Category Archives: NHS

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.

 

 

 

 

 

Copyright © 2018 Health Campaigns Together

 

 

1 Comment

Unite Press Release

Immediate release:  Wednesday 7 November 2018

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

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

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

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

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

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

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

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

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

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

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

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

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

Leave a comment

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

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

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

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

Leave a comment

Brexit is opening the door to NHS chaos in so many ways. But we are now presented with a new threat.

There have been concerns for many years, often expressed in this column, that the 2012 Tory design of the NHS opens the way to privatising not only services but also commissioning itself. Fighting the impact of the 2012 Act and its offspring such as ACOs/ICSs has been paramount. By shrinking the state at the same time as imposing austerity, the Tories have created the conditions for increasing mortality rates. This appears to be taking place now.

But Brexit has opened a new front: The Ideal US-UK Free Trade Agreement – A Free Trader’s Perspective.

Striking trade deals independent of the EU is the Brexiteers’ dream. This document shows how it can become a nightmare for the NHS.

The paper was released in September and is a US/UK collaboration of right-wing institutes fronted by the Initiative for Free Trade and the Cato Institute. MP Daniel Hannan is a co-author……………………

The aim is to open all sectors of the economy to investment from business. It should open all services markets without exception to competition.

They say: “The ideal FTA is one that removes all barriers to trade in goods and services, opens up all sectors of the economy to investment and, ultimately, goes as far as possible to remove all administrative impediments to integration of the economies of the parties without encroaching on the sovereignty of governments to pass laws and regulate in the public interest in ways that do not discriminate against foreign goods, services and companies”

They call for “zero restrictions on competition for government procurement.”

They have a particular interest in health services.

“Health services are an area where both sides would benefit from openness to foreign competition, although we recognise any changes to existing legislation will be extremely controversial. Perhaps, then, the initial focus should be on other fields such as education or legal services, where negotiators can test the waters and see what is possible. That said, we envisage a swift, time-tabled implementation of recognition across all areas within 5 years.”

There it is – a blueprint for privatisation, starting with what they deem softer areas like education and moving on to the NHS within 5 years.

The document goes into some detail about how such a Free Trade Agreement would deal with a range of other arenas and issues.

Milton Friedman, one of the principal architects of the current neo-liberal world order now failing the world, said: “There is nothing as powerful as an idea when its time has come. I say that time is a crisis, actual or perceived. When the crisis occurs, the actions that are taken depend on the ideas lying around.”

Hannan and his co-conspirators are seeding these ideas so that they become available when needed.

Beware Brexiteers bearing false promises – many were hoodwinked by the lies about massive NHS investment. Trade Agreements are likely to offer similar attractive lies. We must remain vigilant against these crazy and dangerous proposals.

Published with acknowledgements of GP Magazine.

 

Leave a comment

Nick Bostock reports at GPonline that:

Under-pressure GPs are delivering ‘remarkable outcomes’ on cancer

You can read the complete article here. Nick reports:

GPs ‘can take a lot of credit’ for marked improvements in early cancer diagnosis and reductions in the proportion of cases detected as an emergency, according to a cancer expert.

In the year to March 2018, the proportion of cancer patients who first presented at hospital as an emergency fell to 18.8% – down from 21% in the year to December 2012.

Over roughly the same period, cancers detected at an early stage increased significantly – rising from 46% in 2013 to 52% by mid-2017, according to figures from the National Cancer Intelligence Network (NCIN).

However: GPonline reported earlier this year on research showing that GPs were as good as consultants at making appropriate use of cancer diagnostic tests – and yet pledges to give GPs direct access to four key diagnostic tests – blood tests, chest X-ray, ultrasound and endoscopy – have not been delivered in many areas.

Isn’t it about time that GPs were also given access to the new technology for GP consultations via mobile and Skype? This is currently being ‘rolled out’ by GP at Hand. Here’s a transcript of the R4 Today programme 13 September at 6 mins to 9:00 am (I made this transcript and I believe it’s a fairly accurate job – but any mistakes are mine):

(Int) Interviewer

AP (Ali Parsa, CEO Babylon – parent company that runs GP at Hand)

RV (Dr Richard Vautrey, Chair GP Committee, British Medical Association)

SoS = Secretary of State

 

(Int): So Ali Parsa just explain to us how your App works.

(AP): So, we have a very simple service. So, what it does is allow patients to check their symptoms whenever they want. To make an appointment with a doctor within seconds, to be able to see a doctor within minutes. In fact, I was just checking my App and it says that if I want to see a doctor I can see one at 9 o’clock today, in the next few minutes.

(Int): You mean ‘see’ over the phone?

(AP): Over the phone. And if you want to see somebody physically then, you can go see them that very same day. It is open 24hrs a day, 365 days of the year. And it is available for the same price the National Health Service pays any other GP. What we have done is to solve the problem of accessibility and the continuity of healthcare – using technology and what the SoS and the NHS is doing today is celebrating that and promising it for the whole country.

(Int): And Richard Vautrey, this is something which patients complain about again and again, isn’t it, access to their GP, so is this kind of App the solution?

(RV): We have real concerns, as well as patients do, about the inability of many practices to be able to offer enough appointments and that’s simply because we haven’t had the funding over the last decade to support the expansion of the health service to be able to meet the growing needs of our patients. What General Practices are doing right now is seeing thousands and thousands – if not a million – patients today offering, you know, face-to-face consultations and seeing them in their surgeries, so that’s when patients approach them today. So that’s happening right now. What we haven’t got is the resources to be able to offer some of the IT technologies in every single practice. And the SoS’s commitment to IT is welcome, but we need to see that commitment translated into resources provided to enable every practice to offer this type of consultation.

(Int): But could this kind of technological approach actually help some of the pressure on GPs because people would consult a doctor over the phone rather than going to the surgery.

(AP): Well many practices, if not most practices, already offer telephone consultations. What they haven’t got is the IT kit to be able to offer smart phone consultations, or Skype-phone computer consultations, any many would like to be able to do that, if the technology was provided to them. But the other big difference is that every Practice that is open today will see any and every patient who lives within their area, and we have concerns about the model of which GP Hand has been built, which is primarily about looking at some of the relatively mobile healthy patients and not accepting every single patient who lives within their area.

(AP): I’m afraid Richard that is simply factually not true. We will ask when patients started the service, to ask patients to seek advice if they want to change their GP Practice to our Practice, if they have any clinical issues. Most patients seek advice and join us – we look after them, young, old, sick, healthy, our patients are across the border, and we don’t do that just in Britain, remember we look after one third of the population in Rwanda, and we do so in the United States, we do this in Canada. . .

(Int): But specifically, on this idea of whether you cherry pick patients, it’s likely that patients who don’t have very serious health problems, and maybe younger, are more likely to want to use an App on their mobile.

(AP) . . . but, why is that? If the patient is not very mobile, if the patient is very old, if the patient can’t wait a few weeks to see their GP, they’re significantly more likely to use a service that is continuously available. Many of our patients have mental health issues – they can’t wait for a few days or a few weeks to see their GP. That’s why they switch to us. A thousand patients today will choose to apply to GP at Hand, and then switch their GP Practice – one every three minutes.

(Int): Richard Vautrey, some GP Practices are worried about the fact that if their patients sign up to GP at Hand they then lose that funding, don’t they?

(RV): That’s exactly right. And the way that General Practice is funded at the moment is a balanced mechanism, so those patients who use the service less, and there are many patients that use the service more, and that overall, that compensates one for another. What we have concerns about is that this would effectively replace a personal service with an anonymous call centre and patients don’t want that.

(Int): And finally, Ali Parsa, this was something that commissioning groups in Birmingham were worried about and that was clinical safety – isn’t it better to see a doctor the next day.

(AP): No, it wasn’t clinical safety, you do see a doctor, not a call centre, face-to-face on your mobile and then see one in one of our surgeries. We will open up across the country physical surgeries, their issue was not that. It was an IT hitch that doesn’t allow its screening to be done with your local hospital and that IT hitch has been fixed. This is the future, and I encourage more and more patients to join it.

(Int): Okay thank you both, we’ll leave it there, let us know what your think via twitter.

Leave a comment

Justin Madders MP

 

You’d be forgiven for not knowing that we are in the midst of even more reorganisation of the NHS. It is in part an attempt by the NHS leadership attempt to reverse the impact of the Health & Social Care Act via any means that does not require primary legislation. Everyone now seems to acknowledge that the top-down reorganisation has been as much of a disaster as Labour warned that it would be at the time.

In some ways, reversing the Lansley legislation and bringing health and social care services together in a fully public system is what Labour has been arguing for. But these aspirations are not going to be possible without far more investment, more rational funding, reversing privatisation and an end to the obsession with markets and competition.

The behind-the-scenes changes are like a parallel universe and none of this has been brought before parliament. No effort has been made to keep the public informed – the Health Secretary hasn’t even put out a press release.

One change being sought by the government is the creation of new bodies, known as Integrated Care Providers (ICPs). Although they could radically alter the entire health and social care landscape if widely adopted, this is all taking place without a vote or even a debate. ICPs will be responsible for running health and social care services in an area for up for up to ten years and, controversially, the contracts can be awarded to private companies.

When challenged on this, the government has tried to reassure people that the process won’t increase privatisation in the NHS. However, during a debate on the new proposals in parliament, health minister Stephen Barclay MP was asked four times by Conservative, SNP and Labour MPs to expressly rule out the new organisations being run by the private sector and he failed to do so on every occasion. The cross-party health select committee has called on the government to do the same, and they cannot offer a credible explanation for their refusal to do so.

The latest acronym for what you may have previously heard being called an STP or an ACO, ICPs are the latest manifestation of a process that has been going on behind the scenes for over two years. This new iteration adds even more confusion, as similar terminology around integration has been used to describe entirely different local models underway in other parts of the country.

Whatever the potential merits of the attempts to bring services together, the process has managed to alienate almost everyone as there was no proper consultation or engagement locally with public, patients or staff. Ambitious sounding STP “plans” fell apart under the mildest scrutiny as the money required for delivery was missing. Wildly optimistic assumptions about “savings” were literally incredible.

This approach was also characterised by the bewildering array of acronyms and complex terminology that has had the effect of shutting the public out of the debate around the future of the NHS. I don’t believe that this has been an accident.

The details setting out what an ICP will do were published during the summer recess, with no publicity – despite recent high-profile court cases that sought to prevent the process from continuing without new legislation being introduced. While very careful drafting means that these changes can technically be made without new legislation, it is clear that this process could mark a radical change to the way in which our health and social care services are organised.

Under the latest proposals, a contract will be awarded to a provider who will be given an annual payment to deliver a wide range of services. It will be compulsory to advertise the contracts to the market, and commissioners are forbidden from discriminating between NHS and non-NHS bidders. Bids can also be made by groups of organisations, so an NHS Trust or a group of GPs could partner with a private company. Previous high profile attempts to do this kind of thing in Staffordshire and in Cambridge collapsed spectacularly with millions of pounds wasted.

Worryingly, one of the criteria used to assess bids will be “whether they are able to deliver value for money”. This marks a significant change to the status quo. While there are clear issues with the current arrangement, it was introduced with the aim of ending competition based upon price and instead to focus on quality and choice. I do not believe that such a fundamental change should be made without the consent of parliament.

It is less than clear what will happen in the event that an ICP ends up in deficit, particularly where a private sector organisation or charity has won the contract. While the consultation documents set out that efforts that will be made to ensure that ICPs are financially viable, the same assurances have been offered about the existing configuration and almost half of all NHS providers were in deficit last year.

A new payment model proposed to fund ICPs where they are adopted will be known as a ‘whole population annual payment’, or WPAP. The ‘population’ to which it will be provided is not the actual population living in the area, but the number of people who have registered with their GP.  This could lead to a significant under-representation in some areas and therefore under-funding.

If the WPAP is not sufficient to deliver the current levels of service, the ICP will be responsible for “managing changes in demand”. While there are merits in a system that incentivises keeping people well, there is a clear danger that “demand” will be managed by rationing access to some treatments. It is far from clear who ultimately would make these decisions on rationing nor how they would be accountable for such decisions. Transparency is a key concern. And all of this raises the spectre of a new postcode lottery, where patient experiences are uneven depending on whom is contracted by an unaccountable panel of commissioners.

The whole approach is simply a farce and part of a smokescreen to hide the huge damage done by years of austerity, made worse by the waste of market reforms and privatisation. Until a Labour government removes all the market architecture and restores a proper public care system, these messy, secretive and ill-conceived Tory reorganisations will continue in perpetuity.

Justin Madders is shadow health minister and MP for Ellesmere Port and Neston.

 

5 Comments

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.

Many thanks to over 750 individuals, NHS campaign groups and trade union branches, who have crowdfunded the £18K costs of the Appeal through CrowdJustice  – info here. 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%.”

Leave a comment

SHA Wales

 

‘LEGISLATION WATCH WALES’ – October 2018

Health and Social Care Briefing

Acts

Additional Learning Needs and Education Tribunal (Wales) Act 2018

http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=16496

The Act makes provision for a new statutory framework for supporting children and young people with additional learning needs. This is to replace existing legislation surrounding special educational needs and the assessment of children and young people with learning difficulties and / or disabilities in post-16 education and training.

The Act also continues the existence of the Special Educational Needs Tribunal for Wales and provides for children, their parents and young people to appeal to it against decisions made in relation to their or their child’s additional learning needs, but renames it the Education Tribunal for Wales

The Bill was introduced on 12 December 2016. Royal Assent was given on 24 January 2018.

Abolition of the Right to Buy and Associated Rights (Wales) Act

http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=17260

According to the Explanatory Memorandum accompanying the Act, the purpose and intended effect of the Act is to end all variations of the Right to Buy and the Right to Acquire.

The key purposes of the Act are to:

  • abolish the right of eligible secure tenants to buy their home at a discount under Part 5 of the Housing Act 1985 (Right to Buy);
  • abolish the preserved right of eligible former secure tenants to buy their home at a discount under section 171A of the Housing Act 1985 (Preserved Right to Buy);
  • abolish the right of eligible assured or secure tenants of a registered social landlord or private registered provider to acquire their home at a discount under section 16 of the Housing Act 1996 (Right to Acquire);
  • encourage social landlords to build or acquire new homes for rent, the Right to Buy, Preserved Right to Buy and Right to Acquire will not be exercisable by tenants who move into new social housing stock more than two months after the Bill receives Royal Assent, subject to certain exceptions;
  • provide for at least one year after the Bill receives Royal Assent before the abolition of the Right to Buy, Preserved Right to Buy and Right to Acquire for existing social housing stock comes into force.

Further detail about the Act can be found in its accompanying Explanatory Memorandum.

The Bill was introduced on 13 March 2017. Royal Assent was given on 24 January 2018.

Public Health (Minimum Price for Alcohol) Wales Act

http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=20029

The Act provides for a minimum price for the sale and supply of alcohol in Wales by certain persons and makes it an offence for alcohol to be sold or supplied below that price.

The Act includes provision for:

  • the formula for calculating the applicable minimum price for alcohol by multiplying the percentage strength of the alcohol, its volume and the minimum unit price (MUP);
  • powers for Welsh Ministers to make subordinate legislation to specify the MUP;
  • the establishment of a local authority-led enforcement regime with powers to bring prosecutions;
  • powers of entry for authorised officers of a local authority, an offence of obstructing an authorised officer and the power to issue fixed penalty notices (FPNs)

The Act proposes the MUP would be specified in regulations. However, for the purpose of assessing impacts and the associated costs and benefits, the Explanatory Memorandum uses a 50p MUP as an example.

The Public Health (Minimum Price for Alcohol) (Wales) Act became law in Wales on the 9th of August 2018.

Regulation of Registered Social Landlords (Wales) Act

http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=19962

The purpose of the Act is to amend or remove those powers which are deemed by the Office for National Statistics (“ONS”) to demonstrate central and local government control over Registered Social Landlords (RSLs).

These changes will enable the ONS to consider reclassifying RSLs as private sector organisations for the purpose of national accounts and other ONS economic statistics.

Further detail about the Act can be found in its accompanying Explanatory Memorandum.

The Regulation of Registered Social Landlords (Wales) Act 2018 became law in Wales on the 13th of June 2018.

Law Derived from the European Union (Wales) Act 2018

http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=21280

A Government Emergency Bill, introduced by Mark Drakeford AM, Cabinet Secretary for Finance. An Emergency Bill is a Government Bill that needs to be enacted more quickly than the Assembly’s usual four stage legislative process allows. A definition of an Emergency Bill is not provided in the Government of Wales Act 2006 (“the 2006 Act”) or in the Assembly’s Standing Orders however Standing Order 26.95 states that:

“If it appears to a member of the government that an Emergency Bill is required, he or she may by motion propose that a government Bill, to be introduced in the Assembly, be treated as a government Emergency Bill.”

As with all Assembly Bills, Emergency Bills must relate to one or more of the 21 Subjects contained in Schedule 7 to the 2006 Act in order for it to be within the scope of the Assembly’s legislative powers.

The Act is intended to preserve EU law covering subjects devolved to Wales on withdrawal of the UK from the EU. Further, it will enable the Welsh Ministers to ensure that legislation covering these subjects works effectively after the UK leaves the EU and the European Communities Act 1972 is repealed by the European Union (Withdrawal) Bill.

The Act enables the Welsh Ministers to legislate to maintain regulatory alignment with the EU in order to facilitate continued access to the EU market for Welsh Businesses. It also creates a default position in law whereby the consent of the Welsh Ministers will be required before any changes are made by UK Ministers to devolved legislation within the scope of EU law.

Further detail about the Bill can be found in its accompanying Explanatory Memorandum.

The Law Derived from the European Union (Wales) Act 2018 became law in Wales on 6 June 2018.

Legislation in Progress – current Bills

Public Services Ombudsman (Wales) Bill

http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=20012

This is a Committee Bill, introduced by Simon Thomas AM, Chair of the Finance Committee. The Business Committee has remitted the Bill to the Equality, Local Government and Communities Committee. The Bill includes provision which set out the new powers for the Ombudsman to:

  • accept oral complaints
  • undertake own initiative investigations
  • investigate private medical treatment including nursing care in a public/private health pathway
  • undertake a role in relation to complaints handling standards and procedures

 

Further detail about the Bill can be found in its accompanying Explanatory Memorandum. The Bill is currently at stage 2.

Autism (Wales) Bill

http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=19233

An Assembly Member Bill, introduced by Paul Davies AM was successful in a legislative ballot in March 2017, and given leave to proceed with his Bill by the Assembly in June 2017.

The Business Committee has remitted the Bill to the Health, Social Care and Sport Committee.

The overall purpose of the Bill is to ensure the needs of children and adults with Autism Spectrum Disorder in Wales are met, and to protect and promote their rights.  The Bill delivers this purpose by seeking to:

  • Introduce a strategy for meeting the needs of children and adults in Wales with ASD conditions which will:
    • Promote best practice in diagnosing ASD, and assessing and planning for meeting care needs;
    • Ensure a clear and consistent pathway to diagnosis of ASD in local areas;
    • Ensure that local authorities and NHS bodies take necessary action so that children and adults with ASD receive the timely diagnosis and support they need across a range of services;
    • Strengthen support for families and carers and ensure their wishes, and those of people with ASD, are taken into account;
    • Promote research, innovation and improvement in ASD Services;
    • Establish practices to enable the collection of reliable and relevant data on the numbers and needs of children and adults with ASD, so that the Welsh Ministers, and local and NHS bodies can plan accordingly;
    • Ensure key staff working with people with ASD are provided with appropriate ASD training; and
    • Regularly review the strategy and guidance to ensure progress.
  • Require the Welsh Ministers to issue guidance to the relevant bodies on implementing the strategy.
  • Require the Welsh Ministers to collect suitable data to facilitate the implementation of the Bill.
  • Require the Welsh Ministers to undertake a campaign to raise awareness and understanding of ASD.

Further detail about the Bill can be found in its accompanying Explanatory Memorandum.

The Bill is currently at stage 1 (consideration of the general principles of the Bill and the agreement of the Assembly to those principles).

Childcare Funding (Wales) Bill

http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=21394

A Welsh Government Bill, introduced by Huw Irranca-Davies AM, Minister for Children, Older People and Social Care. The Business Committee has remitted the Bill to the Children, Young People and Education Committee.

The Childcare Funding (Wales) Bill (“the Bill”) gives the Welsh Ministers the power to provide funding for childcare for qualifying children of working parents and to make regulations about the arrangements for administering and operating such funding.

The Bill is intended to facilitate the delivery of a key commitment in the Welsh Labour manifesto ‘Together for Wales 2016’. This is to provide 30 hours per week of government funded early education and childcare to the working parents of three and four year olds in Wales for up to 48 weeks per year (this is referred to in the Explanatory Memorandum accompanying the Bill as ‘the Offer’).

All eligible 3 and 4-year-old children (from the term after their third birthday) are entitled to a minimum of 10 hours early education per week during term time over 39 weeks of the year. The Offer builds on this universal entitlement and provides up to a total of 30 hours early education and care per week over 48 weeks of the year for the 3 and 4 year olds of working parents.

The Bill relates to the childcare element of the Offer and is therefore concerned with the funding that will be provided in respect of the eligible children of working parents.

Further detail about the Bill can be found in its accompanying Explanatory Memorandum.

The Bill is currently at stage 1 (consideration of the general principles of the Bill and the agreement of the Assembly to those principles).

Renting Homes (Fees etc…) Wales Bill

http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=22120

A Welsh Government Bill, introduced by Rebecca Evans AM, Minister for Housing and Regeneration. The Business Committee has remitted the Bill to the Equality, Local Government and Communities Committee.

The Bill includes provision for:

  • prohibiting certain payments made in connection with the granting, renewal or continuance of standard occupation contracts;
  • the treatment of holding deposits.

Further detail about the Bill can be found in its accompanying Explanatory Memorandum.

The Bill is currently at stage 1 (consideration of the general principles of the Bill and the agreement of the Assembly to those principles).

Future and possible Bills (of interest)

Assembly members have voted to introduce a Welsh Parliament and Elections Bill due to be brought forward in early 2019. The Bill will be designed to change the name of the Assembly to Senedd Cymru/Welsh Parliament; lower the voting age for Assembly elections to 16; amend the law relating to disqualification from being an Assembly Member and make other changes to the Assembly’s electoral and internal arrangements.

http://www.assembly.wales/en/newhome/pages/newsitem.aspx?itemid=1910&assembly=5

In the statement on forthcoming legislation 2018/19, the First Minister highlighted:

  • A Bill to remove the defence of reasonable punishment
  • A Bill to improve accessibility of Welsh Law and how it is interpreted
  • A Local Government Bill (lowering the age for elections and a range of other proposals – not ‘wholescale merger’)
  • A Bill to establish an Duty of Quality for the NHS and a Duty of Candour for Health and Social Care, introduce and establish a new independent body to represent the citizen’s voice in health and social care services and will require LHBs to appoint a Vice Chair
  • Ban the use of wild animals in travelling circuses

Updated October 2018

Leave a comment

Ray Tallis is an active member of Keep Our NHS Public and a strong defender of the NHS. This should be a very interesting lecture

Public Lecture: The Royal College of Physicians and the Politics of Healthcare 2018

8 November 2018
Liverpool Medical Institution, Mount Pleasant, L3 5SR

6pm: Welcoming drinks
6.30pm: Lecture

Raymond Tallis is a philosopher, poet, novelist and cultural critic and was until recently a physician and clinical scientist. In the Economist’s Intelligent Life Magazine (Autumn 2009) he was listed as one of the top living polymaths in the world.

Born in Liverpool in 1946, one of five children, he trained as a doctor at Oxford University and at St Thomas’ in London before going on to become profritic and was until recently a physician and clinical scientist. In the Economist’s Intelligent Life Magazine (Autumn 2009) he was listed as one of the top living polymaths in the world.
Born in Liverpool in 1946, one of five children, he trained as a doctor at Oxford University and at St Thomas’ in London before going on to become professor of geriatric medicine at the University of Manchester and a consultant physician in healthcare of the elderly in Salford. Professor Tallis retired from medicine in 2006 to become a full-time writer, though he remained visiting professor at St George’s Hospital Medical School, University of London until 2008. He was visiting professor of English at the University of Liverpool until 2013.
Over the last 20 years, Raymond Tallis has published fiction, three volumes of poetry, over two hundred articles and 23 books on the philosophy of mind, philosophical anthropology, literary theory, the nature of art and cultural criticism. Together, these works offer a critique of current predominant intellectual trends and an alternative understanding of human consciousness, the nature of language and of what it is to be a human being.

1 Comment

Is this the knife poised to finally kill the NHS and the post 1945 social settlement?

Throughout the 80s under Thatcher, but particularly since the Health and Social Care Act (2012), contract after contract for health provision has gone to the for profit private sector. Sometimes the NHS has won contracts, sometimes the privateer, but overall during this last 6 years, our taxes / resources have been drained from public (NHS) to private providers. Stresses on the NHS have been exacerbated by cuts in financial support and staffing, increased demands and by immigrant doctors, nurses and other staff being unwelcome here following the Brexit vote, and it’s liberating a nasty racism. Remaining staff have been exemplary in trying to cope with these demoralising and exhausting situations, but burn-out is now common, staff are sick with stress, continuing to leave or just hanging on for their retirement. Working life for everyone is just not as good as it used to be. Most Trusts in England are now in deficit. Local Authority Social Care is almost non-existent now, again as the result of Thatcher’s immediate and savage cuts in the 80s, and the situation is worsened as local authority funding from central government has been slashed since 2010, and will disappear entirely by 2020. Yet somehow, these combined deficits are all supposed to transform the red to the black by combining health and social care. The latest vehicle in the alphabet soup of acronyms to assist this introduction is Integrated Care Organisations (ICOs) which come with a small money sweetener. However, this money is temporary; almost certainly a one-off as we know this government does not support the public sector and wants it demolished. As Oliver Letwin, the right wing Tory MP said the NHS will have gone by the next election if we win it.

So how is this to happen? Since the Health and Social Care Act, Section 75 has REQUIRED commissioners to put out to tender everything that couldn’t be provided by the NHS, so hospital services like cleaning, diagnostics, catering etc… have gone already. Now, under the proposed ICOs, Section 75 regulations create rights for commercial providers to promote their interests by rules written by US corporations; these enable any private provider which FAILS to get a contract to compensation by the government if that service returns to the public sector. We have already a foretaste of this, as Virgin claimed and received compensation when it failed to get an NHS contract in Surrey (? Can anyone provide me with the specifics?)   In the past, the Labour Party, the Royal College of GPs and the BMA have demanded that these regulations be scrapped, since clearly the government could not afford to compensate privateers for every contract which had not been accepted – in fact, it would be a great fail-safe money-spinner to submit silly tenders with guaranteed compensation for no service costs at all, especially if those tenders are for 15 years, as is now commonplace! Do I recognise similarities to PFI? ICOs also require to be paid in full for a year BEFORE they actually provide any service, and that money is fixed irrespective of the number or complexity of the procedures they undertake. It looks very much like a ‘race to the bottom’, safeguarding profits by providing the least and cheapest they can.   Is this another echo of PFI? Originally, the commissioners were assured they would not have to use competition in health services, but this seems to have been forgotten and presumably disappears if Section 75 is implemented. When a public contract has been lost to privateers, the service, personnel, equipment and buildings cannot be mothballed, everything is dismantled, and that’s forever. We have so much evidence that privateers ‘cherry pick’ the services which are predictable, easy, most profitable leaving the complex and difficult to the NHS, and if problems arise at some stage in the private service, patients are immediately transferred to the NHS where comprehensive teams of specialist staff, not available in the private hospital, can meet all emergencies IF there’s a spare bed.

There is no evidence that private services provide a better quality service, in fact, they are not as accountable, nor are they as monitored as is the NHS. Competition / marketisation has led to greater inequalities, increased inefficiency, higher costs and greater public dissatisfaction according to Robert Evans, the Prof of Economics at the University of British Columbia.

Judith Varley 19.10.18

Leave a comment

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%.”

1 Comment

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

Leave a comment
%d bloggers like this: