Category Archives: Campaigns

Calderdale and Kirklees 999 Call for the NHS

It’s our NHS – the profiteers, privatisers and austerity liars can jog on

Scrap a new contract that could wreck our NHS!

The quango NHS England is currently holding a badly-publicised public consultation on its new Accountable Care Organisation contract – which it has renamed the Integrated Care Provider contract.

Most people won’t have heard about this. Have you?

 

Why is NHS England consulting on it now, before they even know if their new contract is lawful?

This autumn, 999 Call for the NHS is challenging the lawfulness of this contract in the Court of Appeal.

We are currently crowdfunding the £18K costs of the Appeal through CrowdJustice – please give whatever you can afford. Any amount, big or small, is a huge help and much appreciated. Here’s where you can donate and find out more. http://bit.ly/999CourtofAppeal

NHS England’s consultation is online here.

999 Call for the NHS’s response is online here. (Downloadable word doc.) You’re welcome to use and adapt it for your own response. We do not accept the basic premise of the consultation – that contracts are an appropriate way of planning, delivering and managing NHS services. We are campaigning for the NHS Bill to reinstate the NHS as a  fully publicly funded, managed and provided service.

If you prefer a consultation that is shorter and more to the point, 999 Call for the NHS will shortly be carrying out our own consultation online. Please come back soon to find the link. We will collect the responses and send them to NHS England before their consultation ends on 26th October.

The proposed new contract might sound like a dry legal issue that’s hard to get bothered about. The reality is anything but.

This is about whether patients can continue to access the treatments they need, or whether the doctor – patient relationship will be undermined by making doctors put financial considerations ahead of patients’ clinical needs.

This new 10 year contract is driven by NHS England’s cost-cutting aim of avoiding a projected £22bn funding shortfall by 2020/21 – the result of nearly a decade of NHS underfunding by the government.

The Accountable Care Organisation/Integrated Care Provider contract would pay a new type of  legal entity for a whole range of NHS and social care services in a given area. It would use the same lump sum payment arrangement that has been used to pay for psychiatric intensive care – with disastrous results. Just think about the dire shortage of acute mental health beds.

This contract is explicitly intended to “manage demand” for NHS services – in other words, to restrict patients’ access.

Its cost-cutting payment mechanism would drive down safety standards as well as restricting patients’ access to care.

An Integrated Care Provider could be a private company or joint venture

The new type of single legal entity could be an NHS organisation like a hospital Trust, or a GP Federation, a private company or a joint venture or special purpose vehicle that could include NHS providers and private companies.

This is a complex contract where the legal entity that holds the contract would then subcontract to a number of different healthcare providers – whether NHS, private or 3rd sector companies. This comes with all sorts of risks and hazards.  (For more info, see our answers to questions 3,4 and 5 in NHS England’s Integrated Care Provider Contract consultation.)

The Contract’s wide loopholes would allow far greater privatisation of NHS services – under this contract, a private company could control the delivery of the whole range of out-of-hospital NHS and social care services for a large area. Or indeed could win multiple contracts across many areas, and so establish a near- monopoly.

NHS England has admitted that under current NHS and social care legislation, it is powerless to stop private companies bidding for this – or any other – contract.

Un-evidenced, cost-cutting “care models” and “modern workforce”

This Accountable Care Organisation/Integrated Care Provider contract is designed to cement new NHS “care models” that copy the USA’s Medicare/Medicaid system. This provides a limited range of publicly-funded health care for people who are too poor or ill to access private health insurance.

Under the new “care models, District General Hospitals are being cut and downgraded. Community Hospitals beds are being closed. Family doctors are going under, as they are asked to take on more and more while there is a shortage of GPs and GP funding is flat. They are being replaced by huge new GP super practices serving 30K-70K patients, that are likely to become Integrated Care Providers.

Increasingly, these practices are being taken over by companies like Modality. Modality now operates in 7 Sustainability and Transformation Partnerships across England and has over 300,000 patients registered with it.

Budding local Accountable Care Systems (now rebranded as Integrated Care Systems) say that this is all fine, as care will be delivered out of hospital, in people’s homes, in large scale GP hubs and by means of digital technology.

But the new “care models” come with a “modern workforce” employing cheaper, less qualified new grades of staff – and relying on unpaid volunteers, friends and family.

None of this adds up to a comprehensive NHS that cares for everyone on the basis of clinical need. Instead care will be allocated on the basis of decisions about money.

NHS England laid out its plan for setting up these new care models in its 2015-2020 Five Year Forward View. Since then it has set up Vanguard schemes to trial these new ways of providing NHS and social care. There is just one small problem. There is no real evidence that they work. That is the conclusion of the National Audit Office report.

Opening the NHS to deregulated trade

The NHS quangos are aiming to change the whole architecture of the NHS, so it can deliver these American care models. All the better to open the NHS gates to American corporations, post-Brexit.

Stewart Player recently pointed out that

“…the aim is to impose a kind of global homogeneity of healthcare organization. Such standardization will attempt to safeguard and simplify investment strategies, and to embed corporate control of both purchasing and service delivery within rapidly evolving ‘mixed economies’ of care…

“The use of capitated budgets for ACO providers, for example, is expressly geared towards private investor interests, as the upfront capital can be invested in the global markets, with returns on equity in excess of 16%.”

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Dear NHS Reinstatement Bill Campaign Friends,

I am sharing this as widely as possible. Forgive me if you receive it more than once and forgive the blind copying.

We have launched our joint (KONP/HCT/We Own It) petition calling for the scrapping of the ICP contract and also we are asking people to take part in NHSE’s consultation and give your opinion on this dangerous contract.

‘We Own It’ is hosting the petition, which went live before 6pm today:

https://weownit.org.uk/ICP-petition-NHS

Here is our KONP page with links to the petition, key documents – including the JR4NHS submission, links to NHSE consultation, HCT resources page (very good):

Integrated Care Providers – What are they and how to oppose them

Please make every effort to sign the petition, complete the consultation either on line or in your own words and posting to them, and please SHARE petition link, video link, Facebook and Twitter with all your contacts.

Wtihin 3 hours, the petition is already close to 1000 and we hope to get over 20k to hand in with press coverage and a visible presence at NHSE on 26 October. And would be good to get many good responses to the consultation as well

Tony O’Sullivan

Co-chair of Keep Our NHS Public

@DrTonyOSullivan

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I can’t recommend this film – which focuses mainly on older political activists campaigning for the NHS – too highly.
(Statement of competing interests: I feature briefly in the film)

Pensioners United

Directors: Phil Maxwell, Hazuan Hashim

Country: UK

Running Time: 75′

Year: 2018

A potent account of a passionate group of pensioners who unite together to fight for a better life for themselves and those who will follow them. Starring Jeremy Corbyn, Harry Leslie Smith, the late Tony Benn, and thousands of inspirational pensioners from across the UK.
~ Allyson Pollock

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You may find this video of a meeting held in Birkenhead Town Hall on September 27 of interest. The meeting set the current situation in Wirral, of an accountable care system at a fairly advanced stage, in its national context.

The meeting began with a short contribution from a local GP, Dr Mantgani, who has in the past worked closely with Virgin; he expressed his concerns regarding the threatened closure of five walk in centres.

I then spoke – about 12 minutes into the video – about the historical and current context of NHS cuts, rationing and privatisation.

After a very interesting Q and A, there was a contribution, starting 56 minutes in, from Yvonne Nolan, a former director of social services in Manchester who now lives in Wirral. Yvonne described her work in Manchester, which in effect involved a long period setting up the de facto accountable care organisation which now operates across Greater Manchester. She related this to the current situation in Wirral.

This was followed by further questions and comments; all in all, a fascinating session

https://www.facebook.com/groups/defendournhs

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Can I appeal to everyone, individuals and organisations, to get solidly behind the judicial review as loudly and forcefully as possible.

I’d like to see all of us highlighting and publicising the judicial review in our various communications and campaigns. We are trying in Wirral.

If the review succeeds entire awful council/CCG edifices of pooling and dissembling come tumbling.

If the review doesn’t raise the required £18k we’re all doomed no matter how vocal our local and national campaigns!

Come on! The price of a few glasses of wine/beer/flat white.

https://www.crowdjustice.com/case/justice4nhs-stage5-courtofappeal/

Cheers

Kevin Donovan

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Dear chums

As you may have heard the Wirral Clinical Commissioning Group (CCG) has announced that it wants to close five local NHS clinics because Wirral residents “were confused about where to get help with urgent care”. The CCG, which is the local arm of NHS England, says it wants to “move care closer to home”.

Are YOU confused? Will YOUR care be closer to home if they close centres which are used by THOUSANDS of Wirral residents every week of the year?

Eastham Clinic; Victoria Central, Wallasey; Miriam Medical Centre, Birkenhead; Parkfield Medical Centre, New Ferry; Moreton Medical Centre

All these are due to close. Will a proposed ‘urgent treatment centre’ at Arrowe Park be closer to YOUR home?

You can find a petition from Defend Our NHS here:

https://www.change.org/p/defend-our-nhs-save-our-wirral-walk-in-centres?

Please sign and share with friends.

Thanks

Kevin

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For everyone who couldn’t make the Conference, here is Jessica’s speech to our Fringe meeting on the future of Women’s health that I referred to earlier in a members email.

Jean Hardiman Smith

 

Thank you for inviting me to speak to you today. My name is Jessica Ormerod. I run a research and information organisation called Public Matters with my lovely friend and colleague Deborah Harrington.
Although we write about all aspects of the NHS and other public services, I have a particular interest in maternity. I have been writing about maternity issues for seven years since I was the chair of the maternity services liaison committee for Lewisham Hospital which coincided with our fight to save our maternity services. We won that fight but we have by no means won the war because as you know maternity services up and down the country are being closed and downgraded.
But before anything else I want to paint the picture of what is happening to the NHS as a whole. Because every closed maternity ward, service or reduction in staff is the direct result of changes to the NHS that have been happening since the 2012 Health and Social Care Act. These changes are having a devastating impact on access to care. It is no exaggeration to say that we are witnessing the reversal of 70 years of universal, comprehensive and equitable care.
The 2012 Health and Social Care Act put into place all the major elements for a step change in the privatisation of the NHS.

A QUANGO called NHS England was formed as the Commissioner-in-Chief of the service, with over 200 subordinate local commissioning units. These commissioning units broke with the tradition of planning services, replacing it with buying in from public, private and voluntary sector providers. Areas of work are subdivided into contractable units and NHS public providers are obliged to compete. The loss of a contract means loss of income, which has a knock-on effect on the viability of the public sector, which is left with high cost acute care and a reduced income.

In 2014 a new CEO was appointed to run the NHS in England. He created a new plan for the NHS, the Five Year Forward View and this was greeted by the establishment as a welcome antidote to what was seen as the fragmented mess left by the 2012 Act (this was only a mere 18 months on from it being enacted). But it’s important to recognize that far from being an accident, the Act achieved the fragmentation necessary for privatisation to be embedded at an organisational level, including many major health industry players taking key roles in the commissioning and policy-making process.

At the heart of NHS England’s Five Year Forward View is the idea that the NHS in England will never again be funded to a level that maintains its services in the way they are run now. It puts together a series of proposals for change which are not just cuts but are about a fundamental reshaping of how services are provided. Expensive specialist and emergency care are relocated to centralised hubs and more care is to be delivered in the community via partnerships with local authorities. There is an aspiration for fewer emergency admissions with an improvement to overall health which it argues will lead to less dependency on NHS services.

We could say the scope of this aspiration is far reaching or we could say it is pie in the sky. It not only assumes the NHS can cope with a growing population without corresponding growth in services but that it will do so with a reduced service with much of the change becoming the responsibility of local authorities.

The process of transforming the NHS in England, is based on close co-operation between successive politicians and Department of Health managers over many years with the US Health Maintenance Organisation or Accountable Care Organization principles of managed care. This process is continuing without any checks and balances of substance within the formal organisational structures of government. Politicians go to great lengths to deny both privatisation and US influence on the current changes.

There is, however, a groundswell of resistance to the damage being done to the NHS and there is a lot of knowledge surrounding individual service contractions and closures, but little in the public domain about the overall programme of change. And that is what I am here to talk about today.

The National Maternity Review, aka Better Births – A Five Year Forward View for Maternity Care, is one of the Five Year Forward View’s New Models of Care. It emphasises community care delivered through local hubs with a theoretical reduced demand on hospital services. It recommends an increase in independent sector providers and introduces Personal Care Maternity Budgets. Personal Care Budgets commoditise and monetise the system. They add layers of unnecessary complication, increase expense, fragment accountability and lead to an accounting nightmare.
44 Local Maternity Systems have been established. The systems have been introduced without consultation, peer review, pilot studies or effective oversight from public health or parliamentary scrutiny. They are small-scale Integrated Care Systems. Unlike the Integrated Care Organisations which are now under consultation, they have been put into place with very little fanfare or institutional opposition.
As with all the changes to the NHS currently taking place, there is a real problem that rhetoric about better care closer to home is not matched by real resources or access to physical structures like hospitals. NHS England consistently refers to services being more important than organisations but fail to fill in the blanks about how this works. They also insist that travelling in order to receive excellent care is not a concern to patients. There is no acknowledgment that time, expense and severity of health condition all very much effect the distance people are able to travel regardless of the excellence of the service at the end of the journey.
In the case of maternity, these questions of distance and the emphasis on community care run two different risks. The first being the potential for increase of emergencies outside hospital setting. The second is that mothers might be taken in to hospital for assisted birth or caesarean in order to pre-empt risk arising.
But what makes maternity different from other services?
Most people use health services most at the beginning and end of their lives. Pregnant women are the exception to this. During pregnancy women come into more contact with the NHS than they probably have ever done in their lives. This is particularly the case if they have a complicated pregnancy or birth. Healthy women can become profoundly unwell during pregnancy and they can be vulnerable to life-threatening complications during birth. That’s why it is so important that women have all levels of care within easy access.
Until now maternity services have been provided in the most part by the NHS. Women have always been free to employ a private midwife. But the NHS has a duty to provide a midwife at every birth even if a private midwife is also in attendance.
Maternity services are woven through the traditional structure of the NHS. Women see their midwife at home or at their local GP. They receive a minimum of two scans to check the baby’s progress and health at the local hospital. If they have a pre-existing condition or they develop a pregnancy-related illness then their specialist will work alongside the maternity team to ensure that the woman and baby are safe and as healthy as possible throughout the pregnancy.
Currently women can give birth at home, in a ‘stand-alone’ facility run by midwives, ‘co-located midwifery unit’ – that’s a midwife-run facility on hospital grounds, or in an obstetric unit which includes doctors and surgical theatre. Obstetric units can only be sited in hospitals with A&E because they require acute services which is blood, air and surgeons. A woman can become dangerously ill very quickly during birth so timely access to acute care is essential.
Put this into the context that since 2010 maternity services have been starved of funds and there has been a staff recruitment and retention crisis. Many maternity units have already been downgraded or closed, hundreds of GP practices have also closed so women already travel further to receive care. This means it costs more and takes more time to see a midwife, GP or hospital doctor. It also means longer emergency transfer times. The risk is this will only get worse once the STPs restructuring of the NHS is complete.
Who is driving the changes to maternity?
Surprise, surprise, Better Births panel includes private health providers and those private companies are working with government to re-write policy.
Although most current providers are NHS hospitals, private providers are now being strongly encouraged. Local Maternity Systems set their own payment systems. This means that they can choose whether they pay via their geographical population or they can pay per activity or service. However, they do not follow established budget areas; they do not share boundaries with CCGs or Local Authorities even though they rely on budgets from both. Across the country there is now a mish-mash of payment systems. The risk is that women will fall through the gaps.
NHS Trusts have been ‘incentivised’ to adopt Better Births by offering a chance to win ‘pioneer funding’ to speed up the transition to the New Models of Care. In November 2016, Seven ‘early adopter’ sites started to implement the recommendations – I don’t need tell you about this because you’re part of it! The sites were told to be bold and radical. Another incentive is ‘the maternity challenge fund’ which instructs successful trusts ‘to explore innovative ways to use women’s and their partners’ feedback to improve maternity services’. A pioneer site is not the same as a pilot test site.
LMSs are encouraged to work alongside private providers in order to offer women a wider choice. As most women have previously been cared for by the NHS this simply means opening the door to the private sector. In a climate of serious staff shortages, it is possible that some midwives may see the benefit of setting up an independent midwifery practice rather than staying in the NHS. Despite protestations to the contrary, this does actually reduce the ‘NHS offer’ and opens an income stream for public money to be handed over to the private sector.
Better Births tells us it is working on a new accreditation scheme for maternity providers. But in a publicly provided NHS service, this is unnecessary because the NHS trains staff to a professional standard.
Private providers are required to have a contract with the NHS in order to receive payment via a Personal Care Budget. It is claimed that the budgets (which are described as ‘notional’) will demonstrate to CCGs the kinds of choices women make during pregnancy, birth and postnatally. This will apparently encourage CCGs to respond to women by increasing their offer. The claim is that this will also empower women. But it is decidedly unclear about how this can be achieved. The guidance talks about using Personal Care Budgets for birth pools, place of birth settings or breastfeeding support but all of this should be available to every woman regardless of a personal care budget. In fact, all of these used to be available to women as part of the normal care given by the NHS.
Moreover, it precludes the notion that women become ill in pregnancy. No one chooses to get gestational diabetes, pre-eclampsia, HELLP or any other life-threatening condition. What happens when your health needs change but you’ve used up your £3000 on hypno-birthing? There should be real concern about the potential lack of access to obstetric care when women have serious complications of pregnancy. Or to return to the issue of financial balance, if £3000 is a notional budget for a normal birth which can be used up in a number of ways then the acute hospital will potentially have to pick up the cost of the emergency care without a matching budget.
What does this all mean?
Scale and pace have taken precedence over caution and evidence. Academic research will take years to catch up to establish the public health consequences of this new policy.
This is a top-down reorganisation of a national service with little to no consultation, pilot schemes, peer review, oversight or risk assessment. A Health Select Committee inquiry into the maternity transformation plan was not completed because of the 2017 election. It has not been re-opened.
The Vice-Chair of the maternity transformation programme finishes his report with the following advice to LMSs: Be Bold! Don’t wait for instruction!
Clearly long gone are the years of epidemiological study, of public health planning, of consultation with experts.
Better Births is based on consumer choice issues around personalised maternity care. There is a serious lack of evidence that this restructuring will give women the vital services they need. There are fewer services, obstetric departments are being stretched even further and technology is replacing face-to-face clinical care.

On the other hand, it embeds private care and fee-for-service. And, most importantly of all this is not how a national public service works.

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To all members, comrades and friends on behalf of the Officers and Executive:

First, I would like to thank Judith Varley for the tremendous support she gave me at the Conference as a disabled companion. It was extra good having an active and interested SHA member as a plus to our usual allocation of 2. Judith was invaluable in discussions, and in looking around the wider fringes and events at conference. I hope she will have her own tale to tell. Thanks also to my SHA fellow delegate, Coral, who was just great to work with. Missing her already.
SHA had a wonderful presence at the Labour Party Conference this year (2018). There was a slight disappointment from the perspective of the Socialist Health Association in that the Conference focus was on Brexit. In the Women’s Conference our own delegate, Coral Jones, spoke well and persuasively on our motion on the issue of abortion, and how it is still technically a criminal matter. Coral will tell us more about this in her own words. Although the motion was not chosen to go forward, one on Women and the economy being favoured, all was not lost. Coral managed to speak to it eloquently, persuasively, and at some length, at the end of the main Conference, after Central Council member Norma Dudley proposed a reference back to our SHA motion on NHS renationalisation. Norma was speaking on behalf of her CLP, but she mentioned us warmly, and was speaking for us too. I cannot praise her ability highly enough, she is a real asset, like Coral.
I discovered, if I didn’t already know, that there is a wealth of talent amongst SHA women. Even when they were not speaking on the platform, or chairing sessions, they were showing their understanding and passion on health and care issues from the floor. I will try to remember some names, but everyone I heard was amazing, so if is an oversight if you are not mentioned:
Saturday/Sunday: Myself and fellow SHA member Felicity Dowling were speaking at The World transformed on the way forward for the NHS on Sunday. I hope I did us proud, Felicity certainly did. I am hoping she will let us have a copy of what she said to put on our website. Jessica Ormerod, and Nicholas Csergo were present to support us, as were other members and friends. If you read this, please add to the debate, and add your name to the people present. As speakers we didn’t get to take part in the round table discussions, and it would be good to hear about them.
Other members were speaking at, and supporting the Conference fringes and events on Sunday, and I hope Felicity will also let us know about the Women’s March to save the Royal women’s Hospital in Liverpool on Saturday.

Monday: Our first Fringe event was on Women’s Health and was very ably chaired by Central Council member and Chair of Liverpool SHA, Irene Leonard. It was attended by Alex, me, and Andy Thompson and a lot of other members and supporters. It was great to see Andy, Alex, and Nicholas supporting the session on Women’s Health. Of course, it is not just a women’s issue, and their support and friendship is very much appreciated. Our members Jessica Ormerod, Felicity Dowling and another local activist with a great depth of knowledge (Alex can tell us more about her, and I hope we meet up with her again – and recruit her), spoke so eloquently and passionately on the subject, and members of the audience were able to make very knowledgeable and worthwhile contributions. I hope Irene will say a few more words on this session.
Tuesday: Coral, myself and Judith mostly stayed in the Conference, but in the afternoon, Brian Fisher our Vice President arranged a meet up to talk about Care in the Community. Judith and I attended, while Coral and Norma both covered the Conference.
Tuesday Evening: Our second Fringe meeting on care and the renationalisation of the NHS Bill. We were very lucky with this, as MP Emma Dent Coad, who is the MP who ensured Grenfell did not pass unnoticed, and Eleanor Smith, the MP who is supporting the Renationalisation Bill through Parliament were both able to be present for almost the whole of the session. We also had our SHA member Judy Downey, possibly the foremost expert in the country from SHA perspective, and who is honest, and passionate. Last, but not least, Brian Fisher our Vice President spoke well and passionately about the issues, and a truly Socialist solution. I had the honour of chairing, but with a whole roomful of energised, knowledgeable and passionate people, both speakers and audience, it chaired itself. Again, Nicholas and Alex were there to support, as were Norma, Corrie Lowry, another Central council member, and great speaker, and Felicity. Our own Kathrin Thomas was also there in support. We all agreed that we could not let care be relegated to the long grass, as it seems to be in great danger of doing, and I hope we will get the opportunity to work with the MPs again. Gilda Petersen, from HCT, with whom we (SHA via Brian and me) are working on a Conference in November (details to follow) brought leaflets to the meeting room. I hope everyone will support this. It is in Birmingham on the 17th November and will be another chance to hear some wonderful speakers again, meet with new ones, and spend a whole day thinking about these complex issues.

Judy spoke about the privatisation of Liberty and will do so again in November.

Today I collected our material from the stall, and listened to a great speech from Jonathan Ashworth, and, to come full circle, the debates to which Coral and Norma made such a great SHA contribution.

To all members and friends, I won’t know what everyone did, and your contributions are all important. Please send me your information and opinions, so that all voices are heard

Jean Hardiman Smith Secretary and proud SHA delegate

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Following the Judicial Review in London in July, NHS England quietly launched its promised public consultation on the Integrated Care Provider (ICP) Contracts on 4 August. The consultation closes on 26 October.  If the appeal granted at the other Judicial Review called for by 999 Call for the NHS in Leeds is successful, this ICP contract may yet be unlawful, but it is nonetheless essential that we respond to the feedback.

The ICP consultation document is a daunting read for most of the public. However, Health Campaigns Together (HCT) has provided expert answers to all 12 points in the public feedback document. 

HCT’s aim in providing these answers is to prevent flawed plans being adopted. They are seeking to prevent long-term contracts being signed that will undermine our NHS. This is in order to preserve any hopes of achieving a genuine integration of health and social care as public services, publicly provided free at point of use – and publicly accountable.

 

A reminder on what’s happened so far: There have been two judicial reviews on the Accountable Care Organisations and these Integrated Care Provider (ACO/ICP) contracts. And the courts found in favour of the NHS. But one of the campaign groups, 999 Call for the NHS, has now been granted permission to appeal. 

This is some very good news. But it also means NHS England is consulting on an ACO/ICP contract that may be unlawful. 

NHS England knew full well that an appeal was a possibility. Although fully aware of this, on Friday 3rd August – the day Parliament and the Courts went on holiday – NHS England started a public consultation on the ACO/ICP contract. The consultation says that the Judicial Reviews had ruled in their favour. This consultation runs until 26 Oct.

 

We all know that this ICP consultation needs to be combatted and stopped. But in the meantime, here’s all the information you need to fill in the consultation feedback.

As stated, the judge in the London NHS Judicial Review said that the ACOs (now ICPs) should not be enacted until a lawfully conducted consultation was held, and any eventual ICP contract would have to be lawfully entered into.

Since then, NHS England have moved swiftly and stealthily into gear, and you will find their monstrous ICP ‘consultation’ document at this link.

And here is Health Campaigns Together on the subject at this link.

As you see, the consultation document includes 12 points for feedback and Health Campaigns together has provided suggested responses to these points – very good responses too, I think. You’ll find them at this link.

When you’re ready here is the direct link for public feedback to the document, just copy and paste from the Health Campaigns Together link above.

As stated, there is a move afoot to get the consultation suspended until after the appeal granted to the 999 for the NHS has been concluded, but it’s very important to counter what will definitely be lots of responses from the allies of NHS England. Otherwise they will be able to hail the result as a democratic mandate.

Health Campaigns Together say that it is OK to copy and paste HCT’s responses into the feedback boxes on the questionnaire, although if possible, it would be good if respondents could add a few tweaks of their own.

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First appeared in www.opendemocracy.net/ournhs  on 25 June 2018

If you want to make sure your medical data isn’t shared with third parties for unknown purposes, you may need to take action now. Here’s why – and how.

Image: Yuri Samoilov/Flickr, CCBY licence.

If you happen to visit your doctor in the next few weeks, you may (or may not) spot a new poster or leaflet; they are NHS blue, with a yellow stripe at the bottom, headlined “Your Data Matters to the NHS”. Like all those e-mails you’ve been receiving asking you to opt in to receiving marketing, the poster and leaflet has been prompted by GDPR – but it’s about something rather different, and the choice you are being offered is an opt out, not an opt in.

Simply put, if you have concerns about what’s being done with your medical records – who is getting access to them, and how are they being used – you have the right to opt out of uses of your own health information for purposes beyond your individual care.

This ‘new’ National Data Opt-out that you may (or may not) hear of is in fact based on one of the old care.data opt-outs, formerly known to doctors and Government as a ‘Type 2’, renamed so that – by 2020, we are told – care providers all across the NHS and care system will be able to see and honour your consent choice about what happens to your medical data.

Great, in theory. But in practice?

If you do see the poster, and follow the link – it’s nhs.uk/your-nhs-data-matters/ – you’re told you can exercise your right to choose using a new ‘digital’ opt out process. Unfortunately, NHS Digital’s new process ignores the reality of many patients’ lives and – despite Government digital guidelines – fails to serve families, or the most vulnerable. So much for bridging the digital divide, and reaching the ‘furthest first’…

Notably, too, if your family has children under the age of 13, or if you look after a dependent older relative, then things are even more complicated. Rather than giving a simple instruction to your doctor, those who would prefer their children’s data wasn’t sold to third parties for unknown purposes, will be required to send to NHS Digital, by post, four pieces of ID and documentation along with a seven-page form. So much for Jeremy Hunt’s much-vaunted commitment to a ‘paperless’ NHS

So much for the process – what then happens to your information?

The poster and leaflet go on to say:

In May 2018, the strict rules about how this data can and cannot be used were strengthened. The NHS is committed to keeping patient information safe and always being clear about how it is used.”

You only have to look at (our slightly more readable version of) NHS Digital’s Data Release Register at TheySoldItAnyway.com to see that little substantive has changed in practice.

NHS patients’ data is still being sold to a variety of customers – including for-profit ‘information intermediaries’ which continue to serve commercial customers of their own, including pharmaceutical marketers and private providers.

The law, however, has changed.

As of May 23rd, the UK has a new Data Protection Act 2018 – replacing the expired 1998 Act and bringing the provisions of GDPR into UK law.

NHS Digital, however, holds itself to the Information Commissioner’s old, pre-GDPR, non-statutory Code of Practice on Anonymisation – claiming this allows it to continue to ignore 1.4 million patients’ opt-outs, as it carries on selling ‘Hospital Episode Statistics’ data.

This approach has passed its sell by date; GDPR provides a wider definition of what is ‘identifiable’ data – i.e. data that can be used, including by combining it with other sources of data, to identify individuals, even if supposedly anonymised. UK law agrees with this wider definition, at least in theory – and both GDPR and our new Data Protection Act agree that any information about a person’s physical or mental health is sensitive personal data, and requires additional protections.

Given that ‘Hospital Episode Statistics’ (HES) consists of ‘patient-level’ lifelong medical histories – each row in the data referring to a single person, with every individually-dated hospital event they experienced linked together using a ‘pseudonym’, and containing many other items of data that can act as ‘identifiers’ – it can count as ‘identifiable’ data under the new law and therefore also sensitive personal data, as medConfidential and others have been saying for years – although confusion over the new laws seems to have stretched to the top of NHS Digital, and discussions are ongoing.

Why does this matter? Your medical history is like a fingerprint – unique to you, and identifiable by almost trivial means: a mother with two children is over 99% likely to be identifiable from their children’s birth dates alone, and a single news report could provide the information required to identify the unfortunate subject’s entire hospital history. A single breach of HES could expose millions of patients’ hospital histories, a disaster orders of magnitude greater than the loss of the HMRC Child Benefit discs in 2009.

This also means that, as of May 25th, any customer of NHS Digital receiving full copies of HES is now handling identifiable, sensitive personal data – so if any patient’s opt-out is not being honoured (i.e. if their row of data is not being removed from HES) then, once again, NHS patients are being lied to. You can check for yourself the lists of organisations with projects that ignored opt outs, and those that honoured them, at TheySoldItAnyway.com.

Aside from the posters and leaflets, some patients are being written to directly. But only those who already opted out – clearly NHS England is content, as it was in 2014, for large parts of the rest of the population to remain in the dark. (While NHS Digital must write to those patients who opted out already, it is NHS England’s responsibility to communicate with everyone else.)

Is what patients are told true? The opt-out should apply to all identifiable data; is that what NHS Digital is doing?

NHS England is looking to “empower the patient” by giving already empowered patients marginally more, while ensuring it remains accountable to no-one. For example, aside from “research and planning” uses, how does NHS England itself use data? And can a patient see the list?

medConfidential works to ensure every use of patients’ data is consensual, safe, and transparent. Unlike NHS Digital, NHS England has largely avoided writing down who does what with patients’ data and why, and because of that has accumulated a massive transparency backlog. Though they go beyond research and planning, NHS England’s current uses are likely (almost) all legal – but it can’t explain how, and some of its proposed future uses are still obscure.

medConfidential believes there need be no conflict between good research, good ethics and good medical care; indeed we are enthusiasts of lawful, ethical medical research. By and large, the standards researchers have to meet mean their use of NHS patients’ data already meet GDPR requirements – the paperwork they have to fill in has helped in that.

Commercial deals

Many people have concerns about private companies doing data processing for the NHS; cases such as the illegal deal between Google DeepMind and the Royal Free Hospital suggest some caution is justified. The most toxic problem, however, remains commercial reuse by ‘information intermediaries’ – some of which appear in the list of organisations that have breached not only their contracts with NHS, but existing data protection law.

Promises about the NHS “always being clear about how [patient information] is used” (that poster again…) ring somewhat hollow, while for-profit companies continue using contractual agreements with the NHS as a figleaf to do work for commercial customers such as Pharma marketers who – despite promises elsewhere that patient information won’t be used for “marketing purposes” – use the information to market to doctors.

Patients should know how their information is used if they are to make an informed choice. ‘Your NHS Data Matters’ provides some information about this, but omits some of the more unpalatable truths about what is happening – undermining the important promises it makes.

If after checking what the NHS says and what it does, you do have concerns, medConfidential suggests you opt out now. Opting out will not affect your individual care, and you can always opt in later – e.g. when you are satisfied proper protections are in place.

If you use medConfidential’s opt-out form, your GP data will be covered as well as your hospital data.

About the author

Phil Booth co-ordinates medConfidential – campaigning for medical data privacy. For more on how the changes will affect your medical records, visit medConfidential’s ongoing ‘masterclass’ blog series.

 

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Abdallah al-Qutati: Family and colleagues of third paramedic killed in Gaza speak out

In Medical Aid for Palestinians (MAP)’s latest film, the family, colleagues and friends of 22-year-old first responder Abdallah al-Qutati, who was shot dead by Israeli forces last week, speak out about the circumstances of his killing and their demands for protection and accountability. Abdallah was the third health worker to be killed in Gaza since 30 March.

According to the World Health Organization (WHO), Abdallah was volunteering with a team called ‘Nabd Al-Hayat’ (Life’s Pulse), providing first aid treatment and evacuation for injured demonstrators.

Abdallah was fatally shot on Friday 10 August while providing care to a man who had been shot by Israeli forces during the “Great March of Return” demonstrations east of Rafah, south Gaza. Abdallah was taken to the European Gaza Hospital, where he was pronounced dead. The injured man he was treating, Ali al-Alul, also later died.

In the film, Abdallah’s brother, Mohammed, calls for accountability for his brother’s killing:

Abdallah was performing a humanitarian job. He didn’t hold a gun. He was not a militant, nor a terrorist. He had medical solution and gauze to help the injured. This is a war crime. They must be held accountable in front of the world”.

On the day that Abdallah was killed, there were at least five attacks on healthcare in Gaza in which five health workers were injured in addition to Abdallah and an ambulance was damaged. More than 200 such incidents have been recorded by the WHO since 30 March, with three health workers killed and 379 injured. Sixty-one health vehicles and two health facilities – a specialised centre for people with disabilities and the Ministry of Health central ambulance station – have also been damaged.

Take action

Attacks on healthcare have impacts far beyond the initial pain and harm. They reduce the capacity of the Palestinian health system to adequately care for the population, particularly during emergencies, and therefore undermine Palestinians’ right to health in the long-term.

Failing to ensure accountability for these violations increases the likelihood of recurrence and further erodes the international norms which ensure the protection of health professionals and infrastructure in conflicts around the world.

MAP is calling on the UK and other governments to take action to protect and support Palestinian health workers in Gaza. If you are in the UK, you can sign our petition using the link below:

Sign our petition

 

Credits: Producer and Editor-Halla Alsafadi and Footage-Mohammed Mubayyed

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Despite the legitimate protests against the continued fragmentation of the NHS in England and privatisation of services, a sensible look at the state of play confirms that we still have plenty of NHS to fight for and defend against further erosion. Against the clamour in some quarters that the (English) NHS has already been lost we would propose reasoned counter narrative: that campaigning has been largely successful, in ways not seen in other public services also under attack.

Despite eight brutal years of virtually frozen funding, and legislation (the 2012 Health and Social Care Act) clearly intended to carve up local services and hand over the maximum possible range of services to private providers, the NHS has been remarkably resilient in resisting both “New Public Management” and also the wider neoliberal agenda.

Those of us who have campaigned for more than three decades could instead argue for success.  We are winning the argument. Of course, we keep up the fight and are never complacent, but we need to do this with confidence not in desperation.

This does not mean there is no crisis facing the NHS. There are huge issues caused by years of inadequate funding and compounded by an incoherent fragmented system – but this is not anything new.  The NHS has seen it all before and recovered: for the last 40 years or so, Bevan’s model for the service has effectively weathered the storms of repeated efforts at reform or transformation.

With the exception of some less complex elective care, the acute and tertiary care landscape is much the same. The half-baked efforts at privatising acute management in Hinchingbrooke, George Eliot and Weston hospitals all predictably failed; as did previous attempts at franchise. The private sector has no appropriate expertise to bring to bear. Private hospitals are tiny, exclusive and uncomplicated, focused solely on delivering selected elective treatment – although happy to fill otherwise empty beds with NHS funded patients even at NHS tariff prices. There is little in the way of expansion of private hospital capacity to respond to the growing waiting lists created by flatlining NHS spending.

PFI (as implemented in health together with the equivalent LIFT schemes in primary care) was pretty well recognised and discredited as an expensive failure by the mid noughties long before the high profile collapse of Carillion. Some trusts like Cambridge and Peterborough, Sherwood Forest, and Barts are effectively bankrupted by sky-high and rising annual PFI payments.  They have been bailed out year by year through extra handouts to avoid embarrassing collapse. New schemes have slowed to a halt, the most recent being Birmingham’s Midland Metropolitan Hospital – where construction work is at a standstill.

Realistic plans are now being discussed to claw back the worst of the PFI excesses as trusts count the costs of soaring unitary charge payments. Hundreds of millions in payments each year now flow out of the NHS and out of the country to the tax-dodging offshore companies that have taken them over.  The growing reaction and disgust at windfall profits has made buy outs and forms of nationalisation now credible.

The GP role and nature of their contract in most areas is much the same: APMS contracts allowing corporations to take over have only ever achieved limited penetration, and many of those contracts have failed.  Sadly, parts of non-GP primary care have been fragmented and distorted by privatisation, started over a decade ago as part of splitting purchasing from providing.  But some of these contracts have now come back, and the fragmentation of urgent primary care (NHS 111 and Out of Hours) is being reversed in places.

On the commissioning side, the idea that every service would be put out to tender, as the most vocal supporters and opponents of the H&SC Act claimed and expected, never happened. Section 75 Regulations although eagerly exploited in a few areas, have been largely ignored or circumvented.

A series of major attempts to outsource commissioning for example cancer care and end-of-life care in Staffordshire and older people’s services in Cambridge failed or fell flat.  Huge contracts to put swathes of services in the hands of private companies (which opponents of Accountable Care Organisations fear will follow) are not happening. While the private sector holds 39% of community health contracts, these equate to just 5% of the value, with all the larger contracts remaining with the NHS. Nor, indeed, is there any significant sign of investment by US health care corporations, which would be needed if they were in fact hoping to take over any substantial parts of the NHS.

The experience so far suggests that the idea of private companies acting as the “integrator” or as the “prime contractor” for huge contracts is now laughable.  It is increasingly obvious that private firms will not take on the risk of big contracts, so these have to go to public providers.  The takeover of commissioning support units by the private sector failed and has been abandoned.

Indeed the whole mantra of ‘choice’, ‘markets’ and ‘competition’ has taken a back seat as NHS leaders extol the virtues of cooperation and collaboration. New models of care are openly touted as ways to get around the competition legislation – which remains in place as an obstacle to any genuine integration of health services. Academic efforts to “prove” the claimed benefits of markets and competition have been abandoned as a failure. There is no proof.

Of course it is a concern that the level of private for-profit provision of acute clinical services has risen steadily since 2006 (when collection of data commenced) and is now at 8% of total NHS Budget. However a significant driver for the increase is using private capacity to augment the lack of NHS capacity rather than anything ideological. The rate of increase, far from accelerating as some have feared due to H&SC Act, has slowed.

The 8% level – largely located as it is in the sectors of elective hospital care and provision of mental health beds to fill gaps in NHS provision – is still far smaller than many claim, and hardly shows we have lost the argument, let alone the NHS. Contrast this with social care provision which sadly is almost entirely privatised; with disastrous consequences.

Many of the contracts that have been signed for community health services have been dogged by failure: it’s clear that few if any profits are being made by providers, and contract values have been driven down by spending cuts.

April 2018 saw contracts for the vast majority of NHS services simply agreed between commissioners and NHS Trusts without any sign of any competition at all.  GP contracts also continue to defy competition law. Treatment of private patients in NHS hospitals edged up very slightly but not overwhelmingly as some predicted.  Private providers such as Netcare, which owned the largest chain of private hospitals, are signalling their intended exit, not expansion – there is no money.

In reality the huge consensus appears to be that recent events have shown what the theory and evidence said all along – market competition does not really work for health care services. Private providers increase costs, lower quality and impede integration and efficiency – quite the opposite of conventional claims.

As regards privatisation at service level, or outsourcing, the sell-off of NHS Professionals was abandoned after heavy protests, and there have been successes at stopping back office services being outsourced, NHS Improvement has abandoned its targets from the Carter Review.  However there have also been setbacks, notably the disgraceful recent trend of trusts and foundation trusts setting up “wholly owned companies” as a tax dodge and seeking to shift staff out of the NHS.  But we are also seeing resistance to this from the unions, and other services have been coming back in house.

And so back to campaigning.

There are two threats to the NHS – the first is from the a small minority who reject entirely the NHS model and wish to see an American-style (or more likely a European-style) insurance based model.

The second is from those who think that the NHS should keep its core principles but that private sector providers and private sector styles of management are to be given a much larger role and that patients must have more choice within some sort of competitive market.

Dealing with the first threat it appears that the argument in favour of the traditional NHS, universal, comprehensive, free and funded from taxation has been won; again!  No proper political party dares pronounce itself in favour of changing this, and in fact opinion polling shows no political party could win an election if this was amongst its policies.  Evidence to the Lords sustainability committee showed that support for “our” NHS is as high as ever.

Some argue that by deliberately cutting funding and running down the NHS public opinion will shift, so moves to an American model could be got through. A government attempting this would have to ignore the colossal cost and inefficiency of the US system, which spends more than three times the current British level per head but leaves tens of millions uninsured or under-insured, and wastes more money on admin and other overheads each year than the entire NHS budget. And, political reality suggests any government running the NHS down to a level where it lost all public confidence would not be popular! Nor is there significant support for this even among Tory party members or Tory voters, who like the rest of the population are entirely dependent on NHS provision of emergency and other services.

Others argue that creeping privatisation is being used as a tactic, believing that the introduction of massive cuts through STPs or ACOs will allow us to ‘sleep walk’ into an NHS where charges and top ups have been agreed and providers from America have taken over our hospitals and GP practices by winning long term contracts. But as mentioned above early skirmishes show these tactics are being strongly resisted, the cuts are unlikely to take place and the Americans are showing little interest.

Public vigilance on the NHS has been continually rising, to the level that even relatively marginal cutbacks in provision of walk-in centres can trigger strong public reaction. The Guardian’s leak last year of NHS Improvement’s plans to impose cutbacks through a Capped Expenditure Process triggered a sufficiently widespread angry response to force the plans to be swiftly diluted and dropped. It is inconceivable that plans for any potential US takeover would not result in an even bigger backlash.

Any change from the traditional free NHS would also require a government able to get the necessary extensive and complex primary legislation through parliament, and willing to tough this out in debate in the full gaze of a hostile public.

Nonetheless the second fear, of increased use of the private sector, is genuine and fits to the campaigns that have been running for two decades.

The only way to stop this privatisation is to have a government which does not allow it; or only allows it in extremely limited circumstances.

We want to see legislation removing markets and competition from the care system (health and social care) altogether, moving back to a public service model, minimising and then over time reversing the role for private sector providers who are largely discredited anyway.

The case for that public service approach is gaining ground and is now firmly re-established as mainstream Labour policy.  And despite what some claim we can do this whether we are in or out of the EU.

Until we get a change of government we must continue to campaign wherever necessary. We can do so strengthened by the knowledge that we can win – and steeled by awareness that if we don’t fight we will be sure to lose.

As we celebrate the survival of “Our” NHS after 70 years, and demonstrate to demand a substantial increase in funding, with year by year increases to keep pace with demographic pressures, we can be proud of our successes to date – and prepare for the next battles to come.

By John Lister and Richard Bourne

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