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    Cllr Barry Rawlings, Leader of the Barnet Labour Group

    Particularly since the pandemic, public attention to social care has focussed on the fragility and impoverishment of the major services, residential and domiciliary care, that provide the direct care and support to older and disabled people. However, less visible is the beating heart of social care, which is the way councils identify need, plan support and allocate resources. This is the process that determines the fate of each individual.

    Over the past 18 months, as the Labour opposition to a Tory controlled Council, we have been forensically testing how that system works. We have found its nothing like the claims being made for it. We have been giving a great deal of thought to what is wrong and how it can be put right. We have come to a number of key conclusions.

    The first conclusion is that the UN definition of Independent Living is beyond question the right vision for social care. We believe all Barnet residents who rely on social care, whether in their own home or living communally, should have control over their lives with ‘choices equal to others’ with ‘full inclusion and participation in the community’.

    We have to make this a practical reality, not just a pipe dream and not just yet more rhetoric. This means addressing the resource question. So, our second key conclusion is that the UN approach to the resource consequences is also the right one. States are not expected to have all the resources immediately available but are expected to take ‘concrete steps’ to embark on a process of ‘progressive realisation’ of the resources required.

    So, instead we are looking at the feasibility of a new model of working. That model is:

      • First: To empower our social workers to work in real partnership with our service users to identify and cost all their needs for Independent Living.
      • Second: To put a stop to the miserable, minimalist ‘eligibility’ practices.
      • Third: To ask budget holders to be transparent about what their budgets can afford and what they cannot.
      • Fourth: To expect the Director to explain what is needed for all to have Independent Living, not to reduce ‘need’ to whatever budget is provided.
      • And then to do everything in our power to secure the resources required by using the evidence we have gathered to ask Government for the funds Barnet needs.

     

    That brings me to our third key conclusion. The Care Act already provides the primary legislation to make this happen. Its central concept of wellbeing has 9 dimensions. They include dignity, respect and control over one’s life and services. You couldn’t put a cigarette paper between this and the UN definition of Independent Living. The Act also has provisions that enable councils to be honest about what they can and cannot afford. It also requires councils to  actively find out what resources are required to meet all needs in the communities they serve.

    Our fourth key conclusion is that none of these transformative provisions are being enacted by Barnet Council. Barnet like all Councils, maintain they deliver the national template. All the Care Act has done is provide new language for the same old practices that demean service users by telling them what their needs are, and then defining ‘need’ to suit their budgets.

    Our fifth conclusion is that the problem lies with the secondary legislation – the Statutory Guidance and Regulations. These are the responsibility of Government, not Parliament. They have been constructed in a way that allows councils to by-pass  key provisions of the Care Act   and focus on eligibility rather than wellbeing. These practices serve the political expedients of controlling spend to budget while delivering the political convenience of denying the existence of any unmet need.

    None of this is the fault of local authorities or their social care staff.  Social workers do their best to squeeze as much out of the system as they can for individuals, but it’s a zero-sum game and there are always winners and losers. This is the inbuilt inequity of the system.

    This is an issue that affects all councils, as all will be applying the Statutory Guidance and Regulations. If there is a party-political criticism of the Barnet administration, it is in the enthusiasm with which they embrace the status quo. They have used it to drive spending down in Barnet to the point where they boast about being one of the lowest spending councils in the country, and by a long way.

    The Guidance and Regulations must change. They must make Independent Living the standard of wellbeing for all, require councils to deliver the spirit and letter of the Care Act, to report on unmet needs and require central and local Government to do all in their power to secure the resources required to minimise, if not eliminate, unmet need.  Local authority social care practices will need to be re-purposed  top to bottom. I believe these changes would comprise the ‘concrete steps’ toward ‘progressive realisation’ the UN expects. The UN gave a damning verdict of the UK’s delivery of Independent Living in 2017.

    With real co-production at the heart of needs assessments, as proposed in this new model, we might achieve better health and wellbeing outcomes which will actually save money in the long-term.

    And in the process the narrative will cease to be the dead end of how much money ‘social care’ requires. It attracts little enduring public sympathy. We should promote equivalence in the public mind between best possible wellbeing, which social care delivers, and best possible health of mind and body, which the NHS delivers.

    So, given that ‘adopting into English Law Articles from the UN Convention’ potentially includes changes to the secondary legislation to bring the Care Act to life, I fervently hope the SHA/KONP campaign has the greatest possible impact.

     

    Comments Off on MAKING INDEPENDENT LIVING THE DRIVING VISION FOR SOCIAL CARE

    This is SHA’s response to NHSE’s consultation on putting ICSs on a statutory footing. It is a curation of the generous and thoughtful comments of many members. Please forward to as many of your groups and networks as possible.

     THE SOCIALIST HEALTH ASSOCIATION’S RESPONSE TO “INTEGRATING CARE –

    Next steps to building strong and effective integrated care systems across England”

    WHAT SHA WANTS TO SEE

    A cooperative and democratic health and care system, fully funded through general taxation, free at the point of use, that eliminates the privatisation of clinical services.

     SHA cannot support these proposals.

    RESPONSES TO QUESTIONS

    Q. Do you agree that giving ICSs a statutory footing from 2022, alongside other legislative proposals, provides the right foundation for the NHS over the next decade?
    SHA does not agree. Our many reasons are explained below.

    Q. Do you agree that option 2 offers a model that provides greater incentive for collaboration alongside clarity of accountability across systems, to Parliament and most importantly, to patients?
    SHA does not have a view on this.

    Q. Do you agree that, other than mandatory participation of NHS bodies and Local Authorities, membership should be sufficiently permissive to allow systems to shape their own governance arrangements to best suit their populations needs?
    There need to be national standards, locally delivered, matched to the needs of an area. Please see SHA’s thinking on NHS democracy.

    Q.Do you agree, subject to appropriate safeguards and where appropriate, that services currently commissioned by NHSE should be either transferred or delegated to ICS bodies?

    NHSE, if it continues to exist, should plan for those requirements that are best planned at national level. These could include rare diseases and specialist services.

     SHA’s REASONS FOR REJECTING THE PROPOSALS.

    Based around place

    SHA supports the idea of services based on an area, reflecting the needs of that place. However, this document leaves place ill-defined.

    Relationships with Local Authorities

    There is poor legislative alignment of responsibilities of Local Authorities (LAs) and ICSs.  This is an issue particularly with reference to Public Contract Regulations 2015, which will still apply to Local Authorities and could increase the regulatory burden on local government, create barriers to joint planning arrangements, or result in inappropriate planning via an NHS channel as discussed elsewhere.[i]

    Interactions with local government are alluded to but only vaguely described.  For example, the document states ‘[the proposals] will in many areas provide an opportunity to align decision-making with local government’ [our emphasis]. This is very weak. How will ICS’s that do not align geographically with local authorities function in this respect?  There is a clear risk that such multi-authority ICSs will drive a ‘one-size-fits-all’ approach across diverse communities and geographies in direct opposition to the stated aims of ‘decisions taken closer to the communities’ [para 1.9].

    Overall, it looks as though this is not a collaboration of equals. An ICS as described would be led by the NHS and the LA would be very much a secondary partner. The SHA would like to see a bigger and more equitable role for LAs.

    Devolution

    The statements on devolution such as at 1.11 can be applauded but the reality we know is that since 2011 the NHS has become more centralised. There needs to be more concrete proposals on how this devolution will occur. The mandatory nature of the proposals is a concern and there should be more local discretion within National Care Frameworks and oversight.

    Governance

    Clauses 1.12 and 1.15 are good clear summaries of what the ICS should do and provide. However, 1.16 on page 7 states that primary care, community health and mental health services, social care and support, community diagnostics, urgent and emergency care will be working together with other public or voluntary services Including those providing skills training, assistance into employment, and housing. But no consistent mechanism, structure, governance, regulatory, or accountability framework is defined for this.

    Strategic commissioning/planning (P2, third bullet point) requires the resources of a CCG and of a CSU, but the proposal appears to leave the CSU as a separate organisation (see P24, 2.68) outside of the ICS. No explanation is given for why this is better. Our view is that the CSUs were created outside of the NHS to provide a first landing place in the UK for US insurers who failed to take up the challenge. The most cost-effective route to back office services and business intelligence would be to bring them back into the NHS as shared services operations.

    These clauses do nothing to strengthen the requirement for probity in contracting and appointment procedures made scandalously apparent through court actions presently being pursued in the wake of inappropriate commissioning during Covid.

    There are poorly delineated internal and external accountability processes. As others have noted[ii], [iii] this is a consequence of a lack of precision regarding the function, roles and relationships of ICS. These issues should be clarified.

    There is insufficient detail regarding the openness and transparency of appointments, decision-making and data sharing by ICS and the role of independent sector (IS) organisations in ICSs. While we note that the Government considered ‘it likely that statutory organisations will hold the ICP Contracts’. [iv] Our understanding is that ‘accredited’ companies can be brought in to draw up policies and make service decisions within ICSs. These services could include:

      • Enterprise-wide Electronic Patient Records Systems – for Acute & Community and for Mental Health Hospitals
      • Local health and care record strategy and implementation support and infrastructure
      • ICT infrastructure support and strategic ICT services
      • Informatics, analytics, digital tools to support system planning, assurance and evaluation
      • Informatics, analytics, digital tools to support care coordination, risk stratification and decision support
      • Transformation and change support
      • Patient empowerment and activation
      • Demand management and capacity planning support
      • System assurance support
      • Medicines optimisation

    The role of independent sector organizations in this context must be more clearly defined and regulated, and subject to governance appropriate to a public body. Where possible the NHS should provide such services and/or be empowered to provide any such expertise. We do not agree with private companies being brought in as decision makers. They are bound by law to maximise shareholder profit, not to provide a public service.

    In addition, the document does not address the potential difficulties arising from the requirement on ICS organisations to comply with various competition rules, such as not sharing commercial sensitive information or fixing prices.  For multi-site ICS providers, this presents a system risk in terms of having to share patient and staff data or information with other organisations.  In general, insufficient attention is given to issues around sharing personal health information by ICSs.

    Guidance should be also clearer on the overriding importance of transparency in ICSs decision making. Efforts should be made to limit the use of ‘commercially sensitivity’ as a spurious justification for subverting transparency.

    There is insufficient consideration of potential conflicts of interest within the proposed ICS (e.g. between providers and commissioners, or between public, voluntary, and commercial partners) and how these can be prevented or mitigated. Notably it has been suggested that providers will be able to influence allocations via the ICS partnership board, and there is a credible concern that ‘bigger players’ will skew funding decisions.[v]

    Governance and PCNs

    1.17 mentions PCNs but the regulatory framework through OfSted for children’s services, CQC, NHSE/I, is currently not fit for purpose because it is overlapping and contradictory. There is no governance framework at the moment for PCN collaborations with community and mental health Trusts, and accountability is difficult to pin down.

    Data

    The paper promises to invest in the infrastructure needed to deliver on the transformation plan. This will include shared contracts and platforms to increase resiliency, digitise operational services and create efficiencies, from shared data centres to common EPRs.

    Digital is essential to the current and future NHS. SHA warns against the vaunted flexibility of the transformation plan allowing personal data to be misused by commercial interests even more than it is now. SHA also warns against services rushing into digital solutions without adequate evaluation and without enabling non-digital solutions for those who still require them.

    Health Creation is not mentioned in this paper.

    SHA supports the concept of Health Creation. That is the process of bringing people in contact with each other, building confidence and thereby enabling communities to take more control of their area and their health and care.

    An option we would like to see would be mandating 1% of a PCN’s budget to community strengthening – population Health Creation

    Population health, but almost no mention of Health Inequalities

    There needs to be a clear vision of the metrics of “population health” especially if this it to be the main outcome or “productivity” upon which the NHS and its partners is being judged. The consultation  paper seems silent both  on what these metrics are and on what role the NHS is to play in delivering that outcome. For example, is the metric of population health a pre-determined blend of longevity and the quality of life delivered?  To what extent is managing the ” social determinants of health” to be allied with the NHS as opposed to being the task of wider government and indeed others?

    “Integrating Care” does not really explain “population health”, but the HSSF is more explicit:

    “Population Health Management is an approach aimed at improving the health of an

    entire population and improves population health by data driven planning and delivery

    of care to achieve maximum impact for the population.”

    Any concept of patients and staff planning and evaluating the service, which will involve decisions on what to prioritise, is absent. Instead, the HSSF accredits corporations to support an ICS in taking such decisions. We should propose a 5th principle on the necessary need to involve patients in these arrangements. There is good evidence that such effective engagements lead to better services.

    In practice the emphasis on the role of Foundation Trusts and clinician-leadership is likely to prioritise clinical service provision, whether primary or secondary care, with limited focus on prevention and population health. This is an inherent structural weakness of the ICS model as currently specified.

    SHA cannot support ICSs without a far clearer commitment to tackling health inequalities through tackling the wider determinants of health and working closely with LAs, housing and other key partners. The document states that greater co-ordination between providers at scale can support… ‘reduction of health inequalities, with fair and equal access across sites;’. It is not clear how this follows as no mechanism linking these two is articulated. Vague commitments as outlined in the document are inadequate to address this persistent and worsening problem. Specific goals and mechanisms for reducing health inequalities should be explicit in the proposals.

    Single pot for finance and the legislative proposals
    On the face of it, a single pot (2.40), linked with reducing the importance of competition seems like a significant step forward and a more equitable and efficient approach to funding. SHA is supportive to the extent that these proposals reduce the contract negotiation and monitoring which is so wasteful of time and effort in the NHS, with savings in overhead costs and improvement in services designed by providers aiming at better outcomes, not by commissioners principally aiming to reduce expenditure. There must be appropriate risk sharing because of the danger that an individual ICS could be destabilised by unforeseen and one off events.

    It is not clear how this single pot will be spent, assuring fairness, value for money, quality.

    At 2.47 there is a limited mention of capital. There is no mention in the document of NHS Property Services or Community Health Partnerships or the NHS Estate. This is a major weaknesses in the proposals.

    Taken together with “Integrating Care”, this makes clear that fixed payment to secondary care providers must conform to the ICS system plan. Initially , the fixed payment would be based on the current block payments under the heading of COVID-19, which make up the majority of current CCG budgets. Fixed payments will be determined locally. While national tariffs will no longer apply in general, they may be retained for diagnostic imaging, a highly privatised sector. Some elective activity, again involving the private sector, will also be exempt from blended payment. In other words, private sector suppliers of clinical services will be protected from any local cost reductions.

    However, we also see impossible control totals which will make investing and innovation extremely difficult and constrain ICSs for the future. In effect, this continues austerity. We want to see comprehensive funding for an expanding, publicly funded NHS.

    Allusion is frequently made to anticipated cost savings and efficiency improvements [paras 1.8, 1.9, 2.22, 2.46, 2.51] but it is unlikely that these will be realised in the short-term and short-term costs may even increase.[vi] Evidence from similar interventions in the UK and other countries provides at best equivocal evidence for longer-term improvements in efficiency.[vii], [viii], [ix] Quality rather than cost-savings should be the primary driver of any reorganisation.

    There are other concerns SHA has in respect of the apparent relaxation of privatisation.

    All clinical services should be retained in house and fall under a re-instated duty of the Secretary of State for Health to PROVIDE such services.

    Providers will still be able to use the private sector. There are contracts now through NHS Shared Business Services which appear to require no formal tendering.

    Beware of cementing existing privatisation. This can happen through sub-contracting as above and by current private sector providers expanding through what ever contracting process there may be. The most likely beneficiary is likely to be the privatisation of mental health services through the Priory and similar organisations.

    Backroom functions will continue to be privatised.

    “Integrating Care” never mentions “private”, “independent sector” or “third sector”. The document

    uses a new codeword, namely ‘others’. This suggests that NHSE fully expects the private sector to play a most important part in the future, including for clinical services. (NHSE/I “Integrating Care” KONP)

    Covid has shown us, if we needed showing, that a truly nationalised health and social care service is needed and vital, with the advantages of national estate agility, workforce planning, driven by a national public health strategy to invest in the social care infrastructure of the national economy, whilst local partnerships freed of wasteful market practices are responsible for local delivery and can be locally accountable.

    Staff

    Whilst the fixed payment would be determined locally, neither “Integrating Care” nor

    “Developing the payment system” refer to national agreements on wages, terms and conditions.

    The SHA is very concerned that, despite papers on responding to the staffing problems, we have not seen any recommendations for comprehensive staffing programmes that support pay justice and adequately protect workers.

    Despite discussion emphasizing the key role of the workforce in effecting these changes, mechanisms to allow direct representation of workers or their trade union spokespersons on ICS are entirely lacking in the proposals.

    Any proposal for ICSs should make explicit commitments to ensuring that all workers receive the National Living Wage (and preferably the real Living Wage) whether they are employed by the NHS or by subcontractors to ICSs. ICSs should commit to abolition of zero hours contracts in all its activities.

    Democracy

    Despite frequent criticism of ICSs as being distant from communities and undemocratic (as indeed is the NHS as a whole), this paper gives little confidence for any significant democratic change. Healthwatch is not sufficient, too health focused and with too few teeth.

    SHA would like to see financial transparency, accountable to communities. SHA would like to see ICSs exploring the opportunities for participatory democracy – such as community development, citizens forums, coproduction networks.

    “Current ICS arrangements are outrageously disconnected not only from real democratic structures but also from real centres of identity and community. They are administratively defined and they are under the control of officers who are not accountable to local people.

    What I would like to see is NHS Sheffield accountable to the local people of Sheffield (and likewise for other communities). It is totally inappropriate to leave accountability and governance of supposedly statutory bodies open to development and interpretation by officers of the ICS. All the assets of the ICS should be treated as public assets, especially all the capital assets and these must all be put under local (not national) control.” Duffy, SHA member

    With many thanks to all those SHA members who generously contributed to this response.

    We have also drawn on documents from Keep Our NHS Public and the Local Government Association.

    [i] Integrating care: Next steps to building strong and effective integrated care systems. Local Government Association (https://www.local.gov.uk/parliament/briefings-and-responses/integrating-care-next-steps-building-strong-and-effective accessed 23/12/20)

    [ii] Delivering together: Developing effective accountability in integrated care systems. NHS Confederation/Solace (https://www.nhsconfed.org/-/media/Confederation/Files/Publications/Delivering-together-FNL.pdf accessed 22/12/20)

    [iii] Integrated care systems (ICSs) (https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/integration/integrated-care-systems-icss accessed 24/23/20)

    [iv] Government response to the recommendations of the Health and Social Care Committee’s inquiry into ‘Integrated care: organisations, partnerships and systems’ Cm 9695 (https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiJw-_Dt-ztAhWkoVwKHXuRAkIQFjAAegQIARAC&url=https%3A%2F%2Fwww.gov.uk%2Fgovernment%2Fpublications%2Fgovernment-response-to-the-health-and-social-care-committees-report-on-integrated-care&usg=AOvVaw2k1pzGscqk30BYEL_QbNJt accessed 26/12/20)

    [v] On the day briefing: Integrating care, NHS England and NHS Improvement. NHSProviders 26 November 2020 (https://nhsproviders.org/media/690689/201126-nhs-providers-on-the-day-briefing-integrating-care.pdf accessed 26/12/20)

    [vi] House of Commons Health and Social Care Committee Integrated care: organisations, partnerships and systems Seventh Report of Session 2017–19 (https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjb-oSstuztAhUNYsAKHabDDoYQFjAAegQIBBAC&url=https%3A%2F%2Fpublications.parliament.uk%2Fpa%2Fcm201719%2Fcmselect%2Fcmhealth%2F650%2F650.pdf%3Futm_source%3DThe%2520King%2527s%2520Fund%2520newsletters%2520%2528main%2520account%2529%26utm_medium%3Demail%26utm_campaign%3D9379676_NEWSL_ICB%25202018-06-13%26dm_i%3D21A8%2C5L1EK%2COYZ6AS%2CM5X8X%2C1&usg=AOvVaw0-ZVcp3j_Sh049yv9kdNTA accessed 26/12/20)

    [vii] John Lister, How Keep Our NHS Public should be campaigning on Integrated Care Systems. November 24 2020. (https://keepournhspublic.com/resources/how-keep-our-nhs-public-should-be-campaigning-on-integrated-care-systems/ accessed 26/12 20)

    [viii] Government response to the recommendations of the Health and Social Care Committee’s inquiry into ‘Integrated care: organisations, partnerships and systems’ Cm 9695 (https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiJw-_Dt-ztAhWkoVwKHXuRAkIQFjAAegQIARAC&url=https%3A%2F%2Fwww.gov.uk%2Fgovernment%2Fpublications%2Fgovernment-response-to-the-health-and-social-care-committees-report-on-integrated-care&usg=AOvVaw2k1pzGscqk30BYEL_QbNJt accessed 26/12/20)

    [ix] Scobie S (2019) ‘Are patients benefitting from better integrated care?’, QualityWatch blog. Nuffield Trust and Health Foundation. (www.nuffieldtrust.org.uk/news-item/are-patients-benefiting-from-better-integrated-care accessed 26/12/20)

    SOCIALIST HEALTH ASSOCIATION RESPONSE TO ICS CONSULTATION 7 1 21

    2 Comments

    This week North West council leaders and MPs wrote to the Chancellor asking him to set out plans for what comes next once this lockdown is over. We have been through so much change and uncertainty we deserve to know what lies ahead so we can plan.

    Today, Sunak announced that the furlough scheme will continue at 80% until March. We succeeded in pushing him to give workers what they deserve, not the 13% less that he thought the North was worth.

    This is what we can achieve when we work together and hold the government to account.

    Posted by Jean Hardiman Smith on behalf of Team North West

    Comments Off on Update from Labour Team North West

    What Impact Will the Second National Covid-19 Lockdown Have On Reducing Covid-19 Deaths?

    This of course must be one of the key questions. Seemingly no-one wants to predict a future lockdown-induced death rate figure. It’s probable that the Covid-19 death rate will not fall in November 2020 as those about to die will already be infected, unwell and in hospital. Some have estimated that the lockdown might cut down the Covid-19 infection rate by up to 75%. But with hospitals filling up with Covid-19, patients needing care for cancer, strokes and heart attacks might have their treatment delayed or cancelled resulting in an increase in non-Covid-19 deaths.

    The exact nature of the lockdown is being disputed by some. Schools do seem to be a breeding ground for spreading infection. In Ealing of the 98 state-funded schools 70 of them have Covid-19 cases. Is keeping the schools open such a clever thing to do? Most pubs and restaurants have invested money, time and continuing efforts in making their facilities compliant with Covid-19 restriction. There is scant evidence that they are prime areas for Covid-19 spreading. Closing them all down for at least a month could finally finish off those businesses that don’t own their properties, and will damage the ‘social’ health of their customers.

    There are, of course, increasingly alternative voices who are saying that the lockdown will not save lives but just delay Covid-19 deaths. This lockdown could go on for months, and might be followed by a series of lockdowns – until a successful vaccine is universally available. This would destroy the economy and create huge financial, employment, social, housing, mental health and physical health problems. NHS services would be decimated.

    The lockdown might be buying us time – but at what cost?

    MENTAL HEALTH

    £400 Million Announced to Revamp Mental Health Facilities

    This initiative is aimed at replacing ‘dormitories’ with en-suite rooms. 21 NHS mental health Trusts have apparently been identified to receive the first tranche of grant funding. Sadly the two NHS North West London mental health Trusts are not on this list.

    Also, of the 40 ‘new’ NHS hospitals recently announced by Prime Minister Johnson only two of them will be mental health facilities.

    £250 Million committed to Introducing Mental Health Support in Schools by 2023

    The targets are to cover 25% of England (1.5 million children) by 2023 and for CAMHS to see 345,000 young people by 2023/24. (CAMHS stands for Child and Adolescent Mental Health Services).

    2016 to Date the English NHS Mental Health Workforce has Increased by 13,860

    So said Claire Murdoch at the 20 October 2020 Health and Social Care Select Committee meeting. She ought to know as she is the NHS England (NSHE) Mental Health Director. If you find that figure hard to believe, what is more believable is the number of the extra mental health staff she thinks are needed by 2023. It’s 20,000. This would cast £2.3 billion – if the staff could actually be found.

    NHSE Announces £15 Million Mental Health Support for Covid-19 Nurses and Support Staff

    Claire Murdoch again rather coyly adds that in order to supply the service ‘we will be working with another provider’. Presumably what she means is a private company.

    Mental Health ‘999’ Police Call Outs Up by 41% in Five Years in England

    After years of the Police saying how inappropriate it is for them to deal with the mentally ill, answers to a Freedom of Information request have revealed 301,1444 reported incidents in 2019. In 2015 the figure was 213,513. The biggest increases were in Wiltshire and Lancashire.

    The Royal College of Psychiatrists disclosed in October 2020 that 40% of those waiting for mental health support ended up seeking help from emergency and crisis services.

    NHS Test and Trace

    If it wasn’t so tragic it might be amusing. Just how much longer can Baroness Harding hang on as NHS Test and Trace boss? On 27 October 2020 ‘The Independent’ reported that the Sitel software is clearly not that robust. On Sunday 25 October there was a system fault which resulted in Covid-19 cases not being scheduled for clinical assessment and contact tracing. The fault was still in play on the following day.

    In order for a test and trace operation to be successful 80% of identified close contacts need to be contacted and told to self-isolate. Performance figures released on 22 October 2020 show NHS Test and Trace is attaining 59.6%. The Government claims 300,000 Covid-19 tests are taking place daily and that daily figure will soon reach 500,000. Even if we all believe these figures, what’s the point if 80%+ timely contact tracing and self-isolation isn’t happening?

    Only 15.1% of those tested received test results within 24 hours. In June 2020 Prime Minister Johnson said he wanted 100% test results within 24 hours. 7.1 % of those tested were found to be Covid-19 positive – the highest figure yet.

    Seemingly one of the Government’s approaches to problem solving is to throw much more money at the problem. Briefly an advertisement lingered in the public domain searching for a new boss to ’deliver Trace operations’. The recruitment agency Quast’s advertisement stated its client (DHSC)  was offering £2,000/day (£520,000/year?)

    ‘The Guardian’ on 28 October 2020 revealed that 18 year olds with no clinical experience or knowledge are now working as ‘skilled contact tracers’ for Serco. They were recently ‘upskilled’ to perform this role. They are all being paid minimum wage of £6.45/hour. Whistle blowers have reported unskilled teenagers in tears and having panic attacks as they struggle to perform tasks such as like public health risk assessments.

    Professor Allyson Pollock has yet again exposed one of the key failings of the NHS Test and Trace undertaking. This was the Government’s decision to take testing out of public health services and Local Authorities. This overlooked the importance of clinical input, clinical oversight, clinical integration and statutory disease notification.

    NHS North West London (NWL) Finally Persuades West London CCG to Join the Single Regional CCG 

    ‘Health Service Journal’ has reported that although GPs in Kensington, Chelsea and Westminster voted against the merger of local CCGS in September 2020, in October 2020 they changed their minds. The NWL CCG will be the largest in England with 2.5 million patients and a 2020/21 budget of £4.2 billion. By April 2021 there will be just 5 CCGs in London. In 2019 there were 32 CCGs.

    Discover What the Covid-19 Infection Rate is in Your Neighbourhood

    Just type in your post code at:

    https://coronavirus-staging.data.go.uk

    To give you an idea of the range of rates throughout England, Blackburn with Darwen is one of the highest at 752.5/100,000 people and the lowest includes Somerset Wilton at 44.9/100,000.

    Eric Leach

    Comments Off on Our NHS in Crisis Issue: 110

    The Local Government Association, on behalf the broad leadership of the social care sector including the Association of Directors of Social Services, has published a set of 7 principles to guide the future of adult social care post Covid. But they show the sector’s leadership continuing to be high on rhetoric, but empty on substance. They are bankrupt of ideas to make the rhetoric a reality.

    The 7 principles talk, for the umpteenth time, of social care needing to be based on ‘what works for people, not what works for systems or structures’. They seek to emulate the person centredness that makes the NHS so valued by the public. People trust that when they present symptoms to an NHS clinician the diagnosis and treatment will be based solely on the clinician’s knowledge of what is wrong and what is possible. It would not even occur to the person that the determination of their diagnosis and decisions about the treatment options will be referred upward to a manager, least of all to a manager whose primary task is to manage the budget.

    But, for reasons set out in my recent blog, this is exactly what happens in social care. At the individual level, while need precedes resources in health care, resource precedes need in social care. It’s an arrangement that serves very well the political expedients of keeping spend precisely to budget while denying the existence of any funding gap. The sector’s leadership, sadly and only too willingly, obliges.

    So sector leaders are left yet again repeating mantras with a long record of failure. The history is lamentable.

    Following the failure of the Community Care strategy of the 1990’s to make social care ‘needs led’, the personalisation strategy was launched in 2008 with personal budgets the centre piece. ‘Up-front’ allocations of money would empower service users to purchase their own support package, the ultimate in person centredness. Bu it quickly became apparent that up-front allocations would not happen. Completely impracticable and ignored by the Care Act ‘up-front’ allocations became ‘indicative’ only and thus tokenistic. In 2012, Think Local Act Personal, the organisation charged by Government with leading implementation of the strategy, issued a series on exhortations to practitioners and councils under the banner Making It Real.

    The irony in the implicit message that personal budgets had completely failed to ‘make it real’ was lost on the sector’s leaders. Inevitably, Making It Real had no impact. TLAP duly issued a second iteration of Making It Real in 2018. It too has had no impact. And so to the present and the 7 principles amount to yet a third exhortation to ‘make it real’.

    Exhortations to practitioners and councils to deliver ‘what works for people’ are hopeless in the face of underlying, powerful systemic forces that ensure the system’s priority is to work to sustain itself.

    What of the future for social care – integration with the NHS?

    It’s hard to imagine anyone taking the analysis and remedies of sector leaders seriously. This is not just because of the self harm in exposing the bankruptcy in their own ideas. Covid’s exposure of the impoverishment of social care invites questions of the leadership Councils have provided over the decades. Is it really just about government under-funding? How soon, if not already, before Councils are seen as a busted flush?

    Signs are pointing to integration with the NHS as the political solution. But with social care in its present state, that would be a disaster for both services and the older and disabled people who rely on them. The NHS is at its best delivering clinical care to deliver best possible health. When it moves beyond that into care, its record is even more lamentable than that of local authorities. The bureaucratic opaqueness and gross inequity of Continuing Health Care bears witness to that. A weak and unreformed social care service risks being reduced to little more than a servant to health objectives. This would sound the death knell of the ambition of social care to be the driver of our older and disabled citizens being supported to lead the fulfilling and dignified lives they are capable of.

     

    Colin Slasberg – former Assistant Director of Social Care and Independent Consultant in Social Care.

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    The threat to cut health visitor and community nurse jobs in County Durham, while Covid-19 is still widespread, has been branded as ‘incomprehensible’ by Unite, Britain and Ireland’s largest union, today (Friday 24 July).

    Harrogate and District NHS Foundation Trust (HDFT), which is taking over the County Durham 0-25 family health service contract from 1 September, wants to axe about 37 whole time equivalents (WTEs), while the coronavirus is still widespread across the country.

    Although the HDFT also says it wants to employ 21 WTE new posts, there will be a net loss of 16 WTEs out of a workforce of about 230 WTEs.

    Unite lead officer for health in the north east Chris Daly said: “It is almost incomprehensible that when ‘public health’ is foremost in people’s minds because of coronavirus, Harrogate and District NHS Foundation Trust is swinging the jobs axe.

    “The vast majority of those being earmarked to lose their jobs are health visitors and school nurses – the very professionals at the public health frontline helping families with babies and young children, and children returning to school.

    “Disgracefully, the trust is consulting when staff, have been working flat-out throughout the Covid-19 crisis supporting very stressed families and young people. This flawed exercise is happening before the first wave of the pandemic is over and with the expectation that a second wave will hit this autumn and winter.

    “It is also very wrong that schools and GPs have not been told about the proposed cuts in school nurses. School staff returning in September will be phoning school nurses to come and help with children that they have not seen since March and who may be exhibiting worrying behaviours and dealing with distressing emotions.

    “We believe that already stretched GPs will be expected to pick up the shortfall in keeping babies, children and young people safe. However, there is a real risk that those most at risk may fall through the current safety net that HDFT seems intent on weakening.

    “This is not the time to reduce the health and school nurse provision for children and young people. However, it will be some time before the adverse impact of these cuts are brought into sharp relief.

    “The Durham country council should work with the trust to increase the funding for these essential frontline services. The long-term health of families is never enhanced by reducing the number of healthcare professionals.”

    Unite, which embraces the Community Practitioners’ and Health Visitors’ Association (CPHVA), will be making strong representations on behalf of its members before the consultation process ends on 31 July.

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    The late 1980s and the early 1990s was a time when the HIV and AIDS pandemic was in the news and high on the political agenda.

    Professor Virginia Berridge, Director of the Centre for History in Public Health and author of AIDS in the UK, gives us this accurate and succinct historical context:

    An expert advisory group on AIDS (EAGA) had been set up in 1985 in the Department of Health with input from clinicians and scientists involved. The Chief Medical Officer, the main public health government official, Sir Donald Acheson, led the group. Despite the level of expertise, the committee faced many problems. They included the attitude of sections of the press, which called for a punitive response to HIV/AIDS. An initial lack of political interest and the danger that, if political interest were awakened, the Conservative government led by Prime Minister Margaret Thatcher might take a punitive stance. Issues such as segregation and quarantine were freely talked about.

    In 1986, a sense of national emergency materialised, and developed high-level political interest on the subject. A Cabinet committee on AIDS was set up, a major health education campaign was initiated, funds were released for research, and the main health education body, the Health Education Council, was reformed as the Health Education Authority. Despite this progress, there were still powerful calls for a punitive approach, such as when the Chief Constable of Greater Manchester, James Anderton, spoke of people ‘swirling in a human cesspit of their own making’. However, the general tenor of the government response was pragmatic – focussing on safe sex rather than no sex, and safer drug use rather than no drug use. This liberal response was influential at the international level too and was promoted through AIDS specific organisations set up as part of the World Health Organisation (WHO) and the United Nations (UN).

    Source https://commons.wikimedia.org/wiki/Category:Epidemiology_of_HIV/AIDS

    In South East London, the local HIV groups were formed in response to the direct experiences of people who faced barriers accessing health and social care. These specialist organisations included the Positive Place in Deptford – which started in an office in Sydenham where Cllr Alan Hall was a volunteer.

    Sydenham is a very interesting area. Geographically it is on a hill which has a ridge with its apex at Crystal Palace. Crystal Palace is the place where five local authorities meet – the boundaries of London Boroughs of Bromley, Croydon, Lambeth, Lewisham and Southwark.

    Locally, social services are provided by Councils and health services were overseen by regional health authorities at this time. The provision of HIV services were very variable and much of the work and support was provided by specialist sexual health clinics at the major London teaching hospitals. Hospital social work could provide some support but the end of life care and care at home fell to the patients’ home local authority.

    By 1991 the Government had put in place a ringfenced Government Grant called the AIDS Support Grant (ASG) – this was to recognise the additional resources needed to provide services for people with AIDS.

    AIMS OF THE GRANT SCHEME

    To enable Social Services Departments to draw up strategic plans, based on local population
    needs assessments, for commissioning social care for people with HIV/AIDS; and to enable Social Services Departments to finance the provision of social care for people with HIV/AIDS, and where appropriate, their partners, carers and families.
    The grant is to assist local authorities with the costs of providing HIV related personal social services.

    At the Positive Place – then in Sydenham – we became aware that people with HIV were having problem accessing social services in Bromley. There were general comments and complaints in the other neighbouring boroughs however, in Bromley people were routinely refused a social service.

    After extensive enquiries and local research, a meeting with Bromley Social Services Committee Councillors was arranged and a briefing document produced. Richard Cowie, the Clinical Nurse Specialist for South East London Health Authority, David Thomas a Trustee of the Postive Place which had established as a centre for people with HIV in SE London based in Deptford – joined Alan Hall who had become a member of the Bromley Community Health Council and set up Bromley Positive Support Group in Beckenham.

    The first section is instructive it is called: NO AIDS HERE

    “The first response to deny HIV services is that there is ‘no demand’ for them. In effect, this means no AIDS in Bromley. In 1992 this was the reason used by the London Borough of Bromley for not applying for AIDS Support Grant. Every District Health Authority must submit returns regarding the number of HIV infections and AIDS related deaths yearly and much more detailed information under the provision of the AIDS (Control) Act 1987.”

    “The figures are collated in a technical manner and require considerable caution interpretating them. However the latest report for Bromley (1993/4) shows that there are ’48 people living with HIV infection and 2 babies of indeterminate status’.

    “It is accepted that this is an underestimate. This includes people who attend Bromley Hospitals or services. It does not include all the people attending specialist centres of excellence, eg Middlesex Hospital, King’s College Hospital, St Thomas’ Hospital, Chelsea & Westminster….of which we know there are several cases. We estimate that there are at least 60 cases – this does not include their families, partners or carers. The no AIDS in Bromley is a myth. Indeed, the Department of Health classifies Bromley as a “moderate” prevelance area.”

    “Frequently, AIDS in Bromley has been dismissed as a small number of cases, insignificant. This is a favourite argument of Cllr Cooke. Clearly, 60 people with HIV plus their families is not a small number. Contrast this with the number of people receiving intensive personal care – this is in the order of 70 people.”

    The conclusion of the document states: “All of the myths, I am sure you will find have their root in prejudice and bigotry.”

    Whilst the Positive Place was in Sydenham the local MP, Jim Dowd agreed to ask a Parliamentary Question. This question revealed that Bromley Council had failed to apply for its indicative allocation of AIDS Support Grant in 1992-3.

    Hansard records the written parliamentary question on 14th January 1993:

    AIDS
    Mr. Dowd : To ask the Secretary of State for Health (Virginia Bottomley)

    (1) on what date the London borough of Bromley applied for AIDS support grant for the current financial year ; and what efforts have been made by her Department to urge Bromley to apply for it ;

    (2) what amount of AIDS support grant was allocated to each local authority in each year since 1990-91 :

    (3) what extra costs she estimates to have been incurred by neighbouring boroughs obliged to deal with HIV/AIDS cases turned away by Bromley social services department ; and what steps she proposes to take to recompense the neighbouring boroughs ;

    (4) by what date London boroughs should apply for the AIDS support grant for 1993-94 ; and what steps she will take to ensure that the London borough of Bromley applies for the grant on time ;

    (5) how many people in each London borough have died from AIDS :

    (6) how many cases of HIV have been reported in the borough of Bromley in each year for which figures are available.

    The Minister for Health, Tom Sackville, MP replied:

    Mr. Sackville : In December 1991 the Department issued a circular (LAC(91)22) inviting all social services departments in England to bid for extra resources for HIV and AIDS services in 1992-93 under the AIDS support grant scheme. Criteria for bids under this scheme are set out in the circular. Copies are available in the Library. The closing date for bids was 7 February 1992. The London borough of Bromley submitted an application in November 1992 although not in the form and detail set out in departmental guidance. By that time AIDS support grant moneys had been fully committed. The Department was, therefore, unable to allow Bromley’s bid to proceed. Although not in receipt of AIDS support grant money in 1992 -93, we understand that the London borough of Bromley plans to spend £15,000 on HIV and AIDS services in the current year. We have no information to suggest that the borough has been compelled to turn away people affected by HIV.

    For 1992-93 local authority social services departments will again be invited to apply for an AIDS support grant allocation. The closing date for applications will be 8 February 1993. It will, of course, be open to the London borough of Bromley to bid for funds under this scheme.

    Information on the number of HIV and AIDS cases reported in individual boroughs and of deaths is not held centrally.

    The table shows the AIDS support grant allocations which have been awarded since 1990-91 for a full list in England see Hansard.

    Allocations for Individual Authorities in London are shown.

     

    London Borough Grant 1990-1 Grant 1991-2 Grant 1992-3
    Camden 471,000 489,840 730,000
    Hammersmith 1,003,359 1,042,000 1,300,000
    Kensington 627,500 652,600 970,000
    Lambeth 551,000 573,040 930,000
    Westminster 625,000 650,000 940,000
    Brent 290,000 290,000 400,000
    Ealing 250,000 260,000 290,000
    Greenwich 136,280 136,280 190,000
    Hackney 322,500 335,400 460,000
    Haringey 357,500 371,800 500,000
    Hounslow 231,250 240,500 320,000
    Islington 235,000 244,400 360,000
    Lewisham 163,750 170,300 240,000
    Richmond 135,000 140,400 200,000
    Southwark 215,000 215,000 300,000
    Tower Hamlets 309,000 321,300 481,000
    Wandsworth 165,122 120,152 188,000
    Barking 14,000 17,173 32,236
    Barnet NIL 26,000 40,000
    Bexley 25,000 26,000 46,000
    Bromley 8,500 9,520 NIL
    City of London 25,000 26,000 47,000
    Croydon 24,500 30,000 49,000
    Enfield 14,938 16,702 50,000
    Harrow 25,000 26,000 42,000
    Havering Nil Nil Nil
    Hillingdon 23,207 35,000 120,000
    Kingston 25,000 26,000 64,000
    Merton 14,000 17,178 66,000
    Newham 72,500 110,000 250,000
    Sutton 22,260 30,000 57,000
    Waltham Forest 70,000 90,000 135,000

    The Boroughs are listed in prevalence order and grant awarded

    Alan Hall followed up the lack of funding and more importantly, the lack of a strategy in 1993. On 11th October he received the following reply from Baroness Cumberlege, Parliamentary Under Secretary of State for Health in the Lords, this said: “The Department is aware that there has been an absence of a clear HIV/AIDS strategy in Bromley and has been monitoring the situation.”

    If the Government were aware, why didn’t they act?

    Perhaps, we will never know the answer to that. But the refusal of Bromley Council’s social services Committee members to allocate funding and support proposals for a change in direction led to protest.

    The community activists in Outrage knew that Bromley Council were resisting change and they decided to mount a protest. Activists enetered the Council Chamber, chanting and holding placards. Labour and Liberal Democrat Councillors stayed in the Chamber whilst shocked tories walked out. The photograph below was taken by the acclaimed photographer, Gordon Rainsford.

     

     

    Outrage in the Bromley Council Chamber

    The Pink Paper carried a report of the protest with the headline: “Tory Mayor flees AIDS protesters in Bromley”.

    Outrage alleged that the Mayor of Bromley, Cllr Edgington attacked one of its members. This is particularly interesting as this is believed to be a counterclaim, when the Mayor of Bromley made a complaint to the Police that one of the protesters drank from his glass thereby assaulting him.

    The fifteen activists held a “die in” where they laid down in the Council Chamber and held tombstone shaped placards with slogans such as killed by Bromley neglect.

    In the press report, the case of a 28 year old man who was refused a home help and told to ‘try a private nursing home’ a day before he died is raised.

    Daniel Winchester a local resident said that Bromley Council had shown ‘contempt’ to the ill and dying over the last ten years of the pandemic.

    The independent voice of social workers – Community Care – carried an article on HIV and AIDS social service provision in March 1993 saying: “Bromley Social Services is behind with its HIV work. It’s bid for 1992-3 was late, so it did not benefit from the 50% increase and that there was great pressure to meet the standards for grant status.” In response a senior Bromley Council social services manager is quoted as saying: “Our services are pretty thin on the ground in this area.”

    Leaders in the social work profession at the time, believed that there were additional benefits with specialised HIV services as they were ground breaking and that they benefit other areas of social work like confidentiality and increasing good practice more generally.

     

    Outrage blow fog horns and whistles to get attention from Bromley Council

    website link:  https://alanhall.org.uk/2020/06/30/bromley-council-and-hiv-the-fight-for-social-services/

     

     

     

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    The long-running Lincolnshire health visitors’ dispute is coming to an end with a pay victory that sees the vast majority of the workforce being upgraded.
    Unite, Britain and Ireland’s largest union, today (Thursday 5 December) hailed the victory, which will see most of the union’s members move onto the grade 10 pay scale, as ‘highly significant’.
    Unite regional officer Steve Syson said: “Thanks to the tremendous solidarity that our members have shown since this dispute started in the summer, we have achieved a highly significant and welcome victory.
    “The health visitors’ determination against what they considered as a gross pay injustice was buttressed by the firm backing from the people of Lincolnshire and from supporters across the UK.”
    The dispute had centred on the council’s insistence on different contracts for grade 9 and grade 10 health visitors, while Unite has consistently argued that as all health visitors have the same qualifications they should be paid the same.
    The health visitors have now suspended their month-long strike action while the authority upgrades the health visitors; however, Unite reserves the right to reinstitute strike action if the council does not abide with the agreement. Besides the grade 10 job roles, the health visitors will receive between £2,000- £6,000 in a one-off transitional payment.
    More than 70 Unite health visitors voted for the month-long, now suspended, strike that started on 18 November. Of those, about 58 will now be fast tracked to the grade 10 posts with 16 further Agenda for Change (AfC) staff awaiting confirmation; about 13 have left or are departing to take up alternative employment within nursing, which leaves a handful of relatively new health visitors on grade 9.
    Unite pledged today that it would explore every avenue to get those still on grade 9 uplifted to grade 10 as soon as possible.
    Unite regional secretary for the East Midlands Paresh Patel added: “I think that a number of factors contributed to this positive outcome, including the fact that the council was, and even now, is continuing to lose highly skilled health visitors at the rate of knots, as our members are offered alternative roles elsewhere in recognition of their experience.
    “There was also the stark realisation by council bosses that our members were prepared to take further strike action on top of what they had already taken in the summer, after a second ballot confirmed they were prepared to continue on with further industrial action.
    “This victory should be seen in the context of a broader campaign for a fully-resourced health visiting service across England – that fight will continue across the country in 2020.”

    Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org
    Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.

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    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.

    1 Comment

    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.

    2 Comments

    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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