Category Archives: Campaign resources

Material designed to be practically useful in campaigns. More contributions very welcome!

It was back in 2004, that the then Conservative shadow chancellor, Oliver Letwin, astonished his audience (of businessmen in Dorset) was reported as saying that within five years of a Conservative election victory “the NHS will not exist anymore.   Well look what happened – they’ve only been back in for 4 years and the NHS is already on its knees.  He may not have got the timescale quite right, but if the Tories get back in next year, the NHS that we have known for 65 years – the envy of the world, the greatest British achievement of the post war years, will disappear into a morass of private insurance, multinational run, cash rationed, postcode lottery chaos. 

NHS for people not for profit

The documentary film, One Thousand Thank Yous, shows what can happen though, if local groups fight back.  We don’t have to take it!  Please pledge.

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The new “Workers’ Party” Anthem

 The people’s flag is deepest blue

We’ll take your rights away from you

Your pay is getting less and less

And we’re selling off the NHS

 

We say there’s an economic boom

Then tax you for your extra room

We’ve torn up Health & Safety rules

And Gove is meddling with your schools

 

We’ve made you easier to sack

You’ll never get your old job back

And when we’ve got you on your knees

You can’t afford Tribunal fees

 

We’ll destroy the workers’ powers

So here’s a job on zero hours

The only “workers” we’ll defend

Are all our wealthy Banker friends

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This is  Labour Party  NHS Check 9  originally published by Labour’s Shadow Health Team in 2013

Cameron’s NHS: Hospitals ‘full to bursting’

REVEALED: Hospitals across England too full and patient care put at risk

Official NHS figures for winter 2012/13 show that:

  • Every hospital trust in England operated above recommended safe occupancy levels on a least one day last winter.
  • Almost four in five hospitals filled all standard beds at one point over the winter
  • Half of hospitals filled all standard and extra beds on at least one day – not a single bed available to new patients.

Hospitals have standard ‘core’ beds and use additional ‘escalation’ beds according to demand. During the winter months the Department of Health publishes data on 159 hospital trusts, in Weekly Situation Reports, on bed occupancy levels.
All 159 hospital trusts operated above the recommended safe 85% occupancy at least once over winter. The ‘Dr Foster’ NHS performance watchdog, half Government-owned, warned that above this level quality of care can deteriorate.

The Dr Foster Hospital Guide 2012 said:
“When occupancy rates rise above 85% it can start to affect the quality of care provided to patients and the orderly running of the hospital.”2
In addition:

  • More than half of hospital trusts (86) operated at an average rate of over 95% occupancy
  • 78 trusts have experienced at least one day where there were no beds available at all
  • 27 trusts experienced 10 or more days with no standard or core beds available

Crisis in England’s A&Es

The NHS faced the worst winter in nearly a decade. At every stage of a patient’s journey, waiting times are getting longer. Patients have to wait longer for an ambulance to arrive; patients have to wait longer in ambulances, outside A&Es; patients have to wait longer in A&E before being treated; patients have to wait longer on trolleys before being admitted.

The number of patients waiting longer than four hours in A&E is almost three times higher than in Labour’s last year in office and an extra 161,890 patients waited for more than 4 hours in the last 6 months, compared with the same period last year.

Casualty waitsThere are increasing reports of long waits in A&E departments, with some patients waiting more than 12 hours to be admitted.
“Waiting times are routinely reaching 12 hours in parts of the country, while “queue nurses” have been appointed in others to watch over patients brought in by ambulance until doctors become available.
Official figures submitted by NHS trusts to the Department of Health show that 27,247 patients spent longer than four hours in an emergency department in the week ending March 17, compared with 13,200 in the same week last year.
Telegraph, 24 April 2013

Earlier this month the Norfolk and Norwich University Hospital set up a major incident tent outside its A&E as ambulances queued up outside
“A major incident tent had to be set up outside a Norfolk hospital because ambulances were left to queue outside the A&E department for hours. The mobile treatment area was set up at the Norfolk and Norwich University Hospital after 15 ambulances had to queue up on Monday. The East of England Ambulance Service said each vehicle had to wait for up to three hours to hand over patients. The hospital said demand at the A&E department had been high.
BBC News, 2 April 2013

Low staffing levels

According to the Care Quality Commission, more than 1 in 10 hospitals are operating below safe staffing levels:
“CQC also saw some improvement in staffing levels. However, this was from a low base and the providers still have some way to go. Hospital services met the standard in 89% of inspections.
Care Quality Commission, Care Update Issue 2, March 2013, p. 17

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This is  Labour Party  NHS Check 5 originally published by Labour’s Shadow Health Team in December 2012

Revealed:

•The government has broken its promise to protect funding for cancer networks and heart and stroke networks – vital groups of clinicians and other experts that drive improvements in patient care.

•Cancer networks say their budgets have been cut by a quarter, and their staff by a fifth since 2009/10. Heart and stroke networks say their budgets have been cut by 12% and their staff by 16%.

Funding for both types of networks has fallen year on year under the government, and is now 21% lower than when labour left office.

These cuts mean vital work to improve patient care for cancer and cardiac disease – Britain’s biggest killers –‐ is being scaled back or dropped altogether.

The government’s NHS reorganisation has caused huge uncertainty and confusion about the future of clinical networks, and risks losing vital local specialist expertise

KEY FINDINGS:

• A Freedom of Information survey by Labour reveals severe cuts to budgets and staff in cancer, stroke and heart disease networks, despite repeated reassurances from the Government that funding for clinical networks has been protected.

• Labour received responses from 86% of all Cancer Networks and 82% of Cardiac Networks in England.

Cuts to budgets:

• Responses from Cancer Networks show that their funding has been cut by 26% between 2009/10 and 2012/13. • Stroke and Heart (Cardiac) Network budgets have been cut by 12% in the same period.

Fall in the budgets of Cancer and Cardiac Networks in England (in millions of pounds):

Fall in the budgets of Cancer and Cardiac Networks in England (in millions of pounds)

Cuts to staffing levels:

• Cancer Networks have lost at least 72 members of staff,  20% of their workforce , since 2009/10

• Cardiac Networks have lost at least 38 members of staff, 16% of their workforce, since 2009/10

Fall in the number of staff employed by Cancer and Cardiac Networks in England:

Fall in the number of staff employed by Cancer and Cardiac Networks in England

Cuts, chaos and confusion

Funding cuts combined with the Government’s massive NHS reorganisation have caused huge uncertainty and confusion about the future of clinical networks.

Cancer and Heart and Stroke Networks were supported by regional Strategic Health Authorities. They received funding from  a number of sources including both core and specific project funding from the Department of Health, funding from Strategic Health Authorities and Primary Care Trusts (PCTs), and charities like Macmillan Cancer Support.
Strategic Health Authorities and PCTs were abolished under the Health and Social Care Act 2012. Networks will now be hosted centrally by the new NHS Commissioning Board. Cancer and Cardiac Networks are being merged to cover larger geographical areas and with networks for other medical conditions.
Networks say they are unclear both about their own future and how the new structures will work. This lack of clarity has had a considerable impact on their work:
• Uncertainty as to what will happen after March 2013 has resulted in Networks reducing the number of existing and future projects and initiatives.
• Many have not replaced leaving members of staff due to their unsure future.
• Networks are very concerned that they will have fewer staff to cover wider geographical areas, reducing the effectiveness of their work and risking the loss of vital local specialist expertise.
• At least one network was forced to decline additional grants from charities as this would have required them to make commitments into 2013/14, which they were not in a position to make.

GOVERNMENT’S BROKEN PROMISES

‘The cancer networks funding is guaranteed during the course of 2011-­‐12. There is not a gap, because from April 2012 onwards the NHS commissioning board will take up its responsibilities.’

Andrew Lansley, then Secretary of State  for Health, Second Reading of the Health and Social Care Bill, 31st January 2011
‘Cancer networks are here to stay and their budget  has been protected. They are extremely important’

Jeremy Hunt, Secretary of State for Health, Health Questions, 27th November 2012.

The budget through which the clinical networks are funded is increasing (… ) those clinical networks are extremely important and will continue.’

Jeremy Hunt, Secretary of State for Health, debate on the NHS Commissioning Board Mandate, 13th November 2012.

Labour has repeatedly warned about reductions to clinical networks and how such cuts might harm the crucial work that these networks do:

Liz Kendall: “Funding [for clinical networks] is crucial. In response to a parliamentary question on 21 May this year, the Minister stated that strategic health authorities will be given £18.5 million to fund cancer networks in 2012-­‐13, just as in the previous two years.  Page 6 of the recent document from the Department of Health, “Progress Update on the Design of the NHSCB” states: “Around £10 million of the costs of supporting Networks and Senates are expected to count against running costs.” (…) Will the Minister say whether the £10 million referred to in the document about the future functioning of the NHS Commissioning Board covers all networks, or cancer networks alone? That is a real concern for people who work in cancer networks and are already worried about the future.”

Paul Burstow MP: “(…) On funding cancer networks, my right hon. Friend the Secretary of State has made the position clear. We have provided funding for the remaining year for which the Department is responsible. Indicative figures have been set out. A review is going on of clinical networks and how they are governed. That will ultimately determine precisely how much resource is allocated. There is no final figure at this stage.
Westminster Hall debate on cancer treatments, 19th June 2012

Liz Kendall: “Cancer networks have played a crucial role in improving patient care, including by earlier diagnosis. The former Health Secretary promised this House that their funding would be guaranteed in 2011, but the South East London Cancer Network now says its budget was cut by 40% between 2009 and 2011. This year, it has been slashed by a further 55% and its staff have been cut from 15 to eight. Will the Minister now admit that her Government have cut funding for vital front-­‐line cancer experts and have broken their explicit promises on cancer care?”

Anna Soubry: ” My information is that any 40% reduction is a result of cuts in administration—and that, if I may say so, seems the right way to go about things. This Government are determined to make sure that when we make cuts of that nature, they are not actually cuts.”
Health Questions, 23rd October 2012

Liz Kendall: “The reality is that the Government are ripping away the foundations of better cancer care. The former Health Secretary made a clear promise from the Dispatch Box to protect cancer network funding, but the NHS South East London and Greater Midlands cancer networks both say that their budgets and staff have been slashed. The NHS medical director, Sir Bruce Keogh, says that cancer networks are an NHS success story, and Macmillan Cancer Support says it is nonsensical to cut their specialist expertise. Why do the Government not agree?”

Jeremy Hunt: “Cancer networks are here to stay and their budget has been protected.”

Health Questions, 27th November 2012

NETWORKS REPORT ‐ Impact of budget cuts

‘A network chemotherapy nurse post was not replaced due to the future uncertainty of the networks.’
Arden Cancer Network

‘We lost our stroke education and training lead and as a result have not run the enormous number of training sessions covering care homes, enablement, community and acute trust rehabilitation service that we have previously organised, supported and delivered.’
Bedfordshire and Hertfordshire Heart and Stroke Network

‘From  April 2013 budgets and staffing will be cut further and this will mean that we will be able to achieve less than we have previously.’
Merseyside and Cheshire Heart and Stroke Network

‘There has been reduced clinical training in the Stroke work stream …. the lower funding has meant a reduction in the number  of work streams that are priorities. In addition we were asked to cover two additional work streams – complex vascular surgery and interventional radiology’
North East London Cardiac and Stroke Network

‘In the new structures the network will be unable to provide the wide range of training and educational programmes we offered in previous years and our ability to continue to offer this support in terms of training/education and service improvement support will be greatly reduced in 2013/14.’
Greater Manchester Heart and Stroke Network

‘(…) we have had to decline the offer of £150,000 from Macmillan to support a Survivorship programme as this would have required commitments into 2013/14, which we were not in a position to make. Other support has stopped due to the transition of the NHS.’
Peninsula Cancer Network.

‘…. a reduction is anticipated in 2013/14 in the following functions: training and education; patient and public involvement; Information support; service improvement’
North of England Cardiovascular Network

‘….posts have been removed from the structure as a result of requirements to make savings.. The new structure does not have enough posts for current staff. We are all in a redeployment pool. We have been told that we should know by the 31st December as to whether or not we have a post from 31st March. With no presence in Essex from 1.4.13 for the network current skill set from current staff will be lost.’

Essex Cancer Network

‘Please also note that central project funding in previous years for stroke enabled us to support more projects than we are currently able to.’
South London Heart and Stroke Network

‘This smaller team will also be expected to cover a much larger foot print to include Lancashire and South Cumbria.’
Greater Manchester Heart and Stroke Network

‘….we clearly have rather less capacity overall for all our areas of work.’
Coventry and Warwickshire Cancer Network

NETWORKS REPORT -­‐ Uncertainty about future

‘Uncertainty and transition has resulted in Network reducing the number of new projects and initiatives reducing the size in line with available support.’
South East London Cancer network

‘….a great many [staff] have left and I have not replaced them for financial reasons and also because of uncertainty.’
South West London Cancer Network

‘….some Network staff may ultimately be made redundant as a result of transition to new organisational structures. Details cannot be confirmed at this stage’
Central South Coast Cancer  Network

‘No there will be no Essex Cardiac and Stroke Network. Networks will sit within a senate. There will be a very small support team for senates and networks under the East Anglia Local Area Team, covering the whole of the East of England and more areas. Numbers of staff are not yet clear…. Working locally with stakeholders has been key to the networks success. There is no clear direction on who will undertake the Networks work forward within Essex when it ceases at the end of March 2013.’
Essex Cardiac and Stroke Network

‘The exact operational format has not yet been released to us, but it will not be as it is now’
Surrey Heart and Stroke Network

‘The process for transferring the functions of the Network (including work responsibilities and staff) has yet to be determined.’
South London Heart and Stroke Network

“It is unclear at this point whether or not there will be an outpost in the Beds, Herts and Milton Keynes region anywhere.‘
Bedfordshire and Hertfordshire Heart and Stroke Network

‘The exact format of these new structures is being developed at present, and the final architecture is due to be released in the coming weeks.’
Black Country Cardiovascular Network

‘Details of new structures and supporting arrangements have yet to be finalised.’
Coventry and Warwickshire Cardiovascular Network

‘Cardiac and stroke will be incorporated in the Cardiovascular Disease Strategic Clinical Network which will also incorporate diabetes and  some renal. The design of the Strategic Clinical Network is still in development and it has yet to be established if there will be a local office base within the Peninsula.’
Peninsula Heart and Stroke Network

‘…. The final format is still to be confirmed for the area….’
Sussex Heart Network

‘The details of how this is to be organised and what arrangements will be put in place underneath this  [The Clinical Network] specifically for West Yorkshire are currently under discussion’
West Yorkshire Cardiovascular Network

‘There are indications that there may be a support team based on the current LSCCN footprint which could continue some of the current cancer work streams – although there is a lack of clarity regarding what these might be.’
Lancashire and South Cumbria Cancer Network

‘Detailed arrangements for the future of the Yorkshire Cancer Network in the financial year 2013/14 remain unclear.’
Yorkshire Cancer Network

CLINICAL NETWORKS

• Clinical Networks are teams of experts who help GPs and hospitals to deliver the best outcomes for cancer, heart disease and stroke patients.
• The previous Labour Government established Cancer Networks in the 2000 Cancer Plan and Cardiac Networks in the 2007 National Stroke Strategy to drive up the quality of clinical services delivered to cancer and stroke patients and improve patients’ experience of care.
• Clinical Networks employ both clinical specialists (doctors and nurses) and project managers to put in place a range of programmes to improve cancer and cardiac care.
• Networks have played a vital role in reducing waiting times, such as the crucial maximum 2-­‐week wait between a referral and first appointment at hospital for suspected cancer. For example one cancer network worked to reduce chest x-­‐ray waiting times from an average of 15 to just 3 days
• Networks help avoid unnecessary emergency admissions, reduce the length of time patients need to stay in hospitals, and speed up patients’
recovery for example by informing the patient of the correct dietary requirements or giving them information and exercises to perform after leaving hospital.
• Networks provide information and support to patients on how to deal with their disease during and after their treatment, for example through organising cancer survivor networks. They also work with NHS staff to deliver specialist training and educational programmes, for example on increasing awareness of symptoms to improve early diagnosis, on the best new drugs and treatments, and on how to manage the side effects of cancer treatment and support patients’ recovery.
• Networks also do important work on prevention, for example Cancer Networks have worked to increase breast cancer screening uptake, whilst  heart and stroke networks have worked to identify those at high risk of heart disease in local communities.

ACHIEVEMENTS

Cancer, heart disease and strokes are Britain’s biggest killers, accounting for over 300,000 deaths each year – 6 in 10 of all deaths in the UK. Under the last Labour Government significant improvements were made in the treatment of heart, stroke and cancer patients. Mortality as a result of stroke and heart disease fell by over 50%, and cancer by 16%,  during the 13 years Labour was in government. (House of Commons calculations based on NHS Information Centre Indicator Portal data, December 2012).  Five year survival rates for nearly all types of cancer improved.

The incidence of stroke fell by 29% between 1999 and 2008 and survivors’ chances of recovering without having a major disability increased.

Local clinical leadership, including from Cancer and Heart and Stroke Networks, has played a vital role in making these improvements. Their work is crucial to making further progress patients need in the years ahead.

Clinical networks, both formal and informal, are an NHS success story… For more than 10  years’ we have seen improvements brought about by networks. Combining the experience of clinicians, the input of patients and the organisational vision of NHS staff, they have supported and improved the way we deliver care in distinct areas by enhancing integration across primary, secondary and often tertiary care.
Sir Bruce Keogh, the NHS Medical Director, 9th Aug 2012

“I value very highly the important work currently being done by cancer and cardiovascular networks which enable doctors and nurses to share insight and advice for patient treatment”
Prof Mike Richards, the government’s former cancer tsar who is now the NHS Commissioning Board’s director for reducing premature mortality, 16th Oct 2012

“Heart and stroke networks do very important work. They have made a huge contribution to the NHS. (…) I’m very concerned about the current plans. It would be a tragedy if we started losing things we have  already gained.”
Prof Tony Rudd, the NHS’s stroke director for London, 4th Oct 201213

“Cancer networks provide a valuable service to patients. Their expertise provides support where necessary. This allows clinicians to spend more of their time on what is most important – their patient. It is essential that this expertise is retained within the NHS, yet we risk losing it.”
John Baron MP, chair of the All-­‐Party Parliamentary Group on Cancer, 4th Oct 201214

‘Cancer networks have played a central role in driving up the quality of cancer services and ensuring that patients get the care that  they deserve’
Mike Hobday, Director of Policy and Research at Macmillan Cancer Support, 26th Jul 2012

‘The opportunity to improve outcomes for cancer patients is clear, and cancer networks, established as strategic clinical networks, can and should play a significant role in helping to achieve the Government’s ambition of saving 5,000 lives every year. However, there is a danger that the progress that has  been made in improving cancer outcomes and mortality in recent years could be threatened by the uncertainty in the structures of the new NHS.’
Cancer Campaigning Group, “Developing excellence in cancer networks”, February 2012

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Cameron’s hidden dementia taxes hit vulnerable hardest

REVEALED:

• Older and disabled people will pay an average of £655 more for home help this year compared to four years ago
• Dial-a-ride transport services double in price over same period
• ‘Meals on wheels’ cost 65p more – older people paying an extra £235 per year

Government cuts to local authority care budgets have left the most vulnerable people in society paying spiralling charges for their own care.

A Labour survey of council social care departments reveals the care charges older and disabled people will pay this year.
Government cuts to local authority budgets, which pay for social care, have left councils no choice but to increase the costs billed to individuals and families. These support services include home help – that help people get up, washed and dressed – alongside ‘meals on wheels’ and dial-a-ride transport services.

Last week, an independent survey of social care finances by the Association of Directors of Adult Social Services (ADASS) revealed that Government cuts to councils will mean a further £800m taken from care budgets in the next year – totalling £2.68 billion so far under the current Government.

More than a third of local authorities supplied information to the Labour survey – 64 out of 150 responsible councils.
Labour’s findings show the average charges for an hour of home care increased by 10.6% between 2009/10 and 2013/14 – from £11.87 to £13.13.

An average care user – defined by experts as an individual receiving 10 hours of care each week (The Personal Social Services Research Unit’s report ‘Unit Costs of Health and Social Care 2010’) – will pay £655 more this year compared to four years ago (from £6,172 in 2009/10 to £6,827 in 2013/14).

The cost of council-run ‘Ring and Ride’ and other transport services, to assist people with reduced mobility to travel to day centres and medical appointments, has more than doubled in 4 years – from an average of £1.98 to £4.12 per ride.
Additionally, the average price of a ‘meal on wheels’ has increased from £3.01 in 2009/10 to £3.66 in 2013/14. An extra 65p per meal will add £237 over a year – on the basis of one council-provided meal per day – taking the 2009/10 average annual total of £1095 to £1332 in 2013/14.

Growing ‘postcode lottery’ in care

The survey findings show considerable variation in the price of home care, meals and transport services between different councils.

Whilst responsibility for such huge cuts to care services lies squarely with central Government, it is noticeable that older and disabled people in Conservative areas pay more for each of these on average than friends and family in Labour-controlled areas.

Home care:

An hour of home help costs £20 in Brighton and Hove, whilst Tower Hamlets in London offers it for free.

Older and disabled people receiving services from Conservative councils pay on average £15 per week, or £780 per year, more than neighbours in Labour-controlled areas (based on Conservative councils charging £1.50 per hour more and people receiving an average of 10 hours care per week).

Transport

Several councils provide free transport services to people with reduced mobility, whilst Warwickshire charge as much as £12 per ride. Conservative-run Warwickshire has increased its fare by almost £11 in last four years, now charging three times the national average.

Conservative councils charge £5 on average, £2.10 more than in Labour-controlled areas.

Meals

The most expensive council charges close to three times more for a meal than the cheapest – £5.99 in Richmond compared to £2.30 in Warrington.
A meal in a Conservative area costs 45p more on average than in a Labour-controlled area – adding up to an extra £160 a year on the basis of one meal per day.

Meals services:

Cost of a meal in £

Authority Control 2009/10 2010/11 2011/12 2012/13 2013/14
East Riding of Yorkshire Council Con 3 3.1 3.2 3.35 Service not provided
Bournemouth Borough Council Con 4 4.1 4.1 4.1 Service not provided
London Borough of Bromley Con 3.1 3.2 3.3 n/a Service not provided
Cheshire West and Chester Con 3.03 3.1 3.18 3.26 Service not provided
Milton Keynes Council Con 4 4.2 4.98 5.19 5.19
Isle of Wight Council Con 3 3.1 n/a n/a 5
Dorset County Council Con 4.1 4.1 4.1 4.2 4.5
Herefordshire Council Con 4.4
West Sussex County Council Con 3.3 3.4 3.7 4 4.1
Lancashire County Council Con 3.25 3.25 4.05 4.05 4.05
Essex County Council Con 3.5 3.5 3.5 3.95 3.95
Buckinghamshire County Council Con 3.45 3.5 3.6 3.8 3.9
Spelthorne Borough Council Con 3.3 3.5 3.6 3.7 3.8
Kent County Council Con 3.3 3.4 3.5 3.65 3.75
Surrey Heath Borough Con 2.95 3.5 3.6 3.6 3.6
Waverley Con 3.3 3.4 3.5 3.6 3.6
Gloucestershire County Council Con 2.5 3 3.5 3.5 3.5
Hampshire County Council Con 3.1 3.2 3.3 3.4 3.5
East Sussex County Council Con 3.3 3.3 3.35 3.35 3.4
Woking Con 3.3 3.3 3.3 3.3 3.4
Norfolk County Council Con 3.18 3.24 3.3 3.3 3.37
Lincolnshire County Council Con n/a 2.7 2.79 2.79 2.85
North Yorkshire County Council Con 1.9 2.1 2.2 2.25 2.3
Kensington and Chelsea Con 3.2 3.2 3.3 3.4 3.55
Richmond Con 3.1 3.15 3.3 3.4 5.99
St Helens Metropolitan Borough Council Lab 3.08 3.16 3.24 3.32 Service not provided
Doncaster Metropolitan Borough Council Lab 2.3 2.4 2.5 3 Service not provided
Birmingham City Council Lab 2.7 3.2 3.9 4.1 Service not provided
Barnsley Metropolitan Borough Council Lab N/A N/A N/A N/A N/A
City of York Council Lab 2.45 2.5 2.5 2.5 n/a
Wigan Metropolitan Borough Council Lab 2.8 2.95 3.2 3.85 4.2
Wolverhampton Council Lab 2.4 3.4 3.4 3.95 4.15
Bury Metropolitan Borough Council Lab 3.4 3.5 3.7 3.7 3.9
Hartlepool Borough Council Lab 3.6 3.65 3.65 3.65 3.65
London Borough of Enfield Lab 3.4 3.47 3.5 3.5 3.5
London Borough of Brent Lab 3.5 3.5 3.5 3.5 3.5
Plymouth City Council Lab 2.65 2.65 3 3 3.5
London Borough of Haringey Lab 3 3.2 3.2 3.3 3.4
City of Wakefield Metropolitan District Council Lab 3.1 3.2 3.2 3.3 3.3
Derby City Council Lab 3 3 3.1 3.1 3.2
Halton Borough Council Lab 2.82 2.88 2.94 3.1 3.2
Blackburn with Darwen Borough Council Lab 2.97 2.97 2.97 2.97 2.97
Tameside Metropolitan Borough Council Lab 1.99 2.05 2.6 2.68 2.78
Metropolitan Borough of Wirral Lab 2.6 2.6 2.6 2.68 2.68
Stoke-on-Trent City Council Lab 2.4 2.4 2.4 2.5 2.6
Kingston-Upon-Hull City Council Lab 1.95 2 2.1 2.15 2.55
Warrington Borough Council Lab 2.15 2.2 2.24 2.27 2.3
Gateshead Lab 2.4 2.6 3 3.15 3.2
Islington Lab 3 3 3 3 No extra cost
Newham Lab 2.2 2.2 2.2 5.35 Service not provided
Darlington Lab 3.6 3.65 3.65 3.65 3.65
Waltham Forest Lab 3.61 3.66 3.77 3.94 4.05
Nottingham City Lab 2.5 2.6 3 3.25 3.25
Hounslow Lab 4 4.1 4.1 5.1 5.1
Newcastle City Council Lab 2.45 2.45 2.45 3 3
Hackney Lab 3.6 3.65 3.75 3.75 3.8
Knowsley Lab 2.55 2.55 Service not provided Service not provided Service not provided
Oldham Lab 3.6 3.7 3.8 3.9 4

Community Transport Services

(Charge per ride):

Authority Political control 2009/10 2010/11 2011/12 2012/13 2013/14
Norfolk County Council Con 1.16 1.18 1.2 1.22 1.22
Chesire West and Chester Con 1.63 1.67 1.71 1.75 1.79
Trafford Metropolitan Borough Council Con 1 1 1 2 2
North Yorkshire County Council Con 1.8 2 2.2 2.3 2.4
Dorset County Council Con 2.5 2.5 2.5 2.5 2.5
Milton Keynes Council Con 2 2.3 2.3 2.65 2.65
Woking Con 4 4 4 4 4.2
Surrey Heath Con 3.45 4.1 4.1 4.5 4.5
West Sussex County Council Con 3 3.2 5 5 5.1
Lincolnshire County Council Con 0 0 5 5 5.1
Spelthorne Borough Council Con 4.5 5 6 6.5 6.7
Bournemouth Borough Council Con 5.55 5.7 5.7 5.7 7.81
Buckinghamshire County Council Con n/a n/a n/a 8 8
Warwickshire County Council Con 1.27 1.3 5.29 12.23 12.13
Kensington and Chelsea Con 0 8 8.3 8.7 8.9
Richmond Con 5 5 5 5 5
Plymouth City Council Lab 0 0 0 0 0
Rotherham Metropolitan Borough Council Lab 0.5 0.5 0.5 0.5 0.5
Blackburn with Darwen Borough Council Lab 1 1 1 1 1
Barnsley Metropolitan Borough Council Lab 0.5 0.5 0.5 0.5 1
City of Wakefield Metropolitan District Council Lab 0.45 1 1 1 1.1
Halton Borough Council Lab 1.03 1.05 1.07 1.09 1.31
Tameside Metropolitan Borough Council Lab 1.4 1.45 1.49 1.53 1.59
Doncaster Metropolitan Borough Council Lab n/a n/a n/a n/a 2
Derby City Council Lab 3 3 3.1 3.1 3.2
Warrington Borough Council Lab 1.6 1.6 3.35 3.35 3.38
St Helens Metropolitan Borough Council Lab 2.56 2.62 3.71 3.8 3.9
City of York Council Lab 1.8 1.8 3 3 4
Stoke-on-Trent City Council Lab 0.42 0.45 0.5 0.55 4
Bury Metropolitan Borough Council Lab 3.7 3.8 4 4.1 4.2
Metropolitan Borough of Wirral Lab 4.64 4.78 4.78 4.78 4.78
Hartlepool Borough Council Lab 0 0 0 6.9 6.9
Gateshead Lab 1.09 1.2 1.38 1.45 1.5
Islington Lab 5 5 5 5 5
Darlington Lab n/a n/a n/a 6.9 6.9
Nottingham City Lab 2.5 2.6 4 5 5
Hackney Lab 0 0 0 0 0
Oldham Lab 2.5 2.5 2.6 2.7 2.8

Home Care Costs:

Authority Control 2009/10 2010/11 2011/12 2012/13 2013/14
East Riding of Yorkshire Council Con 10.4 10.6 10.6 10.7 10.8
Bournemouth Borough Council Con 16 13.96 13.96 13.96 13.95
London Borough of Bromley Con 15.76 16.2 14.64 14.64 14.64
Cheshire West and Chester Con 12.78 12.78
Milton Keynes Council Con 14 15 14.12
Trafford Metropolitan Borough Council Con 7.7 8.1 8.5 8.92 12.5
Dorset County Council Con 15 15 15 15 15
Herefordshire Council Con 15.15
Solihull Metropolitan Borough Council Con 16.25 16.65 16.65 16.65 12.68
Lancashire County Council Con 11.9 11.96 11.96 11.96 11.96
Essex County Council Con 13.32 13.52 13.52 13.52 13.64
Buckinghamshire County Council Con 13.8 14.2 18 18 18
East Sussex County Council Con 13 13 13 13 13
Warwickshire County Council Con 9.22 11.36 13.37 14.24 14.24
Kensington and Chelsea Con 7.2 14.3 14.3 14.3 14.3
Hampshire County Council Con 14.4 14.8 15.2 Up to Actual Cost Up to Actual Cost
Norfolk County Council Con 14.04 14.32 14.62
Lincolnshire County Council Con 10.5 10.5 11.93 11.93 11.93
North Yorkshire County Council Con 15 16 16.5 16.9 17.3
Bexley Con n/a n/a n/a n/a 12.6
Richmond Con n/a n/a n/a n/a 12.5
St Helens Metropolitan Borough Council Lab 9.36 9.59 9.83 10.08 10.33
Doncaster Metropolitan Borough Council Lab 9.85 10.15 10.72 11.28 11.28
Birmingham City Council Lab 14.91 16.4 17 17 15
Barnsley Metropolitan Borough Council Lab 5 5 13 13 13
City of York Council Lab 15.75 16 16 16 16
Wigan Metropolitan Borough Council Lab 9.64 9.8 10.8 13.05 13.48
Wolverhampton Council Lab 13.48 13.48 13.48 13.48 13
Bury Metropolitan Borough Council Lab 11.5 11.5 12 12.4 12.7
Greenwich Lab 9.7 9.7 11.2 12.5 13
London Borough of Enfield Lab 16.6 16.6 16.6 16.6 16.6
London Borough of Brent Lab 17.48 17.48 17.48 full cost full cost
Rotherham Metropolitan Borough Council Lab 11.9 12.85 13.9 14.5 14.85
London Borough of Haringey Lab 10.85 11 11 11 11.35
City of Wakefield Metropolitan District Council Lab 9.2 10.45 10.45 11 11
Derby City Council Lab 8 8 11.31 11.72 12.08
Halton Borough Council Lab 11.35 11.35 11.35 11.35 11.46
Blackburn with Darwen Borough Council Lab 9.64 9.72 11.04 11.04 11.04
Tameside Metropolitan Borough Council Lab 10.92 11.25 11.58 11.93 12.37
Metropolitan Borough of Wirral Lab 12 12.28 12.28 12.28 12.28
Stoke-on-Trent City Council Lab 12.8 13.2 13.8 13.2 13.2
Gateshead Lab 9.5 11 10.5 11.48 11.48
Islington Lab 13.64 13.52 13.66 13.66 13.64
Newham Lab n/a n/a n/a 11.62 11.62
Darlington Lab 10.51 full cost full cost full cost full cost
Waltham Forest Lab 15.04 15.28 15.94 16.45 16.94
Nottingham City Lab 8.9 9.2 11.5 13.66 13.66
Newcastle City Council Lab 9.75 10 10 11.72 11
Hackney Lab 10.85 11 11 11 11.35
Tower Hamlets Lab 0 0 0 0 0
Oldham Lab 12.5 12.5 12.95 12.95 12.95

Weekly Care Charge Cap:

Authority Control 2009/10 2010/11 2011/12 2012/13 2013/14
Lincolnshire County Council Con 126 126 250 250 250
Stockport Metropolitan Borough Council Con 245 250 258 271 278
Norfolk County Council Con 273 278 283.56 283.56 289.22
Essex County Council Con 439.11 445.69 459.48 459.48 464.1
Lancashire County Council Con 595 595 625 655 655
Bournemouth Borough Council Con 440 no cap no cap no cap no cap
Buckinghamshire County Council Con 280 no cap no cap no cap no cap
Hampshire County Council Con 435.82 440.23 440.23 no cap no cap
North Yorkshire County Council Con 260 no cap no cap no cap no cap
Trafford Metropolitan Borough Council Con 176 185 194.25 203.96 no cap
Richmond Council Con 310 320 no cap no cap no cap
Kingston-Upon-Hull City Council Lab 99 99 99 99 99
Barnsley Metropolitan Borough Council Lab 60 60 90 9 105
Derby City Council Lab 80 80 125 125 125
Tameside Metropolitan Borough Council Lab 182.52 188 193.64 199.44 206.82
Rotherham Metropolitan Borough Council Lab 200 200 230 240 246
Doncaster Metropolitan Borough Council Lab 338.91 342.3 335.46 335.46 335.46
Bury Metropolitan Borough Council Lab 400 400 400 400 400
City of Wakefield Metropolitan District Council Lab 113 402 402 402 402
London Borough of Brent Lab 415.44 415.44 415.44 no cap no cap
Plymouth City Council Lab 270 270 no cap no cap no cap
St Helens Metropolitan Borough Council Lab no cap no cap no cap no cap no cap
Stoke-on-Trent City Council Lab 128 132 no cap no cap no cap
Gateshead Lab 150 160 184 194 199
Newham Lab n/a n/a n/a 200 200
Waltham Forest Lab 230 233.5 233.5 233.5 no cap
Nottingham City Lab 78.5 81 no cap no cap no cap
Newcastle Lab 150 150 150 200 400
Knowsley Lab 150 150 200 200 200
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This is NHS Check report no 11 originally published by Labour’s Shadow Health Team in June 2013

REVEALED:

  • 66% increase in over 90 year olds arriving at A&E – 110,000 extra patients
  • Cuts to council Adult Social Care budgets now total £1.8 billion since the election

Huge cuts to council social care budgets are leaving older people and their families without the care they need. Without this daily support, increasing numbers face no alternative but to turn to A&E departments.

Labour would invest £1.2 billion of the NHS underspend – which Jeremy Hunt handed back to the Treasury – over the next two years to ease the crisis in social care and tackle this root cause of the pressure on A&E.

Rise in elderly patients arriving at A&E

Official NHS Hospital Episode Statistics reveal a hugely disproportionate increase in the numbers of elderly people arriving at A&E in ambulances in the first two years of this Government.

The most recent data, for the year 2011-12, shows a 66% increase in over 90 year olds arriving at A&E compared to Labour’s last year – an extra 110,000 patients. A&Es saw a 19% rise in attendances from over 80 years olds too – 121,000 patients.

 Age group 2009/10 2011/12 % change 2009/10 to 2011/12
0-9 273,207 263,687 -3.50%
10-11 346,527 278,557 -19.60%
20-29 413,346 449,675 8.80%
30-39 361,469 367,277 1.60%
40-49 404,799 435,371 7.60%
50-59 347,329 390,456 12.40%
60-69 395,486 435,698 10.20%
70-79 562,854 601,637 6.90%
80-89 635,834 757,555 19.10%
90+ 165,910 275,883 66.30%
Unknown 18,158 1,088
Total 3,924,919 4,256,884 8.50%

Cuts to council care budgets

Figures from the House of Commons Library reveal year on year real terms cuts to local authority Adult Social Care budgets across England, now totalling £1.8 billion since the election.

£000s 2009/10 2010/11 2011/12 2012/13
Total Expenditure (including DH funds directed via PCTs) 14,902,492 14,439,270 15,353,842 15,173,007
Projected Real Terms Expenditure if 2009/10 figures increased in line with GDP 14,902,492 15,306,968 15,622,862 15,825,959
Real Terms Cut 867,698 269,020 652,952
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This is  Labour Party  NHS Check 12  originally published by Labour’s Shadow Health Team in October 2013

  • Survey Reveals NHS On Road To Us-Style Healthcare
  • New Evidence Of NHS Hospitals Charging For Essential Treatments That Were Previously Free And Still Free Elsewhere
  • Thousands Of People Missing Out On Essential Treatment As David Cameron’s Postcode Lottery Grows
  • Labour Calls On The Government To Order An Immediate Review Of Rationing In The NHS And To Intervene To Stop Rationing On Grounds Of Cost

This report shows that hospitals are beginning to charge patients for some treatments which were previously free on the NHS and continue to be freely available in other parts of the country.

A Labour survey has revealed the details of punitive new restrictions put in place by Clinical Commissioning Groups. This follows an investigation by the British Medical Journal which found that as many as 1-in-7 of the new bodies have increased the rationing of treatments.

Last year, Labour found that almost half of Primary Care Trusts were restricting routine treatments. Despite warnings from Labour and professional bodies, the problem has worsened – leaving patients facing an agonising decision of going without treatment or paying for private care.

Increases in rationing are leading to a growing postcode lottery

Labour’s Shadow Health Team surveyed all Clinical Commissioning Groups following reports that increasing numbers of patients were being denied GP referrals for treatment previously accessible on the NHS.

An investigation by the BMJ in summer 2013 revealed that in the last six months, since they took control of the new NHS in April, 27 CCGs of 195 CCGs responding to the survey – close to 1 in 7 – had introduced new treatment restrictions. These included 8 CCGs restricting treatment for Foramen Ovale for recurrent migraines, 3 CCGs restricting hip or knee replacement surgery, 2 CCGs restricting cataract surgery, 4 CCGs restricting Caesarean for non-medical reasons, 2 CCGs restricting treatment for carpal tunnel syndrome, and 8 CCGs restricting therapeutic use of ultrasound. The full list of restrictions is listed in the table below.

  • Asymptomatic gall Stones 9
  • Foramen Ovale Closures for recurrent Migraines 8
  • Therapeutic use of ultrasound 8
  • Ganglions 7
  • Hallux Valgus 6
  • Skin Lesions 5
  • Caesarean for non medical reasons 4
  • Tonsilitis 3
  • Knee Surgery/replacements /hip 3
  • Varicose Veins 2
  • Cataracts 2
  • Carpal Tunnel Syndrome 2
  • IVF 1
  • Dupuytrens Contracture 1
  • Myringotomy 1
  • Hysteroscopy 1
  • Trigger Finger 1
  • Dilation and Curettage 1

Labour’s Freedom of Information survey enabled investigation of the consequences of increasing rationing for access to treatment. It revealed wide variation across the country for the same treatment, with some NHS bodies setting down extra conditions before they fund the treatment. For example:

  • Patients in South Reading are required to lose more of their eyesight before they receive cataract surgery than patients in South Kent who qualify sooner.
  • Patients in the Black Country are forced to prove greater levels of pain and attempted weight loss before qualifying for knee replacement surgery, whilst South West London will fund patients in lower levels of pain.
  • Likewise for hip surgery, South West London and Stoke on Trent and North Staffordshire have different pain criteria.

There is a legitimate debate to be had about the effectiveness of particular treatments or their use in particular contexts. But Labour FOIs have added to the growing evidence that some patients are being unfairly denied access to vital treatments.

And as the next section shows, it seems that some hospital trusts are now introducing new private care options for treatments that are being rationed in the local area.

Postcode lottery in cataract surgery

Background

In the 1990s, it was not uncommon for patients to wait up to two years for a cataract operation. The previous Labour Government took action to address this delay. It included issuing good practice guidance which established eligibility criteria and ensured patients should have access to surgery.

The guidance stated that patients should be referred for surgery by their GP if a cataract leaves them with reduced vision or if it negatively impacts their quality of life.

The guidance did not establish visual acuity thresholds – the measure of vision relating to how far a person can read down an eye chart – before a patient qualifies for treatment.

The Royal College of Ophthalmologists cataract guidelines published in 2010 reinforced this guidance.

Hospital Episode Statistics

The latest figures show that the number of elective admissions for cataract surgery declined between 2010/11 and 2011/12 by over 5,000.

These figures are precisely the opposite of what experts would expect. The RNIB have said “We would expect to see both the number of operations and spells to increase as the population ages and demand for surgery rises.”

The figures suggest that since 2009/10, PCTs and CCGs have been introducing restrictions to cataract surgery.

Clinical commentary and patient impact

“Such absolute restrictions have no clinical imperatives. There is now evidence that early cataract surgery is beneficial to patients, and the over reliance of Visual Acuity as a measure is outdated. Delaying surgery leads to more ophthalmic complications, making surgery more risky, and in the event proves costlier”

CCG referral policies – the variations

Labour has uncovered evidence of CCGs who have implemented new restrictions on cataract operations in the last year. Earlier this year, the RNIB found widespread evidence of CCGs implementing restrictive commissioning policies that are not in line with either Department of Health guidance or Royal College guidance.

South Reading CCG’s commissioning policy states: “cataract surgery is only routinely commissioned for patients who, after correction (eg, with glasses), have a visual acuity of 6/12 or worse in their cataract-affected eye.”

However, Brighton and Hove CCG have no arbitrary restrictions on cataract operations and surgery is based on clinical need.

Postcode lottery in knee replacement surgery

Clinical commentary and patient impact:

“Orthopaedic operations such as knee and hip surgery can be due to a traumatic injury such as a sports injury or accidents, or a degenerative disease such as arthritis. Such rationing would aim to discriminate against the latter mainly, as these are chronic conditions. But the disability, pain, reduced social mobility, will cause a lot of suffering to these patients.”

CCG referral policies – the variations

NHS Black Country Cluster will only operate on patients with a BMI of 40 or over if they have documented proof that they have participated in a “comprehensive weight management programme” of at least 6 months duration prior to surgery.

All other patients (ie those with a BMI of less than 40) are now required to meet a range of other criteria before they become eligible which include:

  • Conservative means (e.g. Analgesics, NSAIDS, physiotherapy, advice on walking aids, home adaptations , curtailment of inappropriate activities and general counselling as regards to the potential benefits of joint replacement) have failed to alleviate the patients pain and disability
  • AND Pain and disability should be sufficiently significant to interfere with the patients’ daily life and or ability to sleep/patients whose pain is so severe
  • AND Underlying medical conditions should have been investigated and the patient’s condition optimised before referral

In contrast, Kingston CCG will fund elective surgery on any patient who has an Oxford Knee score – the questionnaire on function and pain – of less than 20 on the 0 to 48 system or greater than 40 on the 60 to 12 system.

Postcode lottery in hip replacement

Clinical commentary and patient impact:

“ Restrictions on hip replacement could well discriminate against older people, for whom hip surgery is not cosmetic but essential to relieve pain, further worsening of their condition and also major social handicaps if surgery did not happen.”

CCG referral policies – the variations

Stoke on Trent CCG will only commission hip surgery if a patient scores 20 or under on the Oxford Hip Score (the equivalent questionnaire).

Merton CCG will fund surgery for patients with a score of 26 or under.

However, Hammersmith and Fulham CCG’s referral policy makes no reference to the Oxford Hip Score.

NHS hospitals charge for rationed treatment

In October 2012, the Government gave NHS Foundation Trusts the freedom to generate up to 49% of their income from private patients. A Labour Freedom of Information request to hospital trusts, on the income generated from private work in the first year of the new arrangements, reveals a significant increase. In 2012/13, hospitals generated £434 million – an additional £47 million on 2010/11. Meanwhile, trusts’ projections show that they envisage this will increase by a further £45 million to £479 million this year.

Labour’s research has uncovered examples of treatments that are now rationed by the GP-led bodies and charged-for by hospitals– so-called ‘self-funding’ patients. This is where NHS hospitals offer to treat people as private patients but charge “NHS rates”.

  • In the last six months, James Paget University Hospitals NHS Foundation Trust has started offering self-funding options for Ophthalmology. Meanwhile, the local CCG NHS Great Yarmouth and Waveney has a restrictive commissioning policy for cataract operations – out of line with Department of Health and Royal College guidance.
  • Earlier this year, Southampton CCG was “red rated” by the RNIB – labelling its policy on cataract operations “very restrictive”. The local trust, Southampton University Hospitals, has a self-funding option in place for treatment in Ophthalmology services. Private patients can choose to benefit from high quality eye care by local NHS consultants at Southampton General Hospital. The hospital trusts website boasts: “Fewer non-urgent services can be paid for by the NHS but we know that patients still want to see our expert staff and be treated within the advanced care environment of a specialist teaching hospital. We offer the full range of consultations, investigations and treatments that you would expect from a specialist hospital […].”1 Also adding: “Our premier cataract service offers a new option, between the traditional private sector and the NHS, bringing private healthcare within the reach of many more people. This service offers you the option of cataract surgery even if your vision is better than the current level required for NHS surgery. We offer surgery when you feel you need it.”
  • Warrington and Halton Hospitals NHS Foundation Trust now offers a self funding option for removal of varicose veins. Their website states: “There are some treatments provided in the past that may no longer be accessible through local NHS funding… However, we know that many patients still want to have these procedures with us. In order to give our patients choice around their care, we have developed the MyChoice service. This allows you to pay (self-fund) to have these procedures with us at the standard NHS price. Private health insurance may also cover the cost of these procedures with us.”
  • Chelsea and Westminster hospital offer self funding options on “All medical and surgical specialities.” NHS North West London have tightened their criteria on a number of treatments in the last year. In June 2013, they updated their policies on removal of benign skin lesions, dupuytren’s contracture, carpal tunnel syndrome and cataract surgery.
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Ipsos Mori have just published Understanding Society – Great Britain: The way we live now.

It’s got a big section on health and Public Opinion on the NHS.

Which of the following statements best reflects your thinking about the NHS?

Which of the following statements best reflects your thinking about the NHS? (%)

The proportion of the population agreeing that the NHS ‘will face a severe funding problem in the future’ has increased to 88%

When 1,009 people were asked if they agreed with the statement: ‘As long as health services are free of charge, it doesn’t matter to me whether they are provided by the NHS or a private company.’  47% of people disagreed, an increase of 11 percentage points on the number of people who disagreed when asked in February 2011. However, people were less likely to be against external providers who are charity or voluntary organisations.

Almost half those polled  agree that, ‘if people choose not to take care of their health, the NHS should be able to limit the treatment it offers them for free’ (47% versus 33% who disagree).

The proportion agreeing that the Government should influence behaviour is lower in the UK than most countries.

It is the government’s responsibility to influence people’s behaviour to encourage healthy lifestyles (%)

It is the government’s responsibility to influence people’s behaviour to
encourage healthy lifestyles (%)

Only five per cent of the British public strongly believe it is the job of the NHS to keep people healthy – a far greater proportion (39%) strongly believe it is the individual’s responsibility to keep themselves healthy.

There is some very interesting material on public attitudes to government interventions to change behaviour – a fizzy drinks tax for example.

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The NHS111 Tardis

The Tardis

Debut of Tomas Northmore as political cartoonist with thanks to Aaron

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Over the last couple of years we have organised and participated in many discussions about threats to the NHS, thanks to Mr Lansley.  These debates have provided an opportunity to reconsider many of the founding principles of the NHS, principles which have been taken for granted for many years.  This is an attempt to distil the wisdom of those debates, and we are grateful to all those who have participated.

The NHS is a large and complex organisation and it means different things to different people.  People who work for the NHS have a different perspective from most patients.  If we are seriously trying to defend the NHS we need to develop a clear vision about what we are defending, and what the threats to it are which we can communicate to the public.

Privatisation

“Health Ministers have said that they will never privatise the NHS“.  David Cameron repeatedly says that there is no privatisation – but he appears to be trying to twist the meaning of the word so that it means charging for services.  We prefer the World Health Organization definition of  privatisation in healthcare as “a process in which non-governmental actors become increasingly involved in the financing and/or provision of healthcare services”.

The SHA warned about the real intention of the Health and Social Care Bill in the Dark Side

Clive Peedel produced a very helpful analysis  of the privatising effect of the Health and Social Care Act.  As far as people who work in the NHS are concerned the key question when services are transferred to a different provider is probably whether the staff will still be in the NHS pension scheme with NHS terms and conditions.  The public, however, seem a bit confused.  If you ask people if they want to see their local NHS services privatised a large majority will say no.  But 56% of those asked by the Health Service Journal said they would not object to using a private supplier of medical treatment, so long as they did not have to pay.

The distinction between public and private provision has become more blurred over time.  Almost all the drugs and equipment used in the NHS are privately produced and always have been.  There are people who want to see the pharmaceutical industry nationalised, but they don’t seem likely to succeed in the near future.  As the technology becomes more complex NHS providers are increasingly entering into deals with suppliers to lease and maintain equipment, rather than buying it.  My local hospital in South Manchester has just entered a deal worth £50 million over seven years with Medtronic, who have won the contract to replace the hospital’s four catheterisation laboratories, on the basis that they are more expert than the hopspital’s staff as far as the kit is concerned.

Those who regard the biggest threat to the NHS as privatisation generally don’t have much to say about primary care.  GPs, dentists, opticians, and pharmacists are almost all private commercial enterprises – and always have been.  At least 90% of public contact with the NHS is with these private providers.  Even organisations like Keep Our NHS Public seem perfectly relaxed about this. In discussion it appears that the objection of most of their members  is not so much to private provision as to corporate provision. The issue is blurred anyway as many GPs have found ways to “profit” through taking interests in companies providing services. Their worry is not the profit individual doctors or dentists make but the prospect of exploitation by faceless corporations.  Or as our academic members put it: “due diligence across different jurisdictions in multinational corporations is poor”.

Of course faceless corporations include drug companies, medical equipment providers, IT suppliers and others all of which make profits from dealing with the NHS.

It was the policy of the Socialist Medical Association for many years that “doctors working in primary care services should be whole-time salaried employees”.  In recent years we haven’t talked much about this, because it seems to be coming about, but not in the way that we envisaged it.  About half of all GPs are now employees – mostly employed by the declining number of other GPs who are partners.  Changes in the structure of primary care may be very significant for the future of the NHS, but have attracted little attention outside the GP profession.

The proportion of NHS hospital activity supplied by the private sector increased, but not by very much, under Labour. Most of the increase was  in routine surgery. This was claimed to be necessary to reduce waiting times which was a policy very popular with patients but not clinicians.  In mental health a much higher proportion of work has been contracted to the private sector for a long time.  In surgery the private sector are accused of cherry-picking – ie only doing easy work.  In mental health the opposite is the case. The private sector mostly does long term, expensive and difficult work – people with learning difficulties and challenging behaviour, eating disorders and the like.  If we are going to use the private sector at all it might be sensible to use it for work of which the quality can easily be monitored.  As Winterbourne View showed, it’s not difficult to take a lot of money in this sort of work and provide a dreadful service. In mental health there aren’t many objective measurements of quality or success.

For Any Qualified Provider contracts, which have long been the norm for eyes, teeth, and drugs, we can see that quality can be defined and measured, there are lots of alternative potential suppliers and that the service is largely independent of other services.  In such cases many argue that having multiple providers including private ones does little harm and can drive improvements.

We should however be worried about developments such as at Hinchingbrooke and at Cambs and Peterborough where it looks more like private providers running whole organisations in mainstream NHS.

We cannot easily demonstrate that the quality supplied by private health care is worse than what is supplied by the NHS, though of course it is easy to suppose that it would be.  There were many scandals in the NHS long stay hospitals for people with learning difficulties  before they were closed.  In general the private health sector in the UK is not easy to compare with NHS provision.  The private sector has been concentrated in what might be termed boutique operations –  small sectors which for various reasons the NHS does not provide.

All this shows how hard it is to define what comprises our NHS in a way which excludes private providers.

Accountability

One of the distinguishing features of public services, as opposed to private, is that they should be accountable to the public.  Nye Bevan famously said that  “the sound of a bedpan falling in Tredegar Hospital would resound in the Palace of Westminster”, but succeeding Secretaries of State – Labour as well as Conservative – have generally felt that this was an unsatisfactory model of accountability.

Prof Alysson Pollock says that the National Health Service was abolished on 1st April. In her terms she is right.  The Health and Social Care Act removed the duty of the health secretary to provide comprehensive healthcare. This was a central issues in the debate over Lansley’s reforms, and the Labour Party have pledged to reinstate the duty.  But the political reality is that accountability for the NHS still remains with the government even if Jeremy Hunt can claim that its nothing to do with him. And those who think the NHS has already been abolished are a very small minority.

Throughout its history the NHS has used its most opaque approach to determine how resources are allocated and priorities are set down to localities – albeit within a system which is both universal and comprehensive.  Key decisions have always been made behind closed doors by unaccountable, unelected and unrepresentative bureaucrats and have been heavily influenced by vested interests and special pleading.  Years of PCGs, PCTs and CCGs have actually changed little around resource allocation.

Labour’s plan, which has been adopted enthusiastically by the Government, was to make all NHS Trusts into Foundation Trusts, which are, in principle, accountable to their members.  However this model has no political credibility.  Of those who have come to discuss their local NHS at our events less than 10% were members of any Foundation Trust, and even those who were members – or in some cases elected governors – did not regard the democratic arrangements as anything more than decorative.

The Act established new local involvement structures.  Local Healthwatch, the latest replacement for Community Health Councils, so far looks very weak.  It’s remit has been expanded but its funding and profile have contracted.  Individual Clinical Commissioning Groups have to make their own local involvement structures, and there seems to be widespread agreement that these are an improvement on what was done by PCTs.  PCTs became increasingly insensitive to local communities as they became more subject to central direction.  CCGs may, of course, go the same way.

Many express the view that commissioning and provision should not be separated, but there is confusion about the difference between planning, strategic commissioning, procurement and purchasing.  In any system there has to be some planning and decisions are made about allocating resources and priorities.  It appears obvious that these decisions should not be made by those who provide the services eg GPs can hardly decide for themselves how much they should be paid and what they are required to deliver; hospitals can’t just decide what services they provide, staff up and pass on the bill.  The long history of the NHS has been tarnished by the way vested interests and historical settlements have taken priority over more sensible ways to provide funding. One of the more dreadful aspects of the Health & Social Care Act is that it effectively removes any idea of planning – it leaves it to the market.

Private Finance Initiative

PFI is fundamentally a much wider issue than the NHS, although the use of PFI in health is the most incompetent.   Of course it’s more expensive to finance developments commercially than directly from Government funds – but direct Government funding has never been widely available.  Paying the charges for PFI schemes is of course a burden on individual NHS Trusts, but perversely, as has been demonstrated in South London having a PFI scheme means your hospital will not be closed.

Annual payment schedule for all NHS PFI schemes

Annual payment schedule for all NHS PFI schemes signed before 15th June 2010 over contracts’ lifetimes

It is often forgotten that the use of the financial model for PFI was only one part of the problem.  Most PFI hospitals were justified based on projections about activity that were signed off by the NHS but very soon turned out to be badly wrong.  The gold plating and over engineering of PFI buildings was signed off by all and sundry.  Many of the benefits around service changes that clinicians and others signed up for – to justify the new build – were never delivered.  The use of private as opposed to public finance just made it worse. Even without PFI most of the projects led by the Department of Health would still have been poor value for money.

Competition and choice

Under the new regime established under the Health and Social Care Act competitive tendering has become much more widespread, especially in the provision of community services.  As might be expected this is leading to a significant expansion of non-NHS provision.   However this expansion is primarily in areas where patients have little choice. In community services, as in mental health, patients generally don’t have any choice about where they are treated.  They are effectively the commodity out of which the provider hopes to make profits.  This sort of competition has nothing to do with patient choice.

Conspiracy

The report that Oliver Letwin  told a private meeting that the “NHS will not exist” within five years of a Conservative election victory has been made much of.  Other Conservatives have said the same sort of thing in the past.  But analysing every policy development in terms of a conspiracy is not very helpful.  After all, our opponents could point to Labour Party members who wanted to nationalise the 200 largest companies, but those ambitions have not been realised.

There are Conservatives who object to the whole idea of the NHS and would like to replace it with an American type insurance based system, but they are kept locked up in a basement somewhere.  Every serious politician understands that moves in that direction would be political suicide.

We know that there are many from various parties and persuasions who do believe that more competition and more entry for other providers is good for the NHS. But we should accept the fact that the current regime is using every opportunity to open up the provision of services to private providers.

Principles of the NHS

The SHA has for many years argued for “Universal healthcare meeting patients’ needs, free at the point of use, funded by taxation.”  We still think that is the fundamental principle that needs to be defended.

Bevan had more to say about the ideas behind the establishment of the NHS.  The one I like best is “The essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged.”  This, like many of the ideas around the NHS is more an aspiration than a principle, but that does not mean it’s unimportant.  He also said “Warm gushes of self-indulgent emotion are an unreliable source of driving power in the field of health organization.”  But he said very little about the merits of public versus private provision.  Public provision does not appear to have been a principle for him.  If we now think its an important principle then as far as most of the public is concerned, we need to explain exactly what the principle is and why its important.

Free at the point of need

Charging for GP consultations is popular with GPs, not as a way of raising money, but as a way of controlling demand.  But it might not work.  If people pay for something they feel a greater sense of entitlement. The people who would be deterred by a charge of £20 or so would be people who would turn up in hospital when their problems are more serious and more expensive to treat. Richer people, who on the whole are less in need, would pay their £20 and demand to be seen more often.

Some hospitals have tried to offer NHS type services for money when commissioners would not pay for them – for example IVF treatment for infertility.  Their reasoning is that they are prepared to give patients an identical service to that given to NHS patients, and for the same price.  Typically private patients get more frills – private rooms and so on – and they are charged more than NHS prices.  Although we sympathise with the intentions we think this is dangerous territory.  The principle that NHS treatment is free unless charges are agreed by Parliament is important.  If you have to pay, however little, it’s not NHS treatment.

Comprehensive

In 1948 patients could be  told the NHS “will provide you with all medical, dental and nursing care.” However what could be provided was very limited by today’s standards.  There weren’t many treatments that worked.  The NHS had a lot of beds but not much else. There wasn’t any talk about rationing.  But as more treatments have been developed the NHS, like every other health system, has introduced measures intended to ensure that only cost-effective treatment is paid for.  We regard the establishment of the  National Institute for Clinical Excellence as one of the most important achievements of the Labour Government.

General government expenditure on UK Health Services: 1950/51 to 2010/11

General government expenditure on UK Health Services: 1950/51 to 2010/11 in 2011 prices

It seems inevitable that more decisions about what treatment can be paid for under the NHS will have to be made. Politicians are uncomfortable with the idea, but all medical treatment is rationed, everywhere.  We should spend our money on the most cost-effective treatments until we’ve used up all the money.

That leads us back to the previous point.  There are already plenty of procedures that the NHS will not provide because they are not regarded as good value for money (the Croydon List), and there will be more as austerity bites deeper.  Some of them are things that some patients would be prepared to pay for.  When we considered the question of “topping-up” NHS services in 2008 we said   “We stand by the line that the NHS – and its staff – should not be offering or delivering additional or better treatment for money.”  That was in the context of privately funded chemotherapy.  Do the same considerations apply, for example, to the removal of tattoos?  If  NHS providers don’t do this sort of work then private providers will.

Defending the National Health Service

Andy Burnham’s position is that the NHS should be the preferred provider of health services.  He hasn’t clearly explained how exactly decisions would be made to contract some other provider. It was Andy who initiated the process which led to Circle getting a  management franchise to run Hinchinbrooke Hospital. There the private sector was used as a last resort – and it still remains to be demonstrated that the private sector can deliver something the NHS could not do.

A commercial health system has no incentive to keep people healthy.  One of  the principles which inspired the setting up of the NHS was that it should be preventative.  The Government’s move towards a more consumer approach to health care undermines that idea.  Medical treatment is not like consumer services.  It isn’t a good thing in itself.  No sane person wants more medical treatment than they can avoid.

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*  Across the country more than 1.5 million patients and their families will be in contact with the NHS every day.
*  Approximately 170,000 people (the same number who attended the Glastonbury music festival) go for an eyesight test each week.
*  Our NHS will help deliver around 16,000 babies at home. This is enough children to fill the Royal Albert Hall three times over.
*  Each month, 23 million people (more than three times the population of London) visit their GP surgery or practice nurse.
*  In a typical week, 1.4 million people will receive help in their home from the NHS.
*  Ambulance services will answer five, 999 calls every minute of every day.
*  In a year District Nurses will call on the equivalent of the populations of Cyprus, Luxembourg, Malta and Iceland – combined!
*  Each full-time GP treats over 255 patients a week.
*  NHS chiropodists inspect more than 150,000 pairs of feet every week. That’s about half the British Army.

The wisdom of the crowd: 65 views of the NHS at 65 – Nuffield Trust

Roy Lilley  says Yes, the NHS has to be efficient and safe and clean but it has to be central to a political desire to promote, encourage and endorse social medicine and its values. I judge it is not. If we want an NHS we have to pay for it.

 Unite events – GMB events Unison events

The NHS at 65: Many happy returns? TUC page

Kings Fund  alternative guide to the new NHS in England in 6.5 minutes

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Ipsos MORI’s Issues Index is conducted monthly and provides an overview of the key issues concerning the country.

 Mori issues May 2013

As they say:  At fifth place both NHS and Education are seen as among the most important issues facing the country (20% and 19% respectively) and both have increased by a fraction since January. For much of Tony Blair’s first years as Prime Minister, and before that, these were the top issues cited by respondents, but, recently, have been less likely to be mentioned.

Long term trends in issues facing the country

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