Category Archives: NHS

Responding to the Health Secretary’s pledge to overhaul mental health and wellbeing services for NHS staff following the launch of a Health Education England review, BMA mental health policy lead, Dr Andrew Molodynski, said:

“Staff are fundamental to the delivery of patient care in the NHS and without a healthy workforce our health service can barely function, let alone thrive.

“Given the current pressures that the NHS workforce is under, the Secretary of State for Health and Social Care’s commitment to improving mental health and wellbeing support for staff is both timely and necessary.

“We know that doctors’ mental health and wellbeing has been adversely affected by the increasing demands of their work and this is true also for medical students who are dealing with stress, fatigue and exposure to traumatic clinical situations, very often without adequate support on hand.

“The BMA recently for greater provision of mental health support for NHS staff as their report¹ found that only about half of doctors were aware of any services that help them with physical and mental health problems at their workplace – while one in five respondents said that no support services are provided.

“While these measures will go a long way to providing much-needed support for NHS workers who are struggling with their mental health and overall wellbeing, more must be done to address the wider pressures on the system, such as underfunding, workforce shortages and rising patient demand, so we can reduce the number needing to seek help in the first place.”

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The Health & Care Professions Council (HCPC) delivered a snub today (Thursday 14 February) by pushing ahead with an ‘extortionate’ registration fee hike, despite receiving a 38,000-signature petition protesting at the 18 per cent increase.
Unite, Britain and Ireland’s largest union, led the protests at the increase from £90 to £106 a year – on Monday (11 February) the union handed in the petition to HCPC chief executive Marc Seale calling for the rise to be scrapped.

Unite lead professional officer for regulation Jane Beach said: “Today the views of the 38,000 mainly health professionals who signed the petition have been ignored which is very disappointing, given the cogent arguments we put forward that NHS pay has stagnated in real terms while the cost of living has raced ahead.

“The HCPC has given a massive snub to our members’ legitimate concerns about any fee hike.

“We consulted widely with our members who have to register with the HCPC in order that they can work professionally – and they gave the proposed increase a resounding thumbs down. Now they have been given a financial kick in the teeth by the HCPC.”
Unite argued that the increase from October 2019 would be another financial blow to hard-pressed NHS staff, such as biomedical scientists, paramedics and speech and language therapists, who have seen the fees increase by 40 per cent since 2014.

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DELIVERED AT JULIAN HART’S FUNERAL — JUNE 16th 2018

 

Julian and I were chatting once about heaven and hell, as you do. He didn’t believe in either, but supposing he was wrong, he thought he might be allowed into heaven, not as a believer, you understand, but for good behaviour.

Julian always wanted to be a doctor in a mining village, partly because his father had been a colliery doctor in Llanelli; partly it was the romance of mining practice as popularised in AJ Cronin ‘s novel The Citadel; but mainly it was the sort of community to which he wanted to belong.

And belong he did. As Gerald Davies, one of his patients, said in a BBC documentary , Julian wasn’t aloof like the other doctors, the headmaster and the colliery manager. He lived in the village and shared the common experience.

He wrote about it for medical students, “No one is a stranger; they are not only patients but fellow citizens. From many direct and indirect contacts, in schools, shops and gossip, I have come to understand how ignorant I would be if I knew them only as a doctor seeing them when they were ill.”

Julian loved his patients – not romantically, of course. The opposite of love in this context is indifference and Julian was never indifferent. He hated when bad things happened to his patients, especially when they could have been prevented. In his last 28 years at Glyncorrwg, there wasn’t a single death in women from cervical cancer.

In his book A New Kind of Doctor, he described a man, invalided out of the steel industry after a leg fracture, aged 42. With no further use for his big muscular body, he had become obese, had high blood pressure and cholesterol, got gout and was drinking too much. 25 years later, Julian described how, after 310 consultations and 41 hours of work, initially face to face, eventually side by side, the most satisfying and exciting things had been the events that had not happened: no strokes, no heart attacks, no complications of diabetes. He described this as the real stuff of primary medical care.

At a seminar in Glasgow, we asked Julian what happened next. The man had died, of something else, a late-onset cancer I think, but when Julian told us this, there was a tear in his eye. His patient had become his friend.

This was Dr ‘art, without an “H”, as known to his Glyncorrwg patients. None of this explains why Dr Julian Tudor Hart became the most famous general practitioner in the history of the NHS.

In 1961 with large numbers of very sick people, huge visiting lists and a nearby colliery that was still working, the Glyncorrwg practice was extremely busy. His initial base was a wooden hut. It took five years to reach a stable position.

He was the first doctor in the world to measure the blood pressures of all his patients. Famously, Charlie Dixon was the last man to take part, had the highest blood pressure in the village but was still alive 25 years later. Julian became an international authority on blood pressure control in general practice and wrote a book about it which went to three editions and was translated into several languages, with a companion book for patients.

What he did for patients with high blood pressure, he did for other patients, delivering unconditional, personalised continuity of care. After 25 years he showed that premature mortality was almost 30% lower than in a neighbouring village – the only evidence we have of what a general practitioner could achieve in a lifetime of practice.

It’s said that behind every great man there is an astonished woman. Behind Julian, was a great woman. When Deborah Perkin was planning her BBC documentary, the Good Doctor, (which we keep showing to medical students and young doctors), I said to her, there is something you have to understand. There’s two of them. Mary was his partner and anchor every step of the way.

Glyncorrwg was the first general practice in the UK to receive research funding from the Medical Research Council. Mary and Julian had both worked with Archie Cochrane and his team at the MRC Epidemiology Unit in Cardiff where they learned a democratic type of research in which everyone’s contribution was important and the study wasn’t complete until everyone had taken part. And so, in Glyncorrwg, there was the Shit Study, the Pee Study, the Salt Studies and the Rat Poison Study, all with astonishing high response rates.

Julian counted as a scientist anyone who measured or audited what they did and was honest with the results. Brecht’s The Life of Galileo was his favourite play and he often quoted Brecht’s line, “The figures compel us.” Julian didn’t pursue scientific knowledge for its own sake. His research always had the direct purpose of helping to improve people’s lives.

He had a talent for the telling phrase. His Inverse Care Law stated that the availability of good medical care tends to vary inversely with the need for it in the population served, or more simply, People without shoes are clearly the ones who need shoes the most.

When Sir Keith Joseph, a Conservative Secretary for Social Services, announced that
“Increased dental charges would give a financial incentive to patients to look after their teeth,” Julian commented, “The government has not yet raised the tax on coffins to reduce mortality, but Sir Keith is assured of a place in the history of preventive medicine.”

Julian’s friend and fellow GP, John Coope from Bollington in Lancashire, admired Julian’s nose for what mattered in the published literature. In his book The Political Economy of Health, that magpie tendency was on display, the footnotes comprising one third of the book and worth reading on their own. A Google search could never assemble such a mix. Goodness knows what readers made of it in the Chinese translation.

He lectured all over the world – in the US, Australia, Kazakhstan, Italy and Spain in particular. Julian could deliver formal lectures but for brilliance and exhilarating an audience he was at his best in impromptu, unscripted exchange.

When principles were at stake, Julian could argue until the cows came home. In his younger years he took no prisoners. A famous medical professor reflected that he had been called many things, but never a snail.

Dr Miriam Stoppard arrived in the village to interview Julian for her TV programme, determined to cast him in the role of a doctor who made life or death decisions concerning his patient’s access to renal dialysis and transplant. They battled for a whole afternoon, Stoppard trying to get Julian to say things on camera that fitted her script. He defied her, ending every sentence by mentioning how much dialysis and transplant surgery the cost of a single Trident missile could buy. She went away defeated and empty-handed.

I was surprised once at Paddington station to see him with a copy of the London Times. He was no fan of the Murdoch press. On boarding the 125 for South Wales, he laid out the newspaper as a tablecloth and over it spread a messy, aromatic Indian carry-out meal. If businessmen in their smart suits wanted to sit next to us, they were very welcome.

Standing for election to the Council of the Royal College of General Practitioners, Julian topped the poll. What he offered GPs was a credible image of themselves as important members of the medical profession – alongside specialists, not beneath them.

Julian was humble in himself but ambitious for his ideas. He accepted with ambivalence the honours and sentimental treatment that came with age but he never lost his edge, and if we are to celebrate his life it should be by holding to the principles he held dear.

The work of a general practitioner is immeasurably enhanced by working in, with and for a local community, for long enough to make a difference.

Everyone is important, the last person as important as the first, and the work isn’t done until everyone is on board.

Julian was the “worried doctor”, anticipating patients’ problems, not waiting for them to happen, and then avoiding them by joint endeavour.

Drawing on his reading of Marx, he saw health care as a form of production, producing not profits but social value, shared knowledge, confidence, the ability to live better with conditions, achieved not by the doctor alone but by doctors and patients working together. Patients were partners, not customers or consumers.

The NHS should never be a business to make money but a social institution based on mutuality and trust – the ultimate gift economy, getting what you need, giving what you can, a model for how society might run as a whole. In re-building society, co-operation would trump competition, not marginally, but as steam once surpassed horsepower. The Glyncorrwg research studies showed glimpses of that social power.

My daughter Nuala met Julian many times. Losing him as a person, she said, was like the Mackintosh Building at Glasgow School of Art, burning down. We lost someone dear, a big part of our lives, an institution, a one man “School of ‘Art”, full of life, light and creativity.

Julian’s gift to us today is not the example he worked out in the microcosm of a Welsh mining village over 25 years ago; it is the present challenge of how we follow and give practical expression to his values in local communities in the future. In honouring his memory, there is work for all of us do.

 

Professor Graham Watt
MD FRCGP FRSE FMedSci CBE
Emeritus Professor
General Practice and Primary Care
University of Glasgow

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‘Back to the Thirties’ by Charles Webster (previously Director, Wellcome Unit for the History of Medicine, University of Oxford).  

First published in September 1984 in the public health journal Radical Community Medicine, this essay reflects many of the issues the NHS and public health face today, from the PR management of statistics and altering of history to the refusal of government to acknowledge the need to spend to alleviate poverty. We are grateful to Alex Scott-Samuel, editor and publisher of the journal, for his kind permission to re-print this essay.  

A multiplicity of ways are being used to undermine public confidence in the National Health Service. Among other things history is being rewritten to cast doubt on the record of the Welfare State. It is now common to find the Welfare State portrayed as a destructive force ‘expanding at an explosive rate’ or as the ‘time bomb ticking under us all’ (Daily Mail 24.1.84). By contrast, in appealing for the revival of Victorian values, it is implied that welfare was handled better under the voluntary system. Social scientists and historians have obligingly come forward to suggest that stories of adverse social effects of the slump have been magnified. The inter-war period is portrayed as a phase of expansion, of new industry and of general increase in living standards. By contrast, the welfare state is described as a ‘cult of superstition’, a myth to be destroyed by the economic realists. We are thus from many different quarters temptingly invited to turn the clock back to the Thirties.

But history is not so obliging a servant of the establishment. To any critical observer it is clear that the NHS was not created out of a gratuitous desire to extend state intervention. Quite the reverse: the NHS was the unavoidable consequence of World War 2.  At the outset of hostilities it was realised that effective defence necessitated complete recasting of the medical services. Once this Emergency Medical Service was in operation it was realised that it would be impossible to revert to the previous system by dismantling what was in effect a prototype NHS. The force of this argument was appreciated by all political parties and by all sections of the medical profession. To this extent the NHS was supported by an almost universal consensus and that consensus has remained intact until the recent commencement of crude attacks upon the Welfare State.

The need to form the Emergency Medical Service and then the NHS thus arose from the unsatisfactory state of the health services in interwar Britain. Because the dismal record of these services is now tending to be overlooked it is useful to recall just how inadequate was the state of healthcare before World War 2.

Paradoxically, one of the striking indications of the inadequacy of Britain’s health record comes from the excessive tone of optimism adopted in official reports, especially the influential Annual Reports of Medical Officers of Health at the local level. These reports tell a story of continuous improvement on almost all fronts. Collectively they convey an impression that problems of ill-health were being contained to such an extent that they had reached an almost irreducible minimum by the Thirties. These records bear comparison with Stalinist excess in statistical falsification and in retrospect it is clear how epidemiological data was used as a political weapon to justify low rates of unemployment relief and as a buttress to the policies of retrenchment of the National government.

Inevitably the above complacency produced a severe backlash. For instance, the MOH for Stockton-on-Tees G C M M’Gonigle and his sanitary inspector published Poverty and Public Health (1936) giving an almost diametrically opposite impression of health in the depressed towns from that contained in official reports. The impact of M’Gonigle’s work was reinforced by the inclusion of a preface written by the great biochemist, Frederick Gowland Hopkins, who was at the time President of the Royal Society. Gradually the rosy edifice of official health statistics crumbled away and it became apparent that minor improvements in indices relating to life expectancy and infant mortality was insufficient to disguise the nation’s inadequate health record.

Among the major grounds for concern were:

  1. By 1939 England and Wales had slipped to ninth position in the League of Nations’ Table of Infant Mortality. Scotland by then was 17th. This was merely one indication that Britain was falling behind its Dominions and other major western nations in its health record.
  2. Striking regional, class and occupational disparities were evident across the broad front of mortality and morbidity statistics. Scotland and Northern Ireland were comparable with the worst regions of England and Wales, which tended to be South Wales and the North West.
  3. The pattern within any region was complex with regard to its distribution of blackspots. For instance, taking the industrial towns of the North West in 1930, the best wards had an Infant Mortality Rate of below 40 whereas in the worst wards the IMR was above 150. Similarly, in better areas the Maternal Mortality Rate was about 2 whereas in ‘problem areas’ it was commonly above 10.
  4. As Titmuss was the first to demonstrate in 1938, there was every sign that differentials between the social classes were persisting, despite the claim that welfare benefits had largely solved the problem. Using methods recently revived for the purposes of the Black Report, Titmuss demonstrated that there was commonly a 500% differential between social classes I and IV. The differential among infants increased rapidly after the first month of life.
  5. Maternal mortality had increased dramatically during the interwar period to reach a peak in 1934. Levels of maternal disablement were so great that formal investigation into this problem was blocked by the Ministry of Health. However, officials confidentially admitted that estimates of some 50,000 cases of maternal disablement occurring annually were likely to be correct.
  6. Among the major causes of maternal mortality and morbidity, it became increasingly clear that a) the low health status of the mother and b) incompetent medical intervention, were of primary importance. Thus, in South Wales, Lady Rhys Williams claimed to achieve a reduction in maternal mortality from 6.39 to 1.64 solely by means of supplementary feeding of mothers. In a representative study by a leading gynaecologist, Aleck Bourne, it was estimated that of 1,917 cases of death, more than half might have been saved if ‘the full resources of knowledge both of prevention and treatment could have been utilised’.
  7. On the basis of the first elaborate nutritional surveys to be undertaken in Britain, Sir John Boyd Orr drew the alarming conclusion that a substantial section of the population was malnourished. Evidence from a variety of sources suggested that up to one half of the child population was malnourished to some degree. On the basis of budgetary surveys it was clear that malnutrition was likely to be endemic among the families of the 1.5 – 3 million unemployed, as well as among a large population of low wage earners, numbering at least 2 million according to Kuczynski.
  8. The large section of the population living in overcrowded or insanitary accommodation was exposed to much higher rates of infectious disease, tuberculosis, bronchial diseases, infestation etc. Once again, levels of overcrowding and slum dwelling were so high that the Ministry of Health adopted standards disguising the seriousness of the problem. Even according to the unrealistic standards adopted by the Ministry, industrial towns commonly showed 20% overcrowding, whilst in Clydesdale this estimate reached 45%.
  9. The above conditions contributed to high levels of debility among working class schoolchildren, which was to some extent reflected in height/weight measurements but even more in levels of rickets, bronchial conditions, rheumatic heart disease, infestation, etc. Prior to World war 2 4,000 child lives were unnecessarily lost each year owing to non-implementation of diphtheria immunisation.

The above catalogue of mortality and debility is by no means exhaustive. Shocked by official complacency concerning these facts, experts such as Titmuss were stung into expressions of deep indignation. ‘The high maternal mortality, the excessive mortality among infants, children and young people, the severe incidence of nutritional defects and tuberculosis among young people, and of deaths from heart disease in the Thirties, the premature ageing and the defect-shortened lives and all the amassed evidential statistics from many and varied sources (shows) that we are losing one quarter of our population every generation, and faced with the fact that that at least 500,000 excess deaths have occurred in the North and Wales during the last ten years can only point…to the presence of intense poverty on a scale so considerable and so widespread…’

Many of the above problems had their roots in poverty, unemployment, low income and environmental degradation. Incompetence of the health service was superimposed on these threats to life. The inefficiency and inadequacy of the interwar health services resulted from the haphazard way in which the structure had developed. By 1939 the British healthcare system had achieved labyrinthine complexity,  but it was still deficient in many respects.

The reputation of this system rested on the much acclaimed ’glory’ of the voluntary hospitals. To be more precise, the genuine reputation derived from the teaching hospitals, whereas the great majority of the 1000 voluntary hospitals were inconveniently small, overcrowded, impoverished and obsolete. The system of honorary medical appointments was breaking down, while the nursing staff were tiring of exploitation. By the outbreak of war the charitable basis of funding had collapsed and the system as a whole was bankrupt.  Although new sources of income had been developed, these were insufficient to keep up with rising costs. By 1940 10 of the 28 teaching hospitals were in deficit. In London, voluntary contributions, which were the traditional source of income, were accounting for only 30% of the voluntary hospital income. Payments from patients were now accounting for a further 30% of that income. In other words the principle of free treatment had been sacrificed. Patients were thus faced with a choice between contributory schemes and means-tested payments.

Of the remaining element in voluntary hospital income, a substantial amount was derived from fees for services paid by local authorities. The war further precipitated reliance on public funds. Consequently by 1945 the voluntary system was voluntary in name only.

The inadequacy of the voluntary hospital system prompted local authorities in many areas to extend into the acute hospital sector. By 1939 the voluntary system and the local authorities were contributing equally to the 140,000 acute beds. Because the local authorities were already providing chronic, mental and mental deficiency hospital care, they now became the dominant partner in the hospital field. By 1939 certain local authorities were providing virtually comprehensive hospital services, which were better coordinated and more adequately financed than the voluntary system. But local authority hospitals were themselves variable in quality, often marred by the taint of the poor law and providing a low grade of service. Only gradually were staff being recruited capable of matching the quality of the honorary medical staff of the teaching hospitals.

Hospitals were merely one part of the expanding constellation of local authority services. Perhaps the most important addition in the ‘30s was the midwifery service. Although in theory local authorities were providing a virtually comprehensive system of clinics for mothers, infants and children, provision of these services was usually not mandatory, while their performance was not as good as the bureaucrats supposed from superficial statistics. There was thus enormous variation in quantity and quality of provision of such services as maternity units, specialist treatment, dental services, nursery schools, or supplementary nutrition for mothers and children. By 1939 25% of deliveries were occurring in hospital; in some districts more than half the deliveries were taking place in maternity units, while in others this facility was vitually absent. Although the school meals service had existed for 30 years by 1939 it was only providing free meals for 2% of the school population. By 1939 only a few towns had immunised more than half of their children against diphtheria, while the level in London was only 6%. Such statistics suggest that for the majority of the population local authority services represented no more than a token effort. Also, by its nature the clinic system tended to sacrifice the important principle of continuity of care, and it related to the single disease rather than to the health of the individual taken as a whole. The latter was supposed to be taken care of by the general practitioner and for this reason the local authorities were forbidden to undertake domiciliary care.

The most highly developed part of the general practitioner service was provided under National Health Insurance, but this ‘panel’ scheme suffered from crippling disadvantages. First, the income limit was £250 until 1942, when it was raised to £420. Consequently a large class of wage earners was excluded from the panel without being sufficiently well-off to afford private medical fees. Secondly the service was limited to GP care and did not extend to specialist treatment. Thirdly, the range of services offered depended on the Approved Society contracted with. On the whole the less needy secured the best additional benefits such as false teeth and glasses. Fourthly, there was a clear sense that NHI was a second class compared with the service secured by fee-paying patients from the same GP. Finally, the greatest defect was the divisiveness resulting from exclusions of dependents from the scheme. Workers deeply resented their wives and children being deprived of the service for which they were paying, even if the service itself was inadequate. This provides just one example of the way in which non-working women were allowed to fall through the net of health services.

Family incomes were of course inadequate to make up for this shortfall in health care provision, with the result that working class wives tended to deprive themselves not only of medical treatment but also of the basic necessities of civilised existence. Janet Campbell rightly detected the intolerable apathy in which working class women habitually sank: ‘They need encouragement to feel a wholesome impatience with remedial discomforts and trials, and some stimulating influence to counteract the inevitable apathy which so naturally settles upon them, as well as practical assistance to rid themselves of some of the almost intolerable weight of unpaid domestic labour which presses so hardly, and which is spoiling not only their own lives but the contribution to national health and efficiency which they might make as happy wives and mothers’.

The above represents the reality of family life for the majority of women before World War II. These realities are worlds apart from the rose-tinted image of Victorian family life which our present political masters believe persisted until its virtues were suppressed by the welfare state. Totally inadequate health services made their contribution to the misery of working class life, and doctrinaire glorification of the voluntary system did more than its share to prevent the modernisation of health care. By the late thirties the weaknesses of all components of the health services were becoming publicised. It was no longer possible for bureaucrats and medical politicians to disguise the bankruptcy of the system. Critics were making their mark and health was emerging as a major political issue. As Bourne noted: ‘there is an almost rebellious feeling abroad that the health conditions of the people are bad because of avoidable causes rather than uncontrollable circumstances or lack of knowledge. Not only are the results of the working of our medical services disheartening as indicated by our existing health standards, but many progressive minds amongst us feel that these poor results can be traced to a fundamental lack of organisation of the profession in the cooperation with central and local public bodies. It is possible to see beyond this, that not only must the machinery of the health services be reorganised, but that the very economic basis of the lives of the people must be changed so that widespread poverty, which is at the root of so much disease, may be abolished rather than masked by what should be the unnecessary sops of social services.’

It was correctly perceived that the only viable way forward rested in the policies that were to create the welfare state and the National Health Service. The vested interests opposed those policies and they prevented their full implementation. These same forces have now regrouped and are determined to set the clock back to the Thirties. They must be defeated!

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This is a talk given by Public Matter’s Deborah Harrington at an NHS event held jointly by NEON (New Economics Organisers Network) and Health Campaigns Together for The World Transformed in October 2018 in Liverpool.

The brief was to speak for no more than 7 minutes and ‘not to dwell on the history’ but on how to move forward.

The talk began with a quote from the novelist Milan Kundera:

“The struggle of man against power is the struggle of memory over forgetting.”

“We allow our futures and our present to be reshaped by others against our interest if we forget what’s important in our own collective history.

Every NHS campaign meeting contains powerful stories from campaigners – on resisting service closures and cuts, fighting for pay and conditions and more. But I would like to make my first point about what we can learn about building a movement from right at the start of the life of the NHS. From Bevan, in fact. I think this has great relevance to what we are talking about today.

In the first half of the 20th century (don’t worry, it’s not a history lesson) the country as a whole suffered from two world wars, an appalling flu epidemic that wiped out whole communities and the Great Depression. The people didn’t need to be lectured about the Big Society to realise they were all in it together (well, almost all).

The fight was between different political factions at government level about what services were to be delivered and how to deliver them.

Doesn’t that sound familiar?

The arguments were fierce, but Bevan won the day (with a few compromises along the way). But it only lasted 3 years before the principles upon which the NHS was founded were under attack.

If you have never read Chapter 5 of Bevan’s set of essays written in 1952, In Place of Fear, you should. Essential reading for two very important reasons: first he counters the arguments put up against his NHS and secondly he makes his case for his vision of the NHS stand out powerfully against the opposition. If you haven’t read it, you may well be shocked to see him facing all the same arguments we face today: the necessity of having out of pocket payments, the cost of immigrants, the unaffordable burden of the old and the excessive demands made on the system ‘because it is free’. I want to stress from this is that there was general support amongst politicians and public alike that the issue was not over whether there would be a National Health Service, but what form it would take. And Bevan held out for his vision – a socialist enterprise in a very rich capitalist society.

So we move on to the second point – which is defining what a vision of a public service NHS should look like today and what are the threats facing it. I would argue that cuts and closures are the symptoms of the threat, not the threat itself. The threat is from a globalised free market vision of public services as divisible into those which can provide a profit stream and those that can’t.

It’s across the services, not just the NHS and it is across the world, not just in the UK.

But the questions which are thrown out at the public – it’s the old/it’s the immigrants/it’s too much demand/it’s unaffordable – are the way in which the corporate sector frame the situation to cast doubt on the future existence of the NHS in its current form.

And that’s where the catch lies – because the corporate sector which is the engine of this change does have a vision of what the future form should be (effectively to turn it into a UK version of Medicare) and they are doing a hard sell on it. And their sales pitch is seductive.

In it they say that in order to have high quality services we must bring them together, in fewer locations. Surplus land can be sold to help pay for the transformation and the new buildings to house new services can be rented from the private sector ‘bringing investment’ into the NHS. They say the new services will utilise new technology to fit modern lifestyles, that personal health vouchers for those with long term or complex conditions will empower them with choice, that the service will be personalised, focused on you, the patient.

They say it’s the quality of care and the joined up nature of the care that matters, not whether the provider is public or private. So the second take home message is to understand the opposition’s arguments, learn how to demolish those arguments quickly and efficiently and to move on to promoting our shared vision. Because our struggle today is not for any old NHS but for a universal, comprehensive, equitable, public service NHS. Because ‘free at the point of need’ only matters if the service you are getting is worth having. And because every word of their seductive sales pitch is designed to hide the destruction of the NHS’ values of universal and comprehensive care and its ethos of public service, not corporate profit.

And so to my third and final point. Across the country we have individual campaign groups who are extraordinarily knowledgeable about their CCGs, STPs, and all the NHS in England acronym soup. We have umbrella groups which link them together which allows lessons learned in one place to be shared with others. But we also have a wide variation in the individual groups. At the grassroots level look at any group on social media and you will see pro-NHS campaigners arguing from a racist and xenophobic perspective that ‘our’ NHS can’t cope with the demand from ‘non-contributors’. Time and again someone will say that ‘the NHS is what they pay their National Insurance for’ (spoiler alert: it doesn’t). And others (whether well meaning and mis-guided, or simply trolls) saying that the NHS needs to change if it is to continue at all.

At the political and opinion forming level (think tanks, politicians, main stream media) there appears to be a consensus that the Health & Social Care Act (2012)  ‘failed’ and that, whilst parliamentary time is so bound up in other matters, it is good that Simon Stevens is working around that legislation to put the NHS in England back together again. My colleague Jessica and I had a meeting with an MP from the North West who said that this view pervades all political parties and indeed it is reflected everywhere from the cross party Health Select Committee to the recent publication from the Labour Party ‘A Picture of Health’.

But we need to remember what is at the heart of our campaign and keep our message simple and strong. And for that I will quote Jessica’s grandfather, the late Julian Tudor-Hart, who wrote in his essay ‘The Inverse Care Law’ in 1971 ‘the availability of good medical care tends to vary inversely with the need for it in the population served. This inverse care law operates more completely where medical care is exposed to market forces, and less so where such exposure is reduced.’

Because I would argue that the 2012 Act has not failed.

It has done its intended job of ripping the NHS into fragments so that its pieces can be reassembled like jigsaw pieces. It absolutely leaves the NHS exposed to market forces and they are being embedded at every level from decision and policy making to running services. The evidence from across the world proves the Inverse Care Law right. So my last take home message would be to remember that this is a struggle that goes further than England’s boundaries. And it also goes across time.

There is a short term and very urgent battle to be won but it is in a broader and ongoing battle of ideals and ideology that isn’t going away any time soon.”

On the platform with Deborah was Bonnie Castillo, Executive Director of the National Nurses United Union in the USA. The NNU is part of the fight for universal healthcare in the USA. Bonnie explained how important the NHS is as a beacon of hope for them, “Your fight to defend the NHS is our fight’ she said.

From this Saturday there is to be a week of cross-Atlantic campaigning as described here in the Guardian. They want Britons to join in with the NNU’s National Medicare for All week of action, running from 9-13 February. NNU is the largest union representing bedside nurses in the US.

https://www.theguardian.com/society/2019/feb/03/momentum-founders-emma-rees-adam-klug-nhs-style-healthcare-in-us?fbclid=IwAR0TXvaVmpkJ-DCPnlbXbp-Ykt6ouW7-NUshTBYTubZXk5yYECiRFqco7Qs

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Health inequalities persist and grow in the UK. Differences in morbidity and mortality add to rising public concerns about household poverty and children’s health and development. Current attempts to redefine and find new national lower measures for poverty in the UK when current measures show increases, talk endlessly about getting more information about poor people and their lives and involving them in defining the problems. This blog is about how the language used itself diverts attention from the real underlying issues, such as why, in the rich UK, are personal and public resources so badly distributed by government or the labour market that anyone is left without sufficient to choose an acceptable conventionally inclusive and healthy lifestyle. Whatever the role of freedom of choice in people’s lives, which is a basic premise of our marketised consumerist society, it follows that no one should have too few resources to exercise it as others do.

Today’s problems are constant reminders of what Sir Douglas Black brought to wider public and political awareness as long ago as 1977. His report concluded that “poverty remains the chief cause of disease, and it is a factor which is beyond the immediate control of medicine”. ‘Disease’ here means all forms of ill-health, and the poverty referred to is not only that of the individual household lacking adequate disposable resources (mainly cash incomes) to be free to make its own healthy choices of food and socially-inclusive lifestyle, but also the lack of the collective resources of decent housing, health and care, children’s services, education, public transport, opportunities for adequately paid work and other collective means of enabling and empowering people to take a recognised part in their society over time. These are matters that Sir Donald Acheson’s report on Inequalities in Health reiterated in 1998 and others repeatedly have since then.

Public expenditure on and availability of all of these collective as well as individual resources at the levels needed to prevent deprivations and health inequalities has been considerably reduced by deliberate government ‘austerity’ policy since 2010. It is just possible that the politicians who devised and maintained these anti-statist policies were unaware of the health consequences of their pursuit of austerity; at any rate, if not culpably ignorant and oblivious, they seem to disregard the reports which increasingly make the connections between their policies and the consequent growth in a wide range of social evils including health inequalities. Beyond a little fire-fighting in crisis situations the current political response is too often to focus on or even blame the victims, suggesting for instance that they wouldn’t be so unhealthy if they’d made the right lifestyle choices compatible with their resources. The current government does not acknowledge that the resources are inadequate for such choices.

The obvious problem of inadequate resources and incompatible objectives, such as eating or heating, can’t be answered as long as we focus only on people in poverty and their own reports. The language we use to talk about the problems (the discourse, to use the technical jargon) not only distorts our focus on underlying causes but actually closes off some options for policy action, and this is being deliberately promoted for ideological reasons by some of the people involved. It’s part of the bigger story of attitudinal manipulation widely discussed in political circles, but it’s relevant in many other fields as well, and it affects social scientists as well as other publics. That’s why the current discourse matters when we discuss health problems.

First, a note about the social science technical aspects. The discourse reflects the currently accepted explanatory paradigms, the self-consistent system of concepts and theories which any scientific system uses to structure its approaches in ways which make it seem like ‘common sense’ not needing to be questioned. That’s why to make sense of what’s happening now, we need to review,  brutally briefly, the succession of dominant poverty paradigms since the 19th century. The traditional paradigm was acceptance of class-based social stratification, given its authority by the dominant social order or even by religious beliefs, in which poverty was the way of life of the lowest layer of society, in terms of squalor and exclusion. Dividing poor people into the ‘roughs’ and the ‘respectables’, many well-off people assumed this was a matter of individual choice even if the system was immutable. But the earliest systematic attempts by such pioneers as Seebohm Rowntree showed the poorest people lacked adequate resources even for physical efficiency. He designed an artificially low ‘primary poverty’ budget to show it was inadequate for real life, but even so it was criticised for superfluity.

This generated the second dominant paradigm in this field, poverty defined as and measured by household incomes below artificial minimum subsistence budgets. In the 20th century this generated an academic industry of competing prescriptions for variants of what the lowest level of living for poor ‘othered’ people could be, some allowing for minimal social participation expenditure as well or targeted on ‘healthy living’. Against this, during the 1930s, Sir John Boyd Orr argued that instead of prescribing minimum budgets for the lowest level of living at which people didn’t show nutritional deficiency symptoms, researchers should study empirically at what minimum levels of income households actually achieved optimum levels of nutrition. This generated lively scientific and professional association arguments for years. In the post-war period, the sociologist Professor Peter Townsend argued that if households were to be studied for sufficient spending on adequate nutrition, this applied even more strongly to adequacy of their resources for social participation. He suggested that seriously lacking resources for participation in conventional lifestyles was the conceptual definition of the social phenomenon of poverty, identifying its cause in the structure of resource distribution and pointing to a more appropriate measure of poverty than normative budgets based on the natural science measures of nutrition and health alone.

This third paradigm thus raised the question of whose standards of adequacy of resources and life choices were to be applied to distinguish normally inclusive lives from poverty. Should they be the experts’ prescriptive (normative) views about healthy diets and lives, or the population’s views about inclusive lifestyles (though research experts are needed to discover empirically what they are)? The question of whose and what standards were to be applied, and the levels of various resources needed to enable inclusive lifestyles, became a matter for the poverty research industry, but some policy-oriented researchers (and many politicians) found it hard to accept the shift from expert to ordinary people in defining what an inclusive lifestyle and adequate resources might be. Some of this was caused by manifest confusion between the social science question of what levels and standards of resources were needed for social inclusion, adequacy, as defined by the whole population, and the completely different political question of what governments asserted ‘the taxpayer’ could afford for social security claimants.

A larger problem, one which is rarely admitted openly but colours all such arguments, is the ancient class distinction between living standards Good Enough for Us, We the People, or sufficient for Them, the Poor. Evidence from social surveys and focus groups shows that when they ask about what levels of living are needed for poor people to escape poverty, participants offer more restrictive views than when they are asked about what all of ‘us’ need to live a minimally decent inclusive life in society. If the word ‘poverty’ is used in the question, responses often ‘other’ the victims as ‘them’. Thus although the currently dominant paradigms may succeed in dominating discourse to squeeze out previous ones, the older ones may leave persistent residues in common thought. Today’s focus on poor people’s lives which avoids the social and economic structures within which they occur harks back to the traditional paradigm of class divisions.

This is no accident. It shows that it’s not only traditional social distinctions but ideology, how power should be used politically, which influences the discourse. The chief distinction is between the traditional conservative view that different minimum standards are naturally hierarchical since in that ideology each class has its ranked position and unequal status and the decent minimum may vary accordingly. By contrast, the socialist egalitarians argue that the minimally adequate inclusive lifestyle standards should apply to everybody. This reflects the recognition that conventionally inclusive lifestyles may remain unequal in many respects but everyone within them has sufficient resources to make choices and still be recognised as included or healthy. Inequalities remain but are no longer caused by a serious lack of resources, and are therefore not a poverty problem even if they are some other. For instance, assessing the promotion of ‘go private and get better service’ in the NHS then depends on whether the standard quality of services in this essential collective resource demonstrably meets the ‘good enough for us all’ expectations or whether it reflects a ‘NHS good enough for those who don’t have resources to make choices’ conservative austerity perspective.

The focus of all the public argument right now against this background is the people in poverty as defined by the current paradigm, as people whose “resources are so seriously below those commanded by the average individual or family that they are, in effect, excluded from ordinary living patterns, customs and activities” (Townsend 1979). Why then do some anti-poverty organisations welcome more intensive study of people in poverty — “to fight poverty, we must first understand more about those in its grip” (The Guardian 17.9.18). This focus dominates much media framing of what to do about poverty. Even if the scope is broader, it’s the counterpart of studying malnutrition in terms of why don’t poor people eat greens instead of junk food. In terms of the old analogy of pulling drowning people out of the river downstream, it’s asking why don’t they swim, and planning to teach them better, instead of asking why did they fall in upstream — or even who keeps pushing them in. The article quoted calls on policy makers to use this focus “to help alleviate poverty in Britain”. But why not work to abolish it? The answer must lie on the political right where alleviating poverty is philanthropic and OK, while policy to abolish it is political and ‘lefty’.

A discourse which focuses obsessively on the characteristics and experiences of people in poverty is a bit like first aid. Victims must of course be relieved, even if at that stage no account is taken of causes. But overall in the health field much more attention is rightly focused on prevention even while state funding is restricted. The danger of the discourse focusing only on victims is that it normalises acceptance of ill-health and alleviation (the conservative stance) instead of emphasising attention to its preventive ‘clean water’ of adequate resources. ‘Poverty porn’ attracts many television viewers and normalises ‘othered’ lifestyles whose deprivations and deviances are enforced. It’s a modern version of visiting Bedlam three hundred years ago. Of course ‘those who experience it are best able to describe it’, a perspective long emphasised by for instance community workers and mental health service patients (not forgetting victims of oppressive social security, as illustrated by ‘I, Daniel Blake’). But this is not the same as the shift to claiming that the ‘voices of the poor’ should be the principal source of valid evidence on how to abolish it. This would be like acknowledging that sick patients are the best guides to what their symptoms feel like, and then claiming their reports as scientific analysis of causes. Cholera patients report fever and diarrhoea, not polluted water supplies. A neglected factor in this well-meaning emphasis on victims’ accounts is the implication that people who aren’t suffering can’t understand it, or even that they lack empathy, which is used to discredit critics who look beyond symptoms to causes.

The more the current discourse emphasises focus on people in poverty, the more it distracts from discussion of preventive measures, especially when these are discussed in terms of government policy instead of the foundations of good health. But to avoid policy argument as “not our business” gives covert support to ideological opposition to structurally redistributive policies, not the foundations of social policy for health and social security of resources for everyone. Evasion of those issues is discourse closure on prevention. Preventing poverty and health inequalities sounds good, but when it means trying to change the behaviour of victims without increasing their access to relevant individual and collective resources to adequacy levels, it’s dishonest.

Poverty prevention is not the only subject closed off by discourse focusing primarily on the lives of people in poverty. In this world of inequalities, there doesn’t seem to have been interest in studying how far statistically normal individual variability in health experience overlaps with health inequalities which themselves correlate with variations in levels of individual or household power over resources and the availability of collective resources. No one expects the normal range to be dependent on resources alone, so we need research to establish what its contribution is. The ‘Money Matters’ research by Kerris Cooper and Kitty Stewart (JRF 2013; 2015) showed that (contrary to some conservative lobby groups’ claims) money indisputably does matter and others showed the causative networks by which it does. Regrettably the project failed to proceed to ask, ‘and if money matters, then how much money matters?’ If we are to have effective preventative policies to abolish poverty as well as alleviating it, then we need to know what the evidence suggests that bit of the anti-poverty target is.

There is no theoretical reason (except perhaps in some neo-liberal economic or politically reactionary fantasies) why anyone in UK society should have too little power over resources to be able to make healthy choices without detriment to their conventionally decent socially-inclusive lives. Discourse matters because when it focuses only on poor people’s health it closes off the bigger problem of those structural inequalities which also damage everyone’s social health.

 

 

Author.

John Veit-Wilson is Emeritus Professor of Social Policy of Northumbria University and guest member of Sociology at Newcastle University. He is author of Setting Adequacy Standards: How governments define minimum incomes (Policy Press 1998) and was poverty consultant to the Joseph Rowntree Foundation’s Money Matters research programme. He was a founding member of the Child Poverty Action Group in 1965.

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Some quick notes on UnitedHealth pulled together fast, to brief those unfamiliar with the threat to the NHS that it poses:

NHS chiefs tell Theresa May it is time to curb privatisation: can it be true?

This is the ultimate in cynical deception. We’re told that the fox is trying to improve the security of the NHS henhouse! In fact the part of the Health and Social Care Act 2012 that Stevens proposes removing makes monopoly control of the NHS illegal under competition law rules. That ban has, as intended, blocked the NHS from excluding private sector competition for its budget and was used as a means for the private sector to extract profits from public funds which should have paid for patient care. But the same rules also make control of the NHS by a company, such as a health insurer like UnitedHealth, illegal. It is these rules that Stevens is now saying he wants removed, at the time when UH is already entrenched inside the NHS: UH man Stevens heads the NHS and UH subsidiary Optum is involved across the country in processing patient care payments for GP practices. This legal change will not halt the privatisation of the NHS, it will accomplish it!

Simon Stevens is posing as a neutral bystander when he is in reality facilitating UnitedHealth’s control of the UK health system. He is enabling a corporate monopoly of the NHS whilst pretending to be against privatisation. Removing competition rules would also have the effect of allowing a now legal takeover to take place behind closed doors, away from public scrutiny.

Thanks to Stevens diligent work facilitating and heading up UnitedHealth’s expansion into the UK over a period of nearly two decades, UnitedHealth, through its subsidiary Optum, is today now well placed in the system to integrate and siphon off the UK’s NHS budget.

Simon Stevens’ CV is here: http://selloff.org.uk/nhs/CVforSimonStevens260516.pdf

Here is an update on UnitedHealth in the NHS:

They have had CCG contracts in every STP area

Their decision support software is used in most GP practices (it was bought by Stevens for the NHS in 2009)

UH was hired onto NHS England’s commissioning outsourcing framework in 2015

UH was hired as consultant and supplier to all of NHS England’s own Commissioning Support Units

UH was selected as one of only two companies on the NHS Shared Business Services Medicine Management Framework offered to CCGs. It has a business relationship with the other one

UH is shaping and integrating the system via IT system involvement, handling contracts and/or advising on cuts in many areas

They have been handling referrals for at least 21 CCGs, which has included developing a list of “procedures of limited clinical value” for CCG use in negotiations with providers, many of which are elective procedures that private providers can sell to patients denied NHS care for them.

Optum was hired last year by NHS England and the Department of Health to shape Independent Care Systems across the NHS, so far they operating in this specific capacity in at least 7 STPs

The Senior Clinical Advisor to NHS England on Integrated Care Systems is the director of an LLP (Limited Liability Partnership) which co-owns a company with Optum; and he also was hired last year by NHS Right Care to focus on leadership https://www.england.nhs.uk/rightcare/2018/08/14/professor-nick-harding-obe-joins-nhs-rightcare/

Hired by NHS England to benchmark spend in local area teams, and devised a “data capture template” for specialised services

Partnered with at least two of the largest “GP Super Partnerships” which are expanding and together span ten STP areas so far

GPs from one of the GP super partnerships have formed a company with Optum

Processing data for multiple CCGs, including identifiable data. Controlling data access for staff in Lincolnshire

Optum staff can be found in key roles in the NHS, including CCGs, Hospitals and at STPs. Also there are many NHS staff have left for Optum in recent years.

Wider influence in the system: partnered with NHS Confederation, the Kings Fund and Nuffield Trust, 2020Health. Optum sponsors BMJ events. The BMJ publishes research from OptumLabs. Regular presence at and sponsor of NHS meetings and conferences.

Paid associate of the All Party Parliamentary Group on Health, which “is recognised as one of the preferred sources of information on health in parliament” (quote is from the APPG website)

Corporate Partner of the National Association of Primary Care involved in implementing the primary care home model across the NHS. Optum is also on their council

Training the “Next Generation” of GPs, on a programme funded by NHS England

Handling Freedom Of Information Requests in Lincolnshire

Six Lords have interests in UnitedHealth, one of them is on the NHS Improvement Board (Lord Carter has shares).

Partnered with charities AgeUK and Alzheimers Society and in education with health departments within the LSE and Imperial college.

An UnitedHealth Director was chosen by the Department of Health to drive new technology and drugs through the NHS – until he was announced as the new Optum CEO. The position was subsequently taken by Lord Darzi – who heads an Institute which is partnered with Optum.

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The NHS long term plan does not face up to ‘the grim reality of the cash crisis confronting the health service’, Unite, Britain and Ireland’s largest union, said today (Monday 7 January).

Unite, which has 100,000 members in the health service, said that prime minister Theresa May was engaged in ‘a smoke and mirrors exercise’ with the promise of an extra £20bn a year for the NHS by 2023-24.

Unite national officer for health Colenzo Jarrett-Thorpe said: “This new cash is, in reality, putting in the funding that the government removed a decade ago. ‘Smoke and mirrors’ is the name of the game.

“The money that is now coming on stream is not enough to meet the ambitious targets to save the almost 500,000 lives outlined in the long term plan.

“The NHS is like a Rolls-Royce that needs constant care and attention – the Tories, since 2010, have neglected its annual maintenance. The NHS requires an immediate cash injection to meet increasing demand. That’s the grim reality.”

Before Christmas Unite warned that the NHS is facing ‘a perfect storm’ winter crisis, due to a number of factors, including the dramatic decline in health visitors and mental health nurses.

Colenzo Jarrett-Thorpe added: “We know that even the projected boost of government funding to the NHS over the next four years does not meet the historic average increase in NHS funding over the last 70 years, which has run at about 3.9 per cent compared to the three per cent minsters are proposing.

“From 2010 up till now, increases in the NHS budget have been barely one per cent.

“For example, because of the massively flawed Health and Social Care Act, many of our public health services have been transferred to local authorities since 2013 and funding in public health has fallen by eight per cent since 2013/1,4 according to the Kings Fund.

“How can this long term plan be implemented if the government gives with one hand and takes away with the other?

“This plan is doomed to failure if ministers do not reverse cuts to local authority budgets or give incentives to councils not to cut public health or community health budgets.

“On top of all this, there are an estimated 100,000 vacancies in the NHS, which are compounding the current crisis. As a country, we also rely on the 63,000 EU citizens working in the NHS in England whose future is being blighted by the unpleasant atmosphere created by Brexit.”

 

For more information please contact Unite senior communications officer Shaun Noble on 020 3371 2060 or 07768 693940. Unite press office is on: 020 3371 2065

Email: shaun.noble@unitetheunion.org

Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org

Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.

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Dear #Justice4NHS Supporters

We wish you a Happy New Year but we are very sorry to tell you that the Court of Appeal has ruled against our case.

The good thing is that – fingers crossed 3rd Time Lucky! – we are now applying for permission to appeal to the SUPREME COURT

We are doing this because the Court of Appeal ruling has not grappled with the vital issues that our case raised. This is not just our opinion, it is also the informed opinion of our legal team.

To say the least this is very annoying – and just plain WRONG. We can’t let the Courts sweep vital public interest and legal issues under the carpet.

We hope you feel as proud as we are, that the 999 Call for the NHS #Justice4NHS legal challenge has been a grassroots crowdfunded case from the very beginning and that together we are all defending the NHS.

If we had not brought our case to the courts, NHS England would have already implemented their contentious new contract back in April 2018.

We can’t thank you enough for helping us through the various stages of this the 2-year legal battle. We hope you may also be able to help take this case forward to the Supreme Court.

We can’t give up now. In 2019 our campaign messages about the damage to our NHS we are all seeing, must be even louder and clearer.

This contentious ACO contract, if implemented, would only increase this damage .

And that is why…

We are not going away.

We wish you all a new year in which you can find hope and strength in the knowledge that what we are doing together is right. It’s a long, tough fight but together we are strong. And we see that more and more of the public are beginning to hear and understand our reasons.

We will shortly begin #Justice4NHS CrowdJustice Stage 6 to raise funds to cover the costs of applying to the Supreme Court for permission to appeal. The amount we are likely to need to raise for this stage is approximately £5,000.

Don’t forget you can also sign up as an Ambassador to receive updates and news about the campaign. SIGN UP

We can’t thank you enough for helping us through the various stages of the the 2-year legal battle and we hope you will continue to lend your support again in 2019.

Thanks and best wishes

Jo, Jenny & Steve

And all the 999 Call for the NHS team

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Very quietly the NHS in North West London has asked GPs and other prescribers to reduce prescribing of medicines and products (under the pretext of promoting ‘self-care’) that can be purchased without a prescription. (List)
The medicines patients are now advised to obtain over the counter include: vitamin D, skin creams, nasal sprays (like Beconase and saline solution for babies), lubricant eye drops, haemorrhoid creams, constipation laxatives (like Cosmocol), the commonly used painkillers, or dispersible aspirin to keep blood thin. One GP tweeted:
GP tweet
Such a money saving move hits hard vulnerable, elderly, school age children* or those on benefits, who are exempted  from the prescription charges but now have to buy these medicines, some of which are quite expensive. In order to save money, people try online shopping with a risk of buying cheap quality medicines.
*(the school age children are exempted if the product needs to be given at school as many schools will not administer medicines that do not have a dispensing label bearing the child’s name and the dose)
concerns2
They do so seemingly to avoid bad rating by the Care Quality Commission inspection that would monitor the prescribing of these medicines.
Those in Harrow who need medical care not only suffer because of the cuts in medicine  but also because of a clinician decision whether a patient meets the evidence-based thresholds for the hospital treatment as defined in the Planned Procedure with a limited Threshold (PPwT) policy and which requires funding approval from the authority running a deficit budget.
There are thirty three  procedures covered under PPwT policy, including cataract surgery, grommets in children, hip replacement, correcting a deformity of the nasal septum and open MRI, for which individual funding request has to be made to the NHS Harrow Clinical Commissioning Group (CCG) where  the  treatment falls under the ‘not normally funded’ category.
We understand Harrow CCG has declined many such requests.

Published with the permission of

Harrow Monitoring Group

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Dear HCT affiliates,

Please find below our December newsletter. We at HCT wish you all a hearty seasons greetings and look forward to a prosperous new year.

Make our NHS Safe for All Campaign
Safety in the NHS in terms of safe staffing and provision is a key talking point in our campaigning, especially going into winter where services are stretched to the limit and dangerous situations can often arise. Health Campaigns Together are very interested in collating data around safety in our NHS and we need your help to kick-start our campaign. If you have any information around an NHS safety concern in any area then please email in confidence to John Lister hctsafetylog@gmail.com – a new and dedicated email set up for this purpose. You can also get more closely involved by signing up to support us and help develop the proposed charter for safer services.
Winter crisis
Sadly, a winter crisis in our NHS has almost become normalised now. We in HCT are all aware of the now seemingly perpetual winter the service suffers, but we must make sure that we keep the plight of the NHS in the news at both a local and national level. Please keep up the excellent work you are all doing in drawing the public’s attention to the conditions in the service over winter. Knowledge is power and if the public aren’t aware, they cannot challenge local representatives. The results from FOIs for OPEL (Operational Pressures Escalation Level) reports are always a good way into the local press in this area.
Social Care Conference
We are delighted to report that thanks to all of you our regional social care conference on 17th of November was a great success with over 100 attendees. There was some very productive networking, and commitment made for future groups and projects, including some important issues raised by disability campaigners. These regional conferences are a great way to feed ideas in from all around the country where we can all make a difference.
HCT help with launch: People’s Assembly “Britain is Broken” national campaign
Last week, friends of HCT the People’s Assembly Against Austerity invited HCT to speak about the NHS crisis as part of a nationwide campaign to highlight the devastating effects of austerity across the country. Our secretary, doctor Aislinn Macklin-Doherty chaired and introduced a dynamic and powerful range of speakers from Unite trade union activists on strike for better pay in the catering industry, to Richard Burgon Labour MP for Leeds. This was an exciting launch to what will be an important campaign to make the voices heard of those hardest hit by austerity. There are other events planned.
Warwick University debate
On 27th of November HCT officer and editor of our paper, John Lister took part in a debate at Warwick University with the Wolverhampton trust CEO. It was a lively and informative event with a lot of agreement on safety and staffing levels. The Institute of Economic Affairs’ Kate Andrews was due to attend but unfortunately withdrew at the last moment citing Westminster business. This is a shame as it would have provided a valuable opportunity to challenge her over her organisation’s pro-privatisation interests.
Google is gobbling up millions of NHS patient’s data
For several years giant tech companies from silicon valley have been making moves to access the wealth of information locked in the NHS. In the last fortnight we heard that finally Google seem to have crowbarred their way in via a subsidiary company they own called DeepMind who had made an agreement with The Royal Free NHS Trust (amongst others) to gain access to 1.6 MILLION patient’s records. With no public scrutiny.
Shockingly in July of this year the Independent Commissioner’s Office ruled that The Royal Free and DeepMind had acted outside the law in sharing this data and importantly, DeepMind PROMISED no other body would have access to patient’s data. But this seems to have been totally dropped when Google announced it had taken over DeepMind’s data. Most shockingly of all this has not made any waves in news headlines and HCT believe this is a very serious issue that needs to be addressed.
For more detailed info please read this report, evidence that good investigative journalists do still exist!
If you are a Royal Free patient or someone who wants to get involved personally with this campaign, please email Aislinn directly at aislinnmacklin@doctors.org.uk
HCT January issue
For inclusion in the January issue of our paper please submit copy and photos to John Lister by Friday 21st December at healthcampaignstogether@gmail.com ‘FAO The Editor’ in subject heading.
Dr Youssef El-Gingihy updated book launched this week
Dr Youssef El-Gingihy is a Tower Hamlets GP at the Bromley by Bow Centre. Many will be familiar with his book How to Dismantle the NHS in 10 Easy Steps which tells the story of how the NHS is being sold off. The new edition contains extra chapters on the junior doctors’ strike and the introduction of US style healthcare models of accountable/integrated care. It also has a coda on how we can save the NHS.
Student groups
Can we ask all affiliated groups to reach out to their local student organisations in order to better facilitate working with younger people and encourage the next generation of health campaigners and activists? We are very lucky to have a wealth of talent across the British Isles involved in Health Campaigns Together but we need to further strengthen our networks with other demographics in order to assure our future and gain new ideas. Why not find out your local FE and HE student union/relevant student societies and invite yourselves as a speaker? Your suggestion could be just what they are waiting for.
Trade Union Delegates needed
Please can our HCT affiliates from trade union branches and trades councils make sure you have chosen your delegate and remember to send them to the HCT affiliates’ meetings? Representation is so important in facilitating good discourse.
Interserve Group

Note that yet another multinational private provider involved in massive public sector contracts is in deep trouble. Watch how this unfolds over the coming weeks!

 

HCT and Keep Our NHS Public websites

Please don’t forget to regularly log in to both our major campaigning websites for new content and information. A lot more news is covered in detail here.
www.healthcampaignstogether.com
www.keepournhspublic.com/newsLocal News
Save Our Services in Surrey
If you are in or around the Surrey area on Saturday 15th of December then please consider joining health workers and others at the march and rally for public safety, and against austerity. Junior doctor and NHS activist Sonia Adesara will be speaking. Assemble at 11am outside Woking borough council offices, marching to the town square. This will be a peaceful, family-oriented event. The march will centre around the mainly pedestrian areas to Jubilee Square for the speeches. Bring home-made banners and placards and be ready to make some noise.
Join Save Our Services in Surrey: www.sosis.org.uk
saveourservicessurrey@gmail.com
www.facebook.com/sosinsurrey
@sos_surrey (Twitter)
South Tyneside Hospital
Monday 17th of December 12-1pm (Harton Lane entrance), South Shields NE34 0PL A Judicial Review challenging Phase 1 of the downgrading and closure of vital acute health services in South Tyneside will take place at the Administrative Court in Leeds over 3 days from Tuesday 18th to Thursday 20th of December 2018. The day before the court case begins there will be a protest vigil at the Harton Lane entrance to South Tyneside Hospital to remind people of the fight and the ongoing service restructuring that is paving the way for increased privatisation here and throughout England.
Success in Nottingham!
Nottingham City Council has pulled out of the Notts Integrated Care System stating there has been a poor degree of information sharing and involvement. This is a impressive victory from our colleagues at Nottingham Keep Our NHS Public who are doing great work. This victory is in no small part due to their local efforts in lobbying and raising awareness around the subject, and from their contact with Cllrs on the Health Scrutiny Cttee & Health & Wellbeing Board. Richard Buckwell (Chair of Nottingham KONP) said:
“We believe it will have a significant effect on progressing the ICS locally & is an excellent message to other authorities as the Greater Nottingham STP was often seen as a lead area on progressing STPs which have now morphed into ICSs.”
Dates for your diary
Our next HCT affiliates meeting is on Saturday 2nd February at Unite the Union, 128 Theobald’s Rd, London WC1X 8TN
Next year’s AGM is on Saturday 6th of April
Kind regards,
The Health Campaigns Together team

Health Campaigns Together

www.healthcampaignstogether.com
Email: healthcampaignstogether@gmail.com
Twitter:@nhscampaigns
Facebook.com/healthcampaignstogether

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A coalition to defend #ourNHS

Follow-up meeting

Thursday December 13, 13.30 – 16.00 at Carr’s Lane Conference Centre Birmingham, B4 7SX

Please let us know if you will be attending, by emailing reclaimsocialcare @gmail.com

 

.

Jan Shortt, NPC General Secretary

Gill Ogilvie, GMB regional organiser

Reclaim Social Care Conference Nov 17, Birmingham

Speakers included

  • Health Campaigns Together editor John Lister,
  • Eleanor Smith MP who has put forward the NHS Reinstatement Bill aimed at preserving the future of the NHS,

and campaigners from

  • the Relatives and Residents Association,
  • North West UNISON Dignity in Care Campaign,
  • “Being the Boss” / Reclaim our Futures,
  • National Pensioners Convention
  • and the Centre for Welfare Reform,

as well as Prof Peter Beresford of Essex University and Gill Ogilvie, a GMB official who has led campaigns for children’s services.

Conor McGurran of NW Region UNISON

Simon Duffy (behind him Prof Peter
Beresford and chair Ann Bannister)

Between them they outlined some of the complexity and the varied interest groups affected by the crisis in social care, spelled out some outlines of policies and objectives that should be the basis for campaigning, and agreed on the need to combat the current dysfunctional and unfair system, while challenging any further cutbacks or privatisation.

It was clear from the conference that there is a common basis for a campaign for a publicly funded and provided social care service that respects the individual needs and capacities of all citizens.

The social care service we want would deliver support as required on the basis of needs and choices, giving a voice to service users, and with services delivered to all without means tested charges and funded nationally from general taxation.

There was also support for public control and ownership of most services, to end the scandal of public money flowing to tax dodging corporations and cheapskate, exploitative home care companies; and proper status, pay, terms and conditions for all care staff, including training where required and a career structure.

We will be posting video and extracts from speeches, but in the meantime please see:

 

The Debate over Social Care

The worsening plight of social care and the financial problems posed for local government have been unveiled by a new National Audit Office Report, available HERE. But how can the problems be addressed, and how far can social care be integrated with the NHS as part of a longer term development?

These are complex questions. Professor Bob Hudson’s BLOG is a basis of discussion, and while many campaigners will share some of these views, many will differ on his conclusions. The debate is an important one in shaping the policy of any future government to replace the Tories, so we invite campaigners to respond and develop this discussion, offer us your thoughts and suggestions, and help us develop a parallel campaign for properly funded and publicly accountable social care in parallel with the fight to defend, reinstate and fully fund our NHS.

Send any contributions (or suggested links and other material) to us at hcteditorial@gmail.com.

FEATURED BLOG

 

Response

 

Links to other articles and analysis on social care:

 

 

  • Hundreds of care home patients have died dehydrated or malnourished – Guardian report based on official figures:
    “More than 1,000 care home patients have died suffering from malnutrition, dehydration or bedsores, new figures reveal.
    “At least one of the conditions was noted on the death certificates of as many as 1,463 vulnerable residents in NHS, local authority and privately-run care homes in England and Wales over the past five years..
    “The figures have been obtained by the Guardian from the Office for National Statistics (ONS), which completed an analysis of death certificates at the newspaper’s request.
    “It follows a separate Guardian investigation that revealed some of the country’s worst care homes were owned by companies that made a total profit of £113m despite poor levels of care.”

 

  • Fair care: A workforce strategy for social care – New IPPR report on the social care system argues that says nearly half of the 1.3million people working in the care sector are earning less that the real living wage of £9 an hour, with one in four (325,000 people) on a zero-hours contracts.
    It warns that unless pay and conditions are improved there could be a shortage of 400,000 care workers by 2028.
    Nearly two-thirds of home care workers are only paid for contact time and not for travel between the homes of people they care for.
    One in three carers said they often don’t have enough time to prepare a meal or help with washing and bathing, while a staggering 89 per cent said that they don’t get enough time even to have a chat with clients.

 

 

 

 

 

 

  • Beyond barriers How older people move between health and social care in England – Another reminder of how far the current health and care system is from any real “integration”. Following comprehensive reviews of 20 local authority areas, the CQC has called for a new approach to the way the country runs health and care services.
    The ‘Breaking Barriers’ report followed people’s journeys through the health and social care system and identified gaps where people experienced poor or fragmented care, with findings showing “the urgent necessity for real change.”

 

 

 

 

  • A fork in the road: Next steps for social care funding reform – A joint report between the Health Foundation and the Kings Fund, which highlights low public awareness of social care and a lack of agreement on priorities for reform as major barriers to progress, despite apparent political consensus on the need for urgent action.
    It argues that reforming the current system will be expensive, but states that if reform is chosen, England is now at a clear ‘fork in the road’ with a choice between “a better means-tested system” and one that is “more like the NHS” — free at the point of use for those who need it.

 

 

 

 

 

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