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Author Archives: Irwin Brown

Irwin Brown has been the editor of Socialism and Health since it was founded in 1965.

We all know that just about every announcement of any change in NHS provision will be met by fierce opposition from local politicians, even from local politicians that have responsibility for the policy that leads to the change!  That is a problem, but it is fair to say that the NHS in general has been hopeless at building the case even for sensible changes. Whilst some in the NHS appear to be unaware of it, there is a lengthy and exhaustive process which is supposed to be used before there is any significant reconfiguration of services.  There are even a […]
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According to the Public Accounts Committee there are over 70 NHS Trusts which had deficits last year and at least 11 existing Foundation Trusts (once the elite) that are not viable.  Top of the list of debtors, although not by much, is South London Healthcare Trust (SLHT).  Proposals to make services sustainable in South East London have been published by the Trust Special Administrator who drew on external consultancy advice from the usual experts. Over recent years, in many of the 70 challenged trusts and others, there have been proposals drawn up by similar experts; proposals then signed off by […]
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It is my belief that there is ample evidence to support the following:- Closing small “A&E” Departments and concentrating emergency surgery (and emergency medicine) on fewer sites saves lives. Closing “A&E” and replacing with an Urgent Care Centre does not save any money. Foundation Trusts are no more innovative than NHS Trusts. It takes significant investment and a period of double running costs to move care out of hospital. Most Foundation Trusts do not want to treat more private patients. Private providers providing services to NHS patients (over £1bn for elective surgery in 2011) do not provide poor quality. Acute […]
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Repeal of the reviled Health Act 2012 cannot be an end in itself.  An alternative vision is needed for an integrated care system. We set out our ideas from a left of centre perspective. We need proposals with the kind of support enjoyed by the 2000 Plan, taking time for genuine consultation, planning and mobilisation before implementation.  A period of structural stability should be used to focus on behavioural and cultural changes. The clinical professional bodies should decide how they can adapt their practices, training and professional development to meet the new challenges. They have also to confront some of […]
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There is a widespread consensus about the challenges which face our care system.  There is a growing consensus that we need to focus more on avoidance and prevention, on behaviour and culture and on things like integrated whole person care and on community development – less on organisations and structures – no more reorganisations. Yet there is a persistent background noise that claims that PFI, private provision, and the cost of the market are what is wrong and that full public provision is the solution. Some PFI contracts offer very poor value for money showing the “experts” that advised the […]
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At the heart of concerns about reconfiguration and the future of our District General Hospitals is the issue around A&E Closures.   A real Accident & Emergency Department must have a genuine 24/7 consultant delivered surgical and medical service.  For a start it must meet the  Royal College of Physicians guidelines so that a consultant physician should always be available ‘on call’ and should be on site at least 12 hours per day, seven days per week with no concurrent duties.  And the admissions unit should have a consultant presence for more than four hours per day, seven days per […]
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A number of commentators have listed 10 things Labour should do to restore our NHS, when they are elected in 2015.  Here is my first go at a list. For context by then the Health & Social Care Act 2012 will have been fully passed into law and much of the implementation will have taken place. So no NHS Trusts; CCGs, Health & Wellbeing Boards, Healthwatch, NCB all in place more or less as envisaged; 30 – 40 mergers involving Foundation Trusts but many FTs still not financially viable; maybe 5 ex NHS Trusts in limbo under franchised management or […]
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Replacing the Health and Social Care Act Simple repeal of the reviled Health Act 2012 cannot be an end in itself.  What is needed is a clear vision of an alternative approach to make our care system better.  We need to repeal and replace. Legislation and structural changes to pursue some ideological end have been shown time and again not to work.  Imposing change on a reluctant and unmotivated workforce is unlikely to end well. New proposals must be subjected to discussion resulting in long term plan with the degree of support enjoyed by the 2000 NHS Plan. Once elected, […]
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The Coalition agreement promised no top down reorganisation of the NHS and the White Paper had lots of nice sounding stuff about patients at the centre, doctors in charge and less bureaucracy.  After lots of consultation making everyone feel important, the Bill was published and signed off by the LibDem leadership.  “Labour attacks Tories on NHS changes” was not a story of any interest. In the Commons the Bill sailed through on coalition votes without any LibDem disquiet and no great outcry from anyone in the professions – just Labour and the Trade Unions in opposition – so again no […]
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My interest in mortality goes back 40 years to when I trained as an actuary and carried out medical underwriting.  I have written before about how early on in my NHS career I suggested applying some of the rigour we used in the insurance industry to mortality studies. I was interested in mortality rates and Hospital Standardised Mortality Ratio; it was familiar territory. Some years later I have grave concerns about the misuse of Hospital Standardised Mortality Ratio, based in part on the academic papers often cited which raise methodological issues.  I am also aware that the different methods to […]
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undated, probably 1967 Every year, the Ministry of Health informs the public that it is doing better and better.  To take one aspect, nursing, there are more nurses doing more work, an increase which is true of each year since the National Health Service began in 1948.  The public may well feel confused by such complacency, for if it should feel ill and go to hospital, it will see that the nursing staff is rushed off its feet, perpetually harassed, and that inadequate staff is available for the night shift, and that reality contradicts official balm. Those who are familiar […]
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A Survey of The English Disease and A Programme for Action Published by The Socialist Medical Association, 13 Prince of Wales Terrace, London, W. 8. undated, probably 1966 In the early years of the 19th century, when evidence on the conditions of workers in the new factories was being sought, a doctor was asked about the effects of working environment on the health of metal workers and metal grinders.  At that time, the dust was so intense and so harmful that the average expectation of life for these workers was less than 30 years. “A little expectoration is a good […]
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