ourNHS https://www.opendemocracy.net/taxonomy/term/12254/all cached version 21/03/2018 12:49:14 en 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 Shine A Light 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 The great British drug rip-off https://www.opendemocracy.net/ournhs/great-british-drug-rip-off <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial;"><span style="font-family: Arial, sans-serif; color: black;">Drug prices are soaring, crippling our NHS. And Big Pharma’s defence (‘research is expensive’) omits one crucial fact…</span></p><div><span style="font-family: Arial, sans-serif; color: black;"><br /></span></div> </div> </div> </div> <p class="MsoNormal"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/nhs drugs.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/nhs drugs.jpg" 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 class="MsoNormal"><span>As he became ‘</span><span><a href="http://www.independent.co.uk/news/people/martin-shkreli-most-hated-man-on-the-internet-breaks-pledge-to-lower-cost-of-hiv-treating-drug-a6750291.html" target="_blank"><span>the most hated man on the Internet’</span></a></span><span>&nbsp;last year, ‘pharma-bro’ Martin Shkreli repeatedly claimed that by hiking the price of HIV drugs he wasn’t doing anything out of the ordinary. Squeezing health services and patients for every last penny is just how the pharmaceutical industry works. And that’s perhaps the only thing he was right about.</span></p><p class="MsoNormal"><span>While multinational drug companies have turned themselves into one of the&nbsp;</span><span><a href="https://www.forbes.com/sites/liyanchen/2015/12/21/the-most-profitable-industries-in-2016/#5b08592a5716" target="_blank"><span>most profitable industries</span></a></span><span>&nbsp;in the world, they have peddled the lie that they’re charging eye-watering prices for their life-saving products because it costs a fortune to research and develop them. What they didn’t tell us is that much of that research is publicly funded in the first place.</span><span></span></p><p class="MsoNormal"><span>A new report,&nbsp;</span><span><a href="http://www.globaljustice.org.uk/news/2017/oct/21/new-report-drug-companies-%C2%A31bn-nhs-rip" target="_blank"><span>Pills and Profits</span></a></span><span>, by Global Justice Now and STOPAIDS has revealed that big drug companies are taking over research funded by British taxpayers and selling the resulting drugs back to the NHS to the tune of more than £1 billion a year. So we are effectively paying twice for our medicines - once to research and develop them, and again to buy the finished drugs.</span><span></span></p><p class="MsoNormal"><span>This is not just a scandal of taxpayers’ money being used to prop up the profits of some of the richest corporations the world has ever seen. Corporate profiteering of public health research puts extreme pressure on NHS budgets and in some cases prevents patients from accessing the treatments they need.</span><span></span></p><p class="MsoNormal"><span>That was the case with prostate cancer drug Abiraterone. The drug was largely developed with UK public funding and has proven to provide a 37% higher survival rate for some types of prostate cancer. But American Janssen Pharmaceuticals (part of the world’s biggest drug company Johnson &amp; Johnson) bought the rights to the drug and demanded prices that left the NHS unable to afford the treatment of thousands of patients in the space of two years.</span><span></span></p><p class="MsoNormal"><span>Now that it is&nbsp;</span><span><a href="http://www.bbc.co.uk/news/health-35861202" target="_blank"><span>finally available on the NHS</span></a></span><span>, Janssen is charging the NHS £98 per day per patient for the drug, despite a generic alternative being available for less than £11 per day per patient. That’s a hefty mark-up on something we’ve spent substantial amounts of money developing in the first place. And Abiraterone is just one of many examples of publicly developed drugs breaking NHS budgets - others include treatments for multiple sclerosis and rheumatoid arthritis.</span><span></span></p><p class="MsoNormal"><span>This is nothing less than a Great British Rip-off, where multinational pharmaceutical companies are competing to make the most extortionate profits. But it’s our health service that gets cut up in the process. Last year the NHS paid&nbsp;<span>£3.8 billion</span></span><span>&nbsp;</span><span>more for medicines than it did 5 years before. That’s&nbsp;</span><span><a href="http://www.globaljustice.org.uk/blog/2017/may/18/rising-drug-prices-are-now-more-twice-entire-nhs-deficit" target="_blank"><span>more than twice</span></a></span><span>&nbsp;the entire NHS deficit. It is particularly infuriating as many of the most expensive drugs have received substantial research funding from the British state - including the&nbsp;</span><span><a href="https://www.globaljustice.org.uk/sites/default/files/files/news_article/pills-and-profits-report-web.pdf" target="_blank"><span>1st and 4th ranking</span></a></span><span>&nbsp;on the list of most costly drugs for NHS England.</span><span></span></p><p class="MsoNormal"><span>UK public health research has led to some of the biggest breakthroughs in medicine in recent decades. But the achievements of scientists at British universities should be a source of pride, not of bankruptcy. As the NHS faces another winter crisis, it is high time politicians stand up to big business and take real action to safeguard our health service. At the very least we should demand affordable prices for drugs that have received taxpayer funding. But in the long term we need to stop the privatisation of public research altogether to make sure that we develop medicines that benefit patients rather than lining corporate pockets.</span><span></span></p><p class="MsoNormal"><span>Such a transformation is also urgently needed beyond this country. As the third biggest funder of medical research after the US and the EU, a change in the UK could make a massive difference to people all across the world who are priced out of access to medicines. An estimated 10 million people globally are dying needlessly every year because they cannot access the medicines they need, most of them in poor and middle-income countries. Any politician who took on that challenge could end up being the most loved person on the internet.</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="/ournhs/diarmaid-mcdonald/big-pharma-now-helping-to-run-kings-college-hospital">Big pharma now helping to run King&#039;s College Hospital?</a> </div> <div class="field-item even"> <a href="/ournhs/mike-marqusee/held-hostage-by-big-pharma">Held hostage by Big Pharma</a> </div> <div class="field-item odd"> <a href="/openindia/ranjitha-balasubramanyam/patents-versus-patients-case-for-affordable-medicine">Patents versus patients: the case for affordable medicine</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 Morten Thaysen Sun, 05 Nov 2017 08:48:04 +0000 Morten Thaysen 114459 at https://www.opendemocracy.net Jeremy Hunt considers banning patients from walking up to A&Es https://www.opendemocracy.net/ournhs/caroline-molloy/jeremy-hunt-considers-banning-patients-from-walking-up-to-aes <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>This isn’t 'managing demand' – it’s playing whack-a-mole with 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/549093/a and e_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/a and e_0.jpg" alt="" title="" width="460" height="310" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>Jeremy Hunt is considering stopping walk-in patients from attending A&amp;E unless they first have a referral from their GP or 111 service, it emerged today.</p> <p>Dr Helen Thomas, national medical advisor for integrated urgent care at NHS England, told doctors’ magazine Pulse “<a href="http://www.pulsetoday.co.uk/news/commissioning/commissioning-topics/urgent-care/revealed-nhs-plans-to-bar-patients-from-attending-ae-without-a-referral/20035470.article">Jeremy Hunt has mentioned to some of my colleagues, maybe we should have a "talk before you walk" and we may well pilot that.</a>”</p> <p>The Department of Health issued its usual mealy-mouthed denials, of course, saying there were ‘no plans’ to pilot such an initiative. But - despite requests from OurNHS - the Department failed to deny the key claim in Pulse’s story - that whilst their might not yet be ‘formal plans’, the health secretary had been in talks about it.</p> <p>Let’s just take one or two moments to imagine how this would work, in practice.</p> <p>Patients go to A&amp;E because they need to – or in some cases, possibly, because they can’t get to see their GP due to extensive GP shortages. Trying to push them back onto already over-loaded GPs doesn’t address the problem, which is one of capacity across the health service. The problem is most visible at the front-line entry points into the NHS – GPs and A&amp;Es – and pushing patients from pillar to post doesn’t fix anything.</p> <p>The plan continues the trend of pushing patients towards&nbsp;<a href="https://www.theguardian.com/society/2017/mar/08/nhs-to-revamp-111-helpline-after-sustained-criticism-of-service">under-staffed and extensively privatised out of hours and 111 services</a>. But these services have been heavily criticised by both ambulance crews and&nbsp;<a href="http://www.telegraph.co.uk/news/nhs/11344941/AandE-crisis-caused-by-NHS-111-phoneline-senior-medic-suggests.html">emergency medics for partially&nbsp;<em>causing&nbsp;</em>the A&amp;E crisis by referring inappropriate patients&nbsp;</a>– often causing delays to the most urgent patients – so it’s hard to see how they will help, really.</p> <p><a href="http://www.dailymail.co.uk/news/article-3976930/Prove-need-GP-Hundreds-doctors-assessing-patients-three-minute-phone-calls-granting-face-face-appointments.html">Pushing patients onto telephone triage has its risks in any case. Senior doctors have already spoken of their concerns</a>&nbsp;that if you don’t see a patient, you’re in danger of missing the pallor, the tremor, the twitch - the indications that something is seriously wrong. If we think a tick box telephone checklist can always supplant the need for face to face assessment, we’re in the realms of magical thinking. Human beings are not algorithms.</p> <p>The most obvious likely outcome of such a scheme would be patients who feel they need to go to A&amp;E, calling an ambulance so they can. Meaning more resources used than ever. Because, you know, we’ve&nbsp;<a href="http://www.independent.co.uk/news/uk/politics/nhs-ambulance-services-national-audit-office-jeremy-hunt-crisis-a7546211.html">obviously got plenty of ambulance capacity to spare….(not).</a></p> <p>Or – given that&nbsp;<a href="http://www.mirror.co.uk/news/uk-news/nhs-privatisation-how-private-firms-1918235">private firms are showing enthusiasm for moving into ‘urgent care’ and are already running some NHS clinics</a>, and already run a range of private services on NHS sites – perhaps in future the patient walking up to A&amp;E will be told – “go away – or, there is a pay-to-see clinic next door…”. Especially as cash-strapped hospitals – cash-strapped because the government has effectively&nbsp;<a href="https://twitter.com/NuffieldTrust/status/917801459428798465">cut their pay for each operation by a quarter since 2010</a>&nbsp;- have already been told by Theresa May that the only solution to their financial woes is to, well,&nbsp;<a href="http://www.independent.co.uk/news/uk/politics/theresa-may-naylor-review-nhs-privatisation-sell-off-property-developers-a7766486.html">sell some land to whoever else wants to develop or run services on it (the Naylor report)</a>.</p> <p>It’s a disastrous idea, not least because making A&amp;E harder to access hits poorer patients (who are disproportionately higher users of A&amp;E services) harder.</p> <p>We’re not quite at Greek austerity levels where&nbsp;<a href="http://www.mirror.co.uk/news/uk-news/nhs-privatisation-how-private-firms-1918235">patients queue outside the A&amp;E on the days its open</a>&nbsp;to the public, as the only way of accessing healthcare – but we’re getting uncomfortably close, if measures like this go through.</p> <p>Earlier this week it was announced that the last bad Department of Health idea – to<a href="https://opendemocracy.net/ournhs/david-wrigley/second-guessing-your-gp-s-referral-nhs-denials-leave-big-questions-unanswered">&nbsp;send all GP referrals to a panel who hadn’t seen the patient, to second guess the referral and cut them by up to 30%</a>&nbsp;- had been shelved for now, under pressure from the BMA amongst others.</p> <p>But it seems, no sooner have we seen off one crazy idea to ‘manage demand’ than an even crazier one comes along.</p> <p>This isn’t ‘managing demand’, as the jargon goes. It’s playing Whack-A-Mole with 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/caroline-molloy/what%27s-really-causing-ae-crisis-and-how-can-we-fix-it">What&#039;s really causing the A&amp;E crisis - and how can we fix it? </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 Fri, 13 Oct 2017 13:18:00 +0000 Caroline Molloy 113999 at https://www.opendemocracy.net Revolving doors at the NHS’s bully-in-chief https://www.opendemocracy.net/ournhs/tamasin-cave/revolving-doors-at-nhs-s-bully-in-chief <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p class="Body">As the NHS’s financial regulator hires a new chair, the destination of its outgoing chair is if anything more noteworthy.</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/A&amp;E_2.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/A&amp;E_2.jpg" alt="" title="" width="460" height="310" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span>Ex-TalkTalk CEO, Dido (Diana) Harding is to take the reins at the NHS’ financial regulator.</p> <p class="Body">NHS Improvement (formed of a merger of Monitor and another NHS regulator) is the body that, while imposing punishing cuts on the NHS (with NHS England), makes senior hospital chiefs, who barely have their heads above water, <a href="https://www.theguardian.com/society/2017/sep/25/hospital-bosses-forced-to-chant-we-can-do-this-over-ae-targets">chant</a> affirmations – 'we can do this' – over A&amp;E targets. </p> <p class="Body">What do we know about Harding?</p> <p class="Body">She comes from the tech world, which makes sense. The government is <a href="https://badinfluence.net/blog/2017/7/5/technology-is-transforming-educationhealth-delete-as-applicable">sold on the idea</a> that tech can ‘transform’ the NHS (‘transform’ in this context meaning shifting patients to digital, probably paid-for, services).</p> <p class="Body">Related to this, Harding’s also been at the helm of a company thrown into crisis by a massive data breach. TalkTalk was hacked in 2015 and the personal details of 150,000 customers stolen, which <a href="https://www.theguardian.com/business/2017/feb/01/talktalk-chief-executive-dido-harding-cyber-attack">led to the firm being fined</a> a record £400,000 for security failings. Whether or not TalkTalk learned from their mistakes is a <a href="https://www.theguardian.com/money/2017/mar/11/talktalk-security-breached-again-scammers-india">moot point</a> – and of course the the NHS sits on a mound of sensitive data of its own.</p> <p class="Body">Harding herself is, of course, an alumni of McKinsey, albeit a long time ago and not for long. A connection with the Firm, though, is obligatory at the regulator, which is widely seen as a McKinsey creation. </p> <p class="Body">Harding is also a well-connected Tory. Elevated to the Lords by David Cameron, with whom she studied politics at Oxford, she’s married to John Penrose, Conservative MP for Weston-Super-Mare. </p> <p class="Body">This might be problematic down the line. Penrose <a href="http://www.bbc.co.uk/news/uk-england-somerset-41524510">says</a> he’s worried about the future of the town’s hospital. Weston General has already seen its A&amp;E close overnight and maternity services aren’t thought to be, in NHSI speak, ‘financially viable’. On top of which Penrose’s constituency is in one of 13 regions <a href="https://www.bma.org.uk/news/media-centre/press-releases/2017/july/cep-shrouded-in-secrecy">earmarked</a> for extra cuts under the ‘capped expenditure process’ being enforced by NHS England and NHS Improvement. Now it’s his wife holding the axe, how loudly will Penrose protest?</p> <p class="Body">Perhaps more interesting than Harding’s arrival, though, is where her predecessor Ed Smith has landed. </p> <p class="Body">In an odd coincidence, Harding was confirmed as chair of NHSI at <a href="https://twitter.com/HSJnews/status/917350316324028416">lunchtime</a> on Monday and at seven o’clock Tuesday morning, it was <a href="https://otp.tools.investis.com/clients/uk/assura2/rns/regulatory-story.aspx?newsid=938089&amp;cid=405">announced</a> that Smith is to join the board of primary care property developer Assura. </p> <p class="Body">Assura’s website describes the firm as ‘the UK’s leading healthcare Real Estate Investment <a href="https://www.assuraplc.com/about-us">Trust’</a>, which both builds and manages GP surgeries and primary care centres.</p> <p class="Body">Assura is one of the big winners from the current reforms being pushed through by NHS leaders. </p> <p class="Body">This is because services across the country are being shifted from hospitals and into primary care settings, such as expanded GP surgeries. Most of the 44 regional Sustainability and Transformation Partnerships include such plans. And of course NHS Improvement, with NHS England, are ‘<a href="https://webcache.googleusercontent.com/search?q=cache:7mO1a-N47d0J:https://www.england.nhs.uk/wp-content/uploads/2017/03/board-paper-300317-item-7.pdf+&amp;cd=2&amp;hl=en&amp;ct=clnk&amp;gl=uk">working closely</a>’ with – which is to say, forcing – these Partnerships to ‘strengthen general practice’.</p> <p class="Body">Earlier this year, Assura said it ‘looked forward optimistically at NHS plans to build more doctors' surgeries’. It is also ‘<a href="https://www.digitallook.com/news/news-and-announcements/assura-hikes-dividend-as-nhs-rent-roll-rises--2502958.html">pleased</a>’ by the government’s decision to create a <a href="https://www.england.nhs.uk/gp/gpfv/infrastructure/estates-technology/">multi-million pound fund</a> to make it happen. </p> <p class="Body">Assura is so optimistic it hiked its quarterly dividend 9% in February. That’s the NHS budget flying into the pockets of shareholders. </p> <p class="Body">Hospital trusts meanwhile are under pressure to balance the books by hook or by crook. Just yesterday NHS Improvement was criticised for the immense pressure it is putting on hospitals to publicly support cuts that aren't achievable, leaving experienced hospital finance chiefs 'feeling bullied'. <a href="https://www.hsj.co.uk/finance-and-efficiency/finance-directors-feel-bullied-by-nhs-regulators-to-agree-targets/7020763.article"></a>Hospitals are pleading for cash – but Theresa May has pointed them to the Naylor review which recommends <a href="http://www.independent.co.uk/news/health/naylor-report-tory-nhs-privatisation-healthcare-flog-off-conservatives-theresa-may-election-2017-a7766326.html">selling off and closing hospital buildings</a> to raise money.</p> <p class="Body">Smith – who spent 30 years as a senior partner at PWC – has a ‘wealth of business experience’, which Assura chair Simon Laffin comments ‘will stand us in good stead’. </p> <p class="Body">Smith himself also currently sits on the board of NHS Property Services. This is the government-owned firm that holds much of the NHS’ primary care estate (and more) and which is now <a href="https://www.opendemocracy.net/ournhs/allyson-pollock/why-next-labour-manifesto-must-pledge-to-legislate-to-reinstate-nhs">charging exorbitant market rents</a> to GPs, forcing some to close. </p> <p class="Body">As NHS Property Services <a href="http://www.property.nhs.uk/about-us/the-board/">says</a>: ‘Ed [Smith] has a unique insight into the priorities and issues facing a large part of NHS Property Services’ customer base.’ I’ll say.</p> <p class="Body">And of the two new hires, I think Smith’s is the more notable.</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/milburn-nhs-and-britains-revolving-door">Milburn, the NHS, and Britain&#039;s &#039;revolving door&#039;</a> </div> <div class="field-item even"> <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 odd"> <a href="/ournhs/deborah-harrington/going-going-gone-great-hospital-selloff">Going, going, gone - the great hospital sell-off?</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 Tamasin Cave Thu, 12 Oct 2017 12:08:39 +0000 Tamasin Cave 113972 at https://www.opendemocracy.net Ex-boss of England’s NHS blasts NHS migrant policy as a “national scandal” https://www.opendemocracy.net/ournhs/ex-boss-of-england-s-nhs-blasts-nhs-migrant-policy-as-national-scandal <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>As activists took to the streets at the weekend to protest Jeremy Hunt’s introduction of NHS passport checks and upfront charges, David Nicholson said the policy was “based on fake evidence” and “the thin end of a very big wedge”.</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/seacole docsnotcops.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/seacole docsnotcops.jpg" alt="" title="" width="460" height="345" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Protestors in front of St Thomas hospital on Saturday. Rights: Docs Not Cops.</em></p><p class="MsoNormal"><span>This weekend, Docs Not Cops held nationwide protests against immigration checks and upfront charges in the UK, amidst concern about the introduction of xenophobic new NHS policies. Our Twitter notifications exploded, our </span><a href="https://twitter.com/DocsNotCops/status/913023715125932032" target="_blank"><span>2 minute #PatientsNotPassports video</span></a><span> went viral.</span></p><p class="MsoNormal"><span>We were delighted to have the support of groups as diverse as Liberty, Sisters Uncut, Medact, Doctors of the World, Global Justice UK and many more.</span></p><p class="MsoNormal"><span>But one message of support came from an unexpected quarter - the former chief executive of NHS England, David Nicholson.</span></p><p class="MsoNormal"><span>Nicholson shared our video with emphatic support, adding the comment: ‘</span><a href="https://twitter.com/DavidNichols0n/status/913870036082810881" target="_blank"><span>This is nothing short of a national scandal based on fake evidence it is the thin end of a very big wedge #PatientsNotPassports</span></a><span>.”</span></p><p class="MsoNormal"><span><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/nicholson tweet.PNG" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/nicholson tweet.PNG" alt="" title="" width="460" height="350" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></span></p><p class="MsoNormal"><span>Nicholson’s intervention – as former head of the NHS - is remarkable. But his intervention is indicative of a deep and growing mood of disgust amongst NHS staff, at the policies now being imposed on patients in the name of xenophobia, not patients.</span></p><p class="MsoNormal"><span>In February this year Jeremy Hunt announced the introduction of <a href="https://www.gov.uk/government/news/recovering-the-cost-of-nhs-treatments-given-to-overseas-visitors">passport checks for all patients accessing NHS services and upfront charging</a> for people who don't qualify for free care. These changes are already being <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/639277/Guidance_to_Charging_Regulations_post_21_August_final__Master_version_.pdf">piloted in over 20 hospitals and will come into full effect on the 23rd October</a>.</span></p><p class="MsoNormal"><span>On Saturday 30th Docs Not Cops marched to St Thomas’ hospital - where a pilot has been taken place. The final gathering at the Mary Seacole statue was moving and beautiful. Hundreds of protestors, many organisations, migration activists, healthcare activists, feminists, and LGBTQI+ activists came together with doctors and nurses to protest cruel policies that will do more harm than good.</span></p><p class="MsoNormal"><span>The broad and growing coalition of people opposed to these policies was clear.</span><span>&nbsp;</span></p><p class="MsoNormal"><span>The Government is trying to blame migrants for the NHS funding crisis, but the numbers show a different story. At most, so called ‘health tourism’ only accounts for <a href="https://fullfact.org/health/health-tourism-savings-wont-plug-hole-nhs-funding/">0.3% of the NHS budget</a>. But Hunt’s policies are destroying patient’s relationships with NHS workers and creating a climate of fear that stops people accessing the care they need. </span></p><p class="MsoNormal"><span>Already there are stories of patients being racially profiled when accessing care and being singled out for immigration checks – including an <a href="http://www.independent.co.uk/news/uk/home-news/nhs-letter-newborn-baby-eight-day-old-identity-documents-free-healthcare-right-violet-nik-horne-a7955211.html">eight day old baby born to two English parents, who received a letter demanding her proof of eligibility</a> for care.</span></p><p class="MsoNormal"><span>At the demonstration, people read out heart-breaking testimonies that had been sent to Docs Not Cops.</span></p><p class="MsoNormal"><span>One read:</span></p><p class="MsoNormal"><span>&nbsp;“</span><span>I’m almost six months pregnant – but I haven’t had any antenatal care at all. I’ve missed several scans and midwife appointments in the past few weeks. I feel trapped… I need to go to the hospital but I can't because I feel my information might not be confidential. I have no idea if my baby is healthy - I think the bump might be too small for 6 months and I don’t know which vitamins or supplements to take. But I’m too afraid to get the care that I need, even though I’ve been told I’m entitled to it, legally. Carrying a child, the last thing you want to worry about is being separated from that child. I am scared that my hospital will share my address with the Home Office, who will then find and deport me, even though my partner is a British citizen.” </span></p><p class="MsoNormal"><span>This fear is sadly rational. As home secretary, </span><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"><span>Theresa May talked of her desire to create a &nbsp;“hostile environment” for migrants</span></a><span>. This year a</span><a href="https://www.doctorsoftheworld.org.uk/news/medics-mobilise-against-nhs-patient-data-sharing" target="_blank"><span> </span><span>Memorandum of Understanding</span></a><span> between the Home Office and NHS Digital formally set out a practice that has been going on for years: </span><a href="https://www.theguardian.com/uk-news/2017/feb/01/home-office-asked-former-nhs-digital-boss-to-share-data-to-trace-immigration-offenders" target="_blank"><span>patient details may be passed on to the Home Office</span></a><span>. </span></p><p class="MsoNormal"><span>Nicholson is not the only significant public figure to express discomfort with the direction of government policy, with its the scapegoating of the vulnerable. Conservative MP for Totnes Sarah Wollaston has commented “If you meet a migrant in the NHS, they are more likely to be treating you than ahead of the queue”. <a href="https://theconversation.com/the-truth-about-migrants-and-the-nhs-60908">Migrant workers are the backbone of the NHS</a>, making up a greater proportion of the workforce than any other health service in Europe (28% of doctors, 13% of nurses).</span></p><p><span>The Conservatives, of course, have a long history of stoking anti-migrant or outright racist sentiment to “</span><a href="https://www.opendemocracy.net/ournhs/whole-agitation-has-nasty-taste-bevan-on-so-called-health-tourism"><span>discredit socialised medicine</span></a><span>” - as NHS founder Nye Bevan noted. Those moderate Tory MPs who have challenged recent scapegoating need to speak up about current policies – or they will be complicit in them.</span><span>&nbsp;</span></p><p class="MsoNormal"><span>The Green Party has spoken out vocally. Jean Lambert MEP described her visit to a Doctors of the World clinic in an <a href="https://www.newstatesman.com/politics/staggers/2017/09/charities-forced-charge-how-government-depriving-most-vulnerable">article in the New Statesman</a>, in which she raised concerns that </span><span>this policy would affect some of the most marginalised people in the UK. In Lambert’s words, “</span><span>It’s now reached the point where victims of trafficking and exploitation are deterred from registering with a GP, as they fear detention and deportation. Women, such as sex workers, are denied access to contraception, safe abortions, and maternal care. Meanwhile, their children may never see a GP or a dentist, putting their own health at risk.</span><span>” &nbsp;</span></p><p class="MsoNormal"><span>&nbsp;</span></p><p class="MsoNormal"><span>The current policies aren’t born of a genuine desire for a fairer NHS, but rather are punitive attempts to penalise those who aren’t born here, those who aren’t fortunate enough to have the seal of approval of a burgundy passport.</span></p><p class="MsoNormal"><span>&nbsp;</span></p><p class="MsoNormal"><span>Discontent amongst healthcare workers is growing. The head of the <a href="https://www.rcm.org.uk/news-views-and-analysis/news/pregnant-migrants-accessing-care-too-late">Royal College of Midwives, Cathy Warwick, said</a> in 2015, “W</span><span>e have real concerns that the aggressive pursuit of charging migrant women for medical care may deter them from accessing maternity care. I fear that these women could fall through the cracks and only find their way into the health system when it is too late – if at all...midwives should not act as gatekeepers to the maternity services. They owe a duty of care to all pregnant women who seek care from them and, they should provide care to all pregnant women irrespective of the woman’s ability to pay.” </span></p><p class="MsoNormal"><span>Hunt’s policies can be seen for what they are by those working on the frontline, those working day-in, day-out alongside their migrant colleagues to provide us with a safe and caring NHS.</span><span>&nbsp;</span></p><p class="MsoNormal"><span>Whether from vulnerable patients, midwives, politicians or from ex-NHS chief executive David Nicholson, the expressions of disgust towards the Department of Health’s regressive, xenophobic migration policy are growing to a cacophony. </span></p><p class="MsoNormal"><span>It’s time for all those in high places, all those who know the facts, figures and inner workings of the NHS, to join the dissent. </span></p><p class="MsoNormal"><span>I hope this will include Nicholson’s successor - current NHS chief executive Simon Stevens. Stevens has </span><a href="http://www.huffingtonpost.co.uk/entry/simon-stevens-nhs-chief-slams-theresa-may-claim-that-health-service-has-enough-money_uk_58764e8fe4b09642a34f24ae" target="_blank"><span>highlighted the underfunding of the NHS</span></a><span> – will he now stand with us and oppose the government’s attempts to blame the NHS funding crisis on migrants?</span></p><p class="MsoNormal"><span>People with platforms need use them to talk about healthcare as a right, not a privilege. These people have the power to challenge the discourse around migrants and the NHS. </span></p><p><em> </em></p><p class="MsoNormal"><span>But whoever you are reading this we need you too. Our resistance needs to be a unified front. If you are a doctor, nurse or other healthcare worker, don’t comply with checking. If you are a current patient or just interested in defending the principles of the NHS, </span><a href="https://www.facebook.com/events/535008143558305/" target="_blank"><span>join the next Docs Not Cops action on October 23rd</span></a><span> when the policy is formally introduced. It is time for all of us including those in power to put their necks on the line. Healthcare is a right not a privilege and we must fight for each other’s rights. </span><span>&nbsp;</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="/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/rayah-feldman/pregnant-women-bear-brunt-of-government-s-clampdown-on-migrant-nhs-care">Pregnant women bear brunt of government’s clampdown on ‘migrant’ NHS care</a> </div> <div class="field-item odd"> <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 even"> <a href="/ournhs/migrant-activists-disrupt-department-of-health">Migrant activists disrupt the Department of Health </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 Ayse Ansell Wed, 04 Oct 2017 15:50:19 +0000 Ayse Ansell 113798 at https://www.opendemocracy.net Why we need a new national care service https://www.opendemocracy.net/uk/laurie-macfarlane/why-we-need-new-national-care-service <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Britain's social care system is in crisis.&nbsp;</p> </div> </div> </div> <p>In 2017, the Labour party manifesto <a href="http://www.labour.org.uk/index.php/manifesto2017/healthcare-for-all">pledged to lay the foundations of a national care service</a> – repeating commitments hinted at prior to previous elections. This comes at a time when experts are increasingly warning of a social care system in “crisis”. Real-terms funding has fallen despite an ageing population creating greater demand, and when the government eventually caved into enormous pressure to release more money, it provided only a small fraction of what is needed - £2 billion over three years, when more than that is needed in this year alone. But the crisis is not just one of funding. It is deep and systemic – but I believe that the “tipping point” experts say we have now reached is an opportunity to take stock and build something more sustainable, resilient and just than the failing system we have today. The social care problem is three-fold: </p><ul> <li>Decreasing resource at a time of increasing need. This is the <strong>funding problem</strong>.</li> <li>The fact that healthcare and social care and separate services despite serving those with the same needs. Healthcare is free at the point of use, whereas social care is heavily means- and needs-tested. This is the <strong>integration problem.</strong></li> <li>You don’t hear much about the third dimension. Social care services are delivered by private providers in a marketplace, but this market has failed. This is the <strong>marketisation problem.</strong></li> </ul><p> I’m going to tackle these three areas individually, but first, let’s take a look at the social care system itself. <strong>The social care system</strong> Unlike healthcare, social care is commissioned by local authorities (LAs), and usually provided by private agencies. Unlike our free-at-the-point-of-use NHS, subsidised care is heavily means- and needs-tested. To confuse matters further, the NHS runs a service called Continuing Healthcare – those who meet the criteria have their fees fully paid without means testing. About half of care users have all their fees paid by the LA or the NHS, and around 41% pay for their own care. The rest get some help towards their fees. Social care is paid for out of council tax and business rates, as well as central government grants such as the Revenue Support Grant. I’m going to tackle three problems individually, but I should point out that all three are interrelated, part and parcel of the same systemic issues. <strong>The funding problem</strong> Fewer and fewer people are receiving the care they need. Money going into the system is dropping in real terms, even though the need is increasing as our population ages. The number of people aged 85+ grew by almost a quarter between 2001 and 2011, but <a href="http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/communities-and-local-government-committee/adult-social-care/written/35913.pdf">according to Age UK</a>, the number of people receiving care fell from 1.2 million in 2005/6 to 850,000 in 2013/4. <a href="http://www.cqc.org.uk/sites/default/files/20170703_ASC_end_of_programme_FINAL2.pdf">According to the regulatory body for social care</a>, the Care Quality Commission (CQC), real-terms funding was 1.5% lower in 2015/16 than it was ten years earlier, despite the ageing population. More and more, care is limited to those with the highest need, and to the minimum required. The funding situation is set to get worse. The government is phasing out its Revenue Support Grant (RSG) to councils as it hands over 100% discretion over business rate spending to LAs in 2019/20. The government argues that this will enable councils to meet their social care spending needs, in combination with the Social Care Precept, which gives LAs discretion to raise council tax above centrally capped levels for the express purpose of spending the proceeds on social care. But organisations like the <a href="http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/communities-and-local-government-committee/adult-social-care/oral/40831.pdf">Association of Directors of Adult Social Services (ADASS) points out that this will create greater care inequality</a>, since the areas most in need of social care are poorer ones where less money is raised through local taxation. Funding cuts mean councils limit services to those with the highest need, and to the minimum required – often less than that. Cuts impact care workers’ pay. <a href="https://www.nmds-sc-online.org.uk/reportengine/GuestDashboard.aspx?type=Medianhourlypay">Median pay for care workers stood at £7.76 per hour in 2017</a>. In residential care, it is estimated that <a href="https://www.nao.org.uk/wp-content/uploads/2015/03/Adult-social-care-in-England-overview.pdf">between 160,000 and 220,000 care workers earn less than the national minimum wage</a>. <a href="https://www.nmds-sc-online.org.uk/Get.aspx?id=980099">According to Skills for Care</a>, registered nurses working in social care in 2015 were paid a mean annual salary of £25,000 – much less than their counterparts in the NHS, and without the same scope for careers progression. Training is woeful as well. No formal qualifications are required to work in social care – making decent training all the more important. <a href="https://www.unison.org.uk/content/uploads/2015/04/TowebUNISONs-Homecare-Training-Survey-Report.pdf">According to UNISON</a>, over a quarter of care workers receive no dementia training, and less than a quarter of those who administer medicines are trained to do so. No wonder <a href="https://www.nmds-sc-online.org.uk/Get.aspx?id=980099">turnover is high</a>, with almost a half of care workers leaving within a year in 2015, and over a third of nurses quitting the sector. Poor training and high turnover and vacancy rates have a knock-on effect on the quality of services on offer. <strong>The integration problem</strong> Because health and social care are separate services, many people experience a bumpy transition from hospital to homecare. Bed delays increased by almost a third between 2013 and 2015, costing the NHS about £820 billion a year, <a href="https://www.nao.org.uk/wp-content/uploads/2015/12/Discharging-older-patients-from-hospital.pdf">according to the National Audit Office</a>. Largely, this was because there was no one available to provide adequate care to these patients at home. The NHS and social care spend a lot of time and money disputing who has responsibility for the patient, because neither wants to bear the cost. This often has tragic consequences – as <a href="https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Commission%20Final%20%20interactive.pdf">Ray’s case illustrates</a>. His daughter Sally-Ann tells Ray’s story, picking up the story at the point of discharge from hospital: “He could not be left unsupervised as he was unable to do anything for himself. He was at risk of malnutrition, dehydration and pressure sores and prone to recurrent infections. None of this seemed to be defined as a health need, and it took five weeks to reach a decision about whether he was entitled to NHS Continuing Healthcare as health and social care fought over who should pay. Where was the person in all of this?” Ray’s application to NHS Continuing Healthcare was declined. This meant the care team he and his family had become familiar with had to change, and suddenly the family had to bear the cost, which ran to a four-figure monthly sum. The community nursing team attempted a last-ditch application for NHS Continuing Healthcare, but it was turned down just 24 hours before Ray died. Sally-Ann says, “What I now ask is: why should anyone at the end of their life have to pay for their own care to die at home?” <strong>The marketisation problem</strong> Since the <a href="https://www.legislation.gov.uk/ukpga/1990/19/contents">1990 NHS and Community Care Act</a>, the system has been run on a marketised model where care is delivered by private providers. Prior to this, LAs generally provided care themselves, but the Act recast them as “enabling authorities”. To ensure this happened, funding from central government came with the requirement that 85% of money should be spent on the purchase of care services from the private sector. If the motive behind marketisation was the idea that a competitive marketplace would incentivise high quality at low cost, then the market has failed spectacularly. Instead of a competitive, dynamic marketplace, we have one made up of a few large providers. <a href="https://chpi.org.uk/wp-content/uploads/2016/11/CHPI-SocialCare-Oct16-Proof01a.pdf">According to the Professor Bob Hudson in a paper for the CHPI thinktank</a>, the 10 largest providers account for 20% of the market, the largest 20 make up 28%. In this climate of austerity-driven fee-squeezing by councils, the system has become precarious as business becomes increasingly untenable for providers. Southern Cross, which collapsed due to financial hardship in 2011, was responsible for almost a tenth (9%) of the national market, and up to 30% in some areas. There is no back-up plan to protect services should providers withdraw. The Southern Cross example shows that the market is not only “inefficient”, to use Professor Hudson’s term, but also unstable. The government says in its <a href="https://www.gov.uk/government/publications/care-act-statutory-guidance/care-and-support-statutory-guidance">guidance to the 2014 Care Act</a> that “high-quality, personalised care and support can only be achieved where there is a vibrant, responsive market of service providers”, but places the burden of creating such a marketplace on local government at a time when a lack of funds has put it in “panic mode” (<a href="http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/communities-and-local-government-committee/adult-social-care/oral/43946.pdf">as put by Alex Fox of Shares Lives Plus</a>), with no appetite for creating such a marketplace. Instead, <a href="http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/communities-and-local-government-committee/adult-social-care/written/35736.pdf">price has become the driving consideration for LAs when choosing a provider</a>, rather than a balance between cost and service quality. This in turn encourages some providers to put in unrealistically low bids which result in poor-quality services, or end in providers handing back undeliverable contracts. LAs often adopt a coercive attitude towards providers, with providers saying that councils have already decided on a price before consultation even begins. As a weighted average, councils pay £2 less than the £16.70 per hour <a href="http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/communities-and-local-government-committee/adult-social-care/oral/42401.pdf">estimated by the UK Homecare Association</a> as the minimum cost of care. Providers rightly argue that profit is needed to make investments in staff and facilities and keep pace with growing demand, with <a href="http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/communities-and-local-government-committee/adult-social-care/written/35565.pdf">one telling the Care Association Alliance</a> that “without profits there can be NO future for this industry and certainly no reinvestment”. On the other hand, providers say they expect a 12% return on investment – which Professor Hudson <a href="https://chpi.org.uk/wp-content/uploads/2016/11/CHPI-SocialCare-Oct16-Proof01a.pdf">in his paper</a> notes is abnormally high for a low-risk industry such as care, where expected returns would usually be in the region of 5%. It is dishonest of providers to claim that they wish to make profits simply to reinvest them – the <a href="researchbriefings.files.parliament.uk/documents/CBP-7463/CBP-7463.pdf">majority are for-profit businesses</a>. Regardless of who is right and who is wrong, this discourse suggests that there are deep and irreconcilable tensions between private care providers and councils. LAs appear to mistrust profit-making organisations. Care providers on the other hand appear to have unreasonable expectations about the level of profit they should be making. If the market cannot profitably provide for people’s needs, this raises the question of whether it should be there in the first place. The social care market has failed citizens, and it has failed providers. The government knows it – that’s why it seeks to balance it through regulation, such as by awarding greater powers awarded to the CQC, including the Fit and Proper Person Test to be applied to directors of CQC-registered agencies. We can keep regulating and reforming the current system until we’re blue in the face, but in the end we’ll find ourselves at the end of a dark alley, with no money and no time. Marketisation has existed for so long, and has become such a dogma, that we’ve lost the ability to imagine beyond it. <strong>What is the way forward?</strong> There are a number of sensible options on the table to bring us back from this tipping point, if the government would only listen. Everybody acknowledges the funding crisis and even our austerity-obsessed government has pledged extra money to help plug the gap – although the money put forward falls far short of what is needed. The government has also latched onto the buzzword “integration”, but failed to make the fundamental reforms needed to achieve this is in any meaningful way. I believe that a combination of three proposals from the King’s Fund, the CHPI and the (cross-party) Local Government and Communities Committee could tackle all three problems I’ve talked about in this article. <strong>An integrated and fully funded system</strong> In 2014, the King’s Fund published a report called “<a href="https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Commission%20Final%20%20interactive.pdf">A New Settlement for Health and Social Care</a>”, the culmination of work carried out by a commission chaired by Kate Barker. The report proposed a fair and sustainable alternative to the current failing system, which the government has since ignored. The report makes two central proposals. Firstly, it recommends meaningfully integrate of health and social care by bringing the two under a single ring-fenced budget, which it suggested could be administered by a single local commissioner. This it says would resolve the seemingly irreconcilable tension between the NHS and LA-provided social care, bringing about the commission’s stated aim of achieving “equal care for equal need”. Secondly, the report also recommends making social care free at the point of use to those in critical and substantial need. The commission’s proposal would cost an extra £3 billion per year, rising to around an extra £5 billion on top of projected spending of £9 billion by 2025. This sounds like a lot, but projected growth to GDP mean that GDP-spending on social care will only actually increase by 1 percentage point. If we adopted the commission’s more radical scenario, whereby free-at-the-point-of-use social care is extended to those with moderate need as well, we would spend a total of roughly £20 billion per year by 2025, compared a projected spend of £9 billion in 2025 at current levels. The report says that this would cost an added 2p per £1 at the basic rate of income tax, although there are other ways to fund it. I should also set the figure in context – in 2017-18, <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/630570/60243_PESA_Accessible.pdf">the UK government will spend over £36 billion on defence alone</a>. <strong>Bringing together commissioning and provision</strong> The Barker Report sets out a brilliant, radical vision of a social care system that works for all and even presents a broad-brush vision for how it can be funded and delivered in a realistic, gradual manner over a ten-year period. What it doesn’t take on is the seeming irreconcilability of the current outsource model. In his report for the CHPI, Professor Bob Hudson sets out an approach for how social care can be gradually and sustainably brought under public provision. He recommends “a gradual resumption of the statutory and third-sector role” through a mixed system which prefers providers with a social purpose in the not-for-profit or public sectors. This could happen over the ten years it takes for the King’s Fund recommendations to come in. <strong>An integrated workforce</strong> In <a href="https://publications.parliament.uk/pa/cm201617/cmselect/cmcomloc/1103/1103.pdf">their 2017 report</a>, the Communities and Local Government Committee urges the government to work with Skills for Care to look at sustainable wage level to aid staff retention in social care. It also says the government should encourage LAs and the NHS to work together on local joint strategies to reduce competition. Social care will continue to lose out while nurses of the same skill level have better pay and career prospects in the NHS. I would go further and say that the government needs to work with Skills for Care to establish a required training path for workers in social care to ensure that everyone has a minimum level of training. This could begin by mandating the vocational qualifications which underpin existing social care apprenticeship schemes. A combination of better pay, required qualifications and a clear career path could give workers a greater sense of pride, and encourage employers to value and invest in their workforce more. This path is ambitious, but it is realistic with a little political will and imagination. The alternative is unthinkable – a slippery slope into a world where care is denied to those in desperate need, and where many of us must lose most of what we have just to maintain our basic needs. In the 21st century, we might not design a care service on the model of the NHS, but as we reap the benefits of that great institution’s success, we need more than ever a truly universal care system.</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> uk ourNHS Jamie Goodland Fri, 29 Sep 2017 14:32:20 +0000 Jamie Goodland 113696 at https://www.opendemocracy.net If our government won’t act to save our NHS this winter, this is what we must do https://www.opendemocracy.net/ournhs/john-lister/if-our-government-won-t-act-to-save-our-nhs-then-we-must <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>NHS plans across England masquerade as ‘integration’ – but this autumn campaigners will meet to expose the reality now unfolding, of bed closures, private takeovers and a US-inspired system.</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/heart monitor_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/heart monitor_0.jpg" alt="" title="" width="460" height="281" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Condition critical?</em></p><p>Ministers have ignored a strident <a href="https://nhsproviders.org/nhs-winter-warning-update/introduction">“winter warning”</a> from NHS Providers – the body that represents NHS and foundation trusts. The government is determined to stick to their plan to freeze NHS budgets for the decade to 2020 even as costs and population rise. </p> <p>England’s hospitals and other NHS providers warned that if an extra £350m were not found by August at the latest, we will face another winter crisis even worse than the situation last year. </p> <p>It’s the middle of September, and there’s no extra cash, and none promised. </p> <p>Nor is there any let-up in the brutal 8 years of frozen or below inflation pay for more than a million NHS staff. Hospitals and community health services are finding it increasingly difficult to maintain hard-pressed services, so hospital bosses are now being <a href="https://twitter.com/HSJEditor/status/908665109945487365">threatened with the sack if they don’t meet A&amp;E targets despite the struggle to retain and recruit staff</a>.</p> <p>Theresa May’s government opted not to contest a <a href="https://www.theguardian.com/politics/2017/sep/13/dup-plans-to-vote-with-labour-on-nhs-pay-and-tuition-fees">vote on scrapping the 1% cap</a>. But May has made clear that she will ignore the will of Parliament, meaning NHS pay levels will be further eroded as inflation nears 3%.</p> <p>The combined impact of these policies can be seen in <a href="http://www.healthcampaignstogether.com/newsroundup.php">Oxfordshire</a>. 110 beds have already been closed with connivance of local councillors, and now the local acute hospitals trust has revealed a further 92 are now closed for “safety” reasons (presumably staff shortages). The county already tops the league for delayed transfers of care. The impact of spending cuts is a system seizing up and increasingly unable to maintain key services.</p> <p>The quest for massive, unprecedented cash savings is of course the backdrop to the 44 Sustainability and Transformation Plans (STPs) secretively developed last year. These plans hinge on “new models of care” which appears to centre on cutting and de-skilling staff, and downgrading, downsizing or privatising key areas of care to cut NHS spending - while maximising openings for private companies to scratch out profits from under-funded services. There’s <a href="http://www.healthcampaignstogether.com/pdf/The%20case%20of%20the%20missing%20evidence%20-%20STPs%20and%20Five%20Year%20Forward%20View-2.pdf">no evidence any of this will be effective, of course</a>.</p> <p>The current round of massive reorganisation and pressure for ‘new models’ is a bonanza for management consultants who are <a href="http://www.pulsetoday.co.uk/news/commissioning/how-the-nhs-is-spending-millions-on-consultancy-firms/20035171.article">coining in millions</a> and effectively now steering many Clinical Commissioning Groups and trusts.</p> <p>The latest step was the publication last month of hundreds of complex pages of guidance and <a href="https://www.google.co.uk/url?sa=t&amp;rct=j&amp;q=&amp;esrc=s&amp;source=web&amp;cd=1&amp;ved=0ahUKEwjm2uas9aTWAhUBZ1AKHa2jBjoQFggpMAA&amp;url=https%3A%2F%2Fwww.england.nhs.uk%2Fwp-content%2Fuploads%2F2016%2F12%2F1693_DraftMCP-1a_A.pdf&amp;usg=AFQjCNFTu18IpzVUuh-sFjh4GF-gqrLlZw">draft contracts</a> for ‘accountable care systems’ (ACSs) and ‘accountable care organisations’ (ACOs) — <a href="https://opendemocracy.net/ournhs/stewart-player/accountable-care-american-import-thats-last-thing-englands-nhs-needs">explicitly drawn from privately-run systems that first emerged in the US</a>. Jeremy Hunt has on several occasions stated: “<a href="https://www.kingsfund.org.uk/blog/2014/08/can-ccgs-become-accountable-care-organisations">We need clinical commissioning groups to become accountable care organisations</a>.” </p> <p>Pace-setters on this among <a href="https://www.england.nhs.uk/2017/06/nhs-moves-to-end-fractured-care-system/">8 vanguard</a> Accountable Care Systems have been South Yorkshire &amp; Bassetlaw (where five Clinical Commissioning Groups have created a ‘shadow’ ACS without bothering to ask the five local authorities to sign it off. It will become a legal entity before April 2018).</p> <p>In Nottinghamshire <a href="http://www.nottinghampost.com/news/health/controversial-firm-capita-handed-27m-377493">the Sustainability and Transformation Partnership is spending £2.7m</a> this year getting bungling consultant <a href="https://opendemocracy.net/ourkingdom/joel-benjamin/dispatches-how-local-governments-are-being-fleeced-by-banks-for-%C2%A315bn">Capita</a> and US health provider <a href="https://www.centene.com/">Centene</a> to help shape up an ACS. </p> <p>In each case the reality will be an Accountant-Controlled System, focused primarily on cutting services to fit within a rigid cash limit. Nottinghamshire could even wind up giving the US company a contract to do the CCGs’ job, controlling budgets and services.</p> <p>Neighbouring Leicestershire Sustainability and Transformation Plan leaders claimed the local authority backed their Accountable Care System. But<a href="https://www.lgcplus.com/services/health-and-care/county-denies-agreement-on-stp-next-phase/7021165.article#.WbKbGwmHqNo.twitter"> the County Council</a> has denied this, and it’s likely that many elected councillors and MPs in the other “vanguard” ACSs will be equally reluctant to take political responsibility for plans which masquerade as “integration” of services but threaten to bring only declining quality and restrictions on access to care. </p> <p>The STPs and ACSs all lack any legal status to force through cuts. Councils still <a href="http://www.healthcampaignstogether.com/councilaction.php">retain powers</a> to challenge and force a review of decisions that represent a threat to local health care services – and they must be pressed to use them.</p> <p>However politicians – like the wider public – will remain in blithe ignorance over developments in the NHS – unless campaigners can pile on enough pressure and present sufficient compelling evidence to make clear what is happening.</p> <p>There is more and more evidence to show which way things are going. It’s reported in Healthcare Europa that NHS England has surreptitiously decided to award all six of the NHS contracts for organising the new “Integrated Care” models to private companies. All but one are American-owned - the other, OptiMedis, is from Germany.</p> <p>If this proves to be correct, Tory politicians will find it even harder to convince suspicious voters that they are not destroying our NHS with cuts only to open the doors to the ultimate horror: US-style health care. Even NHS-run ACSs represent a huge retreat from a national NHS to 44 local plans each with rigid cash limits and no remaining accountability to local communities.</p> <p>Theresa May’s team has adopted an ostrich-style response to the rising cash crisis and its likely impact this winter. But it’s clear that many of her MPs, fearing they could lose their reduced majorities at the next election, are pressing hard behind the scenes for a reprieve for local services. </p> <p>MPs have already forced significant retreats from hospital downgrades in north Devon and Essex. Cabinet minister Andrea Leadsom has backed calls for a reprieve for hospital services at Banbury’s Horton General, and may yet have something to say about Oxfordshire’s latest bed closures. </p> <p>Many more Tory MPs need to be confronted by local pressure to force this weak minority government to back off on cuts and new models – just as they have been forced to drop privatisation of <a href="https://opendemocracy.net/ournhs/ellen-lees/we-did-it-nhs-professionals-stays-public">NHS Professionals</a>. </p> <p>We urgently need to build a big enough and strong enough movement to force politicians to take notice if we are to avoid a further irreversible decline this winter and ever-deepening crisis in the NHS.</p> <p>That’s why <a href="http://www.healthcampaignstogether.com./">Health Campaigns Together</a> has called for the biggest-ever gathering of health campaigners on November 4 in Hammersmith Town Hall in a conference that will share information and experiences, link trade unions, pensioners and campaigners, and build networks that can unite and concentrate the strength of local campaigns. </p> <p>We have nationally known speakers and local campaigners – and lots of time for workshops, networking and discussion. Join us: <a href="http://www.healthcampaignstogether.com/conference.php">book your place now</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/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/it-may-not-look-like-it-but-jeremy-hunt-does-have-plan-for-nhs-0">It may not look like it, but Jeremy Hunt DOES have a plan for the NHS...</a> </div> <div class="field-item odd"> <a href="/ournhs/john-lister/england-has-relatively-few-hospital-beds-so-why-are-there-calls-to-close-more">England has relatively few hospital beds - so why are there calls to close more? </a> </div> <div class="field-item even"> <a href="/ournhs/colin-leys/sustainability-and-transformation-plans-kill-or-cure-for-nhs">Sustainability and Transformation Plans - kill or cure for the NHS?</a> </div> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/what%27s-really-causing-ae-crisis-and-how-can-we-fix-it">What&#039;s really causing the A&amp;E crisis - and how can we fix it? </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 John Lister Tue, 19 Sep 2017 06:52:53 +0000 John Lister 113453 at https://www.opendemocracy.net We did it! NHS Professionals stays public https://www.opendemocracy.net/ournhs/ellen-lees/we-did-it-nhs-professionals-stays-public <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>A people-powered campaign has defeated "<a href="https://opendemocracy.net/ournhs/michael-thorne/most-foolish-nhs-privatisation-yet">the most foolish NHS privatisation yet</a>" - now it's time to build on our momentum and stop the creeping privatisation elsewhere in the health service.</p> </div> </div> </div> <p><em><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/ellen lees.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/ellen lees.jpg" alt="" title="" width="460" height="306" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span>Image: We Own It campaign officer Ellen Lees celebrating the win. </em></p><p>The government announced last week that they <a href="http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-09-07/HCWS116/">have abandoned their plans to sell of NHS Professionals at the 11th hour</a>. This last-minute victory shows that when campaigners, unions, and politicians work together, we can force the government U-turn, and protect vital public services from privatisation.</p> <p>NHS Professionals is a publicly owned staff bank which supplies temporary staff to NHS Trusts and hospitals. It saves the NHS £70m per year by charging low commission on staff wages, and investing its profits back into the NHS. It was created to save the NHS from forking out high commission to private staffing agencies. It serves around a quarter of NHS Trusts, and is looking to expand its service to reach more hospitals, and save more money. The government decided to privatise NHS Professionals to inject private capital, and we think, to palm off responsibility for yet another aspect of the national health service. </p> <p>We Own It ran the campaign to stop the sale, working closely with campaigners from Keep Our NHS Public, Health Campaigns Together, and OurNHS openDemocracy, as well as the health team at Unison, backbenchers and shadow health ministers at Labour, and the Green Party’s Caroline Lucas. </p> <p>The government had planned to sell off a 75% stake in the company, but it will now be kept in public hands. The contract with the new owner was due to begin on 1st September, but was delayed and then abandoned entirely. The government announced their change of heart at 8am on the 7th of September, with as little fanfare as possible.</p> <p>Our supporters were persistent - writing emails, signing petitions and putting pressure on stakeholders from all angles. We’ve proven what we already knew to be true - that people power really does work, and that we can influence the big decisions if our efforts are focused and strategic. </p> <p><a href="https://www.parliament.uk/edm/2017-19/152">100 MPs signed our Early Day Motion</a> against the sale, encouraged by emails from our supporters - their constituents. Thousands of people signed our petition to the Department of Health. <a href="https://weownit.org.uk/blog/national-audit-office-please-investigate-sale-nhs-professionals">We called on the National Audit Office to investigate the sale</a>, along with Justin Madders, MPs, doctors and NHS campaigners. Something must have worked! Between us we pressured Jeremy Hunt and Philip Dunne into reversing the sale. Last Thursday morning, Philip Dunne said in a statement that NHS Professionals would remain ‘wholly in public ownership’. </p> <p>This is a huge victory for the NHS and everyone in this country. The public doesn't want to see senseless privatisations and they have stood up to say no to this one. The government's decision to back away from this sale is absolutely the right thing to do and we hope this will make them look again at other plans for NHS privatisation that are still ongoing.</p> <p>The government has realised that NHS Professionals is a highly valuable public asset that doesn't belong in the private sector. We're glad they've listened to us - to campaigners, doctors and patients. Now we're gearing up to push back privatisation elsewhere in 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/michael-thorne/most-foolish-nhs-privatisation-yet">The most foolish NHS privatisation yet?</a> </div> <div class="field-item even"> <a href="/ournhs/jos-bell/tory-links-of-health-agencies-exposed-as-hunt-lines-up-next-nhs-selloff-in-england">Tory links of health agencies exposed as Hunt lines up next NHS sell-off in England</a> </div> <div class="field-item odd"> <a href="/ournhs/jos-bell/admiral-jeremy-is-not-so-admirable">Admiral Jeremy is not so admirable</a> </div> <div class="field-item even"> <a href="/ournhs/paul-teed/locum-ae-doctor-speaks-out-about-silent-privatisation-of-nhs-workforce">A locum A&amp;E doctor speaks out about the silent privatisation of the NHS workforce</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 Sep 2017 10:46:18 +0000 Ellen Lees 113334 at https://www.opendemocracy.net Why the next Labour Manifesto must pledge to legislate to reinstate the NHS https://www.opendemocracy.net/ournhs/allyson-pollock/why-next-labour-manifesto-must-pledge-to-legislate-to-reinstate-nhs <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Labour’s 2017 health manifesto was a hodgepodge of offers but failed to tackle the underlying issues. Bold thinking and a commitment to the NHS Reinstatement Bill - is needed now.</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/Little_Allyson_400x400.bmp_.png" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/Little_Allyson_400x400.bmp_.png" alt="" title="" width="400" height="400" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>The 2017 Labour manifesto for health, like the road to hell, is paved with good intentions. </p> <p>Its pledges include improving children’s and mental health services, more funding for NHS and social care, tackling obesity and other public health prevention initiatives. However, unlike the Beveridge report of 1942, which considered the social determinants of health in the round, with its plan to slay the five giants of want, disease, ignorance, idleness and squalor, this manifesto for health has no public health framework. It is puzzling to see the issues of tackling unhealthy foods, obesity, physical activity, smoking and alcohol tucked under public health and the NHS, when what is required is an appreciation of the wider health political economy and the roles of industry and poverty. Redistributive policies are absent as are legislative actions, apart from on food labelling, advertising and a sugar tax.</p> <p>This health manifesto has cherry-picked the bits that those with the loudest voices have lobbied for, for example, the cancer fund, PrEP (pre-exposure prophylaxis), sexual health and HIV services, free hospital car parking, medicines review and regulation, the children of alcoholics, young smokers, mixed sex wards and special enquiries into blood contamination and the drug Valproate. It’s a jumble of ideas competing and jostling for priority. Each good intention is individually worthwhile but there’s no coherence as a strategy and no connection to rights to health and social determinants of health. What is missing is the big picture of what is really happening to the NHS, social care and public health.</p> <p><strong>The privatisation problem</strong></p> <p>Let’s start with the NHS and Social Care which are considered separately:</p> <p>“The next Labour government will reverse privatisation of our NHS and return our health service into expert public control. Labour will repeal the Health and Social Care Act that puts profits before patients, and make the NHS the preferred provider.”</p> <p>Care services have been relentlessly privatised over decades (See Pollock, 2005). The Health and Social Care (HSC) Act 2012 abolished and dismantled the NHS in England. Most social care and long-term care is delivered by for-profit companies and is means-tested. Public health has been pushed out to local authorities along with many sexual health, health promotion, HIV, and children’s services, and now the funding is being turned off and services closed. Long-term care has been almost completely privatised. These are structural changes. Yet Labour’s manifesto is virtually silent on the drastic and devastating system changes that have taken place as a result of the 1990 internal market and the 2012 Act. There is no whole-system approach, although the story that is being spun is one of integration of services and budgets.</p> <p>“The National Care Service will be built alongside the NHS, with a shared requirement for single commissioning, partnership arrangements, pooled budgets and joint working arrangements. We will build capacity to move quickly towards a joined-up service that will signpost users to all the appropriate services at the gateway through which they arrive.”</p> <p>There is nothing to differentiate these aspirations from the current Conservative administration’s articulation of its own policies. How exactly are sexual health, public health, mental health and children’s services, which are currently so fragmented - commissioned by so many different bodies and provided by a plethora of ‘providers’ - going to be reintegrated? How is long-term care provision, which is owned and operated by multinational for-profit companies, going to be integrated with publicly owned and publicly provided as well as privately operated health services? What are these partnership and joint working arrangements? How will pooled budgets and integration work, when NHS care is free and social care is charged for and means-tested? There is a marked disconnect in these aspirations.</p> <p>Most worryingly is the manifesto commitment to make the NHS the ‘preferred provider’, continuing the problematic purchaser-provider split and market elements in the NHS. Is there any intention to take long-term care and social care back into public ownership and control and to have national services? Rather, the commitment is to mitigating market excesses: the manifesto declares: “We will introduce a new legal duty on the Secretary of State and on NHS England to ensure that excess private profits are not made out of the NHS at the expense of patient care.”</p> <p>The manifesto makes no mention of commercial contracting being virtually legally compulsory for the NHS. What are excess profits - why have profits at all? In other words, the manifesto is committed to the status quo of commercial contracting, except for limiting excess profiteering. How exactly it is going to do that is a mystery.</p> <p>As for new legal duties, the primary establishing legal duty on the Secretary of State since 1946 has been to provide universal healthcare throughout. It was abolished in 2012. Why doesn’t the manifesto commit the party to restoring the duty to provide, rather than saying: “We will reinstate the powers of the Secretary of State for Health to have overall responsibility for the NHS.”</p> <p>On the <strong>workforce</strong>, the manifesto says: </p> <p>“To guarantee the best possible services for patients, Labour will invest in our health and care workforce. A Labour government will step in with a long-term workforce plan for our health service that gives staff the support they need to do the best for their patients.”</p> <p>Once again the manifesto fails to mention the enormous deregulation of terms and conditions that has occurred as a result of commercial contracting and the internal market. NHS Foundation Trusts are structurally 49% non-NHS and can set their own terms and conditions and determine staffing levels. In the mainly private for-profit long-term care sector, most employees are low-paid women and un-unionised. This is going to get worse under current government plans for partnerships.</p> <p><strong>Partnerships and fragmentation</strong></p> <p>Commercial contracts and joint ventures with the private sector are at the heart of the current government’s plans for radical changes to the NHS and its new models of care, termed Accountable Care Systems (ACSs) and Accountable Care Organisations (ACOs). Currently NHS England and Clinical Commissioning Groups (CCGs) are tendering for many thousands of contracts each year with multiple NHS providers and private companies bidding, all at great cost.</p> <p>In future this could reduce to a few hundred contracts. The Government plans to bundle up services into giant contracts which will be awarded by CCGs and local authorities to the above-mentioned ACOs. Organisations, known variously as Multi-speciality Community Providers (MCPs) and Primary and Acute Services (PACS) comprise these private and/or public NHS providers. These large contracts will be for ten years minimum. ACOs (MCPs and PACs) will in turn manage the risks and costs of care through subcontracts - which in turn may also sub-subcontract for services.</p> <p>NHS providers and private providers can form Special Purpose Vehicles (SPVs). According to accountants PWC, this is an</p> <p>&nbsp;“off-balance sheet vehicle comprised of a legal entity created by the sponsor or originator, typically a major investment bank or insurance company, to fulfil a temporary objective of the sponsoring firm. SPVs can be viewed as a method of disaggregating the risks of an underlying pool of exposures held by the SPV and reallocating them to investors willing to take on those risks. This allows investors access to investment opportunities which would not otherwise exist, and provides a new source of revenue generation for the sponsoring firm.”(1) </p> <p>So SPVs are a mechanism for bringing in private health insurers and property companies and investment bankers. This is what integration means in the market place – bundling up services into giant contracts and tendering them out. This Labour manifesto shows no sign of distancing itself from, and abolishing the market with necessary legislation.</p> <p>Labour is also committed to a new model of care: </p> <p>“We will work towards a new model of community care that takes into account not only primary care but also social care and mental health. We will increase funding to GP services to ensure patients can access the care they need. And we will halt pharmacy cuts and review provision to ensure all patients have access to pharmacy services, particularly in deprived or remote communities.”</p> <p>But Labour is utterly silent on how it will do this and how it will engage with the current Government’s radical ‘new models of care’ or joint ventures, through which it is transferring risks and its responsibilities for funding and providing services to private providers and ultimately patients. The manifesto’s references to partnerships and integration are ominous when there is no pledge to taking back public ownership and renationalising the NHS and social care. GP services are being cut and increasingly run by private for profit companies.</p> <p>“Labour will halt and review the NHS ‘Sustainability and Transformation Plans’, which are looking at closing health services across England, and ask local people to participate in the redrawing of plans with a focus on patient need rather than available finances. We will create a new Quality, safety and excellence regulator – to be called ‘NHS Excellence’.”</p> <p>Sustainability and Transformation Plans (STPs) and ACOs are the key mechanism for privatising NHS clinical services and for introducing alternative sources of funding for health care, namely health insurance and charges. Although there is as yet no legislation for STPs, ACSs and ACOs, the Government is pushing through these new organisational forms and contracts at breakneck speed, under the parliamentary radar and without public knowledge and consent, in order to bind the hands of future governments.</p> <p>NHS England has already appointed clinical leads and managers to many of the 44 STPs, and has spent over £20m on management consultants and staff.(2) For example, a contract worth £2.7m has been awarded to Capita by Nottinghamshire and Nottingham STP to support the area's sustainability developments. Capita in turn has subcontracted with Centene UK, an American insurance company, to provide expertise and run its STP as it moves to ACS status.(3) Centene's core business in the US is in the Medicaid Managed Care market, whereby private insurers control government budgets for the poor, contract with providers, and pocket the difference. Following some highly profitable acquisitions in the US, the company announced its intentions to expand abroad and already has a partnership arrangement with the Valencia government's corporate partner in the Alzira health service, Ribera Salud. Ribera Salud is currently under police investigation for corruption.(4)</p> <p>It's also been recently announced that Nottingham CCG has tendered a contract for community services worth £205m as part of the intended ACS. Given those now involved in the ACS formation, it can safely be assumed this will be awarded to a private company. At least eight other STPs are reported to be following suit in developing ACSs, and will receive £450m of transformation funding from NHS England.</p> <p>Halting and reviewing STPs is a first step but it won't go far enough: the changes are being driven by NHS England. The Labour manifesto is silent on the fact that most Foundation Trusts (FTs), which since 2012 have had new powers to enter into join ventures and to generate 49% of their income from private patients and other non-NHS sources, are entering into giant contracts of their own with property management companies.</p> <p><strong>Funding</strong></p> <p>“Labour will boost capital funding for the NHS, to ensure that patients are cared for in buildings and using equipment that are fit for the 21st century. And we will introduce a new Office for Budget Responsibility for Health to oversee health spending and scrutinise how it is spent.”</p> <p>But there is no mention in the manifesto of the crippling costs of the <strong>Private Finance Initiative</strong> (PFI). A recent study by the Centre for Health and the Public Interest calculated that £831m had been made in pre-tax profits by PFI companies over the past six years, money which has not been available for patient care. This figure is equivalent to at least a quarter of the total NHS hospital deficit over the same period.(5) </p> <p>The Department of Health’s annual capital budget has been frozen in cash terms over the five years to 2020-21. Much of its revenue funding has been rebadged as capital, for example, relabelled Research and Development revenue funding, depreciation and previously committed expenditure. Moreover it is being used to balance growing revenue deficits in the NHS Trust sector. In 2016-17 the DH Annual report and accounts reported that £1.2 billion of capital was moved to revenue expenditure in that year, a recurring pattern year on year.(6)</p> <p>To get around the lack of capital as well as the affordability, debt and deficit problems, FTs, especially those with PFI and deficits, are entering into various forms of joint venture in order to transform estate ownership and control. A hospital trust entering into an SPV with the clinical services income attached will have the additional attraction of being able to generate income from such services to pay the heavy debt charges and to raise borrowings for new capital using existing NHS property and to refinance PFI schemes.</p> <p>University College Birmingham NHS FT has, for example, recently linked up with the Healthcare Corporation of America (HCA) to build a mixed economy facility of 72 public and 66 private beds. According to the Trust, all capital has been provided by HCA. As an FT it can generate up to half its income privately. As such it is well positioned to become an ACO model. HCA currently has four joint ventures with NHS hospitals, including University College Hospital London and the Christie in Manchester.(7)</p> <p>Another form of joint venture, is the <strong>Strategic Estate Partnership</strong> (SEP). These 55 partnerships between the public and private sectors are intended to give the former greater control through non-exclusive contractual relationships where different stages of the process will be open to renewed tendering. In theory at least, this will mean a continual appraisal of value for money arrangements. In practice, however, SEPs are largely about maximising revenue creation in as many ways as possible, including developing retail outlets, car parking, patient hotels, sales and disposals, and private patient units.(8) Indeed many former PFI companies, such as Interserve, Prime and the Rydon Group, have simply transferred their attention to this new model which, given the scale of investment opportunities involved, could be considered a type of ‘<strong>PFI Plus</strong>’.</p> <p>There are currently more than eight SEPs reported on commercial and contracting websites, though it is hard to find any detail on Department of Health and NHS websites. The first SEP was at Lancashire Care Foundation Trust, with others now including Cheshire and Wirral Partnership FT, University Hospital Southampton FT, Isle of Wight Trust, Yeovil District Hospital FT and one at Hinchingbrooke following the collapse of Circle’s management of the Trust. Several more are in the pipeline. These include North West Anglia NHS FT, Oxleas NHS FT, and Whittington Hospital NHS Trust. </p> <p>The Labour manifesto does not mention the <strong>selling off of NHS assets</strong> to create revenue for the Treasury. Yet a key attraction of joint ventures, which allow investment bankers and property management companies to partner in health care, is the sale and disposal of NHS assets. Since the HSC Act 2012, the government has paved the way for privatisation of non-FT estate with the abolition of NHS Estates and creation of two Department of Health-wholly owned companies, NHS Property Services and Community Health Partnerships. NHS Property Services holds the estate of Primary Care Trusts and Strategic Health Authorities which was not transferred to trusts and is among the largest property owners in Europe. It is now charging exorbitant <strong>market rents</strong> to the NHS and GPs, to such an extent that small GP practices are closing and trusts and CCGs are struggling to pay. Community Health Partnerships includes 49 Local Improvement Financial Trust Companies with investment of £2.5 billion and 339 facilities involving 29 companies.</p> <p>NHS England has created six regional public-private partnerships to help speed up disposals, and once approval has been obtained, these will be advertised in the Official Journal of the European Union in six lots worth more than £3bn. Codenamed <strong>Project Phoenix</strong>, “private companies will work with the NHS to achieve the best market price for the sales without the requirement of upfront public investment, with profits shared between the NHS and its private partners. Details of the profit split have yet to be revealed”, according to the Health Service Journal.(9) In August this year Primary Health Properties, Octopus Healthcare and Assura came forward with a combined offer of £3.3bn of investment, which they say would provide the entire private capital necessary to embed STP plans and fund up to 750 new primary care centres at an approximate rental value of £200m per annum. All three companies incorporate both investment and property arms and are based offshore.(10) According to a LaingBuisson market report on primary care from 2015, the three companies, at a combined aggregate of £2.27bn, already had a 19% share of the estimated asset value of all GP premises in the UK.(11) Harry Hyman, managing director of Primary Health Properties, has been quick to say that this is not a form of PFI, rather a “continuation of our business model where we own the properties and rent them for the period of the lease.”(12) </p> <p>The manifesto makes four pledges for increasing funding: </p> <p>“We will increase the social care budgets by a further £8 billion over the lifetime of the next Parliament, including an additional £1 billion for the first year. This will be enough for providers to pay a real living wage…Labour will commit to over £30 billion in extra funding over the next Parliament through increasing income tax for the highest 5 per cent of earners and by increasing tax on private medical insurance, and we will free up resources by halving the fees paid to management consultants.”</p> <p>Of course more funding is necessary. By 2015–16, NHS commissioners, NHS trusts and NHS FTs reported a combined deficit of £1.85 billion, a greater than threefold increase in the deficit position of £574 million reported in 2014–15. Provider trusts’ overall deficit grew by 185% to £2.45 billion, up from £859 million in 2014–15, against a total income of £75.97 billion.</p> <p>In addition, two-thirds of NHS trusts (65%) and NHS FTs (66%) reported deficits in 2015-16, up from 44% of NHS trusts and 51% of NHS FTs in the previous financial year. The number of CCGs reporting cumulative deficits was 32 in 2015–16, up from 19 in both 2014–15 and 2013–14.(13) </p> <p>However, the Labour Manifesto fails to address where the money is going, namely the transactions costs of the market (12-30%), the high costs of PFI and prices of drugs and technologies which rise ahead of NHS pay and the costs of management consultants. It is silent on the enormous costs of administering a market, a market which it plans to retain, stating only that it will free up resources by halving the fees paid to management consultants.</p> <p><strong>The NHS Reinstatement Bill</strong></p> <p>Most surprisingly, the manifesto makes no mention of what will replace the HSC Act 2012 and no mention of the NHS Reinstatement Bill, which Jeremy Corbyn and John McDonnell supported before becoming leader and shadow chancellor respectively. This Bill has been tabled three times in the House of Commons, most recently by Margaret Greenwood MP.</p> <p>Diane Abbott, in her brief tenure as shadow health secretary, told Bill supporters outside parliament that Jeremy Corbyn had made a point of returning to the Commons to be present for the debate. It appears that the lack of manifesto commitment to the Bill comes from quarters within Labour other than Corbyn and his allies. The next Labour manifesto must now remedy the catastrophe that is unravelling and commit to the NHS Reinstatement Bill.(14) Unless this happens, there will be no NHS.</p> <p>The Bill proposes to fully restore the NHS as an accountable public service by reversing 25 years of marketisation in the NHS, abolishing the purchaser-provider split, ending contracting and re-establishing public bodies and public services accountable to local communities. This is necessary to stop the dismantling of the NHS under the HSC Act 2012. It is driven by the needs of local communities. Scotland and Wales have already reversed marketisation and restored their NHS without massive upheaval. England can too.</p> <p>The Bill provides flexibility in how it would be implemented, led by local authorities and current bodies. It would:</p> <p>- reinstate the Government’s duty to provide the key NHS services throughout England, including hospitals, medical and nursing services, primary care, mental health and community services,</p> <p>- integrate health and social care services,</p> <p>- declare the NHS to be a “non-economic service of general interest” and “a service supplied in the exercise of governmental authority,” so asserting the full competence of Parliament and the devolved bodies to legislate for the NHS without being trumped by EU competition law and the World Trade Organization’s General Agreement on Trade in Services,</p> <p>- abolish the NHS Commissioning Board (NHS England) and re-establish it as a Special Health Authority with regional committees,</p> <p>- plan and provide services without contracts through Health Boards, which could cover more than one local authority area if there was local support,</p> <p>- allow local authorities to lead a ‘bottom up’ process with the assistance of CCGs, NHS trusts, NHS FTs and NHS England to transfer functions to Health Boards,</p> <p>-&nbsp; abolish NHS trusts, NHS foundation trusts and CCGs after the transfer </p> <p>- abolish Monitor – the regulator of NHS FTs, commercial companies and voluntary organisations – and repeal the competition and core marketsation provisions of the 2012 Act,</p> <p>- integrate public health services and the duty to reduce inequalities, into the NHS,</p> <p>- re-establish Community Health Councils to represent the interest of the public in the NHS,</p> <p>- stop licence conditions taking effect which have been imposed by Monitor on NHS foundation trusts and which reduce the number of services they currently have to provide,</p> <p>- introduce a system for collective bargaining across the NHS,</p> <p>- centralise NHS debts under the PFI in the Treasury, require publication of PFI contracts and also require the Treasury to report to Parliament on reducing NHS PFI debts,</p> <p>- abolish the legal provisions passed in 2014 requiring certain immigrants to pay for NHS services</p> <p>- declare the UK’s agreement to the proposed Transatlantic Trade and Investment Partnership and other international treaties affecting the NHS to require the prior approval of Parliament and the devolved legislatures,</p> <p>- require the Government to report annually to Parliament on the effect of treaties on the NHS.</p> <p><strong>Conclusion</strong></p> <p>By 2011 David Bennett the former head of Monitor, the economic regulator of the NHS, was telling the <em>Times</em>: “The NHS is ripe for dismemberment.”(15) He declared to the House of Commons health select committee: “We, in the UK, have done this in other sectors before. We did it in gas, we did it in power, we did it in telecoms… We've done it in rail, we've done it in water, so there's actually 20 years of experience in taking monopolistic, monolithic markets and providers and exposing them to economic regulation.”(16)</p> <p>On Sep 27th 2016, Diane&nbsp;Abbott, then shadow health secretary, stated at the Labour Party conference:<br /> “Under Jeremy Corbyn's leadership, the Labour Party will be committed to halting and reversing the tide of privatisation and marketisation of the NHS. The Health and Social Care Act has fragmented the system, making it so much easier for the private sector to move in. Conference, Labour in government will repeal the Health and Social Care Act. This means returning our NHS to what is was originally conceived as: a publicly owned, publicly funded, publicly accountable universal service as outlined in the NHS Reinstatement Bill now being expertly piloted through Parliament by my colleague Margaret Greenwood, MP for Wirral West, with the support of the Labour leadership.”(17)</p> <p>We must all hold the Labour Party to that pledge.</p> <p>&nbsp;</p> <p>The author wishes to acknowledge the help of Stewart Player for his contribution to the analysis of NHS estates.</p> <p>References</p> <p>Allyson M Pollock, <em>NHS PLC: The privatisation of our health care</em> (Verso, 2005). </p> <p>Footnotes</p> <p>(1) <span><a href="https://www.pwc.com/gx/en/banking-capital-markets/publications/assets/pdf/next-chapter-creating-understanding-of-spvs.pdf">https://www.pwc.com/gx/en/banking-capital-markets/publications/assets/pdf/next-chapter-creating-understanding-of-spvs.pdf</a></span> </p> <p>(2) See for example: <span><a href="http://www.pulsetoday.co.uk/news/commissioning/how-the-nhs-is-spending-millions-on-consultancy-firms/20035171.article">http://www.pulsetoday.co.uk/news/commissioning/how-the-nhs-is-spending-millions-on-consultancy-firms/20035171.article</a></span>&nbsp; and <span><a href="https://www.bma.org.uk/news/2017/june/doctors-horrified-by-staff-costs">https://www.bma.org.uk/news/2017/june/doctors-horrified-by-staff-costs</a></span> </p> <p>(3) <span><a href="http://www.nottinghampost.com/news/health/controversial-firm-capita-handed-27m-377493">http://www.nottinghampost.com/news/health/controversial-firm-capita-handed-27m-377493</a></span> </p> <p>(4) <span><a href="https://calderdaleandkirklees999callforthenhs.wordpress.com/2017/09/01/buyer-beware-centene-corporation-contract-with-nottingham-nhs-organisations-is-2-7m-can-of-worms/">https://calderdaleandkirklees999callforthenhs.wordpress.com/2017/09/01/buyer-beware-centene-corporation-contract-with-nottingham-nhs-organisations-is-2-7m-can-of-worms/</a></span> </p> <p>(5) <span><a href="https://chpi.org.uk/papers/reports/pfi-profiting-from-infirmaries/">https://chpi.org.uk/papers/reports/pfi-profiting-from-infirmaries/</a></span> </p> <p>(6) <span><a href="https://publications.parliament.uk/pa/cm201617/cmselect/cmpubacc/887/88702.htm">https://publications.parliament.uk/pa/cm201617/cmselect/cmpubacc/887/88702.htm</a></span> </p> <p>(7) <span><a href="http://www.nhsforsale.info/private-provders/private-provider-profiles-2/hca.html">http://www.nhsforsale.info/private-provders/private-provider-profiles-2/hca.html</a></span> </p> <p>.(8) See for example: <span><a href="http://www.hempsons.co.uk/news/strategic-estates-partnerships-investing-challenging-times-briefing/">http://www.hempsons.co.uk/news/strategic-estates-partnerships-investing-challenging-times-briefing/</a></span> </p> <p>(9) <span><a href="https://www.hsj.co.uk/finance-and-efficiency/exclusive-private-deals-being-planned-to-release-naylor-billions/7018691.article">https://www.hsj.co.uk/finance-and-efficiency/exclusive-private-deals-being-planned-to-release-naylor-billions/7018691.article</a></span> </p> <p>(10) <span><a href="http://www.gponline.com/bma-urges-caution-developers-offer-33bn-primary-care-premises-overhaul/article/1441684">http://www.gponline.com/bma-urges-caution-developers-offer-33bn-primary-care-premises-overhaul/article/1441684</a></span> </p> <p>(11) LaingBuisson, Primary Care &amp; Out-Of-Hospital Services, Second Edition, 2015)</p> <p>(12) <a href="https://www.hsj.co.uk/finance-and-efficiency/exclusive-naylor-delighted-at-33bn-private-investment-offer/7020346.article">https://www.hsj.co.uk/finance-and-efficiency/exclusive-naylor-delighted-at-33bn-private-investment-offer/7020346.article</a> </p> <p>(13) <span><a href="https://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/inquiries/parliament-2015/financial-sustainability-nhs-16-17/">https://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/inquiries/parliament-2015/financial-sustainability-nhs-16-17/</a></span> </p> <p>(14) <a href="http://www.nhsbill2015.org">www.nhsbill2015.org</a> </p> <p>(15) <a href="https://www.thetimes.co.uk/article/a-spoonful-of-competition-is-ordered-to-revitalise-nhs-b3hgvdpfgmg">https://www.thetimes.co.uk/article/a-spoonful-of-competition-is-ordered-to-revitalise-nhs-b3hgvdpfgmg</a> </p> <p>(16) <a href="https://publications.parliament.uk/pa/cm201012/cmselect/cmhealth/1431/1431we06.htm">https://publications.parliament.uk/pa/cm201012/cmselect/cmhealth/1431/1431we06.htm</a> and <span><a href="https://publications.parliament.uk/pa/cm201011/cmselect/cmhealth/796/79611.htm">https://publications.parliament.uk/pa/cm201011/cmselect/cmhealth/796/79611.htm</a></span> </p> <p>(17) <a href="http://press.labour.org.uk/post/151047163644/diane-abbott-mp-shadow-secretary-of-state-for/embed">http://press.labour.org.uk/post/151047163644/diane-abbott-mp-shadow-secretary-of-state-for/embed</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/caroline-lucas/i%E2%80%99m-proud-to-have-presented-crossparty-nhs-reinstatement-bill-in-parliament">To save our health service MPs must stand together and back the NHS Reinstatement Bill</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 Allyson Pollock Tue, 12 Sep 2017 08:17:21 +0000 Allyson Pollock 113307 at https://www.opendemocracy.net “An elderly man cried in the waiting room because he just wanted to get back to his bed” https://www.opendemocracy.net/ournhs/steve-hynd/elderly-man-cried-in-her-waiting-room-because-he-just-wanted-to-get-back-to-his-be <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>When Arriva doesn’t arrive – how privatised ambulances are failing us.</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/arriva.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/arriva.jpg" alt="" title="" width="460" height="259" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>Sat in the waiting room of Cheltenham Hospital with my Dad I started to google ‘<a href="https://www.arrivatransportsolutions.co.uk/">Arriva NHS patient transport</a>’. I had already read all that Hello magazine had to offer, what else was I to do?</p> <p>And so, I read to fill the time. I read about the company that many local NHS managers (including here in Gloucestershire) have contracted to provide patient transport. I read with bemusement about their commitments “to the highest quality of care” and about how patients “inspire” them “to achieve excellence”. I laughed to myself about how this failed to tally with my experience. I also started to read alarming numbers of patient testimonies describing being let down by them. About how the most vulnerable were being left for hours with no adequate care.</p> <p>That morning I had sat by myself for hours as my Dad failed to show up for his appointment. He was coming from Cirencester, less than half an hour’s drive away, but finally arrived close to 2 hours late. Arriva’s patient transport ambulance service had picked him up 15 minutes after his appointment time and then proceeded to pick other patients up on the way meandering through Cotswold villages.</p> <p>In that time, I rescheduled his appointment, twice. The receptionist was wonderfully understanding yet deeply scathing about Arriva. She gave me their direct number saying that the dispatch office of Arriva no longer listened to her. “It shouldn’t but it happens all the time. Where we can we will always try and fit people in. Often, I end up having to book patients taxis. It’s not right that people should have to wait around like this” she said.</p> <p>She was apologetic, nice, but in her mind, unable to help or affect the system that was failing patients.</p> <p>After the appointment was over Arriva informed me that they were, once again, running late. I rang them directly. They apologised over the phone to me and said that there would be an hour delay in getting my Dad picked up.&nbsp;This was at 12:15, about the time I had originally agreed to take over looking after my 5-month-old baby, and about one hour after my 2-hour parking ticket had run out.</p> <p>What happened next was bordering on the farcical. To be exact:</p> <p>I rang at 12:15 to be told they would be there by 1:15.</p> <p>I rang at 1:30 to be told they would be there by 2:00.</p> <p>I rang at 2:15 to be told they would be there by 2:30.</p> <p>I rang at 2:45 to be told they would be there by 3:00.</p> <p>I rang at 3:10 and they arrived a few minutes later.</p> <p>When they did arrive, they apologised for being late by saying “we weren’t sure which department you were in”. I didn’t quite have the emotional energy to respond. I had arrived that morning at 10:30 to support my Dad through a 5-minute routine appointment. I was leaving close to five hours later.</p> <p>Sadly, though this seems far from unusual. As one nurse who came out to see us still waiting retorted, “why am I not surprised to see you still here?”. My cursory google search gave dozens of comparable stories. <a href="http://www.stroudnewsandjournal.co.uk/news/14936712.Fresh_criticism_of_Arriva_after_disabled_Stonehouse_man_left_stranded_and_refused_ride_home_because_of_mobility_scooter/">67-year old Brian Cropton</a> from Stonehouse commented that “it’s just getting worse and worse” after he found himself regularly let down by them being left for hours and on occasion completely abandoned.</p> <p>This chimes not only with the experience of the NHS staff who I spoke to, but also one of the official records. Last year in July members of Gloucestershire County Council’s Health and Care Overview and Scrutiny Committee told Arriva its performance was not good enough. <a href="http://www.wiltsglosstandard.co.uk/news/14621425.Private_health_contractor_comes_under_fire_for____putting_profit_before_service___/">One local councillor commented</a> that “Arriva have patently failed in a number of areas and it simply isn’t good enough”, adding “[The] report is full of excuses”.</p> <p>This came a year after an official warning was issued in late 2015 for “consistent failure to achieve a number of required Key Performance Indicator standards”.</p> <p>I write this now not just because my own experience was awful but because it fits into a wider pattern. Not once since Arriva Transport Ltd took the Gloucestershire NHS contract for non-emergency patient transport have they <a href="http://glostext.gloucestershire.gov.uk/documents/s36081/PTS%20-%20HCOSC%20Update%20March%202017.pdf">hit their own target</a> of 95% of patients being dropped off between 45 minutes before and 15 minutes after their appointments. Pause on this point for a minute. Even if they had hit their targets, 1 in 20 patients would not be dropped off within an hour slot of their appointments. Can you imagine the logistical and financial impact this is having?</p> <p>With one year left on their contract, I wonder if anything will change. Will it just be renewed? Is the NHS in a financial state to pay for better services? Is there any reason not to bring the service back in-house?</p> <p>I don’t know. What I do know though is that the receptionist I spoke to told me about an elderly man who cried in her waiting room because he just wanted to get back to his bed and I know that is not OK.</p> <p><em>This article was cross-posted from <a href="https://stevehynd.com/2017/09/05/nhs-patient-transport-system/">Steve Hynd’s blog</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/julius-marstrand/rushing-off-cliff-privatisation-of-patient-transport-services">Rushing off a cliff - privatisation of patient transport services</a> </div> <div class="field-item even"> <a href="/john-furse/our-nhs-cant-afford-privatisation-why-mps-must-back-nhs-bill-this-friday">Our NHS can&#039;t afford privatisation - why MPs must back the NHS Bill this Friday</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 Steve Hyndside Wed, 06 Sep 2017 13:03:40 +0000 Steve Hyndside 113220 at https://www.opendemocracy.net Second-guessing your GP’s referral - NHS denials leave big questions unanswered https://www.opendemocracy.net/ournhs/david-wrigley/second-guessing-your-gp-s-referral-nhs-denials-leave-big-questions-unanswered <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p class="MsoNormal">Despite attempts by government to squash the ‘NHS referral scheme’ story, senior doctors have serious concerns about the damage the proposed scheme will do to the NHS, people’s health and to the doctor/patient relationship.</p> </div> </div> </div> <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/549093/6894514803_05bab6de11_z.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/6894514803_05bab6de11_z.jpg" alt="" title="" width="460" height="345" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p><em>Image: <a href="https://www.flickr.com/photos/lucasmoratelli/6894514803/in/photolist-bvfc3T-7xVu3G-7xVd69-7BUZQd-oWnxY-p2c9y-e1bVx2-8Js4aG-8xr8C1-S6tFM-8xr8CW-dCkBaH-5aS9Wa-nVBPs-kZYST-reKvuc-6A18ns-6mbZ8g-4Bt4Hv-7bDnSP-Xb1ZwD-2hizu4-6CxuyR-7Tqwpg-nSF6e-aguvS2-UX6Yjd-5o2s86-B1ZBGg-BDFWkh-4eFvyg-VsR8mW-nVAsS-p2c9W-5AG8Zw-FBYad-6sZyEq-FVLyb-fMaXoG-BBHHjM-oWnxs-555uex-qivd7m-SV6WPC-nVBxf-5BWsUk-5P63bB-pipBB-2YQtxw-6jqzRH">Flickr/Lucas Moratelli</a>, Creative Commons</em></p><p>The latest idea from NHS England has got doctors really angry – and it takes a lot to do that these days, given the familiarity of relentless attacks on the profession and the health service itself. </p><p class="MsoNormal"><a href="http://www.pulsetoday.co.uk/news/clinical-news/gps-to-be-asked-to-peer-review-all-referrals/20035161.article">NHS England are to ask CCGs</a> to put every referral from a GP through a new vetting process before they reach the specialist they were intended for, according to a leaked memo of the secret plans. The term for this is ‘referral management’ (there are a few exceptions to this scheme, like urgent or suspected cancer referrals). </p> <p class="MsoNormal">Since 1948 GPs have been at the front line of NHS healthcare. Every UK citizen has the right to register with an NHS GP and that GP is the first port of call if you are unwell or feel worried about your health. Often your GP would undertake further tests or investigations to try and diagnose the illness you presented to them. Sometimes it isn’t possible to confirm a diagnosis and your GP would decide to refer you on to a hospital specialist for their opinion, further investigations and / or advice and treatment.</p> <p class="MsoNormal">So why is NHS England saying that all such referrals now have to be second-guessed by a panel who haven’t even seen the patient – with the suggestion this scheme could reduce referrals by up to 30<a href="http://www.independent.co.uk/news/uk/home-news/gps-hospital-referral-scrutiny-money-saving-cut-costs-leaked-nhs-memo-a7919871.html">%?</a></p> <p class="MsoNormal">In today’s NHS these referrals have <a href="https://www.gov.uk/government/publications/nhs-national-tariff-payment-system-201617">pound signs</a> attached to them. Every GP referral is seen by NHS England as another burden on the NHS budget and they are now looking at ways to reduce those referrals to hospital doctors. NHS England focuses on the pound signs but seem to forget that behind those referrals are real people with real problems who have already seen their GP, often many times, and in need of the help of a hospital specialist.</p> <p class="MsoNormal">The former head of the Royal College of GPs, Maureen Baker, <a href="https://twitter.com/Maureenrcgp/status/904251151566204928">said in response</a> that she is “concerned about the patient safety implications of referral management” and asks “what – if any – risk assessment has been done?” </p> <p class="MsoNormal"><span>Hospital doctors are also deeply concerned, with the President of the Royal College of Physicians </span><a href="https://twitter.com/DacreJane/status/903523216156745728"><span>saying</span></a><span> “</span>Vetting GP referrals to hospital is disempowering. There must be better ways to reduce outpatient attendances.”</p> <p class="MsoNormal">The BMA spokesperson, Dr Andrew Green, is similarly <a href="https://twitter.com/DrAndrewGreen/status/902789087723220992">scathing</a>: <span>“<em><span>We are used to seeing un-referenced claims such as ‘could reduce by up to’ in adverts for anti-wrinkle cream and I am surprised to see such language in an official document.” And he adds “It is important to be aware of the lost-opportunity costs of schemes like this, if we assume an hourly weekly meeting that would be equivalent to removing 1000 GPs from the English workforce, GPs we don’t have.”</span></em><em><span>&nbsp;</span></em></span></p> <p class="MsoNormal">But the loss of GP time in vetting the referrals is also lost on NHS England, it seems.</p> <p class="MsoNormal">We live in a country that is the <a href="https://www.weforum.org/agenda/2017/03/worlds-biggest-economies-in-2017/">5th richest in the world</a> <span>&nbsp;</span>and has an NHS that is the <a href="https://www.theguardian.com/society/2017/jul/14/nhs-holds-on-to-top-spot-in-healthcare-survey">envy of the world</a> despite funding shortfalls that have pushed it close to collapse.</p> <p class="MsoNormal">Usually restrained commentators are now raising concerns over this new scheme. Jeremy Taylor, CEO of <a href="https://www.nationalvoices.org.uk/">National Voices</a>, a coalition of health and social care charities, <a href="https://twitter.com/JeremyTaylorNV/status/904479092082442244">tweeted</a> “Has NHS England consulted anyone? Eg have any patients or patient organisations had any say in this?”</p> <p class="MsoNormal">Rather than face up to the criticism, NHS England seems to be hoping that if it fudges things enough, the storm will blow over. NHS England have their own ‘media’ twitter account (@NHSEnglandMedia) to highlight issues and rebut adverse publicity. On 29th August, the media account was concerned enough to tweet on this hot topic. </p><p class="MsoNormal">Alongside a shot of the Daily Mail front page headline ‘GPs told to slash hospital referrals’ the NHS England media account<span>&nbsp; </span><a href="https://twitter.com/NHSEnglandMedia/status/902649990341955586">claimed that it was</a> ‘Inaccurate nonsense from tomorrow’s Daily Mail’. In another sign of their sensitivity about this issue they even managed to get a rapidly published ‘clarification’ from the Daily Mail – something that some might see as harder than getting blood from a stone. The article published just 2 days later read:</p><p class="MsoNormal"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/clarification_1.png" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/clarification_1.png" alt="" title="" width="460" height="216" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p> <p class="MsoNormal"><span>But this claim feels like a frantic fudge from NHS England’s PR team. Despite numerous requests (including from myself and other high-profile experts), NHS England themselves have pointedly refused to explain publicly how GPs will ‘retain final responsibility’, overturn decisions if there is disagreement, or avoid delays. Many have pointed out that the experience of GPs in areas where ‘referral management’ has already been introduced, is that whatever the spin, these schemes do, in reality, override the GPs decisions.</span></p> <p class="MsoNormal"><span>Dr Steve Kell, former co-chair of NHS Clinical Commissioners is one of those expressing concern. He </span><a href="https://twitter.com/SteveKellGP/status/904575283721904129"><span>tweeted</span></a><span> “Making schemes mandatory is new – we’ve never had one. Lots of twitter noise but no actual guidance yet. Hope someone is watching.” In response to his </span><a href="https://twitter.com/SteveKellGP/status/903567566723059712"><span>question</span></a><span> “</span>So can we refer BEFORE the referral is reviewed?<span>” NHS England Media account merely replied “We will check for you. Please can you DM your contact details”. Kell is still </span><a href="https://twitter.com/SteveKellGP/status/903936231360352256"><span>asking</span></a><span> questions, including “what about…right to a second opinion and confidentiality?” so we can assume he’s not satisfied.</span></p> <p class="MsoNormal">The foundation of the centuries old doctor patient relationship is one of trust and this is why doctors remain one of the <a>most trusted professions in the UK</a>. For patients to find out they have been denied treatment will make them wonder about the reasoning for this. As Professor Martin Marshall, Vice Chair of the RCGP, said in a <a href="http://www.rcgp.org.uk/news/2017/august/peer-reviewing-referrals-should-be-for-good-patient-care-not-efficiency-savings.aspx">statement</a><span class="MsoHyperlink"> “</span><span>our concern is that these schemes can undermine the important trust that exists between GP and patient</span>.”</p> <p class="MsoNormal">As things stand now if your GP feels you need a consultant opinion they will sort this out for you and an appointment will <a href="https://www.theguardian.com/society/2017/mar/31/nhs-surgery-target-operations-cancelled-simon-stevens">eventually arrive</a> on your doormat. Under the new system the GP will not be sure if their referral will get through the ‘vetting process’. Highly trained GPs with years of experience will have to cross their fingers that their referral gets through the system. They will not be able to say to you in the consultation that you will definitely get an appointment. Its yet another stress and burden for GPs – many of whom are <a href="https://www.ft.com/content/16875d1c-8e4e-11e7-9084-d0c17942ba93">leaving their profession in droves</a>. The stress for patients will be evident too and it will raise suspicions by the patient if a GP says ‘I don’t think you need to see a specialist for this problem’. If your referral is knocked back will you wonder whether your local NHS is trying to save money from its already stretched budget?</p> <p class="MsoNormal">And in the long run the measure is likely to be entirely counter-productive. As Kailash Chand OBE, honorary Vice President of the BMA, <a href="http://www.independent.co.uk/voices/general-practice-nhs-hospital-appointments-jeremy-hunt-austerity-gp-a7921866.html">says</a> “if people are denied hospital treatment, then their health will invariably be compromised…In the long term, this measure will therefore end up costing the NHS more money and waste further time”.<span>&nbsp;</span></p> <p class="MsoNormal">GP and assistant medical director of NHS Wales <a href="http://disruptinghealthcare.blogspot.co.uk/2017/09/mandatory-peer-review-of-gp-referrals.html">Sally Lewis</a> agrees, blogging that these ‘referral panels’ will “create a laborious bureaucratic exercise” and “be completely ineffective at managing demand into secondary care” and concludes: “In the final analysis, all referrals are generated by unmet patient need. Let's figure out how to meet that need properly and not just put up the hand. Computer says no.”</p> <p class="MsoNormal">GPs need to speak out about this latest idea from Whitehall and patients need to write to their MPs to tell them they want the NHS to be funded adequately for the care they need and stop inventing new ideas to prevent their necessary care. </p> <p class="MsoNormal">More and more cuts to care are occurring and we must fight back or the NHS as we know it will be lost for good.</p> <p>&nbsp;</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 David Wrigley Tue, 05 Sep 2017 11:05:05 +0000 David Wrigley 113186 at https://www.opendemocracy.net The most foolish NHS privatisation yet? https://www.opendemocracy.net/ournhs/michael-thorne/most-foolish-nhs-privatisation-yet <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>If private staffing agency fees are damaging the NHS so much, why on earth does the government keep trying to privatise the in-house agency set up to help the NHS avoid the problem?</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/549093/10005770825_9f33c825cb_z.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/10005770825_9f33c825cb_z.jpg" alt="" title="" width="460" height="291" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p><a href="https://www.flickr.com/photos/shipleytyke/10005770825/in/photolist-gfbc56-S6KzPC-7BeeC2-ngB51c-SHwHNP-Sqvz1j-gfbo9k-gfaQtL-ngDfup-gfb7kA-7ZFtuM-RpyKQA-ngoriq-ngoazk-dGqmci-oSyKeE-S6rgXS-SCxiFu-pMjLPL-SFhgvZ-S6KA6u-dMpeiw-dMiFo6-gfbzbw-RrAPF4-pjBdLz-nMzL5Y-axrefm-SrP2Hs-bDTWuV-Tjr3Nz-dMpez3-niqaeM-RnK84u-bFL6Mt-Rr48dU-7CNthe-Rsbb1X-334myE-8f2Hnd-bDUiMt-riUS5Q-T5AwGU-bqZ253-aDkRSZ-bFLd3p-cRMkV7-7ZFtzV-auDDaz-bDUjdg"><em>Image: Flickr/Ralph Berry, some rights reserved</em></a></p><p>For the third time since 2010, the government is planning to sell off NHS Professionals, the NHS in-house temporary staffing agency. This is the latest in a long series of gradual and covert moves to privatise our NHS. The obscurity in the privatisation process is no surprise.<a href="https://yougov.co.uk/news/2013/11/04/nationalise-energy-and-rail-companies-say-public/" target="_blank"> 84%</a> of us want a publicly owned NHS. Those who want to place it in private hands know they can’t do so transparently.&nbsp;</p> <p>Plans for the sale of NHS Professionals in 2010 and 2014 were shelved. This time around, the government’s schedule has been disrupted by the election, and now Eleanor Smith, Labour MP for Wolverhampton South West, has tabled an <a href="http://www.parliament.uk/edm/2017-19/152">Early Day Motion (number 152)</a> for concerned MPs to sign, calling on the government to halt the sell-off, co sponsored by the SNP health spokeswoman Dr Philippa Whitford MP and Green Party co-leader Caroline Lucas MP.</p> <p>Lucas has also <a href="http://www.parliament.uk/business/publications/written-questions-answers-statements/written-questions-answers/?page=1&amp;max=20&amp;questiontype=QuestionsOnly&amp;house=commons%2clords&amp;member=3930">tabled written questions to the Department of Health</a> in an effort to find out more information about the sale process. Through parliamentary pressure and a wider campaign by We Own It, this move to privatise yet another part of the NHS can be stopped.</p> <p><strong>NHS recruitment</strong></p> <p>NHS Professionals was set up in 2001 as a response to the unsustainable costs of recruiting temporary healthcare staff through private agencies. It consists of a bank of 88,000 healthcare professionals and is used by around 60 out of 250 NHS Trusts. The organisation <a href="https://www.ft.com/content/5bc8444a-5979-11e7-9bc8-8055f264aa8b?mhq5j=e1" target="_blank">saves the NHS £70 million per year</a> and turned a<a href="https://www.hsj.co.uk/structure/dh-spends-2m-on-stalled-nhs-professionals-sale/7019197.article" target="_blank"> profit of £6.4 million</a> in 2015-16. It is currently owned entirely by the Department of Health, but the government plans to sell 74.9% of it to the highest bidder.</p> <p>Despite the success of NHS Professionals, agency staffing poses a<a href="http://www.telegraph.co.uk/news/2016/05/09/nhs-agency-staff-spending/" target="_blank"> significant financial problem</a> for the NHS. The costs of agency staff have have risen each year from 2011 to 2015-16, in which they reached <a href="https://www.ft.com/content/a199bd70-1e77-11e6-a7bc-ee846770ec15?mhq5j=e1" target="_blank">£3.64 billion</a> – £1.4 billion over budget.</p> <p>Unsurprisingly, a large chunk of this expenditure ends up as profit for recruitment agencies, which is not reinvested in the NHS. Of the £3 billion spent in 2016, between<a href="https://www.hsj.co.uk/technology-and-innovation/workforce-app-targets-agency-fees-costing-nhs-up-to-600m/7018193.article" target="_blank"> £300 and £600 million</a> went into the pockets of recruitment agencies. While hospitals struggle to function, the heads of recruitment agencies earn salaries of<a href="http://www.telegraph.co.uk/news/health/news/11642267/How-nursing-agencies-making-billions-are-bleeding-the-NHS-dry.html" target="_blank"> almost £1 million a year</a>.</p> <p>In October 2015, controls were introduced in an effort to curb extortionate recruitment charges. While this is reported to have saved the NHS<a href="http://www.telegraph.co.uk/news/2016/05/09/nhs-agency-staff-spending/" target="_blank"> £300 million in six months</a>, some trusts have<a href="https://www.nursingtimes.net/news/workforce/agencies-struggle-to-meet-nhs-demand-following-pay-cap/7002337.fullarticle" target="_blank"> struggled to fill vacancies</a> since the imposition of caps on recruitment charges. Even after the controls were introduced, there were reports of recruitment agencies taking a commission as high as<a href="http://www.dailymail.co.uk/news/article-3371332/Nursing-agencies-make-50-profit-fees.html" target="_blank"> 49%</a>.</p> <p><strong>NHS privatisation</strong></p> <p>The staffing problems facing the NHS look set to continue, not least given the<a href="http://www.bbc.co.uk/news/health-40476867" target="_blank"> net loss of nurses</a> reported earlier this year. But the solution is not to hand NHS Professionals over to private control, which would effectively turn it into the kind of organisation it was meant to allow the NHS to avoid.</p> <p>Privatisation damages the NHS is an at least three ways, and the current proposal is no exception.</p> <p>First, privatisation drives up costs. The millions funnelled to recruitment agencies’ shareholders could be reinvested in the NHS under a publicly owned system. The additional bureaucratic costs of running the NHS as a market are also astronomical, estimated to be <a href="https://www.opendemocracy.net/ournhs/caroline-molloy/billions-of-wasted-nhs-cash-noone-wants-to-mention">at least £5bn-£10bn a year</a>. </p> <p>Second, privatisation has led to lower standards of healthcare. Services outsourced to private companies which have repeatedly failed to provide adequate treatment for patients. For example, the handing over of Nottingham’s dermatology centre to Circle – who won NHS contracts worth<a href="http://www.mirror.co.uk/news/uk-news/fury-tory-party-donors-handed-3123469" target="_blank"> nearly £1.5 billion</a> in 2014 – left it<a href="http://www.bbc.co.uk/news/uk-england-nottinghamshire-33007103" target="_blank"> on the brink of collapse</a> in 2015. In 2013, it emerged that Serco had been<a href="http://www.bmj.com/content/347/bmj.f7549?ijkey=a8c29d3f81df5ee9ba54e1c39e9d7973b121e66d&amp;keytype2=tf_ipsecsha" target="_blank"> tampering with data</a> and was forced to pull out of a contract to run out-of-hours GP services in Cornwall. A 2014<a href="http://www.debbieabrahams.org.uk/wp-content/uploads/2014/05/Health-Inquiry-Report_FINAL.pdf" target="_blank"> inquiry led by Debbie Abrahams MP</a> also found evidence on an international scale that privatisation reduces quality of healthcare.</p> <p>Third, privatisation damages accountability. The ‘Clinical Commissioning Groups’ established by the Health and Social Care Act in 2012 frequently outsource work to organisations. Outsourcing companies can also avoid disclosing information by appealing to<a href="https://www.opendemocracy.net/shinealight/allyson-pollock/commercial-confidentiality-trumps-public-right-to-know-in-england-s-new-" target="_blank"> “commercial confidentiality” rules</a>.</p> <p><strong>Next steps</strong></p> <p>The government has already spent<a href="https://www.hsj.co.uk/structure/dh-spends-2m-on-stalled-nhs-professionals-sale/7019197.article" target="_blank"> £2 million</a> arranging the sale, half of which went to the consultancy giant Deloitte. The recruitment agency<a href="http://news.sky.com/story/staffline-tables-bid-for-nhs-nurses-agency-amid-privatisation-row-10885313" target="_blank"> Staffline is one known bidder</a>. The other bidders remain undisclosed, though <a href="http://www.parliament.uk/business/publications/written-questions-answers-statements/written-questions-answers/?page=1&amp;max=20&amp;questiontype=QuestionsOnly&amp;house=commons%2clords&amp;member=3930">Caroline Lucas has asked them to disclose the other bidders</a>. Ultimately, though, we know who is responsible for the sale at the Department of Health: Jeremy Hunt, the Health Secretary; Philip Dunne, Minister of State for Health; and Ben Masterson, Head of Companies Management.</p> <p>These are the actors which the We Own It campaign will target. A<a href="https://weownit.org.uk/act-now/dont-sell-nhs-professionals" target="_blank"> petition</a> to stop the sell-off has already reached 15,000 signatures. Given the government’s weakened mandate there is hope that public outrage, together with action in Parliament from Eleanor Smith MP and others, will force the government to abandon the sale.</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/jos-bell/tory-links-of-health-agencies-exposed-as-hunt-lines-up-next-nhs-selloff-in-england">Tory links of health agencies exposed as Hunt lines up next NHS sell-off in England</a> </div> <div class="field-item even"> <a href="/ournhs/jos-bell/admiral-jeremy-is-not-so-admirable">Admiral Jeremy is not so admirable</a> </div> <div class="field-item odd"> <a href="/ournhs/paul-teed/locum-ae-doctor-speaks-out-about-silent-privatisation-of-nhs-workforce">A locum A&amp;E doctor speaks out about the silent privatisation of the NHS workforce</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 Michael Thorne Thu, 13 Jul 2017 11:56:48 +0000 Michael Thorne 112254 at https://www.opendemocracy.net Why BigData is running roughshod over the NHS - and what to do about it https://www.opendemocracy.net/ournhs/phil-booth/why-bigdata-is-running-roughshod-over-nhs-and-what-to-do-about-it <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>The NHS is being treated as both a 'cash cow' and a 'data cow', a string of recent scandals suggest. And now there's another privacy-bashing tech bonanza on the way, as ID cards rise from the ashes of Brexit policy.</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/549093/9276962702_143a35ff9e_z.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/9276962702_143a35ff9e_z.jpg" alt="" title="" width="460" height="460" 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/adactio/9276962702/in/photolist-f8LRNN-VMEkma-dht2wF-VwXWTq-bm7eAX-deKzer-VcrwRu-cJVgkY-Uv7Neq-ruGnWz-rP23sX-bm7ef2-VMEpUD-TFqnRP-bm7dBa-dMeUvi-bm7ddc-rLJ7PE-bm7eXX-hyUgEr-ruGo1c-hyUhdv-hySNGU-VMEmjT-VMEhqR-hySDNR-Uy7WvX-VwXYVm-F8rYDw-VcrwA9-Vcrx9U-r7tb42-hyTo6q-hySQzS-pVFEZW-hyUfUi-hySRxy-hySNXJ-hyTjSG-qNCjcM-VMEhdg-hyUeEp-hySN5b-nVMo2e-r5aTAu-hyUh4n-pkVM7q-hyTmoh-qaETfM-omdx8f">Flickr/Jeremy Keith</a>, some rights reserved.</em></p><p>It’s no secret. We all know we pay for the NHS through our taxes. But increasingly we’re also paying for health and care services with the invisible currency of our most sensitive personal data; our medical records.<span>&nbsp; </span> </p><p class="MsoNormal">As data companies insinuate themselves into every aspect of our private lives, in the global Information Gold Rush, we must ensure the founding principle of the NHS – healthcare for all, without discrimination, free at the point of delivery – does not fall prey to the curse of free services: “If you ain’t paying, you <em>are</em> the product.”</p> <p class="MsoNormal">Since long before the care.data controversy, patients have been paying with their privacy, and it’s almost always the companies that define the terms of the deal. </p> <p class="MsoNormal">In a data-driven world, corporations run rings around the analogue administrators of the NHS. They siphon off resources and when it goes wrong simply walk away from their responsibilities – as <a href="https://www.theguardian.com/society/2017/jun/27/jeremy-hunt-nhs-shared-business-services-data-loss-scandal"><span>we were reminded this week</span></a> when the NAO slammed the disastrous mess that a part-privatised company made of NHS letters.</p> <p class="MsoNormal">How can Google DeepMind continue copying the data of 1.6 million patients from the Royal Free Hospital, despite having <a href="http://news.sky.com/story/google-received-16-million-nhs-patients-data-on-an-inappropriate-legal-basis-10879142"><span>no lawful basis</span></a> to do so? DeepMind paid negotiators to go to the meeting; the NHS sent doctors.</p> <p class="MsoNormal">How can <a href="http://www.telegraph.co.uk/news/2017/03/17/security-breach-fears-26-million-nhs-patients/"><span>GP IT provider TPP</span></a> get away with deciding that it knew better than GPs who should have access to GP records – and get away with refusing to implement adequate security measures, even when asked? And then, rather than spending engineers’ time fixing the problem, choosing instead to pay its lawyers, strenuously denying to all who would listen that it had done anything wrong?</p> <p class="MsoNormal">Because – as we’ve also seen in the fallout from the Grenfell Tower disaster – commercial interests are allowed to subvert the public good, whilst politicians and senior civil servants fail to reign in those interests, putting deregulation above people’s rights to safety, privacy, and due care.</p> <p class="MsoNormal">Whitehall and Westminster seem locked into a failed model of ‘cutting red tape’ to ‘liberate’ commercial entities to exploit us as they see fit,<strong> </strong>despite the best efforts of clinicians and public-spirited technical staff. In the world of NHS IT, we’ve seen a long line of<strong> </strong>policy decisions, <a href="https://www.gov.uk/government/publications/review-of-data-security-consent-and-opt-outs"><span>ignored warnings</span></a>, inexcusably delayed action and <a href="http://www.independent.co.uk/news/uk/politics/nhs-cyber-attack-jeremy-hunt-tories-accused-ignoring-extensive-warning-signs-outdated-computers-a7734961.html"><span>bodged responses</span></a>, such as when the WannaCry ransomware hit the NHS.</p> <p class="MsoNormal">Meanwhile, the announcement last week that ID cards are effectively back on the table as Brexit Britain draws closer, offers the possibility of a massive bonanza for whoever gets the contracts – and a<strong> </strong>massive challenge to the fundamentals of what we believe as a country.</p> <p class="MsoNormal">Having already introduced measures that try to make NHS staff <a href="http://www.independent.co.uk/news/uk/politics/nhs-hospitals-20-forced-show-passports-id-health-tourism-crackdown-healthcare-jeremy-hunt-government-a7530931.html"><span>hassle </span></a><a href="http://www.independent.co.uk/news/uk/politics/nhs-hospitals-20-forced-show-passports-id-health-tourism-crackdown-healthcare-jeremy-hunt-government-a7530931.html"><span>brown people</span></a><a href="http://www.independent.co.uk/news/uk/politics/nhs-hospitals-20-forced-show-passports-id-health-tourism-crackdown-healthcare-jeremy-hunt-government-a7530931.html"><span> for documentation</span></a>, the NHS now faces a three-way stand-off – a ‘Brexit Triangle’. In the simplest terms: does the Department of Health now direct NHS staff to hassle people with ‘foreign accents’<strong>,</strong> or to hassle everyone, or do we simply give in and issue everyone with ID cards?</p> <p class="MsoNormal">Do we want more cases like Dena Bryant – a <a href="http://www.bbc.co.uk/news/uk-england-lincolnshire-39138733"><span>deaf British woman</span></a> who struggles to communicate verbally, who turned up to A&amp;E with an injured arm only to be quizzed about her nationality after staff didn’t think she looked or sounded English enough?</p> <p class="MsoNormal">It doesn’t have to be this way, of course. The other option, the choice we first made 69 years ago today, when – having survived the horrors and deprivations of WWII, and when people’s now-defunct ID card numbers were used to generate the very first NHS numbers – we as one nation chose to all contribute to the provision of universal healthcare, free at the point of use, without discrimination. </p> <p class="MsoNormal"><a name="_gjdgxs"></a>We heeded well the words of NHS founder Nye Bevan, who said: “<span>How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere 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.”</span></p> <p class="MsoNormal">So what can <em>you</em> do to break the stand-off? While forces far bigger and more complicated than anyone seems to have planned for steamroller on?</p> <p class="MsoNormal">It starts with something quite straightforward: inform yourself, so you can inform others. Get the facts; for, armed with facts, <em>every</em> patient can speak with the authority of their own lived experience of the NHS.</p> <p class="MsoNormal">If you <a href="http://medconfidential.org/for-patients/"><span>have a login for your GP practice’s website</span></a>, go and look at the letters that have been scanned into your record, and count the logos. (If you don’t already have a login for online access, <a href="http://medconfidential.org/for-patients/"><span>here’s how to get one</span></a>.) Then, as your NHS changes over the next few years, do you see more commercial logos or fewer? </p> <p class="MsoNormal">While you’re at it, you may also want to check who’s <a href="https://medconfidential.org/for-patients/your-records/"><span>accessed your GP record</span></a>. </p> <p class="MsoNormal">And while everyone’s been distracted by Brexit, the latest reorganisation of the NHS – the “Sustainability and Transformation Plans” – is descending into a divide-and-conquer carve-up. </p> <p class="MsoNormal">With a democratic deficit in the NHS that does Theresa May proud, there is very little scrutiny of the process by which decisions are made locally around which services will be cut – the amounts of cuts having been decided centrally, with minimal regard for <a href="http://www.independent.co.uk/news/health/nhs-leak-london-hospitals-care-restrictions-secret-cuts-programme-north-central-royal-free-great-a7800366.html"><span>effects on services</span></a>. (Meanwhile, DH and NHS England still want to copy all your medical records into a <a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>data lake</span></a>, <a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>t</span></a>o<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span> </span></a>m<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>i</span></a>c<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>r</span></a>o<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>m</span></a>a<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>n</span></a>a<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>g</span></a>e<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span> </span></a>h<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>o</span></a>s<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>p</span></a>i<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>t</span></a>a<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>l</span></a>s<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span> </span></a>o<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>n</span></a> <a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>a</span></a> <a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>d</span></a>a<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>i</span></a>l<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>y</span></a> <a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>b</span></a>a<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>s</span></a>i<a href="https://medconfidential.org/2017/fishing-in-the-national-data-lake/"><span>s</span></a>…) How would your experience of NHS care have been affected, had those cuts already taken place? </p> <p class="MsoNormal">Since its inception, reorganisation of the NHS has been an ongoing bureaucratic activity – with the expectation that the public and patients will continue to be passive observers. So, what if the public’s interest were to become an active ally to the Hippocratic Oath: do no harm? As STPs move forwards, whether you wish to be a passive observer of the NHS or not – based on your lived experience and that of your loved ones – is a decision only you can make, and talk about with others. </p> <p class="MsoNormal">If you don’t think your experience matters enough to speak up, who do you believe will speak up for you? </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="/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/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 odd"> <a href="/ournhs/colin-leys/how-trustworthy-is-nhs-digital">How trustworthy is NHS Digital?</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 digitaLiberties uk ourNHS Phil Booth Wed, 05 Jul 2017 08:31:38 +0000 Phil Booth 112099 at https://www.opendemocracy.net “Northern Ireland still holds the harshest punishment for illegal abortions anywhere in Europe” https://www.opendemocracy.net/ournhs/tommy-greene/northern-ireland-still-holds-harshest-punishment-for-illegal-abortions-anywhere- <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Last week’s court ruling upholding Northern Ireland’s abortion ban out of political ‘respect’ suggests women’s bodies are still subjugated to politicking. What does the future hold for women across Britain and Ireland?</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/549093/2958609876_96ace9b2e0_z.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/2958609876_96ace9b2e0_z.jpg" alt="" title="" width="460" height="308" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Flickr/Feminist Fightback</em></p><p>&nbsp;</p><p><span>Last Wednesday, </span><span>the Supreme Court narrowly upheld a ruling that</span><span> </span><span><span><a href="http://www.bbc.com/news/uk-northern-ireland-40271763">denies</a> </span></span><a href="http://www.bbc.com/news/uk-northern-ireland-40271763"><span><span>Northern Irish women</span></span></a><span><span> access to free abortion care </span></span><span>through NHS England. The Secretary of State for Health’s bar on Northern Irish </span><span>residents accessing NHS abortion care in England was preserved out of declared </span><span>“respect“ to Northern Irish politicians and for the legitimacy of the devolved </span><span><span>UK political institutions. </span></span></p><p><span>The appeal case was brought by a young woman - referred to throughout court proceedings as “Claimant A”, for age reasons – who became pregnant in 2012 as a fifteen-year-old girl and was forced to travel to England to acquire a medical termination. </span><span>Unable to obtain NHS care, she was</span></p><p><span>forced to pay £900 for a private termination. </span><span>&nbsp;</span></p><p><span>This latest leg of Claimant A’s legal battle with the Department of Health follows on from an </span><a href="http://www.bbc.com/news/business-27325363"><span><span>unsuccessful judicial review</span></span></a><span><span> challenge in 2014, which A’s legal team promised to contest in the Court of Appeal. The girl’s appeal was funded by loans from friends as well as financial backing from the </span></span><a href="https://www.asn.org.uk/"><span><span>Abortion Support Network</span></span></a><span><span>, a charity set up to assist and provide aid for women travelling from Northern Ireland and the Republic of Ireland for overseas abortions.</span></span><span>&nbsp;</span></p><p><span>Under the </span><a href="http://www.legislation.gov.uk/ukpga/1967/87/contents"><span><span>1967 Abortion Act</span></span></a><span><span>, such services are available to women for up to 24 weeks of pregnancy (with some exceptions afterwards where foetal abnormalities or serious health risks to the mother occur) in England, Scotland and Wales. The legislation, however, has never been extended to Northern Ireland. Women in the country are therefore still subject to the </span></span><a href="http://www.legislation.gov.uk/ukpga/Vict/24-25/100"><span><span>1861 Offences Against the Person Act</span></span></a><span><span>. This means that only a very small number of the </span></span><a href="https://www.gov.uk/government/statistics/report-on-abortion-statistics-in-england-and-wales-for-2016"><span><span>724 women</span></span></a><span><span> who travelled to England and Wales for an abortion from Northern Ireland in 2016, and the 3, 265 women travelling from the Republic last year, were able to procure an operation through the NHS. </span>Those Northern Irish women who can get to England face the costs of a private abortion. And the law fails women from lower-income backgrounds even more harshly. Those who lack the money to pay for a private abortion in another part of the UK, and who instead order abortion pills &nbsp;online to take at home, &nbsp;face </span><a href="http://www.independent.co.uk/news/uk/crime/second-northern-irish-woman-to-stand-trial-on-abortion-charges-a6972726.html"><span><span>up to life imprisonment (along with anyone found to be assisting them)</span></span></a><span><span> – even in the case of a fatal foetal abnormality or if their conception is the result of a sexual crime. </span></span><span>&nbsp;</span></p><p><span>One shocking, widely-publicised case last year involved a twenty-one-year-old girl receiving a </span><a href="https://www.theguardian.com/uk-news/2016/apr/04/northern-irish-woman-suspended-sentence-self-induced-abortion"><span><span>suspended sentence</span></span></a><span> for performing an abortion with a pill she obtained online<span>. T</span>he law fails women in other ways too - as shown by story of </span><a href="https://www.youtube.com/watch?v=62ofBHfIs1o&amp;t=205s"><span><span>Sarah Ewart</span></span></a><span><span>, whose experiences formed the basis of a </span></span><a href="https://www.theguardian.com/world/2016/jan/07/northern-ireland-abortion-ban-sarah-ewart-interview"><span><span>separate legal challenge</span></span></a><span><span> against Northern Ireland’s abortion policy when she was not covered after her unborn child was found to have </span></span><a href="https://en.wikipedia.org/wiki/Anencephaly"><span><span>Anencephaly</span></span></a><span><span> part-way during her pregnancy.</span></span></p><p><span>For young women especially, the often </span><a href="https://www.theguardian.com/world/2015/oct/31/abortion-ireland-northern-ireland-women-travel-england-amelia-gentleman"><span><span>daunting nature</span></span></a><span><span> of the trips over to Great Britain, as well as the </span></span><a href="https://www.abortionrightscampaign.ie/category/stigma/"><span><span>stigma attached</span></span></a><span><span> to those who undergo a termination on returning to a largely conservative society </span>on both sides of the Irish border, can add to the traumatic effects brought on for many by the overall process. A </span><a href="http://www.irishtimes.com/news/social-affairs/girl-sectioned-after-psychiatrist-ruled-out-abortion-1.3116111"><span><span>case in the Republic of Ireland</span></span></a><span><span> this week also underlined the callous treatment of women seeking abortion care across the island, as a young girl judged to be at risk of suicide, and sectioned under the Mental Health Act, was denied a termination.</span></span><span></span></p><p><span>Danielle Roberts, an activist with the </span><a href="http://allianceforchoiceni.org/events/"><span><span>Alliance for Choice</span></span></a><span><span> group, commented after the ruling: “Figures out this week show that in 2016 at least 2 women a day travelled from Northern Ireland to Great Britain for abortion healthcare. Recent research published in the BMJ shows that at least 1 woman a day is using safe but illegal abortion pills from </span></span><a href="https://www.womenonweb.org/"><span><span>Women on Web</span></span></a><span><span>, risking up to life in prison”.</span></span></p><p><span>“The drop in women travelling to Great Britain [compared to statistics from previous years] is not surprising, as the use of pills bought online has increased. It remains to be seen if the increasing raids and prosecutions have an impact on this years’ figures [referring, in part, to </span><a href="https://www.theguardian.com/uk-news/2017/mar/13/northern-ireland-police-raided-premises-searching-for-abortion-pills"><span><span>PSNI raids</span></span></a><span><span> of </span></span><a href="https://lastroundblog.wordpress.com/2017/06/17/a-shot-across-the-bow/"><span><span>people suspected to be in possession</span></span></a><span><span> of abortion pills on International Women’s Day this year]. However, earlier this year abortion clinics in England were struggling to meet demand, and had to prioritise NHS patients [from England, who are covered by the 1967 Act]”.</span></span><span></span></p><p><span>In 2015, </span><a href="https://www.theguardian.com/uk-news/2015/nov/30/northern-ireland-law-on-abortion-ruled-as-incompatible-with-human-rights"><span><span>a case</span></span></a><span><span> put forward by the Northern Ireland Human Rights Commission looked to extend the available grounds, or remit, for abortion in the country – leading </span></span><a href="http://www.belfasttelegraph.co.uk/news/northern-ireland/northern-ireland-abortion-laws-not-compatible-with-human-rights-says-high-court-34292281.html"><span><span>a High Court judge</span></span></a><span><span> to conclude that abortion law in Northern Ireland was “incompatible with [EU] human rights [law]”. Propositions like these go some way towards the full legalisation of the procedure that activists like Roberts hope for - </span>at least for as long as EU human rights laws continue to apply in the UK. </span></p><p><span>But for all that, Mr Justice Homer’s “historic” ruling in favour of widening abortion provision was </span><a href="http://www.bbc.co.uk/news/uk-northern-ireland-36574902"><span><span>later appealed</span></span></a><span><span> by Northern Ireland’s Attorney General and the Department of Justice. Northern Ireland’s abortion laws have been heavily criticised by a number of groups, including the </span></span><a href="http://www.nihrc.org/news/detail/human-rights-commission-welcomes-historic-termination-of-pregnancy-ruling-3"><span><span>UN High Commissioner for Human Rights</span></span></a><span><span> and </span></span><a href="https://www.amnesty.org.uk/issues/Abortion-in-Ireland-and-Northern-Ireland"><span><span>Amnesty International</span></span></a><span><span> – which regards abortion and wider bodily autonomy as a </span></span><a href="http://www.irishtimes.com/opinion/letters/amnesty-international-and-abortion-1.2610994"><span><span>“fundamental human right”</span></span></a><span><span>. </span>Northern Ireland still holds the harshest punishment for illegal abortions anywhere in Europe. And its repressive laws on abortion access are surpassed only by those in the Republic of Ireland and Malta currently. </span><span></span></p><p><span>More recently still, marginal progress regarding consultation for increased abortion access in the country was </span><a href="http://www.irishnews.com/news/assemblyelection/2017/01/14/news/o-neill-reform-of-abortion-laws-ruled-out-in-wake-of-political-collapse-884007/"><span><span>put on hold</span></span></a><span><span> when the shut-down of the Northern Irish Assembly was announced earlier this year. The political stalemate over power-sharing talks at Stormont shows </span></span><a href="https://www.theguardian.com/uk-news/2017/apr/12/northern-ireland-power-sharing-talks-given-extended-deadline-james-brokenshire"><span><span>little sign</span></span></a><span><span> of being resolved soon, as both parties (particularly </span></span><a href="http://news.sky.com/story/conservative-dup-agreement-due-next-week-10916703"><span><span>the latter</span></span></a><span><span>) become </span></span><a href="https://www.buzzfeed.com/siobhanfenton/sinn-fein-mp-says-its-pure-fantasy-they-would-take-their?utm_term=.jxQ6B0A4M#.so1QBYJ4d"><span><span>increasingly involved</span></span></a><span><span> in the formation of a new UK government after this month’s inconclusive General Election result.</span></span><span></span></p><p><span>Claimant A’s result marks a disappointing juncture in a legal battle which has dragged on for several years, having already been contested in several domestic courts before being taken to the highest appellate court in the UK. The </span><a href="http://www.doughtystreet.co.uk/news/article/supreme-court-split-on-landmark-northern-ireland-abortion-rights-case"><span><span>close and split nature </span></span></a><span><span>of the judgment, which saw 3 judges vote in favour of the existing policy versus 2 against, may provide some kind of silver lining for the claimant and her team, </span>as does the possibility of the case still being taken to the European Court of Human Rights.</span><span></span></p><p><span>But the decision is undeniably a blow for Pro-Choice groups both north and south of the border.</span>&nbsp;</p><p><span><span>The Republic of Ireland’s “cruel and inhumane” abortion laws came under </span></span><a href="https://www.theguardian.com/world/2017/jun/13/un-denounces-ireland-abortion-laws-as-cruel-and-inhumane-again"><span><span>significant criticisms</span></span></a><span><span> from a UN Committee earlier this week (not for the </span></span><a href="https://www.theguardian.com/world/2016/jun/09/ireland-abortion-laws-violated-human-rights-says-un"><span><span>first time</span></span></a><span><span> over the past 12 months), as it ruled in favour of </span></span><a href="https://www.abortionrightscampaign.ie/tag/siobhan-whelan/"><span><span>Siobhán Whelan</span></span></a><span><span> who was denied an abortion in 2010 despite a diagnosis of fatal foetal syndrome during the course of her pregnancy. </span>A battle looms in the Republic after the </span><a href="https://inews.co.uk/essentials/news/world/irelands-new-leader-announces-abortion-referendum-despite-popes-visit/"><span><span>announcement</span></span></a><span><span> of a referendum on whether to alter the </span></span><a href="https://en.wikipedia.org/wiki/Eighth_Amendment_of_the_Constitution_of_Ireland"><span><span>Eighth Amendment of the Irish Constitution</span></span></a><span><span> – which grants equal value to an unborn foetus and its mother, and equal entitlement to the right to life - to be held next year. </span></span></p><p><span>In Northern Ireland, campaigners have somewhat less cause to be optimistic, </span><span>with Theresa May’s Conservative Party having to rely on the support, in some form or other, of the anti-abortion Democratic Unionist Party (DUP) to form a majority government. &nbsp;</span><span>Despite the DUP’s economic pragmatism moving them to table </span><a href="https://www.buzzfeed.com/siobhanfenton/heres-what-the-dup-might-demand-from-the-tories-to-keep?utm_term=.too1gpEYz#.cxKlxzaA8"><span><span>mostly budgetary demands</span></span></a><span><span>, and to leave some of their more divisive positions on social issues off the negotiating agenda, this arrangement with Westminster means that some concessions and backing will be granted to the party on a number of key issues. </span>Former Northern Ireland secretary and influential backbencher Owen Patterson has already suggested that </span><a href="http://www.independent.co.uk/news/uk/politics/tory-dup-deal-abortion-commons-debate-time-limits-lower-owen-paterson-conservative-mp-minority-a7783221.html"><span><span>lowering of abortion time limits could be up for debate as part of such a deal</span></span></a><span><span>.</span></span><span></span></p><p><span>Up</span><span> until last week’s election result, the DUP were thought to have been on the </span><a href="https://www.ft.com/content/3bd4e9c4-33f7-11e7-bce4-9023f8c0fd2e?mhq5j=e2"><span><span>political backfoot</span></span></a><span><span> in Northern Ireland. Their </span></span><a href="http://www.newsletter.co.uk/news/politics/rhi"><span><span>scandal-hit </span></span></a><span><span>leadership realises the main party for Unionism in the country need to win back the support of large swathes of the Northern Irish electorate. Power-sharing is in disarray, and t</span></span><a href="http://www.independent.co.uk/news/uk/home-news/northern-ireland-assembly-election-power-sharing-collapse-sinn-fein-gains-dup-losses-lgbt-welcome-a7611116.html"><span><span>he unionists lost their overall majority</span></span></a><span><span> for the first time in Northern Ireland’s history this March. It could prove unwise – with the lingering possibility of <a href="/www.irishnews.com/news/politicalnews/2017/04/21/news/stormont-talks-deadline-is-june-29-1003774/">another round of Assembly elections if power-sharing is not restored</a> - for the party to continually block a policy change with so much public backing. One poll last year suggested</span></span><a href="https://www.amnesty.org.uk/press-releases/northern-ireland-nearly-34-public-support-abortion-law-change-new-poll"><span><span> over 70%</span></span></a><span><span> were in favour of amending abortion law.</span></span><span></span></p><p><span>All judges in the case </span><a href="http://www.doughtystreet.co.uk/news/article/supreme-court-split-on-landmark-northern-ireland-abortion-rights-case"><span><span>agreed that women in Northern Ireland are being discriminated against</span></span></a><span><span>, and that the power to alter the policy lies with the Secretary of State for Health. So, with this latest decision and political deadlock appearing to shelve the issue even further, the focus and pressure surely switches to Health Secretary, Jeremy Hunt. Katherine O’Brien of BPAS, </span></span><a href="https://inews.co.uk/opinion/comment/jeremy-hunt-denying-ni-women-nhs-abortions-due-politics-not-economics/"><span><span>writing in the i Paper</span></span></a><span><span> last week, urged Hunt to “do the right thing” and “Put politics aside”, arguing that the case helps to prove “Hunt is maintaining this policy due to political – not economic – reasons”, while Northern Irish women continue to suffer.</span></span><span></span></p><p><a href="http://www.greenpartyni.org/tag/clare-bailey/"><span><span>Claire Baley</span></span></a><span><span>, Green Party MLA for Belfast South, is one of the few elected representatives in Northern Ireland who favour and push for full decriminalisation and provision of abortion services in the country. She echoed O’Brien’s criticisms of Whitehall ministers, stressing shared culpability for the denial of human rights: “The UK government have been complicit in this continued denial of even the minimum human rights standards to women in Northern Ireland. Their failure to allow women access to abortion on the NHS compounds their failure to implement human rights across the whole of the UK. I call on Westminster to address this situation as a matter of urgency so that the women of Northern Ireland can have access to safe, free and legal abortion and be treated like equal citizens of the United Kingdom”.</span></span><span></span></p><p><span>She continued: “it is disappointing that women from Northern Ireland will still not be entitled to access abortion services on the NHS. We are UK taxpayers, yet are denied the same healthcare that our sisters in England, Scotland and Wales receive”. </span><span></span></p><p><span>“The fact remains that Northern Ireland’s abortion laws do not stop abortions. Women will always seek an abortion whenever they need one[…]I only wish that more elected representatives would listen to their words and[,] indeed, the words of the 700 plus women who have had to make the journey across the Irish Sea in the last year alone”.</span><span></span></p><p><span>The vocal and high-presence Pro-Life group, </span><a href="http://www.preciouslife.com/"><span><span>Precious Life</span></span></a><span><span>, as well as MLA Simon Hamilton, of the DUP, and Sinn Féin’s Michelle O’Neill, were all contacted for their reaction to the ruling. It is obviously an abnormally busy time for DUP and Sinn Féin ministers right now, with power-sharing talks and an increased role in Westminster negotiations for both groups happening side by side. But nevertheless, none of them replied to openDemocracy’s requests for comment.</span></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 ourNHS Tommy Greene Tue, 20 Jun 2017 16:22:48 +0000 Tommy Greene 111786 at https://www.opendemocracy.net The debate the media won't have: government snooping made NHS hacking easier https://www.opendemocracy.net/uk/sunny-hundal/debate-media-still-wont-have-government-snooping-has-made-hacking-easier <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Even Microsoft now admits that government snooping has made it much easier for hackers.</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/563411/nhs.png" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/563411/nhs.png" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>NHS workers. Flickr/Emanueletudisco photography. Some rights reserved</span></span></span>On Friday IT systems in Britain and across the world were hit by a devastating hacking attack. </p><p>Dubbed 'WannaCrypt' - it locked users out of their computer system unless they paid a $300 ransom using Bitcoin. Such '<em>ransomware' </em>attacks have become increasingly common across cyberspace as an earner for hackers.</p><p>There is little doubt ensuring government IT systems, especially in critical areas such as the NHS, need to be kept up-to-date. Most of the media attention has largely focused on this area since. In particular, the health secretary Jeremy Hunt has been criticised for <a href="http://www.independent.co.uk/news/uk/politics/nhs-cyber-attack-jeremy-hunt-tories-accused-ignoring-extensive-warning-signs-outdated-computers-a7734961.html">ignoring repeated warnings</a> that NHS IT systems were underfunded and vulnerable.</p><p>But one largely ignored area is how government-mandated backdoor exploits have made it easier for hackers.</p><p>Yesterday evening, Microsoft, the software company whose Windows system was the target of the attack, published a blog-post imploring system users to keep their software up to date. But it <a href="https://blogs.microsoft.com/on-the-issues/2017/05/14/need-urgent-collective-action-keep-people-safe-online-lessons-last-weeks-cyberattack/">also lashed out at</a> government snooping:</p><p>"Finally, this attack provides yet another example of why the stockpiling of vulnerabilities by governments is such a problem. This is an emerging pattern in 2017. We have seen vulnerabilities stored by the CIA show up on WikiLeaks, and now this vulnerability stolen from the NSA has affected customers around the world. Repeatedly, exploits in the hands of governments have leaked into the public domain and caused widespread damage.<span>"</span></p><p><span>The blog-post by Microsoft's President and Chief Legal Officer<a href="https://blogs.microsoft.com/on-the-issues/2017/05/14/need-urgent-collective-action-keep-people-safe-online-lessons-last-weeks-cyberattack/"> went on to say</a>: "</span>We need governments to consider the damage to civilians that comes from hoarding these vulnerabilities and the use of these exploits.<span>"</span></p><p><span>In other words, Microsoft is warning governments that their desire for snooping makes it easier for criminals to exploit those systems and hack people's data.</span></p><p><span>This is relevant to Britain since both the Conservative government and Labour MPs have called on technology companies to give them access to encrypted mobile technologies such as Whatsapp and iMessage. Every terror attack across the US or Europe has been followed by a deman by western governments to have a way to snoop on messages. </span></p><p><span>But tech companies stress that opening encrypted systems to government snooping would eventually end up helping hackers. And the latest cyberattack underscores their point.</span></p><p><span></span>If we allow governments backdoor access to encrypted apps, next time it could be your phone demanding a ransom.</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> uk digitaLiberties uk ourNHS Sunny Hundal Mon, 15 May 2017 11:25:37 +0000 Sunny Hundal 110892 at https://www.opendemocracy.net Migrant activists disrupt the Department of Health https://www.opendemocracy.net/ournhs/migrant-activists-disrupt-department-of-health <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p class="MsoNormal"><span style="font-family: Helvetica, sans-serif;">Migrant solidarity is vital in the fight for a national health service, as 'pay upfront' card machines start to be used by patients' bedsides this week.</span></p> </div> </div> </div> <p class="MsoNormal"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/DSC_8723.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/DSC_8723.jpg" alt="" title="" width="460" height="306" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p class="MsoNormal"><span>‘Excuse me, can I see your passport? Are you here legally?’</span></p> <p class="MsoNormal"><span>Early on Wednesday patients, NHS workers and activists gathered outside the Department of Health and formed a not-so-orderly queue in front of a makeshift border checkpoint. </span></p> <p class="MsoNormal"><span>Dressed in hospital gowns, scrubs, and UKBA uniforms they blocked the entrance to Richmond House, and challenged people heading into work with the question: ‘Can I see your passport?’.</span></p> <p class="MsoNormal"><span>This week’s action was called by <em>Docs Not Cops</em>, a group committed to healthcare as a human right and dedicated to fighting the shift towards migrant charging in the National Health Service. </span></p> <p class="MsoNormal"><span>Changes brought in this month will see NHS trusts obliged to check patients’ passports up front, and if they are ineligible, deny treatment not deemed ‘immediately necessary’ unless it can be paid up-front and in full. </span></p> <p class="MsoNormal"><span>The policy turns doctors, nurses, midwives, and receptionists into immigration officers and border guards, and asks healthcare workers to think about their patients’ immigration statuses before thinking of how best to manage their condition.</span></p> <p class="MsoNormal"><span>The measure was announced in February in a document ironically named ‘Making a Fair Contribution’, alongside announcements of the government’s intentions to further extend charging into new areas of services. GPs will in future be made responsible for identifying ‘chargeable’ patients in primary care. Bringing charging into community services means access to mental health services, hospice care, and termination of pregnancy services will all be affected by the new law. </span></p> <p class="MsoNormal"><span>The same document also said that the Department of Health was considering introducing charging for primary care and Accident &amp; Emergency for those it purports have a ‘temporary relationship with the UK’. Those with precarious, complicated, or no immigration status will be denied care they need and deterred from seeking it. Vulnerable people will be frightened. </span></p> <p class="MsoNormal"><span>Potentially lives will be lost. And being afraid of seeking healthcare for treatable conditions will result in people presenting much later, requiring emergency care, which is more costly and likely to have worse outcomes for the patient. </span></p> <p class="MsoNormal"><span>In 2015, an Albanian national with a suspected brain tumour was reported to immigration authorities by staff at the Royal Victoria Infirmary in Newcastle, after being treated for an aneurysm the previous year. It was shortly announced that “a medical decision was made” that the patient was “for travel and discharge to seek treatment in his own country”.</span></p> <p class="MsoNormal"><span>The latest changes build upon the already harmful effects of the government’s Immigration Act 2014, which has seen hundreds of refugee and migrant women, many with complicated asylum claims, made <a href="https://www.doctorsoftheworld.org.uk/news/pregnant-women-should-never-be-frightened-away-from-antenatal-care">terrified of accessing antenatal care</a> and threatened by the very hospitals they need to help them. </span></p> <p class="MsoNormal"><span>The government’s ‘health tourism’ narrative is being used to expand and tighten immigration control into public services. Health tourism accounts for a modest 0.03% of the annual NHS budget, at the Department’s own estimate. Freedom of Information requests (FOIs) sent last year by<em> Docs Not Cops </em>found that of hospital trusts that had dedicated overseas visitor teams in 156 Trusts contacted, over a third (34%) were spending more on these teams than they were recouping in fees. </span></p> <p class="MsoNormal"><span>These amendments will not make Jeremy Hunt the ‘efficiency savings’ he wants to see by 2018, but it is unclear whether they were actually intended to. They appear to be based on a nationalistic and capitalist ideology, not evidence. </span></p> <p class="MsoNormal"><span>As these policies take root, reports are already emerging of NHS staff racially profiling patients who are not white or who have ‘foreign-sounding’ names. It is not within the job description of any doctor, nurse, or midwife to ask questions more befitting of immigration officers. </span></p> <p class="MsoNormal"><span>The complex nature of the immigration process also means that many healthcare workers may be unclear as to who is, and who isn’t eligible, turning away people well within their rights to seek care. Doctors of the World have found this to be an extensive problem in the case of GP surgeries. They report having seen a homeless Eritrean asylum seeker who had been living in a bus shelter at one of their clinics, who had been turned away by her GP, despite it still currently being the case that <a href="https://www.theguardian.com/uk-news/2017/mar/20/pregnant-asylum-seekers-refugees-afraid-seek-nhs-maternity-care">everyone is entitled to register with a GP and receive primary care</a>.</span></p> <p class="MsoNormal"><em><span>Docs Not Cops</span></em><span>&nbsp;are&nbsp;devising <a href="http://www.docsnotcops.co.uk/resources/">strategies to empower NHS workers to refuse to comply with border policing in the NHS</a>, including setting up a pledge that workers can sign to express their refusal to act as border guards and establishing a national network of groups. We are also encouraging patients to lobby their local GPs, CCGs (Clinical Commissioning Groups), and NHS Trusts. Anyone can&nbsp;</span><span><a href="http://www.docsnotcops.co.uk/mp-letter/"><span>contact their local MP</span></a></span><span>&nbsp;to express their concern about the impact of the charges. </span></p> <p class="MsoNormal"><span>The National Health Service was built on the principle that we all deserve the right to healthcare. Almost 70 years after its inception we are here to demand that this basic tenet remains.</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="/ournhs/rayah-feldman/pregnant-women-bear-brunt-of-government-s-clampdown-on-migrant-nhs-care">Pregnant women bear brunt of government’s clampdown on ‘migrant’ NHS care</a> </div> <div class="field-item even"> <a href="/5050/ramya-ramaswami/why-migrant-mothers-die-in-childbirth-in-uk">Why migrant mothers die in childbirth in the UK </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 Erin Dexter Fri, 07 Apr 2017 10:14:31 +0000 Erin Dexter 109956 at https://www.opendemocracy.net Are NHS staff really getting happier, despite everything? https://www.opendemocracy.net/ournhs/james-lazou/are-nhs-staff-really-getting-happier-despite-everything <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Or is their goodwill being stretched to breaking point? The latest surveys of NHS staff paint a mixed picture.</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-taking-blood-pressure.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/Nurse-taking-blood-pressure.jpg" 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>The latest annual <span><span><a href="http://www.nhsstaffsurveys.com/Page/1056/Home/NHS-Staff-Survey-2016/">NHS staff survey results</a></span></span> came out this month – and they were “surprisingly” good, at least according to NHS England.</p><p>NHS England optimistically celebrated improvements in staff morale and motivation in the NHS, <span><span><a href="https://www.england.nhs.uk/2017/03/staff-survey/">pointing out</a></span></span> that “across 32 key findings, over 80% were more positive than last year.”</p><p> Simon Stevens, Chief Executive of NHS England, said: “perhaps surprisingly given the well understood pressures, it’s encouraging to see that frontline NHS staff say their experience at work continues to improve, with overall employee engagement scores at a five year high.”</p><p> The survey found that over half of all staff (59%) reported that they often or always look forward to going to work, with 74% of staff feeling enthusiastic about their job. 77% of staff felt that time passes quickly whilst they are at work. It found 80% of frontline NHS staff say they are able to do their job to a standard they are personally pleased with, 90% of staff say their job makes a difference for patients, and 92% of staff feel trusted to do their jobs.</p><p> So is staff morale really back up to where it was before 2012’s disastrous Health &amp; Social Care Act?</p><p> In contrast, the 14 NHS trade unions have – as we highlighted in our latest submission to the NHS Pay Review process - found “dangerously declining levels of morale” as a result of cuts, staffing shortages and rising workload and work intensity.</p><p>For example <span><span><a href="https://www.google.co.uk/url?sa=t&amp;rct=j&amp;q=&amp;esrc=s&amp;source=web&amp;cd=1&amp;cad=rja&amp;uact=8&amp;ved=0ahUKEwjWzvLC493SAhUrJMAKHeAuApoQFggdMAA&amp;url=http%3A%2F%2Fwww.unitetheunion.org%2Fuploaded%2Fdocuments%2FUnite%2520evidence%2520to%2520the%2520National%2520Health%2520Service%2520Pay%2520Review%2520Body%25202017-1811-28586.pdf&amp;usg=AFQjCNGcK_c6a-k3j1dCcUg0Gq2LmMtqxQ&amp;bvm=bv.149760088,d.d2s">Unite’s survey</a></span></span> of NHS members found that 80% of respondents reported morale was ‘worse’ or ‘a lot worse’ than a year ago. Similarly <span><span><a href="https://www.google.co.uk/url?sa=t&amp;rct=j&amp;q=&amp;esrc=s&amp;source=web&amp;cd=1&amp;cad=rja&amp;uact=8&amp;ved=0ahUKEwj4zd7P493SAhXpB8AKHT1oDZAQFggdMAA&amp;url=https%3A%2F%2Fwww.unison.org.uk%2Fcontent%2Fuploads%2F2016%2F10%2FUNISON-NHS-PRB-Submission-2017-18.pdf&amp;usg=AFQjCNEgvFM9ZxV2kTBFxhNCUJN5nsBBUg&amp;bvm=bv.149760088,d.d2s">Unison found</a></span></span> that 56% of respondents reported morale being low or very low in their workplace and around two thirds said it had fallen over the last year.</p><p>The <span><span><a href="https://www.google.co.uk/url?sa=t&amp;rct=j&amp;q=&amp;esrc=s&amp;source=web&amp;cd=3&amp;ved=0ahUKEwj0tJKdwN3SAhViB8AKHa1HA0YQFggoMAI&amp;url=https%3A%2F%2Fwww.rcn.org.uk%2F-%2Fmedia%2Froyal-college-of-nursing%2Fdocuments%2Fpublications%2F2016%2Fseptember%2F005803.pdf&amp;usg=AFQjCNEeDrSUiJgvM2vCrX2OfH_Nk-u7sQ">Royal College of Nursing</a></span></span>’s three national staff surveys undertaken last year found “high levels of workload...insufficient staffing levels...a large proportion also indicated they regularly work additional hours; that they have experienced work-related stress and have turned up for work despite not feeling well enough to do so.” </p><p>And a <span><span><a href="http://www.csp.org.uk/professional-union/union-support/pay-conditions/pay-review-body-evidence-2017-18">Chartered Society of Physiotherapy survey</a></span></span> of members who have recently left the NHS found many cited dissatisfaction with the quality of care they felt about to provide, workload, stress and staffing cuts as reasons for leaving. </p><p> <span><span><span><span><span>It’s not only NHS trade unions that have found poor morale in the NHS. Just a few days after the NHS staff survey was released </span></span></span><span><span><a href="https://www.theguardian.com/politics/2017/mar/17/constant-restructuring-nhs-demoralising-staff-survey-retention-hospitals"><span><span>Wilmington Healthcare UK released a poll</span></span></a></span></span><span><span><span> </span></span></span><span><span><span>of nurses,</span></span></span><span><span><span> </span></span></span><span><span><span>GPs</span></span></span><span><span><span> a</span></span></span><span><span><span>nd hospital doctors across the UK. This found that 64% blamed staff retention problems on the continuous and “demoralising” national changes that had occurred since 2000.</span></span></span></span></span></p><p> So what’s really going on?</p><p> What is the cause of this obvious disconnect? There is no doubting that NHS staff surveys are robust in their coverage. </p><p> But as always, it’s about what you are actually measuring, and how you ask the questions. </p><p> Many of the points in the NHS staff survey infer motivation from a broad set of questions about the how workers intrinsically value their own jobs, rather than how they feel under the current climate. </p><p> The union surveys ask specifically about morale. </p><p> And – though they are related - there’s a difference between motivation and morale.</p><p> All surveys continue to show that NHS staff are highly motivated by their work and the vital roles they play in delivering our National Health Service. There is a strongly held public service ethos within the NHS and staff who work under enormous pressure would not do so if they were not motivated to help patients and do their best for those in need. </p><p> In contrast morale refers to how staff feel about how they are valued, their working conditions, pay and terms and also how able they are to carry out their job given the resources available to them. </p><p> Whilst the surveys may not be directly comparable, of course we shouldn’t knock any improvements shown. </p><p> But dig a little deeper into the NHS staff survey figures, and it’s clear <span>there is less cause for celebration. </span> </p><p> <span>Many of the survey results that show the biggest improvements are related to management behaviour such as how well they engage with staff and whether staff are confident reporting incidents. These are all welcome changes - possibly </span><span>a result of the </span><span>CQC’s increased emphasis on whether an organisation is “well led”, the NHS Workforce Race Equality Standard and the financial incentives for organisations to promote staff health and wellbeing. </span> </p><p> <span>That said, in some cases they may mask the issues that staff really experience, for example while reporting of discrimination and violence went up, so too did actual cases of both. </span> </p><p> <span>Another worrying issue is that </span>the NHS staff survey found that 59% of NHS staff are, on average, doing unpaid overtime, and nearly three quarters (72%) are doing overtime. </p><p><a name="_GoBack"></a> The steady increase in both paid and unpaid overtime since 2012 shows not enough has been done to address workload levels and staff shortages. Relying on tired and over-worked staff can lead to poorer standards of care. And of course, Brexit is set to make this worse unless the <span><span><a href="https://fullfact.org/immigration/immigration-and-nhs-staff/">tens of thousands of EU nationals</a></span></span> <span>working in the NHS </span>are granted the right to remain in the UK.</p><p> The NHS staff survey highlights that more than half of staff (56%) report having attended work in the last three months despite feeling unwell, due to pressure from either their manager, colleagues or themselves. While this is a significant improvement since 2012, when 64% attended work despite illness, it is simply not good enough for over half of all staff to be attending work when they are sick.</p><p> The survey also points out that “the proportion of staff who reported feeling unwell due to work-related stress is at its lowest since 2012, down to 37%.” It is hardly cause for celebration when well over a third of staff have been so stressed that they have been unwell. Unite’s survey found that 79% of respondents had experienced work-related stress over the previous year. Taken together it implies that just under half of those staff experiencing stress were being made ill by it. </p><p> Given that long term exposure to stress is one of the worst killers in the workplace and has huge impacts on people’s mental health, what does that say about the state of our health service? Are we happy to watch the people who care for our sick and infirm, die from health service jobs? </p><p> As the NHS unions have said,</p><p> “The NHS fundamentally depends on the psychological contract with their staff – to provide care and compassion, to go the extra mile, to cope with organisational change and financial challenge.” </p><p> Government not listening</p><p>We have a government that simply refuses to understand. Instead of investing in staff and the service they have imposed the<span><span><a href="http://nhsfunding.info/underfunded/is-the-nhs-underfunded/"> worst financial settlement in its history</a></span></span> and capped staff pay below inflation for seven years. </p><p>Nothing highlights this short-sightedness more than <span><span><a href="https://twitter.com/NHSEnglandMedia/status/841971937807110144">Jeremy Hunt’s comments</a></span></span> last week at the Chief Nursing Officers Summit, where he said the priority was to increase nursing numbers, rather than increase their pay or professional development. </p><p> Staff shortages, pay cuts, reorganisations, high levels of sickness and stress are all major reasons why it is so hard to recruit and keep staff. You cannot deal with recruitment without dealing with the working conditions that are preventing it. We need to make the NHS a more appealing place to work through more investment, stability, better pay and terms, and then people will want to work there. This is not rocket science.</p><p> Our members tell us that things are not going to get better any time soon. <span>The Government is demanding even more efficiency savings (ie, cuts), through controversial sustainability and transformation plans (STPs)</span><span> that are being rolled out across England. These plans force through yet another top down </span><span>reorganisation of </span><span>services, in some areas closing h</span>ospitals and departments and potentially opening more services to privatisation. The new ‘footprint areas’ also pose a serious threat to national staff terms and conditions as each area strives to make cuts. </p><p><span>A</span><span>s</span><span> </span><span><span><a href="https://www.theguardian.com/politics/2017/mar/17/constant-restructuring-nhs-demoralising-staff-survey-retention-hospitals">Wilmington Healthcare UK’s survey </a></span></span><span> </span><span>shows, constant reorganisation has been a major disruption to NHS staff over the last few decades and the same is true now. </span>It is testament to the quality and belief that staff have in the NHS that they remain motivated in this current climate.</p><p>NHS staff are carrying a health service that this government has brought to its knees. How long can we take advantage of their good will without something snapping?</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/james-lazou/what-lies-behind-hunts-message-of-bad-cruel-nhs">What lies behind Hunt&#039;s message of the &#039;bad, cruel&#039; NHS?</a> </div> <div class="field-item even"> <a href="/ournhs/carl-walker/jeremy-hunt-launches-doctor-morale-inquiry-heres-sneak-preview-of-its-findings">Jeremy Hunt launches doctor morale inquiry - here&#039;s a sneak preview of its findings...</a> </div> <div class="field-item odd"> <a href="/ournhs/greg-dropkin/junior-doctors-are-fighting-for-nhss-life-whilst-tories-try-to-silence-all-healt">Junior doctors are fighting for the NHS&#039;s life - as the Tories try to silence ALL health workers</a> </div> <div class="field-item even"> <a href="/ournhs/david-wrigley-caroline-molloy/5-reasons-addenbrookes-really-%E2%80%98failed%E2%80%99-%E2%80%93-and-what-it-means-for-">The Sun&#039;s shameful attempts to blame hospital staff for government failures</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 James Lazou Fri, 24 Mar 2017 12:14:09 +0000 James Lazou 109658 at https://www.opendemocracy.net Why you can’t solve the NHS’s problems by banning smokers and the obese from treatment https://www.opendemocracy.net/ournhs/why-you-can-t-solve-nhs-s-funding-problems-by-banning-smokers-and-obese-from-treatment <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>NHS underfunding and legal changes are leading local NHS managers to deny healthcare to large groups of people who need it, on the basis of inappropriate ‘lifestyle’ rationing – meaning more pain, and more cost in the long run.</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/smoking-1026559_960_720.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/smoking-1026559_960_720.jpg" 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>NHS England has previously been clear that even time-limited bans on particular groups of patients receiving treatment is inconsistent with the NHS constitution.</p><p> But now York is rationing surgery on the basis of smoking and obesity – with the support of NHS England.</p><p> The evidence is now coming through that this policy is harming patients, that it is discriminatory – and that it is spreading around England. It is time for ministers to take action and stop blaming ‘local decisions’.</p><p> On 1 February this year, the Vale of York Clinical Commissioning Group (CCG) started delaying surgery to patients who smoked or had a body mass index of more than 30. The policy was first proposed in September last year, withdrawn then <a href="https://twitter.com/pmrleahy/status/803599201036681216">reintroduced in November</a>.</p><p> The reason: to delay immediate spend on surgery. However, it is a totally false economy, and although it may delay CCG spend now, in order to meet imposed spending restrictions, the Royal College of Surgeons says that it may actually increase NHS costs if patients develop complications while waiting for surgery. The College has been clear that rationing policies such as those implemented by the Vale of York CCG are unacceptable.</p><p> The York CCG’s ability to make rationing decisions comes direct from the 2012 Health and Social Care Act. The duty on the Secretary of State for Health to “provide or secure” the health service was removed from section 1 of the National Health Service Act 2006, and replaced by a duty to make provision for the health service. The list of services that the NHS had to provide—a principle that had been embedded in the NHS since its inception—was also removed, meaning there no longer had to be a universal list of service provision, and that each CCG could determine its own. In other words, it became a complete postcode lottery: where someone lives determines the healthcare they can access.</p><p> Jeremy Hunt told the Health Committee on 18 October 2016 that:</p><p> “When we hear evidence of rationing happening, we do something about it…we are absolutely determined to give people the clinical care that they need.”</p><p> He added:</p><p> “When we hear of occasions when we think the wrong choices have been made, when an efficiency saving is proposed that we think would negatively impact on patient care, we step in...”</p><p> Now is the time for Hunt to step in.</p><p> Under-funded and at risk of being put into ‘special measures’ the Vale of York CCG took the decision to ration surgery for up to a year for those overweight and up to six months for smokers. I was a senior physiotherapist in the NHS and I am all too aware of the risk factors created by people smoking and being overweight, not least when it comes to surgery. All clinicians understand the risk factors, which is why it is so important that money is invested in public health services.</p><p> Instead, the Government switched public health back to local authorities and slashed their grants.</p><p> In York, the council has completely cut funding for smoking cessation services and for NHS health checks. It also cut the health walks programme, which was a service to help people exercise more and lose weight.</p><p> In other words, public health measures to address smoking and weight were cut first, and then patients were denied surgery because they smoked or were overweight.</p><p> You really couldn’t make it up.</p><p> GPs are now writing to patients to ask them whether they smoke—not that they have a smoking cessation service to refer them to. They say that it is just “for their records”.</p><p> But patients who a GP wishes to be considered for surgery now have to fill out a form declaring their smoking and weight status. Does this letter than go to the surgeon to make a clinical assessment of the risks and benefits? No.</p><p> Instead the referral is diverted, and the patient is sent a generic letter and a leaflet telling them that they smoke or are overweight and need to change their ways.</p><p> As a penalty, they are denied surgery.</p><p> The specialist never gets the opportunity to assess the patient and make clinical judgements accordingly.</p><p> The Health and Social Care Act was supposedly going to put doctors, not bureaucrats, in charge. Here we have a system where clinicians are being undermined by diktats from bureaucrats; patients and clinicians have no say; and clinical evidence is left wanting.</p><p> The generic letter tells those who are obese that they have to lose 10% of their weight or reduce their BMI to under 30, or wait 12 months. Smokers have to stop smoking for eight weeks, or wait six months. They get a leaflet and a referral to a convoluted website. Any public health practitioner would tell you how inappropriate and ineffective this whole system is. There is no real help available.</p><p> The Royal College of Surgeons says that denying or significantly delaying access to NHS treatment does not help patients to lose weight or stop smoking.</p><p> Now those being denied surgery are paying a heavy price. I have spent much time talking to GPs and surgeons about this matter, as well as to patients. I have also talked to the CCG, which knows that the system is totally wrong, but because it is in a financial hole and NHS England has waved it through, it is just complicit. It is not standing up for patients in York. In fact shockingly it even delayed referrals made before the policy was introduced, so that the first thing that they received was their refusal letter.</p><p> So what is the impact on patients? Well, it is devastating. We already know that waiting times for surgery are going up, and delay in itself worsens conditions. It is true that some patients are exempt - those needing urgent care, the removal of a tumour, or trauma surgery. However, if someone requires a joint replacement because they have not walked well for some time due to osteoarthritis, is in pain, and, as a result of not walking, have put on weight, things are very different. With a new joint, they will be back on their feet. A 12-month delay in being referred – 12 months of degeneration, pain and not being able to walk easily – will mean a more complex operation, a patient who needs more physiotherapy and rehab. Bang!—there go all the savings from rationing and more, all at a cost to the patient and a risk that the long-term clinical outcomes will be worse.</p><p> The British Orthopaedic Association said:</p><p> “There is no clinical, or value for money, justification…Good outcomes can be achieved for patients regardless of whether they smoke or are obese”.</p><p> If someone were 20 stone, they would have to drop to 18 stone before having surgery, but if they were 18 stone, they would have to drop to 16 stone 2 lbs. Why is surgery safe at 18 stone in one case, but not the other?</p><p> I’ve also seen a patient who was prescribed medication that had a side effect of weight gain. They required surgery and were denied it because of their weight.</p><p> I have had a patient who is active and works full time, but is over the weight threshold. She needs surgery to enable her to conceive. She is not young. Surgery is needed now, as recommended by her GP. However, it was denied and could result in her never having a family.</p><p> A patient with hypothyroidism, a chronic condition that leads to weight gain, needs surgery for gastrointestinal abnormalities but, despite their condition, will be restricted.</p><p> One patient was a very fit body builder, but was refused surgery because of their high BMI. The case for delay has not been evidenced.</p><p> We know that there is a strong correlation between smoking and obesity, and social and economic deprivation. As the British Medical Association said, this could also be seen as rationing on the basis of poverty. Those with mental health challenges have a higher propensity to smoke, and those with chronic conditions are more likely to also have elements of depression and possible weight gain. Many people find it difficult to lose weight or give up smoking.</p><p> This policy is harming those with co-morbidities. It is creating problems, not solving them. As the Royal College of Surgeons says,</p><p> “It risks preventing a patient from seeing a consultant who can advise them on the best form of treatment...Surgery may be needed to help someone lose weight.”</p><p> David Haslam, chair of the National Institute for Health and Care Excellence, said that rationing of surgery concerned him. He says that the NICE osteoarthritis guidelines make absolutely clear that decisions should be based on discussions between patients, clinicians and surgeons, and that issues such as smoking, obesity and so on should not be barriers to referral. These are the experts.</p><p> The Vale of York CCG has gone down this route, and others are now following, with 34% of CCGs looking to ration on the basis of obesity or smoking. Harrogate and Rural District CCG and East Riding of Yorkshire CCG target smokers and those who are overweight with a six-month delay. Wyre Forest, Redditch and Bromsgrove, and South Worcestershire CCGs ration on the basis of pain impact. South Cheshire CCG requires a BMI of less than 35—not 30—as does Coventry and Rugby CCG. The policy is spreading. Although York is the worst example of rationing, every clinician knows that it is wrong and contravenes their professional duty of care.</p><p> Clinical decision making is needed. Patients have to be part of this too. And public health programmes need restoring. The passive approach of the CCGs is setting patients up to fail.</p><p> The policy is discriminatory, clinically contraindicated and financially perverse. I would be the first in this House to advocate health optimisation programmes supporting smoking cessation or providing help to improve diet, exercise, wellbeing and lifestyles, but to leave someone in pain or without a child brings our NHS into disrepute.</p><p> The rationing of surgery must end. It is time for Jeremy Hunt to step in, as he promised the Health Committee he would.</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/devon-canary-in-nhs-coalmine">Devon - the canary in the NHS coalmine?</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/nhs-cuts-are-we-in-it-together">NHS cuts - are we in it together?</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 Rachael Maskell Tue, 14 Mar 2017 11:38:41 +0000 Rachael Maskell 109422 at https://www.opendemocracy.net How trustworthy is NHS Digital? https://www.opendemocracy.net/ournhs/colin-leys/how-trustworthy-is-nhs-digital <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>It looks as though ministers are bullying supposedly the independent patient data agency to hand over private information to the Home Office despite an uncertain legal basis.</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/personal_info_618x353.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/personal_info_618x353.jpg" alt="" title="" width="460" height="263" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>Between May 2013 and February 2016 a heated argument took place between Kingsley Manning, the chair of the Health and Social Care Information Centre (now called NHS Digital) on the one hand, and the Home Office and the Department of Health on the other. At stake was the HSCIC’s independence as an Executive Non-Departmental Body responsible to parliament, not to any minister, and its trustworthiness as the guardian of the personal details of every NHS patient in England.</p><p>After his appointment as chair in May 2013 Manning discovered that since at least 2005 the HSCIC and its predecessor, the NHS Information Centre, had been giving details of patients’ present and past addresses and GP registrations to the Home Office, to enable it to trace and deport people who were living in Britain without the right to do so. This appeared clearly to be in breach of the HSCIC’s ‘<a href="http://content.digital.nhs.uk/media/21727/Annual-Report-201516/pdf/annual-report-2015-16.pdf">statutory duty to ensure that the information we hold in trust for the public is always kept safe, secure and private’</a>. But the Home Office, supported by the Department of Health, insisted that tracing ‘illegal immigrants’ was a public interest that overrode any other. The outcome was a Memorandum of Understanding (MoU) between NHS Digital, the Department of Health and the Home Office, which specifies that NHS Digital will hand over the information requested by the Home Office for patients who have ‘breached s.24 of the Immigration Act 1971’, if all other ‘reasonable avenues’ (such as the Department of Work and Pensions and the DVLA) have been exhausted. The memorandum came into effect on 1 January this year.</p><p>In an interview with the <em>Health Service Journal</em> published in February this year Kingsley Manning described how the Home Office and the Department of Health resisted his demand to know the legal basis for what was going on, and to make it public. And on the eventual MoU his comments were as follows: “<a href="https://www.hsj.co.uk/topics/technology-and-innovation/revealed-theresa-mays-clash-with-nhs-over-immigrants-data/7015129.article">There is no provision for transparency, no provision for oversight or scrutiny and there is no role for the National Data Guardian. Nor is there any provision to alert patients to the possibility that information from their NHS patient record could be passed on to the Home Office</a>.” </p><p>Two questions need to be asked about the memorandum. First, what is the legal basis for the breach of confidentiality it normalises? The minutes of an NHS Digital Board meeting in August 2016 record that ‘NHS Digital had received internal advice that there is a high of risk of legal challenge but that there was a robust legal defence’. By the time of the Board’s November meeting this had become ‘we have established the legal basis for data flows to the HO [Home Office]’. Second, whom does the MoU’s codification of procedures protect? Evidently, at least NHS Digital. The Board insisted that the request form specified in the memorandum to be used by the Home Office should ‘note in the form that the form provides an explicit audit trail in the event of challenge or query’. </p><p>NHS Digital may still refuse to hand over information if it is not satisfied that there is a public interest in doing so. In practice, however, a public interest appears to be established if the Home Office says the details are those of someone who is in breach of the Immigration Act and can’t be traced in any other reasonable way. </p><p>The scale of these ‘data flows’ is not insignificant. </p><p><strong>Requests for patients’ data received by NHS Digital (HSCIC) 2013-2016:</strong></p><p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/colin leys nhs digital 1.png" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/colin leys nhs digital 1.png" alt="" title="" width="460" height="325" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p><span><em>Source: NHS Digital data registers. In February 2017 the registers covered only the last nine months of 2013 and the first eleven months of 2016. To avoid understating the data for these years, data for the missing months have been added based on the averages for the reported months in the respective years.</em></span></p><p><strong>Requests for patients’ data accepted by NHS Digital (HSCIC) 2013-2016:</strong></p><p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/colin leys nhs digital 2.png" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/colin leys nhs digital 2.png" alt="" title="" width="460" height="339" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>The data release registers show that patient data are also routinely given to the police and the National Crime Agency (NCA), and to the courts in response to court orders (presumably relating to serious crime), without any MoU; and in 2016 the number of requests from the NCA (mainly) and the police increased by 40%, compared with 2015, accounting for a quarter of all the personal data that NHS Digital handed over last year – on what grounds, in these cases, and on the basis of what authority, we do not know. The effect of a memorandum of understanding seems simply to formalise an unaccountable practice with a debatable basis in law, but which the government wishes to continue. It will be interesting to see if this is compatible with the <a href="https://ico.org.uk/for-organisations/data-protection-reform/overview-of-the-gdpr/principles/">far-reaching new data protection regulations</a> which will come into force in June.</p><p>The risk to public health from handing over personal information that people have been assured is confidential is obvious. Kingsley Manning told the HSJ that ‘My key concern has always been that highly vulnerable people will be deterred from accessing the health system because they are worried that their information will be shared with the Home Office. This puts their health at risk and the health of the public at risk, since infectious diseases such as tuberculosis will become harder to treat.’ He could have gone further. It is estimated that some <a href="https://fullfact.org/immigration/why-we-cant-say-sure-how-many-illegal-immigrants-are-living-uk/">600,000 ‘irregular residents’</a> live in the UK (including children who have been born here and are not immigrants, legal or otherwise). NHS Digital‘s collaboration with the Home Office to help it find and deport them is bound to become common knowledge in these circles, not to mention among those wanted by the police and the NCA. A logical consequence is avoidance of the NHS and the development of an underground private medical system, vulnerable to exploitation and extortion. (The health charity Doctors of the World runs free clinics in London and Brighton, but mainly to help people to get access to needed care from the NHS, whereupon they become liable to have their data shared.)</p><p>NHS Digital is a critically important resource for high quality health care and its 2,700 staff have a well-earned reputation for competence and courtesy. But its independence, and public trust in its determination to protect patients’ privacy, have been seriously compromised, if not destroyed. The message sent by the MoU is, as a <a href="https://www.doctorsoftheworld.org.uk/Handlers/Download.ashx?IDMF=49277781-1263-4bb7-b7a2-944ad379a4ea">briefing by Doctors of the World points out, that ‘when it is politically expedient to do so, our personal information will be shared</a>’. Trust can be restored only by ending the use of NHS Digital (along with <a href="https://www.gov.uk/check-tenant-right-to-rent-documents/who-to-check">landlords</a>, <a href="https://www.theregister.co.uk/2016/12/16/home_office_to_slurp_1500_pupil_records_per_month/">schools</a> and <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/571837/Tier_4_Sponsor_Guidance_-_Document_3_-_Tier_4_Compliance.pdf">universities</a>) as an agency of law enforcement. It would seem from his strongly-worded criticism that this was what Kingsley Manning wanted, and it is to his credit that we know as much about it as we do. </p><p>But why was it so relatively easy for the Home Office to have its way? Manning told the HSJ that he ‘came under immense pressure to leave matters as they were... The threat was that if we pursued this line of questioning we would be deemed to be an ‘insufficient partner within the system’. An ‘insufficient partner within the system’? What exactly was the threat in that? ‘If I didn’t agree to cooperate they would simply take the issue to Downing Street.’ How terrifying! The Board of NHS Digital have a statutory independence from government and, one would think, a moral duty to defend it. Manning announced his resignation in February last year, without giving any reasons. The memorandum was signed by his former colleagues in November.</p><p><em>This article was cross-posted from the <a href="https://chpi.org.uk/">Centre for Health and the Public Interest.</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/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 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/jane-fae/is-selling-our-medical-data-to-insurers-crime-or-not">Is selling our medical data to insurers a crime - or not?</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/whole-agitation-has-nasty-taste-bevan-on-so-called-health-tourism">&quot;The whole agitation has a nasty taste&quot; - Nye Bevan on so-called &#039;health tourism&#039;</a> </div> <div class="field-item even"> <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 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 Colin Leys Mon, 06 Mar 2017 11:59:55 +0000 Colin Leys 109182 at https://www.opendemocracy.net Uncertain, cold, and disempowered – healthcare in Greek refugee camps https://www.opendemocracy.net/ournhs/sarah-walpole/uncertain-cold-and-disempowered-healthcare-in-greek-refugee-camps <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>How can we heal the wounds of refugees in these circumstances,asks a volunteer with the Syrian American Medical Society.</p> </div> </div> </div> <p class="western"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/07-08-SyriaWomen.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/07-08-SyriaWomen.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: UNHCR</em></p><p class="western"><span>In the last few weeks, hundreds of people have been moved out of refugee camps in Northern Greece into hotels or similar accommodation. </span><span>Snow has been falling, and </span><a href="https://www.theguardian.com/world/2017/jan/10/greece-severe-weather-places-refugees-at-risk-and-government-under-fire"><span><span><span>te</span></span></span><span><span><span>mperatures hit minus ten</span></span></span></a><span> at night. </span><span>Frustration and dis-empowerment is everywhere. After months of waiting, th</span><span>ose who remain in the camp know that when they are </span><span>relocated,</span><span> it will be without warning or explanation.</span></p><p class="western"> <span>When the time comes to move f</span><span>amilies or individual </span><span>refugees</span><span> </span><span>out of the camp, they </span><span>are often told late one evening that a van will be moving them the next day. They are given only hours to pack their belongings. </span> </p><p class="western"> <span>During one of my days volunteering for the </span><span><span><a href="https://www.sams-usa.net/greece/"><span>Syrian American Medical Society</span></a></span></span><span>, I spoke to </span><span>refugees</span><span> and families who were about to be taken by bus to the next place that would serve as home. Not one could tell me the name of the street, town or even the region that they were about to be driven to. Only a couple knew which organisation was taking them. </span> </p><p class="western"> <span>Coming as I do from a health service and a society where we place a high value on </span><span><span><a href="https://www.england.nhs.uk/wp-content/uploads/2013/04/ppf-1314-1516.pdf"><span>‘patient engagement’, ‘patient autonomy’ and ‘patient choice’</span></a></span></span><span> the lack of engagement, autonomy or choice afforded to refugees here seems derisory. There’s little I can do to counteract the sense of helplessness that many feel under these circumstances. </span> </p><p class="western"> <span>Gaining the trust of Syrian refugees who access NGO services or Greek healthcare services is difficult. Before the breakdown of the </span><span><span><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3697421/"><span>Syrian healthcare system</span></a></span></span><span>, Syrians were used to relatively easy access to specialists and to many treatments, including antibiotics, that are used more judiciously in Europe. </span> </p><p class="western"> <span>The intricacies of good communication to build a relationship with a patient are hard to access in overcrowded clinic rooms via translators who have had no formal training. The vast majority of the volunteer organisations working in Greek refugee camps </span><span>rely on</span><span> ‘local translators,’ meaning members of the refugee community. Few of the translators have received more than basic education, </span><span>though </span><span>many have worked very hard to teach themselves English. </span> </p><p class="western"> <span>Managing any long term health condition is difficult without access to medical records, </span><span>without</span><span> well-established organisations and structures for coordination between agencies. The systems to support migrant populations will need to </span><span>work better and more flexibly</span><span> to </span><span>cope with the </span><span>frequent and unpredictable changes for many years to come. </span> </p><p class="western"> <span>Supporting</span><span> people</span><span> with mental health or social problems in a refugee camp is particularly challenging. A plethora of mental health problems, from depression to psychosis, are more common in those who have been forced to migrate. A lady I saw in clinic has suffered from increasing pains, confusion and anxiety since she arrived at the camp eight months ago. </span><span>She </span><span>recently started to express hopelessness and difficulty being a mother without her husband here in Greece. </span> </p><p class="western"> <span>Defining ‘normal’ mental health, appropriate behaviour and good care for children in this setting is not straightforward. Cold conditions, a poor diet and a lack of education and stimulation are the norm. </span><span>F</span><span>rustration and depression may result in parents giving less of the right kind of attention to their children.</span></p><p class="western"> <span>When I ask patients who come to clinic what their worries are, they </span><span>most often</span><span> tell me that it is ‘the situation’ that causes their troubles. “What can we do?” They feel trapped and without control over their lives. Their children haven’t been at school regularly for months or years. </span><span>T</span><span>hey have no work or prospect of work. They may have had </span><span><span><a href="http://w2eu.info/greece.en/articles/greece-asylum.en.html"><span>one or both of their asylum interviews</span></a></span></span><span> but they are invariably </span><span>facing months of waiting to </span><span>receive the date of, </span><span>and then</span><span> the outcome from, an interview. </span> </p><p class="western"> <span>The humanitarian organisations working here are also in the dark about what the future holds, both short term and longer term. Rumours circulate that the camps will be cleared and more refugees will be brought here from the islands, but no one seems to know when. Part of the reason that refugees are not being moved from </span><span><span><a href="http://www.aljazeera.com/news/2017/01/concern-spate-deaths-greek-refugee-camps-170130180746859.html"><span>the exposed camps on Lesbos, Chios and the other Greek islands</span></a></span></span><span> may be the EU-Turkey deal. </span><span>Under the deal, </span><span>‘irregular migrants’ (including those who haven’t claimed asylum yet, or have claimed asylum in another country and then moved on) are not to be moved to the Greek mainland, but instead to be returned to Turkey and ‘swapped’ for a migrant in a Turkish refugee camp who will be resettled in the EU. </span> </p><p class="western"> <span>I wondered during my days in Northern Greece what effect the noxious mix of uncertainty, cold and </span><span>dis-empowerment</span><span> will have on those who are growing up with the title of ‘refugee’. How will they process the traumas and challenges of their long journeys? Some refugees tell me that they can talk to a friend </span><span>and</span><span> some receive psychological support from one of the humanitarian organisations. </span><span>But</span><span> many don’t. </span> </p><p><span>Those refugees acting as translators have a particular burden. “They tell me so many stories, but I have my own story,” one translator said to me. Though ‘the migrant crisis’ is such a large scale calamity, it is important that we don’t overlook the horrors that individuals have faced. It will take time and courage to examine and heal their wounds.&nbsp;</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="/ournhs/joy-clarke/from-iraq-to-tilbury-migrants-health-and-borders">From Iraq to Tilbury: migrants, health and borders</a> </div> <div class="field-item even"> <a href="/ournhs/alex-langford/health-is-right-not-reward-for-being-born-in-right-place">Health is a right, not a reward for being born in the right place</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 refugees Sarah Walpole Tue, 28 Feb 2017 13:07:41 +0000 Sarah Walpole 109126 at https://www.opendemocracy.net ‘Dangerous’ new changes planned to force sick people into work – or into poverty https://www.opendemocracy.net/ournhs/debbie-abrahams/dangerous-new-changes-planned-to-force-sick-people-into-work-or-into-poverty <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>The government promised to help disabled people back into work. They’re failing – and now it looks like they’re targeting those who need higher levels of support.</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/i-daniel-blake-3_0.png" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/i-daniel-blake-3_0.png" alt="" title="" width="460" height="239" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>The punitive changes to social security for sick and disabled people were recently highlighted in the film I, Daniel Blake</em></p><p>The Government published its long-awaited ‘Improving Lives: Work, Health and Disability’ Green Paper at the end of October 2016 after originally promising a White Paper in 2015. The White Paper was supposed to define how disabled people would be supported into work and meet the Government’s manifesto pledge of halving the disability employment gap of 34% by 2020 (currently it stands at 32%).</p><p>The employment gap was used to justify further draconian cuts in social security support for disabled people in the Welfare Reform and Work (WRW) Bill published last summer. In particular, the Bill announced cuts of approximately £1,500 a year in Employment and Support Allowance to half a million people in the Work-Related Activity Group (ESA WRAG) – those people who had been found not fit for work, but who may be in the future – to be introduced in April 2017. </p><p>The 2016 Welfare Reform and Work Act followed the 2012 Welfare Reform Act which Scope estimated by 2018 will have cut nearly £28bn of social security support to 3.7m disabled people. Of course this doesn’t include £4.6bn cuts in social services support since 2010 or the NHS crisis, both of which affect disabled people. </p><p>The Green Paper, the consultation for which closed on 17th February just 6 weeks before the ESA WRAG cuts come into place, makes the bold claim that ‘…employment can…promote recovery.’ </p><p>The issue I have with this statement, and the tone of the Green Paper as a whole, is that this implies that disabled people and people with chronic conditions would recover if only they tried a bit harder, or their doctors weren’t such soft touches. It doesn’t mention ‘shirkers’ directly but comments on how some people with the same condition languish in the ESA Support Group whilst others “flourish at work”, making it clear that’s what they’re thinking, ignoring their own rhetoric about “not treating everyone in a one-size-fits-all way”. </p><p>As a former Public Health consultant who researched into the health effects of work and worklessness, I agree that <em>some</em> work is good for health, but I don’t agree with the Government’s flawed thinking underpinning this: that it’s OK for people to return to work when they are still not fit, because it <em>may</em> help. This is not just unsound, it’s dangerous. </p><p>The scapegoating of disabled people, which includes people with physical or mental impairments and long-term health conditions as defined under the 2010 Equality Act, has been a hallmark of this Government and the previous Coalition. But even the conclusion of the United Nations inquiry that the UK Government has been responsible for ‘<a href="http://www.bbc.co.uk/news/uk-37899305">grave…systematic violations</a>’ of the UN Convention on the Rights of Persons with Disabilities since 2010, has been met with Government stonewalling. </p><p><a name="_GoBack"></a> It is already well established that disabled people are twice as likely to live in poverty as non-disabled people as a result of the extra costs associated with their disability. Currently 4.2 million disabled people live in poverty and I have been informed from unpublished analysis by an Economic and Social Research Council research project that this is getting worse. </p><p>The Government has refused to stop the cuts to ESA WRAG and Universal Credit’s Limited Capacity to Work which come in this April, which will undoubtedly increase the numbers of disabled people living in poverty, threatening their health and well-being. Various discretionary funds may be available, for example the Flexible Support Fund, but there is no guarantee of support and they are quite specific in what they can be used for. </p><p>The timing of these cuts when there has been a negligible reduction in the disability employment gap is quite shocking. The Green Paper rings alarm bells that people in the ESA Support Group are the next to be targeted. Linked to this, the new Work Capability Assessment criteria which the Government announced last September (after I committed to scrap the Work Capability Assessment) will be published later this year. These will give a clear indication what the Government’s real agenda is. </p><p>The Green Paper also talks about employers and the need for them to invest more in workplace health and occupational health support. This is, of course, very important; 90% of disability and long-term health conditions are acquired, so it is absolutely right to examine what can be done to reduce the risk of employees falling ill and how employers can make reasoned adjustments to support an employee to stay in work if they become disabled. But Access to Work helped only 36,000 disabled people stay in or access work in 2015 out of the 1.4m disabled people who are fit and able to work. </p><p>To date, the Disability Confident Campaign launched in 2015 has been a dismal failure making a negligible impact on the disability employment gap. Changes in employer attitudes and behaviour needs practical support, including Access to Work. But what is the Government doing to support employers, especially small businesses given that nearly half the workforce is employed by them? How can a small business access affordable, timely occupational health support? With the NHS in crisis and waiting times for non-urgent treatments escalating, how will timely interventions to help people back to work be delivered?</p><p>As always with this Government and the previous Coalition, they are happy to point fingers at everyone else without taking any responsibility themselves. They talk about the impact of work on health and the need for ‘culture change’ and to ‘reinforce health as a work outcome’ but what about the impacts of the social security system on the health of claimants? Their policies have a direct impact on people’s health in the punitive, humiliating way they are too often implemented, but also through the real, enduring poverty and hardship people are forced to live under. </p><p>Labour will hold this Conservative Government to account on all these areas, developing meaningful, alternative, approaches with disabled people, employees, and employers as part of our Disability Equality Roadshow. If this Government is committed to a fairer society, they should stop trying to rebuild the economy off the backs of poor, sick and disabled people.</p><p>&nbsp;</p><p>Labour believe, like the NHS, our social security system should be there for all of us in our time of need, based on principles of inclusion, support and security for all, assuring us of our dignity. &nbsp;&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="/ournhs/peter-beresford/work-makes-us-well-after-austerity-comes-complicity">Work makes you well? After &#039;austerity&#039; comes complicity</a> </div> <div class="field-item even"> <a href="/ournhs/louise-mccudden/take-our-treatment-or-well-stop-your-benefits-tories-threaten-mentally-ill">Take our &#039;treatment&#039; or we&#039;ll stop your benefits, Tories threaten mentally ill</a> </div> <div class="field-item odd"> <a href="/ournhs/carl-walker/dance-of-destitution-psychology%27s-clash-over-coercion">A dance of destitution - psychology&#039;s clash over coercion</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 Debbie Abrahams Fri, 24 Feb 2017 12:59:44 +0000 Debbie Abrahams 109054 at https://www.opendemocracy.net Protests mount against swingeing cuts to children's health services https://www.opendemocracy.net/ournhs/malcolm-hancock/protests-mount-against-swingeing-cuts-to-childrens-health-services <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>If Jeremy Hunt is as keen on preventative health care and 'care in the community' as he claims to be, why is his NHS slashing health visitors and school nurses?</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/unite health visitors protest.png" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/unite health visitors protest.png" alt="" title="" width="418" height="298" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Unite members protest cuts to health visitors and school nurses</em></p><p><span>Health workers, campaigners and concerned families are protesting in Humber over the NHS Foundation Trust’s plans to slash health visitors and school nurses by 25 per cent, in a symptom of the growing public health crisis across England.</span></p><p><span><span><span><span>It seems a long time since the <a href="http://www.telegraph.co.uk/news/health/news/9706565/Extra-1000-health-visitors-in-post-next-year-pledges-minister.html">then prime minister David Cameron </a></span></span></span></span><a href="http://www.telegraph.co.uk/news/health/news/9706565/Extra-1000-health-visitors-in-post-next-year-pledges-minister.html"><span><span><span><span>pledged </span></span></span></span><span><span><span><span>4,200</span></span></span></span><span><span><span><span> extra</span></span></span></span></a><span><span><span><span><a href="http://www.telegraph.co.uk/news/health/news/9706565/Extra-1000-health-visitors-in-post-next-year-pledges-minister.html"> health visitors during the lifetime of the coalition government</a>.</span></span></span></span></p><p><span><span><span><span>Since then there’s b</span></span></span></span><span><span><span><span>een a massive sleight of hand. </span></span></span></span><span><span><span><span>T</span></span></span></span><span><span><span><span>he public health budgets that pay for health visitors, school nurses and community nurses have been transferred from the NHS to local authorities, already hard-pressed after years of funding cuts since 2010.</span></span></span></span></p><p><span><span><span>These budgets should in theory be ring-fenced, but in practice what is deemed as ‘public health’ is open to interpretation and, therefore, at the mercy of council bosses desperately trying to juggle resources.</span></span></span></p><p><span><span><span><span>This is the kernel of the problem at the Humber trust, which serves nearly 600,000 people. The trust was awarded a three-year contract to provide ‘integrated specialist public health nursing service’ for East Riding council due to start on 1 April.</span></span></span></span></p><p><span><span><span><span>But</span></span></span></span><span><span><span><span> because of government cuts the contract was slashed by </span></span></span></span><span><span><span><span>half a million pounds. In response Unite members have been protesting, </span></span></span></span><span><span><span><span>fearful of the damaging impact that the reduction in specialist help will have on babies and children.</span></span></span></span></p><p><span><span><span><span></span></span></span></span><span><span><span>Under the current plans the number of full time equivalent health visitors will fall from 51 to 3</span></span></span><span><span><span>9</span></span></span><span><span><span>, while school nurses will be cut by </span></span></span><span><span><span>a third – leaving just </span></span></span><span><span><span>six full time equivalent </span></span></span><span><span><span>posts</span></span></span><span><span><span>.</span></span></span></p><p><span><span><span><span>These deep c</span></span></span></span><span><span><span><span>uts </span></span></span></span><span><span><span><span>mean reducing</span></span></span></span><span><span><span><span> support and specialist help for families in greater need, </span></span></span></span><span><span><span><span>and reducing s</span></span></span></span><span><span><span><span>upport for issues like domestic violence and safeguarding. </span></span></span></span> </p><p><span><span><span><span>The government talks a lot about how the NHS should focus on ‘prevention’ and ‘care in the community’ - but the cuts to preventative community based care in Humber and elsewhere give the lie to such statements. These cuts are a</span></span></span></span><span><span><span><span> totally self-defeating move which will harm children’s health and end up costing the trust more in the long run.</span></span></span></span></p><p><span><span><span><span>Already, </span></span></span></span><span><span><span><span>child health in the UK is falling behind many other European countries. </span></span></span></span><span><span><span><span>Unite members are urging the </span></span></span></span><span><span><span><span>trust to think again and ditch its plans to slash this vital service.</span></span></span></span></p><p><span><span><span><span>A report by the Royal College of Paediatrics and Child Health published last month found that <a href="http://www.rcpch.ac.uk/news/rcpch-launches-landmark-state-child-health-report">young people in the UK had low wellbeing compared with other comparable countries</a>. </span></span></span></span> </p><p><span><span><span><span>The State of Child Health also found that poverty left children from deprived backgrounds with far worse health and wellbeing than children growing up in affluent families.</span></span></span></span></p><p><span><span><span><span>In 2015-16, 40 per cent of children in England’s most deprived areas were overweight or obese, compared with 27 per cent in the most affluent areas. </span></span></span></span> </p><p><span><span><span><span>The NHS is facing a twin onslaught by this hard-hearted Tory government – the health service is being starved of the cash it needs in real terms to tackle increasing demand and an expanding population. </span></span></span></span> </p><p><span>‘<span><span><span>Headline figure’ rises, so beloved by health secretary Jeremy Hunt, are not the same as the ‘real’ annual increases necessary to shore up the creaking health and social care system.</span></span></span></span></p><p><span><span><span><span>The second threat is the accelerating privatisation of the NHS for the benefit of profit-hungry health companies which will contribute to a fragmented health service and a diminution in service delivery.</span></span></span></span></p><p><span><span><span>That’s why the fight on the Humber is so important – a stand needs to be made not just in that region, but across England <a href="http://www.unitetheunion.org/news/plans-to-axe-up-to-60-nottinghamshire-health-visitors/">where such detrimental proposals </a></span></span></span><span><span><span><a href="http://www.unitetheunion.org/news/plans-to-axe-up-to-60-nottinghamshire-health-visitors/">are </a></span></span></span><span><span><span><a href="http://www.unitetheunion.org/news/plans-to-axe-up-to-60-nottinghamshire-health-visitors/">on the cards</a>.</span></span></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 ourNHS Malcolm Hancock Fri, 10 Feb 2017 13:56:08 +0000 Malcolm Hancock 108719 at https://www.opendemocracy.net How do you keep news of dozens more A&Es closures off the front pages? https://www.opendemocracy.net/ournhs/rachel-clarke/how-do-you-keep-news-of-dozens-of-aes-closures-off-front-pages <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p><span style="color: #292f33;"><span style="font-family: Arial, sans-serif;"><span style="font-size: 9pt;"><span>Government announcements to 'tackle health tourism’ squeezed drastic new A&amp;E closures off the front pages yesterday – showing there’s&nbsp;</span></span></span></span><span style="color: #292f33;"><span style="font-family: Arial, sans-serif;"><span style="font-size: 9pt;"><span>no dead cat as useful as a foreign dead cat.</span></span></span></span></p> </div> </div> </div> <p class="western" lang="en-GB"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/and e.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/and e.jpg" alt="" title="" width="460" height="247" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: One in 6 A&amp;E departments face closure, it emerged yesterday.</em></p><p class="western" lang="en-GB"><span><span><span><span>It’s a trick perfected by Donald Trump, and one which his new soul sister, Theresa May, seems only too happy to embrace with open arms. Turn the heat away from your domestic policy flaws by ramping it up on migrants instead. For Downing Street’s spin doctors, just like the </span></span></span></span><span><span><span><span>White House's</span></span></span></span><span><span><span><span>, any old dead cat will do, it seems, but none works quite as well a foreign one.</span></span></span></span></p><p class="western" lang="en-GB"> <span><span><span><span>The latest example of the brazenness with which May is willing to play the immigrant card is the placing of this week’s story about banning NHS treatments from non-British nationals who cannot afford to pay up front for them. Jeremy Hunt adroitly ensured that so-called ‘health tourists’ would once again dominate the front pages by announcing that, as from April this year, hospitals will be required by law to deny non-emergency treatments to those patients unable to prove they are entitled to free care. </span></span></span></span> </p><p class="western" lang="en-GB"> <span><span><span><span>Right on cue, the right wing press obliged. “NHS tourists made to pay” screamed the front page of the Express, with the Times and the Sun following suit. How very convenient. The story so neatly wiped off the front pages was the devastating news that <a href="https://www.theguardian.com/society/2017/feb/06/one-in-six-ae-departments-at-risk-of-closure-or-downgrade">one in six of England’s Accident and Emergency departments are set to be closed or downgraded over the next four years</a> – a catastrophic blow to the NHS and a direct consequence of the government’s decision to impose £22 billion of cuts during this parliament. </span></span></span></span> </p><p class="western" lang="en-GB"> <span><span><span><span>In the context of the current NHS winter crisis – with patients being treated in corridors, offices, store cupboards and even hospital gyms – the planned cuts to A&amp;E care make a travesty of Hunt’s ostensible commitment to patient safety. With patients already dying on trolleys in corridors, slashing A&amp;E capacity yet further beggars belief. </span></span></span></span> </p><p class="western" lang="en-GB"> <span><span><span><span>Even the Royal College of Emergency Medicine, a body not known for its hyperbole, paints a stark image of the havoc these latest cuts will wreak. </span></span></span></span><span><span><span><span>Its</span></span></span></span><span><span><span><span> vice-president Dr Chris Moulton </span></span></span></span><span><span><span><span>responded,</span></span></span></span><span><span><span><span> “Hospitals are under massive pressure, it’s now horrendously common to have 12-hour trolley waits and in some cases 30-hour waits in A&amp;E. The NHS has been desperately short of capacity for the last few years – it’s crazy to close A&amp;E units when there simply isn’t capacity to cope with these patients elsewhere.”</span></span></span></span></p><p class="western" lang="en-GB"> <span><span><span><span>Hunt has form on using immigrants to divert attention away from the consequences of his party’s political choice to underfund the NHS. At the Conservative party conference last year, his laudable commitment to increasing the number of UK medical school places was overshadowed by his sop to the </span></span></span></span><span><span><span><span>UKIP</span></span></span></span><span><span><span><span> contingent, a promise thereby to make Britain “self-sufficient” in medics. “<a href="http://www.dailymail.co.uk/health/article-3817748/Jeremy-Hunt-Let-s-replace-foreign-doctors-homegrown-talent-Post-Brexit-Britain.html">Let's replace foreign doctors with homegrown talent in Post-Brexit Britain</a>” enthused the Mail on Sunday in their headline interview with the Health Secretary that week. </span></span></span></span> </p><p class="western" lang="en-GB"> <span><span><span><span>The irony that there are tens of thousands of EU doctors and nurses keeping our NHS afloat and, without them, the health service would be unsustainable, </span></span></span></span><span><span><span><span>appeared lost on the Mail</span></span></span></span><span><span><span><span>. The fact is, if saving NHS money were really its main agenda, the government would focus not on the s<a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/331623/Impact_assessment.pdf#page=7">oft target of ‘health tourists’ </a>– who cost a</span></span></span></span><span><span><span><span>t the most</span></span></span></span><span><span><span><span> 0.3% of the overall health budget - but on other, more pressing issues such as the punitive repayments under the private finance initiative (PFI) that are leaching billions of pounds from frontline care and threatening to bankrupt some hospitals. </span></span></span></span> </p><p class="western" lang="en-GB"> <span><span><span><span>And they would c</span></span></span></span><span><span><span><span>ome clean on the start-up and </span></span></span></span><span><span><span><span>ongoing</span></span></span></span><span><span><span><span> costs of introducing NHS-wide bedside chip-and-pin machines through which staff will be expected to collect credit card payments before treatments can proceed. </span></span></span></span> </p><p class="western" lang="en-GB"> <span><span><span><span>Clearly there is covert agenda at play here, and probably several. </span></span></span></span><span><span><span><span>W</span></span></span></span><span><span><span><span>hipping up a furore over those nasty, good-for-nothing foreigners is a cynical smokescreen – straight out of the Trump school of media management - to mask the deliberate fiscal downgrading of the NHS year-on-year since 2010. Every second we spend debating ‘health tourists’ conveniently obscures this fundamental truth. </span></span></span></span> </p><p class="western" lang="en-GB"> <span><span><span><span>And </span></span></span></span><span><span><span><span>one has to wonder at the true motives behind the apparently uncosted – yet no doubt costly – roll out of point-of-care credit card scanners across the NHS nationally. A maximum revenue stream of 0.3% of the NHS budget </span></span></span></span><span><span><span><span>(likely considerably less) </span></span></span></span><span><span><span><span>hardly seems to make the investment worthwhile, which begs the obvious question, who will be tapped next for charges, once the new cash-collection infrastructure is embedded? The obese? Those who smoke? The alcoholics? Or any of the other ‘less-deserving’ folk perceived of as having brought their ill-health upon themselves? </span></span></span></span> </p><p class="western" lang="en-GB"> <span><span><span><span>Clinicians today have discovered that if our patients cannot pay, we will be <a href="http://www.dailymail.co.uk/news/article-4194388/Health-tourists-pay-treatment.html">expected to have “sensible discussions” in which we urge them to have their procedures or treatments back in their home country</a>. But doctors chose to practice medicine neither to raise taxes nor to police Britain’s borders. We have one duty, which is to act in our patients’ best interests, irrespective of country of birth. I have no problem agreeing that a tiny minority of NHS patients are perhaps, one way or another, seeking to milk the system, be they born in the UK or elsewhere. But a government, more than any of us, should show the moral leadership of rising above the demonisation of immigrants, knowing full well how eagerly the xenophobic elements of the national press will lap up their lead. </span></span></span></span> </p><p><span>This policy risks inciting further animosity towards non-British nationals, while simultaneously rendering some of the most vulnerable and powerless individuals in British society potentially too fearful of the repercussions to present, when ill, to hospital. Is that really what Theresa May stands for? She may, but every NHS doctor I know does not. We treat everyone in need without judgement or prejudice. And the prospect of a less tolerant, less inclusive NHS is a loss for the country writ large.&nbsp;</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="/ournhs/whole-agitation-has-nasty-taste-bevan-on-so-called-health-tourism">&quot;The whole agitation has a nasty taste&quot; - Nye Bevan on so-called &#039;health tourism&#039;</a> </div> <div class="field-item even"> <a href="/ournhs/sid-ryan/theresa-may-has-handed-nhs-crisis-to-regions-heres-why-that-should-worry-us-all">Theresa May has handed the NHS crisis to the regions - here&#039;s why that should worry us all</a> </div> <div class="field-item odd"> <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 class="field-item even"> <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 odd"> <a href="/ournhs/caroline-molloy/nhs-cuts-are-we-in-it-together">NHS cuts - are we in it together?</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 Rachel Clarke Tue, 07 Feb 2017 08:18:59 +0000 Rachel Clarke 108626 at https://www.opendemocracy.net "The whole agitation has a nasty taste" - Nye Bevan on so-called 'health tourism' https://www.opendemocracy.net/ournhs/whole-agitation-has-nasty-taste-bevan-on-so-called-health-tourism <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>As the government announces that NHS staff are to be issued with card readers to take payment at hospital bedsides, from anyone who can't prove their eligibility, it's worth re-reading NHS founder Nye Bevan's discussion of the 'health tourism' issue.</p> </div> </div> </div> <p lang="en-US"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/1633_1money_notes_stethoscope_budget_finance__J.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/1633_1money_notes_stethoscope_budget_finance__J.jpg" alt="" title="" width="460" height="345" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p lang="en-US"><span>"One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. This has given rise to </span><strong>a great deal of criticism, most of it ill-informed and some of it deliberately mischievous</strong><span>. Why should people come to Britain and enjoy the benefits of the free Health Service when they do not subscribe to the national revenues? So the argument goes.</span></p> <p lang="en-US"> <span><span><span>No doubt a little of this objection is still based on the confusion about contributions... The fact is, of course, that <strong>visitors to Britain subscribe to the national revenues as soon as they start consuming </strong>certain commodities, drink and tobacco for example, and entertainment. They make no direct contribution to the cost of the Health Service any more than does a British citizen.</span></span></span></p> <p lang="en-US"> <span><span><span>However, there are a number of more potent reasons why it would be <strong>unwise as well as mean </strong>to withhold the free service from the visitor to Britain. </span></span></span> </p> <p lang="en-US"> <span><span><span>How do we distinguish a visitor from anybody else? <strong>Are British citizens to carry means of identification everywhere</strong> 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. </span></span></span> </p> <p lang="en-US"> <span><span><span>Happily, this is one of those occasions when <strong>generosity and convenience march together</strong>. The cost of looking after the visitor who falls ill cannot amount to more than a negligible fraction of £399,000,000, the total cost of the Health Service. It is not difficult to arrive at an approximate estimate. All we have to do is look up the number of visitors to Great Britain during one year and assume they would make the same use of the Health Service as a similar number of Britishers. Divide the total cost of the Service by the population and you get the answer. I had the estimate taken out and it amounted to about £200,000 a year. Obviously this is an overestimate because people who go for holidays are not likely to need a doctor’s attention as much as others. However, there it is. for what it is worth and you will see it does not justify the fuss that has been made about it.</span></span></span></p> <p lang="en-US"> <span><span><span>The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilized principle, Conservatives have tried to <strong>exploit the most disreputable emotions </strong>in this among many other <strong>attempts to discredit socialized medicine.</strong>"</span></span></span></p> <p><span><span><span><span><em>OurNHS editor Caroline Molloy writes:</em></span></span></span></span></p> <p><span><span><span><span>The quote above is from Nye Bevan's chapter on the NHS in his classic book, In Place of Fear.</span></span></span></span></p><p><span><span><span><span>Clearly both NHS costs and the number of foreign visitors have increased since - but interestingly the ratio between the total cost of the NHS (£110bn) and the actual cost of visitor treatment that isn't recouped but could be (£40m), is roughly similar to the ratio set out by Bevan above.&nbsp;</span></span></span></span></p><p><span><span><span><span>Today's proposal to charge foreign visitors upfront, with card-machines by bedsides, before they receive healthcare, is just the latest in a long line of policies to restrict migrant access to healthcare.&nbsp;</span></span></span></span></p> <p><span><span><span><span>There’s at least </span></span><span><span>five</span></span><span><span> reasons these plans are a bad idea:</span></span></span></span></p> <p><span><span><span><span>1. </span></span><span><span>Migrants (who are largely young, active and healthy) </span></span><span><span><strong>contribute far more to the NHS as</strong></span></span><span><span> </span></span><span><span><strong>employees and as people who pay taxes </strong></span></span><span>than they take out of it in care. Already the migrant staff the NHS depends on on a daily basis are beginning to <a href="https://opendemocracy.net/ournhs/roger-kline/racism-in-nhs-don-t-let-unspeakable-become-acceptable">leave, fed up with </a></span><span><a href="https://opendemocracy.net/ournhs/roger-kline/racism-in-nhs-don-t-let-unspeakable-become-acceptable">a government set on migrant-blaming</a> to distract from wider problems with its mismanagement of the NHS.</span></span></span></p> <p><span><span><span><span>2. </span></span><span><span>Not treating non-emergency patients because of where they come from is not just medically unethical – it’s likely to store up </span></span><span><span><strong><a href="https://opendemocracy.net/ournhs/juan-camilo/experts-oppose-migrant-healthcare-proposals-will-government-listen">public health crises</a></strong></span></span><span><span>. Germany reversed a policy to charge low level fees for seeing a doctor, when it found that people just became sicker and more expensive to treat as emergencies in the long run.</span></span></span></span></p> <p><span><span><span><span>3. Administering all this increased charging of visitors is likely to </span></span><span><span><strong>cost more than it saves</strong></span></span><span><span>. Northern Ireland have significantly rejected such moves on these grounds. How much will card readers by the bedside and an army of enforcers, cost? We've not been told.</span></span></span></span></p> <p><span><span><span><span>4. Crucially, moves to charge visitors are being used to </span></span><span><span><strong>normalise</strong></span></span><span><span><strong> </strong></span></span><span><span><strong>c</strong></span></span><span><span><strong>harging </strong></span></span><span><span><strong>for NHS care</strong></span></span><span>, and introduce mechanisms such as card-readers to do so. It’s a w<a href="https://opendemocracy.net/ournhs/greg-dropkin-karen-reissman/healthcare-in-britain-first-they-came-for-immigrants">ell trodden political strategy to </a></span><span><span><a href="https://opendemocracy.net/ournhs/greg-dropkin-karen-reissman/healthcare-in-britain-first-they-came-for-immigrants">start with </a></span></span><span><a href="https://opendemocracy.net/ournhs/greg-dropkin-karen-reissman/healthcare-in-britain-first-they-came-for-immigrants">certain, politically unpopular groups</a> before rolling a policy and enforcement out to other groups and eventually to everyone. Already s</span><span>ome have already suggested charging fat people and smokers for NHS care – and both groups are already being blanket <a href="https://www.theguardian.com/society/2016/nov/29/surgeons-nhs-delay-treatment-obese-patients-smokers-york">refused NHS treatment in Yorkshire and elsewhere</a>, </span><span><span>for non-clinical reasons</span></span><span><span>. </span></span><span>And already, members of the House of Lords are quietly talking about introducing charging for everyone, <a href="https://opendemocracy.net/ournhs/richard-grimes/government-moves-to-consider-nhs-user-charges">in 2015 </a>and now again in <a href="https://www.parliament.uk/nhs-sustainability">a more recent Commission</a>&nbsp;currently underway.</span></span></span></p> <p><span><span><span><span>5. </span></span><span><span>The</span></span><span><span> problem of 'health tourism' is totally overstated – </span></span><span>a <strong>distraction </strong>from government mismanagement of the NHS</span><span><span>. </span></span><span>Rather than fuss about the small amount of money spent on health tourism, why is no-one talking about the <a href="https://opendemocracy.net/ournhs/caroline-molloy/billions-of-wasted-nhs-cash-noone-wants-to-mention">huge sums of money politicians are </a></span><span><a href="https://opendemocracy.net/ournhs/caroline-molloy/billions-of-wasted-nhs-cash-noone-wants-to-mention">wasting on their ideological fixation on running the NHS as a 'market'</a>, </span><span><span>adding</span></span><span><span> a </span></span><span><span>multi-billion</span></span><span><span> layer of bureaucracy - </span></span><span><span>that achieves nothing apart from allowing the private sector to nab the bits it wants</span></span><span><span>?</span></span></span></span></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="/ournhs/juan-camilo/migrants-fairness-and-nhs">Migrants, &quot;fairness&quot; and the NHS</a> </div> <div class="field-item even"> <a href="/ournhs/rayah-feldman/pregnant-women-bear-brunt-of-government-s-clampdown-on-migrant-nhs-care">Pregnant women bear brunt of government’s clampdown on ‘migrant’ NHS care</a> </div> <div class="field-item odd"> <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 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/kambiz-boomla/nhs-and-dog-whistle-politics">The NHS and dog whistle politics</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/nhs-charges-zombie-policies-walking-into-downing-street">NHS charges - the Zombie policies walking into Downing Street?</a> </div> <div class="field-item odd"> <a href="/ournhs/roger-kline/racism-in-nhs-don-t-let-unspeakable-become-acceptable">Racism in the NHS: don’t let the unspeakable become acceptable</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 OurNHS Mon, 06 Feb 2017 08:02:54 +0000 OurNHS 108611 at https://www.opendemocracy.net