Category Archives: Professional opinion

One on International Trade dispute settlements and the other on Social Care.

These are not official SHA policy.

Issues for the NHS during UK Trade deal Negotiations

As socialists we have an almost irreconcilable set of principles

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Responding to the third tranche of inspections from Her Majesty’s Inspectorate of Fire and Rescue Services, Matt Wrack, Fire Brigades Union (FBU) general secretary, said:

On the national view

“This tranche of reports are a complete indictment of the government’s dangerous complacency over the risk of fire, flooding, and other hazardous incidents. Austerity has ravaged our fire and rescue service, leaving residents in many areas at risk. In Gloucester, the inspectorate are clear that changes are needed ‘urgently’, but politicians and fire service management elsewhere must not rest on their laurels.

“With no national standards and no national infrastructure coordinating fire and rescue service policy, residents inevitably face a postcode lottery of fire safety.

“While fire service bosses must be responsible for any failings, so too should the politicians who have starved them of funding, resources and boots on the ground. Our service is collapsing – it’s plainly unsustainable.”

On Grenfell

“The inspectorate’s verdict that London Fire Brigade’s senior management has been slow to learn from the Grenfell Tower tragedy will make worrying reading for firefighters, who have faced unfair criticism while others, including those in government, have no been held to account. It will also be deeply concerning for the Grenfell community and all of London.

“Grenfell must be a turning point for UK fire safety – anything less is completely unacceptable. The inquiry’s vital recommendations must be implemented quickly in London, but they also must be implemented in every fire and rescue service in the country.”

On equality and culture

“It’s shameful that not enough is being done enough to improve equality and diversity in our service. Progress has all but flat-lined under this government – and a severe lack of recruitment and the scrapping of equality targets is largely to blame. We need to recruit more firefighters – and we need to make sure they reflect the communities they serve.

“We are also deeply concerned about toxic bullying and harassment from management in many fire and rescue services. Firefighters give their all to keep the public safe – it’s disgraceful that certain fire service bosses have thanked them with intimidation. We urge any firefighter affected to contact their FBU representative.”


The FBU is the trade union representing the overwhelming majority of firefighters in the UK and serves as the professional voice of firefighters and the fire and rescue service. The union is a core participant in the ongoing Grenfell Tower Inquiry.

The FBU’s initial response to the publication of the Grenfell Tower Inquiry phase one report is available here:

The FBU launched its Grenfell: Never Again campaign on the second anniversary of the fire, with five demands: 1) the removal of all flammable cladding; 2) retrofitting sprinklers wherever a risk assessment deems necessary; 3) ensure a strong, democratic voice for tenants; 4) reverse the cuts to firefighter numbers and fire safety officers and; 5) create a new national body to oversee the fire and rescue service. For more information, please see here:

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A major fire at a Travelodge in Brentford, London, today saw more than 100 firefighters respond.

Matt Wrack, FBU general secretary, said:

“This fire is yet another sign of this government’s utter failure to get to grips with our fire safety crisis. Two years on from Grenfell, there has still been no comprehensive programme testing building materials.
“The approach so far has been the agonisingly slow removal of one particular kind of cladding, but that barely scratches the surface.
“The Tory manifesto made no new policy proposals to tackle the fire safety crisis – just more of the same indifferent inaction. They have slashed the fire and rescue service and could not even bring themselves to mention it in their manifesto. Their record is nothing short of shameful.
“We need to bring together firefighters, government, tenants, and the fire safety industry to properly implement the Grenfell inquiry recommendations and get to grips with this crisis before we have another tragedy.

Media contact: Joe Karp-Sawey, FBU communications officer


The FBU recently called for a forum of all those needed to drive through sweeping changes to UK fire safety, writing to representatives from the government and shadow cabinet, the London Fire Brigade, the National Fire Chiefs Council, the Mayor of London, the Local Government Association, the first ministers of Scotland, Wales and Northern Ireland, fire safety bodies and the Grenfell community. For more information, please see here:

The FBU is the trade union representing the overwhelming majority of firefighters in the UK and serves as the professional voice of firefighters and the fire and rescue service. The union is a core participant in the ongoing Grenfell Tower Inquiry.

The FBU’s initial response to the publication of the Grenfell Tower Inquiry phase one report is available here:

The FBU launched its Grenfell: Never Again campaign on the second anniversary of the fire, with five demands:

1) the removal of all flammable cladding;

2) retrofitting sprinklers wherever a risk assessment deems necessary;

3) ensure a strong, democratic voice for tenants;

4) reverse the cuts to firefighter numbers and fire safety officers and;

5) create a new national body to oversee the fire and rescue service.


For more information, please see here:

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Alice Peterson, (2019) If you were Here, London, Simon and Schuster


This is a novel around Huntington’s Disease (HD).  That in itself is a rarity.  Readers may wonder if a novel on such a subject can work.

Central to the plot are three women of different generations.  The first in grandmother, Peggy.  Her husband died of HD in the period before the book is set.  The next generation is Beth. Like her father she also died of HD.  However, her voice is important for the plot through her diary.  The youngest is Beth’s daughter and Peggy’s granddaughter Florence, known as Flo. Each of the women has a distinct voice.

A novel needs a degree of tension to keep us turning the pages – often an unresolved issue.  A standard ending is to draw together the threads to resolve the problem.

On the face of it the issue does not sound as if it can carry a plot.  But it does.  Flo lives, works and loves dealing with a real-life issue.  The central issue is should Flo have a DNA test to reveal if she has the disease?  Since HD is autosomal dominant there is a 50% chance that her mother has passed it on.  Other things being equal (which they are not), if a sufferer has children, they also each have a 50% chance of inheriting the disease.  We need to add to that the possibly around 10% of cases that arise spontaneously.

In many genetic disorders there are unambiguous benefits to diagnosis, in the UK newborn children are tested routinely for Cystic Fibrosis.  HD is more problematic.  As is revealed through the actors of the novel, HD hits home later in life and is incurable. The progressive nature and very unpleasant later stages may be a blight hanging over a young person.  Would such a person want to know?  The test could bring relief and a happy future. Or it could be a sentence of an early death preceded by suffering.  Can you live with the uncertainty and just get on with life?  Or would it be better to be able to plan the way forward?  This is a real dilemma for those with the family history.

We focus on young Flo and her very full life.  She is a real three-dimensional woman as are the people around her.

The debates and guilt associated with previous decisions hang over the young.  The counsellor is a vital part of the plot and her contribution is excellent.

In the mix of the traditional approach to this disease is the genetic revolution.  This is an area of medicine which is changing fast.  The clinical trial referred to in the book is ongoing.  Not mentioned, however, are other useful approaches.[i]

Can it work as a novel?  Yes! It is dynamic, it flows, it tugs on the heart strings.

Would it be of use for people with a family history of HD?  I feel that it would.  A great deal of information is communicated without being heavy.  It is shown through the characters not preached by an authoritative voice.

[i] See: Philip R. Reilly  (2015) Orphan: The Quest to Save Children with Rare Genetic Disorders: The Quest to Save Children with Rare Genetic Disorders, New York, Cold Spring Harbor Laboratory Press



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We welcome comments on this article which has come out of the Reclaim Social Care Campaign. It is not SHA policy, but it raises important questions relevant to both social care and the NHS.

This is a wide field in which a variety of species flourish, some of which are dangerous invasives. We need to cultivate systematically to ensure that what grows in this field is healthy, productive, and not a threat to other growth. We need to be able to classify, in order to isolate rogues, and then eradicate them. We need to be able clearly to identify some of the more rampant plant life, in order. maybe, to consider techniques of pruning.
I come to this view of the wider challenge from an interest in cultivating a little patch in this field – one area that I think is growing some special and healthy new life. My patch is occupied by a Community Interest Company. This organisation safeguarded one local piece of our National Health Service, by propagating it and preserving it from being hybridised – merged– a with a completely different plant that would have taken us over. We have created an organisation that is of our community, for our community, and owned by our community.
I am a fervent supporter of the NHS, especially having, for 15 years, suffered under the US excuse for a health system. I have been a member of the Labour Party since 1972. The principles of the NHS, as promoted by the Labour Party from 1948, are not negotiable, but there are different ways to organise to support those principles. I believe that there are freedoms in a CIC organisation that make it easier to maintain some aspects of health and social care in conformity with those principles – not everything in the way the NHS organises itself and runs its staff and services is perfect. My purpose in writing this paper is to try to distinguish the different types of possible organisation, to identify the healthy growth points, and also rogue growth.

I start with a straightforward definition:
“A simple definition of “public sector provider” in this context is: one that is constitutionally owned by the community or the State and operates not for profit.”

If one were to operationalise that definition, one would be able to draw a line across one large sector of our field – often called “The Third Sector”. If I understand that term correctly, it contains both charitable bodies and the range of different social enterprises. My simple definition, once operationalised, would separate those two parts of that Third Sector: charitable bodies are accountable through Boards and the Charity Commission – they are not “constitutionally owned by the community or the State”.
The largest part of our health field – diminishing and under threat, but the revered sector whence proliferate (or struggle) the heirloom crops – is defined by the phrase “constitutionally owned by the State”. It should not be hugely difficult to operationalise this definition, in which “State” could be national or local.
That leaves, I think, the cultivators of two sections of field to be pinned down: commercial cultivators and the social enterprises. The word “enterprise” – a word sullied with muck in some horticultural circles – creates a confusion for some, but I think my first definition, with its reference to “constitutionally owned by the community”, serves to draw a line between private enterprise and “mutual enterprise”. I think that an operational definition of private enterprise is achievable.
That leaves the mutuals, or social enterprises. That is a field with subdivisions. Those dividing lines have been traced by Geraint Day and Mo Girach, among others -The semantics of the ‘Big society’: Social enterprises, mutuals and co-operatives, NHS Alliance, August 2010. One subdivision contains CICs, like the one I am associated, whose constitutions place ownership in the hands of not just the workers in the mutual, but the whole community.
There is a programme in this for a whole load of research, I guess:

I would like to ask readers of this paper:

a) If they find the subdivision of the field proposed above useful
b) If they know of any work that pushes forward on defining some of the boundaries in a way that generates precise facts
c) If they know any facts that would give a more accurate version of the numbers guessed in the left-hand part of the diagram above

Once we have divided up the field in a manner that commands some agreement, we can then consider different ways of dealing with different plant species. Even the more aggressive plants might have their uses, if we can refine our horticultural techniques. I believe that there is a lot of mileage in looking at this horticulture from the point of view of risk management. If one can be clear about the risks involved in handling each type of plant, one can be more confident of training each plant to grow to maximise its useful productive capacity. Leaving this (rather seductive) metaphor behind – what one needs to aim at is to understand the types of contract each type of organisation can sustain in a way that optimises their capacity for good, and minimises the risk of bad.
I believe that we can get a long way by distinguishing between contracts in which the best way forward is to share risk between commissioner and provider – those are not safely handled outside public sector partners. But there are also opportunities for what I would call “segregated risk” contracts, where we might watch private enterprise do what it is best at, without massive risk.
But that is another discussion.

And there is a third related discussion we could have: in addition to an operational – i.e. useful – definition of the concepts discussed above, it would be advantageous to come up with legal definitions of some of these concepts. Here are some of the challenges encountered in searching for legal definitions with reference to a CIC:
• The CIC may be “owned” by the citizens of the community/Borough/town, but …
• What are the implications of “ownership”?
• How is the CIC accountable to the owners?
• Our CIC has a Membership Council – community and staff, but …
• Are the members of the Council representatives?
• … of whom?
• What is the “membership”?
We tried launching a membership drive, but foundered on the fact that there was nothing we could offer “members” that we didn’t want to give them simply as one of our population of potential or actual service users. We eschewed the practice of our Acute NHS Foundation (and many other Foundations) – of simply “signing up” everyone who comes through the door, in order to create an artificial “membership” number.

• What if some services are also offered in other communities? What if the organisation is willing to expand into other places it the circumstances are propitious?
• How does one characterise membership in locations where the organisation plays a minor role in the range of care?
• and on and on
The efforts of the CIC to represent the needs of its community may be completely genuine. The CIC may know that the core, at least, of its community is the citizenship of the community/Borough/town that it serves, and that may be enough for pragmatic purposes. It is better to have a practical rationale for pressing forward with doing good, rather than getting too caught up in definitions.
But, if there are readers out there who can help with legal definitions, or examples, or processes for enacting representative monitoring, then please share.

The risk for some social enterprises is that they can be captured by the profit motive or by the private sector. This is a risk that increases as money gets tighter. There are ways to have insurance against that threat, and not necessarily in terms of formal accountability and representativeness. One approach is to mount a diligent programme to embody the principles of organisation in the whole organisation – all members of the staff – and to ensure that principled continuity is not dependent on a small group of founders.
The CIC of which I am a Community Governor has some very creative approaches to ensuring continuity, principle and direction in this way. But that is yet another story.

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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.


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It may not be actually necessary to abolish the term ‘patient activation measure’. It is such an unappealing term anyway, it is hard to feel that patients themselves, despite free tickets as campaigners and leaders to industry-sponsored conferences, wish to be perceived as ‘activated’ like washing machines.

The idea that patients are not passive recipients of medical advice is a crucial one, but that is not the issue.

When I was asked what I would replace the term ‘patient activation measure’ with, I was of course obligated to look up the accepted definition of “patient activation”. This is helpfully supplied by NHS England.

“Patient activation describes the knowledge, skills and confidence a person has in managing their own health and care.”

It’s perhaps worth remembering at this juncture that reports from leading think-tanks can be, potentially, more like marketing than research. The conflicts of interests in corporate-sponsored products, including in academia and think-tanks, are sometimes not scrutinised adequately. And sometimes the aim of the term is more to do with the appeal of the “brand” in marketing (using concepts such as “brand equity“), rather than a coherent analysis of relevant aspects of the underlying field. The name, although being pithy, has to be commercially attractive, such as “electronic frailty index” or “dementia friendly commnunities”. As such, neither suppliers and purchasers want a semantic discussion of what ‘frailty’ is or what ‘friendly’ means, as long as the supplier can create competitive advantage, and use marketing to create a near monopoly in its use. This potential abuse of power is of course facilitated with capture in well-respected “independent” “think tanks”, or charities. Then someone like NHS England or Public Health England, large QUANGOs or actual government, can enforce the ‘brand leader’, the healthcare equivalent of a Big Mac or Whopper. A debate about the “capture” of public health has been started, but really does need to be continued (see for example an excellent BMJ article), promoted manipulatively through terms such as “pre-dementia”, “pre-frailty” and “pre-diabetes” for example. Rather than encouraging diversity, the market is in fact highly skewed in certain directions, and this ultimately, I feel, is to the detriment of the actual end-user (who, wearing different hats on, might be a “service user”, “consumer” or “patient”).

I suppose that it is ‘human nature’ to want a ‘quick fix’, but the potential problem with all of these approaches is that they are not “person-centred” at all (a much misused and bastardised term, which has its origins in sophisticated philosophy about personhood), but are highly individualistic and victim-blaming. It’s not about wanting to know about people’s life plans – it’s about selling the product to commissioners that activated patients will cost you less once activated. It is not a short distance from a failure of ‘patient activation’ to an ‘avoidable admission’, and thenceforth to being a ‘bed blocker’. This is individualistic victim-blaming. It would be wholly unfair for patients who are genuinely at rock bottom in terms of mood or motivation, or cognitive abilities, through absolutely no fault of their own. Whilst these measures are said to be ‘robustly validated’, there for me is something intrinsically unappealing about homogenising the marked heterogeneity in cognitive and behavioural performance (such as attention, memory or perception) in people living, say, with mood disorders, dementia or schizophrenia. You cannot half believe in ‘parity of esteem’, so equity on patient activation is relevant for problems with physical, social or mental health – despite being addressed with the marketing banner that patient activation can ‘reduce social inequalities’ (a claim which is in legal terms is essentially “mere puff”).

The field of ‘patient activation’ is essentially remarkably reminiscent of ‘consumer behaviour‘, and has very little to do with genuinely person-centred approaches (see for example the work of Prof Brendan McCormack or Prof Jan Dewing).

As Wikipedia says,

“Consumer behaviour entails “all activities associated with the purchase, use and disposal of goods and services, including the consumer’s emotional, mental and behavioural responses that precede or follow these activities.” [9] The term, consumer can refer to individual consumers or organisational consumers. Consumer behaviour is concerned with:[10]

A diagnosis and management has to be at the right time for a patient. This simply is not captured in an entirely reductionist way by a number such as a ‘patient activation measure’. If I wanted a genuine behavioural and cultural change, to empowering patients with less paternalism, I would not trademark or license a manoeuvre (meaning people could not merely copy the name). This is all remarkably reminiscent of the trademarking of ‘dementia friends’. Creating a competitive advantage through a unique selling point is an entirely different approach. And, as with dementia friends, patient activation is infested (yes, strong word) with champions, leaders, ambassadors and award ceremonies. But this is not real cultural change. It imposes a definition of what is ‘normal’ or acceptable, completely at odds at recognising a patient’s own unique circumstances perhaps reflected in the wider determinants of health, such as housing or poverty. A number does not properly encapsulate complexity, which might include complexity in a patient’s beliefs, concerns and expectations. But it is entirely consistent with “a selling snake-oil approach”, where memes such as ‘stratifying the population’, ‘ascertaining risk’, and ‘cutting costs’ have become widespread mantra.  Again, the similarities with marketing are terrifying – compare “population segmentation” say in people who are poor at self-activation with “market segmentation” a distinct population subgroup to whom you could direct marketing for products and services towards. Essentially it is about creating new markets and new industry, or profit and surpluses, and it should be called out really for what it is. The term itself is clunky, offensive, and itself does not promote diffusion or adoption of innovations.

It is also striking that for a term so blatantly borrowed from industry and non-clinical approaches that it offends one of the major principles in management. That is, you should manage according to your resources. One of the major criticisms of ‘payment by results’, based on Cooper and Kaplan’s ‘activity based costing’ in management accounting, was that the collection of data to make decisions would itself be counterproductive due to being resource intensive. At a time when we are reliably told that the clinical workforce is overworked and underresourced one has to wonder about the wisdom of siphoning off resources into proprietary devices (for measuring patient activation or how well your friends and family feel their ‘experience’ went). We are told that resources are scarce, and yet somehow money is always found for pet projects where the evidence arguably can be rather flimsy. And a whole new industry is born – take NHS England’s “advice”:

“NHS England’s Realising the Value programme has also identified five evidence-based approaches that engage people in their own health and care. The five areas of practice are self-management education; peer support; health coaching; group activities that promote health and well-being; and asset-based approaches in a health and well-being context.”

I don’t at all disagree with the idea of patients informed about their own conditions making wise choices about improving their health and wellbeing. The term is awful and pejorative, and should be scrapped. It implies that there exists a large group of patients who deliberately want to remain de-activated, rather than the fact that the system as a whole, such as underfunding of the NHS and social care, has ‘deactivated’ them. I wonder how many clinicians in their millions of interactions daily are thinking, ‘I wonder how activated she was today?’. If you’re a member of the Royal College of GPs, you could be asking “Was Enid sufficiently activated today?”

Above all, I am surprised at the lack of sensible discussion about this. We can all do better than this?






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The Health Policy & Politics Network (HPPN) is successor to the Politics of Health Group that has been run for the last 20 years or so in the form of a special interest group of the Political Studies Association. HPPN has now become independent in order more easily to encourage interdisciplinary working. HPPN aims to provide a forum for the reporting of research and analytical discussion about any aspect of the politics of health, health care policy or health services management and to facilitate the development of informal and collaborative relationships between academics and interested practitioners working in the above fields.

We invite submission of paper presentations to our one-day event at Keele University on 24th April on any topic related to health politics, policy or management. Speakers will be allocated 20 minutes plus 10 minutes for discussion/questions.

To propose a paper, please submit an abstract to Calum Paton ( by 1st March 2014.

To register to attend the conference, please fill in and return this Booking form

Fees & accommodation:

There is a small conference fee of £35.  For those needing an overnight accommodation, the cost is £41 per night (B&B at Keele Management Centre).

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First published in Tribune  Saturday, October 19th, 2013

In his speech to this year’s Labour conference, Shadow Health Secretary Andy Burnham confirmed that if the party wins the 2015 general election, he will introduce legislation to repeal the Health Act 2012 in the following Queen’s Speech. He did concede that a repeal bill would keep some of the act’s clauses – for example, retaining those of them that created “new entities” such as health and wellbeing boards. His proposed bill would also amend the role of clinical commissioning groups (CCGs), so they would be focused on designing services “clinician to clinician”, rather than commissioning them.

Burnham’s speech was music to the ears of all who love and value the National Health Service.

Andy Burnham

Andy Burnham at the head of the Save the NHS Demonstration

The coalition’s NHS reforms have been a disaster on all the fronts. The deeply damaging effects of the changes have been to distract and fragment an NHS already facing severe financial pressures. The reforms have ignored the central problem for health systems – how to merge social care for fast-ageing populations with the traditional diagnose-and-treat approach – to achieve the Government’s real desired outcomes.

While Andy Burnham’s “whole care person” approach addresses the core issue, the Conservative-led Government has spent more than two years pushing through changes to the NHS in England on reluctant doctors and vulnerable patients. Yet these changes have done nothing to meet the real challenges we face.

The reforms were supposed to transfer control of the NHS’s £100 billion to the family doctors, or GPs, on the front line. Bizarrely, as hospitals have begun to fail and treatment waiting times rise, Prime Minister David Cameron and Health Secretary Jeremy Hunt now choose to blame those very same doctors for all the ills of the NHS.

In past 21 months, £10.7 billion worth of our NHS has been put up for sale, while 35,000 NHS staff have been axed, including 5,600 nurses. Half of our 600 ambulance stations are earmarked for closure. One-third of NHS walk-in centres have been closed and 10 per cent of accident and emergency units have been shut. The A&E departments are performing at a 10-year low. The morale of the NHS family is at rock bottom. Their pay has now been frozen for two years under the coalition, and they have also been forced to accept a major downgrading of their pension benefits. Freezing and squeezing pay is heaping financial misery on more than a million NHS workers. At the same time, the NHS is going through a massive reorganisation, with staff having to deal with job cuts, rationing and ever-increasing patient numbers.

What kind of message does all this send to health workers about the value this Government places on their work? And what incentive is there for young people to join the NHS when those who currently work in it are so undervalued?

A failing NHS will only help to boost private healthcare insurance for those who can afford it, signalling the death knell for a universal healthcare service, free at the point of use.

There has been a noticeable change in the Government’s attitude to the NHS. It has become openly critical of the service while giving a nod to the right-wing media to launch an unprecedented attack on it. They have seized on the problems at Mid-Staffordshire and 14 other failing trusts to make a general attack on the whole of the NHS in order to justify their plans to reorganise and privatise the service. Government policies are designed to open up health to corporate parasites. The introduction of “any qualified provider” means that private companies must be allowed to bid to provide a range of health services.

In Greater Manchester, for instance, NHS commissioners have drawn up a list of 24 approved providers for diagnostic services. Of these, more than half are from private companies. This will have a significant impact on NHS trusts in the region. Trusts need the funding from routine diagnostic work to subsidise more complex procedures and emergency services.

The Health and Social Care Act 2012 clearly fulfils all the commonly accepted criteria for healthcare privatisation, and that is why the coalition has imposed it on the nation despite near-universal opposition.

To date, we have seen £1.4 billion wasted on redundancy payments, £7.8 billion on agency and consultancy firms, and £500 million extra in negligence. That’s more than £8 billion that could have been used for patient care.

Private sector providers want to de-professionalise and down-skill the practice of medicine in this country, so as to make staff more interchangeable, easier to fire, more biddable and, above all, cheaper. Private sector providers want to replace doctors with nurses and nurses with healthcare assistants. They especially like to replace skilled staff with computer algorithms, which do not have any employment rights. We have seen where such a “cost-saving” and “innovative” strategy leads in the case of the mortgage market, with money lent for consumption to people who cannot repay it, while small firms are starved of essential funds to weather hard times and expand their business when opportunities arise.

The NHS is one of the most cost-effective, highest quality and most equitable healthcare services in the world. Nevertheless, it now stands on the brink of extinction.

If you talk to people from countries which have mainly private sector healthcare systems – as we soon will have, too, if the present Government is allowed to complete its reforms – you will find that they regard the NHS as a jewel beyond price: safe, high-quality care available to all, no matter how poor. This is the most civilised accomplishment for which the Labour Party is responsible.

There is even a nationwide activist movement in the United States devoted to trying to introduce an NHS-style model over there. And yet the British Government led by David Cameron and Nick Clegg is itching to convert our NHS from a public service to a set of business opportunities for US-based transnational insurance and health provider corporations. The Health and Social Care Bill is an irrelevance to the real troubles facing the NHS in England.

The terrible state of the healthcare system in the US, even if Barack Obama’s reforms come into play, reinforces the point that the privatisation of state-funded healthcare delivery is not something that is welcome in England – except by big business and those paid to expedite its entry to the NHS.

Ed Miliband should give a firm commitment that, whomever he choose as Secretary of State for Health in 2015, and even if Labour has to enter a coalition agreement after the next general election, Andy Burnham’s pledge to reverse the NHS Bill will be carried out.

I am a retired Senior Nurse. Have qualifications and experience in Trauma and Orthopaedics.
I will generalise.
Care happens 24 hours a day
A&E staff cannot be  seen sitting around doing nothing -image of administrators.
Day Ward Sisters only work 40 hours a week and with days off, holidays, sickness and study are not covering the ward for more than a fraction of a day. Qualified means little if the person in charge has not the experience to care for an acute admission or returning theatre case.
Progressive patient care and pre convalescence or total ward care ?
Mixing clean and dirty cases on the same ward.
The bane of the Nurses station !
Morale which includes good management, job security and team stability.
Handmaidens to Medics and Administrators due to lack of budget control and “hospital management”
Nurses don’t manage hospitals! Consultants and Administrators with no patient care qualifications do.
Hattie Jacques and Barbara Windsor - archetypal nurses

Hattie Jacques and Barbara Windsor – archetypal nurses

Bring back Matron the sort who were in control, and question Nursing CEO’s basic ward experience !
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There has been a strange two-handed legal dance going on for the last year or so. Ministers, and Monitor officials and pretty much anyone in the DH or NHS England you come across says that there is nothing to fear from the Health and Social Care Act. The Act may say that competition will be a key aspect of the NHS and s75 gives it legal force – but ministers and Monitor continue to say that we are all misguided and paranoid. Just wait for Monitor’s formal guidance and you will see there is nothing to fear.

Well, Monitor’s guidance has arrived. It is fearsome and makes competition the default. And worse. We understand that Monitor refuses to publish the legal advice on which they depend.

Here are some key paragraphs with comments.

Consulting the public

Public consultation is not required for tenders to go ahead.

3.2  What is appropriate will depend on the circumstances of the case, but may include consulting publicly on proposals, engaging with local clinicians.

Going to market

Commissioners have to go out to market unless they think they know all relevant providers and can justify their omniscience.

3.3.1 all potential providers that might be interested in providing a service being procured by the commissioner have been given an adequate opportunity to express an interest in providing those services. Commissioners will need to consider what steps they need to take to identify providers that might potentially be interested in providing the services being procured. In some circumstances commissioners may be able to identify interested providers based on their knowledge of the market.

CCGs will have to go to market when contracts end.

3.3.3 For example, if a particular service (such as community dermatology services) is provided by a single provider in a local area, there is no requirement on the commissioner under the regulations to introduce patient choice……, although when the arrangement with the existing provider comes to an end, the commissioner will need to ensure that the process that it adopts to choose a provider in the future is consistent with the requirements of the Regulations.

Avoiding going to market

CCGs must demonstrate why they are not using the market.

3.3.3 However, Regulation 3(4) does require commissioners to consider whether introducing competition and choice and delivering care in a more integrated way could be used to improve quality and efficiency. Monitor will expect commissioners to be able to demonstrate that they have considered whether services might be improved through such means (including by extending patient choice to services where it is not currently available).

Even the section which outlines circumstances in which competition is NOT required makes it difficult to avoid a competitive approach. There are 3 conditions:

  • When there is only one provider
  • When the commissioner identifies the best provider through a detailed review in which all possible providers are offered the option.
  • Where the benefits of competitive tendering would be outweighed by its costs. This will need to be justified.

However, we understand that legal opinion suggests that the second and third bullet points COULD NOT be used – nothing in the legislation or regulations allows for them.

4.2 Three situations are considered in more detail below:

 Where there is only one provider that is capable of providing the services in question.

 Where a commissioner carries out a detailed review of the provision of particular services in its local area in order to understand how those services can be improved and, as part of that review, identifies the most capable provider or providers of those services.

The commissioner would also need to ensure that its engagement with each of the prospective providers is consistent with its obligation to act transparently and to treat providers equally under the Procurement, Patient Choice and Competition Regulations. In particular, the commissioner would need to ensure that potential providers have a reasonable opportunity to express their interest in providing the services in question.

 Where the benefits of competitive tendering would be outweighed by the costs of publishing a contract notice and/or running a competitive tender process.

Anti-competitive behaviour

When will behaviour be anti-competitive and not in the interests of users of health care services? Monitor will judge anti-competitive behaviour through a cost-benefit analysis, not through benefits for patients.

9.3 Where a commissioner’s conduct is in the interests of patients its behaviour will not be inconsistent with the prohibition on anti-competitive behaviour in Regulation 10. In assessing whether or not anti-competitive behaviour is in the interests of health care service users, Monitor will carry out a cost/benefit analysis. Monitor will consider whether by preventing, restricting or distorting competition behaviour gives rise to material adverse effects (costs) for health care service users.

If we find that behaviour gives rise to material costs, we will consider whether it also gives rise to benefits that could not be achieved without the restriction on competition.

Monitor will then weigh the benefits and costs against each other

Any anti-competitive behaviour must be justified by material and clinical benefits. Any restrictions on competition must be necessary to achieve the benefits.

9.3  Monitor will expect commissioners to be able to identify and describe the benefits to health care service users that arise from any anti-competitive conduct and to provide any relevant evidence in support. In deciding what value should be attributed to claimed benefits, Monitor will consider all relevant factors including, for example:

 the materiality of the benefits submitted;

 the period of time over which the benefits will be realised; and

 the robustness of the analysis and evidence that supports the claimed benefits (in considering clinical benefits, Monitor will have particular regard to supporting research and evidence regarding clinical improvements).

Any restrictions on competition must be necessary to achieve the benefits, if those benefits are to be taken into account for the purposes of establishing whether anticompetitive behaviour is in the interests of health care service users.

Contracts must not include any term or condition restricting competition that is not specifically needed to achieve the benefits. So, it may be difficult to use “continuity of care” or “knowledge of the local scene” as reasons for avoiding anti-competitive behaviour.

9.3 Regulation 10(2) clarifies that that an arrangement for the provision of NHS health care services must not include any term or condition restricting competition that is not necessary for the attainment of relevant benefits. Any term or condition restricting competition that is not necessary – for example because it goes beyond what is necessary to achieve benefits (such as a restriction that has a longer duration than is necessary or applies to a wider range of services than is necessary) – will breach Regulation 10(2).

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Thanks to Radiance Health for this useful graphic.  It’s focussed on South London, but the principles are of wider application, and there are many areas with similar problems.

It shows that

  • there is no NHS deficit. The NHS saved £3bn last year. The NHS is in surplus – and the money was given to the Treasury. There is a strong argument for saying that all surpluses should be ploughed back into the NHS, not given up.

The NHS should not be paying for procedures of little value.  We are committed to evidence based medicine. However, the Labour Party showed that PCTs are stopping procedures of good clinical value (such as bariatric surgery and cataracts).  There will always be rationing of medical treament. But it needs to be done rationally and accountably. Continue reading »

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