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    London has some significant health and care challenges and inequalities. The healthcare system continues to be poor at preventing ill-health and in diagnosing illness early, and too much care is provided in hospitals instead of in the community.

    London has the highest average income but it is also the most polarised in the country, with people in the top 10% of households earning around five and a half times more than those in the bottom 10%. On the whole, people in the more deprived boroughs in London have poorer health. In many London boroughs poverty and affluence and the associated health inequalities exist side by side. In Tower Hamlets women have life expectancy of 54.1 years compared to 72.1 years for women in wealthier Richmond-upon-Thames, a gap of 18 years.

    There is growing pressure on health and social care systems. The number of people with multiple long-term conditions is set to grow to 2.9 million by 2018 and the number of older people likely to require care is predicted to rise by over 60 per cent by 2030.

    More than 1.5 million Londoners live with mental illness which ranges from anxiety, depression, and bipolar disorder to schizophrenia. Mental ill health is more common in London than in other parts of the country with 18% of people living in the capital having a common mental health problem, compared to 16% nationally. London’s leading causes of premature death are from predominantly treatable conditions such as cardiovascular disease, cancers and respiratory disease. Around 80% of these deaths are attributable to lifestyle factors such as excess alcohol, smoking, lack of physical activity and poor diet. Obesity is a bigger problem in outer London, although inner London has higher rates of early death from heart disease and cancer.

    Across London there is a serious shortage of home and community-based care available for patients and carers. Around a quarter of patients who do not need specialist care are admitted to hospital as a result of this, and up to 60% of patients are kept in hospital beyond five days when their needs could be met in more appropriate and cheaper community settings. State-funded social care spending decreased by £1.5 billion between 2006 and 2013 (2012/13 prices). This included a 39% reduction in the use of services for older people, 48% reduction in the use of services for adults with mental health needs and 33% reduction in the use of services by people with physical disabilities.

    Hospital admissions in non-urgent cases could be avoided with better proactive management of patients’ condition in their own home or within a community facility. There is an emerging social enterprise movement of approximately 1000 healthcare co-ops working within the NHS with a combined turnover of £600m. Social enterprises, housing associations and the third sector have developed a range of services to support the marginalised and disadvantaged communities in London in part funded by personalised budgets. We need much more of this approach in London, as it puts more choice in the hands of patients and successfully prevent conditions getting so bad that admission to hospital is required.

    Here’s how we could promote more patient power through the use of social enterprise in London’s healthcare system:

    • make third sector, social enterprises, co-operatives and mutals preferred providers in commissioning healthcare, and take action when there is a bias against using these providers;
    • give patients and staff more control over hospitals by changing foundation trusts into co-operatives;
    • increase the use of personalised budgets and allow budget holders to pool funding to increase their purchasing power to help shape the market and develop more choice;
    • charge private-sector NHS providers 5% of gross profit they make from these services to help develop patient-led healthcare social enterprises with a particular focus on the most socially excluded communities.

    We need a co-operative healthcare agenda for London to give patients a bigger say over the care they receive, reduce health inequalities, and move towards services that prevent health conditions becoming health crises.

    First published by the Co-operative Party


    1st National Coalition for Independent Action  Inquiry reports released

    NCIA has begun the release of 16 major reports as part of its Inquiry into the Future of Voluntary Services. Using the contributions of senior academics, voluntary sector managers, practitioners and consultants, this series of reports presents alarming evidence of the extent to which voluntary groups have allowed themselves to become subservient contractors, in the process muzzling their ability to speak up for their users and communities, and adopting ‘managerialist’ workplace practices in a ‘race to the bottom’. The reports also give examples of people resisting these pressures and their stand with local people affected by cuts, privatisation and austerity.

    The first four reports in the series are now available as downloads:

    • The Ideological Context by Professor Dexter Whitfield examines the changes brought about by the commitment of successive governments to the principles and practice of neo-liberalism, explains what neo-liberalism is, how this has reshaped the environment in which the UK voluntary and community sector now operates and its impact on voluntary agencies.
    • Ordinary Glory: Big Surprise not Big Society by Dr Mike Aiken looks at the impact of this changed environment on small volunteer-based community groups, shows how the influence of contracting and marketisation has damaged all levels of voluntary action but describes how, with a little encouragement, these groups and their activities might discover the seeds of a positive future.
    • Outsourcing and the Voluntary Sector by Laird Ryan documents the Coalition Government’s drive to privatise public services and evidences the damage being wrought by competition and marketisation, shows where the money is going, and uncovers the growing trend of Voluntary Services as sub-contractors to profit-hungry corporations like Serco and G4S
    • The Devil that has come amongst us  by Andy Benson looks in detail at the procurement and commissioning regimes through which this progressive enslavement on voluntary groups has been achieved, and the ways this has diminished interest and capacity to take their mandate from users and communities and speak out against injustice.  

    Further reports will be released over the next few weeks. These will deal with the rise of social enterprise and investment, changes in the ecology of the voluntary services sector, stories from the frontline, the failure of ‘leadership’ at local and national levels, and the impact on volunteering and employment practices. There will also be specific studies on services for black and minority ethnic elders and refugees and migrant workers and reports on Scotland and Northern Ireland. These reports will be available via the NCIA website –

    Further information available from Andy Benson:

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    How the “Big Society” fits into “One Nation” politics.

    Many of us on the left worry that despite the obvious economic difficulties of many in our society, those in positions of economic power continue to act as if nothing has changed from the “glory days” before the crash in 2008.  Large bonuses and payoffs are still the norm, even in some publicly-owned organisations.  Statistics indicate that economic inequality is increasing yet at the same time many of the very rich seem to contribute little to society.Despite the protestations of David Cameron at the last election about the “Big Society” that more services would be run by community groups and social enterprises, a report by the National Audit Office shows that last year £4 billion was paid to four big outsourcing contractors, Serco, Capita, Atos and G4S, despite the fact that there have been some well-publicised failures by these companies.

     I strongly feel that what is behind the increasing inequality in our society, and the idea that it is fair game to make as much money as possible, is the ethic introduced originally by Margaret Thatcher, adopted by Tony Blair, and enthusiastically pursued by the present government,that the only way to run something efficiently is to privatise it.  This unfettered capitalism led to the crash of 2008, and may well do so again unless we think about a better way of running society.

     This is not to deny that some publicly run organisations were inefficient, sometimes overstaffed, and could not operate within cash limits.  Socialists should not try to deny this was true in some cases, but look instead for new and better models of public ownership which are efficient, enterprising and involve the public.

     This book considers some successful social enterprises in the North East of England, and argues that it is model which could be widely extended as part of Labour’s programme.

     Thus I am proposing an extension of the “social enterprise” model to many more services currently run directly by local authorities, and to some such as care homes which are run by private contractors.  I am also suggesting that the Government consolidates its position in the railway sector by running East Coast as a social enterprise and considers managing the West Coast Main Line in the same way.  I also wish the Government to enter the energy sector, challenging the private companies to provide a fairer and more transparent pricing structure, and developing new frontiers in nuclear power, renewables and clean coal, not just going for the cheapest, but in the long run less sustainable, option.

    This is the start.  Let us see how successful we are, and we may go further if we can take the public with us.  They will support us if we are successful.

    This programme is not just about economics.  It is about a new ethical agenda, that important services are run on behalf of us, by us. We want them to be innovative and enterprising, but also to involve us, the public, too.  We should learn from the successful public enterprises in Germany, France and the Netherlands, where far from being “lame ducks” these companies are leading innovators and success stories.

    The term “big society” has been  discredited, and we may worry that if we use it we will be laughed at.  The term “Big Society” however,is something which emphasises the fact that we really are “all in it together”, and that society is run for us, by us. People still use the term “Big Society” and would welcome an approach which actually wants to realise some of its ideals.

    This new approach is something which involves all of us.  But in the end it is not just about a slogan.  We need convincing proposals based on what works.  We must take on the nay-sayers who think that all the Conservatives need to do is produce a few positive economic indicators to win the next election.  The Labour Party needs to recapture the idea of hope for a better society while keeping its feet firmly on the ground.  We must challenge the idea that an ethically based vision of a better society based in economic reality cannot be realised in the twentyfirst century.  But first we have to believe in it ourselves.

     You are invited to attend the  launch  of the book Reclaiming the “Big Society”on Tuesday December 3rd at The Two Chairmen Public House, 39, Dartmouth Street, WESTMINSTER SW1H 9BP

     David is also talking about the ideas in his book at the Tyneside Fabians on Friday December 6th at 7:30 p.m. in the Park Hotel, Tynemouth.  If you wish to attend please contact Rita Stringfellow ((  You must let Rita know if you wish to attend.

     The book is available from Searching Financ Price £8.99p

    1 Comment
    In Hackney the NHS funds more than 100 mental health organisations, ranging from support from Somali women to Sane, the national help-line and IRIS, an rape-support service. The NHS needs organisations like this. What they don’t do is cherry-pick easy cases or over-treat. Transaction (tendering etc.) costs are minimal so far as I know.
    It’s absolutely right that the NHS funds services like these that it cannot provide itself, but I can think of no good reason why existing NHS services should be tendered out to private providers. See my response to accusations of extremism on Radio 3.
    My objections are to a system of competing corporate providers in a system based on competition for patients and profits, which is associated with cherry-picking, disease mongering, fraud, increased costs and inequity.
    The NHS is incapable of effective contracting with the big corporations. For example, NHS choices was burned badly when the contract for management went to Capita and they are now trying to take it back in-house. I don’t think CCGs are anything like skilled enough  to run tendering processes effectively. As a minimum they need to recognise that corporate teams will:
    1. Present a lowest possible price option with alternative options for every eventuality, which will invariably be necessary and far more expensive than the lowest price.
    2. Pimp their bid with claims of ‘innovation’, ‘choice’ etc. etc. to satisfy very clearly every point of specification.
    3. Appeal if they do not win bids. They will not miss an opportunity to use lawyers to frighten commissioners.
    4. Pay their design teams to make their bids look very slick.
    5. Have teams who are paid a big commission to win bids but have no interest in the project afterwards.
    6. Keep these teams entirely separate from those responsible for fulfilling the contract who will say they knew nothing of the bid, that it was a different team and the small print says they are only paid for a part of the contract
    GPs are independent providers, but are very rarely associated with cherry-picking etc. I think we need to be very wary though, because QoF already encourages disease mongering and over treatment, there is already significant inequity and as boundaries are broken down there will be cherry-picking/ patient selection.
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    This article looks at some of the ways in which health voluntary sector organisations currently use research, how new ways of providing support for this are developing. We raise issues with the challenge presented to voluntary sector organisations conducting research in the current economic climate, with regards to the NHS policy context.

    The new NHS provides both a rationale and (perhaps?) new opportunities to undertake research. For example, this could be to examine the nature of the services (and their outcomes) that patients groups receive, or are likely to receive in new commissioning arrangements. Continue reading »

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