ourNHS https://www.opendemocracy.net/taxonomy/term/12254/all cached version 25/05/2018 16:06:47 en Facing legal challenge, Tories hint about scrapping some NHS reforms – but remain wedded to privatising 'solutions' https://www.opendemocracy.net/ournhs/tommy-greene/facing-legal-challenge-tories-hint-about-scrapping-some-nhs-reforms-but-remain-w <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>The effects of the 2012 Health and Social Care Act are now too disastrous to ignore. But Jeremy Hunt’s shift is of rhetoric, not of substance - .and his new “ACO” plans are so dangerous, campaigners this week challenged them in the High Court.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/sue allyson.PNG" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/sue allyson.PNG" alt="" title="" width="460" height="282" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Professor Sue Richards, Dr Colin Hutchinson, Professor Allyson Pollock &amp; Dr Graham Winyard in front of the High Court this week as their Judicial Review opened. Credit: WeOwnIt/Twitter, Fair Use.</em></p><p>The leader of the Opposition’s opening gambit in <a href="https://www.youtube.com/watch?v=lGFMnZnpTu0&amp;t=318s">PMQs</a> this week was to put Theresa May on the spot over how much of NHS services were currently being outsourced to the private sector. Rather predictably, she had no answer of substance to this question.</p><p>Most people are aware by now that the NHS is at breaking point. But what much of the public are still in the dark about is exactly <em>how</em> this crisis is happening or being navigated.</p> <p>Anyone wanting to find out would be well-advised to take a look at incoming Accountable Care Organisations, which threaten to usher in an ‘Americanisation’ of services and possibly the largest vehicle for future privatisation in the NHS’s history. This week, the High Court heard about the impending introduction of these ACOs from a <a href="https://www.crowdjustice.com/case/jr4nhs-round3/">team of 4 senior health professionals</a> (<a href="https://www.theguardian.com/society/2017/dec/08/stephen-hawking-lawsuit-foiling-jeremy-hunt-nhs-shake-up">previously 5</a>, until the death of the late Professor Stephen Hawking in March). This judicial review looks to ensure that a shake-up as large as this does not occur without the proper public consultation and parliamentary scrutiny such a significant restructuring of public healthcare should entail. </p> <p>Along with legislative efforts to reinstate statutory responsibility for the health of people across England – which was essentially torn away by Andrew Lansley <a href="http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted">in 2012</a> - the case forms part of a several-year-long campaign to restore public healthcare (as set out in the NHS’s founding charter) as well as to uncover what transatlantic interests <a href="https://www.opendemocracy.net/ournhs/stewart-player/accountable-care-american-import-thats-last-thing-englands-nhs-needs">have planned</a> for it.</p> <p><strong>What are ACOs? And why are they such cause for concern?</strong></p> <p>Already piloted quietly across <a href="https://www.bigissuenorth.com/news/2018/04/nhs-plans-court/">10 areas in England</a>, Accountable Care Organisations boil down to a large-scale reorganisation and ‘integration’ of care providers. In theory, ACOs could be owned by NHS hospitals or GPs. But there may be nothing in place to stop them from being controlled by large insurance companies, finance and property firms who could eventually take them over and run them purely for profit. </p> <p>Through these new integrated care systems, the government looks to pool health and social care budgets from NHS England, Clinical Commissioning Groups (CCGs) and General Practice with local authority budgets into contracts to be awarded on a per capita basis. This means that ACOs could be a financial “Special Purpose Vehicle”, a public body or a private company. The longer-term upshot may be that CCGs disappear altogether and ACOs take on commissioning responsibilities, presenting them with the power to alter resources and patient composition.</p> <p>One central concern that has been raised relates to the way ACOs appear to blur the lines between the definition of care that’s ‘free at point of use’, care that’s charged at point of use and care that’s sold off privately. This obviously goes straight to the heart of the NHS’s founding principle of universal public healthcare provision. It is also a partial carry-over from NHS England chief Simon Stevens’ nebulous <a href="https://www.opendemocracy.net/ournhs/shibley-rahman/nhs-five-year-forward-view-wishlist-for-privatisers">promise</a> to “dissolve the classic divide[s]” of healthcare in his 2014 <a href="https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf">Five Year Forward View</a>, which at the same time pledged to reduce tens of billions in expenditure before 2021.</p> <p>During the last two years, some of the <a href="http://www.nhsforsale.info/database/market-failures/stps-and-privatisation.html">largest ever contracts</a> for NHS services have emerged. One of the first of these super contracts was in Dudley, where financial details of the 15-year Multispecialty Community Provider (MCP) agreement are not known. Then, in April 2017, a <a href="https://www.hsj.co.uk/hsj-local/commissioners/nhs-north-manchester-ccg/biggest-ever-nhs-tender-launched-as-6bn-contract-put-on-market/7017156.article?blocktitle=Most-popular&amp;contentID=-1">Manchester commissioning group</a> announced the largest ever tender for NHS services, in a contract worth £6 billion, for a provider of all out-of-hospital care in an area serving around 600,000 patients. Last year was also the advent of the <a href="http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/first-voluntary-contracts-awarded-to-gps-and-trusts/20035000.article">first “voluntary” contracts</a> to be awarded to GPs and Trusts now operating as tender-based, unofficially pro-profit businesses.</p> <p>In February this year, a High Court judge temporarily <a href="https://www.independent.co.uk/news/health/nhs-virgin-care-outsourcing-childrens-health-contract-private-company-judge-court-a8221811.html">blocked</a> Lancashire County Council’s attempt to outsource a £104 million childcare contract to Virgin. This ruling came only weeks after NHS bodies were forced to make an <a href="https://www.independent.co.uk/news/health/nhs-richard-branson-virgin-care-legal-settlement-tendering-contract-a8080961.html">undisclosed settlement</a> to the health branch of Richard Branson’s conglomerate over <a href="https://www.ft.com/content/297e7714-089f-11e7-97d1-5e720a26771b">its loss</a> of a £82 million contract to provide children’s health services across Surrey. </p> <p>ACOs could open the door to a great deal more private US equity firms looking to prise open the <a href="https://www.opendemocracy.net/ournhs/caroline-molloy/it-may-not-look-like-it-but-jeremy-hunt-does-have-plan-for-nhs-0">£120 billion oyster</a> of UK healthcare. Fears of backdoor privatisation have been compounded by indications from an increasingly <a href="https://www.telegraph.co.uk/politics/2018/01/31/embattled-theresa-may-vows-steer-britain-though-brexit-beyond/">embattled</a> May desperately <a href="https://www.opendemocracy.net/ournhs/nhs-theresa-mays-dowry-gift-to-donald-trump">scrambling to secure</a> a future trade deal with the US post-Brexit. </p> <p><strong>Accountable Care?</strong></p> <p>Despite talk of unification, “seamless” integration and the government’s persistent use of ‘local’ areas and populations in its language around ACOs, they will almost certainly fragment, outsource and create an increasingly complex commercial model of healthcare - instead of an open, transparent, directly-accountable model of provision. ‘Accountable care’ couldn’t be any more of a misnomer.</p> <p>ACOs’ taxonomy of “local health systems”, each with their own geographic “footprints”, was inherited from the division of local healthcare in England under <a href="https://www.kingsfund.org.uk/publications/articles/big-election-questions-stps">Sustainability and Transformation Plans</a> (STPs), Stevens’ last grand solution to plug a £22 billion annual funding gap before this latest move. A core problem with STPs was its <a href="https://www.opendemocracy.net/ournhs/colin-leys/sustainability-and-transformation-plans-kill-or-cure-for-nhs">delegation of responsibilities</a> to the[se] new ‘localities’, with no clear statutory rules or external regulation governing the care provision process. This question is one that has not become any clearer during the introduction of ACOs, for all the government’s talk of openness and liability.</p> <p>Jeremy Hunt’s <a href="https://www.theguardian.com/society/2017/sep/11/jeremy-hunt-to-unveil-plans-for-digital-led-nhs-treatment-by-2018">visions</a> of a <a href="https://twitter.com/jeremy_hunt/status/973230153060012033?lang=en">tech panacea</a> have also been part of the push towards ACOs, as well as to square various circles left by Stevens’ glib tract[s]. Meanwhile, <a href="https://www.theguardian.com/commentisfree/2017/may/13/nhs-computer-systems-insufficient-funding">underfunding</a> of basic <a href="https://www.telegraph.co.uk/news/2017/05/12/nhs-hit-major-cyber-attack-hackers-demanding-ransom/">IT facilities</a> in hospitals has continued – as was made all too clear in last year’s <a href="http://www.bbc.com/news/technology-41753022">WannaCry</a> ransomware attack[s]. </p> <p>Government officials <a href="https://www.independent.co.uk/news/uk/politics/jeremy-hunt-health-department-nhs-legal-action-americanise-privatisation-customers-id-pay-a8033986.html">maintain</a> that ACOs are not a move towards US-style privatisation, accusing campaigners of generating “pernicious falsehood[s]” and “irresponsible” alarmism, while insisting the plans “are simply about making care more joined-up between different health and care organisations”. The pro-market King’s Fund has <a href="https://www.newstatesman.com/politics/health/2018/02/accountable-care-doesn-t-mean-we-ll-end-us-style-privatised-health">reiterated</a> this message, arguing that identifications with US healthcare are mistaken and that the NHS needs more integrated care to survive. </p> <p>But, as health economist <a href="https://en.wikipedia.org/wiki/Allyson_Pollock">Allyson Pollock</a> has pointed out, commercial contracting and subcontracting in the NHS is already happening on a scale and at a duration never considered by the 2012 Health and Social Care Act. This was one of a number of crucial concerns which either weren’t raised or were stamped out during the legislation’s passage through parliament. It’s little surprise, then, that government and pro-market bodies are trying to keep campaigners quiet about ACOs (<a href="http://www.bbc.com/news/uk-politics-14778406">as they did</a> around the time of Lansley’s reforms) especially given these bodies’ cosy ties with US private health.</p> <p>Although May deflected Corbyn’s outsourcing question at this week’s PMQs, Allyson Pollock argues that only 36% of healthcare contracts were won by NHS providers in the financial year 2016-17, compared to 60% in 2014-15. And we also know private providers won £3.1 billion of new contracts in 2016-17, 43% of total advertised value. </p> <p>If anything, ACOs form part of a discursive shift rather than a shift from policy’s direction of travel after the <a href="http://www.bbc.com/news/health-31145600">effects</a> of the <a href="https://www.theguardian.com/politics/2015/jan/31/health-reform-tories-biggest-mistake-parliament-nhs-stephen-dorrell-mp">disastrous</a> 2012 Act became too obvious to ignore – and then needed to be ‘tidied up’. This shift signalled a move away from talk of breaking up public healthcare (remember, Lansley’s <a href="https://www.economist.com/britain/2014/03/29/health-reform-in-a-cold-climate">top-down reforms</a> were a “reorganisation so big you can see it from outer space”) towards a language of “collaboration” into which the term “integration” fits neatly. </p> <p>The truth is there is no real or meaningful local accountability with ACOs: no one knows what will happen if private contractors walk away from their contracts, or if they choose to close services and sell off buildings in search of more lucrative ventures, as has been happening recently with <a href="https://amp.theguardian.com/business/2018/may/18/royal-free-secretly-planning-to-develop-100-year-old-hospital-into-luxury-flats?CMP=Share_iOSApp_Other&amp;__twitter_impression=true">nursing home closures</a>. </p> <p><strong>The JR4NHS case and NHS re-instatement</strong></p> <p>Sometimes the conversation around the protection and the future of the NHS can seem hopelessly bleak. But, although the task can appear insurmountable, there are groups working to combat the corporate divvy-up of UK public healthcare. And they require public support now more than ever before.</p> <p>This judicial review action, for instance, has already prevented swathes of ACOs from being rubber-stamped until the case and consultation reaches a conclusion – they had initially been scheduled to come into effect this April. </p> <p>The case obviously can only go so far, though, due to its necessarily limited remit besides other things. Beyond other standalone legal battles like it, what has so far been stripped away can only be rehabilitated and restored by an Act of Parliament – which is why it is essential to support the Private Members’ Bill on 11th July to reclaim and begin to re-instate the NHS. </p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/stewart-player/accountable-care-american-import-thats-last-thing-englands-nhs-needs">&#039;Accountable Care&#039; - the American import that&#039;s the last thing England&#039;s NHS needs</a> </div> <div class="field-item even"> <a href="/ournhs/allyson-pollock/why-next-labour-manifesto-must-pledge-to-legislate-to-reinstate-nhs">Why the next Labour Manifesto must pledge to legislate to reinstate the NHS</a> </div> <div class="field-item odd"> <a href="/ournhs/john-lister/if-our-government-won-t-act-to-save-our-nhs-then-we-must">If our government won’t act to save our NHS this winter, this is what we must do</a> </div> <div class="field-item even"> <a href="/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Taking politics out of the NHS? Or constructing an elitist ‘consensus’?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Tommy Greene Fri, 25 May 2018 15:01:04 +0000 Tommy Greene 118069 at https://www.opendemocracy.net NHS data-sharing U-turn is welcome – but more to do to scrap the ‘hostile environment’ https://www.opendemocracy.net/ournhs/peter-pannier/data-sharing-u-turn-is-welcome-but-more-to-do-to-scrap-hostile-environment-in-n <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Recent attention to the Windrush scandal has focused attention on the many ways migrants are deterred from accessing healthcare. This Saturday, join NHS workers protesting that they are not border guards.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/nursenotaborderguard.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/nursenotaborderguard.jpg" alt="" title="" width="460" height="465" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Medact</em></p><p>The government has this week announced it will be <a href="https://www.theguardian.com/society/2018/may/09/government-to-stop-forcing-nhs-to-share-patients-data-with-home-office">suspending “with immediate effect”</a> the controversial memorandum of understanding (MOU) under which NHS Digital<a href="https://www.theguardian.com/uk-news/2017/jan/24/nhs-hands-over-patient-records-to-home-office-for-immigration-crackdown" target="_blank">&nbsp;shared NHS patients’ details with the Home Office</a>.</p> <p>It’s a significant victory for the<a href="https://www.facebook.com/hashtag/stopsharing?source=feed_text" target="_blank"> #StopSharing</a> campaign by Doctors of the World, the National AIDs Trust, and a host of others - including Docs Not Cops. Campaigners have been insisting that patients should not fear immigration enforcement when seeking NHS treatment. The policy – part of the ‘hostile environment’ - has stirred considerable controversy, with a legal challenge from <a href="https://www.crowdjustice.com/case/stopnhsdatasharing/" target="_blank">Migrants’ Rights Network legal challenge</a> due to be heard next month. MPs on the Commons Health Committee also voiced considerable concern after hearing a range of powerful testimony – including from Voices of Domestic Workers, who highlighted a case of a domestic worker who had&nbsp;<a href="https://www.mirror.co.uk/news/politics/domestic-worker-died-too-frightened-11864052" target="_blank">died of pneumonia 'too frightened' to access healthcare</a>.</p> <p>While suspension of this damaging data-sharing provides a rare moment to celebrate, and appreciate the impact campaigning can have, there are caveats and a good deal of context to bear in mind. Firstly, it is essential to emphasise that - thanks to regulations introduced through secondary legislation by Jeremy Hunt in October 2017 - patients will <em>still</em> be required to prove immigration status to&nbsp;access&nbsp;most hospital care. Such a requirement stops people receiving treatment, criminalises patients and makes healthcare workers complicit in racist policy. Further, the NHS is but one arena in which the government’s hostile environment operates - banks will still freeze your account if you're unlucky enough to end up on a Home Office wanted list, and Landlords are still required to check your passport if you're renting from them. The Prevent duty still places students – and patients – under suspicion, as highlighted by the Joint Council for the Welfare of Immigrants,&nbsp;<a href="http://twitter.com/nobankborders" target="_blank">No Borders In Banks</a>, and&nbsp;<a href="https://twitter.com/UnisNotBorders" target="_blank">Unis Not Borders</a>&nbsp;amongst others.</p> <p>Another caveat is that the announcement on NHS data sharing came during a debate on the Data Protection Bill – however during the wider debate on the bill, an amendment which would have definitively scrapped the exemption that allows data protection rules to be broken for immigration purposes was defeated by 18 votes. And the suspension was also announced with a suggestion that in future the Home Office would still be “able to use the data-sharing mechanism to trace people who are being considered for deportation from Britain because they have committed a serious crime”. As Liberty and the National Aids Trust have already noted, the definition of “serious crime” here is vague to say the least.</p> <p>Corey Stoughton, advocacy director at Liberty said: “The government now admits it has been needlessly exploiting NHS patient data on a mass scale for minor immigration enforcement matters. They have undermined the confidentiality and trust at the heart of our healthcare system in the name of pursuing their hostile environment. We welcome the agreement to overhaul its practices and immediately curtail some data-sharing – but its language is worryingly vague. We need a cast-iron commitment that people will no longer have to fear immigration enforcement when seeking urgent medical care.”</p> <p>Any discussion of crime must acknowledge that those who are not white are more likely to be stopped, detained, prosecuted, and receive harsher sentences. Immediately it is clear that not everyone will be safe from data sharing - and instead of protecting people, and ensuring no-one is deterred from seeking treatment, the discussion is once again dragged toward distinctions between ‘good migrants’ and ‘bad migrants’, ‘deserving’ and ‘undeserving’ people.</p> <p>As with much of the recent (and long overdue) media and political attention to the government’s ‘hostile environment’, people who can be deemed 'illegal' are once again dehumanised even by politicians opposing government policy. Labour’s&nbsp;Shadow Secretary of State for International Trade, and for Climate Change,&nbsp;<a href="https://twitter.com/daily_politics/status/990918048633700352" target="_blank">Barry Gardiner recently told the BBC’s Daily Politics</a>&nbsp;"we have to make sure that those people who are in this country illegally are removed from this country... I'm very happy to see a target of the number of those people that we want to remove". When the BBC’s Nick Robinson asked the&nbsp;<a href="https://www.youtube.com/watch?v=gVKs23tCCKU" target="_blank">Shadow Foreign Secretary Emily Thornberry on the Marr Show</a>&nbsp;“Are you saying that you don’t want to see checks when people arrive in hospital for treatment that might cost tens of thousands of pounds – you don’t want to see whether they’re in fact illegal immigrants?”,&nbsp;Emily Thornberry replied “I don’t have a problem with checks being made”. It was disappointing that Thornberry made no attempt to query the premise of the question (where Robinson also suggested&nbsp;illegal migrants "take" jobs and houses from legal residents) or defend the principle that all should be able to access healthcare as a human right. It would have been easy for Thornberry to mention the public health risks entailed when denying people treatment – as&nbsp;<a href="http://politics.co.uk/news/2018/04/19/hostile-environment-government-ignored-warnings-from-public" target="_blank">Public Health England have done</a>.</p> <p>This stance must change - as Luke de Noronha argues, “There are no sharp divisions between ‘legal migrants’ and citizens over here, working hard, paying taxes and playing by the rules, and the ‘illegal immigrants’ over there, sneaking around, stealing jobs and deceiving ordinary Brits. In fact, the law changes around people;&nbsp;<em>illegality is produced</em>&nbsp;in ways which create divisions within our families, communities and classrooms. We can only develop a stronger critique of the UK’s cruel immigration system if&nbsp;<a href="https://www.opendemocracy.net/uk/luke-de-noronha/windrush-generation-and-illegal-immigrants-are-both-our-kin" target="_blank">we see Windrush migrants and ‘illegal immigrants’ as kin</a>, rather than as good and bad migrants to be isolated from one another.” No one should be made to feel undeserving of care.</p> <p>More positively, it is welcome that, responding to the suspension of data-sharing, Shadow Health Secretary Jonathan Ashworth noted yesterday “Theresa May has ignored warnings that the regulations on ID checks at hospitals are also damaging patient care” and added that "<a href="https://www.mirror.co.uk/news/politics/home-office-stop-using-nhs-12508018" target="_blank">The Government must now suspend these regulations while a full review is carried out</a>.” </p> <p>Having been making this case for months - indeed years - we are pleased to hear a senior opposition politician say:</p> <p>“This policy was yet another example of Theresa May’s heartless ‘hostile environment’ which is clearly undermining patient care. This U-turn is a victory for Labour MPs like Paul Williams and Luciana Berger, as well as the Health Select Committee. But the Government needs to go further. Today’s U-turn should only be the start. To protect the best interests of patients the Government must end Theresa May’s hostile environment entirely.”</p> <p>This is a welcome first step - Labour must now commit to scrap these regulations in their entirety, as&nbsp;<a href="https://labourlist.org/2018/03/the-nhs-must-remain-free-at-the-point-of-use-and-based-on-need-not-ability-to-pay/" target="_blank">we've argued on LabourList</a>, and&nbsp;<a href="https://www.opendemocracy.net/ournhs/docs-not-cops/labour-must-tackle-may-s-hostile-environment-for-migrants-in-nhs" target="_blank">ahead of their 2017 conference on OurNHS openDemocracy</a>.</p> <p>Of course, responsibility lies with Jeremy Hunt. That’s why this Saturday 12th May we’re organising a twitter storm for International Nurses Day. This year the International Council of Nurses have chosen “<a href="http://www.icn.ch/publications/2018-nurses-a-voice-to-lead-health-is-a-human-right/" target="_blank">Nurses A Voice to Lead – Health is a Human Right</a>” as their theme. We agree with them that "healthcare should be accessible to all". The government’s ‘hostile environment’ policies go against this principle - making it more and more difficult for people to access the NHS services they need. It is now mandatory for NHS trusts to check people’s immigration status before providing secondary care and to&nbsp;<a href="https://theconversation.com/who-has-to-pay-for-the-nhs-and-when-91344" target="_blank">charge upfront for treatment</a>&nbsp;where people are unable to prove their eligibility. And additionally, the&nbsp;<a href="https://www.theguardian.com/society/2018/feb/05/annual-charge-paid-by-migrants-for-using-the-nhs-to-double" target="_blank">Immigration Health Surcharge is set to be doubled</a>, despite pricing people out of visa applications at the rates introduced in 2014.</p> <p>Already these&nbsp;<a href="https://www.independent.co.uk/news/uk/home-news/nhs-charging-rules-doctors-nurses-government-id-checks-payments-home-office-hospitals-docs-not-cops-a8014966.html" target="_blank">policies are leading to discrimination and racial profiling</a>, to&nbsp;<a href="https://www.independent.co.uk/news/uk/home-news/pregnant-and-ill-migrants-going-without-medical-care-due-to-hardline-government-immigration-policy-a8011351.html" target="_blank">people being too scared to access the care they need</a>, and are&nbsp;<a href="http://www.gal-dem.com/docs-not-cops-new-policy-transforms-nhs-workers-border-guards" target="_blank">turning healthcare workers into border guards</a>.</p> <p>As health workers we are standing up for our patients and advocating for free, universal, non-judgemental healthcare. Ahead of International Nurses Day, a member who is a nurse has written of seeing the <a href="https://www.independent.co.uk/voices/home-office-nhs-doctors-passport-checks-nhs-health-tourism-patients-a8345056.html">fallout of these policies every day in A&amp;E</a>. Join Docs Not Cops in celebrating International Nurses day this Saturday (12 May) by telling Jeremy Hunt it’s time to end prohibitive healthcare charges for migrants, scrap ID checks in hospitals and community care, and time to kick the ‘hostile environment’ out of the NHS. Please tweet a selfie of you and your colleagues (ideally in uniform - but you don’t have to identify anyone) holding a sign saying “We treat patients not passports. I’m a Nurse not a border guard”. For more information go to:<a href="http://www.docsnotcops.co.uk/nursenotaborderguard" target="_blank">&nbsp;docsnotcops.co.uk/nursenotaborderguard</a></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/uk/jess-potter/is-our-personal-data-fair-game-in-drive-to-create-theresa-may-s-hostile-environment-f">Is our personal data fair game in the drive to create Theresa May’s “hostile environment” for migrants?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Peter Pannier Fri, 11 May 2018 06:00:00 +0000 Peter Pannier 117807 at https://www.opendemocracy.net “Simon Jones was 24 when he died, his head crushed by the grab of a crane” https://www.opendemocracy.net/uk/hannah-basson/simon-jones-was-24-when-he-died-his-head-crushed-by-grab-of-crane <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Poor working conditions kill a worker every 11 seconds. All of these deaths are preventable – if the political will is there. An edited version of a speech given on International Workers Day.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/simon jones.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/simon jones.jpg" alt="" title="" width="460" height="421" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Simon Jones's family, pictured 3 years after his death. Credit: Michael Stephens/PA Images.</em></p><p><a href="http://www.simonjones.org.uk/campaign/">Simon Jones was 24 when he died</a>. It was 20 years ago last month.</p> <p>Simon died, his head crushed by the grab of a crane at Shoreham docks. He didn’t know how to do that job. He wasn’t trained for it. But he took a job he was not prepared for and had no experience in, because of the push from the dole office to make him work, and the threat of his benefits being cut.</p> <p>Worldwide, poor working conditions <a href="http://www.hazards.org/wmd/worldoftrouble.htm">kill a worker every 11 seconds</a>. <a href="http://www.hse.gov.uk/statistics/fatals.htm">137 people died at work in the UK in the 2016-17</a>, and in the same year, one and half thousand fatalities arose from work-related incidents.</p> <p>Union health and safety representatives make a difference in the workplace. Yet this government is relentlessly attacking our unions. Workplaces with union representatives and joint safety committees have half the major injury rate of those without. Safety representatives save society up to half billion pounds a year, by reducing time lost through illness and occupational injury. </p> <p>An academic report looked at the construction industry in Northern Ireland and the Irish Republic. It concluded: “<em><a href="https://www.tuc.org.uk/research-analysis/reports/union-effect#_ftn12">the strongest relationship with safety compliance is the presence of a safety representative</a>”.</em> The Health and Safety Executive’s own research has reinforced these conclusions. Other studies have shown that the better an employer consults with reps, the more effective the control measures. </p> <p>And yet, this govt continues its attacks on our unions and our safety.</p> <p>The 1974 Health and Safety at Work Act is our primary piece of legislation covering occupational health and safety in Great Britain. With the hard work, skills, knowledge, and watchful eye of people like our reps and of the Health and Safety Executive, thousands and thousands of lives have been saved. </p> <p>Not only are this government hell bent on destroying the unions, they are attacking the Health and Safety Executive too. <a href="http://www.hazards.org/safetypimp/buyme.htm">By 2020, the HSE budget will have been cut by half</a>. Conservative leaders and a right-wing media, with the approval of sneering government officials, undermine the work of the Health and Safety Executive at every turn, citing any decision as ‘red tape’, the ‘nanny state’, and ‘health and safety gone mad’.</p> <p>The 40-year social partnership between the Health &amp; Safety Executive and the TUC/unions has been scrapped – after talks behind closed doors between the government and lobby groups - and it’s now <em>ministers</em> that decide who represents workers on the HSE board. </p> <p>The need for proper health and safety, the damage that casual labour creates, outsourcing, the demonisation of the sick and disabled – these issues are as important as they ever were. </p> <h2>How outsourcing and privatisation worsen health and safety</h2> <p>Since the last Workers Day, the <a href="http://press.hse.gov.uk/2017/health-care-provider-fined-for-health-and-safety-failures/">Ramsay health group who run the Winfield private hospital in Gloucester were fined</a> for running an insufficiently staffed and managed occupational health service putting staff, as well as public, at risk. </p> <p>Since last Workers Day, Liverpool has held a <a href="http://www.unitetheunion.org/news/vigil-to-remember-liverpool-hospital-worker/">candlelit vigil for an outsourced worker who could not afford adequate time off work to recover</a>, following surgery to have a lung removed in the hospital where she worked. Unfair sick pay meant she lost her home as a result.</p> <p>Here in the NHS in Gloucestershire, <a href="https://opendemocracy.net/ournhs/caroline-molloy/are-cash-strapped-hospitals-walking-into-trap-that-could-cost-nhs-its-family-">hundreds of staff have just been transferred to a new private company, or ‘SubCo’</a> – transferred whilst its owners, Gloucestershire Hospitals NHS Trust, were <em>still discussing</em> what Health and Safety committee provision there would be, whilst they were still tossing ideas around about the occupational health provision that those workers will have access to.</p> <p>Many outsourcings across the NHS and beyond in this last year have led to reductions of sick days for staff. In Gloucestershire, we don’t know yet what several of the policies of the new SubCo will be. We are still waiting to see what new starters terms will be. Our workers in this county in the SubCo, outsourced to save money for the bosses, face many potential sources of injury every hour of the day in the work place. And these are the lowest paid workers in the health service. They are fodder for feeding the bosses’ profits and for feeding the government’s cuts. They are expendable trash, waste products, of a system that favours money over life.</p> <p>Worldwide, working conditions kill a worker every 11 seconds. Every death is avoidable. There is the knowledge, there is the technology, there just isn't the will. </p> <p>Union organisation is proven antidote. Remember Simon, and remember those that die at work everywhere. And think about your friends and family and the people you don’t know personally but greet each day as though they were your friends. Think about their safety, their futures. An injury to one is an injury to all.</p> <p>Simon was an amazing young man who believed in direct action. He knew you couldn’t sit back and wait for politicians to make the changes needed.</p> <p>Before the next government is sworn in, there will more deaths in the workplace. And we can’t wait for the next government. So, for now, we must do all we can to raise awareness of the good that unions do, the need for proper health and safety, the damage that casual labour creates, outsourcing, the demonisation of the employed and the non-employed sick and disabled. And when the next election comes – you know what you have to do. Then, let’s bring in a reversal to union legislation, repeal the vicious trade union legislation – and let’s make the workplace a safer place for everyone</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/opensecurity/henrik-maihack/rana-plaza-bottomup-route-to-workers%E2%80%99-safety">Rana Plaza: the bottom-up route to workers’ safety</a> </div> <div class="field-item even"> <a href="/uk/frances-ogrady/heartunions-why-young-workers-need-trade-unions-more-than-ever">#HeartUnions - why young workers need trade unions more than ever</a> </div> <div class="field-item odd"> <a href="/laurie-macfarlane/precarious-workers-are-organising-trade-unions-need-to-catch-up">Precarious workers are organising - trade unions need to catch up</a> </div> <div class="field-item even"> <a href="/opensecurity/phil-chamberlain/building-blacklist-police-spies-and-trade-unionists">Building the blacklist: police spies and trade unionists</a> </div> <div class="field-item odd"> <a href="/dave-smith/carillion-must-now-face-justice-for-blacklisting-trade-unionists-too">Carillion must now also face justice for blacklisting trade unionists</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> uk uk ourNHS Hannah Basson Thu, 10 May 2018 08:10:57 +0000 Hannah Basson 117786 at https://www.opendemocracy.net To prevent another Alfie Evans case we must reverse cuts to public services https://www.opendemocracy.net/callum-phillips/to-prevent-another-alfie-evans-case-we-must-reverse-cuts-to-public-services <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>The right have used the case as a stick to beat the public services they supported gutted.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/565030/PA-36210904.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/565030/PA-36210904.jpg" alt="Alfie Evans in Alder Hey Children’s Hospital, Liverpool." title="" width="460" height="392" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Alfie Evans in Alder Hey Children’s Hospital, Liverpool. Image: Ropi/Zuma Press/PA Images.</span></span></span></p><p>On April 28th, 23-month-old Alfie Evans died five days after his life support machine was switched off. The entwined web of legal, medical, and ethical issues brought to light by the case has provoked fierce reactions across the globe. On both sides of the Atlantic, the libertarian right have weaponsied Evan’s death to attack the NHS and British legal system, with figures like Nigel Farage branding it “state-sponsored euthanasia”. But contrary to their claims, this tragic story is not the result of government overreach. Rather, it is indicative of the damage being wrought to public services and human lives by the shrinking of the state, a policy that the right has vociferously fought for.&nbsp;</p><div>In the US, commentators such as Liz Wheeler, a host for the ultra conservative news network OAN, have sought to link Evan’s death to the UK’s universal health care system. But even if an American hospital was willing to keep Evans on life support, it would not be able to do so indefinitely given the financial burden on his parents. Regardless, the opinion of the international medical community is that the outcome would have been the same. Impartial medical experts offering opinions, available to read in the court judgements, comprehensively assessed any likelihood of recovery and found none; MRI scans of his brain found the majority of his brain was already crippled beyond repair. They submitted that Evans would never make any developmental progress (motor skills, vision, hearing, social, or emotional) and his illness was irreversible and terminal.</div><div>&nbsp;</div><div>Having already exhausted all their medical knowledge, experience, and options, Alder Hay Hospital continued to keep Evans alive, at no cost to the parents, supporting his failing organs, enabling him to breath, and treating recurrent infections Evans could not fend off himself. Accordingly, Alder Hay provided palliative care to Evans, which some critics have misleadingly tried to equate to euthanasia. It is at this point that a Vatican-run hospital, Bambino Gesú Hospital, and the Pope intervened. Their intentions however have been misreported. The Italian hospital offered no therapeutic benefit, no increased chance of survival. There was no last ditch option maliciously refused to the parents by a child-murdering government. The British government were not a party to any of the legal proceedings, and the constitutionally endorsed independence of the court ensures the government cannot simply dictate their adjudications. To chastise the state is to erroneously conflate the two.</div><div></div><blockquote class="twitter-tweet"><p dir="ltr" lang="en">Moved by the prayers and immense solidarity shown little Alfie Evans, I renew my appeal that the suffering of his parents may be heard and that their desire to seek new forms of treatment may be granted.</p>— Pope Francis (@Pontifex) <a href="https://twitter.com/Pontifex/status/988496588283826177?ref_src=twsrc%5Etfw">23 April 2018</a></blockquote><p><br />Recognising this, the courts and medical specialists at Alder Hay concluded it was in Evans’ best interests to end his suffering by switching off the life support machine keeping him alive. This was against the wishes of his parents, and certainly their opinions were taken into account. However, it is not in their best interests that the courts and doctors are charged with protecting. They are the guardians of a young man unable to communicate his own wishes. It is a wretched decision to have to take, but arguably, those we entrust with such tragedies were in agreement: it was time to let Evans’ life reach a natural conclusion.</p><div>We cannot imagine the suffering which Evans’ parents have gone through. This has been a horrifically sad story from start to finish. However, as a society we must seek to draw beneficial reforms from what has gone before, recognising where we have failed each other.</div><div class="mag-quote-right">Let Evans’ legacy be a call-to-arms to support a health service wishing to protect its citizens</div><div>&nbsp;</div><div>Incorrect legal advice from the Christian Legal Centre prolonged and increased the suffering of the parents and child involved. It gave them a false hope. It misled them as to the actions of the doctors and the position of the law. This cannot be forgotten. Looking forward, we must invest in legal aid access and supporting organisations like Citizens Advice, which have been stretched to breaking point by vicious budget cuts and austerity measures. Hospitals must be enabled to bring in greater specialist grief counselling facilities, to open up a passage of communication between parents and doctors. The adversarial nature of court proceedings should be avoided at all costs, it is to the benefit of neither party. Clinical Ethics Committees are notoriously poorly resourced, resulting in them fighting a battle with one arm tied behind their back. The answer to this case is most certainly not to turn towards a single-payer healthcare system (as seen in America). As former President Obama noted in his 2009 State of the Union, a medical cost induced bankruptcy occurs every 30 seconds due to a system rampantly providing unequal levels of accessibility to care.</div><div>&nbsp;</div><div>The answer is to double-down on our support for universal health care. As citizens touched by Evans’ story, we must come together to fund charities and research into incurable conditions. We must support political parties seeking to empower our NHS and research facilities to provide pioneering treatment and developing those miracle cures we seek. This is clearly not yet the case under our current neoliberal system. Healthcare blind to social class is irrevocably entwined to the very fabric safeguarding British communities, providing protection and care for those other countries would readily leave behind.</div><div>&nbsp;</div><div>Let Evans’ legacy be a call-to-arms to support a health service wishing to protect its citizens, to formulating a legal system accessible by all, and to campaigning for research into conditions not seen as profitable by corporations. It is only through standing up for these notions that we can prevent the suffering of Evans and his family from being in vain.&nbsp;</div><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/5050/lara-whyte/charlie-gard-cause-celebre-us-christian-right">How Charlie Gard became a cause célèbre for the US Christian right </a> </div> <div class="field-item even"> <a href="/5050/lara-whyte/the-rise-of-citizengo">&quot;They are coming for your children&quot; – the rise of CitizenGo</a> </div> </div> </div> </fieldset> <div class="field field-country"> <div class="field-label"> Country or region:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> UK </div> </div> </div> <div class="field field-topics"> <div class="field-label">Topics:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> Civil society </div> </div> </div> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS UK Civil society Callum Phillips Wed, 09 May 2018 12:03:06 +0000 Callum Phillips 117767 at https://www.opendemocracy.net Don't invoke the NHS to sell a false idea of 'good nationalism' https://www.opendemocracy.net/ournhs/caroline-molloy/dont-invoke-nhs-to-sell-false-idea-of-good-nationalism <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>This isn't 'good nationalism'. This is nationalism - as ever, in an English context - as forgetting. A response to Zoe Williams.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/2012 olympics.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/2012 olympics.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: London Olympic games ceremony, 2012. Credit: Julian Behal/PA Images, all rights reserved.</em></p><p>Zoe Williams <a href="https://www.theguardian.com/commentisfree/2018/may/08/nationalism-positive-case-immigration-counter-narrative-nhs">holds up the NHS as an example of ‘good nationalism’ in today’s Guardian</a>, citing Danny Boyle’s 2012 Olympics NHS montage as an example:</p> <p>“Good nationalism is a certain specific solidarity based on the things you have created together, as a nation, and the things you aspire to create: you could call it, for short,&nbsp;<a href="https://www.theguardian.com/sport/2012/jul/27/olympic-opening-ceremony">Danny Boyle nationalism</a>, and it takes in the NHS.”</p> <p>The problem with this kind of narrative is it omits how all English nationalism – even supposedly the ‘good’ kind – allows us all to ignore inconvenient truths.</p> <p>Narratives that sacralise the NHS - or indeed any of our better achievements or virtues - as part of our nationalism, risk making us complacent. We all love the NHS, fair play, queues, warm beer and decency. These things will always be with us, with any temporary lapses promptly corrected. So the story goes.</p> <p>Of course in 2012, just as Boyle’s dancing nurses brought a lump to our throats, the government was enacting the most destructive anti-NHS legislation in history, destroying (in England) its core principle that people got <em>comprehensive</em> healthcare on the basis that they lived here, and needed it, that had endured since 1948.</p> <p>Just a couple of months <em>before</em> the 2012 Olympics, <a href="https://www.telegraph.co.uk/news/uknews/immigration/9291483/Theresa-May-interview-Were-going-to-give-illegal-migrants-a-really-hostile-reception.html">Theresa May also publicly announced the “hostile environment” policy</a>, making it progressively harder over the next few years for migrants to access healthcare or other basic rights, as well as making life progressively more uncomfortable – or impossible – <a href="https://opendemocracy.net/ournhs/ruth-atkinson/brexit-and-nhs-we-need-to-fight-racist-discourse">for migrant workers in the NHS</a>. </p> <p>The Tories genuflect to the NHS as a ‘national religion’ almost as much as Labour - but that hasn’t stopped them disestablishing it and excommunicating large numbers of people from it. </p> <p>And not just migrants, incidentally. Overweight people and smokers are now being banned from <em>all</em> routine NHS procedures <a href="https://www.theguardian.com/society/2017/apr/22/nhs-letter-more-rations-on-operations-obese-smokers">across at least a third of the country</a>, a policy strongly opposed by doctors.</p> <p>Sajid Javid suggested last week that the hostile environment “<a href="https://www.independent.co.uk/news/uk/politics/sajid-javid-theresa-may-new-home-secretary-immigration-rhetoric-hostile-not-british-a8330151.html">did not represent our values as a country</a>”, and <a href="https://www.telegraph.co.uk/politics/2018/05/07/jacob-rees-mogg-amazing-rise-savid-javid-makes-proud-british/">Jacob Rees-Mogg yesterday called the policy “unBritish”.</a> But Eric Pickles called the aforementioned NHS fat bans “<a href="https://www.opendemocracy.net/ournhs/caroline-molloy/dont-want-government-to-let-nhs-die-one-crucial-thing-you-can-do-now">not the kind of Britain I recognise</a>”, too. It seems evoking Britishness doesn’t save us. </p> <h2>&nbsp;‘Good nationalism’ vs ‘bad nationalism’?</h2> <p>Is ‘bad nationalism’ really confined to the Other, to the unashamedly right-wing both here and across the pond? </p> <p>Williams says, “I have no problem with a bordered civic identity: our borders describe the limits of our democratic agency.” She adds, “Good nationalism… includes, by definition, every man, woman and child who contributed to the achievement”. But Williams fails to spell out who this is. Those Caribbean nurses who came here to build the NHS, now finding themselves or their children denied healthcare, and worse? The Commonwealth doctors, routinely discriminated against? The slaves who were forced to help ‘this nation’ establish its wealth? </p> <p>Williams doesn’t say, and such vagueness is not good enough.</p> <p>This isn’t ‘good nationalism’ – this is nationalism (as ever, in the English context) as forgetting. Forgetting that the NHS was not <em>just</em> built “together, as a nation”, as Williams suggests. It was built by a nation that had built its wealth on the back of empire and slavery, by overwriting brown people’s “civic identity”, a nation that had no qualms about interfering in its colonies’ “democratic agency” just long enough to exploit all that could be exploited – and not a moment longer.</p> <p>It’s a message that has been powerfully brought home lately, with the very Commonwealth workers who came over here to help build the NHS, shamefully denied healthcare for themselves or their families. </p> <p>Even now, too many responses to the Windrush scandal fall into <a href="https://www.opendemocracy.net/uk/luke-de-noronha/windrush-generation-and-illegal-immigrants-are-both-our-kin">inherently flawed tropes of ‘good’ and ‘bad’ migrants</a>, with the ‘bad migrants’ category including <a href="https://www.opendemocracy.net/ournhs/juan-camilo/migrants-fairness-and-nhs">children</a>, <a href="https://www.opendemocracy.net/ournhs/rayah-feldman/pregnant-women-bear-brunt-of-government-s-clampdown-on-migrant-nhs-care">pregnant women</a> and <a href="https://www.opendemocracy.net/ournhs/erin-dexter/making-nhs-hostile-environment-for-migrants-demeans-our-country">torture victims and people with infectious diseases</a>, all of whom are still now being refused free healthcare. The former head of the NHS attacked these policies as a “<a href="https://www.opendemocracy.net/ournhs/ex-boss-of-england-s-nhs-blasts-nhs-migrant-policy-as-national-scandal">national scandal” when Jeremy Hunt rolled out upfront passport checks and charges last year</a>. But the <a href="https://www.opendemocracy.net/ournhs/kailash-chand/stop-distracting-us-with-health-tourism-sideshow">grossly exaggerated</a> story of so-called ‘health tourism’ won’t go away, carried by the insidious bleating about ‘an international health service’ that’s travelled from Nick Griffin’s mouth, to Nigel Farage’s, to Jeremy Hunt’s, to even <a href="https://www.youtube.com/watch?v=n9aq47KRrOI">that other bastion of liberal national pride, the BBC</a>.</p> <h2>A little history</h2> <p>A few years after the Windrush generation arrived, <a href="https://www.opendemocracy.net/ournhs/whole-agitation-has-nasty-taste-bevan-on-so-called-health-tourism">Nye Bevan wrote powerfully</a> about the importance of generosity to visitors and of universalism, saying:</p> <p>“it would be&nbsp;unwise as well as mean&nbsp;to withhold the free service from the visitor to Britain. How do we distinguish a visitor from anybody else?&nbsp;Are British citizens to carry means of identification everywhere&nbsp;to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody. Happily, this is one of those occasions when&nbsp;generosity and convenience march together…. The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilized principle, Conservatives have tried to&nbsp;exploit the most disreputable emotions&nbsp;in this among many other&nbsp;attempts to discredit socialized medicine.”</p> <p>Williams writes “Patriotism is democracy, distilled: satisfaction and solidarity rooted in having created the conditions in which generosity and innovation could thrive.”</p> <p>This sounds like a very Blue Labour take (or Blue Corbynism…?).</p> <p>It’s also nonsense. </p> <p>Do we really want to relegate our “generosity” to merely a side-effect of patriotism? Our most generous service – <a href="https://www.newstatesman.com/politics/2013/01/nhs-even-more-cherished-monarchy-and-army">the NHS – has also been our most cherished</a>, for that very reason. The NHS is not a side effect of patriotism. It is, as Bevan himself said, “pure socialism”. </p> <p>And “innovation” in science and medicine has nothing to do with patriotism, either. Our greatest discoveries have been built on cross-border, non-profit collaboration for centuries, and continue to be so – <a href="https://www.opendemocracy.net/ournhs/ted-schrecker/5-reasons-brexit-is-very-bad-for-our-health">though threatened by Brexit</a>. </p> <p>Mangling history to provide comforting myths won’t provide the effective countervailing ‘narrative’ to ‘bad nationalism’ that Williams says the English need. Indeed it just makes ‘bad nationalism’ worse. </p> <p>We need proper history, not more myth making dressed up as ‘narrative’ and ‘framing’.</p> <p>By proper history, I mean a history that acknowledges the role of empire in building our welfare state. A history that doesn’t just portray the NHS as a ‘reward’ for ordinary people that ‘we won’ with our fortitude and sacrifice during our ‘finest hour’, delivered by rulers with an inherent sense of ‘fair play’ and ‘never again’, imbued with the ‘Spirit of 45’ and immediately able to see and embrace the common sense of applying wartime state management to public needs. We also need a history that acknowledges that in fact the NHS’s creation – and that of the rest of the welfare state – was as much to do with elite fears exposed yet again by the demands of war; fears of an enduringly sickly and unproductive workforce, of the pull of communism, and indeed, their fears of a recently demobbed, militarily-trained working class.</p> <h2>Nationalism - same as it ever was</h2> <p>Less than a month after Boyle’s Olympic opening ceremony, the government announced it was setting up ‘Healthcare UK’ to help the <a href="https://www.theguardian.com/society/2012/aug/21/nhs-brand-sold-overseas-hospitals">NHS ‘brand’ to be exported overseas, particularly to the Gulf states, with private firms allowed to “partner with” and benefit from the NHS’s brand recognition</a>. Broadcasting the NHS brand so powerfully to nearly a billion people was undoubtedly useful in helping “<a href="https://healthcareuk.blog.gov.uk/2016/02/23/a-legacy/">public and private sector organisations</a>” build their global healthcare exports. Whatever Boyle’s good intentions – and the government’s <a href="https://www.thetimes.co.uk/article/tories-tried-to-axe-olympic-nhs-celebration-vzc8pmfck">reported initial discomfort</a> – perhaps our desire for a ‘good nationalism’ (<a href="https://www.theguardian.com/sport/2012/jul/28/olympic-games-opening-ceremony-british">gleefully reported at the time</a>) is all too easily hijacked to export (neo)colonialism for the benefit of a few, just as ‘bad nationalism’ was. </p> <p>There is no such thing as ‘good nationalism’, as applied to England, in other words, a nationalism that serves the interests of ordinary people. There is only English nationalism that undermines those interests, that harms our solidarity both in our communities and globally, and that’s a figleaf for pursuing the interests of elites, whilst playing divide and rule amongst the rest of us.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ourkingdom/lara-brearley/exporting-nhs-brand-overseas">Exporting the NHS &#039;brand&#039; overseas?</a> </div> <div class="field-item even"> <a href="/ournhs/why-you-can-t-solve-nhs-s-funding-problems-by-banning-smokers-and-obese-from-treatment">Why you can’t solve the NHS’s problems by banning smokers and the obese from treatment</a> </div> <div class="field-item odd"> <a href="/uk/anthony-barnett/why-brexit-its-english-stupid">Why Brexit? It&#039;s the English, stupid.</a> </div> <div class="field-item even"> <a href="/ournhs/erin-dexter/making-nhs-hostile-environment-for-migrants-demeans-our-country">Making the NHS a “hostile environment” for migrants demeans our country</a> </div> <div class="field-item odd"> <a href="/ournhs/ruth-atkinson/brexit-and-nhs-we-need-to-fight-racist-discourse">Brexit and the NHS - why we all must fight the racist discourse</a> </div> <div class="field-item even"> <a href="/ournhs/greg-dropkin-karen-reissman/healthcare-in-britain-first-they-came-for-immigrants">Healthcare in Britain - first they came for the immigrants</a> </div> <div class="field-item odd"> <a href="/ournhs/juan-camilo/migrants-fairness-and-nhs">Migrants, &quot;fairness&quot; and the NHS</a> </div> <div class="field-item even"> <a href="/ournhs/kailash-chand/stop-distracting-us-with-health-tourism-sideshow">Stop distracting us with the &#039;health tourism&#039; sideshow</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS Can Europe make it? uk ourNHS Caroline Molloy Tue, 08 May 2018 13:00:28 +0000 Caroline Molloy 117743 at https://www.opendemocracy.net Key NHS ‘efficiency’ programme ‘RightCare’ called into question in Liverpool – and elsewhere? https://www.opendemocracy.net/ournhs/greg-dropkin/key-nhs-efficiency-programme-rightcare-called-into-question-in-liverpool-and-els <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>NHS England is promoting ‘RightCare’ as a way for the NHS to deliver still more ‘efficiency savings’. But questions to Liverpool CCG show at least some local NHS managers are well aware of its flaws.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/liverpool.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/liverpool.jpg" alt="" title="" width="460" height="252" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Royal Liverpool University Hospital, PA Images/Peter Byrne, all rights reserved.</em></p><p>RightCare is an NHS England system for encouraging CCGs to compare themselves with other CCGs, with the declared aims of improving performance and reducing costs. When Accountable Care Systems were rebranded as “Integrated Care Systems” in the latest Planning Guidance, NHSE also promoted RightCare. “<a href="https://www.england.nhs.uk/wp-content/uploads/2018/02/planning-guidance-18-19.pdf">Refreshing NHS plans for 2018/19</a>”, which says “In addition to the moderation of emergency demand, the use of RightCare, elective care redesign, urgent and emergency care reform, medicines optimisation, and more integrated primary and community services are also key areas of focus”.</p> <p>Liverpool CCG’s plan for an Integrated Care System was presented on 13 March. It is a 60 page paper “<a href="https://www.liverpoolccg.nhs.uk/media/2943/lccg-gov-body-tuesday-13th-march-18-papers-pack-website-version.pdf">One Liverpool: 2018-2021</a>” written by Healthy Liverpool Integrated Programme Director Carole Hill, with Liverpool CCG Chief Officer Jan Ledward as the Lead Governor. A section on High Impact Priorities waxes lyrical on RightCare.</p> <p>“In support of the work by the Provider Alliance to develop detailed delivery plans, Liverpool CCG has undertaken a review of clinical and non-clinical interventions that have the capacity to deliver high impact change to achieve our outcome ambitions. The review incorporated the Commissioning for Value approach which is embedded in NHS RightCare, the NHS England programme committed to delivering the best care, making the NHS’s money go as far as possible and improving patient outcomes. <a href="https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2017/01/cfv-liverpool-jan17.pdf">Local RightCare data</a> shines a light on variation and performance and supports local health economies to have discussions to agree a starting point for change. NHS RightCare has a three stage, evidence-based methodology, of ‘Where to look’, ‘What to change’ and ‘How to change’ which provides a robust process for service redesign and prioritisation.</p> <h2>Magical Thinking</h2> <p>Describing itself as “a proven approach that delivers better patient outcomes and frees up funds for further innovation”, RightCare turns out to be unproven and based on faulty statistics (<a href="https://blog.oup.com/2017/12/questioning-nhs-rightcare/">Questioning the magical thinking of NHS RightCare</a>). Apparently Liverpool should compare itself with Brighton, Bristol, Sheffield,&nbsp;Newcastle, and Stoke and then save 80 lives per year from lung cancer mortality.</p> <p>Public Health academic Dr Alex Scott-Samuel sent the CCG an FOI request to find out if they’d heard criticism of RightCare.</p> <p>1) Was Liverpool CCG aware of the Journal of Public Health article "<a href="https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdx136/4596536">RightCare: wrong answers</a>", published 3 Nov 2017, when formulating the "One Liverpool" strategy?</p> <p>2) In formulating the "One Liverpool" strategy, how did Liverpool CCG take account of this peer-reviewed criticism of the RightCare methodology?</p> <p>3) Which other specific aspects of Liverpool CCG's work involve RightCare?</p> <p>4) How does Liverpool CCG intend to respond to this peer-reviewed criticism of the RightCare methodology in future? </p> <p>The CCG’s unexpected answer included a less than ringing endorsement:</p> <p>“Liverpool CCG is aware of the article and the conclusions regarding the limitations of the Right Care methodology. The CCG uses the Right Care Methodology as one tool to highlight where there is variation in outcomes and activity, to inform the development of shared priorities for improvement within the Liverpool health and care system. It is not the only method we use and we do acknowledge its limitations. We do not take a literal view of the scale of opportunities set out in our local Right Care data packs... The CCG does not rigidly follow the Right Care methodology to set levels of ambition and does not assume that the efficiencies or outcomes gains published should be modelled in our plans.”</p> <p>Why not ask your CCG about the RightCare magic? Do their Integrated Care plans show the same unbridled enthusiasm for RightCare as “One Liverpool”, or do they take a more sober view?</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Taking politics out of the NHS? Or constructing an elitist ‘consensus’?</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/why-%C2%A38bn-is-zombie-figure-that-won%27t-save-nhs">Why £8bn is a zombie figure that won&#039;t save the NHS </a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS ourNHS Greg Dropkin Mon, 30 Apr 2018 11:50:29 +0000 Greg Dropkin 117572 at https://www.opendemocracy.net GP practices face funding threat as online service ‘targets’ young people https://www.opendemocracy.net/ournhs/david-wrigley/gp-practices-face-funding-threat-as-online-service-targets-young-people <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Doctors and NHS staff raise the alarm as the GP at Hand model threatens the very survival of NHS general practice.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/telephone-mobile-to-call-attainable-40552.jpeg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/telephone-mobile-to-call-attainable-40552.jpeg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Person using mobile, CC0 license.</em></p><p>The traditional GP practice, in place since the NHS’ inception in 1948, is under serious financial threat from a new online service that is draining funding from surgeries.</p> <p>Doctors in Unite (DiU) – part of Unite, the country’s largest union – are warning today that the online NHS&nbsp;GP at Hand&nbsp;service, powered by private digital health provider Babylon, is signing up predominately young people – and putting the future care of vulnerable groups at risk.</p> <p>When patients register with&nbsp;GP at Hand, currently operating just in&nbsp;London,&nbsp;they are ‘de-registered’ from their own surgery with funding being removed from that practice.</p> <p>What’s the problem? Well, losing registration fees for younger, fitter patients who join GP at Hand threatens the model of general practice relied on by so many patients, since the NHS was formed 70 years ago.</p> <p>The scheme is hoovering up the younger, healthier patients and restricts access to those who are pregnant, frail, terminally ill or suffering from multiple health problems. There appears to be an element of cherry picking operating here, which, if true, is to be deplored.</p> <p>In practice, 70 per cent of all patients are reasonably well. Their funding helps surgeries care for the 30 per cent who are sick. It’s a system that works, because it’s fair. We will eventually end up in the 30 per cent - and that’s why we are calling on health and social care secretary Jeremy Hunt to scrap this flawed and misguided model.</p> <p>It is understood that since&nbsp;GP at Hand&nbsp;launched in London in November 2017 about 26,000 patients have registered, most of them being between the ages of 20 and 39.</p> <p>Practices in the capital have seen their list sizes fall for the first time in years due to those patients registering with GP at Hand.</p> <p>There is, no doubt, that GP at Hand&nbsp;will financially destabilise many practices robbing them of the vital risk pooling and cross subsidy which enables them to provide good care to their more complex and unwell patients.</p> <p>GP at Hand targets the most profitable patients – those who are younger and healthier and don’t need extensive care from their GP.</p> <p>Jeremy Hunt has said that general practice is the ‘Jewel in the Crown’ of the NHS. If he truly believes this, he will acknowledge that the GP at Hand model threatens the very survival of NHS general practice.</p> <p>GP at Hand has made it clear it wishes to roll out this model of care across the country, so this scheme will threaten general practice across England.</p> <p>General practice is the cornerstone of the NHS which has provided excellent care with its other community partners for decades.</p> <p>NHS staff who share our concerns can sign the open letter to Jeremy Hunt <a href="https://docs.google.com/forms/d/e/1FAIpQLScDINMclsb7DiYlhq5HwTvr6fg1A-gwRwVhrKooVh5kcdwzIg/viewform">here</a>.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/david-mccoy-lewis-hier-thomas/gp-at-hand-handy-for-whom"> ‘GP at hand’: handy for whom?</a> </div> <div class="field-item even"> <a href="/ournhs/shibley-rahman/247-transparent-nhs-%E2%80%93-or-rise-of-planet-of-apps">A 24/7, transparent NHS – or the rise of the planet of the apps?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS ourNHS David Wrigley Wed, 25 Apr 2018 11:25:28 +0000 David Wrigley 117487 at https://www.opendemocracy.net An 'NHS tax' is perfect for a 'new centrist party'—stale, regressive and technocratic https://www.opendemocracy.net/ournhs/caroline-molloy/nhs-tax-is-stale-regressive-and-technocratic-perfect-for-new-centrist-party <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>National Insurance is regressive. Hypothecating taxes tends to encourage ideas of opt outs &amp; top ups. So why is Liz Kendall promoting these as the 'new consensus' for NHS funding?</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/liz kendall.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/liz kendall.jpg" alt="" title="" width="460" height="286" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Liz Kendall in 2015. Lauren Hurley/PA Images, all rights reserved.</em></p><p>Today, Tory MP Nick Boles, Lib Dem former health minister Norman Lamb and former Blairite health minister Liz Kendall joined forces to promote the idea of a dedicated ‘health and social care tax’, through National Insurance, to replace current NHS funding. Boles grandly proclaimed it “A new Beveridge moment”.</p> <p>The main lesson to be drawn from their interview broadcast on this morning’s BBC Radio Four Today programme, is that it doesn’t take much to excite the media about anything that could be portrayed as - if not the birth pangs, perhaps at least the twinkle in an eye - of <a href="http://www.bbc.co.uk/news/uk-politics-43875246">a ‘new centrist party’</a> run by ‘<a href="https://twitter.com/bbclaurak/status/988724069133619200">grown-ups’</a>. A rehash of an old, bad idea that’s been doing the rounds in right-wing circles for years? That will do just fine. </p> <p>The interview – conducted by the BBC’s political editor Laura Kuenssberg not its health editor Hugh Pym&nbsp;–&nbsp;was notable for its lack of interest in whether such a plan actually had anything useful to offer today’s NHS. Kuenssberg’s line of questioning focused exclusively on the politics: “I mean here we are, an extraordinary degree of consensus…You’re all saying that the parties have to share the political risk… that none of the party leaderships right now are up to this task…”.</p> <p>The stale idea of an ‘NHS tax’ is perfect for those who’ve pinned their hopes on the creation of a ‘new centrist party’. It’s a technocratic issue that’s unlikely to be well understood by most voters, many of whom are under the mistaken impression that National Insurance is what funds the NHS already. The <a href="https://opendemocracy.net/dave-byrne/why-talking-about-nhs-tax-isnt-brave-at-all">history is slightly complicated</a>, but the health service is still overwhelmingly funded as Nye Bevan set out when he <a href="http://www.unitetheunion.org/uploaded/documents/In%20Place%20of%20Fear%20-%20Chapter%205,%20A%20Free%20Health%20Service11-21215.pdf">explicitly rejected the 1911 National Insurance-based system of healthcare</a>&nbsp;as unfair and "peculiarly unsuitable" and instead set up the NHS: </p> <p>“The means of collecting the revenues for the health service are already in the possession of most modern states, and that is the normal system of taxation. This was the course which commended itself to me and it is the basis of the finance of the British Health Service. Its revenues are provided by the Exchequer in the same way as other forms of public expenditure. I am afraid this is not yet fully understood. Many people still think they pay for the National Health Service by way of their contribution to the National Insurance Scheme.”</p> <p>The system Bevan founded continues to enjoy <a href="https://twitter.com/carolinejmolloy/status/914982117305733120">sky-high public support</a>, with <a href="https://www.ipsos.com/ipsos-mori/en-uk/what-do-public-think-about-nhs">nine out of 10 saying its founding principles should still apply today</a>. But being “<a href="https://opendemocracy.net/uk/jeremy-gilbert/antisemitism-cosmopolitanism-and-politics-of-labour-s-old-and-new-right-wings">unencumbered by nostalgia for the 1945 welfare-state settlement</a>” is, as Jeremy Gilbert rightly says, central to the identity of the Blairites and their fellow neoliberal-friendly “centrists” in other parties.</p> <h2>Why ‘comprehensive’ healthcare matters</h2> <p>The ‘NHS tax’ idea is also the antithesis of what campaigning politics is about – focusing, as it does, on inputs rather than outcomes.</p> <p>The public want an NHS that provides the healthcare they need, when they need it – in other words, a comprehensive and timely service. And to the dismay of right-wingers, the public has remained firmly wedded to this outcome that was at the heart of the founding of the NHS. To the idea that it's the state’s duty to provide a comprehensive healthcare service for everyone (though that duty was significantly weakened - <a href="https://www.allysonpollock.com/?p=2270">some say abolished</a> - by the 2012 Health and Social Care Act).</p> <p>The new set of NHS ‘principles’ that Kendall and Boles have produced say nothing about protecting and renewing a ‘comprehensive’ NHS. They will do therefore do nothing to stop people being told – as they are now, increasingly - “not on the NHS” for treatments ranging from <a href="https://www.chesterchronicle.co.uk/news/chester-cheshire-news/cheshire-nhs-plans-sweeping-cuts-12332772">erectile dysfunction</a> and <a href="http://www.bbc.co.uk/news/uk-england-bristol-41913680">vasectomies</a>, to <a href="https://www.thesun.co.uk/news/5436296/hip-and-knee-operations-being-denied/">hip and knee ops</a>, timely <a href="http://www.bbc.co.uk/news/health-18176017">cataract removals</a>&nbsp;and&nbsp;<a href="https://www.theguardian.com/society/2015/jan/03/hearing-aids-supply-cuts-nhs-depression-dementia">hearing aids</a>. Some – like former British Medical Association Deputy Chair <a href="https://www.theguardian.com/society/2016/jun/22/kailash-chand-bma-tory-party-agenda-wash-hands-nhs">Kailash Chand - have already warned</a> that if this trend continues, the NHS is likely to shrink to just an inadequate Medicare style fall-back option for those who can’t afford health insurance. All of the <a href="https://opendemocracy.net/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">many recent attempts to impose a neoliberal-friendly ‘cross party consensus’</a> have <a href="https://opendemocracy.net/ournhs/caroline-lucas/why-i-have-removed-my-backing-for-nhs-commission">failed to incorporate any principled red line about a commitment to comprehensive healthcare</a> – and so all of them have been <a href="https://opendemocracy.net/ournhs/ournhs/nhs-campaigners-say-no-to-nhs-commission">resoundingly rejected by NHS campaigners</a> (as Norman Lamb should know – he’s been involved in most of the recent attempts).</p> <p>The ‘NHS tax’ idea seems unlikely to appeal to any particular demographic of voters. But of course, it could well appeal to a group that most of the ‘centrist party’ fans seem to consider far more important – potential funders. If you look closely at what’s said – and unsaid - in the <a href="https://www.facebook.com/notes/nick-boles-mp/ten-principles-of-long-term-funding-for-nhs-and-social-care/1522885904504144/">Boles/Kendall principles</a>, there’s a lot of music to the ears of corporations and the rich.</p> <h2>The dangers of an “NHS tax”</h2> <p>The most obvious problem in using National Insurance to pay for the NHS is that it is a deeply regressive tax that is capped for the rich. Boles and Kendall nod to this problem, but say only rather vaguely that “higher earners, the self employed, and better off pensioners” will make a “fair” contribution. But if this government is offered a choice between meaningfully reforming a huge loophole that lets them tax poor people more heavily than rich ones – or just loading massive new costs onto an unreformed tax that doesn’t upset the Daily Mail, in the name of ‘saving the NHS’ and ‘a new consensus’ – which do you think Theresa May might pick? </p> <p>Funding through the NHS through the National Insurance system is not just regressive, though. There are other dangers.</p> <p>Firstly, such a plan would probably make it easier – not more difficult&nbsp;–&nbsp;to underfund the NHS, with yet still more quangos and regulators deflecting public concern away from politicians. It would renew the emphasis on the <a href="https://opendemocracy.net/ournhs/richard-murphy/%27nhs-tax%27-is-not-answer">(false) idea that public funds are a simple matter of 'tax in, spending out'</a>, and also the equally false idea that the NHS is somehow separate from the real business of government (a point <a href="https://www.theguardian.com/commentisfree/2018/apr/24/nhs-tax-fragmentation-cross-party-campaign-health-crisis">Caroline Lucas makes excellently in the Guardian today</a>).&nbsp;And whilst Boles and Kendall say the new Fund ought to be “publicly owned”, it’s not hard to imagine the Fund being privatised in the future (right wing Labour MP <a href="https://www.theguardian.com/society/2016/dec/02/run-the-nhs-and-social-care-like-john-lewis-says-frank-field">Frank Field has already called for just such an NI based NHS fund to be run as a ‘mutual’</a> …)</p> <p>Secondly, separating out our payments for the NHS and channelling them through the contributions-based National Insurance system would make it far easier in future to exclude people who – for whatever reason - haven’t earned enough to pay sufficient contributions. </p> <p>Liz Kendall told me in January “<a href="https://twitter.com/carolinejmolloy/status/988712894287237121">I do not support…social insurance</a>”. But the scheme Boles has persuaded her to sign up to looks an awful lot like social insurance in many respects. Admittedly, it does commit to ‘universal’ provision (rather than contributions-based provision) – but how long would such a commitment last, when the mechanism made it so easy to exclude people who could be labelled as ‘less deserving’? (Indeed, we ought to be careful when we’re making the case for the Windrush generation to receive healthcare, that we don’t over-emphasise the fact that they’ve ‘worked and paid taxes’, but rather focus on defending the right to universal, comprehensive healthcare as one of Britain’s highest achievements).</p> <p>Another danger of an ‘NHS tax’ is that such a scheme would also be likely to create pressure to grant an ‘opt out’ for those who pay for private health insurance – much like the NI reforms Thatcher introduced in 1988 which allowed those who signed up to private pensions to opt out of the State Second Pension (with disastrous results). Once an opt-out is allowed, we’re into two-tier healthcare and delivering the insurance firms’ dream.</p> <p>And what of the contributory benefits we currently have? Boles suggests that the entire National Insurance fund be renamed the ‘National Health and Care Fund’. If our healthcare, sick pay and state pensions are all supposedly coming from the same pot, could we in future see them paid out as a merged allowance, from which people can buy their own healthcare from a range of ‘providers’, alongside their fuel bills and weekly shop, topping up from their own money when their 'entitlement' payment runs out? This might sound like a distant Thatcherite dystopia, but it’s a set of ideas some on the right – including the Labour right – have flirted with. Then Chancellor George Osborne <a href="https://www.google.com/url?hl=en-GB&amp;q=https://www.opendemocracy.net/ournhs/caroline-molloy/osborne-lays-out-path-to-broken-nhs-funding-promises&amp;source=gmail&amp;ust=1524673428477000&amp;usg=AFQjCNF7n9gQoaKG1AAAvtlbCMqCZdHXDA">floated the possibility of ‘integrated budgets across health and employment</a>' back in 2014, not long after New Labour think tank DEMOS had laid the groundwork by <a href="https://www.demos.co.uk/project/the-power-of-prepaid-2/">suggesting </a>that benefit and healthcare 'entitlements' could be merged on one ‘entitlement card’. Already the use of fixed ‘entitlement’ sums (known as ‘personal budgets’) is entrenched in social care – and the concept is now being <a href="https://www.theguardian.com/society/2018/apr/16/plans-to-extend-personalised-health-budget-scheme">rolled out with little fanfare into healthcare</a>, enthusiastically promoted by <a href="https://www.ippr.org/news-and-media/press-releases/new-nhs-funding-should-drive-patient-centred-reforms">another Blairite former Health minister Alan Milburn</a>, and by&nbsp;<a href="https://www.theguardian.com/society/2015/apr/28/liz-kendall-shadow-minister-care-health-nhs">Liz Kendall herself</a>.</p> <p>Jeremy Hunt has written to all Tory MPs asking for their ideas for the future of the NHS, and both he and Theresa May have said that they’ll launch a new “long term plan” for the NHS this summer – probably timed to coincide with its 70th birthday. The “centrists” have a truly lousy birthday present up their sleeve. It’s up to the rest of us to keep a close eye on them. </p> <p>Because – as Bevan said, and as we’ve been reminded of in recent weeks:</p> <p>“Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide.”</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/dave-byrne/why-talking-about-nhs-tax-isnt-brave-at-all">Why talking about an &#039;NHS tax&#039; isn&#039;t brave at all</a> </div> <div class="field-item even"> <a href="/ournhs/richard-murphy/%27nhs-tax%27-is-not-answer">An &#039;NHS Tax&#039; is not the answer</a> </div> <div class="field-item odd"> <a href="/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Taking politics out of the NHS? Or constructing an elitist ‘consensus’?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Caroline Molloy Tue, 24 Apr 2018 17:59:05 +0000 Caroline Molloy 117472 at https://www.opendemocracy.net Arron Banks and Brexit’s offshore secrets https://www.opendemocracy.net/uk/brexitinc/marcus-leroux-leigh-baldwin/brexit-s-offshore-secrets-0 <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>In 2015, Arron Banks’s insurance business was bailed out. Where the rescue money came from is unclear—but as the Electoral Commission probes the sources of the Leave donor’s campaign contributions, a group of accountants who specialise in offshore “wealth preservation” may hold the key.</p> </div> </div> </div> <p dir="ltr"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/553846/PA-26717630_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/553846/PA-26717630_0.jpg" alt="" title="" width="460" height="309" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Arron Banks (left) with Nigel Farage (centre), the day after the UK voted to leave the EU. Image, Isabel Infantes/EMPICS Entertainment.</span></span></span></p><p dir="ltr">On 19 October 2017, Alan Kentish was arrested.</p><p dir="ltr">The chief executive officer of STM Group, which specialises in offshore “wealth preservation”, was detained by the Royal Gibraltar Police under the Proceeds of Crime Act. They were investigating whether he had failed to notify the authorities of potential money-laundering by one of STM’s clients. </p><p>Following his arrest, Kentish, who was released on police bail but remains a suspect in Gibraltar, resigned his directorships of two companies linked to multimillionaire Brexit donor Arron Banks.</p><p>Closely associated with Banks for more than a decade, Kentish and STM have drawn attention from authorities in several of the offshore tax havens where they operate. Kentish is appealing a directorship ban in Malta, while regulators in Jersey censured STM after probing its efforts to procure a St Kitts and Nevis passport for a Ukrainian politician on Interpol’s wanted list.</p><p dir="ltr">Now an investigation by SourceMaterial reveals that Kentish and other STM-linked directors were key figures in a bailout of Banks’s Gibraltar-based insurance business Southern Rock that began in 2015, just months before Banks began bankrolling the Leave.EU referendum campaign.</p><p dir="ltr">The mystery cash injection was critical to the survival of Banks’s insurance empire, the foundation of his wealth. Without it, it is hard to see how he could have funded his political donations while keeping the business afloat.</p><p dir="ltr">Banks has declined to answer questions about the origin of the bailout funds, while a spokesman for STM said the company did not supply the money or have any direct connection with the rescue.</p><p dir="ltr">As the Electoral Commission <a href="https://www.electoralcommission.org.uk/i-am-a/journalist/electoral-commission-media-centre/news-releases-donations/electoral-commission-statement-regarding-better-for-the-country-limited-and-mr-arron-banks">examines</a> the source of Banks’s £8.4 million in donations to the Leave campaign, the role of Kentish and other STM-linked figures—who presided over the bailout and were in a position to know where the money came from—may offer new clues to how Brexit was financed.</p><p dir="ltr">Andrew Wigmore, a spokesman for Banks, said our emailed questions were “baseless” and evidence of a “biased hatchet job” but declined to go into further detail. He said in an interview with <a href="https://www.byline.com/column/67/article/2073">Byline</a> in March that Banks paid for his Brexit campaign with proceeds of the sale of NewLaw Group, a law firm Banks partly owned. Wigmore did not elaborate on how Banks was able to bail out Southern Rock.</p><p><a href="https://investegate.co.uk/stm-group-plc--stm-/rns/director-declaration/201711141146274660W/">STM has said</a> the Gibraltar investigation relates to a client company of STM and it expects Kentish to be exonerated.</p><h2>Mister Big</h2><p dir="ltr">Banks, the man behind the GoSkippy car insurance brand, has never been shy about his wealth, often using an internet chatroom to brag about racehorses, diamond mines and jet-setting holidays. His username: Mister Big.</p><blockquote><p dir="ltr">“When I last looked I had”—reads a typical post from April 2014—“a direct insurance group, a gold mining operation in Ghana, four diamond mines in Kimberley (one in Lesotho), a country park complete with beautiful wedding venue, classic car collection, numerous land holdings (including building land acquired at the bottom of the market), a modest art collection and horrendous insomnia brought on by too much port, cigar and a seafood salad last night.”</p></blockquote><p dir="ltr">But much of the image was a mirage. As he lavished cash on Brexit, a series of offshore manoeuvres was underway to save a key company in his empire, Southern Rock Insurance, from bankruptcy.</p><p dir="ltr">In 2014, when a spectacular £1 million pledge to Ukip signalled his arrival in British politics, Banks was already firmly on the radar of authorities in Gibraltar. Finances at his Southern Rock Insurance Company had been shaky for years and now regulators feared a meltdown.</p><p dir="ltr">As the underwriter for policies sold by Banks’s UK insurance broker Eldon, Southern Rock was the cornerstone of his insurance empire. If it folded, Eldon would be crippled too, leaving hundreds of thousands of UK customers with car insurance not worth the paper it was written on. </p><p dir="ltr">Southern Rock’s accounts from as far back as 2011 had warned that it was “<a href="https://www.scribd.com/document/373954159/accounts-2011-technically-insolvent-pdf">technically insolvent</a>” and by the following year it was such dire straits that Banks had <a href="https://www.scribd.com/document/373954218/List-of-assets-assigned-by-Rock-Holdings-to-Southern-Rock">pledged land and sold shares</a> to shore up its capital. The company’s own auditors made clear in 2013 that it was <a href="https://www.scribd.com/document/373954156/auditors-going-concern-12-pdf">dependent on the mercy of the watchdog</a> for survival. &nbsp;</p><p dir="ltr">Meanwhile, the regulators made Southern Rock <a href="https://www.scribd.com/document/373954154/Amendment-to-Southern-Rock-s-articles-of-association">promise not to make any payments</a> to Banks without their prior written consent and hired accountants PwC to assess the company’s vulnerability to shocks.</p><p dir="ltr">When in 2014 PwC’s findings confirmed their fears about Southern Rock’s fragility, Banks was pushed to <a href="https://www.globalreinsurance.com/gibraltar-based-southern-rock-directors-step-down-after-regulatory-probe-/1409043.article">resign</a> as chief executive officer, along with another director and longstanding associate—Alan Kentish.</p><h2>Dramatic rescue</h2><p dir="ltr">By 2015, as the Brexit referendum neared and Banks’ political fortunes went from strength to strength, Southern Rock was teetering on the edge. The rescue, when it came, was dramatic.</p><p dir="ltr">ICS Risk Solutions, a holding company on the Isle of Man, <a href="https://www.scribd.com/document/373714177/Southern-Rock-Insurance-Company-Ltd-2015-accounts">agreed</a> to pump £77.7 million into Southern Rock to save it from collapse. In return, ICS would take a slice of the Gibraltar company’s future income. </p><p>The capital injection allowed the loss-making Southern Rock to meet new EU solvency regulations for insurance companies, described by Banks as “a good example of something no one really wants” being imposed by Brussels.</p><p dir="ltr">Because Banks owned both ICS and Southern Rock, it is not clear where the new money came from. But the arrival of the funds coincided with changes to the management of ICS.</p><p dir="ltr">Corporate records show that in April 2015, the day before the initial rescue deal, Louise Kentish, the wife of STM’s boss, <a href="https://www.scribd.com/document/373717866/ICS-directors-2015">joined the ICS board</a>. On 24 June 2016, the day after the referendum, Alan Kentish <a href="https://www.scribd.com/document/373717784/ICS-directors-2016">followed</a>, along with two other new directors—the former and current chairmen of STM. &nbsp;</p><p dir="ltr">Banks’s ties to Kentish and STM go back to at least 2004, when Kentish became a founding director of Southern Rock. Banks in turn invested in STM and was its largest shareholder before selling his stake in early 2015. More recently, Kentish, Banks and another STM founder co-invested in Legal Protection Group, a broker of insurance for lawyers and doctors that operates from Banks’s Bristol headquarters.</p><p dir="ltr">The arrival of Banks’s longstanding STM contacts at ICS at the time it found the money to save Southern Rock suggests they may hold the secret to the real source of the bailout funds that ensured Bank’s financial survival as he pumped millions into Leave.EU.</p><p dir="ltr">Public records suggest there may be an undeclared shareholder in ICS. Banks has said he owns 90 per cent of the company, with management and staff holding the rest. But the filings state he owns less—between 50 per cent and 75 per cent—with no information on the remainder. Banks declined to answer questions about the holdings.</p><p dir="ltr">SourceMaterial understands that Gibraltar’s Financial Services Commission is closely monitoring the arrangement between ICS and Southern Rock. &nbsp;</p><p dir="ltr">STM’s spokesman, who also responded on behalf of Kentish and the other STM directors, said the rescue “did not involve STM in any way”. He also suggested the bailout was spread over several years to mend the balance sheet without a single large cash injection. He did not address the origin of the funds.</p><h2>Offshore controversies</h2><p dir="ltr"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/553846/Alan Kentish.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/553846/Alan Kentish.jpg" alt="" title="" width="460" height="259" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Alan Kentish with colleague Therese Neish. Image, YouTube, fair use</span></span></span></p><p dir="ltr">Kentish and STM specialise in keeping secrets. A core line of STM’s business is setting up offshore trusts, opaque financial structures that make it difficult to trace who ultimately owns the assets in them.</p><p dir="ltr">In 2002 STM was sued by the UK tax authorities after it set up a trust for an alleged fraudster suspected of masterminding a £100 million VAT scam. Kentish’s arrest in Gibraltar, after which he resigned as a director of Legal Protection Group and ICS, is one of several subsequent brushes with the authorities.&nbsp;</p><p dir="ltr">Early in 2017, STM’s Gibraltar offices received a visit from local regulators, who didn’t like what they saw. Later that year they told STM they were “fundamentally concerned” about its compliance with anti-money-laundering rules, according to Gibraltar court filings. STM tried to block publication of the proceedings, the documents show.</p><p dir="ltr">Particularly worrying to the regulators was the use of STM services to invest pension savings in the Trafalgar Multi Asset Fund, which collapsed in 2016 and is now <a href="https://www.collascrill.com/news/updates/suspicious-minds/">under investigation</a> by the UK’s Serious Fraud Office.</p><p dir="ltr">Angie Brooks, a director of Pension Life, an advocacy group for pension holders, said that STM should have spotted the red flags in the pension debacle. “It was the most toxic mix imaginable. Everything that could go wrong did go wrong and it should have been prevented."</p><p dir="ltr">STM denies any wrongdoing and is not under investigation itself. Liquidators are attempting to salvage the funds but savers have potentially lost millions.&nbsp;</p><h2>Ukrainian politician</h2><p dir="ltr">It wasn’t just Gibraltar. In 2015, STM became the <a href="https://www.collascrill.com/news/updates/suspicious-minds/">first company in Jersey</a> to be prosecuted for money-laundering compliance failures.</p><p dir="ltr">STM was managing operations for Henley &amp; Partners, whose business includes helping rich foreign nationals acquire citizenship of tax havens in return for investment—and whose chairman reportedly has <a href="https://www.thetimes.co.uk/edition/news/cambridge-analytica-british-data-firm-offered-1m-bribe-to-turn-election-psmv359vh">ties to Cambridge Analytica</a>, the election advisor accused of misusing Facebook data and entrapping politicians to skew elections around the world.</p><p dir="ltr">In 2010, STM had used its Henley business to help a Ukrainian politician apply for a passport in St Kitts and Nevis. Viacheslav Suprunenko, son-in-law of the mayor of Kiev and brother of a senior figure in the Moscow-backed Party of Regions, was at the time wanted by Interpol for assault during armed robbery to recover documents in a business dispute. (No charges have been brought.)</p><p dir="ltr">When Suprunenko asked STM to route his payments through offshore vehicles apparently unconnected to him, the company was suspicious enough to refuse the transactions—but failed to report them to the authorities.</p><p dir="ltr">A Henley spokeswoman told SourceMaterial that the company ended its relationship with STM in 2012. “When it comes to politically-exposed figures, we start from the position that any such person automatically requires even greater diligence including a thorough and independent review of friends and family,” she said. “If any criminal activity is suspected, we will immediately decline the applicant.”</p><h2>Money-laundering risks</h2><p dir="ltr">It was just one of a string of incidents in which STM turned a blind eye to money-laundering risks.</p><p dir="ltr">In a period of less than 18 months, junior STM staff filed internal suspicious activity reports on 19 individuals or entities. Only three of these were acknowledged by STM’s compliance officer and none was passed to the island’s financial crimes unit.</p><p dir="ltr">While STM was eventually acquitted in the money-laundering prosecution, it received an<a href="https://www.jerseyfsc.org/media/1101/public-statement-stm-july-2015.pdf"> official order</a> from Jersey’s financial regulator to clean up its behaviour. Its money-laundering compliance officer was banned from holding a regulated position in Jersey.</p><p dir="ltr">In another offshore haven, Malta, the story was much the same.</p><p dir="ltr">Twice in the last two years STM has been fined and officially rebuked, while Kentish was temporarily banned from holding management jobs for failing to inform the regulator when he was forced by the Gibraltar regulator to resign his directorship of Banks’s Southern Rock. STM and Kentish are appealing the sanctions.</p><p dir="ltr">“STM and its officers ensure a strong culture of corporate governance and compliance with industry regulation,” the company’s spokesman said. “This extends across internal and external relationships ensuring that risks to the business are minimised and that products and services are delivered appropriately.”</p><h2>New questions</h2><p dir="ltr">&nbsp;STM also played a cameo in the Brexit movement. Better for the Country Ltd, one of two campaign vehicles that received Banks’ £8.4 million in donations, was <a href="https://s3-eu-west-1.amazonaws.com/document-api-images-prod/docs/J22VO6IwI5BUTD8yGb4wy-KF3yn5SY0450qcd8ARhds/application-pdf?AWSAccessKeyId=ASIAII5UKPTAP7NZOLMA&amp;Expires=1521823382&amp;Signature=JEtO16EHfsJhwujlFMJyHrnhBwM%3D&amp;x-amz-security-token=FQoDYXdzEC4aDFYkZALUJLFVOeYoQCK3A7GnteoYv61JtlQWmCGz%2B%2FEI96CZUpJ0iCpDCCPiz%2F3mpObhoL1ylarxFYeloiSOY%2Bn57bWrzMOSbDCrhn7%2FSo7r7U0SbieK9ivQEf8rmF0hATPk7mAIDw6KcfSJ%2FUR2mGSIF4gKgmhHkhcdEpzl9GocSbLLMMgUasyhOA7B7n6KHSLE4ZXKA4DmvrJ1BfWgiAQfoizNSCYzkaR9PsXO%2F0LLN3PLE9b3Hd0opLO%2BYTBAamY5XOclo0xRCvXtObi7f081%2FMu8WLG%2Bykb0grQdGz6BXlZZpCRYdQoLpjebt9i%2BlbzeMQk9GUps30IC3Xu3v26eYBTJcqdAyagLqjDJgMsBCL25r2GALbpkVL9h4O9d4oggqj5bNXFy%2FzMb%2FhpWaLXLwE%2F3EkHUEqQAa40RZ3Q8wdiP%2FlxIymJXbT4rerHb0qIJYvM83Vk0oE4gsIzYHuwykzPG5ydIRalhR%2Fmg5vuYOoWdUV72aiYnHQ76vs16mdR0IvufkYQNJ0o1yI28ACKRVs3HVM4kXGjr11ky%2B%2F0gW%2FZ4DkxhQkXwwEzFN0WJ7BrIDlHdK0ccE2c5KQry9Zr%2B044ZbPso6vTT1QU%3D">set up</a> by an STM Group company.</p><p dir="ltr">Banks’s links to Alan Kentish and the STM set whose speciality is using offshore havens to guard wealthy clients’ secrets raise new questions about his Brexit campaign.</p><p dir="ltr">The Electoral Commission has set out to trace the ultimate source of the millions Banks put into Leave.EU and Better for the Country, the company STM founded.</p><p dir="ltr">But with cash flowing through island tax havens whose stock in trade is stealth, the answer may prove elusive.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/uk/brexitinc/adam-ramsay/how-did-arron-banks-afford-brexit">How did Arron Banks afford Brexit?</a> </div> <div class="field-item even"> <a href="/uk/brexitinc/leigh-baldwin-marcus-leroux/not-everyone-agrees-with-arron-banks-about-value-of-his-dia">Not everyone agrees with Arron Banks about the value of his diamond mines</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> uk ourNHS Brexit Inc. DUP Dark money Leigh Baldwin Marcus Leroux Thu, 12 Apr 2018 15:48:29 +0000 Marcus Leroux and Leigh Baldwin 117236 at https://www.opendemocracy.net Has Labour really turned its back on pro-market NHS ‘solutions’? https://www.opendemocracy.net/ournhs/stewart-player/has-labour-really-turned-its-back-on-pro-market-nhs-solutions <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>As the NHS turns 70, just which corporate actors are queuing up to drive ‘consensus’-based reform? And is Labour prepared to sufficiently distance themselves from such ideas?</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/ashworth corbyn.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/ashworth corbyn.jpg" alt="" title="" width="460" height="300" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Jeremy Corbyn, NHS worker Judith Clegg &amp; Shadow Health Secretary Jon Ashworth. Ben Birchall/PA Images. All rights reserved.</em></p><p>The current programme of NHS ‘reform’ currently underway has long been hailed as <a href="https://www.hsj.co.uk/technology-and-innovation/stps-offer-private-sector-enormous-opportunity/7006369.article">giving private firms “enormous opportunity”.</a></p> <p>So – as I suggested in January – <a href="https://opendemocracy.net/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Labour’s new commitment to halt these pro-market Sustainability and Transformation Partnerships (STPs)</a> was both welcome assurance to party members, and a break with a damaging 30 year cross-party ‘consensus’ on healthcare policy. </p> <p>Yet soon after I wrote this, Shadow Health Secretary Jonathan Ashworth joined key architects of the transnational agenda of the global health industry at a conference organised by the Institute of Public Policy Research (IPPR).</p> <p>The IPPR conference at the end of January was set up to preview a report on the NHS co-produced by the IPPR and the former Labour Health Minister Lord Darzi, who stepped down in 2009 and who in 2015 <a href="http://www.bbc.com/news/uk-politics-31052010">criticised Labour for its tentative moves away from a pro-privatisation agenda</a>.</p> <p>The event saw Ashworth sharing a platform with signatories to the above-mentioned consensus, including the Conservative peer Lord David Prior and Lib Dem MP Norman Lamb, plus economists from the Health Foundation and representatives of the health industry and leading consultancies. On the surface the event was largely about the technological drivers of change in healthcare, and how funding mechanisms can be applied to harness these. A closer look however indicates the real intent was to reinforce particular aims and relationships; ones that it would be inconsistent for Mr Ashworth to seem to endorse. </p> <h2>Ten Year Plans and long-term alliances</h2> <p>As I pointed out in January, Lord Darzi has become a key actor in the corporate agenda for health care, having been, for example, a member of both the Steering Groups on the World Economic Forum’s work on sustainable healthcare systems. </p> <p>It was also pointed out that Tom Kibasi, who was then working for McKinsey and is now chief executive of the IPPR, was the lead author of the reports that informed the WEF’s work, and subsequently presented its findings to the World Bank and OECD. Indeed Darzi’s and Kibasi’s recent collaboration may reasonably be seen as the latest expression of a long-term strategic partnership, with the forthcoming IPPR-Darzi report marking the tenth anniversary of Darzi’s comprehensive report on the NHS for the Brown government, called ‘High Quality Care for All’, for which Kibasi wrote the final draft. </p> <p>In that initial collaboration Kibasi was on secondment from McKinsey, serving as Senior Policy Advisor to the NHS Chief Executive, Sir David Nicholson. He also worked with Darzi on the latter’s 2008 report for London, which was supported by McKinsey’s leading European partners, Penny Dash and Nicolaus Henke, as well as by the chief executive for NHS London, Ruth Carnall. </p> <p>Among the Darzi report’s prescriptions for the capital were the development of a system of ‘polyclinics’, or integrated care centres, with a view to transferring 40% of acute sector activity to these clinics, as well as 70% of the primary care workforce. The BMA resisted, amidst concerns that the <a href="https://opendemocracy.net/ourkingdom/colin-leys/plot-against-nhs">centres would likely be owned and run by private healthcare corporations</a> adopting the NHS Lift – a kind of Private Finance Initiative for primary care – approach. The plans were eventually abandoned, partly due to the recession and change of government. The incoming Health Secretary, Andrew Lansley, also needed to keep GPs on board, given that he was presenting his creation of ‘clinical commissioning groups’ as supposedly ‘putting GPs in charge’. </p> <p>This pause in Darzi’s polyclinic agenda has served its purpose. GPs are now firmly on the back foot, with many willing to trade their premises and practice lists – the new currency within health economies - for a semblance of security as salaried employees of the ‘new care models’ that the ‘consensus’ advocates. </p> <p>Similarly, the government has recently announced that NHS Lift scheme will be rolled out to new areas of the country through Project Phoenix. It appears they are attempting to complete the vision of both government and investors for a privately owned, primary care estate.&nbsp; </p> <h2>New ‘partners’ – and old ones</h2> <p>The McKinsey/Darzi/Department of Health project of 2008 was intended to be a ten-year strategy for transforming the NHS, and while some of the details may have been tweaked in the interim, its fundamentally market-oriented goals remain, and campaigners fear they will reappear in the forthcoming IPPR-Darzi report. Such fears are grounded both in the continuity of the participants involved in helping to produce the report, and also in terms of its associated sponsors and partners. </p> <p>These include the US pharma corporations Baxter and MSD as ‘strategic partners’. The report’s ‘founding partners’ include another US pharma company, Gilead, the European manufacturing giant, Siemens, and Carnall Farrar Associates. The latter is a consultancy firm set up by former McKinsey alumni together with the afore-mentioned Ruth Carnall. </p> <p>Similarly, the IPPR’s recent report on STPs, entitled ‘Sustainability and Transformation Plans: What, Why and Where Next’, included the pharmaceutical giant, GSK, as a sponsor. This report fully endorsed the STP model, concluding that the STPs have “correctly identified the most pressing reform solutions, including reconfiguration of the acute sector, movement of care into the community, and delivery of an upswing in prevention, with reform to commissioning, workforce, estates and local innovation infrastructure, all considered key enablers”. The sole caveats were a lack of both leadership and funding with which to fulfil such aims. </p> <p>Since his participation at the IPPR conference, Ashworth has spoken strongly about Labour’s unwillingness to participate in a cross party consensus on the NHS, arguing instead that what’s needed to rescue the health service is “a government with the political will” to end the punishing funding squeeze; whereas at the Labour Party conference last year he took the IPPR line on STPs, arguing only that they need to be properly funded so they can meet the changing demands on NHS services. It’s to be hoped that the unambiguous rejection of the market-oriented consensus in his recent speeches represents a firm crystallisation of his final policy position.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Taking politics out of the NHS? Or constructing an elitist ‘consensus’?</a> </div> <div class="field-item even"> <a href="/ournhs/tamasin-cave/privatising-cabal-at-heart-of-our-nhs">The privatising cabal at the heart of our NHS</a> </div> <div class="field-item odd"> <a href="/ourkingdom/colin-leys/plot-against-nhs">The Plot Against the NHS</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Stewart Player Wed, 11 Apr 2018 13:26:19 +0000 Stewart Player 117178 at https://www.opendemocracy.net Why NHS staff should #DitchTheDeal & reject the government pay offer https://www.opendemocracy.net/ournhs/mark-boothroyd/why-nhs-staff-should-ditchthedeal-reject-government-pay-offer <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p class="Default">Nurses and other NHS workers need to fight for a better pay deal to protect the NHS, with the same dedication they use to keep the NHS working every day of the week.</p> </div> </div> </div> <p class="Default"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/fair nhs pay now.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/fair nhs pay now.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: <a href="https://www.flickr.com/photos/forayinto35mm/15805828755">Chris Marchant/Flickr</a>.</em></p><p class="Default">The government is offering NHS staff a 6.5% pay rise, after almost a decade of pay freezes and 1% pay rises. With an NHS in almost permanent crisis and near collapse, this appears like a good thing, but when compared with the reality of the present state of the NHS, it’s a poisoned chalice that union members should reject.</p> <h2>Is the pay rise really 6.5%?</h2> <p class="Default">The pay rise is nowhere near as good as the media is making it out to be.&nbsp;</p> <p class="Default">It’s a three year pay deal, with the 6.5% being spread over three years; 3% first year, 1.7% second year and 1.67% the third year. </p> <p class="Default">This is still a below inflation pay rise. The Office for Budget Responsibility <a href="http://obr.uk/forecasts-in-depth/the-economy-forecast/inflation/">projects inflation to be 8.8-9.6%</a> over the next three years. So NHS staff are still receiving a real term pay cut over the period, just slightly less than the previous 8 years.</p> <p class="Default">There is also 1.1% unconsolidated rise in the second year, unconsolidated meaning it is not permanently counted in the pay structure, but just given as a one-off lump sum at the start of that year.</p> <p class="Default">The government has offered a few changes to the pay band structure which will lead to immediate rises for the minority of staff currently at the bottom of their pay band, but no benefit to more experienced NHS workers who are further up the pay bands. The government offer also changes the way staff move up a pay band, meaning progression will be in fits and starts, rather than annual.</p> <p class="Default">And there’s another big catch - in future, advancement will be performance related, based on yearly appraisals. </p> <p class="Default">Performance related pay has been shown to be bad for black and ethnic minority staff, and disabled staff, as it creates another area in which they can suffer discrimination. It could be used to penalise outspoken union activists. It may also trap staff in their jobs as they won’t be able to move post during the 2-5-year gap between pay steps for fear of losing out.</p> <p class="Default">At least the ‘living wage’ is being brought in to the NHS. This is partly out of necessity; NHS pay had been frozen for so long that the yearly increase in the national minimum wage has almost overtaken band 1 and 2 pay bands. To avoid the embarrassment of being forced to raise NHS pay by the legal minimum wage, the government has decided to give their pay a much-needed boost.</p> <h2>What do the government want in return?&nbsp;</h2> <p class="Default">The government clearly feels that – as they are not faced with active strike action to force them into a proper offer – they can demand our workplace benefits and pay in return.&nbsp;</p> <p class="Default">The original pay deal wanted to claw back one day’s annual leave from all staff, according to leaks. The outcry from NHS staff, the public and the Labour Party saw this withdrawn.</p> <p class="Default">However the government are still asking for givebacks in return for our meagre rise.</p> <p class="Default">They want bands 1-3 to progressively give up their unsocial hours rates over the three years of the deal. So lower paid staff will get an initial pay boost, but in the long run they will lose out on reduced unsocial hours payments.&nbsp;</p> <p class="Default">The plans also include changes to sick pay, so anyone earning over £18,160 (in other words, all but the very lowest paid NHS employees) does not receive their usual unsocial hour rate when off sick, only their base rate of pay. </p> <h2>Why a pay rise now?</h2> <p class="Default">It’s important to look at the context in which this pay rise is being offered. NHS staff have endured 8 years of pay freeze or 1% pay rises. We only secured the commitment to a 1% rise after <a href="http://www.bbc.com/news/health-29560083">going on strike in 2014</a>.</p> <p class="Default">This pay freeze has caused a 10-14% loss in the real value of our pay over this period, and combined with increasing pressures due to austerity, has caused a recruitment crisis which is pushing the NHS to the point of collapse.&nbsp;</p> <p class="Default">The health service has over <a href="https://www.independent.co.uk/news/health/nhs-posts-staffing-recruitment-official-figures-healthcare-hospitals-a8221961.html">100,000 vacant posts</a>, of which <a href="https://fullfact.org/health/are-we-short-40000-nurses/">40,000 are nurses</a>, <a href="http://www.bbc.com/news/health-43143325">10,000 are doctors</a> and 10,000 are HCAs. The pay freeze and staffing crisis are driving thousands of nurses to flee the unsafe and unhealthy working conditions in the NHS, with more nurses <a href="https://www.nmc.org.uk/news/news-and-updates/increasing-number-nurses-midwives-leaving-profession-major-challenges/">leaving the NMC register</a> than joining for the last two years. Combined with the fact that <a href="https://www.kcl.ac.uk/nursing/research/nnru/policy/Policy-Plus-Issues-by-Theme/Labourmarketdynamics/PolicyIssue2.pdf">100,000 nurses</a> - almost a third of the NHS nursing workforce - are within 10 years of retirement, and the impact of Brexit and visa restrictions driving nurses away, this creates an existential crisis for nursing and the NHS.</p> <p class="Default">In response to this crisis in nursing, the RCN was pushed by its members to campaign on pay. They launched the “Scrap the Cap” campaign and began to hold protests and marches around the country. The campaign culminated in the RCN’s first ever indicative ballot for strike action in <a href="https://nursingnotes.co.uk/rcn-announces-vote-industrial-action-pay/">April 2017</a>. While turnout was poor, the <a href="https://www.theguardian.com/society/2017/may/14/nurses-vote-support-ballot-for-strike-action-low-pay">vote in favour of action was 78%</a>, clearly demonstrating nurses anger and willingness to fight.</p> <p class="Default">Theresa May responded by <a href="https://www.ft.com/content/c1b7187a-97b4-11e7-a652-cde3f882dd7b">declaring the pay cap over</a> in September 2017. At this point, all the NHS unions decided to bypass the Pay Review Body, and instead use the traditional union method of submitting a pay claim to the government. This unity strengthened their hand and allowed them to set out terms for the pay deal they wanted, rather than relying on the deliberations of the Pay Review Body. All <a href="http://www.unitetheunion.org/news/all-nhs-staff-need-a-pay-rise/">14 unions submitted a joint pay claim</a> for inflation (at the Retail Price Index, RPI) plus £800, which started a series of negotiations over pay, which have now concluded with the deal which is on offer.</p> <h2>Is the deal worth it?</h2> <p class="Default">The deal is meagre compared both to what we have lost. The boosts for the lowest paid and people at the bottom of their bands are welcome, but the pay rise does not address the serious staffing crisis facing the NHS, and particularly nursing.</p> <p class="Default">While the RCN trumpets 29% pay rises for some staff, most NHS staff (52%) are at the top of their pay band. For them, there is only 6.5%. Overwhelmingly these staff are also those who are within 10 years of retirement. This deal offers them little reason to stay in post and help stave off the looming staffing crisis.</p> <p class="Default">The figure of a 29% pay rise for some is misleading as it counts incremental rises in with the pay offer and the boost for those at the bottom of their pay band. Unions have always rejected the argument that increments are a pay rise; they are meant to reflect skills and experience developed through time in service. Yet the union pay calculator is <a href="https://www.huffingtonpost.co.uk/entry/nhs-pay-data-headlines_uk_5ab381d2e4b004fe24699846">deliberately misleading staff</a>, representing incremental rises as part of the pay deal to increase its appeal.</p> <h2>What is the alternative?</h2> <p class="Default">While this deal was presented as the best we can achieve without strike action, all that it took to achieve this deal was one indicative ballot for strike action by the RCN, and a joint pay claim by all the unions. No other union has balloted for action yet. Imagine how much more we could win from the government if we threatened them with joint strike action between all NHS unions.</p> <p class="Default">As a member of Unite’s National Industrial Sector Committee for Health, I was privy to details of the pay deal as it was being negotiated. We were told that the government “red lines” were asking for one or two days of annual leave, and bands 1-3 moving to the unsocial hour rates for bands 4-8, in return for any pay rise. Yet the government backed down from these “red lines”, after little more than a social media outcry.</p> <p class="Default">This is a government without an overall majority, unpopular for their treatment of the NHS, and the damage that eight years of austerity have done to society, and facing quite possible collapse due to the failing Brexit negotiations. </p> <p class="Default">In this precarious position the government cannot afford for an industrial dispute to develop in the NHS. A big fight with NHS staff might even bring them down.</p> <p class="Default">They desperately want to lock us in to a three year pay deal right before Brexit, so when Brexit occurs and causes inflation to skyrocket even further, we will be stuck receiving 1.7% pay rises for two years.</p> <p class="Default">For all these reasons, I urge all union members to reject the deal. We deserve and need more after eight years without a pay rise. The NHS desperately needs well paid and highly motivated staff to rescue it from its current crisis. And we can’t waste this chance to win the pay and funding the NHS and its staff need to survive in to the future.</p> <p class="Default">All the major NHS unions <a href="http://www.gmb.org.uk/newsroom/reject-nhs-pay-deal">except for the GMB</a> are recommending this deal to members. This is the wrong stance to take. All the unions ought to have the best interests of the NHS at heart, yet they are recommending a deal which doesn't meet the needs of staff or the service.</p> <p class="Default">This is much bigger issue than securing a little extra money in our members pockets. It’s about securing a future for the NHS. Agreeing to this deal will not alleviate our struggles to pay our bills, it won’t solve the NHS staffing crisis, and could even accelerate it as overworked, underpaid staff leave rather than stay working for a government and health service which doesn’t value them.</p> <p class="Default">The government is threatening that if we don’t agree, they will take the money for funding the pay rise off the table and force us to accept a 1% deal through the Pay Review Body. This is a disgraceful threat and an attempt to blackmail NHS staff. We should call their bluff and campaign to reject the deal. </p> <p class="Default">We can reject the deal, then push for coordinated strike ballots across all NHS unions. Joint coordinated strike action is the biggest threat to the government. Coordinated ballots would maximise turn out and help all unions get past the 50% minimum turnout required for legal strike action.</p> <p class="Default">Strike action is doable. The <a href="https://www.ft.com/content/7e391688-b4c5-11e7-a398-73d59db9e399">university lecturers union won a ballot for strike action</a> over pensions just a couple of months before, and <a href="https://www.theguardian.com/business/2017/oct/03/royal-mail-workers-vote-for-industrial-action">so did postal workers</a>. We can too, we just need to organise ourselves and fight for it with the same dedication we use to keep the NHS working every day of the week. The first step in this is campaigning to reject the deal.</p> <p class="Default"><em>Follow the “</em><em><a href="https://www.facebook.com/ditchthedeal/">Ditch the Deal</a></em><em>” Facebook page for updates and information on the campaign to reject the deal.</em><em></em></p> <p class="Default"><em>Full technical details of the pay agreement can be </em><em><a href="https://static1.squarespace.com/static/5a857514bff200aa36889e06/t/5ab23db803ce64be4f073046/1521630651875/NHS+Staff+Council+Framework+agreement+21+March+2018.pdf">accessed here</a></em><em>.</em><em></em></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/mark-boothroyd/day-in-life-of-nhs-nurse-why-government-must-act-to-reduce-workloads">A day in the life of an NHS nurse - how our government is failing both patients and nurses</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Mark Boothroyd Wed, 28 Mar 2018 07:52:26 +0000 Mark Boothroyd 116915 at https://www.opendemocracy.net 'We’ve done you proud' — Families speak after NHS Trust fined £2million over patient deaths https://www.opendemocracy.net/shinealight/sara-ryan/connor-sparrowhawk-southern-health-fined-2m <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p> <!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG ></o> </o:OfficeDocumentSettings> </xml><![endif]--> <!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves ></w> <w:TrackFormatting ></w> <w:PunctuationKerning ></w> <w:ValidateAgainstSchemas ></w> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> 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</w:LatentStyles> </xml><![endif]--> <!--[if gte mso 10]> <mce:style><! /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-ansi-language:EN-US;} --> <!--[endif] --> <!--StartFragment--> <!--EndFragment--></p><p class="MsoNormal"><span style="font-size: 10.0pt; font-family: Helvetica; mso-fareast-font-family: &amp;amp;amp; mso-bidi-font-family: &amp;amp;amp; color: #333333; background: white; mso-ansi-language: EN-GB;">Today Southern Health was fined £2m over the “entirely preventable” deaths of 18-year-old Connor Sparrowhawk and Teresa Colvin, aged&nbsp;</span><span style="font-family: Helvetica; font-size: 13.333333015441895px;">45</span><span style="font-family: Helvetica; font-size: 10pt;">.</span></p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/SARA_RYAN_26MARCH2.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/SARA_RYAN_26MARCH2.jpg" alt="" title="" width="460" height="299" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Sara Ryan speaking in Oxford on 26 March 2018, after Southern Health was fined £2million (image #JusticeforLB)</span></span></span></p> <h2><strong>Clare Sambrook writes:</strong> </h2><p>Today at Oxford Crown Court, Southern Health NHS Foundation Trust was fined £2m for allowing the “entirely preventable” deaths of 18-year-old Connor Sparrowhawk and Teresa Colvin, who was 45.&nbsp;<span>Passing sentence,&nbsp;</span><a href="https://www.judiciary.gov.uk/wp-content/uploads/2018/03/r-v-southern-nhs-sentencing.pdf">Mr Justice Stuart-Smith </a>spoke of their families’&nbsp;“<span>deep, catastrophic and unspeakable pain, sadness and loss</span><span>”.&nbsp;</span></p> <p>Teresa Colvin’s husband Roger,&nbsp;<a href="http://www.bbc.co.uk/news/uk-england-43542284">speaking outside court today</a>,&nbsp;said Teresa, who was affectionately known as TJ, had been “a vivacious, beautiful, and loving woman” who was dearly loved. In a statement he read to the court Roger Colvin spoke of life’s “what-ifs” and how every day something would trigger a memory, accentuating his terrible loss.&nbsp;TJ’s sister Wendy Andrade spoke of anger and hurt that was still very raw for the family and the massive void that&nbsp;TJ’s&nbsp;death had&nbsp;left.&nbsp;</p> <p>Teresa Colvin was found hanged by a phone cord at Woodhaven Adult Mental Health Hospital, Southampton on 22 April 2012.&nbsp;She died four days later.</p> <p>The court heard that Southern Health had failed to act upon warnings about ligature risks from health and safety expert Mike Holder. He&nbsp;<a href="http://www.dailymail.co.uk/news/article-3783528/Shamed-NHS-boss-Health-chief-told-FIVE-YEARS-ago-patients-risk-failed-follow-advice-240k-job.html">resigned in protest at the Trust’s inaction</a> eight weeks before Teresa Colvin’s death.</p> <p>Between 2007 and 2011 more than 1,700 “ligature incidents” had occurred across the Trust. The very phone cord that TJ would later use had been identified as a risk to patients. The cost of eliminating the risk would have been £53. Nothing was done about it.</p><p>&nbsp;</p> <p>Connor Sparrowhawk,&nbsp;<span>a funny, quirky and beloved young man,</span><span>&nbsp;was just 18 when he died on 4 July 2013 whilst a patient at Slade House, a Short Term Treatment and Assessment Centre at Headington in Oxford.</span></p><p><span>Connor had autism, learning difficulties and epilepsy, but it was the Trust’s neglect that caused his death.</span></p> <p>His mother, Sara Ryan, had warned staff —&nbsp;in writing — that Connor had an injury to his tongue that suggested a recent seizure. Yet he was allowed to bathe unsupervised and behind a locked door, and he drowned in the bath.</p><p>&nbsp;</p> <p><a href="https://www.judiciary.gov.uk/wp-content/uploads/2018/03/r-v-southern-nhs-sentencing.pdf">Mr Justice Stuart-Smith said</a>&nbsp;each death was an “unnecessary human tragedy”, and it was a “regrettable fact” that Sara Ryan and Roger Colvin had had to campaign for justice.&nbsp;</p><p>Connor’s family and friends campaigned under the banner #JusticeforLB — his nickname was Laughing Boy because he laughed so much. Their work provoked the exposure of the Trust’s failure to investigate hundreds of unexpected deaths.&nbsp;</p><p> <span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/DZNZPVJX4AAVflC.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Connor Sparrowhawk (#JusticeforLB)"><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/DZNZPVJX4AAVflC.jpg" alt="" title="Connor Sparrowhawk (#JusticeforLB)" width="240" height="353" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style="" /></a> <span class='image_meta'><span class='image_title'>Connor Sparrowhawk (#JusticeforLB)</span></span></span></p><p><span>While failing to watch over Connor,&nbsp;Southern Health had spent months monitoring his mother’s blog. The morning after his death executives <a href="https://opendemocracy.net/shinealight/clare-sambrook/on-connor-sparrowhawk-s-avoidable-death">turned their attention to reputation management</a>. Through years of lies and obfuscation Southern Health attacked bereaved families and&nbsp;</span><a href="https://mydaftlife.com/2015/04/02/farcical-inaccuracies-2/">persistently tried to shift blame</a><span>&nbsp;for Connor’s death from itself to Sara Ryan. One Trust employee left a message on her voicemail calling her “a vindictive cow”.&nbsp;</span></p> <p>The judge&nbsp;paid tribute to Sara Ryan today: “It is clear on the evidence that Dr Ryan in particular faced not merely resistance but entirely unjustified criticism as she pursued her Justice for LB campaign.”</p> <p>He noted Southern Health’s admission:&nbsp;</p> <p>“The Trust fully acknowledges that Dr Sara Ryan has conducted herself and the Justice for LB campaign in a dignified, fair and reasonable way. To the extent that there have been comments to the contrary by Trust staff and family members of staff, these do not represent the view of the Trust and are expressly disavowed.”</p><p>The judge said that victim impact statements from Sara Ryan and from Connor’s step-father Richard Huggins “make for almost unbearable reading”. </p><p>He said: “Dr Ryan describes how the light went out of her life on 4 July 2013. And in dignified and restrained terms she lays bare how the assertion by the Trust in the early days that Connor had died of natural causes compounded her grief. As did Mr Colvin when referring to the loss of TJ, Dr Huggins refers to their grief being raw. Their lives have become dominated by a deep, catastrophic and unspeakable pain, sadness and loss.”</p><p>&nbsp;</p> <p>Over years we have published&nbsp;<a href="https://opendemocracy.net/shinealight/sara-ryan/ministry-of-justice-says-you-don-t-need-lawyer-at-inquest-trust-state">work by Sara Ryan</a>, by&nbsp;<a href="https://opendemocracy.net/shinealight/tom-ryan/since-my-brother-s-preventable-death">Connor’s brother Tom</a>, and&nbsp;<a href="https://opendemocracy.net/shinealight/clare-sambrook/on-connor-sparrowhawk-s-avoidable-death">disclosure stories</a>&nbsp;about Southern Health’s failure to take action to remedy known problems.</p> <p>Today we pay tribute to bereaved families who fight for truth and accountability, who work to make public services safer for everyone. We thank&nbsp;<a href="https://opendemocracy.net/@GeorgeJulian">George Julian</a>, whose reporting of inquests and tribunals through live-tweeting has shone a light on Connor’s and&nbsp;<a href="http://www.georgejulian.co.uk/2018/03/24/live-tweeting-inquests-and-tribunals-10-top-tips-of-learning-so-far-justiceforlb/">other state-related deaths</a>. </p><p>Mr Justice Stuart-Smith<span>’</span>s judgement can be found <a href="https://www.judiciary.gov.uk/wp-content/uploads/2018/03/r-v-southern-nhs-sentencing.pdf">here</a>. Connor’s family’s statement in response to today’s sentencing follows below.</p><p>&nbsp;</p><p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/buses_line_2bigger5_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/buses_line_2bigger5_0.jpg" alt="" title="" width="460" height="65" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><h2>Family statement on the Health &amp; Safety Executive (HSE) prosecution of Southern Health #JusticeforLB</h2><h2>Sara Ryan writes:</h2><p>Five years ago this month we took our beautiful boy to what we thought was a specialist NHS unit. He drowned in the bath 107 days later.</p><p>No one should die a preventable death in the care of the state. Learning disabled people should not die on average twenty years before their non-disabled peers. Families should not have to fight for answers and accountability. They should not have to raise funds for legal representation at a time of unspeakable grief and pain.</p><p>Southern Health dug deep into publicly funded pockets and armed itself with a range of legal weaponry and dirty tricks.</p><p>The #JusticeforLB campaign has shone a light on systemic failings in the care of learning disabled people. We have collectively and effectively revealed weaknesses in regulatory practices, a disregard for the lives and deaths of certain people and the limitations of work by large established charities in this area.</p><p>We appreciate Dr Nick Broughton’s recognition and acknowledgement of the failings that spread across five years under Katrina Percy’s leadership, and his heartfelt apology for these. [Broughton has been Southern Health chief executive since November 2017].</p><p>We thank the HSE for their meticulous and sensitive investigation and everyone who has stood alongside us fighting for what is right and just.</p><p>I’m left thinking if Connor was here now, in the shadow of Oxford Crown Court and the St Aldates police station, he would repeatedly ask ‘<em>why mum?</em>‘</p><p>I’d reply ‘<em>I don’t know matey but we’ve done you proud</em>’.</p><p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/connor_bus2_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Bus, by Connor Sparrowhawk"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/connor_bus2_0.jpg" alt="" title="Bus, by Connor Sparrowhawk" width="460" height="316" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Bus, by Connor Sparrowhawk (#JusticeforLB)</span></span></span></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/shinealight/shinealight/sara-ryan-clare-sambrook/connor-sparrowhawk-justiceforLB">Connor Sparrowhawk: How one boy’s death in NHS care inspired a movement for justice</a> </div> <div class="field-item even"> <a href="/shinealight/tom-ryan/since-my-brother-s-preventable-death">Since my brother’s preventable death . . .</a> </div> <div class="field-item odd"> <a href="/shinealight/clare-sambrook/190k-payoff-for-ex-chief-of-nhs-trust-that-failed-to-investig">£190K payoff for ex-chief of NHS Trust that failed to investigate hundreds of unexpected deaths</a> </div> <div class="field-item even"> <a href="/shinealight/imogen-tyler/connor-sparrowhawk-erosion-of-accountability-in-nhs">Connor Sparrowhawk: the erosion of accountability in the NHS</a> </div> <div class="field-item odd"> <a href="/shinealight/clare-sambrook/on-connor-sparrowhawk-s-avoidable-death">On Connor Sparrowhawk’s avoidable death</a> </div> <div class="field-item even"> <a href="/shinealight/sara-ryan/ministry-of-justice-says-you-don-t-need-lawyer-at-inquest-trust-state">Ministry of Justice says you don’t need a lawyer at an Inquest. Trust the State</a> </div> <div class="field-item odd"> <a href="/shinealight/ally-rogers/we-apologise-to-anybody-who-feels-let-down">‘We apologise to anybody who feels let down’</a> </div> <div class="field-item even"> <a href="/shinealight/frances-webber/uk-government-s-inversion-of-accountability">The UK government’s inversion of accountability</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> Shinealight Shine A Light ourNHS Access to justice Clare Sambrook Sara Ryan Mon, 26 Mar 2018 16:30:34 +0000 Sara Ryan and Clare Sambrook 116882 at https://www.opendemocracy.net Time to halt the NHS gravy train for management consultants https://www.opendemocracy.net/ournhs/jonathan-allsop/time-to-halt-nhs-gravy-train-for-management-consultants <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>New evidence has emerged that management consultants make NHS hospitals <em>less</em>, not more, efficient. Which will be little surprise to the NHS staff who have to deal with them.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/big_4.jpeg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/big_4.jpeg" alt="" title="" width="450" height="299" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>The recent collapse of Carillion not only threw a long overdue spotlight on the billions leached from the NHS and other public services by the Private Finance Initiative but also severely dented the notion that “private knows best” when it comes to running public services. The public sector’s use of management consultants has grown exponentially since the early 1990s to the extent that the use of consultants by the public sector now accounts for over a fifth of the total turnover of management consultancy firms. For as long as I’ve worked in the NHS (I joined as a trainee accountant in 1990) a view has persisted that, whether we’re caring for patients or supporting those who do, no matter how hard we work or how good at our jobs we are we’ll never quite be as efficient as our private sector counterparts; forever the lower league journeymen to their Premier League superstars.</p> <p>I’ve lost count, down the years, of how many times I’ve seen management consultants (more often than not from one of the Big Four accountancy firms) brought in, at considerable expense, to do jobs that people in the NHS with vastly more experience in the relevant area could have done much better for a fraction of the cost. The sums involved, when viewed in isolation, often aren’t headline grabbing but collectively they add up to a substantial flow of money out of the health service and into the coffers of huge multinational corporations. How much exactly? Well, precise figures on how much the NHS as a whole spends on management consultants are difficult to come by but <a href="https://www.theguardian.com/society/2014/dec/09/nhs-management-consultants-bill-doubles-640m">in December 2014 the British Medical Journal reported that NHS spending on management consultants had risen to £640 million per year</a> (compared to £313 million in 2010) as they cashed in on the chaos created by the implementation of the Health and Social Care Act with some consultants charging a whopping £4,000 per day for their services.</p> <p>To illustrate the impact of the health service’s often unnecessary use of management consultants here’s a recent example from my own experience working in an NHS finance department. It comes nowhere close to the scandal of PFI but it’s typical nonetheless of how the NHS has become reliant on the private sector to do work that could quite easily be done in-house. I’ve chosen this particular example as it’s the most recent but, to be honest, there are dozens of others that I could have drawn from - ranging from project managers on eye watering sums per day brought in to lead the implementation of new systems or inject commercial rigour into dull old NHS accounting practices, to poacher-turned-gamekeeper consultants drafted in to advise on the impact of government policy that they’ve already had a hand in writing. (The current work on <a href="https://opendemocracy.net/ournhs/sarah-carpenter/management-consultants-scoop-up-on-secretive-shake-up-of-health-service-in-en">Sustainability and Transformation Plans</a> (STPs) is the latest in a long list of examples of the latter).</p> <p>NHS Improvement, the body responsible for overseeing the financial performance of NHS trusts, is currently driving a move towards trusts identifying the costs of individual patients, rather than averages, under its ‘costing transformation programme’ which is a major focus for me in my role as the costing lead at a mental health trust.&nbsp;One strand of this programme involves independently assessing the accuracy of the costing information that trusts produce. In 2016 <a href="https://improvement.nhs.uk/resources/costing-assurance-programme/">NHS Improvement awarded a three-year contract to perform this work to EY</a> (in previous years the work had been undertaken by PwC and Capita). You might know EY better as Ernst and Young, one of the Big Four multinational accountancy firms who were rebranded in 2013 and are headquartered in smart offices close to Tower Bridge in London. In October of last year <a href="https://www.ft.com/content/540bdc0e-b238-11e7-a398-73d59db9e399">EY were fined £1.8 million</a> by the UK’s financial watchdog the Financial Reporting Council, for “failures to obtain reasonable assurance” about whether the financial statements of global technology company Tech Data “were free from material misstatement”. Not particularly reassuring for the NHS but, hey, away from the beady eyes of the FRC a handy NHS contract like this is money for old rope for the likes of EY. Firms can typically walk away from NHS contracts such as this without any repercussions no matter how shoddy the work.</p> <p>The contract involves auditing the costing information produced by around one-third of NHS trusts each year over the three-year period. In December 2015 NHS Improvement invited tenders to undertake this work and stipulated a maximum price of £3.9 million, but details are sketchy on the actual price agreed with EY. NHS Improvement’s board papers from around the time are rather coy, indicating only that six companies were invited to tender and that EY had won the contract. Later on the&nbsp;<a href="https://improvement.nhs.uk/events/nhs-improvement-board-meeting-28july/"><strong>board papers from its meeting in July 2016</strong></a>&nbsp;referred to a saving of 36% on the contract value after the initial costs and activities within the scope of the audit were challenged. Which represents quite a saving - looking back at footage of the meeting (the public part of NHS Improvement’s board meetings is filmed and available to view on their website) there is more than a little surprise amongst board members as this substantial saving is noted.</p> <p>Such cost cutting is often a false economy though. It usually means cheaper, less experienced members of staff being employed on the contract and this was evidently the case when EY visited our trust in February last year. Very early on in the audit it became apparent that, beyond the basics, the auditor’s knowledge of NHS costing processes and mental health services was scant. In the end, the auditor spent a mere two and a half days on site and this was followed up with a handful of telephone conversations and email queries which barely skimmed the surface of the figures being audited.</p> <p>A first draft of the audit report, when it eventually turned up, after much chasing, over four months later was strewn with errors including reference to “urology IAPT services” which given that IAPT refers to improving access to psychological therapies makes the mind boggle. The errors were eventually corrected, and a second draft was sent out a month later, in the middle of July, requesting our formal management responses to each of their audit recommendations within two working days. That this tends to be the busiest time of the year for anyone involved in NHS costing (the deadline for submitting the annual reference costs return is usually towards the end of July) was seemingly completely lost on EY. The report itself, once published, was lacking in any real insight, full of half-baked recommendations and with the overall feel of a piece of work that had failed to get to grips with the topic that it was meant to be reporting on.</p> <p>It’s staggering that at a time when the health service is enduring the longest squeeze on its finances in its seventy-year history that it can afford to spend a few million pounds on poorly executed work such as this.&nbsp;In the absence of knowing the actual cost of the contract let’s assume, not unreasonably, that EY’s original tender value was close to the maximum price of £3.9 million. In that case a 36% saving would suggest a contract value of around £2.4 million. Now, in the context of an overall budget for the NHS of more than £120 billion that may sound like small beer and indeed when you spread it, rather crudely, across all the trusts that will be audited during the contract period the cost works out at around £10,000 per organisation. Not too bad, you might think, but it’s a frankly ridiculous sum for barely a week’s work and a report that told us nothing about our costing process that we didn’t already know.</p> <p>We have been told repeatedly down the years that the expense of management consultancy is more than off-set by the beneficial effects it has on the efficiency of public sector organisations. However a recent study by a group of academics at Bristol, Seville and Warwick universities on the&nbsp;impact of the use of management consultants on public sector efficiency, perhaps the first of its kind to measure the quantitative impact of using consultants, <a href="http://www.bmj.com/content/360/bmj.k893">concluded that far from boosting efficiency the use of management consultancy actually decreases it</a>. And this didn’t even take account of the, often ignored, demoralising impact on NHS staff of continually seeing management consultants brought in to perform tasks that they could and already are paid to do. One of the authors of the report, Ian Kirkpatrick from Warwick Business School felt that in the current financial climate the NHS must consider “whether it is appropriate to continue using external consulting advice at the current level”.</p> <p>It’s disheartening to say the least to see others brought in, time after time, to work on “exciting” projects and produce work of questionable benefit whilst we get on with our day jobs and are invariably left to pick up the pieces when external consultants depart. Much of this work could be brought in-house and would offer talented, experienced and dedicated NHS staff the chance to look beyond their day jobs to improve the quality of care that patients receive at a fraction of the cost of using the private sector. We might not be as good at spouting the fancy management-speak and preparing the snazzy PowerPoint slides but at least give us a chance. EY’s work on the costing assurance programme could, and should, have been performed by costing leads at other trusts – a form of peer review that would subject the costing processes of each trust to proper scrutiny and offer valuable insights into how those processes might be improved. All this for a mere fraction of the cost of involving the private sector.</p> <p>So it’s refreshing to read the Shadow Chancellor John McDonnell refer to Carillion as a “watershed moment” and promise that a future Labour government would end the “private knows best” rip-off. For too long huge multinational corporations like EY, McKinsey, PwC, KPMG and Capita have been riding this NHS gravy train. Only last week it emerged that&nbsp;<a href="http://www.independent.co.uk/news/health/nhs-spending-kpmg-watchdog-management-consultants-mckinsey-a8253766.html"><strong>NHS Improvement has awarded a £500k contract to McKinsey</strong></a>&nbsp;to apparently help it define its “purpose”. This comes less than two years after a similar deal, worth £1 million, was struck with yet another management consultancy firm KPMG on defining NHS Improvement’s role. Enough is enough, it’s time to bring this nonsense to a halt and&nbsp;let NHS employees get on with what we are paid to do.</p><p><em>This piece is cross-posted from <a href="https://nowtmuchtosay.wordpress.com/2018/03/18/ey-oh-why-oh-why/">Nowt Much to Say</a>&nbsp;with kind permission.</em></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/sarah-carpenter/management-consultants-scoop-up-on-secretive-shake-up-of-health-service-in-en">Management consultants scoop up on the secretive shake-up of the health service in England</a> </div> <div class="field-item even"> <a href="/can-europe-make-it/sol-trumbo-vila/bail-out-industry-finds-its-new-crisis-opportunity-brexit">The bail out industry finds its new crisis opportunity: Brexit</a> </div> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/peterborough-hospital-nhs-and-britains-privatisation-racket">Peterborough Hospital, the NHS and Britain&#039;s privatisation racket</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Jonathan Allsopp Tue, 20 Mar 2018 14:16:42 +0000 Jonathan Allsopp 116771 at https://www.opendemocracy.net Are cash-strapped hospitals walking into a trap that could cost the NHS its family silver? https://www.opendemocracy.net/ournhs/caroline-molloy/are-cash-strapped-hospitals-walking-into-trap-that-could-cost-nhs-its-family- <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Hospitals from Yorkshire to Yeovil are rushing to set up secretive private companies in which to transfer NHS staff and assets. OurNHS looks in depth at the possible impacts – and whether it’s likely to go horribly wrong.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/PA-30392062.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/PA-30392062.jpg" alt="lead " title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: NHS demonstration. PA Images/Victoria Jones.</em></p><p>Dozens of NHS hospital trusts across England are looking at (or already have) set up private companies in which to transfer swathes of vital NHS staff and assets. The moves are, according to Trusts, an attempt to save money through a supposed VAT loophole designed to promote outsourcing, as well as savings on staff pay, terms and conditions. They are also – an aspect overlooked in the <a href="https://amp.theguardian.com/society/2018/feb/14/nhs-trusts-transferring-staff-into-subsidiary-companies-to-cut-vat?__twitter_impression=true">coverage to date</a> – supposed to promote a greater focus on “commercialising” hospital assets. More of that in a bit…</p> <h2>“By the time people realise it’s been a catastrophe, it will be too late to undo”</h2> <p>Unions and staff are up in arms about the damaging impact of these subsidiary companies in creating a <a href="https://southwest.unison.org.uk/campaigns/one-team-one-nhs-subsidiary-companies/">two tier, demoralised workforce</a> whose goodwill and co-operation our doctors and nurses rely on every day to keep hospitals clean, safe, and well-equipped. In Wigan, Harrogate, Bradford, and Calderdale, Unison members are already close to strike action after union ballots overwhelmingly rejected the plans. Gloucestershire – where around 700 staff are affected – is also about to run an indicative ballot, Unison announced at an NHS activists conference in the county on Saturday.</p> <p>Some hospital governors are deeply unhappy too – one in Gloucestershire told OurNHS, “by the time people realise it’s been a catastrophe, it will be too late to undo.”</p> <p>There’s been no public consultation about any of the plans to create private NHS subsidiary companies (known as SubCo’s), it seems. In Gloucestershire, Hospital Chief Executive Deborah Lee told Stroud Labour MP David Drew that “this is not a matter for public consultation as agreed with the Gloucestershire Health Care Overview &amp; Scrutiny Committee (HCOSC)”. However Stroud Council leader Doina Cornell, who sits on the county’s Scrutiny Committee, told OurNHS, “We’ve not been consulted. There’s been a lack of input into it from any councillors.” OurNHS asked Gloucestershire Hospitals about this apparent discrepancy – and about a number of other points in this article. They have so far declined to comment.</p> <p>Cornell adds “Surely this is not the sort of thing we should be doing…. this is a high-risk project.”</p> <h2>“…<strong>a gambit, a pretence, an illusion and make believe…</strong>”</h2> <p>Indeed it is high risk. Whilst staff understandably worry about pay, pensions and conditions cuts – and unions argue that any guarantees from employers are worth little given weak employment law and the various hospital trusts' stated intent to take on new starters on lower conditions – for the <em>public</em>, it gets more worrying still.</p> <p>Many experts suspect the plans could collapse altogether, with the corporates waiting in the wings of course. Respected health commentator Roy Lilley has called the SubCo plans “<strong>a gambit, a pretence, an illusion and make believe</strong>” and on the same subject comments, “<a href="http://campaign.r20.constantcontact.com/render?m=1102665899193&amp;ca=0082c0d7-b2c5-4001-87b1-c74b77a3a566">an astonishing number of Trusts are heading down Carillion Street</a>”. &nbsp;</p> <p>Certainly, it’s worrying that many of the SubCo plans seem to emphasise this VAT “gambit”. Gloucestershire, for example, told staff it would save £35m over 10 years through this ruse, whilst the staff savings were merely “unquantifiable”. But the biggest similar scheme to date, UnitingCare in Cambridgeshire, collapsed spectacularly – and one of the major reasons (according to both <a href="https://www.england.nhs.uk/mids-east/wp-content/uploads/sites/7/2016/04/uniting-care-mar16.pdf">NHS England</a> and the <a href="https://www.nao.org.uk/report/investigation-into-the-collapse-of-the-unitingcare-partnership-contract-in-cambridgeshire-and-peterborough/">National Audit Office report</a>s) was because the NHS signed the contract on the basis of incorrect advice about their VAT position, meaning an unexpected £5m a year was added to the costs and the arrangement collapsed.</p> <h2>Selling off the hospital buildings?</h2> <p>And – perhaps most worryingly of all – now OurNHS openDemocracy has uncovered considerable grounds for concern about what is happening to hospital buildings around the country as part of these plans. We’ve also uncovered a little noted aspect of the Health and Social Care Act 2012 that might partly explain the sudden rush to "commercialise" hospital estates under these new schemes.</p> <p>In existing SubCo’s, tens of millions of pounds of assets appear to have transferred out of the NHS. In Northumberland, Tyne and Wear for example, one of the few SubCo’s where the business case is publicly available, the plan states <a href="https://www.ntw.nhs.uk/content/uploads/2017/04/Agenda-Item-10ii-a-NTW-Solutions-Business-Case.pdf">that £33.5m of land and buildings will be transferred</a> from the NHS to the SubCo. But in most of the plans about to be signed off in the coming weeks and months staff appear to have been given little more than <em>hints</em> of asset transfer (often highly self-contradictory, see for example <a href="https://opendemocracy.net/files/SubCo-QA-A3-D3.pdf">Gloucestershire’s leaked staff Q&amp;A</a>,<strong> </strong>and Airedale’s (which they’ve mostly taken down in the last few days, but you can read the cached link here [editors note - the cached link has <em>also </em>disappeared since this article was published yesterday, <a href="https://opendemocracy.net/files/NHS Airedale Foundation Trust.doc">but here's the page as we downloaded it last week</a>]). </p> <p>Neither staff or public appear to be being told anything about what hospital buildings are involved, and what this means for the future. Whether or not asset transfers are key to the supposed VAT savings in Gloucestershire and elsewhere is one of the unanswered questions put to the Trust. Some of the other SubCo’s appear to anticipate <em>no</em> VAT savings, according to the Health Services Journal (<a href="https://www.hsj.co.uk/finance-and-efficiency/in-full-trusts-with-staff-transfer-plans/7021681.article">paywall</a>). Meanwhile, other established SubCo’s – notably South Warwickshire and East Kent – have been set up to provide clinics and wards for private patients, OurNHS has uncovered. What <em>is</em> going on?</p> <p>The concerns about hospital buildings come in the light of huge pressure on Trusts to sell off or commercialise parts of their estate, under both the Carter Review and <a href="https://www.mirror.co.uk/news/politics/tories-backed-report-recommending-huge-11941502">the Naylor report that Theresa May endorsed last year</a>. Those hawking schemes to encourage sell offs are impatient with the NHS holding on to their assets “<a href="https://www.birminghampost.co.uk/special-features/how-unlock-potential-midlands-nhs-13926365">like the family silver</a>” and preventing housing developers or rival private health companies getting their hands on these ‘strategic locations’. And all the plans – as elsewhere – are clear on one thing – that there will be “new people” with “commercial expertise” running the SubCo’s - perhaps with a different attitude to the family silver?<strong></strong></p> <p>Tax expert Richard Murphy echoes campaigners’ suspicions. Reviewing the <a href="https://www.ntw.nhs.uk/content/uploads/2017/04/Agenda-Item-10ii-a-NTW-Solutions-Business-Case.pdf">Northumberland, Tyne and Wear</a> SubCo business case, he told OurNHS, “Reading between the lines as to the true motive of this&nbsp;arrangement, it looks like a precursor to the sale to commercial third parties of the underlying buildings and the service contracts associated with them". Whether this is the intention – or an unintended consequence, particularly if the financial models don’t otherwise stack up - remains to be seen.</p> <h2>Sneaky legal changes post-2016?</h2> <p>OurNHS has also uncovered that a little spotted legal change seems to be driving the rush to the SubCo model of estates management. In an article written in May 2017 by SubCo advisors DAC Beachcroft (who are advising Gloucestershire amongst others), the solicitors firm describes how “the foundation trust sets up a wholly-owned subsidiary company. The estates workforce works for the company” but they go on to explain that “<a href="https://www.dacbeachcroft.com/en/gb/articles/2017/may/will-this-new-nhs-estates-management-model-improve-trust-efficiency/">the outsourcing involves transferring the estate across into a wholly-owned subsidiary company</a>.” And intriguingly, they add “These are only now possible because of recent changes in legislation that have enabled NHS foundation trusts to transfer their legal rights in operational property”.<strong></strong></p> <p>What “recent changes in legislation” are these? OurNHS has spoken to top NHS campaigning solicitors who are unsure but have suggested it may refer to a change that follows on from the controversial Health and Social Care Act 2012. One little noted aspect of the Act made it easier for the NHS Foundation Trusts to sell off or otherwise dispose of assets, even where those were previously protected because they were used to provide essential healthcare services (known as “Commissioner Requested Services”). There were some transitional arrangements to protect these services and the buildings used to provide them, following the 2012 Act – <a href="http://www.bmj.com/content/349/bmj.g5603">but these arrangements ran out in April 2016</a>.<strong></strong></p> <p>And certainly, the government’s attitude to these SubCo wheezes seems a little slippery. On the one hand, the government’s “NHS Providers Finance Director” Chris Young wrote an apparently strongly worded letter to Trusts last September (and seen by OurNHS), which stated that “HMRC are actively investigating the health sector in relation to tax avoidance schemes” - though perhaps with a chink of a get out clause about such schemes being “acceptable” if there are also “genuine commercial reasons” for pursuing them. Meanwhile numerous parliamentary questions about the SubCo’s have been met with bland indifference from ministers. Whilst some – like Labour’s health spokesman in the Lords, Phil Hunt – have suggested ministers’ relaxed demeanour means any tax savings are likely to be clawed back from the overall NHS budget, NHS insiders have also told OurNHS that their strong impression is the main NHS regulator (NHS Improvement) is quietly promoting these schemes. </p> <h2>So what can campaigners do?</h2> <p>In Gloucestershire, experienced NHS campaigners – who 6 years ago took NHS Gloucestershire to Judicial Review and reversed the planned transfer of nine local hospitals and 4000 staff to a so-called “social enterprise” company - have written today <strong>(<a href="https://opendemocracy.net/files/glos subco letter to board to publish.doc">letter here</a>)</strong> to the local Hospital Trust's Board of Directors. The hospital's directors are due to agree the project on Wednesday (28 February), but campaigners have raised detailed questions regarding all the above issues. The campaigners warn the Directors that the Trust risks being "negligent" with public money and assets if they rubber stamp the plan before they have clear answers to all these questions – which, campaigners point out, should be shared with the public.</p> <h2>So what can Trusts do?</h2> <p>It’s not good enough for Trusts to rely on expensive, unpublished, "commercially confidential" advice from the likes of DAC Beachcroft and KPMG. Gloucestershire for example has set aside £200,000 for this advice, OurNHS has learned. And let’s not forget KPMG’s role in Carillion – a role which prompted Peter Kyle MP to tell them last week in a parliamentary Carillion investigation, <a href="http://www.independent.co.uk/news/business/news/carillion-collapse-kpmg-deloitte-mps-worthless-accounts-business-committee-rachel-reeves-a8223626.html">“I wouldn’t trust you to do an audit of the contents of my fridge”</a>.</p> <p>Nor does it seem wise for the twenty or so Trusts who are relying on advice from QE Facilities Ltd, a SubCo created by Queen Elizabeth Gateshead NHS Foundation Trust. As Unison’s Michael Sweetman drily told OurNHS, “they are selling this deal on the basis that they’ve found it very lucrative – for them – but it’s lucrative for them partly because they’re going around selling their consultancy on how to do it, back to other parts of the NHS.” (Did anyone say “pyramid scheme”?).</p> <p>Of course Trusts are in impossible financial positions, with soaring waiting lists, problems compounded by heavy fines levied if they miss targets, and – as exposed by last week’s BBC File on Four - an <a href="http://www.bbc.co.uk/programmes/b09ry6k8">absurd government fixation on capital controls as hospitals crumble</a>. <a href="https://www.gloucestershirelive.co.uk/news/gloucester-news/how-gloucestershires-hospitals-managed-rack-215076">Gloucestershire is in the same financial black hole as most Trusts – and also in special measures following a recent huge accounting cock-up</a>. </p> <p>Trust Chief Executives have even taken to Twitter to defend their adoption of SubCo’s models, for example Sarah Jane Marsh, CEO of the Birmingham Women and Children’s Hospital Foundation Trust, who also have a SubCo due to go live next month. Marsh&nbsp;<a href="https://twitter.com/BWCHBoss/status/963781922378969088">commented earlier this month</a>, “It’s a real head/heart issue - but the reality is if we don't, we will have to reduce further posts as our CIP [Cost Improvement Plan, ie further 'efficiencies' or cuts needed] for 18/19 is £17 million.” </p> <p>But it’s not good enough for Trusts developing these plans to attempt highly risky ways to wriggle out of government-imposed constraints, remaining tight-lipped about what the plans could really mean. It’s not good enough for Trusts to hope that no-one’s going to weep for the procurement teams, estates managers, cleaners, safety staff and the other workers who keep the NHS show on the road – nor to ignore vital questions about the hospital buildings and financial models, the quality of the advice they’re getting, and the loss of accountability and control these plans entail. Given the secrecy around these SubCo's, it’s particularly unhelpful when Trust Chief Executives <a href="https://www.nhsglos.com/involve/feb2018/">then blame “irresponsible” unions for causing staff anxiety with “political” opposition to the plans, as Gloucestershire’s Chief Executive Deborah Lee was spotted on camera doing last week.</a> </p> <p>Instead, all Trust CEOs should be being as outspoken about the government’s failure to fund the NHS as a few brave ones <em>have</em> been – and as honest about the obscure tricks the government is using to push ever more outsourcing, even as the failures of Carillion, Grenfell and PFI come home to roost. </p> <p>OurNHS openDemocracy will keep investigating. Whatever the intent of Trust directors, the reality is they tend to move on to pastures new within a few years – only one of Gloucestershire’s current directors has been there for any length of time, for example. </p> <p>Meanwhile local people, currently frozen out of decision making, may be left in a few years wondering how our precious hospitals were sold from out under our feet.</p><div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Caroline Molloy Mon, 26 Feb 2018 21:58:53 +0000 Caroline Molloy 116352 at https://www.opendemocracy.net Exposed - the shocking extent of fire risk in our hospitals and mental health trusts https://www.opendemocracy.net/ournhs/minh-alexander/exposed-shocking-extent-of-fire-risk-in-our-hospitals-and-mental-health-trusts <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Even after Grenfell, hospitals are failing to put in place recommended fire safety measures. The UK government passes the buck. Meanwhile, patients have died.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/chase farm hospital.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/chase farm hospital.jpg" alt="" title="" width="460" height="325" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Fire at Chase Farm mental hospital in 2008. Steps have been taken across the NHS since - but are they enough?</em></p><p>Coroners have criticised two recent patient fire deaths at mental health providers <a href="http://www.bbc.co.uk/news/uk-england-cambridgeshire-41916473">Cambridgeshire and Peterborough NHS Foundation Trust</a> and at <a href="http://www.bbc.co.uk/news/uk-england-berkshire-42185454">Berkshire Healthcare NHS Foundation Trust</a>.</p> <p>Fire safety is a concern across the NHS. There are well-known fire safety problems at some PFI hospitals. Investigations after the Grenfell Tower fire exposed <a href="http://www.telegraph.co.uk/news/2017/06/27/nhs-alert-fire-chiefs-warn-38-hospitals-dangerous-grenfell-tower/">the presence of flammable cladding in NHS hospitals. </a>But risk assessment is tangled up with financial imperatives. Some of the flammable cladding in hospitals was <a href="https://www.mirror.co.uk/news/uk-news/hospitals-still-deadly-cladding-similar-11468002">left in situ</a> because it was considered too costly to remove. And such is the general pressure on trusts that <a href="https://www.hsj.co.uk/acute-care/exclusive-more-than-50-trusts-yet-to-carry-out-post-grenfell-fire-checks/7020898.article">some delayed in implementing fire checks</a> ordered by NHS Improvement after the Grenfell fire.</p> <h2>Mental health services are especially vulnerable</h2> <p>Though fire safety is a concern across the NHS, mental health services are especially vulnerable as they must deal with the special risks of fires caused by patients who are disorganised by illness, or people who set fires deliberately. The government acknowledges this risk in its <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/473012/HTM_05-02_2015.pdf">fire safety guidance for the NHS.</a><span></span></p> <p>The <a href="http://www.dailymail.co.uk/news/article-1078080/Patients-flee-ravages-hospital-unit-mentally-ill-criminals.html">2008 Chase Farm Hospital fire of the locked, forensic psychiatric wards</a> was a reminder of the potential lethality of fire in psychiatric hospital settings. Fast staff reaction in the <a href="http://news.bbc.co.uk/1/hi/england/london/7168206.stm">2008 Royal Marsden Hospital fire</a> prevented deaths, but there was major damage. The <a href="https://minhalexander.files.wordpress.com/2018/01/woodlands-unit-fire-investigation-suffolk-fire-and-rescue-2012_12_20-report-of-investigation-final.pdf">damning fire safety report</a> into the <a href="http://www.eadt.co.uk/news/ipswich-suffolk-patient-almost-died-as-fire-alarm-was-ignored-eight-times-1-1748189">2011 fire at Woodlands psychiatric unit at Ipswich Hospital</a> revealed system failures had resulted in the alarm being ignored eight times. Norfolk and Suffolk NHS Foundation trust escaped criminal prosecution only because of a legal loophole. The then Chief Executive of the NHS Trust Development Authority acknowledged this serious mismanagement and <a href="https://www.buildingbetterhealthcare.co.uk/news/article_page/Hospitals_told_to_step_up_fire_security_after_scathing_report_into_Ipswich_blaze/86061">promised that standards would be tightened up</a>. </p> <p>Vigilance and proactive care are needed. But strain on under-funded mental health services result in understaffing, chronic over-occupancy, escalating acuity and failures of clinical observation (<a href="///C:/Users/Caroline/Downloads/cited%20repeatedly%20by%20coroner&#039;s%20warnings%20as%20factors%20in%20avoidable%20deaths">cited repeatedly by coroner's warnings as factors in avoidable deaths).</a> </p> <p>Risk is also posed by an <a href="https://www.theguardian.com/society/2017/oct/03/bill-urgent-repairs-nhs-hospitals">ever-mounting backlog of repairs and maintenance work – including fire prevention work - in our hospitals,</a> as NHS trusts struggle to make ends meet. </p> <p>Worryingly, subsequent enquiries by BBC File on Four revealed that</p> <p><a href="https://minhalexander.files.wordpress.com/2018/01/bbc-file-on-four-29_01_08_fo4_fire.pdf">Fire Services had had to serve enforcement notices against NHS trusts.</a> – and, as a glance at the <a href="http://www.cfoa.org.uk/notices-register">enforcement register</a> shows that this continues despite promises of improvement.</p> <h2>Injuries and deaths in NHS fires</h2> <p>How much fire risk is tolerable, in hospitals with accelerant medical gases and infirm or detained patients? </p> <p>The <a href="https://minhalexander.files.wordpress.com/2017/11/fennell-report-kings-cross-fire-dot_kx1987.pdf">investigation report on the London Underground fire at Kings Cross</a>, which claimed 31 lives, criticised London Underground’s complacent culture and argued:</p> <p><em>“A mass passenger transport service cannot tolerate the concept of an acceptable level of fire hazard”</em></p> <p>Data from routine notification of estate fires by NHS trusts to NHS Digital shows that there were 1701 and 1462 fires in all trusts in <a href="https://minhalexander.files.wordpress.com/2018/02/nhs-digital-eric-2015-2016-data-reps.xlsx">2015/16</a> and <a href="https://digital.nhs.uk/catalogue/PUB30096">2016/17</a> respectively. Mental health trusts accounted for 1138 (67%) fires in 2015/16 and 895 (61%) fires 2016/17 respectively.</p> <p>Over these two years, 88 people were injured in all NHS trust fires, with 64 of these people being injured in fires related to mental health trusts. There were four deaths in trusts fires, three accounted for by mental health trusts.</p><p class="mag-quote-center">There were four deaths in trusts fires, three accounted for by mental health trusts.</p> <h2>Suicides by burning</h2> <p>There were a total of <a href="https://minhalexander.files.wordpress.com/2018/02/ncish-foi-suicide-by-burning-response-5-02-2018.pdf">259 patient suicides and 14 inpatient suicides by burning</a> over the ten years between 2005 and 2015, a request to National Confidential Inquiry into Suicide and Homicide (NCISH) under the Freedom of Information Act has revealed.</p> <p>FOI data from NCISH also suggests that <a href="https://minhalexander.files.wordpress.com/2018/02/ncish-foi-response-suicide-by-burning-9-01-2018.pdf">roughly a fifth of suicides by burning are due to patient suicides by burning.</a></p> <p>Underlying these deaths will be many more injuries and near misses.<strong></strong></p> <h2>Many hospitals do not have sprinkler systems, even now</h2> <p>The Chief Fire Officers Association <a href="https://minhalexander.files.wordpress.com/2018/02/cfoa-statement-130301-sprinklers.pdf">promotes the use of sprinklers.</a> The London Fire Brigade has advocated for the use of <a href="https://minhalexander.files.wordpress.com/2018/02/london-fire-brigade-2016-07-nickcoleshill.pdf">sprinklers in healthcare premises.</a> As the London Fire Commissioner has explained, </p> <p><a href="http://www.london-fire.gov.uk/news/LatestNewsReleases_Sprinklers-13-Sep-2017.asp#.WnUwhZOFigR"><em>"Sprinklers are the only fire safety system that detects a fire, suppresses a fire and raises the alarm. They save lives and protect property and they are especially important where there are vulnerable residents who would find it difficult to escape"</em></a><em></em></p> <p>The government’s fire standards for the NHS briefly mention but do not commit to installation of sprinklers. The guidance also repeatedly states that where sprinklers are used, other fire prevention measures may be reduced for cost-effectiveness.</p> <p>Since Grenfell, the government has been pressed on the <a href="http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2017-09-08/9666/">adequacy of its regulations</a> for sprinklers in hospitals, and <a href="http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2017-12-20/120648">whether sprinklers are required in all hospitals.</a> Last month, the Minister of State advised that all guidance was under review.</p> <p>Many hospitals do not have sprinkler systems. The exact distribution of sprinklers across the NHS estate is uncertain. The data is not collected centrally by NHS Digital. Expectations do not appear high. A fire safety policy by Northumberland Tyne and Wear NHS Foundation Trust states:</p> <p class="p1"><a href="https://minhalexander.files.wordpress.com/2018/02/northumberland-tyne-and-wear-1475659231fp-pgn-11-actfireprecau-v02-iss3-ermar17-issoct16.pdf"><em>"Healthcare premises do not normally have water delivery systems fitted."</em></a></p><p class="p1"><em><span class="mag-quote-center">"Healthcare premises do not normally have water delivery systems fitted."</span></em></p> <p>Recent FOI data reportedly showed that <a href="https://inews.co.uk/news/uk/revaled-thousands-multi-storey-buildings-lack-fire-sprinklers/">thousands of multi-storey buildings, including hospitals, do not have sprinklers.</a></p> <p>Even some new builds such as <a href="https://www.falkirkherald.co.uk/news/hospital-sprinkler-decision-slammed-1-289846">Forth Valley Royal Hospital</a> have not included sprinklers. The troubled Cumberland Infirmary PFI development <a href="http://www.newsandstar.co.uk/news/Carlisle-hospitals-fire-safety-sprinklers-will-not-be-fully-installed-until-2020-3e1e3656-a8ae-474a-8d18-b6b92c08663d-ds">will not have sprinklers fully installed until 2020.</a> Corporate documents and FOI releases by some NHS organisations, for example by <a href="https://minhalexander.files.wordpress.com/2018/02/sheffield-teaching-hospitals-governors-meeting-partial-sprinklers-cog170627_minutes.pdf">Sheffield Teaching Hospitals NHS Foundation Trust</a>, <a href="https://minhalexander.files.wordpress.com/2018/02/nhs-grampian-fire-prevention-foi-responseletter215-2014red.pdf">NHS Grampian</a> and <a href="https://minhalexander.files.wordpress.com/2018/02/nhs-lothian-fire-prevention-foi-4548.pdf">NHS Lothian</a> show patchy sprinkler coverage. </p> <p>Moreover, working on the ‘acceptable hazard’ principle, where one safety precaution is installed, others may be trimmed. For example, one architect reported that on one Scottish NHS PFI project, because sprinklers were specified, there was corner cutting on other safety features:</p> <p><a href="https://www.ifsecglobal.com/architect-says-corners-cut-fire-safety-glasgow-hospital-sprinklers-fitted/"><em>"...lacks exit stairways and exceeds size limits on fire compartments, while a hose-reel for firefighters is too short and some fire doors open in the wrong direction"</em></a><em></em></p> <p><span>Almost no mental health trusts have sprinkler systems</span></p> <p><a href="https://minhalexander.files.wordpress.com/2018/02/mental-health-trusts-and-fires-1-april-2015-to-31-march-20174.xlsx">I sent a Freedom of Information request to 51 mental health trusts. 49 trusts responded.</a></p> <p>The responses revealed that almost no mental health trusts have sprinklers. Three trusts had sprinklers in 10% of their inpatient areas, and in one of these trusts this was only because a <a href="http://www.sthelensstar.co.uk/news/15788041.sprinklers-installed-at-peasley-cross-hospital-wards/">retrofit took place after a contribution by the local fire service.</a> Two other trusts trust leased four community properties equipped with sprinklers, but none of their own properties had sprinklers.</p> <p>Some trusts stressed that installing sprinklers was “not a requirement under current legislation”. However, legality is a moot point after Grenfell and given the controversy about UK fire safety standards.</p> <p>Cambridgeshire and Peterborough NHS Foundation, one of the trusts criticised over a recent fire death, claimed that it could not say how many sprinklers it had, because responsibility for this was outsourced. However, the trust admitted there were no sprinklers in inpatient areas.</p><p class="mag-quote-center">One of the trusts criticised over a recent fire death claimed that it could not say how many sprinklers it had, because responsibility for this was outsourced.</p> <p>South West London and St. Georges Mental Health NHS Trust and Dudley and Walsall Mental Health Partnership NHS Trust refused to answer the question on sprinklers on the grounds that it would endanger safety. After challenge, St Georges admitted that it had no sprinklers.</p> <p>East London NHS Foundation Trust, rated ‘Outstanding’ and praised the Care Quality Commission for its learning culture was one of the trusts which failed to respond to the FOI at all. NHS Digital data shows that there was a fire related death at East London NHS Foundation Trust in 2016/17 and that a total of seven people were injured in fires in 2015/16 and 2016/17.</p> <p>The 49 trusts which responded to the FOI request accounted for a total of 1800 fires over 2015/16 and 2016/17, at least 790 of which were deliberately caused and at least 801 of which were caused by patients (2).</p> <p>Conservatively, at least 1000 of the fires occurred on inpatient units, some in rooms that might potentially be locked or barricaded such as patients’ bedrooms and bathrooms.</p> <p>One mental health trust acknowledged that there is risk inherent in all fires: “they all carry a potential risk of harm”, whereas another claimed that all fires on its wards were “minor in the sense that items burnt were limited to paper and clothing”. Better data is needed on the seriousness of the fires.</p> <p>Questions arise about whether this level of risk management in mental health trusts is acceptable, and whether it is valid to trim back on failsafes. For example, relying on fire alarms instead of sprinklers. This was a justification given by Mersey Care NHS Foundation Trust for not having sprinklers.</p> <p>In particular, the absence of sprinklers in patients’ bedrooms and bathrooms bears further debate, because such areas may not be accessible quickly enough in an emergency. <a href="http://www.bbc.co.uk/news/uk-england-cambridgeshire-41916473">Heather Loveridge died as a result of a fire in a ward toilet</a> and <a href="http://www.bbc.co.uk/news/uk-england-berkshire-42185454">Sarah-Jane Williams died as a result of a fire in a ward bedroom</a> at trusts which had no sprinklers. </p> <p>There are also unanswered questions about sources of ignition on mental health trust wards despite the <a href="https://publichealthmatters.blog.gov.uk/2017/03/17/tobacco-free-nhs-troubleshooting-tips-for-hospitals/">NHS smoking ban</a>. How many ward fires set by patients due to failures to search and remove lighters, reflecting the acute strain on services? <span></span></p> <p>I asked NHS Improvement, the NHS’s financial regulator, if it was doing any work on the special needs of mental health patients with respect to fire safety. </p> <h2>Who’s responsible? Not us!</h2> <p>NHS Improvement referred me to the Department of Health</p> <p><a href="https://minhalexander.files.wordpress.com/2018/02/nhs-improvement-correspondence-fire-risk-mental-health-trusts.pdf">NHS Improvement referred me to the Department of Health and Social Care</a>, based on its impression that the Department had undertaken a 10-year review. This was followed by a hasty retraction, and then a <a href="https://minhalexander.files.wordpress.com/2018/02/dh-fire-response-21-nov-2017-foi-1107984.pdf">denial from the Department of Health and Social Care </a>itself that it held such data. The Department finally suggested that I ask<a href="https://minhalexander.files.wordpress.com/2018/02/dh-fire-response-5-dec-2017-foi-1109518.pdf">&nbsp;NHS Improvement</a> for information.</p> <p>This bureaucratic merry-go-round suggests that either little thought has been given to this matter, or worse, that pass-the-parcel is being played with embarrassing truths whilst mental health patients remain insufficiently protected.</p><p class="mag-quote-center">pass-the-parcel is being played with embarrassing truths whilst mental health patients remain insufficiently protected</p> <p>The Department of Health and Social Care’s own fire guidance states that it is important to demonstrate “<em>due diligence and effective governance”</em> and recommends that the <em>“performance of the fire safety management system is periodically audited and assessed against the organisation’s fire safety objectives”</em></p> <p>The Department should follow its own advice, ensure better oversight and rectify any unwarranted risks to which mental health patients are currently exposed. If risk continues to be tolerated at a systemic level, the government should at least transparently provide justification for this.</p> <p><strong>NOTES</strong></p> <p>(1) The Department of Health and Social Care’s fire safety guidance states:</p> <p><em>“</em><strong><em>5.68</em></strong><em> With the exception of buildings over 30 m in height, the guidance in this document does not require the installation of sprinklers in patient care areas of healthcare buildings. However, the design team is expected to consider the advantages that might be gained by installing life-safety sprinklers throughout the building or to specific areas. Where specific hazards are identified in the building, it may be more appropriate to consider the application of an alternative fire suppression system, such as high pressure water mist technologies.”</em></p> <p>Throughout the guidance, it is stated that where sprinklers are used, other fire prevention measures may be reduced, and this explicitly linked to saving money. For example:</p> <p><em>“<strong>5.85 </strong>In those parts of healthcare buildings where sprinkler systems are provided, the effect of sprinklers on the overall package of fire precautions has to be considered to ensure that a cost-effective fire safety strategy is provided. Where sprinklers are installed in healthcare premises in accordance with the above guidance, some of the requirements of this document may be modified to take account of the effect of sprinkler operation at an early stage of fire development.”</em></p> <p><em>“<strong>5.86</strong> Where sprinklers are installed, the guidance may be modified subject to a suitable and sufficient risk assessment being undertaken and the information being recorded in the fire safety manual. Examples include: </em></p> <p><em>a. progressive horizontal evacuation (paragraphs 3.6–3.15); </em></p> <p><em>b. glazing in sub-compartment walls (paragraphs 5.23–5.25); </em></p> <p><em>c. elements of structure (paragraphs 5.1– 5.7 and 5.14–5.15); </em></p> <p><em>d. compartmentation (paragraphs 5.8– 5.13); </em></p> <p><em>e. fire hazard rooms and areas (paragraphs 5.40–5.44); </em></p> <p><em>f. external fire spread (paragraphs 6.5– 6.15); </em></p> <p><em>g. number and location of fire-fighting shafts (paragraphs 7.11 and 7.13).”</em></p> <p><em>“<strong>3.12</strong> Where sprinklers are installed, the fire resistance of the compartment walls may be reduced to 30&nbsp;minutes (integrity and insulation)”</em></p> <p><em>“</em><strong>5.15</strong> <em>Where sprinklers are installed throughout the whole building, the requirement for elements of structure and compartment walls to be constructed of materials of limited combustibility does not apply”</em></p> <p><em>“<strong>5.25</strong> Where sprinklers are fitted, there is no limit on the use of glazed screens that provide a minimum period of fire resistance of 30 minutes (integrity only), provided the glass is not of the type referred to as “modified toughened”</em></p> <p><strong><em>“5.43</em></strong><em> Where sprinklers are installed, the need to enclose fire hazard rooms in fire-resisting construction should be risk-assessed.”</em></p> <p><a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/473012/HTM_05-02_2015.pdf">Department of Health Technical Memorandum 05-02: Firecode, 2015 Edition</a></p> <p>(2) Both data from NHS Digital and the FOI material from trusts should be viewed with caution. </p> <p>It became clear that some mental health trusts are reporting <em>all</em> fires involving patients to NHS Digital, and not just fires on their own premises. One trust claimed that the NHS Digital figures on its fires was greatly inflated because they included false alarms and not just actual fires. Conversely, some NHS Digital data was placed in doubt after a few apparent zero returns were directly queried with the trusts in question, who gave conflicting data.</p> <p>Some mental health trusts volunteered that all or most their arsons were carried out by patients. Fires were also most frequently located in inpatient areas.</p> <p>By comparison, FOI requests to three acute trusts that had also reported high numbers of fires showed a much lower proportion of fires that were caused deliberately or by patients: there were only 4 deliberately caused fires and three fires caused by patients out of a total of 178 fires over the two years.</p> <p>Rough though the quality of this data is, the differences do support received wisdom that the risk of arson by patients is higher in mental health trusts, and that unsurprisingly, many of the fires are set on inpatient psychiatric wards. This might be expected as the most unwell people will be found on the wards.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/openjustice/roshan-croker/terrible-consequences-of-deregulation-and-cutting-corners">The terrible consequences of deregulation and cutting corners</a> </div> <div class="field-item even"> <a href="/shinealight/clare-sambrook/fail-and-prosper-how-privatisation-really-works">Fail and prosper: how privatisation really works</a> </div> <div class="field-item odd"> <a href="/blood-on-their-hands-sorry-state-of-uk-mental-health-services">“Blood on our hands” - the sorry state of UK mental health services </a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS ourNHS Minh Alexander Fri, 09 Feb 2018 11:01:22 +0000 Minh Alexander 116028 at https://www.opendemocracy.net Is our personal data fair game in the drive to create Theresa May’s “hostile environment” for migrants? https://www.opendemocracy.net/uk/jess-potter/is-our-personal-data-fair-game-in-drive-to-create-theresa-may-s-hostile-environment-f <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> Patients are dying as politicians use the NHS crisis to undermine what we love most about it – a service for all, free at the point of access, that protects our confidential health data. </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/Docs Not Cops.PNG" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/Docs Not Cops.PNG" alt="" title="" width="460" height="301" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>As a doctor and public health researcher, I believe health services should not be <em>de facto</em> border control. Deterring people from seeking help when they are unwell is not only bad for individuals, it is bad for public health. Healthcare is a right for all, not a privilege for some.&nbsp;</p><p>Last week, Dr Sarah Wollaston MP and the rest of the health select committee heard <a href="http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news-parliament-2017/mou-data-sharing-launch-17-19/">evidence</a> to about the impact of a <a href="https://www.gov.uk/government/publications/information-requests-from-the-home-office-to-nhs-digital">Memorandum of Understanding (MoU)</a> between the Home Office and NHS Digital (the national information and technology partner to the health and social care system in the UK). This data-sharing agreement to support the tracing of immigration offenders is one of a “suite of products” that enable the government to maintain the “compliant environment”, as they referred to it on the day.</p> <p>It was upsetting to hear Marissa Bereoni, of Justice for Domestic Workers, describe how a domestic worker had died from pneumonia – a completely treatable condition – because she had been too scared to see a doctor. Further examples were given by GP Lu Hiam who works for Doctors of the World, a charity established because the NHS is not truly accessible to all – some are too afraid to use it. </p> <p>The hearing confirmed what <a href="http://www.independent.co.uk/life-style/health-and-families/nhs-urged-to-share-data-so-patients-can-be-deported-a7566386.html">I and other campaigners have been arguing</a> ever since Theresa May said in 2012, as Home Secretary, that <a href="http://www.telegraph.co.uk/news/uknews/immigration/9291483/Theresa-May-interview-Were-going-to-give-illegal-migrants-a-really-hostile-reception.html">“the aim here in Britain is to create a really hostile environment for illegal immigration”. </a>&nbsp;That creating this hostile environment within a healthcare setting is particularly damaging, and shows little regard to the potentially life-threatening consequences of this blinkered focus on immigration control.</p> <p>Last week’s testimonies also confirm the human stories behind written evidence from Public Health England (PHE). Public Health England highlighted no fewer than 14 research studies demonstrating that the threat of being reported to immigration officials deters people from seeking help when they are unwell.&nbsp; Their evidence was however somewhat undermined by a <a href="http://www.parliament.uk/documents/commons-committees/Health/Correspondence/2016-17/Correspondence-Memorandum-Understanding-NHS-Digital-Home-Office-Department-Health-data-sharing.pdf">disappointing cover letter</a> from PHE’s Chief Executive Duncan Selbie who declared that “whilst there is a wealth of evidence about migrant health behaviours there is no robust <em>statistical</em> evidence about the impact of knowledge of data sharing on deterring immigrants from accessing healthcare treatment”.&nbsp; At the committee hearing, this statement was then used by the government to justify their actions, which begs the question: Exactly how operationally independent is PHE? </p> <p>Of course, as pointed out during the meeting, it is almost impossible to gather “robust statistical evidence” on undocumented migrants, particularly when living in a country where every social interaction they have might either result in abuse or arrest. Nevertheless, PHE has agreed to attempt to collect this data over the course of the next two years, during which time who knows how many more people will come to harm? </p> <p>Another important point raised by a representative of the national data guardian’s office was the paramount importance of the public’s trust in our ability to deliver a confidential healthcare service.&nbsp; As Sarah Wollaston MP pointed out, in the five paragraphs within the MoU that discuss the public interest, the public’s trust that their own personal health data will remain confidential, is not mentioned once. </p> <p>For us healthcare workers, each decision to release confidential data beyond the health service produces blood, sweat and tears.&nbsp; We do not take it lightly.&nbsp; When we do it, it is most likely because life is in danger.&nbsp; Even if you were part of the group who stole all those diamonds from Hatton Gardens, we would still not share your details.&nbsp; </p> <p>And by details I mean primarily your home address, because when you give this in exchange for medical care that is where my contract to protect your data begins.&nbsp; Not so, according to the government.&nbsp; Demographic data is fair game. There is a fundamental disconnect between guidance from both the <a href="https://www.gmc-uk.org/guidance/ethical_guidance/confidentiality.asp">General Medical Council</a> and <a href="https://www.bma.org.uk/news/media-centre/press-releases/2017/july/bma-responds-to-government-public-consultation-on-patient-data-security-reviews">BMA</a> in relation to confidentiality and what the law allows.</p> <p>From the Home Office’s perspective, committing an immigration offence such as living in the UK without appropriate paperwork constitutes a serious enough offence to justify the routine sharing of data with no scrutiny on a case-by-case basis.&nbsp; During the hearing the government claimed that escaping deportation was another crime warranting the use of medical services to track you down.&nbsp; I find this particularly galling given <a href="https://www.theguardian.com/uk-news/2017/nov/20/fourth-death-at-lincoln-immigration-removal-centre-prompts-inquiry">recent reports</a> demonstrating the harmful and even life-threatening effects of unlimited detention in this country.</p> <p>Deterring people from accessing healthcare in this way not only puts lives at risk but results in higher costs. These practices threaten to undermine patients’ trust in my ability to protect their <a href="https://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp">right to confidentiality</a> – the cornerstone of the patient-doctor relationship. </p> <p>The final question of the session was ‘Who can stop this?’&nbsp; The answer: NHS Digital. &nbsp;But only if their evaluation thinks this is the right thing to do. For now, they are happy hiding behind the law because, technically, what they are doing is still legal even if it is not right.&nbsp; This may change if the <a href="http://www.independent.co.uk/news/health/home-office-nhs-data-sharing-patients-human-rights-court-challenge-a8045011.html">legal challenge</a> lead by the NGO Migrants Rights Network succeeds.</p> <p>Unless we stand up and hold the government to account, they will continue to inflict damage to some of the most vulnerable people in our society.&nbsp; Our NHS is in crisis but we must not allow this to undermine what we love most about it – a service for all, free at the point of access.&nbsp; </p> <p><a href="https://www.facebook.com/events/314949055662810/">Join us in the #PatientsNotPassports bloc at the NHS in Crisis protest on Saturday February 3rd</a>.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/docs-not-cops/labour-must-tackle-may-s-hostile-environment-for-migrants-in-nhs">Labour must end May’s ‘hostile environment’ for migrants in the NHS</a> </div> <div class="field-item even"> <a href="/ournhs/erin-dexter/making-nhs-hostile-environment-for-migrants-demeans-our-country">Making the NHS a “hostile environment” for migrants demeans our country</a> </div> <div class="field-item odd"> <a href="/ournhs/ruth-atkinson/brexit-and-nhs-we-need-to-fight-racist-discourse">Brexit and the NHS - why we all must fight the racist discourse</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Jess Potter Thu, 25 Jan 2018 06:00:00 +0000 Jess Potter 115799 at https://www.opendemocracy.net A day in the life of an NHS nurse - how our government is failing both patients and nurses https://www.opendemocracy.net/ournhs/mark-boothroyd/day-in-life-of-nhs-nurse-why-government-must-act-to-reduce-workloads <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Last year 33,000 nurses left the NHS, 3,000 more than were recruited. There’s a simple solution - resisted by a government determined to press ahead with piecemeal privatisation.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/nurse stress_0.png" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/nurse stress_0.png" alt="" title="" width="460" height="230" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>If you take a look at the average daily workload of an NHS nurse, you can see how it would drive any but the most committed to leave the underpaid and undervalued profession.</p> <p>Average staffing levels in NHS wards means that there are 9 patients per nurse. In elderly care wards the average is 11 patients per nurse. The reality for nurses is it can be as much as 10 or 12 patients per nurse on a medical ward, and 14 to 16 patients per nurse on an elderly ward. The National Institute of Clinical Excellent (NICE) and nursing unions recommend no more than 8 patients per nurse, yet 40% of NHS nurses reported to the Royal College of Nursing (RCN) that they are working with ratios higher than this.</p> <p>Imagine you're a nurse with a 12 hour shift. It's meant to only be 11 hours work because you're meant to have a one hour break (which you aren't paid for) but you'll probably end up working through it. You have 10 patients who you have to help wash, give their medications three times a day, and do a minimum of three sets of observations throughout the day. You also have wound dressings to change for several of your patients, and several need help toileting throughout the day. Some may be bed bound and require full double handed care, requiring another nurse to help you. </p> <p>You also need to speak to the medical team for each of them to chase up their plans. Several need to be sent for scans, and you need to speak to the porters and x-ray, CT or ultrasound and get them sent down. Dementia patients or those who are falls risk can require an escort so you have to find someone to go with them.</p> <p>If you're on a surgical ward you will have a couple of patients on Patient Controlled Analgesia, or epidurals needing hourly monitoring, as well as observations hourly for those returning from theatre, hourly sliding scales for diabetes patients, Naso-Gastric or Total Parenteral Nutrition feeds needing checking and monitoring. Alongside that you’re trying to safely take multiple patients to theatres and radiology which means being off ward for ages, while somehow simultaneously closely monitoring the patients you've left behind. </p> <h2>Desperately trying to free up beds</h2> <p>On top of that you will be managing multiple discharges to get patients home to free up beds for the next day’s intake of patients awaiting surgery, and chasing pharmacy for medications. There is barely any time to carry out the essential work of teaching patients about managing new stomas or controlling their diabetes or any of the other essential parts of patient education which are left in the hands of overstretched nursing staff.</p> <p>God forbid any of the patients become acutely unwell. Then you have to drop everything and spend 2-3 hours managing them intensively, calling the medical or surgical team, the clinical response team, maybe the crash team if they suffer a peri-arrest. Performing observations every 15-30 minutes, administering IVs, taking bloods, deciding whether to inform the next of kin if it's a serious deterioration or if they are elderly or at the end of life. If you eventually stabilise them you have to go back and catch up on your work for your other 9 patients, who you haven't been able to do anything for in the meantime.</p> <p>A study in Australia found that on a busy ward, nurses were making roughly 200 decisions every hour regarding their work. You spend all day every day running from task to task, with barely any time to think.</p> <h2>Documenting everything – even when it was done badly</h2> <p>On top of all this you have to find time to document everything about those ten patients; those three sets of observations (as a minimum, more if they become acutely ill), at least one detailed nursing care plan and a follow up note at the end of the shift, noting every time someone was repositioned, every bowel movement, every aspect of personal care, wound care, important conversations you had with the medical team, with patients, their relatives or social services. </p> <p>There aren't enough staff to do all the work, but the hospital still requires you to document everything you did to prove you did if (even though it was probably done badly or in a hurry, or maybe not at all).</p> <p>If there were enough staff to do all the work, this level of documentation wouldn't be necessary. With inadequate levels of staffing, it just become an onerous imposition, and saps what little spare time you have.</p> <p>By the end of your shift if you work flat out, skip your breaks, cut a few corners and don't spend too much time doing any of the niceties for patients (the little chats, extra cups of tea, comforting them if they've had bad news, and so on) you might have just about managed to do all your care and provided decent, if a little basic care for your patients. </p> <p>If you have managed to squeeze in most of your documentation you might only leave 30-40 minutes late as you tidy up the last bits of paperwork, check you've done all your notes, updated all the care plans, fluid balances, stool charts, repositioning charts and the rest. But if someone became really unwell and you spent 2-3 hours nursing them intensively, you'll probably be staying behind an hour or two to finish notes, as the only time you've really got to work on them is when the next shift has arrived and they can take over all your responsibilities.</p> <h2>How the ‘market’ intensifies nurses workloads</h2> <p>The effects of years of austerity on hospital budgets, combined with the market mechanisms which allocate NHS funding, are also driving the workload up for nurses. Hospitals receive a payment (a tariff) per patient admission. Hospitals facing budget restrictions and reductions in bed numbers are utilising medical and surgical advancements to improve patient care, but also to minimise time as inpatients. This is done to maximise through flow of patients so they can receive as many tariff payments and maximise their income at times of budget restrictions. They do this so they can afford to pay staff and continue to maintain services, but it drives up nurses workload to an unprecedented level. Whereas 15-20 years ago patients would stay on wards for weeks at a time till they were full recovered, now it’s common for patients to be discharged home as soon as they are stable and not acutely unwell, the remainder of their care being carried out in the community. </p> <p>Whereas a nurse used to have a mix of acutely unwell patients, and stable recovering patients requiring minimal care, now every patient a nurse cares for is likely to be acutely unwell, meaning their care needs and the workload for the nurse is at maximum every shift. Such a situation creates a horrendous work environment where nurses work flat out all the time, with no downtime or quiet days. It accelerates burnout, and means newly qualified nurses trying to find their feet and develop their skills and resilience are subject to unimaginable pressures and levels of responsibility that they would not have faced 10-15 years ago. </p> <p>This is why nurses are leaving, and until it changes, they won't stop leaving.</p> <h2>The simple solution</h2> <p>The only way to improve retention and begin to reverse the outflow of nurses from the NHS is to reduce their workloads to a safe, manageable level. This means more nursing staff on wards and in community services. </p> <p>There is a remarkably simple policy solution to this which has worked well in other countries; mandatory minimum safe staffing levels, enforced in law. This has been implemented in both Australia and California, in response to concerted protests by nurses and their unions.</p> <p>There is a consensus for this across nursing unions and the nursing workforce. The RCN, UNISON and Unite all call for mandatory minimum safe staffing levels across NHS wards, and surveys of nurses show 90% in favour.</p> <p>What is stopping the government adoption of this policy is the impediment it would pose to cutting and privatising the NHS, and the demand it would create for increased funding to pay for the staffing. But it is absolutely necessary if we are going to see the continued functioning of the NHS, and the survival of nursing as a viable profession. For this reason all nurses and their unions have to become more active and aggressive in campaigning on this issue, for the wellbeing of ourselves, our patients and the NHS.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/mark-boothroyd/nurse-shortage-what-nurse-shortage">Nurse shortage? What nurse shortage?</a> </div> <div class="field-item even"> <a href="/ournhs/mark-boothroyd/government-uturn-on-safe-nursing-levels-branded-betrayal-by-midstaffs-campaign">Government u-turn on safe nursing levels branded a &quot;betrayal&quot; by Mid-Staffs campaigners</a> </div> <div class="field-item odd"> <a href="/ournhs/mark-boothroyd/why-wont-government-implement-safe-staffing-levels-in-nhs">Why won&#039;t the government implement safe staffing levels in the NHS?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Mark Boothroyd Wed, 24 Jan 2018 12:50:18 +0000 Mark Boothroyd 115797 at https://www.opendemocracy.net Taking politics out of the NHS? Or constructing an elitist ‘consensus’? https://www.opendemocracy.net/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>As certain wings of the Labour party join calls for ‘consensus’ on the NHS, a reductive global healthcare consensus has already been established in the meeting rooms of Davos, McKinsey and the World Bank – with pivotal support from Blair-era peers and NHS appointees.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/junior dr protest jeremy hunt_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/junior dr protest jeremy hunt_0.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Flickr/<a href="https://www.flickr.com/photos/garryknight/with/22069935418/">Garry Knight</a>.</em></p><p>“Our manifesto was a key reason for our gains in the 2017 general election. Now its ideas need to be developed and radicalized”.</p> <p>—Shadow Chancellor John McDonnell</p> <p>At the Labour Conference following the election result, emboldened delegates “<a href="http://labourbriefing.squarespace.com/home/2017/11/14/can-labour-renationalise-the-nhs">voted historically and unanimously for complete renationalisation of the NHS in England</a>” – in the words of Alex Scott-Samuel, Socialist Health Association Chair. Since then shadow health secretary Jon Ashworth has further committed Labour to halting the Sustainability and Transformation Plans (STPs) which devolve the national service into local ‘footprints’ with reduced accountability and the potential for marked reductions in healthcare provision, commercial control of both the public estate and the commissioning function, and a final bridge to a US-style system. Prior to the election in June, Ashworth had only said such plans would be reviewed on a case by case basis, but is now obviously responding to a new confidence among party members.&nbsp; </p> <p>A month later however, and no doubt partly in response to these developments, <a href="http://www.bbc.co.uk/news/health-42029445">ninety MPs signed a letter</a> calling on the Prime Minister to set up a cross-party convention on the future of the NHS and social care in England, saying that only a non-partisan debate would be able to deliver a "sustainable settlement". One-third of the MPs who signed the letter were Conservatives, and while the exact political balance is unknown, signatories from the Labour Party include Liz Kendall, Chuka Umunna, Hilary Benn, Frank Field and Caroline Flint. They say the failure of normal party politics to secure the future of the system means a consensual approach is the only way to ensure action is taken, particularly given that the government does not command a majority.</p> <p>And in November – in what seems to be an attempt to give momentum to this <a href="http://www.bbc.co.uk/news/health-42029445">critical stage of the ‘transformation’ process</a> - the Commons Select Committee on Health resumed its inquiry into Sustainability and Transformation Plans (now Partnerships), <a href="http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news-parliament-2017/stps-acss-launch-17-19/">an inquiry that had been suspended owing to the general election</a>.</p> <h2>The annual January chorus of ‘consensus’</h2> <p>It’s worth noting that winter problems in acute care served as a lever for a similar attempt at consensus in January 2016, in which <a href="http://www.bbc.co.uk/news/health-35233346">former health secretaries Alan Milburn and Stephen Dorrell joined with former Lib Dem health minister Norman Lamb in calling for a cross-party commission</a> – moves that were <a href="https://opendemocracy.net/ournhs/ournhs/nhs-campaigners-say-no-to-nhs-commission">sharply rejected by campaigners amidst concern about the lack of ‘red lines’ to protect universal healthcare</a> (and the vested interests of those involved). </p> <p>A similar coalition <a href="http://www.normanlamb.org.uk/norman_lamb_launches_cross_party_nhs_and_care_campaign">tried again in January 2017</a>, with Norman Lamb writing “The public is sick and tired of the NHS and care system being treated like a political football.&nbsp; People have had enough, and are crying out for an honest discussion and bold solutions to these challenges”. </p> <p>By then, the House of Lords was already engaged in producing an extensive report into the ‘Long Term Sustainability of the NHS’. That report – though it was somewhat buried by the election - gives us some idea of what to expect from the latest attempts at constructing consensus. And a closer examination - in particular those they invited to submit evidence - gives us some idea of the forces mobilising such cross-party initiatives.</p> <h2>Constructing consensus</h2> <p>The Lords produced their report, ‘<a href="https://www.parliament.uk/nhs-sustainability">The Long-Term Sustainability of the NHS</a>’, in April 2017 after almost a year of sifting through written submissions and oral evidence. When the Lords Committee finally reported back its conclusion stated, “A new political consensus on the future of the health and care system is desperately needed and this should emerge as a result of Government-initiated cross-party talks and a robust national conversation”. More particularly it stated that “service transformation will be key to delivering a more integrated health and social care system”, and while recognising some of the difficulties posed by STPs, and the new care models involved, the report noted the broad support for these plans from those giving evidence.</p> <p>What’s noticeable about such hearings is the homogeneity of thought among a remarkably cohesive policy community. And while a few deviations were observed, these were largely in terms of application rather than outright opposition. Indeed the evidence that follows suggests the consensus sought by the Lords – not to mention the cross-party conventions - had already been arrived at several years previously, in even less democratic venues, and that the report served merely to ratify this. </p> <h2>London, Paris, Davos, Washington…</h2> <p>In a <a href="https://www.sochealth.co.uk/2017/05/25/truth-stps-simon-stevens-imposed-reorganisation-designed-transnational-capitalism-englands-nhs-stewart-player/">previous article</a> the author argued that NHS England’s chief executive Simon Stevens’ Five Year Forward View, and, by logical extension, the STPs, had their origins in the World Economic Forum, seen by many as the avatar of the global corporate elite. Indeed two reports produced by the WEF in 2012 on healthcare sustainability advanced many of the constructs, such as service transformation and new care models, latterly pursued by NHSE. </p> <p>The article also noted that the WEF reports were the result of a series of meetings organised at different levels. A Steering Board comprising eminent health system leaders offered overall direction, while a Working Group of experts supported the project’s approach and methodology, collating the material from various national workshops held in England, Germany, Spain, Holland, and China. </p> <p>The identification of participants within these groups could, it was argued, reveal a similar chain of command that was being reproduced at the domestic level. Simon Stevens himself, then working for US insurance giant UnitedHealth, led the WEF Steering Board for the first report, alongside representatives from global consultancies, healthcare and pharmaceutical industries, and from institutions such as the World Bank, the EU, and the World Health Organisation.&nbsp; </p> <p>And Michael Macdonnell, then a Senior Fellow at Imperial College London, but now strategic director of the STPs, served on the Working Group, while the English stakeholder workshop participants included people now leading local NHS ‘transformations’, alongside luminaries like Milburn and Dorrell. </p> <p>However some of this analysis needs adjusting as it neglects the extensive role played by the consultancy giant McKinsey, which provided the project team that produced the two WEF reports. The company, whose clients number at least 90% of the Fortune 500, also organised the various stakeholder workshops, and indeed the lead author of the WEF reports, McKinsey’s Tom Kibasi, also presented these to the World Bank in Washington and to the OECD in Paris. This latter point suggests that while the WEF stands as perhaps the apex of the global elite, the agenda and ideas that inform it are continually being disseminated and reinforced in a range of related venues. </p> <h2>Visions ‘remarkable in their consistency’</h2> <p>As far as the WEF’s stakeholder workshops were concerned, the second report noted that the visions expressed by its participants “are remarkable in their consistency. The preferred health system of the future is strikingly different from the national healthcare systems of today, with empowered patients, more diverse delivery models, new roles and stakeholders, incentives and norms”. </p> <p>Such consistency of vision reflects what may be considered a transnational position. Indeed analysis of transnational capitalist class (TCC) formation argues that reorganisation of capital accumulation has required a parallel reshaping of class relations, with the owners of new forms of production and finance coalescing around global agendas and new relations with nation states. This class is increasingly divorced from serving nationally prescribed developmental goals: instead the aim is to rearrange state institutions and services to serve the global economy. Such analysis also posits a clear hierarchy between business, governmental, and media/scientific/intelligentsia fractions within this class, although, as with Stevens, actors can easily segue between these. </p> <p>And of course hierarchies exist within fractions as well. The WEF reports, for example, were developed partly in response to an announcement from Standard &amp; Poor’s in January 2012 that it would in future take into account in its <a href="http://www3.weforum.org/docs/WEF_SustainableHealthSystems_Report_2013.pdf">national credit ratings the financial sustainability of a nation’s healthcare system</a>. Further privileging of the financial sector, or, more accurately, the financial, insurance and real estate (FIRE) sector, can be seen in the drive to enable its control over healthcare funding mechanisms and the NHS’s physical infrastructure. </p> <h2>Who did the noble Lords want to listen to?</h2> <p>As mentioned, those called to give evidence in the Lords hearings were drawn extensively from the state and intelligentsia fractions of the transnational capitalist class. This includes the leading healthcare think tanks, the Kings Fund, Nuffield Trust and Reform. NHS hospital trusts were represented by Chief Executives of the Shelford Group of Trusts, some of whom, like Dame Julie Moore, were WEF stakeholders, while others, such as Andrew Cash and Mike Deegan, can routinely be found in global consultancy conferences. Cash – head of Sheffield Teaching Hospital - also led the Expert Advisory Panel that supported the Dalton Review on acute sector collaboration, whose <a href="https://www.theguardian.com/politics/2014/dec/05/more-nhs-hospitals-privately-operated-healthcare-shakeup-review-dalton">core recommendations included the formation of US-style hospital chains and the private management of NHS hospitals.</a> </p> <p>The former Labour health minster, Lord Darzi, who also sat alongside Stevens in the WEF Steering Board, also gave evidence. As well as being Director of Imperial College London’s Institute for Global Health Innovation, <a href="http://www.imperial.ac.uk/centre-for-health-policy/global-engagement/world-innovation-summit-for-health-wish/">Darzi is also Executive Chair of the World Innovation Summit for Health (WISH)</a> that convenes annually with some 2,500 participants, and is “chaired by a team of experts drawn from academia, industry and policymaking” with “the aim of influencing healthcare policy globally”. WISH’s recent research work has included collaboration <a href="https://www.bcgperspectives.com/content/articles/health_care_payers_providers_accountable_care_around_world_framework_guide_reform_strategies/">with the leading US consultancy, the Boston Consulting Group, on Accountable Care Organisations</a> and value creation in healthcare.</p> <p>Michael Macdonnell, now acting policy director of NHS England’s STP programme, has been working on <a href="http://www.pulsetoday.co.uk/news/commissioning/all-stps-will-become-accountable-care-systems-nhs-england-announces/20034154.article">ACOs, and the aim is for these to be implemented in each footprint</a>. Macdonnell gave evidence to the Lords Committee, as indeed did Sir Muir Gray who has led the value creation programme, <a href="https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdx136/4596536">Right Care</a>, within the NHS.&nbsp; Also present were Ian Forde from the OECD, who has written extensively on the euphemistically titled ‘universal health coverage’ for countries in South America - these involve considerable restrictions on care – as well as the WEF reports lead author, Tom Kibasi himself, though now acting as Chief Executive of the IPPR think tank. </p> <p>Any possibility of dissent was managed by corralling the union representatives, from Unite, Unison and the BMA, into one short session. Mark Britnell, Chairman of the Global Health Practice at KPMG, on the other hand, was offered a session all to himself, where he informed the Lords panel that he was “one of the 12 members of the World Economic Forum Health Council”. While Britnell’s oft-quoted and careless remark to a private equity conference that the NHS would be shown “no mercy” might have cost him his chance of the NHSE chief executive post, it’s clear he still has clout. </p> <p>Selection to the hearings is of course all-important, though the Lords give no indication as to how this was arrived at. Undoubtedly offering assistance in this process were two All Party Parliamentary Groups, the APPG on Health, and the APPG on Global Health. The first claims it “is dedicated to disseminating knowledge, generating debate and facilitating engagement with health issues amongst Members of both Houses of Parliament”. The Group also “comprises members of all political parties, it provides information with balance and impartiality and it focuses on local as well as national health issues. It is recognised as one of the preferred sources of information on health in Parliament”.</p> <p>Several of its Advisory Panel, such as Jennifer Dixon of the Health Foundation think tank, and Sir Cyril Chantler, formerly Chairman of Great Ormond Street Hospital, and now working with the Private Healthcare Information Network, were included in the Lords hearings, as well as organisational affiliates such as the NHS Confederation, the Kings Fund and Nuffield Trust. </p> <p>The APPG on Health’s current <a href="http://www.healthinparliament.org.uk/about-us/associate-membership">website</a> states that it “is supported by an Associate Membership of 14 of the UK's leading organisations working in the health sector”. This is misleading. <a href="https://www.parliament.uk/mps-lords-and-offices/standards-and-financial-interests/parliamentary-commissioner-for-standards/registers-of-interests/register-of-all-party-party-parliamentary-groups/">Business affiliates</a> from the past few years include the large conglomerates Abbott, Bristol Myers, Novartis, Merck, Takeda, Pfizer, Optum, Sanofi, and Novo Nordisk. These companies were present at both the WEF’s reports, some in both the Steering and Working Groups, as well as being heavily represented in the stakeholder forums.</p> <p>The APPG on Global Health on the other hand has a somewhat smaller corporate membership, though this does include the Bill Gates Foundation. Its members however number Lord Darzi, as well as the Lords Ribeiro and Kakkar who were among the dozen core members of the Lords inquiry, as well as its Chairman, Lord Patel. </p> <h2>A new era for Labour?</h2> <p>In June 2014, a <em>Health Service Journal</em> <a href="https://www.hsj.co.uk/comment/leader/public-concern-on-nhs-may-tempt-parties-to-undermine-its-future/5072506.article">editorial</a> welcomed what it regarded as a hard won consensus in healthcare policy, most notably towards care ‘integration’, reducing reliance on hospitals, and better use of technology. As an example of such a consensus it highlighted a commissioning conference held by the NHS Confederation to which shadow health secretary Andy Burnham had been invited to speak on health and social care integration but had to cancel at short notice. The former chair of the Commons Health Committee, the Conservative MP Stephen Dorrell was also invited to speak at the same session, and the HSJ noted “Mr Burnham’s office let it be known they were happy for the former Tory health secretary to reflect their view on the issue”. </p> <p>Perhaps one shouldn’t be too surprised. The Miliband-era 10 year vision for the health and social care system was unveiled in the offices of the Kings Fund, and drew extensively on a report – ‘One Person, One Team, One System’, otherwise known as the Oldham Report – that was <a href="https://www.theguardian.com/healthcare-network/2014/mar/12/people-power-labour-health-policy">largely scripted by PwC and KMPG</a> and project managed by Hugh Alderwick, on secondment from PwC.</p> <p>The labyrinthine details aside, it’s clear that the NHS has come under a sustained offensive from the transnational class. It’s important to note that the business fraction of this class will largely absent itself from overt decision-making channels, such as the House of Lords hearings, to continue the guise of accountability and neutrality. But within such channels the influence of this fraction is pervasive, and the consensus or ‘sustainable settlement’ sought by its supporters is entirely in its favour. However if John McDonnell is to be believed this new era of Labour policy promises something different: in particular a clear rejection of those adherents to a transnational agenda and a genuine pursuit of the wishes of its party member.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/nhs-boss-stevens-and-ttip-lobbyists">NHS boss Stevens and the TTIP &#039;trade&#039; lobbyists who threaten our NHS</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/only-article-about-leadership-campaign-i-ll-write">Labour leadership, the NHS, and &#039;honest politics&#039;</a> </div> <div class="field-item odd"> <a href="/ournhs/ournhs/nhs-campaigners-say-no-to-nhs-commission">NHS campaigners say &#039;No&#039; to NHS Commission </a> </div> <div class="field-item even"> <a href="/ournhs/caroline-lucas/why-i-have-removed-my-backing-for-nhs-commission">Why I have removed my backing for an NHS commission</a> </div> <div class="field-item odd"> <a href="/ournhs/stewart-player/accountable-care-american-import-thats-last-thing-englands-nhs-needs">&#039;Accountable Care&#039; - the American import that&#039;s the last thing England&#039;s NHS needs</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/you-can%27t-defeat-politics-of-fear-with-more-fear">Labour made the NHS both scary and boring</a> </div> <div class="field-item odd"> <a href="/ournhs/tamasin-cave/privatising-cabal-at-heart-of-our-nhs">The privatising cabal at the heart of our NHS</a> </div> <div class="field-item even"> <a href="/ournhs/ournhs/labours-new-health-ideas-will-they-rescue-nhs-from-organisational-dementia">Labour&#039;s new health ideas - will they rescue NHS from &#039;organisational dementia&#039;?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Stewart Player Wed, 17 Jan 2018 11:49:10 +0000 Stewart Player 115690 at https://www.opendemocracy.net Former health secretary Andrew Lansley’s diaries finally released in (nearly) full https://www.opendemocracy.net/ournhs/tamasin-cave/former-health-secretary-andrew-lansley-s-diaries-finally-released-in-nearly-full <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> Insurers and private US healthcare giants are revealed to be amongst those on the inside track of creating huge NHS changes. </div> </div> </div> <p class="BodyA"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/Andrew_Lansley,_October_2009_4.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/Andrew_Lansley,_October_2009_4.jpg" alt="" title="" width="460" height="306" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: The previous Conservative Health Secretary, Andrew Lansley. WikiCommons.</em></p><p class="BodyA">Here’s a belated Christmas present. The Andrew Lansley diaries.</p> <p class="BodyA">The journalist, Simon Lewis – who submitted the original freedom of information request to see the Health Secretary’s diaries from the period leading up to his NHS reforms – has kindly just sent them to me. They were released following a court ruling which the government <a href="https://www.theguardian.com/politics/2017/may/24/andrew-lansley-diary-simon-lewis-foi-request-court">lost </a>after spending tens of thousands of pounds over years trying to block their release.<strong></strong></p> <p class="BodyA">Don’t get too excited. It looks big – there are 181 pages of Lansley’s movements from May 2010 to April 2011 – but a lot of it is wrapping. And a few parts are missing. But there are some little gems inside. </p> <p class="BodyA">Having read the first third closely (the rest less so) one thing stands out immediately. </p> <p class="BodyA">Lansley was a busy man. You almost feel sorry for him. Seven am starts, 9pm finishes and a schedule that just seems exhausting. Except, you then remember what he was busy doing: causing <a href="https://www.ft.com/content/a2426282-9758-11e0-9c9d-00144feab49a">“the biggest car crash</a>” in the history of the NHS.</p> <p class="BodyA">What is equally striking, though, is that Lansley didn’t spend all of his first year as Health Secretary supping with the devil. </p> <p class="BodyA">He had some encounters with the private sector, but there are only traces of any dealings he had with the private health insurers; few obvious boozy lunches courtesy of the outsourcers; no mini-breaks on Branson’s island.</p> <p class="BodyA">What it is is a record of a man on a mission to get his reforms through. His days are spent with officials, advisors, ministerial colleagues and allies, on back-to-back ten-minute telephone calls and in half hour meetings.</p> <p class="BodyA"><strong>Day one in the job</strong></p> <p class="BodyA">On 12 May 2010, his first day in the job<strong>,</strong> Lansley called the head of the NHS Confederation, which represents a range of organisations involved in the NHS, including private healthcare companies (ahead of his colleague at the medicines regulator, NICE). He also managed to squeeze an interview with the <em>Daily Mail </em>into his first 24 hours.</p> <p class="BodyA">Similarly, on ministerial photo day, Lansley put a call in to the insurance industry’s chief lobbyist at the Association of British Insurers (ahead of the Welsh Health Minister).</p> <p class="BodyA">A couple of weeks into the job, Lansley sat down with the pharma lobby group, the Association of the British Pharmaceutical Industry. He also continued his ‘policy discussion’ with the NHS Confederation. </p> <p class="BodyA">This contact is pretty unexceptional and to be expected – though its alarming that the private insurers, to whom Lansley had been talking for years, were so favoured. There are, however, two meetings that are more revealing.</p> <p class="BodyA"><strong>Traces of</strong> <strong>McKinsey?</strong></p> <p class="BodyA">The first is a 90-minute internal meeting on 22 June 2010 in the boardroom of the Department’s Richmond House. The topic of discussion was ‘change management’ in the NHS. All the top brass were there: Lansley; David Nicholson, CEO of the NHS; the Department’s permanent secretary, Hugh Taylor; his soon-to-be replacement, Una O'Brien; Lansley’s private secretary, and other very senior DH officials. </p> <p class="BodyA">But joining them were Olly Benzecry, managing director of NHS contractors Accenture, and someone called Colin Price. I’m going to take a punt that this is Colin Price, then a McKinsey director whose expertise is in ‘change management’.</p> <p class="BodyA">This is the only hint in the diaries, though, at Lansley’s contact with McKinsey, which is surprising. We know from other documents I’ve received under FOI that Lansley sanctioned McKinsey’s involvement in the reforms. An email from an unnamed McKinsey employee to senior Department officials in January 2011 <a href="http://powerbase.info/index.php/McKinsey_&amp;_Company%23McKinsey_ready_to_.27dive_in_and_start_trying_to_help.27">reads</a>: “We now have SoS [Secretary of State, i.e. Lansley’s] approval for me to start working with you good folks again… I’d like to dive right in and start trying to help.” There’s no record of any corresponding conversation between Lansley and McKinsey in the diaries. </p> <p class="BodyA"><strong>The UnitedHealth crowd</strong></p> <p class="BodyA">The second of the diaries’ interesting meetings was held on 13 September 2010. Lansley gave 45 minutes to something called the Commissioning Services Industry Group. This is a significant group, dull as it sounds. Commissioning essentially means deciding who gets what health services and who provides them, the NHS or the private sector.<strong></strong></p> <p class="BodyA">Present at the meeting were Lansley, his special advisers, Nicholson and various officials. Among those representing the ‘industry’ was Kingsley Manning, then CEO of outsourcing firm, Tribal. Just weeks earlier, Manning had said that Lansley’s plans ‘could amount to the <a href="http://powerbase.info/index.php/Tribal_Group%23Helping_to_reform_the_NHS">denationalisation</a> of health care services in England’, which ‘could result in the biggest transfer of employment out of the public sector’ since Thatcher’s reforms. ‘The old certainties are gone,’ Manning said, ‘the NHS cannot be protected from economic reality any longer’. </p> <p class="BodyA">Also present were Vincent Sai, then heading up the UK arm of US health insurance giant, Aetna and Ramu Kannan, European MD of rival US insurer, Humana, both of which were seeking to provide NHS commissioning services. </p> <p class="BodyA">Taking up not one, but three seats in the meeting, though, were representatives of a third US health insurer, UnitedHealth. This is the largest private healthcare company in the world, with a revenue in 2016 of $184 billion. It is also the former employer of Simon Stevens, current head of the NHS. Present at the 2010 meeting were UnitedHealth’s chief lobbyist, Tony Sampson, who knew Stevens from when they worked together at the Department of Health in the early 2000s, as well as Katherine Ward, then CEO of UnitedHealth UK and its chair David Ostler.</p> <p class="BodyA">It is likely this group morphed into the <a href="https://www.theguardian.com/society/2014/aug/30/nhs-bosses-summits-contracts-unitedhealth-insurer">Commissioning Support Industry Group</a>. Coordinated by UnitedHealth, it now included McKinsey, PwC, KPMG, Ernst &amp; Young and Capita, but minus Aetna and Humana. From at least 2013, this group received regular briefings from senior health officials on the NHS commissioning market. </p> <p class="BodyA">Who controls NHS commissioning is now a significant concern, with GP groups stepping back and the private sector set to take over.</p> <p class="BodyA"><strong>Gastro-Lansley</strong></p> <p class="BodyA">From the diaries, we can also see that Lansley wasn’t confined to the office. As is common in politics (and lobbying), he also spent time in Westminster’s private members’ clubs and upmarket restaurants. By contrast, his office Christmas Party was snowball dough balls at Pizza Express. </p> <p class="BodyA"><em>Telegraph </em>editor, Ian MacGregor, took Lansley to lunch at Quirinale in September 2010 (although it’s not logged in his hospitality register, which could, possibly, mean that Lansley picked up the tab). </p> <p class="BodyA">A week before presenting the hugely unpopular Health &amp; Social Care Bill to Parliament, Lansley spent an hour and a half over lunch at a roundtable event hosted by the free market think tank, <a href="http://powerbase.info/index.php?title=Reform">Reform</a>, which had done much to champion his plans. The diary doesn’t say who else was round the table, but around that time, Reform was funded by the Association of British Insurers, General Healthcare Group, KPMG, Ernst &amp; Young, Capita, Serco and others with a commercial interest in the reforms. </p> <p class="BodyA">Less than three months later, on the day that Lansley was forced to tell Parliament that his reforms had to be ‘paused’ because of the public outcry, he chose to lick his wounds with unnamed ‘Lords’ at the Athenaeum private members’ club on Pall Mall. </p> <p class="BodyA">Lansley also attended party political events, such as the dinner at Conservative Party conference in 2010 when he sat on the table paid for by the lobbying firm, Hanover. It’s not known which of Hanover’s <a href="http://powerbase.info/index.php/Hanover_Communications">clients</a> at the time – UnitedHealth, Association of British Insurers, Circle Health, Alliance Medical, or American Pharmaceutical Group - were Hanover’s guests too. Neither do we know which Tory donors, some of whom have private healthcare interests, were present at the Conservative Party ‘Leaders Group Dinner’ Lansley attended on 2 March 2011.</p> <p class="BodyA"><strong>One piece of the jigsaw</strong></p> <p class="BodyA">The diaries contain plenty of gaps and redactions where other conversations could and, no doubt, did take place. It’s unlikely this is a faithful account of his working life in its entirety. </p> <p class="BodyA">For example, we know from another FOI release that Lansley was lobbied by a housing association group, which is partnered with one of the UK’s largest firms in telecare (providers of remote healthcare)<strong>,</strong> at an event in October 2010. There is no obvious sign of this in the ministerial diaries.</p> <p class="BodyA">A large number of meetings with Lansley also contain names that have been redacted (under section 40(2), which exempts ‘personal information’), such as the one on ‘reconfiguration‘ on 18 May 2010, and the discussion on the Health Bill on 26 October 2010. Other meetings will be personal, or political, in nature, which also legitimately exempts them. It is frustrating, though, to have incomplete attendee lists, and to not know who his mystery dinner guests were on 26 July 2010.</p> <p class="BodyA">We know too, from previous FOI releases received, that some major private operators that were actively courting Lansley were redirected to members of his team. Private hospital operator, General Healthcare Group, for example, was after a one-to-one with Lansley in June 2010. Its hired lobbyists, Instinctif Partners (then called College Group), and let Lansley’s office know that General Healthcare Group’s chair, Peter Gershon – at the time an <a href="https://www.theguardian.com/politics/2010/apr/07/general-election-tories-peter-gershon-nhs">adviser to David Cameron</a> on efficiency in government – would also tag along. Health minister Earl Howe declined on Lansley’s behalf, instead inviting the firm to meet with NHS chief David Nicholson, and separately, with junior health minister, Simon Burns, who was charged with ‘discussing the contribution of the independent sector’ to the NHS reforms. In October 2010 Burns met with the NHS Partners Network, which represents private healthcare, including General Healthcare Group.</p> <p class="BodyA">Other private companies made contact with the special adviser, Bill Morgan, as is usual. Serco, after seeking a meeting with Lansley, secured a slot with Morgan instead, having run into him at the Christmas party of the free market think tank, Policy Exchange. UnitedHealth’s lobbyist was also in contact with Morgan. You can even see McKinsey attempting to wangle a meeting with Morgan for someone (who, though, is redacted). Again, we know all this from previous FOI releases. </p> <p class="BodyA">It is sometimes opaque in the diary who Lansley is talking to. An entry on 28 February 2011, for example, has him meeting ‘AM’. It is only through Nicholas Timmins account of Lansley’s reforms, <em>Never Again?, </em>that we know this to be Alan Milburn, former Labour health minister and fellow advocate of markets in health who Lansley had approached with a job offer. </p> <p class="BodyA">The diaries, then, provide only another piece of the jigsaw that shows how the private sector sought to influence the government over its radical reforms.</p> <p class="BodyA"><strong>Things go south for Lansley</strong></p> <p class="BodyA">Early on as health secretary, Lansley had been trusted to get on with the job. You can see from the diaries that the Coalition government’s chief policy adviser, Oliver Letwin, who was coordinating across departments, had been checking in with the health secretary. There seems, though, to have been a disconnect between what Lansley was up to and what the government was saying he was up to. </p> <p class="BodyA">The Coalition’s ‘programme for government’, published just weeks after the 2010 election, pledged to ‘stop the top-down reorganisation of the NHS’. The day before this public promise was made, Lansley and officials were busy discussing the ‘RECONFIGURATION’ of the NHS.</p> <p class="BodyA">In early 2011, as opposition to the reforms exploded, the diaries detail the growing concern inside No10. On 23 March, Lansley is down to have a ‘drink with the PM’. The following day was a one-to-one with the Chancellor, George Osborne. No10’s communications chief, Craig Oliver starts appearing in meetings. Then on 31 March, as Timmins also documents, Lansley was summoned to No10 by Cameron and Deputy PM, Nick Clegg. He was informed that his plans for the NHS were to be ‘paused’ as a means of taking the heat out of the debate. Lansley, fittingly, visited a hospice that evening. </p> <p class="BodyA">The following Monday, Lansley was jeered as he announced the pause to Parliament. He must have been a barrel of laughs that evening at a reception for the Saudi health minister and his 18-strong entourage. On the Wednesday, flanked by Cameron and Clegg, he told the media he would ‘listen, reflect and improve’ his plans.</p> <p class="BodyA">There’s nothing in the diary until the following Wednesday, but from then on it’s clear that Lansley isn’t allowed out in public without the PM, DPM, or another ministerial chaperone.</p> <p class="BodyA"><strong>Trading places</strong></p> <p class="BodyA">All this was a long time ago. What’s interesting now, though, is where Lansley and his crew of ‘reformers’ have landed. As is the often the case, many have moved on to work for the private companies that sought to influence them and their successors. </p> <p class="BodyA">Bill Morgan, Lansley’s special adviser, for example, is now a commercial lobbyist. In late 2012, having been at Lansley’s side throughout, he returned to his former employer, lobbyists MHP, before setting up <a href="http://powerbase.info/index.php/Incisive_Health">Incisive Health</a>, an influential healthcare lobbying firm. Its clients today include NHS Partners Network, Virgin Care, the Association of the British Pharmaceutical Industry, as well as, curiously, the grassroots network, 38 Degrees. </p> <p class="BodyA">Sean Worth, No 10’s special adviser on health who was drafted in to help diffuse Lansley’s bomb, quit in summer 2012 for the lobbying industry and now runs his own firm, <a href="http://powerbase.info/index.php/Westminster_Policy_Institute">WPI Strategy</a> (clients unknown).</p> <p class="BodyA">Among the senior officials that feature heavily in the diaries: Jim Easton quit his job as a director at the Department to join healthcare provider, Care UK, which is among the biggest winners from Lansley’s reforms; colleague Ian Dalton went on to become health chief at BT, another beneficiary (he has since returned to the NHS); ex-NHS CEO, David Nicholson now works for, among others, KPMG; Sebastian Habibi, former deputy director at the Department is also now full-time at KPMG; Richard Douglas, the Department’s ex-head of finance is an advisor to Bill Morgan’s lobbying firm, Incisive Health. As is Mike Richards, ex-Chief Inspector of Hospitals, who also took on an advisory role with management consultants, PwC. It employs Alan Milburn too, and former regional NHS director Mike Farrar, who features in the diaries. Neil McKay, another regional director who attended meetings with the secretary of state, is now with consultants GE Finnamore.</p> <p class="BodyA">And then, of course, there’s Lansley himself. Since being removed from his job as health secretary, <a href="http://www.dailymail.co.uk/news/article-3320858/Should-not-work-Ex-Health-Secretary-Andrew-Lansley-defends-private-sector-jobs-including-advising-drugs-firm.html%23ixzz53XcNnPwI">he has been paid by</a>: Blackstone, the US private equity giant, which has significant healthcare interests; US management consultants, Bain, which <a href="https://www.buzzfeed.com/solomonhughes/andrew-lansley-takes-job-with-pro-nhs-privatisation-firm?utm_term=.mi5bmrrVM%23.heJbGooEa">advised clients</a> in 2013 that ‘what was traditionally locked up in the NHS is going to become available to the private sector’; pharmaceutical giant, Roche; and his wife’s consultancy, Low Associates, which provides ‘strategic policy’ advice to clients. All that and a seat in the House of Lords.</p> <p class="BodyA">It is no coincidence that all these people have found themselves employed by companies with an interest in healthcare policy. They are valuable in a market that trades in introductions and intelligence. They are a sign that, while Lansley’s term is over, his reforms have handed the private sector plenty of opportunities worth pursuing. </p> <p class="BodyA">The diaries don’t contain a smoking gun. This is a day-to-day account of a minister who was already persuaded. Instead, what we have is another glimpse of the real and more mundane world of lobbying: of networks, conferences, lunches, phone calls and, for some at least, a seat at the table.</p> <p class="BodyA"><em>Lansley’s diaries can be downloaded <a href="https://opendemocracy.net/files/170719 Lord Lansley Diary for Disclosure 20.7.17.PDF">here</a>. Let me know if you spot anything I’ve overlooked: <a href="https://twitter.com/CaveTamasin">@CaveTamasin</a>. This piece is co-published with <a href="https://badinfluence.net/">Bad Influence</a>.</em></p><div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Tamasin Cave Wed, 10 Jan 2018 13:42:47 +0000 Tamasin Cave 115594 at https://www.opendemocracy.net Privatised services are failing thousands of vulnerable addicts and alcoholics https://www.opendemocracy.net/ournhs/jon-ashworth/privatised-services-are-failing-thousands-of-vulnerable-addicts-and-alcoholics <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>It’s entirely unacceptable that people suffering from addiction are forced to turn to the inadequate private sector for treatment, writes shadow Health Secretary Jon Ashworth in the wake of a damning report by the regulator.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/empty%20bottles.jpg%21d" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/empty%20bottles.jpg%21d" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>The disgraceful failure by the private sector to provide vulnerable addicts with the safest and best quality treatment available was exposed at the end of last month in a <a href="https://www.cqc.org.uk/news/releases/serious-concerns-uncovered-residential-detox-clinics-regulator-demands-improvements">damning report issued by the Care Quality Commission (CQC)</a>.</p><p>72% of private providers of residential-based detoxification were found to have been failing in at least one of the fundamental standards of care that everyone has a right to receive. Shamefully, providing ‘safe care and treatment’ was where the CQC found the most breaches: 63% of providers failed to meet this standard at the time of their first inspection.</p> <p>Detoxification under clinical supervision is often the first stage of a person’s addiction treatment. Often difficult and unpleasant, it is vital that they receive the best possible treatment to support their onward rehabilitation and recovery.</p> <p>And yet systemic faults were found in the way these services are provided by the private sector. Many were basic and entirely avoidable errors.</p> <p>For example, some staff were caught giving paracetamol to people within their care more frequently than every four hours, despite the heightened risk of liver damage among heavy alcohol users. In other cases, staff failed to plan how they would manage fits during withdrawal, despite knowing that the people in their care were at risk of having seizures. </p> <p>Training in basic life support, consent, mental capacity and safeguarding were all found to be severely lacking. At times staff were found to be administering medication, including controlled drugs like methadone, without the appropriate training or being assessed as competent to do so.</p> <p>This is extremely serious. People undergoing residential-based medical detoxification from alcohol or drugs often have complex physical and mental health problems alongside their addictions. According to the Royal College of Psychiatrists, the potential dangers of erroneous detoxification include fits and hallucinations, suicide risk and risk of prescription opiate drug overdose. </p> <p>That’s why it is essential staff looking after these vulnerable patients are properly trained, follow national clinical guidelines and have appropriate 24-hour medical cover.</p> <p>So what explains this appalling failure?</p> <p>My own research in September revealed that the Tories have cut vital alcohol and drug treatment programmes by £43 million this year, forcing many people to turn to the independent sector for help. These cuts are part of wider damaging public health cuts, to the tune of £800 million by 2021.</p> <p>Specifically, 106 local authorities are reducing their drug treatment and prevention budgets this year, with a combined cut across England of £28.4 million. Similarly, 95 local authorities are reducing their alcohol treatment and prevention budgets this year by a total of £6.5 million. Equally concerning, services for children needing help with drink and drugs will be slashed by £8.3m across 70 town halls.</p> <p>Last month the Children’s Society revealed that parent’s alcohol abuse is damaging the lives of 700,000 teenagers across the UK. Frustratingly, at a time when demand for councils’ children’s services is rising, severe funding cuts from central Government are leaving more and more families to deal with these huge problems alone. </p> <p>Yet without support at an early stage as problems emerge, families can quickly reach crisis point and the risks for the children involved grow. </p> <p>The children of addicts must not be forgotten and supporting them is a personal priority of mine. Having grown up with an alcoholic father, I’m acutely aware that as a society we simply aren’t doing enough to deal with the effects of addiction.</p> <p>We know that children growing up with an alcoholic parent can often themselves go on to develop problems with alcohol or drugs or suffer mental health problems.</p> <p>That’s why during our party conference I reiterated my pledge to implement the first ever national strategy to support children of alcoholics and drug users. </p> <p>We also mustn’t ignore other forms of serious addiction. My colleague Tom Watson, Labour’s Deputy Leader, has powerfully exposed the Government’s abject failure to treat problem gamblers. </p> <p>According to the Gambling Commission the <a href="https://inews.co.uk/news/uk/gibraltar-liberia-online-gambling-generates-billions-revenue-real-winners/">number of people with a serious habit has risen to 430,000</a>, with a further 1.6 million at risk of developing a problem.</p> <p>And yet, shockingly, the government has no idea how many problems gamblers are being treated by the NHS or how much their addiction is costing. Like alcohol and drug addiction, we must start viewing gambling addiction as a mental health problem and not a moral failing. </p> <p>Theresa May’s mishandling of Brexit and her narrow majority in the Commons has left her with little ability or inclination to tackle these ‘burning injustices’ across society. Addiction treatment services have unquestionably suffered as a result.</p> <p>Forcing people to turn to inadequate private sector treatment is entirely unacceptable. That’s why Labour will continue the fight to ensure our health and care system, including addiction services, remains public, free at the point of use and there for all who need it.&nbsp;</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/steve-topple/alcoholism-nhs-and-political-hypocrisy">Alcoholism, the NHS, and political hypocrisy</a> </div> <div class="field-item even"> <a href="/5050/leo-barasi/addiction-social-stigma-and-barriers-to-recovery">Addiction, social stigma and the barriers to recovery</a> </div> <div class="field-item odd"> <a href="/transformation/tommy-ellis/why-shouldnt-heroin-addicts-be-punished">Why shouldn&#039;t heroin addicts be punished?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Jon Ashworth Fri, 15 Dec 2017 07:59:00 +0000 Jon Ashworth 115334 at https://www.opendemocracy.net Brexit isn't the only thing parliament needs to demand a vote on right now - the NHS is too https://www.opendemocracy.net/ournhs/ellen-lees/brexit-isnt-only-thing-parliament-needs-to-demand-vote-on-right-now-nhs-is-too <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>In January, Jeremy Hunt will attempt to sneak through secondary regulations, without parliamentary debate, what some have called the ‘biggest change to the NHS since its creation. Do enough MPs care enough to stop him?</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/jeremy-hunt-parliament.png" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/jeremy-hunt-parliament.png" alt="" title="" width="460" height="294" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>Jeremy Hunt is trying to sneak through legal changes that will fundamentally change the NHS - with no scrutiny and no debate.</p> <p>So, no surprise there. </p> <p>The next step for Jeremy Hunt’s plans to overhaul the NHS is the introduction of Accountable Care Organisations (ACOs). ACOs are the latest incarnation of other controversial NHS plans that have been cooked up since Cameron’s infamous 2012 Health &amp; Social Care Act meant the government had less responsibility to secure comprehensive, universal healthcare. Leading <a href="https://healthcampaignstogether.com/pdf/The%20case%20of%20the%20missing%20evidence%20-%20STPs%20and%20Five%20Year%20Forward%20View-2.pdf">campaigners</a>, <a href="https://twitter.com/nhsbillnow/status/935891847045672960">doctors</a> and <a href="https://opendemocracy.net/ournhs/stewart-player/accountable-care-american-import-thats-last-thing-englands-nhs-needs">journalists</a> have scrutinised these latest plans and found them both vague and alarming. In the words of <a href="https://twitter.com/carolinejmolloy/status/939586692310237184">this site’s editor</a>, these so-called Accountable Care Organisations “aren’t accountable, and they don’t really care”.</p> <p>The ACOs (which aren’t, legally, accountable public/NHS organisations) are being “put in charge of allocating resources”, according to leading health campaigner Professor Allyson Pollock – with private ‘partners’ having larger contracts and more and more of a role in decision making, it seems. Kailash Chand of the BMA has also <a href="https://twitter.com/Momentum_NHS/status/938007245404672000">said</a> ACOs are a ‘trojan horse’ for privatisation – particularly as they talk of ‘integrating’ payment systems for both health and social care without addressing the fact that <em>social</em> care has already been mostly privatised. Chand has also warned that GPs “will no longer be independent advocates for their patients” under this new system of outsourced decision making.</p> <p>We now know that Hunt plans to change 10 pieces of secondary legislation to make it possible to create ACOs. The shape of these legal changes will inform what ACOs look like, and whether they are indeed accountable, or if they will pave the way for mass privatisation of NHS services. </p> <p>There is no current plan to allow MPs to debate these changes in Parliament. Jeremy Hunt plans to push these changes through with absolutely no scrutiny from MPs. </p> <p>We need MPs to scrutinise ACOs because of the potential they have to damage the NHS. Some have suggested that there may be a way to introduce ACOs in a way that doesn’t encourage or allow privatisation, and which integrates primary and secondary NHS services. But the evidence is scanty – and there is the sizeable risk that ACOs will be vehicles for large scale privatisation by healthcare organisations like Kaiser Permanente. They are, after all, based on an American system of healthcare organisation – and Michael Moore’s devastating film Sicko exposed how ‘Accountable Care’ in the US means denial of care, and how ‘prevention’ means making it hard for patients to access hospitals. </p> <p>So, it couldn’t be more important that MPs get a say in how ACOs are implemented.</p> <p>Jonathan Ashworth has tabled EDM 660 to gather support in Parliament from MPs for a debate on ACOs. He has written to Andrea Leadsom, the leader of the House of Commons, to ask her to call a debate. At the time of writing, 59 MPs have signed EDM 660, but we need many more.</p> <p>We’ve set up a tool to let you email your MP and ask them to sign the EDM. Over 8,000 emails have been sent so far, and nearly every MP has received at least one email, but more pressure is needed! <a href="https://weownit.org.uk/act-now/demand-debate-nhs-privatisation">Take action here</a> by entering your postcode.</p> <p>The more MPs sign EDM 660, the more pressure will be put on the leader of the House of Commons to allow a debate. This EDM is different to most, in that it can be signed by ministers and shadow ministers. Usually ministers stay away from EDMs, but this one was tabled by Jeremy Corbyn and members of his shadow cabinet team, so all MPs are encouraged to sign. </p> <p>It’s not exclusive to Labour MPs either! SNP MPs have signed (even though ACOs are unlikely to <em>directly</em> affect the Scottish NHS, <a href="https://opendemocracy.net/ournhs/caroline-molloy/vote-yes-for-nhs-independence-is-best-chance-to-protect-scotland%27s-nhs">they may well affect it indirectly</a>) as has Green MP Caroline Lucas. Conservative MPs are unlikely to sign an EDM sponsored by the leader of the opposition, although some with a regard for due process might be able to sign it... Regardless, Conservative MPs should certainly be encouraged to write to Andrea Leadsom and ask for a debate. They will be much more influential than letters from Labour MPs.</p> <p>Are Conservatives interested in ensuring that Parliament gets a say on the future of the NHS?</p> <p>This is urgent – we’ve only got a few days to make sure MPs get a say on the future of the NHS. The changes are set to go through in January, and with the Christmas holidays on the horizon, Parliament is running out of time to schedule a debate. <a href="https://weownit.org.uk/act-now/demand-debate-nhs-privatisation">Email your MP now</a>.</p> <p><em>Additional reporting by Caroline Molloy</em></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/stewart-player/accountable-care-american-import-thats-last-thing-englands-nhs-needs">&#039;Accountable Care&#039; - the American import that&#039;s the last thing England&#039;s NHS needs</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/jeremy-hunt-considers-banning-patients-from-walking-up-to-aes">Jeremy Hunt considers banning patients from walking up to A&amp;Es</a> </div> <div class="field-item odd"> <a href="/ournhs/jenny-shepherd/are-plans-to-move-nhs-into-community-wolf-in-sheeps-clothing">Are plans to move the NHS &#039;into the community&#039;, a wolf in sheep&#039;s clothing?</a> </div> <div class="field-item even"> <a href="/ournhs/allyson-pollock/why-next-labour-manifesto-must-pledge-to-legislate-to-reinstate-nhs">Why the next Labour Manifesto must pledge to legislate to reinstate the NHS</a> </div> <div class="field-item odd"> <a href="/ournhs/john-lister/if-our-government-won-t-act-to-save-our-nhs-then-we-must">If our government won’t act to save our NHS this winter, this is what we must do</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Ellen Lees Thu, 14 Dec 2017 08:33:36 +0000 Ellen Lees 115310 at https://www.opendemocracy.net ‘GP at hand’: handy for whom? https://www.opendemocracy.net/ournhs/david-mccoy-lewis-hier-thomas/gp-at-hand-handy-for-whom <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>New technology should be managed for the benefit of all – not used to allow profit-hungry firms to cherry-pick healthy patients.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/smartphone.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/smartphone.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: <a href="https://www.pexels.com/photo/iphone-technology-iphone-6-plus-apple-17663/">Adrianna Calvo/Pexels</a>.</em></p><p>A new initiative for a private company to deliver NHS care in London was launched last month. Catchily titled <a href="https://www.gpathand.nhs.uk/"><em>GP at hand</em></a><em>, </em>it promises access to your GP remotely through a video consultation from your hand-held smartphone or tablet. It guarantees a same-day appointment; but if you need to see a health professional in the flesh, you can go to one of six clinics located in London.</p> <p><em>GP at hand </em>is run by Babylon Healthcare Services Limited, a commercial outfit that can be traced back to a <a href="https://beta.companieshouse.gov.uk/company/09229684/filing-history">holding company in Jersey</a>. Heading up Babylon is Ali Parsa, ex-Goldman Sachs banker and former Chief Executive of Circle, the company at the heart of the failed experiment to privatise the management of Hinchingbrooke Hospital near Cambridge, and which resulted in <a href="https://www.theguardian.com/society/2014/sep/26/care-quality-commission-hinchingbrooke-hospital">compromised patient care</a> and<a href="https://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news/report-circle-withdrawal-from-hinchingbrooke-hospital/"> a costly bill</a> for the taxpayer. <a href="http://uk.businessinsider.com/deepmind-cofounders-invest-in-babylon-health-2016-1">Amongst Babylon’s investors is Demis Hassabis</a>, founder of the <a href="http://www.deepmind.com/">DeepMind</a> company which was recently caught up in a controversy with the Royal Free NHS Trust over <a href="http://www.bbc.co.uk/news/technology-39301901">concerns about inadequate protection of patient data</a>. </p> <p>Patients will register with <em>GP at hand</em> as their GP practice. Every patient registered will come with an allocation of public money that will effectively be the payment to <em>GP at hand</em> for providing NHS primary care. </p> <p>This allocation of money per registered individual is one of the main ways that GP practices are funded, and is often called a capitation fee. The fee is set by the Department of Health, and adjusted for individual practices to accommodate factors such as the estimated level of disease burden and socio-economic deprivation of a GP practice’s patient list. </p> <p>The way <a href="https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/commissioning-and-funding-general-practice-kingsfund-feb14.pdf">GP practices are funded</a> is actually more complex. For example, they are also paid for achieving certain targets, or providing additional specialised services. However, a key feature of the funding model is that budgets are set for populations, rather than individuals. Thus, the capitation fee of all individuals on a GP practice list is combined into a single (and larger) budget that is used to plan and provide services. </p> <p>Traditionally, the practice list is made up of a mix of people (old and young, healthy and unwell) who live nearby. Such a system affirms two key traditional principles of the NHS. Firstly, that NHS funding is pooled to allow the healthy to subsidise the costs of treating those who fall sick or are injured. Secondly, that healthcare services are organised around geographic areas to enable better integration and coordination with local hospitals and local authority services.</p> <p><em>GP at hand</em> is set to undermine this model of primary care. It is looking to register patients who live or work within anywhere within 35-40 minutes of one of the clinics - either home or work, provided they are happy to see their doctor remotely by video and willing to travel to one of six clinics in London should they need a physical consultation. One way that private companies maximise their profits is to seek to ‘cherry pick’ low-cost patients who are generally healthy and young while excluding patients with complex needs who will need higher levels of care. This <a href="https://www.theguardian.com/society/2017/nov/06/gp-smartphone-service-risks-luring-frontline-practice">concern was raised by the Chair of the Royal College of GPs, Helen Stokes-Lampard</a>, who said in response to the launch of <em>GP at hand </em>that “we are really worried that schemes like this are creating a twin-track approach to NHS general practice and that patients are being ‘cherry-picked”. Indeed, its<em> </em>own promotional material <a href="https://support.gpathand.nhs.uk/hc/en-us/articles/115003670889-Can-anyone-register-">discourages</a> older people, pregnant women and anyone with ‘complex’ social, physical and psychological needs from registering, noting that the NHS feels these groups would be "less appropriate" for the service.</p> <p>It’s not hard to see how this cleaving of populations between those who are relatively young and healthy and those who may need physical consultations, home visits or urgent treatment could result in a widening of inequities. A divide will also be created between companies like <em>GP at hand</em> who will run a profit driven system of care for selected clients, and traditional GP practices who will remain committed to the principle of holistic and integrated care <em>for all</em> in their local community. </p> <p>In theory, the fee paid to <em>GP at hand</em> could be reduced to reflect their younger and healthier client list. Currently, we don’t know what fees and payments <em>GP at hand</em> is getting from the NHS. However, we do know that the setting of more specific risk-adjusted capitation fees would be complex and costly. We also know that for-profit companies will be expected to game the system<strong> </strong>in their favour, and that attempts to regulate such behaviour will add further costs for the taxpayer (with no guarantee of success).</p> <p><em>GP at hand</em> is perhaps the logical extension of controversial changes made in 2013 which allowed individuals to register with GP practices outside the local area of their home, such as where they work. Although ‘commuter practices’ and ‘electronic practices’ like <em>GP at hand</em> might be more convenient for some individuals, they can diminish the efficiency of the health<em> </em>system as a whole. </p> <p>This is not to say that we should deny or ignore developments in information technology and artificial intelligence. The ‘digital health revolution’ has the potential to improve healthcare, including for the frail, elderly and chronically unwell. And one can argue that new technologies <em>should</em> be disruptive of old models of service provision.</p> <p>But technological disruptions should also be socially managed to avoid unwanted effects or inadvertent harms. They should also be harnessed to improve the quality of the healthcare system <em>as a whole</em> and <em>for everyone</em>, not just cheapen the cost of delivering care. And they should not be a Trojan Horse for private capital to exploit the NHS and undermine those features that make it fair, trusted and hugely respected across the world.</p> <p>The NHS should work with private digital companies. But not through this particular model of primary care, and perhaps not with a company that can be traced back to a holding company based in Jersey and to the <a href="https://www.opendemocracy.net/ournhs/caroline-molloy/hinchingbrooke-why-did-england%27s-privatised-hospital-deal-really-collapse">Hinchingbrooke debacle</a>. </p> <p><em>Editors note:</em></p> <p>openDemocracy asked Babylon for a statement responding to the concerns raised in the piece. They responded that “Babylon’s mission is to put accessible and affordable healthcare in the hands of every person on earth” and that they were “leading the way in using technology to make it more accessible to all”, adding ''This new NHS service makes it&nbsp;easier for patients to see a doctor&nbsp;quickly&nbsp;at anytime and&nbsp;from&nbsp;anywhere and&nbsp;doesn’t cost the NHS a penny more.&nbsp;It’s a win&nbsp;win.”</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/shibley-rahman/247-transparent-nhs-%E2%80%93-or-rise-of-planet-of-apps">A 24/7, transparent NHS – or the rise of the planet of the apps?</a> </div> <div class="field-item even"> <a href="/ournhs/alex-nunns/hinchingbrooke-how-disastrous-privatisation-duped-political-class">Hinchingbrooke - how a disastrous privatisation duped the political class</a> </div> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/hinchingbrooke-why-did-england%27s-privatised-hospital-deal-really-collapse">Hinchingbrooke - why did England&#039;s privatised hospital deal REALLY collapse?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Lewis Hier Thomas David McCoy Fri, 01 Dec 2017 12:00:00 +0000 David McCoy and Lewis Hier Thomas 114924 at https://www.opendemocracy.net We survive - but AIDS is not over - a BANG BUS special https://www.opendemocracy.net/uk/ash-kotak/we-survive-but-aids-is-not-over-bang-bus-special <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>AIDS is not over – not for the millions still being infected both at home and globally, nor for those of us still living with the consequences of infection, survival and harsh early treatments. We need both actions and memorial.</p> </div> </div> </div> <p class="Body"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/Bang Bus World AIDS Day Special - Miqx - ACT UP LONDON.png" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/Bang Bus World AIDS Day Special - Miqx - ACT UP LONDON.png" alt="" title="" width="460" height="302" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Bang Bus tour, 25th November 2017, by Holly Buckle.</em></p><p class="Body">Last weekend the BANG BUS - World AIDS Day Special bought together a group of creatives, medical staff and HIV activists in a theatrical bus-tour of London’s fight against HIV/AIDS.</p> <p class="Body">As well as remembering the struggle, the past actions and slogans and our key turning points – and demanding a memorial as so many other countries have built – we also reminded onlookers that AIDS is Not Over, and warned the government “Don’t F*** with our NHS”. <em>&nbsp;</em><em></em></p> <p class="Body"><strong>AIDS is Not Over</strong><strong></strong></p> <p class="Body">The majority of the 104,000 plus people living with HIV in the U.K. now live near normal lives. Yet <em>AIDS is Not Over. </em>&nbsp;</p> <p class="Body">Last year’s figures are startling: Over 1 million people died of AIDS worldwide, according to the Bloomsbury Clinic HIV unit/UCL. Five thousand people died in the USA alone (where only 30% of positive people access medications). There were over a million new infections, taking the number living with HIV worldwide to over 38 million people - a staggering 53% of whom cannot access life-saving treatment. </p> <p class="Body">AIDS remains a political choice, a syndrome that kills the poor and women worldwide (51% of all cases are in women). Some gay men in the Western world speak of the end of AIDS and a post-AIDS world. It seems to be a rather ‘I’m okay Jack’ attitude: “We have our meds; we will survive Gloria and so it’s business as usual”. Figures from other London clinics such as 56 Dean Street show that new infections in the U.K. for white gay men have fallen dramatically over the last couple of years. But in the UK, they are not falling dramatically amongst black and ethnic minority men (both gay and straight) or the trans community, and amongst women the figures rose. </p> <p class="Body">Forgotten too are us long-term survivors. Many of us live without savings or pensions. Our disability benefits – our lifeline - are being stolen in the government’s inhumane ‘austerity’ drive. We suffer from the inadequacies of the early medications – before the 1996 medical miracle of combination therapy - and their long-term side effects such as exhaustion, depression, lipodystrophy (muscle wasting and localised loss of fat tissue) and now cancers. And we are developing age-related new conditions - the majority of people living with HIV in the UK are now over 50. &nbsp;</p> <p class="Body">We were meant to die, many of us were on the verge of death and we survived only to be now attacked, once more by an indifferent Britain of 2017. &nbsp;</p> <p class="Body">Then there is the PTSD and other mental health issues caused by being told at a young age there was little hope. &nbsp;We cared for so many loved and still remembered friends, rehearsing our fates as they died terrible deaths. Then against all odds, we survived. We are scarred not just by the plague and its early treatments, but by guilt - ‘how did I survive when my friends are dead?’. And shame remains an issue. &nbsp;The morality police, mimicking the grotesque newspaper headlines of the 1980s and 1990s, remain a constant added pressure. </p> <p class="Body"><strong>Stigma</strong><strong></strong></p> <p class="Body">Prejudice is the overriding blindness of HIV/AIDS, a dark smog over the world. Guilt relates to others (our dead friends), whilst shame completely invades the self, stemming from an ever present sultry stigma. &nbsp;It has shown the failings of us as human beings and of our huge collective fear of death. It has led to the destruction of love and loving relationships and to an unbearable loneliness of HIV positive people, a huge killer in itself. &nbsp;Stigma is especially bad from the same communities which bore the brunt of AIDS. Just ask any positive gay man in the UK or those from the black and minority ethnic communities. &nbsp;Of course there are many enlightened soldiers who fought and continue to fight with us, but it still feels like a continuous civil war.</p> <p class="Body">Over 30 years since the effective/shocking 1986 <em>Don’t Die of Ignorance</em> Campaign, its fearmongering message still prevails and its evocations are remembered: a volcano erupting (in Britain!); a tombstone being chiselled sounding like a pressing death knell (on display now at the Wellcome Collection, London). Above all the immortal voice of John Hurt’s warning “a danger that has become a threat to us all.” </p> <p class="Body">I produced a short film in 1987 which John starred in not long after he did the advert. It won many awards and we remained friends, often meeting for drinks in the infamous Coach and Horses in Soho, London. Overt homophobia and racism were ever present in those days, living in ‘sin’ was not the norm and underage sex was ignored. A mutual drinking buddy, an actor, had suddenly died of AIDS in 1988 and it all became very real to us. John Hurt declared, for all to hear, “I wish I’d never done that bloody ad”. Showbiz was being hit hard, and the media-fuelled cruelty shown by our fellow Britons towards the severely ill was soul-destroying. </p> <p class="Body">In September 1993 I disclosed to John I had been diagnosed after having been raped (not that it matters how one acquires HIV, but male-male rape is an issue we still barely recognise). I was too scared to report it; I was young, drunk and looking for love in very hostile times, and carried the additional burden of coming from a community that was pushing me to marry for the sake of the family name. John bought me a drink. He told me that it will make me look at who are important in my life, what I value and it will focus me on what matters. He always knew what to say. I reminded him of what he had said about the tombs and volcano advert. “Did I say that!” he answered in his well recognised voice. </p> <p class="Body">Two years later, in 1995, my partner died and an ex-lover soon after and too many close friends; death was all around. I was not even 30; in retrospect life became more urgent, dancing beside death and his gloomy game with life. We danced a lot in those days - often at Trade after funeral after funeral. &nbsp;</p> <p class="Body"><strong>Turning Points</strong> </p> <p class="Body">Today with the availability of <em>PREP</em> (a pill taken prior to sex to stop the transmission of HIV) and <em>PEP</em> (a combination of pills to stop HIV taking hold after unsafe sex or rape), we now have the tools to stop the spread of HIV. Also it is now generally accepted that U=U – i.e. that Undetectable equals Untransmittable/Uninfective. In other words, anyone who is on treatment for HIV and has reached an undetectable viral load status in their blood, cannot pass on HIV. Undetectable is the new negative.</p> <p class="Body">Between September 2010 and May 2014, the PARTNER study monitored 1166 sero-different couples at 75 clinical sites in 14 European countries. Entry criteria included the positive partner having an undetectable viral load on treatment and that the couples were not always using condoms when they had sex. After at least 58,000 distinct times when couples had penetrative sex without condoms there were zero transmissions of HIV from the undetectable partner to the negative partner. It is a turning point. </p> <p class="Body"><strong>Fast-Track - Ending the AIDS epidemic by 2030</strong><strong></strong></p> <p class="Body">The Executive Director of UNAIDS, Michel Sidibé gave a stark warning only one year ago “The progress we have made is remarkable, particularly around treatment, but it is also incredibly fragile. New threats are emerging and if we do not act now we risk resurgence and resistance. We have seen this with TB. We must not make the same mistakes again.” There is an international fast-track strategy in place to end the spread of the AIDS pandemic by 2030 set by UNAIDS. But none of the UK political parties are doing enough about it – as has long been the case.</p> <p class="Body"><strong>Save the NHS</strong><strong></strong></p> <p class="Body">So what are these new threats? </p> <p class="Body">Another BANG BUS theme was <em>Don’t F*** with the NHS</em>. Each year in the UK too many people needlessly die of AIDS as they test too late. NHS HIV specialist services are vital to ensure that treatment is adhered to and new infections are caught early. </p> <p class="Body">A pilot scheme at London’s King’s College Hospital A&amp;E, where routine HIV tests were taken, found 32 people unknowingly carrying the virus. They are lucky that they were caught early. This scheme must be expanded throughout the UK. </p> <p class="Body">The growing threat of drug-resistance needs to be taken far more seriously. Other challenges are the mental health issues connected to contracting a once life-threatening virus, which can lead to suicide, drug taking and alcoholism and poor medicine adherence. Chemsex (when people take drugs that enhance sex and make them feel uninhibited) is a huge issue for gay men in metropolitan areas in the Western World and needs to be treated without prejudice. There is also the growing threat of co-morbidity factors, as the HIV population ages, and a resultant medical interaction situation.</p> <p class="Body"><strong>#AidsMemoryUK Campaign </strong><strong></strong></p> <p class="Body">The final theme of the Bang Bus was the need of <em>a National AIDS Tribute in London - </em>the city which was home to the most people who died of AIDS in the UK and from where the early response against the battle was directed from. Having won many battles, a lot of us need closure and a place to focus our memories and our bereavements. </p> <p class="Body">AIDS was, and continues to be, the major health issue of the latter 20th and early 21st centuries, killing 35 million people worldwide, so far. Many countries have national memorials including the USA, most EU countries, South Africa, Brazil, Russia, Belarus and the Ukraine. But the UK lags behind. AIDS is part of the UK’s history, it changed how we looked at ourselves as a nation. It is a triumphant example of how people came together often with contradictory value systems and overcame their own prejudices to fight together. It is an important message to remember.</p> <p class="Body">On the BANG BUS, different communities of all ages, classes, sexualities, genders, races, politics, religions, positive, undetectable and negative shouted AIDS is Not Over, Don’t F*** with the NHS and Support the AidsMemoryUK Campaign. We demanded that our memories and pain are memorialised. We demand that 38 million people have access to HIV medications. </p> <p class="Body">Activists from ACT UP London carried their own wounds, their memories, and their gallantry awards on foot, in heels, in wheelchairs, with walking sticks and leg braces to say we are still here, we survived, we must never forget.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/5050/jane-shepherd/rhetoric-meets-reality-debating-hiv-and-aids">Rhetoric meets reality: ending HIV and AIDS</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> uk uk ourNHS Ash Kotak Fri, 01 Dec 2017 08:54:06 +0000 Ash Kotak 115001 at https://www.opendemocracy.net Connor Sparrowhawk: How one boy’s death in NHS care inspired a movement for justice https://www.opendemocracy.net/shinealight/shinealight/sara-ryan-clare-sambrook/connor-sparrowhawk-justiceforLB <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <ul><li>The story of a UK campaign for truth and accountability. And respect for the lives of people who have learning disabilities. Review by Clare Sambrook. Extract by Sara Ryan.</li></ul> </div> </div> </div> <p style="text-align: center;"><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/Ryan_Sara.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Sara Ryan"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/Ryan_Sara.jpg" alt="" title="Sara Ryan" width="460" height="376" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'><span class='image_title'>‘What has Steve Wright got, Mum?’ he asked. ‘DJitis,’ I said. Sara Ryan (Rich Huggins)</span></span></span></p><hr /><p>&nbsp;</p><h2><a href="http://www.jkp.com/uk/justice-for-laughing-boy-2.html"><em>Justice for Laughing Boy: Connor Sparrowhawk – &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;A Death by Indifference</em>, by Sara Ryan</a></h2><h2>Review by Clare Sambrook</h2> <p>Sara Ryan began a blog six years ago, “mostly to document the funny stories that happened in our everyday lives.” Called <a href="https://mydaftlife.com">mydaftlife</a>, it’s a warm and funny read. Ryan has an ear for dialogue, a photographer’s eye —&nbsp;and she’s a nifty swearer. Star of the show is her son Connor, his quirky take on life. One of five children, they call him Laughing Boy, LB for short. He loves lorries, buses, coaches, London, Eddie Stobart, and the family’s Jack Russell, Chunky Stan. </p> <p>Connor is 15 when the blog starts. Here’s a conversation:</p> <ul><li>‘Hey LB! How did meal prep go today?’</li><li>‘Not good, Mum.’</li><li>‘Oh. Why not?’</li><li>‘I failed, Mum.’</li><li>‘Whaddayamean, you failed?’</li><li>‘I failed, Mum.’</li><li>‘Why? What did you cook?’</li><li>‘Kebabs, Mum.’</li><li>‘Oh. I don’t get it. What went wrong?’</li><li>‘I didn’t have a skewer, Mum.’</li><li>‘Oh. Why not?’</li><li>‘Dunno, Mum.’</li><li>‘So what did you eat for lunch?’</li><li>‘Bits, Mum.’</li></ul> <p>Connor has autism, learning difficulties, epilepsy. He’s nearing 18 and the prospect of leaving school, the people he knows and likes, when the story darkens. An early encounter with adult social care comes with a manager’s humourless remark: “I am his future.”</p> <p>At home and at school Connor becomes anxious, unhappy, unpredictable, unlike himself. Things come to a head when he punches Big Sue, his beloved support teacher. The family, at their wit’s end, learn that there’s an NHS unit close by that can help. It’s a Short Term Assessment and Treatment Unit (STATT, for short), a mile or two from their Oxford home. It’s called Slade House and run by Southern Health NHS Foundation Trust. There a team of learning disability specialists —&nbsp;psychiatrists, psychologists, occupational therapists, nurses —&nbsp;will keep Connor safe, take a few weeks to assess him, work out the cause of his distress.</p> <p>Connor is admitted one night in March 2013. The next morning, in the early hours, he is forcibly restrained by four staff, pinned face-down. Says Ryan: “That was the day he stopped being a sixth former.”</p> <p>Weeks pass. Connor loses weight. One morning, fifteen weeks and two days after his admission, Connor (he has epilepsy, remember) is left alone, behind a locked door, out of earshot, in a steep-sided bath. He has a seizure. And he drowns.</p> <p>His <a href="https://mydaftlife.com">mother’s blog</a>, and now her book, tells this story and its brutal aftermath, as Connor’s family tries to find out what exactly happened to him, how on earth it <em>can</em> have happened at all. </p><p> <span class='wysiwyg_imageupload image imgupl_floating_left 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/Ryan_Justice640.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/Ryan_Justice640.jpg" alt="" title="" width="240" height="363" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_medium" style=""/></a> <span class='image_meta'></span></span></p><p><a href="https://www.inquest.org.uk/family-campaigns">Other families</a> bereaved by state neglect and wrongdoing might find their own experience reflected here: the “indescribable terror”, the pain and struggle, being blocked and bewildered by official lying and contempt. The bullying and the bruising, the character attack, the surveillance, the accusation that <em>you&nbsp;</em>are the problem. </p><p>The waiting. </p><p>And the inequality of arms. About the early days, Ryan writes: “We had no idea how uneven the ‘playing field’ was in a game we didn’t yet understand we were playing.”</p> <p>Ryan’s craft —&nbsp;she is a Senior Research Lead at Oxford University —&nbsp;serves the fight.<strong> </strong>Her partner Richard Huggins is an academic too. Their #JusticeforLB campaign, supported by family, friends, and the charity INQUEST, forces the exposure of negligence and incompetence on a scale that is hard to comprehend. </p> <p>It turns out that seven years <em>before</em> Connor died, another patient <a href="https://mydaftlife.com/2016/03/27/one-way-wriggle-to-the-moon/">drowned in the same NHS unit</a>. <em>In the same bath.</em> A fact that Southern Health concealed for more than two years after Connor’s death. </p> <p>It turns out that Southern Health has <a href="https://www.theguardian.com/society/2015/dec/09/southern-health-nhs-trust-failed-investigate-patient-deaths-inquiry">failed properly to investigate</a> more than 1,000 unexpected deaths —&nbsp;in only four years —&nbsp;and that the deaths of people with learning disabilities are least likely to be investigated. Fewer than 1% of <em>their</em> unexpected deaths have been looked into. <em>One per cent</em>. As if their lives and deaths don’t matter.</p> <p>Without #JusticeforLB these things and more would likely have stayed hidden.</p> <p>Ryan points to the premature mortality rates of people with learning disabilities in the UK, the hate crime, the “lukewarm outrage” to documented experiences of abuse, the lethal undertow of eugenics.</p> <p>Connor’s life, a happy life, well-lived, shared, recorded, celebrated, proves the wrong and falsity in all of that. </p> <p>Ryan’s book speaks of a family’s dreadful loss, charts a creative, comradely and joyous campaign for truth, for justice and accountability, strikes a blow for human rights. And brings to life her funny, kind and much-loved son.</p><hr /><p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/buses_line_2bigger5.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/buses_line_2bigger5.jpg" alt="" title="" width="460" height="65" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'></span></span></p><hr /><p>&nbsp;</p><p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/3500.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Connor at his school prom"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/3500.jpg" alt="" title="Connor at his school prom" width="460" height="276" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'><span class='image_title'>Connor at his school prom (#JusticeforLB)</span></span></span></p> <p>&nbsp;</p><h2><a href="http://www.jkp.com/uk/justice-for-laughing-boy-2.html"><em>Justice for Laughing Boy: Connor Sparrowhawk – &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;A Death by Indifference</em></a></h2><h2>Extract by Sara Ryan</h2><p>One thing that was never pinned down during the inquest was what actually happened on the morning Connor died. We found out from the documentation and witness statements that Connor woke up and was going to have a bath before going to visit the Oxford Bus Company. According to the documentation his support worker and key nurse checked on him every 15 minutes until 9.15am when he was found unconscious. Where the decision for 15-minute observations came from was never uncovered, as witness after witness was asked and said they didn’t know.</p> <p>They were both in the nurses’ office which was across the corridor from the bathroom, a short distance away. The support worker was doing an online Tesco order in between checking on Connor. The mundaneness of this detail fills me with queasiness. Still. Ticking the ‘3 for 2’ box while Connor drowned feet away. Their statements and witness testimony provided contradictory evidence about who did what and when. The support worker’s evidence revealed that the bathroom door was locked. She used a key to open it before she found him. Until then, we hadn’t been told that the bathroom door had been locked. </p> <p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/connor_bus2.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="‘Bus’ by Connor Sparrowhawk"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/connor_bus2.jpg" alt="" title="‘Bus’ by Connor Sparrowhawk" width="460" height="316" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'><span class='image_title'>‘Bus’ by Connor Sparrowhawk</span></span></span></p><p>So, not only was Connor not supervised in the bath, but he was locked in the room. This was presented as allowing Connor the privacy to do ‘what boys do in the bathroom’. It was never made clear who locked the door. When it was raised a second time, one or two barristers leapt up to say that we did not know if the door was ‘locked’ – this in spite of the evidence given by the support worker that she had ‘used a key to open it’.</p> <p>Thinking back to Connor bathing at home in the downstairs bathroom with no door, and a constant in‑and‑out of talking to him, reminding him to wash his hair, chatting&nbsp;to him and answering his endless questions, I felt physically sick. In 18 years, we had never left him in the bath with the door shut, let alone locked. Big Sue and Tina said that, on residential school trips, they would always stand by the door of the shower and talk to the kids, even those without epilepsy. </p> <p>Sitting there in full view of the jury and listening to the evidence – ‘I checked…oh no, he checked’ sort of stuff – my brain was screaming: ‘What the actual fuck were you doing? Who checked? When? Did you ever fucking “check”? Or did you suddenly wonder where he was?’ The contradictory evidence over who checked and when was never fully addressed during the inquest.</p> <p>Staff evidence exhibited a mix of remorsefulness, defensiveness, reflectiveness and the downright offensive. The hardest to sit through was [consultant psychiatrist] Dr Murphy, which spread from the Friday afternoon in person to the following Monday by video link from Ireland.</p><p style="text-align: center;"><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/Justicequilt-6_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Step-dad, Rich, brothers Owen &amp; Tom, Connor (far right) two weeks before his death (Ryan)"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/Justicequilt-6_0.jpg" alt="" title="Step-dad, Rich, brothers Owen &amp; Tom, Connor (far right) two weeks before his death (Ryan)" width="460" height="308" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'><span class='image_title'>Step-dad, Rich, brothers Owen & Tom, Connor (far right) two weeks before he died (Ryan)</span></span></span></p> <p>We knew from the Verita review [February 2014,&nbsp;<a href="http://www.southernhealth.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=76277">PDF here</a>]&nbsp;that Dr Murphy had assessed that Connor had not had a seizure on 20 May. She took his subsequent statement that he remembered biting his tongue when angry as the accepted version of what happened without discussion with us. The fact that she interacted with Connor a handful of times across the 107 days was irrelevant.</p> <p>When asked about if Connor had had a seizure, would it be appropriate to leave him in the bath, she replied, ‘If it was a proven seizure, it wouldn’t have been appropriate.’ She went on to say, ‘My understanding is Connor didn’t have a seizure while he was on the ward’ – a point the Coroner dismissed, gently reminding her Connor had a seizure on the day he died.</p> <p>When questioned about the bleedingly obvious point that you don’t rule seizure activity out in a patient with epilepsy, she replied, ‘I made a judgement call on that day, with all the information I had and I’m always thinking bigger picture and I think that’s normal.’</p> <p>Paul Bowen QC, [the family’s barrister] making his polite, missile-like points, continued his questioning, drawing on the testimony of expert witness Professor Crawford, a consultant neurologist and Director of the Special Centre for Epilepsy, York.</p><p>‘Dr Ryan had seen her son have seizures in the past.’</p> <p>‘Yes.’</p> <p>‘And she had seen how he presented after a seizure. And she was the best person to know, having seen him that day whether it was likely or not that he had had a seizure, wasn’t she?’</p> <p>‘I suppose so.’</p> <p>‘And indeed, I could put it to you that Professor Crawford draws the conclusion that it probably was as a result of an unobserved seizure that he bit his tongue.’</p> <p>‘Well, with all due respect, Professor Crawford wasn’t there.’</p> <p>‘I could say the same, you weren’t actually there when he was supposed to have had the seizure.’</p> <p>No.</p> <p>The inquest was obviously a difficult process, and compounded by what seemed to be a continuing tendency to mother‑blame. The staff witness statements produced for Connor’s inquest offered further examples of this. This set of statements typically included a section headed ‘My Relationship with Dr Ryan’ or just ‘Dr Ryan’. Such a heading was unnecessary for many reasons, not least that Connor clearly had a large family who (apart from Tom, who at 13 years old was not allowed on the ward) visited him in the Unit and interacted with staff. It was also odd given I was called Sara in the Unit – there was no ‘Dr’ stuff in those days.</p><p style="text-align: center;"><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/connor_tom.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Connor and his brother Tom"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/connor_tom.jpg" alt="" title="Connor and his brother Tom" width="460" height="339" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'><span class='image_title'>At Marble Arch, waiting for the bus home after birthday day out, Connor & Tom (Sara Ryan)</span></span></span></p> <p>Charlotte [Haworth Hird, a leading human rights solicitor] sent us these witness statements in September 2015 with an email warning us of the content. It’s odd really, contrasting the actions that help or ease, with those that make a devastating situation worse. Reading the evidence in advance of Connor’s inquest was devastating. For example, a student nurse who until that point I thought I had got on well with stated:</p> <p>‘I had seen Dr Ryan shouting at a consultant and I did not want to experience that. I was scared of her; she was a bit different.’</p> <p>When something goes catastrophically wrong, pinning the blame on ‘Mum’ or the family rather than trying to establish openly and transparently what went wrong is one of those aspects of public sector provision that has consistently floored us over the past few years. Of course, mother-blame does, in effect, help to relieve a Trust or County Council from having to think about the pain and grief bereaved families experience.</p> <p><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/Ch6x2nsWwAEZjdZ.jpg-large_0.jpeg" rel="lightbox[wysiwyg_imageupload_inline]" title="Craftivisim by George Julian"><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/Ch6x2nsWwAEZjdZ.jpg-large_0.jpeg" alt="" title="Craftivisim by George Julian" width="240" height="300" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style=""/></a> <span class='image_meta'><span class='image_title'>Craftivisim by George Julian #JusticeforLB</span></span></span>It is also indicative of a wider shortcoming in many health and social care services – of failing to want to understand the experiences and views of families, and failing to factor this in when making decisions or statements.</p> <p>The County Council was also firing nuclear-type missiles our way. We received an independent report commissioned by the Director of Adult Social Care one morning, out of the blue. The report arrived in my inbox two weeks after it had been circulated to everyone and their dog. It was almost farcical, as so much of it was inaccurate. It was also deeply biased, slipping into a review about me and my actions rather than what happened and why.</p> <p>Days before Connor’s inquest began, Alicia Wood, then CEO of the Housing and Support Alliance (now known as Learning Disability England), had forwarded a copy of a letter to Caoilfhionn Gallagher, the human rights barrister who had earlier offered us pro bono support. The letter was from a less reflective Oxford County Council commissioner who had written to two disability activists excusing the Council’s role in commissioning such crap services. As I read it, I could see again subtexts of mother-blame.</p> <p>She described feeling ‘immense sympathy’ for me while stating, in the same sentence, that she believed my campaigning had done a lot of damage. ‘In hindsight’ featured, as it does so commonly when something goes catastrophically wrong. We-could-possibly-have-done-more-but-we-were-so-stretched-type bollocks. The letter ends with a toe-curling paragraph which combines ‘immensely sorry’ with the comment that bloggers have ‘a duty to be honest and accurate’:</p><p>‘My hope is that she can find some kind of peace with this, and that one day, she might be able to move on.’</p><p>Weary Mother, a regular contributor to my blog, captured what the experience is like for many mothers in the following comment on mydaftlife:</p> <p class="blockquote-new">So many of us have fought so bloody hard for justice for our sons and daughters and have all been treated as brutally as Sara and her family has…just for seeking justice. Many of us battle on, like Sara, now. </p><p class="blockquote-new">My son is an actor with a group composed of people with learning disabilities. With tears running down my face I watched him when they performed a play about the First World War. My son was the only soldier from that village to come home. In his tattered uniform he came slowly down the aisle in church, Last Post playing quietly. He leaned heavily on stick (as he now does from damage done to him in real life), his head bandaged and bloody. At front the widows wait with his wife, who moves towards him in beautiful and moving joy. </p><p class="blockquote-new">In the background, slowly and in time to the gently played Last Post, a row of our dead boys walk in line, eyes bandaged and unseeing, comrades all. Arm stretched out, hand on comrade’s shoulder. </p><p class="blockquote-new">I wept. So many, so many…so bloody many. Harm is done to our boys and our girls and like those widows, we are grateful if they just come home.</p> <p>&nbsp;</p><p>When cross-questioned at Connor’s inquest, the student nurse changed her position and said she was not scared of me. She said I was a mother trying to do her best for her son.</p><hr /><p>&nbsp;</p><p><em><a href="http://www.jkp.com/uk/justice-for-laughing-boy-2.html">Justice for Laughing Boy: Connor Sparrowhawk – A Death by Indifference</a>,</em>&nbsp;by Sara Ryan with a foreword by Baroness Helena Kennedy QC.<br /> <strong>To order a copy for £12.99 go to&nbsp;<a href="https://www.jkp.com/uk/justice-for-laughing-boy-2.html">Jessica Kingsley Publishers</a>.</strong></p><hr /><p><iframe width="460" height="258" src="https://www.youtube.com/embed/gMtOGXBEDuo" frameborder="0" allowfullscreen></iframe></p><p>&nbsp;</p><h2><a style="font-size: 17px;" href="https://twitter.com/hashtag/justiceforlb?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Ehashtag">#JusticeforLB: Notes by Clare Sambrook</a></h2> <p>• Sara Ryan continues to blog at <a href="http://mydaftlife.wordpress.com/">mydaftlife</a>.</p> <p>• Connor’s family is supported by the charity&nbsp;<a href="http://www.inquest.org.uk/">INQUEST</a>, and represented by INQUEST Lawyers Group member Charlotte Hird Haworth of Bindmans solicitors.</p> <p>• Six weeks after Connor died, an unannounced inspection of Slade House by the Care Quality Commission found it to be inadequate in all 10 measures of assessment. That CQC report, published in November 2013, can be found in <a href="https://mydaftlife.files.wordpress.com/2014/03/cqc-slade-house-final-report-1.pdf">PDF here.</a>&nbsp;Sara Ryan notes: “The report reads like an inspection of a Victorian asylum.”</p> <p>• In February 2014 the Verita report, commissioned by Southern Health, confirmed&nbsp;that Connor’s death was preventable. <a href="http://www.southernhealth.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=76277">PDF here.</a>&nbsp;</p> <p>•&nbsp;A police investigation into Connor’s death was closed in August 2014.</p> <p>•&nbsp;An inquest jury determined in October 2015 that Connor’s death was contributed to by neglect and very serious failings —&nbsp;failings in the assessment, care and risk management of epilepsy in patients with learning disability, errors and omission in Connor’s care at the unit, Southern Health NHS Foundation Trust Short Term Assessment and Treatment Unit (STATT), Slade House. The <a href="justiceforlb.org:full-jury-findings-connor-sparrowhawk-justiceforlb">full jury findings are here.</a></p><p style="text-align: center;"><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/DNpj-P4XUAUI5qo.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Sara Ryan at the launch of her book, Doughty Street Chambers, 2 November 2017"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/DNpj-P4XUAUI5qo.jpg" alt="" title="Sara Ryan at the launch of her book, Doughty Street Chambers, 2 November 2017" width="460" height="345" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'><span class='image_title'>Sara Ryan at the launch of her book, Doughty Street Chambers, London, November 2017</span></span></span></p> <p>• Under pressure from the #JusticeforLB campaign, NHS England commissioned an independent review of deaths of people with a learning disability or mental health problem in contact with Southern Health (from April 2011 to March 2015), known as the Mazars review. Despite Southern Health’s attempts to stop it, the report was published in December 2015. Mazars identified multiple failures of leadership and governance, and revealed that Southern Health had failed properly to investigate more than a thousand unexpected deaths, and that fewer than 1% of the unexpected deaths of people with learning disabilities were looked into. <a href="https://www.england.nhs.uk/south/wp-content/uploads/sites/6/2015/12/mazars-rep.pdf">PDF here.</a> The matter was debated in the House of Lords on 10 December 2015. <a href="https://publications.parliament.uk/pa/ld201516/ldhansrd/text/151210-0001.htm">Text here</a>.</p> <p>• The Mazars findings prompted the Secretary of State for Health to ask the Care Quality Commission to examine how acute, community and mental health NHS trusts across England investigate and learn from deaths and identify necessary improvements. That review, published in December 2016 (<a href="https://www.cqc.org.uk/sites/default/files/20161213-learning-candour-accountability-full-report.pdf">PDF here</a>), reported that “families often have a poor experience of investigations and are not always treated with kindness, respect and honesty.” And: “This was particularly the case for families and carers of people with a mental health problem or learning disability.”</p> <p>•&nbsp;On 9 June 2016, Southern Health accepted full responsibility for Connor’s death, admitted negligence, admitted that it had violated both Connor’s and his family’s human rights. Statement <a href="http://www.southernhealth.nhs.uk/news-archive/2016/trust-statement-regarding-connor-sparrowhawks-death/">here</a> and below. </p> <p><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/KatrinaPERCY_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Ex-chief executive Katrina Percy"><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/KatrinaPERCY_0.jpg" alt="" title="Ex-chief executive Katrina Percy" width="240" height="264" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style=""/></a> <span class='image_meta'><span class='image_title'>Ex-chief executive Katrina Percy</span></span></span>• In <a href="http://www.bbc.co.uk/news/uk-england-36922039">July 2016 the BBC revealed</a> that Southern Health had handed contracts worth millions of pounds to past associates of chief executive Katrina Percy.</p><p>•&nbsp;In August 2016, under pressure from the public, patients and families bereaved by the Trust’s neglect, the Southern Health NHS Trust Board invited chief executive Katrina Percy to step sideways into a <a href="http://www.bbc.co.uk/news/uk-england-37288843">£240,000-a-year job created especially for her</a>. </p><p>• In October 2016, under continued pressure, <a href="https://opendemocracy.net/shinealight/clare-sambrook/190k-payoff-for-ex-chief-of-nhs-trust-that-failed-to-investig">Percy stepped down from that role with a £190,000 payoff</a>. At the time of writing (November 2017) Percy is advertising her <a href="https://www.linkedin.com/in/katrina-percy-88481258/">“strategic consultancy” services on Linkedin</a>. She cites her “inspirational and visionary leadership”, her reputation for “creating a culture which is open, accessible and energised”, and for “delivering ambitious service transformation, financial, quality and operational performance.”</p> <p>•&nbsp;In August 2017 a medical tribunal found multiple failings by Dr Valerie Murphy, the lead clinician responsible for treating Connor. During the tribunal Sara Ryan was grilled for two hours by Dr Murphy’s barrister which she described as a “barbaric experience”. Ryan <a href="http://www.oxfordmail.co.uk/news/15488161.__39_Inhumane__39___Connor_Sparrowhawk__39_s_mum_outraged_by_delay_to_tribunal_decision/">told the Oxford Mail</a>: “It was truly traumatising. It was a complete shock.” In November 2017 the tribunal found Murphy <a href="http://www.oxfordmail.co.uk/news/15656594.TRIBUNAL___Deplorable__care_failures_in_Connor_Sparrowhawk_tragedy/">guilty of misconduct</a> and said she had failed in ways that “fellow professionals would regard to be deplorable.” The Tribunal is due to meet in February 2018 to consider a sanction for Dr Murphy.</p> <p>• On 18 September 2017, Southern Health <a href="http://press.hse.gov.uk/2017/southern-health-nhs-foundation-trust-pleads-guilty-following-hse-prosecution/">pleaded guilty to breaching health and safety laws</a> in relation to Connor’s death. Two months later Southern Health <a href="https://www.shponline.co.uk/southern-health-nhs-trust-admits-guilt-womans-death/">admitted guilt</a> in relation to the death in April 2012 of 45 year old Teresa Colvin. The Trust’s new chief executive Dr Nick Broughton said: “The prosecutions against the trust are extremely serious and have contributed to a wholesale programme of change.”</p><hr /><p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/buses_line_CROP_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/buses_line_CROP_0.jpg" alt="" title="" width="460" height="23" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'></span></span></p><p>&nbsp;</p> <blockquote class="twitter-tweet"><p dir="ltr" lang="en">We can't stop thinking about this dream of <a href="https://twitter.com/sarasiobhan">@sarasiobhan</a> 's. Wouldn't it just be incredible? <a href="https://t.co/g4ugkT9Zl5">https://t.co/g4ugkT9Zl5</a> <a href="https://t.co/WexHTdOa6W">pic.twitter.com/WexHTdOa6W</a></p>— My Life My Choice (@mylifemychoice1) <a href="https://twitter.com/mylifemychoice1/status/723161111189659648">April 21, 2016</a></blockquote><hr /><p>&nbsp;</p><h2><a href="http://www.southernhealth.nhs.uk/news-archive/2016/trust-statement-regarding-connor-sparrowhawks-death/">Trust statement regarding Connor Sparrowhawk’s death</a></h2> <p><span style="font-size: 1.2em;"><strong>Southern Health NHS Trust Statement, June 2016</strong></span></p><p>Almost three years ago Connor Sparrowhawk died while in our care, for which we are deeply sorry, and we would like to take this opportunity to again offer our unreserved apologies to his family for his preventable death.</p> <p>We have now been able to come to a successfully mediated settlement with Connor’s family, as detailed in the statement below. The statement and an easy version of the statement are also attached on the right hand side of this page as pdf documents.</p> <p><strong>PUBLIC STATEMENT BY THE TRUST</strong></p> <p>1. Southern Health NHS Foundation Trust (“the Trust”) accepts that it was responsible for the death of Connor Sparrowhawk, an 18-year-old boy who was a much loved son, brother and friend. He died on 4th July 2013 whilst in the care and custody of the Short Term Assessment and Treatment (“STATT”) Unit, Slade House, for which the Trust was responsible. Connor’s preventable death was the result of multiple systemic and individual failures by the Trust in the care provided to Connor on the STATT Unit.</p> <p>2. The Trust accepts:</p> <p>(i) The findings of the independent investigation into the death of Connor Sparrowhawk by Verita, dated February 2014, which concluded that his death was preventable and found significant failings in the care provided to Connor in particular concerning the management of his epilepsy;</p> <h2><span class='wysiwyg_imageupload image imgupl_floating_right 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/southern_banner.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/southern_banner.jpg" alt="" title="" width="240" height="121" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_medium" style=""/></a> <span class='image_meta'></span></span><a href="http://www.southernhealth.nhs.uk/news-archive/2016/trust-statement-regarding-connor-sparrowhawks-death/"></a></h2><p><a href="http://www.southernhealth.nhs.uk/news-archive/2016/trust-statement-regarding-connor-sparrowhawks-death/"></a></p><p>(ii) The findings of the inquest jury on 16th October 2015, which determined that Connor died by drowning following an epileptic seizure while in the bath, contributed to by neglect* due to a number of very serious failings. These failings included both failures in the systems and processes in place to ensure adequate assessment, care and risk management of epilepsy in patients with learning disability at the STATT Unit, and in terms of errors and omissions in relation to Connor’s care whilst on the Unit. The Trust accepts that contributory factors included:</p> <ul><li>(a) A lack of clinical leadership on the STATT Unit;</li><li>(b) A lack of adequate training and the provision of guidance for nursing staff in the assessment, care and risk management of epilepsy;</li><li>(c) Very serious failings in relation to Connor’s bathing arrangements;&nbsp;</li><li>(d) Failure to complete an adequate history of Connor’s epilepsy;&nbsp;</li><li>(e) Failure to complete an epilepsy risk assessment soon after admission;</li><li>(f) Failure to complete an epilepsy risk assessment thereafter;&nbsp;</li><li>(g) Inadequate communication by staff with Connor’s family regarding his epilepsy care, needs and risks.</li></ul><p> 3. Southern Health NHS Foundation Trust acknowledges and accepts that:</p> <p>(i) The failings identified by Verita and by the inquest jury:</p> <ul><li>(a) Caused Connor’s death.</li><li>(b) Were negligent breaches of the duty of care the Trust owed to Connor.</li><li>(c) Violated Connor’s right to life protected by Article 2 of the European Convention on Human Rights.</li><li>(d) Violated the Article 2 rights of Connor’s family.</li></ul> <p>(ii) The Trust failed to take all reasonable steps to locate all relevant evidence and to disclose this to the Coroner and Connor’s family.</p> <p>4. The Trust will pay Connor’s family the sum of £80,000 by way of compensation for its unlawful acts and omissions.</p> <p>5. The Trust fully acknowledges that Dr. Sara Ryan has conducted herself and the Justice for LB campaign in a dignified, fair and reasonable way. To the extent that there have been comments to the contrary by Trust staff and family members of staff, these do not represent the view of the Trust and are expressly disavowed.</p> <p>*As that word is understood in coronial law.</p><p>&nbsp;</p><hr /><p>&nbsp;</p><h2><a href="http://www.jkp.com/uk/justice-for-laughing-boy-2.html"><em>Justice for Laughing Boy: Connor Sparrowhawk – &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;A Death by Indifference</em>, by Sara Ryan</a>&nbsp;with a foreword by Baroness Helena Kennedy QC.&nbsp;</h2><h2><strong>To order a copy for £12.99 go to&nbsp;<a href="https://www.jkp.com/uk/justice-for-laughing-boy-2.html">Jessica Kingsley Publishers</a>.<hr /></strong></h2><p><strong><br /></strong></p><h2><strong><em>Produced by Clare Sambrook for&nbsp;<a href="https://opendemocracy.net/shinealight">Shine A Light</a>.</em></strong></h2><p style="text-align: center;"><strong><em><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/buses_line_CROP_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/buses_line_CROP_0.jpg" alt="" title="" width="460" height="23" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style=""/></a> <span class='image_meta'></span></span><br /></em></strong></p><p><strong><em>&nbsp;</em></strong></p><hr /><p><strong><em><br /></em></strong></p><p>&nbsp;</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/shinealight/tom-ryan/since-my-brother-s-preventable-death">Since my brother’s preventable death . . .</a> </div> <div class="field-item even"> <a href="/shinealight/clare-sambrook/190k-payoff-for-ex-chief-of-nhs-trust-that-failed-to-investig">£190K payoff for ex-chief of NHS Trust that failed to investigate hundreds of unexpected deaths</a> </div> <div class="field-item odd"> <a href="/shinealight/imogen-tyler/connor-sparrowhawk-erosion-of-accountability-in-nhs">Connor Sparrowhawk: the erosion of accountability in the NHS</a> </div> <div class="field-item even"> <a href="/shinealight/clare-sambrook/on-connor-sparrowhawk-s-avoidable-death">On Connor Sparrowhawk’s avoidable death</a> </div> <div class="field-item odd"> <a href="/shinealight/sara-ryan/ministry-of-justice-says-you-don-t-need-lawyer-at-inquest-trust-state">Ministry of Justice says you don’t need a lawyer at an Inquest. Trust the State</a> </div> <div class="field-item even"> <a href="/shinealight/ally-rogers/we-apologise-to-anybody-who-feels-let-down">‘We apologise to anybody who feels let down’</a> </div> <div class="field-item odd"> <a href="/shinealight/frances-webber/uk-government-s-inversion-of-accountability">The UK government’s inversion of accountability</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> Shinealight uk 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