NHS strikes reflect staff feelings of injustice

The Unison, Unite, GMB and Royal College of Midwives strikes on 13th October were well supported as was the radiographers' strike on 20th October. Despite Hunt's refusal to budge, mood on the picket lines was buoyant with moving speeches, especially from the groups new to striking like the midwives, about how mistreated and exploited they feel. Radiographers made excellent use of their skeleton motifs.

Management and government cannot ignore how the more and more overt and shameless 'squeezing' of staff to produce more and more will eventually lead to service failure. As experienced staff haemorrhage to better paid and less stressful jobs abroad, managers scrabble around competing with each other to attract nurses and other staff from less well off countries who need their own trained staff. Simon Stevens skirts round this in his Five Year Forward Look, but staff issues need to be addressed directly. Treating staff decently is not a luxury - it is essential to a caring service.

Sheffield NHS public meetings in September

Sheffield Clinical Commissioning Group

Thursday 4th September 2014 4pm Darnall. Business meeting in Public . NB Quality reports are beginning to show significant deterioration in performance against targets for the Hospital Trusts and the Ambulance Service and the CCG has applied or is considering contract sanctions. This is important not just because it shows increasing strain in the system but also because if some NHS services are judged not to be providing a satisfactory service, the pressure will grow to put them out to market. There have also been problems with diagnostics, particularly in cardiology leading some GPs to ask whether they can refer direct to Thornbury. The CCG has visited the hospital and is working with the Trust on improvements.

Thursday 11th September 2014 AGM open to the public. 2 – 4 pm The Workstation, Paternoster Row, Sheffield, S1 2BX.

Reserve a place by emailing SHECCG.EngagementActivity@nhs.net. The CCG usually takes questions on the day either answering from the platform or sending a response later but if you want to be sure your question is taken at the meeting email it to the above address or alternatively call them on 0114 305 4609. They were asking for reservations and questions by Friday 22 August but are probably still accepting them.

The CCG has put quite a lot of work into making its website more accessible so it's worth a look and you can read the Annual Report there.

Sheffield Joint Health and Wellbeing Board

Next meeting Thursday 25th September - 2pm Workstation, Paternoster Row. the week before the meeting you can check the agenda at http://sheffielddemocracy.moderngov.co.uk/ieListDocuments.aspx?CId=366&MId=5649&Ver=4

Sheffield Teaching Hospitals Foundation Trust
Monday 22nd September Annual Members Meeting in the Medical Education Centre Northern General . Lecture Theatre 2, 12pm on 22nd September 2014 (refreshements from 11.30) arrive early because it can be tricky to find and last year it was quite full.

Sheffield Health and Social Care Foundation Trust
Annual Members' Meeting on Monday 22 September 2014 from 12.45pm to 3.30pm at the Showroom & Workstation, 15 Paternoster Row, Sheffield S1 2BX It's tends to be pretty busy. You can reserve a place by emailing karen.jones@shsc.nhs.uk

Sheffield Children's Hospital Foundation Trust
Tuesday 23rd September 6.30pm (buffet from 5.30) Lecture Theatre, Stephenson Wing, Children's Hospital.

Healthwatch Sheffield Board meeting
23 September, 2pm, St Mary's Bramall Lane:

Yorkshire Ambulance Service Trust
Annual General Meeting 30 September 2014 1015-1145 and Trust Board Meeting In Public: 1300-1530, Leeds - Thackray Medical Museum.

999callfortheNHS Darlington Mums to march through Sheffield

Updated 10th August, 13th August, 31st August
It was good to see so many people turn out to support the marchers, especially in the wet on the Bank Holiday. Thanks to all our speakers and to the members of the Socialist Choir and Body of Sound for their performances and all their help, as well as to the Sheffield Street Band for adding oomph on both days.

Meanwhile in Sheffield, cuts both in the NHS and in local authority services which affect health are biting deeper. The new head of the NHS, Simon Stevens, with a strong background in the health market, will be outlining his proposals for the NHS in the next few weeks. Labour and the Lib Dems will be firming up their positions in their Party Conferences. Defenders of the NHS need to be on their toes.

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The big summer campaigning event for the NHS in Sheffield will be the arrival of the People's March for the NHS, organised by the Darlington Mums. You can see details of the routes and download posters from the march website.

This is a really exciting and spontaneous manifestation of popular support for the NHS and against the fragmentation and privatisation brought in by the current Government. There is a lot of support up and down the country, not only along the route and on each leg the core marchers will be joined by local people, accompanying them on all or part of the way. The marchers are very keen to demonstrate the breadth of support for the NHS and are not tied to any particular organisation. All groupings which support the principles of the NHS are encouraged to participate and support. SSONHS is co-ordinating part of the Sheffield route.

The march is from Jarrow to Parliament and will reach South Yorkshire on Sunday 24th August, overnighting in Barnsley and then setting off for Sheffield from Barnsley District Hospital on August Bank Holiday Monday, 25th August. After a night in Sheffield the march will set off for Chesterfield from the Town Hall on 26th August.

We are expecting the marchers to reach Weston Park by 5pm on 25th August, where there will be a reception and short rally. We suggest that people who want to join the march before then do so at Hillsborough Park at the Parkside Road entrance at around 3 pm. After marchers and the heir hosts have a meal at the Broomhall Centre, Broomspring Lane, there will be an informal social/get together from about 7.30 at the same venue, not the Shakespeare as previously posted. There will be informal music etc and a BYO arrangement for drinks.

On the following day (26th) the march will be seen off from Sheffield Town Hall by the Leader of the Council, Cllr Julie Dore and Cllr Jillian Creasy for the Green Party. There will be a short rally outside the Hallamshire Hospital, addressed by representatives of people working in the NHS and the march will then go through Hunters Bar, Nether Edge (11.30), and Woodseats to Graves Park and Meadowhead.

We have put out an appeal for help with resources (practical and financial), accommodation and transport, and have already offers of help from local organisations and individuals. Apart from the events we need to raise money for meals and refreshments. We need help with stewarding the march and setting up the rally at Weston Park. For offers or inquiries please email us here or if the link doesn't work try team@sheffieldsaveournhs.co.uk

for updates see our web page

We hope this will be a very special celebration of the NHS here in Sheffield

Is the NHS really in crisis? SSONHS Public Meeting 24th July

This meeting (details above) seems to be generating a lot of interest - we have even had people asking whether it is necessary to book - a welcome first for us.

We're experimenting with a format which opens up discussion - rather than suggesting there are easy answers. We start from the given that the government's failure to keep up with the 4% real term increase in the NHS budget, on top of the so-called efficiency cuts, has put the NHS in real trouble. Even senior Tories are saying that more money has to be put in. The question is, of course, how it should be raised. The Tories may well try some sort of patch up before the election and Labour are flirting with the idea of hypothecated National Insurance. But that's not what we want to talk about on Thursday.

The deeper debate is whether there are other changes needed in the NHS to meet changing social, demographic, economic and technical developments in order to maintain a universal health service true to its founding principles.

We've chosen to focus on certain aspects - first access to health services, a discussion led by two experienced GPs who are committed to the reduction of health inequalities. In the second half, two academics with considerable experience of the organisational side of the NHS will address issues such as competition vs collaboration, accountability, and whether preventative and community-based services will be both effective and save money. All the speakers will be in a personal capacity and will talk for about 10 minutes each.

It's a lot to pack in and there are bound to be a host of other issues coming up from the floor. We hope for a lively discussion.

At the end of the meeting we will have few minutes to discuss how to take things further, including whether we should organise more meetings of this sort and on what topics. We will also alert people to the developing arrangements for the Darlington marchers.

Transatlantic Trade negotiations (TTIP) and their effect on health

This is a speech for the World Development Association Day of Action on TTIP July 12th

The proposed international trade partnership agreements TTIP and TISA have the potential to damage our health as well as our economy and environment. But you have to peer through a load of sliding windows, shifty statements and economic pie in the sky to find this out.

Let’s start off by debunking two myths. First of all there are arguments that population health will improve because we will all be better off. This increase in wealth – estimated at something like 9.7% change in real per capita income (Bertelsmann Foundation) - is what seems to bind the Labour leadership into the overall concept of the TTIP. What on earth makes people think that this sort of benefit will happen?

1. First of all the figures for economic benefit are grossly inflated because they are based on the assumption that all aspects of trade will be brought into the treaty – which they won’t be.

2. Secondly, even if there is an economic benefit, what makes anyone think it will be distributed evenly? This average trades off the losses – of jobs, job protection and freely available public services – the losses for ordinary people against the very considerable gains that will be made by the rich, the 1%, the business leaders with their golden hellos and golden handshakes, the shareholders and celebrities with their offshore accounts.

3. Thirdly the potential downgrading of regulation in other spheres – the loss of environmental protection, certain food measures, drugs and advertising, workers’ health and safety all have the potential to make our health a lot worse.

4. Fourthly there is the threat of the ISDS – the secret court where companies can sue governments which threaten competition. Philip Morris are suing Australia under an obscure international provision to try and prevent them going ahead with blank cigarette packets. Hardly good for our health?

So let’s call on the Labour leadership to take off their primrose spectacles and look at the real needs of the people they are supposed to represent.

On the other hand some TTIP opponents give the impression that the NHS will fall to pieces because under the TTIP, healthcare services will be brutally exposed to takeover by international corporations. Well this isn’t quite true either. The NHS as we used to know it even up to 2006 and even just about before the 2012 would have a significant degree of protection either because it was a publicly funded service or because it can be excluded during negotiations – and this is what is made a clear in a letter issued yesterday by the senior EU TTIP negotiator, Sñr Bercero, to one of our local MPs John Healey.

But since the opening up of NHS provision to the private sector, tried by Thatcher, then insinuated into the NHS Plan by Labour from 2001 to 2006 and since then legally institutionalised by the Coalition government, this protecting veil becomes full of holes. Every specialist service which is opened up to tender by NHS England, every CCG which goes out to private tender for NHS services, and, most alarmingly, every decision by the holders of the new personal health budgets to enter the healthcare market, puts that service into the competitive arena and vulnerable to TTIP.

And it’s not just TTIP. As part of the WTO a separate negotiation called TISA is progressing among 20 developed countries including the UK about liberalising the service sector. Here the dangers for a part privatised NHS are even worse especially if the Tories get in next time and especially if Andrew Lansley were to achieve his ambition to become an EU commissioner.

TISA will lock in the rights of private services. Take the example of Bolivia – before Morales was elected president a previous government placed Bolivia’s then pretty awful healthcare system into the WTO system, trying to encourage foreign investment. Of course this hardly produced a service which met the needs of the Bolivian people but when Morales tried to take it out to encourage the growth of an indigenous public service, WTO members like the USA refused to allow the return of hospital services to public control. Good article about TISA in the Big Issue.

Can healthcare be excluded from the TTIP? Of course it can as Sñr Bercero has made clear. The French, right from the beginning, fought hard on one of their perennial bottom line issues – protection from US cultural influences. Paris refused to be involved, exercising a virtual veto, unless cultural issues (mainly films and audio-visual media) were excluded. And they won. Last year the USA and Canada updated their trade agreement. Canada, which has much more publicly funded healthcare, despite cuts there too, refused to include healthcare and the USA was forced to agree. Ironically this has led some liberals in the US to press much harder for healthcare to be included in the TTIP in order to bring more competition into their own appalling system. But not at the cost of our own NHS! No thanks Uncle Sam.

Cameron has dodged all requests for healthcare to be excluded. All the supposed assurances given by government ministers have been equivocal. Sñr Bercero says public services can be protected not that they will be protected. Why this reticence from Cameron? Could it be because of the money given to the Tories by private healthcare interests? Could it be because of the number of Tory and Lib Dem MPs and peers with significant investments in private healthcare? 65 Tory Lords; 12 Lib Dem Lords, 37 Labour Lords, 31 cross benchers, not to mention 63 Tory MPs. (Social Investigations) Surely this can’t be the case. And yet….maybe it could.

Recently the EU halted negotiations in order to start an elaborate public consultation on ISDS which suggested that public provision in areas like health could be excluded from litigation provided government actions were not manifestly unfair. Well who decides what manifestly means? The ISDS secret court no doubt. It is quite clear that any government which was seeking to bring services back into the public sphere, would, at the very best, have to invest considerable resources into protecting itself from litigation.

Let’s be clear, this is not particularly about the EU. There are campaigners against the TTIP like the Greens who are in favour of the EU and others from the Left who are against it. UKIP have nothing to say. A UKIP government would not only be cutting and privatising the NHS but looking for a bilateral agreement between the UK and USA to deliver exactly the same sort of deals for business. So people should not be gulled into looking to UKIP for protection.

So what’s to be done?

First it is clear that the EU negotiators, despite all the fences, are susceptible to pressure. They have already been shamed into delay and attempts at consultation and transparency. So keep it up, locally, nationally and internationally.

1. The campaign needs to carry on right the way through this year and up to and including any EU parliament vote. Our MEPs must be held to account on this.

2. Secondly don’t take any half-baked assurances that our health services are safe. Healthcare needs to be formally exempted and no weasel words from the government can be tolerated. Take every opportunity to press your elected representatives either directly or through organisations like 38 degrees.

3. Finally we need to stop the privatisation rot in the NHS. Even under the present system commissioners need to understand that if they put services out to tender, they are potentially damaging not just the present but the future of the NHS as a publicly owned, publicly provided and publicly accountable service.

For more information, come to the SSONHS meeting on 24th July 2014, 7pm at the Quaker Meeting House. Leading local experts will discuss the issues facing the NHS.

To show your dissent to government policy on the NHS - Join the People’s March for the NHS organised by the Darlington Mums. We hope to see you on August 25th or 26th on the march or at Weston Park. Look out for more details

Local and European Elections May 22nd

Here are some NHS related questions for Council and European Parliament candidates which might help if you get into discussion with any of them. Particularly in the local elections, candidates may not be able to answer specifically, but one or more of these should help reveal attitudes and degree of interest.

Local Elections

Do you oppose the NHS being forced into open and competitive tendering for services (opening them up to be taken over by the private sector) where there is public and professional support for preferred NHS provider arrangements?

What is your view on Sheffield Council's decision to put the learning disability service, currently provided to the Council under contract from the NHS, out to tender? Do you support the Council's recommendation that the decision should be left to officers rather than be part of the political process?

Do you agree that the public health budget for the City Council should be ringfenced for public health issues?

Do you agree that important changes to NHS and council services should be put out for proper and timely public consultation, no matter who instigates them?

Do you agree that the extension of charging for access to healthcare included in the Immigration Bill risks widening health inequalities, threatening communicable disease control, and costing more to implement than is recouped in payments? If so, do you oppose its implementation?

What do you think about the Government's decision to postpone the Better Care Fund which would enable NHS money to support local authority social care?

European Elections

Do you oppose major NHS services being put out to competitive tender, thus opening them up to be taken over by the private sector. Are you prepared to work in the European Parliament to help minimise the attempts by big corporations to erode the provision of publicly funded healthcare?

Do you agree that health care should be exempted from the proposed EU/USA Transatlantic Trade and Investment Partnership agreement?

29th May Postscript
At the hustings there were positive commitments to the NHS and to support on health issues in Europe from both Labour and Green MEP candidates. However there was a lot of concern from the floor about EU competition law and the proposed EU/USA trade agreement. The effect of the UKIP showing on the NHS is not clear. Farage is apparently going to include NHS issues prominently in his new manifesto to be launched in Doncaster this autumn. Expect this to be a pretty uninformed attack on bureaucracy "There is plenty of room for cuts and efficiencies" BBC interview July 2013. Other UKIP candidates (e.g. Paul Nuttall NW UKIP MEP) explicitly support privatisation. Ironically Le Pen's party in France is strongly against the Trade Agreement but we don't think this will be UKIP's position, if indeed they consider the issue at all.

Supported Living Services in Sheffield and Doncaster

Sheffield Council has issued a competitive tender for Supported Living services including the Learning Disability service which has been provided by the NHS for nearly 40 years (not over 50 as previously stated). They want to 'stimulate the local market' in order to find cheaper solutions which avoid costly external placements. This follows dramatic overspending in 2013-14 which led to the suspension of the Head of Learning Disability Services.

If the NHS fails to win renewal of its contract, Unison estimate the loss to local NHS revenue of around £6m. Instead the contract would go to an organisation like Care UK, with possibly similar results to those in Doncaster. At the moment it is not even clear whether TUPE would apply. The Council has delegated the contracting decision to officers and Sheffield Unison is (belatedly) running a campaign against it.

So what is happening in Doncaster where Care UK workers are on strike?

Here is an extract from a UNISON BULLETIN: CARE UK DISPUTE, DONCASTER

"The above Dispute concerns a Supported Living Contract where Doncaster Metropolitan Borough Council are the client, but the NHS has run the service on their behalf for many years. Regrettably last year, prior to the new Labour Mayor being elected, DMBC let the contract to Care UK. Late last year Care UK announced that they wished to change the terms and conditions of those employees who transferred with this contract, in some cases the changes mean a cut of 50% to their take home pay, by ending weekend and night working enhancements and Bank and Public holiday enhancements. It is clear that the employer intends to de-skill and dumb down the skill base enjoyed by the current staff and replace them with minimum wage carers, thereby reducing the quality of the service provided. Indeed evidence of this has been obtained from the local job centre where a care worker for this contract was recently advertised on a pay rate of £6.73 per hour for a 40 hour week, with no additions or enhancements for evening or weekend working or for bank or public holiday working and also no pension provision.

"In response to this UNISON have tried to negotiate with Care UK who refuse to change their position. This led our 150 members in Doncaster to request a ballot for industrial action, where over 90% of those voting, voted for a combination of strike action and action short of strike action. Our members have already had a period of 7 days strike action, followed by action short of strike action in the form of withdrawal of goodwill, working to contract, non-use of company or personal cars on business, etc. Our members also undertook a further 7 day period of strike action, commencing on Wednesday, 19 March 2014.

"Up until the beginning March, the employer had refused to negotiate with us and despite an approach from us to use ACAS, they had indicated that they were willing to use ACAS but had advised that they had nothing to offer.

"This changed and discussions were held under the auspices of ACAS, unfortunately the employer was only prepared to increase the protection offer by a mere two months which was completely unsatisfactory and the talks broke down. In addition to this the employer has approached individuals participating in the action, as well as other employees currently not involved, and tried to get them to sign up to the new terms and conditions, indicating to them that if there are any improvements conceded they will honour them for any who sign up to the new terms. To say this has incensed our members is putting it mildly.

"Our members subsequently voted for further 3 day and 4 day periods of Strike action the first of which took place on the 6,7 and 8 April with a further 4 days commencing on the 18 April (Good Friday), 19 April, 20th April (Easter Sunday) and 21 April (Easter Monday).

"At the Strike Rally on the 18th April our members voted for a further 14 day period of strike action, subsequently through the auspices of ACAS, UNISON negotiators met with representatives of Care UK to try and reach a resolution to the dispute. Regrettably, Care UK were not prepared to negotiate they merely restated their position and said they were not prepared to make any concessions. In a letter sent after this meeting to local MP’s they made outrageous, misleading and inaccurate claims to have made concessions on their initial proposals and even went as far as to claim that ACAS supported their view. This has been categorically denied by ACAS and our lead negotiator has written to Care UK asking for an explanation of just what ‘concessions’ they think they have offered."

The Doncaster, District and Bassetlaw health branch has launched an appeal to help members who are taking action. Please make donations payable to Doncaster, District and Bassetlaw Health Branch 20511, and send them to the UNISON Office, Jenkinson House, White Rose Way, Doncaster DN4 5GJ. Send solidarity messages and requests for speakers to: admin@unison-dab.org.uk Click here to download an updated collection sheet. Obviously there will be collections at the Saturday events.

For more info see here and here

Visit the strike Facebook page ‘Doncaster Supported Living Unison Strike’


Meanwhile in Bradford there is another problem involving Care UK and caused by competitive tendering.

1) Bradford: Private Provider muddle
1000 people have signed a petition started by a teenager to save the Eccleshill health centre in Bradford which offers NHS services but is run by Care UK under contract to Bradford CCG. The contract expires on July 7th. The contract was put out to tender and the CCG judged that no bid was acceptable including a renewal bid from Care UK. According to the local MP, LIb Dem David Ward, the CCG have stated that they are looking at all alternative options to ensure that the current services provided by the Treatment Centre continue to be provided for patients within the area.

This illustrates another ridiculous and dangerous side of the competitive tendering system. Unless the CCG is actually trying to cut the services we have a situation where the process is just going to leave a blank. It's not surprising that local people are upset but I imagine few of them are clear whether they are campaigning for the NHS or for Care UK. The CCG hasn't managed its communications well either, probably not helped by the commercial confidentiality around the procurement process. The CCG should be able to say clearly why the tenders were not acceptable - then people would know if it was something to do with Care UK - like what is happening in Doncaster.

Independent Review of Whole Person Care compiled for the Labour Party

Andy Burnham, Shadow Secretary of State for Health commissioned an independent review led by Sir John Oldham - a former high ranking NHS manager - to produce proposals relating to Whole Person Care - i.e. the integration of health and social care. The review was for the Labour Party but was not funded by them or indeed by anyone apparently. It has just been published as

One Person supported by people acting as One Team from organisations behaving as One System

and is available on the Labour policy website Your Britain

Most of the team are from an NHS background, including Professor Hilary Chapman, Director of Nursing at Sheffield Teaching Hospitals. Two are from local government (though one of these is a trained nurse) and one from the Alzheimer's society. At first glance the thrust of the review seems to move towards bringing social care into the NHS structure.

In the introduction the review comments " The emphasis of this report is recommendations for an incoming government in 2015. They are built on three themes: giving meaningful power to people using the health and care system; reorienting the whole system around the true needs of the population in the 21st century; and, addressing the biases in the established system that prevent necessary change happening. For too long health and social care have been considered separately. They are inextricably linked. However we do not believe the answer includes yet another major structural reform at this time. The scale of recent reforms so damaged the NHS and care system that we believe it would not survive intact from a further dose of structural change. We are not saying that the current structures are right, or that they won’t need to change in the future – they aren’t and they will. We reflect some of that in our recommendations on national organisations. However, relationships and culture trump structures. We should not focus now on what the structures are, but the relationships among them, the people who work in them, and what they do. This is the essence of care and what really matters. These changes may not be as tangible and headline grabbing as scrapping and creating organisations. Arguably they are, taken together, more radical."

The recommendations are significant, far reaching and controversial. They include the renaming of NHS England as Care England which would be the strategic lead behind which other NHS organisations including Monitor should aligned themselves. The report recommends that the S75 regulations (on competition) be abolished.

The report is 92 pages and needs careful reading but the issues it raises are probably worth openly debating in the city. Comments and more information are welcome.