Category Archives: Local Government

This article was first published by Simon Collins at HIV i-Base on 2 September 2019.

On 2 September 2019, leading HIV charities including HIV i-Base and the UK-Community Advisory Board (UK-CAB), published an open letter to Rt Hon Amber Rudd MP in her capacity as Minister for Women and Equalities, calling for an urgent intervention to include sexual health in the upcoming Government Spending Round. [1]

In England, the responsibility for sexual health was disastrously shifted from the NHS to local authorities, whose public health budgets have been cut in real terms by £700 million over the last five years.

These cuts have directly reduced access to sexual health services, where many people are unable to routinely access treatment and testing due to limitations in allocation of daily appointments.

Many of these cuts disproportionately affect lesbian, gay, bisexual and transgender (LGBT+) and black and minority ethnic (BAME) communities, and young people.

A similar joint letter calling for increased funding for sexual health was also sent today by LGBT+ groups from the Labour, LibDeb and Conservative parties.

Last year, a review of services in South London reported that 1 in 8 people with symptoms were being turned away from sexual health clinics. This included 40% who were under 25 years old and 6% who were under 18.

References

  1. Green I et al. Urgent request to intervene: Funding for sexual health services. 2 September 2019.
    http://www.tht.org.uk
  2. Collins S. Almost 1 in 8 people with symptoms turned away from sexual health clinics in SE London: 40% are under 25 and 6% under 18 years old. HTB 01 May 2018.
    http://i-base.info/htb/33968

Please see this Press Release from BASHH (British Association of Sexual Health and HIV) and BHIVA (British HIV Association) from October 2018: Government funding cuts leave sexual health and HIV care at ‘breaking point’

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Today the Mail on Sunday published an article headlined ‘HIV treatment now costs NHS as much as breast cancer – Fears £606m annual bill for sexually transmitted disease is fuelled by flood of foreign health tourists‘.

The only views to ‘balance’ the diatribe published in the paper and online was a short rebuttal from BHIVA  (British HIV Association) and NAT (National AIDS Trust) as well as a short statement from NHS England on how costs for HIV treatment are actually reducing:

A spokesman for the BHIVA said: ‘In the UK, new diagnoses of HIV are now falling because of the success of testing and treatment.’

An NHS England spokesman said the cost of HIV treatment had fallen £28 million from £634 million in 2017/18 to £606 million in 2018/19.

A Department of Health spokesman said: ‘We’ve seen a decline of almost a third in new HIV diagnoses in the UK in recent years.

‘As with all other serious infectious diseases, we do not charge overseas visitors for treatment for HIV as, if left untreated, there is a significant risk to others in this country.’

Deborah Gold, chief executive of the NAT, said: ‘The concept of health tourism for HIV treatment is an outdated myth.

‘It is actually a problem that we have such long average delays, usually years, between migrants’ arrival in the UK and them accessing HIV testing and care.

‘Universal availability of HIV treatment is a cornerstone of the response in the UK. Any suggestion this is a poor use of NHS money, or that access to treatment should be limited for anyone, is outrageous. In fact, it is evidence of the NHS at its best: saving lives and preventing ill-health.’

UK-CAB (the UK Community Advisory Board) responded to the article via this tweet with the following statement:

“The UK is a world leader in reducing the numbers of new HIV diagnoses and one of only six countries to have already met the UNAIDS 90-90-90 targets. This achievement would not have been possible without upscaling HIV testing and providing immediate antiretroviral treatment to all people living with HIV in the UK.

People with HIV on effective antiretroviral treatment cannot pass the virus on to their sexual partners or to their unborn child during birth and pregnancy. The investment in free HIV treatment for everyone with HIV is fundamental to meeting the Government’s commitment to end new transmissions by 2030.

Stigmatising information like that reported in today’s Mail on Sunday only serves to hinder the UK’s response to the HIV epidemic. Whilst we have made huge strides in reducing new diagnoses by an incredible 28% between 2015 and 2017, the numbers of people diagnosed late is still too high.

Late diagnosis not only increases the chances of premature death but also heightens the risk of HIV being unknowingly transmitted to sexual partners. We cannot tolerate attitudes which put people off testing and finding out their HIV status.

People living with HIV should not be pitted against other patient groups or conditions.

Access to treatment and care for all people living with HIV ensures that individuals can live well and in good health and also stops transmission of the virus to others. Any insinuation that denying HIV treatment to those without ‘settled’ status would be a benefit to the nation’s public health or NHS budgets is nonsense.”

Please circulate this as widely as possible.

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The following article was first published in the Camden New Journal on 06 December, 2018

A private company being promoted
by government to recruit patients to its doctor service spells ruin for the whole-person integrated care we need from the NHS, argue
Susanna Mitchell and Roy Trevelion

The sneaking privatisation of our National Health Service now aggressively threatens our GPs. In Camden and across London, we all need to be aware of the long-term harms this development will cause GPs and primary care NHS services.

Last year, a global multinational corporation called Babylon Healthcare – owned by a former Goldman Sachs investment banker and Circle Health CEO – established a “digital- first” business called “GP at Hand”.

Disastrously for the NHS, Babylon Healthcare Services Ltd can be traced back to a holding company in Jersey, the offshore tax haven.

GP at Hand is contactable through a mobile app which uses standard calculations as a symptom checker. Unfortunately NHS England have not provided our existing practices with this software.

Instead any patient registering with this commercial enterprise will be deregistered from their normal GPs. And, although the GPs employed by the company can also be accessed by video or phone, this process delivers no continuity of care or whole-patient assessment.

Continuity of care is a cornerstone of general practices. However, Matt Hancock, the health secretary says, “If we need to change the rules to work with the new technology then change the rules we must.”

In addition GP at Hand’s own promotion material actively discourages older people from registering. Explicitly these are those who are frail or living with dementia, or in need of end-of-life care. Pregnant women and those it describes as having complex social physical and psychological needs are also discouraged from signing up.

In other words it is “cherry-picking” young and healthy patients who will be more profitable to its shareholders. Its use of standard practice via information technology, and the easy access it offers, is particularly attractive to the young.

Of the 31,519 new patients who have signed up with GP at Hand over the past 12 months, 87 per cent are aged between 20 and 39 years, while patients over 65 now make up just 1 per cent of the population registered with the service.

All this poses serious problems both for patients and general practices. In the first place, our present primary care system consists of GP practices committed to whole-person and integrated care for everyone in their local communities. Healthcare services are organised around geographic areas to enable better co-ordination with hospitals and social services.

In contrast to this, GP at Hand fractures this fair and impartial community-based model, registering patients who live or work anywhere within 35 to 40 minutes of one of the clinics. In addition, should any of their patients require more complex care, they will no longer have their own GP to turn to.

Secondly, by picking the most profitable patients, GP at Hand drains money away from ordinary GP surgeries. Normal GPs are funded according to the number of people on their patient list and this funding is combined into a single budget to provide the services they offer. This means that funding from the roughly 80 per cent of patients who remain reasonably well helps to pay for the 20 per cent who are elderly, who are chronically sick, or have multiple illnesses.

But if the “capitation fee” of the young and healthy is scooped up by a for-profit company like GP at Hand, it will critically undermine the funding available to surgeries. This will leave practices to deal with the sick, the frail and the old on a much reduced budget.

Shockingly this commercial entity is funded by NHS England. It can be commissioned through our clinical commissioning groups (CCGs).

It’s expanding fast, and already has over 35,000 patients. Currently the corporation operates out of five clinical locations in London including one in King’s Cross. Plans for rolling it out nationwide are under discussion. It is also advertised widely, with the health secretary Matt Hancock recently announcing that he has registered with the company.

Future developments in information technology and artificial intelligence that can be useful to our public health systems should be funded directly towards our existing GP surgeries.

It should not be used as a vehicle for profit-making by private corporations at the expense of our NHS.
We need to make the dangers of adopting this business model clear to the widest possible public. We must encourage those who care about our publicly-funded NHS to boycott Babylon’s GP at Hand.

We need to bring public pressure to bear and end this attack on a valued and trusted institution that serves us all.

The NHS has always been for the benefit of everybody. It must be kept that way.

• Susanna Mitchell and Roy Trevelion are members of the Holborn & St Pancras Labour Party and of the Socialist Health Association.

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Unite Press Release

Immediate release:  Wednesday 7 November 2018

Vote for Cornwall’s children’s services to remain in-house applauded by Unite 

Cornwall Council’s decision today (Wednesday 7 November)) to keep children’s services in-house, and not to outsource them, has been hailed as ‘a significant victory’ by Unite the union.

The council’s cabinet voted to adopt the option – outlined in its One Vision blueprint – to keep children’s services in-house from April 2019.

However, Unite warned that the possibility of parents paying for health visitors to carry out vital health checks on their babies and children still remains as the ‘means tested charging’ wording is in the One Vision document.

Unite regional officer Deborah Hopkins said: “We welcome the decision of the council’s cabinet to keep children’s services in-house and not outsource them to a separate company.

“It is a very significant victory for the people of Cornwall and a big set-back for the insidious privatisation agenda.

“We welcome the council’s announcement that parents won’t be means tested when they require children’s services, such as a visit from a health visitor.

“However, that possibility is still within the wording of the One Vision framework and until that is finally jettisoned from the document, Unite will be following developments in the weeks and months ahead very closely.

“Unite is keen to work collaboratively and constructively with the management of children’s services to ensure the best possible outcomes for families and children in Cornwall, which is one of the poorest counties in England.”    

The other option that councillors rejected today was for a so-called ‘alternative delivery model’ by a company that is separate from the council with the potential to make profits from parents.

The introduction of charging is in the document’s section on Drawing on funding opportunities where one proposal is: ‘Introduce means tested charging for a range of family support services’.

About 235 health visitors and school nurses are transferring into a Cornwall Council integrated children’s service in April 2019, to work with a multi-disciplinary team, alongside services for families and young people.

A recent survey revealed that nearly 20 neighbourhoods in Cornwall are among the 10 per cent most deprived in England, according to The Index of Multiple Deprivation.

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Chipping Barnet CLP notes that access to contraception is a fundamental human right underpinning equality, impacting on the health, structure and prosperity of both society and families. The 2012 Health and Social Care Act disadvantaged women, separating much of the funding for contraceptive care from the NHS by moving the responsibility for commissioning into Local Authorities, with NHS providers competing for contracts. As a result, the commissioning of contraception is now separate from the commissioning of other aspects of women’s health, including abortion. From both a woman’s and a clinical perspective, this is illogical. Compounding this, the impact of austerity on Local Authorities has led to a reduction in services, reduced access and to a postcode lottery for contraception in England.

Chipping Barnet CLP believes that contraceptive services need to be fully funded and accessible in all areas of the UK, with co-operation replacing competition. It welcomes the commitment of the Shadow Health Department to abolish competitive tendering for these essential services, and to work with clinicians to establish centres of excellence alongside regular accessible clinics to which women have free and easy access to confidential care.

Chipping Barnet CLP calls on the Labour Party to resolve to deliver fully funded contraceptive services in all areas of the UK, setting up a working group whilst still in opposition, composed of experienced clinicians and commissioners, to write a blueprint for delivery which will be implemented within the first year of the Labour Government.

Published by Jean Hardiman Smith with the permission of Sarah Pillai ( Chipping Barnet CLP )

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

Pensioners United

Directors: Phil Maxwell, Hazuan Hashim

Country: UK

Running Time: 75′

Year: 2018

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

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

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

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

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

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

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

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

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

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

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

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

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

Cheers

Kevin Donovan

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Dear chums

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

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

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

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

You can find a petition from Defend Our NHS here:

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

Please sign and share with friends.

Thanks

Kevin

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The introduction of Accountable Care Organisations – or whatever they are called this week – brings a lot of talk not only about integrating health and social care, but also about local accountability.  The accountability seems to be more about accountants than about democracy, but in principle local elected councillors could have a voice in the working of health services  which they haven’t had for many years.  We asked our members how health had featured in their local election campaiogns.

Of course we were looking mostly at how local Labour parties dealt with health – but some of our members reported that the Green Party had more to say about the NHS than Labour.

Enfield Labour Party

Their manifesto said they had  IMPROVED HEALTH:

  • Increased fitness with 12 outdoor gyms and outdoor playing spaces
  • Opened a world class sexual health clinic
  • Cut smoking prevalence by 6% since 2012
  • Helped cut the life expectancy gap between the rich and poor and cut teenage pregnancy rate in the borough

and pledged that they would:

  • launch a Borough Poverty and Community Fairness Commission
  •  tackle discrimination based on sex, race, disability, age, sexual orientation, gender reassignment, religion or belief, marital status, or pregnancy and maternity
  • oppose Tory policies that drive division and disadvantage in our community and tackle the causes of childhood poverty giving every child a good start in life
  • develop our holistic approach to adult social care meeting needs in housing, advocacy and support
  • continue to oppose the privatisation of our NHS
  • campaign for more GPs and better surgeries
  • put public health at the heart of policies for improving the quality of life of residents by promot-ing healthy lifestyles and physical activities
  • continue to subsidise leisure facilities and services for older people
  • give mental health the same priority as physical health
  • support increased integration between the NHS and Adult Social Care to meet residents’ needs and cut bureaucracy
  • reduce air pollution through clever design and screening of roads
  • crackdown on illegal tobacco and cigarette selling
  • ensure food safety standards and hygiene in business premises

Hertfordshire Labour Party

Hertfordshire leaflet

Colchester Borough Labour Party

reported they had redesigned two outdated sheltered housing schemes to provide fully accessible 21st Century older persons’ apartments.

Manifesto commitments:  A Labour-led council would improve the health and wellbeing of the Borough and its residents by:

  • Continuing to question whether the merger of Colchester and Ipswich Hospital Trusts is in the best interests of our residents and communities;
  • Demanding a greater say in the NHS Sustainability and Transformation plans and programmes for our area, which means objecting to one Clinical Commissioning Group run from Suffolk;
  • Involving the Borough Council in the integration of health and social care provision;
  • Lobbying the government to significantly increase spending on the NHS;
  • Providing more sheltered, supported and extra care accommodation by working with a range of partners across all sectors;
  • Campaign on easy accessibility for all public buildings – especially the Work Capability Assessment centre;
  • Instigating more Changing Places toilets.

Manchester Labour Party

Put Health and Social Care at the front of their campaign – as perhaps is appropriate when Manchester is said to be leading the way.

Manchester people made caring for those most in need in the City their number one priority so it is the number one priority for Manchester Labour. By taking control of our health and care services we will protect our NHS and help Manchester people live longer, healthier, happier lives.

We will:
● Increase pay for homecare workers to at least the Manchester Living Wage
● Employ more people to support vulnerable residents to stay in their own homes using the 1.5% Council Tax increase raised for adult
care
● Begin construction of at least 200 homes for older people at social rents as part of our extra-care schemes
● Invest to improve local access to community mental health services

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Alan Hall

Speaking the truth to power is always a risky business.  No more so than when considering how millions of pounds of public money should be shovelled into developments and contracts.

Local government overview & scrutiny has been with us since the Local Government Act 2000 and the advent of the cabinet system and executive mayors. In the case of executive mayors –  a single politician making the decisions to spend millions of pounds of public money albeit with the advice of officers and an appointed cabinet – it is easy to see how local councillors could feel disempowered if they are not allowed a proper say on the decisions taken. Overview and scrutiny committees can provide a proactive, pre-decision mechanism for proper political involvement and public engagement. This scrutiny system improves and refines decisions, weeds out poor proposals and advances evidence-based policies.

Good council scrutiny can also allow for challenge to government too. Following the roll-out of austerity and public spending cuts led a review of the London Borough of Lewisham’s emergency services which reported in 2013.

The review showed that significant funding cuts had put services under severe strain, with an impact on preventative services and areas like probation too.

The process allowed for proper scrutiny of these changes both by the council and external public agencies and, during the review, Lewisham Council successfully challenged Jeremy Hunt, secretary of state for health over the proposed closure of Lewisham hospital’s A&E department.

An example of proactive scrutiny came after the tragic Grenfell Tower fire. All housing authorities rightly reviewed their housing stock and hopefully their policies. As a matter of urgency, I wrote to Barry Quirk the then chief executive of Lewisham council to ask that a fire and risk assessment be made of all tall buildings and I invited the borough’s fire commander to address us to give the public and the council the assurances it needed.

Party politics will, of course, play a part in any local government setting and it is naive to think that elected politicians forget their party in scrutiny. But, as a recent Communities & Local Government Select Committee report on local authority scrutiny says, council leaderships have a responsibility to foster an environment that welcomes constructive challenge and debate. I have always held that scrutiny meetings can provide a platform to explain and publicise good policy initiatives and challenge assumptions or ‘group think’.  Let’s imagine the alternative – complete, untrammelled power of the executive.

Instructing scrutiny members how to vote and threatening them with the whip does not foster the constructive challenge we need. Scrutiny committee members need to be able to hold their cabinet colleagues to account.

But if proper scrutiny is to play a full part in effective local government, we will need a culture shift.  The scrutiny process – sometimes seen as the trainspotting of the council world – needs to be valued every bit as much as executive decision-making. This parity of esteem should mean getting access to the resources needed to do the job – including professional and independent advice.

The Financial Reporting Council and the Institute of Chartered Secretaries & Administrators advise that a company’s board should make funds available to their audit committee to enable it to take independent legal, accounting or other advice when the audit committee reasonably believes it necessary to do so. However, scrutiny committees have no such right. Indeed I have requested independent legal advice in the past and an eminent QC has given an opinion supporting a refusal of this request. I believe this change would help proper scrutiny when a council’s legal officers are advising the executive on hugely complex and controversial developments and contracts. It would solve an inherent conflict of interest.

Meanwhile, the government has responded positively to the select committee’s recommendations that overview and scrutiny committees should report to their full councils and not just the executive and that officers should provide impartial and professional advice. That after 18 years of local government scrutiny these recommendations need to be made at all is telling. There is a long way to go before there is anything like parity of esteem between the executive and scrutiny functions.

I helped pilot scrutiny arrangements in Lewisham in 2001 and more recently I am pleased to have had the endorsement of Lord Kennedy – and, somewhat to my surprise a government minister Lord Young – when I led the questioning of a compulsory purchase order around Millwall Football Club’s ground in South East London. The lesson I have learnt is that scrutiny is best when gathering evidence from beyond the usual officers and paid advisors. In the words of an Ofsted inspector who I gave evidence to recently: “Triangulate – don’t only listen to your officers.”

Council scrutiny is a crucial part of our local democracy. It benefits councils and residents alike, contributing to better decisions, better use of public resources, better public engagement and – ultimately – better services.

this article was originally published by The Fabian Society

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In recent days there has been a storm about the recently announced 2016/17 local government grant settlement from central government. The creation of a new £300m relief fund will mainly be used to help Tory-run councils, like David Cameron’s Oxordshire County Council, with Labour leveling the accusation that this is to buy off Tory MPs.

I will leave it to others to form a view on whether this is fair or not. But this whole storm did get me thinking about the scale of the cuts not just for this year, but over the past few years, since the Tories came to power.

So I grabbed hold of the 2011/12 figures for “council spending power” and compared them to the recently announced 2016/17 figures and worked out the percentage cut in spending power for each council. I picked 2011/12 as a base year this was the first full council financial year the Tories were able to fully influence after being elected.

I decided to look only at the 152 County Councils and Single Tier Councils (e.g. London Boroughs, Unitary Councils, Metropolitan Boroughs etc) as they make up over 93 per cent of all council spending. There are 201 district council but they make only about 7 per cent of total council spending. Hence looking only at the “Upper Tier” councils as this made the analysis more focussed.

The thing I wanted to test was the theory that the most deprived councils were worst hit. So I took a trip over to the Office of National Statistics (ONS) English indices of deprivation for 2015 website. Here I got the Index of Multiple Deprivation (IMD) average score breakdown by council areas and then  used the rank of the average IMD score to plot percentage change in revenue spending power using versus the IMD average score rank.

Below is the very telling plot of this data. Note councils with low ranks on the IMD (those plotted to the left) are the most deprived and those with high ranks on the IMD (those plotted to the right) are the least deprived.

Upper Tier Council Cuts versus IMD

This graph shows a strong and clear relationship that the councils that are serving the most deprived communities have suffered the largest cuts over the past five years. This very strong relationship is evidenced by the high R2 value (or coefficient of determination) of 0.81. A value of 1 would indicate a perfect fit on the line of best fit, and a value of 0 would mean the data does not fit the line in any way. A value of 0.81 shows a strong and clear fit/relationship.

So there you have it: the numbers don’t lie. The poorest and most deprived have suffered the largest percentage council cuts. The poor have been robbed to subsidise the rich.

If you want to check the data and my calculations you can download it here.

First published on Ravi’s own blog More Known Than Proven

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