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    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.

    1 Comment
    Public Health England (PHE) and its dedicated staff are being lined up as ‘the fall guy’ for ministers’ bungling over the handling of the coronavirus pandemic, Unite, Britain and Ireland’s largest union, said today (Monday 17 August).
    Unite, which is the lead union for employees at PHE, said that instead of merging PHE into a new body charged with preventing future pandemics, the PHE should continue in its present role – and the money cut from its budget by the government should be restored.
    Unite also said that there should be proper consultations with the unions about the future of PHE, an executive agency of the Department of Health and Social Care. Unite strongly disputes media reports that the unions were consulted.
    Unite national officer for health Jackie Williams said: “It is clear that Public Health England and its dedicated staff are being lined up to be the fall guy for continual bungling by Boris Johnson and his ministers since coronavirus emerged at the beginning of the year.
    “The catalogue of errors ranges from the lateness to lockdown in March to the failure to have a so-called ‘world beating’ test-and-trace system in place by June.
    “In their desperation to find anyone or any organisation to blame for their own failings, Boris Johnson and health and social care secretary Matt Hancock are lining up the PHE and its staff to be the fall guy.
    “We think that the underlying agenda here is the future privatisation of PHE’s national infection service – the Tory government is obsessed with NHS privatisation which has been shown to be highly flawed and not a good use of taxpayers’ money.
    “We are calling for PHE to continue in its present role and allowed to do its vital work, rather than spend huge amounts of time, effort and money reorganising England’s public health structures in the middle of a global pandemic.
    “We are also calling for the swingeing cuts to its budget over recent years restored. The lack of consultation is both appalling and insulting.
    “PHE needs to have the resources to do the job it is designed to do, which is protecting the public health of the people in England, without inappropriate buck-passing political interference.”
    Shaun Noble
    Unite senior communications officer
    2 Comments

    To Members of the West Midlands SHA

    Dear Colleague
    Please find below the Sunday Times Response to the Government
    Courtesy of Spellar News
    John Charlton
    Secretary

    Coronavirus: how the government tried to dismiss Sunday Times investigation

    Senior scientists, a former civil service chief and Tory ex-ministers criticise the official response to our report

    Insight | Jonathan Calvert and George Arbuthnott  Saturday April 25 2020, 6.00pm, The Sunday Times

    The government’s defence of Boris Johnson over his failure to attend five successive meetings of the Cobra national crisis committee on the coronavirus has been dismissed by former Whitehall officials and senior politicians.A former head of the civil service, three Conservative ex-ministers and a former Downing Street chief of staff said it was usual for the prime minister to attend Cobra if he was in easy reach of London.They spoke out after the government issued a 14-point response in a 2,100-word blog to The Sunday Times’s account of the five weeks from late January, detailing how government inaction compromised attempts to tackle the virus.

    The government’s most senior ministers — including Dominic Raab, Michael Gove and Matt Hancock — leapt to the prime minister’s defence and tweeted copies of the blog, which claimed that the Insight team’s report contained a “series of falsehoods and errors”.Gove, the Cabinet Office minister, said on the BBC last week that “most Cobra meetings don’t have the prime minister attending them”.The government’s spin doctors were accused of misrepresentation by a doctor and a scientist who were quoted in the official response as suggesting that the severity of the threat from the coronavirus was not fully appreciated when Johnson missed the first Cobra meeting.The doctor, Richard Horton, editor of the medical journal The Lancet, accused the government of “Kremlinesque” manipulation of his words.The scientist, Martin Hibberd, professor of emerging infectious disease at the London School of Hygiene and Tropical Medicine, said the government’s response used his words out of context, cutting out a sentence calling for urgent action to gather evidence in preparation for a possible pandemic.

    The Sunday Times article revealed that Johnson did not attend his first Cobra meeting on the virus until March 2. He skipped the January and February Cobra meetings despite being in Westminster on four of the days that they were held and an hour’s drive away in Kent on the other.An analysis of more than 40 Cobra meetings on major emergencies that have been published in the decade since the Conservatives came to power shows that prime ministers usually chaired them — unless they were too far away from London to get to the committee on time. Only three were chaired by a secretary of state when the prime minister was in Westminster.

    Lord Kerslake, the head of the civil service between 2012 and 2014, said the prime minister typically chaired three-quarters of the Cobra meetings and the main reason for non-attendance was that they were away from London.He said: “[Cobra] is there for a national emergency and you don’t call it unless there’s something pretty serious. And if there’s something pretty serious, you would expect the prime minister to chair it.”His views were supported by three Conservative former ministers who were familiar with the workings of Cobra and by Jonathan Powell, Downing Street chief of staff under Tony Blair, who said he was not aware of an occasion when Blair had missed a Cobra meeting while he was at Westminster.Powell said: “It’s not impossible for the prime minister to miss Cobra meetings if something is happening in the world that’s more important or he’s out of the country. But the point of missing five is it’s a sign that we’re not taking the problem seriously enough.”

    In Johnson’s defence, the government’s “blog” gave three examples of times when a minister had chaired Cobra instead of the prime minister over the past 11 years. In two of these examples, it has emerged that the prime minister was unable to attend because he was abroad. One occasion was when Gordon Brown was in Poland — and yet he still phoned in to take part in Cobra. The other was when Johnson’s plane had just touched down in New York.The third example given by the government said Gove chaired Cobra over preparations for a no-deal Brexit. This meeting had never previously been acknowledged in public and this weekend Downing Street declined to say when it took place.

    Yesterday, Downing Street responded to our inquiries by sending a short paragraph taken from the 2011 cabinet manual, which states: “In general the chair [of Cobra] will be taken by the secretary of state of the government department with lead responsibility for the particular issue being considered.”However, a 2013 government document gives a fuller description of Cobra’s role. It says Cobra is mostly convened for “level 2” international emergencies — using the example of the swine flu threat — and says these meetings are controlled by the “Strategy Group”, which is chaired by the prime minister, home secretary or foreign secretary.Kerslake said it was customary for the prime minister to chair the strategy group.“Under the emergency planning guidance you would expect the prime minister to attend Cobra over the coronavirus crisis because it is clearly at least a level 2 emergency. Given its seriousness, I would be surprised if it was classified [as] any different from this.”

    Here we reproduce each section of the government’s statement and The Sunday Times’s replies.

     Government statement:

    Claim [by The Sunday Times] – On the third Friday in January Coronavirus was already spreading around the world but the government ‘brushed aside’ the threat in an hour-long COBR meeting and said the risk to the UK public was ‘low’.

    Response [by the government] – At a very basic level, this is wrong. The meeting was on the fourth Friday in January. The article also misrepresents the Government’s awareness of Covid 19, and the action we took before this point. Health Secretary Matt Hancock was first alerted to Covid 19 on 3 January and spoke to Departmental officials on 6th Jan before receiving written advice from the UK Health Security Team.

    He brought the issue to the attention of the Prime Minister and they discussed Covid 19 on 7 January. The government’s scientific advisory groups started to meet in mid-January and Mr Hancock instituted daily coronavirus meetings. He updated Parliament as soon as possible, on January 23rd.

    The risk level was set to “Low” because at the time our scientific advice was that the risk level to the UK public at that point was low. The first UK case was not until 31 January. The specific meaning of “public health risk” refers to the risk there is to the public at precisely that point. The risk was also higher than it had been before — two days earlier it had been increased “Very Low” to “Low” in line with clinical guidance from the Chief Medical Officer.

    The WHO did not formally declare that coronavirus was a Public Health Emergency of International Concern (PHEIC) until 30 January, and only characterised it as a global pandemic more than a month later, on 11 March. The UK was taking action and working to improve its preparedness from early January.

    Sunday Times reply:
    It was indeed the fourth Friday in January, but the date (January 24) was correct. We regret the error. The article does not misrepresent “the government’s awareness of Covid-19” before January 24. The article begins its narrative on January 24 and does not comment on what actions were taken before that date. The rest of this section challenges nothing that was reported in the article.

    ● Government statement:

    Claim [by The Sunday Times–‘This was despite the publication that day of an alarming study by Chinese doctors in the medical journal The Lancet. It assessed the lethal potential of the virus, for the first time suggesting it was comparable to the 1918 Spanish flu pandemic, which killed up to 50 million people.’

    Response [by the government] – The editor of the Lancet, on exactly the same day – 24 January – called for “caution” and accused the media of ‘escalating anxiety by talking of a ‘killer virus’ and ‘growing fears’. He wrote: ‘In truth, from what we currently know, 2019-nCoV has moderate transmissibility and relatively low pathogenicity. There is no reason to foster panic with exaggerated language.’ The Sunday Times is suggesting that there was a scientific consensus around the fact that this was going to be a pandemic – that is plainly untrue.

    https://twitter.com/richardhorton1/status/1220606842449072128?s=19

    Sunday Times reply:
    This is misrepresentation. Mr Horton issued his tweet at 7.18am and the alarming new Chinese study came in later the same day and was published straight away by The Lancet, which is confirmed by a tweet by Mr Horton at 3.05pm. Next day Mr Horton tweeted: “The challenge of 2019-nCoV is not only the public health response. It is clinical capacity. A third of patients so far have required admission to ICU. 29% developed ARDS. Few countries have the clinical capacity to handle this volume of acutely ill patients. Yet no discussion.” Two months later (March 27), Mr Horton said on BBC Question Time: “Honestly, sorry to say this, but it’s a national scandal. We shouldn’t be in this position. We knew in the last week of January that this was coming. The message from China was absolutely clear that a new virus with pandemic potential was hitting cities. People were being admitted to hospital, admitted to intensive care units and dying and the mortality was growing. We knew that 11 weeks ago, and then we wasted February when we could have acted. Time when we could have ramped up testing time when we could have got personal protective equipment ready and disseminated. We didn’t do it.”

    After the government cited Horton in its statement on Sunday night, Mr Horton tweeted on Monday: “Just for the record: the UK government is deliberately rewriting history in its ongoing COVID-19 disinformation campaign. My Jan 24 tweet called for caution in UK media reporting. It was followed by a series of tweets drawing attention to the dangers of this new disease.” On Tuesday Mr Horton told The Sunday Times that the government’s use of his tweet in their response to the article was “redolent of Kremlin-esque manipulation of evidence”. He added: “I find it very funny that Matt Hancock was asked a question about disinformation and he said, ‘we take it very seriously and we need to correct disinformation’. They really are scared that the verdict of history is going to condemn them for contributing to the deaths of tens of thousands of British citizens. And because they know they wasted a minimum of five weeks through February and early March they are desperately trying to rewrite the timeline of what happened. And we must not let them do that.”

    ● Government statement:

    Claim [by The Sunday Times] – It was unusual for the Prime Minister to be absent from COBR and is normally chaired by the Prime Minister.

    Response [by the government] – This is wrong. It is entirely normal and proper for COBR to be chaired by the relevant Secretary of State. Then Health Secretary Alan Johnson chaired COBR in 2009 during H1N1. Michael Gove chaired COBR as part of No Deal planning. Transport Secretary Grant Shapps chaired COBR during the collapse of Thomas Cook. Mr Hancock was in constant communication with the PM throughout this period.

    At this point the World Health Organisation had not declared COVID19 a ‘Public Health Emergency of International Concern’, and only did so only 30 January. Indeed, they chose not to declare a PHEIC the day after the COBR meeting.

    Examples of scientific commentary from the time:

    Prof Martin Hibberd, Professor of Emerging Infectious Disease, London School of Hygiene and Tropical Medicine, said:

    “This announcement is not surprising as more evidence may be needed to make the case of announcing a PHEIC. WHO were criticised after announcing the pandemic strain of novel H1N1_2009, when the virus was eventually realised to have similar characteristics to seasonal influenza and is perhaps trying to avoid making the same mistake here with this novel coronavirus. To estimate the true severity of this new disease requires identifying mild or asymptomatic cases, if there are any, while determining the human to human transmission rate might require more evidence.”

    Dr Adam Kamradt-Scott, Senior Lecturer in International Security Studies, University of Sydney, said: “Based on the information we have to date, the WHO Director-General’s decision to not declare a Public Health Emergency of International Concern is not especially surprising. While we have seen international spread of the virus, which is one of the criteria for declaring a PHEIC, the cases in those countries do not appear to have seeded further local outbreaks. If that was to start to occur, it would constitute a greater concern but at the moment the outbreak is largely contained within China.”

    Sunday Times reply:
    It is unusual for the prime minister not to chair Cobra, although, at times, ministers can stand in for the prime minister, especially when he or she is away. Boris Johnson was in Westminster for four of the five Cobra meetings and was a one-hour drive away in Kent for the other, yet he did not attend any of them. Alan Johnson chaired a meeting of Cobra during H1N1 because Gordon Brown, the prime minister, was in Poland (and phoned in from there). Mr Shapps chaired the Thomas Cook Cobra because Boris Johnson was in New York. Mr Gove chaired a daily “operations committee” known as XO in the Cabinet Office’s Cobra room while in charge of no-deal planning in 2019, but these were not Cobra meetings.

    The use of the two experts for the scientific commentary is selective quotation and misrepresentation. These two quotes are taken from six opinions published on January 24 by the Science Media Centre (SMC), a not-for-profit organisation that provides expert information for journalists. They were issued in response to the decision by the World Health Organisation not to declare the China coronavirus outbreak a public health emergency of international concern.

    It is notable that the government statement did not include Professor Hibberd’s final sentence, which says: “However, all this new evidence needs to be rapidly obtained over the next few days if the world is to be as prepared as possible, so WHO should issue a different type of alert to mobilise a full investigation.”

    Last week Hibberd told The Sunday Times that the government had taken his comment out of context and scientists’ warnings proposing caution and preparedness did not appear to have been acted on sufficiently by the government. He added: “I think all of the comments made on the 24th January in response to the WHO response, including my own full comment, reflected the need to prepare as much as possible for this new virus. While we were still seeking to learn what its full impact might be, we also expected our preparedness plans to be in place and in action, so that we could remain in control of this outbreak as much as possible. This was certainly done by other governments at the time, such as Singapore. We should not be caught unaware, even if we were unsure of the true severity.”

    The government also ignored another of the opinions published by the SMC that day, which amounted to a warning that the situation was very serious. It was by Dr Jeremy Farrar, the director of the Wellcome Trust, who unlike Hibberd and Kamradt-Scott is on the government’s key Scientific Advisory Group for Emergencies (Sage) committee. He said: “This virus has crossed from animals into people. That does not happen often, and it is, without doubt, very serious. People are scarred by the memory of Sars, and a global outbreak of a novel respiratory virus like this, is something experts have warned about for many years.”

    ● Government statement:

    Claim [by The Sunday Times] – ‘Imperial’s [Professor Neil] Ferguson was already working on his own estimate — putting infectivity at 2.6 and possibly as high as 3.5 — which he sent to ministers and officials in a report on the day of the Cobra meeting on January 24. The Spanish flu had an estimated infectivity rate of between 2.0 and 3.0, so Ferguson’s finding was shocking.’

    Response [by the government] – Infectivity on its own simply reveals how quickly a disease spreads, and not its health impact. For that, it is necessary to know about data such as associated mortality/morbidity. It is sloppy and unscientific to use this number alone to compare to Spanish flu.

    Sunday Times reply:
    The article made clear that what made the virus frightening in late January was the combination of the infectivity rate and the high rate of people dying and needing intensive care in the early study by the Chinese scientists.

    ● Government statement:

    Claim [by The Sunday Times] – No 10 “played down the looming threat” from coronavirus and displayed an “almost nonchalant attitude … for more than a month”.

    Response [by the government] – The suggestion that the government’s attitude was nonchalant is wrong. Extensive and detailed work was going on in government because of coronavirus, as shown above.

    Sunday Times reply:
    There are no examples given “above” of the government’s “extensive and detailed work”. Whether the government was nonchalant is a matter of opinion. The Sunday Times reported the facts.

    ● Government statement:

    Claim [by The Sunday Times] – By the time the Prime Minister chaired a COBR meeting on March 2 “the virus had sneaked into our airports, our trains, our workplaces and our homes. Britain was on course for one of the worst infections of the most insidious virus to have hit the world in a century.”

    Response [by the government] – This virus has hit countries across the world. It is ridiculous to suggest that coronavirus only reached the UK because the health secretary and not the PM chaired a COBR meeting.

    Sunday Times reply:
    The article did not say this.

    ● Government statement:

    Claim [by The Sunday Times] – “Failure of leadership“ by [the prime minister, according to an] anonymous senior advisor to Downing Street.

    Response [by the government] – The Prime Minister has been at the helm of the Government response to Covid 19, providing the leadership to steer his Ministerial team through a hugely challenging period for the whole nation. This anonymous source is variously described as a ‘senior adviser to Downing Street’ and a ‘senior Downing Street adviser’. The two things are not the same. One suggests an adviser employed by the government in No10. The other someone who provides ad hoc advice. Which is it?

    Sunday Times reply:
    The source was in a position to observe the prime minister’s leadership style. It is notable that no attempt has been made to deny the prime minister’s absence from key meetings and from Downing Street itself. Michael Gove has confirmed the prime minister missed five coronavirus Cobra meetings.

    ● Government statement:

    Claim [by The Sunday Times] – The government sent 279,000 items of its depleted stockpile of protective equipment to China during this period in response to a request for help from the authorities there.

    Response [by the government] – The equipment was not from the pandemic stockpile. We provided this equipment to China at the height of their need and China has since reciprocated our donation many times over. Between April 2-April 15 we have received over 12 million pieces of PPE in the UK from China.

    Sunday Times reply:
    Downing Street told The Sunday Times before publication of the article that the 12 million pieces of PPE from China was a commercial deal. It was not reciprocation for generosity.

    ● Government statement:

    Claim [by The Sunday Times] – Little was done to equip the National Health Service for the coming crisis in this period.

    Response [by the government] – This is wrong. The NHS has responded well to Coronavirus, and has provided treatment to everyone in critical need. We have constructed the new Nightingale hospitals and extended intensive care capacity in other hospitals.

    Sunday Times reply:
    The Nightingale hospital programme was announced in late March, long after the period in question, and was acknowledged in the article.

    ● Government statement:

    Claim [by The Sunday Times] – Among the key points likely to be explored are why it took so long to recognise an urgent need for a massive boost in supplies of personal protective equipment for health workers; ventilators to treat acute respiratory symptoms; and tests to detect the infection.

    Response [by the government] – The Department for Health began work on boosting PPE stocks in January, before the first confirmed UK case.

    – Discussions on PPE supply for COVID-19 began w/c 27 January (as part of Medical Devices and Clinical Consumables), with the first supply chain kick-off meeting on 31 January. The first additional orders of PPE was placed on 30 January via NHS Supply Chain’s ‘just-in-time contracts’. BAU orders of PPE were ramped up around the same date.

    – Friday, 7 February, the department held a webinar for suppliers trading from or via China and the European Union. Over 700 delegates joined and heard the Department’s requests to carry out full supply chain risk assessments and hold onto EU exit stockpiles where they had been retained.

    – Monday, 10 February, the department spoke with the major patient groups and charities to update them on the situation regarding the outbreak and to update them on the steps it was taking to protect supplies.

    – Tuesday, 11 February, the department wrote to all suppliers in scope of the Covid 19 supply response work – those trading from or via China or the EU – repeating the messages from the webinar and updating suppliers on the current situation relating to novel coronavirus. The NHS has spare ventilator capacity and we are investing in further capacity.

    Sunday Times reply:
    The article reported that the department had placed orders under “just-in-time contracts” on January 30. However, it pointed out that the source said these ran into difficulties because they were with manufacturers in China, which desperately needed its own PPE supplies at the time. Downing Street and the Department of Health confirmed to The Sunday Times that the “just-in-time contracts” were proving difficult. In contrast to what the government is claiming to be “detailed and extensive” activity, it presents no evidence of any further activity on PPE acquisition between February 11 and the beginning of March or any activity before the week beginning January 27. Its failure to point to a single delivery of PPE, testing equipment or ventilators during this period suggests a level of achievement even lower than the article reported.

    ● Government statement:

    Claim [by The Sunday Times] – Suggestion that “lack of grip” had the knock-on effect of the national lockdown being introduced days or even weeks too late, causing many thousands more unnecessary deaths.

    Response [by the government] – The government started to act as soon as it was alerted to a potential outbreak. Mr Hancock was first alerted to Covid 19 on 3 January and spoke to Departmental officials on 6th Jan before receiving written advice from the UK Health Security Team. He brought the issue to the attention of the Prime Minister and they discussed Covid 19 on 7 January. The government’s scientific advisory groups started to meet in mid-January and Hancock instituted daily meetings to grip the emerging threat. We have taken the right steps at the right time guided by the scientific evidence.

    Sunday Times reply:
    The government response does not address whether the lockdown was too late.

    ● Government statement:

    Claim [by The Sunday Times] – Scientists said the threat from the coming storm was clear and one of the government’s key advisory committees was given a dire warning a month earlier than has previously been admitted about the prospect of having to deal with mass casualties.

    Response [by the government] – The government followed scientific advice at all times. The WHO only determined that COVID 19 would be a global pandemic on 11 March. Claiming that there was scientific consensus on this is just wrong. Sage met on January 22 but the first NERVTAG meeting was held on 13 January (NERVTAG is the New and Emerging Respiratory Virus Threats Advisory Group – see here https://www.gov.uk/government/groups/new-and-emerging-respiratory-virus-threats-advisory-group).

    Sunday Times reply:
    These statements of fact contradict nothing in the article.

    ● Government statement:

    Claim [by The Sunday Times] – The last rehearsal for a pandemic was a 2016 exercise codenamed Cygnus, which predicted the health service would collapse and highlighted a long list of shortcomings — including, presciently, a lack of PPE and intensive care ventilators.

    Response [by the government] – The Government has been extremely proactive in implementing lessons learnt around pandemic preparedness, including from Exercise Cygnus. This includes being ready with legislative proposals that could rapidly be tailored to what became the Coronavirus Act, plans to strengthen excess death planning, planning for recruitment and deployment of retired staff and volunteers, and guidance for stakeholders and sectors across government.

    Sunday Times reply:
    The Coronavirus Act received royal assent on March 25 of this year, so any measures brought in under the law were put in place after the virus had seriously taken hold in Britain and almost four years after the exercise itself.

    ● Government statement:

    Claim [by The Sunday Times] – By February 21 the virus had already infected 76,000 people, had caused 2,300 deaths in China and was taking a foothold in Europe, with Italy recording 51 cases and two deaths the following day. Nonetheless NERVTAG, one of the key government advisory committees, decided to keep the threat level at “moderate”.

    Response [by the government] – This is a misrepresentation of what the threat level is. This is about the current public health danger – and on February 21, when the UK had about a dozen confirmed cases, out of a population of over 66 million, the actual threat to individuals was moderate. In terms of the potential threat, the government was clear – on 10 February the Secretary of State declared that “the incidence or transmission of novel Coronavirus constituted a serious and imminent threat to public health”.

    Sunday Times reply:
    If on February 10 the virus was considered — even potentially — a serious and imminent threat to public health, why did the prime minister not attend a Cobra meeting until March 2?

    Comments Off on Sunday Times Response to Government
    All the Tory contenders to be prime minister should categorially rule out the NHS being part of any future US/UK trade deal, Unite, Britain and Ireland’s largest union, said today (Wednesday 5 June).
    Unite, which has 100,000 members in the health service, said the new prime minister ‘should not offer up the NHS as a sacrificial lamb to US president Donald Trump’.
    Unite national officer for health Colenzo Jarrett-Thorpe said: “The Tory prime ministerial contenders need to put the national interest – in this case, the safeguarding the NHS from US privateers – before the personal ambition of getting their hands on the keys to 10 Downing Street.” 
    Concern about what a US/UK trade deal could mean for the NHS has heightened this week following remarks by Donald Trump and his ambassador in London, Woody Johnson about the NHS being included in a future US trade deal
    Colenzo Jarrett-Thorpe added: “The NHS is the UK’s greatest achievement – but for Trump and his ilk, who despise the very idea of universal healthcare free at the point of delivery, all they can see is the money to be made from the sick, frail and vulnerable. 
    “This was made obvious by the US ambassador’s very frank comments about his country’s intentions towards the NHS in any future US/UK trade deal, a point that was again made by Trump himself. The president’s comments today are not reassuring in any way. Unless the government categorically says that the NHS is not for sale, then patients and staff will face increasing uncertainty and worry.
    “The Tory leadership hopefuls need to state categorially to the British public that the NHS is not up for sale to profit hungry US private healthcare companies as part of a future trade deal.
    ‘Leading Tories and their cheerleaders in the media may think that the US offers a blueprint for how a post-Brexit Britain should be – however, it should not be forgotten that millions of Americans don’t have any health insurance which does not inspire confidence.
    “We strongly believe that the NHS should not be offered up as a free trade sacrificial lamb to the mercurial whims of Donald Trump – our sick, frail and vulnerable deserve so much better.”

     

    Comments Off on NHS should not be ‘sacrificial lamb’ in any US/UK free trade deal, says Unite

    For your entertainment.

    Comments Off on A Bit of Fry and Laurie: Young Tory of the Year

    We will never know how many patients will have died or will die because the Prime Minister is prepared to uphold austerity measures in the face of the worst crisis to hit the NHS for many years.  Home Secretary, Mrs May forced through cuts in police budgets and she is now prepared to face out calls from many distinguished health figures warning of the consequences if the NHS does not receive an immediate emergency cash injection.

    The announcement that medical students are being persuaded to assist the NHS crisis is a further indication of deteriorating health services under austerity.

    Another example of the utter policy failure of the May government is to be seen in the removal of student nurse bursaries that funded their study and help with living costs.  The nursing shortfall caused by years of undersupply is at further risk of worsening if Brexit affects international recruitment.

    Beyond the current NHS austerity crisis there is the advent of “Accountable Care Organisations” that would introduce new commercial non-NHS bodies to run health and social services without proper public consultation and without full parliamentary scrutiny. Currently the Courts have agreed to a Judicial Review, made possible by public funds. These ACOs would represent the breaking up of a single national health service with national terms and conditions, into 44 sub-regions with fixed restricted budgets and rationed services.  This implies a loss of all the principles behind the NHS, a loss of universalism, comprehensiveness, national terms and conditions and quality standards.  Even if they were wholly in the public centre that would be the case.  And public ACOs would still very clearly be a stepping stone towards patient selection, personal health budgets, co-payments, charges, insurance and ultimately privatisation.

    In this,  the year of NHS 70,  we must be ready to celebrate but also to strongly PROTEST at the extreme threats to our beloved NHS.

    As Nye Bevan, the creator of our national health service said: “Illness is neither an indulgence for which people should have to pay, nor an offence for which they should be penalised, but a misfortune , the cost of which should be shared by the community”.

    2 Comments

    Printed in New Statesman in October 1994 in a competition asking for poems by doctors. 

     

    Yet another awful day which sets me thinking glumly

    That it’s time to write a letter to the dreaded Mrs Bottomley.

    “Dear Sir, My frank opinion of your ‘Health Reforms’ is this:

    That they do not work and never will: they’re just a load of contribution!

    What seems to be the problem, and please do not say I’m lying,

    Is I’ve just rung seven hospitals while patients here are likely to require only tender loving care,

    And some say ‘Try Mount Vernon’ and others ‘Tooting Bec’

    When I see that Trust Director I will dislocate several of his cervical vertebrae!

    If you’d only seen me earlier before you drafted bills

    I’d have diagnosed the problem and prescribed these special – can’t quite read what I wrote there –

    Next please! “ I mean “Yours Faithfully”.  I hope I really shocked her,

    “An overbudget, overworked but loyal General Practitioner, B. Chir, M.R.C.P., L.R.C.S.”

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    It is tempting to join in the general hilarity of the Prime Minister’s speech to the Tory Party Conference, portrayed at large as Carry On Up the Conference!

    TM: (coughs and is offered a cough drop)

    Chancellor: Have one of these!

    TM: Don’t mind if I do!

    TM: Oh dearie me, I can’t talk and suck at the same time!

    Cut to shot of conference delegates and gales of canned laughter.

    But the day before the speech the headlines shrieked, ‘Up to 8,000 deaths every year may be caused by rising bed-blocking’. And the day after, we have the grim news that the Royal Cornwall Hospital has been put in special measures after delays in processing test results, cancelled appointments and increasing waiting lists are likely to have led to deaths and blindness.

    According to the Guardian’s article on the Royal Cornwall, “We were informed of two patients who had died of cardiac-related causes while delayed on the waiting list,” inspectors say in the report. “While it is not possible to say the deaths were directly linked to the delay, the trust reported it was highly likely.” Hundreds of patients with cardiac problems had experienced ‘notable’ delays along with 6.503 patients with sight problems.

    The research which produced the ‘8,000 deaths’ headlines, published in the BMJ Journal of Epidemiology and Community Health on 2 September 2017 stated the already known statistic that 2015 saw the largest annual increase in mortality for almost 50 years. The research was an exploratory study which shows that the increasing prevalence of delayed discharges between the NHS and social care and the increased waiting time for acute patients has a positive association with the number of deaths and mortality rate.

    In short, two of the country’s key support systems designed in principle to keep people healthy are failing in their task under the auspices of Theresa May’s government, which bears the ultimate responsibility.

    The tone of May’s conference speech was set by a blithe autobiographical reason why she is a Conservative, ‘at its heart a simple promise that spoke to me, my values and my aspirations that each new generation should be able to build a better future…the British dream’. As her central theme, she praised and embedded the free market system at the heart of her agenda, as the engine of progress, the great innovator and provider of opportunity and equality, effectively acceding the responsibility of government to the market as she did so. She ended with an extraordinarily condescending approach to what could be paraphrased as the ‘common folk who don’t bother about great affairs of state like this as they scurry about their little lives’ and for whom she says she has dedicated her political career, working for ‘the most vulnerable’ and ‘giving a voice to the voiceless’.

    On the NHS, May talked of, ‘investing more in mental health than ever before,’ whilst Jeremy Hunt solemnly nodded his agreement from the audience. She blamed out of date legislation from 3 decades ago for any problems currently being experienced. She talked of ‘our great national achievement: our NHS’. ‘Let us not forget’, she said, ‘that it is this party that has invested in the National Health Service and upheld its founding principles through more years in government than any other’.

    To hear a Conservative Party leader describe the NHS as ‘the very essence of solidarity in our United Kingdom…a symbol of our commitment to each other’, in the face of the service’s near-collapse from the top down re-dis-organisation, de-funding and privatisation is surely to have passed through The Looking Glass. She talks of year on year per-head increases in expenditure on the NHS, of the greatest investment in training of doctors and nurses ever. She says they will always support safe, high quality care.

    The reality on the ground is a list of serious issues confronting the NHS as a result of constant turmoil from NHS England’s endless series of ‘new’ models and test-beds, re-shaping the service to fit the 5 Year Forward View. There is the current report on delayed discharge and increased mortality; the CQC report on the Royal Cornwall; serious difficulty in recruiting to fill the GP shortfall (Pulse magazine reported earlier this year an increase from 2.1% unfilled GP vacancies in 2011 to 12.2% this year); constant A&E crisis; scapegoating of one group of patients or another as the cause of all problems; and more.

    At a bare minimum it is unacceptable that Theresa May should position her party as the custodians of the NHS.

    Let us assume for a moment that she does not understand the current progress of the NHS towards US-style Accountable Care; that she has been convinced that it is simply a change in the management style, not a radical undermining of the principle of universality. Then we are left with the possibility that the worst of this situation may lie in her blithe confidence in the ‘values’ of her party and her belief that only a further de-regulated free market economy can provide the strong economic background needed to support the NHS. In that case she would appear to be immunised to the truth.

    Either way we are faced with the real possibility that has existed since David Cameron’s, ‘I’ll cut the deficit, not the NHS’. She either knows what is happening to our greatest public service under her government and lies about it. Or she doesn’t know in which case she and her party are not fit to govern.

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    Cheered up by last week? The last few weeks have given us a respite from a seemingly endless wave of victories by populists and the right: after a miserable 2016, we have seen the radical right narrowly defeated in the Austrian presidential election, heavily defeated in the second round of the French presidential election and in the legislative vote, in decline in Germany and locked out of government in the Netherlands. And did I mention a hung parliament in the UK?

    Brexit bus

    It might be nice to relax and go back to critiquing neoliberalism, but we should not. The populist radical right is still a force to worry about for four reasons.

    First, these electoral victories are not so impressive as they might look. In electoral terms, these votes are still scary. Only in the context of 2016 should we be glad that over forty percent of the French and Austrian electorates have voted for candidates from the darkest areas of the right.

    Second, the right is directly wielding a lot of power. The radical right is in government or close to it in a number of smaller European countries. Trump is president. Despite much wishful thinking, he is likely to be president until January 2021. The UK is still likely to be governed by the Conservatives… partnering with the Democratic Unionists, a party of the radical right that has benefited until now from the refusal of the UK media to pay attention to Northern Ireland.

    Third, the right shapes agendas. There is an alarming coincidence between the manifestos of UKIP and the manifesto that gave the Tories one of their highest-ever vote shares in the last election. The French even have a word for it: Droitisation, or the way the far right pulls the moderate right and even the center-left towards it, aping its arguments in an effort to get its voters. Theresa May’s whole campaign is a nice example of that. But Jeremy Corbyn, who broke with convention on so much, didn’t break with the increasingly nativist tone of politics on Brexit or immigration control.

    Fourth, as the last two years have shown, politics after a decade of financial crisis isn’t easy to predict. Parties and party systems across the West have been losing stability for decades, social democratic parties have been eroding and the center-right becoming less centrist while the populist radical right parties grow.

    Political scientists have written much about the populist radical right, which I review in a new article (free). The populist radical right has three characteristics. It is populist, siding with the people’s common sense over elite knowledge. It is nativist, believing there is a nation that needs defending. And it is authoritarian, expressing love and respect for authority. In the UK, that means UKIP and the DUP as well as some solid fraction of the Conservative party.

    This is basically a toxic brew from the perspective of any likely reader of this blog. Populism is affirming since it relies on arguments anybody can understand. Authoritarianism is both popular in its own right and easy to trigger with, for example, scare stories about migrants.

    Nativism, finally, can lead to “welfare chauvinism”, or what Alexandre Afonso calls “fake socialism”: not a neoliberal platform of cutbacks, but rather a generous and very exclusive, nativist welfare state. Think a well funded NHS that you can only use if you provide two forms of ID proving you legally reside in the UK. Trump, Le Pen, and May all campaigned on platforms with a strong element of welfare chauvninism.

    Fortunately, there is not a lot of research showing that the populist radical right in office actually pursues welfare chauvinist policies. For a long time, the research found that they ran on welfare chauvinist themes and then enacted classic right-wing cutbacks (which is what you would expect of parties with a strong base in small business people who are notoriously hostile to regulation and welfare states). More recent research has found that in systems where they enter government in coalition, such as Austria or Belgium, they achieve little and what they achieve is in restricting access to benefits- more chauvinism, but not more welfare. The main reason or that is coalition government, which tempers the policy effect of any given party. The newest research seems to show that they also cut back less on welfare budgets relative to more conventional right parties. So: lots of chauvinism, not so much welfare.

    In other words, the potential of welfare chauvinism is not being exploited, or at least consistently translated into policy. Trump is a particularly extreme example. After running as a welfare chauvinist candidate (whose logic pointed to a fully funded NHS for white people), he is promoting a Tea Party agenda that will be devastating to, in particular, working class rural whites above fifty who are a key part of his support. May talked a good welfare chauvinist game until people saw the Conservative manifesto, which was chauvinist without the welfare.

    As the Canadian writer Jeet Heer noted of the unexpectedly good Labour result, it “looks like you can get young people, minorities, and white working class in a coalition if you offer them something.” That is a niche worth filling. Social Democratic parties exist to fill it, and collapsed after instead becoming unconvincing catch all parties. The populist radical right remains a threat, but if it empowers social democrats to actually pursue social democracy, then the long run outcome might be positive.

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    The NHS is facing persistent rising costs and funding pressures. Health care needs continue to rise as a result both of an ageing population and of a changing profile of morbidity, with increasing numbers of people suffering multiple long-term conditions. Even more cost pressures arise from technology and medical advances, and the labour intensive nature of much health care means that the NHS rate of inflation is significantly higher than the general rate of inflation.

    Funding pledges

    Yet neither the Labour nor the Conservative manifestos promise adequate funding. While the Conservatives are promising an extra £8bn a year by 2022, and Labour an extra £12bn in comparison with current funding, this represents in both cases a further decline in the proportion of the GDP being allocated to health care (from 7.3% in 2017/18 to 7.0% and 7.2% respectively, according to the Nuffield Trust). This is likely to reflect a commitment by Conservative-led administrations to reduce the share of the national income accruing to the NHS and, perhaps, a view in Labour circles that the NHS has so far got off lightly under austerity, compared to other departments’ cuts.

    While the obduracy of the government and its ideological ambivalence concerning the NHS make the Conservative proposal unsurprising, Labour’s stance must be seen as a disappointment. The impact of the financial stress endured by those working in the service, and the mounting scale of cuts and closures to services consequent upon inadequate resourcing are effectively being disregarded.

    Labour promises extra capital funding but does not say by how much; the Conservatives promise £10bn of capital expenditure but do not say where the funds will come from. There is of course an irony in borrowing more expensively from the private sector when public borrowing is so cheap.

    Mental health services

    Commitments to funding are not a minor detail since they point to doubts as to whether the parties’ other health proposals can be achieved – and this is not just the re-pledged commitment by the Conservatives to a ‘truly seven-day NHS’. Labour promises ‘well-resourced services’, ‘safe staffing levels’ and ‘world-class quality of care’ despite the fact that inadequate funding may make these impossible to achieve. Labour will also attempt to ‘tackle’ the rationing of services and will end the ‘routine breach’ of safe bed occupancy levels but as each is likely to entail an expansion in capacity, the party’s stance on funding may impede their achievement.

    This will be a source of particular anxiety to those keen to see improved mental health services. Here, Labour promise parity of esteem; ring-fence budgets; increase the proportion of the mental health budget spent on children; and end out-of-area placements. Oblivious to the consequences of their stance on funding, the Conservatives promise that those with mental health problems will get the ‘care and support they deserve’ and that medical training will ensure a deeper understanding of mental health.

    Health care reorganisation

    The Conservatives remain committed to the contentious Sustainability and Transformation Plans (STPs), drawn up in secret at a local level to reorganise services and simultaneously cut their costs. The privileging of financial sustainability has rather overtaken the promised transformation. But, contrary to government and NHS England assumptions, transferring services out of acute hospitals and into community settings is unlikely to achieve cheaper health care if they are to remain high quality services. Moreover, the transitional period itself requires additional funding. ‘Vanguard projects’ are currently piloting new ways of providing services and local NHS leaders are being expected to implement changes while an evidence base is still to be produced.

    Labour does not promise a roll-back of STPs but instead a ‘halt and review’, with local people invited to participate in redrawing them. This feels an ambiguous passage in the manifesto which might reflect the competing pressures of cautious endorsement of STPs from some think-tanks, given the funding constraints and the perceived desirability of making more services available in community settings, on the one hand, and the fierce opposition, on the other, from local people who experience their STP as the vehicle by which large-scale cuts and closures are being implemented.

    Staffing levels

    Quality services also require adequate staffing levels. Labour has costed its plans to reinstate bursaries for nurses and to lift the pay cap for NHS staff – some of whom have suffered more than a 10% reduction in the real terms value of their pay since the financial crash. Its commitments on NHS staffing – recruitment and retention – differ somewhat from those in the Conservative manifesto. Labour promises an immediate guarantee of the rights of EU staff, lifelong education and development for doctors, and reinstating the role of the independent pay review body. The Conservative Party promises 10,000 extra staff in mental health service, an extra 1500 doctors a year in training, stronger staff entitlement to work flexibly, and the development of new roles in health care. This is perhaps to facilitate the shift to more generic roles heralded in some STPs, and the greater use of unregistered nurse associates and physician associates to supplement (or supplant) the registered professionals. Where all these staff will come from remains unclear. The Conservatives offer EU nationals working in the NHS only the promise that they will do their best for them in the Brexit negotiations.

    Privatisation

    Those who have been campaigning against privatisation and the use of market forces in the NHS will welcome Labour’s commitment to reversing the privatisation of the NHS. They will also hope that this is compatible with Labour’s promise to introduce a new legal duty on the Secretary of State to ensure ‘excess private profits are not made out of the NHS at the expense of patient care’. They will certainly welcome the repeal of the infamous 2012 Health and Social Care Act.

    The Conservative manifesto also points to the prospect of legislative change and indicates that the provisions of the Health and Social Care Act – a highly unpopular piece of legislation among both campaigners and professional associations – may not be sacrosanct where they interfere with the implementation of STPs. This hints at the fact that much STP activity has occurred outside statutory provision and is an implicit acknowledgment by the Conservatives that Accountable Care Organisations (ACOs) offer a better route to commercialisation than a model based on a competitive provider market in a time of financial constraint. Anti-privatisation campaigners, aware that ACOs can be contracted out to non-public organisations and always suspicious of Conservative intentions, will take little comfort from this.

    This was first published on the British Politics and Policy blog.

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    And does it matter if I still get treatment free at the point of use?

    The short answer is yes, not just plans but plenty of private contracts have been issued taking the NHS down the privatisation route. And yes, it will matter to you when you have to pay for your treatment from medical insurance and risk bankruptcy if you require multiple or long-term care. Here is the ‘blueprint’ for privatisation laid nearly 30 years ago by Letwin and Redwood – see for yourself how close we are to the end game.

    In 1988 Letwin and Redwood (conservative) laid down the blueprint for the privatisation of the NHS.  It is worth reading this document in full as it will explain both our current position and give insight into the next steps.

    Letwin and Redwood

    Starting with a negative analysis of the use of waiting times to ration resources they swiftly moved into the reasons why the NHS needs a fundamental overhaul:

    At the end of 1986 (the latest date for which figures are available), there were almost 700,000 people on NHS waiting lists; of these, half were destined to wait more than two months for treatment and one in fifty for more than a year.

    When compared to today’s figures of 3.66 million waiting for routine treatment, up 11% from Dec 15 – Dec 16 and a target time now of 18 weeks (nearly 5 months) with 92% waiting significantly longer than that, House of Commons/Feb/2017  we can see the figures used by Letwin and Redwood actually reflected an efficient NHS service.   But then the premise for privatisation must start from the basis that the current system is broken.  

    By chapter 2 they confirm;  [note the italics]

    The need for change is now widely accepted.

    The first step is to restructure at management level and make the NHS bodies independent to ‘give clear lines of responsibility’ which do not reach back to government.

    1. Establishment of the NHS as an independent trust.
    2. Increased use of joint ventures between the NHS and the private sector.
    3. Extending the principle of charging.
    4. A system of  ‘health credits’.
    5. A national health insurance scheme.

    It would appear that we are currently moving between point 2 and 3 of this agenda.

    By chapter 3,  Letwin and Redwood introduce the notion of charging – an idea fundamentally at odds with the ethos of the NHS – free at the point of delivery.

    Another avenue which has been tentatively explored by the Government is charging. In principle, this could be extended to the point of universality – a charge for every service. That could permanently solve the problems of waiting lists and of basic attitudes towards patients – since the NHS could charge enough for each service to ensure that demand matched supply, every patient would become a valuable customer, bringing  funds to the system. If combined with the establishment of the NHS as an independent trust, this would in effect turn the NHS into a nationalised non-profit service competing on level terms with the private sector, and at arms-length  from the Government.

    The NHS was already a nationalised non-profit service, so what is new here is the idea that it should ‘compete on level terms with the private sector’ and be ‘arms-length’ from the Government.  ‘Charge enough for each service to ensure that demand matched supply’ indicates hiking prices on treatments in demand – in the same way that airfares rise in school holidays.  Aware that charging would preclude sections of the population from accessing health care the pair put forward the idea of ‘credit notes’ which would create a two-tier system.

    Each individual patient would receive, from his GP, a ‘credit note’, entitling him to treatment for a specific complaint. This credit note would cover the charge ·levied by the NHS for the treatment in question. If the patient chose instead to go to a private sector hospital he would be entitled to carry the credit with him making up any difference in cost out of his own resources or through private insurance.        

    In order to bring in the ‘benefits of marketisation it is suggested that;

    In short, increased competition would be created not only between the NHS and the private sector but also between one NHS hospital and another. Under such an arrangement, it might be possible to go even further than the establishment of the entire NHS as an independent trust or company: each major hospital or district could be separately established with only a national funding authority left at the centre to administer the payment of credits.

    And finally, we reach the end goal – a fragmented NHS service, competing with itself and private providers, funded by individual payments into a National Health Insurance Scheme. 

    A method of overcoming the drawback of a pure ‘credits’  scheme is to ally it to a national health insurance system. Under such a system, every adult would contribute a fixed insurance premium each year to a national health insurance fund.

    Having established that under this scheme the NHS would charge the full cost of each treatment to be reclaimed by insurance, Letwin and Redwood confirm;

    The existence of a national health insurance scheme would not, of course, be to the detriment of the private sector. Indeed, under any of the variants, contributors to the national scheme could be given rights to carry some or all of the insurance cover to the private sector, either in the form of rebates for private insurance or in the form of ‘credits’ usable in private sector hospitals.

    The insurance premium could be actuarially adjusted, like car insurance to reflect the varying risks associated with different categories of contributor though this would need to be balanced by subsidies to those who were not well off, and were either already ill or in a high – risk category.

    Before concluding;

    To a great degree, the divisions between the public and private sector would fade.

    Indeed, given that we would all be paying the full cost of treatment from our own insurance policies.  If you have recently taken a pet for treatment at your local vet you will know the eye-watering cost of a single blood test, let alone the management of a long-term condition.  Although apparently convinced by their own arguments, they realised that moving from a universal system of free treatment to one where we individually cover our own care through differentiated insurance, would take time.

    A system of this sort would be fraught with transitional difficulties. And it would be foolhardy to move so far from the present one in a single leap. But need there be just one leap? Might it not, rather, be possible to work slowly from the  present system towards a national insurance scheme? One could begin, for example, with the establishment of the NHS as an independent trust, with increased joint ventures between the NHS and the private sector; move on next to the use of  credits’ to meet standard charges set by a central NHS funding. administration for independently managed hospitals or districts; and only at the last stage create a national health insurance scheme separate from the tax system.

    ‘…and only at the last stage create a national health insurance scheme separate from the tax system.’   The last stage is presumably when the entire reorganisation is complete and we have no option but to take out our own insurance policies.

    Read more of this story by following the link below and find out how talks between Jeremy Hunt and Kaiser Permanente are sealing the deal with the big US health insurance companies waiting to step in.

    This is an editted version of a post by socialistinsurrey.com.

     

     

     

     

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    Extracted from the Conservative Manifesto

    The mental health gap

    It was Conservatives in government that gave parity of esteem to the treatment of mental health in the National Health Service. We have backed this with a significant increase in 57 funding: since 2010 we have increased spending on mental health each year to a record £11.4 billion in 2016/17, with a further investment of £1 billion by 20/21, so that we can deliver the mental health services people deserve. We will now build on this commitment.

    First, we will address the need for better treatments across the whole spectrum of mental health conditions. We will make the UK the leading research and technology economy in the world for mental health, bringing together public, private and charitable investment.

    Improving treatment services will not be sufficient, however. We will also reform outdated laws to ensure that those with mental illness are treated fairly and employers fulfil their responsibilities effectively.

    The current Mental Health Act does not operate as it should: if you are put on a community treatment order it is very difficult to be discharged; sectioning is too often used to detain rather than treat; families’ information about their loved ones is severely curtailed – parents can be the last to learn that their son or daughter has been sectioned. So we will introduce the first new Mental Health Bill for thirty-five years, putting parity of esteem at the heart of treatment.

    We will transform how mental health is regarded in the workplace. We will amend health and safety regulations so that employers provide appropriate first aid training and needsassessment for mental health, as they currently do for risks to physical health, and extend Equalities Act protections against discrimination to mental health conditions that are episodic and fluctuating. We will consider the findings of the Stevenson-Farmer Review into workplace mental health support, working with employers to encourage new products and incentives to improve the mental health and wellbeing support available to their employees. And, as we did with Dementia Friends, we will train one million members of the public in basic mental health awareness and first aid to break the stigma of mental illness.

    The disability gap

    We will build on the proud Conservative record in supporting those with disabilities, including the landmark Disability Discrimination Act of 1995. We want to see attitudes to disability shift as they have for race, gender and sexuality in recent years: it should be completely unacceptable for people with disabilities to be treated negatively.

    We will get 1 million more people with disabilities into employment over the next ten years. We will harness the opportunities of flexible working and the digital economy to generate jobs for those whose disabilities make traditional work difficult. We will give employers the advice and support they need to hire and retain disabled people and those with health conditions. We will continue to ensure a sustainable welfare system, with help targeted at those who need it most. We will legislate to give unemployed disabled claimants or those with a health condition personalised and tailored employment support.

    We believe that where you live, shop, go out, travel or park your car should not be determined by your disability. So we will review disabled people’s access and amend regulations if necessary to improve disabled access to licensed premises, parking and housing. We will work with providers of everyday essential services, like energy and telecoms, to reduce the extra costs that disability can incur.

    A long-term plan for elderly care

    Our system of care for the elderly is not working for the hundreds of thousands currently not getting the dignified and careful attention they deserve, nor for the people and organisations providing that care, nor is it sustainable for today’s younger people who will potentially one day face care costs themselves. It is not fair that the quality of care you receive and how much you pay for it depends in large part on where you live and whether you own your own home.  Where others have failed to lead, we will act. We have already taken immediate action, putting £2 billion into the social care system and allowing councils to raise more money for care themselves from Council Tax. We are now proposing medium and long-term solutions to put elderly care in our country on a strong and stable footing.

    Under the current system, care costs deplete an individual’s assets, including in some cases the family home, down to £23,250 or even less. These costs can be catastrophic for those with modest or medium wealth. One purpose of long-term saving is to cover needs in old age; those who can should rightly contribute to their care from savings and accumulated wealth, rather than expecting current and future taxpayers to carry the cost on their behalf. Moreover, many older people have built considerable property assets due to rising property prices. Reconciling these competing pressures fairly and in a sustainable way has challenged many governments of the past. We intend to tackle this with three connected measures.

    First, we will align the future basis for means-testing for domiciliary care with that for residential care, so that people are looked after in the place that is best for them. This will mean that the value of the family home will be taken into account along with other assets and income, whether care is provided at home, or in a residential or nursing care home.

    Second, to ensure this is fair, we will introduce a single capital floor, set at £100,000, more than four times the current means test threshold. This will ensure that, no matter how large the cost of care turns out to be, people will always retain at least £100,000 of their savings and assets, including value in the family home.

    Third, we will extend the current freedom to defer payments for residential care to those receiving care at home, so no-one will have to sell their home in their lifetime to pay for care.

    We believe this powerful combination maximises protection for pensioner households with modest assets, often invested in the family home, while remaining affordable for taxpayers. We consider it more equitable, within and across the generations, than the proposals following the Dilnot Report, which mostly benefited a small number of wealthier people.

    An efficient elderly care system which provides dignity is not merely a function of money. So our forthcoming green paper will also address system-wide issues to improve the quality of care and reduce variation in practice. This will ensure the care system works better with the NHS to reduce unnecessary and unhealthy hospital stays and delayed transfers of care, and provide better quality assurance within the care sector. We will reduce loneliness and promote technological solutions to prolong independent living, and invest in dementia research. As the majority of care is informally provided, mainly by families, we will give workers a new statutory entitlement to carer’s leave, as enjoyed in other countries.

    Creating a sustainable elderly care system means making decisions about how the rising budget devoted to pensioners is spent, so we will target help where it is needed most. So we will look at Winter Fuel Payments, the largest benefit paid to pensioners, in this context. The benefit is paid regardless of need, giving money to wealthier pensioners when working people on lower incomes do not get similar support. So we will meanstest Winter Fuel Payments, focusing assistance on the least well-off pensioners, who are most at risk of fuel poverty. The money released will be transferred directly to health and social care, helping to provide dignity and care to the most vulnerable pensioners and reassurance to their families. We will maintain all other pensioner benefits, including free bus passes, eye tests, prescriptions and TV licences, for the duration of this parliament.

    OUR NATIONAL HEALTH SERVICE

    Our National Health Service is the essence of solidarity in our United Kingdom – our commitment to each other, between young and old, those who have and those who do not, and the healthy and the sick. The Conservative Party believes in the founding principles of the NHS. First, that the service should meet the needs of everyone, no matter who they are or where they live. Second, that care should be based on clinical need, not the ability to pay. Third, that care should be free at the point of use. As the NHS enters its eighth decade, the next Conservative government will hold fast to these principles by providing the NHS with the resources it needs and holding it accountable for delivering exceptional care to patients wherever and whenever they need it.

    The money and people the NHS needs

    In five ways, the next Conservative government will give the NHS the resources it needs.

    First, we will increase NHS spending by a minimum of £8 billion in real terms over the next five years, delivering an increase in real funding per head of the population for every year of the parliament.

    Second, we will ensure that the NHS and social care system have the nurses, midwives, doctors, carers and other health professionals that it needs. We will make it a priority in our negotiations with the European Union that the 140,000 staff from EU countries can carry on making their vital contribution to our health and care system. However, we cannot continue to rely on bringing in clinical staff instead of training sufficient numbers ourselves. Last year we announced an increase in the number of students in medical training of 1,500 a year; we will continue this investment, doing something the NHS has never done before, and train the doctors our hospitals and surgeries need.

    Third, we will ensure that the NHS has the buildings and technology it needs to deliver care properly and efficiently. Since its inception, the NHS has been forced to use too many inadequate and antiquated facilities, which are even more unsuitable today. We will put this right and enable more care to be delivered closer to home, by building and upgrading primary care facilities, mental health clinics and hospitals in every part of England. Over the course of the next parliament, this will amount to the most ambitious programme of investment in buildings and technology the NHS has ever seen.

    Fourth, whilst the NHS will always treat people in an emergency, no matter where they are from, we will recover the cost of medical treatment from people not resident in the UK. We will ensure that new NHS numbers are not issued to patients until their eligibility has been verified. And we will increase the Immigration Health Surcharge, to £600 for migrant workers and £450 for international students, to cover their use of the NHS. This remains competitive compared to the costs of health insurance paid by UK nationals working or studying overseas.

    Fifth, we will implement the recommendations of the Accelerated Access Review to make sure that patients get new drugs and treatments faster while the NHS gets best value for money and remains at the forefront of innovation.

    Holding NHS leaders to account

    It is NHS England that determines how best to organise and deliver care in England, set out in its own plan to create a modern NHS – the Five Year Forward View. We support it. We will also back the implementation of the plan at a local level, through the Sustainability and Transformation Plans, providing they are clinically led and locally supported.

    We will hold NHS England’s leaders to account for delivering their plan to improve patient care. If the current legislative landscape is either slowing implementation or preventing clear national or local accountability, we will consult and make the necessary legislative changes. This includes the NHS’s own internal market, which can fail to act in the interests of patients and creates costly bureaucracy. So we will review the operation of the internal market and, in time for the start of the 2018 financial year, we will make non-legislative changes to remove barriers to the integration of care.

    We expect GPs to come together to provide greater access, more innovative services, share data and offer better facilities, while ensuring care remains personal – particularly for older and more vulnerable people – with named GPs accountable for individual patients. We will support GPs to deliver innovative services that better meet patients’ needs, including phone and on-line consultations and the use of technology to triage people better so they see the right clinician more quickly. We will ensure appropriate funding for GPs to meet rising costs of indemnity in the short term while working with the profession to introduce a sustainable long-term solution.

    We will introduce a new GP contract to help develop wider primary care services. We will reform the contract for hospital consultants to reflect the changed nature of hospital care over the past twenty years. We shall support more integrated working, including ensuring community pharmacies can play a stronger role to keep people healthy outside hospital within the wider health system. We will support NHS dentistry to improve coverage and reform contracts so that we pay for better outcomes, particularly for deprived children. And we will legislate to reform and rationalise the current outdated system of professional regulation of healthcare professions, based on the advice of professional regulators, and ensure there is effective registration and regulation of those performing cosmetic interventions.

    We will also help the million and more NHS clinicians and support staff develop the skills they need and the NHS requires in the decades ahead. We will encourage the development of new roles and create a diverse set of potential career paths for the NHS workforce. And we will reform medical education, including helping universities and local health systems work closer together to develop the roles and skills needed to serve patients.

    We want the NHS to become a better employer. We will strengthen the entitlement to flexible working to help those with caring responsibilities for young children or older relatives. We will introduce new services for employees to give them the support they need, including quicker access to mental health and musculoskeletal services. We will act to reduce bullying rates in the NHS, which are far too high. We will take vigorous and immediate action against those who abuse or attack the people who work for and make our NHS.

    Exceptional standards of care, wherever, whenever

    Outcomes in the NHS for most major conditions are considerably better than three, five or ten years ago. However, the founding intention for the NHS was to provide good levels of care to everyone, wherever they live. This has not yet been achieved: there remain significant variations in outcomes and quality across services and across the country. We will act to put this right.

    To help the NHS provide exceptional care in all parts of England, we will make clinical outcomes more transparent so that clinicians and frontline staff can learn more easily from the best units and practices, and where there is clear evidence of poor patient outcomes, we will take rapid corrective action. We will ensure patients have the information they need to understand local services and hold them to account.

    We will empower patients, giving them a greater role in their own treatment and use technology to put care at their convenience. In addition to the digital tools patients already have, we will give patients, via digital means or over the phone, the ability to book appointments, contact the 111 service, order repeat prescriptions, and access and update aspects of their care records, as well as control how their personal data is used. We will continue to expand the number of NHS approved apps that can help monitor care and provide support for physical and mental health conditions. We will pilot the live publication of waiting times data for A&Es and other urgent care services. We will further expand the use of personal budgets. We will also continue to take action to reduce obesity and support our National Diabetes Prevention Programme.

    Our ambition is also to provide exceptional care to patients whenever they need it. That is why we want England to be the first nation in the world to provide a truly seven-day healthcare service. That ambition starts with primary care. Already 17 million people can get routine weekend or evening appointments at either their own GP surgery or one nearby, and this will expand to the whole population by 2019.

    In hospitals, we will make sure patients receive proper consultant supervision every day of the week with weekend access to the key diagnostic tests needed to support urgent care. We will also ensure hospitals can discharge emergency admissions at a similar rate at weekends as on weekdays, so that when someone is medically fit to leave hospital they can, whichever day of the week it is.

    We will retain the 95 per cent A&E target and the 18-week elective care standard so that those needing care receive it in a timely fashion. We will continue to help the NHS on its journey to being the safest healthcare system in the world. We will extend the scope of the CQC to cover the health-related services commissioned by local authorities. We will legislate for an independent healthcare safety investigations body in the NHS. We will require the NHS to continue to reduce infant and maternal deaths, which remain too high.

    Our commitment to consistent high quality care for everyone applies to all conditions. We will set new standards in some priority areas and also improve our response to historically underfunded and poorly understood disease groups.

    In cancer services, we will deliver the new promise to give patients a definitive diagnosis within 28 days by 2020, while expanded screening and a major radiotherapy equipment upgrade will help ensure many more people survive cancer.

    We will continue to rectify the injustice suffered by those with mental health problems, by ensuring that they get the care and support they deserve. So we will make sure there is more support in every part of the country by recruiting up to 10,000 more mental health professionals. We shall require all our medical staff to have a deeper understanding of mental health and all trainees will get a chance to experience working in mental health disciplines; we shall ensure medical exams better reflect the importance of this area. And we will improve the co-ordination of mental health services with other local services, including police forces and drug and alcohol rehabilitation services.

    We have a specific task to improve standards of care for those with learning disabilities and autism. We will work to reduce stigma and discrimination and implement in full the Transforming Care Programme.

    We will improve the care we give people at the end of life. We will fulfil the commitment we made that every person should receive attentive, high quality, compassionate care, so that their pain is eased, their spiritual needs met and their wishes for their closing weeks, days and hours respected. We will ensure all families who lose a baby are given the bereavement support they need, including a new entitlement to child bereavement leave.

    Children’s and young people’s health

    We believe government has a role to play in helping young people get the best possible start in life. We are seeing progress: smoking rates are now lower than France or Germany, drinking rates have fallen below the European average and teenage pregnancies are at record lows. We will continue to take action to reduce childhood obesity. We will promote efforts to reduce unhealthy ingredients and provide clearer food information for consumers, as our decision to leave the European Union will give us greater flexibility over the presentation of information on packaged food. We shall continue to support school sport, delivering on our commitment to double support for sports in primary schools.

    We understand the massively increased pressures on young people’s mental health. We will take focused action to provide the support needed by children and young people. Half of all mental health conditions become established in people before the age of fourteen. So we will ensure better access to care for children and young people. A Conservative government will publish a green paper on young people’s mental health before the end of this year. We will introduce mental health first aid training for teachers in every primary and secondary school by the end of the parliament and ensure that every school has a 73 single point of contact with mental health services. Every child will learn about mental wellbeing and the mental health risks of internet harms in the curriculum. And we will reform Child and Adolescent Mental Health Services so that children with serious conditions are seen within an appropriate timeframe and no child has to leave their local area and their family to receive normal treatment.

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