RESIST THE BREAKUP OF THE NHS THROUGH PRIVATISATION AND CUTS!
BRIEF UPDATE April 2018
(N.B. This site is not currently being regularly updated. )
FOR COMING EVENTS, MEETINGS AND OTHER INFORMATION
SEE BELOW AND THE MAIN SSONHS WEBSITE
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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 firstname.lastname@example.org
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
Tuesday, 28 July 2015
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.
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
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.