(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 in
creasingly 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 campaig
ners 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.

NHS21END_(Small)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


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

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


Tuesday 22nd September, 7pm screening of Sell Off, attended by well over 100 people.

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

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.

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. Thanks to everyone for helping and joining in.

24th JULY 2014 Public Meeting jointly with Sheffield Medsin

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

Tuesday, 24 November 2015

Osborne's £3.8 billion sleight of hand

So Chancellor Osborne is claiming to be rescuing the NHS by frontloading (significant increases beginning this year) the £8billion+ it promised over 5 years, rather than backloading as originally intended.

The Government is still claiming that this will pay for a 7 day NHS (which hardly anyone wants - e.g. 2/3 of patients just surveyed by the Royal College of GPs say the government should improve existing services before stretching them) and might even allow Hunt some margin to settle with the Junior Doctors. However a good chunk of the funding will be swallowed up by the deficits already run up this year throughout the NHS. Nearly everyone outside the government agrees that the £22 billion efficiency savings which Simon Stevens imagined as balancing the books cannot be achieved so the deficit will still keep on growing.

Except that there are some private sector suppliers rubbing their hands, not in healthcare but in IT. Articles from Computer Weekly and unearthed by Our NHS state that the Department of Health, advised of course by the notorious McKinsey consultants (whose 2010 Labour commissioned report provided part of the motor for the Health and Social Care Bill), has asked the Treasury for £3.5 billion for IT investment (including electronic records) in order to save up to £8billion. I think we've heard this one before and the problems associated with the implementation of STHFT's new Lorenzo system (palmed off by the government to desperate Trusts despite its being generally regarded as unfit) hardly help the credibility of IT led solutions. But rest assured - the Department is spending money on developing a digital maturity index to be applied to CCGs and health economies by the Care Quality Commission!

So there is going to have to be a lot of pressure to try and ensure that any additional funding does actually do some good. There is an additional problem in that the budget for the following 2 to 3 years is pretty flat. Real terms investment will drop to just £500m in the third year, before rising again to £1.7bn in 2020-21. And beware of percentages - different estimates of the total Department of Health budget are being used; also details of the overall budget under tomorrow's full spending review announcement are still not clear.

And where is the money coming from? Well, partly from the non ring-fenced parts of healthcare, including nurse training, public health and the Care Quality Commission, while the cuts in social care are being allowed only a smidgeon of necessary relief by allowing councils to raise an extra 2% in council tax - for which of course they will get the resentment. And then of course from all the other services (and service users, benefit recipients, tax credit claimants etc). Announcing the NHS budget separately from all the others shows that the Treasury still has not made the connections.

It's not exactly a recipe for national health - and incidentally the government yesterday closed a short and less than token consultation on its mandate to NHS England which was not publicised and barely noticed until Keep Our NHS Public people kicked up a stink because the website would not even accept responses to the consultation! In it they claimed that improving the nation's health was one of their overarching objectives. So why cut public health expenditure? And why put out an 8 page mandate which mentions staff only once?

The Attack On Junior Doctors Is An Attack On Us All

SSONHS was represented at the Junior Doctors October protest in Leeds. This update is by SSONHS supporter Rachel Hallam and written for the Sheffield Student Union paper Forge Press November 22, 2015

On 28 October, around 250 Sheffield students travelled up to Leeds to join a 2,000-strong protest against the new junior doctors’ contracts. This protest mirrors protests and marches taking place up and down the country (including a march of 20,000 in London) in the past two months and support has been building to oppose contracts which are unsafe for patients and unfair to doctors.

The “non-negotiable” terms of the new contract are an extension of the existing standard working time of junior doctors from 60 to 90 hours per week, changing ‘social hours’ to 7am-10pm Monday to Saturday. This means that Junior Doctors will be paid the same for working 9am on a Monday morning as they will for working 9pm on a Saturday.

The new contracts put an end to banding payments, which have built-in safeguards to prevent excessive hours and to ensure sufficient breaks. This means there will be no way of preventing unsafe hours from being worked or to guarantee junior doctors are paid when shifts overrun.

Changes to pay progression will impact heavily on part-time workers and will put junior doctors off undertaking specialist training, in addition to disadvantaging those wishing to take maternity leave.

These changes will affect the quality of life for those giving care, overall exacerbating the health inequalities already rife within the UK. Get the 83a in Sheffield from Fulwood to Ecclesfield and the life expectancy of the people around you drops by a year for every three minutes you travel. GPs who are tired and demoralised will not be able to treat their patients to the high standards NHS patients deserve.

The British Medical Association (BMA) balloted its junior members in England for industrial action, with an almost unbelievable 98% voting in favour. If strike action takes place, the BMA require the following concrete assurances before re-entering into the negotiations with NHS employers:
• Proper recognition of unsocial hours as premium time
• No disadvantage for those working unsocial hours compared to the current system
• No disadvantage for those working less than full time and taking parental leave compared to the current system pay for all work done.
• Proper hours safeguards protecting patients and their doctors

Industrial action for junior doctors poses some serious questions to medical students: do they leave their placements to support their colleagues and defend their future careers?

The General Medical Council say that a medical student is “unfit to practice” if their attendance is less than 80 per cent, so medical schools are currently unable to explicitly support their students in strike action. It will come down to the individual’s decision if they want to join the junior doctors on the picket line.

If medical students do attend placement on the days of the strike, they risk the pressure of doing more procedures unsupervised, on understaffed wards, putting themselves and patients at risk. If they don’t, they risk penalisation for their absence. Caught between a rock and a hard place, they now need as much support as possible from their peers and lecturers.

How does this fit into the NHS as a whole? Since Health Secretary Jeremy Hunt refuses to back down on the most contentious issues of the Junior Doctors contract, health workers and patients must unite to defend their NHS. If the BMA (the union Aneurin Bevan had to pay off in order to found the welfare state) isn’t safe, then nobody is.

Monday, 7 September 2015

This is the month in which NHS bodies hold their annual meetings which are supposed to be a key part of their accountability to the public. Annual Reports are presented, together sometimes with presentations highlighting a particular piece of the Trust's work. Then there is opportunity for public questions to the Trust Board. The STHFT and SHSCT meetings are usually well attended. Whereas the CCG presents a Commissioning point of view, this is a chance to hear from the Chair and Finance Directors of providers. Expect gloomy predictions about finance. (This is the only chance to question the STHFT Board as it is the only local Trust not to allow questions at the monthly Board meetings.).

Thursday 10th Sept CCG Annual Meeting 1.30 for 2pm at the Source. Details here.

Tuesday 15 September 2015 Sheffield Children's Hospital Annual Members' Meeting 5.30pm refreshments / 6.00pm start
Helena Davies Lecture Theatre, Sheffield Children's Hospital. "The Annual Members' Meeting is a great opportunity to find out about what has been happening at the Trust during the last year and hear about our plans for the future. This year's meeting will also have a special feature on the development of the Trust's Respiratory Team. If you would like to attend please contact"

(TUESDAY 22nd September 7pm SSONHS screening of Sell Off + guest speaker and performance. Theatre Delicatessen The Moor, S1(where the old Woolworth's used to be)

Wednesday 23 Sept 12.30-3.30 pm Sheffield Teaching Hospitals Annual Members Meeting Meeting 12.30 prompt followed by stalls highlighting research in SAHTFT. Sandwiches provided. Lecture Theatre 2, Medical Education Centre Northern General Hospital. It's usually quite full so reserve your place by emailing

Thursday 24th Sept. 2pm - 4pm Sheffield Health and Wellbeing Board 2pm - 4 pm Sheffield Town Hall. Papers will be available on line from 18th Sept here . If devolution of health has featured in the local proposals submitted to government this week, this is as good a place as any to ask questions about it.

Tuesday 29 September 2015 Sheffield Health and Social Care Trust Annual Members Meeting. 12.45pm to 4pm Executive Suites, 2nd Floor, Sheffield United Football Club, John Street, Sheffield. Information about the meeting will be available on the website in the next few days. To book a place email

Tuesday 29 September 2015 Yorkshire Ambulance Service Trust Annual General Meeting (AGM) 10.45am Presentation on NHS 111 Service. 11.15am - 12.30 pm AGM. Trust Board Meeting held in public between 1.00pm and 3.30pm Doncaster Racecourse, The Grandstand, Leger Way, Doncaster, South Yorkshire, DN2 6BB. If you would like to attend the meeting and lunch, please email or telephone 01924 584416.

Thursday 1st October Sheffield CCG Governing Body meeting in public 4pm Darnall.

Tuesday, 28 July 2015

The future shape of NHS services in Sheffield

Sheffield CCG has been running a series of workshops in Sheffield entitled Changing the Balance - A 2020 Vision of Health and Social Care in Sheffield.

Changing the Balance - A 2020 Vision of Health and Social Care in Sheffield; (Health and Wellbeing Board) The notes of the first 2020 vision meeting in May are here. There are further similar events coming up on 12th August and in early September. See here. The introduction highlighted an expected £65m funding gap for the NHS in Sheffield by 2020 and set increasing demand caused by an ageing society, more long-term conditions and increasing expectations against supply issues: increasing costs of provision; limits to productivity gains; and reducing public expenditure. On an electronic poll most participants agreed that the NHS had to change but the changes were all discussed in terms of improving services within the current context of public provision and increased VCF participation.

This is certainly not the case in most areas outside Sheffield especially for those CCGs and parts of NHS England for whom only the private sector can deliver more cheaply and for those who continue to drive moves to an insurance based system (which the forms of Simon Stevens' Five Year Forward View' fit nicely). Sheffield may be one of the few places where there is still sufficient expertise, resource and collective commitment to make a realistic stab at delivering on its joint strategies but the history of attempts to make savings through integration, moving services into the community, increasing productivity, seven day working etc is pretty grim. See this Morning Star article by John Lister of London Health Emergency.

None of Sheffield's current rush of consultations touches the overall shape of services, decision making and accountability. The position of the biggest provider, the Sheffield Teaching Hospitals Trust, which also runs many community services, is difficult to assess and, for the first time, it expects to report a deficit this year because of the national tariff reforms. The Health and Social Care Trust is so concerned at the erosion of what others think of as its 'non-core' care services that it is considering setting up a company to bid more cheaply.

but things must shortly come to a head as the city-region faces up to George Osborne's challenges about devolution and his demand for a local decision before his autumn financial statement. Both the CCG and the Trusts are joining wider groups of similar bodies to make more regional decisions. Could 'local' (i.e. sub-regional as opposed to national) decision making (let's leave the mayor question for the moment) help Sheffield become safer in trying to pursue a continuation of publicly provided services or will the region be cast off with limited budgets, internal squabbling about financial allocations, unaccountable local processes and the final condition that the Secretary of State can prevent any action which he or she dislikes? And does devolution of NHS services itself mean the fragmentation of the NHS as a national service? The issue of localism in the NHS has tended to surface only in terms of the postcode lottery. The Medical Practitioners Union is one group arguing that moves to localism only make sense in the context of restoring the Secretary of State's duty to provide a comprehensive health service, but that won't happen for at least five years now. There is also widespread concern that this will mean local government and local politicians controlling NHS spending See John Lister again.

Locally Sheffield for Democracy has over the last year been raising significant questions about the format of the city region and its decision making, and is now taking these concerns into the devolution debate. SSONHS will also be tackling these issues in the coming weeks and raising questions for the CCG, the Council and other relevant bodies.

GP funding crisis update

Update 7th October. Practices are now having their special case applications considered by the CCG. Some practices with income loss have chosen to explore other solutions like mergers. The CCG is to become a Level 3 co-commissioner of primary care with NHS England which means that once again (as in the Sheffield Primary Care Trust abolished by the Coalition) commissioning decisions for Sheffield will be taken in Sheffield - though GPs are excluded from the actual decision making.

July 2015 A packed public meeting of the CCG goverening body on 16th July heard almost an hour of representations from the public, a presentation from the CCG and statements from NHS England, the Local Medical Committee and GP representatives of the four Sheffield localities. The CCG stated that the 11 practices most at risk were from different and differing areas of the city, not just disadvantaged areas but support for Devonshire Green and Page Hall was explicit, including from other GPS who supported the general principle of equalisation. In the end Members of the Board eligible to vote agreed the original proposal but with an apparently enhanced safety net (in terms of criteria rather than money)giving more weight to health inequalities, a commitment that no practice would be left unviable and an agreement to report back in public during September.

The CCG's relief was understandable. They took the risk of holding a complicated decision making meeting in public, they gave space to the public to voice their feelings, they gained a lot of useful feedback and they got their original recommendation through. Campaigners (especially the two practices most at risk) were also successful in getting very strong shows of patient support particularly from migrant communities which are not often heard, let alone seen at public meetings.

However for the most vulnerable practices the relief must have been more double edged. They could feel both pleased and relieved at some of the assurances given, but were also alarmed that little or no additional resources were being made available and that they would have to spend a considerable amount more time and effort to make very strong cases to prevent actual cuts in practice income and therefore services. The only disadvantage weighting used for the equalisation proposal has been the inadequate modified Carr-Hill formula from 2004 which does not include ethnicity or language and the new safety net measure have to recognise that this will not do and the CCG must be pushed to recognise the particular problems of serving transient populations where the list/per capita model of financing does not reflect patient demand. Development of these arguments, particularly from Devonshire Green, has been going on for a long time; NHS England and the CCG have no excuse for not producing appropriate, effective, fair and acceptable solutions. Some services will probably have to be shared with / co-delivered by neighbouring practices and as with most NHS reconfigurations, however justified, these changes may affect jobs, earnings and livelihoods as well as services.

Overall and not surprisingly GPs were overwhelmingly in favour of the equalisation policy especially now that collaboration and integration are being given a bit more emphasis than competition. All practices feel stretched and from a business point of view equalisation now makes more sense. This probably reflects the uneven development of PMS contracts where nationally some practices working with disadvantaged populations have sought to maximise the resources they can bring to meeting their health needs, but others have involved GPs finding ways of increasing their practice income without increasing services. The historical anomalies surrounding contracts have resulted in situations where neighbouring surgeries serving similar populations (including disadvantaged ones or communities with special needs) receive considerable different incomes. Interestingly the promotion of PMS income opportunities by Labour in the 2000s could be seen as reflecting Labour's belief at that time in competition and choice: unequal resources mattered less because they promoted competition between GPs which therefore increased patient choice. This is yet another of the ways in which Blairite Labour laid the foundations for Andrew Lansley.

SSONHS has actively offered support to the surgeries under threat and has received formal thanks from them. If progress on the safety net for practices is not clearly being made by September the next Business Meeting of the CCG on September 3rd and the CCG AGM on September 10th will have to be lobbied even more strongly.

Tuesday, 7 July 2015

Crisis and possibly closure for some of our best GP practices

NHS England has ordered that some of the ways in which GPs are funded has to be changed. Over the last few months we have seen practices all over the country, including Devonshire Green Surgery in Sheffield fighting the abolition of the Minimum Practice Income Guarantee. Now NHS England has ordained that another form of funding, PMS, should be phased out over a much shorter time putting 11 practices at risk in Sheffield.

Since the foundation of the NHS GPs have been independent practitioners working for the NHS on a contract basis. Following the abolition of Primary Care Trusts in 2012, contracts have been overseen by NHS England, although CCGs have recently been encouraged to get involved in co-commissioning. Traditionally these contracts have been for GPs to provide General Medical Services (GMS). The terms of the contract are set nationally and have undergone significant revisions at different times, most recently in 2004. However since about 1997 and more so since 2004 many practices have been on a more flexible contract called PMS (Personal Medical Services) which was intended to allow practices to tailor their services more specifically to local needs and priorities and which made it easier to employ salaried GPs. Also in 2004 there were changes to the basis on which GP core practice income was calculated; these were intended to make the income more sensitive to practice needs (including deprivation) but when the calculations were delivered to practices there was a huge outcry because nearly every practice would lose money and many would be made financially unviable. As a result the formula was revised during a heavy week of negotiations and an emergency correction factor was introduced, the Minimum Practice Income Guarantee (MPIG) to save practices, especially those most at risk. The NHS is full of such measures which are introduced because some other decision has had unintended consequences, which is partly why NHS funding is so complicated - and often unfair.

Over the last 10 years there have been significant changes in the expectations of and demands on General Practice, especially the services they provide within surgeries and NHS England has been looking for savings or reallocations. A study they commissioned suggested that these days there is far less practical difference between GMS and PMS surgeries and that PMS practices are actually receiving a premium (i.e. extra money which is not reflected in extra services) put nationally at £260m. Whether this is correct or not is open to argument. In addition NHS England decided that the MPIG was having less and less effect overall and that it should be phased out, although it admitted that this would seriously affect the practices which MPIG was originally introduced to help, among them Devonshire Green Surgery. MPIG is already being phased out over 7 years and this is what Devonshire Green has been protesting about. Other surgeries which have been vigorously campaigning include the Limehouse Practice in Tower Hamlets. See this facebook page

NHS England has now also instructed that the PMS system should be abolished but within a much shorter period. Local CCGs have been told to distribute the savings around local GPs in whatever they determine to be an equitable manner. A report to the CCG Governing Body meeting of 2nd July recommended that this surplus ( the estimated local premium totalling around £2.9m) should be redistributed equally around local practices, subject to certain adjustments for deprivation weighting and the possibility that practices at risk could apply to the CCG for special consideration because of the services they provide.

The report said that 62 out of the 87 practices in Sheffield would lose out, with 11 practices losing more than £20 per weighted patient – a potential loss of more than £200,000 per year. Without special help, these practices may not be able to survive so that thousands of Sheffield patients, including many from vulnerable groups, face the possible closure of their General Practice during the next 18 months. The full list has not been made public because of confidentiality issues but it includes Devonshire Green Surgery and Page Hall Medical Centre. Doctors from both these surgeries attended the successful SSONHS meeting last Thursday.

The CCG had to deal with this in an extraordinary way. GPs were excluded from the decision making (because of their financial interest) leaving the CCG inquorate, so it had been decided in advance to run a contiguous sub committee of non-executive directors, CCG officers and the co-option of regular participant observers. They were told that the decision had to be taken fairly quickly or more problems would arise.

In the public questions part of the meeting the paper had been challenged by Dr Graham Pettinger from Devonshire Green Surgery and by a representative of Sheffield Save Our NHS on the basis that it contained no Equality Impact Assessment and that the criteria for special help seemed far too rigid.

Also in the preliminary discussion Dr Mark Durling from the Local Medical Committee representing all GPs said that general practice faced a catastrophe. Demand, stress, financial pressures and bureaucracy were causing many middle aged doctors to leave. The historical system of GP funding does not work properly but the current proposals, as they stood, would severely affect practices with dedicated doctors and staff who were putting all their resources into the care of their patients. The implication of Dr Durling's remarks is that these are practices which really are using their PMS money for extra services, and now risk being put out of action because of this. The notion that these practices are receiving an undeserved premium is quite wrong.

In the formal discussion on the paper the CCG officers apologised for not including an EIA and said that some of the criteria for special help could be adjusted as could the sum set aside from CCG funds. However they said that a decision was needed urgently as further uncertainty might lead doctors in some of the non PMS practices to start withdrawing services such as phlebotomy which they are having to meet out of their own core funding and sending patients to hospital instead. Board members seemed to accept during the meeting that there was not an agreed interpretation of word 'equitable' which is required by NHS England as a criterion for this redistribution. In this case we are talking both about effects on health inequalities and equity as fairness for practices. They were also troubled by the lack of information especially the EIA and decided to defer the decision for a fortnight.

SSONHS members have been supporting Devonshire Green from the start of their campaign; we alerted practices about the impending decision; and since the meeting we have been liaising with some of the GPs from the practices at risk. We want to see doctors working together to find the best way of supporting the varied need of patients across Sheffield. We do not want to see those doctors who have made huge efforts to connect with their local communities and meet their needs being hung out to dry.

There is also a further risk to practices consisting of salaried GPs and run by the Sheffield Health and Social Care Trust. These contracts are due to expire soon meaning that the practices may be put out to competitive tender and fall under the control of private companies such as Virgin. Independent research has shown that GP services run by private companies are less effective than NHS GPs on 14 out of 17 measures.

The doctors have been discussing the best way to campaign; it's not easy because the interests, needs and finances of all the practices are different making common ground more difficult to establish in detail. What's more they are forced to compete with each other for survival - which would not be happening if the overall funding to GPs was not being reduced by the Government. It is also obvious that any practice closures or service reductions will put far more financial pressure on other parts of the system.

Devonshire Green has had its own campaigning site for some months, and this will be regularly updated. See here Other practices may set up their own Save Our Surgery campaigns but will, we hope, also link up to provide a more concerted public presence.

SSONHS supporters who are patients of the practices at risk are urged to offer direct support when they identify themselves and to support any more centralised protests - see our website for updates. Things may develop quite rapidly unless the practices receive adequate assurances from the CCG. Already in the last 6 months NHS England has been forced to abandon threats of practice closure in both Sheffield and Goldthorpe when local patients have organised to protest.

Friday, 8 May 2015

So the Conservatives won the election ....

Update 3rd June. We're pleased to report a big surge in interest since the election as people want to know how they can resist the threat of a 5 year Tory government both to the NHS and to health in general. Come to our public meeting on 2nd July (7pm Quaker Meeting House) to find out more.

Original Post Well it wasn't because of their policies on the NHS. More a matter of a heavily funded press-backed fear campaign based partly on xenophobia against an opposition which at a national level lacked presence, profile, conviction, narrative and personality. To the myth that Labour were mostly responsible for the banking crisis is now being added the myth that Labour went too far to the left. As if. It made mild moves about taxation, refused - for business reasons - to back an EU referendum and offered little in the way of redistribution - buying into the shirkers smears. Now it will have to regenerate.

What does this mean for the NHS? Well the first thing to recognise is that the national and local campaigns for the NHS have not been wasted. They placed the NHS high (though not high enough)among voter priorities and held at least some of the worst intentions of Lansley's reforms in check. They also forced Cameron to pledge continued funding for the NHS. Now we can expect to see the further reconfigurations of the 5 year Forward View being rolled out along with attempts (which will include cuts) to deal with the immediate funding crisis. One of the most crucial tests will be seeing how the government deals with the likely vast increase in hospital financial 'failures'. Will offers to the private sector be their first solution and is so will the private sector bite? There will need to be significant and prolonged campaigning as has recently begun in Staffordshire, backed by national liaison through organisations such as Keep Our NHS Public (to which SSONHS is at present affiliated). Trades Unions will need to improve the ways they informing the public and canvas support.

At the same time campaigning will have to be well informed. Resisting all changes to hospitals and other services, including transfers of services to community bases, will neither be helpful nor successful. We will have to disentangle all the projected winners and losers from each proposal.

There will also be the question of devolution and whether it will, as in Manchester, include health spending. Local politicians, especially Labour, will need persuading not to accept chalices which contain the poisons of limited funding and limited accountability (national or local) as well as others to be identified.

Health treatment for migrants will also be an issue, with the Tories likely to use this as a pilot for further charges.

Neither Cameron (nor Hunt if he continues) will embark on policies which can be easily branded as the breakdown of the NHS. They will be more subtle building on the the quite widely voiced feeling (including among doctors) that the conditions of a service matter more than who provides it (without seeing how the two are related).

But most importantly of all, the NHS cannot be viewed in isolation. Cameron refused to say where his promised funding of the NHS would come from - and remember it was on top of the £12billion welfare cuts. If he works to a fixed budget, backed by his promised tax lock, all other public services, especially those for the poorest, will suffer worst - thus causing even more of a burden on the NHS. This cannot be allowed to happen - it will not have been this for which people voted - rather that they felt safer under Cameron. Instead they have voted to live on a cliff edge which is being eroded from below. Disasters will undoubtedly follow.

To continue campaigning SSONHS will need more support from all those dismayed at the scale of the Tory triumph and who are rightly fearful of what it will mean for all our services, especially the NHS.

If you are not already a SSONHS supporter and want to be more involved, let us know by emailing We will need people who are willing to get involved all sorts of different ways of trying to protect the NHS, from making sure that the public are aware of what will be planned to getting involved in some of the detailed consultations and engagement we can expect from our local NHS.

Wednesday, 29 April 2015

Privatisation of the NHS

There was a dire health debate on the Daily Politics show this afternoon, which proved to be another example of how to engender despair at our self aggrandising macho political system. The only woman, Jillian Creasy from the Greens, fought her corner but was allowed no chance to try and change the terms of the debate. What a contrast from some of the local discussions in Sheffield which have brought people together in a genuine effort to bring about service improvement as a partnership.

During the discussion (or rather during the series of interruptions)it became clear that mainstream journalists are willing to take on defenders of the NHS as a public service by arguing that the NHS is not being privatised because no shares are being sold. This has been going on since 2011.

Let's be clear. Shares are not being sold because at the moment there are no shares to be sold but that doesn't mean that they couldn't be. On the provider side Trusts were created by the Tories for the internal market, then made into more independent financial entities by Labour (Foundation Trusts)- which could easily become more independent still (those that are not bogged down in bankrupting PFI agreements at least); while the proposals in the Five Year Forward View can easily lead to the creation of local health corporations.

But shareholding isn't the point. Creeping privatisation is the normalisation of commercial and market relationships in the NHS by enforcing competitive tendering and allowing the private sector 'a level playing field'. This changes the value base of the NHS and also leads to its resources being fed into the pockets of private providers and shareholders. (That's the theory - though in practice private contracts are proving more loss making than profitable at the moment.) For a patient it means that her or his service is dependent on decisions made by commercial providers for commercial reasons which do not have the patient's interest as their prime objective. If there are issues or gaps, resolution will depend not on what is best for the patient but what is in the contract. And of course there is no security because a private provider can simply walk away from provision leaving the NHS to pick up the pieces.

Both Andrew Neill and Jeremy Hunt argued that the increase in contracts to the private sector was relatively small compared to what Labour had started but Andy Burnham was right to reply that it is not so much the value of the contracts being given that needs to be taken into account (a few are huge but the most expensive NHS services remain in house) but their number - leading to a huge increase in the number of occasions that a patient will encounter private providers with no accountability to her or him, and also to the fragmentation of services.

The overall scenario is best put by James Meek in his book Private Island (Verso 2014.)The NHS 'hasn't been privatised and the political parties vie with each other to show that it's safest in their hands. Yet it has been commercialised and repeatedly reorganised, with competition introduced, in such a way as to create a kind of shadowing of an as-yet-unrealised private health insurance system.' (p19) and 'The more closely you look at what has happened over the last twenty-five years, the more clearly you can see a consistent programme of commercialising the NHS which is independent of party political platforms.'(p163). See also his recent articles .

There is little evidence that private contracting is working. Apart from the well-known failure of Circle in the acute sector at Hinchingbrooke and the chaos engendered by some of the contracts elsewhere ( Muscoloskeletal services in Bedfor, Dermatology in Nottingham) a study just published in the Journal of the Royal Society of Medicine has found that alternative providers of primary care, including private companies (such as Virgin) and voluntary organisations, do not perform as well as traditional GP practices. Among the differences between types of practices, alternative providers had worse results for patients’ diabetes control, higher hospital admission rates for chronic conditions, and lower overall patient satisfaction. See also various press reports including this one

We may be able to guess the stance of the next government by its decision about the almost completed privatisation of primary care support services (the backroom services for GPs, dentists etc). This is the one for which Lockheed Martin was not shortlisted but the three leading bidders are all private sector. NHS England has already announced the impending closure of more than 9 offices with something like 348 redundancies (about half voluntary). The result of the tendering process is not due to be announced until after the election but will need to be one of the first operational decisions permitted or refused by the new Secretary of State.

There is also the impending privatisation of cancer care at Stafford. Protestors will be marching across Staffordshire during the May Day weekend. Join them if you can.
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Tuesday, 28 April 2015

Is the NHS in crisis? 3) staffing

This is the third in a series of comments on key issues in the NHS. They don't represent an agreed or formal position of SSONHS but are a collection of thoughts broadly consistent with views across the group's point of view.

Earlier in April the Daily Mail ran a campaign to show how badly the NHS is working - designed of course to soften up the argument for privatisation - choosing their examples carefully - like the lead off story about the £25 million which Trust bosses have apparently awarded themselves in pay rises over the last year. (In Sheffield, Sir Andrew Cash, (the second most highly rated Trust boss in England) has remained in the same pay band between 2011/12 and 2013/14 (but this is £215-£220,000 plus increasing pension and other benefits). However the Director of Finance saw his payband increase in 2012/13 from £150-155000 to £170-£175000 whilst the Director of Service Development saw her pay move from £125-130000 when first appointed in 2011 to 140-145000 last year.)

The party leaders have been proclaiming figures for extra recruitment of doctors, nurses and other front line staff, most of which make little sense, either in terms of where they would come from or where they would go. We've heard about the number of GPs likely to retire in the next few years, we know about the shortages of nurses on wards and in the community, and we know about the lack of staff willing to maintain A&E and ambulance services. Promises about recruitment make no sense if new staff pick up training and experience and then leave for the private sector or abroad - while Trusts are spending huge amounts on recruiting from abroad. (The same is happening with teachers.)

Meanwhile the Tories are playing confusing number games with staffing changes since 2010 (made all the more difficult by the number of staff they have fired and then rehired). Tory leaflets claim that 'Under David Cameron we've got 9,500 more doctors, 7,000 more nurses, and 2,200 more midwives caring for us, (since 2010).' Obviously with the ringfencing of the budget you would expect that overall numbers would not have declined - even with the redundancies in 2010-11. (Health minister Dan Poulter said last year that an estimated 3,950 NHS staff were made redundant between May 2010 and November 2013 and subsequently rehired, 2,570 of them having been employed on a permanent basis and 1,380 on fixed-term contracts.) Many of the 'efficiency' savings have come through reallocations or pushing people harder rather than staff reductions but, in the words of one Sheffield Trust Finance Director last year, there is nowhere to go other than squeezing staff still more.

However all the figures mean different things, and, for instance, depend on whether they refer to the actual number of employees (headcount) or Whole Time Equivalents. There may be more staff but working fewer hours so the WTE figure will vary accordingly. Figures are also affected by downbanding and outsourcing (when staff TUPEd over to a private contractor no longer count as part of the NHS workforce).

According to the NHS Information Centre the total number of medical and dental staff in 2010 was 97,636 (WTE) in 2010 and 104,501 in 2014. In general there have been increases in all specialties and in General Practice. (Incidentally among hospital and community health medical staff, 66% qualified in the UK, 8% in Europe and 26% elsewhere.) However among GPs, since 2004, there has been a 46% increase in the number of female GPs (headcount) and a decline of 4.7% in male GPs (headcount).

The employment count figures are rather different for nurses. In 2010 there were 323,783 total qualified nursing staff (WTE) but this number declined to 319,755 in 2012 before going up again (post mid-Staffs) to 322,635 (WTE) in 2013. The most significant and persistent decline is in mental health nursing (including community psychiatric nurses) and learning disabilities (where changes towards more community settings may have had an effect). A decrease in the number of nursing assistants was matched by an increase in the number of healthcare assistants. The number of midwives increased from 20,126 in 2010 to 21,670 in 2014 (WTE).

And of course the NHS spends a fortune on (around £2.5bn per year) on agency staff and locums - with a big proportion of that going to the agencies.

But the numbers game is probably not as important as the conditions. Although the NHS staff survey reports some increases in job satisfaction etc over recent years, it is astonishing that 24% of NHS staff said they had been bullied or harassed by managers or colleagues last year. A Unison survey of 5,000 nursing staff reported that half who responded (49 per cent) thought that staffing levels had got worse since May 2010. Nearly two-thirds (65 per cent) reported that patients missed out on care due to understaffing, while around half (49 per cent) reported not having enough time with each patient. 45 per cent felt there were not adequate staff numbers to deliver safe and dignified care; 70 per cent were unable to take all or some of their breaks that day; 65 per cent reported care was left undone due to understaffing; 75 per cent worked up to an hour of additional time, but only 8 per cent were paid for working overtime. One staff member surveyed said: “I could not offer adequate food or fluids due to workload. Another said: “I was unable to give pain relief immediately as it is a controlled drug and two nurses are rarely available to check drugs for long periods of time.”

Meanwhile 'fear stalks the corridors' as the relentless push from patients on the one hand and managers on the other squeezes the frontline workers in the middle. Clare Gerada wrote recently about the toxic effects of fear of annihilation, loss of jobs, loss of service, and humiliation (on doctors as well as nurses and other workers). Recently the huge London Trust Barts Health was put into special measures (with the subsequent resignation of senior management) and particular reference was made to the appalling and bullying working conditions at Whipps Cross. An occupational therapist, Charlotte Munro, who was a long standing trade unionist, had spoken out against conditions and against cuts to the stroke service in 2013 and was dismissed that November. However the better news is that a huge local campaign and a vigorous defence from Unison finally resulted in her reinstatement following a tribunal decision last month.

The lesson from all of this is that numbers, while important, are not the whole answer. Politicians need to recognise that the success of the NHS needs to be measured not just by numbers, nor even just by outcomes but also by the health of the organisation. And the health of the organisation is not just about wellbeing, it is about enabling staff to change practice to improve services or meet changing needs. When politicans can find ways of boasting not just about improvements for patients but about how they have made the NHS really worth working in, rather than staff being taken for granted, we will know they are getting somewhere.

Is the NHS in crisis? 2) Demand, rationing and charges

This is the second in a series of comments on key issues in the NHS. They don't represent an agreed or formal position of SSONHS but are a collection of thoughts broadly consistent with views across the group's point of view.

We hear a lot about the rising demand on the NHS - to do with demographic changes, more advanced diagnostics, more technological treatment, rising expectations etc. We also hear from people on the front line increasing resentment at what they perceive as abuse - something which leads some NHS workers in the most vulnerable areas such as GP surgeries and emergency medicine openly to canvas the idea of charges (either generic or linked to causal factors such as alcohol). Even more punitively the call to exclude people such as smokers or who are obese from treatment until they change their lifestyle is gathering more adherents.

As with funding crises, fears about demand have a long history. On the first day of the NHS one group of doctors and healthworkers in Birmingham barricaded themselves into their clinic, only to find, when they peeped out, an orderly queue of mothers and babies. But demand was much greater than expected, not just for medicines, but for aids like cottonwool (rationing was still in force). People place their hopes in medicines. There are also the abusers, the careless, the thoughtless and those who think they are entitled to get something back for their taxes, just like people who bump up their insurance claim if they have been paying premiums for years.

Austerity has its own answer to the demographic change. Life expectancies for women aged 65, 75, 85 and 95 all fell in 2012 compared with a year earlier, the first slip in all age groups in nearly two decades. There was also a small drop in life expectancy for men at ages 85 and 95, while longevity for men in the two younger age groups stagnated, according to a Guardian report referring to Public Health England. Although the figures for 2013 did not show any further falls, the life expectancies for men and women aged 85 and 95 failed to recover to 2011 levels, which were the highest to date. This looks like one gift of the Coalition's austerity programme - to manage demand by killing people off earlier especially if they are no longer in the workforce. If the Conservatives are elected they promise to make things worse. Apart from the cuts they also threaten in their manifesto impose benefit sanctions on people who won't accept recommended medical treatment.

Debates over priority for treatment are complex but nearly all the electoral talk has a victim-blaming edge to it. Rationing by severity of condition and predisposing behaviour are one tack - already introduced by some CCGs. But lifestyle issues are not just down to individual decision. Apart from restrictions on budget (so that the poor always have the poorest choices) health-affecting lifestyle choices are driven by commercial interests - especially the tobacco and alcohol industries, soft drinks manufacturers and the purveyors of fast food. At one stage it looked as if the Tories were actually going to stand up to the brewers, distillers and supermarkets by introducing minimum pricing. But then the public health researchers (principally from the University of Sheffield) who had shown the positive effects of this were frozen out of the Department of Health which set up meeting after meeting with the manufacturers. We also know that poverty and austerity ensure that the proportion of junk food consumed is much greater. One million people are using food banks but the only food available there is prepacked or processed with healthy options restricted.

We've heard over the last few years that fewer young people are taking addictive drugs and (until vaping got going) smoking. It is very likely that some of this was due to the Healthy Schools movement (eventually partially funded by the Labour government) which grew rapidly from 2006 but was then largely sabotaged by the Coalition's drive towards Academies. There is a huge amount of potential work to be done here but it threatens significant sectors of economic activity with access to powerful lobbyists.

So what about patient charges? Dr Mark Porter from the BMA (an opponent of the Health and Social Care Act and of charging) recently raised the spectre of extended charges (which currently raise about 1% of NHS income). The Coalition has already strengthened hospital charging mechanisms for overseas visitors and migrants (e.g. the new pre-entry charge for temporary migrants) which it was considering extending to primary care. This move was 'deprioritised' before the election. There is apparently intention to undertake an independent Major Projects Authority review into the impacts of charges on vulnerable groups - which could be a foundation for extending charges more widely. If current coalition policies continue, it is quite likely that the issue of potential primary and A & E charges will be put out to further public consultation in the autumn and this could include all NHS services inside and outside hospital as well as those commissioned from outside providers.

There is no doubt that charges totally undermine the basic concept of the NHS as a universal service. All of us will know people who have not taken up prescriptions, particularly for longer periods of treatment, because they cannot afford them, or people on low incomes who have had to cancel even dental checkups because there is no money that week for family food. It was shocking to read recently of the increase in DIY dental kits, including tooth extractors. Would everyone be charged (the £10 per GP visit for example) or would there be a vast range of exemptions? If only selected groups were charged (e.g. people with alcohol problems) who decides whether a charge is appropriate. And what is the difference between an alcohol-related injury and a sports one? How much would it cost to administer a charging system. And how much would it cost in terms of delaying diagnosis and treatment? There is no evidence to suggest that charging would not cause and cost much more than it might save.

Demand needs to be managed but in other ways - and it is possible to rethink the whole way in which people access the NHS. Technology may be part of the answer but making basic advice more available is also important. Meanwhile people are being blamed both for worrying too much about their health and for neglecting worrying symptoms - something for which they could get penalised.

The development of more community based health services is probably one part of the answer. Charges and sanctions are definitely not - another reason to try and ensure the Tories don't get back into power.

Is the NHS in crisis? (1) Funding

This is the first in a series of comments on key issues in the NHS. They don't represent an agreed or formal position of SSONHS but are broadly consistent with views across the group's point of view.

Any universal health system will have persistently rising expenditure and this does have to be controlled. However most of the finance figures which are bandied around are constructed to serve either political or vested interests. (see for example here. There is no reason we cannot afford a properly managed universal health service free at the point of access. We currently continue to spend proportionately less than many European countries and in many circumstances (though not all) achieve better outcomes. However a service funded out of general taxation means that there does have to be sufficient general taxation.

For the last two years the successive heads of NHS England have been warning of a funding crisis. The current figure, put out by Simon Stevens in the Five Year Forward View, suggests that on present trends of income and expenditure the NHS will have a funding gap of £30 billion by 2020. He has suggested that this should be met by £22 billion efficiency savings and £8 billion extra from Government. This £8 billion represents a growth figure which Stevens describes as flat real per person (simply taking account of population growth)so is an ambition tailored to Goerge Osborne's targets. However most people seem to agree that the £22 billion efficiency savings cannot be reached - at least not without major cost cutting and privatisation. So flat real per person growth is not enough. However if there were a real term increase of between 2-3%, it has been estimated that the total funding gap could come down to £8 billion. Historically until 2011-12 there was on average a real term annual increase in funding of over 3.7%. The funding nettle has to be grasped. We will get the service we pay for. Apart from the taxes aimed at the wealthy, there is increasing evidence that most people would support small increases in general taxation which were for the NHS.

NB these figures are for the NHS and do not include social care where there has been an overall spending reduction of 13.4% including a 17.4% reduction in spending for older people. (Is it any surprise there is more of a burden on the NHS?)

Talk of a funding crisis is nothing new and was seen by Nye Bevan as one of the essential characteristics of the NHS. His now famous quote about needing to fight for the NHS needs to be linked with things he said even before July 5th 1948, for example: "We shall never have all that we need. Expectations will always exceed capacity."; and "The service must always be changing, growing and improving: it must always appear inadequate." Bevan and Wilson resigned in 1951 when Attlee's Labour government, squeezed by the Korean War, insisted on bringing in charges for spectacles and dentures. The successor Tory Churchill government then introduced prescription charges, using legislation previously set in place by Labour but not implemented. The NHS remained somewhat on the ropes (especially because of issues with GPs) until the Guillebaud report in 1956 showed what good value the NHS provided as a proportion of Gross National Product. Since then in various financial crises even Tory Chancellors have recognised the value of NHS expenditure. Tony Blair vowed to bring health expenditure as a proportion of GDP up to the level of other countries and briefly did so. It has now dropped back.

The current parliament will have had the lowest rate of growth in health spending across the UK since 1955 (0.6%) In 2012 health spending as a share of GDP averaged 9.9% among the EU-15 nations. Only five EU-15 countries spent a lower share of GDP on health (Greece, Italy, Finland, Ireland and Luxembourg). UK GDP has risen by over 9% since 2010. If NHS funding had been maintained at 2010 levels (9.9% of GDP), the NHS budget for the UK could now be over £150bn instead of £113bn. In 2013 Cameron and Hunt were ordered by the head of the UK Statistics Authority to stop saying they had put extra money into the NHS.

This year for the first time in several years the NHS has ended the financial year in deficit - to the tune of about £2 billion. There is general agreement that it it is working at its limit and that staff morale is low. Within the NHS tariff cuts have severely reduced hospital income . Most Trusts which have financial reserves have raided them to break even. Well respected hospital organisations are beginning to panic at the possibility of financial failure. However the definitions of 'failing' Trusts are not moral judgements but are constructed from arbitrary financial rules. Different ways of assessing financial performance would not lead so easily to the risk of major services being offered to private providers.

Some commissioners - both CCGs and NHS England specialist commissioners are also in deficit. By September, especially as winter planning gets under way, the next government will have to find funding to get the NHS through. This may be under guise of a transformation fund to help accelerate changes. Labour has a plan for this, just about, though it is likely to mean more borrowing at least before the projected tax changes kick in. The Tories and Lib Dems have fluttering promises which are being disparaged by financial commentators.

The required changes should include:

1) Abolition of the market. A minimum real estimate of the costs of the market was made a couple of years ago at £4.5billion per year. The actual cost is likely to be much higher. Since the market was introduced, administration costs in the NHS have risen from aroun 6% to 14%. (The US system runs at over 30% admin costs). Not all of this would be saved by market abolition because other mechanisms would also have a cost, but nothing like as much. (NHS Management is generally scapegoated by anyone dissatisfied but poor management, whether by bureaucrats or clinicians, doesn't mean that the NHS does not need management as long as they are managers committed to the service, not beancounters, accountants and marketing people). In some analyses the NHS actually has fewer managers than comparable private sector organisations and charities (though that may depend on the definition of manager). A King's Fund report in 2011 actually suggested that the NHS might be undermanaged (though they too have a vested interest! This should certainly start off with the external marker but should work towards eliminating the internal market as well (introduced under Thatcher).

3) An attack on the PFI agreements which are bankrupting hospitals, sucking money out of the NHS into big service, construction or property organisations. This is covered in the NHS Reinstatement Bill.

3) A revamped approach to human resources, emphasing human, not resources. This will include proper staffing levels, only to be supplemented by expensive agency staff in exceptional circumstances.

4)Productivity improvements (secured through operational changes, not by squeezing staff still further). These could include service integration (done with an emphasis on meeting need, not with cost-cutting as the prime objective; lots of pitfalls here), further identification of wasteful practice (including the advantages of clinicians having regard to the whole person and not just the specialist symptom with which they are presented), the improvement of systems, and, most fundamentally, an unprejudiced look at how hospitals and community health care should be linked up.

5) Better management of demand (see subsequent post) and understanding that if everything else is cut the NHS will be expected to pick up all the resulting problems.

6) A clearer focus on public and community health but, again, understanding how it should link with curative health care. If the NHS is going to put out all sorts of messages about early recognition of symptoms etc, it has to recognise the demand this will generate. Conversely a reduction in public health measures (and lack of consideration of health impact) will lead to more demand for emergency treatments and consequently greater expenditure (as well as trauma for the patient).

Most of these have been somewhere on the agenda since 2010. Lansley's damaging reforms plus the small state mentality of most Tories and the free trade aspirations of many Lib Dems have proved costly distractions (to use a polite word). Regardless of the actual figures, the government must take the blame for the financial chaos they are leaving.

Friday, 24 April 2015

The main English party manifestos on health

Here is information (not intended to be impartial) about the manifestos of four parties as they relate to health. The Conservatives are mentioned only in passing. After 2010 who is to believe them, especially now they are plucking billions of pounds for health out of thin air.

Labour's Health Manifesto is a mixed bag. The promise to repeal the 2012 Health and Social Care Act seems to be presented almost as an unimportant afterthought. Nonetheless several of the specific undertakings we have been looking for are there - restoration of accountability; repeal of the competition framework; some promised security against TTIP; some control of the private sector, plus a number of positive measures. There are promises of moves towards devolution (which some people may read as threats to the NHS) and Labour is now expressing doubt about the Manchester proposals as they stand.

Funding remains an issue although Labour obviously thinks that what can be saved from marketisation red tape (£100m) is considerably less than the much higher and pretty unrealistic figure of well over £5 billion being quoted by some campaigners. This may lead people to suspect that Labour's commitment to reduce the market is weaker than it appears; certainly they do not appear to be abolishing the commissioning approach and nothing is said about the impending privatisation of the Commissioning Support Organisations. The NHS Reinstatement Bill is not mentioned. Labour also steps back here from explicitly endorsing the Five Year Forward Look (again by not mentioning it – though Andy Burnham has said subsequently that it would need adaptation since Labour will be starting from a different place), thus freeing itself from endorsing the financial package of £8 billion extra before 2020 and the further £22 billion of efficiency and other savings which Stevens says are also required if there is to be zero growth. There are also doubts about how quickly Labour's promised extra funding will kick in. Money has to be found for the NHS during 2015-16.

What the manifesto does evidence is some very real thought about the NHS, about integration of services, the impact of cuts elsewhere, and in particular in social care, on the NHS and, to some extent about public health. The promised figures for increases in staffing seem plucked out of the air, but the focus on improving access to primary care is more realistic than Cameron's unfunded and overambitious promise of 7 day working. "The next Labour Government will guarantee the right to a same-day consultation with a doctor or a nurse at your GP surgery, and the right to a GP appointment within 48 hours. We will also ensure patients have the right to book more than 48 hours ahead with the GP of their choice."

Certainly the manifesto is by far the most detailed approach to securing the NHS of any of the parties so far and contrasts with the rose-coloured haze cast over the current working of the NHS by the Conservatives and their apparently unfunded promise of the £8 billion over 5 years requested by Simon Stevens has to be linked with the £22 billion 'efficiency savings' mentioned above. Be sure that this will mean further radical changes.

Undecided voters should seriously consider that Conservative promises on the NHS cannot be trusted. Last time we had 'no top down reorganisation'; this time we have a conjuring promise of extra money with no indication where it will come from nor of how the £12 billion welfare cuts will affect people with severe health needs. Cameron parrots the current fashionable demand for 7 day working, without helping us to any real understanding about what this means, which services it will affect, and how it will be achieved. The apparent commitment to the 5 year forward view suggests that parcelling up of the NHS can be expected to proceed apace. For instance the Wirral which has a privatising CCG has just announced that its vanguard partnership will consist of the hospital trust, other local public sector health providers, Wirral Council and three outside bodies: Cerner UK Ltd - (informatic solutions and population health management) Advocate Physician Partners ACO (USA) - (modelled Accountable Care Organisation deployment and learning" and the King's Fund - (research, learning, evaluation and dissemination).

The Green Party Manifesto has also been launched, with a significant section on health, (pp31-35) some of it written by Sheffield Green Party parliamentary candidate Jillian Creasy. The programme is much clearer in its attack on the market and calls for an end to the commissioning mechanism and to the blanket use of 'commercial confidentiality'. It is specific about PFI (not even mentioned by Labour) and contains a number of brave promises - including bringing addiction services across to the Department of Health. On p74 the Greens confirm opposition to TTIP. There is mention of transferring hospital services to the community without it being clear how this will be done (Labour envisages a continuous institution, which may or may not prove to be a good idea.) Jillian's section on a 'person-centred' NHS is particularly interesting for its intent to enable the time and opportunity for staff to care effectively by being able to respond more directly to patient needs. The manifesto supports the NHS Reinstatement Bill, already introduced to Parliament by Caroline Lucas, but rather glosses over its application. Critics will probably say that it is strong on good intentions but much weaker on delivery, both in terms of structures and the rather optimistic funding mechanisms.

The Lib Dem manifesto contains a lot of fine intentions, but, given that the Lib Dems are not going to lead a government, they have two purposes - one to attract/retain voters in marginal constituencies, the other to act as bargaining points in any sort of coalition or hung parliament.

The Lib Dems say (p73) they will repeal parts of the Health and Social Care Act “which make NHS services vulnerable to forced privatisation through international agreements on free markets in goods and services - so the TTIP pressure is getting through to Clegg. What he won't admit is that it's not just 'parts' of the Act. They don't admit their responsibility for putting the NHS in this situation in the first place. They are more careful about specific promises around staff recruitment - preferring to talk about different ways of accessing GPs rather than 7 day working or unrealistic estimates of GP numbers. They also have specific and often welcome proposals on social care and public health and have clearly majored on mental health. This contrasts with the Tories - whose manifesto is now discovered to contain the threat of benefit sanctions against people who refuse medical treatment.

UKIP's manifesto is a hotchpotch of opportunist and populist proposals designed to reassure prospective UKIP voters that it cares about the NHS whose ills it puts down to demographic change, immigration and the EU. The proposals are, in our view, little more than pub speeches. It contains promises to rebalance funding away from Scotland and towards Wales and England, to insist on health insurance for all migrants, and to increase some GP availability. It enters the staff number lottery by promising 8000 more GPs, 20,000 nurses and 3,000 midwives and will, from somewhere, put a GP in every A&E (presumably paid at extravagant locum rates and deflecting GPs from local practices although they do say they will pay for additional consultants by preventing the current reliance on locums). UKIP claims commitment to the founding principles of the NHS. It will increase funding for mental health, end hospital parking charges and build a new specialist military hospital. Obviously it opposes TTIP as an EU initiative and wants to demand specific exclusion of the NHS. However UKIP will pursue a separate trade deal with the USA.

UKIP will finance improvements in social care (including the end of zero hours contracts for care workers) through a sovereign wealth fund financed by taxes on fracking (assuming any fracking takes place!). So that’s social care down the sinkhole then.

Saturday, 4 April 2015

Election sparks growing public concern about the future of the NHS

As the election swings under way, public concern about the NHS is mounting and the parties are being pushed to come clean about their intentions. However it is becoming increasingly clear that the main parties are dodging the most serious questions. A further post with more detailed comments will appear here shortly.

The questions SSONHS is asking of candidates are on our website campaign page.

Interest in Sheffield is mainly focused on Sheffield Hallam but Sheffield Central also offers a choice between two strong NHS supporters - Labour's Paul Blomfield and the Green Party's Jillian Creasy.

On 1st April Jillian Creasy kicked off a lively discussion on the NHS as part of the Sheffield Festival of Debate. There was a good audience, including many younger people and NHS workers. For an account of the meeting see Facebook or Twitter