet</a> and <a href="http://www.bbc.co.uk/news/uk-england-berkshire-42185454">Sarah-Jane Williams died as a result of a fire in a ward bedroom</a> at trusts which had no sprinklers. </p> <p>There are also unanswered questions about sources of ignition on mental health trust wards despite the <a href="https://publichealthmatters.blog.gov.uk/2017/03/17/tobacco-free-nhs-troubleshooting-tips-for-hospitals/">NHS smoking ban</a>. How many ward fires set by patients due to failures to search and remove lighters, reflecting the acute strain on services? <span></span></p> <p>I asked NHS Improvement, the NHS’s financial regulator, if it was doing any work on the special needs of mental health patients with respect to fire safety. </p> <h2>Who’s responsible? Not us!</h2> <p>NHS Improvement referred me to the Department of Health</p> <p><a href="https://minhalexander.files.wordpress.com/2018/02/nhs-improvement-correspondence-fire-risk-mental-health-trusts.pdf">NHS Improvement referred me to the Department of Health and Social Care</a>, based on its impression that the Department had undertaken a 10-year review. This was followed by a hasty retraction, and then a <a href="https://minhalexander.files.wordpress.com/2018/02/dh-fire-response-21-nov-2017-foi-1107984.pdf">denial from the Department of Health and Social Care </a>itself that it held such data. The Department finally suggested that I ask<a href="https://minhalexander.files.wordpress.com/2018/02/dh-fire-response-5-dec-2017-foi-1109518.pdf">&nbsp;NHS Improvement</a> for information.</p> <p>This bureaucratic merry-go-round suggests that either little thought has been given to this matter, or worse, that pass-the-parcel is being played with embarrassing truths whilst mental health patients remain insufficiently protected.</p><p class="mag-quote-center">pass-the-parcel is being played with embarrassing truths whilst mental health patients remain insufficiently protected</p> <p>The Department of Health and Social Care’s own fire guidance states that it is important to demonstrate “<em>due diligence and effective governance”</em> and recommends that the <em>“performance of the fire safety management system is periodically audited and assessed against the organisation’s fire safety objectives”</em></p> <p>The Department should follow its own advice, ensure better oversight and rectify any unwarranted risks to which mental health patients are currently exposed. If risk continues to be tolerated at a systemic level, the government should at least transparently provide justification for this.</p> <p><strong>NOTES</strong></p> <p>(1) The Department of Health and Social Care’s fire safety guidance states:</p> <p><em>“</em><strong><em>5.68</em></strong><em> With the exception of buildings over 30 m in height, the guidance in this document does not require the installation of sprinklers in patient care areas of healthcare buildings. However, the design team is expected to consider the advantages that might be gained by installing life-safety sprinklers throughout the building or to specific areas. Where specific hazards are identified in the building, it may be more appropriate to consider the application of an alternative fire suppression system, such as high pressure water mist technologies.”</em></p> <p>Throughout the guidance, it is stated that where sprinklers are used, other fire prevention measures may be reduced, and this explicitly linked to saving money. For example:</p> <p><em>“<strong>5.85 </strong>In those parts of healthcare buildings where sprinkler systems are provided, the effect of sprinklers on the overall package of fire precautions has to be considered to ensure that a cost-effective fire safety strategy is provided. Where sprinklers are installed in healthcare premises in accordance with the above guidance, some of the requirements of this document may be modified to take account of the effect of sprinkler operation at an early stage of fire development.”</em></p> <p><em>“<strong>5.86</strong> Where sprinklers are installed, the guidance may be modified subject to a suitable and sufficient risk assessment being undertaken and the information being recorded in the fire safety manual. Examples include: </em></p> <p><em>a. progressive horizontal evacuation (paragraphs 3.6–3.15); </em></p> <p><em>b. glazing in sub-compartment walls (paragraphs 5.23–5.25); </em></p> <p><em>c. elements of structure (paragraphs 5.1– 5.7 and 5.14–5.15); </em></p> <p><em>d. compartmentation (paragraphs 5.8– 5.13); </em></p> <p><em>e. fire hazard rooms and areas (paragraphs 5.40–5.44); </em></p> <p><em>f. external fire spread (paragraphs 6.5– 6.15); </em></p> <p><em>g. number and location of fire-fighting shafts (paragraphs 7.11 and 7.13).”</em></p> <p><em>“<strong>3.12</strong> Where sprinklers are installed, the fire resistance of the compartment walls may be reduced to 30&nbsp;minutes (integrity and insulation)”</em></p> <p><em>“</em><strong>5.15</strong> <em>Where sprinklers are installed throughout the whole building, the requirement for elements of structure and compartment walls to be constructed of materials of limited combustibility does not apply”</em></p> <p><em>“<strong>5.25</strong> Where sprinklers are fitted, there is no limit on the use of glazed screens that provide a minimum period of fire resistance of 30 minutes (integrity only), provided the glass is not of the type referred to as “modified toughened”</em></p> <p><strong><em>“5.43</em></strong><em> Where sprinklers are installed, the need to enclose fire hazard rooms in fire-resisting construction should be risk-assessed.”</em></p> <p><a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/473012/HTM_05-02_2015.pdf">Department of Health Technical Memorandum 05-02: Firecode, 2015 Edition</a></p> <p>(2) Both data from NHS Digital and the FOI material from trusts should be viewed with caution. </p> <p>It became clear that some mental health trusts are reporting <em>all</em> fires involving patients to NHS Digital, and not just fires on their own premises. One trust claimed that the NHS Digital figures on its fires was greatly inflated because they included false alarms and not just actual fires. Conversely, some NHS Digital data was placed in doubt after a few apparent zero returns were directly queried with the trusts in question, who gave conflicting data.</p> <p>Some mental health trusts volunteered that all or most their arsons were carried out by patients. Fires were also most frequently located in inpatient areas.</p> <p>By comparison, FOI requests to three acute trusts that had also reported high numbers of fires showed a much lower proportion of fires that were caused deliberately or by patients: there were only 4 deliberately caused fires and three fires caused by patients out of a total of 178 fires over the two years.</p> <p>Rough though the quality of this data is, the differences do support received wisdom that the risk of arson by patients is higher in mental health trusts, and that unsurprisingly, many of the fires are set on inpatient psychiatric wards. This might be expected as the most unwell people will be found on the wards.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/openjustice/roshan-croker/terrible-consequences-of-deregulation-and-cutting-corners">The terrible consequences of deregulation and cutting corners</a> </div> <div class="field-item even"> <a href="/shinealight/clare-sambrook/fail-and-prosper-how-privatisation-really-works">Fail and prosper: how privatisation really works</a> </div> <div class="field-item odd"> <a href="/blood-on-their-hands-sorry-state-of-uk-mental-health-services">“Blood on our hands” - the sorry state of UK mental health services </a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS ourNHS Minh Alexander Fri, 09 Feb 2018 11:01:22 +0000 Minh Alexander 116028 at https://www.opendemocracy.net Is our personal data fair game in the drive to create Theresa May’s “hostile environment” for migrants? https://www.opendemocracy.net/uk/jess-potter/is-our-personal-data-fair-game-in-drive-to-create-theresa-may-s-hostile-environment-f <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> Patients are dying as politicians use the NHS crisis to undermine what we love most about it – a service for all, free at the point of access, that protects our confidential health data. </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/Docs Not Cops.PNG" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/Docs Not Cops.PNG" alt="" title="" width="460" height="301" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>As a doctor and public health researcher, I believe health services should not be <em>de facto</em> border control. Deterring people from seeking help when they are unwell is not only bad for individuals, it is bad for public health. Healthcare is a right for all, not a privilege for some.&nbsp;</p><p>Last week, Dr Sarah Wollaston MP and the rest of the health select committee heard <a href="http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news-parliament-2017/mou-data-sharing-launch-17-19/">evidence</a> to about the impact of a <a href="https://www.gov.uk/government/publications/information-requests-from-the-home-office-to-nhs-digital">Memorandum of Understanding (MoU)</a> between the Home Office and NHS Digital (the national information and technology partner to the health and social care system in the UK). This data-sharing agreement to support the tracing of immigration offenders is one of a “suite of products” that enable the government to maintain the “compliant environment”, as they referred to it on the day.</p> <p>It was upsetting to hear Marissa Bereoni, of Justice for Domestic Workers, describe how a domestic worker had died from pneumonia – a completely treatable condition – because she had been too scared to see a doctor. Further examples were given by GP Lu Hiam who works for Doctors of the World, a charity established because the NHS is not truly accessible to all – some are too afraid to use it. </p> <p>The hearing confirmed what <a href="http://www.independent.co.uk/life-style/health-and-families/nhs-urged-to-share-data-so-patients-can-be-deported-a7566386.html">I and other campaigners have been arguing</a> ever since Theresa May said in 2012, as Home Secretary, that <a href="http://www.telegraph.co.uk/news/uknews/immigration/9291483/Theresa-May-interview-Were-going-to-give-illegal-migrants-a-really-hostile-reception.html">“the aim here in Britain is to create a really hostile environment for illegal immigration”. </a>&nbsp;That creating this hostile environment within a healthcare setting is particularly damaging, and shows little regard to the potentially life-threatening consequences of this blinkered focus on immigration control.</p> <p>Last week’s testimonies also confirm the human stories behind written evidence from Public Health England (PHE). Public Health England highlighted no fewer than 14 research studies demonstrating that the threat of being reported to immigration officials deters people from seeking help when they are unwell.&nbsp; Their evidence was however somewhat undermined by a <a href="http://www.parliament.uk/documents/commons-committees/Health/Correspondence/2016-17/Correspondence-Memorandum-Understanding-NHS-Digital-Home-Office-Department-Health-data-sharing.pdf">disappointing cover letter</a> from PHE’s Chief Executive Duncan Selbie who declared that “whilst there is a wealth of evidence about migrant health behaviours there is no robust <em>statistical</em> evidence about the impact of knowledge of data sharing on deterring immigrants from accessing healthcare treatment”.&nbsp; At the committee hearing, this statement was then used by the government to justify their actions, which begs the question: Exactly how operationally independent is PHE? </p> <p>Of course, as pointed out during the meeting, it is almost impossible to gather “robust statistical evidence” on undocumented migrants, particularly when living in a country where every social interaction they have might either result in abuse or arrest. Nevertheless, PHE has agreed to attempt to collect this data over the course of the next two years, during which time who knows how many more people will come to harm? </p> <p>Another important point raised by a representative of the national data guardian’s office was the paramount importance of the public’s trust in our ability to deliver a confidential healthcare service.&nbsp; As Sarah Wollaston MP pointed out, in the five paragraphs within the MoU that discuss the public interest, the public’s trust that their own personal health data will remain confidential, is not mentioned once. </p> <p>For us healthcare workers, each decision to release confidential data beyond the health service produces blood, sweat and tears.&nbsp; We do not take it lightly.&nbsp; When we do it, it is most likely because life is in danger.&nbsp; Even if you were part of the group who stole all those diamonds from Hatton Gardens, we would still not share your details.&nbsp; </p> <p>And by details I mean primarily your home address, because when you give this in exchange for medical care that is where my contract to protect your data begins.&nbsp; Not so, according to the government.&nbsp; Demographic data is fair game. There is a fundamental disconnect between guidance from both the <a href="https://www.gmc-uk.org/guidance/ethical_guidance/confidentiality.asp">General Medical Council</a> and <a href="https://www.bma.org.uk/news/media-centre/press-releases/2017/july/bma-responds-to-government-public-consultation-on-patient-data-security-reviews">BMA</a> in relation to confidentiality and what the law allows.</p> <p>From the Home Office’s perspective, committing an immigration offence such as living in the UK without appropriate paperwork constitutes a serious enough offence to justify the routine sharing of data with no scrutiny on a case-by-case basis.&nbsp; During the hearing the government claimed that escaping deportation was another crime warranting the use of medical services to track you down.&nbsp; I find this particularly galling given <a href="https://www.theguardian.com/uk-news/2017/nov/20/fourth-death-at-lincoln-immigration-removal-centre-prompts-inquiry">recent reports</a> demonstrating the harmful and even life-threatening effects of unlimited detention in this country.</p> <p>Deterring people from accessing healthcare in this way not only puts lives at risk but results in higher costs. These practices threaten to undermine patients’ trust in my ability to protect their <a href="https://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp">right to confidentiality</a> – the cornerstone of the patient-doctor relationship. </p> <p>The final question of the session was ‘Who can stop this?’&nbsp; The answer: NHS Digital. &nbsp;But only if their evaluation thinks this is the right thing to do. For now, they are happy hiding behind the law because, technically, what they are doing is still legal even if it is not right.&nbsp; This may change if the <a href="http://www.independent.co.uk/news/health/home-office-nhs-data-sharing-patients-human-rights-court-challenge-a8045011.html">legal challenge</a> lead by the NGO Migrants Rights Network succeeds.</p> <p>Unless we stand up and hold the government to account, they will continue to inflict damage to some of the most vulnerable people in our society.&nbsp; Our NHS is in crisis but we must not allow this to undermine what we love most about it – a service for all, free at the point of access.&nbsp; </p> <p><a href="https://www.facebook.com/events/314949055662810/">Join us in the #PatientsNotPassports bloc at the NHS in Crisis protest on Saturday February 3rd</a>.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/docs-not-cops/labour-must-tackle-may-s-hostile-environment-for-migrants-in-nhs">Labour must end May’s ‘hostile environment’ for migrants in the NHS</a> </div> <div class="field-item even"> <a href="/ournhs/erin-dexter/making-nhs-hostile-environment-for-migrants-demeans-our-country">Making the NHS a “hostile environment” for migrants demeans our country</a> </div> <div class="field-item odd"> <a href="/ournhs/ruth-atkinson/brexit-and-nhs-we-need-to-fight-racist-discourse">Brexit and the NHS - why we all must fight the racist discourse</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Jess Potter Thu, 25 Jan 2018 06:00:00 +0000 Jess Potter 115799 at https://www.opendemocracy.net A day in the life of an NHS nurse - how our government is failing both patients and nurses https://www.opendemocracy.net/ournhs/mark-boothroyd/day-in-life-of-nhs-nurse-why-government-must-act-to-reduce-workloads <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Last year 33,000 nurses left the NHS, 3,000 more than were recruited. There’s a simple solution - resisted by a government determined to press ahead with piecemeal privatisation.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/nurse stress_0.png" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/nurse stress_0.png" alt="" title="" width="460" height="230" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>If you take a look at the average daily workload of an NHS nurse, you can see how it would drive any but the most committed to leave the underpaid and undervalued profession.</p> <p>Average staffing levels in NHS wards means that there are 9 patients per nurse. In elderly care wards the average is 11 patients per nurse. The reality for nurses is it can be as much as 10 or 12 patients per nurse on a medical ward, and 14 to 16 patients per nurse on an elderly ward. The National Institute of Clinical Excellent (NICE) and nursing unions recommend no more than 8 patients per nurse, yet 40% of NHS nurses reported to the Royal College of Nursing (RCN) that they are working with ratios higher than this.</p> <p>Imagine you're a nurse with a 12 hour shift. It's meant to only be 11 hours work because you're meant to have a one hour break (which you aren't paid for) but you'll probably end up working through it. You have 10 patients who you have to help wash, give their medications three times a day, and do a minimum of three sets of observations throughout the day. You also have wound dressings to change for several of your patients, and several need help toileting throughout the day. Some may be bed bound and require full double handed care, requiring another nurse to help you. </p> <p>You also need to speak to the medical team for each of them to chase up their plans. Several need to be sent for scans, and you need to speak to the porters and x-ray, CT or ultrasound and get them sent down. Dementia patients or those who are falls risk can require an escort so you have to find someone to go with them.</p> <p>If you're on a surgical ward you will have a couple of patients on Patient Controlled Analgesia, or epidurals needing hourly monitoring, as well as observations hourly for those returning from theatre, hourly sliding scales for diabetes patients, Naso-Gastric or Total Parenteral Nutrition feeds needing checking and monitoring. Alongside that you’re trying to safely take multiple patients to theatres and radiology which means being off ward for ages, while somehow simultaneously closely monitoring the patients you've left behind. </p> <h2>Desperately trying to free up beds</h2> <p>On top of that you will be managing multiple discharges to get patients home to free up beds for the next day’s intake of patients awaiting surgery, and chasing pharmacy for medications. There is barely any time to carry out the essential work of teaching patients about managing new stomas or controlling their diabetes or any of the other essential parts of patient education which are left in the hands of overstretched nursing staff.</p> <p>God forbid any of the patients become acutely unwell. Then you have to drop everything and spend 2-3 hours managing them intensively, calling the medical or surgical team, the clinical response team, maybe the crash team if they suffer a peri-arrest. Performing observations every 15-30 minutes, administering IVs, taking bloods, deciding whether to inform the next of kin if it's a serious deterioration or if they are elderly or at the end of life. If you eventually stabilise them you have to go back and catch up on your work for your other 9 patients, who you haven't been able to do anything for in the meantime.</p> <p>A study in Australia found that on a busy ward, nurses were making roughly 200 decisions every hour regarding their work. You spend all day every day running from task to task, with barely any time to think.</p> <h2>Documenting everything – even when it was done badly</h2> <p>On top of all this you have to find time to document everything about those ten patients; those three sets of observations (as a minimum, more if they become acutely ill), at least one detailed nursing care plan and a follow up note at the end of the shift, noting every time someone was repositioned, every bowel movement, every aspect of personal care, wound care, important conversations you had with the medical team, with patients, their relatives or social services. </p> <p>There aren't enough staff to do all the work, but the hospital still requires you to document everything you did to prove you did if (even though it was probably done badly or in a hurry, or maybe not at all).</p> <p>If there were enough staff to do all the work, this level of documentation wouldn't be necessary. With inadequate levels of staffing, it just become an onerous imposition, and saps what little spare time you have.</p> <p>By the end of your shift if you work flat out, skip your breaks, cut a few corners and don't spend too much time doing any of the niceties for patients (the little chats, extra cups of tea, comforting them if they've had bad news, and so on) you might have just about managed to do all your care and provided decent, if a little basic care for your patients. </p> <p>If you have managed to squeeze in most of your documentation you might only leave 30-40 minutes late as you tidy up the last bits of paperwork, check you've done all your notes, updated all the care plans, fluid balances, stool charts, repositioning charts and the rest. But if someone became really unwell and you spent 2-3 hours nursing them intensively, you'll probably be staying behind an hour or two to finish notes, as the only time you've really got to work on them is when the next shift has arrived and they can take over all your responsibilities.</p> <h2>How the ‘market’ intensifies nurses workloads</h2> <p>The effects of years of austerity on hospital budgets, combined with the market mechanisms which allocate NHS funding, are also driving the workload up for nurses. Hospitals receive a payment (a tariff) per patient admission. Hospitals facing budget restrictions and reductions in bed numbers are utilising medical and surgical advancements to improve patient care, but also to minimise time as inpatients. This is done to maximise through flow of patients so they can receive as many tariff payments and maximise their income at times of budget restrictions. They do this so they can afford to pay staff and continue to maintain services, but it drives up nurses workload to an unprecedented level. Whereas 15-20 years ago patients would stay on wards for weeks at a time till they were full recovered, now it’s common for patients to be discharged home as soon as they are stable and not acutely unwell, the remainder of their care being carried out in the community. </p> <p>Whereas a nurse used to have a mix of acutely unwell patients, and stable recovering patients requiring minimal care, now every patient a nurse cares for is likely to be acutely unwell, meaning their care needs and the workload for the nurse is at maximum every shift. Such a situation creates a horrendous work environment where nurses work flat out all the time, with no downtime or quiet days. It accelerates burnout, and means newly qualified nurses trying to find their feet and develop their skills and resilience are subject to unimaginable pressures and levels of responsibility that they would not have faced 10-15 years ago. </p> <p>This is why nurses are leaving, and until it changes, they won't stop leaving.</p> <h2>The simple solution</h2> <p>The only way to improve retention and begin to reverse the outflow of nurses from the NHS is to reduce their workloads to a safe, manageable level. This means more nursing staff on wards and in community services. </p> <p>There is a remarkably simple policy solution to this which has worked well in other countries; mandatory minimum safe staffing levels, enforced in law. This has been implemented in both Australia and California, in response to concerted protests by nurses and their unions.</p> <p>There is a consensus for this across nursing unions and the nursing workforce. The RCN, UNISON and Unite all call for mandatory minimum safe staffing levels across NHS wards, and surveys of nurses show 90% in favour.</p> <p>What is stopping the government adoption of this policy is the impediment it would pose to cutting and privatising the NHS, and the demand it would create for increased funding to pay for the staffing. But it is absolutely necessary if we are going to see the continued functioning of the NHS, and the survival of nursing as a viable profession. For this reason all nurses and their unions have to become more active and aggressive in campaigning on this issue, for the wellbeing of ourselves, our patients and the NHS.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/mark-boothroyd/nurse-shortage-what-nurse-shortage">Nurse shortage? What nurse shortage?</a> </div> <div class="field-item even"> <a href="/ournhs/mark-boothroyd/government-uturn-on-safe-nursing-levels-branded-betrayal-by-midstaffs-campaign">Government u-turn on safe nursing levels branded a &quot;betrayal&quot; by Mid-Staffs campaigners</a> </div> <div class="field-item odd"> <a href="/ournhs/mark-boothroyd/why-wont-government-implement-safe-staffing-levels-in-nhs">Why won&#039;t the government implement safe staffing levels in the NHS?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Mark Boothroyd Wed, 24 Jan 2018 12:50:18 +0000 Mark Boothroyd 115797 at https://www.opendemocracy.net Taking politics out of the NHS? Or constructing an elitist ‘consensus’? https://www.opendemocracy.net/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>As certain wings of the Labour party join calls for ‘consensus’ on the NHS, a reductive global healthcare consensus has already been established in the meeting rooms of Davos, McKinsey and the World Bank – with pivotal support from Blair-era peers and NHS appointees.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/junior dr protest jeremy hunt_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/junior dr protest jeremy hunt_0.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Flickr/<a href="https://www.flickr.com/photos/garryknight/with/22069935418/">Garry Knight</a>.</em></p><p>“Our manifesto was a key reason for our gains in the 2017 general election. Now its ideas need to be developed and radicalized”.</p> <p>—Shadow Chancellor John McDonnell</p> <p>At the Labour Conference following the election result, emboldened delegates “<a href="http://labourbriefing.squarespace.com/home/2017/11/14/can-labour-renationalise-the-nhs">voted historically and unanimously for complete renationalisation of the NHS in England</a>” – in the words of Alex Scott-Samuel, Socialist Health Association Chair. Since then shadow health secretary Jon Ashworth has further committed Labour to halting the Sustainability and Transformation Plans (STPs) which devolve the national service into local ‘footprints’ with reduced accountability and the potential for marked reductions in healthcare provision, commercial control of both the public estate and the commissioning function, and a final bridge to a US-style system. Prior to the election in June, Ashworth had only said such plans would be reviewed on a case by case basis, but is now obviously responding to a new confidence among party members.&nbsp; </p> <p>A month later however, and no doubt partly in response to these developments, <a href="http://www.bbc.co.uk/news/health-42029445">ninety MPs signed a letter</a> calling on the Prime Minister to set up a cross-party convention on the future of the NHS and social care in England, saying that only a non-partisan debate would be able to deliver a "sustainable settlement". One-third of the MPs who signed the letter were Conservatives, and while the exact political balance is unknown, signatories from the Labour Party include Liz Kendall, Chuka Umunna, Hilary Benn, Frank Field and Caroline Flint. They say the failure of normal party politics to secure the future of the system means a consensual approach is the only way to ensure action is taken, particularly given that the government does not command a majority.</p> <p>And in November – in what seems to be an attempt to give momentum to this <a href="http://www.bbc.co.uk/news/health-42029445">critical stage of the ‘transformation’ process</a> - the Commons Select Committee on Health resumed its inquiry into Sustainability and Transformation Plans (now Partnerships), <a href="http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news-parliament-2017/stps-acss-launch-17-19/">an inquiry that had been suspended owing to the general election</a>.</p> <h2>The annual January chorus of ‘consensus’</h2> <p>It’s worth noting that winter problems in acute care served as a lever for a similar attempt at consensus in January 2016, in which <a href="http://www.bbc.co.uk/news/health-35233346">former health secretaries Alan Milburn and Stephen Dorrell joined with former Lib Dem health minister Norman Lamb in calling for a cross-party commission</a> – moves that were <a href="https://opendemocracy.net/ournhs/ournhs/nhs-campaigners-say-no-to-nhs-commission">sharply rejected by campaigners amidst concern about the lack of ‘red lines’ to protect universal healthcare</a> (and the vested interests of those involved). </p> <p>A similar coalition <a href="http://www.normanlamb.org.uk/norman_lamb_launches_cross_party_nhs_and_care_campaign">tried again in January 2017</a>, with Norman Lamb writing “The public is sick and tired of the NHS and care system being treated like a political football.&nbsp; People have had enough, and are crying out for an honest discussion and bold solutions to these challenges”. </p> <p>By then, the House of Lords was already engaged in producing an extensive report into the ‘Long Term Sustainability of the NHS’. That report – though it was somewhat buried by the election - gives us some idea of what to expect from the latest attempts at constructing consensus. And a closer examination - in particular those they invited to submit evidence - gives us some idea of the forces mobilising such cross-party initiatives.</p> <h2>Constructing consensus</h2> <p>The Lords produced their report, ‘<a href="https://www.parliament.uk/nhs-sustainability">The Long-Term Sustainability of the NHS</a>’, in April 2017 after almost a year of sifting through written submissions and oral evidence. When the Lords Committee finally reported back its conclusion stated, “A new political consensus on the future of the health and care system is desperately needed and this should emerge as a result of Government-initiated cross-party talks and a robust national conversation”. More particularly it stated that “service transformation will be key to delivering a more integrated health and social care system”, and while recognising some of the difficulties posed by STPs, and the new care models involved, the report noted the broad support for these plans from those giving evidence.</p> <p>What’s noticeable about such hearings is the homogeneity of thought among a remarkably cohesive policy community. And while a few deviations were observed, these were largely in terms of application rather than outright opposition. Indeed the evidence that follows suggests the consensus sought by the Lords – not to mention the cross-party conventions - had already been arrived at several years previously, in even less democratic venues, and that the report served merely to ratify this. </p> <h2>London, Paris, Davos, Washington…</h2> <p>In a <a href="https://www.sochealth.co.uk/2017/05/25/truth-stps-simon-stevens-imposed-reorganisation-designed-transnational-capitalism-englands-nhs-stewart-player/">previous article</a> the author argued that NHS England’s chief executive Simon Stevens’ Five Year Forward View, and, by logical extension, the STPs, had their origins in the World Economic Forum, seen by many as the avatar of the global corporate elite. Indeed two reports produced by the WEF in 2012 on healthcare sustainability advanced many of the constructs, such as service transformation and new care models, latterly pursued by NHSE. </p> <p>The article also noted that the WEF reports were the result of a series of meetings organised at different levels. A Steering Board comprising eminent health system leaders offered overall direction, while a Working Group of experts supported the project’s approach and methodology, collating the material from various national workshops held in England, Germany, Spain, Holland, and China. </p> <p>The identification of participants within these groups could, it was argued, reveal a similar chain of command that was being reproduced at the domestic level. Simon Stevens himself, then working for US insurance giant UnitedHealth, led the WEF Steering Board for the first report, alongside representatives from global consultancies, healthcare and pharmaceutical industries, and from institutions such as the World Bank, the EU, and the World Health Organisation.&nbsp; </p> <p>And Michael Macdonnell, then a Senior Fellow at Imperial College London, but now strategic director of the STPs, served on the Working Group, while the English stakeholder workshop participants included people now leading local NHS ‘transformations’, alongside luminaries like Milburn and Dorrell. </p> <p>However some of this analysis needs adjusting as it neglects the extensive role played by the consultancy giant McKinsey, which provided the project team that produced the two WEF reports. The company, whose clients number at least 90% of the Fortune 500, also organised the various stakeholder workshops, and indeed the lead author of the WEF reports, McKinsey’s Tom Kibasi, also presented these to the World Bank in Washington and to the OECD in Paris. This latter point suggests that while the WEF stands as perhaps the apex of the global elite, the agenda and ideas that inform it are continually being disseminated and reinforced in a range of related venues. </p> <h2>Visions ‘remarkable in their consistency’</h2> <p>As far as the WEF’s stakeholder workshops were concerned, the second report noted that the visions expressed by its participants “are remarkable in their consistency. The preferred health system of the future is strikingly different from the national healthcare systems of today, with empowered patients, more diverse delivery models, new roles and stakeholders, incentives and norms”. </p> <p>Such consistency of vision reflects what may be considered a transnational position. Indeed analysis of transnational capitalist class (TCC) formation argues that reorganisation of capital accumulation has required a parallel reshaping of class relations, with the owners of new forms of production and finance coalescing around global agendas and new relations with nation states. This class is increasingly divorced from serving nationally prescribed developmental goals: instead the aim is to rearrange state institutions and services to serve the global economy. Such analysis also posits a clear hierarchy between business, governmental, and media/scientific/intelligentsia fractions within this class, although, as with Stevens, actors can easily segue between these. </p> <p>And of course hierarchies exist within fractions as well. The WEF reports, for example, were developed partly in response to an announcement from Standard &amp; Poor’s in January 2012 that it would in future take into account in its <a href="http://www3.weforum.org/docs/WEF_SustainableHealthSystems_Report_2013.pdf">national credit ratings the financial sustainability of a nation’s healthcare system</a>. Further privileging of the financial sector, or, more accurately, the financial, insurance and real estate (FIRE) sector, can be seen in the drive to enable its control over healthcare funding mechanisms and the NHS’s physical infrastructure. </p> <h2>Who did the noble Lords want to listen to?</h2> <p>As mentioned, those called to give evidence in the Lords hearings were drawn extensively from the state and intelligentsia fractions of the transnational capitalist class. This includes the leading healthcare think tanks, the Kings Fund, Nuffield Trust and Reform. NHS hospital trusts were represented by Chief Executives of the Shelford Group of Trusts, some of whom, like Dame Julie Moore, were WEF stakeholders, while others, such as Andrew Cash and Mike Deegan, can routinely be found in global consultancy conferences. Cash – head of Sheffield Teaching Hospital - also led the Expert Advisory Panel that supported the Dalton Review on acute sector collaboration, whose <a href="https://www.theguardian.com/politics/2014/dec/05/more-nhs-hospitals-privately-operated-healthcare-shakeup-review-dalton">core recommendations included the formation of US-style hospital chains and the private management of NHS hospitals.</a> </p> <p>The former Labour health minster, Lord Darzi, who also sat alongside Stevens in the WEF Steering Board, also gave evidence. As well as being Director of Imperial College London’s Institute for Global Health Innovation, <a href="http://www.imperial.ac.uk/centre-for-health-policy/global-engagement/world-innovation-summit-for-health-wish/">Darzi is also Executive Chair of the World Innovation Summit for Health (WISH)</a> that convenes annually with some 2,500 participants, and is “chaired by a team of experts drawn from academia, industry and policymaking” with “the aim of influencing healthcare policy globally”. WISH’s recent research work has included collaboration <a href="https://www.bcgperspectives.com/content/articles/health_care_payers_providers_accountable_care_around_world_framework_guide_reform_strategies/">with the leading US consultancy, the Boston Consulting Group, on Accountable Care Organisations</a> and value creation in healthcare.</p> <p>Michael Macdonnell, now acting policy director of NHS England’s STP programme, has been working on <a href="http://www.pulsetoday.co.uk/news/commissioning/all-stps-will-become-accountable-care-systems-nhs-england-announces/20034154.article">ACOs, and the aim is for these to be implemented in each footprint</a>. Macdonnell gave evidence to the Lords Committee, as indeed did Sir Muir Gray who has led the value creation programme, <a href="https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdx136/4596536">Right Care</a>, within the NHS.&nbsp; Also present were Ian Forde from the OECD, who has written extensively on the euphemistically titled ‘universal health coverage’ for countries in South America - these involve considerable restrictions on care – as well as the WEF reports lead author, Tom Kibasi himself, though now acting as Chief Executive of the IPPR think tank. </p> <p>Any possibility of dissent was managed by corralling the union representatives, from Unite, Unison and the BMA, into one short session. Mark Britnell, Chairman of the Global Health Practice at KPMG, on the other hand, was offered a session all to himself, where he informed the Lords panel that he was “one of the 12 members of the World Economic Forum Health Council”. While Britnell’s oft-quoted and careless remark to a private equity conference that the NHS would be shown “no mercy” might have cost him his chance of the NHSE chief executive post, it’s clear he still has clout. </p> <p>Selection to the hearings is of course all-important, though the Lords give no indication as to how this was arrived at. Undoubtedly offering assistance in this process were two All Party Parliamentary Groups, the APPG on Health, and the APPG on Global Health. The first claims it “is dedicated to disseminating knowledge, generating debate and facilitating engagement with health issues amongst Members of both Houses of Parliament”. The Group also “comprises members of all political parties, it provides information with balance and impartiality and it focuses on local as well as national health issues. It is recognised as one of the preferred sources of information on health in Parliament”.</p> <p>Several of its Advisory Panel, such as Jennifer Dixon of the Health Foundation think tank, and Sir Cyril Chantler, formerly Chairman of Great Ormond Street Hospital, and now working with the Private Healthcare Information Network, were included in the Lords hearings, as well as organisational affiliates such as the NHS Confederation, the Kings Fund and Nuffield Trust. </p> <p>The APPG on Health’s current <a href="http://www.healthinparliament.org.uk/about-us/associate-membership">website</a> states that it “is supported by an Associate Membership of 14 of the UK's leading organisations working in the health sector”. This is misleading. <a href="https://www.parliament.uk/mps-lords-and-offices/standards-and-financial-interests/parliamentary-commissioner-for-standards/registers-of-interests/register-of-all-party-party-parliamentary-groups/">Business affiliates</a> from the past few years include the large conglomerates Abbott, Bristol Myers, Novartis, Merck, Takeda, Pfizer, Optum, Sanofi, and Novo Nordisk. These companies were present at both the WEF’s reports, some in both the Steering and Working Groups, as well as being heavily represented in the stakeholder forums.</p> <p>The APPG on Global Health on the other hand has a somewhat smaller corporate membership, though this does include the Bill Gates Foundation. Its members however number Lord Darzi, as well as the Lords Ribeiro and Kakkar who were among the dozen core members of the Lords inquiry, as well as its Chairman, Lord Patel. </p> <h2>A new era for Labour?</h2> <p>In June 2014, a <em>Health Service Journal</em> <a href="https://www.hsj.co.uk/comment/leader/public-concern-on-nhs-may-tempt-parties-to-undermine-its-future/5072506.article">editorial</a> welcomed what it regarded as a hard won consensus in healthcare policy, most notably towards care ‘integration’, reducing reliance on hospitals, and better use of technology. As an example of such a consensus it highlighted a commissioning conference held by the NHS Confederation to which shadow health secretary Andy Burnham had been invited to speak on health and social care integration but had to cancel at short notice. The former chair of the Commons Health Committee, the Conservative MP Stephen Dorrell was also invited to speak at the same session, and the HSJ noted “Mr Burnham’s office let it be known they were happy for the former Tory health secretary to reflect their view on the issue”. </p> <p>Perhaps one shouldn’t be too surprised. The Miliband-era 10 year vision for the health and social care system was unveiled in the offices of the Kings Fund, and drew extensively on a report – ‘One Person, One Team, One System’, otherwise known as the Oldham Report – that was <a href="https://www.theguardian.com/healthcare-network/2014/mar/12/people-power-labour-health-policy">largely scripted by PwC and KMPG</a> and project managed by Hugh Alderwick, on secondment from PwC.</p> <p>The labyrinthine details aside, it’s clear that the NHS has come under a sustained offensive from the transnational class. It’s important to note that the business fraction of this class will largely absent itself from overt decision-making channels, such as the House of Lords hearings, to continue the guise of accountability and neutrality. But within such channels the influence of this fraction is pervasive, and the consensus or ‘sustainable settlement’ sought by its supporters is entirely in its favour. However if John McDonnell is to be believed this new era of Labour policy promises something different: in particular a clear rejection of those adherents to a transnational agenda and a genuine pursuit of the wishes of its party member.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/nhs-boss-stevens-and-ttip-lobbyists">NHS boss Stevens and the TTIP &#039;trade&#039; lobbyists who threaten our NHS</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/only-article-about-leadership-campaign-i-ll-write">Labour leadership, the NHS, and &#039;honest politics&#039;</a> </div> <div class="field-item odd"> <a href="/ournhs/ournhs/nhs-campaigners-say-no-to-nhs-commission">NHS campaigners say &#039;No&#039; to NHS Commission </a> </div> <div class="field-item even"> <a href="/ournhs/caroline-lucas/why-i-have-removed-my-backing-for-nhs-commission">Why I have removed my backing for an NHS commission</a> </div> <div class="field-item odd"> <a href="/ournhs/stewart-player/accountable-care-american-import-thats-last-thing-englands-nhs-needs">&#039;Accountable Care&#039; - the American import that&#039;s the last thing England&#039;s NHS needs</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/you-can%27t-defeat-politics-of-fear-with-more-fear">Labour made the NHS both scary and boring</a> </div> <div class="field-item odd"> <a href="/ournhs/tamasin-cave/privatising-cabal-at-heart-of-our-nhs">The privatising cabal at the heart of our NHS</a> </div> <div class="field-item even"> <a href="/ournhs/ournhs/labours-new-health-ideas-will-they-rescue-nhs-from-organisational-dementia">Labour&#039;s new health ideas - will they rescue NHS from &#039;organisational dementia&#039;?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Stewart Player Wed, 17 Jan 2018 11:49:10 +0000 Stewart Player 115690 at https://www.opendemocracy.net Former health secretary Andrew Lansley’s diaries finally released in (nearly) full https://www.opendemocracy.net/ournhs/tamasin-cave/former-health-secretary-andrew-lansley-s-diaries-finally-released-in-nearly-full <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> Insurers and private US healthcare giants are revealed to be amongst those on the inside track of creating huge NHS changes. </div> </div> </div> <p class="BodyA"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/Andrew_Lansley,_October_2009_4.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/Andrew_Lansley,_October_2009_4.jpg" alt="" title="" width="460" height="306" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: The previous Conservative Health Secretary, Andrew Lansley. WikiCommons.</em></p><p class="BodyA">Here’s a belated Christmas present. The Andrew Lansley diaries.</p> <p class="BodyA">The journalist, Simon Lewis – who submitted the original freedom of information request to see the Health Secretary’s diaries from the period leading up to his NHS reforms – has kindly just sent them to me. They were released following a court ruling which the government <a href="https://www.theguardian.com/politics/2017/may/24/andrew-lansley-diary-simon-lewis-foi-request-court">lost </a>after spending tens of thousands of pounds over years trying to block their release.<strong></strong></p> <p class="BodyA">Don’t get too excited. It looks big – there are 181 pages of Lansley’s movements from May 2010 to April 2011 – but a lot of it is wrapping. And a few parts are missing. But there are some little gems inside. </p> <p class="BodyA">Having read the first third closely (the rest less so) one thing stands out immediately. </p> <p class="BodyA">Lansley was a busy man. You almost feel sorry for him. Seven am starts, 9pm finishes and a schedule that just seems exhausting. Except, you then remember what he was busy doing: causing <a href="https://www.ft.com/content/a2426282-9758-11e0-9c9d-00144feab49a">“the biggest car crash</a>” in the history of the NHS.</p> <p class="BodyA">What is equally striking, though, is that Lansley didn’t spend all of his first year as Health Secretary supping with the devil. </p> <p class="BodyA">He had some encounters with the private sector, but there are only traces of any dealings he had with the private health insurers; few obvious boozy lunches courtesy of the outsourcers; no mini-breaks on Branson’s island.</p> <p class="BodyA">What it is is a record of a man on a mission to get his reforms through. His days are spent with officials, advisors, ministerial colleagues and allies, on back-to-back ten-minute telephone calls and in half hour meetings.</p> <p class="BodyA"><strong>Day one in the job</strong></p> <p class="BodyA">On 12 May 2010, his first day in the job<strong>,</strong> Lansley called the head of the NHS Confederation, which represents a range of organisations involved in the NHS, including private healthcare companies (ahead of his colleague at the medicines regulator, NICE). He also managed to squeeze an interview with the <em>Daily Mail </em>into his first 24 hours.</p> <p class="BodyA">Similarly, on ministerial photo day, Lansley put a call in to the insurance industry’s chief lobbyist at the Association of British Insurers (ahead of the Welsh Health Minister).</p> <p class="BodyA">A couple of weeks into the job, Lansley sat down with the pharma lobby group, the Association of the British Pharmaceutical Industry. He also continued his ‘policy discussion’ with the NHS Confederation. </p> <p class="BodyA">This contact is pretty unexceptional and to be expected – though its alarming that the private insurers, to whom Lansley had been talking for years, were so favoured. There are, however, two meetings that are more revealing.</p> <p class="BodyA"><strong>Traces of</strong> <strong>McKinsey?</strong></p> <p class="BodyA">The first is a 90-minute internal meeting on 22 June 2010 in the boardroom of the Department’s Richmond House. The topic of discussion was ‘change management’ in the NHS. All the top brass were there: Lansley; David Nicholson, CEO of the NHS; the Department’s permanent secretary, Hugh Taylor; his soon-to-be replacement, Una O'Brien; Lansley’s private secretary, and other very senior DH officials. </p> <p class="BodyA">But joining them were Olly Benzecry, managing director of NHS contractors Accenture, and someone called Colin Price. I’m going to take a punt that this is Colin Price, then a McKinsey director whose expertise is in ‘change management’.</p> <p class="BodyA">This is the only hint in the diaries, though, at Lansley’s contact with McKinsey, which is surprising. We know from other documents I’ve received under FOI that Lansley sanctioned McKinsey’s involvement in the reforms. An email from an unnamed McKinsey employee to senior Department officials in January 2011 <a href="http://powerbase.info/index.php/McKinsey_&amp;_Company%23McKinsey_ready_to_.27dive_in_and_start_trying_to_help.27">reads</a>: “We now have SoS [Secretary of State, i.e. Lansley’s] approval for me to start working with you good folks again… I’d like to dive right in and start trying to help.” There’s no record of any corresponding conversation between Lansley and McKinsey in the diaries. </p> <p class="BodyA"><strong>The UnitedHealth crowd</strong></p> <p class="BodyA">The second of the diaries’ interesting meetings was held on 13 September 2010. Lansley gave 45 minutes to something called the Commissioning Services Industry Group. This is a significant group, dull as it sounds. Commissioning essentially means deciding who gets what health services and who provides them, the NHS or the private sector.<strong></strong></p> <p class="BodyA">Present at the meeting were Lansley, his special advisers, Nicholson and various officials. Among those representing the ‘industry’ was Kingsley Manning, then CEO of outsourcing firm, Tribal. Just weeks earlier, Manning had said that Lansley’s plans ‘could amount to the <a href="http://powerbase.info/index.php/Tribal_Group%23Helping_to_reform_the_NHS">denationalisation</a> of health care services in England’, which ‘could result in the biggest transfer of employment out of the public sector’ since Thatcher’s reforms. ‘The old certainties are gone,’ Manning said, ‘the NHS cannot be protected from economic reality any longer’. </p> <p class="BodyA">Also present were Vincent Sai, then heading up the UK arm of US health insurance giant, Aetna and Ramu Kannan, European MD of rival US insurer, Humana, both of which were seeking to provide NHS commissioning services. </p> <p class="BodyA">Taking up not one, but three seats in the meeting, though, were representatives of a third US health insurer, UnitedHealth. This is the largest private healthcare company in the world, with a revenue in 2016 of $184 billion. It is also the former employer of Simon Stevens, current head of the NHS. Present at the 2010 meeting were UnitedHealth’s chief lobbyist, Tony Sampson, who knew Stevens from when they worked together at the Department of Health in the early 2000s, as well as Katherine Ward, then CEO of UnitedHealth UK and its chair David Ostler.</p> <p class="BodyA">It is likely this group morphed into the <a href="https://www.theguardian.com/society/2014/aug/30/nhs-bosses-summits-contracts-unitedhealth-insurer">Commissioning Support Industry Group</a>. Coordinated by UnitedHealth, it now included McKinsey, PwC, KPMG, Ernst &amp; Young and Capita, but minus Aetna and Humana. From at least 2013, this group received regular briefings from senior health officials on the NHS commissioning market. </p> <p class="BodyA">Who controls NHS commissioning is now a significant concern, with GP groups stepping back and the private sector set to take over.</p> <p class="BodyA"><strong>Gastro-Lansley</strong></p> <p class="BodyA">From the diaries, we can also see that Lansley wasn’t confined to the office. As is common in politics (and lobbying), he also spent time in Westminster’s private members’ clubs and upmarket restaurants. By contrast, his office Christmas Party was snowball dough balls at Pizza Express. </p> <p class="BodyA"><em>Telegraph </em>editor, Ian MacGregor, took Lansley to lunch at Quirinale in September 2010 (although it’s not logged in his hospitality register, which could, possibly, mean that Lansley picked up the tab). </p> <p class="BodyA">A week before presenting the hugely unpopular Health &amp; Social Care Bill to Parliament, Lansley spent an hour and a half over lunch at a roundtable event hosted by the free market think tank, <a href="http://powerbase.info/index.php?title=Reform">Reform</a>, which had done much to champion his plans. The diary doesn’t say who else was round the table, but around that time, Reform was funded by the Association of British Insurers, General Healthcare Group, KPMG, Ernst &amp; Young, Capita, Serco and others with a commercial interest in the reforms. </p> <p class="BodyA">Less than three months later, on the day that Lansley was forced to tell Parliament that his reforms had to be ‘paused’ because of the public outcry, he chose to lick his wounds with unnamed ‘Lords’ at the Athenaeum private members’ club on Pall Mall. </p> <p class="BodyA">Lansley also attended party political events, such as the dinner at Conservative Party conference in 2010 when he sat on the table paid for by the lobbying firm, Hanover. It’s not known which of Hanover’s <a href="http://powerbase.info/index.php/Hanover_Communications">clients</a> at the time – UnitedHealth, Association of British Insurers, Circle Health, Alliance Medical, or American Pharmaceutical Group - were Hanover’s guests too. Neither do we know which Tory donors, some of whom have private healthcare interests, were present at the Conservative Party ‘Leaders Group Dinner’ Lansley attended on 2 March 2011.</p> <p class="BodyA"><strong>One piece of the jigsaw</strong></p> <p class="BodyA">The diaries contain plenty of gaps and redactions where other conversations could and, no doubt, did take place. It’s unlikely this is a faithful account of his working life in its entirety. </p> <p class="BodyA">For example, we know from another FOI release that Lansley was lobbied by a housing association group, which is partnered with one of the UK’s largest firms in telecare (providers of remote healthcare)<strong>,</strong> at an event in October 2010. There is no obvious sign of this in the ministerial diaries.</p> <p class="BodyA">A large number of meetings with Lansley also contain names that have been redacted (under section 40(2), which exempts ‘personal information’), such as the one on ‘reconfiguration‘ on 18 May 2010, and the discussion on the Health Bill on 26 October 2010. Other meetings will be personal, or political, in nature, which also legitimately exempts them. It is frustrating, though, to have incomplete attendee lists, and to not know who his mystery dinner guests were on 26 July 2010.</p> <p class="BodyA">We know too, from previous FOI releases received, that some major private operators that were actively courting Lansley were redirected to members of his team. Private hospital operator, General Healthcare Group, for example, was after a one-to-one with Lansley in June 2010. Its hired lobbyists, Instinctif Partners (then called College Group), and let Lansley’s office know that General Healthcare Group’s chair, Peter Gershon – at the time an <a href="https://www.theguardian.com/politics/2010/apr/07/general-election-tories-peter-gershon-nhs">adviser to David Cameron</a> on efficiency in government – would also tag along. Health minister Earl Howe declined on Lansley’s behalf, instead inviting the firm to meet with NHS chief David Nicholson, and separately, with junior health minister, Simon Burns, who was charged with ‘discussing the contribution of the independent sector’ to the NHS reforms. In October 2010 Burns met with the NHS Partners Network, which represents private healthcare, including General Healthcare Group.</p> <p class="BodyA">Other private companies made contact with the special adviser, Bill Morgan, as is usual. Serco, after seeking a meeting with Lansley, secured a slot with Morgan instead, having run into him at the Christmas party of the free market think tank, Policy Exchange. UnitedHealth’s lobbyist was also in contact with Morgan. You can even see McKinsey attempting to wangle a meeting with Morgan for someone (who, though, is redacted). Again, we know all this from previous FOI releases. </p> <p class="BodyA">It is sometimes opaque in the diary who Lansley is talking to. An entry on 28 February 2011, for example, has him meeting ‘AM’. It is only through Nicholas Timmins account of Lansley’s reforms, <em>Never Again?, </em>that we know this to be Alan Milburn, former Labour health minister and fellow advocate of markets in health who Lansley had approached with a job offer. </p> <p class="BodyA">The diaries, then, provide only another piece of the jigsaw that shows how the private sector sought to influence the government over its radical reforms.</p> <p class="BodyA"><strong>Things go south for Lansley</strong></p> <p class="BodyA">Early on as health secretary, Lansley had been trusted to get on with the job. You can see from the diaries that the Coalition government’s chief policy adviser, Oliver Letwin, who was coordinating across departments, had been checking in with the health secretary. There seems, though, to have been a disconnect between what Lansley was up to and what the government was saying he was up to. </p> <p class="BodyA">The Coalition’s ‘programme for government’, published just weeks after the 2010 election, pledged to ‘stop the top-down reorganisation of the NHS’. The day before this public promise was made, Lansley and officials were busy discussing the ‘RECONFIGURATION’ of the NHS.</p> <p class="BodyA">In early 2011, as opposition to the reforms exploded, the diaries detail the growing concern inside No10. On 23 March, Lansley is down to have a ‘drink with the PM’. The following day was a one-to-one with the Chancellor, George Osborne. No10’s communications chief, Craig Oliver starts appearing in meetings. Then on 31 March, as Timmins also documents, Lansley was summoned to No10 by Cameron and Deputy PM, Nick Clegg. He was informed that his plans for the NHS were to be ‘paused’ as a means of taking the heat out of the debate. Lansley, fittingly, visited a hospice that evening. </p> <p class="BodyA">The following Monday, Lansley was jeered as he announced the pause to Parliament. He must have been a barrel of laughs that evening at a reception for the Saudi health minister and his 18-strong entourage. On the Wednesday, flanked by Cameron and Clegg, he told the media he would ‘listen, reflect and improve’ his plans.</p> <p class="BodyA">There’s nothing in the diary until the following Wednesday, but from then on it’s clear that Lansley isn’t allowed out in public without the PM, DPM, or another ministerial chaperone.</p> <p class="BodyA"><strong>Trading places</strong></p> <p class="BodyA">All this was a long time ago. What’s interesting now, though, is where Lansley and his crew of ‘reformers’ have landed. As is the often the case, many have moved on to work for the private companies that sought to influence them and their successors. </p> <p class="BodyA">Bill Morgan, Lansley’s special adviser, for example, is now a commercial lobbyist. In late 2012, having been at Lansley’s side throughout, he returned to his former employer, lobbyists MHP, before setting up <a href="http://powerbase.info/index.php/Incisive_Health">Incisive Health</a>, an influential healthcare lobbying firm. Its clients today include NHS Partners Network, Virgin Care, the Association of the British Pharmaceutical Industry, as well as, curiously, the grassroots network, 38 Degrees. </p> <p class="BodyA">Sean Worth, No 10’s special adviser on health who was drafted in to help diffuse Lansley’s bomb, quit in summer 2012 for the lobbying industry and now runs his own firm, <a href="http://powerbase.info/index.php/Westminster_Policy_Institute">WPI Strategy</a> (clients unknown).</p> <p class="BodyA">Among the senior officials that feature heavily in the diaries: Jim Easton quit his job as a director at the Department to join healthcare provider, Care UK, which is among the biggest winners from Lansley’s reforms; colleague Ian Dalton went on to become health chief at BT, another beneficiary (he has since returned to the NHS); ex-NHS CEO, David Nicholson now works for, among others, KPMG; Sebastian Habibi, former deputy director at the Department is also now full-time at KPMG; Richard Douglas, the Department’s ex-head of finance is an advisor to Bill Morgan’s lobbying firm, Incisive Health. As is Mike Richards, ex-Chief Inspector of Hospitals, who also took on an advisory role with management consultants, PwC. It employs Alan Milburn too, and former regional NHS director Mike Farrar, who features in the diaries. Neil McKay, another regional director who attended meetings with the secretary of state, is now with consultants GE Finnamore.</p> <p class="BodyA">And then, of course, there’s Lansley himself. Since being removed from his job as health secretary, <a href="http://www.dailymail.co.uk/news/article-3320858/Should-not-work-Ex-Health-Secretary-Andrew-Lansley-defends-private-sector-jobs-including-advising-drugs-firm.html%23ixzz53XcNnPwI">he has been paid by</a>: Blackstone, the US private equity giant, which has significant healthcare interests; US management consultants, Bain, which <a href="https://www.buzzfeed.com/solomonhughes/andrew-lansley-takes-job-with-pro-nhs-privatisation-firm?utm_term=.mi5bmrrVM%23.heJbGooEa">advised clients</a> in 2013 that ‘what was traditionally locked up in the NHS is going to become available to the private sector’; pharmaceutical giant, Roche; and his wife’s consultancy, Low Associates, which provides ‘strategic policy’ advice to clients. All that and a seat in the House of Lords.</p> <p class="BodyA">It is no coincidence that all these people have found themselves employed by companies with an interest in healthcare policy. They are valuable in a market that trades in introductions and intelligence. They are a sign that, while Lansley’s term is over, his reforms have handed the private sector plenty of opportunities worth pursuing. </p> <p class="BodyA">The diaries don’t contain a smoking gun. This is a day-to-day account of a minister who was already persuaded. Instead, what we have is another glimpse of the real and more mundane world of lobbying: of networks, conferences, lunches, phone calls and, for some at least, a seat at the table.</p> <p class="BodyA"><em>Lansley’s diaries can be downloaded <a href="https://opendemocracy.net/files/170719 Lord Lansley Diary for Disclosure 20.7.17.PDF">here</a>. Let me know if you spot anything I’ve overlooked: <a href="https://twitter.com/CaveTamasin">@CaveTamasin</a>. This piece is co-published with <a href="https://badinfluence.net/">Bad Influence</a>.</em></p><div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Tamasin Cave Wed, 10 Jan 2018 13:42:47 +0000 Tamasin Cave 115594 at https://www.opendemocracy.net Privatised services are failing thousands of vulnerable addicts and alcoholics https://www.opendemocracy.net/ournhs/jon-ashworth/privatised-services-are-failing-thousands-of-vulnerable-addicts-and-alcoholics <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>It’s entirely unacceptable that people suffering from addiction are forced to turn to the inadequate private sector for treatment, writes shadow Health Secretary Jon Ashworth in the wake of a damning report by the regulator.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/empty%20bottles.jpg%21d" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/empty%20bottles.jpg%21d" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>The disgraceful failure by the private sector to provide vulnerable addicts with the safest and best quality treatment available was exposed at the end of last month in a <a href="https://www.cqc.org.uk/news/releases/serious-concerns-uncovered-residential-detox-clinics-regulator-demands-improvements">damning report issued by the Care Quality Commission (CQC)</a>.</p><p>72% of private providers of residential-based detoxification were found to have been failing in at least one of the fundamental standards of care that everyone has a right to receive. Shamefully, providing ‘safe care and treatment’ was where the CQC found the most breaches: 63% of providers failed to meet this standard at the time of their first inspection.</p> <p>Detoxification under clinical supervision is often the first stage of a person’s addiction treatment. Often difficult and unpleasant, it is vital that they receive the best possible treatment to support their onward rehabilitation and recovery.</p> <p>And yet systemic faults were found in the way these services are provided by the private sector. Many were basic and entirely avoidable errors.</p> <p>For example, some staff were caught giving paracetamol to people within their care more frequently than every four hours, despite the heightened risk of liver damage among heavy alcohol users. In other cases, staff failed to plan how they would manage fits during withdrawal, despite knowing that the people in their care were at risk of having seizures. </p> <p>Training in basic life support, consent, mental capacity and safeguarding were all found to be severely lacking. At times staff were found to be administering medication, including controlled drugs like methadone, without the appropriate training or being assessed as competent to do so.</p> <p>This is extremely serious. People undergoing residential-based medical detoxification from alcohol or drugs often have complex physical and mental health problems alongside their addictions. According to the Royal College of Psychiatrists, the potential dangers of erroneous detoxification include fits and hallucinations, suicide risk and risk of prescription opiate drug overdose. </p> <p>That’s why it is essential staff looking after these vulnerable patients are properly trained, follow national clinical guidelines and have appropriate 24-hour medical cover.</p> <p>So what explains this appalling failure?</p> <p>My own research in September revealed that the Tories have cut vital alcohol and drug treatment programmes by £43 million this year, forcing many people to turn to the independent sector for help. These cuts are part of wider damaging public health cuts, to the tune of £800 million by 2021.</p> <p>Specifically, 106 local authorities are reducing their drug treatment and prevention budgets this year, with a combined cut across England of £28.4 million. Similarly, 95 local authorities are reducing their alcohol treatment and prevention budgets this year by a total of £6.5 million. Equally concerning, services for children needing help with drink and drugs will be slashed by £8.3m across 70 town halls.</p> <p>Last month the Children’s Society revealed that parent’s alcohol abuse is damaging the lives of 700,000 teenagers across the UK. Frustratingly, at a time when demand for councils’ children’s services is rising, severe funding cuts from central Government are leaving more and more families to deal with these huge problems alone. </p> <p>Yet without support at an early stage as problems emerge, families can quickly reach crisis point and the risks for the children involved grow. </p> <p>The children of addicts must not be forgotten and supporting them is a personal priority of mine. Having grown up with an alcoholic father, I’m acutely aware that as a society we simply aren’t doing enough to deal with the effects of addiction.</p> <p>We know that children growing up with an alcoholic parent can often themselves go on to develop problems with alcohol or drugs or suffer mental health problems.</p> <p>That’s why during our party conference I reiterated my pledge to implement the first ever national strategy to support children of alcoholics and drug users. </p> <p>We also mustn’t ignore other forms of serious addiction. My colleague Tom Watson, Labour’s Deputy Leader, has powerfully exposed the Government’s abject failure to treat problem gamblers. </p> <p>According to the Gambling Commission the <a href="https://inews.co.uk/news/uk/gibraltar-liberia-online-gambling-generates-billions-revenue-real-winners/">number of people with a serious habit has risen to 430,000</a>, with a further 1.6 million at risk of developing a problem.</p> <p>And yet, shockingly, the government has no idea how many problems gamblers are being treated by the NHS or how much their addiction is costing. Like alcohol and drug addiction, we must start viewing gambling addiction as a mental health problem and not a moral failing. </p> <p>Theresa May’s mishandling of Brexit and her narrow majority in the Commons has left her with little ability or inclination to tackle these ‘burning injustices’ across society. Addiction treatment services have unquestionably suffered as a result.</p> <p>Forcing people to turn to inadequate private sector treatment is entirely unacceptable. That’s why Labour will continue the fight to ensure our health and care system, including addiction services, remains public, free at the point of use and there for all who need it.&nbsp;</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/steve-topple/alcoholism-nhs-and-political-hypocrisy">Alcoholism, the NHS, and political hypocrisy</a> </div> <div class="field-item even"> <a href="/5050/leo-barasi/addiction-social-stigma-and-barriers-to-recovery">Addiction, social stigma and the barriers to recovery</a> </div> <div class="field-item odd"> <a href="/transformation/tommy-ellis/why-shouldnt-heroin-addicts-be-punished">Why shouldn&#039;t heroin addicts be punished?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Jon Ashworth Fri, 15 Dec 2017 07:59:00 +0000 Jon Ashworth 115334 at https://www.opendemocracy.net Brexit isn't the only thing parliament needs to demand a vote on right now - the NHS is too https://www.opendemocracy.net/ournhs/ellen-lees/brexit-isnt-only-thing-parliament-needs-to-demand-vote-on-right-now-nhs-is-too <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>In January, Jeremy Hunt will attempt to sneak through secondary regulations, without parliamentary debate, what some have called the ‘biggest change to the NHS since its creation. Do enough MPs care enough to stop him?</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/jeremy-hunt-parliament.png" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/jeremy-hunt-parliament.png" alt="" title="" width="460" height="294" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>Jeremy Hunt is trying to sneak through legal changes that will fundamentally change the NHS - with no scrutiny and no debate.</p> <p>So, no surprise there. </p> <p>The next step for Jeremy Hunt’s plans to overhaul the NHS is the introduction of Accountable Care Organisations (ACOs). ACOs are the latest incarnation of other controversial NHS plans that have been cooked up since Cameron’s infamous 2012 Health &amp; Social Care Act meant the government had less responsibility to secure comprehensive, universal healthcare. Leading <a href="https://healthcampaignstogether.com/pdf/The%20case%20of%20the%20missing%20evidence%20-%20STPs%20and%20Five%20Year%20Forward%20View-2.pdf">campaigners</a>, <a href="https://twitter.com/nhsbillnow/status/935891847045672960">doctors</a> and <a href="https://opendemocracy.net/ournhs/stewart-player/accountable-care-american-import-thats-last-thing-englands-nhs-needs">journalists</a> have scrutinised these latest plans and found them both vague and alarming. In the words of <a href="https://twitter.com/carolinejmolloy/status/939586692310237184">this site’s editor</a>, these so-called Accountable Care Organisations “aren’t accountable, and they don’t really care”.</p> <p>The ACOs (which aren’t, legally, accountable public/NHS organisations) are being “put in charge of allocating resources”, according to leading health campaigner Professor Allyson Pollock – with private ‘partners’ having larger contracts and more and more of a role in decision making, it seems. Kailash Chand of the BMA has also <a href="https://twitter.com/Momentum_NHS/status/938007245404672000">said</a> ACOs are a ‘trojan horse’ for privatisation – particularly as they talk of ‘integrating’ payment systems for both health and social care without addressing the fact that <em>social</em> care has already been mostly privatised. Chand has also warned that GPs “will no longer be independent advocates for their patients” under this new system of outsourced decision making.</p> <p>We now know that Hunt plans to change 10 pieces of secondary legislation to make it possible to create ACOs. The shape of these legal changes will inform what ACOs look like, and whether they are indeed accountable, or if they will pave the way for mass privatisation of NHS services. </p> <p>There is no current plan to allow MPs to debate these changes in Parliament. Jeremy Hunt plans to push these changes through with absolutely no scrutiny from MPs. </p> <p>We need MPs to scrutinise ACOs because of the potential they have to damage the NHS. Some have suggested that there may be a way to introduce ACOs in a way that doesn’t encourage or allow privatisation, and which integrates primary and secondary NHS services. But the evidence is scanty – and there is the sizeable risk that ACOs will be vehicles for large scale privatisation by healthcare organisations like Kaiser Permanente. They are, after all, based on an American system of healthcare organisation – and Michael Moore’s devastating film Sicko exposed how ‘Accountable Care’ in the US means denial of care, and how ‘prevention’ means making it hard for patients to access hospitals. </p> <p>So, it couldn’t be more important that MPs get a say in how ACOs are implemented.</p> <p>Jonathan Ashworth has tabled EDM 660 to gather support in Parliament from MPs for a debate on ACOs. He has written to Andrea Leadsom, the leader of the House of Commons, to ask her to call a debate. At the time of writing, 59 MPs have signed EDM 660, but we need many more.</p> <p>We’ve set up a tool to let you email your MP and ask them to sign the EDM. Over 8,000 emails have been sent so far, and nearly every MP has received at least one email, but more pressure is needed! <a href="https://weownit.org.uk/act-now/demand-debate-nhs-privatisation">Take action here</a> by entering your postcode.</p> <p>The more MPs sign EDM 660, the more pressure will be put on the leader of the House of Commons to allow a debate. This EDM is different to most, in that it can be signed by ministers and shadow ministers. Usually ministers stay away from EDMs, but this one was tabled by Jeremy Corbyn and members of his shadow cabinet team, so all MPs are encouraged to sign. </p> <p>It’s not exclusive to Labour MPs either! SNP MPs have signed (even though ACOs are unlikely to <em>directly</em> affect the Scottish NHS, <a href="https://opendemocracy.net/ournhs/caroline-molloy/vote-yes-for-nhs-independence-is-best-chance-to-protect-scotland%27s-nhs">they may well affect it indirectly</a>) as has Green MP Caroline Lucas. Conservative MPs are unlikely to sign an EDM sponsored by the leader of the opposition, although some with a regard for due process might be able to sign it... Regardless, Conservative MPs should certainly be encouraged to write to Andrea Leadsom and ask for a debate. They will be much more influential than letters from Labour MPs.</p> <p>Are Conservatives interested in ensuring that Parliament gets a say on the future of the NHS?</p> <p>This is urgent – we’ve only got a few days to make sure MPs get a say on the future of the NHS. The changes are set to go through in January, and with the Christmas holidays on the horizon, Parliament is running out of time to schedule a debate. <a href="https://weownit.org.uk/act-now/demand-debate-nhs-privatisation">Email your MP now</a>.</p> <p><em>Additional reporting by Caroline Molloy</em></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/stewart-player/accountable-care-american-import-thats-last-thing-englands-nhs-needs">&#039;Accountable Care&#039; - the American import that&#039;s the last thing England&#039;s NHS needs</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/jeremy-hunt-considers-banning-patients-from-walking-up-to-aes">Jeremy Hunt considers banning patients from walking up to A&amp;Es</a> </div> <div class="field-item odd"> <a href="/ournhs/jenny-shepherd/are-plans-to-move-nhs-into-community-wolf-in-sheeps-clothing">Are plans to move the NHS &#039;into the community&#039;, a wolf in sheep&#039;s clothing?</a> </div> <div class="field-item even"> <a href="/ournhs/allyson-pollock/why-next-labour-manifesto-must-pledge-to-legislate-to-reinstate-nhs">Why the next Labour Manifesto must pledge to legislate to reinstate the NHS</a> </div> <div class="field-item odd"> <a href="/ournhs/john-lister/if-our-government-won-t-act-to-save-our-nhs-then-we-must">If our government won’t act to save our NHS this winter, this is what we must do</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Ellen Lees Thu, 14 Dec 2017 08:33:36 +0000 Ellen Lees 115310 at https://www.opendemocracy.net ‘GP at hand’: handy for whom? https://www.opendemocracy.net/ournhs/david-mccoy-lewis-hier-thomas/gp-at-hand-handy-for-whom <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>New technology should be managed for the benefit of all – not used to allow profit-hungry firms to cherry-pick healthy patients.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/smartphone.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/smartphone.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: <a href="https://www.pexels.com/photo/iphone-technology-iphone-6-plus-apple-17663/">Adrianna Calvo/Pexels</a>.</em></p><p>A new initiative for a private company to deliver NHS care in London was launched last month. Catchily titled <a href="https://www.gpathand.nhs.uk/"><em>GP at hand</em></a><em>, </em>it promises access to your GP remotely through a video consultation from your hand-held smartphone or tablet. It guarantees a same-day appointment; but if you need to see a health professional in the flesh, you can go to one of six clinics located in London.</p> <p><em>GP at hand </em>is run by Babylon Healthcare Services Limited, a commercial outfit that can be traced back to a <a href="https://beta.companieshouse.gov.uk/company/09229684/filing-history">holding company in Jersey</a>. Heading up Babylon is Ali Parsa, ex-Goldman Sachs banker and former Chief Executive of Circle, the company at the heart of the failed experiment to privatise the management of Hinchingbrooke Hospital near Cambridge, and which resulted in <a href="https://www.theguardian.com/society/2014/sep/26/care-quality-commission-hinchingbrooke-hospital">compromised patient care</a> and<a href="https://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news/report-circle-withdrawal-from-hinchingbrooke-hospital/"> a costly bill</a> for the taxpayer. <a href="http://uk.businessinsider.com/deepmind-cofounders-invest-in-babylon-health-2016-1">Amongst Babylon’s investors is Demis Hassabis</a>, founder of the <a href="http://www.deepmind.com/">DeepMind</a> company which was recently caught up in a controversy with the Royal Free NHS Trust over <a href="http://www.bbc.co.uk/news/technology-39301901">concerns about inadequate protection of patient data</a>. </p> <p>Patients will register with <em>GP at hand</em> as their GP practice. Every patient registered will come with an allocation of public money that will effectively be the payment to <em>GP at hand</em> for providing NHS primary care. </p> <p>This allocation of money per registered individual is one of the main ways that GP practices are funded, and is often called a capitation fee. The fee is set by the Department of Health, and adjusted for individual practices to accommodate factors such as the estimated level of disease burden and socio-economic deprivation of a GP practice’s patient list. </p> <p>The way <a href="https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/commissioning-and-funding-general-practice-kingsfund-feb14.pdf">GP practices are funded</a> is actually more complex. For example, they are also paid for achieving certain targets, or providing additional specialised services. However, a key feature of the funding model is that budgets are set for populations, rather than individuals. Thus, the capitation fee of all individuals on a GP practice list is combined into a single (and larger) budget that is used to plan and provide services. </p> <p>Traditionally, the practice list is made up of a mix of people (old and young, healthy and unwell) who live nearby. Such a system affirms two key traditional principles of the NHS. Firstly, that NHS funding is pooled to allow the healthy to subsidise the costs of treating those who fall sick or are injured. Secondly, that healthcare services are organised around geographic areas to enable better integration and coordination with local hospitals and local authority services.</p> <p><em>GP at hand</em> is set to undermine this model of primary care. It is looking to register patients who live or work within anywhere within 35-40 minutes of one of the clinics - either home or work, provided they are happy to see their doctor remotely by video and willing to travel to one of six clinics in London should they need a physical consultation. One way that private companies maximise their profits is to seek to ‘cherry pick’ low-cost patients who are generally healthy and young while excluding patients with complex needs who will need higher levels of care. This <a href="https://www.theguardian.com/society/2017/nov/06/gp-smartphone-service-risks-luring-frontline-practice">concern was raised by the Chair of the Royal College of GPs, Helen Stokes-Lampard</a>, who said in response to the launch of <em>GP at hand </em>that “we are really worried that schemes like this are creating a twin-track approach to NHS general practice and that patients are being ‘cherry-picked”. Indeed, its<em> </em>own promotional material <a href="https://support.gpathand.nhs.uk/hc/en-us/articles/115003670889-Can-anyone-register-">discourages</a> older people, pregnant women and anyone with ‘complex’ social, physical and psychological needs from registering, noting that the NHS feels these groups would be "less appropriate" for the service.</p> <p>It’s not hard to see how this cleaving of populations between those who are relatively young and healthy and those who may need physical consultations, home visits or urgent treatment could result in a widening of inequities. A divide will also be created between companies like <em>GP at hand</em> who will run a profit driven system of care for selected clients, and traditional GP practices who will remain committed to the principle of holistic and integrated care <em>for all</em> in their local community. </p> <p>In theory, the fee paid to <em>GP at hand</em> could be reduced to reflect their younger and healthier client list. Currently, we don’t know what fees and payments <em>GP at hand</em> is getting from the NHS. However, we do know that the setting of more specific risk-adjusted capitation fees would be complex and costly. We also know that for-profit companies will be expected to game the system<strong> </strong>in their favour, and that attempts to regulate such behaviour will add further costs for the taxpayer (with no guarantee of success).</p> <p><em>GP at hand</em> is perhaps the logical extension of controversial changes made in 2013 which allowed individuals to register with GP practices outside the local area of their home, such as where they work. Although ‘commuter practices’ and ‘electronic practices’ like <em>GP at hand</em> might be more convenient for some individuals, they can diminish the efficiency of the health<em> </em>system as a whole. </p> <p>This is not to say that we should deny or ignore developments in information technology and artificial intelligence. The ‘digital health revolution’ has the potential to improve healthcare, including for the frail, elderly and chronically unwell. And one can argue that new technologies <em>should</em> be disruptive of old models of service provision.</p> <p>But technological disruptions should also be socially managed to avoid unwanted effects or inadvertent harms. They should also be harnessed to improve the quality of the healthcare system <em>as a whole</em> and <em>for everyone</em>, not just cheapen the cost of delivering care. And they should not be a Trojan Horse for private capital to exploit the NHS and undermine those features that make it fair, trusted and hugely respected across the world.</p> <p>The NHS should work with private digital companies. But not through this particular model of primary care, and perhaps not with a company that can be traced back to a holding company based in Jersey and to the <a href="https://www.opendemocracy.net/ournhs/caroline-molloy/hinchingbrooke-why-did-england%27s-privatised-hospital-deal-really-collapse">Hinchingbrooke debacle</a>. </p> <p><em>Editors note:</em></p> <p>openDemocracy asked Babylon for a statement responding to the concerns raised in the piece. They responded that “Babylon’s mission is to put accessible and affordable healthcare in the hands of every person on earth” and that they were “leading the way in using technology to make it more accessible to all”, adding ''This new NHS service makes it&nbsp;easier for patients to see a doctor&nbsp;quickly&nbsp;at anytime and&nbsp;from&nbsp;anywhere and&nbsp;doesn’t cost the NHS a penny more.&nbsp;It’s a win&nbsp;win.”</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/shibley-rahman/247-transparent-nhs-%E2%80%93-or-rise-of-planet-of-apps">A 24/7, transparent NHS – or the rise of the planet of the apps?</a> </div> <div class="field-item even"> <a href="/ournhs/alex-nunns/hinchingbrooke-how-disastrous-privatisation-duped-political-class">Hinchingbrooke - how a disastrous privatisation duped the political class</a> </div> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/hinchingbrooke-why-did-england%27s-privatised-hospital-deal-really-collapse">Hinchingbrooke - why did England&#039;s privatised hospital deal REALLY collapse?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Lewis Hier Thomas David McCoy Fri, 01 Dec 2017 12:00:00 +0000 David McCoy and Lewis Hier Thomas 114924 at https://www.opendemocracy.net We survive - but AIDS is not over - a BANG BUS special https://www.opendemocracy.net/uk/ash-kotak/we-survive-but-aids-is-not-over-bang-bus-special <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>AIDS is not over – not for the millions still being infected both at home and globally, nor for those of us still living with the consequences of infection, survival and harsh early treatments. We need both actions and memorial.</p> </div> </div> </div> <p class="Body"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/Bang Bus World AIDS Day Special - Miqx - ACT UP LONDON.png" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/Bang Bus World AIDS Day Special - Miqx - ACT UP LONDON.png" alt="" title="" width="460" height="302" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Bang Bus tour, 25th November 2017, by Holly Buckle.</em></p><p class="Body">Last weekend the BANG BUS - World AIDS Day Special bought together a group of creatives, medical staff and HIV activists in a theatrical bus-tour of London’s fight against HIV/AIDS.</p> <p class="Body">As well as remembering the struggle, the past actions and slogans and our key turning points – and demanding a memorial as so many other countries have built – we also reminded onlookers that AIDS is Not Over, and warned the government “Don’t F*** with our NHS”. <em>&nbsp;</em><em></em></p> <p class="Body"><strong>AIDS is Not Over</strong><strong></strong></p> <p class="Body">The majority of the 104,000 plus people living with HIV in the U.K. now live near normal lives. Yet <em>AIDS is Not Over. </em>&nbsp;</p> <p class="Body">Last year’s figures are startling: Over 1 million people died of AIDS worldwide, according to the Bloomsbury Clinic HIV unit/UCL. Five thousand people died in the USA alone (where only 30% of positive people access medications). There were over a million new infections, taking the number living with HIV worldwide to over 38 million people - a staggering 53% of whom cannot access life-saving treatment. </p> <p class="Body">AIDS remains a political choice, a syndrome that kills the poor and women worldwide (51% of all cases are in women). Some gay men in the Western world speak of the end of AIDS and a post-AIDS world. It seems to be a rather ‘I’m okay Jack’ attitude: “We have our meds; we will survive Gloria and so it’s business as usual”. Figures from other London clinics such as 56 Dean Street show that new infections in the U.K. for white gay men have fallen dramatically over the last couple of years. But in the UK, they are not falling dramatically amongst black and ethnic minority men (both gay and straight) or the trans community, and amongst women the figures rose. </p> <p class="Body">Forgotten too are us long-term survivors. Many of us live without savings or pensions. Our disability benefits – our lifeline - are being stolen in the government’s inhumane ‘austerity’ drive. We suffer from the inadequacies of the early medications – before the 1996 medical miracle of combination therapy - and their long-term side effects such as exhaustion, depression, lipodystrophy (muscle wasting and localised loss of fat tissue) and now cancers. And we are developing age-related new conditions - the majority of people living with HIV in the UK are now over 50. &nbsp;</p> <p class="Body">We were meant to die, many of us were on the verge of death and we survived only to be now attacked, once more by an indifferent Britain of 2017. &nbsp;</p> <p class="Body">Then there is the PTSD and other mental health issues caused by being told at a young age there was little hope. &nbsp;We cared for so many loved and still remembered friends, rehearsing our fates as they died terrible deaths. Then against all odds, we survived. We are scarred not just by the plague and its early treatments, but by guilt - ‘how did I survive when my friends are dead?’. And shame remains an issue. &nbsp;The morality police, mimicking the grotesque newspaper headlines of the 1980s and 1990s, remain a constant added pressure. </p> <p class="Body"><strong>Stigma</strong><strong></strong></p> <p class="Body">Prejudice is the overriding blindness of HIV/AIDS, a dark smog over the world. Guilt relates to others (our dead friends), whilst shame completely invades the self, stemming from an ever present sultry stigma. &nbsp;It has shown the failings of us as human beings and of our huge collective fear of death. It has led to the destruction of love and loving relationships and to an unbearable loneliness of HIV positive people, a huge killer in itself. &nbsp;Stigma is especially bad from the same communities which bore the brunt of AIDS. Just ask any positive gay man in the UK or those from the black and minority ethnic communities. &nbsp;Of course there are many enlightened soldiers who fought and continue to fight with us, but it still feels like a continuous civil war.</p> <p class="Body">Over 30 years since the effective/shocking 1986 <em>Don’t Die of Ignorance</em> Campaign, its fearmongering message still prevails and its evocations are remembered: a volcano erupting (in Britain!); a tombstone being chiselled sounding like a pressing death knell (on display now at the Wellcome Collection, London). Above all the immortal voice of John Hurt’s warning “a danger that has become a threat to us all.” </p> <p class="Body">I produced a short film in 1987 which John starred in not long after he did the advert. It won many awards and we remained friends, often meeting for drinks in the infamous Coach and Horses in Soho, London. Overt homophobia and racism were ever present in those days, living in ‘sin’ was not the norm and underage sex was ignored. A mutual drinking buddy, an actor, had suddenly died of AIDS in 1988 and it all became very real to us. John Hurt declared, for all to hear, “I wish I’d never done that bloody ad”. Showbiz was being hit hard, and the media-fuelled cruelty shown by our fellow Britons towards the severely ill was soul-destroying. </p> <p class="Body">In September 1993 I disclosed to John I had been diagnosed after having been raped (not that it matters how one acquires HIV, but male-male rape is an issue we still barely recognise). I was too scared to report it; I was young, drunk and looking for love in very hostile times, and carried the additional burden of coming from a community that was pushing me to marry for the sake of the family name. John bought me a drink. He told me that it will make me look at who are important in my life, what I value and it will focus me on what matters. He always knew what to say. I reminded him of what he had said about the tombs and volcano advert. “Did I say that!” he answered in his well recognised voice. </p> <p class="Body">Two years later, in 1995, my partner died and an ex-lover soon after and too many close friends; death was all around. I was not even 30; in retrospect life became more urgent, dancing beside death and his gloomy game with life. We danced a lot in those days - often at Trade after funeral after funeral. &nbsp;</p> <p class="Body"><strong>Turning Points</strong> </p> <p class="Body">Today with the availability of <em>PREP</em> (a pill taken prior to sex to stop the transmission of HIV) and <em>PEP</em> (a combination of pills to stop HIV taking hold after unsafe sex or rape), we now have the tools to stop the spread of HIV. Also it is now generally accepted that U=U – i.e. that Undetectable equals Untransmittable/Uninfective. In other words, anyone who is on treatment for HIV and has reached an undetectable viral load status in their blood, cannot pass on HIV. Undetectable is the new negative.</p> <p class="Body">Between September 2010 and May 2014, the PARTNER study monitored 1166 sero-different couples at 75 clinical sites in 14 European countries. Entry criteria included the positive partner having an undetectable viral load on treatment and that the couples were not always using condoms when they had sex. After at least 58,000 distinct times when couples had penetrative sex without condoms there were zero transmissions of HIV from the undetectable partner to the negative partner. It is a turning point. </p> <p class="Body"><strong>Fast-Track - Ending the AIDS epidemic by 2030</strong><strong></strong></p> <p class="Body">The Executive Director of UNAIDS, Michel Sidibé gave a stark warning only one year ago “The progress we have made is remarkable, particularly around treatment, but it is also incredibly fragile. New threats are emerging and if we do not act now we risk resurgence and resistance. We have seen this with TB. We must not make the same mistakes again.” There is an international fast-track strategy in place to end the spread of the AIDS pandemic by 2030 set by UNAIDS. But none of the UK political parties are doing enough about it – as has long been the case.</p> <p class="Body"><strong>Save the NHS</strong><strong></strong></p> <p class="Body">So what are these new threats? </p> <p class="Body">Another BANG BUS theme was <em>Don’t F*** with the NHS</em>. Each year in the UK too many people needlessly die of AIDS as they test too late. NHS HIV specialist services are vital to ensure that treatment is adhered to and new infections are caught early. </p> <p class="Body">A pilot scheme at London’s King’s College Hospital A&amp;E, where routine HIV tests were taken, found 32 people unknowingly carrying the virus. They are lucky that they were caught early. This scheme must be expanded throughout the UK. </p> <p class="Body">The growing threat of drug-resistance needs to be taken far more seriously. Other challenges are the mental health issues connected to contracting a once life-threatening virus, which can lead to suicide, drug taking and alcoholism and poor medicine adherence. Chemsex (when people take drugs that enhance sex and make them feel uninhibited) is a huge issue for gay men in metropolitan areas in the Western World and needs to be treated without prejudice. There is also the growing threat of co-morbidity factors, as the HIV population ages, and a resultant medical interaction situation.</p> <p class="Body"><strong>#AidsMemoryUK Campaign </strong><strong></strong></p> <p class="Body">The final theme of the Bang Bus was the need of <em>a National AIDS Tribute in London - </em>the city which was home to the most people who died of AIDS in the UK and from where the early response against the battle was directed from. Having won many battles, a lot of us need closure and a place to focus our memories and our bereavements. </p> <p class="Body">AIDS was, and continues to be, the major health issue of the latter 20th and early 21st centuries, killing 35 million people worldwide, so far. Many countries have national memorials including the USA, most EU countries, South Africa, Brazil, Russia, Belarus and the Ukraine. But the UK lags behind. AIDS is part of the UK’s history, it changed how we looked at ourselves as a nation. It is a triumphant example of how people came together often with contradictory value systems and overcame their own prejudices to fight together. It is an important message to remember.</p> <p class="Body">On the BANG BUS, different communities of all ages, classes, sexualities, genders, races, politics, religions, positive, undetectable and negative shouted AIDS is Not Over, Don’t F*** with the NHS and Support the AidsMemoryUK Campaign. We demanded that our memories and pain are memorialised. We demand that 38 million people have access to HIV medications. </p> <p class="Body">Activists from ACT UP London carried their own wounds, their memories, and their gallantry awards on foot, in heels, in wheelchairs, with walking sticks and leg braces to say we are still here, we survived, we must never forget.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/5050/jane-shepherd/rhetoric-meets-reality-debating-hiv-and-aids">Rhetoric meets reality: ending HIV and AIDS</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> uk uk ourNHS Ash Kotak Fri, 01 Dec 2017 08:54:06 +0000 Ash Kotak 115001 at https://www.opendemocracy.net Connor Sparrowhawk: How one boy’s death in NHS care inspired a movement for justice https://www.opendemocracy.net/shinealight/shinealight/sara-ryan-clare-sambrook/connor-sparrowhawk-justiceforLB <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <ul><li>The story of a UK campaign for truth and accountability. And respect for the lives of people who have learning disabilities. Review by Clare Sambrook. Extract by Sara Ryan.</li></ul> </div> </div> </div> <p style="text-align: center;"><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/Ryan_Sara.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Sara Ryan"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/Ryan_Sara.jpg" alt="" title="Sara Ryan" width="460" height="376" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'><span class='image_title'>‘What has Steve Wright got, Mum?’ he asked. ‘DJitis,’ I said. Sara Ryan (Rich Huggins)</span></span></span></p><hr /><p>&nbsp;</p><h2><a href="http://www.jkp.com/uk/justice-for-laughing-boy-2.html"><em>Justice for Laughing Boy: Connor Sparrowhawk – &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;A Death by Indifference</em>, by Sara Ryan</a></h2><h2>Review by Clare Sambrook</h2> <p>Sara Ryan began a blog six years ago, “mostly to document the funny stories that happened in our everyday lives.” Called <a href="https://mydaftlife.com">mydaftlife</a>, it’s a warm and funny read. Ryan has an ear for dialogue, a photographer’s eye —&nbsp;and she’s a nifty swearer. Star of the show is her son Connor, his quirky take on life. One of five children, they call him Laughing Boy, LB for short. He loves lorries, buses, coaches, London, Eddie Stobart, and the family’s Jack Russell, Chunky Stan. </p> <p>Connor is 15 when the blog starts. Here’s a conversation:</p> <ul><li>‘Hey LB! How did meal prep go today?’</li><li>‘Not good, Mum.’</li><li>‘Oh. Why not?’</li><li>‘I failed, Mum.’</li><li>‘Whaddayamean, you failed?’</li><li>‘I failed, Mum.’</li><li>‘Why? What did you cook?’</li><li>‘Kebabs, Mum.’</li><li>‘Oh. I don’t get it. What went wrong?’</li><li>‘I didn’t have a skewer, Mum.’</li><li>‘Oh. Why not?’</li><li>‘Dunno, Mum.’</li><li>‘So what did you eat for lunch?’</li><li>‘Bits, Mum.’</li></ul> <p>Connor has autism, learning difficulties, epilepsy. He’s nearing 18 and the prospect of leaving school, the people he knows and likes, when the story darkens. An early encounter with adult social care comes with a manager’s humourless remark: “I am his future.”</p> <p>At home and at school Connor becomes anxious, unhappy, unpredictable, unlike himself. Things come to a head when he punches Big Sue, his beloved support teacher. The family, at their wit’s end, learn that there’s an NHS unit close by that can help. It’s a Short Term Assessment and Treatment Unit (STATT, for short), a mile or two from their Oxford home. It’s called Slade House and run by Southern Health NHS Foundation Trust. There a team of learning disability specialists —&nbsp;psychiatrists, psychologists, occupational therapists, nurses —&nbsp;will keep Connor safe, take a few weeks to assess him, work out the cause of his distress.</p> <p>Connor is admitted one night in March 2013. The next morning, in the early hours, he is forcibly restrained by four staff, pinned face-down. Says Ryan: “That was the day he stopped being a sixth former.”</p> <p>Weeks pass. Connor loses weight. One morning, fifteen weeks and two days after his admission, Connor (he has epilepsy, remember) is left alone, behind a locked door, out of earshot, in a steep-sided bath. He has a seizure. And he drowns.</p> <p>His <a href="https://mydaftlife.com">mother’s blog</a>, and now her book, tells this story and its brutal aftermath, as Connor’s family tries to find out what exactly happened to him, how on earth it <em>can</em> have happened at all. </p><p> <span class='wysiwyg_imageupload image imgupl_floating_left 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/Ryan_Justice640.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/Ryan_Justice640.jpg" alt="" title="" width="240" height="363" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_medium" style=""/></a> <span class='image_meta'></span></span></p><p><a href="https://www.inquest.org.uk/family-campaigns">Other families</a> bereaved by state neglect and wrongdoing might find their own experience reflected here: the “indescribable terror”, the pain and struggle, being blocked and bewildered by official lying and contempt. The bullying and the bruising, the character attack, the surveillance, the accusation that <em>you&nbsp;</em>are the problem. </p><p>The waiting. </p><p>And the inequality of arms. About the early days, Ryan writes: “We had no idea how uneven the ‘playing field’ was in a game we didn’t yet understand we were playing.”</p> <p>Ryan’s craft —&nbsp;she is a Senior Research Lead at Oxford University —&nbsp;serves the fight.<strong> </strong>Her partner Richard Huggins is an academic too. Their #JusticeforLB campaign, supported by family, friends, and the charity INQUEST, forces the exposure of negligence and incompetence on a scale that is hard to comprehend. </p> <p>It turns out that seven years <em>before</em> Connor died, another patient <a href="https://mydaftlife.com/2016/03/27/one-way-wriggle-to-the-moon/">drowned in the same NHS unit</a>. <em>In the same bath.</em> A fact that Southern Health concealed for more than two years after Connor’s death. </p> <p>It turns out that Southern Health has <a href="https://www.theguardian.com/society/2015/dec/09/southern-health-nhs-trust-failed-investigate-patient-deaths-inquiry">failed properly to investigate</a> more than 1,000 unexpected deaths —&nbsp;in only four years —&nbsp;and that the deaths of people with learning disabilities are least likely to be investigated. Fewer than 1% of <em>their</em> unexpected deaths have been looked into. <em>One per cent</em>. As if their lives and deaths don’t matter.</p> <p>Without #JusticeforLB these things and more would likely have stayed hidden.</p> <p>Ryan points to the premature mortality rates of people with learning disabilities in the UK, the hate crime, the “lukewarm outrage” to documented experiences of abuse, the lethal undertow of eugenics.</p> <p>Connor’s life, a happy life, well-lived, shared, recorded, celebrated, proves the wrong and falsity in all of that. </p> <p>Ryan’s book speaks of a family’s dreadful loss, charts a creative, comradely and joyous campaign for truth, for justice and accountability, strikes a blow for human rights. And brings to life her funny, kind and much-loved son.</p><hr /><p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/buses_line_2bigger5.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/buses_line_2bigger5.jpg" alt="" title="" width="460" height="65" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'></span></span></p><hr /><p>&nbsp;</p><p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/3500.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Connor at his school prom"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/3500.jpg" alt="" title="Connor at his school prom" width="460" height="276" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'><span class='image_title'>Connor at his school prom (#JusticeforLB)</span></span></span></p> <p>&nbsp;</p><h2><a href="http://www.jkp.com/uk/justice-for-laughing-boy-2.html"><em>Justice for Laughing Boy: Connor Sparrowhawk – &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;A Death by Indifference</em></a></h2><h2>Extract by Sara Ryan</h2><p>One thing that was never pinned down during the inquest was what actually happened on the morning Connor died. We found out from the documentation and witness statements that Connor woke up and was going to have a bath before going to visit the Oxford Bus Company. According to the documentation his support worker and key nurse checked on him every 15 minutes until 9.15am when he was found unconscious. Where the decision for 15-minute observations came from was never uncovered, as witness after witness was asked and said they didn’t know.</p> <p>They were both in the nurses’ office which was across the corridor from the bathroom, a short distance away. The support worker was doing an online Tesco order in between checking on Connor. The mundaneness of this detail fills me with queasiness. Still. Ticking the ‘3 for 2’ box while Connor drowned feet away. Their statements and witness testimony provided contradictory evidence about who did what and when. The support worker’s evidence revealed that the bathroom door was locked. She used a key to open it before she found him. Until then, we hadn’t been told that the bathroom door had been locked. </p> <p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/connor_bus2.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="‘Bus’ by Connor Sparrowhawk"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/connor_bus2.jpg" alt="" title="‘Bus’ by Connor Sparrowhawk" width="460" height="316" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'><span class='image_title'>‘Bus’ by Connor Sparrowhawk</span></span></span></p><p>So, not only was Connor not supervised in the bath, but he was locked in the room. This was presented as allowing Connor the privacy to do ‘what boys do in the bathroom’. It was never made clear who locked the door. When it was raised a second time, one or two barristers leapt up to say that we did not know if the door was ‘locked’ – this in spite of the evidence given by the support worker that she had ‘used a key to open it’.</p> <p>Thinking back to Connor bathing at home in the downstairs bathroom with no door, and a constant in‑and‑out of talking to him, reminding him to wash his hair, chatting&nbsp;to him and answering his endless questions, I felt physically sick. In 18 years, we had never left him in the bath with the door shut, let alone locked. Big Sue and Tina said that, on residential school trips, they would always stand by the door of the shower and talk to the kids, even those without epilepsy. </p> <p>Sitting there in full view of the jury and listening to the evidence – ‘I checked…oh no, he checked’ sort of stuff – my brain was screaming: ‘What the actual fuck were you doing? Who checked? When? Did you ever fucking “check”? Or did you suddenly wonder where he was?’ The contradictory evidence over who checked and when was never fully addressed during the inquest.</p> <p>Staff evidence exhibited a mix of remorsefulness, defensiveness, reflectiveness and the downright offensive. The hardest to sit through was [consultant psychiatrist] Dr Murphy, which spread from the Friday afternoon in person to the following Monday by video link from Ireland.</p><p style="text-align: center;"><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/Justicequilt-6_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Step-dad, Rich, brothers Owen &amp; Tom, Connor (far right) two weeks before his death (Ryan)"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/Justicequilt-6_0.jpg" alt="" title="Step-dad, Rich, brothers Owen &amp; Tom, Connor (far right) two weeks before his death (Ryan)" width="460" height="308" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'><span class='image_title'>Step-dad, Rich, brothers Owen & Tom, Connor (far right) two weeks before he died (Ryan)</span></span></span></p> <p>We knew from the Verita review [February 2014,&nbsp;<a href="http://www.southernhealth.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=76277">PDF here</a>]&nbsp;that Dr Murphy had assessed that Connor had not had a seizure on 20 May. She took his subsequent statement that he remembered biting his tongue when angry as the accepted version of what happened without discussion with us. The fact that she interacted with Connor a handful of times across the 107 days was irrelevant.</p> <p>When asked about if Connor had had a seizure, would it be appropriate to leave him in the bath, she replied, ‘If it was a proven seizure, it wouldn’t have been appropriate.’ She went on to say, ‘My understanding is Connor didn’t have a seizure while he was on the ward’ – a point the Coroner dismissed, gently reminding her Connor had a seizure on the day he died.</p> <p>When questioned about the bleedingly obvious point that you don’t rule seizure activity out in a patient with epilepsy, she replied, ‘I made a judgement call on that day, with all the information I had and I’m always thinking bigger picture and I think that’s normal.’</p> <p>Paul Bowen QC, [the family’s barrister] making his polite, missile-like points, continued his questioning, drawing on the testimony of expert witness Professor Crawford, a consultant neurologist and Director of the Special Centre for Epilepsy, York.</p><p>‘Dr Ryan had seen her son have seizures in the past.’</p> <p>‘Yes.’</p> <p>‘And she had seen how he presented after a seizure. And she was the best person to know, having seen him that day whether it was likely or not that he had had a seizure, wasn’t she?’</p> <p>‘I suppose so.’</p> <p>‘And indeed, I could put it to you that Professor Crawford draws the conclusion that it probably was as a result of an unobserved seizure that he bit his tongue.’</p> <p>‘Well, with all due respect, Professor Crawford wasn’t there.’</p> <p>‘I could say the same, you weren’t actually there when he was supposed to have had the seizure.’</p> <p>No.</p> <p>The inquest was obviously a difficult process, and compounded by what seemed to be a continuing tendency to mother‑blame. The staff witness statements produced for Connor’s inquest offered further examples of this. This set of statements typically included a section headed ‘My Relationship with Dr Ryan’ or just ‘Dr Ryan’. Such a heading was unnecessary for many reasons, not least that Connor clearly had a large family who (apart from Tom, who at 13 years old was not allowed on the ward) visited him in the Unit and interacted with staff. It was also odd given I was called Sara in the Unit – there was no ‘Dr’ stuff in those days.</p><p style="text-align: center;"><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/connor_tom.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Connor and his brother Tom"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/connor_tom.jpg" alt="" title="Connor and his brother Tom" width="460" height="339" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'><span class='image_title'>At Marble Arch, waiting for the bus home after birthday day out, Connor & Tom (Sara Ryan)</span></span></span></p> <p>Charlotte [Haworth Hird, a leading human rights solicitor] sent us these witness statements in September 2015 with an email warning us of the content. It’s odd really, contrasting the actions that help or ease, with those that make a devastating situation worse. Reading the evidence in advance of Connor’s inquest was devastating. For example, a student nurse who until that point I thought I had got on well with stated:</p> <p>‘I had seen Dr Ryan shouting at a consultant and I did not want to experience that. I was scared of her; she was a bit different.’</p> <p>When something goes catastrophically wrong, pinning the blame on ‘Mum’ or the family rather than trying to establish openly and transparently what went wrong is one of those aspects of public sector provision that has consistently floored us over the past few years. Of course, mother-blame does, in effect, help to relieve a Trust or County Council from having to think about the pain and grief bereaved families experience.</p> <p><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/Ch6x2nsWwAEZjdZ.jpg-large_0.jpeg" rel="lightbox[wysiwyg_imageupload_inline]" title="Craftivisim by George Julian"><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/Ch6x2nsWwAEZjdZ.jpg-large_0.jpeg" alt="" title="Craftivisim by George Julian" width="240" height="300" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style=""/></a> <span class='image_meta'><span class='image_title'>Craftivisim by George Julian #JusticeforLB</span></span></span>It is also indicative of a wider shortcoming in many health and social care services – of failing to want to understand the experiences and views of families, and failing to factor this in when making decisions or statements.</p> <p>The County Council was also firing nuclear-type missiles our way. We received an independent report commissioned by the Director of Adult Social Care one morning, out of the blue. The report arrived in my inbox two weeks after it had been circulated to everyone and their dog. It was almost farcical, as so much of it was inaccurate. It was also deeply biased, slipping into a review about me and my actions rather than what happened and why.</p> <p>Days before Connor’s inquest began, Alicia Wood, then CEO of the Housing and Support Alliance (now known as Learning Disability England), had forwarded a copy of a letter to Caoilfhionn Gallagher, the human rights barrister who had earlier offered us pro bono support. The letter was from a less reflective Oxford County Council commissioner who had written to two disability activists excusing the Council’s role in commissioning such crap services. As I read it, I could see again subtexts of mother-blame.</p> <p>She described feeling ‘immense sympathy’ for me while stating, in the same sentence, that she believed my campaigning had done a lot of damage. ‘In hindsight’ featured, as it does so commonly when something goes catastrophically wrong. We-could-possibly-have-done-more-but-we-were-so-stretched-type bollocks. The letter ends with a toe-curling paragraph which combines ‘immensely sorry’ with the comment that bloggers have ‘a duty to be honest and accurate’:</p><p>‘My hope is that she can find some kind of peace with this, and that one day, she might be able to move on.’</p><p>Weary Mother, a regular contributor to my blog, captured what the experience is like for many mothers in the following comment on mydaftlife:</p> <p class="blockquote-new">So many of us have fought so bloody hard for justice for our sons and daughters and have all been treated as brutally as Sara and her family has…just for seeking justice. Many of us battle on, like Sara, now. </p><p class="blockquote-new">My son is an actor with a group composed of people with learning disabilities. With tears running down my face I watched him when they performed a play about the First World War. My son was the only soldier from that village to come home. In his tattered uniform he came slowly down the aisle in church, Last Post playing quietly. He leaned heavily on stick (as he now does from damage done to him in real life), his head bandaged and bloody. At front the widows wait with his wife, who moves towards him in beautiful and moving joy. </p><p class="blockquote-new">In the background, slowly and in time to the gently played Last Post, a row of our dead boys walk in line, eyes bandaged and unseeing, comrades all. Arm stretched out, hand on comrade’s shoulder. </p><p class="blockquote-new">I wept. So many, so many…so bloody many. Harm is done to our boys and our girls and like those widows, we are grateful if they just come home.</p> <p>&nbsp;</p><p>When cross-questioned at Connor’s inquest, the student nurse changed her position and said she was not scared of me. She said I was a mother trying to do her best for her son.</p><hr /><p>&nbsp;</p><p><em><a href="http://www.jkp.com/uk/justice-for-laughing-boy-2.html">Justice for Laughing Boy: Connor Sparrowhawk – A Death by Indifference</a>,</em>&nbsp;by Sara Ryan with a foreword by Baroness Helena Kennedy QC.<br /> <strong>To order a copy for £12.99 go to&nbsp;<a href="https://www.jkp.com/uk/justice-for-laughing-boy-2.html">Jessica Kingsley Publishers</a>.</strong></p><hr /><p><iframe width="460" height="258" src="https://www.youtube.com/embed/gMtOGXBEDuo" frameborder="0" allowfullscreen></iframe></p><p>&nbsp;</p><h2><a style="font-size: 17px;" href="https://twitter.com/hashtag/justiceforlb?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Ehashtag">#JusticeforLB: Notes by Clare Sambrook</a></h2> <p>• Sara Ryan continues to blog at <a href="http://mydaftlife.wordpress.com/">mydaftlife</a>.</p> <p>• Connor’s family is supported by the charity&nbsp;<a href="http://www.inquest.org.uk/">INQUEST</a>, and represented by INQUEST Lawyers Group member Charlotte Hird Haworth of Bindmans solicitors.</p> <p>• Six weeks after Connor died, an unannounced inspection of Slade House by the Care Quality Commission found it to be inadequate in all 10 measures of assessment. That CQC report, published in November 2013, can be found in <a href="https://mydaftlife.files.wordpress.com/2014/03/cqc-slade-house-final-report-1.pdf">PDF here.</a>&nbsp;Sara Ryan notes: “The report reads like an inspection of a Victorian asylum.”</p> <p>• In February 2014 the Verita report, commissioned by Southern Health, confirmed&nbsp;that Connor’s death was preventable. <a href="http://www.southernhealth.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=76277">PDF here.</a>&nbsp;</p> <p>•&nbsp;A police investigation into Connor’s death was closed in August 2014.</p> <p>•&nbsp;An inquest jury determined in October 2015 that Connor’s death was contributed to by neglect and very serious failings —&nbsp;failings in the assessment, care and risk management of epilepsy in patients with learning disability, errors and omission in Connor’s care at the unit, Southern Health NHS Foundation Trust Short Term Assessment and Treatment Unit (STATT), Slade House. The <a href="justiceforlb.org:full-jury-findings-connor-sparrowhawk-justiceforlb">full jury findings are here.</a></p><p style="text-align: center;"><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/DNpj-P4XUAUI5qo.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Sara Ryan at the launch of her book, Doughty Street Chambers, 2 November 2017"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/DNpj-P4XUAUI5qo.jpg" alt="" title="Sara Ryan at the launch of her book, Doughty Street Chambers, 2 November 2017" width="460" height="345" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'><span class='image_title'>Sara Ryan at the launch of her book, Doughty Street Chambers, London, November 2017</span></span></span></p> <p>• Under pressure from the #JusticeforLB campaign, NHS England commissioned an independent review of deaths of people with a learning disability or mental health problem in contact with Southern Health (from April 2011 to March 2015), known as the Mazars review. Despite Southern Health’s attempts to stop it, the report was published in December 2015. Mazars identified multiple failures of leadership and governance, and revealed that Southern Health had failed properly to investigate more than a thousand unexpected deaths, and that fewer than 1% of the unexpected deaths of people with learning disabilities were looked into. <a href="https://www.england.nhs.uk/south/wp-content/uploads/sites/6/2015/12/mazars-rep.pdf">PDF here.</a> The matter was debated in the House of Lords on 10 December 2015. <a href="https://publications.parliament.uk/pa/ld201516/ldhansrd/text/151210-0001.htm">Text here</a>.</p> <p>• The Mazars findings prompted the Secretary of State for Health to ask the Care Quality Commission to examine how acute, community and mental health NHS trusts across England investigate and learn from deaths and identify necessary improvements. That review, published in December 2016 (<a href="https://www.cqc.org.uk/sites/default/files/20161213-learning-candour-accountability-full-report.pdf">PDF here</a>), reported that “families often have a poor experience of investigations and are not always treated with kindness, respect and honesty.” And: “This was particularly the case for families and carers of people with a mental health problem or learning disability.”</p> <p>•&nbsp;On 9 June 2016, Southern Health accepted full responsibility for Connor’s death, admitted negligence, admitted that it had violated both Connor’s and his family’s human rights. Statement <a href="http://www.southernhealth.nhs.uk/news-archive/2016/trust-statement-regarding-connor-sparrowhawks-death/">here</a> and below. </p> <p><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/KatrinaPERCY_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Ex-chief executive Katrina Percy"><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/KatrinaPERCY_0.jpg" alt="" title="Ex-chief executive Katrina Percy" width="240" height="264" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style=""/></a> <span class='image_meta'><span class='image_title'>Ex-chief executive Katrina Percy</span></span></span>• In <a href="http://www.bbc.co.uk/news/uk-england-36922039">July 2016 the BBC revealed</a> that Southern Health had handed contracts worth millions of pounds to past associates of chief executive Katrina Percy.</p><p>•&nbsp;In August 2016, under pressure from the public, patients and families bereaved by the Trust’s neglect, the Southern Health NHS Trust Board invited chief executive Katrina Percy to step sideways into a <a href="http://www.bbc.co.uk/news/uk-england-37288843">£240,000-a-year job created especially for her</a>. </p><p>• In October 2016, under continued pressure, <a href="https://opendemocracy.net/shinealight/clare-sambrook/190k-payoff-for-ex-chief-of-nhs-trust-that-failed-to-investig">Percy stepped down from that role with a £190,000 payoff</a>. At the time of writing (November 2017) Percy is advertising her <a href="https://www.linkedin.com/in/katrina-percy-88481258/">“strategic consultancy” services on Linkedin</a>. She cites her “inspirational and visionary leadership”, her reputation for “creating a culture which is open, accessible and energised”, and for “delivering ambitious service transformation, financial, quality and operational performance.”</p> <p>•&nbsp;In August 2017 a medical tribunal found multiple failings by Dr Valerie Murphy, the lead clinician responsible for treating Connor. During the tribunal Sara Ryan was grilled for two hours by Dr Murphy’s barrister which she described as a “barbaric experience”. Ryan <a href="http://www.oxfordmail.co.uk/news/15488161.__39_Inhumane__39___Connor_Sparrowhawk__39_s_mum_outraged_by_delay_to_tribunal_decision/">told the Oxford Mail</a>: “It was truly traumatising. It was a complete shock.” In November 2017 the tribunal found Murphy <a href="http://www.oxfordmail.co.uk/news/15656594.TRIBUNAL___Deplorable__care_failures_in_Connor_Sparrowhawk_tragedy/">guilty of misconduct</a> and said she had failed in ways that “fellow professionals would regard to be deplorable.” The Tribunal is due to meet in February 2018 to consider a sanction for Dr Murphy.</p> <p>• On 18 September 2017, Southern Health <a href="http://press.hse.gov.uk/2017/southern-health-nhs-foundation-trust-pleads-guilty-following-hse-prosecution/">pleaded guilty to breaching health and safety laws</a> in relation to Connor’s death. Two months later Southern Health <a href="https://www.shponline.co.uk/southern-health-nhs-trust-admits-guilt-womans-death/">admitted guilt</a> in relation to the death in April 2012 of 45 year old Teresa Colvin. The Trust’s new chief executive Dr Nick Broughton said: “The prosecutions against the trust are extremely serious and have contributed to a wholesale programme of change.”</p><hr /><p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/buses_line_CROP_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/buses_line_CROP_0.jpg" alt="" title="" width="460" height="23" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'></span></span></p><p>&nbsp;</p> <blockquote class="twitter-tweet"><p dir="ltr" lang="en">We can't stop thinking about this dream of <a href="https://twitter.com/sarasiobhan">@sarasiobhan</a> 's. Wouldn't it just be incredible? <a href="https://t.co/g4ugkT9Zl5">https://t.co/g4ugkT9Zl5</a> <a href="https://t.co/WexHTdOa6W">pic.twitter.com/WexHTdOa6W</a></p>— My Life My Choice (@mylifemychoice1) <a href="https://twitter.com/mylifemychoice1/status/723161111189659648">April 21, 2016</a></blockquote><hr /><p>&nbsp;</p><h2><a href="http://www.southernhealth.nhs.uk/news-archive/2016/trust-statement-regarding-connor-sparrowhawks-death/">Trust statement regarding Connor Sparrowhawk’s death</a></h2> <p><span style="font-size: 1.2em;"><strong>Southern Health NHS Trust Statement, June 2016</strong></span></p><p>Almost three years ago Connor Sparrowhawk died while in our care, for which we are deeply sorry, and we would like to take this opportunity to again offer our unreserved apologies to his family for his preventable death.</p> <p>We have now been able to come to a successfully mediated settlement with Connor’s family, as detailed in the statement below. The statement and an easy version of the statement are also attached on the right hand side of this page as pdf documents.</p> <p><strong>PUBLIC STATEMENT BY THE TRUST</strong></p> <p>1. Southern Health NHS Foundation Trust (“the Trust”) accepts that it was responsible for the death of Connor Sparrowhawk, an 18-year-old boy who was a much loved son, brother and friend. He died on 4th July 2013 whilst in the care and custody of the Short Term Assessment and Treatment (“STATT”) Unit, Slade House, for which the Trust was responsible. Connor’s preventable death was the result of multiple systemic and individual failures by the Trust in the care provided to Connor on the STATT Unit.</p> <p>2. The Trust accepts:</p> <p>(i) The findings of the independent investigation into the death of Connor Sparrowhawk by Verita, dated February 2014, which concluded that his death was preventable and found significant failings in the care provided to Connor in particular concerning the management of his epilepsy;</p> <h2><span class='wysiwyg_imageupload image imgupl_floating_right 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/southern_banner.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/southern_banner.jpg" alt="" title="" width="240" height="121" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_medium" style=""/></a> <span class='image_meta'></span></span><a href="http://www.southernhealth.nhs.uk/news-archive/2016/trust-statement-regarding-connor-sparrowhawks-death/"></a></h2><p><a href="http://www.southernhealth.nhs.uk/news-archive/2016/trust-statement-regarding-connor-sparrowhawks-death/"></a></p><p>(ii) The findings of the inquest jury on 16th October 2015, which determined that Connor died by drowning following an epileptic seizure while in the bath, contributed to by neglect* due to a number of very serious failings. These failings included both failures in the systems and processes in place to ensure adequate assessment, care and risk management of epilepsy in patients with learning disability at the STATT Unit, and in terms of errors and omissions in relation to Connor’s care whilst on the Unit. The Trust accepts that contributory factors included:</p> <ul><li>(a) A lack of clinical leadership on the STATT Unit;</li><li>(b) A lack of adequate training and the provision of guidance for nursing staff in the assessment, care and risk management of epilepsy;</li><li>(c) Very serious failings in relation to Connor’s bathing arrangements;&nbsp;</li><li>(d) Failure to complete an adequate history of Connor’s epilepsy;&nbsp;</li><li>(e) Failure to complete an epilepsy risk assessment soon after admission;</li><li>(f) Failure to complete an epilepsy risk assessment thereafter;&nbsp;</li><li>(g) Inadequate communication by staff with Connor’s family regarding his epilepsy care, needs and risks.</li></ul><p> 3. Southern Health NHS Foundation Trust acknowledges and accepts that:</p> <p>(i) The failings identified by Verita and by the inquest jury:</p> <ul><li>(a) Caused Connor’s death.</li><li>(b) Were negligent breaches of the duty of care the Trust owed to Connor.</li><li>(c) Violated Connor’s right to life protected by Article 2 of the European Convention on Human Rights.</li><li>(d) Violated the Article 2 rights of Connor’s family.</li></ul> <p>(ii) The Trust failed to take all reasonable steps to locate all relevant evidence and to disclose this to the Coroner and Connor’s family.</p> <p>4. The Trust will pay Connor’s family the sum of £80,000 by way of compensation for its unlawful acts and omissions.</p> <p>5. The Trust fully acknowledges that Dr. Sara Ryan has conducted herself and the Justice for LB campaign in a dignified, fair and reasonable way. To the extent that there have been comments to the contrary by Trust staff and family members of staff, these do not represent the view of the Trust and are expressly disavowed.</p> <p>*As that word is understood in coronial law.</p><p>&nbsp;</p><hr /><p>&nbsp;</p><h2><a href="http://www.jkp.com/uk/justice-for-laughing-boy-2.html"><em>Justice for Laughing Boy: Connor Sparrowhawk – &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;A Death by Indifference</em>, by Sara Ryan</a>&nbsp;with a foreword by Baroness Helena Kennedy QC.&nbsp;</h2><h2><strong>To order a copy for £12.99 go to&nbsp;<a href="https://www.jkp.com/uk/justice-for-laughing-boy-2.html">Jessica Kingsley Publishers</a>.<hr /></strong></h2><p><strong><br /></strong></p><h2><strong><em>Produced by Clare Sambrook for&nbsp;<a href="https://opendemocracy.net/shinealight">Shine A Light</a>.</em></strong></h2><p style="text-align: center;"><strong><em><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/buses_line_CROP_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/buses_line_CROP_0.jpg" alt="" title="" width="460" height="23" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'></span></span><br /></em></strong></p><p><strong><em>&nbsp;</em></strong></p><hr /><p><strong><em><br /></em></strong></p><p>&nbsp;</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/shinealight/tom-ryan/since-my-brother-s-preventable-death">Since my brother’s preventable death . . .</a> </div> <div class="field-item even"> <a href="/shinealight/clare-sambrook/190k-payoff-for-ex-chief-of-nhs-trust-that-failed-to-investig">£190K payoff for ex-chief of NHS Trust that failed to investigate hundreds of unexpected deaths</a> </div> <div class="field-item odd"> <a href="/shinealight/imogen-tyler/connor-sparrowhawk-erosion-of-accountability-in-nhs">Connor Sparrowhawk: the erosion of accountability in the NHS</a> </div> <div class="field-item even"> <a href="/shinealight/clare-sambrook/on-connor-sparrowhawk-s-avoidable-death">On Connor Sparrowhawk’s avoidable death</a> </div> <div class="field-item odd"> <a href="/shinealight/sara-ryan/ministry-of-justice-says-you-don-t-need-lawyer-at-inquest-trust-state">Ministry of Justice says you don’t need a lawyer at an Inquest. Trust the State</a> </div> <div class="field-item even"> <a href="/shinealight/ally-rogers/we-apologise-to-anybody-who-feels-let-down">‘We apologise to anybody who feels let down’</a> </div> <div class="field-item odd"> <a href="/shinealight/frances-webber/uk-government-s-inversion-of-accountability">The UK government’s inversion of accountability</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> Shinealight uk ShineALight ourNHS Prisons & child prisoners Access to justice Shine A Light Clare Sambrook Sara Ryan Wed, 29 Nov 2017 00:06:20 +0000 Sara Ryan and Clare Sambrook 114931 at https://www.opendemocracy.net