Category Archives: NHS

Calderdale and Kirklees 999 Call for the NHS

It’s our NHS – the profiteers, privatisers and austerity liars can jog on

Scrap a new contract that could wreck our NHS!

The quango NHS England is currently holding a badly-publicised public consultation on its new Accountable Care Organisation contract – which it has renamed the Integrated Care Provider contract.

Most people won’t have heard about this. Have you?

 

Why is NHS England consulting on it now, before they even know if their new contract is lawful?

This autumn, 999 Call for the NHS is challenging the lawfulness of this contract in the Court of Appeal.

We are currently crowdfunding the £18K costs of the Appeal through CrowdJustice – please give whatever you can afford. Any amount, big or small, is a huge help and much appreciated. Here’s where you can donate and find out more. http://bit.ly/999CourtofAppeal

NHS England’s consultation is online here.

999 Call for the NHS’s response is online here. (Downloadable word doc.) You’re welcome to use and adapt it for your own response. We do not accept the basic premise of the consultation – that contracts are an appropriate way of planning, delivering and managing NHS services. We are campaigning for the NHS Bill to reinstate the NHS as a  fully publicly funded, managed and provided service.

If you prefer a consultation that is shorter and more to the point, 999 Call for the NHS will shortly be carrying out our own consultation online. Please come back soon to find the link. We will collect the responses and send them to NHS England before their consultation ends on 26th October.

The proposed new contract might sound like a dry legal issue that’s hard to get bothered about. The reality is anything but.

This is about whether patients can continue to access the treatments they need, or whether the doctor – patient relationship will be undermined by making doctors put financial considerations ahead of patients’ clinical needs.

This new 10 year contract is driven by NHS England’s cost-cutting aim of avoiding a projected £22bn funding shortfall by 2020/21 – the result of nearly a decade of NHS underfunding by the government.

The Accountable Care Organisation/Integrated Care Provider contract would pay a new type of  legal entity for a whole range of NHS and social care services in a given area. It would use the same lump sum payment arrangement that has been used to pay for psychiatric intensive care – with disastrous results. Just think about the dire shortage of acute mental health beds.

This contract is explicitly intended to “manage demand” for NHS services – in other words, to restrict patients’ access.

Its cost-cutting payment mechanism would drive down safety standards as well as restricting patients’ access to care.

An Integrated Care Provider could be a private company or joint venture

The new type of single legal entity could be an NHS organisation like a hospital Trust, or a GP Federation, a private company or a joint venture or special purpose vehicle that could include NHS providers and private companies.

This is a complex contract where the legal entity that holds the contract would then subcontract to a number of different healthcare providers – whether NHS, private or 3rd sector companies. This comes with all sorts of risks and hazards.  (For more info, see our answers to questions 3,4 and 5 in NHS England’s Integrated Care Provider Contract consultation.)

The Contract’s wide loopholes would allow far greater privatisation of NHS services – under this contract, a private company could control the delivery of the whole range of out-of-hospital NHS and social care services for a large area. Or indeed could win multiple contracts across many areas, and so establish a near- monopoly.

NHS England has admitted that under current NHS and social care legislation, it is powerless to stop private companies bidding for this – or any other – contract.

Un-evidenced, cost-cutting “care models” and “modern workforce”

This Accountable Care Organisation/Integrated Care Provider contract is designed to cement new NHS “care models” that copy the USA’s Medicare/Medicaid system. This provides a limited range of publicly-funded health care for people who are too poor or ill to access private health insurance.

Under the new “care models, District General Hospitals are being cut and downgraded. Community Hospitals beds are being closed. Family doctors are going under, as they are asked to take on more and more while there is a shortage of GPs and GP funding is flat. They are being replaced by huge new GP super practices serving 30K-70K patients, that are likely to become Integrated Care Providers.

Increasingly, these practices are being taken over by companies like Modality. Modality now operates in 7 Sustainability and Transformation Partnerships across England and has over 300,000 patients registered with it.

Budding local Accountable Care Systems (now rebranded as Integrated Care Systems) say that this is all fine, as care will be delivered out of hospital, in people’s homes, in large scale GP hubs and by means of digital technology.

But the new “care models” come with a “modern workforce” employing cheaper, less qualified new grades of staff – and relying on unpaid volunteers, friends and family.

None of this adds up to a comprehensive NHS that cares for everyone on the basis of clinical need. Instead care will be allocated on the basis of decisions about money.

NHS England laid out its plan for setting up these new care models in its 2015-2020 Five Year Forward View. Since then it has set up Vanguard schemes to trial these new ways of providing NHS and social care. There is just one small problem. There is no real evidence that they work. That is the conclusion of the National Audit Office report.

Opening the NHS to deregulated trade

The NHS quangos are aiming to change the whole architecture of the NHS, so it can deliver these American care models. All the better to open the NHS gates to American corporations, post-Brexit.

Stewart Player recently pointed out that

“…the aim is to impose a kind of global homogeneity of healthcare organization. Such standardization will attempt to safeguard and simplify investment strategies, and to embed corporate control of both purchasing and service delivery within rapidly evolving ‘mixed economies’ of care…

“The use of capitated budgets for ACO providers, for example, is expressly geared towards private investor interests, as the upfront capital can be invested in the global markets, with returns on equity in excess of 16%.”

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Dear NHS Reinstatement Bill Campaign Friends,

I am sharing this as widely as possible. Forgive me if you receive it more than once and forgive the blind copying.

We have launched our joint (KONP/HCT/We Own It) petition calling for the scrapping of the ICP contract and also we are asking people to take part in NHSE’s consultation and give your opinion on this dangerous contract.

‘We Own It’ is hosting the petition, which went live before 6pm today:

https://weownit.org.uk/ICP-petition-NHS

Here is our KONP page with links to the petition, key documents – including the JR4NHS submission, links to NHSE consultation, HCT resources page (very good):

Integrated Care Providers – What are they and how to oppose them

Please make every effort to sign the petition, complete the consultation either on line or in your own words and posting to them, and please SHARE petition link, video link, Facebook and Twitter with all your contacts.

Wtihin 3 hours, the petition is already close to 1000 and we hope to get over 20k to hand in with press coverage and a visible presence at NHSE on 26 October. And would be good to get many good responses to the consultation as well

Tony O’Sullivan

Co-chair of Keep Our NHS Public

@DrTonyOSullivan

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

Pensioners United

Directors: Phil Maxwell, Hazuan Hashim

Country: UK

Running Time: 75′

Year: 2018

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

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

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

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

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

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

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

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Saving the NHS: Planning our fightback

Few people know that the North West of England can proudly lay claim to be the conception point of our NHS. It was here at the 1934 Labour Party Conference that the party accepted a paper on the creation of a National Health Service by Labour politician, surgeon and founding President of the Socialist Health Association, Somerville Hastings. He was a primary mover in the fight for the NHS from the mid-1930s, and we in the SHA today remain steadfast supporters of the values on which the NHS was founded, the values of the welfare state and the values of Summerville Hastings.

Sommerville Hastings spoke to the Labour programme For Socialism and Peace, at the Labour Party Conference 1934.

This committed the party to the establishment of a State Health Service

To quote the programme:  “Labour proposes to utilise medical discovery to the full in the service of the nation. Labour’s general aim is to provide eventually domiciliary and institutional care to the community as a whole—a State Health Service evolving round a system of up-to-date clinics, with provision for specialist and other forms of treatment. Individual poverty must not be a barrier to the best that medical science can provide.”

70 years on the public are told the NHS is struggling by the Tories and right-leaning think tanks with high media profiles.  We believe that this has nothing to do with our ageing population, nor with the costs of drugs and medical technology as they claim.  A wealthy country like the UK can afford to provide a good health and care service. Like the USA it is increasingly choosing not to. The populace has been trained for decades to think of the economy like children pleading for pocket money for a puppy and being refused as the money is needed (by sensible adults) to put a meal on the table. The evidence shows it is not like that, but far more sophisticated. Money spent on health and care, and on decent terms, training and conditions for staff is money going into, and building, the economy.  It makes more than it spends when looking at the wider picture.

The attack is ideological. Conservatives are using the smokescreen of austerity to form their all-out attack on Labour’s welfare state of which the NHS was the jewel in the crown. Their manoeuvres are, by means of cuts, fragmentation rationing and privatisation. Deficits were artificially engineered, and operations like cataracts, and joint replacements denied. The NHS was split into 44 corporate Integrated Care Systems, and poorer areas have had their funding for health diverted to richer ones – with worse, much worse, to follow.  Watch this space!!!  The NHS is fragmented and no longer national.

And as far as privatisation is concerned, the NHS is now a logo behind which you may unknowingly be using a service contracted out to Virgin or SpecSavers. The whole system is devised and often managed by transnational corporations like McKinsey, Capita and KPMG. As a result of this covert “cultural revolution” billions are wasted on the transaction costs of the Tory NHS market and on the business infrastructure necessary to maintain it. Meanwhile, chronic disease sufferers, older people and maternity patients especially are being enticed to adopt personal health budgets to undermine public sector NHS funding in preparation for linking with health insurance co-payments (for those who can afford them).

Until very recently Labour lacked the political courage to challenge the neoliberal takeover of our NHS. That is until 2017 when the SHA motion to renationalise the NHS was adopted as official Party policy.  The SHA has been at the forefront of the fightback.  We support campaigning organisations in any way we can, but as a think tank, our job is to sweat over the minutiae of the structures by which a socialist government could implement the return of the NHS as a truly world class nationwide system, free at the point of use, according to need, and funded from general taxation. Many of us have a vision that Care also could be nationalised, to fully support our most vulnerable citizens, without milking them of their hard-earned savings and possessions, and with the risks truly spread, like the NHS, via general taxation. It makes financial good sense, as well as being more humane and ethical. Our people deserve no less. It may be a simple sounding vision, but it will need a great deal of thought, hard work and dedication to implement, given the dreadful state of the care system, the increasingly fractured and struggling NHS and the entangled vested interests of privateers and ideologues.

We in the SHA have thousands of people who are experts in their own right as members and supporters, and we encourage them to engage as we work to refine the socialist vision, identify the barriers, and offer detailed and practical solutions to overcome them.  As a long-established part of the Labour movement, we have been meeting regularly with the Shadow Health Team. SHA policies, if they are to be utilised like the vision of Somerville Hastings to build a new and improved NHS which works for the many not the few, will need courage, boldness, hard work from a future labour Shadow Health Team,   and a Secretary of State , who will take full responsibility, and who has the heart to put people, patients and the staff who support them, first. It will also need funding, funding which cannot be allowed to line the pockets of the greedy and unscrupulous.At last year’s Labour conference, we broke through the barrier against NHS renationalisation.

The composite NHS motion, originally drafted by the Socialist Health Association (SHA) and proposed by SHA Chair Alex Scott-Samuel, made it clear that the whole health system is being opened up to corporate interests; This motion committed Labour to actively opposing NHS England’s 5 Year Forward View plan and its accountable (now integrated) care systems. On June 27, Eleanor Smith MP, who has supported our president Professor Allyson Pollock, and Peter Roderick’s NHS Reinstatement Bill, together with Shadow Health secretary Jon Ashworth, signed the NHS Takeback Pledge which is directly derived from the Reinstatement Bill. Labour has aligned itself with the voice of the people.  The SHA has played no small part in this.  We must be vigilant and ensure there is no backtracking or fudging from this commitment.

The SHA believes the fight for the NHS and the soul of our country is between democracy and corporate power. The Socialist Health Association continues to fight for democracy.  We believe that healthcare is a human right, and everyone, regardless of income, class, creed or ethnicity, mental or and physical ability or sexual orientation has a right to access the best quality of healthcare and care. The pooling and sharing of risk on a national basis liberates us from fear of illness. Before the NHS, illness and pregnancy could lead inexorably to poverty, starvation and death. The NHS defined our nation as civilized and caring and has given us 70 years of freedom from fear. We must all work together, as individuals and organisations, to ensure that our children and grandchildren enjoy this same freedom.

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Dear chums

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

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

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

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

You can find a petition from Defend Our NHS here:

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

Please sign and share with friends.

Thanks

Kevin

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For everyone who couldn’t make the Conference, here is Alison Scouller’s ( Vice Chair ) speech. An audio file is also posted.

Jean Hardiman Smith

Hello Alison Scouller here, sorry I can’t be with you. These are my thoughts to accompany the SHA discussion document before you. We decided to write this policy as part of our wider policy work, as we had no statement of the SHA’s perspective on maternity care.
I’m a retired midwife who worked in hospital, community and latterly as a midwifery lecturer in South Wales. To devise a policy I took inspiration from the Save Liverpool Women’s Hospital campaign’s manifesto for maternity and worked initially with two Welsh members, Billie Hunter, Professor of Midwifery and Gill Boden who is a campaigner for AIMS, and another Midwifery Professor Mavis Kirkham from Sheffield as well as liaising with our secretary Jean Hardiman Smith. Since then we have revised the policy considerably, following suggestions and contributions from Central Council members.
We have taken on board the particular concerns of the Liverpool campaigners in the context of the creeping privatization of the English NHS, but in writing this policy we had to have a policy which is applicable across the UK. Therefore the first paragraph sets this out. .
We decided that the right to access contraception and abortion that should form part of another document about reproductive rights, including fertility treatment, and that here we should focus on care for pregnancy.
As you can see in point 1) we put the importance of addressing poverty centre stage, and the overarching importance of good nutrition from pre to post pregnancy, in fact throughout everyone’s life! We decided not to be too specific on particular public health measures, as our policy has to be applicable in different versions of the NHS and the wider context. We also included the issue of other forms of stress and their detrimental effect on pregnancy outcomes, both in terms of women and babies.
The next 2 points emphasize the importance of those at the centre of maternity care needing to be listened to, whether it’s about their own individual situation or in terms of general observations about how care should be. Planning for care should of course reflect diversity in all communities. In order to address inequalities in society, whilst all should receive the same level of care, extra provision should be there for some, as was recognized by previous Labour Governments in projects such as Sure Start.
We went on to identify issues related to specific stages in pregnancy itself, having covered the pre pregnancy period. In point 6) Antenatal care is clearly crucial to ensure that women are aware of as many aspects of their health as possible, such as family history, normal physiological changes of pregnancy, Body Mass Index , any pathological conditions already present or precipitated by pregnancy, and how these may impact on their pregnancy outcomes. It needs to be accessible as early in pregnancy as needed. It should be as local to women as possible and include at least one home visit, unless the woman does not wish for this, with her named midwife.
When we talk about antenatal education this does not mean in a formal, school type environment but can range from physically meeting in a group setting with a midwife to having education available on CDs, online and via social media. It’s not just about being given information for example about how labour may progress but also learning practical skills to cope with it, such as exercise and relaxation. It’s also about what happens after the birth and coping strategies for parents. The social and support aspects of women and family members meeting with others going through a similar experience are usually the most valued by those enjoying group education. Of course specific needs have to be catered for, so that some women may prefer to attend women only groups and prefer less formal settings.
The evidence for the effects of adverse childhood experiences on people’s ability to be good parents is now quite compelling, hence point 7)
In relation to point 8) We know from research and experience that women’s wishes in relation to place of birth are determined by many factors, and these are very varied. Health care professionals must strive to provide as much evidence based information to enable women and their families to make the right choices for them. All places of birth carry some risks, with home birth and stand alone birth centres there are always concerns about access to ‘back up’ in emergencies. On the other hand there are risks associated with unnecessary intervention (mistimed, inappropriate and even dangerous) in childbirth, both in terms of mortality but also morbidity of mothers and babies I think Lesley page coined the phrase ‘too much too soon, too little too late’ to summarise the problems unfortunately still occurring. The other thing to bear in mind is the importance of antenatal care and education in ensuring safe outcomes. If that care is as it should be, then women at risk of complications are less likely to have poor outcomes because care will have been tailored to mitigate those complications.
Moving on to point 9) we identify the importance of continuity of care. This can be difficult to achieve in cash strapped services but has been consistently shown in research and other feedback to be a key concern for women and promotes positive outcomes.
Finally we put in relation to after birth, points 10) and 11). Physical, emotional and mental health are equally important here. Increasing breastfeeding rates would make a huge difference to children’s health, yet initiation and continuation of breastfeeding rates in the UK remain low. Once again peer support has been shown to be critical to breastfeeding success, as well as support from midwives and health visitors.
In the past, care of women’s mental health has lacked coordination between midwives, health visitors, GPs and community mental health nurses. Equally where babies have been compromised by maternal complications before or during birth and/or being born preterm then neonatal special and intensive care cots should to be available as needed.

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For everyone who couldn’t make the Conference, here is Jessica’s speech to our Fringe meeting on the future of Women’s health that I referred to earlier in a members email.

Jean Hardiman Smith

 

Thank you for inviting me to speak to you today. My name is Jessica Ormerod. I run a research and information organisation called Public Matters with my lovely friend and colleague Deborah Harrington.
Although we write about all aspects of the NHS and other public services, I have a particular interest in maternity. I have been writing about maternity issues for seven years since I was the chair of the maternity services liaison committee for Lewisham Hospital which coincided with our fight to save our maternity services. We won that fight but we have by no means won the war because as you know maternity services up and down the country are being closed and downgraded.
But before anything else I want to paint the picture of what is happening to the NHS as a whole. Because every closed maternity ward, service or reduction in staff is the direct result of changes to the NHS that have been happening since the 2012 Health and Social Care Act. These changes are having a devastating impact on access to care. It is no exaggeration to say that we are witnessing the reversal of 70 years of universal, comprehensive and equitable care.
The 2012 Health and Social Care Act put into place all the major elements for a step change in the privatisation of the NHS.

A QUANGO called NHS England was formed as the Commissioner-in-Chief of the service, with over 200 subordinate local commissioning units. These commissioning units broke with the tradition of planning services, replacing it with buying in from public, private and voluntary sector providers. Areas of work are subdivided into contractable units and NHS public providers are obliged to compete. The loss of a contract means loss of income, which has a knock-on effect on the viability of the public sector, which is left with high cost acute care and a reduced income.

In 2014 a new CEO was appointed to run the NHS in England. He created a new plan for the NHS, the Five Year Forward View and this was greeted by the establishment as a welcome antidote to what was seen as the fragmented mess left by the 2012 Act (this was only a mere 18 months on from it being enacted). But it’s important to recognize that far from being an accident, the Act achieved the fragmentation necessary for privatisation to be embedded at an organisational level, including many major health industry players taking key roles in the commissioning and policy-making process.

At the heart of NHS England’s Five Year Forward View is the idea that the NHS in England will never again be funded to a level that maintains its services in the way they are run now. It puts together a series of proposals for change which are not just cuts but are about a fundamental reshaping of how services are provided. Expensive specialist and emergency care are relocated to centralised hubs and more care is to be delivered in the community via partnerships with local authorities. There is an aspiration for fewer emergency admissions with an improvement to overall health which it argues will lead to less dependency on NHS services.

We could say the scope of this aspiration is far reaching or we could say it is pie in the sky. It not only assumes the NHS can cope with a growing population without corresponding growth in services but that it will do so with a reduced service with much of the change becoming the responsibility of local authorities.

The process of transforming the NHS in England, is based on close co-operation between successive politicians and Department of Health managers over many years with the US Health Maintenance Organisation or Accountable Care Organization principles of managed care. This process is continuing without any checks and balances of substance within the formal organisational structures of government. Politicians go to great lengths to deny both privatisation and US influence on the current changes.

There is, however, a groundswell of resistance to the damage being done to the NHS and there is a lot of knowledge surrounding individual service contractions and closures, but little in the public domain about the overall programme of change. And that is what I am here to talk about today.

The National Maternity Review, aka Better Births – A Five Year Forward View for Maternity Care, is one of the Five Year Forward View’s New Models of Care. It emphasises community care delivered through local hubs with a theoretical reduced demand on hospital services. It recommends an increase in independent sector providers and introduces Personal Care Maternity Budgets. Personal Care Budgets commoditise and monetise the system. They add layers of unnecessary complication, increase expense, fragment accountability and lead to an accounting nightmare.
44 Local Maternity Systems have been established. The systems have been introduced without consultation, peer review, pilot studies or effective oversight from public health or parliamentary scrutiny. They are small-scale Integrated Care Systems. Unlike the Integrated Care Organisations which are now under consultation, they have been put into place with very little fanfare or institutional opposition.
As with all the changes to the NHS currently taking place, there is a real problem that rhetoric about better care closer to home is not matched by real resources or access to physical structures like hospitals. NHS England consistently refers to services being more important than organisations but fail to fill in the blanks about how this works. They also insist that travelling in order to receive excellent care is not a concern to patients. There is no acknowledgment that time, expense and severity of health condition all very much effect the distance people are able to travel regardless of the excellence of the service at the end of the journey.
In the case of maternity, these questions of distance and the emphasis on community care run two different risks. The first being the potential for increase of emergencies outside hospital setting. The second is that mothers might be taken in to hospital for assisted birth or caesarean in order to pre-empt risk arising.
But what makes maternity different from other services?
Most people use health services most at the beginning and end of their lives. Pregnant women are the exception to this. During pregnancy women come into more contact with the NHS than they probably have ever done in their lives. This is particularly the case if they have a complicated pregnancy or birth. Healthy women can become profoundly unwell during pregnancy and they can be vulnerable to life-threatening complications during birth. That’s why it is so important that women have all levels of care within easy access.
Until now maternity services have been provided in the most part by the NHS. Women have always been free to employ a private midwife. But the NHS has a duty to provide a midwife at every birth even if a private midwife is also in attendance.
Maternity services are woven through the traditional structure of the NHS. Women see their midwife at home or at their local GP. They receive a minimum of two scans to check the baby’s progress and health at the local hospital. If they have a pre-existing condition or they develop a pregnancy-related illness then their specialist will work alongside the maternity team to ensure that the woman and baby are safe and as healthy as possible throughout the pregnancy.
Currently women can give birth at home, in a ‘stand-alone’ facility run by midwives, ‘co-located midwifery unit’ – that’s a midwife-run facility on hospital grounds, or in an obstetric unit which includes doctors and surgical theatre. Obstetric units can only be sited in hospitals with A&E because they require acute services which is blood, air and surgeons. A woman can become dangerously ill very quickly during birth so timely access to acute care is essential.
Put this into the context that since 2010 maternity services have been starved of funds and there has been a staff recruitment and retention crisis. Many maternity units have already been downgraded or closed, hundreds of GP practices have also closed so women already travel further to receive care. This means it costs more and takes more time to see a midwife, GP or hospital doctor. It also means longer emergency transfer times. The risk is this will only get worse once the STPs restructuring of the NHS is complete.
Who is driving the changes to maternity?
Surprise, surprise, Better Births panel includes private health providers and those private companies are working with government to re-write policy.
Although most current providers are NHS hospitals, private providers are now being strongly encouraged. Local Maternity Systems set their own payment systems. This means that they can choose whether they pay via their geographical population or they can pay per activity or service. However, they do not follow established budget areas; they do not share boundaries with CCGs or Local Authorities even though they rely on budgets from both. Across the country there is now a mish-mash of payment systems. The risk is that women will fall through the gaps.
NHS Trusts have been ‘incentivised’ to adopt Better Births by offering a chance to win ‘pioneer funding’ to speed up the transition to the New Models of Care. In November 2016, Seven ‘early adopter’ sites started to implement the recommendations – I don’t need tell you about this because you’re part of it! The sites were told to be bold and radical. Another incentive is ‘the maternity challenge fund’ which instructs successful trusts ‘to explore innovative ways to use women’s and their partners’ feedback to improve maternity services’. A pioneer site is not the same as a pilot test site.
LMSs are encouraged to work alongside private providers in order to offer women a wider choice. As most women have previously been cared for by the NHS this simply means opening the door to the private sector. In a climate of serious staff shortages, it is possible that some midwives may see the benefit of setting up an independent midwifery practice rather than staying in the NHS. Despite protestations to the contrary, this does actually reduce the ‘NHS offer’ and opens an income stream for public money to be handed over to the private sector.
Better Births tells us it is working on a new accreditation scheme for maternity providers. But in a publicly provided NHS service, this is unnecessary because the NHS trains staff to a professional standard.
Private providers are required to have a contract with the NHS in order to receive payment via a Personal Care Budget. It is claimed that the budgets (which are described as ‘notional’) will demonstrate to CCGs the kinds of choices women make during pregnancy, birth and postnatally. This will apparently encourage CCGs to respond to women by increasing their offer. The claim is that this will also empower women. But it is decidedly unclear about how this can be achieved. The guidance talks about using Personal Care Budgets for birth pools, place of birth settings or breastfeeding support but all of this should be available to every woman regardless of a personal care budget. In fact, all of these used to be available to women as part of the normal care given by the NHS.
Moreover, it precludes the notion that women become ill in pregnancy. No one chooses to get gestational diabetes, pre-eclampsia, HELLP or any other life-threatening condition. What happens when your health needs change but you’ve used up your £3000 on hypno-birthing? There should be real concern about the potential lack of access to obstetric care when women have serious complications of pregnancy. Or to return to the issue of financial balance, if £3000 is a notional budget for a normal birth which can be used up in a number of ways then the acute hospital will potentially have to pick up the cost of the emergency care without a matching budget.
What does this all mean?
Scale and pace have taken precedence over caution and evidence. Academic research will take years to catch up to establish the public health consequences of this new policy.
This is a top-down reorganisation of a national service with little to no consultation, pilot schemes, peer review, oversight or risk assessment. A Health Select Committee inquiry into the maternity transformation plan was not completed because of the 2017 election. It has not been re-opened.
The Vice-Chair of the maternity transformation programme finishes his report with the following advice to LMSs: Be Bold! Don’t wait for instruction!
Clearly long gone are the years of epidemiological study, of public health planning, of consultation with experts.
Better Births is based on consumer choice issues around personalised maternity care. There is a serious lack of evidence that this restructuring will give women the vital services they need. There are fewer services, obstetric departments are being stretched even further and technology is replacing face-to-face clinical care.

On the other hand, it embeds private care and fee-for-service. And, most importantly of all this is not how a national public service works.

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

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

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

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

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

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

Jean Hardiman Smith Secretary and proud SHA delegate

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Following the Judicial Review in London in July, NHS England quietly launched its promised public consultation on the Integrated Care Provider (ICP) Contracts on 4 August. The consultation closes on 26 October.  If the appeal granted at the other Judicial Review called for by 999 Call for the NHS in Leeds is successful, this ICP contract may yet be unlawful, but it is nonetheless essential that we respond to the feedback.

The ICP consultation document is a daunting read for most of the public. However, Health Campaigns Together (HCT) has provided expert answers to all 12 points in the public feedback document. 

HCT’s aim in providing these answers is to prevent flawed plans being adopted. They are seeking to prevent long-term contracts being signed that will undermine our NHS. This is in order to preserve any hopes of achieving a genuine integration of health and social care as public services, publicly provided free at point of use – and publicly accountable.

 

A reminder on what’s happened so far: There have been two judicial reviews on the Accountable Care Organisations and these Integrated Care Provider (ACO/ICP) contracts. And the courts found in favour of the NHS. But one of the campaign groups, 999 Call for the NHS, has now been granted permission to appeal. 

This is some very good news. But it also means NHS England is consulting on an ACO/ICP contract that may be unlawful. 

NHS England knew full well that an appeal was a possibility. Although fully aware of this, on Friday 3rd August – the day Parliament and the Courts went on holiday – NHS England started a public consultation on the ACO/ICP contract. The consultation says that the Judicial Reviews had ruled in their favour. This consultation runs until 26 Oct.

 

We all know that this ICP consultation needs to be combatted and stopped. But in the meantime, here’s all the information you need to fill in the consultation feedback.

As stated, the judge in the London NHS Judicial Review said that the ACOs (now ICPs) should not be enacted until a lawfully conducted consultation was held, and any eventual ICP contract would have to be lawfully entered into.

Since then, NHS England have moved swiftly and stealthily into gear, and you will find their monstrous ICP ‘consultation’ document at this link.

And here is Health Campaigns Together on the subject at this link.

As you see, the consultation document includes 12 points for feedback and Health Campaigns together has provided suggested responses to these points – very good responses too, I think. You’ll find them at this link.

When you’re ready here is the direct link for public feedback to the document, just copy and paste from the Health Campaigns Together link above.

As stated, there is a move afoot to get the consultation suspended until after the appeal granted to the 999 for the NHS has been concluded, but it’s very important to counter what will definitely be lots of responses from the allies of NHS England. Otherwise they will be able to hail the result as a democratic mandate.

Health Campaigns Together say that it is OK to copy and paste HCT’s responses into the feedback boxes on the questionnaire, although if possible, it would be good if respondents could add a few tweaks of their own.

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FINAL DETAILS – PLEASE COME VERY EARLY

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

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

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

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

See you there!

Keith Venables, HCT and George Woods, NEON.

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

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

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

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

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

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 Court of Appeal grants NHS campaign group permission to appeal against NHS England’s new Integrated Care Provider contract

Some very good news – which also means NHS England is consulting on an ACO contract that may be unlawful.

They knew full well that was a possibility, despite their protestations in the consultation document that both Judicial Reviews had ruled in their favour.

(They have rebranded the ACO contract the Integrated Care Provider contract and their consultation runs until 26 Oct.)

We shall be putting out more info shortly about this.

 

The Court of Appeal has issued an order granting campaign group 999 Call for the NHS permission to appeal the ruling against their Judicial Review of the proposed payment mechanism in NHS England’s Accountable Care Organisation contract.

The Accountable Care Organisation Contract (now rebranded by NHS England as the Integrated Care Provider contract) proposes that healthcare providers are not paid per treatment, but by a ‘Whole Population Annual Payment’, which is a set amount for the provision of named services during a defined period. This, 999 Call for the NHS argues, unlawfully shifts the risk of there being an underestimate of patient numbers from the commissioner to the provider, and endangers service standards.

In April, the High Court ruled against the campaign group’s legal challenge to NHS England’s Accountable Care Organisation contract – but the group and their solicitors at Leigh Day and barristers at Landmark Chambers found the ruling so flawed that they immediately applied for permission to appeal.

Although fully aware of this, on Friday 3rd August – the day Parliament and the Courts went on holiday – NHS England started a public consultation on the Accountable Care Organisation contract – now renamed the Integrated Provider Organisation contract.

The consultation document asserts that the payment mechanism in the ACO/ICP contract is lawful, because:

“The High Court has now decided the two judicial reviews in NHS England’s favour.”

Steve Carne, speaking for 999 Call for the NHS, said

“It beggars belief that NHS England is consulting on a contract that may not even be lawful.

And a lot of public funds is being spent on developing the ACO model – including on the public consultation.

We are very pleased that 3 judges from the Court of Appeal will have time to consider the issues properly.

We shall shortly issue our stage 5 Crowd Justice appeal for £18k to cover the costs of the Appeal.

We are so grateful to all the campaigners and members of the public who have made it possible for us to challenge the lawfulness of NHS England’s attempt to shoehorn the NHS into an imitation of the USA’s Medicare/Medicaid system.

We will not see our NHS reduced to limited state-funded health care for people who can’t afford private health insurance.”

Jo Land, one of the original Darlo Mums when 999 Call for the NHS led the People’s March for the NHS from Jarrow to London, added,

“All along we have been warning about the shrinkage of the NHS into a service that betrays the core principle of #NHS4All – a health service that provides the full range of appropriate health care to everyone with a clinical need for it, free at the point of use.

Since we first started work two years ago on bringing this judicial review, there have been more and more examples of restrictions and denials of NHS care, and the consequent growth of a two tier system – private for those who can afford it, and an increasingly limited NHS for the rest of us.”

Jenny Shepherd said

“NHS England’s rebranded Accountable Care Organisation contract consultation is a specious attempt to meet the requirement to consult on a significant change to NHS and social care services.

We don’t support the marketisation of the NHS that created the purchaser/provider split and requires contracts for the purchase and provision of services.

Integration of NHS and social care services, in order to provide a more straightforward process for patients with multiple ailments, is not aided by a system that essentially continues NHS fragmentation.

This new proposed contract is a complex lead provider contract that creates confusion over the respective roles of commissioner and provider. It requires multiple subcontracts that are likely to need constant wasteful renegotiation and change over the duration of the lead provider contract. This is just another form of fragmentation, waste and dysfunctionality.

The way to integrate the NHS and social care is through legislation to abolish the purchaser/provider split and contracting; put social care on the same footing as the NHS as a fully publicly funded and provided service that is free at the point of use; and remove the market and non-NHS bodies from the NHS.

Such legislation already exists in the shape of the NHS Reinstatement Bill.”

The campaign team say they are determined in renewing the fight to stop and reverse Accountable Care. Whether rebranded as Integrated Care or not, they see evidence that it is the same attempt to shoehorn the NHS into a limited role in a two tier healthcare system that feeds the interests of profiteering private companies.

Steven Carne emphasised,

“It is vital that we defend the core NHS principle of providing the full range of appropriate treatments to everyone with a clinical need for them.”

999 Call for the NHS hope the 2 day appeal in London will happen before the end of the year. The Appeal will consider all seven grounds laid out in the campaign group’s application – with capped costs.

Details on the first instance judgment can be found here, and the judgment itself here.
David Lock QC and Leon Glenister represent 999 Call for the NHS, instructed by Rowan Smith and Anna Dews at Leigh Day.

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