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    Something major happened in the NHS in February. No, not the new White Paper on rearranging the furniture; something else. This was the announcement, or lack of announcement, that a large number of GP Practices have been taken over by a US Health Insurance giant – Centene. AT Medics, a London based GP group, which runs 37 practices, has essentially been bought out by Centene. This means overnight hundreds of thousands of patients woke up with a new GP provider, without their consent. The acquisition makes Centene the largest provider of General Practice in England with 69 practices.

    The way this has happened follows a pattern seen in recent years. No consultation or public scrutiny; use of legal loopholes; and the use of the revolving door of ex-NHS leaders who know the system as gamekeepers turned poachers. It is possible by a sleight of hand similar to the methods of the cuckoo. The incoming company adds or replaces directors of the ‘host’ organisation, which technically still exists so keeps its NHS contracts, just as a cuckoo displaces the host’s chicks out of the original nest.

    The significance is twofold.

    Firstly, deep and comprehensive commercial involvement in our NHS is troubling. In this case the US health insurer is not only now the largest provider of GP services in the country, it also is providing contracts to NHS England and Integrated Care Systems to advise how they run the NHS – nationally and locally. This gives great insight into the decision makers and influence over how the money is spent. Combined with Centene having a major stake in private hospitals, it is not hard to join the dots- involvement in the design of systems, financing of services and the provision of services gives companies a great degree of involvement in our NHS.

    Secondly these developments are a logical conclusion to major changes for some years in the way family doctors services are organised and delivered. As a GP I have huge concerns and patients will do as well. Why does it matter?

    When invited in Parliament by his shadow, Jonathan Ashworth, to condemn the takeover, Secretary of State Matt Hancock declined, replying: ‘What matters for patients is the quality of patient care… what matters to people is the quality of care. That is what we should look out for’.

     Is he correct? Is the quality of care all that matters? Or do the people providing it, and their ethos, motivation, interests and agenda matter? Is it possible to disentangle ‘quality’, an abstract notion, from the specific people providing a service and their very non-abstract interests?

    One of the reasons I became a GP, and probably the major reason I have stayed in my practice working full time for nearly 15 years, is the deep-rooted feeling that I have of being part of something more than just a clinical service. Myself and my GP colleagues, similar to many across the country, both lead the service and work in it. Every day we see our patients and work in our communities, we know the people and the community. There is no escaping direct and sometimes blunt feedback. Our teams are small, if there is a problem, we are around to fix it. If something needs to change, we don’t need to enter into a large corporate machine for it to happen. We get the spanner out and make the adjustment.

    Can we really say the same for a company that has its eye on more than just providing a ‘good quality’ GP service for the 69 different sites it has control of? There are those who compare health care to supermarkets, or banks. The argument is that efficiency and scale are what is needed; the people who provide it can change and the patient-doctor relationship isn’t a problem, as long as the measurements prove ‘quality’. This may work for a simple transactional arrangement, such as buying some groceries or cashing a cheque, but healthcare – and especially holistic primary healthcare is a more complicated than that. It does matter who cares. It is all about the people, their motivations and their relationship with their patients and community. This is not to say that UK General Practice can’t be improved, but let’s at least keep the baby if we are changing some of the bathwater.

    If anything, General Practice feels more like farming than retail. When done well, looking after the health of the community well takes time, and deep commitment. When done badly it can result in destruction of the environment and soulless communities. Will this new huge, commercial type of model of healthcare care about this?

    I doubt it.

    https://www.theguardian.com/society/2021/feb/26/nhs-gp-practice-operator-with-500000-patients-passes-into-hands-of-us-health-insurer

    https://hansard.parliament.uk/commons/2021-02-23/debates/7CDE78FD-D275-41D3-B02E-D7690F054DB1/TopicalQuestions

     

    US Centene expands in the UK with increased stake in Circle Health

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    Issue: 111 – 10 November 2020

    Pfizer Covid-19 Vaccine

    This could be the only good Covid-19 news we have had in a very long time. Regulators have still not approved the vaccine though, but allegedly this will happen soon. According to DHSC guidelines issued in September 2020, the top priority list for those being given the vaccine is older adults resident in care homes and care home workers, 80 years of age and over and health and social care workers, 75+, 70+. 65+, and high risk adults under 65.

    The Government has an agreement with Pfizer to buy 30 million doses, with 10 million due by the end of December 2020.

    Very Steep Rise in Secondary School Covid-19 Infection Rates

    The National Education Union (NEU) has analysed Covid-19 infection data published by the Office for National Statistics. The NEU states that Infection rates in Secondary schools in England are an astonishing 50 times higher since September 2020. In Primary schools the rise is nine times. The NEU maintains these figures clearly show that schools are engines for virus transmission.

    The NEU recommends schools staying open only for children of key workers and for vulnerable children during Covid-19 lockdown. The NEU membership is 450,000 teachers, lecturers, educational support staff and leaders. More at:

    https://neu.org.uk

    As a postscript to this, when I researched infection rates across many Ealing neighbourhoods on 9 November 2020 the three highest rates were in neighbourhoods containing secondary schools – Northolt South (349 cases/100,000), Southall Green (310.1) and Cuckoo Park, Hanwell (280.9).

    Hospitals are Breeding Grounds for Covid-19 Infections

    On 9 November 2020, ‘ITV’ reported that of the 12,903 new Covid-19 cases between 18 September and 18 October 2020. 1,772 were acquired in hospital. Of the 700 new hospital cases in south east England, 23% were contracted in hospital.

    It seems for all kinds of reasons hospital staff and patients are not being tested on a regular basis. By 20 November 2020, allegedly, all patient-facing NHS staff will be asked to test themselves at home twice a week with results available before coming to work.

    Covid-19 Lockdowns Impacting the Mental and Emotional Health of Young People

    The NSPCC AND Childline are both reporting increasing telephone and counselling sessions. Young people are increasingly presenting with feelings of isolation, anxiety, insecurity and eating and body image disorders. More at:

    www.nspcc.org.uk

    www.childline.org.uk

    Is Covid-19 Population Testing (Mass-Screening of Asymptomatic People) in Liverpool Simply the Wrong Thing to Do?

    80 test centres and 2,000 troops involved. This sounds expensive. But will it ‘work’? Professor Allyson Pollock, a recognised Public Health expert, has her doubts. On 3 November 2020, as part of the Government’s £100 billion ‘Operation Moonshot’, population-wide Covid-19 testing of asymptomatic people in Liverpool was announced. Eight test centres opened on 6 November 2020.

    Professor Pollock has pointed out that this initiative is at odds with the SAGE advice of 10 September 2020 and with the current World Health Organisation (WHO) guidance. SAGE and WHO favour prioritising the rapid testing of symptomatic people, contact tracing and identification of infection clusters. Her concerns about the Liverpool pilot include:

    • a diversion of public money and resources. The OptiGene tests have cost £323 million.

    • the use of inadequately evaluated Covid-19 tests (direct LAMP test (OptiGene) and a lateral flow assay (Innova)

    • WHO evaluations of similar tests suggest between 1% and 5% of people without infection may get false positive readings. (With 392,000 adults in Liverpool these false positives could number anything between 3,920 to 19,600 adults)

    • there is no evidence demonstrating that Covid-19 mass screening can achieve benefit cost-efficiency

    • smaller pilot studies should have been carried out first before launching a massive pilot study of 498,000 people. (Allegedly a pilot was carried out in Manchester and it was found that half of the infections were missed).

    More at:

    https://allysonpollock.com

    The ‘Sunday Times‘ of 8 November 2020 leaked that three towns would be added to the mass-testing project. One is thought to be in The Midlands and one in the south of England. This would add another 100,000 people to be regularly tested.

    Reduced Support for the Homeless in Lockdown 2

    During Lockdown 1 many homeless people were put up in hotels, hostels and other forms of accommodation. This Government funded ‘Everyone In’ strategy was deemed to be successful in saving lives and reducing Covid-19 infections rates during Lockdown 1.

    Now it appears that money is running out to support the homeless and getting them off the street during Lockdown 2. Almost half of the night sleepers in London are foreign nationals and under the October 2020 post-Brexit legislation they could face deportation if found sleeping in the street.

    One week into Lockdown 2

    On day one of Covid-19 National Lockdown 2 (5 November 2020), I researched the following Ealing Covid-19 infection rates per 100,000 people. A week later I did this again:

    Southall Park: 265.3 became 244.1

    Ealing Broadway: 247.6 became 281.4

    Acton Central: 147.8 became 113.7

    West Ealing: 132.9 became 122.9

    A very small sample I know, but in three out of the four neighbourhoods the rate had fallen.

    Government’s Vaccine Taskforce Chair Spends £670,000 on Public Relations

    Kate Bingham, Chair of the Government’s Vaccine Taskforce, has allegedly hired eight Admiral Associates public relations consultants at £167,000/year each. Ms Bingham, a qualified biochemist and venture capitalist, was hired by the Government in May 2020. She is married to Jesse Norman MP. Bizarrely she reports directly to Prime Minister Johnson.

    Town/Hospital Based NHS Activist Groups Slowly Being Marginalised

    Three main factors at work here. Firstly the demolition of local CCGs. In 2018/19 there were 195 of them. By 1 April 2021 they will all have been closed down and ‘replaced’ be some 42 regional CCGs. Secondly, the Covid-19 response National Lockdown 2 has shifted commissioning from local, through regional, to a national undertaking. Thirdly, Covid-19 has allowed NHS bodies and Local Authorities to remove citizens from any effective, real time involvement in statutory body public meetings. In Ealing, for example, virtual, public Council care meetings employ MS-Teams software in a restricted, unhelpful fashion.

    NHS NWL EPIC

    On 17 December 2019 In NHS North West London (NWL) a public engagement initiative called ‘EPIC’ was launched at a workshop. 80 people attended of whom 34 were ‘patients’. EPIC is being used ‘to gather public opinion about local and NHS activities, involving ‘local residents in shaping and co-producing our services’. NHS NWL EPIC has built a ‘Citizen’s Panel’ of 4,000 north west London residents. The make up of the panel is allegedly representative of the 2.5 million residents in the region. I applied to join this panel but my application was ignored. Another EPIC Citizen’s panel meeting – this time a virtual one – was held 27 October 2020. In this meeting the idea of a ’Patient Forum in each borough’ was floated. The local Healthwatch, the local Council and the local voluntary sector would be invited. No timescale was set and it’s obvious that the forums would have no statutory significance whatsoever.

    Public Involvement Charter (PIC)

    EPIC is also developing its own ‘Public Involvement Charter’ (PIC). The PIC has admirable intentions and ‘core values’ – ‘the right to be involved, influence, improving outcomes, inclusion, engagement as residents want, information and transparency’. And all this as ‘we move more towards the (non-statutory) Integrated Core System (ICS)’.

    With all the generosity I can muster, I find the non-statutory EPIC, Citizen’s Panel and the Public Involvement Charter to be underwhelming, likely to be expensive and probably a complete waste of NHS and citizen’s time.

    Eric Leach

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    The Socialist Health Association is appalled by reports that Kate Bingham, who heads up Boris Johnson’s vaccine taskforce, has charged the government £670,000, for what is described as a ’team of boutique relations consultants.’ Each consultant is reportedly paid £167,000 a year – more than the Prime Minister. There appears to have been no formal process to appoint Bingham to chair Britain’s vaccine taskforce.

    This would appear to be a gross waste of public funds, which are desperately needed to fight the Covid pandemic.

    The Sunday Times reported that Bingham had shared government documents to investors at a $200-a-head virtual conference – an appearance that was not signed off by ministers. At the same time, she manages private investments in companies developing coronavirus drugs.

    We note that Ms Bingham, a venture capitalist, is married to Jesse Norman, a Tory Treasury minister, which only underlines the potential conflicts of interest.

    The SHA calls for the pandemic to be fought through the NHS and other public bodies, and not to be outsourced to private interests.

    https://www.thelondoneconomic.com/politics/kate-bingham-vaccine-tsar-runs-up-670000-taxpayer-funded-pr-bill/08/11/

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    SHA Cymru fully supports the actions of the First Minister and the Welsh Government in their management of the current crisis resulting from COVID 19. During this time SHA officers have had opportunities to meet with a number of Welsh Ministers. We have been impressed with the sheer amount of work they are undertaking and by the collegiate and thoughtful style they have adopted.
    The decision-making process has been clear, evidenced based, and methodical. It stands in sharp contrast to the vacillation of the Prime Minister and his Cabinet. We take some confidence from this that Wales and its people will emerge from the pandemic knowing that the Welsh Government, using scientific evidence available to them at the time, aimed to reduce further significant loss of lives and huge damage to the Welsh economy.

    Any questions or comments to Tony Beddow, tonesue@aol.com

    2 Comments

    This week North West council leaders and MPs wrote to the Chancellor asking him to set out plans for what comes next once this lockdown is over. We have been through so much change and uncertainty we deserve to know what lies ahead so we can plan.

    Today, Sunak announced that the furlough scheme will continue at 80% until March. We succeeded in pushing him to give workers what they deserve, not the 13% less that he thought the North was worth.

    This is what we can achieve when we work together and hold the government to account.

    Posted by Jean Hardiman Smith on behalf of Team North West

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    Biomedical scientists in the frontline of Covid-19 testing at a Lancashire NHS trust are losing about £7,000-a-year because hardline bosses refuse to pay ‘the going rate for the job’.
    Unite, Britain and Ireland’s largest union, said that the Lancashire Teaching Hospitals NHS Foundation Trust is facing a retention crisis as underpaid biomedical scientists are voting with their feet and moving to other trusts in the north west that pay the correct Agenda for Change (AfC) pay rate.
    Now the 13 biomedical scientists, who carry out vital tests once patients have been admitted to hospital with Covid-19, will be balloted from Monday 9 November for strike action or industrial action short of a strike. The ballot closes on Thursday 19 November.
    The crux of the dispute is that the biomedical scientists have been held back on Band 5 (AfC), despite qualifying for Band 6 (just under £38,000-a-year) due to working unsupervised for a number of years. The majority of Unite’s 13 members have lost about £7,000 annually as Band 5 pays about £30,000.
    Unite regional officer Keith Hutson said: “Our biomedical scientists have had years of training and are highly skilled, but are not paid a fortune. They are in the frontline of carrying Covid-19 related tests once patients are admitted to hospital.
    “Yet, we have a hardline trust management that is not prepared to pay ‘the going rate for the job’ for essential NHS workers at a time of national emergency.
    “This issue has been dragging on for over a year. At the start of the pandemic earlier this year, our members, as an act of good faith, put this dispute on the backburner.
    “When the number of infections dropped in the summer, we raised this issue again – but have been met by a brick wall from a skinflint management. Our members are being ripped off and short-changed which is not a great advert for this trust.
    “The result is that we have a retention crisis at the Lancashire Teaching Hospitals NHS Foundation Trust as our members are voting with their feet and move to trusts, such as in Blackpool and Blackburn, which appreciate their skills and dedication during this challenging time for the NHS – and pay the proper rate for the job.
    “Now, reluctantly, our members will be balloted for industrial action. However, there is a generous window of opportunity for the management to resolve this dispute and Unite’s door is open 24/7 for constructive talks.”
    The trust covers Chorley and South Ribble Hospital, and the Royal Preston Hospital.
    Shaun Noble
    Unite senior communications officer 
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    What happened during the first wave of Coronavirus and what can be done about it

    In the first wave of the Coronavirus pandemic, mortality rates for people in care homes were shockingly high. Many people living in residential care and nursing homes have cognitive impairments that make it hard for them to agree to their living conditions. In the spring and summer of this year, rights-based legal safeguards designed to protect people seem to have been ignored or set aside. The NHS and adult social care services are currently bracing themselves for a second wave. This article asks whether the safeguards are likely to be more robust this time around, and what can be done to ensure people’s rights are upheld in the future.

    ***

    According to the Office for National Statistics, there were 19,394 Covid-related deaths among care home residents between 2/3/20 and 12/6/20. About half the people in this group were recorded as having a pre-existing condition of dementia. Many will have been assessed as not having the mental capacity to decide where to live, and consequently should have been subject to Deprivation of Liberty Safeguards (DOLS).

    DOLS were introduced in 2009 after a landmark case in the European Court of Human Rights. Deprivations of liberty can be authorised by local authorities where they are proportionate, where there is no reasonable alternative, and critically where they are in people’s best interests. Local authorities have always lacked the resources to process applications, and backlogs began to build up as soon as the safeguards were introduced. Another legal ruling in 2014 held that many more people were being deprived of their liberty than had initially been supposed, putting even more pressure on the system. In 2019 the law was amended to introduce a new, speedier system, though this was contentious because it allowed care home managers a greater role in deciding whether deprivations were necessary or proportionate. This had been due to come in this month (October 2020), but implementation has now been put back to April 2022.

    During the first wave of the pandemic, the larger numbers of people moving into care homes should have resulted in a bigger figure for DOLS applications. Instead, the Care Quality Commission (CQC) recorded a 31% reduction in DOLS applications between April and June 2020 compared to 2019. It seems that the requirement to ensure that restrictions were in people’s ‘best interests’ was being quietly ignored. As well as considering the rights of the 25,000 or so people who were discharged from hospital to care homes with Coronavirus, it’s also important to consider the risks to the much larger number who were already resident. As care home staff struggled to prevent cross-contamination with inadequate PPE and high levels of staff sickness, many residents were confined to their rooms in accordance with government advice. The Mental Capacity Act 2005 may only be used to confine people in their best interests; where the deprivation is for public health purposes different provisions should have been used. Research by Dr Lucy Series showed that public health provisions were only applied a handful of times. The point here is not to second-guess the actions of staff who were clearly doing their best to manage under very difficult circumstances, but to ask ‘What’s the point of legal safeguards if they can just be ignored?’.

    In June the Equality and Human Rights Commission recommended that  the “ … Government should urgently undertake or commission a review into deaths in care homes during the pandemic, in line with its equality and human rights obligations…”. One would have expected that in the pause afforded after the first wave of infections, lessons would have been learned and changes made.  Instead we have an adult social care winter plan that promises (but has not yet developed) a “…designation scheme with the CQC for premises that are safe for people leaving hospital who have tested positive or are awaiting a test result.” It seems that the government is anticipating that people with the virus will be discharged into care homes, but a process for this to be safely managed is not yet in place. At the same time revised guidance that suggests that where new restrictions are imposed to prevent cross-infection “…in many cases [they] will not be…” new Deprivations of Liberty. However, considering the significantly greater risk of mortality under these circumstances, it seems at least reasonable to question whether the original judgements about what is in a person’s best interests would still be valid.

    ***

    The specific issue of DOLS is one of a large number where human rights seem to have been set aside during the initial Coronavirus outbreak. A report from Amnesty International published earlier this week found that the “…UK government, national agencies, and local-level bodies have taken decisions and adopted policies during the COVID-19 pandemic that have directly violated the human rights of older residents of care homes in England—notably their right to life, their right to health, and their right to non-discrimination.” Early on in the Pandemic there was concern that the frailty scale being used to decide whether people would get life-saving treatment was being used inappropriately with younger disabled groups, leading DHSC to issue urgent ‘clarification’. Last week the CQC was asked by DHSC to review the way that Do Not Attempt Resuscitation (DNAR) notices were used by clinicians. ONS data re-analysed by Prof. Chris Hatton shows in-patients with autism and learning disabilities were subjected to more restraints during the pandemic. Organisations such as Inclusion London, Inclusion Scotland and Disability Rights UK have highlighted linked concerns among other groups of disabled people. During the outbreak the majority of disabled people experienced difficulties accessing basic care, medicines and food. Many of these organisations have joined the EHRC and Amnesty in calling for an inquiry into the events of this year, and ultimately for stronger legal guarantees.

    Another important lesson relates to funding. The lack of social work capacity for DOLS authorisations, wider under-staffing and poor pay in the care sector, and the absence of alternatives to ‘congregate’ care have all contributed to the events described in this article. Adult social care services have been subjected to growing demands and reduced resources for over a decade. Why is it that vital local social care services are still facing massive financial shortfalls at the same time that central government is putting record sums into the NHS and privatised test-and-trace services? An urgent solution to funding in adult social care is also a necessary component of any solution. Many argue that this will only be politically viable when social care is seen not as a destination but as a vehicle for helping the people we are and the people we love to lead rich and full lives. These three strands – a brighter vision, a new financial solution, and stronger support for human rights – can form a common ground for campaigning and activism that can help us future-proof social care against similar crises in the future.

    Jon Hyslop, Oxfordshire Branch, 19/10/20

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    News Release

    23 September 2020

    Evidence shows failure of consecutive governments to properly regulate, FBU says

    Emails seen by the Grenfell Tower Inquiry reveal “just how lax” ministers allowed UK building regulations to become, the Fire Brigades Union (FBU) says.

    The correspondence revealed that housing and construction industry salespeople knew that, without government intervention, high-rise buildings would continue to be constructed with flammable cladding.

    The Aluminium Composite Material (ACM) cladding on Grenfell had a flammble polyethylene (PE) core, but was also available with a less combustible fire rated (FR) core.

    In an email seen by the inquiry, a salesperson said that Alcoa (now Arconic) “won’t change their core [to fire rated] until they are forced to due to changes in the fire regulations”.Responding, Matt Wrack, FBU general secretary, said:

    “Ministers have avoided scrutiny so far in this inquiry, but today’s evidence shows just how lax UK building regulations had become before Grenfell.

    “People in the industry knew that, until government stepped in, homes would continue to be wrapped in flammable cladding and constructed with other dangerous materials, but ministers showed no interest in tackling the problem.

    “There’s no depth that businesses will not sink to within the law to turn a profit. Consecutive governments oversaw decades of deregulation, privatisation, and austerity, utterly failing to ensure the housing and construction sectors were acting safely.

    Joe Karp-Sawey, FBU communications officer

    • NOTE 1: Screenshot of email from Geof Blades of CEP Architectural Facades

    • The Fire Brigades Union (FBU) is the trade union representing the overwhelming majority of firefighters in the UK and serves as the professional voice of firefighters and the fire and rescue service. The union is a core participant in the Grenfell Tower Inquiry
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    There has been too much reliance on the private sector when it comes to laboratory testing for coronavirus and not enough investment in long-established NHS facilities, Unite, Britain and Ireland’s largest union, said today (Wednesday 16 September).
    Unite’s stance is underpinned by its Biomedical Scientist Covid-19 survey, launched today, which highlights the under-use of NHS science facilities and resources as the crisis over the nationwide gaps in the Covid-19 testing regime escalates.
    The survey reveals Unite members’ unhappiness at the government’s reliance and priority given to the seven Lighthouse Laboratories, with private sector involvement, while long-established NHS facilities are being apparently sidelined when it comes to investment.
    The report is being sent to health and social care secretary Matt Hancock, and the chair of the Commons health and social care select committee Jeremy Hunt, as well as MPs.
    The survey said: Concerns about under-utilisation of NHS resources were matched by concerns around the introduction of the new Lighthouse Laboratories and the impact this was having on NHS services.
    “Broadly these concerns focused on the quality of services provided, the diversion of resources from the public sector and the decision making, and transparency process used to commission these new laboratories.
    Healthcare science staff and their trade unions have been left in the dark regarding these processes.”
    More than 85 per cent of the survey’s respondents agreed that there was concern about the service quality from the Lighthouse Laboratories and over 90 per cent concurred that there were worries about the transparency and contracting arrangements for these laboratories.
    In contrast, only 38 per cent said their NHS laboratories were working at full capacity, but there was near unanimous support for further investment in NHS labs, so they are well-placed to undertake the mass testing of millions envisaged by Operation Moonshot.
    Unite said that Operation Moonshot should not become ‘an ill-deserved pay day bonanza’ for private healthcare companies which had fallen short during the pandemic to the extent that they have asked the NHS to help out.
    Unite lead officer for healthcare science Gary Owen said: “The government’s obsession with involving the private sector in the Covid-19 ‘trace and test’ regime has been shown to be flawed and misguided, as more and more people report difficulties in trying to get a test near to their home.
    “If ministers have learnt any lessons from Covid-19 it should be that the NHS, with the right level of investment, is best placed to provide laboratory testing for such a global pandemic as we are currently going through.”
    Chair of the Unite healthcare science committee Ian Evans said: “Long-established NHS laboratories with a wealth of professional experience built up over decades appear to have been marginalised in the battle against coronavirus – this has been a huge mistake.”

    The report can be accessed via:

    https://unitetheunion.org/media/3331/9199_biomed-scientists_survey_summer2020_final-digital.pdf

    The survey was distributed on two dates in June by email to all Unite members within healthcare science. This snapshot survey generated 388 responses from across the UK.

    Unite senior communications officer Shaun Noble

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    Today HIV i-Base (where I work part-time) and the UK-CAB (of which I’m a member) joined with more than 70 other organisations sending a joint statement to the Prime Minister, the Secretary of State for Health, and the interim leadership of Public Health England regarding our concerns of the restructuring of public health in England.

    Over 70 health organisations unite to raise serious concerns with Government about plans to reorganise the public health system

    Today over 70 health organisations and alliances have sent a joint statement to the Prime Minister, the Secretary of State for Health, and the interim leadership of Public Health England, raising serious concerns about the reorganisation of public health now underway. This follows recent announcements that PHE will cease to exist by April next year and be replaced by the National Institute of Health Protection.

    The statement is endorsed by a wide range of leading health organisations, including the Association of Directors of Public Health, the Faculty of Public Health, the Royal Society for Public Health, the Academy of Medical Royal Colleges, the BMA, the SPECTRUM public health research collaboration, the Smokefree Action Coalition and the Richmond Group of health and care charities. The statement warns that:

    “Reorganisation risks fragmentation across different risk factors and between health protection and health improvement. Organisational change is difficult and can be damaging at the best of times and these are not the best of times. A seamless transition from the current to the new system is essential.”

    While recognising that there are opportunities:

    “There are opportunities from this re-organisation to improve on current delivery, but only if there is greater investment combined with an emphasis on deepening expertise, improving co-ordination and strengthening accountability.”

    The statement, launched today in a letter to the BMJ from key signatories sets out the principles which all agree must underpin the new health improvement system. This includes the need for renewed investment into public health to address the years of cuts the sector has seen, an interconnected approach with the right infrastructure and expertise to support national, regional and local delivery; and the need to sustain local government system leadership at local level, while strengthening co-ordination with the NHS.

    Dr Nick Hopkinson, a respiratory specialist at Imperial College London, chair of Action on Smoking and Health, speaking on behalf of the Smokefree Action Coalition as a signatory to the letter said:

    “We are in a state of public health emergency because of COVID-19, and system reorganisation at this time brings with it great risks, as well as opportunities. That is why the public health community has come together to set out for Government the principles that we all agree must underpin any reorganisation of the health improvement and wider functions of Public Health England (PHE). If we are to recover from the global pandemic and recession, health improvement is not a ‘nice to have’ but an essential component of a successful response to the challenges we face.”

    Professor Maggie Rae, President of the Faculty of Public Health, signatory to the BMJ letter, said:

    “Reorganisation of Public Health England (PHE) brings with it a real risk that some of the critical functions of PHE will be ignored. The pandemic has shone the light on the health inequalities that exist in the country and it is clear that those with the poorest health have been hit hardest. Scaling up, not down, the health improvement functions of PHE is a prerequisite if the Government is to deliver on its commitments to ‘level up’ society; increase disability-free life years significantly, while reducing inequalities; to improve mental health; increase physical activity; reduce obesity and alcohol harm; and to end smoking. Ensuring there is adequate funding, a robust infrastructure and sufficient public health expertise to deliver at national, regional and local level, is fundamental.”

    Professor Linda Bauld, Chair of Public Health at the University of Edinburgh and Director of public health research consortium SPECTRUM, signatory to the BMJ letter said:

    “While COVID-19 is a pressing emergency, the truth is that chronic non-infectious diseases are still overwhelmingly responsible for preventable death and disease in this country. What’s more those with the poorest existing health have the worst outcomes from COVID-19. A future public health system must be robust enough to protect us from the threats posed by both infectious and non-infectious diseases.”

    Joint statement to the Government on Public Health Reorganisation. Link to statement and list of signatories https://smokefreeaction.org.uk/phehealthimprov/

    Link to BMJ letter: Rapid Response: Joint statement to the Government on Public Health Reorganisation: https://www.bmj.com/content/370/bmj.m3263/rr-1

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    Joint response to the announcement of the National Institute for Health Protection and the future of public health, published today 18 August 2020:

    Terrence Higgins Trust, National AIDS Trust (NAT), British HIV Association (BHIVA), British Association for Sexual Health and HIV (BASHH), the UK Community Advisory Board (UK-CAB) HIV treatment advocates network – Tuesday 18 August 2020

    Following today’s announcement regarding the National Institute for Health Protection, and the implications for the future of public health, five of the nation’s leading HIV and sexual health organisations have issued a joint response.

    The Secretary of State’s speech today leaves us with more questions than answers.

    Public Health England (PHE) is responsible for far more than its scientific work – it plays a significant role in the response to HIV, sexual health and reproductive health and has driven innovative national health improvement efforts. Today’s announcement provides no clarity on the future of this important health improvement function and we are concerned that structural changes could risk a reversal of the progress that has been made to date.

    We also need urgent clarity on the future home of the world-leading PHE HIV and sexual health epidemiology and surveillance work that has underpinned our national efforts in tackling HIV and sexually transmitted infections (STI’s) and delivering care to vulnerable population groups at this crucial moment in the fight against HIV and the delivery of better sexual health in England.

    At this juncture a kneejerk restructure of the public health system which is non-transparent, ill-thought through and leads to more fragmentation in accountability structures risks holding us back.

    We know from past reforms that any sudden structural changes by government can result in poorer outcomes and risk leaving key policy areas falling through the cracks. Experience has shown us that any new agencies must to be free of politics and be science and expert led.

    Any changes to PHE must also protect the prevention and policy work that it currently leads in HIV, sexual health and reproductive health and ensure that there is no backtracking, or slowing down of existing commitments, particularly:

    • to end new HIV transmissions by 2030 in England;
    • to deliver a national PrEP programme;
    • to consider and act on the recommendations of the independent HIV Commission;
    • to improve access to contraception including LARC;
    • and to oversee the development of a much needed new national sexual and reproductive health strategy.

    The announcement made today focuses on “new” and “external” health threats whilst not acknowledging the public health emergencies that already exist in the UK. While attention has rightly been given to the ongoing COVID-19 pandemic, focus must not be lost in tackling longstanding HIV and STI infection rates and reversing sexual health inequalities.

    It is not acceptable that these changes are being proposed in a vacuum. All changes in regard to the new National Institute for Health Protection must be fully consulted on, which includes a meaningful conversation with charities, community organisations and healthcare professionals in the HIV and sexual health sectors, to ensure that there is no harmful impact.

    We urge the Government to think carefully before major changes to PHE are enacted. Any change must strengthen the national action around public health including sexual health and HIV. National accountability must be transparent, and it is essential that PHE, or its successor, is provided with the power to drive change and improvements to continue to make progress on HIV and tackle sexual ill-health.

    Roy Trevelion
    Member, UK-CAB and BHIVA

     

    Comments Off on Joint response to the announcement of the National Institute for Health Protection and the future of public health

    This week the Government is expected to announce that it will scrap the pandemic response function of Public Health England, and merge this with NHS Test and Trace to form an agency “similar to the German Robert Koch Institute”. It is also particularly distressing that the news was leaked to the press before PHE staff could be told.

    The SHA warns the reckless decision to restructure and defund public health services in the midst of a pandemic will result in further avoidable deaths. The public health service, nationally and locally has already been severely starved of funds as a result of austerity.

    The NHS Test and Trace Service (led by Baroness Dido Harding, and run by Deloitte, Serco, Sitel and other private sector outsourcing companies) has received strong criticism for its poor response to the COVID 19 pandemic.

    Dr Brian Fisher, SHA Chair, says “This is yet another example of the Government putting lives at risk by pursuing ideologically driven privatisation in a time of crisis.”

    Socialist Health Association members have told us that “this is another example of this government’s scapegoating, most especially since the man telling us the PHE response has been unacceptable was the man in charge, deliberately ignoring their expert recommendations and favouring sweet manufacturers and other non-expert businesses to deliver a service to the public. Public health has been underfunded, to the point it has required almost superhuman efforts from its staff to maintain a quality of service from the time of the so called Lansley Reforms. For that, our public health experts, like our nurses, are rewarded with a kick in the teeth.”

    SHA calls on the Government to reinvest funds from failing NHS Test and Trace private providers into the public sector pandemic response across the NHS, Public Health England and Local Authorities.

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