Category Archives: Campaigns

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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For the first time, Jon Ashworth refers to the loss of national risk pooling posed by the STPs, ACOs and ICSs. He also states his intention once in government to introduce a (note: not the) NHS Reinstatement Bill.

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That this year is still the 100th anniversary of World War 1 seems to have escaped many people. 1918 was a momentous year, beginning with the onslaught of German Spring Offensive as their armies, freed from the Russian conflict, turned to the west.

Thanks largely to a restored Haig’s strategy and British fighting ability the offensive failed after two weeks. It was the beginning of the end for the Germans. Within 6 months the war was over. Victory had been snatched from the jaws of defeat. But the cost had been enormous, totalling nearly 180,000 British casualties – in just 15 days.

War in the trenches

This year we also celebrate the 70th anniversary of the NHS, and it is the year we must rescue the NHS from the chaos that Jeremy Hunt has plunged it into. Even the most incompetent British general could not have succeeded in demoralising his workforce the way our politicians have. The NHS is one of the largest and most successful organisations in the world. NHS England is five times the size of the Fifth Army, which held back the German Spring Offensive, yet it is treated as a plaything, an organisational laboratory for the neoliberal aspirations of the current government.

This great company could have treated all 600,000 casualties from the Spring Offensive, German and Allied, in just one day. That is how significant it is. Yet the government treats it with contempt, permitting the Secretary of State to behave exactly as the worst general in World War 1, dismissive of the employees, balkanisation of the assets, dreadful planning and supply, and the creation of crisis after crisis which the medical staff, like the exhausted troops in World War 1, have to cope with.

World War 1 lasted four terrible years. The Lansley bill was passed almost exactly 6 years ago on March 20th, 2012. This means that the dire mismanagement has now gone on for two years longer than the tragedy of the war. It now has to stop. We need to dismiss the failed strategy and its “generals”.

corridor medicine

Patients being treated in corridors – Lister hospital, Stevenage (Debs Thompson Facebook)

Where to begin? First, we challenge the obsession with targets, which only the witless and the control freaks deploy. It does not improve performance, but damages patient care in and promotes fear. We provide data showing its failure and the cost of that failure.

Then we demand that the NHS Reinstatement bill is debated and passed.

At this year’s Sheffield Festival of Debate begins with an NHS session on to how we do this on the afternoon of April 25th. It is called Saving the NHS for the Next Generation by stopping The Sovietisation of the NHS, signalling the start of our defence of the NHS – in Sheffield.

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As many of you may know, NHS England’s latest project is to establish Accountable Care Organisations (ACOs) throughout the NHS. ACOs consist of huge consortiums of NHS trusts, CCGs, local authorities, GP federations and so on, and contracts to run them can be held by private companies, effectively privatising the NHS.

Jeremy Hunt is currently trying to enshrine the ACOs in law by slipping the programme through Parliament by means of secondary legislation, without submitting it to normal democratic parliamentary scrutiny. This is the greatest threat the NHS has ever faced.

The campaign against this profoundly undemocratic plan has already scored a big victory in obtaining permission for Judicial Review, but the judge has refused to cap costs should the case fail. Therefore, Crowd Justice need to collect more funds to cover this possibility.

Please donate to this appeal as generously as you can, and forward it to your contacts, so that Crowd Justice – and Professor Stephen Hawking, Dr Colin Hutchinson, Professor Allyson Pollock, Professor Sue Richards and Dr Graham Winyard – can proceed to the judicial review.

Here is the latest from Peter Roderick and Crowd Justice:

Update on Urgent Legal Action for Our NHS – now it’s Round 3

Dearest Round 1 and 2 supporters,

I hadn’t been expecting to be writing again quite so soon, but….we’ve got a serious problem.

You’ll know from my last two emails that we’re winning our fight against Jeremy Hunt’s and NHS England’s plans to allow private companies to take control of our health and care services – a national public consultation on implementing the policy on accountable care organisations (ACOs) has been conceded, and a judge has ruled that arguments on the lawfulness of the ACO policy itself should be heard.

But here’s our problem. We’ve raised £180,000 altogether. An amazing and remarkable achievement. We were confident that this would be enough. We were wrong.

The government and NHS England are resisting every inch of the way and have already run up over £90,000 that they have claimed from us. On the basis of their estimated costs we have been advised that we face a potential liability of £350-400,000 if we lose. Plus maybe VAT. If we can’t limit our potential liability, then the case is over. We would have to withdraw.

But we don’t want to withdraw. We want the case to continue. So: can we show the government, NHS England and the court that thousands of others do too?

We have good arguments as to why we should not have to pay anywhere near this amount, even if we don’t win in the end, but the risk of not persuading a judge when the amount is so high is too great.

When we asked the court for permission to bring the case we also asked for a cost capping order, and we told the court that we would withdraw from the case without one. Mr Justice Walker gave permission for a full hearing, but he decided not to cap costs on the grounds that there was good reason to believe we would raise the money from crowd funding.

We may appeal against this decision – which itself means more costs – but in the meantime our solicitors have now written to the lawyers for the Secretary of State and NHS England, pointing out the importance of this case and  suggesting we agree that each side bear their own costs, whatever the outcome.  This would act as a disincentive to running up unnecessary costs and mean the case could be heard.  We hope they will agree, but if not we will ask the court again for a cost capping order.

It would help our case and show our determination to continue if we ask the public now if they are willing to keep this case going and so at 8 p.m. tonight [30 January 2018] we are launching a third round of fundraising.    

This is the link for Round 3: 

We have set a target of £100,000, but we can’t possibly know at this point how much more we need – so the target isn’t really a target, it’s just an amount that seems to us reasonable in all the circumstances.

Having a third round of fundraising was the last tghing we expected to be doing, but we want to keep the case going and want to give the public the chance to show that they do as well.

Please do what you can to let as many people as possible know – here again is the link: 

We are only in this position because of everybody’s fantastic support. We need it now as much as ever.

Many many thanks,


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This winter crisis is entirely of the government’s making and they must be held to account. The protest organisations Health Campaigns Together and The People’s Assembly have called a demonstration in London on 3 February.

If you have never been on a demonstration before, this is the time to change – and bring everyone you know! The march won’t save the NHS on its own, but as part of a whole host of campaigns all over the country it can play a large part. There will be local marches, too, so please look at to find out what’s happening in your area.

There can be no doubt that the NHS is facing an unprecedented crisis when Chris Hopson, chief executive of NHS Providers says that ‘current winter pressures facing the NHS have brought us to a watershed moment’. The governments repeat the mantra that health spending is greater than ever before. This may be true purely in cash terms, but in real terms this is far from the case.

NHS crisis

Health spending is currently at £123.8bn. The Office of Budget Responsibility projects that, to maintain standards and meet rising demand, spending needs to rise to approximately £153bn and at a rate of 4.3% annually. The King’s Fund think tank has shown that the rate of growth of the DH (recently renamed the DHSC) budget has slowed considerably from the long-term average of approximately 4% a year, to 1.2% in real terms between 2009/10 and 2020/21.

This financial squeeze with drastic cuts in hospital beds by over a third between 2000 and 2015 alongside swingeing cuts to social care have created a perfect storm.

The media headlines paint a graphic picture of what this means for patients. In the week between Christmas and New Year nearly 17,000 people were forced to wait more than half an hour in ambulances outside A&E departments. Elective surgery has been cancelled to free up beds, which over the Christmas period had average occupancy rates of 91.7%, far exceeding the accepted safe upper limit of 85%.

Some hospitals are caring for patients in corridors and medical students are being urged to help relieve the NHS winter crisis because short-staffed hospitals are struggling to cope. Nurses have resorted to using food banks as they struggle to make ends meet on low pay and are leaving the profession in greater numbers than they are joining it.

GP surgeries are so stretched that there is often a two- to three-week wait for a routine appointment.

This is an NHS at breaking point. The situation is extremely unsafe and it is only because of the dedication of NHS staff that there has not been a major catastrophe…yet.

The government has tried to scapegoat overseas migrants, GPs for not having enough appointments to offer and patients for ‘inappropriate’ use of the NHS. Yet the truth is that none of these groups are responsible. The NHS would collapse without foreign health workers. We are far more likely to be treated by someone from overseas than to be competing with them for care.

GP access

Evidence shows that patients who are heavy users of A&E are also heavy users of general practice, debunking the myth that more GP appointments would ease the pressure on A&E. These people are ill, they are not abusing the NHS.

The truth is that the blame for this debacle lies squarely with the government who choose to underfund the health service. We are told that the NHS is unsustainable and needs to reform, yet Britain is the fifth or sixth largest economy in the world and the NHS is the most cost-effective healthcare system in the developed world. If we could afford to build the NHS out of the ashes of World War Two when government debt was far higher we can afford it now.

We must protest in the strongest terms about what is being done to our NHS. There is huge public affection for the NHS and rising outrage as people are beginning to understand the threat it is under. This is crunch time for the NHS, we must stand up and fight for it now or we will lose it.

GPs are ideally placed to advertise the demonstration and to encourage people to attend. Leaflets can be downloaded from the Health Campaigns Together website, printed off and put in waiting rooms. Posters can decorate walls.

We owe it to our children and grandchildren to preserve the NHS, publicly funded out of general taxation, publicly provided and free at the point of delivery. Aneurin Bevan said that the NHS will survive only while there are folk with the faith to fight for it. Will you be one of those folk?

Join us on Saturday 3 February on Gower St, London at midday.

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The CCG have decided to restrict discussion on the future of the hospital to just one option, not the four explicitly

The North of England Clinical senate has advised on this single option. The North of England Clinical senate is not a neutral body but one that works within the Government plans for the NHS, which includes privatisation and shrinking services. It is not a neutral body.

  • The move will be massively costly, over £10 million. This at a time the Royal College of Nursing says nursing staff shortages are compromising patient care, staffing is so tight that patients can be left to die alone. The removal of bursaries is hitting recruitment.
  • Services across the country are being restricted.
  • The actual problems at the Liverpool Women’s Hospital cannot wait the 5 years or so a new building might take, The neonatal unit needs to expand and update, the blood services (not just at LWH) and imaging need to be improved, now.
  • Maternity care facilities are being cut across the country and the pernicious Maternity Review is being
    implemented. This area is a maternity vanguard area. They are on record as saying they want women to give
    birth at home, not in a hospital. See our facebook for the video
  • The US model of care to which the NHS moving, does not cater well for maternity. Texas has the highest
    maternal mortality rates in the developed world
  • The NHS in the north of England (covered by the NHS Senate,that penned,the report) also said,
    Women in labour can safely travel four hours without risk to their baby.
  • Many hospitals are on more than one site, including both the Liverpool Royal and Arrowe Park, yet it is said to be too dangerous for the Liverpool Women’s to be a mile away from an acute hospital? One mile away is dangerous, we are told, yet women giving birth at home could be many miles away.
  • At Free Standing midwife units, (unlike the alongside midwife led unit at our hospital) one in four women need to be transferred to hospital. On that basis, this must also be dangerous. Yet four hours travel in labour is safe?
  • Most of the cost problems in Liverpool Women’s hospital come from the internal structures and systems of
    the internal market in the NHS.
  • The Maternity Vanguard are intent on setting up a “pop up” maternity unit to “explore women’s choices”. No mention of the choices tens of thousands of women have indicated in our petition. Choosing our choices
    for us it seems.
  • The NHS needs to be fully funded with more beds doctors and nurses and midwives and related professions.
  • The STPs and accountable care organisations are a risk to the whole NHS, free at the point of need,  publicly provided and a universal service. Merseyside and Cheshire STP is one of the largest.
  • PFI hospital building has wasted billions of pounds of taxpayer money and not one is fire safe. The private companies get the fees and profits and guess who pays to make these brand new hospitals fire safe?
  • Staff still work under the pay cap and many cannot make ends meet. What does Hunt the health secretary offer? An app to let you do more shifts.
  • Not one mention of the major problems of traffic pollution at the proposed site which especially damages babies in the womb and new borns. The site proposed will include the Cancer centre and a life sciences commercial building, bringing in still more traffic. Can we have some joined up thinking please?

How you can be involved?

Invite our campaign to meet a group of your friends or your organisation. Ask us to your union meeting. Come to a campaign meeting. Leaflet your street.

Contact us on facebook

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Ministers have ignored a strident “winter warning” from NHS Providers – the body that represents NHS and foundation trusts. The government is determined to stick to their plan to freeze NHS budgets for the decade to 2020 even as costs and population rise.

England’s hospitals and other NHS providers warned that if an extra £350m were not found by August at the latest, we will face another winter crisis even worse than the situation last year.

It’s the middle of September, and there’s no extra cash, and none promised.

Nor is there any let-up in the brutal 8 years of frozen or below inflation pay for more than a million NHS staff. Hospitals and community health services are finding it increasingly difficult to maintain hard-pressed services, so hospital bosses are now being threatened with the sack if they don’t meet A&E targets despite the struggle to retain and recruit staff.

Theresa May’s government opted not to contest a vote on scrapping the 1% cap. But May has made clear that she will ignore the will of Parliament, meaning NHS pay levels will be further eroded as inflation nears 3%.

The combined impact of these policies can be seen in Oxfordshire. 110 beds have already been closed with connivance of local councillors, and now the local acute hospitals trust has revealed a further 92 are now closed for “safety” reasons (presumably staff shortages). The county already tops the league for delayed transfers of care. The impact of spending cuts is a system seizing up and increasingly unable to maintain key services.

The quest for massive, unprecedented cash savings is of course the backdrop to the 44 Sustainability and Transformation Plans (STPs) secretively developed last year. These plans hinge on “new models of care” which appears to centre on cutting and de-skilling staff, and downgrading, downsizing or privatising key areas of care to cut NHS spending – while maximising openings for private companies to scratch out profits from under-funded services. There’s no evidence any of this will be effective, of course.

The current round of massive reorganisation and pressure for ‘new models’ is a bonanza for management consultants who are coining in millions and effectively now steering many Clinical Commissioning Groups and trusts.

The latest step was the publication last month of hundreds of complex pages of guidance and draft contracts for ‘accountable care systems’ (ACSs) and ‘accountable care organisations’ (ACOs) — explicitly drawn from privately-run systems that first emerged in the US. Jeremy Hunt has on several occasions stated: “We need clinical commissioning groups to become accountable care organisations.”

Pace-setters on this among 8 vanguard Accountable Care Systems have been South Yorkshire & Bassetlaw (where five Clinical Commissioning Groups have created a ‘shadow’ ACS without bothering to ask the five local authorities to sign it off. It will become a legal entity before April 2018).

In Nottinghamshire the Sustainability and Transformation Partnership is spending £2.7m this year getting bungling consultant Capita and US health provider Centene to help shape up an ACS.

In each case the reality will be an Accountant-Controlled System, focused primarily on cutting services to fit within a rigid cash limit. Nottinghamshire could even wind up giving the US company a contract to do the CCGs’ job, controlling budgets and services.

Neighbouring Leicestershire Sustainability and Transformation Plan leaders claimed the local authority backed their Accountable Care System. But the County Council has denied this, and it’s likely that many elected councillors and MPs in the other “vanguard” ACSs will be equally reluctant to take political responsibility for plans which masquerade as “integration” of services but threaten to bring only declining quality and restrictions on access to care.

The STPs and ACSs all lack any legal status to force through cuts. Councils still retain powers to challenge and force a review of decisions that represent a threat to local health care services – and they must be pressed to use them.

However politicians – like the wider public – will remain in blithe ignorance over developments in the NHS – unless campaigners can pile on enough pressure and present sufficient compelling evidence to make clear what is happening.

There is more and more evidence to show which way things are going. It’s reported in Healthcare Europa that NHS England has surreptitiously decided to award all six of the NHS contracts for organising the new “Integrated Care” models to private companies. All but one are American-owned – the other, OptiMedis, is from Germany.

If this proves to be correct, Tory politicians will find it even harder to convince suspicious voters that they are not destroying our NHS with cuts only to open the doors to the ultimate horror: US-style health care. Even NHS-run ACSs represent a huge retreat from a national NHS to 44 local plans each with rigid cash limits and no remaining accountability to local communities.

Theresa May’s team has adopted an ostrich-style response to the rising cash crisis and its likely impact this winter. But it’s clear that many of her MPs, fearing they could lose their reduced majorities at the next election, are pressing hard behind the scenes for a reprieve for local services.

MPs have already forced significant retreats from hospital downgrades in north Devon and Essex. Cabinet minister Andrea Leadsom has backed calls for a reprieve for hospital services at Banbury’s Horton General, and may yet have something to say about Oxfordshire’s latest bed closures.

Many more Tory MPs need to be confronted by local pressure to force this weak minority government to back off on cuts and new models – just as they have been forced to drop privatisation of NHS Professionals.

We urgently need to build a big enough and strong enough movement to force politicians to take notice if we are to avoid a further irreversible decline this winter and ever-deepening crisis in the NHS.

That’s why Health Campaigns Together has called for the biggest-ever gathering of health campaigners on November 4 in Hammersmith Town Hall in a conference that will share information and experiences, link trade unions, pensioners and campaigners, and build networks that can unite and concentrate the strength of local campaigns.

We have nationally known speakers and local campaigners – and lots of time for workshops, networking and discussion. Join us: book your place now!

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The BMA have begun to ballot GPs in response to the Tower Hamlets motion passed at LMC conference in May which said:

“That conference believes that the GP Forward View is failing to deliver the resources necessary to sustain general practice and demands that GPC ballot GPs as to whether they would be prepared to collectively close their lists in response to this crisis.”

It is beyond doubt that General Practice is in meltdown. Despite the best efforts of GPC Executive all we have been offered is a totally inadequate GP Forward View and a couple of other sweeteners such as reimbursement of CQC fees.

STPs will finally push us over the edge as patient care is moved out of hospitals into an already oversaturated community to “save” £22 billion in England.

Collectively closing our lists to manage our workload would benefit the safety of our registered patients and send a message to the Government that we cannot continue to work under the current level of pressure.

Many forms of action to reduce our workload, such as refusing to cooperate with CQC inspections, would risk practices being served with breach notices. List closure however is allowed under GMS and PMS contracts to give practices: “a degree of workload control…. in situations of workforce or recruitment difficulties that affect a practice’s ability to provide to an acceptable and safe standard.” Given that 84% of us said last year that our workload undermines our ability to provide safe patient care, most of us can surely argue that we can temporarily close legitimately on this basis.

Practices in areas of high turnover may be concerned that list closure will result in sharp drops in income as patient numbers fall. This could be mitigated by choosing a maximum list size which enables safe patient care, closing when the list exceeds this number and opening again when it drops below. The requirement that practices opt out of additional and enhanced services if they close their patient list, is no longer in the regulations. There will thus be no impact on the services practices are currently commissioned to provide. Collective list closure would mean lack of access for some but General Practice will collapse and there will not be access for anyone if we do nothing. Patients will support us if we explain that we want to provide safe, comprehensive General Practice to everyone, but that in the current climate this is not possible. We do not contemplate this action lightly, but the Government have not listened to years of warnings and General Practice is now on the point of collapse. We struggle to provide a safe service due to our workload and this is not good for patients. Many already understand the pressures that the health service is under, 250,000 marched in defence of the NHS earlier this year.

Patients can be engaged by asking them to sign petitions in our waiting rooms or to write to their MP.

The Government could easily avert this crisis. They could:

  1. Accept the GPCs Urgent Prescription for General Practice in full
  1. Take responsibility for indemnity as they do with hospital doctors.
  1. Allow patients to refer themselves directly for services such as antenatal care, weight management programmes and physiotherapy to remove this needless administrative burden from General Practice.
  1. Get rid of the hoops that we are forced to jump through for tiny pots of money, such as those in the GP Forward View, and put these sums into our baselines to allow us to plan our services.
  1. Assure rights of residency for non UK born doctors and nurses so that these valuable NHS staff stay.
  1. Stop outsourcing to profit driven companies like Capita whose appalling service causes daily chaos.
  1. Resource the NHS adequately. We are the fifth richest country in the world and can easily afford the NHS which remains the most cost effective health care system in the developed world. In 2015 the UK spent 7.3% of GDP on the NHS. This is lower than comparable European countries and is set to decease to 6.6% by 2020. The UK has fewer hospital beds per head at 2.8/1000 than the OECD overage of 3.3 and has fewer doctors and nurses per head than comparable developed nations.
  1. Abolish the NHS market, which fragments the health service and costs billions to administer.
  1. Repeal The Health and Social Care Act, with its myriad of committees and procurement panels which take us away from patient facing care.
  1. Abandon the STP project.

The key to success is in the word “collective”. We must all take part. Together we are strong. Of course there are risks and none of us will undertake this lightly but we cannot continue to work under these pressures. It is not safe for patients. If Government won’t listen we must make them listen.

Q: Why are we balloting for willingness to take action?

A: It is beyond doubt that General Practice is in meltdown. STPs threaten to finally push us over the edge as they demand £22 billion in “efficiency savings” Young doctors are not choosing General Practice as a career and many older GPs are retiring early. To add insult to injury the public sector pay cap has meant that doctors have effectively taken a 22% pay cut in the last decade. Despite the best efforts of GPC Executive all we have been offered is a totally inadequate GP Forward View and a couple of other sweeteners such as reimbursement of CQC fees.

Q: Why are GPC proposing list closure?

A: General Practice is governed by contract. Refusing to comply with many clauses in the contract, such as refusal to cooperate with CQC, would risk a breach notice. List closure however, if carried out on the grounds of patient safety, is allowed under the contract.

“A practice can decide not to register new patients, provided it has ‘reasonable and non-discriminatory grounds for doing so’, (such as protecting the quality of patient services.) In such cases, the regulations allow practice to refuse to register new patients (Schedule 6, Part 2, paragraph 17).”

Q: What should I say to patients?

A: Be honest. Tell them we regret taking this action and do not do it lightly, but that the Government have not listened to years of warnings about the strain on General Practice and that now it is on the point of collapse. We have to do something to stop it breaking down altogether. We struggle to provide a safe service due to our workload and that this is not good for patients. Ask patients to support you, put a petition in the waiting room and ask them to write to their MP. Our patients are the strongest weapon we have in fighting for general practice. Tell them what you are doing and why.

Q: My practice has a high turnover, if we close our list we will rapidly lose income.

A: For practices like yours, consider deciding a minimum list size to sustain the service, then temporarily close your list until patient numbers had dropped below this. You could then re-open until your safe limit was reached, closing again and so on. Remember the aim is to highlight the dangerous working conditions we all face and the impact this has on patient care. You can still achieve this.

Q: What about the patients who are not registered with a GP?

A: GPs will remain able to see patients as temporary residents in emergency circumstances. We regret that this action will mean a delay in registering fully with a GP, but failure to act will lead to the collapse of General Practice which would mean a lack of access for all. As a profession we do not do this lightly, but the risk to our patients is greater if we do nothing. NHS England will still be able to allocate patients to closed lists, as is the case currently in many areas where all practices have closed lists. If this list closure happens nationwide however it causes a significant increase in workload for NHSE, as well as public embarrassment to the government.

Q: I understand the need to take action but I am nervous.

A: Of course. We are a caring profession who are reluctant to do anything to hurt or upset our patients. Having considered many options, we genuinely believe this is the best choice to cause maximum disruption for Government, but minimal harm to patients. The risk of continuing to provide care at this unsafe workload outweighs the risk of carrying out this action.

Q: Why are we balloting for “collective” list closure?

A: Because together we are much stronger and can have a much bigger impact. If we stand united across the profession, supporting each other we can make rapid gains. Uniting GPs across the country means we can deliver a stronger message and hopefully achieve our aims quickly.

Q: What do you want the Government to do?

A: There are many things that Government could do. These are some suggestions:

  1. Enact BMA policy and fund the NHS to the level of comparable countries and at the same time increase the proportion of NHS funding which is allocated to General Practice to at least 15%.  In 2015 the UK spent 7.3% of GDP on the NHS. This is lower than most other European countries and is set to decease to 6.6% by 2020. The UK has fewer hospital beds per head at 2.8/1000 than the OECD overage of 3.3 and has fewer doctors and nurses per head than comparable developed nations. Despite this the NHS is regularly found to be the most cost effective health care system in the developed world.
  2. Take responsibility for GP indemnity in the same way that they do for hospital doctors.
  3. Allow patients to directly refer themselves for services such as antenatal, terminations of pregnancy, podiatry, physiotherapy, weight management programmes etc, to remove needless administrative burden from general practice.
  4. Remove all of the hoops that we have to jump through to for example obtain the tiny pots of money in the GP Forward View. Funding must be made directly available for all practices.
  5. Deal with the incompetence of companies such as Capita and NHS Property Services whose failures cause such time wasting in surgeries.
  6. Sort out NHS Property Services so that they stop wasting practices time with repeated premises surveys and sending unjustifiable service charge bills.

    Attract doctors and nurses into General Practice, both young doctors and those who have left. Increasing doctors and nurses will help decrease the workload which 84% of us have said undermines our ability to provide safe patient care and enable us to provide a safe service for patients.

  8. Confirm the residency status of all non British born doctors and nurses immediately so that they remain here making their vital contribution to our health service.
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Jeremy Hunt’s STPs – the sustainability and transformation plans – are”a massive top down reorganisation that is destroying England’s national health service.

Slash, Trash and Privatise is what the letters really stand for.  Hunt and his cheerleader Simon Stevens (director of NHS England) are getting away with murder. Even Margaret Thatcher didn’t dare to attack the NHS in the way they are doing.

They are breaking up our shared national service and putting it out to tender – this week Manchester put £6 billion of our NHS on the open market. They deliberately did this before the May elections to force the hand of the incoming Mayor. It is an absolute disgrace that government spin doctors present this as being good for the NHS.

Although many Labour councils have spoken out against the STPs – such as Liverpool and several London boroughs – most are rolling over and collaborating now that Hunt and Stevens have forced local NHS bodies to sign the STP contracts.

As a result many hospitals are under threat of being replaced by deskilled, community based services with fixed pre-set budgets: these are purposefully designed for privatisation and insurance funding.

The fixed budgets prevent flexible responses to need, as we are used to in the NHS. Top-up payments and insurance will become essential for those who can afford it – indeed they are already happening in many areas where cataract surgery and joint replacements are being rationed. The rest of us will have a second class public safety net as in the USA.

All Labour councillors and members of NHS bodies should do everything in their power to prevent the implementation of these sick plans. Theresa May claims to represent ordinary working families but she is destroying the health service they depend on.

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Sion Simon

We’ll defend our NHS, prioritising mental health and championing a healthy region
I want to see an outstanding NHS in the West Midlands – with parity of esteem between mental and physical health,  supported by a physical activity strategy for everyone in the region. Yet the Tories are doing their best to destroy it.

This is how we will take control of our NHS in the West Midlands:

  • Defend the NHS against Tory cuts – demanding our fair share so that frontline services in the West Midlands are of the highest standard. Seek powers to devolve more NHS strategic planning and commissioning to the regional level.
  • On taking office I will immediately convene a task and finish group, using the outstanding professional expertise we have in the region – to radically redesign our approach to both the health care and social care of our older people. We will seek extra powers from government if needed.
  •  The Tories have shortchanged the care of our older people. We will have to use our skills strategy to create a bigger care workforce, encourage new entrants to the market through social enterprises and push for universal recognition of the Ethical Care Campaign, which champions our region’s caring home-workers.
  • Back the NHS by working with local universities to train more nurses and doctors in the West Midlands – and keep them in the region. We’ll work with our hospitals to grow the number of local people we train to deliver the NHS of the future.
  •  Mental health to have parity of esteem with physical health – working with partners to achieve early diagnosis and treatment, more and better support for carers, and steps to tackle stigma. Fully implement the WMCA Mental Health Action Plan, while extending a pro-active approach towards mental health to childhood.
  •  Work with local authorities to produce a West Midlands strategy for physical activity, giving everyone in the region the confidence, opportunity and motivation to participate in sport and recreation.
  •  Maintain and grow the world class research base in life sciences of the West Midlands – strengthening partnerships between universities and local business.
  •  Give people more control over their own health – by supporting the development of apps that provide health information, supporting the development of personalised care budgets, and crucially improving prevention of health
    problems. We’ll bring public services together to promote health initiatives, promoting healthy food availability and tackling bad practices in advertising and promotion of unhealthy food.
  • Make the public realm as supportive and inclusive as possible for those with dementia, autism, and all those with conditions that need particular forms of support – and encourage a wider understanding of the care required for these people to live with appropriate dignity and vitality.
  • We will raise awareness of the importance of children’s oral health, promote new schemes in nurseries and schools and aim to reduce the number of child tooth extractions – which cost our NHS millions every year.
  • In line with our ethos of early intervention, we will introduce a new general principle in the West Midlands that no child here who needs mental health support will be turned away or forced to wait long periods to access the support they need.
  •  We will encourage innovative approaches to GP prescribing across the West Midlands, where GPs are able to offer patients a range of non-traditional support, working with voluntary organisations to deliver more counselling and
    help to get active.
  •  Monitor the impact of health and social care  devolution in Greater Manchester and move to replicate successes, providing sufficient funding is secured from central government.
    • Working with the NHS to tackle health inequalities and improve awareness of LGBT issues and tackling domestic abuse in the LGBT community and the barriers that exist around reporting.

More about Sion’s manifesto

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My name is Jenny Crane and I work on a Wellcome Trust project about the Cultural History of the NHS, looking at how the meanings of this key British institution have changed over time.  I also co-ordinate our engagement programme, the People’s History of the NHS, in which we collect memories, stories, and opinions from as many people as possible, to feed this in to shape our research work and outputs.

In terms of our engagement work, we have organised multiple physical events: with Museums, hospitals, art galleries, local history societies, and campaign groups.  Our upcoming events can be found here, please do join us!  We also try to extend the reach of our work through our public-facing website.  On the website, we write short articles about our findings, and have a ‘Virtual Museum of the NHS’ displaying pictures of NHS objects, from baby glasses and tags to portraits of Nye Bevan.  We also invite anyone to contribute to our website – it is free, quick and easy to sign up, and then myNHS members can see the memories which others have shared, and contribute their own.

So far, we have received 76 memories, many of which relate to campaigning around the NHS.  These submissions have really enriched my research into this area, and changed the nature of the questions which I’m asking of my archival materials.  Mostly from our responses I’ve been very struck by the variety of campaigning around the NHS – from the work of Leagues of Friends to raise money for new equipment, to marching and protest in various areas, and campaigns through letter-writing, petitions, and legal challenges.  The submissions have already started to give me some idea in to how NHS campaigning has changed over time – for example from multiple local groups to a more cohesive national movement, trying to mobilise collectively to defend the NHS as a whole, rather than local hospitals.  One submission suggested also that campaigning had moved to some extent from outside, protesting, as protesters had aged, and media and police come to manage such activism more.  Instead, the contributor argued, much campaigning was now done through letter-writing, Freedom of Information requests, petitions, and, of course, using the virtual space of the internet.  The extent to which the internet has been a good thing for campaigners – spreading the message, engaging new audiences, linking disparate groups together – or a bad thing – leading to lazy ‘clicktism’, dissuading political action – has been a regular debate in responses to my survey for NHS campaigners.

Another fascinating question raised by contributors is about the extent to which pro-NHS campaigning is radical, given that this Service has rated very highly in public opinion polls since its inception.  One member argued that this was radical, because promoting democratisation of the NHS placed campaigners up against large and powerful bodies – particularly the Trusts and the Clinical Commissioning Groups.  Another question raised is the extent to which NHS activism, or indeed activism in general, may be generational.  One of our submissions is from a campaigner who mobilised in 2010, because she saw changes being made to the NHS, and also in that year received papers from her father, defending the Service as early as the 1950s.  In one speech, made in 1955 to an American audience, the father argued against the idea in American media that a medical service run publicly was ‘both inexpedient and morally wrong’.  Rather, he argued, that the NHS cost a similar amount to the American health system, and yet was also ‘there for all’, reliant on the ‘venerable principle’ that everyone would contribute to the care of the sick.  His argument was both based on statistics and information, as a scientist, and on a moral call about entitlement and welfare: two strands which continue to be key to NHS campaigning together.

We’ve also received brilliant visual culture about campaigning through our website.   We have received for example pictures from Stroud Against the Cuts (see left) of their exhibition and campaign hub run in February 2017 in an empty shop on Stroud High Street.  We have also received photos of placards, t-shirts, and leaflets from Leeds Hospital Alert; a group founded in 1981 in response to Kenneth Clark’s proposal to allow hospitals to ‘opt-out’ of local authority control.

My research looks to understand different types of NHS activism; how these have changed over time, and when they have been successful, or not.  Looking at historical archives, I can see how campaign groups were received by media, politicians, think-tanks, and legal and medical professionals.  However, it is also invaluable to hear from campaigners themselves.  However involved you’ve been with NHS campaigning – whether you’ve just signed a petition once, or whether you’ve established a campaign group and led rallies – I am keen to hear your story.  By understanding these stories, I can better understand what the NHS means to people, and when and why and how people have, historically and today, made the shift from appreciation for this Service in to political action.

If you’d be happy to tell me more, please do consider contributing any photos or memories at our project website here.  It is free and simple to join up.  You can also email me directly at, or fill out my short survey for NHS campaigners.

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On 27th February 2017, the Government debated an e-petition which had received 117,344 signatures through the Parliamentary website.  The petition noted that there are 193 attacks on NHS staff per day in England, and called for it to become a specific offence to attack a member of NHS staff, in line with legislation specifically prohibiting violence against police officers.  Following Parliamentary debate, the Ministry of Justice argued that ‘assaults again NHS staff are completely unacceptable’, but also that there were already sufficient offences which criminalised assault and violent behaviour.  The example of this recent petition raises broader historical questions – who has created petitions about the NHS over time?  Have these been effective, and in what ways?  How do such petitions fit in to a broader model of NHS-related campaigning?

The first known petitions to Parliament date back as early as the fourteenth century, and petitions have emerged as a popular way for members of the public to try and influence Parliamentarians, particularly since the 1600s, initially about personal grievances and later seeking to change policy.  The historian Richard Huzzey has demonstrated that popular petitions in the late eighteenth century ‘transformed the fortunes of the anti-slavery cause, which had little prospect for political attention before them.’  Huzzey argues that these petitions were effective because of their reach (attracting signatures from as many as 1 in 5 adult men), and because political elites genuinely feared that they marked a sign of impending revolution.

The first petitions which I have found in relation to the National Health Service – and I’d be keen to hear if you know of earlier examples – were created in the 1960s and 1970s, usually by doctors as a tool during industrial dispute.  For example, in 1975 the Daily Mail reported that sixty ‘militant hospital doctors’ from Hillingdon Hospital had a petition signed by 600 patients to support their mass resignations (over the Government’s refusal to increase overtime pay).  An increasing number of petitions on every topic, including the NHS, were presented to Parliament in the early 1980s.  The House of Commons Information Office has attributed this to the emergence of several highly contested issues in debate at this time, many of which were related to health such as contraception, abortion, and embryo research.

This increase in the numbers of petitions also perhaps reflected a less deferential electorate, who were mobilising politically in a variety of ways, and concerned about the future of the welfare state under Thatcher’s reforms.  Certainly, NHS petitions were now created by members of the public, as well as NHS staff, and petitions began to challenge government cuts and the perceived privatisation of the NHS, both nationally and locally.  In December 1989, 4.5 million people signed a petition in defence of ambulance crews.  The physical content of these petitions filled 100 boxes, only 25 of which were allowed in to the House of Commons by the Speaker Barbara Weatherill.  Petitions were in part seen as a tool of specifically left-wing revival at this time: in 1991 Dr Clive Froggatt, of the Conservative Medical Society, argued that a petition created by the NHS Support Federation, calling for a halt to NHS reforms, was a barely concealed ‘political message…telling people to support Labour.’

From the mid-2000s, e-petition sites were created by the UK’s Parliaments and private –e-petition companies such as and 38 Degrees were founded.  Analysing the petitions on these websites allows us to look more closely at the relative popularity of the NHS as a topic of petitioning.  Considering the Government’s e-petition website (running from July 2015 – March 2017 so far), health issues are well-represented as a topic.  Of the top ten most popular petitions ever created on this website, the third most popular called to provide the meningitis B vaccine for all children, the seventh was a vote of no confidence in Jeremy Hunt, and the eighth called to lower the age of cervical screening to 16.

Looking at all petitions on this website, 1,852 out of 28,831 (6%) mention the NHS.  This seems significant.  Of these petitions, 40 received over 10,000 signatures, and thus a response from the government.  Nineteen of these petitions were about the treatment of specific diseases in the NHS – such as meningitis and cervical health – and one was about the firing of a particular member of staff.  These petitions, arguably, tell us more about concerns about the nation’s health than about NHS provision (although perhaps that preventative services are seen as part of the mandate of the NHS is also significant).  Nonetheless, half of these popular petitions – 20 – were about the NHS specifically and, like the petitions from the 1980s, the aims of these reflected a fear that the NHS was ‘in crisis’ due to cuts and privatisation wrought by a Conservative government.

Looking at the topics of popular petitions suggests a high level of public interest in the NHS and in health, which is played out on a national and a local level.  In terms of NHS campaigning, petitioning has been particularly prominent during periods of right-wing Government – the 1980s and 2010 to present – in which campaigners have sought to use petitions to criticise changing policy.  The extent to which petitions have been successful in this regard is difficult to assess.  Some petitions can be linked to change.  In 2007, Cancer Research UK presented a petition signed by over a quarter of a million people to Parliament, calling for cancer to be placed at the top of the Government agenda.  Soon after, the Government launched a new cancer plan for England.  In 2008, the British Medical Association presented a petition of 1.2 million signatures against the emergence of ‘polyclinics’, combining primary and secondary care.  The plans for such clinics were put on hold in 2010 by the new incoming Government.  The responses to the former petition, however, may have been merely rhetorical; or the changes wrought following both petitions, if real, could have been part of a new or changing government strategy anyway.

Something easy to find in newspaper archives and amongst campaigners is irritation and sadness that petitions do not affect change.  Prime Minister Margaret Thatcher did not even feel that it was politically necessary to meet the parents behind a petition to increase funding to Birmingham Children’s Hospital, simply telling the media that the NHS would not be given a ‘blank cheque’.  Campaigners in the 1980s and today suggest that various petitions against hospital closures meant that ‘barely an eyelid was batted’ (Daily Mail, 2002), and that the ‘voice of the people’ was ignored (The Times, 1994) or ‘very ineffective’ (own survey of NHS campaigners, 152 responses).  Nonetheless, however, despite this cynicism about the effect of surveys from both the political science literature and from campaigners themselves, we continue to create and sign surveys in mass numbers.

This may be for several reasons.  Perhaps those establishing surveys are inspired and hopeful, having noticed the success of some high-profile surveys (for example one which postponed the instatement of a new Road Tax in 2006, another which lead to an apology for the treatment of Alan Turing in 2009).  Research suggests that 19 out of 20 e-petitions (on the Downing Street petition website, 2006-9) were launched by individuals, rather than by groups or organisations – perhaps these individuals do not have the cynicism about petitions mentioned by the weary long-term campaigners above.  Petitions may also carry a higher function than merely calling for political change.  Some campaigners in my survey mention that promoting a petition is an easy way to bring members of the public into their groups, where they can also become involved with other forms of activism such as leafleting, discussion, and writing to MPs.  For others, signing a petition may enable them to feel like part of a particular ideological or moral community, or a way of perhaps may be a way in which they construct and understand their identity or position in society.

If you’ve ever signed a petition about the NHS, I’d be very interested to hear more.  Why, when, how did you do this, and what happened next?  Please do either comment below, respond to my survey for campaigners, or email me at (Jenny Crane).

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