SSONHS Activity in 2017-18

Apologies that there have been no new updates for a while.  Most information is now on our revamped website - with further improvements planned for later this year and updates here will be only occasional.  If you want to be on our email list which contains various posts with updates and information please contact teamssonhs@gmail.com.

There have been two main focuses of activity in Sheffield during the last six months - active participation in the Clinical Commissioning Group's consultation on Urgent Care - involving the closure of the Minor Injuries Unit at the Hallamshire and the Walk-In Centre at Broad Lane, plus the regrading of the Eye Clinic to Emergency only.  The proposal was to replace these with an Urgent Care Centre at Northern General Hospital and to improve access to GP appointments and non-emergency eye care in localities.  We helped mount a significant campaign which persuaded the CCG to extend the consultation deadline from December to the end of January, generated several petitions totalling over 10000 signatures, particularly to save the Minor Injuries Unit and pushed the CCG in to reevaluating its proposals in the light of suggestion made by campaigners (and other NHS organisations) across the city.

The CCG Primary Care Commissioning Committee will be considering the results of this work on May 17th.  Pressure will need to be kept up if it is not to revert to a reiteration of the original proposals.

The other focus has been the development of local NHS organisations into South Yorkshire and Bassetlaw STP footprints (Sustainability and Transformation Plans, then Partnerships) followed by Accountable Care Systems (then Organisations) and then Integrated Care Systems (or Partnerships). South Yorks is one of 8 Vanguard organisations for this in the country and has got some extra resources but the whole process has been very murky despite the SYB ICS adopting the hashtag Honest and Open. Anxiety about the future of local services has been mounting in Barnsley, Bassetlaw, Doncaster and Rotherham.  Banrsley have instituted a judicial review application of the consultation so far carried out about stroke services and Doncaster have initiated a formal S Yorks Save Our NHS Party which will be standing National Health Action Party Treasurer Naveen Judah from Rotherham in the Sheffield City Region Elections.

In Sheffield the Accountable Care Partnership Board which has been meeting privately for a year will begin public meetings in June.  The Council is part of this Board in shadow format and has undertaken to consult further if the Board becomes formalised with local powers before fully signing up.

There will be a debate about accountable care and decision making at a Festival of Debate event on 26th June and SSONHS will hold its FoD panel debate on 27th June at Roco.

Could support for the NHS block May's attempt at a landslide election victory?

Theresa May's Easter meditations let her to thoughts of a triumphant Tory Ascension to a landslide election victory.  But things haven't quite worked out like this.  Corbyn's defiance and gathering support, reinforced by the way that other parties have plugged not just the plight of the NHS but of all public services,  have forced May into Fortress Brexit.

It is vital to keep public attention on to the financial and staffing crises facing the NHS.  Make no mistake, if the Conservatives achieve a substantial majority they will tell Simon Stevens to get on with his Forward View, devised at Davos with the help of his previous employers United Healthcare, and deliver a reduced but supposedly more efficient NHS which will meet his financial targets.  Rationing and closures will increase apace as the unaccountable Sustainability and Transformation Plans take hold, imposed by Boards to which local CCGs have ceded power, even though they are the organisations which are currently statutorily responsible for ensuring our health care.

Allthough none of the parties are promising resource to the level which NHS providers are asking for, the Conservatives offer the least and their u-turns on social care betray the fact that few of them have any actual idea about public services and those who use them.  Jeremy Hunt told Sky News that more funding for the NHS depended on a good Brexit deal.  So where is his commitment? There may not be an NHS by that time on Tory levels of resourcing.  Labour offers the most, but only if it can raise the money not just for the NHS but for its other promises as it seeks to undo some of the misery imposed by the Conservatives and their Coalition predecessors.  The Greens offer principled opposition and go further than Labour in seeking to undo current 'directions of travel' such as the Sustainability and Transformation Plans but are short on practical proposals.

SSONHS supporters include members of electorally competing parties as well as those who are non-aligned or support other groups.  We don't therefore have a specific electoral line but we urge supporters, young and old, to vote for the NHS.  Remember also that if you are in what seems like a safe seat, your vote is still important in terms of turnout.  The fact that Trump lost the popular vote to Clinton, despite winning in the electoral college, is still something which gives encouragement to all those who want to see him reined in.

Sustainability and Transformation Plan update

The STPs look like being neither sustainable nor transforming, except for introducing cuts. They're more like castles in the air. At the time of writing the STPs are still mostly secret despite having been submitted on 21st October. Some details of the Sheffield Place Plan were published at the Sheffield CCG meeting on 6th October here.  NHS England have instructed that all local communication about the STPs must be processed through their central communications team.

Some call the STPs the least bad option (Chris Ham here) but campaigners like John Lister of London Health Emergency and Keep Our NHS Public are more scathing.  Campaigners are pushing local Councils not to sign up to the STPs if they involve cuts. Two London Councils decided to publish the STPs anyway in order to bring them into the public domain and, because they involve disputed hospital closures, to seek a judicial review.

Opposing STPs does put cash-strapped councillors in a dilemma because the STPs are a potential source of funds for social care. But to accept this is just making matters worse. The plans need to be part of a proper public debate which must surely but back pressure on Hunt and May to recognise they can't go on pretending that the NHS is managing.  Cracks are appearing all over.  The Chancellor's neglect of the NHS and social care in his Autumn Statement was quite shocking.


Update 28th November

The South Yorkshire and Bassetlaw STP has been published on the website of South and Mid Yorkshire Commissioners Working Together, the group which is providing administrative support for the STP.  Here you can also find consultation proposals about the reconfiguration of Hyper acute stroke services and children's surgery. (Scroll down for the link to the STP page).

The STP does not involve any immediate cuts in Sheffield but significant changes are hinted at.  The financial strategy is not yet written or agreed.

We have attended a number of local events to challenge assumptions in the STP process but both the STP and the Sheffield Plan are up for approval at Sheffield CCG on 1st December.

Update 10th December

Sheffield Clinical Commissioning Group agreed the Direction of Travel of the STP and also approved the outline of the Sheffield Plan.  However at the full meeting of Sheffield Council on 7th December Cllr Cate Macdonald, Cabinet Member for Health and Social Care, said that it was not currently the intention of the Council to approve the STP because of the implications of agreeing the cuts which it implies, both at local and national level.  Hostility has also been expressed within Barnsley Council.  Other Councils up and down the country (including Tory controlled Devon) have also refused to agree their STPs.  The NHS leadership is showing signs that it recognises the process is in trouble, but for the moment it remains the only game in town.  There is likely to be more consultation and wooing of Councils and other organisations but the press seems clear that Theresa May is adamant in her refusal of more money for the NHS despite its increasing desperation.  Expect more trouble and confrontation from many quarters, not excluding staff groups as things become more and more stretched.

The Shaping Sheffield event held on 8th December was notable for avoiding the phrase STP wherever possible (though it was raised by the SSONHS speaker) and it seems likely that the Sheffield Plan (which predates the STP though is based on similar principles) will carry on edging forward under its own branding. 

Sheffield's "Place Plan" - part of the South Yorkshire and Bassetlaw STP

The NHS was instructed early this year to prepare Sustainability and Transformation Plans for 44 NHS Footprint areas. Ours is South Yorkshire and Bassetlaw and it is founded on so-called Place Plans for each of the CCG areas involved. The foundation for Sheffield's Place Plan is the Out of Hospital Strategy previously adopted by the CCG.

The STPs are unequivocally about getting the NHS to make local decisions about how to manage within the very tight and effectively reducing Government budget for the NHS. Nervous about this, NHS England placed a ban on public involvement during the preparation of the plans. In many areas (including West Yorkshire) they involve hospital closures. Some London Councils have refused to sign up to STPs where they involve the closure of popular facilities and the organisation Health Campaigns Together is calling on all Councils to refuse to sign up to STPs where they involve significant closures.

Some details of the Sheffield Plan will be made available on 29th Sept but local statements suggest that the process is currently more fluid than the early proclamations from NHS England anticipated. Although the plans are scheduled for implementation from April 2017 there will have to be formal public consultation from October. In Sheffield this will include sub-regional consultation on new proposals for hyper-acute stroke and paediatric surgery services - separate from but linked to the STP - and any changes deemed 'significant' by Sheffield CCG on Urgent and Emergency Care. the changes to stroke and paediatric services will involve some services ceasing in some centres (e.g. Barnsley and Rotherham) in order to reinforce/improve the regional services from the centres regarded as stronger (including Sheffield. This will have implications for income, viability and capacity in all local hospitals and the consultation will need to be vigorously addressed.

The Sheffield Plan is due to be approved by the Clinical Commissioning Group on 1st December and will be the subject of a citywide workshop on 8th December, hosted by Sheffield Health and Wellbeing Board and Sheffield Healthwatch.

So after the Brexit vote, what next?

Whatever you make of the Brexit vote, the ensuing chaos must be laid firmly at the door of the Conservative Party which forced the idea of the referendum, organised it (if that's the right word), failed to be honest about the issues (on either side), alienated the public and failed also to plan for an unexpected result.

The EU Leave campaign made a deliberate point of promising extra money for the NHS. The extent of the pledge was quickly revealed to be a lie and, indeed, post referendum, has already been retreated from by the likes of Nigel Farage. Nevertheless comments from the public both before and after referendum day suggested that it stuck in the memory and influenced people’s votes.

Whatever happens to the UK’s relationship with the EU after the vote in favour of Leave, the current government's austerity programme has placed the NHS in dire trouble and it is now issuing new threats to public spending. Goerge Osborne warned that even his so-called protection for the NHS budget was unlikely to be guaranteed. Starved of resources, haemorrhaging clinical staff, and facing continually rising expectations, the NHS faces new threats of further cuts because of growing economic weakness, rising inflation as a result of currency fluctuation and the likely diminution of the 52000 EU immigrant staff who help to keep services meeting patient need. As budgets get tighter national and local NHS leaders are being forced into ever more contortions to keep the service going - the latest being so-called Sustainability and Transformation Plans, in our case covering the whole of South Yorkshire and Bassetlaw. In many parts of the country these plans introduce cuts and closures and are already subject to challenge.

In the General Election our area voted overwhelmingly for pro-NHS candidates but in the referendum it voted narrowly for Leave. Few in Sheffield want to see the NHS collapse so we have a collective responsibility to ensure that what we value about our system lives on. We, the public, NHS patients and NHS staff, whether we are Remainers or Brexiters, need to care for the NHS both in the demands we must make of decision makers in all parts of the political spectrum and in the way in which we use it. Otherwise. before very long, we will find ourselves faced with an increasing spread of charges and the collapse of many parts of the system into private hands with no sense of responsibility to society at large. We've already seen the mess which has been left in places like Nottingham, Cambridgeshire and Cornwall when that happens. Sheffield Save Our NHS will be continuing to campaign both locally and in partnership with others in Yorkshire and the rest of the country to keep the NHS as a public provider of quality universal health care.

Come to our meeting on 4th July at the United Reform Church (6.30 for 7pm) to celebrate the 68th anniversary of the NHS, to hear about developments across Yorkshire, and to plan how best to campaign for the NHS in the future.

The EU Leave campaign has no right to claim the NHS logo

SSONHS isn't taking a stance on whether the UK should or shouldn't remain in the EU. However we decided to circulate a comment to our email list on the unjustified use of the NHS logo on Leave publicity material including bus advertising. We thought that NHS England had not challenged this but a reply told us that apparently government lawyers did request them to stop in March but the Leave campaign refused accusing the government of 'bully-boy tactics' and no further action was taken. It says a lot about the debasement of the logo through its regular licensing to private firms that NHS England went no further than a threat and that the Leave campaign was so shameless.

Whatever side you are on in the referendum debate the NHS should not in itself be a crunch issue although broader health considerations may be. The NHS is not directly relevant to the basic arguments for or against EU membership especially as the debate becomes increasingly polarised between those who consider they have a lot to lose and those voters who feel they have very little left to lose.

The basic trope of the Leave campaign in relation to the NHS is that more money will be available for the NHS if we leave and that pressure on services will be reduced because there will be less immigration. Two Tories have commented on the finance issue: Dr Sarah Wollaston the GP who was part of the Leave campaign, has changed sides because she could not justify the claim that £350billion is paid to the EU, let alone that a significant part of this would be available for the NHS. Also speaking about the NHS last week, John Major, ex Tory PM, told Andrew Marr on the BBC that "Michael Gove wanted to privatise it, Boris wanted to charge people for using it and Iain Duncan Smith wanted a social insurance system. The NHS is about as safe with them as a pet hamster would be with a hungry python". As for immigration, yes there are pressures on the NHS just as there are pressures on the Spanish health service because of elderly Brit expatriates. These might change slightly if Brexit secured some change in migration rules but would not necessarily be hugely different especially if we remained in the single market. The threat to the many non UK nationals working in the NHS would be significantly undermining and an extension to the threats faced by non-UK NHS staff earning under £18000 under the current Tory system. We have also been told about the importance of EU membership for collaboration on medical and public health research.

The Remain campaign claim that the Brexit would lead to economic difficulties and confusion for the economy as a whole and this, as Simon Stevens (head of NHS England) has warned, could seriously affect the NHS both short and long term. The NHS is highly vulnerable right now and the head of NHS Improvement has already said that the NHS will be unable to meet its national undertaking to break even this financial year. However the dire general warnings being uttered by lead Remain campaigners and European leaders seem much too catastrophic. Faced with Brexit more bilateral or alternative agreements could and would be drawn up to cover such issues as EHIC although some of the arrangements for elective treatment in EU countries currently available for NHS patients are likely to become unavailable and this would create more demand on UK services. Nevertheless Brexit supporters who are concerned for the NHS have to weigh up whether the longish period of serious economic and political uncertainty which will follow any vote, together with the consequent high level of threat to public sector spending and an NHS which is already over-stretched, is worth the risk against whatever they think will be gained. It is quite possible that the administrative strain of leaving the EU could be at least as stressful for the NHS as Lansley's Act.

Broader health issues and the consequent effects on the NHS are also relevant. We already have austerity and further economic uncertainty will, in the short term at any rate, affect jobs and the national income. Some of the issues are listed in a BMJ article but the links are behind a pay wall. Some medical opinion is summarised by The Independent here. Most medical opinion is in the Remain camp. The EU has taken significant public health initiatives although these are constrained by the lumbering nature of the way in which decisions are taken. Would the sort of UK government or regime which might follow a Brexit vote be likely to give equal support to public health issues, environmental considerations or even human rights given that a prime argument for leaving is deregulation?

Against this it is perfectly possible to argue that taking back responsibility for decision making into UK hands would mean that credit or blame for outcomes, for instance on the NHS, could be squarely put where it belongs instead of using the EU as scapegoat or smokescreen. Some financiers fear that Brexit could give space for 'madcap left ideas' if EU restrictions on state aid to industries are withdrawn (although other EU countries seem to have found ways to provide state support where necessary/desired). One positive outcome of the referendum arguments is the present government's agreement to formally exclude the NHS from TTIP - though the real worth of this assurance is still be tested. Brexit may of course eventually exempt the UK from EU competition laws (though these might still apply, at least partially, in a single market) but what would be the likelihood of a UK government taking an even more pro-competition stance? Business leaders who favour Brexit are overwhelmingly taking a neoliberal free market line.

If this piece is read as being pro-Remain, it is largely because of the misleading claims about the NHS being made by the Leave campaign and the distrust this generates. Campaigners report doorstep opinion that the Brexit campaign is more pro NHS which, as the quotes above suggest, is absolutely untrue.

If we remain in the EU, we know what the general climate is. If we leave then we will have to fight even harder to try and retain the public services we value. For some this may in the long term be a more attractive scenario because it can be argued to favour self-organisation. For others it can only create serious alarm.

Treat our doctors fairly Mr Hunt, so that they can treat us safely

Update 18th June
As the Junior Doctors begin to vote on the contract offer, opinion remains split. There are plenty of reasons for rejecting the offer but many doctors feel they have gone as far as they can and want to get on with their training/careers. Another result for Hunt - divide the opposition. Most are agreed that the current offer is a massive improvement on the original proposals and also on the March offer. There are some significant concessions by the junior doctors (for example the loss of increments) and other technical worries remain partly because of Hunt's insistence on the 7 day concept and his neutral cost envelope. But the main concern is the effect on staffing and recruitment as well as the loss of momentum in the huge wave of public support to preserve the NHS. The rejecters say "The contract on offer will not fix the recruitment and retention crisis. It is not going to help trainees on rotas with less than 50% fill rates such as GP and Core Medical Training. It is not going to help with the cost of living crisis as inflation continues to outstrip pay. It is not going to attract trainees back from abroad and encourage people to stay as a doctor in the NHS. It will drive LTFT [doctors in less than full-time training] out of medical and surgical specialties and possibly out of medicine as a career, despite the best efforts of our negotiators to prevent that. It will require a constant fight with management in order to be paid for the work we do, with no independent oversight, without concrete safeguards that a hospital has any legal duty to honour." See here

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We were asked by the Sheffield Star to submit a short article for possible publication in a feature on the strikes on 26th April. This is what we wrote.

"Talk to almost any junior doctor and you’ll immediately sense their anxiety not just about their own future but about the whole NHS. Jeremy Hunt’s insistence on trying to stretch the NHS while cutting its funding is squeezing staff at all levels beyond endurance. As numbers fall, junior doctors find themselves rostered to provide more and more extra cover with less help, often in unfamiliar surroundings and knowing that any mistake will be jumped on. In the 2015 NHS Staff Survey only 31% of staff agreed that there are enough staff for them to do their job properly.

We already have fewer doctors per head than most other European countries. 80% of junior doctors work unpaid overtime, often 11 hours a week. In 2008, 22% of doctors using the official ‘sick doctor service’ were aged under 35 but by 2015 that number was 54%. In 5 years newly qualified doctors joining NHS training schemes have reduced from 71% to 52%. Many trainees are planning gap years from this August because the proposed contract is the last straw. It also discriminates against women doctors.

Hunt’s 7 day service plan is based on misleading statistics and an ill-thought-out manifesto commitment totally derailed by his government’s austerity programme. The NHS will be less safe and possibly not even sustainable. Despite considerable progress in negotiations, the disagreement about Saturday working is less about pay than about clinical staff being able to retain enough control over their working lives to ensure they can make decisions and carry out treatments safely. If the doctors lose, nurses and other clinical staff will be next. We call on Sir Andrew Cash at STHFT not to implement the contract locally.

Without junior doctors our health service will collapse. Nobody wants these strikes but any short term safety risks are outweighed by the longer term danger of system collapse. Not all doctors’ strikes have been for the NHS but this one definitely is. They need our support."

Although several of us are away during the week, we shall be supporting the pickets at the major hospitals and the rally in Barkers Pool at 1pm on 27th April.

Taking Back Our NHS SSONHS Saturday Workshop 12th March

Update 21 March. The workshop went well and generated a lot of information sharing, comment and suggestions. We will be discussing future plans, together with updates on local and national issues at our monthly meeting on 4th April.
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Sheffield Save Our NHS will be hosting a half day event of information, discussion and campaign planning.

Taking Back Our NHS

Saturday 12th March 2016, 10am - 2pm
The Roco, 342 Glossop Road, Sheffield. S10 2HW

Keynote speaker Dr David Wrigley, Carnforth GP, Member of BMA Council and GP Committee and longstanding KONP activist. Plus regional and local speakers, who will cover the situation in Sheffield, the parliamentary NHS Bill to reinstate the NHS, and the Junior Doctors' dispute; followed by guided discussion and action planning.

The NHS is reeling under the pressure of the new market structures and the financial restrictions introduced by the 2010-15 Coalition government and reinforced by the current Conservative government. What is the impact in Sheffield and what can we do about it?

The Junior Doctors dispute has shone a light on the discontent felt about the government's agenda by many NHS staff and provided a focus for showing support for the NHS. Find out the latest in the dispute and what can be done to build solidarity.

This event is part of national action called by Keep our NHS Public to mark the second Parliamentary reading on March 11th of the National Health Service Bill, introduced by Caroline Lucas MP (Green Party) and co-sponsored by the Labour leader Jeremy Corbyn MP.

All welcome to come along and contribute Refreshments and low cost lunch available.

Accessible venue.

Register for the event at Eventbrite.co.uk,
or email team@sheffieldsaveournhs.co.uk
Pre-registration would be helpful to us but you can just turn up on the day