Category Archives: Social Care

Join us on September the 12th at the Quaker Meeting House, Sheffield, at 6pm.

PM Boris Johnson, on the steps of Downing Street: “My job is to protect you, or your parents or grandparents, from the fear of having to sell your home to pay for the costs of care and so I am announcing now on the steps of Downing Street that we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve.” July 24th 2019

 

Social Care: Fixing the broken system – The Marmot Review 10 years on.  Economic growth is not the most important measure of our country’s success. The fair distribution of health, well-being and sustainability are important social goals. The Marmot Report.

We invite our Yorkshire community to join this vital conversation on ensuring that, finally, a Prime Minister’s words become action. For too long successive governments have promised action and failed:

  • Labour admitted yesterday that it had failed to transform the life chances of Britain’s poorest children, despite a succession of initiatives costing billions of pounds. (The Times, February 25, 2005)
  • The Government has cut funding for childcare despite a Conservative manifesto pledge to double the number of free hours parents get, says the NAO (Independent, March 2,  2016)
  • Theresa May pledges to seek long-term solution to social care squeeze … through a properly funded social care system”. Then, in 2017. May’s opinion poll lead ahead of a June 8 election halved in two recent polls since she set out proposals to reduce financial support for elderly voters. Theresa May’s social care package fails “to tackle the biggest problem” facing elderly people, Sir Andrew Dilnot has said.(Independent, May 18, 2017)

 

Format

Dr Simon Duffy, Founder of the Centre for Welfare Reform: The “what and how to” challenge to Boris Johnson based on Simon’s policy proposal for the Reclaim Social Care campaign.

A panel of experts, council members and users, will join him, with full participation from the audience.

We will agree a list of demands to present to the Prime Minister that must be included in his plan. Easy sound-bite pledges and promises of money mean nothing if there is no improvement plan.

The goal of the Great Yorkshire Conversation is to get the right government action and the right funding to put right the system that has been broken by Austerity and sticking plaster policies.

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SHA Central Council unanimously passed this motion at its last meeting. Please circulate and discuss at your CLPs and wards and consider whether you want to choose this as a motion to go to conference. It is an opportunity to shift Labour policy forward. The beginning of the motion succinctly describes the current disastrous situation, deepened by this government:

 

England’s Social Care system is broken. LAs faced £700m cuts in 2018-9 with £7 billion slashed since 2010. 26% fewer elderly receive support, demand grows.

People face isolation, indignity, maltreatment, neglect, barriers to inclusion and independent living.

Most care is privatised, not reflecting user needs/wishes. Public money goes to shareholders and hedge funds as profits.  Service users and families face instability as companies go bust.

Staff wages, training and conditions are slashed.  Staff turnover is 30+%.

8 million unpaid, overworked family carers, including children and the elderly, provide vital support.

 

The second part of the motion offers a set of solutions that go beyond more funding – we are exploring routes to a socialist approach to social care and support:

 

Conference demands Labour legislates a duty on the SoS to provide a universal system of social care and support acknowledging a right to independent living wherever possible:

  • Based on need and offering choice.
  • Meeting the needs of all disabled, frail and sick throughout life with robust safeguarding procedures.
  • Free at the point of use, universally provided, fully funded through progressive taxation
  • Subject to national standards based on Human Rights, choice, dignity and respect for all, complying with the UN Rights of persons with disabilities, including Articles on Independent Living (19) Highest Attainable Health (25) and Education (24).
  • Democratically run services, delivered through local public bodies working co-productively together with users and carers.
  • Training to nationally agreed qualifications, career structure, pay and conditions.
  • Gives informal carers strong rights and support, including finances and mental health.

 

Labour to establish a taskforce involving users and carers/Trade Unions/relevant organisations to deliver the above, including an independent advocate system, and national independent living support service.

Do contact us if you need any information or advice about submitting or debating this motion. “

Thanks

Brian

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Introduction

 

The  SHA Council agreed to pull together some of the existing policies on prevention and public health, introduce new proposals that have been identified and put them into a policy framework to influence socialist thinking, Labour Party (LP) manifestoes and future policy commitments. The SHA is not funded by the industry, charitable foundations or by governments. We are a socialist society which is affiliated to the Labour Party (LP) and we participate in the LP policy process and promote policies which will help build a healthier and fairer society within the UK and globally. An SHA working group was established to draft papers for the Central Council to consider (Annex 1).

 

The group were asked to provide short statements on the rationale for specific policies (the Why?), reference the evidence base and prioritise specific policies (the What?). Prevention and Public Health are wide areas for cross government policy development so we have tried to selectively choose policies that would build a healthier population with greater equity between social groups especially by social class, ethnicity, gender and geographical localities. We have taken health and wellbeing to be a broad concept with acknowledgement that this must include mental wellbeing, reduce health inequalities as well as being in line with the principles of sustainable health for future generations locally and globally.

 

The sections

 

These documents are divided into five sections to allow focus on specific policy areas as follows:

 

  1. Planetary health, global inequalities and sustainable development
  2. Social and the wider determinants of health
  3. Promoting people’s health and wellbeing
  4. Protecting people’s health
  5. Prevention in health and social care

 

The working group have been succinct and not reiterated what is a given in public health policies and current LP policy. So for example we accept that smoking kills and what we will propose are specific policies that we should advocate to further tackle Big Tobacco globally, prevent the recruitment of children to become new young smokers, protect people from environmental smoke and enable smokers to quit. We look to a tobacco free society in the relatively near future. Whether tobacco, the food and drink industry, car manufacturers or the gambling sector we will emphasise the need to regulate advertising, protecting children and young people especially and make healthy choices easier and cheaper through regulations and taxation policies.

 

Wherever appropriate we take a lifecourse approach looking at planned parenthood, maternity and early years all the way through to ageing well. We recognise the importance of place such as the home environment, schools, communities and workplaces and include occupational health and spatial planning in our deliberations.

 

We discuss the NHS and social care sector and draw out specific priorities for prevention and public health delivery within these services. The vast number and repeated contact that people have with these servces provides opportunities to work with populations across the age groups, deliver specific prevention programmes and use the opportunities for contacts by users as well as carers and friends and relatives to cascade health messages and actions.

 

The priorities and next steps

 

In each section we have identified up to ten priorities in that policy area. In order to provide a holistic selection of the overall top ten priorities we have created  a summary box of ten priorities which identify the goals, the means of achieving them and some success measures.

 

This work takes a broad view of prevention and public health. It starts with considering Planetary Health and the climate emergency, global inequalities and the fact that we and future generations live in One World. A central concern for socialists is building a fairer world and societies with greater equity between different social classes, ethnic groups, gender and locality. We appreciate that the determnants of such inequalities lie principally in social conditions, cultural and economic influences. These so called ‘wider determinants and social influences’ need to be addressed if we are to make progress. The sections on the different domains of public health policy and practice sets out a holistic, ecological and socialist approach to promoting health, preventing disease and injury and providing evidence based quality health and social care services for the population.

 

The work focuses on the Why and What but we recognise the need for further work to support the implementation of these priorities once agreed by the SHA Council. Some will be relatively straightforward but others will be innovative and we need to test them for ease of implementation. A new Public Health Act, as has been established in Wales, but for UK wide policies would make future public health legislation and regulation easier.

 

The SHA now needs to advocate for the strategic approach set out here and the specific priorities identified by us within the LP policy process so they become part of the LP manifesto commitments.

 

Dr Tony Jewell (Convener/Editor)

Central Council

July 2019

The complete policy document is available below for downloading.

Public health and Prevention in Health and Social carefinaljuly2019

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You may have seen the Panorama programmes about the shocking crisis in social care. If not, please see links to iPlayer at the end of this post.

Below is a motion that I’ll present at my local Labour Party branch meeting on 9 July next week.

The motion has been agreed by the Reclaim Social Care Group (RSCG) with the aim of getting it discussed and accepted as union policy at Labour Party Conference this year.  Although I’m not ‘registered’ disabled, I’m a member of Disabled People Against Cuts (DPAC).

The RSCG is co-ordinated through the umbrella group, Health Campaigns Together (HCT). It includes representation from Socialist Health Association (SHA), and KONP (Keep Our NHS Public).  Also included in RSCG are the National Pensioners’ Convention (NPC), several unions including Unite and Unison branches, and a wide range of disabled people’s user-led groups, and writers and academics.

Motion: Reclaim Social Care

England’s social care system is broken. Local Authorities face £700m cuts in 2018-19. With £7 billion slashed since 2010, 26% fewer older people receive support, while demand grows.

Most care is privatised, doesn’t reflect users’ needs and wishes; charges are high. Consequences include isolation, indignity, maltreatment. Disabled and elderly people face barriers to inclusion and independent living, thousands feel neglected.

8 million unpaid, overworked family carers, including children and elderly relatives, provide vital support.

Public money goes to shareholders and hedge funds as profits. Service users and families face instability as companies go bust.

Staff wages, training and conditions are slashed. Staff turnover over 30%.

This branch demands Labour legislates a duty on the SoS to provide a universal social care and support system based on a universal right to independent living: 

 

  • Free at point of use

 

  • Fully funded through progressive taxation

 

  • Subject to national standards based on article 19 of the United Nations Convention on the Rights of Persons with Disabilities addressing people’s aspirations and choices and with robust safeguarding procedures.

 

  • Publicly, democratically run services, designed and delivered locally, co-productively involving local authorities, the NHS and service users, disabled people and carers

 

  • Nationally agreed training, qualifications, career structure, pay and conditions.

 

  • Giving informal carers the rights and support they need.

 

Labour to establish a taskforce involving user and carers organisations, trade unions, pensioners and disabled people’s organisations to develop proposals for a national independent living support service, free to all on the basis of need.

 

(250 words)

Notes for members

SoS – Secretary of state

Reclaiming Our Futures Alliance (ROFA).

This is an alliance of Disabled People and their organisations in England who have joined together to defend disabled people’s rights and campaign for an inclusive society. ROFA fights for equality for disabled people in England and works with sister organisations across the UK in the tradition of the international disability movement. We base our work on the social model of disability, human and civil rights in line with the UN Convention on the Rights of Persons with Disabilities (CRPD).

We oppose the discriminatory and disproportionate attacks on our rights by past and current Governments. Alliance member organisations have been at the forefront of campaigning against austerity and welfare reform and inequality.

National independent living service

The social care element of Disabled people’s right to independent living will be administered through a new national independent living service managed by central government, but delivered locally in co-production with Disabled people. It will be provided on the basis of need, not profit, and will not be means tested. It will be independent of, but sit alongside, the NHS and will be funded from direct taxation.

The national independent living service will be responsible for supporting disabled people through the self-assessment/assessment process, reviews and administering payments to individual Disabled people. Individuals will not be obliged to manage their support payments themselves if they choose not to.

The national independent living service will be located in a cross-government body which can ensure awareness of and take responsibility for implementation plans in all areas covered by the UNCRPD’s General Comment on Article 19 and by the twelve pillars of independent living, whether it be in transport, education, employment, housing, or social security. The cross-government body will also be responsible for ensuring that intersectional issues are adequately addressed.

BBC Panorama – Social care 

Part 1:  https://www.bbc.co.uk/iplayer/episode/m0005jpf/panorama-crisis-in-care-part-1-who-cares

Part 2 – https://www.bbc.co.uk/iplayer/episode/m0005qqr/panorama-crisis-in-care-part-2-who-pays

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Peter Beresford, Professor of Citizen Participation at Essex University and Co-Chair of Shaping Our Lives, the user led organisation.

Nothing less than a root and branch reform of English social care is now needed. Its funding and principles must be radically reviewed. Only this will end its permanent state of crisis. Nothing else will make anything like a reasonable life possible for the millions of older and disabled people and family carers now suffering-  sometimes in extreme – from its gross failure and ever declining reach. Some commentators still wait hopefully for the promised government green paper that never comes, but given this administration is still committed to its same old neoliberal goals, it is difficult to see why. What’s needed is a fresh start.

According to the NHS’s own figures, since 2009 the number of people receiving adult social care in England has fallen, despite significantly growing levels of need. In 2009 1.8 million people received some adult care services in a 12 months period. Today the figure is estimated just over 1 million, a cut of 44%. People are also receiving less support and in the many cases where they have to pay, paying more. This year Age UK estimated that 1.2 million people don’t receive the care support they need with essential living activities.

Most people assume that social care is provided on the same basis as the NHS, paid for out of general taxation and free at the point of delivery. In fact the absolute opposite is the case. It is a relic of the old much hated Victorian Poor law. It is both means and needs tested. This coupled with years of arbitrary welfare benefits cuts in the name of ‘austerity’ and combatting ‘fraud’, means that the lives of many older and disabled people have never been so insecure, impoverished or undermined since the creation of the post war welfare state.

So that’s the first thing that must change. It’s not just that social care needs to be ‘integrated’ with the NHS – a favourite word of current policymakers – in principle and practice – in values and funding base as a universalist service, free for those who need it. It also need to be based on the philosophy of independent living developed by the disabled people’s movement. This means that instead of framing service users in deficit terms – what they can’t do – it is rebuilt on the fundamental principle of making it possible for them to live their lives on as equal terms as non-disabled people, non-service users. And this demands similarly based income maintenance, housing, education, employment, planning, transport and other policies.

We are not going to see this from right wing governments committed to ‘the small state’, the individualising values of the market, regressive taxation and cutting state spend on supporting people. But this must be the basis for any political party committed for the future to securing the rights and needs of all its citizens (as well as challenging hostility and discrimination against non-citizens).

To achieve this, advocates of truly radical reform of social care, are calling for an ‘independent living service’, which has the financial backing and overview of the treasury and which brings together the roles and responsibilities of all departments to make possible equal lives for the rapidly growing minority of disabled and older people who can expect to need support. Thus, like the NHS it would be harmonised from the centre, to avoid the problems of the present post-code lottery arrangements linked with the current locally led system.

The present loss and impoverishment of many user led organisations; that is to say those directly controlled by disabled people and other service users, needs urgently to be reversed and such a national network supported to be a key provider of support and services on a human and local scale for service users, offering a key source of accessible high quality training and employment to service users for whom employment is a positive and realistic choice.

Finally in an aged of AI – artificial intelligence – social care needs to be reconceived as a major generator of positive relationship-based employment and a net social and economic contributor that can be part of a new sustainable economics and social policy. Here we can see the vanguard of a new planet friendly approach to social policy, that offers the promise of high quality support, high quality employment and truly participatory policy and practice.

Professor Peter Beresford is author of All our Welfare: Towards Participatory Social Policy, Policy Press. He is emeritus professor of social policy at Brunel University London, professor of citizen participation at Essex University and co-chair of Shaping Our Lives.

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

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

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

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

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

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

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In the two decades since the publication of the Sutherland Royal Commission report on long-term care the issues around the cost of caring for an ageing population remains one of the major issues in public policy. And we remain no nearer to its resolution.

While varying elements of catering for long-term care remain the responsibility of the UK Government, devolution has allowed a fair level innovation and diversity in approach including the introduction of free personal care in Scotland which was one of the main recommendations of the Sutherland Commission.

In Wales the National Assembly’s Finance Committee has recently published a useful report on the matter from a Welsh perspective.

In very broad terms the report looked at two inter-related issues i) delivering quality care and ii) how that care will be accessed and paid for.

The report highlighted that while social care in under considerable financial pressure in Wales the level of spend has remained broadly flat in real terms between 2009-10 and 2015-16 compared to a 6.4% decline in England. None the less with an increasingly older population the per capita spending has reduced by 12%.

In responding to this pressure, and despite the increase in numbers, there was evidence that fewer older adults were receiving care. It was suggested that this was in part a reflection of the Welsh Government’s policy to promote more self-reliance and a better matching of service to need but concerns was also expressed that eligibility criteria were being tightened which means that it is more difficult to access care.

There is a greater proportion of unpaid carers in Wales compared to other parts of the UK and Europe representing 12% of the population. They are responsible for 96% of the care that is given in the community even though 65% of older carers have health problems of their own. The Social Services and Well-being Act (2014) in Wales was intended to increase support for carers but of the 370,000 carers only about 6,200 / year had an assessment with less than 20% receiving an offer of care. In response the Welsh Government has said that it is preparing a major publicity drive to make the carers more aware of their rights and to better equip social workers in their assessment of carers’ needs.

In Wales the means testing for care services is more generous that in England with the Welsh Government committed to increasing the capital eligibility thresholds for residential care to £50,000 by the end of it present term. In addition there is a cap on the level of payments for domiciliary packages. There were concerns that these thresholds could deprive social services departments of vital resources but the Welsh Government grant support has prevented that from happening.

The social care sector remains in a fragile state.. There are many instances in which private domiciliary care companies have handed back contracts to local authorities who have, in some instances, been obliged to in-source the service. The residential care sector is also under pressure particularly smaller more community based care homes. In part this is down to the fees that it is able to agree with social services departments. The rates vary across Wales, often inexplicably, and the Welsh Government has committed itself to introducing a new assessment methodology to bring greater transparency and consistency in the fee structure. In addition it is hoped that this new process will address the concerns where self-funding care home residents are paying fee levels which are, in effect, cross subsidising the public sector.

These problems are compounded by the difficulties in the recruitment and retention of staff with some providers reporting turnover levels of 25-33% every year. There are real issues of pay, status and training that need to be addressed. The Welsh Government has been promoting the voluntary registration of domiciliary care workers from 2018 with the target of compulsory registration by 2020. As well it is committed to reducing the use of zero hours contracts and to requiring a delineation between travel and work time in the working day. However it is still difficult to keep care staff when faced with better pay and conditions in other parts of the public and private sector. And all of this is likely to be exacerbated by the UK’s departure from the EU.

The report also looked at future funding models. The Welsh Government believes that a UK wide solution would be preferable but the continuing postponement of the UK Government’s green paper on social care means that other options will have to be looked at including the use of Welsh income tax powers which will be available from April 2019.

In addition a lot of consideration was given to the social care levy which has been advanced by Prof Gerry Holtham and Tegid Roberts.. Their proposal involves the HMRC to collect a levy between 1-3% depending on a person’s age. This sum would be lodged in an investment fund and used to pay for an enhanced social care package. However the report strongly believed that there needed to be a wider public debate on what the public could expect to receive in return for their contributions. The Welsh Government has established an Inter-Ministerial Group on Paying for Social Care with five separate work streams to consider the the full range of the implications of such a social care levy.

The Welsh Government’s policy statement A Healthier Wales (2018) confirmed its intent to support closer collaboration between health and social care in Wales using regional partnership boards as their main instrument to achieve this. Concerns were expressed that Wales lacked a sufficiently robust evidence base to inform social care planning thought the Welsh Government was not convinced about this. There was also a recognition of the very useful role that the Intermediate Care Fund has played in facilitating joint working between health and local government bodies.

Overall this is a useful report which highlights many of the key challenges facing social care in Wales. However there is little evidence that the Welsh Government is in a position to move toward an fully integrated “health and care service” free at the point of use or that it is likely to seek the devolution of the administration welfare benefits service which could allow for a more innovative proposals for the paying for the care of older people in Wales.

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A coalition to defend #ourNHS

Follow-up meeting

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

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

 

.

Jan Shortt, NPC General Secretary

Gill Ogilvie, GMB regional organiser

Reclaim Social Care Conference Nov 17, Birmingham

Speakers included

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

and campaigners from

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

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

Conor McGurran of NW Region UNISON

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

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

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

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

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

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

 

The Debate over Social Care

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

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

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

FEATURED BLOG

 

Response

 

Links to other articles and analysis on social care:

 

 

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

 

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

 

 

 

 

 

 

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

 

 

 

 

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

 

 

 

 

 

Copyright © 2018 Health Campaigns Together

 

 

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Reclaim Social Care Conference 17.11.18 final flier

Full details also on the Events page. Please circulate as widely as possible.

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Following the Judicial Review in London in July, NHS England quietly launched its promised public consultation on the Integrated Care Provider (ICP) Contracts on 4 August. The consultation closes on 26 October.  If the appeal granted at the other Judicial Review called for by 999 Call for the NHS in Leeds is successful, this ICP contract may yet be unlawful, but it is nonetheless essential that we respond to the feedback.

The ICP consultation document is a daunting read for most of the public. However, Health Campaigns Together (HCT) has provided expert answers to all 12 points in the public feedback document. 

HCT’s aim in providing these answers is to prevent flawed plans being adopted. They are seeking to prevent long-term contracts being signed that will undermine our NHS. This is in order to preserve any hopes of achieving a genuine integration of health and social care as public services, publicly provided free at point of use – and publicly accountable.

 

A reminder on what’s happened so far: There have been two judicial reviews on the Accountable Care Organisations and these Integrated Care Provider (ACO/ICP) contracts. And the courts found in favour of the NHS. But one of the campaign groups, 999 Call for the NHS, has now been granted permission to appeal. 

This is some very good news. But it also means NHS England is consulting on an ACO/ICP contract that may be unlawful. 

NHS England knew full well that an appeal was a possibility. Although fully aware of this, on Friday 3rd August – the day Parliament and the Courts went on holiday – NHS England started a public consultation on the ACO/ICP contract. The consultation says that the Judicial Reviews had ruled in their favour. This consultation runs until 26 Oct.

 

We all know that this ICP consultation needs to be combatted and stopped. But in the meantime, here’s all the information you need to fill in the consultation feedback.

As stated, the judge in the London NHS Judicial Review said that the ACOs (now ICPs) should not be enacted until a lawfully conducted consultation was held, and any eventual ICP contract would have to be lawfully entered into.

Since then, NHS England have moved swiftly and stealthily into gear, and you will find their monstrous ICP ‘consultation’ document at this link.

And here is Health Campaigns Together on the subject at this link.

As you see, the consultation document includes 12 points for feedback and Health Campaigns together has provided suggested responses to these points – very good responses too, I think. You’ll find them at this link.

When you’re ready here is the direct link for public feedback to the document, just copy and paste from the Health Campaigns Together link above.

As stated, there is a move afoot to get the consultation suspended until after the appeal granted to the 999 for the NHS has been concluded, but it’s very important to counter what will definitely be lots of responses from the allies of NHS England. Otherwise they will be able to hail the result as a democratic mandate.

Health Campaigns Together say that it is OK to copy and paste HCT’s responses into the feedback boxes on the questionnaire, although if possible, it would be good if respondents could add a few tweaks of their own.

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A Healthier Wales?
Cymru Iachach?
Monday October 1st 7pm to 9pm
The new Welsh Government Plan for Health and Social Care What does this mean for us in North Wales?

Come and hear the debate from our expert Panel

Huw Irranca-Davies,
Minister for Children, Older People and Social Care
Donna Hutton
UNISON Cymru Wales Head of Health
Professor Rhiannon Tudor-Edwards
Professor of Health Economics, Bangor University
Dr Matthew Davies
General practitioner, BCUHB Cluster Lead
Chair: Tony Beddow
Secretary, SHA Cymru Wales

Register at
https://www.eventbrite.com/e/a-healthier-wales-cymru-iachach-tickets-49012698300?aff=es2
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As the NHS passes its 70th birthday the recent report from the Health and Social Care Committee on Integrated Care could find little wrong with the direction of travel within the health service. While critics might cavil about the threat of further privatization, the Committee argued instead that the service was entering a new phase of collaboration rather than competition. Notions about the Americanization of the NHS were misplaced, due in part to the terminology surrounding Accountable Care Organizations, while the somewhat less than transparent introduction to this new phase had added to the confusion. Such problems could however be remedied by a “clear and compelling narrative” developed by the Department of Health, NHS England and other associated bodies, which would reassure both patients and taxpayers that the path of transformation was sound, sustainable, and in their best interests.

The Committee also argued that clarity could be more readily achieved by developing this narrative from a patients perspective, rather than focusing on systemic transformation. Such a perspective would focus on “how patients experience the health and care services they use”, and that what matters is that providers, whether public or non-statutory, “create coherent and comprehensive services, share information, work together and put patients’ needs, priorities and goals at the centre”. Indeed one can anticipate the content to be apolitical, dull, and with cross-party consensus and a new ‘NHS Assembly’ lending extra layers of concerned neutrality towards the co-design of the forthcoming 10-year plan.

 

HOMOGENEITY

In order to contest this it’s essential to identify the real guiding narrative for transformation, one which, while not always transparent, is overtly politicized and global in reach. It’s arguable that such a narrative already exists, is securely in place and has been for some time, and seeks to reconstruct healthcare systems to benefit transnational capital. Led by a transnational capitalist class with few, if any, allegiances to domestic staples, particularly re-distributional welfare, the aim is to impose a kind of global homogeneity of healthcare organization. Such standardization will attempt to safeguard and simplify investment strategies, and to embed corporate control of both purchasing and service delivery within rapidly evolving ‘mixed economies’ of care.

Homogeneity also gives meaning to attempts at trade deregulation; the TTIP, for example, would be somewhat limited if domestic systems weren’t fully investor compatible. The use of capitated budgets for ACO providers, for example, is expressly geared towards private investor interests, as the upfront capital can be invested in the global markets, with returns on equity in excess of 16%.

The insistence on fiscal austerity has accelerated such changes, transcribing the demands of financial regimes onto healthcare systems via the concept of sustainability. This not only permits a reframing of what care is to be available, but also a radical reframing of the delivery system. It was no surprise, for example, that the World Economic Forum’s (WEF) year long deliberations on healthcare followed the announcement by Standard & Poors in January 2012 that national healthcare systems must demonstrate sustainability in order for their economies to maintain credit ratings.  Workshops held in New York, Berlin, Istanbul, Tianjin, Madrid, Basel, the Hague, and London that year, were, according to the WEF, “remarkable in their consistency of vision”, advocating, for example, delivery from “capital-light settings” using “leveraged talent models” and “low-cost channels, such as home-based models”. In other words, what’s happening to the NHS is being reproduced on a global scale.

It’s also important to identify chains of command within these processes, and, owing to its economic strength, a key role is played by the US. Not only will US corporations be privileged, but also the standard template mentioned above builds upon the country’s main organizational format: that of ‘managed care’. Private insurance-led and with minimal recourse to federal programmes, managed care also involves a range of hospital- or physician-based provider networks. And it’s no accident that prior to his appointment as Chief Executive of NHSE, Simon Stevens led the Global Health Division of the US’s largest insurer, UnitedHealth, and was also chair of the WEF’s Steering Group on system sustainability. The interoperability of transnational and US ambitions isn’t always so clearly expressed.

 

TRANSLATIONS

As mentioned, the WEF’s reports were released in early 2013, and Stevens’ first main task for NHSE was in producing the Five Year Forward View in late 2014. Conceived as an overall appraisal of the NHS, the centerpiece of the Forward View was the introduction of new care models, namely the Trust-led Primary and Acute Care Systems (PACS), the primary care-led Multispecialty Community Providers (MCPs), and the more radical variant, the system-wide Accountable Care Organization (ACO). Such formats would be test-bedded across England in a series of vanguard sites offering examples of how these models would shape up in practice.

One such example is the South Somerset Symphony Programme. Led by Yeovil District Hospital NHS Foundation Trust (FT), the project is an advanced PACS vanguard in all aspects of the FYFV’s vision, incorporating radical changes in workforce, infrastructure and partnership arrangements. Working relationships have been established with Somerset CCG and Somerset County Council, as well as partnerships with other providers, and commissioners are working on similar approaches for the rest of the county with the aim of establishing a countywide ACO by 2019.

In terms of finding private partners for the new model, the FT was guided by the US-based global consultancy, Oliver Wyman, a company that “serves clients in the pharmaceutical, biotechnology, medical devices, provider, and payer sectors with strategic, operational, and organizational advice”. Private partnerships with the Trust now include those for services in diagnostics, digital services, online booking and management, ophthalmology, and in elective care. The last named is provided by ASI, the international arm of Amsurg, the US’s largest operator of day case facilities. The FT also partners Interserve Prime in a ‘strategic estates partnership’, to develop a wide range of retail outlets as well as a nursing home, GP practice and pharmacy, all of which, according the Trust’s CEO, could be run by the private sector.

Also assisting in the transition to an ACO has been Optum, the UK arm of UnitedHealth. The Trust’s document, ‘Join the Revolution’ is worth quoting in full:

“As (we) move towards an outcomes based contract in April 2017, the creation of an ACO is core to its effective delivery. The ACO model born in the US market is new to the UK, and as such we have partnered with globally experienced Optum who are guiding our journey into this new world. The partnership initially for a 9-month period is helping to plan, design and communicate the way the ACO’s will work, and critically financially model the value of managing a budget for the whole population of Somerset over a 10 year contract period”.

As mentioned, commissioners aim to extend this approach to the whole county, with Optum supporting other peers in the locality. As a Kings Fund document points out, the CCG envisages restructuring its services so that it can play “a more strategic role in overseeing the system, and expects a ‘managed services organization’” – such as Optum – “will sit within the ACO and act as its ‘engine room’”.

 

TEXTBOOK

While at first sight the scale of change in Yeovil is surprising, a close reading indicates it’s more textbook than anomalous. According to the Kings Fund, Optum, currently “supports GPs and provider groups in delivering new care models, including through offering analytics, actuarial support, decision support for clinicians and support for contracting”. Which, it has to be said, sounds remarkably like a health insurer. One of Optum’s clients is the Modality Partnership, which while it began in Birmingham, now straddles several counties, and is perhaps the leading MCPs vanguard. Some of the new care models “saw strong benefits of partnerships with private providers such as Optum because they could offer capital investment to support transformation, particularly if the government is less able to provide this investment in future”.

Similarly for PACS vanguard sites in Birmingham, Airedale, Fylde and North Tyneside, the Oliver Wyman company helped introduce “proven care models from other countries, customizing them to local needs, and then implementing them”. One of Oliver Wyman’s senior partners, Crispin Ellison, served in the Prime Minister’s Office, where he “identified new care models for health and community care” that “drew on best practice innovation in public and private sectors globally, as well as lessons learned in implementing major change initiatives”.

At a conference held by Wymans in London several months before the publication of the FYFV, all the trusts and CCGs from the above mentioned sites were present, alongside representatives from NHSE, Monitor, 10 Downing Street, and several other authors of the forthcoming narrative on integrated care.

Interestingly Wymans has a regular advert in LaingBuisson’s ‘Healthcare Markets’, the UK’s leading journal for the private healthcare industry. Under the banner ‘Transform Care: Implementing New Models to Improve Care and Value’, the company offers “To build sustainable solutions that are patient/ customer focused, health and social care systems need to optimize outcomes and experience, while delivering on value. We help clients transform care through the development and implementation of innovative, proactive, patient-centred models that address gaps and inefficiencies in our current delivery system”. The narrative used for both private and public sectors is interchangeable.

The company may also invite local NHS ‘leaders’ to its annual conference in Chicago, which brings together CEOs from major corporations – over 50% C-Suite in the blurb – who are “committed to the market transformation that will migrate $1 trillion to new players, new industry segments, and traditional companies that are delivering better health value”. The companies involved in the 2015 event included the insurers Blue Cross, Humana, Anthem and UnitedHealth, as well as various big pharma companies and Walgreens and Wallmart. It also included the CEO of Yeovil Foundation Trust.

 

ENDPIECE

In a blog to accompany its submission to the Health Committee, the Kings Fund, which also acted as chief advisers to the report, said, “there is no evidence that private providers of clinical services are taking on a bigger role in areas that are furthest ahead in developing accountable care”. It also said that while the proposed ACO contract may in theory open the NHS to companies from the US to compete to deliver care to NHS patients, this was “highly unlikely in practice”. As the examples above attest this is simply not the case. The range of private healthcare provision in Somerset is remarkably extensive, so much so in fact that the vanguard can no longer be considered a public entity. US companies it would appear are not simply offering services, but providing capital investment, acting as brokers for other private providers, and also acting as de facto commissioners of care at a county-wide level. It would appear that the ‘engine room’ of change for the English NHS is firmly transatlantic.

In its conclusion the Health Committee thought that too much emphasis had been place on wider processes at work within the NHS, and had come at the expense of more accessible interpretations of the changes deemed necessary to keep the health service afloat. As such, the Committee argued that there “needs to be a clearer narrative to explain the direction of travel: what are these reforms trying to achieve; what does the end state look like; what are the risks and what the benefits for patients and taxpayers”. There is a clear narrative involved, developed in the meeting rooms and conference centres in Chicago, Davos, and other loci of power, which pursues a US-led transnational agenda. And it’s one that does not aim to benefit patients.

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