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
Wednesday, 29 April 2015
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
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.
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.
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
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) https://www.greenparty.org.uk/we-stand-for/2015-manifesto.html 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
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