N30 Day of Action

It is clear to us that the votes to strike across the public sector are due not just to indignation over the big pension steal but to the way in which the public sector is being treated by the Coalition Government.  Pensions are the unifying factor although maybe the pay freeze announced today by George Osborne will have a similar effect.  But it's also true that many parts of the public sector, in particular the NHS, are highly demoralised and increasingly exhausted by the demands and chaos which the Coalition Ministers are heaping on them and by the doom scenario with which they are threatened if they do not comply.

The Occupation movement is one response, as is the Day of Action.  At a national level the unions seem to have handled this quite well, co-ordinating action and resisting the Coalition's carrots and sticks.  Unfortunately the local response is more chaotic.  At a well attended rally on 10th November, addressed by Mark Serwotka among others, it was announced that pickets and events in the morning would be be followed by a rally at 12 then a march round the city centre.  A lot of people and organisations made their arrangements accordingly.  Then suddenly on 27th Nov an email came round from the regional TUC in Leeds saying that Unison, Unite and GMB had decided this novel approach (rally then march) would not work and the march would now start from Devonshire Green at 11 though the rally would still be at 12.  This last minute change (as far as I can see because local union leaders couldn't see beyond a conventional format) has wrecked a number of other arrangements for the day.  There has been too little open communication locally and it is almost as if the local leadership don't think (or maybe want) too many people to be involved.  If we are to put up an effective fight for public services locally, we must have a clearer and more confident leadership.  We hope that the turnout for 30th Nov, despite the confusion, will encourage more people to make a stand.  

OCCUPY SHEFFIELD

The Occupation Movement reached Sheffield on November 5th with the establishment of a camp on the Cathedral forecourt.  The struggle to protect the NHS is closely linked to the general challenge presented by the Occupiers to the way in which 1%  of the population monopolise resources and powers.

This thread is for comments and information relating to Occupy Sheffield and its links with SSONHS.  We will be discussing this at our meeting on 14th November - with the possibility of organising an event to be held at the occupation site.  The occupiers are happy to display material relating to the preservation of our National Health Service.  SSONHS supporters are encouraged to go down and meet the occupiers and to offer whatever help they can.  

Please contibute information or comments to this thread.

For more information see http://www.occupysheffield.org.uk/ 
also https://occupywiki.org.uk/Sheffield/Wishlist

HSC Bill in the House of Lords

The Bill was accepted for second reading in the House of Lords by a large majority after a debate in which nearly 100 peers spoke.  Most (even some Conservatives) were critical of the Bill.  Lord Tugendhat (a Conservative lawyer and judge) said it would have been sufficient to have used the 4% efficiency cuts as a lever of change instead of saddling the NHS with all these changes as well.

Many Liberal Democrats (including Lady Williams) voted against Lord Rea's proposal to reject the Bill and 60 voted against Lord Owen's proposal for a Select Committee.  The only excuse was that it would put certain amendments in the hands of a smaller group when many peers wanted to have a say.

10 days of debate have been provisionally allocated for debate lasting until 19th December.  Labour offered to guarantee this date if Lord Owen's amendment was accepted.  If not, they said they would be pressing hard (along with many Lib Dems) for more time to be allocated for debate.  The Third Reading of the Bill will be expected in mid January, when it will return to the Commons to consider amendments agreed by the Lords.

The debate will now become quite technical but it seems likely that the main principles of the Bill will remain and successful amendments are more likely to be in the form of damage limitation.

Local implementation of cuts, changes, transfers etc. will need to be resisted by all means possible, from demanding consultations, participation in consultation over changes to make objections clear, and then whatever other action may be necessary to protect services.  Broad public action protesting against the Bill will need to continue.

Resist the first wave of privatisation masquerading as Patient Choice. Write to NHS Sheffield via the weblink below

At Andrew Lansley's instructions, NHS Sheffield and the other South Yorkshire PCTs are running a consultation (lasting about 10 days) to find three community services to be put out to tender from Any Qualified Provider.   

From a list of eight possibilities suggested by the Department of Health (covering about £1 billion of NHS expenditure nationally), NHS Sheffield has selected two:  Diagnostic Tests (such as ultrasound, MRI and CT Scans) closer to home; and Physiotherapy Services to treat back and neck pain.   The short list is completed with the addition of three others: services to help with the self-management of Long Term Conditions; Community Chemotherapy, including home chemotherapy; Dementia Care/ Memory Services.

Although some of the services selected could be provided or differently or are new approaches, the money will be going out of the public purse often to large profit making companies who can offer the best economies.  The government claims that there will be cost savings, but these will be achieved through poorer working conditions or sometimes even because regulations are biased towards the private sector.

The whole scheme is fraught with dangers.  By and large patients want a good service, not a lot of complicated choices.  For most of us it is hard enough to decide whether to have a particular treatment, let alone who is going to provide it.  There is also an increasing risk that doctors will have conflicts of interest because they have financial interests in local providers or may even want to offer services from their own surgeries for a fee. If Lansley’s reforms weren’t looming over everyone, it might be easier to do some limited experiments especially around home-based services, but this is the thin end of the wedge. We must write in now with our protests.

We urge people in South Yorkshire who oppose the privatisation of the NHS by stealth to tell the PCTs what they think on or before 12^th October by using the South Yorkshire/Bassetlaw PCTs questionnaire which you can find at http://bit.ly/n6pIUA. 

Even writing Don’t Do This will have to count but the questions are broad enough for you to put in your own opinions about the whole exercise.  NHS Sheffield wants to know:

a)      If you think there are any services on this list for which patients would NOT benefit from being able to choose who delivers their service

b)      If you think there are any health services that would benefit from this approach that are not on our current list

c)       How do you think having choice like this might benefit patients?

d)      Any other comments/ concerns you want to raise with us about this

 

Scrap NHS reforms, doctors tell Lords

Experts including 40 directors of public health say government's health and social care bill will cause 'irreparable harm'

 Sarah Boseley, health editor  guardian.co.uk, Monday 3 October

More than 260 senior doctors and public health experts are calling on the House of Lords to throw out the government's health and social care bill, saying it will do "irreparable harm to the NHS, to individual patients and to society as a whole".

The signatories include Professor Sir Michael Marmot, the author of several reports on the links between wealth and health that suggest children born into poverty are penalised for life. Marmot has until now not been openly critical of the coalition's approach, and instead has offered encouragement for David Cameron and Andrew Lansley's apparent enthusiasm for public health.

But Marmot and others in senior positions have now concluded the bill will damage all aspects of the health service.  "While we welcome the emphasis placed on establishing a closer working relationship between public health and local government, the proposed reforms as a whole will disrupt, fragment and weaken the country's public health capabilities," says the letter.

"The government claims that the reforms have the backing of the health professions. They do not. Neither do they have the general support of the public." The letter details the harms the experts believe the health reform bill will do.

"It ushers in a significantly heightened degree of commercialisation and marketisation that will lead to the harmful fragmentation of patient care; aggravate risks to individual patient safety; erode medical ethics and trust within the healthcare system; widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond effectively and efficiently to communicate disease outbreaks and other public health emergencies," the letter says.

In their judgment, the signatories say, the bill "will erode the NHS's ethical and co-operative foundations" and "will not deliver efficiency, quality, fairness or choice". The signatories include around 40 directors of public health from around the country who have taken the difficult decision to go public with their concerns. There are also two senior members of the Faculty of Public Health, one of whom, Dr John Middleton, is a vice-president. Other well-known names include Professor John Ashton, director of public health in Cumbria, and Professor Michel Coleman from the London School of Hygiene and Tropical Medicine.

Dr David McCoy, consultant in public health medicine at the Inner North West London primary care trust, one of the organisers of the letter, said he was surprised at the number of people prepared to sign. "I think if we had continued to collect signatures, I'm quite sure we would have collected another 200 It is having a snowball effect," he said. "I think the feeling is incredibly strong."

There was a lot of debate about whether we should call for outright rejection or amendments, but there is a feeling the whole package of reforms is harmful and we need to express our position in the strongest terms. I think there was a feeling the forthcoming reading in the House of Lords is the last chance of minimising the harm and damage."

The public health community has not spoken out in this way before. "I think there has been an attempt to work with the reforms and work behind the scenes to optimise the proposed reforms," said Dr McCoy.

Dr Middleton said there was no great opposition to the planned move to place public health services such as smoking cessation within local authorities. "But the letter is a recognition from the public health community that the reforms proposed around the NHS are deeply damaging to the public health in themselves," he said. There was concern that they would lead to inequalities in healthcare and less access for the poorest and most deprived to the services they need.
"The experience of other countries that have 'liberated' their health systems has resulted in very poor health services for their communities. I'm thinking of Russia and China where a free market in health resulted in major falls in life expectancy and systems that had provided some safety net cover have failed," he said.

Commenting on the letter, published in the Daily Telegraph on the eve of health secretary Andrew Lansley's address to the Tory party conference, shadow health secretary John Healey said: "David Cameron is in denial, both about the damage his plans are doing to the NHS and the strength of opposition to his health bill.

"There is no mandate for the bill, either from the election or the coalition agreement. With the government having railroaded its plans through the Commons, heavy responsibility is now going to be shouldered by the Lords."

http://www.guardian.co.uk/society/2011/oct/03/nhs-bill-doctors-lords

RCN in plea to families for DIY health care on hospital wards

The Royal College of Nursing are apparently requesting that hospital visiting hours are extended so that relatives can provide more care for patients on wards, including feeding at mealtimes.  The Patient's Association calls this the thin end of the wedge and even the Department of Health says that families should not be asked to perform nursing tasks.

We were asked to comment by Radio Sheffield early on Monday morning, but nobody was available to make an instant response.  Our comments would have included:

1. NHS staff are under enormous pressure, not least because of the current reform proposals and the efficiency cuts.  The idea of asking relatives to provide more help is not new but it is absolute nonsense to suggest that relatives should be doing basic physical and nursing care tasks for hospital patients.  
2. Most relatives who are able to visit are probably only too willing to do some extra so that their loved ones are comfortable. But that is extra - not providing the basics.  Families are under pressure too - the demands of modern life are already stressful but the government is adding to them by reducing benefits and allowances, forcing parents to look for work even when there are few jobs available, and encouraging people to be mobile.  Working days are getting longer again and people may have much further to go.  Hospitals can be expensive to visit in terms of rising bus fares and parking fees.  To add an expectation that relatives should spend more time in hospital visits makes one question what officials think hospital 'care' is all about.  It breaks some of the basic understandings about the NHS.
3. There are real issues about the differentiation between nursing care and the work of less well paid health care assistants.  First we have health care assistants often feeling forced to do work which is beyond their job description in order to cope with a lack of nurses; then we have relatives being asked to do the work of health care assistants for free.  It is a disgrace. 

The NHS will be 'off Lansley's hands' if the Bill is passed

The parliamentary process for the Health and Social Care Bill is reaching its climax.  The Government steamrollered its amendments through in Committee during July and will re-present the Bill to the full House of Commons on 6th and 7th September, before it goes to the Lords.

Supporters of 38 degrees have funded a legal opinion on two aspects of the Bill /- the Secretary of State's responsibility, and the competition provisions.  You can see the results at  http://blog.38degrees.org.uk.  "Effectively, the duty to provide a national health service would be lost if the Bill becomes law. It would be replaced by a duty on an unknown number of commissioningconsortia with only a duty to make or arrange provision for that section of the populationfor which it is responsible. Although some people will see this as a good thing, it iseffectively fragmenting a service that currently has the advantage of national oversightand control, and which is politically accountable via the ballot box to the electorate."

On competition the opinion states " It appears however that the government has simply failed to grapple with the front line issues in procurement, has wholly underestimated the increasing rather than diminishing complexity in the area and has had no or perhaps little regard tothe administrative and financial burdens arising from the regime."

An email from Nick Clegg's office to one of our members states "As you know, the Health and Social Care Bill is due to have its report stage and third reading on 6th and 7th September 2011. At this point the Liberal Democrats will continue to look to protect an NHS that is universal, based on need and free at the point of use. This is a clear priority for the party and a clear priority for Nick."

Lib Dem MPs should be told that the removal of the Secretary of State's duty to provide a comprehensive health service means that the service can no longer be universal and therefore the Bill should be voted down.

JOIN THE MARCH ON 3rd Sept and the vigil on the 6th Sept.  Lobby your MPs especially if they are Lib Dems.   

Health and Social Care Bill July - August 2011

The cost of the government's plans to restructure the NHS is rising at almost £1m a day - http://www.guardian.co.uk/society/2011/jul/28/cost-nhs-changes-rising

The Bill finished its second committee stage before the recess, with the Coalition using its majority to get its amendments through.  It will return to the Commons on 6th September for report with a vote on 7th September and then be passed through to the Lords.

Meanwhile Andrew Lansley published the government's first response http://www.dh.gov.uk/en/Consultations/Responsestoconsultations/DH_125442 .
This document instructs PCTs to consult about "extending choice" for 8 services, of which each PCT is to choose 3.  This is to be done during September/October.  Details of this instruction are in the operational guidance - http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_128462.pdf

The Bill is not a done deal and Evan Harris, a doctor and former Lib Dem MP who led the opposition at the Lib Dem Conference, says that despite concessions in the small print, the core privatisation principle remains.  Let's hope the Lib Dems can still be persuaded to vote against it - not to mention the Lords.  Pressure on MPs and peers must be maintained.  The Bill can still be defeated in the Commons if all the opposition MPs vote against it.

38 degrees now have funding to examine the legal issues in much more detail and will be reporting on this soon.

NHS Sheffield responses to questions put at the 5th July Public Meeting

NHS Sheffield offers the public the opportunity to ask questions of the Board at its public meetings.  To celebrate the 63rd birthday of the NHS we posed three sets of questions particularly around what the NHS might look like in 2013 when it reaches 65.  The Chair of the PCT was anxious to assure us that they were working hard to ensure that they achieve the best handover possible.

 

The PCT meeting itself was a long one because of the care homes issue so we only got to ask verbally the first of our questions about the reforms - but we were assured we will get written answers to the questions about patient involvement and privatisation and we had brief but friendly conversations with some PCT directors before the private part of their meeting began.  

The question we did ask centered around what the local NHS structure might look like under the amended Bill (part of the question about additional costs will be answered separately as well). 

 

As had been said earlier in the meeting, the situation changes week by week if not day by day and David Nicholson, the head of the NHS, will be making a key speech on Friday.  Some of the national information plus a minor leak is at http://www.guardian.co.uk/society/2011/jul/05/leaked-paper-nhs-commissioning-board

 

We were told that the government does appear to have rowed back from its original intention to place the support organanisations for commissioning into a market.  The Guardian article above refers to quite a large NHS commissioning Board at national level, with, presumably, local outposts.  As of this week there will now be four Strategic Health Authorities (divisions not yet decided) plus, I think, London. To these will report a number of PCT clusters  but these will not necessarily by the same as the ones which have just been developed (ours is currently South Yorks + Bassetlaw).  The clusters will have clinical commissioning groups , one for each local authority area (to fit in with the new health and wellbeing boards) and GP consortia will be represented on these - along with the other reps added under the Bill amendments.  Associated somehow with these groups will be the specialised regional networks (like the cancer network) which Lansley originally wanted to abolish.  Also somehow associated will be the amendments' new construction of a 'clinical senate'.

 

Commissioning will be supported by a Community Support Services organisation with Community Support Units covering populations of around 1.5 - 2 million (? the size of a cluster?).  The government's original intention was to put this out to tender but it now seems possible that this will not happen and the new organisations seem likely to be formed out of existing staff (for my comment see below.)  

 

The 4 current consortia in Sheffield will work together and possibly move to forming one organisation but with a strong local service focus.  Although GPs will have the key involvement in commissioning, fewer of them will actually be involved directly than seemed likely under the original Bill.  More GPs in Sheffield are interested than there will be places, but others are getting put off as the bureaucratic implications become clearer. 

 

The issue of the transfer of public health to local government etc awaits further pronouncement later this month. 

 

The Bill's intention is that Clinical Commissioning Groups, once approved for competence by the National Commissioning Board, will be legal entities beginning from April 2013 when the PCTs will be abolished if the Bill becomes law.  The National Commissioning Board itself will be established as a Special Health Authority in October this year.  Clincial Commissioning groups will act as committees of the PCT Cluster Boards and operate as 'shadows' until they become legal.  The Chair of the PCT commented earlier in the meeting that 'there are many transitional arrangements and they are not 100% clean" i.e. clearly defined.

 

I will only make two comments:

 

1) What on earth has been the point?

 

2) The remarks about the move away from a market for support organisations may provide some reassurance, but the status of the organisations is unclear (Will they be NHS? How will staff be employed there? Will they have to wind up their jobs and re-apply to the new organisation?  Will they be TUPE'd.).  There still seems to be no absolute guarantee that private organisations will not be involved. 

 

MS

Sheffield NHS Cutswatch

We are keen to establish a central log of NHS cuts which people are aware of in Sheffield.  We know that the PCT and the Council will prefer not to present cuts as such and the first people know of them is when they can't get a service.  Many will be quite small cuts in themselves, but together they are likely to mount up to huge losses of service, both in the community and within NHS organisations like the hospitals.  We also know that people who work in the NHS are anxious about the personal risks if they report cuts, so we want to establish routes whereby cuts can be reported, verified and put on our website.  Please either contribute to the blog or email us.

At our public meeting on 3rd May, people posted up details of hospital ward closures or bed reductions (elderly care, urology, rheumatology) and cuts to services like midwifery, cataract operations and intensive care rehabilitation.

The mental health services are under particular threat, with proposed losses in psychiatry and the community response team.

For several months two care homes for people with dementia have been running a campaign against closure.  A report to NHS Sheffield this month said that not a single response to their consultation had supported closure.  The Council's Health Scrutiny Committee said it would refer any closure to the Secretary of State.  As a result NHS Sheffield has been preparing other options and a final decision will be taken on 5th July. 

The Health and Social Care Bill June 2011

With the end of the "listening period", the impending publication of the full report of the NHS Futures Forum and the Government's commitment to amend the Bill, there is an eerie pause.  It is rumoured that parts of the Bill will return to committee in the House of Commons between 28\06 & 14/07. The remit is the areas of change from original bill.  Labour are apparently still trying to push for the whole Bill to go back to Committee.  The Bill will then go to the Lords after the summer recess.

At our meeting on 13th June, we agreed that although an amended Bill may not be as obviously life threatening to the NHS as the original version, there is every likelihood that that fudged wording will enable a lot of Lansley's original agenda to go through.  Also it seems to be increasingly obvious that many of the changes don't actually make much practical sense on the ground - the whole thing is becoming infinitely more complex than the PCT system we have now, and seems likely to grind to a halt.  Apart from anything else the argument that trying to reorganise from root to branch while imposing heavy cuts (efficiency or otherwise) is a recipe for disaster.  The battle to save the NHS is not over, and the biggest danger may be if Lib Dems (especially) want to congratulate themselves on securing amendments, and let the Bill slide through.

The Bill must be scrapped, not amended.

There are a host of comments available and bloggers might want to contribute the links they find most helpful.  Wendy Savage's latest comments are at
http://www.opendemocracy.net/ourkingdom/wendy-savage/saving-nhs-fight-goes-on .   See also
http://falseeconomy.org.uk/blog/lansley-clings-on-to-nhs-any-qualified-provider-policy-but-its-in-a-mess

We need to ensure that the Bill is kept in the news by continuing active protest, exposing its growing contradictions and dangers and keeping up pressure on MPs.  Keep up with the 38 degrees campaign, keep writing to the papers, contribute to radio through phone-ins - etc etc.   Come to our meetings and actions.

Activating the Sheffield Save Our NHS Blog

Apologies that because of limited resources, this blog has not been active since May.  We are now hoping to make this more of a forum to discuss the Health and Social Care Bill, feed in information about local developments, provide links to important news stories and promote meetings etc.

So please register and contribute and let's see how we go. 

Senior doctor leading a review into NHS Reforms: "essential services could be destroyed"

News.Sky.Com

The senior doctor leading a review into the Government's health service reforms has warned they could "destroy essential services".

Plans to reform the NHS have divided opinion

Professor Steve Field is the chairman of the NHS Future Forum - the group set up to examine the changes.
He said that proposals by Health Secretary Andrew Lansley to increase competition within the health service would be "destabilising".

"If you had a free market, that would destroy essential services in very big hospitals but also might destroy the services that need to be provided in small hospitals," he said.

"The risk in going forward (with the Bill) as it is, is (of) destabilising the NHS at a local level. It would lead to some hospitals not being able to continue as they are."

Cameron Health Advisor: NHS To Be Shown "No Mercy" In Privitisation

Political Scrapbook


One of David Cameron’s most senior health advisers told a conference of health executives that the NHS will be privatised, advising representatives from healthcare companies of an impending goldrush in the wake of Andrew Lansley’s health reforms.

Mark Britnell was NHS director general for commissioning and system management before joining the private sector as global head of health at KPMG. He was recently appointed to a new panel of senior health policy experts by David Cameron, attending their first meeting last week.

According to the public relations industry monitoring site Spinwatch Britnell did not mince his words on privatisation when addressing a seminar called “Reform Revolution” at a conference for healthcare corporations:

“In future, the NHS will be a state insurance provider not a state deliverer.”

NHS cuts: the first casualties

The Guardian

 

Two care homes in Sheffield that specialise in looking after patients with dementia are under threat after the city's PCT said it was considering withdrawing £2.8m of "top-up" funding for them. Woodland View and Birch Home between them care for 100 residential patients.

The homes are twice as expensive as other care homes providing similar care for people with similar health needs, says the PCT. But campaigns to save them say that other homes deal with less needy patients. A 15,000-strong petition was given to the city's Liberal Democrat-run council last week protesting against the possible closure.

Campaigner Rita Brookes said: "Withdrawing the NHS funding would be devastating. These homes provide specialist care that isn't available elsewhere. Relocating dementia patients increases mortality rates, too."

The PCT will make a final decision in June.

Parliamentary Select Committee report on the Bill

5/04/2011

UK Parliament 

The Parliamentary Select Committee report on the Health and Social Care Bill 2011 will be available at http://www.parliament.uk/healthcom from about 11.00 am.  The Committee is headed by a Conservative former Secretary of State, Stephen Dorrell, but the report is expected to be critical.

Private Healthcare Network SpinWatch

Map of how private healthcare companies have built what Professor David Miller calls "a dense and largely opaque network of political contacts in the UK with one aim – to influence policy in their interests and get the reforms they want".