Blog

  • Categories
  • Category Archives: Manchester

    On Saturday July 4th, the day before the 72nd anniversary of the founding of the NHS – we demonstrated, jointly with Manchester Trade Union Council, with Unison, Unite and any other unions involved, with Keep Our NHS Public and with Health Campaigns Together (with PPE and social distancing) against the privatisation of the Department of Reproductive Medicine at St Mary’s Hospital Manchester.

    NEXT EVENT

    VIRTUAL PUBLIC MEETING: No privatisation of Manchester’s fertility service!
    Monday, 20 July 2020 from 19:00-20:30

    Details at the end of this article

    Women in the Labour Movement have been campaigning for at least 100 years on issues of maternal health and the right to choose whether and when to have children, and to use any technological advances that might make those choices easier, or even possible. From 1924 onwards the Women’s Labour League annually and unanimously supported birth control. The men in the Labour and Trade Union Movement were not always so unanimous, or so interested in the subject.

    In 1924 the first Labour Government was elected, and the League bombarded John Wheatley – the first Labour Minister of Health – with demands for improved health care in childbirth and after, and for the provision of free, state birth control clinics. They organised meetings and major demonstrations. They kept reminding him that giving birth had four times the death rate of working in the mines, the most dangerous job for men, and twenty times the likelihood of permanent disability.

    However, it was not until 1974 – another 50 years later – that women achieved the right to free contraception on the NHS, irrespective of age or marital status, by which time I had joined the Labour Party and it was one of the issues I was campaigning for myself, first through the Young Socialists and then the Labour Women’s organisation . Nowadays, men can also get free vasectomies  and, whether for contraception or protection against HIV, free condoms on the NHS, also irrespective of age. None of these successes, in areas where some people like to make moral rather than medical judgements, was easy or straightforward.

    For example, even after the beginning of the decriminalisation of homosexuality for men in 1967, homophobia was still rampant for many years. Thus, more than 20 years later in 1988, Thatcher was able to introduce Clause 28. Roy Trevelion (London SHA member) in Age UK’s Opening Doors London, likens the mental health of many HIV positive men – as a consequence of the AIDS epidemic and ongoing homophobia – to Post Traumatic Stress Disorder. Most gay men who obtained free condoms would have been more likely to get them from organisations like the Lesbian and Gay Foundation in Manchester (and similar ones elsewhere), which is registered as a charity and raised money to provide them on that basis. Many gay men would have been more able and less anxious to get their condoms from peer-support charities like this than to risk accidentally outing themselves at the doctor’s or clinic.

    The post World War II economic boom brought rising employment of women and improved living standards, and with increased confidence, women demanded recognition for their contribution to society and the right to control their own lives. These led to the Abortion Act 1967 as well as to Equal Pay (1970) and Sex Discrimination (1975) legislation, and the right to paid maternity leave (1975). The Abortion Act did not give women the right to choose, but made it legal for abortions to be carried out with the approval of two doctors under certain circumstances. In effect it decriminalised what women had been doing for centuries, just as the 1967 Sexual Offences Act (partially) decriminalised homosexual acts between men.

    Making abortion illegal in 1861 had not stopped it, and the 1967 Act did not encourage it: it just made the difference between a woman dying as a consequence, or surviving. (In Romania, abortion was illegal until 1989: but abortions still outnumbered live births – in 1987 by four to one.) I remember providing accommodation to Spanish women coming to the UK for abortions before 1985, when it became legal in Spain, and from the Republic of Ireland before the end of 2018 when it was legalised there.

    However, the 1967 Abortion Act, like the 1967 Sexual Offences Act, was not the end of the matter. There were several attempts to repeal or considerably amend the Abortion Act, such as the White Bill, the Corrie Bill and the Alton Bill, which gave rise in turn to their own protest movements. A very large demonstration against the Corrie Bill was called by the TUC (on the initiative of the Women’s TUC) in 1980, the first time in the world that a major trade union federation had called a demonstration on abortion rights; and another against the Alton Bill in 1988, again with the support of the trade union movement. None of these Private Member’s Bills was successful, but in the end the period during which abortion could be legally carried out was reduced to 24 weeks in 1990, by the Human Fertilisation and Embryology Act.

    The Human Fertilisation and Embryology Act, based on the recommendations of the Committee of the same name, chaired by Mary Warnock, was passed in 1990. When it was originally passed it allowed access to infertility treatment, such as Artificial Insemination or In Vitro Fertilisation, at a cost (in money and patience, especially with IVF) but it also required the women who wanted medical assistance to become mothers, to conform to a very traditional view of motherhood and the family, as reflected in the attitudes of doctors, hospital ethical committees and the Warnock Committee at that time, and laid down in Codes of Practice. These were not medical decisions but social and moral ones.

    For example, to be “suitable” for treatment, a woman had to be living in a stable relationship with a man, and usually had to be able-bodied. Some clinics were reluctant to treat couples where the man was not in work, or the woman not prepared to give up work. Single women and lesbian couples were not usually eligible.  Tory MP David Wilshire made it clear in his speech that he was particularly concerned that “assisted conception” would not produce families dependent on the state, and another amendment was passed to include “the need of a child for a father”.

    Why is Reproductive Technology a Political Issue?

    Thirty years ago I wrote those words in a book called “Whose Choice?”, published at the time of the Human Fertilisation and Embryology Bill which became law in 1990. The question was why the Labour Movement should take up issues such as contraception, abortion and treatment of infertility, which were often seen as purely personal matters.

    My answer, on behalf of the (then) Manchester and Liverpool Labour Women’s Councils, was that it was our belief that decisions about whether or not to have children, how many to have, whether or not to have an abortion or use any of the technologies available to overcome or by-pass infertility, or to avoid having a child with disabilities, or to enable those of us who were lesbians to become parents, were all personal decisions to be taken by the individuals concerned, and not by the Church, the State or the Medical Profession.

    And since it is women who give birth to children and even now usually bear the main responsibility for child rearing, these decisions must primarily be theirs. As socialists we argue for women to have the maximum choice possible in the decisions that shape their lives.

    The campaign then – and still is now – was not just for legal rights, but for the practical means to realise them. In order for a working class woman to have the choices already available to richer women, she must have the economic means (a living wage or income), and necessary social arrangements, such as childcare and decent housing, so that she can choose to have a child. It means expanding the NHS, taking back control of the services that have been contracted out to the private sector, resisting any further attempts to privatise parts of the NHS, and running the NHS democratically so that women can have access to free and safe abortion, contraception, artificial insemination and IVF treatment.

    It means carrying out the research to find contraceptives that meet the needs identified by both women and men; research to enable women to have earlier abortions and make them safer; research into causes of infertility and its prevention; research into chromosomal and genetic disorders and their prevention; and research into products and services that would improve the lives of disabled people.

    All these things are entirely reasonable and technically possible; but they raise, in turn, important – essentially political – questions. Who does the research and in whose interests? The rubber goods manufacturers (for decades before the 1960s, clandestine or even illegal): the vulcanisation of rubber revolutionised birth control as well as road transport; but  nowadays research is dominated by the pharmaceutical industry. And of course the research is done to make a profit.

    The drug industry is one of the most research-intensive sectors: but it spends more on marketing and advertising than on research. That was the case when the last official UK Government report on the industry was published (The Sainsbury Report, HMSO, 1967) and it was even more the case, according to the most recent figures (OECD Main Science and Technology Indicators, annual, covering all OECD member countries in the year of publication.)

    Pressure to be first to market can lead to corner-cutting in testing: the most notorious case where this happened was Thalidomide, a tranquilliser that had been declared safe, and was explicitly prescribed, for pregnant women. But it caused major deformities in their babies who were, most notably, born either without some or all of their limbs or with major deformities in them.

    Although it was known by then that some drugs could cause foetal damage, it was not yet specifically a legal requirement to test for them, and the tests were not done. (Only the USA’s Food and Drug Adminstration refused to grant a licence for thalidomide to be prescribed, because the FDA official responsible insisted on having evidence on the foetal effects of the drug, which were not available.) Criticism of government “interference” in the affairs of business is very common in the United States (often framed as interference in the public’s right to choose – except women’s right to choose abortion). Today the FDA is still the butt of criticism of lack of freedom from government interference.

    The Warnock Report, on which the Human Fertilisation and Embryology Bill was based, commented on the lack of research into causes of infertility. This is still the case to some extent, though knowledge in this area has been increasing since the discussions around the Warnock Report and the debates on the Human Fertilisation and Embryology Bill.

    But we can be sure that thorough studies, once publicised and popularised, will lead to increased demands for improved health and safety at work; and for the replacement of industrial processes, chemicals and other materials causing infertility; and that responding to these demands would threaten profits. A thorough study would also raise questions about the under-funding of the NHS and the number of diseases that are not adequately diagnosed, or possibly not adequately treated, and which lead to infertility.

    The issue of women’s rights in reproduction is therefore a political and class question: not just because it is mainly working class women and men who are affected by lack of choice and unsafe working conditions, but also because the ability of all women to have a real choice will only be possible as a result of the struggle of working class women and men to change society. This means campaigning on reproductive rights as well as on better housing, higher wages and defence of the NHS. It especially means we must control the resources of society and organise them for need rather than profit.

    St Mary’s Department of Reproductive Medicine (DRM) – Summary of Background Briefing

    St Saint Mary’s Hospital, Manchester, was founded in 1790. Today it provides a wide range of medical services, mainly for women, babies and children. It is highly regarded for teaching and research, and has an internationally recognised Genomics Centre and Department of Reproductive Medicine (DRM). The DRM employs 70 staff and delivers clinical, laboratory and counselling services for about 3000 patients a year. Most of St Mary’s services and research activity is carried out in a building dating from the late 1960s. In 2009 paediatric services were transferred to the newly built Royal Manchester Children’s Hospital on the same site.

    The issue at the centre of the protest is that the DRM is housed in the Old St Mary’s Building (also on the same site) which dates from just after the death of Queen Victoria, and is in desperate need of repair. Manchester University NHS Foundation Trust (MFT) believes that relocation of DRM within the Trust could cost up to £10 million just in capital expenditure, and is talking about privatisation.

    DRM offers a fertility assessment and infertility service. Artificial Insemination and IVF are offered to women who may benefit, on referral by a GP. This can be both NHS funded and private – the latter for women for whom it is clinically appropriate but whose CCG would not fund the necessary cycles of treatment. It offers a fertility preservation service for patients who wish to preserve eggs or sperm while having medical treatment – eg for cancer – that might affect future fertility. DRM offers sperm-testing and specialist treatment for patients whose sperm has been identified as presenting fertility issues; and on the other hand post-vasectomy checks.

    An anonymous or by-arrangement sperm-donation service is also offered to lesbians, and to heterosexual women either without a partner or who cannot conceive with their partner’s sperm for any reason. The Department also offers a reproductive endocrinology service which focuses on the way in which hormones affect fertility; and specialist counselling to any of the patients using their services. DRM runs the national proficiency scheme involving distribution to other reproductive medicine labs across the country and checks that the results are consistent. Finally, the Department makes a significant contribution to fertility research in conjunction with the University of Manchester.

    In early March the Trust briefed all service staff that they would undertake a 12 month options appraisal exercise to identify whether the service should remain within the Trust or be re-commissioned elsewhere. (Since the pandemic this has been put back.) The unions argue:

    • that there would be significant capital costs involved in privatising the service, which would have to be borne by the hospital (eg to store embryos – the store would need to remain on the site and continue to be run, inspected and managed by MFT, because the cost of doing otherwise would be prohibitive).
    • that the service is unique in Greater Manchester, and to a large extent in the entire North West Region.
    • It has significant associated capital and operational costs so other NHS trusts are likely to be reluctant to bid to host the service.
    • The private sector may offer an option that appears to be cheaper, but offers a far lower level of service than that currently provided at St Mary’s – but the NHS might be obliged to accept the private bid, because it is lower.

    The unions are also concerned about the impact of any potential future privatisation of the service for many reasons, including:

    • St Mary’s offers specialist care to a number of people with Protected Characteristics under the Equality Act 2010, which might not be available under private sector provision.
    • The services offered by St Mary’s are highly specialised – Trafford CCG ring-fenced them on behalf of all the CCGs in Greater Manchester, not requiring them to participate in an IVF procurement exercise in 2019 for this reason.
    • The andrology service works with eg men with Cystic Fibrosis who are often infertile and need surgery if they wish to have a chance of creating a family, and another specialist service involving the only UK-based partnership with the long established FAIRFAX cryo-spermbank.
    • The National External Quality Assessment Scheme for reproductive medicine is currently based in the DRM laboratories. If DRM was closed or moved, this would need a new home, too.
    • The kind of research investment and relationship with academic institutions that St Mary’s has would not be replicated in private sector provision where profits have to be made.
    • Despite assurances from MFT, the unions believe that the terms and conditions of the staff in the private sector, if they had to move and could do so, would not be as good as those in the NHS under the Agenda for Change national pay system.
    • In other areas where NHS services have been privatised, there has often been an erosion of terms and conditions, and of collective bargaining, either through attrition over time or an aggressive stance by employers. Unions believe that this is a significant risk.
    • The cost to fee-paying patients is less than the alternative provision in the private sector, and for NHS patients, the NHS pays via CCGs around £4000 per IVF cycle at St Mary’s, but significantly more (£5-6,000) to private providers per cycle.
    • The DRM is part of St Mary’s and both are located on the MFT Oxford Road Campus next to the University of Manchester. Patients with co-morbidities and other conditions which may have an impact on their fertility and associated treatments, can benefit from the expertise and clinical care available within MFT close to their fertility treatment. At the same time, staff can benefit from the close proximity of other specialisms which may be relevant to a patient’s ongoing care.

    The Next Stage in the Campaign to Save St Mary’s

    There will be a public meeting (via internet) hosted by Keep Our NHS Public as below. Please join us via Greater Manchester Keep Our NHS Public (GM KONP)’s Facebook page.

    PUBLIC MEETING: No privatisation of Manchester’s fertility service!
    Monday, 20 July 2020 from 19:00-20:30

    https://www.facebook.com/events/280845443022548/

    The fertility service provided by the Department of Reproductive Medicine at St Mary’s hospital, Manchester, faces privatisation. According to reports, Manchester Foundation Trust announced earlier this year that the service would go over to a private company in 2021. This would be a disaster for the service and future patients.

    Now the Trust has begun an “options appraisal” over the future of the service. We insist that the #1 option must be keeping it public and keeping it where it is. We demand a public consultation so the people of Manchester have their say.

    Join our online public meeting to hear about the situation and how we can campaign to win. There will be discussion after the speakers, who are:

    Denise Andrews, Unison union rep, DRM
    Liz Holland, Unite the Union branch secretary, MFT
    James Bull, Unison union regional officer

    Pia Feig, a feminist perspective
    Chaired by Caroline Bedale, Greater Manchester Keep Our NHS Public and Greater Manchester Socialist Health Association.

    This will be a Facebook Live event broadcast through the event page.

    Mailing address for

    Keep Our NHS Public Greater Manchester

    c/o KONP national, Unit 12-13 Springfield House 5 Tyssen Street

    LondonE8 2LY

    United Kingdom

    Vivien Walsh (Greater Manchester SHA)

    Comments Off on Privatisation Protest at St Mary’s Hospital, Manchester

    The Royal College of Nursing, in its super-polite way, has written a letter to the Home Secretary, Priti Patel, asking her to make sure that those risking their lives for us in the NHS, should not have to pay punitive extra charges if they become ill themselves. For NHS workers have been surcharged for NHS treatment since 2015, if they have come from overseas. There is a petition “How can we expect nurses to come to Britain and fill our NHS vacancies, risk their lives when they have to pay £11,000 to use – the NHS?” which you can sign if you wish: http://chng.it/mkPN7jmwzm.

    Doctors, nurses and paramedics have now been granted a one-year exemption. One year!   But Dominic Raab said on Monday (18th May) that there were no plans to extend even the one year exemption to care workers. The Royal College of Nursing would be entirely justified if they decided to call for a strike or work to rule until this unfair surcharge is removed permanently, as indeed would the unions representing all health related workers, including the porters, caterers and cleaners (whose employment in most cases is contracted out under privatisation introduced by Thatcher). But if nurses and other health workers feel unable to strike (especially now, which no doubt the Government are counting on) other unions could take action in support of all health and care workers!

    Maya Goodfellow, author of the book Hostile Environment (Verso, 2019), wrote in the Guardian yesterday (19.05.20): “By asking them to pay twice for healthcare, the government is betraying the very people it applauds so publicly”. She pointed out that the British Medical Association has consistently been saying that all healthcare workers should be exempt from the immigration health surcharge. They are already paying tax and national insurance like everyone else. So they are paying twice for NHS treatment.

    All the other political parties have opposed this surcharge.

    Today in Parliament, Keir Starmer raised the issue again in Prime Minister’s Questions, pointing out that a care home worker would have to work a 70 hour week to make enough to pay the surcharge. I was watching the BBC broadcast, and heard Johnson say, of course, lots of stuff about the wonderful NHS, and the overseas workers that saved his life. But on the key point about them paying hundreds of pounds extra to use the NHS, in which they are risking their lives to work, Johnson had the gall to say “the NHS needs another £900 million from such sources”. I am not quite sure what the other sources of the £900m were, besides the surcharge from overseas workers, that he had in mind, but this was utterly shocking and disgraceful. I also had the pleasure of seeing the Speaker of the House, Lindsay Hoyle, threaten to throw Matt Hancock (Secretary of State for Health) out of the House for speaking over Keir Starmer, which has now been reported in the papers for tomorrow.

    Vivien Walsh, Manchester

    1 Comment

    From Ekua Bayunu, Member of Greater Manchester Socialist Health Association, and selected candidate for Hulme in the next Manchester City Council elections.

    When I joined SHA a couple of years ago I wanted to focus my energies on action against inequalities in the health systems around race, particularly in mental health. We now have evidence of the toxins that were seeping into us from the right, distracting us from actually building effective socialist action on health issues here in Greater Manchester.

    Skip forward and we are slap bang in the eye of the storm of the Covid 19 pandemic and still searching for some strength in our unity to make a difference to our communities. Many of our members are fully immersed in either working on the frontline, in providing care in our institutions, or in volunteering in mutual aid groups, many doing both and I send love and admiration out to us all.

    We lost my neighbour, an elderly Somalian man, to the virus on the last weekend in March. It felt like the storm that was brewing had just swept in and taken one of ours before we barely knew it was coming. Then the statistics started coming in. We are dying in inexplicably large numbers. We? I’m a woman of African heritage, my community is African, South Asian, Working class.

    My close friend, a street away, is a nurse working at MRI, already stressed by the lack of PPE, worrying about her family, the risk she posed to her 3 daughters and husband at home, when she got ill two weeks ago, together with two colleagues from her ward. They got tested. She doesn’t have access to a car, and the only testing is drive-through. No you can’t walk in. No you can’t get in a taxi! She started talking to us about wills and supporting her daughters and all the worries she has for them. Her eldest also works as a nurse, the youngest is only 10. Her cultural background is Turkish, and she knew she might die.

    She is in recovery, but the statistics get worse and worse. The demand for action grows as do the questions and desire for investigation. I read articles in the silo of my social media accounts and watched as it began to break slowly into mainstream media. At first I thought: they are holding back on the narrative, because it doesn’t suit their agenda to highlight how many were dying in service to us all who were from Diasporan African, Asian and other minority communities. We entered this year with forced deportations built on a narrative that these were the communities of criminals and spongers on the state. Suddenly the NHS workforce were our heroes, they put out ads supporting these workers and most of the workers were white. Did you all notice?

    Then as the statistics leaked into a wider societal consciousness, I became openly worried. Information being fed via the television is so absent of any real analysis that it actually begins to shape a eugenicist narrative, which the Prime Minister does little to distance himself from. Our deaths are not real sacrifices based on years of inequalities in education, health care, housing and employment, but gives out a message of our inherent weakness and inferiority! And whilst we all are shut in, angry, confused, needing to have something or someone to blame, in the place of blaming this government for its lack of care in putting profit over people, it is easy to discern they are creating a diversionary agenda.

    It is becoming increasingly clear BAME people are dying disproportionally, on the wards, driving our buses, cleaning our streets, in our care homes. They are presented as the problem, when they are the heroes and victims of the pandemic. Last week the government finally pulled together a commission with PHE to investigate the causes of BAME people dying disproportionally. Do we all assume that the why will lead to how to stop this? To a solution to help us? I can’t.

    Posted by Jean Hardiman Smith on behalf of Ekua Bayunu, Member of Greater Manchester Socialist Health Association

    1 Comment

    Assemble 12:00 Portland Place, London W1A

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

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

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

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

    Bookings will not be accepted after Monday 10 March.

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

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

    or on the Unite website

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

    Kind regards

    Lorna Woods Moses

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

    Unite the Union Liverpool

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

    The announcement in February 2015 that local councils in Greater Manchester would be given a say in the management of the NHS in the conurbation generated a lot of publicity. This is an attempt to make sense of what has happened since.

    The announced devolution of powers in relation to the NHS doesn’t amount to very much. All the laws, regulations and structures which apply in the rest of England still apply in Manchester. That is not the case in Wales, Scotland or Northern Ireland. This is more like delegation than devolution.

    DevoManc

    A Memorandum of Understanding was agreed by NHS England, 12 NHS Clinical Commissioning Groups, 15 NHS providers and 10 local authorities. It establishes a health and social care partnership board which manages the £6 billion annual budget and a £450million transformation fund. This gives local councils a formal role in the management of health care – something they have not had since 1974. The board are developing a common technology strategy, which is intended to to enable the sharing of patient records between different organisations. They have also agreed a common approach to public health – something which councils have been responsible for since 2012.

    A strategic plan has been agreed in each borough, and these are developing independently. There will be some concentration of specialities into fewer centres, so, for example, it is proposed to establish four centres for elective orthopaedic surgery, and three centres for emergency surgery so these will not be provided in every borough. This concentration will require considerable capital investment and it is not clear where that will come from.

    The intention is to integrate health and social care, and establish what are called local care organisations. These involve bringing adult social care staff into NHS organisations. This happened in Salford some time ago, and is developing in other boroughs. Social care is still meanstested. It is difficult to see what this means in practice. Given that the councils’ budgets have been reduced substantially it seems likely that NHS funds will be used to support social care, as it is much cheaper for trusts to move people into residential care, or pay for equipment than to keep patients in hospital. It has certainly meant that social care staff are under a lot of pressure to get services organised if they are needed to get people out of hospital.

    In Manchester City itself involving local councillors has generated some radical changes. Three hospitals, currently run by three different NHS trusts, are in the process of amalgamating into a single organisation. The three Clinical Commissioning Groups have merged into one and are to move into the City Council. A tender has just been announced to run all health and social care services outside hospital. Over ten years this would amount to £6 billion. The hospital consortium is an obvious bidder. At the time of writing it is not clear if there will be any other bidders. This local care organisation would run social care and manage the contracts of voluntary organisations. According to the commissioners it will… “not only improve health outcomes and support people to live independent lives, but also gives us a way of addressing some of the financial pressures we face. “

    It remains to be seen whether this approach will give better results than those taken in the rest of England.

    This is a personal view.  It first appeared in The Pensioner.

    Tagged | Comments Off on Health and Care Services in Manchester

    A new, independent and broad-based citizens’ initiative – the People’s Plan – was launched in Greater Manchester last October and has now published its findings.  This extract covers health and care  – but other parts of the plan would also impact on health. 

    People's plan

    Since 2016 Greater Manchester has responsibilities for managing and integrating hitherto separate, centrally funded NHS services and local authority adult care services. Both services are in crisis: in adult care, austerity budget cuts have reduced numbers receiving home care by some 20% nationally; and in health services, the halving of the number of hospital beds over the past thirty years has created a fragile system that suffers with demand peaks or delayed discharges. The National Audit Office has questioned whether integration of health and care will save money or reduce hospital admissions; and this finding is ominous when Greater Manchester has a predicted £2 billion shortfall in health and care expenditure within five years. Against this background, it is unclear how Greater Manchester will find the policy levers, financial resources and political will to tackle prevention of ill health and low life expectancy in deprived localities.

    Challenge 1:How to lever in more financial resources for health and care services, where social ownership and operation of free services should be defended

    Event participants recognised that “services cannot be run without proper funding” and the first priority of survey respondents is levering in more public funding. In health, as in housing, what citizens want is public provision that depends on reversing austerity cuts. By implication, the Greater Manchester mayor and other Greater Manchester politicians need to change central priorities as much as manage local services; as a Bury event participant put it: “make it the Mayor’s job to fight for more money for local services”.

    The other clear theme is that public funding should support socially owned and operated services. While voluntary and other third-sector providers are often complimented, references to private providers in health and care are mostly negative: “Resist the influence of the private sector, because it takes money out of the system”; other respondents had concerns for poor pay and conditions in outsourced adult care.

    Pointers on what to do:

    • Lever in more public funding.

    83% of all survey respondents agreed that ‘Greater Manchester should urgently seek a better funded deal for health and social care’ – with just 2% opposed. Here again, as in other policy areas, like housing, what respondents want the Greater Manchester mayor and other Greater Manchester politicians to do is not just manage the system within existing funding limits but claim more resources. For example, investment in training for ongoing supply of nurses in Greater Manchester services is an area where consequences of cuts to bursaries are a serious concern.

    • Use public funds to support not-for-profit and publicly owned and operated services.

    Survey respondents and event participants were against further outsourcing or privatisation. Health and care services need new ‘step down’ facilities for discharged hospital patients who cannot go back to their own homes and do not have a care home bed; but 67% of all survey respondents believed such facilities should be built and operated by NHS providers and 74% also supported provision by other not-for-profit providers, with only 10% supporting private for-profit providers.

    People's Plan

    Challenge 2: Build a new kind of NHS as a civic institution which offers a wide range of stakeholders more participation in decision-making as well as providing more user-friendly services

    Citizen attachment to the NHS is not all sentimental and uncritical. Ministers and managers have sought to restructure health and care services so that they meet user demands more effectively, but citizen critics go further and ask for a redefinition of the NHS as a new kind of civic institution where a wide range of local stakeholders would have a major influence over decision-making.

    At a café-style event conversation about ‘Devo Manc’, participants posed a challenge to “find ways to put health and social care close to communities”. There is widespread dissatisfaction with current forms of consultation that are too often about changes already decided by service managers.

    Pointers on what to do:

    • Experiment with direct public participation in decision-making.

    65% of all survey respondents wanted direct participation by the public for proposed changes, through means such as online polling, for example, whose results could not be easily ignored.

    • Create an advisory board representing wider interests.

    More traditional forms of representative democracy have even wider support. 77% of all survey respondents wanted a wider advisory board representing different stakeholders including voluntary and community organisations as well as provider groups. For example, representation for those with learning disabilities and their many challenges was strongly featured in the Health and Care themed event.

    • Provide more user-friendly services on a local community basis.

    This is the point where citizen priorities align with those of politicians and service managers. At a Greater Manchester Older People’s Network event and in surveys, the GP and hospital appointments systems were described as “barriers” to access, with specific criticism about the availability of “on the day” appointments; and at a Wythenshawe event the complaint was that “public transport never lines up properly with health services”

    Challenge 3: How to put more resources into prevention and into the inadequately funded ‘Cinderella’ services of mental health and adult care, which have now been damaged by austerity cuts

    Many of the open survey responses and comments of event participants highlighted the problem of ‘Cinderella’ services. Some event participants thought hospitals were claiming resources that should have gone to prevention, primary and community provision; all agreed with the survey respondent who wanted “greater emphasis on prevention not cure” and worried about how austerity cuts in mental health and adult care had aggravated long standing problems about service provision. The result is pervasive insecurity about service availability, crystallised by the question at one Tameside event: ”will it be there when you or your family members need it?”.

    Pointers on what to do

    • Stop cuts to mental health services and increase funding.

    This connects with prevention because, as one survey respondent argued, with more funding for primary care, GPs should be able to prescribe more one-on-one counselling and for more than six weeks.

    • Revalue the workforce in adult care.

    Some open responses registered the point that care workers are paid and trained worse than health service workers, although they had an increasingly important role in an ageing society. As one respondent argued: ”properly trained care assistants would help people to stay at home”.

    David was  one of the people involved in contributing/drafting/editing/finalising the plan, but he is not the sole author

    Tagged | 2 Comments

    Statement by Labour candidates for election as governors of Greater Manchester Mental Health NHS Foundation Trust.

    This is a challenging time for the NHS, particularly for mental health services. We are a group of Labour Party members campaigning for genuine parity of esteem for mental health, in order to ensure that patients get the full range of services and quality care that they deserve.

    We believe that:

    • Prevention is always better than cure, where possible, through the promotion of wellbeing within the community and ensuring that support is available to people who need it sooner rather than later.
    • A variety of mental health training within schools, workplaces and communities is essential to reduce the number of admissions, combat stigma and promote mental wellbeing.
    • A&E and community services for people experiencing a mental health crisis are currently inadequate and must improve. No patient should have to stay in police custody due to a lack of beds.
    • Patients must be treated with the utmost respect and compassion, and their feedback valued along with the opinions of friends and family as well as the wider community.
    • Mental health services must be properly funded by the government, including funding aimed at tackling the social factors contributing to mental illness.

    As Governors we will ensure that feedback from service users and their friends and families is kept at the forefront of care provision by Greater Manchester Mental Health NHS Foundation Trust. We will make certain that the Trust is properly represented in the “Devo Manc” environment so that services are adequately funded and supported across all of Greater Manchester.

    Bryan Blears – Salford

    Michael Crouch – Service User and Carer

    Peter Dodd – City of Manchester

    Thomas McAlpine OBE – City of Manchester

    Simon Morton – Staff – Non-Clinical

    Voting will open on 14th February 2017. Electors will receive an e mail containing unique voting details

    This is the first time we have had an SHA slate in an election.  In England you can be a member of your local Foundation Trusts, and there are also many which have a category of membership for the whole of England. 

    Tagged , | 1 Comment

    Video of the three candidates Ivan Lewis, Tony Lloyd and Andy Burnham (links are to their initial statements) at our hustings on 25th June.

    Tagged , , , | Comments Off on Manchester Mayoral hustings

    “Some people believe football is a matter of life and death,” Bill Shankly, Liverpool FC’s manager between 1959 and 1974, once said. “I am very disappointed with that attitude. I can assure you it is much, much more important than that”. Now imagine the newspaper headlines if at the end of the football season three of the biggest English football clubs – Manchester City, Everton and Liverpool – were relegated from the league. If football were really a matter of life and death, this is exactly what would happen.

    We put together a public health league table which ranks the areas local to the 2014-15 Premier League football clubs from best to worst using key health indicators with a corresponding code: the percentage of smokers (P, played); weight – percentage of obesity and overweight (W, won); deaths – all cause mortality rates per 100.000 (D, drawn); life expectancy for males in years (L, lost); female life expectancy in years (F, for); alcohol-related hospital admissions per 100,000 (A, against); and the gap or difference in life expectancy for men between the most and least deprived areas of the local authority in years (GD, goal difference).

    The final league points represent the sum of ranks for each outcome. For example, Chelsea’s league-winning score of 114 points comes from ranking second for P, first for W, D, L, F, and A and last for GD.

    Public Health League

    While Chelsea would still be winners in the public health league table, Crystal Palace, Manchester United and Tottenham Hotspurs would join them in the top four, with West Ham in fifth place. As the bottom three in the table, Manchester City, Everton and Liverpool are all relegated.

    The data we used came from PHE Outcomes Framework Data, the Office for National Statistics and the Public Health Observatory Wales. Premier League clubs were geo-referenced to the local area with which they are most associated, so Manchester United’s data, for example, is for Trafford Council, Chelsea FC is represented by data from the Royal Borough of Kensington and Chelsea, and Swansea is represented by data from the local health board (although the Wales average had to be used for the alcohol variable). Liverpool and Everton have the same data as their grounds, Anfield and Goodison,are located in the same local authority.

    Life expectancies

    Apart from throwing up some unusual league places, the league table also further demonstrates the extent of the north-south divide in health in England: the top half of the table is dominated by southern clubs and the relegated trio are all from the north-west. To those working in public health, this will not be surprising as the cities of Liverpool and Manchester have some of the worst health outcomes in the country. The contrast between winners Chelsea and relegated Manchester City in terms of life expectancy is immense at seven years for men and six years for women.

    The PHLT also demonstrates the local health inequalities that exist within our towns and cities. So while Manchester United place in the top four, their “noisy neighbours” Manchester City are relegated. Life expectancy for men and women on the red side of Greater Manchester is four years higher than for those on the blue side – only a couple of miles down the road. This is probably related to the stark differences on these two sides of the same city in terms of economic deprivation with, for example, child poverty rates of 34% for Manchester City Council compared to 14% in Trafford.

    Manchester death league

    Even within local authorities there are high inequalities in life chances with, for example, a 14-year gap in male life expectancy between the most and least deprived areas of Chelsea.

    The north-south health divide, local health inequalities, and inequalities within local authorities are a serious public health concern – to the extent that they were the subject of Due North, the first Public Health England commissioned independent review in 2014. This report recommended a number of ways in which central and local government and the voluntary sector and the NHS could help reduce these health divides. The league table is another way of showing these divisions and raising awareness of the inequalities in “life and death” that exist in our country today.

    This was first published on The Conversation

    Tagged | 1 Comment