Category Archives: Socialist Health Association

Author Tony Beddow 1.11.18

Purpose

This short report gives progress made with our policy development process since the last Central Council meeting.

Members may recall that central Council previously agreed that four possible areas of work could form the focus of policy development in the coming months.

These are:

  1. Mental Health – building upon the (inchoate) policy produced by the Labour’s National Policy Forum
  2. Public Health policy – building upon current SHA policy, identifying gaps and undertaking work to fill them
  3. A National Care Service – exploring the boundaries of this emerging concept, its funding and governance and other aspects deemed relevant.
  4. The needs of carers – exploring the different needs of young and old carers, carers in rural and urban areas, carers with their own care needs, and other characteristics that require a policy response.

Progress to date

Member working groups have been established for b) and c) with co-conveners being Mike Roberts and Dr Tony Jewell for b) and Dr Brian Fisher and Tony Beddow for c).

Members of a) have been identified and two possible co-convenors are, at the time of writing, discussing how they might take this forward.

In all cases, membership has been drawn from different pars of the UK and from different experiences – with a workable group total of 7- 8 members.

The needs of carers did not engender much interest and this group remains to be formed.

Next steps

Co – conveners have been asked to provide a “scoping report” to the next Central Council setting out their proposals for the topics, questions or enquiries that they seek to explore or address, the timescales for doing this, and the target date for bringing a draft policy document to Central Council for debate and either adoption after amendment, or for further revision and work.

Central Council is requested to note this report.

4 Comments

April 2014

Call for Action—for a democratically accountable, membership led SHA

The Socialist Health Association’s January Central Council (CC) and March AGM have highlighted serious issues of governance and accountability within the SHA, problems which remain to be addressed. The AGM did not adopt either the Treasurer’s or the Auditor’s report and merely noted the Director’s and Chair’s reports.

The SHA is a democratically accountable membership organisation.

In the light of concerns about previous elections January CC agreed that the 2014 election would be tightly managed including a more formal and more clearly labelled call for nominations to go out. This did not happen.

In response to concerns raised that the CC included individuals with potential conflicts of interest through NHS-related consultancy and business work, the governance group requested that all candidates for election to be formally required to declare all relevant interests. This did not happen.

Requests were made by the governance group to confirm the list of eligible members and make these list accessible to all Branches. This did not happen.

In accordance with the Constitution, any CC members who had consistently failed to attend meetings were to be reminded of their duties and rendered ineligible for election. This did not happen.

Emails have been seen which appear to indicate that the Director disseminated selective information to individuals or branches, which would have influenced the outcome of the election. We seek credible reassurances that this did not happen

During the past year at a time when health policy and the NHS was at the top of the political agenda the SHA national body has not been visible on any of the major issues affecting the NHS in England.

No clear position on how the H & SC Act should be repealed. Likewise no clear view on Lord Owen’s Bill to re-establishing the Secretary for Health’s requirement to provide a full and comprehensive health service is forthcoming. No clear position has been taken on the care data issue, nor on Section 75, nor on Clause 119, nor on PFIs, nor on the dangers of the EU/US treaty, i.e. the Transatlantic Trade and Investment Partnership (TTIP), on the health service.

The SHA is a democratically accountable Labour Party Affiliate.

Do members of CC and Officers accept that the current governance arrangements including the lack of legal structure, lack of clear line management arrangements,  lack of communications oversight, lack of policy formation oversight carry significant risks, not least in terms of reputational damage to individuals, the SHA, and the Labour Party, as per the Governance Groups report and recommendations?

The work of the Governance Group evidence based, comprehensive and rooted in good practice, including other Labour Party affiliates. The views of the entire SHA membership had been sought on this work.

The group met with officers and staff and invited constructive suggestions on several occasions.

The group was told by officers that its work and recommendations were broadly welcomed. However the work was then publicly disparaged by Officers and the paid staff. The process was publicly misrepresented by the Officers who claimed not to have met with the Governance Group. The final Governance report was not published to members as requested. Officers instead submitted a separate tranche of changes to the AGM without reference to the Governance Group.

Most of the Governance Group’s proposals received majority support at the Council but not the required two thirds majority. However, this matter will not go away, Council should determine which Governance Group proposals need re-examining.

The GG recommended an Executive is needed to ensure the SHA follows through on decisions of the CC to tackle urgent matters.

 

The SHA is a membership organisation, tasked with contributing to the development of Labour Party health policy.

  •  How has the SHA enabled its membership as a whole, and its Central Council in particular, to effectively and efficiently feed into the LP policy development process?
  •  Does Council recognise concerns that – even taking into account limited resources – the SHA is not amplifying the expertise and experience of its membership, to identify and influence key areas for policy development?
  •  The system of policy formation is weak. Task and finish groups should be set up and supported to ensure this is done effectively.
  •  How is it ensured that public SHA statements are representative of agreed policy? When an SHA spokesperson disregards agreed SHA positions (or opens politically sensitive debates in an erratic fashion) how under the current arrangements – is that addressed and managed?

Concerns were raised in 2011 about how the SHA was being represented online, in public. We draw the CC’s attention to the Communications Protocol accepted by CC in 2011 as a proposed way forward. The issues persisted and in June 2013 the Editorial Board was installed to address these.

The EB was tasked with developing and ensuring best practice in communications and establishing a clear oversight of statements made by those representing the organisation in public. Its work was undermined by Officers.

An (uncosted) Mediation process was proposed and agreed in January 2014 to address what were presented as urgent issues. However, no effective action appears to have been taken by officers to expedite this and three months later these issues persist.

What oversight of the SHA’s online presence does CC propose and what accountability is there for what is published online under the SHA name? Eg in November 2014 the EB requested that a page was removed because it undermined agreed SHA positions four months later the article in question was reinstated without any consultation with CC.

In public representations and communications how does the SHA Leadership currently ensure that public statements promote and do not damage the reputation of either the LP or the SHA?

The SHA is a voluntary organisation and its greatest asset is its membership.

Like all voluntary organisations its effectiveness relies on the contribution and goodwill of its active members.

How has the SHA Leadership encouraged and supported current members who have volunteered to contribute to the work of the organisation and what measures has it taken to recruit new members?

We draw attention to the fact that currently at least three Central Council members are disabled; Central Council should ensure that all meetings are held in an accessible meeting place with accessible transport links – which has not always been the case.

We also note the inconsistencies in re-imbursement of travel and printing costs by volunteer Council members who incurred costs as part of agreed work.

Given the continued under-representation shown to women, ethnic minorities and disabled people, and the fact that members of these groups have highlighted a non equalities-friendly culture, what has the SHA Leadership (Officers and paid staff) undertaken to improve this sitaution and enable and support women, disabled and ethnic minority members to be actively involved in the SHA?

Call for Action

The SHA at UK level needs to consider all these matters. We need an SHA that is fit for purpose. We ask officers and Central Council, as well as the Director, to address these matters urgently and ensure that CC has sufficient time dedicated to discussing these matters at the July meeting of CC or at a specially called for

EGM and decide on necessary actions.

Harry Clarke

Noemi Fabry

Councillor Mike Roberts

Vice Chairs to March 2014

Prof Tony Beddow CC

Vivien Giladi CC

Judith Varley CC

Dr Thomas Fitzgerald CC & Auditor

Ali Syed MBE CC

Councillor Rachel Harris CC April 2013

Caroline Molloy—CC co-opted 2013-14

John Lipetz CC

Reposted for inclusion in the November Central Council meeting.

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SHA Birmingham Central Council 1.9.18 in the Birmingham and Midlands Institute. The meeting opened at 1.30

Headings, significant actions and other matters in bold

Present:   Alex Scott-Samuel Chair (ASS), Andy Thompson Vice Chair (AT), Tom Fitzgerald Treasurer (TF), Alison Scouller (AS), David Mattocks, Vivien Walsh (VW), Paul Leake (PL), Caroline Bedale (CB), Mark Ladbrooke (ML), Catherine Grundy Glew (CGG), Steve Bedser (SB), Tony Beddow (TB), Irene Leonard (IL), Mike Roberts (MR), Helen Cranage (HC), Pater Mayer, Vivien Giladi (VG), John Lipetz (JL), Brian Fisher (BF), Allison Gardner (AG), Carol Ackroyd (CA), James Williamson (JW), Gurinder Singh Josan (GSJ), Corrie Lowry (CL), Judith Varley

Apologies for this meeting: Jean Hardiman Smith Secretary (JHS), Kathrin Thomas, Chris Bain, Colenzo Jarret-Thorpe, Dave Watson, David Davies, Guy Baily, Jacky Davis, Jessica Ormerod, Jon Shaffer, Katrina Murray, Sina Lari, Stephen Warren, Tony Jewell, Lawrence Cotter, Coral Jones, Diane Jones, Jane Roberts, Nico Csergo, Guy Collis, Shaun McBride, Jos Bell, Corrie Lowry

Leeds meeting amendments: present: Vivien Walsh, Peter Marshall    Apologies: Catherine Grundy Glew

Birmingham meeting    Observers:   None

2   Minutes of Leeds meeting: Several delegates were missed off the list of those present, others said they’d sent their apologies but these had not been recorded. Delegates must take personal responsibility for signing the attendance sheet. Apologies will be recorded if they’ve been seen. The Minutes were accepted with those amendments and an understanding that they are not a record of every comment or question

VG suggested delegates who had missed 2 successive CC meetings without apologies should be removed from CC and GSJ said branch Secretaries should be informed before any action was taken against delegates elected by branches. ASS said Officers would consider these matters

ML asked if paper work could be sent several days ahead of a meeting and together rather than piecemeal

AT will be looking at the website, how it functions and to provide access passwords

CB mentioned that the final window for contemporary motions is noon 13 September

MR said the Clarke commissioned Report should be on the Agenda for the next meeting, since some elements are not fit for purpose, others are out of date and the recommendations had not been agreed by CC in 2014. This and the call for Action Report should both be addressed by CC particularly as a more intelligible version is now available

There were discussions about points of order, dispute and dissent at the Leeds meeting and about how fully these should be recorded. ASS pointed out that minutes were never to be verbatim, only summaries. GSJ asked that points of order and action should be recorded and that delegates should understand the meaning of incorporation of the association because of liability problems which might arise in future. Was it a personal decision for a delegate to be replaced by someone else? ASS said that the ‘presumptive delegate’ at the Leeds meeting was attempting to substitute for an elected delegate who hadn’t resigned, so this was unconstitutional and unacceptable. JL suggested that delegates standing down and their replacements should notify CC. TB said that as a delegate based organisation, SHA regions / branches are responsible for selecting and de-selecting delegates but resignations are accepted and new delegates normally appointed at the end of the year. Points of Order are normally challenged under Standing Orders. Points of Order or Points of Information are often used to get a voice in situations where the individual might not otherwise be able to speak. Generally, matters are understood in accordance with the Labour Party Rule book.

JW questioned the process and said it should be fair and transparent. AT replied that he had spoken of ‘back channel pressures’ operating outside the meeting and in social media with the intention of influencing the outcome of the disciplinary hearing and therefore were NOT relevant to the meeting.

BF asked how delegates could intervene in the business of the meeting without Points of Order and was assured all members were able to express their views, and unscheduled items could be raised under AoB if they weren’t on the agenda. SB said the Chair had managed time thereby frustrating delegates wishing to speak at CC. As there were no guarantees of delegates being able to express ideas or challenges at CC, perhaps agenda items should be timed in future. ASS said long discourses were inappropriate, and he’s also keen on gender balance if possible.   CGG asked if contentious issues should be high on the agenda so there’s adequate time to air views

3   Chair’s Report: The disciplinary procedure is on-going involving a huge amount of work for the Officers and Vice Chairs. ASS formally thanked and congratulated all those who have taken part and for the support they have given

4   Secretary’s Report:   JHS was absent due to illness (see apologies), so there was no written report, but she and her husband, Ken, have already done enormous amounts of SHA admin work throughout the Summer for which both are thanked. JHS is continuing to run all admin functions. Comments and articles for facebook should be sent to her. Once official speakers are confirmed, she’ll advertise in the official LP Conference material though BF asked if this would be possible since there’s still no proper access to accounts. Commitments to premises and other arrangements for the SHA fringe meeting have been met. Membership lists are up-to-date though some have multiple inaccuracies, (to be reported more fully). Claims for expenses, including any outstanding expenses from previous meetings, should be sent to Jean along with bank account details if she hasn’t got them already. The expenses listed on the Birmingham attendance sheet have been sent to Jean. VW asked about the Manchester branch meeting arranged for 2 weeks time; Jean is in discussion with members about this. GSJ asked about the website development, which subgroups have been set up, who’s doing what etc… AT said he’d been fully occupied with the panel but would be asking for working group volunteers after the LP Conference. CB asked if anything could be shared with anyone else to relieve the load on Jean and Ken, but as matters are still so tangled, that’s not possible.

5   Treasurer’s Report   Access to bank accounts is still incomplete, compounding current problems. We cannot pay for meetings, local or national, without being sure we have funds to cover them, and changing signatories to the accounts has been difficult and is still underway. ASS has contacted previous signatories regarding their replacement so Officers can recover control and the process is still underway too. Formal agreement to the new signatories, Tom Fitzgerald, Alex Scott-Samuel and Jean Hardiman Smith has been recorded. Previous arrangements meant Martin Rathfelder had discharge of matters costing less than £500, the Treasurer, those of greater value. This report and changes were accepted and agreed unanimously by the meeting.   IL said there’d been a similar problem in the CLP, changes to signatories had to be notified by the Secretary on headed notepaper with the appropriate Minute and it all took time. ASS commented that 3 former signatories had been supportive but progress was slow as it entailed postal mail exchanges.   For the future, we need to consider having transfer forms for signatories already prepared. TF confirmed our purpose is to run campaigns, a key one currently being to save the NHS, and to support local SHA groups, Manchester branch has funds and Martin Rathfelder is its Treasurer. However, honouring our previous commitments prevents making further financial commitments to any branch event until we have access to all accounts, and claims cannot be backdated. Current travel re-imbursements can be met. ML said Oxford branch had raised £150 in a meeting held in one of the most deprived area of Oxford, and offered to loan money to branches in difficulty, with the proviso that branches should seek to raise their own funding. CB said she had been nominated to become Manchester branch Treasurer, but Martin Rathfelder had objected. TB wondered if Martin was Treasurer by default or had been elected and then AT blocked further discussion since it might affect the current process. BF said SHA needed a proper financial policy for central and peripheral matters

6   Labour Party matters. A proposal for Contemporary Resolution, on Social Care by Brian Fisher still needed a title but was open for endorsement by CC. JL asked that it be proposed in the spirit of Nye Bevan as was done in the health motion last year, social care should be free, universally available and publically funded. CA was thanked for her contribution and seconded the proposal. It was thought there was little chance of it being discussed at Conference but social care will be a big issue over the coming year. MR mentioned refs to the Green Paper including one entitled ‘Adult Social Care and Support’; support was low whilst demand was so high, and it all meant more pressure on the health service. The problems arising from not doing anything on social care whilst the government insists it’s the responsibility of the Local Authority are immense and it’s essential to focus on the impact of the National HEALTH Service. BF said the proposal needed debate since the current incumbent had no commitment to this motion, and whilst he (BF) thought it would get through the Contemporary Motion gate, he didn’t want it framed with impact on the NHS as it’s about social care. VG thanked BF and colleagues for their work but wanted permission to ‘tweak’ it to get it through various gates at Conference. ML commented on the crisis in social care funding with many regressive ideas. ASS asked for motions to be submitted to the Conference Committee via him or JHS, and by 20 Sept. Branches and CLPs should be encouraged to support it as it will go to a priority themes ballot. JHS or Coral Jones will be invited to the Composite Committee if it’s accepted. This year’s conference has NO slot for health and social care! SB offered tactical advice that each region should have a delegate branch meeting on Sunday am as this would enhance chances of the motion being called, and we should all seek local supporters for the Contemporary Motion. JL reminded us of the inadequacies of support for children’s and older people’s support. CA commented that a Report on the Crisis on Social Care had been published on 31 Aug. Public funding, free at point of access had been addressed. The Women’s Group need to deal with the infrastructure including ‘soft’ budget funding, some minor ‘tweaking’ is necessary. BF will not be at the Composite meeting and Jean and Coral need to be briefed. GSJ asked if delegates might contribute to the tweaking if they’re present as delegates. This was accepted by the meeting.

Women’s Group meeting. Decriminalisation of abortion across the UK had been popular and support was building. One motion can be selected to take forward to the main Conference. VG thanked AS for her work preparing this doc.

SHA fringe meetings   Maternity policy and Save Liverpool Women’s Hospital 12.30 – 2.30 Monday 24 Sept, chaired by Irene Leonard

Re-nationalising Social Care 6.00 – 8.00 Tuesday 25 Sept. Brian Fisher in conjunction with Health Campaigns Together. Eleanor Smith MP will speak at this meeting

Both the events detailed above will be at the Quaker Meting House, 22 School Lane, L1 3BT. One or both of these sessions will commemorate Julian Tudor Hart; they are open to all comers.

BF will also be submitting a Contemporary Motion on Social Care to the main LP Conference as described previously.

In addition, Sunday 23 Sept 11.00 at ‘The World Transformed’ at the Blackie there will be a session on NHS Campaigning with SHA, Health Campaigns Together and ‘Neon’

There will also be the march in support of the Liverpool Women’s Hospital led by Prof Wendy Savage on 22 Sept starting at 12.00 at the Hospital and arriving at the LP Conference site for speeches and the Socialist Singers at around 3.00

21 Sept   ‘Pensioners United’ screened at the Plaza in Crosby. Tickets via Eventbrite. John McDonnell likely to be present.

As we have missed the deadline to be in the printed programme, we must use social media and the app. To publicise SHA events. Targeting similar meetings and entrances with fliers works well in Liverpool. CB asked about the cost of doing this and whether personal underwriting is possible to us included in the official brochure.

7 Any Thompson’s interim Report on the Resolution of the Disciplinary Panel and Incorporation

Main points:

No one person should hold the logins, passwords and control of finances; all Officers should have access. The process and culture should be of transparency to everyone anywhere. The lack of policies has created massive difficulties. New financial arrangements will be instituted and best practices implemented.

SHA cannot continue as an unincorporated organisation; this needs urgent attention with liability / member expressly limited (likely to be £1). Employer’s liability insurance will cover risks.

The website should be bespoke, not ‘standard’; it needs urgent attention enabling Officers (and maybe some sub-groups) to access a full range of all SHA documents. Maintenance and development of the website is likely to take some time, but some immediate steps are needed.

The Disciplinary Panel work is in accordance with NHS Guidelines and is compliant with other systems. Legal advice will be sought if, when, where necessary. Several legal opinions might be sought; those associated with appointment tribunals might be appropriate. AT believes the disciplinary process is defensible, he wants prompt resolution without undue delay of the process for reasons of time, public discussion and in the interests of the members. David Wrigley who will chair the Appeal has had all the paper work and has reported to Jean.

Andy’s statement prompted comments, suggestions and questions which are summarised below.

They included recruitment procedures, affiliation to other organisations, competence, training needs for Officers, clear job descriptions – maybe needing HR analysis -, governance, accountability and responsibilities issues, and a Director subject to a contract which MUST be delivered. The Clarke Report, originally rejected, should now be revisited. SHA has an accountant, and the Labour Party can advise on some issues. For recruitment, it will be necessary to determine functions, and it seems likely that 1 person will be insufficient. MR suggested the Chair of Labour Business is a lawyer and might give cost effective advice. Sorting everything is a long process, and should not to be de-railed or fail for some minor problem. Key matters needed resolution, the 2014 report on the SHA website by a working group headed by Neomi Fabry should be looked at again.  AT’s recommendations would result in a long report, but when fully implemented, SHA would be professionally fit for the 21st century. BF commented that the process had been criticised but Andy’s recommendations should be taken seriously, and need to be seen as fair. SB said we needed to get the basics right first, and then tackle core policies; whilst robust advice must be paid for, the CVS might have some appropriate ‘off the shelf’ policies we could use alongside current practices to see if they were better. The Officers would agree how best to take forward the Report’s recommendations. JL thanked AT for his work and CC accepted and agreed his Report.

8 Policy Development Process   TB presented Kathrin Thomas’s paper which raised 3 points:   1 Individual members getting their ideas to CC via the delegate structure should first test them in the branches to remove glitches.   2 Is the policy group a filter before the policy commission?   3 new polices should be linked to those already existing. ASS said that as agreed by CC on June 9, TB is Vice Chair leading on policy and his brief includes making recommendations and picking up the work of Brian and the policy commission. ASS is the link to the shadow health team. BF commented that a rapid reaction process is needed – a turn-round of responses within half a day. Some way of CC agreeing something quickly is necessary, and a key matter is how a policy is finally signed off. It was suggested that any active policy discussion should be flagged up for delegates to contribute. CGG considered the time frame for passing policy and whether this allowed for adequate branch level discussion. Delegates were especially aware of the special situation of social care needing small group discussion. MR commented that a ‘Green Paper’ approach should be adopted; the whole of local government needs examining, public health, health inequalities, and the framework whereby best practice can be brought forward. IL proposed a discussion forum for the website. ML said consultation / engagement was very necessary and to bear in mind that International Aid under Theresa May was linked to trade deals and Trump policies. TB supported the Green Paper approach and said that CC should hold policy development sessions twice yearly. Public health gap analysis, carers issues, issues arising from combining health and social care and funding had all been addressed in the last year, all fairly heavy policy concerns yet the LP has no formal policy. What relationship did SHA have with the shadow team? Other players need to be influenced, like media, web-based discussions etc.. but may be beyond our technical competence. Volunteers? Mental health was assessed as needing £20 billion when MPs last considered NHS shortfalls. Serious debate on taxation policy was required. ASS asked for TB to develop this programme further and CC agreed this decision

AoB AT returned to technological concerns, particularly ways of engaging with members, including those in remote areas, in live discussion. Raising money is always difficult and he favoured a land value tax targeting the wealthy. CL voiced her concern about what we can all see happening in the country and hopes to see a more positive attack from the LP. AG commented that standards shpuld be developed and met, and collaborative on-line meetings should not be impossible to organise.

The meeting closed at 4.30     Date of next meeting Nov 10 London

Judith Varley   10.9.18

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

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

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

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

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SHA Wales

 

‘LEGISLATION WATCH WALES’ – October 2018

Health and Social Care Briefing

Acts

Additional Learning Needs and Education Tribunal (Wales) Act 2018

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

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

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

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

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

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

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

The key purposes of the Act are to:

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

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

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

Public Health (Minimum Price for Alcohol) Wales Act

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

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

The Act includes provision for:

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

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

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

Regulation of Registered Social Landlords (Wales) Act

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

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

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

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

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

Law Derived from the European Union (Wales) Act 2018

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

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

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

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

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

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

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

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

Legislation in Progress – current Bills

Public Services Ombudsman (Wales) Bill

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

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

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

 

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

Autism (Wales) Bill

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

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

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

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

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

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

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

Childcare Funding (Wales) Bill

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

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

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

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

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

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

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

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

Renting Homes (Fees etc…) Wales Bill

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

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

The Bill includes provision for:

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

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

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

Future and possible Bills (of interest)

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

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

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

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

Updated October 2018

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General comments:   It was wonderful to be amongst such an enthusiastic group of diverse people, of wide age range, varied skin tones, many dressed relating to the country of their family origins, with and without disabilities (wheel chairs were very much in evidence); they seemed to reflect the diversity of our population as I experience it on the street. There was a joyful atmosphere despite almost all the topics reflecting the distress amounting to cruelty imposed by this current government on those least able to fight back; the hunger for change, just the prospect of being able to work in a co-ordinated and supportive way to do something about it is palpable. It’s always so stimulating to be amongst people who are energised to tackle the job for which we know there is such urgent need, although the practicalities of undoing the effects of this long austerity will not be easy. It was also useful to encounter organisations of which I was only vaguely aware previously. All the events out of the main hall in both the main conference and the World Transformed were jammed with people, seats quickly taken, standing room also gone and people bulging into the corridor, leaning one ear towards the door to catch as much as they could.

Women’s Conference:   The SHA Motion supporting Abortion Rights across the UK was not taken forward to the main conference. Coral Jones seconded this motion with a strong statement, and spoke of the dilemmas facing Northern Ireland GPs forced by the 1861 law to make decisions they wouldn’t choose in non-professional circumstances, and that Ulster women choosing an illegal abortion might face imprisonment for the rest of their lives. There is also the situation of BAME women who cannot speak openly for cultural and patriarchal reasons. The other motions were Childcare, Women’s Health and Safety and Women and the Economy. The motions, presentations and supporting contributions from the floor were so persuasive, I would have found it difficult to choose which one to support for the main conference had I been a voting delegate.   All of these motions indicate a deteriorating situation for women and therefore the health and well being of future generations too since such adversities cascade down the generations; problems introduced in one generation may never, or take many generations, or take many generations to be resolved. I suggest SHA takes up the 3 motions which were rejected for the main conference at an early date. Domestic violence, the silenced experience of 1 in 3 women is commonplace, whilst specialist supportive services for women and children have been lost since 2010. Two women killed each week in the UK is not a trivial matter; these murders are about male power and coercive control of ‘his’ woman and a new campaign ‘Level Up’ aims to get more informed, responsible, less sexist, reporting of these situations in which the woman is usually ‘blamed’ for promoting his violence. Support is being given to address male violence (which seems good), but takes funding from the woman and children and often gives the man access to his family again without having reformed his abuse of them

World Transformed – SHA, Health Campaigns Together and NEON (New Economics Organisation Network) combined presenting the debate on ‘Saving the NHS’. Speakers including Jean Hardiman Smith and Deborah Harrington (www.publicmatters.org.uk) made excellent cases with many references back to Nye Bevan’s ‘In place of fear’, how the arguments and threats raised in chapter 5 of this pamphlet in the 1940s are very relevant today, services being unaffordable, people living too long, demand too high etc… and to Julian Tudor Hart’s Inverse Care Law applying throughout the World. There was a pertinent reminder that services free at the point of need only matter if they’re of good quality. Bonnie Castillo, a nurse from the US – National Nurses United (www.nationlnursesunited.org) – pointed out that most and rising ill-health in the US is from preventable diseases, US neo-natal mortality is the highest in the developed world, and that though grass roots demand ‘Medicare for All’ is huge, it’s frustrated by corporate donor pressure blocking supportive Democrats from voting for it. It’s a timely reminder for us in England as corporate lobbying of politicians erupts volcanically here; conflicts of interest seem never to be challenged now and politicians switch easily between well paid corporate and governmental posts.

Fringe meetings on the Future of Care and Universal Credit (in association with the Trussell Trust) were predictably bleak. Barbara Keeley MP said all aspects of care is in crisis, (services, informal family and paid care); care itself had become more intensive and complex as people live for longer, sometimes with profound disabilities and requiring much more intimate intensive personal support often than before. The hollowing out of social care had led to 25% of caring situations now rated as poor resulting in ever more responsibilities being left to involuntary ‘volunteer’ family / friends. The Government’s promise of a Carers Action Plan (vague at best) and extra support for young carers had been forgotten, whilst Local Authorities, deprived of funding could not meet statutory responsibilities, so many people in England now never even approached their Councils for help, thereby contrasting with Scotland where Social Care is still funded. A commission to investigate the range of problems consequent to unpaid care in England would raise the profile of family carers and point out its impact on neglected matters like their entitlement to a pension; a pension is only available to those on the meagre Carers Allowance. The lack of training for unpaid and newer recruits to paid care also needs addressing; insofar as it works currently, the care system relies on an older workforce teaching the younger recruits voluntarily. Re-ablement, helping people to recover care for themselves is of very low priority. It would be useful to publicise the Dilnot Commission Report on Social Care (2011) and its recommendations and to take government to task for its failures. Why call it a caring system when it clearly isn’t?

The many flaws of Universal Credit and the damning report of July 2018 were aired. The numbers of food banks increased by 13% in the last year, 52% in areas where they were fully established already. The Left Behind Report has highlighted the brutality of the immediate problems of 70% of claimants who go into debt whilst waiting to gain access to support. No-one at these meetings could ever doubt the urgent need for reform of Universal Credit and re-instatement of a proper supportive welfare state providing the safety net it used to do with benefits linked to needs. Work coaches are primarily about implementing cuts. It’s not ‘just about managing’, but a question of survival now with 66% of benefit spent on food and the rest on utilities and never forgetting that this situation applies to 1 in 6 families where at least one member is in work and in work poverty has risen from 13 to 32% in recent years.

There were 2 SHA fringe meetings, both held at the Quakers and chaired by Jean

Emma Dent Code, MP for Kensington and Chelsea claimed it was the most unequal borough in Britain, with care homes run by a well known provider, it has 4 of the worse in the country according to the CQC, it has 4 food banks and has had the greatest fall of life expectation ever recorded – 6 years since 2010. She gave the example of a male in one part of the Borough with a life expectation of 63 years, whilst another living near Harrods would have 92 years. She reported many Grenfell related horror stories.

Judy Downing of the Relatives and Residents Association gave an outstanding presentation of the Labour Party’s failure to highlight the lack of standards and needs of the work force in care homes, many of which were run by small providers for profit. She claimed 1.4 million paid carers in care homes had no qualifications, (whilst this is a situation worse than operated in kennels, the same is true for informal family carers). Staff turn-over in care homes is about 28% (costing an estimated £3 – 5 billion), many leaving in less than a year, and about 50% of care homes are inadequate. Currently, US companies are making 12% profit from care homes in exchange for ‘crap’ care.   She suggested CQC should be nationalised to address these horrors with mandatory regulations and training elements.

Eleanor Smith MP called for re-nationalisation of the NHS, with a proper training budget again. Social care and care for the elderly budgets had plummeted since the 1980s, and the NHS would soon be in the same state if nothing was done. Private providers, international hedge fund managers (‘vampire capitalists’) would soon be able to affect health budgets – a clear conflict of interest – and Local Authority care workers are being warned off speaking about what’s happening. 60% of care homes don’t do health checks, there have been 3 times as many cuts in residential home beds as in the NHS. A Mental Health Capacity Amendment Bill if enacted would allow a care home manager to make the decision to deprive someone of his liberty – a privatisation of liberty! There is a financial incentive NEVER to discharge a patient when it is so profitable to keep him, as has happened for decades in private mental health care homes.

In the Health Inequalities session we were reminded of the Black Report of 1980 which linked health inequalities and poverty and was ignored by Mrs Thatcher so that since then, services have been lost and deaths have risen. How many more tragedies will happen before it is realised that we need a properly funded NATIONAL Health Service? The process has been to carve up the NHS, give powers to the Local Authorities then slash their funding. This has resulted in public health, drug and alcohol services, sexual health clinics, mental health rehab facilities, women and child welfare and support facilities, preventive medicine of all kinds, life expectation and quality of life all plummeting. Staff see a daily erosion of their service, they are subjected to constant pressure, unrealistic targets, so that many at all levels leave ill. Cuts and privatisation are rife. This is a quote from a nurse who can’t wait to leave ‘I did not become a nurse to make profits to line wealthy pockets.’ The NHS is for the people NOT profiteers. NHS Well-being terms are needed to address the injustice and assess the impact of all these changes on the lives people live including those with chronic and disabling health conditions (not forgetting mental ill-health), the unemployed, especially women’s and BAME’s lives

On the last day, Denis Skinner’s contribution was welcomed with a standing ovation. He described being inspired to leave mining and become an MP by the Atlee government of 1945. He has seen an inclusion at the Conference just not seen in everyday life. A fairer society should be judged by the obstacles it overcomes. He was there at the birth of the NHS, mentioned the various surgical procedures without which he wouldn’t now be addressing us. One was a heart by-pass performed by a United Nations team, and he listed all the countries from which the various medical staff had come – it was huge, as was his reception with laughter, clapping and cheering as the list went on and on.

Judith Varley   11.10.18.

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

Pensioners United

Directors: Phil Maxwell, Hazuan Hashim

Country: UK

Running Time: 75′

Year: 2018

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

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

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

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

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

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

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

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Saving the NHS: Planning our fightback

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

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

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

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

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

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

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

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

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

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

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

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Waiting for Jeremy: Wavertree Chair Alex Scott-Samuel and other invited Merseyside activists on stage awaiting the Leader’s Speech at #Lab18

Note the SHA tee-shirt.

 

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

Jean Hardiman Smith

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

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

Jean Hardiman Smith

 

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

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

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

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

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

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

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

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

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

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