ourNHS https://www.opendemocracy.net/taxonomy/term/12254/all cached version 19/11/2018 10:57:25 en Why politicians need to 'take responsibility' for children's health too https://www.opendemocracy.net/ournhs/al-aynsley-green/why-politicians-need-to-take-responsibility-for-childrens-health-too <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>This government is betraying children on a grand scale, and making positive ‘choices’ impossible.</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/child poverty.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/child poverty.jpg" alt="" title="" width="460" height="276" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Image: Clacton, Essex. Credit: Nick Ansell/PA Images, all rights reserved.</span></span></span></p><p>Matt Hancock, Secretary of State for Health rightly points out that preventing ill health is crucially important in tackling the soaring costs of health care. This week he <a href="https://www.independent.co.uk/news/health/nhs-responsibility-health-prevention-matt-hancock-a8617501.html">exhorts people to “take responsibility” for their health</a>. </p> <p>But he omits to say that much adult ill health has its roots in childhood. And current government policy is not only failing to give children to the best start in life, but creating an economic environment driven by austerity where parents and families are unable to take control of their children’s health.</p> <p>This government is betraying children on a grand scale, and making positive ‘choices’ impossible. </p> <p>Poverty stalks the land with <a href="https://www.theguardian.com/society/2018/sep/16/new-study-finds-4.5-million-uk-children-living-in-poverty">more than 4.5 million children living below the breadline</a>, over half of them being trapped there for years. It is hardly surprising that those in hardship are more likely to have poor health, bombarded with pressures to eat cheap fast food, <a href="https://www.bbc.co.uk/news/education-45420295">unable to afford to meet government healthy eating recommendations</a> and without time or <a href="https://www.theguardian.com/environment/2018/nov/04/childhood-obesity-linked-to-air-pollution-from-vehicles?CMP=twt_gu">healthy environments to take exercise in</a>. </p> <p>Shamefully <a href="http://www.endchildpoverty.org.uk/the-extra-costs-of-raising-a-disabled-child/">poverty is especially prevalent in families with a child with a disability</a>. Just imagine what it is like trying to provide for healthy food, sport and exercise in a family with a disabled child requiring 24-hour care seven days a week. </p> <p>Take the plight of mother Jo Cousins who is facing the loss of vital support for her disabled son Seth as a result of <a href="https://www.northamptonchron.co.uk/news/our-children-are-so-vulnerable-mother-wants-northampton-respite-centre-s-funding-reinstated-so-it-can-continue-to-provide-invaluable-service-to-her-disabled-son-1-8456697">Northamptonshire’s dire finances closing the centre for respite care</a>. </p> <p>The difficulties these families face is exacerbated by the “<a href="https://www.theguardian.com/society/2018/nov/06/mps-call-for-review-of-pointlessly-cruel-benefit-sanctions?CMP=share_btn_tw">pointlessly cruel” benefit sanctions</a> identified by MPs to be arbitrary and punitive. </p> <p>The debacle over changes to Universal Credit expose a ‘group think’ political mindset out of touch with real people and their lives alongside a stark lack of compassion for the most vulnerable.</p> <p>The heart-rending report of a <a href="https://www.mirror.co.uk/news/uk-news/universal-credit-girl-forced-beg-13546259">9-year old child begging a charity for any work going to pay for food</a> since her mum had died and her dad had lost his job is a devastating indictment of the effects of this political attitude driven by the Treasury. </p> <p>The number of homeless children and those needing protection is soaring, with many authorities failing to intervene until complex cases reach crisis point; <a href="https://www.theguardian.com/society/2013/oct/15/child-protection-inadequate-ofsted-report">around two thirds of all looked after children (around 47,000) are under the care of councils that, say Ofsted, are inadequate or require improvement</a>. </p> <p>Eight years of savage austerity have devastated children’s services so that we now have some of the <a href="https://medicalxpress.com/news/2018-10-british-state-betrayed-children-countries.html">worst outcomes for children</a> across health, social care, education, youth justice and poverty in the developed world. </p> <p>The health of children overall is dismal including soaring rates of emotional and mental ill health – despite the fact that <a href="https://www.bma.org.uk/collective-voice/policy-and-research/public-and-population-health/child-health/growing-up-in-the-uk">the challenges have been well known for at least 20 years</a>. Over 150 children every day are being turned away from CAMHS (child and adolescent mental health services) with some children being <a href="https://www.telegraph.co.uk/news/2018/03/08/gps-telling-children-exaggerate-mental-health-symptoms-want/">advised by GPs to exaggerate their symptoms to get access to treatment</a>.</p> <p>Over one third of children are obese, we have one of the lowest rates of breastfeeding in Europe, poor control of diabetes, and inadequate transition to adult services for children with physical and learning disabilities. It all points to <a href="https://www.rcpch.ac.uk/resources/state-child-health">massive challenges for families and children created by government policies</a>. </p> <p>But it is not only in health and social care where there are shocking examples of disastrous political policy, indifference to the best interests of children, and an ideological fixation on making ‘choices’ which are, to many, an impossible dream.</p> <p>Thus, outstanding schools teach a minority of children where parents can pay for independent education or live in the catchment of an excellent state school; but there are countless other children whose parents can’t. Children whose schools are hit by a government-triggered <a href="https://www.independent.co.uk/voices/teachers-crisis-education-leaving-profession-jobs-market-droves-who-would-be-one-a7591821.html">exodus of experienced teachers</a>. A government that has <a href="https://www.tes.com/news/teacher-training-we-are-witnessing-dangerous-lowering-bar-entry">lowered the entrance requirements for teacher training</a>, and has cut school funding so deeply that <a href="https://www.theguardian.com/education/2018/sep/28/a-complete-crisis-2000-school-leaders-rally-against-cuts">thousands of head teachers have taken to the streets to protest</a>, that has imposed a narrow test-oriented curriculum driven by zealots teaching to the test. A government that dismisses the stress and even child exclusions caused by the perverse incentives of SATS league tables. </p> <p>It all points to an education system not fit for purpose today. Against this we have a <a href="https://www.independent.co.uk/news/education/education-news/school-funding-cuts-dfe-uk-statistics-authority-headteachers-investigation-a8569116.html">minister being exposed to distort the statistics on spending for schools, deepening public distrust of politicians</a>.</p> <p>Alongside poverty and inequality of hope there is the <a href="http://www.revolving-doors.org.uk/file/2230/download?token=6OH6Xo32.">revolving door of young offenders returning to prison</a> in a ‘system’ attuned to the Victorian ethos of punishment and control. </p> <p>An objective observer such as an alien from Mars would see here today a government that appears oblivious to the importance of children in society.</p> <p>Through an economic lens we need healthy, educated, creative, happy children equipped with the life skills for those who can to become confident adults and parents in due course. And those who can’t through disability or disadvantage must be supported to develop their full potential. Surely, this should drive political policy, but it doesn’t. </p> <p>My new book “The British Betrayal of Childhood” highlights the need for a “paradigm shift” in our public and political attitude to children, modelling an approach from the very best countries for children such as Canada, Holland and Finland. </p> <p>Building local community responsibility for children is key. “It takes a village to raise a child”, as they say. In other words, the ‘nurture’ of children should be everybody’s business – parents and families, schools, faiths, businesses, voluntary and statutory services – all driven by the best interests of children in policies and practices that address their needs.</p> <p><a href="http://earlylearning.ubc.ca/">The Human Early Learning Partnership model in Canada</a> describes the local<em> </em>context through ‘mapping’ children’s lives from routine data. The concept is simple – to ‘map’ by postcode locality data on children’s lives – inputs, outputs and outcomes across health, education, social care, youth justice and poverty. These data are used by childhood coalitions, schools, government ministries and researchers to inform advocacy for children’s needs, and to recommend changes to policies and funding. </p> <p>There is incontrovertible evidence that we really are betraying our children on a grand scale in Britain today. Rather than exhorting the poor, the young and the marginalised to exercise ‘choices’ they simply don’t have, I call on politicians of all parties to listen to the reality of child and family life, understand the enormity of what has to be done and produce a coherent long term cross-party political agreement on what we should be trying to achieve for our children. This can then be the basis for consensual, common sense policies to improve outcomes. Politicians have responsibilities for children too! </p> <p><em>Sir Al Aynsley-Green’s book <a href="https://www.routledge.com/The-British-Betrayal-of-Childhood-Challenging-Uncomfortable-Truths-and/Aynsley-Green/p/book/9781138297920">‘The British Betrayal of Childhood’ is published now by Routledge</a></em>.</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/childhood.png" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/childhood.png" alt="" title="" width="229" height="361" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></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/rebecca-omonira-oyekanmi/how-mental-health-services-fail-young-people-and-wh">How mental health services fail young people and what can be done about it</a> </div> <div class="field-item even"> <a href="/5050/shauneen-lambe-maryrachel-mccabe/how-we-treat-children-in-uk-dark-side-of-our-soul">How we treat children in the UK: the dark side of our soul</a> </div> <div class="field-item odd"> <a href="/uk/ian-sinclair/universal-credit-internationally-unique-in-its-harshness-and-headed-for-7-million-of">Universal Credit - internationally “unique” in its harshness, and headed for 7 million of us</a> </div> <div class="field-item even"> <a href="/shinealight/al-aynsley-green/who-is-speaking-for-britains-children-and-young-people-challenge-to-chi">Who is speaking for Britain&#039;s children and young people?: a challenge to the children’s sector</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-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by 4.0 </div> </div> </div> ourNHS uk ourNHS UK health Children Al Aynsley-Green Fri, 09 Nov 2018 06:00:00 +0000 Al Aynsley-Green 120507 at https://www.opendemocracy.net Why healthcare for all is a feminist issue https://www.opendemocracy.net/ournhs/feminist-fightback/why-healthcare-for-all-is-feminist-issue <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Health charges for migrants are hitting women hardest. Yesterday feminist activists changed the sign on the new Millicent Fawcett statue in Parliament square in protest.</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/group photo.JPG" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/group photo.JPG" alt="" title="" width="460" height="345" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Image: Protestors in parliament square yesterday. Credit: Feminist Fightback</span></span></span></p><p>Yesterday dressed as suffragettes, activists from Feminist Fightback changed the sign on the new Millicent Fawcett statue in Parliament Square from ‘Courage calls to Courage Everywhere’ to ‘Feminists demand healthcare for all,’ in protest against NHS charges for migrants.</p> <p>“We took this action because universal healthcare, like universal suffrage, is a feminist issue”, explained Eleanor Smith, who took part in the action. “This year marks 100 years since some women got the vote, but women under thirty and 2 million working-class women who did not meet the property qualification had to wait another 10 years. Today, there are exclusions too. Some people are eligible for free abortion and pregnancy services, which feminists have fought for, while others must pay enormous charges for the care they need.”</p> <p>Migrants who are not considered ‘settled’ in the UK are now charged for these essential, life-saving services at 150% of the cost. Abortion is charged up front, costing £1,300 in an NHS hospital. Birth, including pre and post-natal care, is charged after the event and costs up to £7,000.</p> <p>Hospitals may pass debts on to a debt collector who will harass the patient. In fear of debt, deportation or because they are unable to pay, some people do not access the healthcare they need, with devastating consequences.&nbsp;</p> <p>Beatrice came to the UK in 2012 from West Africa as a student and was disowned by her family after becoming pregnant. Because she did not have a visa, Beatrice was billed around £6,000 the day after her baby was born, a sum that is totally unaffordable for her. In the months after the birth, she was harassed by calls from debt collectors.</p> <p>“It’s just me alone with my child. And they’re telling me you have to pay, when my child was four months. I almost went mad. I almost went crazy”, Beatrice said. “When they were calling me and saying I have to pay, I have to do this, there was a point I felt like just dying.”</p> <p>Beatrice had several common but potentially dangerous medical conditions during the pregnancy. However, she told campaign group Maternity Action that if she had known about the charges, she would have avoided going to hospital and tried to give birth at home.</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/megaphone photo (1).jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/megaphone photo (1).jpg" alt="" title="" width="460" height="613" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Image: Feminist Fightback</span></span></span></p><p>Rosa Campbell, another Feminist Fightback member, said, “We changed the banner because we do not uncritically celebrate Millicent Fawcett. Fawcett, like other suffragettes, was complicit in racism and imperialism. Fawcett was outraged that Maori women in New Zealand got the vote before British women. Ensuring everyone has access to the care they need, irrespective of immigration status, is a critical issue for feminists. We believe we must move forward with a feminism that challenges oppression and fights genuinely for justice for all.”</p> <p><strong>Get involved:</strong></p> <p>Come to a <a href="http://www.feministfightback.org.uk/events/category/organising-meeting/" target="_blank">Feminist Fightback meeting</a> and be part of the campaign to end the charges. The meetings are open to all women, including intersex, trans and cis women, and to people of diverse gender identities in need of feminist solidarity.</p> <p>Get involved with <a href="http://www.docsnotcops.co.uk/" target="_blank">Docs Not Cops</a>.</p> <p>Use the <a href="http://patientsnotpassports.co.uk/" target="_blank">Patients not Passports toolkit</a> to find out how you can start a campaign where you are or how you can take action if you’re a healthcare worker.</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/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/ed-jones/upfront-nhs-charges-one-year-on-6-reasons-why-they-harm-us-all">Upfront NHS charges one year on - 6 reasons why they harm us all</a> </div> <div class="field-item odd"> <a href="/ournhs/rayah-feldman/pregnant-women-bear-brunt-of-government-s-clampdown-on-migrant-nhs-care">Pregnant women bear brunt of government’s clampdown on ‘migrant’ NHS care</a> </div> <div class="field-item even"> <a href="/ournhs/ex-boss-of-england-s-nhs-blasts-nhs-migrant-policy-as-national-scandal">Ex-boss of England’s NHS blasts NHS migrant policy as a “national scandal”</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by 4.0 </div> </div> </div> ourNHS uk ourNHS Feminist Fightback Wed, 07 Nov 2018 11:37:02 +0000 Feminist Fightback 120486 at https://www.opendemocracy.net Upfront NHS charges one year on - 6 reasons why they harm us all https://www.opendemocracy.net/ournhs/ed-jones/upfront-nhs-charges-one-year-on-6-reasons-why-they-harm-us-all <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>And what can we do to stop these harmful charges?</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/hostile4.JPG" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/hostile4.JPG" alt="" title="" width="460" height="388" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Image: Poster in Guys & St Thomas's Hospital. Credit: Docs not Cops</span></span></span></p><p>When you’re expecting a baby the last thing you want to be thinking about is whether you can afford <a href="https://www.maternityaction.org.uk/wp-content/uploads/WhatPriceSafeMotherhoodFINAL.pdf">over £6,000</a> to go into hospital for the labour. For most people in England this isn’t yet a consideration but for the past year it has been the reality for many migrant women.</p> <p>A year ago today, the government introduced upfront <a href="https://www.gov.uk/government/collections/nhs-visitor-and-migrant-cost-recovery-programme">NHS</a> <a href="http://sci-hub.tw/https:/doi.org/10.12968/hmed.2018.79.6.C94"></a><a href="http://sci-hub.tw/https:/doi.org/10.12968/hmed.2018.79.6.C94">charges</a> for <a href="https://www.doctorsoftheworld.org.uk/Handlers/Download.ashx?IDMF=2841d219-9ff0-40cf-9cf6-9eefd32d042c">certain migrants</a> as part of its '<a href="https://corporatewatch.org/the-hostile-environment-turning-the-uk-into-a-nation-of-border-cops-2/">hostile environment</a>'. Before that bills were sent after people received medical care. Primary care (i.e. GP visits), visits to accident and emergency, and treatment for some infectious diseases remains free for all. However, <a href="https://www.doctorsoftheworld.org.uk/Handlers/Download.ashx?IDMF=2841d219-9ff0-40cf-9cf6-9eefd32d042c">secondary care</a> (such as being on a ward in the hospital or X-Rays), <a href="http://sci-hub.tw/https:/doi.org/10.12968/hmed.2018.79.6.C94">community care</a> (including midwifery and abortion services), and care deemed ‘non-urgent’ is now liable for upfront costs for many migrants.</p> <p>I’ve seen it for myself when I volunteered with <a href="https://www.doctorsoftheworld.org.uk/">Doctors of the World</a>, supporting migrants to access healthcare in the UK. One patient we saw had a stroke, and was admitted to hospital unconscious. They were not charged for their time in A&amp;E, however they were charged over £40,000 for their time in the Intensive Care Unit (secondary care). The Doctors of the World clinics in London <a href="https://www.doctorsoftheworld.org.uk/news/nhshospitalswithholdingnonurgentcare">see many cases</a> where lifesaving care – including cancer chemotherapy, surgery and palliative care – is withheld unless paid for upfront because it is classified as ‘non-urgent.’</p> <p>The <a href="https://www.theguardian.com/uk-news/windrush-scandal">Windrush scandal</a> has shown how ‘hostile environment’ policies – which are also <a href="https://corporatewatch.org/the-hostile-environment-turning-the-uk-into-a-nation-of-border-cops-2/">present in housing, banking, employment</a> and other areas – can devastate people’s lives. </p> <p>Evidence is mounting that turning medical professionals into border guards is a bad idea. Here’s why - and what we can do about it.</p> <h2>1) Lives are at risk</h2> <p>Volunteers at Doctors of the World have seen many people deterred from going to the doctor because they are worried they can’t afford the charges or that they will be reported to – and deported by – the Home Office. People's health conditions often get worse as a result, <a href="https://www.doctorsoftheworld.org.uk/Handlers/Download.ashx?IDMF=2a7fc733-ceef-4417-9783-d69b016ff74f">as research</a> by Doctors of the World has shown.</p> <p>Women have not been accessing antenatal, perinatal and postnatal care because they are scared of mounting up debts or being reported to the authorities, a recent Maternity Action <a href="https://www.maternityaction.org.uk/wp-content/uploads/WhatPriceSafeMotherhoodFINAL.pdf">report</a> found. This means unborn babies and mothers are <a href="http://b.3cdn.net/droftheworld/5a507ef4b2316bbb07_5nm6bkfx7.pdf">more at risk</a> of poor outcomes, including death, low birth weight and the transmission of various diseases. <a href="https://b.3cdn.net/droftheworld/5a507ef4b2316bbb07_5nm6bkfx7.pdf">Doctors of the World’s</a> research at their London drop-in clinic reached similar conclusions.</p> <p>Under current regulations, if people incur healthcare debts over £500 they can be reported to the Home Office after only two months of non-payment. Maternity Action found that women – many of whom had just given birth – were being sent threatening NHS bills and some had been chased by debt collection agencies. They also spoke to women who had been wrongly charged for their care.</p> <p>We are in the middle of the <a href="http://www.unhcr.org/figures-at-a-glance.html">biggest refugee crisis</a> since the Second World War, partly fuelled by British foreign policy and arms sales. Do we really want the government to respond by preventing access to medical treatment to those in need, including pregnant women?</p> <h2>2) <strong>It is a </strong><a href="https://academic.oup.com/jpubhealth/article/38/2/384/1753511"><strong>public health risk</strong></a></h2> <p>NHS charges deter and delay vulnerable migrants from seeking the healthcare that they need, increasing harm to the individual and putting the health of the public at risk, as research conducted by post-graduate students at Kings College London at a Doctors of the World clinic <a href="https://www.doctorsoftheworld.org.uk/news/new-research-shows-nhs-charging-is-pushing-sick-and-pregnant-migrants-away">has confirmed</a>.</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/hostile3.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/hostile3.jpg" alt="" title="" width="460" height="393" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Image: On display in Ashford & St Peter's Hospital Trust. Credit: Docs not Cops</span></span></span></p><p>If people don't go to the doctor when they need to it will increase the spread of infectious diseases, including <a href="http://www.who.int/tb/areas-of-work/drug-resistant-tb/en/">drug resistant</a> strains of tuberculosis (TB). Although treatment for many infectious diseases do not incur charges under <a href="https://www.gov.uk/government/collections/nhs-visitor-and-migrant-cost-recovery-programme">the current</a> <a href="http://sci-hub.tw/https:/doi.org/10.12968/hmed.2018.79.6.C94"></a><a href="http://sci-hub.tw/https:/doi.org/10.12968/hmed.2018.79.6.C94">system</a>, many <a href="https://www.researchgate.net/profile/Jessica_Potter/publication/326155664_Tuberculosis_looking_beyond_%27migrant%27_as_a_category_to_understand_experience/links/5b3b70a2aca2720785062bac/Tuberculosis-looking-beyond-migrant-as-a-category-to-understand-experience.pdf">migrants do not know</a> that this is the case. Research in the <a href="http://sci-hub.tw/https:/academic.oup.com/eurpub/article/doi/10.1093/eurpub/cky048.146/4973469">European Journal of Public Health</a> looking at 100 recent migrants diagnosed with tuberculosis, found that at least 69% of them did not know that TB treatment was free prior to their diagnosis. Another recent study in <a href="https://thorax.bmj.com/content/72/Suppl_3/A20.1">the journal Thorax</a> looking over 2,000 tuberculosis cases showed a significant association between the roll out of NHS charging and worsening delays in diagnosis amongst the non-UK born population.</p> <h2>3) It’s a false economy and will likely cost the NHS more money than it saves. </h2> <p>The Department of Health previously estimated that it was unclear whether the NHS charging system generated a <a href="https://fullfact.org/sites/fullfact.org/files/782677R%20Chap%202%20of%20Review%20pages%2055-89.pdf#page=31">net benefit or a net loss</a> in an Internal Review of the Overseas Visitor Charging System. This is in large part due to the administrative cost of charging people and running an overseas charging team. Quantifying the cost of healthcare visits requires a vast amount of administration time, taking doctors and nurses away from providing care. It requires a huge investment in time providing training in costing, determining who is eligible or not, then ongoing time allowed to cost medical interventions. This needs to be supported by administration, managerial and accountancy staff to process bills and chase payments. Billing equipment is also needed as well as training, engineering and IT support to maintain the above.</p> <p>When people don't go to the doctor early on, many health conditions can also become much <a href="http://www.rcgp.org.uk/about-us/news/2017/september/investing-in-primary-care-is-cost-effective-for-the-nhs-and-good-for-patient-care-says-college.aspx">more difficult and costly to treat</a>, especially if they worsen, become chronic and/or spread if infectious, resulting in more people turning up to A&amp;E. <a href="http://www.rcgp.org.uk/news/2017/september/investing-in-primary-care-is-cost-effective-for-the-nhs-and-good-for-patient-care-says-college.aspx">For example,</a> high blood pressure can be relatively cheap to treat and manage early on, but if left unchecked it places patients at risk of a number of conditions including cardiovascular disease. Untreated high blood pressure may end up in A&amp;E with a heart attack and require much costlier interventions – such as heart bypass surgery – with all the associated costs of stays in hospital.</p> <p>Health tourism is currently a very small percentage of NHS costs – the upper end of the government’s rough estimates are <a href="https://fullfact.org/health/health-tourism-whats-cost/">around 0.3%</a>. The cost of what little ‘health tourism’ that exists, including treatment for <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/251909/Quantitative_Assessment_of_Visitor_and_Migrant_Use_of_the_NHS_in_England_-_Exploring_the_Data_-_FULL_REPORT.pdf#page=74">British 'expats'</a>, would be covered <a href="https://www.theguardian.com/news/series/paradise-papers">thousands of times over</a> if tax avoidance loopholes were closed. Everyone living in and visiting the UK also pays some tax – it is almost impossible to avoid taxes such as VAT. Bearing this in mind it just doesn’t make sense to suffer all these problems to attempt to recover a small portion of the NHS budget. </p> <h2>4) Upfront charges undermine the universality of the healthcare system and expand the infrastructure to further privatise the NHS. </h2> <p>Depending on how you measure it, around 8% of the NHS services have already been <a href="https://fullfact.org/health/how-much-more-nhs-spending-private-providers/">outsourced to private providers</a>, although privatisation is much more extensive if you include the <a href="http://www.patients4nhs.org.uk/marketisation-of-the-nhs/">internal market</a>, <a href="https://fullfact.org/health/what-nhs-paying-private-finance-initiatives/">private finance initiatives</a>, and withdrawal and restriction of services. What, or who, will be next? Introducing upfront charges for migrants has made it potentially much easier to do the same for other groups of patients and normalises the concept of upfront charging.</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/hostile1.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/hostile1.jpg" alt="" title="" width="460" height="345" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Image: On display in St Georges University Hospitals. Credit: Docs not Cops.</span></span></span></p><h2>5) It sets a terrible international example </h2> <p>The system potentially will reduce access to healthcare for UK citizens when they travel abroad. Until recently, we had one of the most inclusive healthcare systems, so why change it? The US demonstrates how large private medical bills deter the poor, vulnerable and people of colour from accessing healthcare. This is a large part of why so many women die <a href="http://www.bbc.co.uk/news/av/world-us-canada-42031800/why-do-so-many-us-women-die-giving-birth">during childbirth in the US</a>.</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/hostile2.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/hostile2.jpg" alt="" title="" width="399" height="339" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Image: On display in Whittington Hospital. Credit: Docs not Cops.</span></span></span></p><p>When <a href="https://en.wikipedia.org/wiki/Aneurin_Bevan">Aneurin Bevan</a> – a former miner and Trade Union activist – led the creation of the NHS as Health Minister after the Second World War, he <a href="https://www.sochealth.co.uk/national-health-service/the-sma-and-the-foundation-of-the-national-health-service-dr-leslie-hilliard-1980/aneurin-bevan-and-the-foundation-of-the-nhs/in-place-of-fear-a-free-health-service-1952/">intentionally ensured</a> that the healthcare system was universal for all, including visitors to the UK. He wanted to set a positive example, in part to ensure British people are treated when abroad, but also as a positive example of what can be done internationally.</p> <h2>6) It is a racist policy. </h2> <p>This policy denies basic human rights to healthcare and asks healthcare workers and receptionists to determine whether someone can access healthcare – which is not the job they have trained for and distracts from what should be their priority: the <a href="https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice">care of the patient</a>. Indeed, many NHS professionals are confused on how the new rules should be applied, with some <a href="https://www.theguardian.com/society/2017/oct/23/rules-allowing-upfront-charges-for-foreign-users-of-nhs-come-into-force">incorrectly thinking</a> that some patients are ineligible for life-saving medical care.</p> <p>‘Hostile environment’ policies can also target people with names that don’t sound ‘British’, as well as people of colour. If people can’t prove their status they may fall foul of the system. On top of that, <a href="http://webarchive.nationalarchives.gov.uk/20160107124139/http:/www.ons.gov.uk/ons/dcp171776_310441.pdf">17% of UK residents</a> don’t have a passport at all, according to the 2011 census. This has implications for some of the UK’s most vulnerable citizens, including the homeless and those living in poverty.</p> <h2>What can we do?</h2> <p>There have been some significant wins for the growing campaign against the ‘hostile environment’ in healthcare. In May 2018 the government <a href="https://www.opendemocracy.net/ournhs/peter-pannier/data-sharing-u-turn-is-welcome-but-more-to-do-to-scrap-hostile-environment-in-n">reversed</a> arrangements to share patient details with the Home Office. The government has also <a href="https://www.theguardian.com/uk-news/windrush-scandal">significantly backtracked</a> over the Windrush scandal. Change can happen - here are some ways you can help:</p> <p>1) Today - 23rd October 2018 - there is a day of action focusing on supporting healthcare workers that are resisting ID checks and upfront charging in Barts Health NHS Trust in London - the<a href="https://www.facebook.com/events/154192525531454/"> Facebook event page</a> has the timetable. There will be pickets at 3 Barts hospitals in the morning, a<a href="https://twitter.com/search?q=%23PatientsNotPassports&amp;src=typd"> #PatientsNotPassports</a> selfie twitter storm between 12 and 2pm aimed at Barts Trust, and a rally at the Royal London Hospital in the evening from 6PM. Join online or in person!</p> <p>2) Sign <a href="https://pledgeforthenhs.com/">the pledge</a> to stop NHS charges.</p> <p>3) Get involved with <a href="http://www.docsnotcops.co.uk/">Docs Not Cops</a> (<a href="https://www.facebook.com/docsnotcops/">Facebook</a>, <a href="https://twitter.com/docsnotcops?lang=en">@DocsNotCops</a>) or the <a href="https://www.medact.org/project/rsg/">Medact refugee solidarity group</a> (<a href="https://www.facebook.com/MedactRefugeeSolidarityGroup/">Facebook</a>, <a href="https://twitter.com/Medact">@Medact</a>) who are both fighting to stop the targeting of migrants in healthcare. They are open to everyone, not just doctors and other medical professionals.</p> <p>4) <a href="https://www.doctorsoftheworld.org.uk/volunteer-roles">Volunteer with</a> or <a href="https://donate.doctorsoftheworld.org.uk/page/14476/data/1">donate</a> to Doctors of the World to help ensure migrants access healthcare in the UK. You don't have to be a medical professional to volunteer – you can do clinic support, case work or other tasks. GPs, nurses and medical students are also needed.</p> <p>5) If you work in healthcare, do not ask to see ID, or turn a blind eye when you can. See who will co-operate with you in your workplace. Please bear in mind this will work better in some places than others. This is partly because patients could be identified to be charged at a later time than admission, or at a later admission, and will then still be eligible for the full cost of the care. See the <a href="http://www.patientsnotpassports.co.uk">Patients Not Passports toolkit</a> which has a step-by-step advocacy guide to help healthcare workers find a way to exempt patients, gives detailed signposting advice, and also provides support to start campaigns. </p> <p>6) If you are a member of the public, if you can, do not comply with requests to show forms of identity like passports and driving licenses when accessing NHS care. Support those targeted when you witness racial discrimination and report it to Docs Not Cops or Doctors of the World.</p> <p>7) If you work in healthcare join a union <a href="http://sci-hub.tw/https:/doi.org/10.1136/bmj.k471">like Doctors in Unite</a> which vows to support NHS staff who refuse to act as ‘border guards’ and opposes the ‘hostile environment’ in healthcare. Alternatively get your current union to vow to provide such support as well as campaign on this.</p> <h2>Further reading</h2><p><a href="http://sci-hub.tw/https:/doi.org/10.12968/hmed.2018.79.6.C94">Understanding changes to NHS charging regulations for patients from overseas</a> by Dr Lisa Murphy, Dr Joanna Dobbin, Dr Sarah Boutros in the British Journal of Hospital Medicine.</p><p><a href="http://patientsnotpassports.co.uk/">Patients Not Passports</a> - A toolkit designed to support you in advocating for people facing charges for NHS care, and in taking action to end immigration checks and upfront charging in the NHS. By Docs Not Cops, Medact and Migrants Organise.</p><p><a href="https://www.libertyhumanrights.org.uk/sites/default/files/HE%20web.pdf">A GUIDE TO THE HOSTILE ENVIRONMENT: The border controls dividing our communities – and how we can bring them down</a> by Liberty (editor).</p><p><a href="https://theconversation.com/who-has-to-pay-for-the-nhs-and-when-91344">Who has to pay for the NHS and when?</a> By Jessica Potter in The Conversation.</p><p><a href="https://www.doctorsoftheworld.org.uk/publications">Publications by Doctors of the World</a> - includes policy briefings, evidence submissions and research reports.</p><p><a href="https://corporatewatch.org/the-hostile-environment-turning-the-uk-into-a-nation-of-border-cops-2/">The Hostile Environment: turning the UK into a nation of border cops</a> by Corporate Watch.</p><p><a href="https://www.maternityaction.org.uk/wp-content/uploads/WhatPriceSafeMotherhoodFINAL.pdf">What Price Safe Motherhood? Charging for NHS Maternity Care in England and its Impact on Migrant Women</a> by Maternity Action.</p><p><a href="https://www.researchgate.net/publication/327252907_Patients_Not_Passports-No_borders_in_the_NHS">Patients Not Passports – No borders in the NHS</a>! by Jessica Potter in collaboration with Docs Not Cops.</p><p><a href="http://raceequalityfoundation.org.uk/wp-content/uploads/2018/07/REF-Better-Health-443.pdf">Tuberculosis: looking beyond ‘migrant’ as a category to understand experience</a> by Jessica L Potter &amp; Adrienne Milner, Race Equality Foundation Briefing Paper.</p><p><a href="http://sci-hub.tw/https:/academic.oup.com/eurpub/article/doi/10.1093/eurpub/cky048.146/4973469">Did migrants with tuberculosis in the UK know their condition was exempt from charges?</a> by J Potter, V White, D Swinglehurst, C Griffiths in the European journal of Public Health.</p><p><a href="http://sci-hub.tw/https:/doi.org/10.1136/bmj.j4713">Upfront charging of overseas visitors using the NHS</a> by Lucinda Hiam and Martin McKee, in the BMJ.</p><p><a href="http://sci-hub.tw/10.1016/S1470-2045%2818%2930152-9">The NHS and migrant patients with cancer</a> by Sophie Williams, Erin Dexter, Jessica L Potter, in the Lancet.</p><p><a href="http://sci-hub.tw/https:/doi.org/10.1093/pubmed/fdy050">Implications of upfront charging for NHS care: a threat to health and human rights</a> by James Smith and Erin Dexter, in the Journal of Public Health.</p><p><a href="http://sci-hub.tw/https:/doi.org/10.1136/bmj.j4091">Tougher charging regime for “overseas” patients</a> by Sarah Steele et al., in the BMJ.</p><p><a href="https://blogs.bmj.com/bmj/2017/11/10/roghieh-dehghan-a-migrant-gp-on-upfront-nhs-charges/">Roghieh Dehghan: A migrant GP on upfront NHS charges</a>, in BMJ Opinion.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/whole-agitation-has-nasty-taste-bevan-on-so-called-health-tourism">&quot;The whole agitation has a nasty taste&quot; - Nye Bevan on so-called &#039;health tourism&#039;</a> </div> <div class="field-item even"> <a href="/ournhs/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/ex-boss-of-england-s-nhs-blasts-nhs-migrant-policy-as-national-scandal">Ex-boss of England’s NHS blasts NHS migrant policy as a “national scandal”</a> </div> <div class="field-item even"> <a href="/ournhs/erin-dexter/making-nhs-hostile-environment-for-migrants-demeans-our-country">Making the NHS a “hostile environment” for migrants demeans our country</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by 4.0 </div> </div> </div> ourNHS uk ourNHS Ed Jones Mon, 22 Oct 2018 23:01:00 +0000 Ed Jones 120232 at https://www.opendemocracy.net We need to raise ‘wealth taxes’ to fund the NHS https://www.opendemocracy.net/ournhs/rob-palmer/we-need-to-raise-wealth-taxes-to-fund-nhs <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>How will the Chancellor find the £20bn a year Theresa May has promised for England's NHS?&nbsp;</p> </div> </div> </div> <p class="Normal1"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/may hammond.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/may hammond.jpg" alt="" title="" width="460" height="383" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: The PM and Chancellor at the Royal Free Hospital in June, where May pledged £20bn extra to the NHS. Credit: Stefan Rousseau/PA Images, all rights reserved.</em></p> <p class="Normal1">At the Conservative party conference in Birmingham last week Theresa May danced onto the stage and <a href="https://www.theguardian.com/politics/2018/oct/03/theresa-may-conference-speech-ambasts-labour-as-she-calls-for-tory-unity">declared that austerity was over</a>. This was just the latest sign of a growing agreement in British politics that public services are under strain and need an injection of cash. </p> <p class="Normal1">An area of particular cross-party consensus is that the NHS should have more money. A vast majority of the public agree, and the government has <a href="https://www.bbc.co.uk/news/health-44495598">promised an extra £20 billion a year by 2023</a>. Both the Prime Minister and the Chancellor have said that at least some of this will come from “fair and balanced” tax rises, to be announced at the Budget at the end of this month. </p> <p class="Normal1">The question now is which taxes might rise, and by how much.</p> <p class="Normal1">At <a href="http://www.taxjustice.uk/">Tax Justice UK</a> we believe that if the government is going to increase taxes, those with the broadest shoulders should pay the most. Our new report, <em>“The World We Want: The role of taxes in funding the NHS and other public services”</em>, sets out one way the government could find the promised £20 billion. </p> <p class="Normal1">We followed four guiding principles for any tax changes: companies and the wealthiest should pay their fair share to ensure trust in the system; tax should increase in proportion to a person’s wealth and income; a sustainable tax system needs to look beyond increasing taxes on just those at the top and companies; and the poorest should be protected from tax rises.</p> <p class="Normal1">Taxing wealth better is at the heart of our proposal. In the UK, <a href="https://www.equalitytrust.org.uk/scale-economic-inequality-uk">wealth is spread deeply unevenly,</a> with knock on effects on people’s life chances. Those with the least suffer the most, with insecure work and skyrocketing housing costs. This is made worse by a growing generational gap: young adults today are unlikely to be as well off as their parents. </p> <p class="Normal1">Importantly, there is political support for raising taxes on wealth across the political spectrum, including from <a href="https://www.dailymail.co.uk/debate/article-6132531/PETER-OBORNE-Welby-right-help-poor-tax-grab-fills-fear.html">Peter Oborne</a>, Lord Willetts, Rachel Reeves and <a href="https://www.theguardian.com/commentisfree/2018/sep/12/wealth-inequality-liberal-democrats-economic-reform">Vince Cable</a>. And doing so would pay multiple dividends: not just helping to find the extra money the NHS needs, but redressing imbalances in our society that were part of the reason people voted for Brexit and that continue to foment unrest. </p> <p class="Normal1">A first step would be to <strong>cancel the plans to cut corporation tax </strong>from the current rate of 19% to 17%, which even many business groups don’t support. Corporation tax is an indirect way of taxing wealth, as share ownership and pension holdings are concentrated amongst the rich. A rate of at least 20% would bring in an extra £8.4bn a year, and would have a <a href="https://home.kpmg.com/uk/en/home/media/press-releas-%20es/2016/11/cutting-the-corporate-tax-rate-is-unlikely-to-be-enough-to-encou.html">much less dramatic impact</a> on inward investment than some claim. </p> <p class="Normal1">The government should also fix council tax, which is a mess. Wealth in Britain is primarily made up of pensions and property, both of which attract significant tax breaks. Due to huge changes in property prices over the last three decades, the amount people pay is only weakly connected to the value of their property. </p> <p class="Normal1">A proposal from the <a href="https://www.resolutionfoundation.org/media/press-releases/britains-increasingly-unevenly-shared-property-wealth-is-driving-up-inequality-after-a-decade-long-fall/">Resolution Foundation</a>, which would replace the current system with a <strong>tax levied in proportion to a property’s value</strong>, would leave nearly three-quarters of people better off while raising an extra £5 billion. This money should stay with local authorities to help plug the holes in their budgets, including for adult social care. </p> <p class="Normal1">Other recommendations in our report include: <strong>abolishing entrepreneurs’ relief</strong>, which would raise £2.7bn; <strong>taxing income from wealth at the same level as income from work</strong>, which could raise £4bn; <strong>applying National Insurance to earnings of those older than the state pension age</strong>, which would raise £1.3bn; and <strong>curbing the pension subsidy to the wealthy</strong>, which would raise £2bn. </p> <p class="Normal1">In total, we’ve identified a possible £23.4bn in savings from these progressive tax reforms, and believe more could be unlocked if the same guiding principles were followed. </p> <p class="Normal1">For too long in the UK we have been living in a fantasy world whereby we can have low taxes – our corporation tax rate is the lowest in the G7 – and very high-quality public services. Mrs May’s conference speech was tantamount to an agreement that this position is neither sustainable nor in the country’s best interests. </p> <p>The promised increase in funding for the NHS should be a starting point for a broader debate about the level of public services we want and how to pay for them. Tax Justice UK’s vision is of a society where people do not have to wait months for desperately needed operations, schools have enough resources to teach children properly, people have access to affordable housing, and elderly and vulnerable citizens are properly cared for. </p> <p>Achieving this will mean taxing many of us more, and taxing the wealthiest the most. It will mean taking on powerful vested interests and rebuilding a sense of unity and solidarity in an increasingly divided country. And it needs to start now. </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-tax-is-stale-regressive-and-technocratic-perfect-for-new-centrist-party">An &#039;NHS tax&#039; is perfect for a &#039;new centrist party&#039;—stale, regressive and technocratic</a> </div> <div class="field-item even"> <a href="/ournhs/jenny-shepherd/us-inspired-reorganisation-is-about-to-hit-nhs-help-fund-legal-challenge">A US-inspired reorganisation is about to hit England&#039;s NHS – &#039;help us stop it&#039; </a> </div> <div class="field-item odd"> <a href="/ournhs/laurie-laybourn-langton/nhs-proves-there-s-always-been-alternative">The NHS proves there’s always been an alternative</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by 4.0 </div> </div> </div> ourNHS uk ourNHS Rob Palmer Fri, 12 Oct 2018 06:51:05 +0000 Rob Palmer 120060 at https://www.opendemocracy.net A US-inspired reorganisation is about to hit England's NHS – 'help us stop it' https://www.opendemocracy.net/ournhs/jenny-shepherd/us-inspired-reorganisation-is-about-to-hit-nhs-help-fund-legal-challenge <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>NHS plans due to take effect next spring could make general healthcare as difficult to access as mental healthcare already is – and lock future governments into long contracts with private firms, warn campaigners.</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/Marching to Leeds High Court2.JPG" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/Marching to Leeds High Court2.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: Campaigners march to court. Rights: 999 Call for the NHS</em></p><p>Members of the public, NHS campaign groups and trade unions are acting to stop NHS England from introducing a cost-cutting Accountable Care Organisation contract that will make it harder to get the healthcare we are entitled to. In their hundreds, they are <a href="http://bit.ly/999CourtofAppeal">donating to help crowdfund a legal challenge</a> to this contract in the Court of Appeal later this autumn.</p> <p>This legal challenge - brought by national campaign group 999 Call for the NHS and internationally recognised public law firm Leigh Day - is the only way of stopping the contract.</p> <p>NHS England has recently rebranded the “Accountable Care Organisation contract as the “Integrated Care Provider” contract, to avoid the USA connotations of the term Accountable Care Organisation - the type of healthcare provider used by Medicare/Medicaid, which provides a limited range of healthcare for Americans who are too poor or ill to get private health insurance.</p> <p>If this contract goes ahead, Clinical Commissioning Groups will be using it to procure a whole range of NHS services from April 2019.</p> <p>The Integrated Care Provider contract is not fully finalised, NHS England admitted in a recent consultation, making a mockery of the consultation itself. The contract does not even mention arrangements for integrating public health and social care with NHS services, though this is supposedly the public rationale for the change. </p> <p>999 Call for the NHS say that even if they agreed with the initial premise of contracting - which they don’t - they can’t see that this contract is fit for the provision of social care and public health services.</p> <p>Why is NHS England in such a rush that it is prepared to expose Clinical Commissioning Groups to the risks associated with procuring huge, complex 10 year contracts for a whole range of NHS, social care and public health services from a new untried form of healthcare provider, on the basis of an unfinished contract? </p> <p>Perhaps most worryingly of all, this contract would subject a whole range of NHS services to the same kind of cuts and pressures as <a href="https://www.theguardian.com/society/2018/jul/21/nhs-beds-number-mental-health-patients-falls">acute mental health services</a>.&nbsp;It’s designed to “manage demand” for a whole range of NHS services in a given area - in the same way as mental health services contracts already operate.&nbsp;</p> <p>Currently, in most NHS contracts apart from mental health, a set payment is made for each treatment provided to individual patients. But the new ICP contract would pay the provider a fixed lump sum at the start of each year, to cover the costs of a range of treatments for the whole population.</p> <p>The result of this payment arrangement for mental health services is that it is now normal for there to be NO hospital beds for acute mental health patients in their own area. They are routinely taken by ambulance across the country to wherever there’s a hospital bed. And at times, it seems that have been <a href="http://www.nhsconfed.org/~/media/Confederation/Files/Publications/Documents/Is%20mental%20health%20crisis%20care%20in%20crisis%20MHN%20Briefing%20290.pdf%20%5d">NO acute mental health beds free anywhere in the country</a>, according to Mental Health Network members.</p> <p>This 10 year contract would lock in that payment arrangement for a whole range of NHS services.&nbsp;</p> <p>It would set in concrete new “care models” that are based on the USA’s Medicare/Medicaid system that only provides limited health care for people who can’t afford private health insurance.</p> <p>A new government would be powerless to stop and reverse this because the contracts would lock it in for a continuous period of 10 years..</p> <p>Local NHS campaigns together with national 999 Call for the NHS are joining the dots between the cuts that they're fighting in their areas and the contract that 999 Call for the NHS are challenging in the Court of Appeal.&nbsp;</p> <p>This Court of Appeal hearing is NHS campaigners' best shot at stopping the contract that could set all these cuts - and worse - in stone for 10 years, imposing the same "demand management" payment arrangement that has been used to decimate acute mental health services.</p> <p>Jo Land, one of the Darlo Mums who organised the 999 Call for the NHS Jarrow to London March for the NHS in 2014, said:&nbsp;</p> <p>“The Accountable Care Organisation contract might seem like a dry legal issue that’s hard to get bothered about. The reality is anything but. This is about whether patients can continue to access the treatments they need, or whether the doctor-patient relationship will be undermined by making doctors put financial considerations ahead of patients’ clinical needs.”</p> <p>The campaign group point out that the payment arrangement in the Accountable Care Organisation/Integrated Care Provider contract would allow for price competition between providers when bidding for the contract. They argue this is contrary to Parliament’s express intentions, in passing NHS and social care legislation in 2012.</p> <p>In dismissing the 999 Call for the NHS Judicial Review earlier this year, the court ruled that this argument was a political issue - not a matter for the court.</p> <p>But the Court of Appeal has allowed an appeal on all seven grounds the campaign group’s legal team applied for - and has speeded up the process because the NHS is important to the public.</p> <p>Steve Carne, a 999 Call for the NHS campaigner said:&nbsp;</p> <p>“Call it what you like - Accountable Care Organisation or Integrated Care Provider - we can’t see that this new way of paying NHS providers is lawful. And if it’s introduced, it will restrict access to NHS treatments and accelerate the creation of a two tier health system. People with money will pay to go private while the rest of us make do with a limited NHS that operates like a health insurance company - putting financial considerations first.”</p> <p>If you would like to help 999 Call for the NHS to bring their challenge to the Integrated Care Provider contract in the Court of Appeal this autumn, <a href="http://bit.ly/999CourtofAppeal">here’s where you can donate</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> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by 4.0 </div> </div> </div> ourNHS uk ourNHS Jenny Shepherd Mon, 08 Oct 2018 13:35:05 +0000 Jenny Shepherd 119964 at https://www.opendemocracy.net What would a society designed for well-being look like? https://www.opendemocracy.net/transformation/tabita-green/what-would-society-designed-for-well-being-look-like <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Economic justice goes a long way to improving mental health up and down the socioeconomic ladder.</p> </div> </div> </div> <p><img src="//cdn.opendemocracy.net/files/LydiaSmith4_0.jpg" alt="" width="460" /></p><p class="image-caption">Credit:&nbsp;<a href="https://pixabay.com/en/despair-alone-being-alone-archetype-513529/">Pixabay/Geralt</a>.&nbsp;<a href="https://creativecommons.org/publicdomain/zero/1.0/deed.en">CC0 Public Domain</a>.</p> <p>In early June of this year, the back-to-back suicides of celebrities Anthony Bourdain and Kate Spade, coupled with&nbsp;<a href="https://stacks.cdc.gov/view/cdc/53785">a new report revealing a more than 25 percent rise in U.S. suicides&nbsp;</a>since 2000, prompted—again—a national discussion on suicide prevention, depression, and the need for improved treatment. Some have called for the development of new antidepressants, noting the lack of efficacy in current medical therapies. But developing better drugs buys into the mainstream notion that the collection of human experiences called “mental illness” is primarily physiological in nature, caused by a “broken” brain.</p> <p>This notion is misguided and distracting at best, deadly at worst. Research has shown that, to the contrary, economic inequality could be a significant contributor to mental illness. Greater disparities in wealth and income are associated with increased status anxiety and stress at all levels of the socioeconomic ladder. In the United States, poverty has a negative impact on children’s development and can contribute to social, emotional, and cognitive impairment. A society designed to meet everyone’s needs could help prevent many of these problems before they start.</p> <p>To address the dramatic increase in mental and emotional distress in the U.S., we must move beyond a focus on the individual and think of well-being as a social issue. Both the World Health Organization and the United Nations have made statements in the past decade that mental health is a social indicator, requiring “<a href="http://www.euro.who.int/__data/assets/pdf_file/0012/100821/E92227.pdf">social, as well as individual, solutions</a>.” Indeed, WHO Europe stated in 2009 that “[a] focus on social justice may provide an important corrective to what has been seen as a growing overemphasis on individual pathology.” </p> <p>The UN’s independent adviser&nbsp;<a href="https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=21689">Dainius Pūras reported in 2017&nbsp;</a>that “mental health policies and services are in crisis—not a crisis of chemical imbalances, but of power imbalances,” and that decision-making is controlled by “biomedical gatekeepers,” whose outdated methods “perpetuate stigma and discrimination.” Our economic system is a fundamental aspect of our social environment, and the side effects of neoliberal capitalism are contributing to mass malaise.</p> <p>In&nbsp;<em>The Spirit Level</em>, epidemiologists Kate Pickett and Richard G. Wilkinson show a close correlation between income inequality and rates of mental illness in 12 Organisation for Economic Co-operation and Development member countries. The more unequal the country, the higher the prevalence of mental illness. Of the 12 countries measured on the book’s mental illness scatter chart, the United States sits alone in the top right corner—the most unequal and the most mentally ill.</p> <p>The seminal&nbsp;<a href="https://www.cdc.gov/violenceprevention/acestudy/about.html">Adverse Childhood Experiences Study&nbsp;</a>revealed that repeated childhood trauma results in both physical and mental negative health outcomes in adulthood. Economic hardship is the most common form of childhood trauma in the U.S.—one of the richest countries in the world. And the likelihood of experiencing other forms of childhood trauma—such as living through divorce, death of a parent or guardian, a parent or guardian in prison, various forms of violence, and living with anyone abusing alcohol or drugs—also increases with poverty.</p> <p>Clearly, many of those suffering mental and emotional distress are actually having a rational response to a sick society and an unjust economy. This revelation doesn’t reduce the suffering, but it completely changes the paradigm of mental health and how we choose to move forward to optimize human well-being. </p> <p>Instead of focusing only on piecemeal solutions for various forms of social ills, we must consider that the real and lasting solution is a new economy designed for all people, not only for the ruling corporate elite. This new economy must be based on principles and strategies that contribute to human well-being, such as family-friendly policies, meaningful and democratic work, and community wealth-building activities to minimize the widening income gap and reduce poverty.</p><p><img src="//cdn.opendemocracy.net/files/Tabitagreen2.jpg" alt="" width="460" /></p> <p>The seeds of human well-being are sown during pregnancy and the early years of childhood.&nbsp;<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640562/">Research shows that mothers&nbsp;</a>who are able to stay home longer (at least six months) with their infants are less likely to experience depressive symptoms, which contributes to greater familial well-being. Yet in the United States, one-quarter of new mothers return to work within two weeks of giving birth, and only 13 percent of workers have access to paid leave. A new economy would recognize and value the care of children in the same way it values other work, provide options for flexible and part-time work, and, thus, enable parents to spend formative time with their young children—resulting in optimized well-being for the whole family.</p> <p>In his book&nbsp;<em>Lost Connections,&nbsp;</em>journalist Johann Hari lifts up meaningful work and worker cooperatives as an “unexpected solution” to depression. “We spend most of our waking time working—and 87 percent of us feel either disengaged or enraged by our jobs,” Hari writes.</p> <p>A lack of control in the workplace is particularly detrimental to workers’ well-being, which is a direct result of our hierarchical, military-influenced way of working in most organizations. Worker cooperatives, a building block of the solidarity economy, extend democracy to the workplace, providing employee ownership and control. When workers participate in the mission and governance of their workplace, it creates meaning, which contributes to greater well-being. While more research is needed, Hari writes, “it seems fair ... to assume that a spread of cooperatives would have an antidepressant effect.”</p> <p>Worker cooperatives also contribute to minimizing income inequality through low employee income ratios and wealth-building through ownership—and can provide a way out of poverty for workers from marginalized groups. In an&nbsp;<a href="https://soundcloud.com/upstreampodcast/jessica-gordon-nembhard">Upstream podcast interview</a>, activist scholar Jessica Gordon Nembhard says, “We have a racialized capitalist system that believes that only a certain group and number of people should get ahead and that nobody else deserves to … I got excited about co-ops because I saw [them] as a place to start for people who are left behind.” </p> <p>A concrete example of this is the Cleveland Model, in which a city’s anchor institutions, such as hospitals and universities, commit to purchasing goods and services from local, large-scale worker cooperatives, thus building community wealth and reducing poverty.</p> <p>The worker cooperative is one of several ways to democratize wealth and create economic justice. The Democracy Collaborative lists dozens of strategies and models to bring wealth back to the people on the website community-wealth.org. The list includes municipal enterprise, community land trusts, reclaiming the commons, impact investing, and local food systems. All these pieces of the new economy puzzle play a role in contributing to economic justice, which is inextricably intertwined with mental and emotional well-being.</p> <p>In&nbsp;<em>Lost Connections,</em>&nbsp;Hari writes to his suffering teenage self: “You aren’t a machine with broken parts. You are an animal whose needs are not being met.” Mental and emotional distress are the canaries in the coal mine, where the coal mine is our corporate capitalist society. Perhaps if enough people recognize the clear connection between mental and emotional well-being and our socioeconomic environment, we can create a sense of urgency to move beyond corporate capitalism—toward a new economy designed to optimize human well-being and planetary health.</p> <p>Our lives literally depend on it.</p> <p class="image-caption">This article was first published in <a href="https://www.yesmagazine.org/issues/mental-health/what-a-society-design-for-well-being-looks-like-20180912?utm_medium=email&amp;utm_campaign=YTW_20180914&amp;utm_content=YTW_20180914+CID_3a58e48b2a7b6e0ca7425d920c5743f5&amp;utm_source=CM&amp;utm_term=What%20a%20Society%20D">YES! Magazine</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="/transformation/ray-filar/mental-health-why-were-all-sick-under-neoliberalism">Mental health: why we&#039;re all sick under neoliberalism </a> </div> <div class="field-item even"> <a href="/transformation/lydia-smith/why-mental-health-is-hidden-cost-of-housing-crisis">Why mental health is the hidden cost of the housing crisis</a> </div> <div class="field-item odd"> <a href="/transformation/joel-millward-hopkins/neoliberal-psychology">Neoliberal psychology</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by 4.0 </div> </div> </div> Transformation ourNHS Transformation Tabita Green The politics of mental health Care Thu, 04 Oct 2018 15:00:36 +0000 Tabita Green 119712 at https://www.opendemocracy.net "Not on the NHS" – from grommets to hysterectomies – unless you act now https://www.opendemocracy.net/ournhs/greg-dropkin-samantha-wathen/not-on-nhs-from-varicose-vein-treatments-to-hysterectomies-unles <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>The government plans to exclude 17 important medical treatments from the NHS across the whole of England, with more restrictions in the pipeline. A consultation on the proposals is open until this Friday.</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/childs ear.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/childs ear.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: Grommets for glue ear are one of the procedures being largely cut from the NHS. Credit: <a href="https://www.flickr.com/photos/tbisaacs/3911558890">Travis Isaacs/Flickr,</a> CC 2.0</em></p><p>At the end of June NHS England <a href="https://www.healthcampaignstogether.com/pdf/HCTNo11.pdf">formally announced its plan to withdraw 17 clinical procedures</a> meaning they would no longer be routinely offered on the NHS. This move means treatments such as knee arthroscopies for patients with osteoarthritis, and snoring surgery, will no longer be available to anyone on the NHS. And procedures such as varicose vein removal, grommets for glue ear in children, hysterectomy for heavy menstrual bleeding, tonsillectomies, and treatments to release carpal tunnel syndrome or to remove benign skin lesions, will no longer be available to anyone on the NHS, unless complex criteria are met.</p> <p>This is clearly a further step towards introducing a two-tier system with the better off being able to pay for non-NHS treatment, the poorer suffering in silence and private companies making a profit. NHSE is implementing what is arguably a prime example of this government’s long-term agenda – to severely restrict public health care and to promote private health care, and here it is in full flow.</p> <p>However, treatments cannot simply be withdrawn without <a href="https://www.england.nhs.uk/evidence-based-interventions/">consultation</a>. Keep Our NHS Public asks clinicians and the public to complete the online survey (which closes this Friday 28 September) – <a href="https://keepournhspublic.com/wp-content/uploads/2018/09/Responding-to-NHSE-Consultation-on-low-value-interventions.pdf">guidance from Keep Our NHS Public is here.</a> </p> <p>We need to reject unjustified rationing plans which will force patients to either suffer or seek private treatment, the thin end of the wedge for further cuts to come.</p> <p>In their 103 page public consultation, NHS England gives the impression that the proposals are fully in line with NICE, whose logo appears on the cover, and that NICE was a source for the proposals. </p> <p>But in fact, NHS England’s proposals to withdraw 17 NHS clinical procedures <em>contradict</em> existing guidance from the National Institute for Health and Care Excellence (NICE), the recognised authority advising clinicians on the current state of research evidence. </p> <p>Research undertaken by Keep Our NHS Public paints a very different and alarming picture. It details that for nine of the 17 procedures, NHSE does not cite any evidence at all from NICE. For five procedures the NICE evidence cited does not support the NHSE proposal and for one, the NICE evidence cited gives only partial support. For only two out of seventeen withdrawn procedures does the cited NICE evidence back the NHSE proposal. The government have not listened to clinicians, campaigners or crucially, to NICE in rationing these arguably essential treatments. </p> <p>Keep Our NHS Public supports evidence-based policy, and where clinical evidence backs it up procedures in certain circumstances may not always be appropriate (e.g. tonsils used to be removed in over 50% of children). But the good practice guidance already exists and NHSE is now seeking to artificially extend it. Grommets for instance may have been overused in the past, but they are subject to guidance now and are still necessary in some cases.</p> <p>Some NICE guidance (not cited by NHS England) directly contradicts proposals and/or refers to relevant ongoing research. In one case (intervention for snoring surgery), NHS England is bypassing unfinished NICE research which isn’t due to be finished and published until August 2020. It appears that NHSE is ‘cherry-picking’ the evidence available to suit its own ends.</p> <p>Clinicians should read NICE guidance for themselves rather than take NHS England’s word for it.</p> <h2>Ignoring clinicians, listening to McKinsey</h2> <p>NHS England also make explicit that they intend to “rapidly expand” the restrictions after this consultation. Already, many more so-called “clinically ineffective” treatments are restricted in areas across the country – in Bristol, 104 interventions are being excluded. The threat is explicit that NHS England is looking to replicate this nationally as the government potentially seeks to withdraw ever more NHS provision.</p> <p>In attempting to ration NHS treatments, NHS England and the government presuppose they know better than qualified and skilled clinicians. It should not be the decision of ministers in Whitehall who can and cannot access much needed medical treatment. Indeed, this decision making should never be taken on the basis of cost as is happening here. The approach appears to derive from a 2009 report by the McKinsey Corporation on how the NHS could respond to the banking crisis, that included hip and knee replacements, hernia and cataract surgery in a list of <a href="https://www.healthcampaignstogether.com/pdf/HCTNo11.pdf">“procedures of limited clinical benefit”.</a></p> <p>NICE guidelines are being ignored when the health and wellbeing of real patients is at stake. Existing NICE and other clinical guidelines are already cautious, conservative, thorough and periodically under clinical review. Clinical practice should change in response to proven research following systematic review, not pre-empt it. NHSE is bypassing unfinished research cited in NICE guidance. Clinicians should take decisions in discussion with patients without bureaucratic referral-blocking processes when guidance exists and is in practice already.</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-cuts-are-we-in-it-together">NHS cuts - are we in it together?</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/eight-reasons-you-really-can%27t-trust-tories-with-nhs">Eight reasons you really can&#039;t trust the Tories with the NHS</a> </div> <div class="field-item odd"> <a href="/ournhs/paul-hobday/seven-things-private-healthcare-insurance-adverts-wont-tell-you">Seven things the private healthcare insurance adverts won&#039;t tell you</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by 4.0 </div> </div> </div> ourNHS uk ourNHS Samantha Wathen Greg Dropkin Tue, 25 Sep 2018 15:36:15 +0000 Greg Dropkin and Samantha Wathen 119815 at https://www.opendemocracy.net NHS bosses call "pause" on controversial "SubCo" NHS privatisations - for now https://www.opendemocracy.net/ournhs/colenzo-j/strikes-planned-against-backdoor-nhs-privatisation-fools-gold <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>NHS workers and communities are uniting to fight back against the dangerous creation of NHS ‘wholly owned subsidiaries.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/unite WWL.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/unite WWL.jpg" alt="" title="" width="460" height="384" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p><em>Image: Pickets at WWL NHS this summer, where backdoor privatisation plans were halted. Credit: @Unite_NorthWest.</em></p><p><em>UPDATE 18.15pm 19/9/18: Just as this story was published, <a href="https://www.hsj.co.uk/policy-and-regulation/nhsi-tells-trusts-to-pause-subsidiary-plans/7023407.article?utm_source=t.co&amp;utm_medium=Social&amp;utm_campaign=newsfeed">the main NHS regulator announced it was calling for a 'pause' on all new NHS Wholly Owned Subsidiary plans</a>, pending the issuing of new guidance next month. Unite's Colenzo Jarrett-Thorpe commented: <span>“Unite the Union welcomes NHS Improvement's call to a halt the establishment of more Wholly Owned Subsidiaries. We hope that this instruction extends to NHS Foundation Trusts that plan to transfer staff into these companies in the next couple of weeks, such as East Kent and York, and others with board approval like Chesterfield. We hope NHS Improvement consults as many NHS stakeholders as possible including community groups, patient groups and trade unions regarding the future of wholly owned subsidiaries.&nbsp; We will be writing to the Chief Executive of NHS Improvement to express our concerns.”</span></em></p><p>NHS trusts in England are setting up wholly owned subsidiaries (WOSs) in a bid to avoid tax. And the dangers inherent in are becoming increasingly apparent in terms of threats to patient services and jobs.</p> <p>Worryingly there are about 40 of these entities announced or already up-and-running in England’s NHS – for estates staff (from management to electricians) as well as porters, cleaners and other key support staff. Many out-patient pharmacies in hospitals have gone the same way.&nbsp;</p> <p>But there are signs the tide is finally turning. <a href="https://www.gazettelive.co.uk/news/teesside-news/nhs-trust-scraps-plans-outsource-15149720">Tees Esk and Wear Valley NHS Trust has just announced it has ditched its plans to create a wholly owned subsidiary</a>.&nbsp;&nbsp;</p> <p>This follows NHS trusts -&nbsp;<a href="https://www.morningstaronline.co.uk/article/unite-celebrates-nhs-trust-victory">Leicester</a>,&nbsp;<a href="https://www.yorkshirepost.co.uk/news/health/trust-u-turn-is-victory-for-principles-of-nhs-1-9300508">Mid York</a>,&nbsp;<a href="https://www.yorkshirepost.co.uk/news/unions-hope-to-defeat-hospital-staff-transfers-as-leeds-nhs-trust-puts-private-company-move-on-hold-1-9265997">Leeds</a>&nbsp;and&nbsp;<a href="https://www.bristolpost.co.uk/news/bristol-news/southmead-hospital-bosses-scrap-proposal-1157104">North Bristol</a>&nbsp;- where trust managements have retreated from proposals to create these private limited companies.</p> <p>In each case, local campaigns brought together staff and the community. Their rallying cry? That the NHS means an NHS for <em>all</em> - and calling out wholly owned subsidiaries for what they are, backdoor NHS privatisation masquerading as an exercise in financial efficiency.</p> <p>Unite is concerned that the trusts are forming these entities so that they can register for VAT exemption and compete on a level-playing field with commercial competitors. Private firms can register for VAT exemption for their work in the NHS, when NHS trusts can’t.&nbsp;</p> <p>Unite, which has 100,000 members in the health service, wants HMRC to close this loophole, but the request has so far been rebuffed by the Treasury.&nbsp;&nbsp;</p> <p>This summer, the Department of Health and Social Care took steps to ensure that if an NHS trust or foundation trust wants to set up a wholly owned subsidiary they will have to get approval from the Department of Health via NHS Improvement (NHSi), and report their interest in setting up the company to NHSi.&nbsp;</p> <p>The main purpose of this is to ensure that an NHS trust does not place itself at financial risk by setting up a wholly owned subsidiary. Unite welcomes this statement, but believes the government should go further.</p> <p>Unite wrote earlier this year to the former health and social care secretary Jeremy Hunt calling for an immediate moratorium on further private limited companies being established by NHS trusts in England.&nbsp;</p> <p>At the time, Hunt failed to address these concerns – we hope for a more positive response from his successor, Matt Hancock.&nbsp;</p> <p>We believe WOSs could be creating a Pandora’s Box of dozens of Carillion-type meltdowns among NHS trusts in England, which would have a detrimental effect on key health services and the employees that provide these services.</p> <p>Unite members in East Kent (<a href="//2">24-28 September</a>) and York (<a href="//3">27-29 September</a>) will be taking industrial action, as a last resort in their campaign to stop their outsourcing to a private limited company, a WOS. Our members want to defend their NHS status, and to halt privatisation of vital NHS services.&nbsp;&nbsp;</p> <p>They will be building on the efforts of workers at Wrightington, Wigan and Leigh NHS Foundation Trust, where outsourcing to a wholly owned subsidiary culminated in strike action in July. This action ended in success when a solution was found and staff were not transferred to the WOS. Again, protests involving the local council, MPs and the community contributed to this heartening victory.</p> <p>Electricians, plumbers, fitters, porters and cleaners carry out a crucial role in keeping hospitals open and properly functioning. They are a core part of the NHS’ family’ and their jobs should not be hived off.&nbsp;</p> <p>Unite is not prepared to allow the jobs of our members to be sold off, which would inevitably lead to job cuts and attacks on the terms and conditions further down the line. And it would be fool’s gold anyway, if the HMRC eventually closes the tax loophole.&nbsp;</p> <p>Though NHS Providers promote the creation of WOSs, they are not the answer to the last eight years of chronic underfunding of the NHS and the parlous finances of many NHS trusts in England.&nbsp;&nbsp;</p> <p>There is strong evidence where wholly owned subsidiaries have been set up that once staff are transferred to the private limited company, new employees are not given access to the NHS pension scheme and are offered inferior Agenda for Change terms and conditions.&nbsp;&nbsp;</p> <p>This is where these companies seek to make savings, by short changing hard working staff under the rubric of becoming more ‘commercial’ and ‘sustainable’&nbsp;(NHS companies – An enterprising approach to health, Grant Thornton, 2017).</p> <p>Our members in East Kent and York hospitals are at the forefront of a much wider policy struggle over the future direction of the NHS and the disaster of the 2012 Health and Social Care Act which has created a privatised, fragmented health system even health leaders don’t understand and cannot navigate.&nbsp;</p> <p>Unite says we must call time on wholly owned subsidiaries specifically and NHS privatisation generally. The NHS means the NHS.&nbsp;</p> <p>&nbsp;</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/are-cash-strapped-hospitals-walking-into-trap-that-could-cost-nhs-its-family-">Are cash-strapped hospitals walking into a trap that could cost the NHS its family silver?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by 4.0 </div> </div> </div> ourNHS uk ourNHS Colenzo Jarrett-Thorpe Wed, 19 Sep 2018 15:20:16 +0000 Colenzo Jarrett-Thorpe 119728 at https://www.opendemocracy.net What happens when mental health professionals also get sick? https://www.opendemocracy.net/transformation/lydia-smith/what-happens-when-mental-health-professionals-also-get-sick <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p class="normal">It’s no wonder that almost half of all psychotherapists in the National Health Service say they feel depressed.</p> </div> </div> </div> <p class="normal"><img src="//cdn.opendemocracy.net/files/LydiaSmith4.jpg" alt="" width="460" /></p><p class="image-caption">Credit: <a href="https://pixabay.com/en/despair-alone-being-alone-archetype-513529/">Pixabay/Geralt</a>. <a href="https://creativecommons.org/publicdomain/zero/1.0/deed.en">CC0 Public Domain</a>.</p> <p class="normal">Overwhelmed by soaring demand, mental health services are under growing pressure on both sides of the Atlantic. According to a <a href="https://www.mentalhealth.org.uk/publications/surviving-or-thriving-state-uks-mental-health">2017 Mental Health Foundation survey</a> two-thirds of British adults experience mental ill-health issues at some point in their lives. In England alone, <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/mental-health-and-wellbeing-trends-among-children-and-young-people-in-the-uk-19952014-analysis-of-repeated-crosssectional-national-health-surveys/AB71DE760C0027EDC5F5CF0AF507FD1B">such issues in young people have risen sixfold since 1995</a>. US figures paint a similar picture: <a href="https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201600260">a study published in Psychiatry Online in 2017</a> found that more than eight million Americans suffer from serious psychological distress.</p> <p class="normal">But this crisis isn’t just affecting the general public; an increasing number of mental health professionals are also struggling with their wellbeing. In a recent <a href="https://www.bps.org.uk/news-and-policy/new-savoy-survey-shows-increasing-mental-health-problems-nhs-psychotherapists">survey</a> undertaken by the New Savoy Partnership—a coalition of organisations that came together in 2007 to persuade government to recognise the value of providing psychological therapies free of charge—almost half of 1,227 NHS psychotherapists said that they had felt depressed in the last week “some, most or all of the time,” up from 40 per cent in 2014.</p> <p class="normal">In already highly-pressured environments like the NHS, increasing demands on staff, tight time limits and the prominence of targets mean that many nurses and specialists are suffering from the same mental health problems they are treating in their patients. This isn’t just a problem for professionals who lack access to the appropriate support; keeping staff healthy is also crucial for patients, communities and our collective wellbeing.</p> <p class="normal">“High caseloads, lots of clients back to back—the work of a therapist is tough emotionally and takes a lot of energy out of you,” counsellor and psychotherapist Katerina Georgiou told me in a recent interview. “It’s also a very responsible role—you’ve got vulnerable people placing their trust in you, and that’s a responsibility you can’t take lightly. You need to care about people and fully attend to them. You’re switched on throughout a session. If you’ve then got five or six sessions back to back, that’s a lot of time switched on,” adding that burnout can be common.</p> <p class="normal">At a time when the demand for mental health services is rising, funding cuts and austerity measures have caused essential resources to dwindle, staff workloads to mount, pay stagnate and morale crumble. According to <a href="https://www.centreformentalhealth.org.uk/parity-of-esteem">The Centre for Mental Health</a>, mental illness accounts for 28 per cent of the overall disease burden of the NHS but receives just 13 per cent of total funding.&nbsp; Between 2009 and 2017, the King’s Fund think tank reported a <a href="https://www.kingsfund.org.uk/publications/funding-staffing-mental-health-providers">13 per cent drop in full-time NHS mental health nurses</a>.</p> <p class="normal">“Mental health professionals will feel the cuts in the sense of noticing increased caseloads, perhaps not having much time in between clients, not as much time to write up notes, and the demand for outcomes increased,” Georgiou says. “The breathing space decreases, which can increase stress, maybe even build resentment. And the thing is, you can’t let that stress and resentment get in the way of your work.”</p> <p class="normal">Health staff are being asked to see huge numbers of patients for shorter periods of time, and their managers are under pressure to prioritise targets—like treating minimum numbers of clients—over their wellbeing. As a result, sickness rates among staff have become a common concern, with stress and anxiety-issues <a href="https://www.kingsfund.org.uk/publications/funding-staffing-mental-health-providers">one of the most frequently stated causes of absence among mental health </a><a href="https://www.kingsfund.org.uk/publications/funding-staffing-mental-health-providers">nurses</a>.</p> <p class="normal">“Working in an under-resourced, under-pressure NHS leaves doctors struggling to provide the high-quality care patients deserve,” <a href="https://www.bma.org.uk/">British Medical Association</a> Consultants’ Committee mental health lead Dr Andrew Molodynski told me. “This leads to doctors burning out and becoming unwell, and patients suffer further.”</p> <p class="normal">Louise Watson, a UK-based clinical psychologist, adds that professionals working privately may also face “internal pressures,” perhaps seeing more clients in a day than may be healthy because of the intense nature of the job. Moreover, mental health professionals may struggle to come forward for help, or simply soldier on and mask their problems. “I think another internal pressure is that perhaps mental health professionals feel a level of demand that they shouldn’t be struggling with mental health issues themselves,” Watson told me.</p> <p class="normal">“Most people who are in the profession are there because there is something in their personality or background that means they are comfortable in that role of helping other people, so to be on the other side of the fence is difficult. They may put off going for help longer than they should because of that.”</p> <p class="normal">Making sure that everyone who needs help is able to access it is essential, not least because the number of people in need of specialist care is growing, and staffing levels are already in crisis. “It speaks for itself that if mental health professionals are off work with stress, or aren’t functioning to their full capacity because they are under too much pressure, then there won’t be anybody to look after anybody,” Watson says. “It’s a bit like on an airplane and the oxygen masks drop down, you need to fit your own oxygen mask first before you help others.”</p> <p class="normal">Mental health services in the US are also under threat. Earlier this year, President <a href="https://www.apnews.com/4db5c3de76d6440fbe35485af6cc0678/Budget-undercuts-Trump-focus-on-mental-health,-school-safety">&nbsp;Trump’s budget proposed slashing Medicaid, the major source of public funds for mental health treatment</a> which serves more than 70 million low-income and disabled people. America is also facing an acute shortage of mental health professionals in rural areas, with 65 per cent of non-metropolitan counties lacking a psychiatrist and nearly half without a psychologist according to a recent study in the <a href="https://www.ajpmonline.org/article/S0749-3797(18)30005-9/fulltext">American Journal of Preventive Medicine</a>.</p> <p class="normal">It’s no surprise that a shortage of staff and other resources have had a direct impact on access to services, including longer waits for people in dire need of help, which can lead to an <a href="https://www.bma.org.uk/news/2018/february/the-devastating-cost-of-treatment-delays">increased risk of self-harm and suicide.</a> In 2018, the US <a href="https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a1.htm?s_cid=mm6722a1_w">Centers for Disease Control</a> found that suicide rates have risen by 30 per cent in America since 1999. An increasing number of teenagers in England and Wales are also dying by suicide, <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2017registrations">with 177 suicides among 15- to 19-year-olds in 2017</a> compared to 110 in 2010.</p> <p class="normal">“There would be an argument to say that we ought to be prioritising making sure people who are helping others are healthy,” Watson told me. “If we don’t, there won’t be any mental health care. And that will have knock on effects on society like having large numbers of people off work with stress.”</p> <p class="normal">It’s not just public health that suffers if we fail to support mental health staff but the whole of society and the economy. The UK government’s <a href="https://www.gov.uk/government/publications/thriving-at-work-a-review-of-mental-health-and-employers">Thriving at Work review</a> published in 2017 concluded that poor mental health costs the economy up to £99 billion a year. Of this amount, employers lose up to £42 billion through staff turnover, sick leave and ‘presenteeism’—working while sick, which causes losses in productivity.</p> <p class="normal">Importantly though, if a mental health professional is experiencing a problem and seeks help, this can be a positive thing for care all-round. “It increases your ability to empathise with your own clients if you have been through a similar situation, and gives you first-hand experience of seeing what you thought was helpful,” Watson explained. “If you work in mental health and you suffer with an issue yourself, maybe it ought to be seen as a helpful experience in terms of improving our own practice.”</p> <p class="normal">It also breaks down the ‘them and us’ feeling that is common in the health system, Watson adds. “The client may see the psychologist as a doctor who is there to fix them, but what I think can be helpful in a therapeutic relationship is to feel a rapport—that we are both human beings. It is about working together to find an answer.”</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/transformation/lydia-smith/why-mental-health-is-hidden-cost-of-housing-crisis">Why mental health is the hidden cost of the housing crisis</a> </div> <div class="field-item even"> <a href="/transformation/lydia-smith/why-we-should-all-be-concerned-about-musicians-mental-health">Why we should all be concerned about musicians’ mental health</a> </div> <div class="field-item odd"> <a href="/transformation/ray-filar/mental-health-why-were-all-sick-under-neoliberalism">Mental health: why we&#039;re all sick under neoliberalism </a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by 4.0 </div> </div> </div> Transformation ourNHS Transformation Lydia Smith The politics of mental health Care Tue, 18 Sep 2018 19:09:08 +0000 Lydia Smith 119690 at https://www.opendemocracy.net NHS charging for overseas visitors – wrong on every level https://www.opendemocracy.net/ournhs/martin-mckee/nhs-charging-for-overseas-visitors-in-nhs-wrong-on-every-level <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Regulations that deny visitors NHS care –&nbsp;except for certain infectious diseases and to relieve death pains - are riven with contradictions. And will hit some unexpected victims as well as the intended scapegoats.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/nhs-poster-not-free-to-all.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/nhs-poster-not-free-to-all.jpg" alt="" title="" width="380" height="214" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Poster in Newham hospital. Rights: <a href="https://newhamsaveournhs.weebly.com/">Newham Save Our NHS.</a></em></p> <p>Given the choice, the British government’s <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/729872/Guidance_on_implementing_the_overseas_visitor_charging_regulations_-_May_2018.pdf">guidelines on implementing their overseas visitor charging regulations</a> would not have been top of my reading list. Especially because I had already read them once – but still had to revisit them to formulate an answer to a question on a list server. The question was, at least superficially, simple. The regulations contain a list of diseases which -&nbsp; for any visitor to the United Kingdom unlucky enough to have one of them – the NHS will still provide free treatment. Is this list appropriate? Is there anything that is missing? As is often the case, an apparently simple question opens up many other less obvious issues. Here are just a few of them.</p> <p>The guidelines were written for health professionals and managers who must decide whether a patient is entitled to free NHS care, in the light of recent regulations restricting access for visitors.</p><p>To make their decision, NHS staff are confronted with a set of guidelines that stretches to 117 pages, which they are expected to understand and apply, even in the midst of working frantically to save a patient’s life.</p><p>It gets worse. NHS organisations “are advised to seek their own legal advice on the extent of their obligations when necessary”. Why? Because the regulations are incredibly complex, and involve balancing requirements under a wide range of other legislation, including data protection, prohibition of discrimination, and much else. Also there are still unresolved ambiguities. As the guidelines note, “’Ordinarily resident’ is not defined in the 2006 Act”, even though it is a key concept in making decisions under the regulations.</p><p>NHS staff really don't need all of this. In a health service that has been starved of resources for almost a decade, health workers are already overstretched. Posts remain unfilled, and rotas have many gaps. In some parts of the country, many of those providing direct patient care are agency staff, who must spend precious time orientating themselves to different settings. The rapidly changing nature of healthcare means that they must constantly update their knowledge, both in relation to clinical matters and to an often bewildering array of statutory requirements.&nbsp;</p><p class="mag-quote-center">“providing timely and effective care to migrants saves money in the long run”</p><p>Leaving aside the morality of the government’s “<a href="https://www.ncbi.nlm.nih.gov/pubmed/29306349">hostile environment</a>” to visitors, these regulations also completely fail to recognise that what is presented as a cost saving measure is anything but. For many hospitals, the cost of complying with the regulations far outweighs any income that they may generate. And&nbsp;<a href="https://www.ncbi.nlm.nih.gov/pubmed/26201017">research from Germany</a>&nbsp;shows clearly that providing timely and effective care to migrants saves money in the long run. But then, as is apparent with the government’s pursuit of Brexit, deterring migrants is much more important than growing the economy.</p> <p>The politics behind the regulations are obvious. The main exemption from charges is for infectious diseases deemed to pose a threat to the resident population. Visitors will be entitled to care in an emergency department, but only until the point where they require admission to hospital. Palliative care is also exempt, presumably because of the media attention that visitors dying in agony might attract.</p> <p class="mag-quote-center">The list gives an impression of having been drafted several decades ago</p> <p>It is the list of infectious diseases that is most intriguing. Some are highly contagious but others are not. Leprosy, for example, is only transmitted when there is prolonged contact between people. Others are included even though they are transmitted by vectors not normally present in the United Kingdom. Yet other vector borne diseases (such as <a href="http://www.who.int/chagas/resources/Eurosurv_art19968/en/">Chagas Disease</a>, increasingly being diagnosed among migrants from South America) are excluded. Smallpox remains on the list, despite having been eradicated globally almost 40 years ago. The list gives an impression of having been drafted several decades ago, with individual diseases being added on an ad hoc basis.</p> <p>There will, however, be an opportunity to update the list. The guidelines are full of references to the European Union and the European Economic Area. Visitors from the countries concerned are, of course, entitled to treatment paid for by their home health authorities. Should British ministers ever manage to agree on a feasible plan to leave the European Union, then this will have to change completely. However, given the many other challenges that they will face, including shortages of staff, medicines, equipment, and above all money, this may be well down the list of priorities.</p> <p class="mag-quote-center">British pensioners who have retired to the Mediterranean…will find, to their surprise, that they are not entitled to NHS treatment under the regulations</p> <p>So it may take some time for them to address one of the more pressing issues. This is the potential return of large numbers of British pensioners who have retired to the Mediterranean. Many of them will find, to their surprise, that they are not entitled to NHS treatment under the regulations as they are not ordinarily resident. Given that many are elderly, with multiple chronic conditions, this will pose a considerable challenge. In some cases, they will have family members who are not British citizens, just to add to the complexity.</p> <p>Postscript: As I was finalising this blog, the Home Office issued its guidance on <a href="https://www.theguardian.com/politics/2018/sep/04/concerns-raised-over-59-page-handbook-on-brexit-settled-status-scheme?CMP=share_btn_tw">applications for settled status for EU citizens post-Brexit</a>. The good news – it is only 59 pages long. Remember that the then Home Secretary said this would be <a href="https://www.theguardian.com/politics/2018/apr/23/amber-rudd-online-eu-registration-system-lk-bennett">as simple as opening an account at a certain upmarket retailer</a>. The bad news – the guide to the process for such applicants is almost as incomprehensible as the guidance for NHS staff outlined above. This time, the government claims the default position will favour the applicant but, given this would be a 180 degree turn by the Home Office, and totally at odds with the culture of xenophobia it has worked so hard to create, no-one believes it.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/ex-boss-of-england-s-nhs-blasts-nhs-migrant-policy-as-national-scandal">Ex-boss of England’s NHS blasts NHS migrant policy as a “national scandal”</a> </div> <div class="field-item even"> <a href="/ournhs/erin-dexter/making-nhs-hostile-environment-for-migrants-demeans-our-country">Making the NHS a “hostile environment” for migrants demeans our country</a> </div> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/dont-invoke-nhs-to-sell-false-idea-of-good-nationalism">Don&#039;t invoke the NHS to sell a false idea of &#039;good nationalism&#039;</a> </div> <div class="field-item even"> <a href="/ournhs/kailash-chand/nhs-passport-proposals-are-just-more-grubby-politics-from-may-and-hunt">NHS passport proposals are just more grubby politics from May and Hunt</a> </div> <div class="field-item odd"> <a href="/ournhs/migrant-activists-disrupt-department-of-health">Migrant activists disrupt the Department of Health </a> </div> <div class="field-item even"> <a href="/ournhs/docs-not-cops/labour-must-tackle-may-s-hostile-environment-for-migrants-in-nhs">Labour must end May’s ‘hostile environment’ for migrants in the NHS</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by 4.0 </div> </div> </div> ourNHS uk ourNHS Martin McKee Wed, 05 Sep 2018 08:55:52 +0000 Martin McKee 119545 at https://www.opendemocracy.net Social activism and the economics of mental health https://www.opendemocracy.net/transformation/john-picton/social-activism-and-economics-of-mental-health <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Apolitical volunteering is ill-equipped to address the structural causes of depression.</p> </div> </div> </div> <p><img src="//cdn.opendemocracy.net/files/John Picton.jpg" alt="" width="460" /></p><p class="image-caption">“Volunteering.” Credit: <a href="https://www.flickr.com/photos/danielthornton/8620041374">Flickr/Daniel Thornton</a>. <a href="https://creativecommons.org/licenses/by/2.0/">CC BY 2.0</a>.</p> <p>‘Social prescribing,’ where patients with depression join in community activities as a part of their treatment, is moving from the fringe of medical practice to the mainstream. Matt Hancock, the new British Minister for Health and Social Care, <a href="https://www.gov.uk/government/news/social-prescribing-schemes-across-england-to-receive-45-million">has pledged £4.5m to promote it</a>, but we should stop to think before we take this medicine: linking patients to their communities is a positive step, but a better move would be for people to get involved in social activism.</p> <p>The Minister probably has one eye on his budget, since social prescribing <a href="https://www.huffingtonpost.co.uk/entry/social-prescribing-health-conditions_uk_5b586a95e4b0de86f4923524">is thought to stop patients coming back to doctor’s surgeries</a>—so saving the state money in the National Health Service (NHS). But this scheme, which normally involves referring the patient to a link worker who then recommends different types of community activity for them, is about more than balancing the books: in fact the NHS is administering a large dose of social theory. </p> <p>Almost 20 years ago, the American Political Scientist <a href="http://robertdputnam.com/">Robert Putnam</a> published <em><a href="https://en.wikipedia.org/wiki/Bowling_Alone">Bowling Alone</a></em>. Since then there has been a groundswell of interest in its central concept of ‘social capital’—the idea that community bonds such as those developed in bowling leagues in the USA make both individuals and societies happier and healthier. </p> <p>Putnam is a nuanced writer, but the core focus of <em>Bowling Alone</em> is on community participation not social activism. He wants to unify us not cause political fights, and hopes to develop a country of association-joiners: religious service attenders, sports club players, park gardeners, members of knitting circles and school governors. In one interview <a href="https://www.theguardian.com/society/2007/jul/18/communities.guardiansocietysupplement">he analogises this to a honeycomb</a>, a social system of welcoming and interlocking groups, each empowered as a part of a greater civic whole.</p> <p>Charismatic, and with the enigmatic appearance of a nineteenth century preacher, Putnam has become an academic celebrity. His ideas on social capital have been met with great enthusiasm by policy makers on both sides of the Atlantic. <a href="https://www.behaviouralinsights.co.uk/north-america/robert-putnam-celebrating-his-incredible-contribution-to-the-study-of-social-capital/">One British policy group</a> working right at the heart of the Cabinet Office has called him the most influential political scientist alive. Before his promotion, Hancock held the British Government’s brief for civil society, and the influence of <em>Bowling Alone</em> can be clearly felt in his new policy on social prescribing. Linking individual depression to a lack of community activity takes a leaf straight out of Putnam’s book. </p> <p>At core the idea is simple: integrating patients into their communities is thought to <a href="https://bmcfampract.biomedcentral.com/articles/10.1186/1471-2296-9-27">develop self-esteem</a> and social support, providing a holistic treatment instead of just prescribing drugs. In turn, the community will also be improved. It would take a hard heart to reject this idea completely; friends and community really are an important element in our lives whether or not we have depression. </p> <p><a href="https://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Health-and-wellbeing/Social_Prescribing_Report.pdf?dtrk=true">One report by the charity Age Concern</a> describes the case of a woman who, having lost her husband to suicide, found solace in volunteering as a befriender and in theatre outings. Another, trapped in a rural community without access to transport, was encouraged to organise a local party. Social prescribing <a href="https://www.kingsfund.org.uk/publications/social-prescribing">is also deployed</a> in support of community gardening, sports and arts and crafts. Although there <a href="https://bmjopen.bmj.com/content/7/4/e013384">is little hard evidence</a> to back this up, strengthening the community links of patients seems likely to have a positive impact on their health.</p> <p>But there is something missing from this picture. Depression is intimately connected with economic structures. Even when we are well paid we might still have a difficult boss. Target-driven work culture <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30176-7/fulltext">is bad for us</a>, leading to intense and demanding jobs in environments over which we have little control. When we are also short of money our situation gets even worse; unemployment impacts negatively on health, and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0001879109000037">the effect is more pronounced</a> in countries with weak social security systems. Discrimination <a href="http://journals.sagepub.com/doi/abs/10.1111/1471-6402.00090">impairs our mental well-being</a>.</p> <p>In their new book <em><a href="https://www.opendemocracy.net/transformation/kate-pickett-richard-wilkinson/enemy-between-us-how-inequality-erodes-our-mental-heal">The Inner Level</a></em>, epidemiologists Kate Pickett and Richard Wilkinson make a data-based case, not only that unequal societies are worse to live in but also that inequality erodes trust and leads to anxiety, causing an arms race in competitive consumption. This animus is good for no one; disparities in wealth connect with the prevalence of mental illness, and so depression is linked to a deep economic ordering which volunteering is ill-equipped to address. No bowling league will work for a fairer society and no gardening club can keep your boss off your back. </p> <p>It’s not that social capital theory is wrong, just incomplete: community networks are an important, perhaps vital, element of our lives. But even combined with medication they are not a truly holistic solution to depression. By emphasising community over political action, social prescribing side-steps the economics of mental illness: a focus on social capital shifts the frame away from the social effects of capitalism. It is <em>economic </em>society that needs a visit to the doctor. </p> <p>Of course we should not abandon hope in voluntary action. In its more radical guise as social activism it focuses attention on the economic context of depression. In this vein, a charity called <a href="https://www.time-to-change.org.uk/get-involved/activity/persuade-your-employer-sign-time-change-pledge">Time to Change</a> encourages its members to meet with their bosses, requesting a pledge to tackle mental health stigma in the workplace. Another charity, <a href="https://www.mind.org.uk/about-us/our-policy-work/benefits/">Mind</a>, works to improve welfare benefits for mental health sufferers, encouraging its members to lobby Parliament. In contrast to much community work, these campaigns put politics at the centre.</p> <p>In the period since Putnam wrote <em>Bowling Alone</em>, it has become obvious that society cannot realistically be theorised as a civic whole of interlocking groups: there is no ‘honeycomb.’ News reports reflect a world of irreconcilable conflict, from Brexit in the UK to the polarising impact of President Trump in the USA. Yet the fact that we can no longer ignore our divisions might lead us to mount a back-to-front argument <em>against</em> politicising volunteering in this way: in a context of strife, non-political community work could be said to provide a neutral space which opens up a civic domain in which we can come together and leave politics at the door; a place where we might give it all a rest and just concentrate on something fun like bowling.</p> <p>There is some mileage in this view. It’s true that not everyone wants to talk politics with their neighbours, but all political silence has a cost. After two years of field work, the American Sociologist <a href="https://www.jstor.org/stable/658024?seq=1#page_scan_tab_contents">Nina Eliasoph concluded</a> that volunteers often work to keep their conversations neutral, taking care not to sour the mood at meetings. Yet to disengage on social questions is to accept a type of disempowerment, a self-removal from the scene. For Eliasoph, social activists have something valuable that community workers do not—a willingness to recognise complexity, challenge authority, and relate deeply with each other. To confront political issues is only to recognise social reality. </p> <p>While a focus on the economics of depression might push some right-leaning volunteers out of the meeting room, single-issue activism can still be reasonably inclusive. In contrast to party membership, which might require the broad embrace of a cluster of divisive policies, social activism hones in on a cause. A single issue can provide a point around which diverse people might coalesce, even when they agree on little else. At best, activists enjoy the community advantages of a cell in Putnam’s honeycomb. They can be tightly bound together as friends, but they also have a critical awareness of cracks in the overall social and political structure.</p> <p>Social activism can mean leafletting, door knocking and collecting signatures, but it is not necessary to get cold outside in order to change the world. Those that prefer the warm might turn to art. <a href="https://www.jstor.org/stable/3653925?seq=1#page_scan_tab_contents">William Morris</a>, the Victorian socialist and designer thought that joy in creativity was nature’s compensation for toil in labour. Depressed in office work, we might still take pleasure in music, dance, film, photography, crafts or ‘<a href="https://www.opendemocracy.net/transformation/kali-swenson/social-justice-with-knitting">craftivism</a>.’ It is even possible to politicise a knitting circle if activists put slogans onto clothes, quilts and samplers, voicing the economics of depression in cross-stitch. Or they might write and blog together, explaining the world in order to change it. What matters is that we do all our work with an awareness of society, politics and economics, combined with a willingness to change all three.</p> <p>The British Minister for Health should be given credit for being innovative, but it is unrealistic to expect him embrace or encourage social activism. No Minister could prescribe social change on the National Health Service; part of the attraction of Putnam’s theory is precisely its political safety. Policy-makers are responsible for steadying the ship of state not rocking it. </p> <p>When Brooks Newmark, a former British Minister for Civil Society <a href="https://www.theguardian.com/society/2014/sep/03/charities-knitting-politics-brook-newmark">said recently</a> that charities should “stick to their knitting,” he meant to imply that they should keep out of political and economic issues. But that is the voice of the <em>status quo</em>. In fact, politics is precisely what volunteers should be doing—not least with their needlework.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/transformation/michael-edwards/when-is-civil-society-force-for-social-transformation">When is civil society a force for social transformation?</a> </div> <div class="field-item even"> <a href="/participation-now/hilde-c-stephansen-leah-lievrouw-nick-mahony/when-is-citizen-participation-transfo">When is citizen participation transformative? </a> </div> <div class="field-item odd"> <a href="/transformation/peroline-ainsworth-kiran-nihalani/five-ways-to-build-solidarity-across-our-difference">Five ways to build solidarity across our differences</a> </div> </div> </div> </fieldset> <div class="field field-topics"> <div class="field-label">Topics:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> Civil society </div> </div> </div> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> Transformation ourNHS Transformation Civil society John Picton The politics of mental health Activism Tue, 21 Aug 2018 20:02:44 +0000 John Picton 119353 at https://www.opendemocracy.net The NHS deal is not an acceptable settlement https://www.opendemocracy.net/ournhs/rachel-harrison/nhs-deal-is-not-acceptable-settlement <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>GMB, the only union to vote against the government's NHS pay deal, pledge to continue fighting it.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/565030/22241083476_458f212dda_z.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/565030/22241083476_458f212dda_z.jpg" alt="Junior doctors protest contract changes in 2015." title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Junior doctors protest contract changes in 2015. Image: <a href="https://www.flickr.com/photos/rohinfrancis/22241083476/in/photostream/" target="_blank">Rohin Francis</a> (CC BY 2.0) </span></span></span>Since our members overwhelmingly rejected Jeremy Hunt’s dodgy three year NHS pay deal earlier this year, we have been consulting them on the next steps.</p><p>During the past few weeks, members have used the <a href="https://opendemocracy.net/ournhs/caroline-molloy/nhs-staff-discover-they-will-get-hundreds-of-pounds-less-than-they-thought" target="_blank">ballot process to tell reps on the ground about their huge disappointment at this pay deal and how let down they feel by it</a>.</p><p>After nearly a decade of wage freezes and caps that have seen our dedicated NHS and ambulance workers’ pay pinched and left them thousands of pounds out of pocket, a below inflation wage increase for some of the longest-serving, most dedicated staff in the health service is not good enough. Our members deserve far more than a real terms pay cut.&nbsp;</p><p>We have said all along that we could not in good conscience recommend Jeremy Hunt’s offer to our members. And so we didn’t.&nbsp;</p><p>GMB was the only union of 14 health service representative bodies to have rejected Jeremy Hunt’s offer for what it was, and our ability to take industrial action this year alone has been limited accordingly. That, coupled with the government’s anti-trade union legislation which makes it extremely difficult to meet legal thresholds for a formal industrial action ballot, are why we are unable to trigger a formal industrial action vote over NHS pay this year.&nbsp;</p><p class="mag-quote-right">Our members deserve far more than a real terms pay cut&nbsp;</p><p>The message from GMB members has been loud and clear throughout our consultation – we must continue to campaign for more funding for NHS pay. This three year deal is not an acceptable settlement for us.</p><p>A joint meeting between GMB National NHS and Ambulance Service reps and officers has overwhelmingly agreed that although we are not in a position to ballot for industrial action, GMB's campaign does not stop here. As we have promised to members, GMB will continue to push the government into increasing funding into the NHS for pay. Anyone who thinks we will lie down and simply accept this pay deal for the next three years is very wrong. It’s not good enough – and this is not the end of the matter. The strength of feeling among GMB members is very clear on that.&nbsp;</p><p>We’re incredibly proud of our members for taking a stand – and grateful to the support and solidarity we have received from workers across the NHS and from the public at large who support our call for properly funded fair pay for the heroes working in our health service.&nbsp;</p><p>Under this government our NHS is under threat. For it to survive, we need to continue to fight for it and the people who keep it going every day. And GMB will.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/nhs-staff-discover-they-will-get-hundreds-of-pounds-less-than-they-thought">NHS staff discover they will get hundreds of pounds less than many thought</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/nhs-pay-deal-row-intensifies-as-nurses-call-for-union-leader-to-quit">NHS pay deal row intensifies as nurses call for union leader to quit</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS ourNHS Rachel Harrison Mon, 13 Aug 2018 15:45:19 +0000 Rachel Harrison 119249 at https://www.opendemocracy.net NHS pay deal row intensifies as nurses call for union leader to quit https://www.opendemocracy.net/ournhs/caroline-molloy/nhs-pay-deal-row-intensifies-as-nurses-call-for-union-leader-to-quit <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Calls for resignations and for NHS pay vote to be rerun as Royal College of Nursing chief admits they gave incorrect pay deal information.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/pay deal story 2.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/pay deal story 2.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Nurses pay protest 2017. Credit: Yui Mok/PA Images, all rights reserved</em></p><p>Furious members of the Royal College of Nursing last night <a href="https://docs.google.com/forms/d/e/1FAIpQLScapLCouL3tNwINQU5MiaJsNatBlaZ39h6IgXP5fjFTBslNbg/viewform">launched a petition calling for the union’s leaders to stand down</a> over their handling of communications about this year’s NHS pay deal in England.</p> <p>OurNHS understands the petition is well over halfway to the required number of signatures to trigger an emergency general meeting, another of its demands. It was started after the head of the RCN, Janet Davies, last night took the unprecedented step of writing to members to apologise that they were given incorrect information about the pay deal that they voted on in the spring. Ms Davies acknowledged that many have received less than the RCN told them they would.</p> <p>Her email comes after <a href="https://opendemocracy.net/ournhs/caroline-molloy/nhs-staff-discover-they-will-get-hundreds-of-pounds-less-than-they-thought">OurNHS exposed last week</a> that many NHS staff felt disappointed and upset&nbsp;as it emerged that many would not immediately get the full pay rise they were expecting.</p> <p>The email, seen by OurNHS, shows that their concerns were justified. In it, Ms Davies says:</p> <p>"I wanted to write to you myself over the recent NHS pay deal.&nbsp;It has come to my attention in the last 24 hours that the deal was not as straightforward as we said and for that I offer you a sincere personal apology.</p> <p>"I’m as dismayed and angry as you are and will fight the corner of members at every turn.&nbsp;In good faith, we told all members that they would receive a 3 per cent uplift this summer. I now find that this is not the case for everyone.”</p> <p>Ms Davies went on, "I can assure you that I am demanding answers for you. In the meantime, I can only apologise for this unnecessary confusion and assure you that I am determined to resolve it.&nbsp;Your elected Council and Trade Union Committee will be meeting in the next few days and I will update you on next steps."</p> <p>Along with the other main unions, apart from the GMB, the RCN had recommended the pay deal to members.</p> <h2>Anger from below</h2> <p>Last night there was renewed fury amongst RCN activists and members. Anthony Johnson, a health visitor, RCN member and former ‘pay champion’ (members who help organise local action around pay) told OurNHS that the RCN “shouldn’t have trusted the government… It seems like they’ve just gone for the deal and been screwed over, but they’ve sold the deal so it’s their fault”. </p> <p>Asked about the assertion by some unions that the deal was understood, Mr Johnson replied, “No way is that true that staff understood. People were still passing around incorrect information right up till the vote.” Many staff have been making similar comments both to OurNHS and on social media in recent days, as payslips land on NHS staff doorsteps this week.</p> <p>Mr Johnson’s views are echoed across social media. Many NHS staff are furious with the government. Lauren Gavaghan, a consultant psychiatrist,&nbsp;<span><a href="https://twitter.com/DancingTheMind/status/1019835168260001798" target="_blank">tweeted</a></span>&nbsp;that the debacle was “Jeremy Hunt’s parting gift to NHS staff”. The anonymous @GPConsortia account <span><a href="https://twitter.com/gpconsortia/status/1019936011416162305" target="_blank">tweeted</a></span>&nbsp;merely, “Swine.” Retired doctor Mark Cheeseman&nbsp;<span><a href="https://twitter.com/stilton54/status/1019674728968196097" target="_blank">tweeted</a></span>,<strong>&nbsp;“</strong>The NHS worries why it’s losing so many staff. And then double-crosses the ones they have got on a pay deal.”</p> <p>Another NHS worker commented on OurNHS’s original story<strong>, “</strong>I'm a band 6 nurse at spine point 27, with incremental date of end of January. I cast my vote based on information given to me from the pay calculator [from unison],&nbsp;which indicates that in year 1 my pay would increase by £1,672. According to these newly released figures from [the nhs employers site] above, my pay will actually increase by £491, and I will have to wait until my next incremental date before I see the pay rise I voted for. Since my pay was always going to increase on my next incremental date, I feel that I was misled.”</p> <p>Another commented, “I work with highly intelligent, analytically astute people who are used to dealing with numbers and figures on a daily basis... and they were inveigled by the purposely Byzantine structure proposed.”</p> <p>Gordon Marsden, a Labour MP and shadow education minister,&nbsp;<span><a href="https://twitter.com/GordonMarsden/status/1022398603971776513" target="_blank">tweeted</a></span>&nbsp;in response to an openDemocracy update last night, “Looks like Jeremy Hunt got out of [Department of] Health just in time ...another 'con' from a discredited 'Con' Govt They’ll sneak things out to dodge scrutiny … &amp; now misrepresent underpar NHS rises.”</p> <p>Many were angry with both the government and the unions who recommended the deal. One NHS scientist&nbsp;<span><a href="https://twitter.com/wakeyrule/status/1022369064184889344" target="_blank">tweeted</a></span>, “The gasps of disbelief from NHS staff as they open their pay packets is reverberating around the Trust where I work. Overwhelming feeling is that the Unions have been hoodwinked by the Govt.”</p> <p>A community health nurse&nbsp;<span><a href="https://twitter.com/IsiSiewruk/status/1022199715587399680" target="_blank">replied</a></span>&nbsp;to a tweet by the RCN that mentioned a 3% pay rise, saying “That’s just not true though is it. It’s around 1.5 percent until increment date, so not 3% for the full year. The NHS Employer tool also shows that will also happen in year 2 and 3 for me. Not how it was sold to staff before the vote.”</p> <p>An advanced nurse practitioner&nbsp;<span><a href="https://twitter.com/scarymonstertwo/status/1022164916432789504" target="_blank">tweeted</a></span>, “Rather than an apology, how about a public denouncement of the deal, an apology and a declaration to fight it and poll members for action?”</p> <h2>Official responses</h2> <p>Danny Mortimer, head of NHS Employers, told OurNHS today that this was “an issue between the RCN and its membership”. He said, “The letter states that the RCN has in error told members in one of its documents that they would all receive ‘a 3 per cent uplift this summer’… This miscommunication is very unfortunate and clearly the RCN will need to review all of its communications to understand the extent of its error.” In response to a specific question NHS Employers confirmed to OurNHS that <a href="https://twitter.com/TweetBails/status/1021707924404662272">a poster showing the apparently higher pay figures</a>&nbsp;(ie, including a full year's increment for those staff not at the top of their bands) was put up on their website 21 March and taken down on 13 June, and told us that “materials explaining are regularly updated in light of feedback and questions".</p> <p>An RCN spokesperson told OurNHS, “This is not about reopening the deal. Despite some delays to payments, over the three years the deal has to run, members will receive the full amount promised. We are sorry for any confusion caused about what members were due to receive this month.” </p> <h2>Trouble for the Tories</h2> <p>The pay offer came at a point when the government was under considerable political pressure. After one of the hardest winters in NHS history, union leaders were loudly pointing out that eight years of zero or 1% pay rises (a real-terms cut of 14% after inflation) was contributing to serious and worsening staff shortages.&nbsp;<a href="https://www.theguardian.com/society/2017/sep/06/enough-is-enough-nurses-protest-against-pay-cap-outside-westminster" target="_blank">For months, nurses had been warning the government</a>&nbsp;that unless pay was addressed properly they would take historically unprecedented strike action.</p> <p><a href="https://www.independent.co.uk/news/uk/home-news/nurses-vote-overwhelmingly-to-strike-for-first-time-ever-over-1-pay-rises-a7735451.html" target="_blank">Four out of five nurses&nbsp;were prepared to strike</a>&nbsp;over pay, according to an initial RCN ballot of its members during the 2017 election campaign. The government’s pay cap was widely seen by commentators to have contributed to the Tories’ poor performance in that election. Asked during the campaign why nurses were having to rely on foodbanks, Theresa May told the BBC that there were “many complex reasons”—a response for which she was widely criticised.</p> <p>In March 2018 Jeremy Hunt, then health secretary, tweeted that he was “Delighted to confirm pay rise of between 6.5 and 29% for NHS staff who have worked so hard over a tough Winter, in a £4.2bn deal.” Hunt told Parliament, “Rarely has a pay rise been so well deserved for NHS staff, who have never worked harder.”</p> <h2>Pensions problem</h2> <p>In further developments, fresh concerns have emerged about the impact of&nbsp;<span><a href="http://campaign.r20.constantcontact.com/render?m=1102665899193&amp;ca=e2244e75-6316-43e3-939c-7792b7a1680b" target="_blank">pensions</a></span>. The leaders of the GMB have expressed disappointment at the actual increase, and both&nbsp;<span><a href="http://www.labournet.net/ukunion/1807/nhspay1.html" target="_blank">activists</a>&nbsp;in other unions</span> and the GMB leadership have reiterated their previous concerns about the deal, including the impact of inflation and changes to&nbsp;payments for unsocial hours. The GMB&nbsp;<span><a href="https://twitter.com/GMB_union/status/1022216933649907715" target="_blank">tweeted</a></span>&nbsp;yesterday, “We couldn’t recommend Jeremy Hunt’s dodgy NHS pay offer to our members. And so we didn’t.”</p> <p>OurNHS has also seen materials that the RCN circulated to its reps and pay champions before the vote on the pay deal, asking them to recommend the deal even if they didn’t fully understand it. One leaflet for reps tells them to “encourage [members] to say yes to the deal”. Another says, “We believe it’s the best deal we can expect in the current climate of austerity and we’re now recommending members accept it. As a pay champion, we expect you to spread the word about the deal.” Inside, the FAQs include: “<strong>The pay deal looks complex, do I need to learn it all?</strong>&nbsp;The short answer is no. We don’t expect you to advise members on the pay deal. You should signpost them to&nbsp;<span><a href="http://www.rcn.org.uk/nursing-pay" target="_blank">www.rcn.org.uk/nursing-pay</a></span>&nbsp;and pay meetings where they can ask questions.&nbsp;<strong>What if I don’t agree with the deal?&nbsp;</strong>… If you strongly disagree with the deal we hope that you will still give out the leaflets and put up the posters…you can also have your say when voting opens on 23 April.”</p> <p>Some staff who did ask questions told OurNHS they got short shrift. Mr Johnson says that when he raised questions about aspects of the pay deal, including unsocial hours payments, he was told “you don’t understand maths”.</p> <p>NHS Employers told the Health Services Journal last night they were “disappointed” at the RCN’s email to its members yesterday, and “surprised as no concerns were raised with us”.</p> <p>In a separate statement NHS Employers focused on a separate issue, which is that whilst the pay deal will be applied to this month’s pay packets, staff won’t get the backdated pay till August rather than July.&nbsp;&nbsp;</p> <p>The RCN represents 435,000 members.</p> <p>This week NHS doctors are also&nbsp;<span>up in arms about their own, separate pay deal,</span>&nbsp;as it emerged on the last day of Parliament that they, like other public-sector workers including police officers, would this year receive a below-inflation rise of 2%. This is less than the independent NHS Pay Review Body recommended, and comes after doctors, like other NHS workers, have endured years of pay austerity.</p> <p>Calls for the vote to be re-run are widespread,&nbsp;with prominent NHS blogger Roy Lilley saying,<strong> “</strong>Tonight the RCN have ‘apologised’ for ‘the dismay’ I think a re-ballot is called for. Only&nbsp;<span><a href="https://twitter.com/GMB_union" target="_blank">@GMB_union</a></span> opposed the award and they are right<strong>.”</strong></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/nhs-staff-discover-they-will-get-hundreds-of-pounds-less-than-they-thought">NHS staff discover they will get hundreds of pounds less than many thought</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Caroline Molloy Thu, 26 Jul 2018 13:14:13 +0000 Caroline Molloy 119029 at https://www.opendemocracy.net NHS staff discover they will get hundreds of pounds less than many thought https://www.opendemocracy.net/ournhs/caroline-molloy/nhs-staff-discover-they-will-get-hundreds-of-pounds-less-than-they-thought <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Nearly a million NHS staff are due to receive a long-awaited pay rise at the end of this month. But new figures released quietly last week have caused fury—and confusion even amongst some unions.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/rcn protest.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/rcn protest.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Nurses protest against the government's pay cap, September 2017. Credit: NurPhoto/SIPA/PA Images</em></p><p><em>BREAKING NEWS: UPDATE 20:15, 25th July 2018:<br /></em></p><p><em>The head of the Royal College of Nursing, Janet Davies, has today taken the unprecedented step of writing to members to apologise that staff were given incorrect information about their pay deal voted on in the Spring, and large numbers have received less than the RCN told them they would receive. The email (seen by OurNHS) confirms OurNHS's revelations last week. In it, Ms Davies says:<br /></em></p><p><em>"I wanted to write to you myself over the recent NHS pay deal.&nbsp;It has come to my attention in the last 24 hours that the deal was not as straightforward as we said and for that I offer you a sincere personal apology.<br /></em></p><p><em>"I’m as dismayed and angry as you are and will fight the corner of members at every turn.&nbsp;In good faith, we told all members that they would receive a 3 per cent uplift this summer. I now find that this is not the case for everyone.<br /></em></p><p><em>"I can assure you that I am demanding answers for you. In the meantime, I can only apologise for this unnecessary confusion and assure you that I am determined to resolve it.&nbsp;Your elected Council and Trade Union Committee will be meeting in the next few days and I will update you on next steps."<br /></em></p><p><em>OurNHS will cover this rapidly developing story as it unfolds tomorrow.</em></p><p><span>NHS staff vented fury yesterday as newly published figures suggested that they may have accepted a pay offer last month on the basis of information that did not mean what they thought it did.</span></p> <p>The three-year deal – trumpeted by Jeremy Hunt as “an incredibly well deserved pay rise for staff who have never worked harder” – came after years of pay freezes and real-terms pay cuts. NHS staff were expecting a nice chunk of back pay for the first year’s rise to be in their pay packets at the end of July (as they’ve been paid at last year’s rate until everything was settled).</p> <p>But many NHS workers could be in for a nasty shock. <a href="http://www.nhsemployers.org/-/media/Employers/Documents/Pay-and-reward/NHS-TCS-2018-Pay-scales-poster-2018-19.pdf">NHS Employers, the official body in charge of NHS staff, has just published the new 2018/9 pay rates</a> – and&nbsp;<span>to many NHS workers they do not appear to be</span>&nbsp;the same as the 2018/9 pay figures staff were pointed to <em>before</em> they voted on the deal.&nbsp;<span>In fact, averaged across all</span><span> pay </span><span>bands and scale</span><span> points</span><span>, they appear to award </span><span>initially </span><span>only</span><span> around half the pay </span><em><span>rise from April 2018 that many staff may have been expecting</span></em><em><span>,</span></em><span> according to OurNHS’s calculations.</span></p> <p><span>Nearly a million staff are covered by the NHS pay deal, though not hospital doctors</span>. Unions thrashed out the deal with the government in March, and balloted their members in the spring, with most union leaderships (except the GMB) recommending support. There were arguments about the headline figures, so most unions strongly advised their members to check out what it meant for them on a ‘<a href="https://www.nhspay.org/pay-calculator/">pay calculator</a>’ before making up their minds. (Unison created its <a href="https://www.unison.org.uk/nhs-pay-calculator">own calculator</a> which drew from and was identical to the NHS Pay one).</p> <p>For example, Unison emailed members in April, saying, “It’s really important that you understand what it would mean for you before you cast your vote. If you haven’t already, you might find trying out our pay calculator useful – just enter your pay point and your pay band to find out exactly how much your salary would change.” </p> <p>Similarly Unite emailed members in March, linking to the calculator - <a href="http://www.nhspay.org/">www.nhspay.org/</a>.</p> <p>However, it now transpires that, when spinning the new deal, the NHS employers jumbled up two different things in the pay calculators. One was the long-awaited (not very big) cost of living increase across the NHS. The other,&nbsp;<span>Often much larger&nbsp;</span>part of the pay rise people were told they would get turns out to be the normal pay increase that most NHS employees receive every year anyway, in recognition of their growing experience. This is known as their ‘increment’. </p> <p><span>A bigger problem arises because the cost-of-living increase and the increment will be received on very different dates</span>. While many staff thought that the whole new salary would be back-dated to the start of the financial year in April, in fact, only the relatively small cost of living increase will be. Their annual increment - usually the bigger part of the increase - will only come in on the anniversary of when they started with the NHS: which could be many months later. The result is that many staff will be earning hundreds - or even thousands - of pounds less this year than they had understood when they voted for the package.&nbsp;<span>The issue potentially affects nearly half of NHS staff, though those on the top of their pay bands are not affected as they were not due an increment anyway, and those on the very lowest levels of pay (the 90,000 staff currently earning under £17,460) are not affected as they will get the full pay rise with effect from 1 April, unlike other staff.&nbsp;</span></p> <p>In fact, it’s not just staff who are confused. I’ve asked NHS Employers and the unions to explain the discrepancy, and have had totally conflicting answers.</p> <p>Today, the Royal College of Nursing press office told me that a typical nurse on point 20 in the middle of Band 5 (for example), previously earning £25,551 a year, would receive the entire rise with effect from the 1st of April, saying “yes, that member of staff will earn £26,963 [the new rate for that point and band] with effect from April 2018”. </p> <p>But both Unison and NHS Employers have today made clear to OurNHS that that member of staff would be paid only £25,934 from the 1 April. That’s only around a <em>quarter</em> of their promised 2018 increase on basic pay (a difference of nearly £100 a month in this typical example)&nbsp;<span>until their increment payment kicks in at their anniversary date at some point over the following 12 months</span>.</p> <p>The RCN also told OurNHS that<strong> </strong>“the original calculator is for existing staff, and the&nbsp;NHS&nbsp;Employers&nbsp;poster sets out what new staff will earn. Two different tools serving different purposes. Existing staff should use the old calculator to work out their pay uplift.” But this is not what other unions and NHS Employers seem to be saying.</p> <p>OurNHS asked the RCN if they understood why staff might feel they had been misled. They replied, “We are working with&nbsp;NHS&nbsp;Employers&nbsp;to produce a simple explanation of the differences between the individual pay journey document, and the pay calculator, pay scales and new web tool, to prevent further confusion and information overload.&nbsp;We are hoping this will be published this Friday 20th July in time for pay day the following week.”</p> <p>OurNHS has approached NHS Employers for comment, but has not received any formal statement at the time of writing.</p> <p>GMB’s National Officer Rachel Harrison commented, “All that glitters is not gold and it's now clear that Jeremy Hunt's last act was to try and mislead NHS workers who have already endured years of real-terms pay cuts. We have always warned that the devil would be in the detail, and so it has proved...That is why GMB is holding an indicative ballot for industrial action over this pay offer."</p> <p>Furthermore, the GMB told OurNHS that under the pay deal, the ‘increment’ is no longer automatic or definite – in future, it will depend on assessment, though there will be a transitional period (though we've been told contradictory infomation about this).</p> <p>A Unison spokesperson told OurNHS that the need to implement the pay offer as soon as possible meant that the existing issue of the split between April part rises and incremental / anniversary rises later in the year, had not been addressed. The union’s deputy head of health, Helga Pile, said “this agreement won’t solve all problems overnight, but it will ease the financial strain suffered by staff over many years. The deal delivers substantial increases to starting salaries, meaningful pay rises on promotion and faster progression through most pay bands”.</p> <p>The small print in the materials promoted to staff <em>did</em> make reference to increment dates, OurNHS has established. But the question remains, were both the employers and the union leaderships (except the GMB) perhaps (after years of bruising battles, and a long strike over separate junior doctors’ negotiations the previous year) perhaps a little too keen on sealing a deal?</p> <p>The confusion is likely to stoke fury, with many staff affected across the board.<strong> </strong>A senior nurse or Occupational Therapist on pay band 6, point 28, was promised an increase of £3,995 in year one – but instead, according to NHS Employers, from April 2018 they’ll get only £508 more until their incremental increase kicks in. At more junior levels an experienced Healthcare Assistant in the middle of Band 3 will have been expecting their pay to rise by £1039, but instead from April 2018&nbsp;<span>until their increment kicks in&nbsp;</span>will get an increase of only £291 a year. Such examples are typical - according to OurNHS’s calculations, on the basis of the pay calculator information, NHS employees (averaged across all grades and pay points) were expecting a pay rise from April 2018 of £2,184.18 a year. To begin with at least, they’ll get less than half that – an average across all grades from April 2018 of £973.16. (Note – all these figures are higher than the actual average across <em>all staff</em>, because they are skewed by the relatively small number of staff on higher grades).</p> <p>The deal also incudes a "no detriment" clause, which means that no one should be worse off. But mmembers of NHS staff Facebook groups were last night saying they felt “shafted”, “screwed over” and that “the government has lied” – with some also criticising unions.&nbsp;<span>All of this gives weight to <a href="https://opendemocracy.net/ournhs/mark-boothroyd/why-nhs-staff-should-ditchthedeal-reject-government-pay-offer">union activists warnings</a> that NHS staff would have been better rejecting the pay deal and taking further industrial action.</span></p><p class="mag-quote-center">we all deserve to be told why the deal being implemented by the Employers is not the deal many members believed they had voted for</p> <p><a href="http://www.labournet.net/ukunion/1807/nhspay1.html">Unison activist Greg Dropkin commented last night</a> that the source of the discrepancy was “unclear” but he suspected there had been “a failure to explain during the vote that the pay table as circulated did not show the rate for each pay point, but the rate which an employee who was on that pay point in 2017/18 could “expect” to receive in each of the following years…we all deserve to be told why the deal being implemented by the Employers is not the deal many members believed they had voted for”.&nbsp;</p> <p>Perhaps it’s just a case of ‘buyer beware’ – or ‘voter beware’ (there’s a lot of that about in Brexit Britain). Should have read the small print. </p> <p>And perhaps it’s just sheer chance that NHS Employers happened to release actual figures last week, when just about everyone’s attention was maxed out with Donald Trump’s visit, the World Cup and the government falling apart.</p> <p>Certainly, our investigation suggests there are serious questions to answer about whether NHS workers were misinformed about the impact on their pay, and if so, what that means for the future.</p><p><em>19 July: This article has been amended to clarify that no staff should be worse off as a result of this deal, and that we've been told contradictory information about the exact timing of changes to the increment process.</em></p><p><em>20 July: this article has been further amended to remove reference to average salary changes while we discuss these with health unions.</em></p><p><span><em>25 July: this article has been amended to reinstate the reference to average changes, and also to further clarify the timing of those changes and that there are some groups of staff not affected by these issues.</em></span></p><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-pay-deal-row-intensifies-as-nurses-call-for-union-leader-to-quit">NHS pay deal row intensifies as nurses call for union leader to quit</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Caroline Molloy Wed, 18 Jul 2018 16:23:16 +0000 Caroline Molloy 118923 at https://www.opendemocracy.net The NHS proves there’s always been an alternative https://www.opendemocracy.net/ournhs/laurie-laybourn-langton/nhs-proves-there-s-always-been-alternative <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> As Britain’s National Health Service celebrates 70 years today, its troubles expose neoliberalism’s lies. </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/NHS-image-960x605.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/NHS-image-960x605.jpg" alt="" title="" width="460" height="290" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Birmingham Eastside, CC 2.0</em></p><p>Emerging from the ashes of the Second World War, the founding principles of the NHS – free to all, at the point of use, beyond the insurance principle – allowed Britain to win the peace. Universal health coverage - founded across the UK seventy years ago today - gave succour to a sick and dispirited nation, providing the conditions in which Fordist consumer-capitalism could mature by creating a&nbsp;<a href="https://www.gresham.ac.uk/lecture/transcript/download/aneurin-bevan-and-the-socialist-ideal/">“secret, silent column”</a>&nbsp;of healthy and productive citizens who helped usher in the post-war Keynesian boom. For a nation bowed but unbroken, scuttling its empire in a new age of human rights, it may have seemed reasonable for Aneurin Bevan to proclaim that Britain, with its NHS, now had “the moral leadership of the world”.</p> <p>This was an era of rapid and momentous change. Little less than a year before, at the stroke of midnight, the nations of India and Pakistan achieved freedom from a dying empire; in 1948, as 4th&nbsp;July turned to 5th, the British people could dream of freedom from fear.</p><h2>Support for the NHS across the British state</h2> <p>The NHS was the archetypal child of its ideological time. The concept of public healthcare under the NHS model sat atop a new wave of political and economic ideas. Centralised state bureaucracies and Keynesian demand management washed away the failed political economy of the Wall Street Crash and the Great Depression. As Bevan pushed through his plan for a publicly provided rather than ‘publicly organised’ NHS, a former Conservative health secretary&nbsp;<a href="http://news.bbc.co.uk/1/hi/uk_politics/460009.stm">asserted</a>&nbsp;that this “would destroy so much in this country that we value”. Precisely the opposite occurred.</p> <p>However, contrary to some contemporary opinion, this revolutionary turn in the role and functions of government came with broad support from across the British state. This is not to disavow the achievement, merely a reminder that the time for a profound shift in political and economic ideas had come. When it came again, in the late seventies and early eighties, the vanguard of the new order identified themselves almost in direct opposition to what the NHS stood for, the ideas that justified it, and the objective reality it delivered.</p> <p>The NHS has always been the target of opprobrium from the intellectual evangelists of incongruous market liberalism. This is the case whether they are set to gain from outsourcing and privatisation, or are merely captured by the shadows on the collective cave of our economic discourse. In the case of the former, from its&nbsp;inception, health insurance giants watched the NHS and pumped money into proto-neoliberal think tanks that criticised all facets of Britain’s public healthcare model with gleeful abandon.</p><p class="mag-quote-center">proto-neoliberal think tanks that criticised all facets of Britain’s public healthcare model with gleeful abandon</p> <p>It was in reaction to an attack on the principles of non-fee-paying blood donation that the sociologist Richard Titmuss wrote<em>&nbsp;The Gift Relationship</em>, his seminal exploration of the impacts of pecuniary incentives in social policy. Titmuss warned that the unabashed introduction of markets into previously untouched areas of policy would result in a destructive, pervasive “ideology to end all ideologies”. Into what future would we now head if it was this book that British prime ministers pulled from their bags, slammed onto tables, and over which they declared “this is what we believe”?</p><h2>Neoliberal revolution strikes</h2> <p>As the post-war consensus fell, practical men, finding themselves quite exempt from intellectual influence, slaved away to deliver the assertions of defunct economists. The theoretical basis of neoliberal economic ideas considers markets the superior means of coordinating allocation of resources under conditions of scarcity. However, when applied to healthcare, market dynamics are profoundly inappropriate. This is not the case with, say, food, where you, endowed with sufficient information on which apple is appropriate for your own needs, can enjoy the benefits of a plurality of apple vendors, each optimising their products and prices to meet market demand. For serious heart problems, even a world-renowned cardiothoracic&nbsp;surgeon would suffer from incomplete understanding of her condition and treatment, opening up information asymmetries with the consultant sitting opposite.</p> <p>It took until the nineties for the neoliberal revolution to strike the NHS. Market structures were the order of the day as the state sailed heroically into the End of History. The NHS, as with all areas of public provision, was now going to compete – by hell, high-water or penalty imposed from central government. That it has taken until now for the contradictions, inefficiencies and failures of marketisation to be recognised by elements of the political mainstream stands testament to the dangerous paucity of our policy discourse. One cannot look upon the collapse of Carillion and the eye-watering&nbsp;<a href="https://researchbriefings.parliament.uk/ResearchBriefing/Summary/SN06007">cost of the Private Finance Initiative</a>&nbsp;– £310 billion&nbsp;for assets worth around £55 billion – without concluding that something is profoundly wrong with those economic ideas that justify such cruel, inefficient policies. Where does duty of care come in a contract that allows a private company to&nbsp;<a href="https://www.independent.co.uk/news/business/analysis-and-features/pfi-what-private-finance-initiatives-good-bad-carillion-collapse-public-sector-contracts-government-a8165971.html">charge an NHS hospital</a>£333 for a lightbulb?</p><h2>Marketisation brings waste, moral hazard and structural risks</h2> <p>The NHS under neoliberalism has failed on its own terms. Firstly, inappropriate and unnecessary marketisation has delivered waste, moral hazard, and, ultimately, exposed the system to structural risks, imposing large costs on the taxpayer through the socialisation of failure. The Centre for Health and the Public Interest estimates that the annual cost of marketisation in the NHS is in excess of £4.5 billion per year, with additional start-up costs of over&nbsp;<a href="https://chpi.org.uk/wp-content/uploads/2014/02/At-what-cost-paying-the-price-for-the-market-in-the-English-NHS-by-Calum-Paton.pdf">£3 billion per major market reform</a>. Indeed, the benefits of market ‘reforms’ have always been hotly contested, with opposition across academics and health practitioners, who stress a high opportunity cost in forgone patient care and clinical innovation.</p> <p>Secondly, privatisation – distinct to the&nbsp;<a href="https://www.independent.co.uk/news/health/nhs-capita-patient-risk-outsourcing-gp-pharmacy-dentists-privatisation-england-a8354651.html">wasteful outsourcing</a>&nbsp;of healthcare provision to private companies – has seen the loss of assets built up over decades and paid for by generations of taxpayers, a particularly vindictive, socially and economically irrational policy. For example, the coalition government famously sold 80% of the UK’s blood plasma resource company to Bain Capital for £90 million, putting the security of blood supplies at risk. Bain soon&nbsp;<a href="http://www.bpl.co.uk/about-bpl/news/q/date/2016/08/02/press-release-creat-group-corporation-completes-acquisition-of-bio-products-laboratory-ltd/">enjoyed profits</a>&nbsp;in excess of £700 million when the company was subsequently sold to Chinese investors. Into the future, the government is seeking to sell large quantities of NHS land, imposing the&nbsp;<a href="http://www.bmj.com/content/bmj/358/bmj.j4290.full.pdf">opportunity cost</a>&nbsp;of missed public investment in productive assets, such as the construction of much needed hospitals and the installation of renewable energy that could power the NHS and reduce its carbon emissions.</p><p class="mag-quote-center">the loss of assets built up over decades and paid for by generations of taxpayers</p> <p>Thirdly, it has simply been a deliberate political choice to underfund the NHS over a period that now approaches a decade. Over the 2015/16 financial year, NHS trusts and foundation trusts fell into a&nbsp;<a href="https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/trusts-deficit">combined deficit</a>&nbsp;of nearly £2.5 billion, only three years after reporting a surplus of over £500 million. While the changing nature of ill health and demand for services plays a part, this gap has opened up due to a&nbsp;<a href="https://www.opendemocracy.net/neweconomics/why-is-the-nhs-in-crisis/">deliberate policy of underfunding</a>: real terms increases in NHS funding were 0.9% a year between 2010-2015, in contrast to an average of 3.7% over its lifetime. There is now a near universal consensus that the NHS is underfunded and that the lack of resource is the greatest contributor to successive crises – something that even the government has begun recognised. In all, health and social care spending cuts have been linked to&nbsp;<a href="https://bmjopen.bmj.com/content/7/11/e017722">120,000 excess deaths</a>.</p> <p>At best, the justifications for George Osborne’s ‘Age of Austerity’ were the spurious frenzies of a politician appealing to the polluted ideas of a discredited yesteryear to benefit wealthy vested interests. At worst, they have cost lives and halted the inexorable, centuries-long tradition of improvement in public health driven by the noble efforts of British academics and clinicians. Do not forget that life expectancy had been rising continuously for over one hundred years, a trend that has&nbsp;<a href="http://marmot-review.blogspot.co.uk/2017/11/ncds-health-equity-and-social.html">likely faltered</a>&nbsp;because of the political choice to cut public expenditure, with the rate of increase in life expectancy having dropped by almost 50% since austerity began. If medical science has been of the greatest benefit to mankind, uncritical adherence to outworn economic dogma has been of the&nbsp;<a href="https://www.theguardian.com/books/2013/may/27/economic-stuckler-money-king-review">greatest detriment</a>.</p><h2>The human cost</h2> <p>For the neoliberal experiment, as in nearly all areas of policy, has imposed a wicked cost on our health. It has damaged systems that seemed to be working moderately well in the past and eroded the institutional basis upon which we can effectively respond to the challenges of the age. Take the future of the digital technology, which could alter social and economic relations at a pace and scale not seen since the Industrial Revolution. The manner in which digital technology is integrated into healthcare in the UK is and will always be a political choice. Smart phones, ubiquitous data collection and machine learning could be harnessed by the NHS to better realise its founding principles, creating possibilities beyond the wildest imaginings of Bevan, Beveridge et al. Instead, the digital frontier is dominated by multinational monopolists and speculators pumping money into consumerist start-ups that flood markets springing up in anticipation of continued underfunding and privatisation. We can do better.</p> <p>Moreover, the very basis of our healthcare model is being shaken by demographic change and a shift in the nature of ill health. Underfunding is simply unsustainable in the face of these trends. Into the future, environmental change, already described as the greatest threat (<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60931-X/abstract">and opportunity</a>) to public health, will determine the parameters of our healthcare imaginations. There is no room for systemic waste, fragmented private providers, and the inefficient adoption of innovative technologies in a world that has warmed by 1.5C and in which the&nbsp;<a href="https://www.scientificamerican.com/article/only-60-years-of-farming-left-if-soil-degradation-continues/">majority of soil fertility has been lost</a>.</p><h2>What is to be done?</h2> <p>What is to be done? Much of a post-neoliberal approach to the NHS must seek to repair the damage done over the last few decades. Primarily, the NHS needs to be adequately funded as part of a wider move away from the discredited policy of austerity. Ill health over the period of fiscal retrenchment has resulted from damage to the systems of the state, encompassing everything from transport to social care, that provide the foundations upon which good health can spring. It will be a tragedy if the number of lives lost during the application of these failed, pre-Keynesian ideas should not banish them forever.</p> <p>The government’s recent pledge to up NHS spending by an average of&nbsp;<a href="https://www.nuffieldtrust.org.uk/news-item/funding-settlement-a-big-step-forward-but-pm-s-ambition-for-world-class-nhs-difficult-to-achieve">around 3% a year</a>&nbsp;to 2023/24 does not do this. It is below the&nbsp;<a href="https://www.kingsfund.org.uk/press/press-releases/4-billion-needed-next-year-to-stop-nhs-care-deteriorating">4.3% annual growth needed</a>&nbsp;to keep pace with demand and much lower than that needed to recover from the damage wrought by the past eight years of underfunding. What’s more, the funding is delayed until next year, opening up a cavern across which the NHS must jump and into which much of it could fall, particularly if another cold winter pushes the service into collapse. The increase also leaves out public health, staff training and building and other key capital investments. It has nothing to say about the cost of debt repayment.</p> <p>Marketisation can no longer be the first port of call for policymakers, as should be the case across the public sector. This includes needing to handle the growing burden of PFI debts, with options including the centralisation and renegotiation of contracts. Into the future, the social, environmental and economic power of the NHS should be brought to bear, with hospitals acting as ‘<a href="https://www.bmj.com/content/361/bmj.k2101">anchor institutions</a>’ that provide a local basis for everything from the rollout of clean energy through building energy assets on NHS land, to improving employment standards by targeting local recruitment and procurement. These developments are already occurring, with, for example, some hospitals in London&nbsp;<a href="http://www.renewableenergyfocus.com/view/42570/gospel-oak-a-district-heating-success-story/">recycling their heat into local housing</a>. Maximising the local socioeconomic role of the NHS could also present a more meaningfully democratised approach to decision-making.</p> <p>Until then, be wise to what neoliberalism has done and will continue to do to the NHS. Born of war and strife, Britain’s health service celebrates its 70th&nbsp;birthday in a bad way – bowed, nearly broken, ill-prepared to suffer the burden of continued underfunding and held together by the goodwill of staff. All the while, foreign insurance giants watch with patient eyes for opportunities arising from Brexit trade deals. The NHS is about being civilised; as we dismantle it, we become less civilised.</p><p class="mag-quote-center">The NHS is about being civilised; as we dismantle it, we become less civilised.</p> <p>Over the course of the 70th&nbsp;anniversary, the official celebrations shall likely focus on NHS staff. Quite right. But do not forget that the NHS is and has always been about economics, politics and power. It is about multinational corporations getting richer while sick people die in corridors. It is about bright young management consultants repeating failed economic cantations to justify inefficiency. Alone in a society brutalised by years of austerity, the NHS is increasingly the first and last line of care for people up and down the country, and is kept going by the blood, sweat and tears of its staff.</p> <p>The NHS is no longer national. Fragmented and sucked dry of resources, it cannot invest in responding to modern health problems. The NHS is increasingly becoming a logo under which private enterprise may suckle on the teat of the state, growing fat off our taxes. The predicament of the NHS at 70 is the result of a concerted application of failed economic ideology. Neoliberalism’s legacy is the private ambulance provider who bungles an emergency call because their staff are under-trained and poorly equipped; it is the baby who dies in the night, away from their parents, as the private provider of an out-of-hours service fails to adequately respond. Stand this no longer. If the Labour Party are to enter government in the near future, a test of their willingness to deliver a new society will be whether they create a post-neoliberal NHS.</p> <p>The NHS can be all that its staff and its patients believe it to be. A harbour in which fear is kept at bay, in which everyone maintains the right to be relieved of the pressures of ill health. In the final analysis, the crisis of neoliberalism is inherently a political crisis founded on the inadequacy of a certain set of economic ideas. In the same way that the NHS has always proven there is an alternative, the orthodox approach to healthcare policy proves that we need, now more than ever, an alternative to neoliberalism.</p> <p><em>This essay is a modified version of an article&nbsp;<a href="https://www.themintmagazine.com/issue-5-laybourn">published in the Mint</a>.</em></p><div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS ourNHS Laurie Laybourn-Langton Thu, 05 Jul 2018 12:25:00 +0000 Laurie Laybourn-Langton 118724 at https://www.opendemocracy.net Is the government telling us the truth about GDPR and our NHS medical data? https://www.opendemocracy.net/ournhs/phil-booth/is-government-telling-us-truth-about-gdpr-and-your-nhs-medical-data <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>If you want to make sure your medical data isn’t shared with third parties for unknown purposes, you may need to take action now. Here’s why – and how.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/safe_share_padlock.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/safe_share_padlock.jpg" alt="" title="" width="460" height="227" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Yuri Samoilov/Flickr, CCBY licence.</em></p><p>If you happen to visit your doctor in the next few weeks, you may (or may not) spot a new poster or leaflet; they are NHS blue, with a yellow stripe at the bottom, headlined “Your Data Matters to the NHS”. Like all those e-mails you’ve been receiving asking you to opt in to receiving marketing, the poster and leaflet has been prompted by GDPR – but it’s about something rather different, and the choice you are being offered is an opt <em>out</em>, not an opt in.</p> <p>Simply put, if you have concerns about what’s being done with your medical records – who is getting access to them, and how are they being used – you have the right to opt out of uses of your own health information for purposes beyond your individual care.</p> <p>This ‘new’ National Data Opt-out that you may (or may not) hear of is in fact based on one of the old care.data opt-outs, formerly known to doctors and Government as a ‘Type 2’, renamed so that – by 2020, we are told – care providers all across the NHS and care system will be able to see and honour your consent choice about what happens to your medical data.</p> <p>Great, in theory. But in practice?</p> <p>If you do see the poster, and follow the link – it’s <span><a href="https://www.nhs.uk/your-nhs-data-matters/">nhs.uk/your-nhs-data-matters/</a></span> – you’re told you can exercise your right to choose using a new ‘digital’ opt out process. Unfortunately, NHS Digital’s new process ignores the reality of many patients’ lives and – despite Government digital guidelines – fails to serve families, or the most vulnerable. So much for bridging the digital divide, and reaching the ‘furthest first’...</p> <p>Notably, too, if your family has children under the age of 13, or if you look after a dependent older relative, then things are even more complicated. Rather than giving a simple instruction to your doctor, those who would prefer their children’s data <em>wasn’t</em> sold to third parties for unknown purposes, will be required to send to NHS Digital, by post, four pieces of ID and documentation along with a seven-page form. So much for Jeremy Hunt’s much-vaunted commitment to a ‘paperless’ NHS</p> <p>So much for the process – what then happens to your information?</p> <p>The poster and leaflet go on to say:</p> <p>“<em>In May 2018, the strict rules about how this data can and cannot be used were strengthened. The NHS is committed to keeping patient information safe and always being clear about how it is used.”</em></p> <p>You only have to look at (our slightly more readable version of) NHS Digital’s Data Release Register at <span><a href="https://www.theysolditanyway.com/">TheySoldItAnyway.com</a></span> to see that little substantive has changed in practice. </p> <p>NHS patients’ data is still being sold to a variety of customers – including for-profit ‘information intermediaries’ which continue to serve commercial customers of their own, including pharmaceutical marketers and private providers.</p> <p>The law, however, <em>has</em> changed. </p> <p>As of May 23rd, the UK has a new Data Protection Act 2018 – replacing the expired 1998 Act and bringing the provisions of GDPR into UK law.</p> <p>NHS Digital, however, holds itself to the Information Commissioner’s old, pre-GDPR, non-statutory Code of Practice on Anonymisation – claiming this allows it to continue to <span><a href="https://medconfidential.org/2017/your-hospital-data-is-still-being-sold-and-heres-why-it-matters/">ignor</a><a href="https://medconfidential.org/2017/your-hospital-data-is-still-being-sold-and-heres-why-it-matters/">e</a><a href="https://medconfidential.org/2017/your-hospital-data-is-still-being-sold-and-heres-why-it-matters/"> 1.4 million patients’ opt-outs</a></span>, as it carries on selling ‘Hospital Episode Statistics’ data. </p> <p>This approach has passed its sell by date; GDPR provides a wider definition of what is ‘identifiable’ data – i.e. data that can be used, including by combining it with other sources of data, to identify individuals, <a href="https://ico.org.uk/for-organisations/guide-to-the-general-data-protection-regulation-gdpr/what-is-personal-data/what-is-personal-data/">even if supposedly anonymised</a>. UK law agrees with this wider definition, at least in theory – and both GDPR and our new Data Protection Act agree that any information about a person’s physical or mental health is <em>sensitive</em> personal data, and requires additional protections. </p> <p>Given that ‘Hospital Episode Statistics’ (HES) consists of ‘patient-level’ lifelong medical histories – each row in the data referring to a single person, with every individually-dated hospital event they experienced linked together using a ‘pseudonym’, and containing many other items of data that can act as ‘identifiers’ – it can count as ‘identifiable’ data under the new law and therefore also sensitive personal data, as medConfidential and others have been saying for years – although <a href="https://www.hsj.co.uk/technology-and-innovation/patient-data-flow-suspended-amid-11th-hour-gdpr-confusion/7022507.article">confusion over the new laws seems to have stretched to the top of NHS Digital</a>, and discussions are ongoing.</p> <p>Why does this matter? Your medical history is like a fingerprint – unique to you, and identifiable by almost trivial means: a mother with two children is over 99% likely to be identifiable from their children's birth dates alone, and <span><a href="https://www.bbc.co.uk/news/uk-england-suffolk-44155784">a single news report</a></span> could provide the information required to identify the unfortunate subject’s entire hospital history. A single breach of HES could expose millions of patients’ hospital histories, a disaster orders of magnitude greater than the <span><a href="https://www.theguardian.com/politics/2007/nov/21/immigrationpolicy.economy3">loss of the HMRC Child Benefit discs</a></span> in 2009.</p> <p>This also means that, as of May 25th, any <em>customer</em> of NHS Digital receiving full copies of HES is now handling identifiable, sensitive personal data – so if any patient’s opt-out is not being honoured (i.e. if their row of data is not being removed from HES) then, once again, NHS patients are being lied to. You can check for yourself the lists of organisations with projects that ignored opt outs, and those that honoured them, at <span><a href="https://www.theysolditanyway.com/">TheySoldItAnyway.com</a></span>.</p> <p>Aside from the posters and leaflets, some patients are being written to directly. But only those who already opted out – clearly NHS England is content, as it was in 2014, for large parts of the rest of the population to remain in the dark. (While NHS Digital must write to those patients who opted out already, it is NHS England’s responsibility to communicate with everyone else.)</p> <p>Is what patients are told true? The opt-out should apply to all identifiable data; is that what NHS Digital is doing?</p> <p>NHS England is looking to “empower the patient” by giving already empowered patients marginally more, while ensuring it remains accountable to no-one. For example, aside from “research and planning” uses, how does NHS England itself use data? And can a patient see the list?</p> <p>medConfidential works to ensure every use of patients’ data is consensual, safe, and transparent. Unlike NHS Digital, NHS England has largely avoided writing down who does what with patients’ data and why, and because of that has accumulated a massive transparency backlog. Though they go beyond research and planning, NHS England’s current uses are likely (almost) all legal – but it can’t explain how, and some of its proposed future uses are still obscure. </p> <p>medConfidential believes there need be no conflict between good research, good ethics and good medical care; indeed we are enthusiasts of lawful, ethical medical research. By and large, the standards researchers have to meet mean their use of NHS patients’ data already meet GDPR requirements – the paperwork they have to fill in has helped in that.</p> <p><strong>Commercial deals</strong></p> <p>Many people have concerns about private companies doing data processing for the NHS; cases such as the <span><a href="https://medconfidential.org/whats-the-story/health-data-ai-and-google-deepmind/">illegal deal between Google DeepMind and the Royal Free Hospital</a></span> suggest some caution is justified. The most toxic problem, however, remains commercial <em>reuse</em> by ‘information intermediaries’ – some of which appear in the <span><a href="https://www.theysolditanyway.com/">list of organisations that have breached</a></span> not only their contracts with NHS, but existing data protection law.</p> <p>Promises about the NHS “<em>always being clear about how [patient information] is used” </em>(that poster again...) ring somewhat hollow, while for-profit companies continue using contractual agreements with the NHS as a figleaf to do work for commercial customers such as Pharma marketers who – <span><a href="https://www.nhs.uk/your-nhs-data-matters/who-uses-your-data/">despite promises elsewhere</a></span> that patient information <em>won’t</em> be used for “marketing purposes” – use the information to market to doctors. </p> <p>Patients should know how their information is used if they are to make an informed choice. ‘Your NHS Data Matters’ provides <em>some</em> information about this, but omits some of the more unpalatable truths about what is happening – undermining the important promises it makes.</p> <p>If after checking <span><a href="https://www.nhs.uk/your-nhs-data-matters/">what the NHS says</a></span> and <span><a href="https://www.theysolditanyway.com/">what it does</a></span>, you do have concerns, medConfidential suggests you opt out now. Opting out will not affect your individual care, and you can always opt in later – e.g. when you are satisfied proper protections are in place. </p> <p><em>If you use medConfidential’s <span><a href="https://medconfidential.org/how-to-opt-out/">opt-out form</a></span>, your GP data will be covered as well as your hospital data.</em></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/phil-booth/your-medical-data-on-sale-for-pound">Your medical data - on sale for a pound</a> </div> <div class="field-item even"> <a href="/ournhs/jane-fae/sleepwalking-into-information-grab-by-private-health">Sleepwalking into an information grab by private health?</a> </div> <div class="field-item odd"> <a href="/ournhs/phil-booth/caredata-is-dead-long-live-caredata">Care.data is dead - long live care.data?</a> </div> <div class="field-item even"> <a href="/ournhs/tamasin-cave/tim-telstra-and-tech-takeover-of-nhs">Tim, Telstra, and the tech takeover of the NHS</a> </div> <div class="field-item odd"> <a href="/ournhs/jane-fae/your-medical-data-in-their-hands-concerns-mount-over-new-nhs-it-project">Your medical data in their hands - concerns mount over new NHS IT project</a> </div> <div class="field-item even"> <a href="/ournhs/jane-fae/caredata-questions-mount-just-wholl-get-our-medical-data">Care.data questions mount - just who&#039;ll get our medical data?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Phil Booth Mon, 25 Jun 2018 11:47:48 +0000 Phil Booth 118577 at https://www.opendemocracy.net Want better protection for whistleblowers? Your experiences needed! https://www.opendemocracy.net/uk/minh-alexander-clare-sardari/want-better-protection-for-whistleblowers-your-experiences-needed <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p class="p1">From the NHS to rigged elections, care homes to financial fraud - existing UK whistleblowing protection laws are not protecting concerned staff, nor the public. Call for evidence for forthcoming expert event.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/whistleblow.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/whistleblow.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Stephen Depolo/Flickr. Rights: CC 2.0.</em></p><p class="p1">The freedom of ordinary people to look after each other is fundamental to values of decency and fairness.</p> <p class="p1">Whistleblowing is a vital part of this and whether it is hospital workers raising the alarm over unsafe care, care home staff reporting abuse of older people, financial sector staff flagging up fraud or tech workers speaking out about stolen elections, the function of whistleblowing is to uphold the common good and to protect other people’s rights.</p> <p class="p1">Powerful organisations sometimes suppress whistleblowers, quite brutally. In the UK the law which is supposed to protect workers who whistleblow, the Public Interest Disclosure Act 1998 (PIDA), does not actually protect.</p> <p class="p1">PIDA only allows whistleblowers to sue employers for compensation after they have been seriously harmed, for example if they are unfairly dismissed. Compensation is not guaranteed and is not usually enough to reflect loss of livelihood and blacklisting. Neither does it make up for the trauma that many whistleblowers and their families experience.</p> <p class="p1">PIDA does not even ensure that whistleblowers’ concerns are properly investigated. It does not hold the individuals who cover up and victimise whistleblowers to account. PIDA cases are hard to win because of the way the law is structured and because employers usually outgun whistleblowers in court. This particularly happens in the public sector where taxpayers pick up very large legal bills for cases that are in fact fought against their interests.</p> <p class="p1">Far from being protected, whistleblowers are in reality vulnerable to mistreatment by overbearing employers.</p> <p class="p1">The weakness of UK whistleblowing law allows those who speak up in the public interest to be legally mobbed and robbed. Too many end up with broken health and insecure futures.</p> <p class="p1">There is no meaningful deterrence against this. Professor David Lewis of Middlesex University who led the research for the Freedom To Speak Up Review on NHS whistleblowing comments:</p> <p class="p1"><em>"A major problem in relation to reprisals being taken against UK whistleblowers is that retaliators can simply pay compensation in order to get out of trouble. In some countries this matter is taken more seriously and retaliation is treated as criminal offence. While I would not anticipate that many people would be prosecuted if&nbsp;</em><em>criminal sanctions were introduced in the UK, the possibility might deter some inappropriate behaviour and would send out a positive message about the importance of whistleblowing in a democratic society".</em></p> <p class="p1">We and other whistleblowers across all sectors believe that PIDA should be replaced.</p> <p class="p1">We have negotiated <a href="https://minhalexander.com/2018/04/26/a-whistleblower-led-event-on-uk-whistleblowing-law-reform-the-public-interest-disclosure-act-needs-to-be-replaced/">an event sponsored by the NHS National Freedom To Speak Up Guardian </a>, to be held this coming 19 October, which will present expert legal evidence on the need to reform UK whistleblowing law reform.</p> <p class="p1">Ministers and the Law Commission, which has responsibility for reviewing inefficient and flawed law, will be invited.</p> <p class="p1">Eminent specialist speakers on whistleblowing law, <a href="https://www.mdx.ac.uk/about-us/our-people/staff-directory/profile/lewis-dave">Professor David Lewis </a>of Middlesex University, <a href="https://www.liverpool.ac.uk/law/staff/ashley-savage/">Dr Ashley Savage </a>of Liverpool University and Employment Law and Whistleblowing Specialist <a href="https://www.linkedin.com/in/lauren-kierans-1b8a01a0">Lauren Kierans </a></p> <p class="p1">Barrister, will discuss a range of issues, including the need for meaningful penalties for whistleblower reprisal, the need for pro-active (or ‘pre-detriment’) protection starting from the point that workers whistleblow, and the need to compel the proper investigation of whistleblowers’ concerns.</p> <p class="p1">To support the case for law reform, and to inform this event, we will shortly invite whistleblowers from all sectors <span>with experience of using PIDA</span> to submit written evidence. All such first-hand accounts will be very valuable in driving improvements.</p> <p class="p1">Any whistleblowers who want to register interest in the project and to be kept informed about the forthcoming call for evidence can contact us <a href="https://minhalexander.com/contact/">here.</a></p> <p class="p1">Some outline information for whistleblowers about the project can be found <a href="https://minhalexander.files.wordpress.com/2018/03/forthcoming-call-for-evidence-from-whistleblowers-for-a-symposium-on-replacing-the-public-interest-disclosure-act-1998.pdf">here.</a></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/rebecca-sentance/why-whistleblowers-are-essential-to-democracy">Why whistleblowers are essential to democracy</a> </div> <div class="field-item even"> <a href="/ournhs/minh-alexander/no-one-believes-jeremy-hunt-on-patient-safety-and-whistleblowers-not-even-his-">No-one believes Jeremy Hunt on patient safety and whistleblowers – not even his own appointees</a> </div> <div class="field-item odd"> <a href="/uk/brexitinc/peter-geoghegan-adam-ramsay/new-evidence-that-leave-groups-co-ordinated-to-get-round-re">&#039;Crimes&#039; committed by Brexit campaigners? One extraordinary coincidence offers a new clue</a> </div> <div class="field-item even"> <a href="/ournhs/minh-alexander-anonymous-pam-linton-clare-sardari/why-is-cqc-ignoring-or-even-suppressing-pri">Who&#039;s keeping a lid on &quot;priceless&quot; whistleblower information in our health system - and why?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> uk uk ourNHS Clare Sardari Minh Alexander Fri, 01 Jun 2018 11:48:34 +0000 Minh Alexander and Clare Sardari 118197 at https://www.opendemocracy.net The great NHS property sell-off gathers pace https://www.opendemocracy.net/ournhs/jessica-ormerod/great-nhs-property-sell-off-gathers-pace <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>A reliance on firesales of NHS buildings – both unused and currently in use – returns us to the bad old days of a few rich London hospitals and impoverished hospitals everywhere else.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/nhs for sale building.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/nhs for sale building.jpg" alt="" title="" width="460" height="368" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: <a href="https://www.flickr.com/photos/saulalbert/37947961555">Saul Albert/Flickr</a>, CC 2.0.</em></p><p>On 18 May, in its property section, the&nbsp;<a href="https://www.theguardian.com/business/2018/may/18/royal-free-secretly-planning-to-develop-100-year-old-hospital-into-luxury-flats">Guardian ran an article</a>&nbsp;entitled ‘NHS privately planning to develop Royal Free nurses’ home into luxury flats.’</p> <p>A week earlier&nbsp;<a href="https://www.hsj.co.uk/university-college-london-hospitals-nhs-foundation-trust/teaching-trust-boasts-76m-surplus-after-asset-sales-and-stf-bonus/7022345.article?mkt_tok=eyJpIjoiWVdVMk16STFNbUZqTURobSIsInQiOiJrQjZyUVQ5RnVHZWwyQzJtRmRcL1p0bjE1d0tYQ1FoM2YwYVk0NXhZeFBvOFdIalJWdlF4aEZYTUIzZUFGanZjajNURXVjbGx3UEIwUm9EcHNuMmNCV3dLR2lyNzcwXC9sUWZ2UTZCcVR1RlA4U3BUdnBBeFpGa2hUc0szdEczVG8rIn0%3D">the HSJ (paywalled) reported</a>&nbsp;that University College London Hospital Foundation Trust boasted a £76m surplus after asset sales and a Sustainability and Transformation ‘bonus’. </p> <p>Most of&nbsp;the&nbsp;focus on privatisation of the NHS has been on&nbsp;the&nbsp;outsourcing of clinical services to private health providers. More recently the creation of wholly-owned private Subsidiary Companies has attracted attention&nbsp;and they&nbsp;have been&nbsp;<a href="https://hansard.parliament.uk/Commons/2018-03-06/debates/EEF6EE28-8B5F-4A3A-8C07-8DA267FB6805/NHSWhollyOwnedSubsidiaryCompanies">debated in parliament</a>.&nbsp;But there is consistently less attention paid to the extent of the policies in place dedicated to selling NHS land.&nbsp;These policies are shrinking the amount of publicly owned land in the name of providing cash to ‘pump prime’ transformation.</p> <p>In a&nbsp;<a href="https://www.theguardian.com/commentisfree/2018/feb/08/biggest-privatisation-land-margaret-thatcher-britain-housing-crisis">Guardian article 8 February</a>&nbsp;Brett&nbsp;Christophers,&nbsp;Professor&nbsp;of Social and Economic Geography at Uppsala University wrote, “All told, around 2 million hectares of public land have been privatised during the past four decades. This amounts to an eye-watering 10% of the entire British land mass, and about half of all the land that was owned by public bodies when (Mrs) Thatcher assumed power.” </p> <p>Despite all protestations to the contrary the NHS has been increasingly expected to transform to commercial business practice over the last 40 years and the articles above illustrate the effects of those policies. This is a mass transfer of property from public to&nbsp;private ownership. It has affected our utilities, education, the courts, probation and prison service, housing – and the NHS. There are no exceptions. </p> <h2>Reducing the NHS Estate: The 5 Year Forward View and&nbsp;The Naylor review</h2> <p><a href="https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf">The 5 Year Forward View</a>&nbsp;(5YFV)&nbsp;and the&nbsp;<a href="https://www.gov.uk/government/publications/nhs-property-and-estates-naylor-review">Naylor Review</a>&nbsp;are based specifically on the reduction of the number of sites from which the NHS operates: fewer GP family practices, closure and downgrading of hospitals, centralisation of services. The ownership of sections of the NHS is played out in the language of the private sector – mergers and acquisitions, sweating assets – and belongs firmly in the realm of privatisation. Sales, leases with commercial rents for properties that were previously part of a real ‘one public estate’ and the transfer of properties out of the control of local governing bodies and into publicly-owned private companies like NHS Property Services are all part of the process.&nbsp;</p> <p>The Naylor Review was published in March 2017. It examines how the NHS in England can raise cash from its premises. Its findings are in line with the requirements set out in the Sustainability and Transformation Plans (STPs) which were introduced in December 2015 to fast forward NHS England’s 5YFV.</p> <p>The Review emphasises the need to develop out of hospital care and to provide the necessary infrastructure to increase care in the community. It explicitly states that it is the acute division of the service that is to be scaled back and the GP family practice model to be dismantled.</p> <p>Naylor argues that 57% of the cash that can be found from the sales which will pump prime these changes will be found in London. Charing Cross Hospital, for example, may be reduced to just 14% of its existing area and the&nbsp;<a href="https://www.theguardian.com/society/2017/jun/16/most-of-central-london-hospital-to-be-sold-off-secret-plans-reveal">rest sold off for development</a>. He has a second report on London estates unpublished for reasons of commercial confidentiality.</p> <p>The reality for investors looking at development properties is that central London hospitals occupy valuable sites; long-derelict, small town general practice surgeries do not. Naylor’s Review emphasises the combination of sales of existing estates and the introduction of private finance to create newbuilds as key to changing the Estate to meet the New Models of Care set out in the 5YFV.</p> <h2>The danger of taking ‘surplus’ land at face value&nbsp;</h2> <p>Although the NHS land sales are being used as part of a programme for enforced change, they are not unique in the public sector. Across all departments land sales are being promoted as a solution to the housing crisis. Theresa May chose to prioritise this area in her 2017 conference speech. This appears to be evidence of a worrying trend to prioritise land values and property, which give high returns to private investors, over the provision of essential public services. The real risk for the NHS is that the more it moves from its core purpose, the less likely it is to be there to provide a service for future generations.</p> <p>There are a growing number of campaigners, think tanks and housing organisations who support the ‘release’ of land on the basis that it should be re-used for beneficial public purpose of a different kind.</p> <p>For example, New Economics Foundation has&nbsp;<a href="http://neweconomics.org/2017/10/new-map-shows-public-land-sale-brings-people-together-save/">an interactive map</a>&nbsp;which shows a huge amount of public property for sale and proposes that users start to have a say in creating new community developments on those sites. The National Housing Federation produced a briefing,&nbsp;<a href="https://www.housinglin.org.uk/_assets/Resources/Housing/OtherOrganisation/NHF_Releasing_NHS_Estates_Briefing_v3_002.pdf">‘Releasing NHS Estates for Community Benefit’</a>. Its executive summary says:</p> <p>“The National Housing Federation has been working to explore new ways that housing providers and the NHS can work together to use NHS surplus land. NHS trusts often have surplus land, but do not have the skills or resources to develop and manage it. Given that early release housing or key worker housing could provide improved patient outcomes and reduce cost of care there is a strong case for housing providers and NHS trusts to work together in developing surplus land.</p> <p>On this principle three uses have been identified: step down facility, supported housing and key worker housing.&nbsp;</p> <p>The challenge with these proposals are the Treasury targets for income and housing receipts.&nbsp;This paper, including analysis from Frontier Economics seeks to explore the economic benefit and examine some specific case studies for how organisations can work together.”</p> <h2>The Royal Free and the lie of ‘surplus’ land&nbsp;</h2> <p>The clash between rhetoric and reality is illustrated in the case of the Royal Free. In the Guardian article the property for sale is already keyworker accommodation. But because it is a valuable site it is proposed that it should be sold off for development for luxury flats. However, the building itself was gifted to the Royal Free nearly 100 years ago by Lord Leverhulme. That means that its current running cost will be modest and accommodation can be provided at low rents. To buy land at current prices in order to develop new key worker accommodation is likely to be impossible without increasing rental charges.&nbsp;&nbsp;</p> <p>The agents,&nbsp;Frank, Knight and&nbsp;Rutley&nbsp;are advertising the development on a restricted access webpage. The plans have not yet received local authority planning permission, but with everyone from the Prime Minister to local housing campaign groups squarely supporting a policy of surplus land disposal, it is easy to see why the estate agent is behaving as if it is a foregone conclusion. In the article, one current resident said, “the trust has sold several other key worker accommodation blocks in recent years”. “We wouldn’t be the first residential place they’ve sold,” he said. “They seem to be doing quite a lot of selling their affordable properties for development.”&nbsp;</p> <p>Perhaps the resident was referring to The Royal Free Foundation Trust acquisition of Barnet and Chase Farm Hospitals NHS Trust in July 2014. Chase Farm Hospital was the focus of local campaigning over the loss of its A&amp;E but it is now subject to planning permission. Although a downgraded hospital is included in the plans, the key workers’ accommodation there has been lost too and 500 residential homes and a primary school will be built on the site.&nbsp;&nbsp;</p> <h2>Resistance will be met with regulatory power&nbsp;</h2> <p>As well as a push to develop any identified surpluses, Naylor’s recommendations are that GPs must move out of their old properties which they own into new ones which they will not own. Naylor suggests,&nbsp;“GP practices can be given incentives to move into new facilities, supported by substantial private sector investment. NHS commissioners and regulators have considerable latent authority to insist that premises be fit for purpose. These powers could&nbsp;be used far more explicitly to ensure that new investment is in line with the 5YFV and to force the pace of investment in or exit from inadequate premises.”&nbsp;</p> <p>Naylor’s analysis of the GP estate demonstrates a clear preference and expectation of mass transfer from public to private ownership and financing. Naylor himself was reported as being delighted at the £3.3billion of private financing for new primary care facilities. According to the investors, the money could fund up to 750 new primary care centres but this is&nbsp;<a href="https://octopushealthcare.com/news/property-investors-make-3-3billion-commitment-to-kick-start-next-generation-of-nhs-medical-centres/">predicted to cost the NHS up to £200million</a>&nbsp;a year in new rental charges.&nbsp;</p> <p>The Review claims that within each STP those providers that have greater potential to raise money will share the money with those poorer and less well-endowed providers they are partnered with. However, with the bulk of the cash being found from sales in London it is not clear how these benefits will extend to the whole country. And that highlights a problem with the Guardian’s headline: ‘NHS privately planning to develop Royal Free nurses’ home into luxury flats’&nbsp;because it isn’t ‘the NHS’ that is doing this, it is the Foundation Trust, as a business, which will reap the profit itself.&nbsp;</p> <h2>What’s mine is mine: the&nbsp;inexorable&nbsp;rise of the disproportionately wealthy hospital trusts&nbsp;</h2> <p><a href="http://www.shelfordgroup.org/">The Shelford Group</a>, representing some of the richest foundation trusts in the country, raised the issue of cross-subsidy in their&nbsp;<a href="http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/health-and-social-care-committee/integrated-care-organisations-partnerships-and-systems/written/77219.html">written submission to the Health Select Committee</a>&nbsp;on Integrated Care Systems. The&nbsp;<a href="https://www.hsj.co.uk/finance-and-efficiency/exclusive-advanced-health-economies-reject-terms-of-system-control-totals/7022146.article">HSJ 13 April 2018</a>&nbsp;reported that the Integrated Care Systems are under threat from this approach as organisations are unwilling to risk losing their sustainability funding if a neighbouring clinical commissioning group fails to meet its plan.&nbsp;&nbsp;</p> <p>The HSJ article on University College London Hospitals Foundation Trust (UCLH) shows just how much that matters. The Trust has sold The Eastman Dental Hospital site to University College London. It has also sold a subsidiary company it created in 2011 for its radiology services in which it had a 50% share in partnership with Australian firm Everlight Radiology.&nbsp;</p> <p>The HSJ says,&nbsp;‘the&nbsp;trust said it was approached to dispose of its stake as part of a process in which&nbsp;Everlight&nbsp;sold its teleradiology business to an asset management group.’&nbsp;It was sold for £6.1m, generating a profit of £4.8m. Its original stake in the partnership had been £0.75m.&nbsp;&nbsp;</p> <p>These profits will net UCLH additional Sustainability and Transformation Fund payments of £35m on top of its own core allocation of £15m. This is the second year running it has accrued substantial additional payments because of land sales. The extra money comes from awards allocated but not paid to other Trusts either because they failed to meet their financial targets or didn’t agree one.&nbsp;</p> <h2>The&nbsp;PropCo&nbsp;and Commercial Rents&nbsp;</h2> <p>The 5YFV’s New Models of Care, on which all these property deals and ‘re-shaping’ of the estate are based, are experimental. Such a large-scale change without extensive consultation and testing jeopardises the NHS’s ability to provide safe care. Historically the replacement of NHS delivery of mental health care led to disastrous consequences for patients. The 5YFV relies on a similar care-in-the-community model replacing many NHS services with an emphasis on self-care and non-clinical services. Land sales and privatisation must be examined in this context.&nbsp;</p> <p>The Health &amp; Social Care Act (2012) made provision for the creation of the NHS’ own private limited company which was registered with Companies House in 2011 (before the Act was passed), NHS Property Services Ltd (PropCo). It owns the property which was previously under the stewardship of the Strategic Health Authorities and the Primary Care Trusts. Although it is currently wholly-owned by the Secretary of State for Health, it is a private limited company. These properties have passed from public to private ownership.&nbsp;</p> <p>The precipitous creation of the company and its nature caused concern to the House of Commons Health Committee. The&nbsp;<a href="https://www.nao.org.uk/wp-content/uploads/2014/05/Investigation-into-NHS-Property-Services-Limited.pdf">National Audit Office (NAO) investigated</a>&nbsp;and uncovered failures of good practice.&nbsp;It noted that the government had failed to properly consider forms of public ownership and failed to provide detailed operating objectives. The NAO noted that one of the outlined advantages of setting up a company was the possibility of a future complete sale to the private sector. &nbsp;</p> <p>There is precedent for this with the sale of both the Department of Work &amp; Pensions estate and the HMRC estate, so this is not idle speculation.&nbsp;</p> <p>The PropCo announced in April 2016 it was to start charging market rents to its NHS tenants with immediate effect. The company has already commercialised the leases on the properties it acquired. The biggest transfer of properties so far took place in December 2016, when the company completed the acquisition of the freeholds of 12 Community Hospitals in Devon into its ownership, with the last line of their press release stating:&nbsp;<a href="http://www.property.nhs.uk/biggest-transfer-of-properties-to-nhs-property-services/">‘leases to regularise occupation are currently being finalised’</a>.&nbsp;It is clear that in this context ‘regularise’ can only mean ‘commercialise’ and that rent increases will follow.&nbsp;&nbsp;</p> <p>It is estimated that GP surgeries and Community Hospitals owned by the PropCo (which are not already listed or projected for sale) will have to find in the region of £60million a year from their diminishing incomes to pay these rents.  This is another step in aligning the NHS with commercial and market practices. &nbsp;</p> <p>Despite the commercial rents the PropCo is taking from the funding given to NHS bodies by the government to provide frontline services, its Annual Report and Accounts show it is making a loss. Its auditors report that:&nbsp;‘the substantial shortfall between the costs required to provide the company’s services and the income derived through rental is funded through a recharge to NHS England and the Clinical Commissioning Groups. This recharge is&nbsp;in the nature of a&nbsp;grant and does not have any conditions attached to it.’&nbsp;&nbsp;</p> <p>It is a private company whose debts are covered by the Treasury to keep it solvent whilst its charges undermine the solvency of its tenants.&nbsp;</p> <h2>Project Phoenix: private organisations rising from the ashes of public service&nbsp;</h2> <p>The latest private sector creation to be involved with this complex web of sales and public-private partnerships is Project Phoenix. Project Phoenix is the creation of six major regional public/private property deals which could be in place by June 2019. The procurement process is due to start shortly. The Project is described as a venture to attract companies to ‘unlock’ capital funding for the NHS. The companies formed by these six property deals will be known as Regional Health Infrastructure Companies (RHICs). Just like PFI, these infrastructure projects will be ‘off the balance sheet’ and will sell publicly owned property and replace it with private rented. They are described as the “delivery route” for trusts and Sustainability and Transformation Partnerships to transform their estate.&nbsp;</p> <p>Project Phoenix is the realisation of Sir Robert Naylor’s plan in his review of NHS property. He calculated that up to £5.7billion of funds could be ‘accessed’. The RHICs will increase the number of private subsidiary companies already proliferating in the NHS as they will be set up to run the development projects necessary to create the new privatised NHS estate.&nbsp;</p> <h2>Bring it back into public hands&nbsp;&nbsp;</h2> <p>The response from the Department of Health and Social Care to the petitioner who achieved the debate on privatisation which was held in Westminster Hall on 23 April said,&nbsp;“the private sector has always played a vital supporting role in the NHS, for example in building hospitals, in providing facilities management services”. But the pretence that this commercial property and private company development is a normal part of public service delivery must not be allowed to carry on if we are to retain an NHS which is fit for purpose.&nbsp;</p> <p>Private companies can be sold, as the NAO warned about NHS Property Services Ltd and UCLH have demonstrated with their sale of their radio-imaging company. Unless something is done, unless this process is halted, there will be a proliferation of sales and developments of land, and transfers of subsidiary companies into private hands. The need to restore the NHS to public service becomes ever more urgent.</p><p><em>This article is cross-posted with kind permission from&nbsp;<a href="http://publicmatters.org.uk/">Public Matters</a>.</em></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/deborah-harrington/going-going-gone-great-hospital-selloff">Going, going, gone - the great hospital sell-off?</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/jeremy-hunt-considers-banning-patients-from-walking-up-to-aes">Jeremy Hunt considers banning patients from walking up to A&amp;Es</a> </div> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/are-cash-strapped-hospitals-walking-into-trap-that-could-cost-nhs-its-family-">Are cash-strapped hospitals walking into a trap that could cost the NHS its family silver?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Jessica Ormerod Wed, 30 May 2018 11:33:51 +0000 Jessica Ormerod 118140 at https://www.opendemocracy.net Facing legal challenge, Tories hint about scrapping some NHS reforms – but remain wedded to privatising 'solutions' https://www.opendemocracy.net/ournhs/tommy-greene/facing-legal-challenge-tories-hint-about-scrapping-some-nhs-reforms-but-remain-w <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>The effects of the 2012 Health and Social Care Act are now too disastrous to ignore. But Jeremy Hunt’s shift is of rhetoric, not of substance - .and his new “ACO” plans are so dangerous, campaigners this week challenged them in the High Court.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/sue allyson.PNG" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/sue allyson.PNG" alt="" title="" width="460" height="282" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Campaigners in front of the High Court this week as their Judicial Review opened. Credit: Daniel Lucas/Dpict Media</em></p><p>The leader of the Opposition’s opening gambit in <a href="https://www.youtube.com/watch?v=lGFMnZnpTu0&amp;t=318s">PMQs</a> this week was to put Theresa May on the spot over how much of NHS services are currently being outsourced to the private sector. Rather predictably, she had no answer of substance to this question.</p><p>Most people are aware by now that the NHS is at breaking point. But what much of the public are still in the dark about is exactly <em>how</em> this crisis is happening or being navigated.</p> <p>Anyone wanting to find out would be well-advised to take a look at incoming Accountable Care Organisations, which threaten to usher in an ‘Americanisation’ of services and possibly the largest vehicle for future privatisation in the NHS’s history. This week, the High Court heard about the impending introduction of these ACOs from a <a href="https://www.crowdjustice.com/case/jr4nhs-round3/">team of 4 senior health professionals</a> (<a href="https://www.theguardian.com/society/2017/dec/08/stephen-hawking-lawsuit-foiling-jeremy-hunt-nhs-shake-up">previously 5</a>, until the death of the late Professor Stephen Hawking in March). This judicial review looks to ensure that a shake-up as large as this does not occur without the proper public consultation and parliamentary scrutiny such a significant restructuring of public healthcare should entail. </p> <p>Along with legislative efforts to reinstate statutory responsibility for the health of people across England – which was essentially torn away by Andrew Lansley <a href="http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted">in 2012</a> - the case forms part of a several-year-long campaign to restore public healthcare (as set out in the NHS’s founding charter) as well as to uncover what transatlantic interests <a href="https://www.opendemocracy.net/ournhs/stewart-player/accountable-care-american-import-thats-last-thing-englands-nhs-needs">have planned</a> for it.</p> <p><strong>What are ACOs? And why are they such cause for concern?</strong></p> <p>Already piloted quietly across <a href="https://www.bigissuenorth.com/news/2018/04/nhs-plans-court/">10 areas in England</a>, Accountable Care Organisations boil down to a large-scale reorganisation and ‘integration’ of care providers. In theory, ACOs could be owned by NHS hospitals or GPs. But there may be nothing in place to stop them from being controlled by large insurance companies, finance and property firms who could eventually take them over and run them purely for profit. </p> <p>Through these new integrated care systems, the government looks to pool health and social care budgets from NHS England, Clinical Commissioning Groups (CCGs) and General Practice with local authority budgets into contracts to be awarded on a per capita basis. This means that ACOs could be a financial “Special Purpose Vehicle”, a public body or a private company. The longer-term upshot may be that CCGs disappear altogether and ACOs take on commissioning responsibilities, presenting them with the power to alter resources and patient composition.</p> <p>One central concern that has been raised relates to the way ACOs appear to blur the lines between the definition of care that’s ‘free at point of use’, care that’s charged at point of use and care that’s sold off privately. This obviously goes straight to the heart of the NHS’s founding principle of universal public healthcare provision. It is also a partial carry-over from NHS England chief Simon Stevens’ nebulous <a href="https://www.opendemocracy.net/ournhs/shibley-rahman/nhs-five-year-forward-view-wishlist-for-privatisers">promise</a> to “dissolve the classic divide[s]” of healthcare in his 2014 <a href="https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf">Five Year Forward View</a>, which at the same time pledged to reduce tens of billions in expenditure before 2021.</p> <p>During the last two years, some of the <a href="http://www.nhsforsale.info/database/market-failures/stps-and-privatisation.html">largest ever contracts</a> for NHS services have emerged. One of the first of these super contracts was in Dudley, where financial details of the 15-year Multispecialty Community Provider (MCP) agreement are not known. Then, in April 2017, a <a href="https://www.hsj.co.uk/hsj-local/commissioners/nhs-north-manchester-ccg/biggest-ever-nhs-tender-launched-as-6bn-contract-put-on-market/7017156.article?blocktitle=Most-popular&amp;contentID=-1">Manchester commissioning group</a> announced the largest ever tender for NHS services, in a contract worth £6 billion, for a provider of all out-of-hospital care in an area serving around 600,000 patients. Last year was also the advent of the <a href="http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/first-voluntary-contracts-awarded-to-gps-and-trusts/20035000.article">first “voluntary” contracts</a> to be awarded to GPs and Trusts now operating as tender-based, unofficially pro-profit businesses.</p> <p>In February this year, a High Court judge temporarily <a href="https://www.independent.co.uk/news/health/nhs-virgin-care-outsourcing-childrens-health-contract-private-company-judge-court-a8221811.html">blocked</a> Lancashire County Council’s attempt to outsource a £104 million childcare contract to Virgin. This ruling came only weeks after NHS bodies were forced to make an <a href="https://www.independent.co.uk/news/health/nhs-richard-branson-virgin-care-legal-settlement-tendering-contract-a8080961.html">undisclosed settlement</a> to the health branch of Richard Branson’s conglomerate over <a href="https://www.ft.com/content/297e7714-089f-11e7-97d1-5e720a26771b">its loss</a> of a £82 million contract to provide children’s health services across Surrey. </p> <p>ACOs could open the door to a great deal more private US equity firms looking to prise open the <a href="https://www.opendemocracy.net/ournhs/caroline-molloy/it-may-not-look-like-it-but-jeremy-hunt-does-have-plan-for-nhs-0">£120 billion oyster</a> of UK healthcare. Fears of backdoor privatisation have been compounded by indications from an increasingly <a href="https://www.telegraph.co.uk/politics/2018/01/31/embattled-theresa-may-vows-steer-britain-though-brexit-beyond/">embattled</a> May, who is desperately <a href="https://www.opendemocracy.net/ournhs/nhs-theresa-mays-dowry-gift-to-donald-trump">scrambling to secure</a> a future trade deal with the US post-Brexit. </p> <p><strong>Accountable Care?</strong></p> <p>Despite talk of unification, “seamless” integration and the government’s persistent use of ‘local’ areas and populations in its language around ACOs, they will almost certainly fragment, outsource and create an increasingly complex commercial model of healthcare - instead of an open, transparent, directly-accountable model of provision. ‘Accountable care’ couldn’t be any more of a misnomer.</p> <p>ACOs’ taxonomy of “local health systems”, each with their own geographic “footprints”, was inherited from the division of local healthcare in England under <a href="https://www.kingsfund.org.uk/publications/articles/big-election-questions-stps">Sustainability and Transformation Plans</a> (STPs), Stevens’ last grand solution to plug a £22 billion annual funding gap before this latest move. A core problem with STPs was its <a href="https://www.opendemocracy.net/ournhs/colin-leys/sustainability-and-transformation-plans-kill-or-cure-for-nhs">delegation of responsibilities</a> to these new ‘localities’, with no clear statutory rules or external regulation governing the care provision process. This question is one that has not become any clearer during the introduction of ACOs, for all the government’s talk of openness and liability.</p> <p>Jeremy Hunt’s <a href="https://www.theguardian.com/society/2017/sep/11/jeremy-hunt-to-unveil-plans-for-digital-led-nhs-treatment-by-2018">visions</a> of a <a href="https://twitter.com/jeremy_hunt/status/973230153060012033?lang=en">tech panacea</a> have also been part of the push towards ACOs, as well as to square various circles left by Stevens’ glib tracts. Meanwhile, <a href="https://www.theguardian.com/commentisfree/2017/may/13/nhs-computer-systems-insufficient-funding">underfunding</a> of basic <a href="https://www.telegraph.co.uk/news/2017/05/12/nhs-hit-major-cyber-attack-hackers-demanding-ransom/">IT facilities</a> in hospitals has continued – as was made all too clear in last year’s <a href="http://www.bbc.com/news/technology-41753022">WannaCry</a> ransomware attacks. </p> <p>Government officials <a href="https://www.independent.co.uk/news/uk/politics/jeremy-hunt-health-department-nhs-legal-action-americanise-privatisation-customers-id-pay-a8033986.html">maintain</a> that ACOs are not a move towards US-style privatisation, accusing campaigners of generating “pernicious falsehoods” and “irresponsible” alarmism, while insisting the plans “are simply about making care more joined-up between different health and care organisations”. The pro-market King’s Fund has <a href="https://www.newstatesman.com/politics/health/2018/02/accountable-care-doesn-t-mean-we-ll-end-us-style-privatised-health">reiterated</a> this message, arguing that identifications with US healthcare are mistaken and that the NHS needs more integrated care to survive. </p> <p>But, as public health expert&nbsp;<a href="https://en.wikipedia.org/wiki/Allyson_Pollock">Allyson Pollock</a> has pointed out, commercial contracting and subcontracting in the NHS is already happening on a scale and at a duration never considered by the 2012 Health and Social Care Act. This was one of a number of crucial concerns which either weren’t raised or were stamped out during the legislation’s passage through parliament. It’s little surprise, then, that government and pro-market bodies are trying to keep campaigners quiet about ACOs (<a href="http://www.bbc.com/news/uk-politics-14778406">as they did</a> around the time of Lansley’s reforms) especially given these bodies’ cosy ties with US private health.</p> <p>Although May deflected Corbyn’s outsourcing question at this week’s PMQs, Allyson Pollock argues that only 36% of healthcare contracts were won by NHS providers in the financial year 2016-17, compared to 60% in 2014-15. And we also know private providers won £3.1 billion of new contracts in 2016-17, 43% of total advertised value. </p> <p>If anything, ACOs form part of a discursive shift rather than a shift from policy’s direction of travel after the <a href="http://www.bbc.com/news/health-31145600">effects</a> of the <a href="https://www.theguardian.com/politics/2015/jan/31/health-reform-tories-biggest-mistake-parliament-nhs-stephen-dorrell-mp">disastrous</a> 2012 Act became too obvious to ignore – and then needed to be ‘tidied up’. This shift signalled a move away from talk of breaking up public healthcare (remember, Lansley’s <a href="https://www.economist.com/britain/2014/03/29/health-reform-in-a-cold-climate">top-down reforms</a> were a “reorganisation so big you can see it from outer space”) towards a language of “collaboration” into which the term “integration” fits neatly. </p> <p>The truth is there is no real or meaningful local accountability with ACOs: no one knows what will happen if private contractors walk away from their contracts, or if they choose to close services and sell off buildings in search of more lucrative ventures, as has been happening recently with <a href="https://amp.theguardian.com/business/2018/may/18/royal-free-secretly-planning-to-develop-100-year-old-hospital-into-luxury-flats?CMP=Share_iOSApp_Other&amp;__twitter_impression=true">nursing home closures</a>. </p> <p><strong>The JR4NHS case and NHS re-instatement</strong></p> <p>Sometimes the conversation around the protection and the future of the NHS can seem hopelessly bleak. But, although the task can appear insurmountable, there are groups working to combat the corporate divvy-up of UK public healthcare. And they require public support now more than ever before.</p> <p>This judicial review action, for instance, has already prevented swathes of ACOs from being rubber-stamped until the case and consultation reaches a conclusion – they had initially been scheduled to come into effect this April. </p> <p>The case can only go so far, though, due to its necessarily limited remit. Beyond other standalone legal battles like it, what has so far been stripped away can only be rehabilitated and restored by an Act of Parliament – which is why it is essential to support the Private Members’ Bill on 11th July to reclaim and begin to re-instate the NHS. </p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/stewart-player/accountable-care-american-import-thats-last-thing-englands-nhs-needs">&#039;Accountable Care&#039; - the American import that&#039;s the last thing England&#039;s NHS needs</a> </div> <div class="field-item even"> <a href="/ournhs/allyson-pollock/why-next-labour-manifesto-must-pledge-to-legislate-to-reinstate-nhs">Why the next Labour Manifesto must pledge to legislate to reinstate the NHS</a> </div> <div class="field-item odd"> <a href="/ournhs/john-lister/if-our-government-won-t-act-to-save-our-nhs-then-we-must">If our government won’t act to save our NHS this winter, this is what we must do</a> </div> <div class="field-item even"> <a href="/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Taking politics out of the NHS? Or constructing an elitist ‘consensus’?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Tommy Greene Fri, 25 May 2018 15:01:04 +0000 Tommy Greene 118069 at https://www.opendemocracy.net We must protect the lives of people with learning disability https://www.opendemocracy.net/shinealight/deborah-coles/inquest-leder-report-learning-disability <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Time and time again, grieving families are left to fight for accountability and expose systemic failings in the care of learning disabled people.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/connor_bus2_1.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/connor_bus2_1.jpg" alt="" title="" width="460" height="316" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Bus, by Connor Sparrowhawk (#JusticeforLB)</span></span></span></p><p>INQUEST works with an increasing number of families&nbsp;impacted by learning disability deaths. Central to our work is the need to amplify the&nbsp;concerns of families who feel let down&nbsp;by the social care&nbsp;system; to help&nbsp;them establish the truth behind&nbsp;a death; secure justice on behalf of their deceased relative; and prevent future deaths.&nbsp;</p><p>In many cases the&nbsp;circumstances surrounding a death were entirely&nbsp;preventable, had families’ voices and concerns been&nbsp;listened to&nbsp;by those responsible for their relative’s care. The cases of&nbsp;<a href="https://opendemocracy.net/shinealight/shinealight/kate-dolan/small-details-my-sister-life-cut-short">Josanne Wadsworth</a>,&nbsp;<a href="https://www.inquest.org.uk/richard-handley-conclusion">Richard Handley</a>, <a href="https://www.inquest.org.uk/oliver-mcgowan-conclusion">Oliver McGowan</a>,&nbsp;<a href="https://www.inquest.org.uk/danny-tozer-conclusion">Daniel Tozer</a>&nbsp;and <a href="https://opendemocracy.net/shinealight/shinealight/sara-ryan-clare-sambrook/connor-sparrowhawk-justiceforLB">Connor Sparrowhawk</a>— all of whom&nbsp;had a range of complex needs and disabilities — present a picture of missed opportunities and chaotic care that exacerbated their symptoms prior to their death.&nbsp;</p><p><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/DANIEL_TOZER.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/DANIEL_TOZER.jpg" alt="" title="" width="240" height="297" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style="" /></a> <span class='image_meta'><span class='image_title'>Daniel Tozer</span></span></span></p><p><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/JOSANNE3.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/JOSANNE3.jpg" alt="" title="" width="240" height="300" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style="" /></a> <span class='image_meta'><span class='image_title'>Josanne Wadsworth at 15</span></span></span></p><p><span>In the words of Daniel Tozer’s parents, “Danny’s senseless death has devastated his family and friends” and deprived them of the opportunity&nbsp;to spend a life with someone who “lit up our lives”.</span></p><p><a href="https://opendemocracy.net/shinealight/shinealight/kate-dolan/small-details-my-sister-life-cut-short">Kate Dolan</a> has&nbsp;written about the death of her sister of Josanne Wadsworth who had severe learning disabilities and epilepsy. Josanne died aged 31 in hospital in January 2017. <a href="https://opendemocracy.net/shinealight/shinealight/kate-dolan/small-details-my-sister-life-cut-short">In her blog</a>, Kate describes her relief at the hospital’s frank acknowledgement of the failings surrounding Josanne’s death. Sadly, this open approach on behalf of the hospital is not a common feature in most cases.&nbsp;</p><p><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/Richard_Handley-portrait_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/Richard_Handley-portrait_0.jpg" alt="" title="" width="240" height="304" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style="" /></a> <span class='image_meta'><span class='image_title'>Richard Handley</span></span></span><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/Oliver-McGowan-350.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/Oliver-McGowan-350.jpg" alt="" title="" width="240" height="254" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style="" /></a> <span class='image_meta'><span class='image_title'>Oliver McGowan</span></span></span><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/connorsparrowhawk_crop_1.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/connorsparrowhawk_crop_1.jpg" alt="" title="" width="240" height="293" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style="" /></a> <span class='image_meta'><span class='image_title'>Connor Sparrowhawk</span></span></span>Many families are confronted with a culture of denial and defensiveness, where public bodies are more concerned with reputational management. Further still, the majority of learning disability deaths are not independently investigated, and many are not followed by an inquest. In fact, it is often only through families dogged persistence that failings are brought to light.&nbsp;</p><p>Behind a shadow of injustice are the many untold stories of those who have died in care, and an institutional resistance to transparency or learning. This means many more lives are put at risk due to the continuation of unsafe practices. To combat this, INQUEST has long campaigned for a national oversight mechanism to collate, analyse and monitor learning arising from the deaths of learning disabled people.&nbsp;</p><p>We have also called for unexpected and unnatural learning disability deaths to be investigated by an independent body. This would put an end to the current practice of NHS Trusts, which have overall responsibility for the care of those with learning disability, investigating themselves.</p><p><span>Premature deaths precipitated by unacceptable standards of care has prompted mounting concerns, with the mother of 18-year-old Connor Sparrowhawk, Sara Ryan,&nbsp;</span><a href="https://www.inquest.org.uk/inquest-responds-leder-report">describing</a><span>&nbsp;the “label of learning disability” as synonymous with “a diagnosis of a life limiting illness.” Further still, many families are aggrieved to see countless reports referring to dangerous policies and practices, which are not acted upon.</span></p><p>The recently published&nbsp;<a href="https://www.hqip.org.uk/resource/the-learning-disabilities-mortality-review-annual-report-2017/#.Wvq5G2gvyUm">LeDeR report</a>&nbsp;of learning disability deaths, commissioned by NHS England,&nbsp;has flagged instances of abuse, delays or gaps in treatment in 1 of the 8 cases examined. </p><p>What is particularly&nbsp;worrying is that these findings offer a partial account of the systemic problems which plague the care sector. Only 103 out of 1,311 learning disabilities deaths were reviewed by the University of Bristol Learning Disabilities Mortality Review&nbsp;team&nbsp;due to inadequate resources committed by&nbsp;NHS England.</p><p><span class="mag-quote-right">Many families are confronted with a culture of denial and defensiveness.</span>There are patterns of poor care, neglect and abuse of some of the most vulnerable groups in society. This results in poorer health outcomes and shorter life expectancy of those with a learning disability. Evidence from the LeDeR review&nbsp;shows that on average&nbsp;men with learning disabilities die 23 years younger than their non-disabled peers, while&nbsp;women die 29 years younger.&nbsp;</p><p>Learning disabled people are entitled to the same rights and protections that others enjoy. However too often inquests and investigation reveal a systematic disregard for their lives. There needs to be a more focused approach on providing the best care and treatment to those with complex needs and disabilities. This can only happen if policymakers and medical professionals extract lessons from previous deaths and force a cultural change that recognises the rights of the 1.5 million people with a learning disability in the UK.&nbsp;</p><hr /><p>For more information on learning disability deaths you can follows blogs by&nbsp;<a href="https://mydaftlife.com/">Sara Ryan</a>&nbsp;and&nbsp;<a href="http://www.georgejulian.co.uk/blog/">George Julian</a>. If you would like to support INQUEST’s work, please donate to our Family Participation Officer Ayesha’s&nbsp;<a class="OWAAutoLink" href="https://www.justgiving.com/fundraising/ayesha-carmouche1">fundraising page</a>.&nbsp;Ayesha is running a half marathon to raise money to expand INQUEST’s advocacy work with families impacted by a state-related death.</p><p>&nbsp;</p><p>&nbsp;</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/shinealight/kate-dolan/my-sister-life-cut-short">The significance of small details. My sister’s life cut short</a> </div> <div class="field-item even"> <a href="/shinealight/sara-ryan/connor-sparrowhawk-southern-health-fined-2m">&#039;We’ve done you proud&#039; — Families speak after NHS Trust fined £2million over patient deaths</a> </div> <div class="field-item odd"> <a href="/shinealight/imogen-tyler/connor-sparrowhawk-erosion-of-accountability-in-nhs">Connor Sparrowhawk: the erosion of accountability in the NHS</a> </div> <div class="field-item even"> <a href="/shinealight/shinealight/sara-ryan-clare-sambrook/connor-sparrowhawk-justiceforLB">Connor Sparrowhawk: How one boy’s death in NHS care inspired a movement for justice</a> </div> <div class="field-item odd"> <a href="/shinealight/tom-ryan/since-my-brother-s-preventable-death">Since my brother’s preventable death . . .</a> </div> <div class="field-item even"> <a href="/shinealight/deborah-coles-ayesha-carmouche/case-for-independent-investigation-of-deaths-in-mental-he">The case for independent investigation of deaths in mental health institutions</a> </div> <div class="field-item odd"> <a href="/shinealight/sara-ryan/ministry-of-justice-says-you-don-t-need-lawyer-at-inquest-trust-state">Ministry of Justice says you don’t need a lawyer at an Inquest. Trust the State</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> Shinealight ShineALight ourNHS Deborah Coles Wed, 23 May 2018 06:50:00 +0000 Deborah Coles 117921 at https://www.opendemocracy.net The significance of small details. My sister’s life cut short https://www.opendemocracy.net/shinealight/kate-dolan/my-sister-life-cut-short <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Like so many people who have learning disabilities Josanne Wadsworth died an early and preventable death.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/JOSANNE.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Josanne, 29 years old, in 2015, at St Elizabeth&#039;s Centre in Hertfordshire"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/JOSANNE.jpg" alt="" title="Josanne, 29 years old, in 2015, at St Elizabeth&#039;s Centre in Hertfordshire" width="460" height="344" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Josanne, aged 29, embracing life at St Elizabeth's Centre in Hertfordshire, 2015</span></span></span></p><p>Sometimes it’s the little things that make the biggest difference. I once came back from dropping my child at playgroup to find that I couldn’t get into my house. I put the key in the lock but when I tried to turn it it wouldn’t move. Jammed. Stuck. Locked out. After enlisting the help of a locksmith, it transpired that a tiny millimetre length of metal had broken off the mechanism. The littlest thing stopped the whole thing from working. A millimetre away from getting into my house, yet wholly locked out.</p><p>Little things can be so important. Take, for example, the&nbsp;<a href="https://littlebluecup.org/category/about-us/">Little Blue Cup</a>&nbsp;campaign launched in recent months. A 13 year old autistic boy with severe learning disabilities had used a blue sippy cup since he was two, and wouldn’t drink from anything else. His father managed to find a replacement from a friend when the first cup wore out. But as this second cup began deteriorating and efforts to get him to drink from other cups - however similar - failed, they grew increasingly concerned. Without that blue sippy cup he would become dehydrated and had already spent time in hospital.&nbsp;</p><p>The cup was discontinued, so in a desperate plea online via Twitter, his dad asked if anyone could find and send them these little blue cups. The response was unexpected and truly heart-warming: from&nbsp;<a href="http://www.bbc.co.uk/news/uk-england-37988508">viral re-tweets to offers of cups</a>, to the company themselves&nbsp;<a href="http://www.bbc.co.uk/news/uk-england-devon-38141319">successfully finding</a>&nbsp;the old mould and producing a lifetime’s supply of blue sippy cups for him!&nbsp;&nbsp;</p><p>I like this story, not only for its happy ending, but for the success of a parent fighting for their child, understanding him totally, knowing what’s needed and communicating it successfully to people who listen and respond. Little things, perhaps, making a big difference.</p><p class="mag-quote-right">Knowing and being known was important to Josanne.</p><p>Having grown up with my sister, Josanne, who had severe learning disabilities, I can appreciate the fine line between things being alright and things causing distress. Little things made a big difference. Josanne loved the little details. She used to like to know where people were, and would run through the members of the family in turn saying where they should be and what they would be doing. Knowing and being known was important to her. Knowing the little things formed the depth of her relationship with others and enabled the key to turn in the lock.</p><p>Josanne had severe learning disabilities and intractable epilepsy from infancy. She had been admitted to hospital several times in the past when she experienced clusters of seizures that wouldn’t stop. Sadly her time in hospital was often extended because she didn’t get the medications she needed at the correct times, or she wasn’t monitored closely enough, and she deteriorated enough to require intensive care.&nbsp;</p><p>One of these admissions resulted in paralysis, another in transfer to the leading London neurological hospital. It was during the latter crisis that she was prescribed a newly-licensed drug, which wonderfully caused a termination in seizures for the last two years of her life, and we saw her flourish.</p><p>Josanne had a good quality of life, despite her paralysis and learning disabilities. She had moved to St Elizabeth’s Centre in Hertfordshire aged 19, and had lived there happily for 12 years. She was a character and always secured the affections of staff and carers, even if they had heard her loud rendition of “Happy Birthday” for the umpteenth time that day (and it probably wasn’t anybody’s birthday)! There is a nursing unit on site, and specialist epilepsy nurses cared brilliantly for her. Unless she needed treatment that she could only get in hospital, she got all the care she needed there.&nbsp;</p><p>So when Josanne needed to go to hospital in January 2017 for a routine PEG replacement procedure, having removed her old one too many times, we weren’t particularly worried that she would suffer further setbacks; she wasn’t going into hospital ill, she was going in to prevent future illness. The feeding tube known as a PEG (percutaneous endoscopic gastrostomy)&nbsp;was the means of securing her essential medication and nutrition intake. A small thing, perhaps, but it made all the difference.</p><p>Josanne’s history showed that if she didn’t get her medication reliably she was likely to experience seizures and compounding complications if she entered status epilepsy (where epileptic fits follow one another without recovery of consciousness between), but the procedure was repeatedly delayed, which meant she wasn’t getting her essential medications. My Mum and St Elizabeth’s staff raised concerns, emphasising the severity of potential outcomes if the procedure didn’t happen imminently. But the hospital’s realisation came too late. Josanne had missed too many doses of medication, started having seizures, and quickly became too ill to have the procedure. Her seizures worsened in frequency and severity, and, as those who knew her best had warned, she developed aspiration pneumonia, and tragically died. She was 31.</p><p>The coroner concluded at an inquest held in November 2017 that Josanne died of natural causes, contributed to by neglect, with the hospital demonstrating serious failings in her care.</p><p><span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/JOSANNE2.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/JOSANNE2.jpg" alt="" title="" width="460" height="588" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>At 15 Josanne lived at home and attended a special school in Cambridge.</span></span></span></p><p>The fact it was so clear cut is a consolation. The hospital didn’t try to hide their failings or apportion blame elsewhere, but instead produced a 22-page Serious Incident Report that gave appalling detail to the circumstances surrounding Josanne’s death. We realise this is rarely the case, and many families supported by INQUEST are not so fortunate and have far bigger battles in their quest for justice.&nbsp;</p><p>There are many factors I could talk about - the high rate of mortality amongst learning disabled patients, poor understanding of and adherence to the Mental Capacity Act, communication issues between those who know the patient best and the medical staff, or, more positively, the difference it makes when an organisation is willing to admit mistakes and make changes to prevent similar tragedies occurring. But these are by no means little things, and deserve a greater depth of discussion than I can give here.</p><p>Perhaps the littlest thing that could have made the biggest difference was in the process of flagging vulnerable patients on admission. When Josanne was admitted to hospital the Learning Disabilities flag on the patient information system wasn’t activated. Normally it would be automatic, but, despite having lived in Hertfordshire for 12 years and having a Hertfordshire GP, Josanne was not registered on the Local Authority’s patient list as having Learning Disabilities because Josanne was originally from Cambridgeshire and her previous hospital admissions had been to the nearby hospital in Essex.</p><p><span class="mag-quote-right">A little thing. Without it the door to essential medical care didn’t open.</span>Why didn’t a Learning Disability flag get passed from one county to the next? Why didn’t a GP’s patient information system link into the hospital’s patient information system? And, given the severity of Josanne’s learning disability, why didn’t it occur to staff to check the flag had been activated? This would have triggered an alert to the specialist Learning Disabilities Nurse, who has greater understanding of the potential issues faced by vulnerable patients and can advocate for them. But the Learning Disabilities Nurse wasn’t even aware that Josanne was in hospital until 13 days into her stay, by which time it was too late.&nbsp;</p><p>It may just have taken a little thing, but without it the mechanism didn’t work properly, the door to essential medical care didn’t open. Josanne was instead locked in a waiting room of neglect until she died.</p><p>Whilst the hospital have frankly examined their failings and have put things in place to prevent it happening again, my concern is that other hospitals could easily make the same mistakes if learning from this incident isn’t shared. If little things like Learning Disabilities flags aren’t activated somewhere else another time, then this could happen again.&nbsp;</p><p>The wonderful story of the Little Blue Cup continues. Requests for little things that make a big difference to learning disabled people’s lives are now shared on a website and items are united with those who need them. How wonderful it would be if little needs in bigger scenarios could also be met! If healthcare professionals could make seemingly small changes to how they treat and assess vulnerable patients, it could make the biggest difference and unlock the door to saving many lives.</p><p>&nbsp;</p><hr /><p><a href="https://www.inquest.org.uk/our-services">The charity INQUEST</a>&nbsp;provides free and independent advice to bereaved people following a death in state care or detention in England and Wales. This piece, edited by Ayesha Carmouche, is the first in a series of collaborations between families, INQUEST and <a href="https://opendemocracy.net/shinealight">Shine A Light</a>.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/shinealight/deborah-coles/inquest-leder-report-learning-disability">We must protect the lives of people with learning disability</a> </div> <div class="field-item even"> <a href="/shinealight/sara-ryan/connor-sparrowhawk-southern-health-fined-2m">&#039;We’ve done you proud&#039; — Families speak after NHS Trust fined £2million over patient deaths</a> </div> <div class="field-item odd"> <a href="/shinealight/imogen-tyler/connor-sparrowhawk-erosion-of-accountability-in-nhs">Connor Sparrowhawk: the erosion of accountability in the NHS</a> </div> <div class="field-item even"> <a href="/shinealight/shinealight/sara-ryan-clare-sambrook/connor-sparrowhawk-justiceforLB">Connor Sparrowhawk: How one boy’s death in NHS care inspired a movement for justice</a> </div> <div class="field-item odd"> <a href="/shinealight/tom-ryan/since-my-brother-s-preventable-death">Since my brother’s preventable death . . .</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> Shinealight ShineALight ourNHS Kate Dolan Wed, 23 May 2018 06:50:00 +0000 Kate Dolan 117795 at https://www.opendemocracy.net NHS data-sharing U-turn is welcome – but more to do to scrap the ‘hostile environment’ https://www.opendemocracy.net/ournhs/peter-pannier/data-sharing-u-turn-is-welcome-but-more-to-do-to-scrap-hostile-environment-in-n <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Recent attention to the Windrush scandal has focused attention on the many ways migrants are deterred from accessing healthcare. This Saturday, join NHS workers protesting that they are not border guards.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/nursenotaborderguard.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/nursenotaborderguard.jpg" alt="" title="" width="460" height="465" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Medact</em></p><p>The government has this week announced it will be <a href="https://www.theguardian.com/society/2018/may/09/government-to-stop-forcing-nhs-to-share-patients-data-with-home-office">suspending “with immediate effect”</a> the controversial memorandum of understanding (MOU) under which NHS Digital<a href="https://www.theguardian.com/uk-news/2017/jan/24/nhs-hands-over-patient-records-to-home-office-for-immigration-crackdown" target="_blank">&nbsp;shared NHS patients’ details with the Home Office</a>.</p> <p>It’s a significant victory for the<a href="https://www.facebook.com/hashtag/stopsharing?source=feed_text" target="_blank"> #StopSharing</a> campaign by Doctors of the World, the National AIDs Trust, and a host of others - including Docs Not Cops. Campaigners have been insisting that patients should not fear immigration enforcement when seeking NHS treatment. The policy – part of the ‘hostile environment’ - has stirred considerable controversy, with a legal challenge from <a href="https://www.crowdjustice.com/case/stopnhsdatasharing/" target="_blank">Migrants’ Rights Network legal challenge</a> due to be heard next month. MPs on the Commons Health Committee also voiced considerable concern after hearing a range of powerful testimony – including from Voices of Domestic Workers, who highlighted a case of a domestic worker who had&nbsp;<a href="https://www.mirror.co.uk/news/politics/domestic-worker-died-too-frightened-11864052" target="_blank">died of pneumonia 'too frightened' to access healthcare</a>.</p> <p>While suspension of this damaging data-sharing provides a rare moment to celebrate, and appreciate the impact campaigning can have, there are caveats and a good deal of context to bear in mind. Firstly, it is essential to emphasise that - thanks to regulations introduced through secondary legislation by Jeremy Hunt in October 2017 - patients will <em>still</em> be required to prove immigration status to&nbsp;access&nbsp;most hospital care. Such a requirement stops people receiving treatment, criminalises patients and makes healthcare workers complicit in racist policy. Further, the NHS is but one arena in which the government’s hostile environment operates - banks will still freeze your account if you're unlucky enough to end up on a Home Office wanted list, and Landlords are still required to check your passport if you're renting from them. The Prevent duty still places students – and patients – under suspicion, as highlighted by the Joint Council for the Welfare of Immigrants,&nbsp;<a href="http://twitter.com/nobankborders" target="_blank">No Borders In Banks</a>, and&nbsp;<a href="https://twitter.com/UnisNotBorders" target="_blank">Unis Not Borders</a>&nbsp;amongst others.</p> <p>Another caveat is that the announcement on NHS data sharing came during a debate on the Data Protection Bill – however during the wider debate on the bill, an amendment which would have definitively scrapped the exemption that allows data protection rules to be broken for immigration purposes was defeated by 18 votes. And the suspension was also announced with a suggestion that in future the Home Office would still be “able to use the data-sharing mechanism to trace people who are being considered for deportation from Britain because they have committed a serious crime”. As Liberty and the National Aids Trust have already noted, the definition of “serious crime” here is vague to say the least.</p> <p>Corey Stoughton, advocacy director at Liberty said: “The government now admits it has been needlessly exploiting NHS patient data on a mass scale for minor immigration enforcement matters. They have undermined the confidentiality and trust at the heart of our healthcare system in the name of pursuing their hostile environment. We welcome the agreement to overhaul its practices and immediately curtail some data-sharing – but its language is worryingly vague. We need a cast-iron commitment that people will no longer have to fear immigration enforcement when seeking urgent medical care.”</p> <p>Any discussion of crime must acknowledge that those who are not white are more likely to be stopped, detained, prosecuted, and receive harsher sentences. Immediately it is clear that not everyone will be safe from data sharing - and instead of protecting people, and ensuring no-one is deterred from seeking treatment, the discussion is once again dragged toward distinctions between ‘good migrants’ and ‘bad migrants’, ‘deserving’ and ‘undeserving’ people.</p> <p>As with much of the recent (and long overdue) media and political attention to the government’s ‘hostile environment’, people who can be deemed 'illegal' are once again dehumanised even by politicians opposing government policy. Labour’s&nbsp;Shadow Secretary of State for International Trade, and for Climate Change,&nbsp;<a href="https://twitter.com/daily_politics/status/990918048633700352" target="_blank">Barry Gardiner recently told the BBC’s Daily Politics</a>&nbsp;"we have to make sure that those people who are in this country illegally are removed from this country... I'm very happy to see a target of the number of those people that we want to remove". When the BBC’s Nick Robinson asked the&nbsp;<a href="https://www.youtube.com/watch?v=gVKs23tCCKU" target="_blank">Shadow Foreign Secretary Emily Thornberry on the Marr Show</a>&nbsp;“Are you saying that you don’t want to see checks when people arrive in hospital for treatment that might cost tens of thousands of pounds – you don’t want to see whether they’re in fact illegal immigrants?”,&nbsp;Emily Thornberry replied “I don’t have a problem with checks being made”. It was disappointing that Thornberry made no attempt to query the premise of the question (where Robinson also suggested&nbsp;illegal migrants "take" jobs and houses from legal residents) or defend the principle that all should be able to access healthcare as a human right. It would have been easy for Thornberry to mention the public health risks entailed when denying people treatment – as&nbsp;<a href="http://politics.co.uk/news/2018/04/19/hostile-environment-government-ignored-warnings-from-public" target="_blank">Public Health England have done</a>.</p> <p>This stance must change - as Luke de Noronha argues, “There are no sharp divisions between ‘legal migrants’ and citizens over here, working hard, paying taxes and playing by the rules, and the ‘illegal immigrants’ over there, sneaking around, stealing jobs and deceiving ordinary Brits. In fact, the law changes around people;&nbsp;<em>illegality is produced</em>&nbsp;in ways which create divisions within our families, communities and classrooms. We can only develop a stronger critique of the UK’s cruel immigration system if&nbsp;<a href="https://www.opendemocracy.net/uk/luke-de-noronha/windrush-generation-and-illegal-immigrants-are-both-our-kin" target="_blank">we see Windrush migrants and ‘illegal immigrants’ as kin</a>, rather than as good and bad migrants to be isolated from one another.” No one should be made to feel undeserving of care.</p> <p>More positively, it is welcome that, responding to the suspension of data-sharing, Shadow Health Secretary Jonathan Ashworth noted yesterday “Theresa May has ignored warnings that the regulations on ID checks at hospitals are also damaging patient care” and added that "<a href="https://www.mirror.co.uk/news/politics/home-office-stop-using-nhs-12508018" target="_blank">The Government must now suspend these regulations while a full review is carried out</a>.” </p> <p>Having been making this case for months - indeed years - we are pleased to hear a senior opposition politician say:</p> <p>“This policy was yet another example of Theresa May’s heartless ‘hostile environment’ which is clearly undermining patient care. This U-turn is a victory for Labour MPs like Paul Williams and Luciana Berger, as well as the Health Select Committee. But the Government needs to go further. Today’s U-turn should only be the start. To protect the best interests of patients the Government must end Theresa May’s hostile environment entirely.”</p> <p>This is a welcome first step - Labour must now commit to scrap these regulations in their entirety, as&nbsp;<a href="https://labourlist.org/2018/03/the-nhs-must-remain-free-at-the-point-of-use-and-based-on-need-not-ability-to-pay/" target="_blank">we've argued on LabourList</a>, and&nbsp;<a href="https://www.opendemocracy.net/ournhs/docs-not-cops/labour-must-tackle-may-s-hostile-environment-for-migrants-in-nhs" target="_blank">ahead of their 2017 conference on OurNHS openDemocracy</a>.</p> <p>Of course, responsibility lies with Jeremy Hunt. That’s why this Saturday 12th May we’re organising a twitter storm for International Nurses Day. This year the International Council of Nurses have chosen “<a href="http://www.icn.ch/publications/2018-nurses-a-voice-to-lead-health-is-a-human-right/" target="_blank">Nurses A Voice to Lead – Health is a Human Right</a>” as their theme. We agree with them that "healthcare should be accessible to all". The government’s ‘hostile environment’ policies go against this principle - making it more and more difficult for people to access the NHS services they need. It is now mandatory for NHS trusts to check people’s immigration status before providing secondary care and to&nbsp;<a href="https://theconversation.com/who-has-to-pay-for-the-nhs-and-when-91344" target="_blank">charge upfront for treatment</a>&nbsp;where people are unable to prove their eligibility. And additionally, the&nbsp;<a href="https://www.theguardian.com/society/2018/feb/05/annual-charge-paid-by-migrants-for-using-the-nhs-to-double" target="_blank">Immigration Health Surcharge is set to be doubled</a>, despite pricing people out of visa applications at the rates introduced in 2014.</p> <p>Already these&nbsp;<a href="https://www.independent.co.uk/news/uk/home-news/nhs-charging-rules-doctors-nurses-government-id-checks-payments-home-office-hospitals-docs-not-cops-a8014966.html" target="_blank">policies are leading to discrimination and racial profiling</a>, to&nbsp;<a href="https://www.independent.co.uk/news/uk/home-news/pregnant-and-ill-migrants-going-without-medical-care-due-to-hardline-government-immigration-policy-a8011351.html" target="_blank">people being too scared to access the care they need</a>, and are&nbsp;<a href="http://www.gal-dem.com/docs-not-cops-new-policy-transforms-nhs-workers-border-guards" target="_blank">turning healthcare workers into border guards</a>.</p> <p>As health workers we are standing up for our patients and advocating for free, universal, non-judgemental healthcare. Ahead of International Nurses Day, a member who is a nurse has written of seeing the <a href="https://www.independent.co.uk/voices/home-office-nhs-doctors-passport-checks-nhs-health-tourism-patients-a8345056.html">fallout of these policies every day in A&amp;E</a>. Join Docs Not Cops in celebrating International Nurses day this Saturday (12 May) by telling Jeremy Hunt it’s time to end prohibitive healthcare charges for migrants, scrap ID checks in hospitals and community care, and time to kick the ‘hostile environment’ out of the NHS. Please tweet a selfie of you and your colleagues (ideally in uniform - but you don’t have to identify anyone) holding a sign saying “We treat patients not passports. I’m a Nurse not a border guard”. For more information go to:<a href="http://www.docsnotcops.co.uk/nursenotaborderguard" target="_blank">&nbsp;docsnotcops.co.uk/nursenotaborderguard</a></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/uk/jess-potter/is-our-personal-data-fair-game-in-drive-to-create-theresa-may-s-hostile-environment-f">Is our personal data fair game in the drive to create Theresa May’s “hostile environment” for migrants?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Peter Pannier Fri, 11 May 2018 06:00:00 +0000 Peter Pannier 117807 at https://www.opendemocracy.net “Simon Jones was 24 when he died, his head crushed by the grab of a crane” https://www.opendemocracy.net/uk/hannah-basson/simon-jones-was-24-when-he-died-his-head-crushed-by-grab-of-crane <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Poor working conditions kill a worker every 11 seconds. All of these deaths are preventable – if the political will is there. An edited version of a speech given on International Workers Day.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/simon jones.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/simon jones.jpg" alt="" title="" width="460" height="421" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Simon Jones's family, pictured 3 years after his death. Credit: Michael Stephens/PA Images.</em></p><p><a href="http://www.simonjones.org.uk/campaign/">Simon Jones was 24 when he died</a>. It was 20 years ago last month.</p> <p>Simon died, his head crushed by the grab of a crane at Shoreham docks. He didn’t know how to do that job. He wasn’t trained for it. But he took a job he was not prepared for and had no experience in, because of the push from the dole office to make him work, and the threat of his benefits being cut.</p> <p>Worldwide, poor working conditions <a href="http://www.hazards.org/wmd/worldoftrouble.htm">kill a worker every 11 seconds</a>. <a href="http://www.hse.gov.uk/statistics/fatals.htm">137 people died at work in the UK in the 2016-17</a>, and in the same year, one and half thousand fatalities arose from work-related incidents.</p> <p>Union health and safety representatives make a difference in the workplace. Yet this government is relentlessly attacking our unions. Workplaces with union representatives and joint safety committees have half the major injury rate of those without. Safety representatives save society up to half billion pounds a year, by reducing time lost through illness and occupational injury. </p> <p>An academic report looked at the construction industry in Northern Ireland and the Irish Republic. It concluded: “<em><a href="https://www.tuc.org.uk/research-analysis/reports/union-effect#_ftn12">the strongest relationship with safety compliance is the presence of a safety representative</a>”.</em> The Health and Safety Executive’s own research has reinforced these conclusions. Other studies have shown that the better an employer consults with reps, the more effective the control measures. </p> <p>And yet, this govt continues its attacks on our unions and our safety.</p> <p>The 1974 Health and Safety at Work Act is our primary piece of legislation covering occupational health and safety in Great Britain. With the hard work, skills, knowledge, and watchful eye of people like our reps and of the Health and Safety Executive, thousands and thousands of lives have been saved. </p> <p>Not only are this government hell bent on destroying the unions, they are attacking the Health and Safety Executive too. <a href="http://www.hazards.org/safetypimp/buyme.htm">By 2020, the HSE budget will have been cut by half</a>. Conservative leaders and a right-wing media, with the approval of sneering government officials, undermine the work of the Health and Safety Executive at every turn, citing any decision as ‘red tape’, the ‘nanny state’, and ‘health and safety gone mad’.</p> <p>The 40-year social partnership between the Health &amp; Safety Executive and the TUC/unions has been scrapped – after talks behind closed doors between the government and lobby groups - and it’s now <em>ministers</em> that decide who represents workers on the HSE board. </p> <p>The need for proper health and safety, the damage that casual labour creates, outsourcing, the demonisation of the sick and disabled – these issues are as important as they ever were. </p> <h2>How outsourcing and privatisation worsen health and safety</h2> <p>Since the last Workers Day, the <a href="http://press.hse.gov.uk/2017/health-care-provider-fined-for-health-and-safety-failures/">Ramsay health group who run the Winfield private hospital in Gloucester were fined</a> for running an insufficiently staffed and managed occupational health service putting staff, as well as public, at risk. </p> <p>Since last Workers Day, Liverpool has held a <a href="http://www.unitetheunion.org/news/vigil-to-remember-liverpool-hospital-worker/">candlelit vigil for an outsourced worker who could not afford adequate time off work to recover</a>, following surgery to have a lung removed in the hospital where she worked. Unfair sick pay meant she lost her home as a result.</p> <p>Here in the NHS in Gloucestershire, <a href="https://opendemocracy.net/ournhs/caroline-molloy/are-cash-strapped-hospitals-walking-into-trap-that-could-cost-nhs-its-family-">hundreds of staff have just been transferred to a new private company, or ‘SubCo’</a> – transferred whilst its owners, Gloucestershire Hospitals NHS Trust, were <em>still discussing</em> what Health and Safety committee provision there would be, whilst they were still tossing ideas around about the occupational health provision that those workers will have access to.</p> <p>Many outsourcings across the NHS and beyond in this last year have led to reductions of sick days for staff. In Gloucestershire, we don’t know yet what several of the policies of the new SubCo will be. We are still waiting to see what new starters terms will be. Our workers in this county in the SubCo, outsourced to save money for the bosses, face many potential sources of injury every hour of the day in the work place. And these are the lowest paid workers in the health service. They are fodder for feeding the bosses’ profits and for feeding the government’s cuts. They are expendable trash, waste products, of a system that favours money over life.</p> <p>Worldwide, working conditions kill a worker every 11 seconds. Every death is avoidable. There is the knowledge, there is the technology, there just isn't the will. </p> <p>Union organisation is proven antidote. Remember Simon, and remember those that die at work everywhere. And think about your friends and family and the people you don’t know personally but greet each day as though they were your friends. Think about their safety, their futures. An injury to one is an injury to all.</p> <p>Simon was an amazing young man who believed in direct action. He knew you couldn’t sit back and wait for politicians to make the changes needed.</p> <p>Before the next government is sworn in, there will more deaths in the workplace. And we can’t wait for the next government. So, for now, we must do all we can to raise awareness of the good that unions do, the need for proper health and safety, the damage that casual labour creates, outsourcing, the demonisation of the employed and the non-employed sick and disabled. And when the next election comes – you know what you have to do. Then, let’s bring in a reversal to union legislation, repeal the vicious trade union legislation – and let’s make the workplace a safer place for everyone</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/opensecurity/henrik-maihack/rana-plaza-bottomup-route-to-workers%E2%80%99-safety">Rana Plaza: the bottom-up route to workers’ safety</a> </div> <div class="field-item even"> <a href="/uk/frances-ogrady/heartunions-why-young-workers-need-trade-unions-more-than-ever">#HeartUnions - why young workers need trade unions more than ever</a> </div> <div class="field-item odd"> <a href="/laurie-macfarlane/precarious-workers-are-organising-trade-unions-need-to-catch-up">Precarious workers are organising - trade unions need to catch up</a> </div> <div class="field-item even"> <a href="/opensecurity/phil-chamberlain/building-blacklist-police-spies-and-trade-unionists">Building the blacklist: police spies and trade unionists</a> </div> <div class="field-item odd"> <a href="/dave-smith/carillion-must-now-face-justice-for-blacklisting-trade-unionists-too">Carillion must now also face justice for blacklisting trade unionists</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> uk uk ourNHS Hannah Basson Thu, 10 May 2018 08:10:57 +0000 Hannah Basson 117786 at https://www.opendemocracy.net To prevent another Alfie Evans case we must reverse cuts to public services https://www.opendemocracy.net/callum-phillips/to-prevent-another-alfie-evans-case-we-must-reverse-cuts-to-public-services <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>The right have used the case as a stick to beat the public services they supported gutted.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/565030/PA-36210904.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/565030/PA-36210904.jpg" alt="Alfie Evans in Alder Hey Children’s Hospital, Liverpool." title="" width="460" height="392" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Alfie Evans in Alder Hey Children’s Hospital, Liverpool. Image: Ropi/Zuma Press/PA Images.</span></span></span></p><p>On April 28th, 23-month-old Alfie Evans died five days after his life support machine was switched off. The entwined web of legal, medical, and ethical issues brought to light by the case has provoked fierce reactions across the globe. On both sides of the Atlantic, the libertarian right have weaponsied Evan’s death to attack the NHS and British legal system, with figures like Nigel Farage branding it “state-sponsored euthanasia”. But contrary to their claims, this tragic story is not the result of government overreach. Rather, it is indicative of the damage being wrought to public services and human lives by the shrinking of the state, a policy that the right has vociferously fought for.&nbsp;</p><div>In the US, commentators such as Liz Wheeler, a host for the ultra conservative news network OAN, have sought to link Evan’s death to the UK’s universal health care system. But even if an American hospital was willing to keep Evans on life support, it would not be able to do so indefinitely given the financial burden on his parents. Regardless, the opinion of the international medical community is that the outcome would have been the same. Impartial medical experts offering opinions, available to read in the court judgements, comprehensively assessed any likelihood of recovery and found none; MRI scans of his brain found the majority of his brain was already crippled beyond repair. They submitted that Evans would never make any developmental progress (motor skills, vision, hearing, social, or emotional) and his illness was irreversible and terminal.</div><div>&nbsp;</div><div>Having already exhausted all their medical knowledge, experience, and options, Alder Hay Hospital continued to keep Evans alive, at no cost to the parents, supporting his failing organs, enabling him to breath, and treating recurrent infections Evans could not fend off himself. Accordingly, Alder Hay provided palliative care to Evans, which some critics have misleadingly tried to equate to euthanasia. It is at this point that a Vatican-run hospital, Bambino Gesú Hospital, and the Pope intervened. Their intentions however have been misreported. The Italian hospital offered no therapeutic benefit, no increased chance of survival. There was no last ditch option maliciously refused to the parents by a child-murdering government. The British government were not a party to any of the legal proceedings, and the constitutionally endorsed independence of the court ensures the government cannot simply dictate their adjudications. To chastise the state is to erroneously conflate the two.</div><div></div><blockquote class="twitter-tweet"><p dir="ltr" lang="en">Moved by the prayers and immense solidarity shown little Alfie Evans, I renew my appeal that the suffering of his parents may be heard and that their desire to seek new forms of treatment may be granted.</p>— Pope Francis (@Pontifex) <a href="https://twitter.com/Pontifex/status/988496588283826177?ref_src=twsrc%5Etfw">23 April 2018</a></blockquote><p><br />Recognising this, the courts and medical specialists at Alder Hay concluded it was in Evans’ best interests to end his suffering by switching off the life support machine keeping him alive. This was against the wishes of his parents, and certainly their opinions were taken into account. However, it is not in their best interests that the courts and doctors are charged with protecting. They are the guardians of a young man unable to communicate his own wishes. It is a wretched decision to have to take, but arguably, those we entrust with such tragedies were in agreement: it was time to let Evans’ life reach a natural conclusion.</p><div>We cannot imagine the suffering which Evans’ parents have gone through. This has been a horrifically sad story from start to finish. However, as a society we must seek to draw beneficial reforms from what has gone before, recognising where we have failed each other.</div><div class="mag-quote-right">Let Evans’ legacy be a call-to-arms to support a health service wishing to protect its citizens</div><div>&nbsp;</div><div>Incorrect legal advice from the Christian Legal Centre prolonged and increased the suffering of the parents and child involved. It gave them a false hope. It misled them as to the actions of the doctors and the position of the law. This cannot be forgotten. Looking forward, we must invest in legal aid access and supporting organisations like Citizens Advice, which have been stretched to breaking point by vicious budget cuts and austerity measures. Hospitals must be enabled to bring in greater specialist grief counselling facilities, to open up a passage of communication between parents and doctors. The adversarial nature of court proceedings should be avoided at all costs, it is to the benefit of neither party. Clinical Ethics Committees are notoriously poorly resourced, resulting in them fighting a battle with one arm tied behind their back. The answer to this case is most certainly not to turn towards a single-payer healthcare system (as seen in America). As former President Obama noted in his 2009 State of the Union, a medical cost induced bankruptcy occurs every 30 seconds due to a system rampantly providing unequal levels of accessibility to care.</div><div>&nbsp;</div><div>The answer is to double-down on our support for universal health care. As citizens touched by Evans’ story, we must come together to fund charities and research into incurable conditions. We must support political parties seeking to empower our NHS and research facilities to provide pioneering treatment and developing those miracle cures we seek. This is clearly not yet the case under our current neoliberal system. Healthcare blind to social class is irrevocably entwined to the very fabric safeguarding British communities, providing protection and care for those other countries would readily leave behind.</div><div>&nbsp;</div><div>Let Evans’ legacy be a call-to-arms to support a health service wishing to protect its citizens, to formulating a legal system accessible by all, and to campaigning for research into conditions not seen as profitable by corporations. It is only through standing up for these notions that we can prevent the suffering of Evans and his family from being in vain.&nbsp;</div><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/5050/lara-whyte/charlie-gard-cause-celebre-us-christian-right">How Charlie Gard became a cause célèbre for the US Christian right </a> </div> <div class="field-item even"> <a href="/5050/lara-whyte/the-rise-of-citizengo">&quot;They are coming for your children&quot; – the rise of CitizenGo</a> </div> </div> </div> </fieldset> <div class="field field-country"> <div class="field-label"> Country or region:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> UK </div> </div> </div> <div class="field field-topics"> <div class="field-label">Topics:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> Civil society </div> </div> </div> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS UK Civil society Callum Phillips Wed, 09 May 2018 12:03:06 +0000 Callum Phillips 117767 at https://www.opendemocracy.net Don't invoke the NHS to sell a false idea of 'good nationalism' https://www.opendemocracy.net/ournhs/caroline-molloy/dont-invoke-nhs-to-sell-false-idea-of-good-nationalism <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>This isn't 'good nationalism'. This is nationalism - as ever, in an English context - as forgetting. A response to Zoe Williams.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/2012 olympics.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/2012 olympics.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: London Olympic games ceremony, 2012. Credit: Julian Behal/PA Images, all rights reserved.</em></p><p>Zoe Williams <a href="https://www.theguardian.com/commentisfree/2018/may/08/nationalism-positive-case-immigration-counter-narrative-nhs">holds up the NHS as an example of ‘good nationalism’ in today’s Guardian</a>, citing Danny Boyle’s 2012 Olympics NHS montage as an example:</p> <p>“Good nationalism is a certain specific solidarity based on the things you have created together, as a nation, and the things you aspire to create: you could call it, for short,&nbsp;<a href="https://www.theguardian.com/sport/2012/jul/27/olympic-opening-ceremony">Danny Boyle nationalism</a>, and it takes in the NHS.”</p> <p>The problem with this kind of narrative is it omits how all English nationalism – even supposedly the ‘good’ kind – allows us all to ignore inconvenient truths.</p> <p>Narratives that sacralise the NHS - or indeed any of our better achievements or virtues - as part of our nationalism, risk making us complacent. We all love the NHS, fair play, queues, warm beer and decency. These things will always be with us, with any temporary lapses promptly corrected. So the story goes.</p> <p>Of course in 2012, just as Boyle’s dancing nurses brought a lump to our throats, the government was enacting the most destructive anti-NHS legislation in history, destroying (in England) its core principle that people got <em>comprehensive</em> healthcare on the basis that they lived here, and needed it, that had endured since 1948.</p> <p>Just a couple of months <em>before</em> the 2012 Olympics, <a href="https://www.telegraph.co.uk/news/uknews/immigration/9291483/Theresa-May-interview-Were-going-to-give-illegal-migrants-a-really-hostile-reception.html">Theresa May also publicly announced the “hostile environment” policy</a>, making it progressively harder over the next few years for migrants to access healthcare or other basic rights, as well as making life progressively more uncomfortable – or impossible – <a href="https://opendemocracy.net/ournhs/ruth-atkinson/brexit-and-nhs-we-need-to-fight-racist-discourse">for migrant workers in the NHS</a>. </p> <p>The Tories genuflect to the NHS as a ‘national religion’ almost as much as Labour - but that hasn’t stopped them disestablishing it and excommunicating large numbers of people from it. </p> <p>And not just migrants, incidentally. Overweight people and smokers are now being banned from <em>all</em> routine NHS procedures <a href="https://www.theguardian.com/society/2017/apr/22/nhs-letter-more-rations-on-operations-obese-smokers">across at least a third of the country</a>, a policy strongly opposed by doctors.</p> <p>Sajid Javid suggested last week that the hostile environment “<a href="https://www.independent.co.uk/news/uk/politics/sajid-javid-theresa-may-new-home-secretary-immigration-rhetoric-hostile-not-british-a8330151.html">did not represent our values as a country</a>”, and <a href="https://www.telegraph.co.uk/politics/2018/05/07/jacob-rees-mogg-amazing-rise-savid-javid-makes-proud-british/">Jacob Rees-Mogg yesterday called the policy “unBritish”.</a> But Eric Pickles called the aforementioned NHS fat bans “<a href="https://www.opendemocracy.net/ournhs/caroline-molloy/dont-want-government-to-let-nhs-die-one-crucial-thing-you-can-do-now">not the kind of Britain I recognise</a>”, too. It seems evoking Britishness doesn’t save us. </p> <h2>&nbsp;‘Good nationalism’ vs ‘bad nationalism’?</h2> <p>Is ‘bad nationalism’ really confined to the Other, to the unashamedly right-wing both here and across the pond? </p> <p>Williams says, “I have no problem with a bordered civic identity: our borders describe the limits of our democratic agency.” She adds, “Good nationalism… includes, by definition, every man, woman and child who contributed to the achievement”. But Williams fails to spell out who this is. Those Caribbean nurses who came here to build the NHS, now finding themselves or their children denied healthcare, and worse? The Commonwealth doctors, routinely discriminated against? The slaves who were forced to help ‘this nation’ establish its wealth? </p> <p>Williams doesn’t say, and such vagueness is not good enough.</p> <p>This isn’t ‘good nationalism’ – this is nationalism (as ever, in the English context) as forgetting. Forgetting that the NHS was not <em>just</em> built “together, as a nation”, as Williams suggests. It was built by a nation that had built its wealth on the back of empire and slavery, by overwriting brown people’s “civic identity”, a nation that had no qualms about interfering in its colonies’ “democratic agency” just long enough to exploit all that could be exploited – and not a moment longer.</p> <p>It’s a message that has been powerfully brought home lately, with the very Commonwealth workers who came over here to help build the NHS, shamefully denied healthcare for themselves or their families. </p> <p>Even now, too many responses to the Windrush scandal fall into <a href="https://www.opendemocracy.net/uk/luke-de-noronha/windrush-generation-and-illegal-immigrants-are-both-our-kin">inherently flawed tropes of ‘good’ and ‘bad’ migrants</a>, with the ‘bad migrants’ category including <a href="https://www.opendemocracy.net/ournhs/juan-camilo/migrants-fairness-and-nhs">children</a>, <a href="https://www.opendemocracy.net/ournhs/rayah-feldman/pregnant-women-bear-brunt-of-government-s-clampdown-on-migrant-nhs-care">pregnant women</a> and <a href="https://www.opendemocracy.net/ournhs/erin-dexter/making-nhs-hostile-environment-for-migrants-demeans-our-country">torture victims and people with infectious diseases</a>, all of whom are still now being refused free healthcare. The former head of the NHS attacked these policies as a “<a href="https://www.opendemocracy.net/ournhs/ex-boss-of-england-s-nhs-blasts-nhs-migrant-policy-as-national-scandal">national scandal” when Jeremy Hunt rolled out upfront passport checks and charges last year</a>. But the <a href="https://www.opendemocracy.net/ournhs/kailash-chand/stop-distracting-us-with-health-tourism-sideshow">grossly exaggerated</a> story of so-called ‘health tourism’ won’t go away, carried by the insidious bleating about ‘an international health service’ that’s travelled from Nick Griffin’s mouth, to Nigel Farage’s, to Jeremy Hunt’s, to even <a href="https://www.youtube.com/watch?v=n9aq47KRrOI">that other bastion of liberal national pride, the BBC</a>.</p> <h2>A little history</h2> <p>A few years after the Windrush generation arrived, <a href="https://www.opendemocracy.net/ournhs/whole-agitation-has-nasty-taste-bevan-on-so-called-health-tourism">Nye Bevan wrote powerfully</a> about the importance of generosity to visitors and of universalism, saying:</p> <p>“it would be&nbsp;unwise as well as mean&nbsp;to withhold the free service from the visitor to Britain. How do we distinguish a visitor from anybody else?&nbsp;Are British citizens to carry means of identification everywhere&nbsp;to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody. Happily, this is one of those occasions when&nbsp;generosity and convenience march together…. The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilized principle, Conservatives have tried to&nbsp;exploit the most disreputable emotions&nbsp;in this among many other&nbsp;attempts to discredit socialized medicine.”</p> <p>Williams writes “Patriotism is democracy, distilled: satisfaction and solidarity rooted in having created the conditions in which generosity and innovation could thrive.”</p> <p>This sounds like a very Blue Labour take (or Blue Corbynism…?).</p> <p>It’s also nonsense. </p> <p>Do we really want to relegate our “generosity” to merely a side-effect of patriotism? Our most generous service – <a href="https://www.newstatesman.com/politics/2013/01/nhs-even-more-cherished-monarchy-and-army">the NHS – has also been our most cherished</a>, for that very reason. The NHS is not a side effect of patriotism. It is, as Bevan himself said, “pure socialism”. </p> <p>And “innovation” in science and medicine has nothing to do with patriotism, either. Our greatest discoveries have been built on cross-border, non-profit collaboration for centuries, and continue to be so – <a href="https://www.opendemocracy.net/ournhs/ted-schrecker/5-reasons-brexit-is-very-bad-for-our-health">though threatened by Brexit</a>. </p> <p>Mangling history to provide comforting myths won’t provide the effective countervailing ‘narrative’ to ‘bad nationalism’ that Williams says the English need. Indeed it just makes ‘bad nationalism’ worse. </p> <p>We need proper history, not more myth making dressed up as ‘narrative’ and ‘framing’.</p> <p>By proper history, I mean a history that acknowledges the role of empire in building our welfare state. A history that doesn’t just portray the NHS as a ‘reward’ for ordinary people that ‘we won’ with our fortitude and sacrifice during our ‘finest hour’, delivered by rulers with an inherent sense of ‘fair play’ and ‘never again’, imbued with the ‘Spirit of 45’ and immediately able to see and embrace the common sense of applying wartime state management to public needs. We also need a history that acknowledges that in fact the NHS’s creation – and that of the rest of the welfare state – was as much to do with elite fears exposed yet again by the demands of war; fears of an enduringly sickly and unproductive workforce, of the pull of communism, and indeed, their fears of a recently demobbed, militarily-trained working class.</p> <h2>Nationalism - same as it ever was</h2> <p>Less than a month after Boyle’s Olympic opening ceremony, the government announced it was setting up ‘Healthcare UK’ to help the <a href="https://www.theguardian.com/society/2012/aug/21/nhs-brand-sold-overseas-hospitals">NHS ‘brand’ to be exported overseas, particularly to the Gulf states, with private firms allowed to “partner with” and benefit from the NHS’s brand recognition</a>. Broadcasting the NHS brand so powerfully to nearly a billion people was undoubtedly useful in helping “<a href="https://healthcareuk.blog.gov.uk/2016/02/23/a-legacy/">public and private sector organisations</a>” build their global healthcare exports. Whatever Boyle’s good intentions – and the government’s <a href="https://www.thetimes.co.uk/article/tories-tried-to-axe-olympic-nhs-celebration-vzc8pmfck">reported initial discomfort</a> – perhaps our desire for a ‘good nationalism’ (<a href="https://www.theguardian.com/sport/2012/jul/28/olympic-games-opening-ceremony-british">gleefully reported at the time</a>) is all too easily hijacked to export (neo)colonialism for the benefit of a few, just as ‘bad nationalism’ was. </p> <p>There is no such thing as ‘good nationalism’, as applied to England, in other words, a nationalism that serves the interests of ordinary people. There is only English nationalism that undermines those interests, that harms our solidarity both in our communities and globally, and that’s a figleaf for pursuing the interests of elites, whilst playing divide and rule amongst the rest of us.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ourkingdom/lara-brearley/exporting-nhs-brand-overseas">Exporting the NHS &#039;brand&#039; overseas?</a> </div> <div class="field-item even"> <a href="/ournhs/why-you-can-t-solve-nhs-s-funding-problems-by-banning-smokers-and-obese-from-treatment">Why you can’t solve the NHS’s problems by banning smokers and the obese from treatment</a> </div> <div class="field-item odd"> <a href="/uk/anthony-barnett/why-brexit-its-english-stupid">Why Brexit? It&#039;s the English, stupid.</a> </div> <div class="field-item even"> <a href="/ournhs/erin-dexter/making-nhs-hostile-environment-for-migrants-demeans-our-country">Making the NHS a “hostile environment” for migrants demeans our country</a> </div> <div class="field-item odd"> <a href="/ournhs/ruth-atkinson/brexit-and-nhs-we-need-to-fight-racist-discourse">Brexit and the NHS - why we all must fight the racist discourse</a> </div> <div class="field-item even"> <a href="/ournhs/greg-dropkin-karen-reissman/healthcare-in-britain-first-they-came-for-immigrants">Healthcare in Britain - first they came for the immigrants</a> </div> <div class="field-item odd"> <a href="/ournhs/juan-camilo/migrants-fairness-and-nhs">Migrants, &quot;fairness&quot; and the NHS</a> </div> <div class="field-item even"> <a href="/ournhs/kailash-chand/stop-distracting-us-with-health-tourism-sideshow">Stop distracting us with the &#039;health tourism&#039; sideshow</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS Can Europe make it? uk ourNHS Caroline Molloy Tue, 08 May 2018 13:00:28 +0000 Caroline Molloy 117743 at https://www.opendemocracy.net Key NHS ‘efficiency’ programme ‘RightCare’ called into question in Liverpool – and elsewhere? https://www.opendemocracy.net/ournhs/greg-dropkin/key-nhs-efficiency-programme-rightcare-called-into-question-in-liverpool-and-els <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>NHS England is promoting ‘RightCare’ as a way for the NHS to deliver still more ‘efficiency savings’. But questions to Liverpool CCG show at least some local NHS managers are well aware of its flaws.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/liverpool.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/liverpool.jpg" alt="" title="" width="460" height="252" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Royal Liverpool University Hospital, PA Images/Peter Byrne, all rights reserved.</em></p><p>RightCare is an NHS England system for encouraging CCGs to compare themselves with other CCGs, with the declared aims of improving performance and reducing costs. When Accountable Care Systems were rebranded as “Integrated Care Systems” in the latest Planning Guidance, NHSE also promoted RightCare. “<a href="https://www.england.nhs.uk/wp-content/uploads/2018/02/planning-guidance-18-19.pdf">Refreshing NHS plans for 2018/19</a>”, which says “In addition to the moderation of emergency demand, the use of RightCare, elective care redesign, urgent and emergency care reform, medicines optimisation, and more integrated primary and community services are also key areas of focus”.</p> <p>Liverpool CCG’s plan for an Integrated Care System was presented on 13 March. It is a 60 page paper “<a href="https://www.liverpoolccg.nhs.uk/media/2943/lccg-gov-body-tuesday-13th-march-18-papers-pack-website-version.pdf">One Liverpool: 2018-2021</a>” written by Healthy Liverpool Integrated Programme Director Carole Hill, with Liverpool CCG Chief Officer Jan Ledward as the Lead Governor. A section on High Impact Priorities waxes lyrical on RightCare.</p> <p>“In support of the work by the Provider Alliance to develop detailed delivery plans, Liverpool CCG has undertaken a review of clinical and non-clinical interventions that have the capacity to deliver high impact change to achieve our outcome ambitions. The review incorporated the Commissioning for Value approach which is embedded in NHS RightCare, the NHS England programme committed to delivering the best care, making the NHS’s money go as far as possible and improving patient outcomes. <a href="https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2017/01/cfv-liverpool-jan17.pdf">Local RightCare data</a> shines a light on variation and performance and supports local health economies to have discussions to agree a starting point for change. NHS RightCare has a three stage, evidence-based methodology, of ‘Where to look’, ‘What to change’ and ‘How to change’ which provides a robust process for service redesign and prioritisation.</p> <h2>Magical Thinking</h2> <p>Describing itself as “a proven approach that delivers better patient outcomes and frees up funds for further innovation”, RightCare turns out to be unproven and based on faulty statistics (<a href="https://blog.oup.com/2017/12/questioning-nhs-rightcare/">Questioning the magical thinking of NHS RightCare</a>). Apparently Liverpool should compare itself with Brighton, Bristol, Sheffield,&nbsp;Newcastle, and Stoke and then save 80 lives per year from lung cancer mortality.</p> <p>Public Health academic Dr Alex Scott-Samuel sent the CCG an FOI request to find out if they’d heard criticism of RightCare.</p> <p>1) Was Liverpool CCG aware of the Journal of Public Health article "<a href="https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdx136/4596536">RightCare: wrong answers</a>", published 3 Nov 2017, when formulating the "One Liverpool" strategy?</p> <p>2) In formulating the "One Liverpool" strategy, how did Liverpool CCG take account of this peer-reviewed criticism of the RightCare methodology?</p> <p>3) Which other specific aspects of Liverpool CCG's work involve RightCare?</p> <p>4) How does Liverpool CCG intend to respond to this peer-reviewed criticism of the RightCare methodology in future? </p> <p>The CCG’s unexpected answer included a less than ringing endorsement:</p> <p>“Liverpool CCG is aware of the article and the conclusions regarding the limitations of the Right Care methodology. The CCG uses the Right Care Methodology as one tool to highlight where there is variation in outcomes and activity, to inform the development of shared priorities for improvement within the Liverpool health and care system. It is not the only method we use and we do acknowledge its limitations. We do not take a literal view of the scale of opportunities set out in our local Right Care data packs... The CCG does not rigidly follow the Right Care methodology to set levels of ambition and does not assume that the efficiencies or outcomes gains published should be modelled in our plans.”</p> <p>Why not ask your CCG about the RightCare magic? Do their Integrated Care plans show the same unbridled enthusiasm for RightCare as “One Liverpool”, or do they take a more sober view?</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Taking politics out of the NHS? Or constructing an elitist ‘consensus’?</a> </div> <div class="field-item even"> <a href="/ournhs/caroline-molloy/why-%C2%A38bn-is-zombie-figure-that-won%27t-save-nhs">Why £8bn is a zombie figure that won&#039;t save the NHS </a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS ourNHS Greg Dropkin Mon, 30 Apr 2018 11:50:29 +0000 Greg Dropkin 117572 at https://www.opendemocracy.net GP practices face funding threat as online service ‘targets’ young people https://www.opendemocracy.net/ournhs/david-wrigley/gp-practices-face-funding-threat-as-online-service-targets-young-people <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Doctors and NHS staff raise the alarm as the GP at Hand model threatens the very survival of NHS general practice.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/telephone-mobile-to-call-attainable-40552.jpeg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/telephone-mobile-to-call-attainable-40552.jpeg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Person using mobile, CC0 license.</em></p><p>The traditional GP practice, in place since the NHS’ inception in 1948, is under serious financial threat from a new online service that is draining funding from surgeries.</p> <p>Doctors in Unite (DiU) – part of Unite, the country’s largest union – are warning today that the online NHS&nbsp;GP at Hand&nbsp;service, powered by private digital health provider Babylon, is signing up predominately young people – and putting the future care of vulnerable groups at risk.</p> <p>When patients register with&nbsp;GP at Hand, currently operating just in&nbsp;London,&nbsp;they are ‘de-registered’ from their own surgery with funding being removed from that practice.</p> <p>What’s the problem? Well, losing registration fees for younger, fitter patients who join GP at Hand threatens the model of general practice relied on by so many patients, since the NHS was formed 70 years ago.</p> <p>The scheme is hoovering up the younger, healthier patients and restricts access to those who are pregnant, frail, terminally ill or suffering from multiple health problems. There appears to be an element of cherry picking operating here, which, if true, is to be deplored.</p> <p>In practice, 70 per cent of all patients are reasonably well. Their funding helps surgeries care for the 30 per cent who are sick. It’s a system that works, because it’s fair. We will eventually end up in the 30 per cent - and that’s why we are calling on health and social care secretary Jeremy Hunt to scrap this flawed and misguided model.</p> <p>It is understood that since&nbsp;GP at Hand&nbsp;launched in London in November 2017 about 26,000 patients have registered, most of them being between the ages of 20 and 39.</p> <p>Practices in the capital have seen their list sizes fall for the first time in years due to those patients registering with GP at Hand.</p> <p>There is, no doubt, that GP at Hand&nbsp;will financially destabilise many practices robbing them of the vital risk pooling and cross subsidy which enables them to provide good care to their more complex and unwell patients.</p> <p>GP at Hand targets the most profitable patients – those who are younger and healthier and don’t need extensive care from their GP.</p> <p>Jeremy Hunt has said that general practice is the ‘Jewel in the Crown’ of the NHS. If he truly believes this, he will acknowledge that the GP at Hand model threatens the very survival of NHS general practice.</p> <p>GP at Hand has made it clear it wishes to roll out this model of care across the country, so this scheme will threaten general practice across England.</p> <p>General practice is the cornerstone of the NHS which has provided excellent care with its other community partners for decades.</p> <p>NHS staff who share our concerns can sign the open letter to Jeremy Hunt <a href="https://docs.google.com/forms/d/e/1FAIpQLScDINMclsb7DiYlhq5HwTvr6fg1A-gwRwVhrKooVh5kcdwzIg/viewform">here</a>.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/david-mccoy-lewis-hier-thomas/gp-at-hand-handy-for-whom"> ‘GP at hand’: handy for whom?</a> </div> <div class="field-item even"> <a href="/ournhs/shibley-rahman/247-transparent-nhs-%E2%80%93-or-rise-of-planet-of-apps">A 24/7, transparent NHS – or the rise of the planet of the apps?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS ourNHS David Wrigley Wed, 25 Apr 2018 11:25:28 +0000 David Wrigley 117487 at https://www.opendemocracy.net An 'NHS tax' is perfect for a 'new centrist party'—stale, regressive and technocratic https://www.opendemocracy.net/ournhs/caroline-molloy/nhs-tax-is-stale-regressive-and-technocratic-perfect-for-new-centrist-party <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>National Insurance is regressive. Hypothecating taxes tends to encourage ideas of opt outs &amp; top ups. So why is Liz Kendall promoting these as the 'new consensus' for NHS funding?</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/liz kendall.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/liz kendall.jpg" alt="" title="" width="460" height="286" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Liz Kendall in 2015. Lauren Hurley/PA Images, all rights reserved.</em></p><p>Today, Tory MP Nick Boles, Lib Dem former health minister Norman Lamb and former Blairite health minister Liz Kendall joined forces to promote the idea of a dedicated ‘health and social care tax’, through National Insurance, to replace current NHS funding. Boles grandly proclaimed it “A new Beveridge moment”.</p> <p>The main lesson to be drawn from their interview broadcast on this morning’s BBC Radio Four Today programme, is that it doesn’t take much to excite the media about anything that could be portrayed as - if not the birth pangs, perhaps at least the twinkle in an eye - of <a href="http://www.bbc.co.uk/news/uk-politics-43875246">a ‘new centrist party’</a> run by ‘<a href="https://twitter.com/bbclaurak/status/988724069133619200">grown-ups’</a>. A rehash of an old, bad idea that’s been doing the rounds in right-wing circles for years? That will do just fine. </p> <p>The interview – conducted by the BBC’s political editor Laura Kuenssberg not its health editor Hugh Pym&nbsp;–&nbsp;was notable for its lack of interest in whether such a plan actually had anything useful to offer today’s NHS. Kuenssberg’s line of questioning focused exclusively on the politics: “I mean here we are, an extraordinary degree of consensus…You’re all saying that the parties have to share the political risk… that none of the party leaderships right now are up to this task…”.</p> <p>The stale idea of an ‘NHS tax’ is perfect for those who’ve pinned their hopes on the creation of a ‘new centrist party’. It’s a technocratic issue that’s unlikely to be well understood by most voters, many of whom are under the mistaken impression that National Insurance is what funds the NHS already. The <a href="https://opendemocracy.net/dave-byrne/why-talking-about-nhs-tax-isnt-brave-at-all">history is slightly complicated</a>, but the health service is still overwhelmingly funded as Nye Bevan set out when he <a href="http://www.unitetheunion.org/uploaded/documents/In%20Place%20of%20Fear%20-%20Chapter%205,%20A%20Free%20Health%20Service11-21215.pdf">explicitly rejected the 1911 National Insurance-based system of healthcare</a>&nbsp;as unfair and "peculiarly unsuitable" and instead set up the NHS: </p> <p>“The means of collecting the revenues for the health service are already in the possession of most modern states, and that is the normal system of taxation. This was the course which commended itself to me and it is the basis of the finance of the British Health Service. Its revenues are provided by the Exchequer in the same way as other forms of public expenditure. I am afraid this is not yet fully understood. Many people still think they pay for the National Health Service by way of their contribution to the National Insurance Scheme.”</p> <p>The system Bevan founded continues to enjoy <a href="https://twitter.com/carolinejmolloy/status/914982117305733120">sky-high public support</a>, with <a href="https://www.ipsos.com/ipsos-mori/en-uk/what-do-public-think-about-nhs">nine out of 10 saying its founding principles should still apply today</a>. But being “<a href="https://opendemocracy.net/uk/jeremy-gilbert/antisemitism-cosmopolitanism-and-politics-of-labour-s-old-and-new-right-wings">unencumbered by nostalgia for the 1945 welfare-state settlement</a>” is, as Jeremy Gilbert rightly says, central to the identity of the Blairites and their fellow neoliberal-friendly “centrists” in other parties.</p> <h2>Why ‘comprehensive’ healthcare matters</h2> <p>The ‘NHS tax’ idea is also the antithesis of what campaigning politics is about – focusing, as it does, on inputs rather than outcomes.</p> <p>The public want an NHS that provides the healthcare they need, when they need it – in other words, a comprehensive and timely service. And to the dismay of right-wingers, the public has remained firmly wedded to this outcome that was at the heart of the founding of the NHS. To the idea that it's the state’s duty to provide a comprehensive healthcare service for everyone (though that duty was significantly weakened - <a href="https://www.allysonpollock.com/?p=2270">some say abolished</a> - by the 2012 Health and Social Care Act).</p> <p>The new set of NHS ‘principles’ that Kendall and Boles have produced say nothing about protecting and renewing a ‘comprehensive’ NHS. They will do therefore do nothing to stop people being told – as they are now, increasingly - “not on the NHS” for treatments ranging from <a href="https://www.chesterchronicle.co.uk/news/chester-cheshire-news/cheshire-nhs-plans-sweeping-cuts-12332772">erectile dysfunction</a> and <a href="http://www.bbc.co.uk/news/uk-england-bristol-41913680">vasectomies</a>, to <a href="https://www.thesun.co.uk/news/5436296/hip-and-knee-operations-being-denied/">hip and knee ops</a>, timely <a href="http://www.bbc.co.uk/news/health-18176017">cataract removals</a>&nbsp;and&nbsp;<a href="https://www.theguardian.com/society/2015/jan/03/hearing-aids-supply-cuts-nhs-depression-dementia">hearing aids</a>. Some – like former British Medical Association Deputy Chair <a href="https://www.theguardian.com/society/2016/jun/22/kailash-chand-bma-tory-party-agenda-wash-hands-nhs">Kailash Chand - have already warned</a> that if this trend continues, the NHS is likely to shrink to just an inadequate Medicare style fall-back option for those who can’t afford health insurance. All of the <a href="https://opendemocracy.net/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">many recent attempts to impose a neoliberal-friendly ‘cross party consensus’</a> have <a href="https://opendemocracy.net/ournhs/caroline-lucas/why-i-have-removed-my-backing-for-nhs-commission">failed to incorporate any principled red line about a commitment to comprehensive healthcare</a> – and so all of them have been <a href="https://opendemocracy.net/ournhs/ournhs/nhs-campaigners-say-no-to-nhs-commission">resoundingly rejected by NHS campaigners</a> (as Norman Lamb should know – he’s been involved in most of the recent attempts).</p> <p>The ‘NHS tax’ idea seems unlikely to appeal to any particular demographic of voters. But of course, it could well appeal to a group that most of the ‘centrist party’ fans seem to consider far more important – potential funders. If you look closely at what’s said – and unsaid - in the <a href="https://www.facebook.com/notes/nick-boles-mp/ten-principles-of-long-term-funding-for-nhs-and-social-care/1522885904504144/">Boles/Kendall principles</a>, there’s a lot of music to the ears of corporations and the rich.</p> <h2>The dangers of an “NHS tax”</h2> <p>The most obvious problem in using National Insurance to pay for the NHS is that it is a deeply regressive tax that is capped for the rich. Boles and Kendall nod to this problem, but say only rather vaguely that “higher earners, the self employed, and better off pensioners” will make a “fair” contribution. But if this government is offered a choice between meaningfully reforming a huge loophole that lets them tax poor people more heavily than rich ones – or just loading massive new costs onto an unreformed tax that doesn’t upset the Daily Mail, in the name of ‘saving the NHS’ and ‘a new consensus’ – which do you think Theresa May might pick? </p> <p>Funding through the NHS through the National Insurance system is not just regressive, though. There are other dangers.</p> <p>Firstly, such a plan would probably make it easier – not more difficult&nbsp;–&nbsp;to underfund the NHS, with yet still more quangos and regulators deflecting public concern away from politicians. It would renew the emphasis on the <a href="https://opendemocracy.net/ournhs/richard-murphy/%27nhs-tax%27-is-not-answer">(false) idea that public funds are a simple matter of 'tax in, spending out'</a>, and also the equally false idea that the NHS is somehow separate from the real business of government (a point <a href="https://www.theguardian.com/commentisfree/2018/apr/24/nhs-tax-fragmentation-cross-party-campaign-health-crisis">Caroline Lucas makes excellently in the Guardian today</a>).&nbsp;And whilst Boles and Kendall say the new Fund ought to be “publicly owned”, it’s not hard to imagine the Fund being privatised in the future (right wing Labour MP <a href="https://www.theguardian.com/society/2016/dec/02/run-the-nhs-and-social-care-like-john-lewis-says-frank-field">Frank Field has already called for just such an NI based NHS fund to be run as a ‘mutual’</a> …)</p> <p>Secondly, separating out our payments for the NHS and channelling them through the contributions-based National Insurance system would make it far easier in future to exclude people who – for whatever reason - haven’t earned enough to pay sufficient contributions. </p> <p>Liz Kendall told me in January “<a href="https://twitter.com/carolinejmolloy/status/988712894287237121">I do not support…social insurance</a>”. But the scheme Boles has persuaded her to sign up to looks an awful lot like social insurance in many respects. Admittedly, it does commit to ‘universal’ provision (rather than contributions-based provision) – but how long would such a commitment last, when the mechanism made it so easy to exclude people who could be labelled as ‘less deserving’? (Indeed, we ought to be careful when we’re making the case for the Windrush generation to receive healthcare, that we don’t over-emphasise the fact that they’ve ‘worked and paid taxes’, but rather focus on defending the right to universal, comprehensive healthcare as one of Britain’s highest achievements).</p> <p>Another danger of an ‘NHS tax’ is that such a scheme would also be likely to create pressure to grant an ‘opt out’ for those who pay for private health insurance – much like the NI reforms Thatcher introduced in 1988 which allowed those who signed up to private pensions to opt out of the State Second Pension (with disastrous results). Once an opt-out is allowed, we’re into two-tier healthcare and delivering the insurance firms’ dream.</p> <p>And what of the contributory benefits we currently have? Boles suggests that the entire National Insurance fund be renamed the ‘National Health and Care Fund’. If our healthcare, sick pay and state pensions are all supposedly coming from the same pot, could we in future see them paid out as a merged allowance, from which people can buy their own healthcare from a range of ‘providers’, alongside their fuel bills and weekly shop, topping up from their own money when their 'entitlement' payment runs out? This might sound like a distant Thatcherite dystopia, but it’s a set of ideas some on the right – including the Labour right – have flirted with. Then Chancellor George Osborne <a href="https://www.google.com/url?hl=en-GB&amp;q=https://www.opendemocracy.net/ournhs/caroline-molloy/osborne-lays-out-path-to-broken-nhs-funding-promises&amp;source=gmail&amp;ust=1524673428477000&amp;usg=AFQjCNF7n9gQoaKG1AAAvtlbCMqCZdHXDA">floated the possibility of ‘integrated budgets across health and employment</a>' back in 2014, not long after New Labour think tank DEMOS had laid the groundwork by <a href="https://www.demos.co.uk/project/the-power-of-prepaid-2/">suggesting </a>that benefit and healthcare 'entitlements' could be merged on one ‘entitlement card’. Already the use of fixed ‘entitlement’ sums (known as ‘personal budgets’) is entrenched in social care – and the concept is now being <a href="https://www.theguardian.com/society/2018/apr/16/plans-to-extend-personalised-health-budget-scheme">rolled out with little fanfare into healthcare</a>, enthusiastically promoted by <a href="https://www.ippr.org/news-and-media/press-releases/new-nhs-funding-should-drive-patient-centred-reforms">another Blairite former Health minister Alan Milburn</a>, and by&nbsp;<a href="https://www.theguardian.com/society/2015/apr/28/liz-kendall-shadow-minister-care-health-nhs">Liz Kendall herself</a>.</p> <p>Jeremy Hunt has written to all Tory MPs asking for their ideas for the future of the NHS, and both he and Theresa May have said that they’ll launch a new “long term plan” for the NHS this summer – probably timed to coincide with its 70th birthday. The “centrists” have a truly lousy birthday present up their sleeve. It’s up to the rest of us to keep a close eye on them. </p> <p>Because – as Bevan said, and as we’ve been reminded of in recent weeks:</p> <p>“Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide.”</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/dave-byrne/why-talking-about-nhs-tax-isnt-brave-at-all">Why talking about an &#039;NHS tax&#039; isn&#039;t brave at all</a> </div> <div class="field-item even"> <a href="/ournhs/richard-murphy/%27nhs-tax%27-is-not-answer">An &#039;NHS Tax&#039; is not the answer</a> </div> <div class="field-item odd"> <a href="/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Taking politics out of the NHS? Or constructing an elitist ‘consensus’?</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Caroline Molloy Tue, 24 Apr 2018 17:59:05 +0000 Caroline Molloy 117472 at https://www.opendemocracy.net Arron Banks and Brexit’s offshore secrets https://www.opendemocracy.net/uk/brexitinc/marcus-leroux-leigh-baldwin/brexit-s-offshore-secrets-0 <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>In 2015, Arron Banks’s insurance business was bailed out. Where the rescue money came from is unclear—but as the Electoral Commission probes the sources of the Leave donor’s campaign contributions, a group of accountants who specialise in offshore “wealth preservation” may hold the key.</p> </div> </div> </div> <p dir="ltr"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/553846/PA-26717630_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/553846/PA-26717630_0.jpg" alt="" title="" width="460" height="309" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Arron Banks (left) with Nigel Farage (centre), the day after the UK voted to leave the EU. Image, Isabel Infantes/EMPICS Entertainment.</span></span></span></p><p dir="ltr">On 19 October 2017, Alan Kentish was arrested.</p><p dir="ltr">The chief executive officer of STM Group, which specialises in offshore “wealth preservation”, was detained by the Royal Gibraltar Police under the Proceeds of Crime Act. They were investigating whether he had failed to notify the authorities of potential money-laundering by one of STM’s clients. </p><p>Following his arrest, Kentish, who was released on police bail but remains a suspect in Gibraltar, resigned his directorships of two companies linked to multimillionaire Brexit donor Arron Banks.</p><p>Closely associated with Banks for more than a decade, Kentish and STM have drawn attention from authorities in several of the offshore tax havens where they operate. Kentish is appealing a directorship ban in Malta, while regulators in Jersey censured STM after probing its efforts to procure a St Kitts and Nevis passport for a Ukrainian politician on Interpol’s wanted list.</p><p dir="ltr">Now an investigation by SourceMaterial reveals that Kentish and other STM-linked directors were key figures in a bailout of Banks’s Gibraltar-based insurance business Southern Rock that began in 2015, just months before Banks began bankrolling the Leave.EU referendum campaign.</p><p dir="ltr">The mystery cash injection was critical to the survival of Banks’s insurance empire, the foundation of his wealth. Without it, it is hard to see how he could have funded his political donations while keeping the business afloat.</p><p dir="ltr">Banks has declined to answer questions about the origin of the bailout funds, while a spokesman for STM said the company did not supply the money or have any direct connection with the rescue.</p><p dir="ltr">As the Electoral Commission <a href="https://www.electoralcommission.org.uk/i-am-a/journalist/electoral-commission-media-centre/news-releases-donations/electoral-commission-statement-regarding-better-for-the-country-limited-and-mr-arron-banks">examines</a> the source of Banks’s £8.4 million in donations to the Leave campaign, the role of Kentish and other STM-linked figures—who presided over the bailout and were in a position to know where the money came from—may offer new clues to how Brexit was financed.</p><p dir="ltr">Andrew Wigmore, a spokesman for Banks, said our emailed questions were “baseless” and evidence of a “biased hatchet job” but declined to go into further detail. He said in an interview with <a href="https://www.byline.com/column/67/article/2073">Byline</a> in March that Banks paid for his Brexit campaign with proceeds of the sale of NewLaw Group, a law firm Banks partly owned. Wigmore did not elaborate on how Banks was able to bail out Southern Rock.</p><p><a href="https://investegate.co.uk/stm-group-plc--stm-/rns/director-declaration/201711141146274660W/">STM has said</a> the Gibraltar investigation relates to a client company of STM and it expects Kentish to be exonerated.</p><h2>Mister Big</h2><p dir="ltr">Banks, the man behind the GoSkippy car insurance brand, has never been shy about his wealth, often using an internet chatroom to brag about racehorses, diamond mines and jet-setting holidays. His username: Mister Big.</p><blockquote><p dir="ltr">“When I last looked I had”—reads a typical post from April 2014—“a direct insurance group, a gold mining operation in Ghana, four diamond mines in Kimberley (one in Lesotho), a country park complete with beautiful wedding venue, classic car collection, numerous land holdings (including building land acquired at the bottom of the market), a modest art collection and horrendous insomnia brought on by too much port, cigar and a seafood salad last night.”</p></blockquote><p dir="ltr">But much of the image was a mirage. As he lavished cash on Brexit, a series of offshore manoeuvres was underway to save a key company in his empire, Southern Rock Insurance, from bankruptcy.</p><p dir="ltr">In 2014, when a spectacular £1 million pledge to Ukip signalled his arrival in British politics, Banks was already firmly on the radar of authorities in Gibraltar. Finances at his Southern Rock Insurance Company had been shaky for years and now regulators feared a meltdown.</p><p dir="ltr">As the underwriter for policies sold by Banks’s UK insurance broker Eldon, Southern Rock was the cornerstone of his insurance empire. If it folded, Eldon would be crippled too, leaving hundreds of thousands of UK customers with car insurance not worth the paper it was written on. </p><p dir="ltr">Southern Rock’s accounts from as far back as 2011 had warned that it was “<a href="https://www.scribd.com/document/373954159/accounts-2011-technically-insolvent-pdf">technically insolvent</a>” and by the following year it was such dire straits that Banks had <a href="https://www.scribd.com/document/373954218/List-of-assets-assigned-by-Rock-Holdings-to-Southern-Rock">pledged land and sold shares</a> to shore up its capital. The company’s own auditors made clear in 2013 that it was <a href="https://www.scribd.com/document/373954156/auditors-going-concern-12-pdf">dependent on the mercy of the watchdog</a> for survival. &nbsp;</p><p dir="ltr">Meanwhile, the regulators made Southern Rock <a href="https://www.scribd.com/document/373954154/Amendment-to-Southern-Rock-s-articles-of-association">promise not to make any payments</a> to Banks without their prior written consent and hired accountants PwC to assess the company’s vulnerability to shocks.</p><p dir="ltr">When in 2014 PwC’s findings confirmed their fears about Southern Rock’s fragility, Banks was pushed to <a href="https://www.globalreinsurance.com/gibraltar-based-southern-rock-directors-step-down-after-regulatory-probe-/1409043.article">resign</a> as chief executive officer, along with another director and longstanding associate—Alan Kentish.</p><h2>Dramatic rescue</h2><p dir="ltr">By 2015, as the Brexit referendum neared and Banks’ political fortunes went from strength to strength, Southern Rock was teetering on the edge. The rescue, when it came, was dramatic.</p><p dir="ltr">ICS Risk Solutions, a holding company on the Isle of Man, <a href="https://www.scribd.com/document/373714177/Southern-Rock-Insurance-Company-Ltd-2015-accounts">agreed</a> to pump £77.7 million into Southern Rock to save it from collapse. In return, ICS would take a slice of the Gibraltar company’s future income. </p><p>The capital injection allowed the loss-making Southern Rock to meet new EU solvency regulations for insurance companies, described by Banks as “a good example of something no one really wants” being imposed by Brussels.</p><p dir="ltr">Because Banks owned both ICS and Southern Rock, it is not clear where the new money came from. But the arrival of the funds coincided with changes to the management of ICS.</p><p dir="ltr">Corporate records show that in April 2015, the day before the initial rescue deal, Louise Kentish, the wife of STM’s boss, <a href="https://www.scribd.com/document/373717866/ICS-directors-2015">joined the ICS board</a>. On 24 June 2016, the day after the referendum, Alan Kentish <a href="https://www.scribd.com/document/373717784/ICS-directors-2016">followed</a>, along with two other new directors—the former and current chairmen of STM. &nbsp;</p><p dir="ltr">Banks’s ties to Kentish and STM go back to at least 2004, when Kentish became a founding director of Southern Rock. Banks in turn invested in STM and was its largest shareholder before selling his stake in early 2015. More recently, Kentish, Banks and another STM founder co-invested in Legal Protection Group, a broker of insurance for lawyers and doctors that operates from Banks’s Bristol headquarters.</p><p dir="ltr">The arrival of Banks’s longstanding STM contacts at ICS at the time it found the money to save Southern Rock suggests they may hold the secret to the real source of the bailout funds that ensured Bank’s financial survival as he pumped millions into Leave.EU.</p><p dir="ltr">Public records suggest there may be an undeclared shareholder in ICS. Banks has said he owns 90 per cent of the company, with management and staff holding the rest. But the filings state he owns less—between 50 per cent and 75 per cent—with no information on the remainder. Banks declined to answer questions about the holdings.</p><p dir="ltr">SourceMaterial understands that Gibraltar’s Financial Services Commission is closely monitoring the arrangement between ICS and Southern Rock. &nbsp;</p><p dir="ltr">STM’s spokesman, who also responded on behalf of Kentish and the other STM directors, said the rescue “did not involve STM in any way”. He also suggested the bailout was spread over several years to mend the balance sheet without a single large cash injection. He did not address the origin of the funds.</p><h2>Offshore controversies</h2><p dir="ltr"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/553846/Alan Kentish.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/553846/Alan Kentish.jpg" alt="" title="" width="460" height="259" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Alan Kentish with colleague Therese Neish. Image, YouTube, fair use</span></span></span></p><p dir="ltr">Kentish and STM specialise in keeping secrets. A core line of STM’s business is setting up offshore trusts, opaque financial structures that make it difficult to trace who ultimately owns the assets in them.</p><p dir="ltr">In 2002 STM was sued by the UK tax authorities after it set up a trust for an alleged fraudster suspected of masterminding a £100 million VAT scam. Kentish’s arrest in Gibraltar, after which he resigned as a director of Legal Protection Group and ICS, is one of several subsequent brushes with the authorities.&nbsp;</p><p dir="ltr">Early in 2017, STM’s Gibraltar offices received a visit from local regulators, who didn’t like what they saw. Later that year they told STM they were “fundamentally concerned” about its compliance with anti-money-laundering rules, according to Gibraltar court filings. STM tried to block publication of the proceedings, the documents show.</p><p dir="ltr">Particularly worrying to the regulators was the use of STM services to invest pension savings in the Trafalgar Multi Asset Fund, which collapsed in 2016 and is now <a href="https://www.collascrill.com/news/updates/suspicious-minds/">under investigation</a> by the UK’s Serious Fraud Office.</p><p dir="ltr">Angie Brooks, a director of Pension Life, an advocacy group for pension holders, said that STM should have spotted the red flags in the pension debacle. “It was the most toxic mix imaginable. Everything that could go wrong did go wrong and it should have been prevented."</p><p dir="ltr">STM denies any wrongdoing and is not under investigation itself. Liquidators are attempting to salvage the funds but savers have potentially lost millions.&nbsp;</p><h2>Ukrainian politician</h2><p dir="ltr">It wasn’t just Gibraltar. In 2015, STM became the <a href="https://www.collascrill.com/news/updates/suspicious-minds/">first company in Jersey</a> to be prosecuted for money-laundering compliance failures.</p><p dir="ltr">STM was managing operations for Henley &amp; Partners, whose business includes helping rich foreign nationals acquire citizenship of tax havens in return for investment—and whose chairman reportedly has <a href="https://www.thetimes.co.uk/edition/news/cambridge-analytica-british-data-firm-offered-1m-bribe-to-turn-election-psmv359vh">ties to Cambridge Analytica</a>, the election advisor accused of misusing Facebook data and entrapping politicians to skew elections around the world.</p><p dir="ltr">In 2010, STM had used its Henley business to help a Ukrainian politician apply for a passport in St Kitts and Nevis. Viacheslav Suprunenko, son-in-law of the mayor of Kiev and brother of a senior figure in the Moscow-backed Party of Regions, was at the time wanted by Interpol for assault during armed robbery to recover documents in a business dispute. (No charges have been brought.)</p><p dir="ltr">When Suprunenko asked STM to route his payments through offshore vehicles apparently unconnected to him, the company was suspicious enough to refuse the transactions—but failed to report them to the authorities.</p><p dir="ltr">A Henley spokeswoman told SourceMaterial that the company ended its relationship with STM in 2012. “When it comes to politically-exposed figures, we start from the position that any such person automatically requires even greater diligence including a thorough and independent review of friends and family,” she said. “If any criminal activity is suspected, we will immediately decline the applicant.”</p><h2>Money-laundering risks</h2><p dir="ltr">It was just one of a string of incidents in which STM turned a blind eye to money-laundering risks.</p><p dir="ltr">In a period of less than 18 months, junior STM staff filed internal suspicious activity reports on 19 individuals or entities. Only three of these were acknowledged by STM’s compliance officer and none was passed to the island’s financial crimes unit.</p><p dir="ltr">While STM was eventually acquitted in the money-laundering prosecution, it received an<a href="https://www.jerseyfsc.org/media/1101/public-statement-stm-july-2015.pdf"> official order</a> from Jersey’s financial regulator to clean up its behaviour. Its money-laundering compliance officer was banned from holding a regulated position in Jersey.</p><p dir="ltr">In another offshore haven, Malta, the story was much the same.</p><p dir="ltr">Twice in the last two years STM has been fined and officially rebuked, while Kentish was temporarily banned from holding management jobs for failing to inform the regulator when he was forced by the Gibraltar regulator to resign his directorship of Banks’s Southern Rock. STM and Kentish are appealing the sanctions.</p><p dir="ltr">“STM and its officers ensure a strong culture of corporate governance and compliance with industry regulation,” the company’s spokesman said. “This extends across internal and external relationships ensuring that risks to the business are minimised and that products and services are delivered appropriately.”</p><h2>New questions</h2><p dir="ltr">&nbsp;STM also played a cameo in the Brexit movement. Better for the Country Ltd, one of two campaign vehicles that received Banks’ £8.4 million in donations, was <a href="https://s3-eu-west-1.amazonaws.com/document-api-images-prod/docs/J22VO6IwI5BUTD8yGb4wy-KF3yn5SY0450qcd8ARhds/application-pdf?AWSAccessKeyId=ASIAII5UKPTAP7NZOLMA&amp;Expires=1521823382&amp;Signature=JEtO16EHfsJhwujlFMJyHrnhBwM%3D&amp;x-amz-security-token=FQoDYXdzEC4aDFYkZALUJLFVOeYoQCK3A7GnteoYv61JtlQWmCGz%2B%2FEI96CZUpJ0iCpDCCPiz%2F3mpObhoL1ylarxFYeloiSOY%2Bn57bWrzMOSbDCrhn7%2FSo7r7U0SbieK9ivQEf8rmF0hATPk7mAIDw6KcfSJ%2FUR2mGSIF4gKgmhHkhcdEpzl9GocSbLLMMgUasyhOA7B7n6KHSLE4ZXKA4DmvrJ1BfWgiAQfoizNSCYzkaR9PsXO%2F0LLN3PLE9b3Hd0opLO%2BYTBAamY5XOclo0xRCvXtObi7f081%2FMu8WLG%2Bykb0grQdGz6BXlZZpCRYdQoLpjebt9i%2BlbzeMQk9GUps30IC3Xu3v26eYBTJcqdAyagLqjDJgMsBCL25r2GALbpkVL9h4O9d4oggqj5bNXFy%2FzMb%2FhpWaLXLwE%2F3EkHUEqQAa40RZ3Q8wdiP%2FlxIymJXbT4rerHb0qIJYvM83Vk0oE4gsIzYHuwykzPG5ydIRalhR%2Fmg5vuYOoWdUV72aiYnHQ76vs16mdR0IvufkYQNJ0o1yI28ACKRVs3HVM4kXGjr11ky%2B%2F0gW%2FZ4DkxhQkXwwEzFN0WJ7BrIDlHdK0ccE2c5KQry9Zr%2B044ZbPso6vTT1QU%3D">set up</a> by an STM Group company.</p><p dir="ltr">Banks’s links to Alan Kentish and the STM set whose speciality is using offshore havens to guard wealthy clients’ secrets raise new questions about his Brexit campaign.</p><p dir="ltr">The Electoral Commission has set out to trace the ultimate source of the millions Banks put into Leave.EU and Better for the Country, the company STM founded.</p><p dir="ltr">But with cash flowing through island tax havens whose stock in trade is stealth, the answer may prove elusive.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/uk/brexitinc/adam-ramsay/how-did-arron-banks-afford-brexit">How did Arron Banks afford Brexit?</a> </div> <div class="field-item even"> <a href="/uk/brexitinc/leigh-baldwin-marcus-leroux/not-everyone-agrees-with-arron-banks-about-value-of-his-dia">Not everyone agrees with Arron Banks about the value of his diamond mines</a> </div> </div> </div> </fieldset> <div class="field field-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-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 UK Brexit investigations Arron Banks DUP Dark Money Brexit Inc. Leigh Baldwin Marcus Leroux Thu, 12 Apr 2018 15:48:29 +0000 Marcus Leroux and Leigh Baldwin 117236 at https://www.opendemocracy.net Has Labour really turned its back on pro-market NHS ‘solutions’? https://www.opendemocracy.net/ournhs/stewart-player/has-labour-really-turned-its-back-on-pro-market-nhs-solutions <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>As the NHS turns 70, just which corporate actors are queuing up to drive ‘consensus’-based reform? And is Labour prepared to sufficiently distance themselves from such ideas?</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/ashworth corbyn.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/ashworth corbyn.jpg" alt="" title="" width="460" height="300" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Jeremy Corbyn, NHS worker Judith Clegg &amp; Shadow Health Secretary Jon Ashworth. Ben Birchall/PA Images. All rights reserved.</em></p><p>The current programme of NHS ‘reform’ currently underway has long been hailed as <a href="https://www.hsj.co.uk/technology-and-innovation/stps-offer-private-sector-enormous-opportunity/7006369.article">giving private firms “enormous opportunity”.</a></p> <p>So – as I suggested in January – <a href="https://opendemocracy.net/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Labour’s new commitment to halt these pro-market Sustainability and Transformation Partnerships (STPs)</a> was both welcome assurance to party members, and a break with a damaging 30 year cross-party ‘consensus’ on healthcare policy. </p> <p>Yet soon after I wrote this, Shadow Health Secretary Jonathan Ashworth joined key architects of the transnational agenda of the global health industry at a conference organised by the Institute of Public Policy Research (IPPR).</p> <p>The IPPR conference at the end of January was set up to preview a report on the NHS co-produced by the IPPR and the former Labour Health Minister Lord Darzi, who stepped down in 2009 and who in 2015 <a href="http://www.bbc.com/news/uk-politics-31052010">criticised Labour for its tentative moves away from a pro-privatisation agenda</a>.</p> <p>The event saw Ashworth sharing a platform with signatories to the above-mentioned consensus, including the Conservative peer Lord David Prior and Lib Dem MP Norman Lamb, plus economists from the Health Foundation and representatives of the health industry and leading consultancies. On the surface the event was largely about the technological drivers of change in healthcare, and how funding mechanisms can be applied to harness these. A closer look however indicates the real intent was to reinforce particular aims and relationships; ones that it would be inconsistent for Mr Ashworth to seem to endorse. </p> <h2>Ten Year Plans and long-term alliances</h2> <p>As I pointed out in January, Lord Darzi has become a key actor in the corporate agenda for health care, having been, for example, a member of both the Steering Groups on the World Economic Forum’s work on sustainable healthcare systems. </p> <p>It was also pointed out that Tom Kibasi, who was then working for McKinsey and is now chief executive of the IPPR, was the lead author of the reports that informed the WEF’s work, and subsequently presented its findings to the World Bank and OECD. Indeed Darzi’s and Kibasi’s recent collaboration may reasonably be seen as the latest expression of a long-term strategic partnership, with the forthcoming IPPR-Darzi report marking the tenth anniversary of Darzi’s comprehensive report on the NHS for the Brown government, called ‘High Quality Care for All’, for which Kibasi wrote the final draft. </p> <p>In that initial collaboration Kibasi was on secondment from McKinsey, serving as Senior Policy Advisor to the NHS Chief Executive, Sir David Nicholson. He also worked with Darzi on the latter’s 2008 report for London, which was supported by McKinsey’s leading European partners, Penny Dash and Nicolaus Henke, as well as by the chief executive for NHS London, Ruth Carnall. </p> <p>Among the Darzi report’s prescriptions for the capital were the development of a system of ‘polyclinics’, or integrated care centres, with a view to transferring 40% of acute sector activity to these clinics, as well as 70% of the primary care workforce. The BMA resisted, amidst concerns that the <a href="https://opendemocracy.net/ourkingdom/colin-leys/plot-against-nhs">centres would likely be owned and run by private healthcare corporations</a> adopting the NHS Lift – a kind of Private Finance Initiative for primary care – approach. The plans were eventually abandoned, partly due to the recession and change of government. The incoming Health Secretary, Andrew Lansley, also needed to keep GPs on board, given that he was presenting his creation of ‘clinical commissioning groups’ as supposedly ‘putting GPs in charge’. </p> <p>This pause in Darzi’s polyclinic agenda has served its purpose. GPs are now firmly on the back foot, with many willing to trade their premises and practice lists – the new currency within health economies - for a semblance of security as salaried employees of the ‘new care models’ that the ‘consensus’ advocates. </p> <p>Similarly, the government has recently announced that NHS Lift scheme will be rolled out to new areas of the country through Project Phoenix. It appears they are attempting to complete the vision of both government and investors for a privately owned, primary care estate.&nbsp; </p> <h2>New ‘partners’ – and old ones</h2> <p>The McKinsey/Darzi/Department of Health project of 2008 was intended to be a ten-year strategy for transforming the NHS, and while some of the details may have been tweaked in the interim, its fundamentally market-oriented goals remain, and campaigners fear they will reappear in the forthcoming IPPR-Darzi report. Such fears are grounded both in the continuity of the participants involved in helping to produce the report, and also in terms of its associated sponsors and partners. </p> <p>These include the US pharma corporations Baxter and MSD as ‘strategic partners’. The report’s ‘founding partners’ include another US pharma company, Gilead, the European manufacturing giant, Siemens, and Carnall Farrar Associates. The latter is a consultancy firm set up by former McKinsey alumni together with the afore-mentioned Ruth Carnall. </p> <p>Similarly, the IPPR’s recent report on STPs, entitled ‘Sustainability and Transformation Plans: What, Why and Where Next’, included the pharmaceutical giant, GSK, as a sponsor. This report fully endorsed the STP model, concluding that the STPs have “correctly identified the most pressing reform solutions, including reconfiguration of the acute sector, movement of care into the community, and delivery of an upswing in prevention, with reform to commissioning, workforce, estates and local innovation infrastructure, all considered key enablers”. The sole caveats were a lack of both leadership and funding with which to fulfil such aims. </p> <p>Since his participation at the IPPR conference, Ashworth has spoken strongly about Labour’s unwillingness to participate in a cross party consensus on the NHS, arguing instead that what’s needed to rescue the health service is “a government with the political will” to end the punishing funding squeeze; whereas at the Labour Party conference last year he took the IPPR line on STPs, arguing only that they need to be properly funded so they can meet the changing demands on NHS services. It’s to be hoped that the unambiguous rejection of the market-oriented consensus in his recent speeches represents a firm crystallisation of his final policy position.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/stewart-player/taking-politics-out-of-nhs-or-constructing-elitist-consensus">Taking politics out of the NHS? Or constructing an elitist ‘consensus’?</a> </div> <div class="field-item even"> <a href="/ournhs/tamasin-cave/privatising-cabal-at-heart-of-our-nhs">The privatising cabal at the heart of our NHS</a> </div> <div class="field-item odd"> <a href="/ourkingdom/colin-leys/plot-against-nhs">The Plot Against the NHS</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Stewart Player Wed, 11 Apr 2018 13:26:19 +0000 Stewart Player 117178 at https://www.opendemocracy.net Why NHS staff should #DitchTheDeal & reject the government pay offer https://www.opendemocracy.net/ournhs/mark-boothroyd/why-nhs-staff-should-ditchthedeal-reject-government-pay-offer <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p class="Default">Nurses and other NHS workers need to fight for a better pay deal to protect the NHS, with the same dedication they use to keep the NHS working every day of the week.</p> </div> </div> </div> <p class="Default"><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/fair nhs pay now.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/fair nhs pay now.jpg" alt="" title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: <a href="https://www.flickr.com/photos/forayinto35mm/15805828755">Chris Marchant/Flickr</a>.</em></p><p class="Default">The government is offering NHS staff a 6.5% pay rise, after almost a decade of pay freezes and 1% pay rises. With an NHS in almost permanent crisis and near collapse, this appears like a good thing, but when compared with the reality of the present state of the NHS, it’s a poisoned chalice that union members should reject.</p> <h2>Is the pay rise really 6.5%?</h2> <p class="Default">The pay rise is nowhere near as good as the media is making it out to be.&nbsp;</p> <p class="Default">It’s a three year pay deal, with the 6.5% being spread over three years; 3% first year, 1.7% second year and 1.67% the third year. </p> <p class="Default">This is still a below inflation pay rise. The Office for Budget Responsibility <a href="http://obr.uk/forecasts-in-depth/the-economy-forecast/inflation/">projects inflation to be 8.8-9.6%</a> over the next three years. So NHS staff are still receiving a real term pay cut over the period, just slightly less than the previous 8 years.</p> <p class="Default">There is also 1.1% unconsolidated rise in the second year, unconsolidated meaning it is not permanently counted in the pay structure, but just given as a one-off lump sum at the start of that year.</p> <p class="Default">The government has offered a few changes to the pay band structure which will lead to immediate rises for the minority of staff currently at the bottom of their pay band, but no benefit to more experienced NHS workers who are further up the pay bands. The government offer also changes the way staff move up a pay band, meaning progression will be in fits and starts, rather than annual.</p> <p class="Default">And there’s another big catch - in future, advancement will be performance related, based on yearly appraisals. </p> <p class="Default">Performance related pay has been shown to be bad for black and ethnic minority staff, and disabled staff, as it creates another area in which they can suffer discrimination. It could be used to penalise outspoken union activists. It may also trap staff in their jobs as they won’t be able to move post during the 2-5-year gap between pay steps for fear of losing out.</p> <p class="Default">At least the ‘living wage’ is being brought in to the NHS. This is partly out of necessity; NHS pay had been frozen for so long that the yearly increase in the national minimum wage has almost overtaken band 1 and 2 pay bands. To avoid the embarrassment of being forced to raise NHS pay by the legal minimum wage, the government has decided to give their pay a much-needed boost.</p> <h2>What do the government want in return?&nbsp;</h2> <p class="Default">The government clearly feels that – as they are not faced with active strike action to force them into a proper offer – they can demand our workplace benefits and pay in return.&nbsp;</p> <p class="Default">The original pay deal wanted to claw back one day’s annual leave from all staff, according to leaks. The outcry from NHS staff, the public and the Labour Party saw this withdrawn.</p> <p class="Default">However the government are still asking for givebacks in return for our meagre rise.</p> <p class="Default">They want bands 1-3 to progressively give up their unsocial hours rates over the three years of the deal. So lower paid staff will get an initial pay boost, but in the long run they will lose out on reduced unsocial hours payments.&nbsp;</p> <p class="Default">The plans also include changes to sick pay, so anyone earning over £18,160 (in other words, all but the very lowest paid NHS employees) does not receive their usual unsocial hour rate when off sick, only their base rate of pay. </p> <h2>Why a pay rise now?</h2> <p class="Default">It’s important to look at the context in which this pay rise is being offered. NHS staff have endured 8 years of pay freeze or 1% pay rises. We only secured the commitment to a 1% rise after <a href="http://www.bbc.com/news/health-29560083">going on strike in 2014</a>.</p> <p class="Default">This pay freeze has caused a 10-14% loss in the real value of our pay over this period, and combined with increasing pressures due to austerity, has caused a recruitment crisis which is pushing the NHS to the point of collapse.&nbsp;</p> <p class="Default">The health service has over <a href="https://www.independent.co.uk/news/health/nhs-posts-staffing-recruitment-official-figures-healthcare-hospitals-a8221961.html">100,000 vacant posts</a>, of which <a href="https://fullfact.org/health/are-we-short-40000-nurses/">40,000 are nurses</a>, <a href="http://www.bbc.com/news/health-43143325">10,000 are doctors</a> and 10,000 are HCAs. The pay freeze and staffing crisis are driving thousands of nurses to flee the unsafe and unhealthy working conditions in the NHS, with more nurses <a href="https://www.nmc.org.uk/news/news-and-updates/increasing-number-nurses-midwives-leaving-profession-major-challenges/">leaving the NMC register</a> than joining for the last two years. Combined with the fact that <a href="https://www.kcl.ac.uk/nursing/research/nnru/policy/Policy-Plus-Issues-by-Theme/Labourmarketdynamics/PolicyIssue2.pdf">100,000 nurses</a> - almost a third of the NHS nursing workforce - are within 10 years of retirement, and the impact of Brexit and visa restrictions driving nurses away, this creates an existential crisis for nursing and the NHS.</p> <p class="Default">In response to this crisis in nursing, the RCN was pushed by its members to campaign on pay. They launched the “Scrap the Cap” campaign and began to hold protests and marches around the country. The campaign culminated in the RCN’s first ever indicative ballot for strike action in <a href="https://nursingnotes.co.uk/rcn-announces-vote-industrial-action-pay/">April 2017</a>. While turnout was poor, the <a href="https://www.theguardian.com/society/2017/may/14/nurses-vote-support-ballot-for-strike-action-low-pay">vote in favour of action was 78%</a>, clearly demonstrating nurses anger and willingness to fight.</p> <p class="Default">Theresa May responded by <a href="https://www.ft.com/content/c1b7187a-97b4-11e7-a652-cde3f882dd7b">declaring the pay cap over</a> in September 2017. At this point, all the NHS unions decided to bypass the Pay Review Body, and instead use the traditional union method of submitting a pay claim to the government. This unity strengthened their hand and allowed them to set out terms for the pay deal they wanted, rather than relying on the deliberations of the Pay Review Body. All <a href="http://www.unitetheunion.org/news/all-nhs-staff-need-a-pay-rise/">14 unions submitted a joint pay claim</a> for inflation (at the Retail Price Index, RPI) plus £800, which started a series of negotiations over pay, which have now concluded with the deal which is on offer.</p> <h2>Is the deal worth it?</h2> <p class="Default">The deal is meagre compared both to what we have lost. The boosts for the lowest paid and people at the bottom of their bands are welcome, but the pay rise does not address the serious staffing crisis facing the NHS, and particularly nursing.</p> <p class="Default">While the RCN trumpets 29% pay rises for some staff, most NHS staff (52%) are at the top of their pay band. For them, there is only 6.5%. Overwhelmingly these staff are also those who are within 10 years of retirement. This deal offers them little reason to stay in post and help stave off the looming staffing crisis.</p> <p class="Default">The figure of a 29% pay rise for some is misleading as it counts incremental rises in with the pay offer and the boost for those at the bottom of their pay band. Unions have always rejected the argument that increments are a pay rise; they are meant to reflect skills and experience developed through time in service. Yet the union pay calculator is <a href="https://www.huffingtonpost.co.uk/entry/nhs-pay-data-headlines_uk_5ab381d2e4b004fe24699846">deliberately misleading staff</a>, representing incremental rises as part of the pay deal to increase its appeal.</p> <h2>What is the alternative?</h2> <p class="Default">While this deal was presented as the best we can achieve without strike action, all that it took to achieve this deal was one indicative ballot for strike action by the RCN, and a joint pay claim by all the unions. No other union has balloted for action yet. Imagine how much more we could win from the government if we threatened them with joint strike action between all NHS unions.</p> <p class="Default">As a member of Unite’s National Industrial Sector Committee for Health, I was privy to details of the pay deal as it was being negotiated. We were told that the government “red lines” were asking for one or two days of annual leave, and bands 1-3 moving to the unsocial hour rates for bands 4-8, in return for any pay rise. Yet the government backed down from these “red lines”, after little more than a social media outcry.</p> <p class="Default">This is a government without an overall majority, unpopular for their treatment of the NHS, and the damage that eight years of austerity have done to society, and facing quite possible collapse due to the failing Brexit negotiations. </p> <p class="Default">In this precarious position the government cannot afford for an industrial dispute to develop in the NHS. A big fight with NHS staff might even bring them down.</p> <p class="Default">They desperately want to lock us in to a three year pay deal right before Brexit, so when Brexit occurs and causes inflation to skyrocket even further, we will be stuck receiving 1.7% pay rises for two years.</p> <p class="Default">For all these reasons, I urge all union members to reject the deal. We deserve and need more after eight years without a pay rise. The NHS desperately needs well paid and highly motivated staff to rescue it from its current crisis. And we can’t waste this chance to win the pay and funding the NHS and its staff need to survive in to the future.</p> <p class="Default">All the major NHS unions <a href="http://www.gmb.org.uk/newsroom/reject-nhs-pay-deal">except for the GMB</a> are recommending this deal to members. This is the wrong stance to take. All the unions ought to have the best interests of the NHS at heart, yet they are recommending a deal which doesn't meet the needs of staff or the service.</p> <p class="Default">This is much bigger issue than securing a little extra money in our members pockets. It’s about securing a future for the NHS. Agreeing to this deal will not alleviate our struggles to pay our bills, it won’t solve the NHS staffing crisis, and could even accelerate it as overworked, underpaid staff leave rather than stay working for a government and health service which doesn’t value them.</p> <p class="Default">The government is threatening that if we don’t agree, they will take the money for funding the pay rise off the table and force us to accept a 1% deal through the Pay Review Body. This is a disgraceful threat and an attempt to blackmail NHS staff. We should call their bluff and campaign to reject the deal. </p> <p class="Default">We can reject the deal, then push for coordinated strike ballots across all NHS unions. Joint coordinated strike action is the biggest threat to the government. Coordinated ballots would maximise turn out and help all unions get past the 50% minimum turnout required for legal strike action.</p> <p class="Default">Strike action is doable. The <a href="https://www.ft.com/content/7e391688-b4c5-11e7-a398-73d59db9e399">university lecturers union won a ballot for strike action</a> over pensions just a couple of months before, and <a href="https://www.theguardian.com/business/2017/oct/03/royal-mail-workers-vote-for-industrial-action">so did postal workers</a>. We can too, we just need to organise ourselves and fight for it with the same dedication we use to keep the NHS working every day of the week. The first step in this is campaigning to reject the deal.</p> <p class="Default"><em>Follow the “</em><em><a href="https://www.facebook.com/ditchthedeal/">Ditch the Deal</a></em><em>” Facebook page for updates and information on the campaign to reject the deal.</em><em></em></p> <p class="Default"><em>Full technical details of the pay agreement can be </em><em><a href="https://static1.squarespace.com/static/5a857514bff200aa36889e06/t/5ab23db803ce64be4f073046/1521630651875/NHS+Staff+Council+Framework+agreement+21+March+2018.pdf">accessed here</a></em><em>.</em><em></em></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/mark-boothroyd/day-in-life-of-nhs-nurse-why-government-must-act-to-reduce-workloads">A day in the life of an NHS nurse - how our government is failing both patients and nurses</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Mark Boothroyd Wed, 28 Mar 2018 07:52:26 +0000 Mark Boothroyd 116915 at https://www.opendemocracy.net 'We’ve done you proud' — Families speak after NHS Trust fined £2million over patient deaths https://www.opendemocracy.net/shinealight/sara-ryan/connor-sparrowhawk-southern-health-fined-2m <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p> <!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG ></o> </o:OfficeDocumentSettings> </xml><![endif]--> <!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves ></w> <w:TrackFormatting ></w> <w:PunctuationKerning ></w> <w:ValidateAgainstSchemas ></w> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> 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</w:LatentStyles> </xml><![endif]--> <!--[if gte mso 10]> <mce:style><! /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-ansi-language:EN-US;} --> <!--[endif] --> <!--StartFragment--> <!--EndFragment--></p><p class="MsoNormal"><span style="font-size: 10.0pt; font-family: Helvetica; mso-fareast-font-family: &amp;amp;amp; mso-bidi-font-family: &amp;amp;amp; color: #333333; background: white; mso-ansi-language: EN-GB;">Today Southern Health was fined £2m over the “entirely preventable” deaths of 18-year-old Connor Sparrowhawk and Teresa Colvin, aged&nbsp;</span><span style="font-family: Helvetica; font-size: 13.333333015441895px;">45</span><span style="font-family: Helvetica; font-size: 10pt;">.</span></p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/SARA_RYAN_26MARCH2.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/SARA_RYAN_26MARCH2.jpg" alt="" title="" width="460" height="299" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Sara Ryan speaking in Oxford on 26 March 2018, after Southern Health was fined £2million (image #JusticeforLB)</span></span></span></p> <h2><strong>Clare Sambrook writes:</strong> </h2><p>Today at Oxford Crown Court, Southern Health NHS Foundation Trust was fined £2m for allowing the “entirely preventable” deaths of 18-year-old Connor Sparrowhawk and Teresa Colvin, who was 45.&nbsp;<span>Passing sentence,&nbsp;</span><a href="https://www.judiciary.gov.uk/wp-content/uploads/2018/03/r-v-southern-nhs-sentencing.pdf">Mr Justice Stuart-Smith </a>spoke of their families’&nbsp;“<span>deep, catastrophic and unspeakable pain, sadness and loss</span><span>”.&nbsp;</span></p> <p>Teresa Colvin’s husband Roger,&nbsp;<a href="http://www.bbc.co.uk/news/uk-england-43542284">speaking outside court today</a>,&nbsp;said Teresa, who was affectionately known as TJ, had been “a vivacious, beautiful, and loving woman” who was dearly loved. In a statement he read to the court Roger Colvin spoke of life’s “what-ifs” and how every day something would trigger a memory, accentuating his terrible loss.&nbsp;TJ’s sister Wendy Andrade spoke of anger and hurt that was still very raw for the family and the massive void that&nbsp;TJ’s&nbsp;death had&nbsp;left.&nbsp;</p> <p>Teresa Colvin was found hanged by a phone cord at Woodhaven Adult Mental Health Hospital, Southampton on 22 April 2012.&nbsp;She died four days later.</p> <p>The court heard that Southern Health had failed to act upon warnings about ligature risks from health and safety expert Mike Holder. He&nbsp;<a href="http://www.dailymail.co.uk/news/article-3783528/Shamed-NHS-boss-Health-chief-told-FIVE-YEARS-ago-patients-risk-failed-follow-advice-240k-job.html">resigned in protest at the Trust’s inaction</a> eight weeks before Teresa Colvin’s death.</p> <p>Between 2007 and 2011 more than 1,700 “ligature incidents” had occurred across the Trust. The very phone cord that TJ would later use had been identified as a risk to patients. The cost of eliminating the risk would have been £53. Nothing was done about it.</p><p>&nbsp;</p> <p>Connor Sparrowhawk,&nbsp;<span>a funny, quirky and beloved young man,</span><span>&nbsp;was just 18 when he died on 4 July 2013 whilst a patient at Slade House, a Short Term Treatment and Assessment Centre at Headington in Oxford.</span></p><p><span>Connor had autism, learning difficulties and epilepsy, but it was the Trust’s neglect that caused his death.</span></p> <p>His mother, Sara Ryan, had warned staff —&nbsp;in writing — that Connor had an injury to his tongue that suggested a recent seizure. Yet he was allowed to bathe unsupervised and behind a locked door, and he drowned in the bath.</p><p>&nbsp;</p> <p><a href="https://www.judiciary.gov.uk/wp-content/uploads/2018/03/r-v-southern-nhs-sentencing.pdf">Mr Justice Stuart-Smith said</a>&nbsp;each death was an “unnecessary human tragedy”, and it was a “regrettable fact” that Sara Ryan and Roger Colvin had had to campaign for justice.&nbsp;</p><p>Connor’s family and friends campaigned under the banner #JusticeforLB — his nickname was Laughing Boy because he laughed so much. Their work provoked the exposure of the Trust’s failure to investigate hundreds of unexpected deaths.&nbsp;</p><p> <span class='wysiwyg_imageupload image imgupl_floating_left caption-medium'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/DZNZPVJX4AAVflC.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Connor Sparrowhawk (#JusticeforLB)"><img src="//cdn.opendemocracy.net/files/imagecache/article_medium/wysiwyg_imageupload/536680/DZNZPVJX4AAVflC.jpg" alt="" title="Connor Sparrowhawk (#JusticeforLB)" width="240" height="353" class="imagecache wysiwyg_imageupload caption-medium imagecache imagecache-article_medium" style="" /></a> <span class='image_meta'><span class='image_title'>Connor Sparrowhawk (#JusticeforLB)</span></span></span></p><p><span>While failing to watch over Connor,&nbsp;Southern Health had spent months monitoring his mother’s blog. The morning after his death executives <a href="https://opendemocracy.net/shinealight/clare-sambrook/on-connor-sparrowhawk-s-avoidable-death">turned their attention to reputation management</a>. Through years of lies and obfuscation Southern Health attacked bereaved families and&nbsp;</span><a href="https://mydaftlife.com/2015/04/02/farcical-inaccuracies-2/">persistently tried to shift blame</a><span>&nbsp;for Connor’s death from itself to Sara Ryan. One Trust employee left a message on her voicemail calling her “a vindictive cow”.&nbsp;</span></p> <p>The judge&nbsp;paid tribute to Sara Ryan today: “It is clear on the evidence that Dr Ryan in particular faced not merely resistance but entirely unjustified criticism as she pursued her Justice for LB campaign.”</p> <p>He noted Southern Health’s admission:&nbsp;</p> <p>“The Trust fully acknowledges that Dr Sara Ryan has conducted herself and the Justice for LB campaign in a dignified, fair and reasonable way. To the extent that there have been comments to the contrary by Trust staff and family members of staff, these do not represent the view of the Trust and are expressly disavowed.”</p><p>The judge said that victim impact statements from Sara Ryan and from Connor’s step-father Richard Huggins “make for almost unbearable reading”. </p><p>He said: “Dr Ryan describes how the light went out of her life on 4 July 2013. And in dignified and restrained terms she lays bare how the assertion by the Trust in the early days that Connor had died of natural causes compounded her grief. As did Mr Colvin when referring to the loss of TJ, Dr Huggins refers to their grief being raw. Their lives have become dominated by a deep, catastrophic and unspeakable pain, sadness and loss.”</p><p>&nbsp;</p> <p>Over years we have published&nbsp;<a href="https://opendemocracy.net/shinealight/sara-ryan/ministry-of-justice-says-you-don-t-need-lawyer-at-inquest-trust-state">work by Sara Ryan</a>, by&nbsp;<a href="https://opendemocracy.net/shinealight/tom-ryan/since-my-brother-s-preventable-death">Connor’s brother Tom</a>, and&nbsp;<a href="https://opendemocracy.net/shinealight/clare-sambrook/on-connor-sparrowhawk-s-avoidable-death">disclosure stories</a>&nbsp;about Southern Health’s failure to take action to remedy known problems.</p> <p>Today we pay tribute to bereaved families who fight for truth and accountability, who work to make public services safer for everyone. We thank&nbsp;<a href="https://opendemocracy.net/@GeorgeJulian">George Julian</a>, whose reporting of inquests and tribunals through live-tweeting has shone a light on Connor’s and&nbsp;<a href="http://www.georgejulian.co.uk/2018/03/24/live-tweeting-inquests-and-tribunals-10-top-tips-of-learning-so-far-justiceforlb/">other state-related deaths</a>. </p><p>Mr Justice Stuart-Smith<span>’</span>s judgement can be found <a href="https://www.judiciary.gov.uk/wp-content/uploads/2018/03/r-v-southern-nhs-sentencing.pdf">here</a>. Connor’s family’s statement in response to today’s sentencing follows below.</p><p>&nbsp;</p><p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/buses_line_2bigger5_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/buses_line_2bigger5_0.jpg" alt="" title="" width="460" height="65" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><h2>Family statement on the Health &amp; Safety Executive (HSE) prosecution of Southern Health #JusticeforLB</h2><h2>Sara Ryan writes:</h2><p>Five years ago this month we took our beautiful boy to what we thought was a specialist NHS unit. He drowned in the bath 107 days later.</p><p>No one should die a preventable death in the care of the state. Learning disabled people should not die on average twenty years before their non-disabled peers. Families should not have to fight for answers and accountability. They should not have to raise funds for legal representation at a time of unspeakable grief and pain.</p><p>Southern Health dug deep into publicly funded pockets and armed itself with a range of legal weaponry and dirty tricks.</p><p>The #JusticeforLB campaign has shone a light on systemic failings in the care of learning disabled people. We have collectively and effectively revealed weaknesses in regulatory practices, a disregard for the lives and deaths of certain people and the limitations of work by large established charities in this area.</p><p>We appreciate Dr Nick Broughton’s recognition and acknowledgement of the failings that spread across five years under Katrina Percy’s leadership, and his heartfelt apology for these. [Broughton has been Southern Health chief executive since November 2017].</p><p>We thank the HSE for their meticulous and sensitive investigation and everyone who has stood alongside us fighting for what is right and just.</p><p>I’m left thinking if Connor was here now, in the shadow of Oxford Crown Court and the St Aldates police station, he would repeatedly ask ‘<em>why mum?</em>‘</p><p>I’d reply ‘<em>I don’t know matey but we’ve done you proud</em>’.</p><p><span class='wysiwyg_imageupload image imgupl_floating_none caption-xlarge'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/536680/connor_bus2_0.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title="Bus, by Connor Sparrowhawk"><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/536680/connor_bus2_0.jpg" alt="" title="Bus, by Connor Sparrowhawk" width="460" height="316" class="imagecache wysiwyg_imageupload caption-xlarge imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'><span class='image_title'>Bus, by Connor Sparrowhawk (#JusticeforLB)</span></span></span></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/shinealight/shinealight/sara-ryan-clare-sambrook/connor-sparrowhawk-justiceforLB">Connor Sparrowhawk: How one boy’s death in NHS care inspired a movement for justice</a> </div> <div class="field-item even"> <a href="/shinealight/tom-ryan/since-my-brother-s-preventable-death">Since my brother’s preventable death . . .</a> </div> <div class="field-item odd"> <a href="/shinealight/clare-sambrook/190k-payoff-for-ex-chief-of-nhs-trust-that-failed-to-investig">£190K payoff for ex-chief of NHS Trust that failed to investigate hundreds of unexpected deaths</a> </div> <div class="field-item even"> <a href="/shinealight/imogen-tyler/connor-sparrowhawk-erosion-of-accountability-in-nhs">Connor Sparrowhawk: the erosion of accountability in the NHS</a> </div> <div class="field-item odd"> <a href="/shinealight/clare-sambrook/on-connor-sparrowhawk-s-avoidable-death">On Connor Sparrowhawk’s avoidable death</a> </div> <div class="field-item even"> <a href="/shinealight/sara-ryan/ministry-of-justice-says-you-don-t-need-lawyer-at-inquest-trust-state">Ministry of Justice says you don’t need a lawyer at an Inquest. Trust the State</a> </div> <div class="field-item odd"> <a href="/shinealight/ally-rogers/we-apologise-to-anybody-who-feels-let-down">‘We apologise to anybody who feels let down’</a> </div> <div class="field-item even"> <a href="/shinealight/frances-webber/uk-government-s-inversion-of-accountability">The UK government’s inversion of accountability</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> Shinealight ShineALight ourNHS Access to justice Clare Sambrook Sara Ryan Mon, 26 Mar 2018 16:30:34 +0000 Sara Ryan and Clare Sambrook 116882 at https://www.opendemocracy.net Time to halt the NHS gravy train for management consultants https://www.opendemocracy.net/ournhs/jonathan-allsop/time-to-halt-nhs-gravy-train-for-management-consultants <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>New evidence has emerged that management consultants make NHS hospitals <em>less</em>, not more, efficient. Which will be little surprise to the NHS staff who have to deal with them.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/big_4.jpeg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/big_4.jpeg" alt="" title="" width="450" height="299" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span></p><p>The recent collapse of Carillion not only threw a long overdue spotlight on the billions leached from the NHS and other public services by the Private Finance Initiative but also severely dented the notion that “private knows best” when it comes to running public services. The public sector’s use of management consultants has grown exponentially since the early 1990s to the extent that the use of consultants by the public sector now accounts for over a fifth of the total turnover of management consultancy firms. For as long as I’ve worked in the NHS (I joined as a trainee accountant in 1990) a view has persisted that, whether we’re caring for patients or supporting those who do, no matter how hard we work or how good at our jobs we are we’ll never quite be as efficient as our private sector counterparts; forever the lower league journeymen to their Premier League superstars.</p> <p>I’ve lost count, down the years, of how many times I’ve seen management consultants (more often than not from one of the Big Four accountancy firms) brought in, at considerable expense, to do jobs that people in the NHS with vastly more experience in the relevant area could have done much better for a fraction of the cost. The sums involved, when viewed in isolation, often aren’t headline grabbing but collectively they add up to a substantial flow of money out of the health service and into the coffers of huge multinational corporations. How much exactly? Well, precise figures on how much the NHS as a whole spends on management consultants are difficult to come by but <a href="https://www.theguardian.com/society/2014/dec/09/nhs-management-consultants-bill-doubles-640m">in December 2014 the British Medical Journal reported that NHS spending on management consultants had risen to £640 million per year</a> (compared to £313 million in 2010) as they cashed in on the chaos created by the implementation of the Health and Social Care Act with some consultants charging a whopping £4,000 per day for their services.</p> <p>To illustrate the impact of the health service’s often unnecessary use of management consultants here’s a recent example from my own experience working in an NHS finance department. It comes nowhere close to the scandal of PFI but it’s typical nonetheless of how the NHS has become reliant on the private sector to do work that could quite easily be done in-house. I’ve chosen this particular example as it’s the most recent but, to be honest, there are dozens of others that I could have drawn from - ranging from project managers on eye watering sums per day brought in to lead the implementation of new systems or inject commercial rigour into dull old NHS accounting practices, to poacher-turned-gamekeeper consultants drafted in to advise on the impact of government policy that they’ve already had a hand in writing. (The current work on <a href="https://opendemocracy.net/ournhs/sarah-carpenter/management-consultants-scoop-up-on-secretive-shake-up-of-health-service-in-en">Sustainability and Transformation Plans</a> (STPs) is the latest in a long list of examples of the latter).</p> <p>NHS Improvement, the body responsible for overseeing the financial performance of NHS trusts, is currently driving a move towards trusts identifying the costs of individual patients, rather than averages, under its ‘costing transformation programme’ which is a major focus for me in my role as the costing lead at a mental health trust.&nbsp;One strand of this programme involves independently assessing the accuracy of the costing information that trusts produce. In 2016 <a href="https://improvement.nhs.uk/resources/costing-assurance-programme/">NHS Improvement awarded a three-year contract to perform this work to EY</a> (in previous years the work had been undertaken by PwC and Capita). You might know EY better as Ernst and Young, one of the Big Four multinational accountancy firms who were rebranded in 2013 and are headquartered in smart offices close to Tower Bridge in London. In October of last year <a href="https://www.ft.com/content/540bdc0e-b238-11e7-a398-73d59db9e399">EY were fined £1.8 million</a> by the UK’s financial watchdog the Financial Reporting Council, for “failures to obtain reasonable assurance” about whether the financial statements of global technology company Tech Data “were free from material misstatement”. Not particularly reassuring for the NHS but, hey, away from the beady eyes of the FRC a handy NHS contract like this is money for old rope for the likes of EY. Firms can typically walk away from NHS contracts such as this without any repercussions no matter how shoddy the work.</p> <p>The contract involves auditing the costing information produced by around one-third of NHS trusts each year over the three-year period. In December 2015 NHS Improvement invited tenders to undertake this work and stipulated a maximum price of £3.9 million, but details are sketchy on the actual price agreed with EY. NHS Improvement’s board papers from around the time are rather coy, indicating only that six companies were invited to tender and that EY had won the contract. Later on the&nbsp;<a href="https://improvement.nhs.uk/events/nhs-improvement-board-meeting-28july/"><strong>board papers from its meeting in July 2016</strong></a>&nbsp;referred to a saving of 36% on the contract value after the initial costs and activities within the scope of the audit were challenged. Which represents quite a saving - looking back at footage of the meeting (the public part of NHS Improvement’s board meetings is filmed and available to view on their website) there is more than a little surprise amongst board members as this substantial saving is noted.</p> <p>Such cost cutting is often a false economy though. It usually means cheaper, less experienced members of staff being employed on the contract and this was evidently the case when EY visited our trust in February last year. Very early on in the audit it became apparent that, beyond the basics, the auditor’s knowledge of NHS costing processes and mental health services was scant. In the end, the auditor spent a mere two and a half days on site and this was followed up with a handful of telephone conversations and email queries which barely skimmed the surface of the figures being audited.</p> <p>A first draft of the audit report, when it eventually turned up, after much chasing, over four months later was strewn with errors including reference to “urology IAPT services” which given that IAPT refers to improving access to psychological therapies makes the mind boggle. The errors were eventually corrected, and a second draft was sent out a month later, in the middle of July, requesting our formal management responses to each of their audit recommendations within two working days. That this tends to be the busiest time of the year for anyone involved in NHS costing (the deadline for submitting the annual reference costs return is usually towards the end of July) was seemingly completely lost on EY. The report itself, once published, was lacking in any real insight, full of half-baked recommendations and with the overall feel of a piece of work that had failed to get to grips with the topic that it was meant to be reporting on.</p> <p>It’s staggering that at a time when the health service is enduring the longest squeeze on its finances in its seventy-year history that it can afford to spend a few million pounds on poorly executed work such as this.&nbsp;In the absence of knowing the actual cost of the contract let’s assume, not unreasonably, that EY’s original tender value was close to the maximum price of £3.9 million. In that case a 36% saving would suggest a contract value of around £2.4 million. Now, in the context of an overall budget for the NHS of more than £120 billion that may sound like small beer and indeed when you spread it, rather crudely, across all the trusts that will be audited during the contract period the cost works out at around £10,000 per organisation. Not too bad, you might think, but it’s a frankly ridiculous sum for barely a week’s work and a report that told us nothing about our costing process that we didn’t already know.</p> <p>We have been told repeatedly down the years that the expense of management consultancy is more than off-set by the beneficial effects it has on the efficiency of public sector organisations. However a recent study by a group of academics at Bristol, Seville and Warwick universities on the&nbsp;impact of the use of management consultants on public sector efficiency, perhaps the first of its kind to measure the quantitative impact of using consultants, <a href="http://www.bmj.com/content/360/bmj.k893">concluded that far from boosting efficiency the use of management consultancy actually decreases it</a>. And this didn’t even take account of the, often ignored, demoralising impact on NHS staff of continually seeing management consultants brought in to perform tasks that they could and already are paid to do. One of the authors of the report, Ian Kirkpatrick from Warwick Business School felt that in the current financial climate the NHS must consider “whether it is appropriate to continue using external consulting advice at the current level”.</p> <p>It’s disheartening to say the least to see others brought in, time after time, to work on “exciting” projects and produce work of questionable benefit whilst we get on with our day jobs and are invariably left to pick up the pieces when external consultants depart. Much of this work could be brought in-house and would offer talented, experienced and dedicated NHS staff the chance to look beyond their day jobs to improve the quality of care that patients receive at a fraction of the cost of using the private sector. We might not be as good at spouting the fancy management-speak and preparing the snazzy PowerPoint slides but at least give us a chance. EY’s work on the costing assurance programme could, and should, have been performed by costing leads at other trusts – a form of peer review that would subject the costing processes of each trust to proper scrutiny and offer valuable insights into how those processes might be improved. All this for a mere fraction of the cost of involving the private sector.</p> <p>So it’s refreshing to read the Shadow Chancellor John McDonnell refer to Carillion as a “watershed moment” and promise that a future Labour government would end the “private knows best” rip-off. For too long huge multinational corporations like EY, McKinsey, PwC, KPMG and Capita have been riding this NHS gravy train. Only last week it emerged that&nbsp;<a href="http://www.independent.co.uk/news/health/nhs-spending-kpmg-watchdog-management-consultants-mckinsey-a8253766.html"><strong>NHS Improvement has awarded a £500k contract to McKinsey</strong></a>&nbsp;to apparently help it define its “purpose”. This comes less than two years after a similar deal, worth £1 million, was struck with yet another management consultancy firm KPMG on defining NHS Improvement’s role. Enough is enough, it’s time to bring this nonsense to a halt and&nbsp;let NHS employees get on with what we are paid to do.</p><p><em>This piece is cross-posted from <a href="https://nowtmuchtosay.wordpress.com/2018/03/18/ey-oh-why-oh-why/">Nowt Much to Say</a>&nbsp;with kind permission.</em></p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/ournhs/sarah-carpenter/management-consultants-scoop-up-on-secretive-shake-up-of-health-service-in-en">Management consultants scoop up on the secretive shake-up of the health service in England</a> </div> <div class="field-item even"> <a href="/can-europe-make-it/sol-trumbo-vila/bail-out-industry-finds-its-new-crisis-opportunity-brexit">The bail out industry finds its new crisis opportunity: Brexit</a> </div> <div class="field-item odd"> <a href="/ournhs/caroline-molloy/peterborough-hospital-nhs-and-britains-privatisation-racket">Peterborough Hospital, the NHS and Britain&#039;s privatisation racket</a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Jonathan Allsopp Tue, 20 Mar 2018 14:16:42 +0000 Jonathan Allsopp 116771 at https://www.opendemocracy.net Are cash-strapped hospitals walking into a trap that could cost the NHS its family silver? https://www.opendemocracy.net/ournhs/caroline-molloy/are-cash-strapped-hospitals-walking-into-trap-that-could-cost-nhs-its-family- <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Hospitals from Yorkshire to Yeovil are rushing to set up secretive private companies in which to transfer NHS staff and assets. OurNHS looks in depth at the possible impacts – and whether it’s likely to go horribly wrong.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/PA-30392062.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/PA-30392062.jpg" alt="lead " title="" width="460" height="307" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: NHS demonstration. PA Images/Victoria Jones.</em></p><p>Dozens of NHS hospital trusts across England are looking at (or already have) set up private companies in which to transfer swathes of vital NHS staff and assets. The moves are, according to Trusts, an attempt to save money through a supposed VAT loophole designed to promote outsourcing, as well as savings on staff pay, terms and conditions. They are also – an aspect overlooked in the <a href="https://amp.theguardian.com/society/2018/feb/14/nhs-trusts-transferring-staff-into-subsidiary-companies-to-cut-vat?__twitter_impression=true">coverage to date</a> – supposed to promote a greater focus on “commercialising” hospital assets. More of that in a bit…</p> <h2>“By the time people realise it’s been a catastrophe, it will be too late to undo”</h2> <p>Unions and staff are up in arms about the damaging impact of these subsidiary companies in creating a <a href="https://southwest.unison.org.uk/campaigns/one-team-one-nhs-subsidiary-companies/">two tier, demoralised workforce</a> whose goodwill and co-operation our doctors and nurses rely on every day to keep hospitals clean, safe, and well-equipped. In Wigan, Harrogate, Bradford, and Calderdale, Unison members are already close to strike action after union ballots overwhelmingly rejected the plans. Gloucestershire – where around 700 staff are affected – is also about to run an indicative ballot, Unison announced at an NHS activists conference in the county on Saturday.</p> <p>Some hospital governors are deeply unhappy too – one in Gloucestershire told OurNHS, “by the time people realise it’s been a catastrophe, it will be too late to undo.”</p> <p>There’s been no public consultation about any of the plans to create private NHS subsidiary companies (known as SubCo’s), it seems. In Gloucestershire, Hospital Chief Executive Deborah Lee told Stroud Labour MP David Drew that “this is not a matter for public consultation as agreed with the Gloucestershire Health Care Overview &amp; Scrutiny Committee (HCOSC)”. However Stroud Council leader Doina Cornell, who sits on the county’s Scrutiny Committee, told OurNHS, “We’ve not been consulted. There’s been a lack of input into it from any councillors.” OurNHS asked Gloucestershire Hospitals about this apparent discrepancy – and about a number of other points in this article. They have so far declined to comment.</p> <p>Cornell adds “Surely this is not the sort of thing we should be doing…. this is a high-risk project.”</p> <h2>“…<strong>a gambit, a pretence, an illusion and make believe…</strong>”</h2> <p>Indeed it is high risk. Whilst staff understandably worry about pay, pensions and conditions cuts – and unions argue that any guarantees from employers are worth little given weak employment law and the various hospital trusts' stated intent to take on new starters on lower conditions – for the <em>public</em>, it gets more worrying still.</p> <p>Many experts suspect the plans could collapse altogether, with the corporates waiting in the wings of course. Respected health commentator Roy Lilley has called the SubCo plans “<strong>a gambit, a pretence, an illusion and make believe</strong>” and on the same subject comments, “<a href="http://campaign.r20.constantcontact.com/render?m=1102665899193&amp;ca=0082c0d7-b2c5-4001-87b1-c74b77a3a566">an astonishing number of Trusts are heading down Carillion Street</a>”. &nbsp;</p> <p>Certainly, it’s worrying that many of the SubCo plans seem to emphasise this VAT “gambit”. Gloucestershire, for example, told staff it would save £35m over 10 years through this ruse, whilst the staff savings were merely “unquantifiable”. But the biggest similar scheme to date, UnitingCare in Cambridgeshire, collapsed spectacularly – and one of the major reasons (according to both <a href="https://www.england.nhs.uk/mids-east/wp-content/uploads/sites/7/2016/04/uniting-care-mar16.pdf">NHS England</a> and the <a href="https://www.nao.org.uk/report/investigation-into-the-collapse-of-the-unitingcare-partnership-contract-in-cambridgeshire-and-peterborough/">National Audit Office report</a>s) was because the NHS signed the contract on the basis of incorrect advice about their VAT position, meaning an unexpected £5m a year was added to the costs and the arrangement collapsed.</p> <h2>Selling off the hospital buildings?</h2> <p>And – perhaps most worryingly of all – now OurNHS openDemocracy has uncovered considerable grounds for concern about what is happening to hospital buildings around the country as part of these plans. We’ve also uncovered a little noted aspect of the Health and Social Care Act 2012 that might partly explain the sudden rush to "commercialise" hospital estates under these new schemes.</p> <p>In existing SubCo’s, tens of millions of pounds of assets appear to have transferred out of the NHS. In Northumberland, Tyne and Wear for example, one of the few SubCo’s where the business case is publicly available, the plan states <a href="https://www.ntw.nhs.uk/content/uploads/2017/04/Agenda-Item-10ii-a-NTW-Solutions-Business-Case.pdf">that £33.5m of land and buildings will be transferred</a> from the NHS to the SubCo. But in most of the plans about to be signed off in the coming weeks and months staff appear to have been given little more than <em>hints</em> of asset transfer (often highly self-contradictory, see for example <a href="https://opendemocracy.net/files/SubCo-QA-A3-D3.pdf">Gloucestershire’s leaked staff Q&amp;A</a>,<strong> </strong>and Airedale’s (which they’ve mostly taken down in the last few days, but you can read the cached link here [editors note - the cached link has <em>also </em>disappeared since this article was published yesterday, <a href="https://opendemocracy.net/files/NHS Airedale Foundation Trust.doc">but here's the page as we downloaded it last week</a>]). </p> <p>Neither staff or public appear to be being told anything about what hospital buildings are involved, and what this means for the future. Whether or not asset transfers are key to the supposed VAT savings in Gloucestershire and elsewhere is one of the unanswered questions put to the Trust. Some of the other SubCo’s appear to anticipate <em>no</em> VAT savings, according to the Health Services Journal (<a href="https://www.hsj.co.uk/finance-and-efficiency/in-full-trusts-with-staff-transfer-plans/7021681.article">paywall</a>). Meanwhile, other established SubCo’s – notably South Warwickshire and East Kent – have been set up to provide clinics and wards for private patients, OurNHS has uncovered. What <em>is</em> going on?</p> <p>The concerns about hospital buildings come in the light of huge pressure on Trusts to sell off or commercialise parts of their estate, under both the Carter Review and <a href="https://www.mirror.co.uk/news/politics/tories-backed-report-recommending-huge-11941502">the Naylor report that Theresa May endorsed last year</a>. Those hawking schemes to encourage sell offs are impatient with the NHS holding on to their assets “<a href="https://www.birminghampost.co.uk/special-features/how-unlock-potential-midlands-nhs-13926365">like the family silver</a>” and preventing housing developers or rival private health companies getting their hands on these ‘strategic locations’. And all the plans – as elsewhere – are clear on one thing – that there will be “new people” with “commercial expertise” running the SubCo’s - perhaps with a different attitude to the family silver?<strong></strong></p> <p>Tax expert Richard Murphy echoes campaigners’ suspicions. Reviewing the <a href="https://www.ntw.nhs.uk/content/uploads/2017/04/Agenda-Item-10ii-a-NTW-Solutions-Business-Case.pdf">Northumberland, Tyne and Wear</a> SubCo business case, he told OurNHS, “Reading between the lines as to the true motive of this&nbsp;arrangement, it looks like a precursor to the sale to commercial third parties of the underlying buildings and the service contracts associated with them". Whether this is the intention – or an unintended consequence, particularly if the financial models don’t otherwise stack up - remains to be seen.</p> <h2>Sneaky legal changes post-2016?</h2> <p>OurNHS has also uncovered that a little spotted legal change seems to be driving the rush to the SubCo model of estates management. In an article written in May 2017 by SubCo advisors DAC Beachcroft (who are advising Gloucestershire amongst others), the solicitors firm describes how “the foundation trust sets up a wholly-owned subsidiary company. The estates workforce works for the company” but they go on to explain that “<a href="https://www.dacbeachcroft.com/en/gb/articles/2017/may/will-this-new-nhs-estates-management-model-improve-trust-efficiency/">the outsourcing involves transferring the estate across into a wholly-owned subsidiary company</a>.” And intriguingly, they add “These are only now possible because of recent changes in legislation that have enabled NHS foundation trusts to transfer their legal rights in operational property”.<strong></strong></p> <p>What “recent changes in legislation” are these? OurNHS has spoken to top NHS campaigning solicitors who are unsure but have suggested it may refer to a change that follows on from the controversial Health and Social Care Act 2012. One little noted aspect of the Act made it easier for the NHS Foundation Trusts to sell off or otherwise dispose of assets, even where those were previously protected because they were used to provide essential healthcare services (known as “Commissioner Requested Services”). There were some transitional arrangements to protect these services and the buildings used to provide them, following the 2012 Act – <a href="http://www.bmj.com/content/349/bmj.g5603">but these arrangements ran out in April 2016</a>.<strong></strong></p> <p>And certainly, the government’s attitude to these SubCo wheezes seems a little slippery. On the one hand, the government’s “NHS Providers Finance Director” Chris Young wrote an apparently strongly worded letter to Trusts last September (and seen by OurNHS), which stated that “HMRC are actively investigating the health sector in relation to tax avoidance schemes” - though perhaps with a chink of a get out clause about such schemes being “acceptable” if there are also “genuine commercial reasons” for pursuing them. Meanwhile numerous parliamentary questions about the SubCo’s have been met with bland indifference from ministers. Whilst some – like Labour’s health spokesman in the Lords, Phil Hunt – have suggested ministers’ relaxed demeanour means any tax savings are likely to be clawed back from the overall NHS budget, NHS insiders have also told OurNHS that their strong impression is the main NHS regulator (NHS Improvement) is quietly promoting these schemes. </p> <h2>So what can campaigners do?</h2> <p>In Gloucestershire, experienced NHS campaigners – who 6 years ago took NHS Gloucestershire to Judicial Review and reversed the planned transfer of nine local hospitals and 4000 staff to a so-called “social enterprise” company - have written today <strong>(<a href="https://opendemocracy.net/files/glos subco letter to board to publish.doc">letter here</a>)</strong> to the local Hospital Trust's Board of Directors. The hospital's directors are due to agree the project on Wednesday (28 February), but campaigners have raised detailed questions regarding all the above issues. The campaigners warn the Directors that the Trust risks being "negligent" with public money and assets if they rubber stamp the plan before they have clear answers to all these questions – which, campaigners point out, should be shared with the public.</p> <h2>So what can Trusts do?</h2> <p>It’s not good enough for Trusts to rely on expensive, unpublished, "commercially confidential" advice from the likes of DAC Beachcroft and KPMG. Gloucestershire for example has set aside £200,000 for this advice, OurNHS has learned. And let’s not forget KPMG’s role in Carillion – a role which prompted Peter Kyle MP to tell them last week in a parliamentary Carillion investigation, <a href="http://www.independent.co.uk/news/business/news/carillion-collapse-kpmg-deloitte-mps-worthless-accounts-business-committee-rachel-reeves-a8223626.html">“I wouldn’t trust you to do an audit of the contents of my fridge”</a>.</p> <p>Nor does it seem wise for the twenty or so Trusts who are relying on advice from QE Facilities Ltd, a SubCo created by Queen Elizabeth Gateshead NHS Foundation Trust. As Unison’s Michael Sweetman drily told OurNHS, “they are selling this deal on the basis that they’ve found it very lucrative – for them – but it’s lucrative for them partly because they’re going around selling their consultancy on how to do it, back to other parts of the NHS.” (Did anyone say “pyramid scheme”?).</p> <p>Of course Trusts are in impossible financial positions, with soaring waiting lists, problems compounded by heavy fines levied if they miss targets, and – as exposed by last week’s BBC File on Four - an <a href="http://www.bbc.co.uk/programmes/b09ry6k8">absurd government fixation on capital controls as hospitals crumble</a>. <a href="https://www.gloucestershirelive.co.uk/news/gloucester-news/how-gloucestershires-hospitals-managed-rack-215076">Gloucestershire is in the same financial black hole as most Trusts – and also in special measures following a recent huge accounting cock-up</a>. </p> <p>Trust Chief Executives have even taken to Twitter to defend their adoption of SubCo’s models, for example Sarah Jane Marsh, CEO of the Birmingham Women and Children’s Hospital Foundation Trust, who also have a SubCo due to go live next month. Marsh&nbsp;<a href="https://twitter.com/BWCHBoss/status/963781922378969088">commented earlier this month</a>, “It’s a real head/heart issue - but the reality is if we don't, we will have to reduce further posts as our CIP [Cost Improvement Plan, ie further 'efficiencies' or cuts needed] for 18/19 is £17 million.” </p> <p>But it’s not good enough for Trusts developing these plans to attempt highly risky ways to wriggle out of government-imposed constraints, remaining tight-lipped about what the plans could really mean. It’s not good enough for Trusts to hope that no-one’s going to weep for the procurement teams, estates managers, cleaners, safety staff and the other workers who keep the NHS show on the road – nor to ignore vital questions about the hospital buildings and financial models, the quality of the advice they’re getting, and the loss of accountability and control these plans entail. Given the secrecy around these SubCo's, it’s particularly unhelpful when Trust Chief Executives <a href="https://www.nhsglos.com/involve/feb2018/">then blame “irresponsible” unions for causing staff anxiety with “political” opposition to the plans, as Gloucestershire’s Chief Executive Deborah Lee was spotted on camera doing last week.</a> </p> <p>Instead, all Trust CEOs should be being as outspoken about the government’s failure to fund the NHS as a few brave ones <em>have</em> been – and as honest about the obscure tricks the government is using to push ever more outsourcing, even as the failures of Carillion, Grenfell and PFI come home to roost. </p> <p>OurNHS openDemocracy will keep investigating. Whatever the intent of Trust directors, the reality is they tend to move on to pastures new within a few years – only one of Gloucestershire’s current directors has been there for any length of time, for example. </p> <p>Meanwhile local people, currently frozen out of decision making, may be left in a few years wondering how our precious hospitals were sold from out under our feet.</p><div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS uk ourNHS Caroline Molloy Mon, 26 Feb 2018 21:58:53 +0000 Caroline Molloy 116352 at https://www.opendemocracy.net Exposed - the shocking extent of fire risk in our hospitals and mental health trusts https://www.opendemocracy.net/ournhs/minh-alexander/exposed-shocking-extent-of-fire-risk-in-our-hospitals-and-mental-health-trusts <div class="field field-summary"> <div class="field-items"> <div class="field-item odd"> <p>Even after Grenfell, hospitals are failing to put in place recommended fire safety measures. The UK government passes the buck. Meanwhile, patients have died.</p> </div> </div> </div> <p><span class='wysiwyg_imageupload image imgupl_floating_none 0'><a href="//cdn.opendemocracy.net/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/549093/chase farm hospital.jpg" rel="lightbox[wysiwyg_imageupload_inline]" title=""><img src="//cdn.opendemocracy.net/files/imagecache/article_xlarge/wysiwyg_imageupload/549093/chase farm hospital.jpg" alt="" title="" width="460" height="325" class="imagecache wysiwyg_imageupload 0 imagecache imagecache-article_xlarge" style="" /></a> <span class='image_meta'></span></span><em>Image: Fire at Chase Farm mental hospital in 2008. Steps have been taken across the NHS since - but are they enough?</em></p><p>Coroners have criticised two recent patient fire deaths at mental health providers <a href="http://www.bbc.co.uk/news/uk-england-cambridgeshire-41916473">Cambridgeshire and Peterborough NHS Foundation Trust</a> and at <a href="http://www.bbc.co.uk/news/uk-england-berkshire-42185454">Berkshire Healthcare NHS Foundation Trust</a>.</p> <p>Fire safety is a concern across the NHS. There are well-known fire safety problems at some PFI hospitals. Investigations after the Grenfell Tower fire exposed <a href="http://www.telegraph.co.uk/news/2017/06/27/nhs-alert-fire-chiefs-warn-38-hospitals-dangerous-grenfell-tower/">the presence of flammable cladding in NHS hospitals. </a>But risk assessment is tangled up with financial imperatives. Some of the flammable cladding in hospitals was <a href="https://www.mirror.co.uk/news/uk-news/hospitals-still-deadly-cladding-similar-11468002">left in situ</a> because it was considered too costly to remove. And such is the general pressure on trusts that <a href="https://www.hsj.co.uk/acute-care/exclusive-more-than-50-trusts-yet-to-carry-out-post-grenfell-fire-checks/7020898.article">some delayed in implementing fire checks</a> ordered by NHS Improvement after the Grenfell fire.</p> <h2>Mental health services are especially vulnerable</h2> <p>Though fire safety is a concern across the NHS, mental health services are especially vulnerable as they must deal with the special risks of fires caused by patients who are disorganised by illness, or people who set fires deliberately. The government acknowledges this risk in its <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/473012/HTM_05-02_2015.pdf">fire safety guidance for the NHS.</a><span></span></p> <p>The <a href="http://www.dailymail.co.uk/news/article-1078080/Patients-flee-ravages-hospital-unit-mentally-ill-criminals.html">2008 Chase Farm Hospital fire of the locked, forensic psychiatric wards</a> was a reminder of the potential lethality of fire in psychiatric hospital settings. Fast staff reaction in the <a href="http://news.bbc.co.uk/1/hi/england/london/7168206.stm">2008 Royal Marsden Hospital fire</a> prevented deaths, but there was major damage. The <a href="https://minhalexander.files.wordpress.com/2018/01/woodlands-unit-fire-investigation-suffolk-fire-and-rescue-2012_12_20-report-of-investigation-final.pdf">damning fire safety report</a> into the <a href="http://www.eadt.co.uk/news/ipswich-suffolk-patient-almost-died-as-fire-alarm-was-ignored-eight-times-1-1748189">2011 fire at Woodlands psychiatric unit at Ipswich Hospital</a> revealed system failures had resulted in the alarm being ignored eight times. Norfolk and Suffolk NHS Foundation trust escaped criminal prosecution only because of a legal loophole. The then Chief Executive of the NHS Trust Development Authority acknowledged this serious mismanagement and <a href="https://www.buildingbetterhealthcare.co.uk/news/article_page/Hospitals_told_to_step_up_fire_security_after_scathing_report_into_Ipswich_blaze/86061">promised that standards would be tightened up</a>. </p> <p>Vigilance and proactive care are needed. But strain on under-funded mental health services result in understaffing, chronic over-occupancy, escalating acuity and failures of clinical observation (<a href="///C:/Users/Caroline/Downloads/cited%20repeatedly%20by%20coroner&#039;s%20warnings%20as%20factors%20in%20avoidable%20deaths">cited repeatedly by coroner's warnings as factors in avoidable deaths).</a> </p> <p>Risk is also posed by an <a href="https://www.theguardian.com/society/2017/oct/03/bill-urgent-repairs-nhs-hospitals">ever-mounting backlog of repairs and maintenance work – including fire prevention work - in our hospitals,</a> as NHS trusts struggle to make ends meet. </p> <p>Worryingly, subsequent enquiries by BBC File on Four revealed that</p> <p><a href="https://minhalexander.files.wordpress.com/2018/01/bbc-file-on-four-29_01_08_fo4_fire.pdf">Fire Services had had to serve enforcement notices against NHS trusts.</a> – and, as a glance at the <a href="http://www.cfoa.org.uk/notices-register">enforcement register</a> shows that this continues despite promises of improvement.</p> <h2>Injuries and deaths in NHS fires</h2> <p>How much fire risk is tolerable, in hospitals with accelerant medical gases and infirm or detained patients? </p> <p>The <a href="https://minhalexander.files.wordpress.com/2017/11/fennell-report-kings-cross-fire-dot_kx1987.pdf">investigation report on the London Underground fire at Kings Cross</a>, which claimed 31 lives, criticised London Underground’s complacent culture and argued:</p> <p><em>“A mass passenger transport service cannot tolerate the concept of an acceptable level of fire hazard”</em></p> <p>Data from routine notification of estate fires by NHS trusts to NHS Digital shows that there were 1701 and 1462 fires in all trusts in <a href="https://minhalexander.files.wordpress.com/2018/02/nhs-digital-eric-2015-2016-data-reps.xlsx">2015/16</a> and <a href="https://digital.nhs.uk/catalogue/PUB30096">2016/17</a> respectively. Mental health trusts accounted for 1138 (67%) fires in 2015/16 and 895 (61%) fires 2016/17 respectively.</p> <p>Over these two years, 88 people were injured in all NHS trust fires, with 64 of these people being injured in fires related to mental health trusts. There were four deaths in trusts fires, three accounted for by mental health trusts.</p><p class="mag-quote-center">There were four deaths in trusts fires, three accounted for by mental health trusts.</p> <h2>Suicides by burning</h2> <p>There were a total of <a href="https://minhalexander.files.wordpress.com/2018/02/ncish-foi-suicide-by-burning-response-5-02-2018.pdf">259 patient suicides and 14 inpatient suicides by burning</a> over the ten years between 2005 and 2015, a request to National Confidential Inquiry into Suicide and Homicide (NCISH) under the Freedom of Information Act has revealed.</p> <p>FOI data from NCISH also suggests that <a href="https://minhalexander.files.wordpress.com/2018/02/ncish-foi-response-suicide-by-burning-9-01-2018.pdf">roughly a fifth of suicides by burning are due to patient suicides by burning.</a></p> <p>Underlying these deaths will be many more injuries and near misses.<strong></strong></p> <h2>Many hospitals do not have sprinkler systems, even now</h2> <p>The Chief Fire Officers Association <a href="https://minhalexander.files.wordpress.com/2018/02/cfoa-statement-130301-sprinklers.pdf">promotes the use of sprinklers.</a> The London Fire Brigade has advocated for the use of <a href="https://minhalexander.files.wordpress.com/2018/02/london-fire-brigade-2016-07-nickcoleshill.pdf">sprinklers in healthcare premises.</a> As the London Fire Commissioner has explained, </p> <p><a href="http://www.london-fire.gov.uk/news/LatestNewsReleases_Sprinklers-13-Sep-2017.asp#.WnUwhZOFigR"><em>"Sprinklers are the only fire safety system that detects a fire, suppresses a fire and raises the alarm. They save lives and protect property and they are especially important where there are vulnerable residents who would find it difficult to escape"</em></a><em></em></p> <p>The government’s fire standards for the NHS briefly mention but do not commit to installation of sprinklers. The guidance also repeatedly states that where sprinklers are used, other fire prevention measures may be reduced for cost-effectiveness.</p> <p>Since Grenfell, the government has been pressed on the <a href="http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2017-09-08/9666/">adequacy of its regulations</a> for sprinklers in hospitals, and <a href="http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2017-12-20/120648">whether sprinklers are required in all hospitals.</a> Last month, the Minister of State advised that all guidance was under review.</p> <p>Many hospitals do not have sprinkler systems. The exact distribution of sprinklers across the NHS estate is uncertain. The data is not collected centrally by NHS Digital. Expectations do not appear high. A fire safety policy by Northumberland Tyne and Wear NHS Foundation Trust states:</p> <p class="p1"><a href="https://minhalexander.files.wordpress.com/2018/02/northumberland-tyne-and-wear-1475659231fp-pgn-11-actfireprecau-v02-iss3-ermar17-issoct16.pdf"><em>"Healthcare premises do not normally have water delivery systems fitted."</em></a></p><p class="p1"><em><span class="mag-quote-center">"Healthcare premises do not normally have water delivery systems fitted."</span></em></p> <p>Recent FOI data reportedly showed that <a href="https://inews.co.uk/news/uk/revaled-thousands-multi-storey-buildings-lack-fire-sprinklers/">thousands of multi-storey buildings, including hospitals, do not have sprinklers.</a></p> <p>Even some new builds such as <a href="https://www.falkirkherald.co.uk/news/hospital-sprinkler-decision-slammed-1-289846">Forth Valley Royal Hospital</a> have not included sprinklers. The troubled Cumberland Infirmary PFI development <a href="http://www.newsandstar.co.uk/news/Carlisle-hospitals-fire-safety-sprinklers-will-not-be-fully-installed-until-2020-3e1e3656-a8ae-474a-8d18-b6b92c08663d-ds">will not have sprinklers fully installed until 2020.</a> Corporate documents and FOI releases by some NHS organisations, for example by <a href="https://minhalexander.files.wordpress.com/2018/02/sheffield-teaching-hospitals-governors-meeting-partial-sprinklers-cog170627_minutes.pdf">Sheffield Teaching Hospitals NHS Foundation Trust</a>, <a href="https://minhalexander.files.wordpress.com/2018/02/nhs-grampian-fire-prevention-foi-responseletter215-2014red.pdf">NHS Grampian</a> and <a href="https://minhalexander.files.wordpress.com/2018/02/nhs-lothian-fire-prevention-foi-4548.pdf">NHS Lothian</a> show patchy sprinkler coverage. </p> <p>Moreover, working on the ‘acceptable hazard’ principle, where one safety precaution is installed, others may be trimmed. For example, one architect reported that on one Scottish NHS PFI project, because sprinklers were specified, there was corner cutting on other safety features:</p> <p><a href="https://www.ifsecglobal.com/architect-says-corners-cut-fire-safety-glasgow-hospital-sprinklers-fitted/"><em>"...lacks exit stairways and exceeds size limits on fire compartments, while a hose-reel for firefighters is too short and some fire doors open in the wrong direction"</em></a><em></em></p> <p><span>Almost no mental health trusts have sprinkler systems</span></p> <p><a href="https://minhalexander.files.wordpress.com/2018/02/mental-health-trusts-and-fires-1-april-2015-to-31-march-20174.xlsx">I sent a Freedom of Information request to 51 mental health trusts. 49 trusts responded.</a></p> <p>The responses revealed that almost no mental health trusts have sprinklers. Three trusts had sprinklers in 10% of their inpatient areas, and in one of these trusts this was only because a <a href="http://www.sthelensstar.co.uk/news/15788041.sprinklers-installed-at-peasley-cross-hospital-wards/">retrofit took place after a contribution by the local fire service.</a> Two other trusts trust leased four community properties equipped with sprinklers, but none of their own properties had sprinklers.</p> <p>Some trusts stressed that installing sprinklers was “not a requirement under current legislation”. However, legality is a moot point after Grenfell and given the controversy about UK fire safety standards.</p> <p>Cambridgeshire and Peterborough NHS Foundation, one of the trusts criticised over a recent fire death, claimed that it could not say how many sprinklers it had, because responsibility for this was outsourced. However, the trust admitted there were no sprinklers in inpatient areas.</p><p class="mag-quote-center">One of the trusts criticised over a recent fire death claimed that it could not say how many sprinklers it had, because responsibility for this was outsourced.</p> <p>South West London and St. Georges Mental Health NHS Trust and Dudley and Walsall Mental Health Partnership NHS Trust refused to answer the question on sprinklers on the grounds that it would endanger safety. After challenge, St Georges admitted that it had no sprinklers.</p> <p>East London NHS Foundation Trust, rated ‘Outstanding’ and praised the Care Quality Commission for its learning culture was one of the trusts which failed to respond to the FOI at all. NHS Digital data shows that there was a fire related death at East London NHS Foundation Trust in 2016/17 and that a total of seven people were injured in fires in 2015/16 and 2016/17.</p> <p>The 49 trusts which responded to the FOI request accounted for a total of 1800 fires over 2015/16 and 2016/17, at least 790 of which were deliberately caused and at least 801 of which were caused by patients (2).</p> <p>Conservatively, at least 1000 of the fires occurred on inpatient units, some in rooms that might potentially be locked or barricaded such as patients’ bedrooms and bathrooms.</p> <p>One mental health trust acknowledged that there is risk inherent in all fires: “they all carry a potential risk of harm”, whereas another claimed that all fires on its wards were “minor in the sense that items burnt were limited to paper and clothing”. Better data is needed on the seriousness of the fires.</p> <p>Questions arise about whether this level of risk management in mental health trusts is acceptable, and whether it is valid to trim back on failsafes. For example, relying on fire alarms instead of sprinklers. This was a justification given by Mersey Care NHS Foundation Trust for not having sprinklers.</p> <p>In particular, the absence of sprinklers in patients’ bedrooms and bathrooms bears further debate, because such areas may not be accessible quickly enough in an emergency. <a href="http://www.bbc.co.uk/news/uk-england-cambridgeshire-41916473">Heather Loveridge died as a result of a fire in a ward toilet</a> and <a href="http://www.bbc.co.uk/news/uk-england-berkshire-42185454">Sarah-Jane Williams died as a result of a fire in a ward bedroom</a> at trusts which had no sprinklers. </p> <p>There are also unanswered questions about sources of ignition on mental health trust wards despite the <a href="https://publichealthmatters.blog.gov.uk/2017/03/17/tobacco-free-nhs-troubleshooting-tips-for-hospitals/">NHS smoking ban</a>. How many ward fires set by patients due to failures to search and remove lighters, reflecting the acute strain on services? <span></span></p> <p>I asked NHS Improvement, the NHS’s financial regulator, if it was doing any work on the special needs of mental health patients with respect to fire safety. </p> <h2>Who’s responsible? Not us!</h2> <p>NHS Improvement referred me to the Department of Health</p> <p><a href="https://minhalexander.files.wordpress.com/2018/02/nhs-improvement-correspondence-fire-risk-mental-health-trusts.pdf">NHS Improvement referred me to the Department of Health and Social Care</a>, based on its impression that the Department had undertaken a 10-year review. This was followed by a hasty retraction, and then a <a href="https://minhalexander.files.wordpress.com/2018/02/dh-fire-response-21-nov-2017-foi-1107984.pdf">denial from the Department of Health and Social Care </a>itself that it held such data. The Department finally suggested that I ask<a href="https://minhalexander.files.wordpress.com/2018/02/dh-fire-response-5-dec-2017-foi-1109518.pdf">&nbsp;NHS Improvement</a> for information.</p> <p>This bureaucratic merry-go-round suggests that either little thought has been given to this matter, or worse, that pass-the-parcel is being played with embarrassing truths whilst mental health patients remain insufficiently protected.</p><p class="mag-quote-center">pass-the-parcel is being played with embarrassing truths whilst mental health patients remain insufficiently protected</p> <p>The Department of Health and Social Care’s own fire guidance states that it is important to demonstrate “<em>due diligence and effective governance”</em> and recommends that the <em>“performance of the fire safety management system is periodically audited and assessed against the organisation’s fire safety objectives”</em></p> <p>The Department should follow its own advice, ensure better oversight and rectify any unwarranted risks to which mental health patients are currently exposed. If risk continues to be tolerated at a systemic level, the government should at least transparently provide justification for this.</p> <p><strong>NOTES</strong></p> <p>(1) The Department of Health and Social Care’s fire safety guidance states:</p> <p><em>“</em><strong><em>5.68</em></strong><em> With the exception of buildings over 30 m in height, the guidance in this document does not require the installation of sprinklers in patient care areas of healthcare buildings. However, the design team is expected to consider the advantages that might be gained by installing life-safety sprinklers throughout the building or to specific areas. Where specific hazards are identified in the building, it may be more appropriate to consider the application of an alternative fire suppression system, such as high pressure water mist technologies.”</em></p> <p>Throughout the guidance, it is stated that where sprinklers are used, other fire prevention measures may be reduced, and this explicitly linked to saving money. For example:</p> <p><em>“<strong>5.85 </strong>In those parts of healthcare buildings where sprinkler systems are provided, the effect of sprinklers on the overall package of fire precautions has to be considered to ensure that a cost-effective fire safety strategy is provided. Where sprinklers are installed in healthcare premises in accordance with the above guidance, some of the requirements of this document may be modified to take account of the effect of sprinkler operation at an early stage of fire development.”</em></p> <p><em>“<strong>5.86</strong> Where sprinklers are installed, the guidance may be modified subject to a suitable and sufficient risk assessment being undertaken and the information being recorded in the fire safety manual. Examples include: </em></p> <p><em>a. progressive horizontal evacuation (paragraphs 3.6–3.15); </em></p> <p><em>b. glazing in sub-compartment walls (paragraphs 5.23–5.25); </em></p> <p><em>c. elements of structure (paragraphs 5.1– 5.7 and 5.14–5.15); </em></p> <p><em>d. compartmentation (paragraphs 5.8– 5.13); </em></p> <p><em>e. fire hazard rooms and areas (paragraphs 5.40–5.44); </em></p> <p><em>f. external fire spread (paragraphs 6.5– 6.15); </em></p> <p><em>g. number and location of fire-fighting shafts (paragraphs 7.11 and 7.13).”</em></p> <p><em>“<strong>3.12</strong> Where sprinklers are installed, the fire resistance of the compartment walls may be reduced to 30&nbsp;minutes (integrity and insulation)”</em></p> <p><em>“</em><strong>5.15</strong> <em>Where sprinklers are installed throughout the whole building, the requirement for elements of structure and compartment walls to be constructed of materials of limited combustibility does not apply”</em></p> <p><em>“<strong>5.25</strong> Where sprinklers are fitted, there is no limit on the use of glazed screens that provide a minimum period of fire resistance of 30 minutes (integrity only), provided the glass is not of the type referred to as “modified toughened”</em></p> <p><strong><em>“5.43</em></strong><em> Where sprinklers are installed, the need to enclose fire hazard rooms in fire-resisting construction should be risk-assessed.”</em></p> <p><a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/473012/HTM_05-02_2015.pdf">Department of Health Technical Memorandum 05-02: Firecode, 2015 Edition</a></p> <p>(2) Both data from NHS Digital and the FOI material from trusts should be viewed with caution. </p> <p>It became clear that some mental health trusts are reporting <em>all</em> fires involving patients to NHS Digital, and not just fires on their own premises. One trust claimed that the NHS Digital figures on its fires was greatly inflated because they included false alarms and not just actual fires. Conversely, some NHS Digital data was placed in doubt after a few apparent zero returns were directly queried with the trusts in question, who gave conflicting data.</p> <p>Some mental health trusts volunteered that all or most their arsons were carried out by patients. Fires were also most frequently located in inpatient areas.</p> <p>By comparison, FOI requests to three acute trusts that had also reported high numbers of fires showed a much lower proportion of fires that were caused deliberately or by patients: there were only 4 deliberately caused fires and three fires caused by patients out of a total of 178 fires over the two years.</p> <p>Rough though the quality of this data is, the differences do support received wisdom that the risk of arson by patients is higher in mental health trusts, and that unsurprisingly, many of the fires are set on inpatient psychiatric wards. This might be expected as the most unwell people will be found on the wards.</p><fieldset class="fieldgroup group-sideboxs"><legend>Sideboxes</legend><div class="field field-related-stories"> <div class="field-label">Related stories:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> <a href="/openjustice/roshan-croker/terrible-consequences-of-deregulation-and-cutting-corners">The terrible consequences of deregulation and cutting corners</a> </div> <div class="field-item even"> <a href="/shinealight/clare-sambrook/fail-and-prosper-how-privatisation-really-works">Fail and prosper: how privatisation really works</a> </div> <div class="field-item odd"> <a href="/blood-on-their-hands-sorry-state-of-uk-mental-health-services">“Blood on our hands” - the sorry state of UK mental health services </a> </div> </div> </div> </fieldset> <div class="field field-rights"> <div class="field-label">Rights:&nbsp;</div> <div class="field-items"> <div class="field-item odd"> CC by NC 4.0 </div> </div> </div> ourNHS ourNHS Minh Alexander Fri, 09 Feb 2018 11:01:22 +0000 Minh Alexander 116028 at https://www.opendemocracy.net