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    MASS TESTING PROGRAMMES FOR COVID 19 USING NOVEL TESTS

    SITUATION

    Last week [November 9th] the government proudly announced a major expansion of the UK s testing programme to provide rapid access testing of asymptomatic people for COVID 19 [1].

    They claimed this programme was : –

    • a“ vital tool to help control this virus and get life back to normal “
    • a partnership between national Test and Trace and local public health directors ‘
    • to develop the evidence base on how testing with rapid reliable COVID-19 tests can be delivered at scale

    Liverpool has nearly completed a two -week “pilot” programme to offer rapid testing to the half a million people who live in the city.

    The stated aim of this pilot is to: –

    “identify many more cases of COVID and break chains of disease transmission” and

    “ to protect those at highest risk from the virus and enable residents to get back to their day to day lives

    Meanwhile the Government has also announced following a report by Public Health England / Porton Down [2] that they are extending this pilot and releasing 600000 lateral flow test kits for local authorities to use on asymptomatic people “ at their discretion “.

    So far, 87 Local Authorities have opted to take part in this new pilot programme. Each will receive weekly batches of 10000 test kits

    ASSESSMENT

    The roll out of mass testing on people without symptoms is happening at an alarming pace

    SAGE s advice [14] on 10 September 2020 was that: –

    “Prioritising rapid testing of symptomatic people is likely to have a greater impact on identifying positive cases and reducing transmission than frequent testing of asymptomatic people in an outbreak area”.

    Some highly respected scientists and public health doctors have criticized the conclusions drawn from the evaluation of these novel tests – namely that they are sensitive and specific enough to use on asymptomatic people.

    Others have described these mass testing programmes [originally part of Operation Moonshot] to be “scientifically unsound unethical, unevaluated and a costly mess “ [3,4]

    What are these concerns?

    [Refs 3,4,5,6 7,8]

    1 Accuracy of the tests

    1. The relationship between these novel tests being positive and clinical infectiousness is unknown. [8]

    Sensitivity

    2 The lateral flow tests chosen for mass testing are not sensitive enough to accurately detect infection when used on asymptomatic people.

    Between 1 in 4 and 1 in 2 infectious cases will be missed, when used in the field. Many people will be given false reassurance that they are not infectious and need to have repeat “gold standard” PCR tests to confirm the results.

    Specificity

    3 When infection rates are low or prevalence is falling as it is in Liverpool , a large number of people will falsely test positive and be told to self isolate. Many will experience the harmful and regressive effects of self-isolation.[ 7 ]

    2 Design and evaluation

    The National Screening Committee and National Institute for Health Research (NIHR) have not been involved or asked about the design of this programme.

    Their design lacks transparency and a clear set of objectives.

    No criteria or protocols for evaluation have ever been made available in the public domain.

    Unlike other screening programmes, there is no systematic call or recall of an identified, registered population and no expectations about population reach or uptake.

    [Initial findings from the Liverpool pilot would appear to indicate that those most at risk of being infected have been the least likely to come forward for testing.

    Positivity rates amongst the 110, 000 people tested so far are low [about half that of the current prevalence [ 2.2%] in the north west region [11]

    3 Follow up of positive cases and their contacts

    More cases will generate many more contacts to follow up

    In Liverpool, follow up of positive cases and their contacts has been entrusted to the national Test and Trace system. Over the last 4 months, this national system has only been reaching around 58% of contacts  [10] i.e. well below that required to stop onward transmission.

    4 Ethical issues

    The ethical basis for expanding mass testing using novel tests is very shaky.

    These pilot programmes have not undergone the normal process required for ethical approval.

    People are invited to have a test which has not yet been properly peer reviewed. The results of these tests if positive could have serious consequences for their personal freedoms, income and well-being. [7]

    There are also concerns about the process and practices for gaining consent to participate.

    4 Sustainability

    The government has, yet again, chosen to use a separate and privately run infrastructure to deliver this mass testing pilot programme.

    If rolled out nationally, the Liverpool population mass testing programme would need the equivalent of 260, 000 army personnel to deliver it. It is hugely expensive and not sustainable.

    Other options, such as using existing well distributed highly accessible primary care services [including local pharmacies] to provide rapid access testing should have been explored.

    5 Overload of local authorities and public health teams

    The burden of organizing new testing programmes for asymptomatic people will place another strain on already overburdened local public health teams.

    Their priorities should be to: –

    • Identify and manage clusters of cases /outbreaks in high risk settings such as schools, care homes, prisons and other geographical hot spot areas [12]

    • Improve adherence to isolation through organizing support and accommodation for people who are finding it difficult to self isolate. [13]

    6 Implementation

    Implementation has so far been rushed –leading to long queues of both symptomatic and non-symptomatic people, wrong invitation letters issued by schools and questionable practice in relation to “ informed consent”.

    The lack of rigour and consistency with respect to research design and implementation across different local authorities means that it will be very difficult understand the impact of these new mass-testing programmes on COVID transmission.

    Conclusion

     The widespread introduction of these mass screening pilot programmes using novel tests can have serious consequences for people’s lives.

    Politicians need to understand that concerns expressed about the choice of tests and the design of these programmes are not just a matter for academic debate or professional discussion.

    Accepted standards for design, ethics and evaluation must be adopted – otherwise they could seriously undermine public trust, confidence and future willingness to engage in helping to control this pandemic.

    RECOMMENDATIONS

    1. The continued roll out of these mass screening pilot programmes should be paused immediately.
    2. 2 The UK National Screening Committee should have oversight of their design and implementation
    3. Mass screening ‘pilot “programmes should be funded as research – and undertaken through the NIHR in order to ensure public and patient benefit
    4. Primary care service [including local pharmacies] should be the preferred route for the future distribution of rapid access tests if these are recommended for use by the general population

    References

    1 https://www.gov.uk/government/news/more-rapid-covid-19-tests-to-be-rolled-out-across-england

    2 https://www.ox.ac.uk/sites/files/oxford/media_wysiwyg/UK%20evaluation_PHE%20Porton%20Down%20%20University%20of%20Oxford_final.pdf

    https://www.bmj.com/content/370/bmj.m3699

    Operation Moonshot proposals are scientifically unsound]

    Jonathan J Deeks, Anthony J Brookes, Allyson M Pollock

    BMJ 2020; 370: m3699  (Published 22 Sep 2020)

     

    4 https://www.bmj.com/content/371/bmj.m4436

    https://www.sochealth.co.uk/2020/11/05/asymptomatic-covid-19-screening-in-liverpool/

    6 https://blogs.bmj.com/bmj/2020/11/09/screening-the-healthy-population-for-covid-19-is-of-unknown-value-but-is-being-introduced-nationwide/

    7 Waugh P. NHS test and trace chief admits workers fear “financial” hit if they self-isolate. Huffington Post 2020 Nov 7.

    8

    https://journals.sagepub.com/doi/full/10.1177/0141076820967906

     

    9 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/926953/S0743_SPI-M-O_Statement_on_population_case_detection.pdf

     

    10 https://www.gov.uk/government/publications/nhs-test-and-trace-england-and-coronavirus-testing-uk-statistics-1-october-to-7-october-2020

     

    11 https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/6november2020#regional-analysis-of-the-number-of-people-in-england-who-had-covid-19

     

    12 https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/operational-considerations-contact-tracing.html

     

    13 Covid-19: breaking the chain of household transmission. BMJ2020;370:m3181.doi:10.1136/bmj.m3181 pmid:32816710

    14 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/926953/S0743_SPI-M-O_Statement_on_population_case_detection.pdf

    Leave a comment

    We  are  writing to you in response to the apparently hurried decision to begin population-wide testing in Liverpool, as part of the £100 + billion ‘Operation Moonshot’, in order to “find positive cases and to break chains of transmission” (Government Press Release, 3rd November 2020).

    This announcement is inconsistent with the SAGE advice at its 56th meeting on 10 September 2020 that it had “high confidence” that “Prioritising rapid testing of symptomatic people is likely to have a greater impact on identifying positive cases and reducing transmission than frequent testing of asymptomatic people in an outbreak area”. This chimes with WHO guidance to focus on contact tracing and identification of clusters, and which does not recommend mass screening.  Proposals for mass screening in their current form will undermine this priority.  

    Searching for symptomless yet infectious people is like searching for needles that appear transiently in haystacks. The potential for harmful diversion of resources and public money is vast. Also of concern are the potential vested interests of commercial companies supplying new and as yet inadequately evaluated tests. If the programme is to proceed, then the contracts awarded, or advertised, should be made public, including their cost to the public purse. (The government is already facing a judicial review for failing to publish covid-19 contracts, brought by your fellow MPs Debbie Abrahams, Layla Moran and Caroline Lucas with the Good Law Project.)

     There is currently no evidence demonstrating that SARS-CoV-2 screening can bring benefit cost-efficiently, and experience shows that unless screening is delivered as a systematic programme with quality assurance for every step of the pathway then any theoretical benefit will not be realised in practice, even where a benefit is possible.

    We would like to ask you what has been decided, and how were decisions reached, regarding the types of tests to be used, what exactly are they aiming to detect, and how has their accuracy been evaluated?  We understand that the Liverpool pilot is likely to use a direct LAMP test (Optigene) and a lateral flow assay (Innova). Currently there is little or no evidence of the accuracy of either of these tests from their use in presymptomatic and asymptomatic cases, or in field settings.  There is substantial uncertainty as to whether they can detect the lower viral loads that are likely in symptomless people, which appears to be the aim of this mass pilot.  If the tests fail to detect cases, then the programme will waste resources and time, and give people false reassurance which could increase transmission.   Similarly, the false positive rates of these tests have not been established in community use and neither have the implications for contact tracing services.  Evaluations of other similar tests by the WHO has suggested between 1% and 5% of people without infection may get false positive findings.  This means that if 1 in 100 people tested in the pilot have asymptomatic infections, as few as 1 in 5 of those getting positive results will actually have Covid-19 – and 4 out of 5 would be false positives and they and their contacts would unnecessarily be told to isolate.

    The accuracy of tests for identifying symptomless infection in a healthy population need to be evaluated in a pilot study with proper research design to assess the extent to which asymptomatic people contribute to overall case-loads, whether they play a significant role in transmission, and whether screening can help. We see no evidence that the Liverpool has such a research design.

    It appears unclear what will happen when people test positive, and negative, whether there will be clinical oversight in interpretation of the results and whether the results will be sent to patients’ GPs and integrated with medical records. What will people be offered? What will they be instructed to do? What support structures are in place to achieve this? It is also unclear how this programme will be integrated into, and affect, the track and trace system, which is already performing poorly.

    Are all the above considerations documented in a format suitable for the lay public to understand as part of an opt-in informed consent process? Is there an option to withdraw from the scheme at any stage, including freeing people of any study requirements? Are participants afforded the right to access their information, to know with whom it is being shared, and to request its deletion – in line with GDPR and the Data Protection Act?

    These are just some of the questions and issues that are concerning us and that need to be pursued, along with asking the government to explain why they are acting inconsistently with SAGE’s advice. We urge you to do so as soon as possible.

    If we can be of any assistance, please do not hesitate to contact us.

    Yours sincerely,

    Allyson Pollock

    Professor of Public Health, Newcastle University

    Anthony J. Brooks

    Professor of Genomics and Bioinformatics, Leicester University

    Louisa Harding-Edgar, General Practitioner and Academic Fellow in General Practice. Glasgow University

    Angela E. Raffle, Consultant in Public Health, Honorary Senior Lecturer in Public Health, Bristol Medical School Department of Population Health Sciences, University of Bristol

    Stuart Hogarth, Lecturer, Department of Sociology, University of Cambridge.

    Leave a comment

    Dear friends (including many joining in recent weeks)

    Corona Confusion: lies, deceit, trickery and failure

    The shocking and rising UK death toll from the pandemic is now the highest in Europe.

    Wirral, where most DONHS activists are based, is one of the country’s worst-affected boroughs.

    Yet the scale of the heartbreaking human tragedies which result was not inevitable. The crisis has been made worse – and the number of deaths has been multiplied – by the failure of the government to act promptly and adequately in response.

    Their evident incompetence, their arrogant dismissal of criticism, and their litany of lies, deceit, trickery and failure are appalling. The long list below represents a shameful catalogue*.

    What is to be done?

    Well, we’re starting by inviting you to a rally. Yes, it’s a Zoom meeting** which we know many of you are using for social and serious reasons at this time. It’s easy to add to your device and to use.

    The rally will be on Wednesday 3rd June from 7:00pm. We have invited several guest speakers. Professor Allyson Pollock  and Professor John Ashton have confirmed and other names will be announced.

    We are expecting a large attendance so interaction is inevitably limited. But please submit any question for our speakers by email (to the address below) by 27th May at the latest.

    More details and confirmation will be sent over the next two weeks.

    Please visit (from midnight tonight) https://www.eventbrite.co.uk/e/corona-confusion-lies-deceit-trickery-and-failure-defend-our-nhs-tickets-105310370152

    Keep safe

    On behalf of Defend Our NHS

    defendournhswirral@gmail.com

    ………………………………………………………………………………………………………………………………………………………..

     

    • For anyone who still thinks the Johnson government and predecessors have been doing a good job just take a moment to read this. It is an augmented version of a Facebook post by Ray Harris https://www.facebook.com/ray.harris.7946

    The arrogance and incompetence are truly horrifying. This information should be shared widely.

    • 2011 Cameron adviser Mark Britnell, who was appointed to a “kitchen cabinet” advising the prime minister on reforming the NHS, tells a conference of executives from the private sector that future reforms would show “no mercy” to the NHS and offer a “big opportunity” to the for-profit sector.
    • 2012 Andrew Lansley’s Health and Social Care Act is passed with the support of the coalition government. It effectively abolishes a national health service replacing it with a confused jigsaw of clinical commissioning groups (CCGs) and financial regimes and what are now 42 ‘integrated care systems’.
    • The ‘efficiency’ measures of US management consultancy corporation McKinsey and various ‘market-led’ measures are imposed on flailing CCGs.
    • 2014-19 Local authority public health budgets are slashed by 35%. And the 10 most deprived areas in England are hit with nearly 15% of all these cuts.
    • 2016 is the year that Jeremy Hunt lies about and alienates the junior doctors, provoking a series of strikes against the imposition of unsafe working practices.
    • AND the government buries the warnings about the implications of a pandemic from their Exercise Cygnus.
    • The re-disorganisation of the NHS continues apace – with the programme of STP (renamed ‘slash, trash and privatise’ by campaigners) accelerating during the crisis which follows.
    • 2016-2020 UK government stockpiles containing protective equipment for healthcare workers in the event of a pandemic fall in value by almost 40% over six years.
    • December 31st 2019 China alerts WHO to new virus.
    • January 23rd 2020 Study reveals a third of China’s patients require intensive care.
    • January 24th Johnson misses first Cobra meeting.
    • January 29th Johnson misses second Cobra meeting.
    • January 31st The NHS declares first ever ‘Level 4 critical incident’ Meanwhile, the government declines to join European scheme to source PPE.
    • Early February it’s claimed by the Times that Cummings tells a meeting it was all about “herd immunity, protect[ing] the economy and if that means some pensioners die, too bad”
    • February 5th Johnson misses third Cobra meeting.
    • February 12th Johnson misses fourth Cobra meeting. Exeter University publishes study warning the coronaviruscould infect 45 million people in the UK if left unchallenged.
    • February 13th Johnson misses conference call with European leaders.
    • February 14th Johnson goes away on holiday. Aides are told keeps Johnson’s briefing notes short or he will not read them.
    • February 18th Johnson misses fifth Cobra meeting.
    • February 26th Johnson announces ‘Herd Immunity’ strategy, announcing some people will lose loved ones. Government document is leaked, predicting half a million Brits could die in ‘worse case scenario’
    • February 29th Johnson retreats to his country manor. NHS warns of ‘PPE shortage nightmare’. Stockpiles have dwindled or expired after years of austerity cuts.
    • March 2nd Johnson attends his first Cobra meeting, declining another opportunity to join European PPE scheme. Government’s own scientists say over half a million Brits could die if virus left unrestrained. Johnson tells country “We are very, very well prepared.”
    • March 3rd Scientists urge Government to advise public not to shake hands. Johnson brags about shaking hands of coronavirus patients.
    • March 4th Government stops providing daily updates on virus following a 70% spike in UK cases. They will later U-turn on this amid accusations they are withholding vital information.
    • March 5th Johnson tells public to ‘wash their hands and business as usual’
    • March 6th Health secretary Hancock says he has talked to supermarkets to safeguard food supplies.
    • March 7th Supermarkets say Hancock is lying.
    • March 7th Johnson joins 82,000 people at Six Nations rugby match.
    • March 9th After Ireland cancels St Patrick’s Day parades, the UK government says there’s “No Rationale” for cancelling sporting events.
    • March 10th-13th Cheltenham race meeting takes place. More than a quarter of a million people attend.
    • March 11th 3,000 Atletico Madrid fans fly to Liverpool.
    • March 11th Cummings asks technology CEO and business leaders in a Downing Street meeting to share skills and talent with the government in order to tackle the coronavirus pandemic.
    • March 12th Johnson says banning events such as Cheltenham will have little effect. The Imperial College study finds the government’s plan is projected to kill half a million people.
    • March 13th The FA suspends the Premier League, citing an absence of Government guidance. Britain is invited to join European scheme for joint purchase of ventilators, and refuses. Johnson lifts restrictions of those arriving from Coronavirus hot spots.
    • March 14th Government is still allowing mass gatherings, as Stereophonics play to 5,000 people in Cardiff.
    • March 16th Johnson asks Britons not to go to pubs, but allows them to stay open. During a conference call, Johnson jokes that push to build new ventilators should be called ‘Operation Last Gasp’
    • March 19th Hospital patients with coronavirus are returned to care homes in a bid to free up hospital space. What follows is an explosion of virus cases in care homes.
    • March 20th The Government states that PPE shortage crisis is “Completely resolved”. Less than two weeks later, the British Medical Association reports an acute shortage of PPE.
    • March 23rd UK goes into lock-down.
    • March 26th Johnson is accused of putting ‘Brexit over Breathing’ by not joining EU ventilator scheme. The government then state they had not joined the scheme because they had ‘missed the email’
    • March 27th Both Johnson and Cummings admit to developing COVID-19.
    • April 1st The Evening Standard reports that just 0.17% of NHS staff have been tested for the virus.
    • April 3rd The UK death toll overtakes China.
    • April 5th Johnson admitted to St Thomas’s Hospital.
    • April 5th 17.5 million antibody tests, ordered by the government and described by Johnson as a ‘game changer’ are found to be a failure.
    • April 7th Johnson is moved to intensive care with coronavirus. He later says the NHS saved his life. Subsequently it is revealed he was not using a ventilator but extra oxygen, a solution not applied universally.
    • April 10th FT reports that private clinics in the UK selling COVID-19 testing kits insist they are still able to source supplies, despite complaints from the government that shortages have prevented testing being rolled out more quickly.
    • April 16th Flights bring 15,000 people a day into the UK – without virus testing.
    • April 17th Health Secretary Matt Hancock says “I would love to be able to wave a magic wand and have PPE fall from the sky.” The UK has now missed four opportunities to join the EU’s PPE scheme.
    • April 21st The Government fails to reach its target of face masks for the NHS, as it is revealed manufacturers’ offers of help were met with silence. Instead millions of pieces of PPE are being shipped from the UK to Europe.
    • April 23rd-24th Government announces testing kits for 10 million key workers. Orders run out within minutes as only 5,000 are made available.
    • April 24th The Guardian reveals that Cummings, and a data scientist he worked with on the Vote Leave campaign for Brexit are on the secret scientific group advising the government on the coronavirus pandemic.
    • April 25th UK death toll from coronavirus overtakes that of The Blitz.
    • April 28th Hancock says “Of course care homes have been a top priority right from the start.  We’ve strengthened the rules around what happens in care homes and tightened infection control, also making testing available throughout the care centre I think is incredibly important as we’ve ramped up the availability of testing.”
    • April 28th A third of all coronavirus deaths in England and Wales are now happening in care homes
    • April 29th NHS England (London) sneak out a letter accelerating the integrated care system. Their‘Journey to a New Health and Care System’ states that over the next 12-15 months they hope to keep public engagement to a bare minimum.
    • April 30th Johnson announces the UK has succeeded in avoiding a tragedy that had engulfed other parts of the world. At this point, the UK has the 3rd highest death toll in the world.
    • May 1st The Government announces it has reached its target of 100,000 tests – They haven’t conducted the tests, but posted the testing kits.
    • May 4th It is now clear that Deloitte, KPMG, Serco, Sodexo, Mitie, Boots and the US data mining group Palantir have secured taxpayer-funded commissions to manage COVID-19 drive-in testing centres, the purchasing of personal protective equipment (PPE) and the building of Nightingale hospitals.
    • May 5th The UK death toll becomes the highest in Europe.
    • May 6th Johnson announces the UK could start to lift lock-downrestrictions by next week.
    • May 7th Guardian columnist writes that “outsourcing the coronavirus crisis to business has failed – and NHS staff know it”.
    • May 16th Hancock says that “right from the start we’ve tried to throw a protective ring around our care homes.” This is categorically untrue. Care homes were left without testing. Without contract tracing. Without PPE. Without support.
    • May 19th On ITV Piers Morgan once again accuses a cabinet minister, talking about testing, of ‘lying through her back teeth’ to BBC viewers.
    Comments Off on Defend Our NHS: Corona Confusion: lies, deceit, trickery and failure

    Vested interest alert – yes I’m claiming that word back – I come from a family of school staff, teachers, TAs, school governors. The dedication and hard work of all school staff, caretakers, cleaners, cooks, governors have shown for the safety, education, well-being, in many instances feeding, their pupils throughout this crisis has been extraordinary.

    I am totally dismayed at any criticism. Staff have the well being and safety of their pupils at their very heart. Their views on the total opening of schools and the views of their representatives have to be totally respected. The issue is complex. In Liverpool, the elected City Mayor has chosen not to open schools on June 1st as a safe-guarding issue as this wonderful city is still reeling from a high rate of infection. Questions are being asked as to why Mayor Joe Anderson has taken this stance when schools in Denmark, led by our sister party, are opening. Joe has never said Liverpool can’t open its schools, he has said when it’s safe to do so and only then. Each local authority has its own characteristics, not only in terms of levels of this dreadful pandemic, but the physical nature and age of its school buildings, levels of deprivation, staffing, the amount of public funding available and not available, the differing needs of its pupils. Country by country comparison is far too simplistic. This is an educational, health and societal issue.

    We all want all our children back in school and we are most worried about our most vulnerable, where home-schooling in a cramped flat with no outdoor space is stretching our children’s educational and physical and mental health well-being. I have family members with differing views – what I do know is that they are taking decisions based on local circumstances and always with the education and health of their pupils and staff foremost in their thinking. What is clear is that our health and education services, so starved of resources in this dangerous and false economy of austerity, especially in cities like Liverpool, have to be funded properly based on demographic need. I sincerely hope this Government remembers that but I fear not. Is it safe to open schools to children other than those of key workers or classed as vulnerable? There will always be risk – the question is how to reduce it. We must now learn from other countries – transmission from children to adults, children returning to schools in Italy presenting with multisystem inflammatory syndrome weeks after exposure.

    The UK did not have community testing, contact tracing and isolation early. Surely the question is are schools safe enough to open? Which means we need information and monitoring at a local level, the amount of new cases locally and rates of transmission. Local data should be driving policy and assuming a date for the entire country is ideologically rather than data driven. We need to get children back into education, but a locally managed data driven approach has to be the only way. Prioritising testing over a date. Listening to our teaching staff and our unions.

    For Liverpool in present circumstances – I’m with Joe.

    Theresa Griffin Labour MEP North West 2014-2020

    Member SHA

    1 Comment

    Dear friends of the NHS

    Despite the three week lock-down the government has failed to keep us safe.

    @DefendOurNHS is increasingly frustrated and angry at the inadequate government response to the crisis*.

    Our message is simple. We ask you to adopt it and share it as widely as possible.

    The message is Test! Trace! PPE!

    The hashtag on twitter is #TestTracePPE.

    Let’s try to have a Twitter ‘storm’ at 5:00pm on Wednesday.

    Please use this message at every opportunity when contacting family, friends and the wider public.

    You might also include the message in the rainbow posters appearing in windows. Examples you can use are on our Facebook page (in the ‘files’ section’).

    When you go outside to clap and bang pans on Thursday, please chant Test! Trace! PPE!

    This appeal is urgent. Help us to get the word out now!

    Thank you.

    On behalf of Defend Our NHS

     

    • Bottom of the international virus testing league table, no sign of systematic contact tracing, health and care staff pleading on social media (including our Facebook page) for supplies of personal protective equipment.

    1 Comment

    Assemble 12:00 Portland Place, London W1A

    In anticipation of the above march and rally we are making preparations for Unite members  to travel to London to support the above march and rally.

    Unite are providing day return train tickets for members  from Manchester Piccadilly station and Liverpool Lime Street, anyone requiring transport to the march and rally should contact Lorna Woods Moses at the Liverpool office by email – lorna.woodsmoses@unitetheunion.org

    Please ensure you provide your name, membership number, contact details and preferred departure point.

    Please note that block bookings will not be accepted and seats are limited.

    Bookings will not be accepted after Monday 10 March.

    Further information about the march route can be found on the Stand Up to Racism website

    http://www.standuptoracism.org.uk/un-anti-racism-day-demo-saturday-21-march/

    or on the Unite website

    https://unitetheunion.org/news-events/events/march-against-racism/

    Kind regards

    Lorna Woods Moses

    Secretary to Deputy Regional Secretary Debbie Brannan  & Regional Coordinating Officer Mick Chalmers

    Unite the Union Liverpool

    Comments Off on MARCH AND RALLY AGAINST RACISM ON SATURDAY 21 MARCH

     

    Make the UK the safest place world to have a baby!

    Why is the UK still not in the top ten countries for infant mortality and for maternal deaths? Why? We are a rich country. We have an established high-quality health service. Healthcare is supposed to be accessible to all. How come babies and mothers die or are badly hurt at birth? How come Black and Ethnic minority babies suffer most? Why do poor areas have worse outcomes than wealthy areas? Why is infant mortality rising? (The infant mortality rate is the number of children that die under one year of age in a given year, per 1,000 live births. The neonatal mortality rate is the number of children that die under 28 days of age in a given year, per 1,000 live births. These are both common measures of health care quality, but they are also influenced by social, economic and environmental factors). Are there fundamental problems with core policy documents like the maternity review “Better births”? These are painful questions.

    Our campaign wants real improvements for mothers and babies. This posting is not intended as a clinical paper, it is a discussion amongst activists and concerned citizens about where the problems lie. A key set of participants in this discussion are mothers who have given birth, including those who have lost babies, grandmothers and other birth partners, and women who could not conceive.

    Our campaign published our Maternity Manifesto during the election but though well shared on Facebook, it did not get into any parties’ manifesto.

    We also called a national meeting on issues in maternity care.

    What then are the factors that result in UK outcomes at birth worse than other advanced countries?

    The answers include shortage of NHS funding, staffing shortages, poor management in some hospitals, staff in fear of speaking out, some policies and procedures, disrespect towards the women carrying the baby, and, as cited in the East Kent enquiry, a lack of practical understanding by staff and by mums of the need to “count the kicks” in the latter part of pregnancy. The introduction of charges for migrant women has also caused deaths. NHS material seems to centre the cause on mothers who smoke, or who are overweight. (Now smoking in pregnancy is plain stupid, it really is, and most mums would not do so if they were not addicted. Don’t do it!). However, other countries, Greece for example, who smoke more, have better outcomes in pregnancy than does the UK. Wider problems like obesity and diabetes, and even women giving birth older, are mentioned in the literature about this. Again, the age of the mother as a factor, but this is only partly true. Giving birth older is often safer than giving birth too young. Globally it is most often young girls who die in childbirth.

    Answers may lie in the financially and emotionally vulnerable place that pregnant women occupy in our society, including poverty, violence and stress. Poverty and inequality are factors in infant mortality; “The sustained and unprecedented rise in infant mortality in England from 2014 to 2017 was not experienced evenly across the population. In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100 000 live births per year (95% CI 6 to 42), relative to the previous trend. There was no significant change from the pre-existing trend in the most affluent local authorities. As a result, inequalities in infant mortality increased, with the gap between the most and the least deprived local authority areas widening by 52 deaths per 100 000 births (95% CI 36 to 68). Overall from 2014 to 2017, there were a total of 572 excess infant deaths (95% CI 200 to 944) compared with what would have been expected based on historical trends. We estimated that each 1% increase in child poverty was significantly associated with an extra 5.8 infant deaths per 100 000 live births (95% CI 2.4 to 9.2). The findings suggest that about a third of the increases in infant mortality between 2014 and 2017 can be attributed to rising child poverty (172 deaths, 95% CI 74 to 266).” (Our bold for emphasis).

    The UK is a rich advanced country, with a long history of universal healthcare but we have rising infant mortality. “Rising infant mortality is unusual in high-income countries, and international data show that infant mortality has continued to decline in most rich countries in recent years” and “In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100,000 live births per year, relative to the previous trend“.

    Poverty is not the sole cause of high Infant Mortality though, Cuba has good outcomes equal to the UK for infant mortality. Cuba is very poor indeed and the UK is one of the wealthiest economies (sadly Cuba does less well on maternal deaths).  

    Research shows out of 700,000 births a year in England and Wales, around 5,000 babies are stillborn or die before they are a month old”. 5,000 babies each year. There have been major news stories about baby deaths in many hospitals, notably in ShropshireEast Kent and Morecombe Bay.

    Maternal deaths. The UK is not in the top ten countries with the lowest infant mortality rate, neither is it the safest place to give birth. In 2015-17“209 women died during or up to six weeks after pregnancy, from causes associated with their pregnancy, among 2,280,451 women giving birth in the UK. 9.2 women per 100,000 died during pregnancy or up to six weeks after childbirth or the end of pregnancy.” In 2016 The UK ranked 24th in the world in Save the Children’s Mothers’ Index and Country Ranking Norway, Finland, Iceland, Denmark, Sweden, Netherlands, Spain, Germany, Australia, Belgium, Austria, Italy, Switzerland, Singapore, Slovenia, Portugal, New Zealand, Israel, Greece, Canada, Luxembourg, Ireland, and France, all did better than the UK. The situation in some other countries is massively worse than here but that is no excuse. But these baby and mothers’ deaths must stop. We cannot sit back and let these deaths continue.

    Let’s be clear, the situation for women in pregnancy and childbirth is massively better than before the NHS, and is head and shoulders better than in the USA today. But maternal mortality is an issue here in the UK, and a huge issue in poorer countries, especially where women give birth without a trained professional being in attendance. Quite rightly professionals and campaigners in the UK participate in international endeavours to improve this situation. The NHS should be training and sending midwives to those countries, instead, it is recruiting midwives from poorer countries. In Europe we have cuts in healthcare through Austerity; in the global south, the same concept of cutting public services to the bone is called Restructuring.

    Why is the UK, a rich country with (almost) universal health care not doing better by its mothers and babies? Look at just this case and see the problems in the provision of maternity care;

    Archie Batten

    Archie Batten died on 1 September 2019, shortly after birth.

    When his mother called the hospital to say she was in labour, she was told the QEQM maternity unit was closed and she should drive herself to the trust’s other hospital, the William Harvey in Ashford, about 38 miles away.

    This was not feasible and midwives were sent to her home but struggled to deliver the baby and she was transferred by ambulance to QEQM where her son died. Archie’s inquest is scheduled for March. (BBC).

    We know that temporarily “closing” maternity units because they are full is a common occurrence. Women then have to go to a different hospital. Induction of labour can be halted because the unit is full. It is not a pleasant situation for mothers. Some maternity units have closed permanently, meaning mothers have to travel further for treatment, at a time when the ambulance service is under great strain (though being in labour is not considered an emergency for the ambulance service!).

    Shortage of Midwives and consequent overwork for the existing staff. The UK has a shortage of three thousand five hundred midwives. The midwife workforce is skewed towards older midwives who will retire soon.

    Gill Walton, general secretary and chief executive of the Royal College of Midwives said “We know trusts are facing huge pressures to save money demanded by the government, but this cannot be at the expense of safety. We remain 3,500 midwives short in England and if some maternity units regularly have to close their doors it suggests there is an underlying problem around capacity staffing levels.

    Training midwives is not just about recruiting new starters to university courses. There need to be sufficient training places in the Hospitals who are already working flat out, leaving little time for mentoring of students, as well as places in the Universities. Alison Edwards, senior lecturer in midwifery at Birmingham City University, who says: ‘It isn’t as simple as recruiting thousands more students as this requires the infrastructure to support it.

    ‘You need more tutors, more on-site resources and, perhaps more importantly, more mentors and capacity in placement areas – which is currently under immense strain.’ 

    One student midwife wrote about her experiences in this letter, where she described very hard work without either pay or good quality mentoring.

    The government and the NHS call for Continuity Care from Midwives. This means the same midwife or small team of midwives cares for the mother through her pregnancy, birth and postnatal period. We too believe this would be wonderful if it were possible. It is however impossible with the existing ratio of midwives to mothers. Providing continuity of care to the most vulnerable mothers is a good step. NICE have reduced this to the idea of each woman having a named midwife. One to One a private midwife company claimed to provide this but was unable to continue trading, and went bust leaving the NHS to pick up the pieces.

    Nationally the NHS is underfunded and looks set to continue so. Much of the problem comes from a long period of underfunding. We spend less than 9.8 per cent of GDP on health. Switzerland, Germany, France, Sweden, Japan, Canada, Denmark. Belgium Austria Norway and the Netherlands all spend more. That places the UK 13th in the list of high spenders on health care. The US spends 16.9 %. (although a lot of that money is diverted from patient care to the big corporations and insurance companies). The NHS was the most cost-efficient health care service in the world.

    Underfunding causes staff shortages. Some errors at birth come from staff being overworked and making mistakes.

    Some, our campaign believes, flow from fundamental flaws in government policy such as in the Maternity Review, where the pressure is on staff not to intervene in labour.

     Listen to the Mother. Some of the deaths are from women not being heeded in pregnancy and childbirth. This is backed up in reports from mothers, including some quoted in the big reviews mentioned above. However, overworked and tired staff who know labour like the back of their hand can easily stop heeding an inexperienced mother.

    Poverty kills mothers and babies. As we said above, some deaths, poor baby health, and injuries come from growing maternal poverty and ill-health. Low-income families find it hard to afford good food. Food poverty affects a staggering number of children. The charity UNICEF estimates that “2.5m British children, or 19%, now live in food-insecure households. This means that there are times when their family doesn’t have enough money to acquire enough food, or they cannot buy the full variety of foods needed for a healthy diet. In addition, 10% of these children are also classified as living in severe food insecurity (the European average is 4%) and as a result, are set to experience adverse health.”

    Studies show that;

    The Independent inquiry into inequalities in health (Acheson 1998) found that a child’s long term health was related to the nutrition and physique of his/her mother. Infants whose mothers were obese had a greater risk of subsequent coronary heart disease. Low birth weight (under 2500 g) was associated with increased risk of death in infancy and with increased risk of coronary heart disease, diabetes and hypertension in later life. Accordingly, the Inquiry recommended, ‘improving the health and nutrition of women of childbearing age and their children, with priority given to the elimination of food poverty and the reduction of obesity’. (NICE )

    A significant number of deaths of new mothers come from mental health issues that spiral out of control. Some of these will be newly developed conditions and some existing conditions made worse by pregnancy and childbirth. Mothers family and professionals must all be on the alert and intervene early. There are good ways to treat mental health in pregnancy.

    Reducing the social and economic stresses around pregnancy would also help reduce the deaths and suffering

    When Birth goes wrong it can be a dreadful experience for everyone involved. In most cases, the panic button brings in a well-drilled team of experts who can solve nearly every problem and do it calmly. At other times, it is dreadful, as described in the coverage of the birth and death of baby Harry Richford. Harry Richford was born at the Queen Elizabeth the Queen Mother Hospital in Margate in 2017 but died a week later. https://www.bbc.co.uk/news/uk-england-kent-51097200

    Sands, the baby death charity explains that there are many causes of babies dying before birth. Crucially important is that mothers are heeded when they are concerned and that everyone Counts the Kicks

     

    Maternity is not the only area of the NHS that suffers. There have been serious mistakes in NHS planning including closing far too many beds. The NHS closed 17,000 beds and now is working beyond safe bed occupancy. There are 100,000 staff vacancies. Waiting times in A and E are dreadful, as are waiting times for cancer treatment. NHS managers and the Government have taken the NHS far from the Bevan model of healthcare (for history read this).

    Press coverage. How does the press cover the NHS, and baby deaths? There are very real problems in the NHS and maternity care but the coverage in the press of these problems seems to switch on and off in strange ways, often to suit Conservative Party political requirements. The NHS and the Government are masters of propaganda and news manipulation. The public needs to learn to judge the news and to look both for actual problems and look out for bullshit and manipulation. Why was news of the arrest of the nurse from the Countess of Chester hospital headlines on the 70th Anniversary of the NHS? Why was the news of the understaffing there not given similar nationwide publicity? Why have we heard little or nothing since?

    If the government can switch the blame to the professionals in the NHS (but not their mates the high admin of the NHS), then they seem to be happy to publicise the problems. In other cases, problems are swept under the carpet.

    Professionals expect to (and do) take responsibility for their own actions. Mistakes will be made. It is impossible to go through life without some mistakes. When we are dealing with life and death mistakes can be catastrophic, even where there is no ill intent.

    Malicious action is rare.   There are the terrible cases of serial murderer Harold Shipman, and the convicted surgeon Ian Paterson who falsely told women, they had breast cancer and operated on them unnecessarily. The hierarchical system in the NHS and the lack of regulation in private hospital, which was described as “dysfunctional at almost every level” allowed that harmWe have not found such a case in maternity.

    Unintentional bad practice, however, has also harmed babies. No one went to work intending to harm in the events publicised in the Morecombe Bay Enquiry into the deaths of 11 babies and one mother. It was said that “The prime responsibility for ensuring the safety of clinical services rests with the clinicians who provide them, and those associated with the unit failed to discharge this duty over a prolonged period. The prime responsibility for ensuring that they provide safe services and that the warning signs of departure from standards are picked up and acted upon lies with the Trust, the body statutorily responsible for those services.”

    The Enquiry described what happens like this “In the maternity services at Furness General Hospital, this ‘drift’ involved a particularly dangerous combination of declining clinical skills and knowledge, a drive to achieve normal childbirth ‘whatever the cost’ and a reckless approach to detecting and managing mothers and babies at higher risk.”

    The Furness General Hospital was pushing for Foundation Trust status at the time and was not exercising the necessary supervision.

    “Maternity care is almost unique amongst NHS services: the majority of those using it are not ill but going through a sequence of normal physiological changes that usually culminate in two healthy individuals. In consequence, the safety of maternity care depends crucially on maintaining vigilance for early warning of any departure from normality and on taking the right, timely action when it is detected. The corollary is that, if those standards are not met, it may be some time before one or more adverse events occur; given their relative scarcity in maternity care, it is vital that every such occurrence is examined to see why it happened.

    So, many factors come into play in such incidents of harm to mother and baby. Professionals too can be emotionally wrecked by tragedy.

    Huge personal and professional lessons can be learned from a detailed review of cases where mistakes are made. There is a whole literature about learning from mistakes. The worst such incidents are referred to as Never Events. This is just one article about such errors but there is a whole field of research devoted to it. Serious Mistake Reviews often happen at the end of shifts, and in the worst cases, may lead to long public enquiries.

    NHS as a research organisation One of the great virtues of the NHS is the research base it offers professionals. What happens in the NHS which covers 62 million people is studied, evaluated, and researched. This is invaluable to staff and above all to patients. Sadly this research is also of interest to big business especially to those who sell health insurance and to the big corporations who have their ‘snouts’ in the NHS ‘trough’. Research for the common good is clearly different from research to make money. We see that regularly in big pharma. Cheap effective medicines do not make money for the companies. Yet the government is giving away our medical data to companies to make a profit.

    There are also “errors” that happen when everyone is following accepted procedures and protocols; “untoward events, complications, and mishaps that resulted from acceptable diagnostic or therapeutic practice”. Procedures within the NHS can be robust and well researched, and problems still occur.

    https://www.mamaacademy.org.uk/news/mbrrace-saving-lives-improving-mothers-care-2019/

    Research matters. Only by studying outcomes can these errors be revealed. A classic example is the once customary practice of episiotomy, cutting a woman to prevent tears to the perineal skin in childbirth, which is now no longer used except in an emergency. Research both formal and informal changed that practice. As another example of such research, Liverpool Women’s hospital has been involved in research about the benefits of leaving the baby attached by the cord if they are born unwell. NHS staff and other health professionals, academics and pressure groups are working hard to improve outcomes for mothers and babies. Each mothers death is reviewed in the MBRRACE-UK report

    https://mamadoc.co.uk/the-maternal-mortality-report-we-should-all-learn-from/

    Never again. The tragedy of the death of a mother and or baby is felt by that whole extended family. Most families want to know it will never happen again. Cover-ups and lies mean it will happen again, so brutal honesty is needed.

     

    The aftermath of medical treatment or neglect which causes real harm is complex. Whether the outcome is death, life long impairment, or long term physical and mental health issues, these are very significant events for all concerned.

    Campaigners in Liverpool campaign for SEN funding to be returned. 2019

    If a baby is born with life-changing impairments, the baby is left facing catastrophic difficulties and the mother and family can face major heartbreak and hardship. The huge love we have for our kids (may it long continue), whatever their issues, does not prevent the financial, housing and employment issues families with disabled children face. Nor does it guarantee the best educational opportunities, SEN is being battered by cuts. but parents and teachers are fighting back.

     

    The cost of financial “compensation” from an injury to a newborn is huge because it is life long. The cost of this “compensation” used to be carried by the government but the system changed to make hospitals “buy” insurance from a government body which is set up like an insurance company. The cost to the hospital is charged on the basis or earlier claims, like car insurance. Obstetrics make the highest claims of any section of the NHS.

    Liverpool Women’s Hospital had a huge case (not about babies) some years ago, arising from a surgeon who left many women damaged after incontinence operations. Their total bill, over 5 years, according to the Echo, was £58.8 million. “The NHS trust has been forced to pay out £58.8m in the last five years for both recent and historic negligence cases.

    The limited work we do, as a campaign, in holding the hospital to account, leads us to believe lessons have been learned by the hospital. However, in every hospital, there are pressures which could lead to problems. These pressures include financial and organisational, problems of management ethos, and the potential for bullying, the distrust by the staff of their management, and disrespect for whistleblowers.

    The NHS has gone through years of reorganisation after reorganisation. In that time the financial and government pressure has been to complete the re-organisation, or face catastrophic consequences so very many hours of admin and senior doctor time has been wasted on this process. That time could have been focussing on saving babies.

    At STP and national level, there are other problems. The NHS is intensely political. There are deep structural problems. (We believe the NHS should return to the Bevan Model of health care)

    The NHS is not only deprived of adequate funding, but it has also been forced to implement many market-based changes, including the internal market, outsourcing and commissions of services to for-profit companies. These market-based structures are expensive.

    The NHS has also seen dire staff shortages resulting from stupid decisions like removing bursaries, not training enough doctors and the hostile environment to migrant staff.

    There are moral and financial issues in all cases of such errors. The hurt to the babies is our priority.

    Baby deaths and severe injury at birth have complex roots. Though what happens in the hospital is crucial, it is not just what happens in the hospitals that matter. The stress, poverty and anxiety many mothers endure during pregnancy do sometimes affect the outcomes for the child. Many women are still sacked for being pregnant but families can rarely cope with just one wage (do fight back against sacking pregnant women!). See Maternity Action for details. Both mums and midwives can call Maternity Action for advice.

    Low pay or the dreaded universal credit can make food heating and rent all too expensive. This can lead to food poverty. Women do not yet have real equal pay but mothers have the worst pay of all  Benefits are no longer allowed for a third child. even though most claimants are working. Whether parents are working or not, every child has a right to food and shelter, be they first or 10th child. The child gets no choice!

    Not every pregnant woman is in a stable caring relationship. Housing, especially private renting, becomes more difficult when women are pregnant. Who can forget the story of the homeless woman giving birth to twins in the street? Pregnancy is often the time when domestic violence is inflicted on a woman but it is the time when women are least able to walk away. Poverty kills babies too.

    Please join us in campaigning for better outcomes for all mothers and babies in the NHS and across the globe. We want this to start a discussion, so please send us your views. and information

     

    Comments Off on New post on Save Liverpool Women’s Hospital

    This is a talk given by Public Matter’s Deborah Harrington at an NHS event held jointly by NEON (New Economics Organisers Network) and Health Campaigns Together for The World Transformed in October 2018 in Liverpool.

    The brief was to speak for no more than 7 minutes and ‘not to dwell on the history’ but on how to move forward.

    The talk began with a quote from the novelist Milan Kundera:

    “The struggle of man against power is the struggle of memory over forgetting.”

    “We allow our futures and our present to be reshaped by others against our interest if we forget what’s important in our own collective history.

    Every NHS campaign meeting contains powerful stories from campaigners – on resisting service closures and cuts, fighting for pay and conditions and more. But I would like to make my first point about what we can learn about building a movement from right at the start of the life of the NHS. From Bevan, in fact. I think this has great relevance to what we are talking about today.

    In the first half of the 20th century (don’t worry, it’s not a history lesson) the country as a whole suffered from two world wars, an appalling flu epidemic that wiped out whole communities and the Great Depression. The people didn’t need to be lectured about the Big Society to realise they were all in it together (well, almost all).

    The fight was between different political factions at government level about what services were to be delivered and how to deliver them.

    Doesn’t that sound familiar?

    The arguments were fierce, but Bevan won the day (with a few compromises along the way). But it only lasted 3 years before the principles upon which the NHS was founded were under attack.

    If you have never read Chapter 5 of Bevan’s set of essays written in 1952, In Place of Fear, you should. Essential reading for two very important reasons: first he counters the arguments put up against his NHS and secondly he makes his case for his vision of the NHS stand out powerfully against the opposition. If you haven’t read it, you may well be shocked to see him facing all the same arguments we face today: the necessity of having out of pocket payments, the cost of immigrants, the unaffordable burden of the old and the excessive demands made on the system ‘because it is free’. I want to stress from this is that there was general support amongst politicians and public alike that the issue was not over whether there would be a National Health Service, but what form it would take. And Bevan held out for his vision – a socialist enterprise in a very rich capitalist society.

    So we move on to the second point – which is defining what a vision of a public service NHS should look like today and what are the threats facing it. I would argue that cuts and closures are the symptoms of the threat, not the threat itself. The threat is from a globalised free market vision of public services as divisible into those which can provide a profit stream and those that can’t.

    It’s across the services, not just the NHS and it is across the world, not just in the UK.

    But the questions which are thrown out at the public – it’s the old/it’s the immigrants/it’s too much demand/it’s unaffordable – are the way in which the corporate sector frame the situation to cast doubt on the future existence of the NHS in its current form.

    And that’s where the catch lies – because the corporate sector which is the engine of this change does have a vision of what the future form should be (effectively to turn it into a UK version of Medicare) and they are doing a hard sell on it. And their sales pitch is seductive.

    In it they say that in order to have high quality services we must bring them together, in fewer locations. Surplus land can be sold to help pay for the transformation and the new buildings to house new services can be rented from the private sector ‘bringing investment’ into the NHS. They say the new services will utilise new technology to fit modern lifestyles, that personal health vouchers for those with long term or complex conditions will empower them with choice, that the service will be personalised, focused on you, the patient.

    They say it’s the quality of care and the joined up nature of the care that matters, not whether the provider is public or private. So the second take home message is to understand the opposition’s arguments, learn how to demolish those arguments quickly and efficiently and to move on to promoting our shared vision. Because our struggle today is not for any old NHS but for a universal, comprehensive, equitable, public service NHS. Because ‘free at the point of need’ only matters if the service you are getting is worth having. And because every word of their seductive sales pitch is designed to hide the destruction of the NHS’ values of universal and comprehensive care and its ethos of public service, not corporate profit.

    And so to my third and final point. Across the country we have individual campaign groups who are extraordinarily knowledgeable about their CCGs, STPs, and all the NHS in England acronym soup. We have umbrella groups which link them together which allows lessons learned in one place to be shared with others. But we also have a wide variation in the individual groups. At the grassroots level look at any group on social media and you will see pro-NHS campaigners arguing from a racist and xenophobic perspective that ‘our’ NHS can’t cope with the demand from ‘non-contributors’. Time and again someone will say that ‘the NHS is what they pay their National Insurance for’ (spoiler alert: it doesn’t). And others (whether well meaning and mis-guided, or simply trolls) saying that the NHS needs to change if it is to continue at all.

    At the political and opinion forming level (think tanks, politicians, main stream media) there appears to be a consensus that the Health & Social Care Act (2012)  ‘failed’ and that, whilst parliamentary time is so bound up in other matters, it is good that Simon Stevens is working around that legislation to put the NHS in England back together again. My colleague Jessica and I had a meeting with an MP from the North West who said that this view pervades all political parties and indeed it is reflected everywhere from the cross party Health Select Committee to the recent publication from the Labour Party ‘A Picture of Health’.

    But we need to remember what is at the heart of our campaign and keep our message simple and strong. And for that I will quote Jessica’s grandfather, the late Julian Tudor-Hart, who wrote in his essay ‘The Inverse Care Law’ in 1971 ‘the availability of good medical care tends to vary inversely with the need for it in the population served. This inverse care law operates more completely where medical care is exposed to market forces, and less so where such exposure is reduced.’

    Because I would argue that the 2012 Act has not failed.

    It has done its intended job of ripping the NHS into fragments so that its pieces can be reassembled like jigsaw pieces. It absolutely leaves the NHS exposed to market forces and they are being embedded at every level from decision and policy making to running services. The evidence from across the world proves the Inverse Care Law right. So my last take home message would be to remember that this is a struggle that goes further than England’s boundaries. And it also goes across time.

    There is a short term and very urgent battle to be won but it is in a broader and ongoing battle of ideals and ideology that isn’t going away any time soon.”

    On the platform with Deborah was Bonnie Castillo, Executive Director of the National Nurses United Union in the USA. The NNU is part of the fight for universal healthcare in the USA. Bonnie explained how important the NHS is as a beacon of hope for them, “Your fight to defend the NHS is our fight’ she said.

    From this Saturday there is to be a week of cross-Atlantic campaigning as described here in the Guardian. They want Britons to join in with the NNU’s National Medicare for All week of action, running from 9-13 February. NNU is the largest union representing bedside nurses in the US.

    https://www.theguardian.com/society/2019/feb/03/momentum-founders-emma-rees-adam-klug-nhs-style-healthcare-in-us?fbclid=IwAR0TXvaVmpkJ-DCPnlbXbp-Ykt6ouW7-NUshTBYTubZXk5yYECiRFqco7Qs

    1 Comment

    General comments:   It was wonderful to be amongst such an enthusiastic group of diverse people, of wide age range, varied skin tones, many dressed relating to the country of their family origins, with and without disabilities (wheel chairs were very much in evidence); they seemed to reflect the diversity of our population as I experience it on the street. There was a joyful atmosphere despite almost all the topics reflecting the distress amounting to cruelty imposed by this current government on those least able to fight back; the hunger for change, just the prospect of being able to work in a co-ordinated and supportive way to do something about it is palpable. It’s always so stimulating to be amongst people who are energised to tackle the job for which we know there is such urgent need, although the practicalities of undoing the effects of this long austerity will not be easy. It was also useful to encounter organisations of which I was only vaguely aware previously. All the events out of the main hall in both the main conference and the World Transformed were jammed with people, seats quickly taken, standing room also gone and people bulging into the corridor, leaning one ear towards the door to catch as much as they could.

    Women’s Conference:   The SHA Motion supporting Abortion Rights across the UK was not taken forward to the main conference. Coral Jones seconded this motion with a strong statement, and spoke of the dilemmas facing Northern Ireland GPs forced by the 1861 law to make decisions they wouldn’t choose in non-professional circumstances, and that Ulster women choosing an illegal abortion might face imprisonment for the rest of their lives. There is also the situation of BAME women who cannot speak openly for cultural and patriarchal reasons. The other motions were Childcare, Women’s Health and Safety and Women and the Economy. The motions, presentations and supporting contributions from the floor were so persuasive, I would have found it difficult to choose which one to support for the main conference had I been a voting delegate.   All of these motions indicate a deteriorating situation for women and therefore the health and well being of future generations too since such adversities cascade down the generations; problems introduced in one generation may never, or take many generations, or take many generations to be resolved. I suggest SHA takes up the 3 motions which were rejected for the main conference at an early date. Domestic violence, the silenced experience of 1 in 3 women is commonplace, whilst specialist supportive services for women and children have been lost since 2010. Two women killed each week in the UK is not a trivial matter; these murders are about male power and coercive control of ‘his’ woman and a new campaign ‘Level Up’ aims to get more informed, responsible, less sexist, reporting of these situations in which the woman is usually ‘blamed’ for promoting his violence. Support is being given to address male violence (which seems good), but takes funding from the woman and children and often gives the man access to his family again without having reformed his abuse of them

    World Transformed – SHA, Health Campaigns Together and NEON (New Economics Organisation Network) combined presenting the debate on ‘Saving the NHS’. Speakers including Jean Hardiman Smith and Deborah Harrington (www.publicmatters.org.uk) made excellent cases with many references back to Nye Bevan’s ‘In place of fear’, how the arguments and threats raised in chapter 5 of this pamphlet in the 1940s are very relevant today, services being unaffordable, people living too long, demand too high etc… and to Julian Tudor Hart’s Inverse Care Law applying throughout the World. There was a pertinent reminder that services free at the point of need only matter if they’re of good quality. Bonnie Castillo, a nurse from the US – National Nurses United (www.nationlnursesunited.org) – pointed out that most and rising ill-health in the US is from preventable diseases, US neo-natal mortality is the highest in the developed world, and that though grass roots demand ‘Medicare for All’ is huge, it’s frustrated by corporate donor pressure blocking supportive Democrats from voting for it. It’s a timely reminder for us in England as corporate lobbying of politicians erupts volcanically here; conflicts of interest seem never to be challenged now and politicians switch easily between well paid corporate and governmental posts.

    Fringe meetings on the Future of Care and Universal Credit (in association with the Trussell Trust) were predictably bleak. Barbara Keeley MP said all aspects of care is in crisis, (services, informal family and paid care); care itself had become more intensive and complex as people live for longer, sometimes with profound disabilities and requiring much more intimate intensive personal support often than before. The hollowing out of social care had led to 25% of caring situations now rated as poor resulting in ever more responsibilities being left to involuntary ‘volunteer’ family / friends. The Government’s promise of a Carers Action Plan (vague at best) and extra support for young carers had been forgotten, whilst Local Authorities, deprived of funding could not meet statutory responsibilities, so many people in England now never even approached their Councils for help, thereby contrasting with Scotland where Social Care is still funded. A commission to investigate the range of problems consequent to unpaid care in England would raise the profile of family carers and point out its impact on neglected matters like their entitlement to a pension; a pension is only available to those on the meagre Carers Allowance. The lack of training for unpaid and newer recruits to paid care also needs addressing; insofar as it works currently, the care system relies on an older workforce teaching the younger recruits voluntarily. Re-ablement, helping people to recover care for themselves is of very low priority. It would be useful to publicise the Dilnot Commission Report on Social Care (2011) and its recommendations and to take government to task for its failures. Why call it a caring system when it clearly isn’t?

    The many flaws of Universal Credit and the damning report of July 2018 were aired. The numbers of food banks increased by 13% in the last year, 52% in areas where they were fully established already. The Left Behind Report has highlighted the brutality of the immediate problems of 70% of claimants who go into debt whilst waiting to gain access to support. No-one at these meetings could ever doubt the urgent need for reform of Universal Credit and re-instatement of a proper supportive welfare state providing the safety net it used to do with benefits linked to needs. Work coaches are primarily about implementing cuts. It’s not ‘just about managing’, but a question of survival now with 66% of benefit spent on food and the rest on utilities and never forgetting that this situation applies to 1 in 6 families where at least one member is in work and in work poverty has risen from 13 to 32% in recent years.

    There were 2 SHA fringe meetings, both held at the Quakers and chaired by Jean

    Emma Dent Code, MP for Kensington and Chelsea claimed it was the most unequal borough in Britain, with care homes run by a well known provider, it has 4 of the worse in the country according to the CQC, it has 4 food banks and has had the greatest fall of life expectation ever recorded – 6 years since 2010. She gave the example of a male in one part of the Borough with a life expectation of 63 years, whilst another living near Harrods would have 92 years. She reported many Grenfell related horror stories.

    Judy Downing of the Relatives and Residents Association gave an outstanding presentation of the Labour Party’s failure to highlight the lack of standards and needs of the work force in care homes, many of which were run by small providers for profit. She claimed 1.4 million paid carers in care homes had no qualifications, (whilst this is a situation worse than operated in kennels, the same is true for informal family carers). Staff turn-over in care homes is about 28% (costing an estimated £3 – 5 billion), many leaving in less than a year, and about 50% of care homes are inadequate. Currently, US companies are making 12% profit from care homes in exchange for ‘crap’ care.   She suggested CQC should be nationalised to address these horrors with mandatory regulations and training elements.

    Eleanor Smith MP called for re-nationalisation of the NHS, with a proper training budget again. Social care and care for the elderly budgets had plummeted since the 1980s, and the NHS would soon be in the same state if nothing was done. Private providers, international hedge fund managers (‘vampire capitalists’) would soon be able to affect health budgets – a clear conflict of interest – and Local Authority care workers are being warned off speaking about what’s happening. 60% of care homes don’t do health checks, there have been 3 times as many cuts in residential home beds as in the NHS. A Mental Health Capacity Amendment Bill if enacted would allow a care home manager to make the decision to deprive someone of his liberty – a privatisation of liberty! There is a financial incentive NEVER to discharge a patient when it is so profitable to keep him, as has happened for decades in private mental health care homes.

    In the Health Inequalities session we were reminded of the Black Report of 1980 which linked health inequalities and poverty and was ignored by Mrs Thatcher so that since then, services have been lost and deaths have risen. How many more tragedies will happen before it is realised that we need a properly funded NATIONAL Health Service? The process has been to carve up the NHS, give powers to the Local Authorities then slash their funding. This has resulted in public health, drug and alcohol services, sexual health clinics, mental health rehab facilities, women and child welfare and support facilities, preventive medicine of all kinds, life expectation and quality of life all plummeting. Staff see a daily erosion of their service, they are subjected to constant pressure, unrealistic targets, so that many at all levels leave ill. Cuts and privatisation are rife. This is a quote from a nurse who can’t wait to leave ‘I did not become a nurse to make profits to line wealthy pockets.’ The NHS is for the people NOT profiteers. NHS Well-being terms are needed to address the injustice and assess the impact of all these changes on the lives people live including those with chronic and disabling health conditions (not forgetting mental ill-health), the unemployed, especially women’s and BAME’s lives

    On the last day, Denis Skinner’s contribution was welcomed with a standing ovation. He described being inspired to leave mining and become an MP by the Atlee government of 1945. He has seen an inclusion at the Conference just not seen in everyday life. A fairer society should be judged by the obstacles it overcomes. He was there at the birth of the NHS, mentioned the various surgical procedures without which he wouldn’t now be addressing us. One was a heart by-pass performed by a United Nations team, and he listed all the countries from which the various medical staff had come – it was huge, as was his reception with laughter, clapping and cheering as the list went on and on.

    Judith Varley   11.10.18.

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    Ray Tallis is an active member of Keep Our NHS Public and a strong defender of the NHS. This should be a very interesting lecture

    Public Lecture: The Royal College of Physicians and the Politics of Healthcare 2018

    8 November 2018
    Liverpool Medical Institution, Mount Pleasant, L3 5SR

    6pm: Welcoming drinks
    6.30pm: Lecture

    Raymond Tallis is a philosopher, poet, novelist and cultural critic and was until recently a physician and clinical scientist. In the Economist’s Intelligent Life Magazine (Autumn 2009) he was listed as one of the top living polymaths in the world.

    Born in Liverpool in 1946, one of five children, he trained as a doctor at Oxford University and at St Thomas’ in London before going on to become profritic and was until recently a physician and clinical scientist. In the Economist’s Intelligent Life Magazine (Autumn 2009) he was listed as one of the top living polymaths in the world.
    Born in Liverpool in 1946, one of five children, he trained as a doctor at Oxford University and at St Thomas’ in London before going on to become professor of geriatric medicine at the University of Manchester and a consultant physician in healthcare of the elderly in Salford. Professor Tallis retired from medicine in 2006 to become a full-time writer, though he remained visiting professor at St George’s Hospital Medical School, University of London until 2008. He was visiting professor of English at the University of Liverpool until 2013.
    Over the last 20 years, Raymond Tallis has published fiction, three volumes of poetry, over two hundred articles and 23 books on the philosophy of mind, philosophical anthropology, literary theory, the nature of art and cultural criticism. Together, these works offer a critique of current predominant intellectual trends and an alternative understanding of human consciousness, the nature of language and of what it is to be a human being.

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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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