Category Archives: Liverpool

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

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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

 

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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

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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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Waiting for Jeremy: Wavertree Chair Alex Scott-Samuel and other invited Merseyside activists on stage awaiting the Leader’s Speech at #Lab18

Note the SHA tee-shirt.

 

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For those who were unable to attend Conference, here is Dr Coral Jones speaking at the conference.

https://www.youtube.com/watch?v=q7oiIeuQfqk&feature=share

Jean Hardiman Smith

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

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

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

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

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

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

Jean Hardiman Smith Secretary and proud SHA delegate

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FINAL DETAILS – PLEASE COME VERY EARLY

Saving the NHS: Planning Our Fightback
Sunday 23rd September, 10.45 – 12.45
organised by Health Campaigns Together and NEON.

Venue: Black E (sometimes described as Liverpool’s third cathedral) at
1 Great George St, Liverpool L1 5EW
http://www.theblack-e.co.uk/content/location

This is part of a series of events, alongside the Labour Party Conference,
organised by The World Transformed.

We plan a lively session that asks participants to think forward and think strategically.
Speakers include John Lister from HCT, Public Matters, National Nurses United, Save Liverpool
Women’s Hospital, Wigan Outsourcing Campaign, Socialist Health Association, Just Treatment.

See you there!

Keith Venables, HCT and George Woods, NEON.

Lastly, ahead of the event we’d really appreciate you helping us promote it and get the word out.

You could retweet the @TWT_NOW tweet here
You could add something like this to the tweet:

‘We’re going to be at the session on a mass movement to save the NHS at @TWT_NOW this year!

Join us to help build a practical plan to defeat privatisation and cuts https://www.facebook.com/event s/289263841860031/

Join and share the Facebook event page here https://www.facebook.com/event s/289263841860031/

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My priorities for Health Behaviours …

  1. Change the language!
  2. More controls on junk food marketing to kids
  3. Minimum unit pricing for alcohol is a must
  4. Start taking cycling seriously
  5. Betting. When the ‘fun’ stops

Liverpool

This is my city

It is not a rich city!

Do not blame us about how we live or tell us it’s about our lifestyles or our behaviour but do something about our environment so that it’s easier for us to live healthier and longer.

Premature Deaths from Cardiovascular Disease are significantly higher in Liverpool City Region – 80% could be avoided through behaviour change:

Deaths from Cardiovascular Disease

DSRs = Directly Age-Standardised Rates

But for behaviour change to happen we need less emphasis on the individual more on the environment

  • We are surrounded by junk food and bombarded with messages to buy sugary drinks and processed food
  • It’s sometimes cheaper to buy alcohol than bottled water
  • Our traffic systems are built around cars when bicycles are the environmentally healthy choice
  • And a growing habit-forming behaviour that is leading to public health concerns
More controls on junk food marketing to kids

More controls on junk food marketing to kids

A Labour Government should close existing loopholes to restrict children’s exposure to junk food marketing across all the media they are exposed to. This should include updating current broadcast regulations with a 9pm watershed on advertising of food and drinks high in fat, sugar and salt to protect children during family viewing time and taking action to ensure online restrictions apply to all content watched by children. In addition rules should be extended to cover sponsorship of sports and family attractions and marketing communications in schools”  – Obesity Health Alliance Manifesto, April 2017. Emphasis my own.

Cheap lager

Minimum Unit Price of Alcohol. Ok in Scotland and Wales. How about the UK?

  • Low prices lead to increased alcohol consumption and alcohol-related harms
  • The cheapest products are favoured by the heaviest drinkers
  • A minimum unit price will reduce consumption and harms and will do this more effectively and more fairly by targeting the heaviest drinkers

Congested street

Have things changed from the ‘90s? This is Liverpool

People will only turn to cycling in great numbers when there is a significant investment in safe infrastructure.  

“Doctors should care about cycling, as it’s one of the best preventive health interventions we have. Active commuting, including cycling, is associated with reductions in mortality, cardiovascular disease, and cancer. Body mass index and the percentage of body fat are lower in active commuters …

And it’s not just the individual cyclist who benefits. Car drivers who switch to a bike will reduce air pollution”.

Dr Margaret McCartney, BMJ, October 2017

Go by bike

Cycle commuting is associated with a lower risk of CVD, cancer, and all cause mortality. Walking commuting was associated with a lower risk of CVD independent of major measured confounding factors.

Gambling – How has it got to this?

Gambling sponsors football

Gambling is a Public Health Issue

  • It was the Labour Party who deregulated gambling in 2005. It has damaged the health of the nation
  • It’s a problem that goes beyond simply dealing with Fixed-Odds Betting Terminals
  • The Gambling Commission estimate that the number of British adults with gambling problems is in excess of 400,000 with a further two million at risk of significant health and social problems
  • Let’s ban shirt sponsorship by gambling companies in football
  • And let’s have a radical overhaul of gambling regulation
Benjamin Franklin 1706-1790

Benjamin Franklin 1706-1790

Prevention demonstrates a substantial RETURN ON INVESTMENT – most published health interventions are substantially COST-SAVING

Public Health Priorities for Labour – How Far Do You Dare To Reach?

  1. Change the environment so the default option is healthier.  Lay off on the victim blaming!
  2. We must do more to prevent junk food marketing to our kids which in turn fuels childhood obesity
  3. The evidence is there for Minimum Unit Pricing for Alcohol. Please act
  4. Cycling can and should be for everyone but there must be significant  investment outside London
  5. There should be a radical overhaul of gambling regulation

This was presented at our conference Public Health Priorities for Labour

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