RESIST THE BREAKUP OF THE NHS THROUGH PRIVATISATION AND CUTS!
BRIEF UPDATE April 2018
(N.B. This site is not currently being regularly updated. )
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The government's increasingly desperate attempts to defend their record on the NHS have become less and less credible over the last year. This is partly due to increasingly effective local and national campaigns and partly to the crisis in hospitals, primary care and social care has forced more and more of those involved to speak out against the damage being caused by austerity. But many of those who are being damaged have no voice. Poor people, disabled people and the chronically ill have fewer opportunities to make their case as their benefit and treatment rights become eroded. NHS staff are generally gagged in one way or another. Exit can be the only escape leaving the NHS still weaker and now less and less able to recruit staff from overseas.
Large national demonstrations and industrial action by junior doctors, nurses and others have made the strength of feeling around the country quite clear, to the extent that even the Conservatives have got worried enough to promise the outlines of a new financial deal this summer. But will it be too late? Certainly it will be insufficient to undo the damage inflicted since 2010. Meanwhile the stress on services which affect the need for healthcare becomes more and more acute. The unspupported costs of Social Care (which is subject to means tested charges) is driving local authorities to bankruptcy.
Another threat is the developing reorganisation into Integrated Care Systems (previously known as Accountable Care Systems) which threaten to become Accountable Care Organisations. In our local area the Integrated Care System covers Barnsley, Rotherham, Doncaster and Bassetlaw as well as Sheffield. (See posts below.) Increasing pressure from campaigners and within the Labour Party is deterring local councils to sign up to these in case they become vehicles for further cuts and privatisation.
Across South Yorkshire resistance is building to the threatened implications of the ICS for local services and South Yorkshire Save Our NHS have formed a political party to stand in the Sheffield City Region Mayoral election on May 3rd 2018. See also Barnsley Save Our NHS.
THE NHS IS NOT KILLED OFF YET. Campaigning does work whether on the streets, in the press or, increasingly in the lawcourts. The government's high-handed tactics are being subjected to an increasing number of judicial reviews. At national level these have forced a public consultation on Accountable Care Organisations starting in May 2018.
Cartoons by Samantha Galbraith @sgalbraith47
For more national information see Health Campaigns Together and Keep Our NHS Public
April 14th 2018 11.45 Regional Demonstration to Save the NHS Leeds
April 25th Soviet Healthcare via Targets: Are Governments Bringing it into the NHS? Roco 2pm or 7pm
April 28th Sheffield Demonstration against proposed closure of the Minor Injuries and Walk-in Centres (see main website for details)
June 27th The NHS is 70 - but what is its life expectancy? Festival of Debate / SSONHS panel discussion and social. Roco 7pm - 11 pm.
June 30th Health Campaigns Together march for the NHS in London See main wesbite for details.
SSONHS planning and information meetings are generally on the first Monday of the month, except for bank holidays. They are usually at 6pm at the United Reform Church. Chapel Walk/Norfolk St S1
To contact us email email@example.com
In 2016 abnd 2017 we worked with Sheffield Festival of Debate and other colleagues to promote realistic discussion of the issues facing the NHS. On 4th May 2017 we had a lively meeting debating the future of hospitals and in 2016 we mounted an exhibition on NHS privatisation to coincide with a play, A DUTY OF CARE about Labour and the healthcare market. On 22nd November 2016 we held a panel-led debate on the future of the NHS with local NHS leaders, academics and campaigners. We also held a public meeting on 4th July 2016 to celebrate the NHS anniversary, discuss the STPs, the implications for privatisation in South Yorkshire and North Derbyshire and the consequences of the EU referendum result.
In March 2016 we held a successful workshop Taking Back Our NHS
We supported the Junior Doctors throughout their action because we felt they were being unfairly treated and were being treated as the advance guard for Hunt's uncosted, unfunded and misconceived ambition for a 7 day NHS. (For one of our supporter's views at the beginning of the dispute see this column in the Sheffield Star http://tinyurl.com/oo8qoc3)
For our questions to 2017 General Election candidates and canvassers about the NHS see our website campaign page
2016 8th-22nd November Exhibition on NHS privatisation How come we didn't know by London photographer Marion Macalpine
Theatre Delicatessen, The Moor
22nd November SSONHS Festival of Debate event Why is the NHS Under so much pressure? How can we save it for future generations?
Speakers included Dr Tim Moorhead, Chair, Sheffield CCG, Kevan Taylor (Sheffield Health and Social Care Trust) and Professor Sarah Salway (University of Sheffield, Public Health) + local campaigners
Taking Back Our NHS SSONHS workshop
Saturday 12th March 2016, 10am - 2pm
Campaigning for GP practices at risk of closure
2nd July Successful SSONHS public meeting addressed by Ray Tallis and speakers from Devonshire Green and Unison.
2nd May SSONHS stall in city centre from 11.30 Come and see us.The 38 degrees ambulance will also be in Surrey Street at 12pm and conveying the 38 degrees petitions to local Hallam candidates at Wesley Hall in Crookes for 3pm.
25th April - March through Sheffield Hallam, with the People's NHS and 38 degrees
28th February 38 degrees petitioning around Sheffield http://www.thestar.co.uk/news/health/local-health/campaigners-take-to-sheffield-streets-in-fight-to-save-nhs-1-7132981
22nd November Leafleting in Sheffield City Centre from 12.00 pm in support of the NHS strikers. For A5 and A4 copies of the leaflet which has more information on it see the Campaigns Page at our website
24th November NHS picket lines from 7am to 11am. Rallies at the Hallamshire and Northern General (Herries Road) at 10 am.
24th JULY 2014 Public Meeting jointly with Sheffield Medsin
We were proud to support the Jarrow to London march for the NHS, organised by Darlington Mums passing through Sheffield on August Bank Holiday Monday. http://999callfornhs.org.uk/ Thanks to everyone for helping and joining in.
Is our NHS really in crisis? Behind the headlines and soundbites
Panel discussion led by GPs and health experts from the NHS and universities.
For past activities see our website www.sheffieldsaveournhs.co.uk
Saturday, 25 October 2014
Stevens is adamant that the NHS needs to change in order to meet new demands, new expectations, higher standards and new technology and suggests that these changes need to be locally designed (within a choice of nationally approved models) and locally led. "England is too diverse for a ‘one size fits all’ care model ... Different local health communities will instead be supported by the NHS’ national leadership to choose from amongst a small number of radical new care delivery options, and then given the resources and support to implement them where that makes sense."
Stevens is reasonably frank about the money needed to finance the NHS (which secures him internal support) and he also makes a perfectly justifiable case that the NHS cannot survive if it is expected to pick up an infinite bill for lifestyle related ill health. He does not present competition as the key dynamic of change, indeed does not explicitly mention it at all, thus enabling Burnham to claim he is on their side and Hunt to mock Burnham for raising false fears.
But behind these bold strokes lie a multitude of problems.
The first question to ask is 'Is this a new version of the Tory "No top down reorganisation" pledge of 2010?' The paper rubbishes frequent changes of direction by politicians wanting to reform the NHS and Stevens insists that he is about changing the front-line, not the back-room. The problem is that this leaves the existing backroom (with its market oriented structure) in place with CCGs having an expanded role. The about to be marketed Commissioning Support Units, which have a big influence of CCGS and may go into the hands of privateers are not mentioned. Councils and elected mayors are seen more as a source of public health support than joint commissioners - Stevens is at best luke warm about Health and Wellbeing Boards - which reflects a general and long-standing hostility within the NHS to being under any sort of direct local political control. Meanwhile we hear that GP-led CCGs will be given more collective responsibility to develop primary care. There are clear and major conflicts of interest here - which have already surfaced in discussions about whether CCGs and NHS England can co-commission local GP contracts. There is little detail about how exactly changes will be brought about but either the existing structure will produce a bias towards the market, or there will be further backroom reorganisation because the current structure is 'not fit for purpose'.
Secondly it is perfectly possible that the front line reorganisations planned will actually, under the disguise of integration, create a number of new local services which CCGs may either want to put out to tender, prompted by the CSUs, if current laws and regulations stay in force, or which will be much more bite-sized enterprises for future privatisation, just as in social care.
Thirdly Stevens tries to give the impression that he recognises the need to carry staff with him especially as the new models will require major adaptation by staff, and he continually speaks the language of incentives, whether for producing better services, or for improving their own health. However if these are on the lines of the arguable unethical offer of payment to GPs to diagnose dementia, they will cause chaos. Yes he says that pay freezes cannot last indefinitely but that's not much reassurance when he talks about ensuring pay is in line with the private sector (which generally means high salaries for the top managers and low wages / zero hour contracts for the rest).
Fourthly there is quite a lot of faith in the benefits of technology - diagnostic, assistive, informational etc. We all fantasise that this might be so, but efficacy and patient benefit are not yet adequately evidenced on a broader scale.
Fifthly we don't yet know what integrated care will actually mean in practice - though there will be a chance to understand it in Sheffield as local proposals for the largest Better Care Fund in England take shape over the next few months. Again the benefits to patients need to be clearly evidenced, and not just be aspirational.
Fifthly the politicians have already run away from the financial analysis. OK it's early days but they don't want this commitment even based on Stevens' optimistic predictions of efficiency gains. Already the NHS is saying that most of the easy efficiency gains have been made. Future efficiency gains will mean job losses and quite possibly more low cost outsourcing. Stevens observes about work-place health that mental health problems have overtaken MSK as sick leave issues. Well, quite. In the NHS, as elsewhere, we all know that this is partly related to squeezing the staff harder as part of efficiency measures. Nothing is said about dismantling the expensive structures for administering a market in healthcare. Nor, as Clive Peedell has pointed out for the NHAP, has Stevens said anything about how the cost of the new investments he proposes will actually be met.
Stevens' financial predictions are also based on more effective prevention services. Well these may or may not happen / be effective, but they certainly won't under this government which has caved in to commercial pressures from the alcohol, tobacco and fast food industries, undermined public provision of all sorts and, through its attacks on benefits, women and disabled people has increased the ill health of the very people whom the NHS identifies as having the most needs.
There's a lot to analyse and debate in Stevens' proposals - and there are plenty of interesting and positive ideas to work with. It is not however any sort of yellow brick road for NHS survival. Indeed a senior lawyer at Price Waterhouse Cooper has commented to HSJ: “There will be a number of challenges including leadership, culture, how money flows in the system, and allowing time for improvement. But the most difficult challenge will be political. The radical agenda will require political leaders to pick up the gauntlet thrown down by NHS leaders. Politicians will need to embrace the reform challenges as well as the resource challenges. Change of this scale will not be pain free. Each political party ahead of the next election will need to set out how it plans to champion changes to local health services including hospitals.”
So pressure needs to be kept on the parties - particularly Labour - to set out how in more detail what their proposals may be: both for finance and for structure. Here are a few possible key points.
The NHS needs a minimum 4% annual real terms increase, and all parties should recognise that NHS funding can't be seen in isolation from what is happening to public services in general.
Even given the need to keep reorganisation to a minimum, the competition regulations must be removed, the market-oriented structure replaced and injurious PFI contracts renegotiated or abolished.
National and local decision making must be democratically accountable and transparent.
NHS staff must be valued with reward not just words and positively enabled to increase their ability to adapt to changing needs.
Rushes into outsourcing must be prevented especially in the likely to be vulnerable community services.
The assumptions of austerity budgeting and a low tax economy need to be challenged
Management and government cannot ignore how the more and more overt and shameless 'squeezing' of staff to produce more and more will eventually lead to service failure. As experienced staff haemorrhage to better paid and less stressful jobs abroad, managers scrabble around competing with each other to attract nurses and other staff from less well off countries who need their own trained staff. Simon Stevens skirts round this in his Five Year Forward Look, but staff issues need to be addressed directly. Treating staff decently is not a luxury - it is essential to a caring service.