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    By Shaun Noble in BAME, COVID-19, Health and Social Care Act 2012, NHS, Pay Freeze, Privatisation, Staffing, Unite the Union

    Pay is ‘elephant in the room’, says Unite, as new NHS England People Plan launched

    July 30, 2020

    A deserved boost in pay for NHS staff, who have battled through the pandemic, is ‘the elephant in the room’ in the latest plan for the health service in England, Unite, Britain and Ireland’s largest union, said today (Thursday 30 July).
    Health and social care secretary Matt Hancock today welcomed the launch of the NHS People Plan as a new bureaucracy busting drive, so staff can spend less time on paperwork and more time with their patients.
     
    Unite, which has 100,000 members in the health service, said that the aims of this latest plan for the NHS would be hampered by the fragmentation caused by the 2012 Health and Social Care Act with its remit for increased competition for NHS services.
    Unite national officer for health Colenzo Jarrett-Thorpe said: “There have been a plethora of plans for the future of the NHS over the years and this latest manifestation neatly avoids ‘the elephant in the room’ – that of NHS pay.
    “NHS staff have worked ceaselessly throughout the pandemic at great risk to themselves and a generous pay rise would recognise that dedication as well as staunch the ‘recruitment and retention’ crisis that is currently afflicting the NHS – for example, there are about 40,000 nursing vacancies in England alone.
    “It is all very well for the plan to trumpet bureaucracy busting measures, but it was the flawed 2012 Act of the then health secretary Andrew Lansley that created the extra bureaucracy by fragmenting the NHS in the first place.
    “One of the key chapters of the People Plan is ‘belonging to the NHS’. This terms rings hollow to thousands of health visitors and school nurses cast outside the NHS; or the catering, cleaning, portering and maintenance staff that have been outsourced to private contractors or dispensed to wholly owned subsidiaries.
    “The English ideological obsession with marketisation and privatisation in the NHS must be terminated without delay and this report does nothing to address this.
    “We, of course, welcome such measures in the plan as boosting the mental health and cancer workforce; full risk assessments for vulnerable staff, including BAEM workers; and all jobs to be advertised with flexible working options from January.
    “But without addressing the issue of pay, highly skilled NHS staff will consider looking for more lucrative work elsewhere, possibly abroad.”
    Last week, chancellor Rishi Sunak awarded up to a 3.1 per cent pay rise for 900,000 public sector workers, including doctors, teachers and police officers. Unite accused the chancellor of having ‘a selective memory’ when it comes to public sector pay, rewarding some, but ignoring hundreds of thousands of others.

    Unite senior communications officer Shaun Noble

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    By Shaun Noble in Austerity, COVID-19, NHS, Staffing, Unite the Union

    Anger over NHS pay sparks Downing Street march tomorrow

    July 28, 2020

    Unite NHS members will be at the forefront of a march to Downing Street tomorrow (Wednesday 29 July) to show their anger at being overlooked in the latest round of public sector pay rises – despite more than 500 NHS and social care staff dying from Covid-19.
    The Unite branch at Guy’s and St Thomas Hospital will be marching to Downing Street at 18.00 tomorrow from St Thomas Hospital, Westminster Bridge Road, SE1 7EH to protest at the government’s decision to put off a pay rise for NHS staff until April next year – when the three year pay deal comes to an end. The march will be attended and supported by NHS staff across London.
    Last week, chancellor Rishi Sunak awarded up to a 3.1 per cent pay rise for 900,000 public sector workers, including doctors, teachers and police officers. Unite accused the chancellor of having ‘a selective memory’ when it comes to public sector pay, rewarding some, but ignoring hundreds of thousands of others.
    Unite national officer for health Colenzo Jarrett-Thorpe said: “Nursing staff and other allied health professionals have reacted with anger to being overlooked when pay rises were given to many in the public sector last week and the government not hearing the health trade unions’ call to bring their pay rise forward from April 2021.
    “This sense of anger was heightened, especially in light of their work and sacrifices during the global pandemic which has taken the lives of more than 500 NHS and social care staff across the UK.
    “We are facing a perfect storm for recruitment and retention in the NHS – in a decade of Tory austerity, NHS staff have seen their pay cut by 20 per cent in real terms and many are considering leaving the health service; at the same time, there are about 40,000 nursing vacancies in England alone.
    “This crisis is also being exacerbated by the scrapping of the student bursary, which is putting off many who may have considered becoming one of the next generation of nurses.
    “What we have seen in the last few months is generous praise, warm words, and lots of Thursday evening clapping by ministers; yet we got a flavour of the government’s true feelings with Rishi Sunak’s lack of a pay announcement for NHS staff last week, with no statement dealing with our call to move the pay of NHS workers forward.
    “The public expects – and ministers should deliver – a substantial pay increase for NHS staff that reflects their real worth to the NHS and society more generally. NHS workers shouldn’t have to wait till April 2021.”
    Unite branch secretary at Guy’s and St Thomas Hospital Mark Boothroyd said: “We have called this demonstration to express the anger that so many of our members feel at the government’s derisory treatment of NHS staff.
    “After all our sacrifice during the pandemic, to exclude us from the pay deal and make us wait till April 2021 is a slap in the face, and our members are going to Downing Street to tell Boris Johnson this directly.”

     

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    By Shaun Noble in Accountability, Care Sector, COVID-19, Health Care, Local Government, NHS Management, North East, Public Health, Staffing, Unite the Union

    Durham health visitor and school nurse job losses ‘incomprehensible’ with Covid-19 still prevalent, says Unite

    July 24, 2020

    The threat to cut health visitor and community nurse jobs in County Durham, while Covid-19 is still widespread, has been branded as ‘incomprehensible’ by Unite, Britain and Ireland’s largest union, today (Friday 24 July).

    Harrogate and District NHS Foundation Trust (HDFT), which is taking over the County Durham 0-25 family health service contract from 1 September, wants to axe about 37 whole time equivalents (WTEs), while the coronavirus is still widespread across the country.

    Although the HDFT also says it wants to employ 21 WTE new posts, there will be a net loss of 16 WTEs out of a workforce of about 230 WTEs.

    Unite lead officer for health in the north east Chris Daly said: “It is almost incomprehensible that when ‘public health’ is foremost in people’s minds because of coronavirus, Harrogate and District NHS Foundation Trust is swinging the jobs axe.

    “The vast majority of those being earmarked to lose their jobs are health visitors and school nurses – the very professionals at the public health frontline helping families with babies and young children, and children returning to school.

    “Disgracefully, the trust is consulting when staff, have been working flat-out throughout the Covid-19 crisis supporting very stressed families and young people. This flawed exercise is happening before the first wave of the pandemic is over and with the expectation that a second wave will hit this autumn and winter.

    “It is also very wrong that schools and GPs have not been told about the proposed cuts in school nurses. School staff returning in September will be phoning school nurses to come and help with children that they have not seen since March and who may be exhibiting worrying behaviours and dealing with distressing emotions.

    “We believe that already stretched GPs will be expected to pick up the shortfall in keeping babies, children and young people safe. However, there is a real risk that those most at risk may fall through the current safety net that HDFT seems intent on weakening.

    “This is not the time to reduce the health and school nurse provision for children and young people. However, it will be some time before the adverse impact of these cuts are brought into sharp relief.

    “The Durham country council should work with the trust to increase the funding for these essential frontline services. The long-term health of families is never enhanced by reducing the number of healthcare professionals.”

    Unite, which embraces the Community Practitioners’ and Health Visitors’ Association (CPHVA), will be making strong representations on behalf of its members before the consultation process ends on 31 July.

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    By Colin Salsberg in Funding, Housing, Professional opinion, Research, Social Care, Staffing, Work and health

    SECURING A SOCIALLY JUST SYSTEM OF SOCIAL CARE

    July 21, 2020

    At a time of heightened public interest in the future of social care, what would be the way forward guided by the principle of social justice? Some of it is in plain view and takes the form of immediate funding shortfalls. The only issue is the political will to find the money. Important as these issues are, their resolution will do nothing to redress what many believe is the most painful injustice of all. The system used to identify ‘need’ and allocate resources – based on the eligibility ‘needs test’ –  is not only inherently inequitable but works in a way that deprives the individual of the control over their lives essential to us all for our dignity, self worth and wellbeing. The system built around the needs test is obscure to the public and has no public appeal. It need be no surprise that social care cannot muster the political will to address the more obvious funding shortfalls.

    For a truly socially just system the ‘needs test’ must be abolished and replaced with a system that manages the tension between needs and resources very differently. This will not require more money. But it will require political will and the intellectual effort for new thinking.

    The immediate funding issues

    Before considering the needs test, it may be worth reflecting on the immediate funding issues.

    The issue presently uppermost in the public mind is the undervaluing of care staff. With something like 1 million care staff, every pound an hour they are paid will cost about £1.8BN

    Not far behind that in the public mind, and with a political head of steam developing to do something about it, is the means test. It results in the unfairness of the ‘dementia tax’, of people having to sell their houses to pay for care, and of as many people funding their own care or going without as receive state support.

    There are two proposals to reform the means test. One is the idea of the ‘care cap’ – a lifetime limit to how much an individual would have to pay in charges. Introduced by the Dilnot Commission in 2011, it is estimated this would cost in the region of £3BN. The other is to make all ‘personal care’ free as in Scotland. The House of Lords Economic Affairs Committee favours this and costed it at £7BN last year.

    A third would be to simply abolish the means test altogether (or charge only the ‘hotel costs’ of a residential care placement which was the very limited intention when the means test was introduced by the Attlee Government in 1948). The cost would likely to be somewhere nearer to £15BN.

    There would be some good news for the Treasury from a system driven by social justice. It would surely bring an end to public companies raking in excess profits. Research by the Centre of Public Health Information established that some £1.5BN is leaked out of the residential care market in this way. That amounts to some 10% of the value of the residential care sector.

    The gross spend on social care is currently £20BN. Addressing the means test and paying a fair price for care to ensure care workers are properly remunerated could potentially double that. But doing all of this would be leave the fundamental nature and character of the service unchanged.

    The eligibility needs test

    A founding principle of the NHS was that need will precede resource and that the resource would be publicly funded.  This has arguably been the principle that, whatever its faults, has made the NHS an enduring beacon of social justice.

    However, when it came to the care of older and disabled people this principle was reversed. The priority of the Attlee government was to end the grave injustice of the institutionalisation of older and disabled people in workhouses. Poor Law Boards would be abolished and responsibility transferred to Local Authorities. But when asked in Parliament what Local Authorities would actually do, the Minister for Health replied ‘as much as our resources will allow’.

    Surely unintended, this had two devastating consequences. It implicitly put care of older and disabled people at the back of the queue for public resources, leading it to its Cinderella status. Secondly, it reversed the polarity of needs and resources. Instead of need determining resource, resource would determine need.

    The modern manifestation of the principle is the concept of ‘eligibility criteria’. The justifying theory is that there is a body of ‘needs’ for care and support that can be applied to any and all. Application by all councils of the same ‘eligibility criteria’ will ensure fairness and equity. It’s a theory that has superficial appeal. It is unchallenged. All councils claim to be delivering the National Eligibility Criteria (currently established under the Care Act of 2014).

    It is, however, a myth without mitigation. In a system where need must be determined by resource, it’s the local resources that must be the driver. The ‘eligibility’ decision must be localised to local budgets. National criteria are irrelevant.  They are, indeed, written in a way that makes the key decisions meaningless. This is necessary for local discretion.

    Not only is this localism logically the case, the empirical evidence leaves little room for doubt. Councils report annually on how many people they support and the amount they spend in doing so. Dividing one by the other – which government reports do not do – gives the average spend per person. Once adjusted for regional price differences, this surely gives the best measure of equity. The highest spending councils in 2018/19 spent an average of £22.7K and the lowest £12.9K – an astonishing 70% difference.

    This is no random unevenness that can be explained away as the uniqueness of communities served. There is a clear pattern. Deprivation of communities served is the key factor. The means test results in the most affluent communities serving 50% fewer people per head of population than councils serving the most deprived communities. Councils spending the most can spread the jam much more thickly. The highest spending councils serve communities significantly more affluent than the lowest.

    So to the inequity is added injustice.

    The damage does not end there. The eligibility process works by standardising ‘need’. Standardisation cannot be made to fit with the highly individual nature of the lived experience of need. Needs arise from the complex interplay of a host of factors each of which are themselves highly variable. It has become a modern cliché that each person is ‘expert in their own needs’. The cliché is reduced to lip service when delivered in a system which allows the person to express only ‘wishes’ while the council determines their ‘needs’. It’s infantilising. It is inaccurate as a way to identify need and therefore inefficient.

    Failure in delivery of the principle must not be allowed to dim the importance of the principle that individuals are indeed the best experts in their own needs. Their view of their needs should prevail subject only to their view making best use of resources to enable them to have their best level of wellbeing.

    There will be a dividend for the Treasury.  The greater accuracy of the assessment will mean much greater for value for money from the resource made available. The sector itself believes, although wrongly ascribing blame on poor social work practice, that the current eligibility driven system wastes significant levels of resource through poor use of resources.

    Why does the eligibility needs test persist?

    The needs test has survived since 1948 and defeated countless attempts at transformative change of social care. These include the Community Care reforms of the 1990’s and the more recent personalisation strategy.

    Why is it so enduring? Again, the answer is plain. It serves two political expedients. Firstly it keeps spending to budget, no matter the real need. Secondly, it ensures there is never any record of unmet need. This is important because, in contrast to the NHS where growing waiting lists in the NHS creates political pressure, there is no equivalent in social care. Sir Chris Wormald, Permanent Secretary to the Department of Health and Social Care told the Public Accounts Committee, who wanted to know how much funding social care needed, told them that councils had all the money they required to meet their responsibilities under the Care Act. What he didn’t say was that would be true no matter the size of the budget or the level of real need.

    What will it take to abolish the needs test?

    One obvious answer is to guarantee funding will meet all needs to ensure all have the quality of life they can reasonably expect. But the uniqueness of individual needs and the huge variability in the cost of meeting them would mean social care could have to be delivered on an ‘open cheque’ basis. No public service, not even the highly valued NHS, enjoys that. Credibility demands that strategies assume social care will continue to be delivered within a budget not likely to meet all needs. Success is to be measured by the smallness of the gap between needs and resources.

    Can the needs test be abolished in a budgeted system?

    The answer is an unequivocal ‘yes’. ‘Need’ must be identified in the context of securing the quality of life reasonable for each older and disabled person to expect through. The resources must make the best use of resources but without regard to what happens to be available. The United Nations definition of Independent Living provides a ready made standard of wellbeing to adopt. This would put the UK in the forefront internationally. From that point, decisions must be made as to how many each of those needs the council can afford to meet. Spending will be controlled to budget. However, it no longer be through eligibility of need but by affordability of need.

    The law, through the Care Act, has already made this possible. It provides for ‘need’ to be assessed against 9 dimensions of wellbeing. These dimensions are synonymous with Independent Living. The Act also creates the legal conditions to enable councils to say if they can or cannot afford to meet need. None of these provisions are currently being used. They are being ignored by councils as, under the influence of the Government’s Statutory Guidance to the Act, they are perpetuating a localised eligibility process.

    In February the Labour opposition in Barnet put forward a 4 point plan to replace eligibility of need with affordability of need as the means to control spending. This was to ensure the assessment process was able always to put the person and their welllbeing at the heart of their assessment process and to ensure the Council would be aware of any gap in funding between needs and resources. The Conservative administration rejected the proposal. They believed the Council was already delivering the Care Act and its wellbeing principle, that resources never interfere with the assessment of need, and that choice always determines what people received. The Labour group is currently testing the veracity of those claims.

    Will the needs test be abolished?

    The key issue is political will. The gap between needs and resources will be publicly exposed. What waiting times do for the NHS in creating political pressure, unmet need will do for social care. Political leaders will have to leave behind the comfort the eligibility system has provided them. The greater the funding gap given authenticity through deriving from the aggregated lived experience of need, the greater the political discomfort. But it can be expected the public narrative will shift from what ‘social care’ requires to what older and disabled people require. Few people understand or care about the former, but many are likely to about the latter. Currently councils are seen as visionless machines, employing what Tracey Lazard of Inclusion London (a network of disabled peoples’ organisations) describes as ‘dark arts’ to ensure the system’s delivery under cover of misleading public messages. Councils will be on the side of the older and disabled people they serve, free to promote public understanding of the real needs within their communities.

    Insofar as public sentiment drives political will, social care will stand a much improved chance of securing the funding it truly requires.

    Conclusion

    The needs test, and all its attendant ills, is the unintended legacy of what was otherwise a great reforming Labour government. Although understandable in the context of the 1940’s, rectification is long overdue. There is a clear moral argument that it falls to Labour to ensure it happens.

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    By Alan Hall in Accountability, Campaigns, Care Sector, London, NHS, Staffing, Work and health

    THANKS AND THOUGHTS ON NHS BIRTHDAY – PAY CAREWORKERS THE LIVING WAGE

    July 6, 2020

    https://youtu.be/1jFWY7WmPBA

    Campaigners and Lewisham residents offer thoughts and thanks to the NHS.

    The Save Lewisham Hospital Campaign has launched a new video on the 72nd Birthday for the NHS on Sunday, 5th July 2020. The Campaign say: “In the middle of a global pandemic, with 65,000 deaths in the UK, some thanks and thoughts on the NHS 72nd birthday.”

    Happy birthday to the NHS – you were clapped but tories will not deliver the cash needed #NHSBirthday #SecondWave https://t.co/WOrG41PeDl

    — Alan Hall (@alan_ha11) July 5, 2020

    On this day, The Observer reports that the Chancellor of the Exchequer, Rushi Sunak refuses a £10 billion cash injection as Ministers have been warned that a second surge of Covid 19 infections let alone the now usual ‘winter pressures’ will leave the NHS “crippled” and “perilously unprepared”.

    The Government promised that the NHS would receive “whatever it needs” and NHS bosses claim that this pledge is to be broken now.

    Further claims that the Government’s chronic underfunding of the NHS will inevitably lead on to the fragmentation and privatisation of the NHS have been made.

    Interestingly, in the video a resident reflects by saying:

    “Stop using Covid as a cover to push through a restructuring of the NHS without public consultation.”

    Periodically, when cash has been tight in the NHS proposals surface to downgrade Lewisham Hospital’s A&E Department.

    Brian Fisher, a retired Lewisham GP, in the video says: “We continue to defend you [NHS] and fight for publicly funded social care.”

    In that spirit, Cllr Alan Hall has written to the Chancellor of the Exchequer, Rishi Sunak supporting Citizen’s UK asking for social care workers to be paid the London Living Wage locally.

    You’ve clapped, now’s the time to act! 🌈

    We know that care workers deserve a real Living Wage so here’s a little reminder that you can send to your MP.

    Help care workers get a real #LivingWage by clicking the link below 👇 https://t.co/iwlaKjaPex#LivingWage4KeyWorkers

    — Citizens UK (@CitizensUK) July 5, 2020

    Time to pay care workers a London Living Wage

    Citizen’s UK say: “Careworkers have been on the frontline of the UK’s fight against COVID-19, but a Real Living Wage would put them at the heart of our economic recovery too. Increasing pay to £9.30 an hour (£10.75 in London) would enable a million low-paid workers to start spending in local businesses and communities up and down the country.”

    The text of the letter is below.

    Dear Chancellor Rt Hon Rishi Sunak MP,

    On the 72nd NHS Birthday, I am writing to you as a constituent to ask for your support for Citizens UK’s Living Wage for Careworkers Charter, which aims to ensure careworkers are paid the real Living Wage of £9.30 an hour (£10.75 in London).

    Those in the social care sector are at the frontline of the fight against Covid-19 and I know in our community so many care recipients and their families value their vital work.

    We have all been ‘clapping for carers’ on Thursday evenings in recognition of the danger they face, and yet they are often paid the minimum wage (also known as the National Living Wage) of £8.72 an hour.

    Citizens UK is calling for the UK government to invest the £1.4 billion that the Resolution Foundation estimates it would cost for every care sector worker, who delivers publicly–funded care, to be paid the real Living Wage of £9.30 per hour. This would allow careworkers to live with greater dignity and to escape from poverty pay.

    We know that the public, commissioners of social care such as local authorities, employers of care workers, and recipients of care would all like care workers to be paid the real Living Wage, but to do that we need additional investment from the UK Government.

    I really hope we can also count on your support for our campaign. Please let me know whether or not we can add your name to Citizens UK’s Living Wage for Careworkers Charter, which you can find below.

    Citizens UK’s Living Wage for Careworkers Charter:

    We all rely on the one million careworkers on the frontline of the UK’s fight against the pandemic. Careworkers have worked tirelessly throughout Covid-19 to look after the most vulnerable in our society – and have found themselves at risk, often without adequate PPE, and without the esteem afforded to NHS workers.

    Over half of frontline careworkers earn below the voluntary Living Wage of £9.30 an hour (£10.75 in London) and are struggling to keep their heads above water.

    As careworkers, care recipients, care commissioners, council leaders, politicians and community leaders, we all agree that no careworker deserves poverty pay. We have applauded careworkers on Thursday evenings – now is the time to match our applause with a guarantee that they will earn enough to live a decent life.

    We call on the UK Government to provide the £1.4 billion in additional funding so that every care sector worker that delivers publicly funded care can be paid at least the voluntary Living Wage of £9.30 an hour (£10.75 in London).

    Yours sincerely,

    Cllr Alan Hall

     

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    By Brian Fisher in Clinical conditions, COVID-19, Democracy, Doctors, Health Inequalities, Information Technology, NHS Commissioning, Primary Care, Socialist Health Association, Staffing, Work and health

    SHA Briefing – Primary Care

    June 22, 2020

    This paper was developed by a group of primary care clinicians for the Labour Shadow Health Team at their request. We hope it helps illuminate the next steps for primary care.

    WHAT ARE THE RISKS, OPPORTUNITIES AND CHALLENGES FACING  PRIMARY CARE PROVISION DURING AND AFTER ITS RETURN  TO A NORMAL STATE OF OPERATION?

     

    “We will be facing some tough challenges over at least the next year: managing more consultations (and clinical risk) remotely by phone or video; catching up with resurgent patient demand, catching up with the care of long-term conditions (whilst trying to protect groups of vulnerable people from a continuing threat of Covid); managing a backlog of people who need to be referred; and coping with any spikes in Covid. This comes on top of the usual (preceding) strains on limited resources and lengthening ‘winter pressures.’ I don’t think that we will be seen as ‘NHS heroes’ in a few months!”

     

    DIGITAL WORKING IS TRANSFORMING CARE

    Opportunities

    • Easier and more flexible for people and practices, so may aid GP recruitment
    • The complex and subtle nature of the consultation seems to be maintained
    • Communication across sectors can be dramatically improved. One GP described helping a patient with lymphoma – in 10mins he was able to include a Ca nurse and consultant in a conversation with the patient.
    • Telephone triage also successful
    • Bricks and mortar general practice may become less necessary
    • Combining online personalised advice with online access to records opens the way to improved self-care

    Challenges:

    • Digital can widen inequalities and disenfranchise. Experience suggests it is the elderly rather than the poor who struggle the most.
    • The best balance between remote and face-to-face is unclear. Video may be best for follow-ups.
    • Video is seldom preferred by people. The telephone or face to face are most popular.

    Actions:

    • Support the elderly to become more digitally able while ensuring that traditional approaches remain available
    • Support digital cross-sector working: GP/hospital/Social Care
    • Encourage digital mentoring to improve self-care for people with LTCs

     

    SHIFTING TO PROACTIVE WORK WITH COMMUNITIES

    Opportunities

    • The spontaneous rise in mutual community organisations has been remarkable, often outwith the traditional voluntary sector, improving safeguarding and perhaps saving lives.
    • Primary care has been able to embrace that.
    • It offers a model for the future
    • There have been many examples of successful cooperation with communities, but they have been dependent on local circumstances and local heroes.
    • The health gain comes when communities can take more control over the area and their lives
    • The NHS and local government need to create the conditions whereby communities can work collaboratively with the statutory sector sharing decisions with their communities. We need a systematic approach for mobilising civil society, working with NHS and LAs.
    • PCNs offer a good base for such cross-sector working

    Challenges:

    • Sharing decisions with communities is a difficult skill the NHS would have to learn, perhaps from LAs and housing associations.
    • Building on existing work and with councillors would be essential. No new unnecessary initiatives.

    Actions:

    • Jointly fund, via NHS and LA, community development workers in each PCN, working with social prescribers. They would support the statutory sector sharing decisions with their communities.
    • Primary Care to be encouraged to support community groups and community development by, for instance, enabling practice space to be used by communities.
    • Asset mapping with LA and PH colleagues would be one early step
    • Encourage and incentivise cross-sector working.

     

    PRIMARY CARE TO ACTIVELY WORK ON THE SOCIAL DETERMINANTS OF HEALTH AND HEALTH INEQUALITIES

    These have been thrown into sharp relief through the pandemic.

    Opportunities

    • Essential to make any progress on health improvement
    • Community development can assist
    • Local work on poverty, race issues, migrant issues, housing
    • Cross-sector working is essential to do this.

    Challenges

    • The independent contractor status of general practice may hinder this process.
    • Cross-sector working is difficult
    • It is political work

    Actions

    • Promote training GPs with a Special Interest in Public Health, sitting astride the PCN and LA
    • Support areas to become Marmot towns.
    • PCNs to link formally with LAs
    • Boost the status and effectiveness of Well-Being Boards
    • Borough-level linking (not merging) of LAs and NHS.

     

    PRIMARY CARE AND LONG-TERM CONDITIONS INC COVID

    Opportunities

    • The importance of community service provision has been made plain by the pandemic
    • Extensive primary care services and rehab re likely to be required for people recovering from Covid

    Challenges

    • Managing more serious illnesses outside hospital may require differently trained primary care staff such as District Nurses

    Actions:

    • Use a range of approaches to contact those who have delayed seeking help for potentially life-threatening illnesses
    • Digital self-care with remote links to home monitoring such as BP, weight, Peak Flows
    • Secondary care doing remote consultations to reduce the backlog
    • Explore a range of differently skilled staff for primary care

     

    RELAXATION OF RULES HAS BEEN HELPFUL

    Opportunities  

    • There has been relaxation of some bureaucracy
    • Flexible approaches have enabled doctors to return to the workforce.
    • These changes have enabled GPs to devote more time to patient care.

    Challenges

    • Some of this bureaucracy is useful. We don’t want wholesale deregulation: that has often been dangerous
    • It is difficult to know which parts need to be kept and which don’t.

    Actions

    • Explore with the profession which regulatory aspects need to be kept and which don’t.

     

    FUNDING, TRAINING AND STAFFING

    Challenges

    • Primary care, GPs, HVs and DNs remain substantially understaffed. This must change.
    • Different training requirements may be needed for a different future.
    • The RCN is calling for wage increases for nurses

    Actions:

    • A system to support on-going review and remodelling of workforce capacity is needed to ensure that the primary care workforce is responsive to emerging need which may increase over time.
    • Clarification of plans for student health visitors and others who have had their training disrupted during the pandemic

     

    STAFF SAFETY IN THE TIME OF COVID

    • Continued need for PPE to protect staff and patients
    • Mental health support for staff

     

    PRIMARY CARE BUILDINGS

    Challenges:

    • Many primary care buildings were inadequate before Covid
    • Many more now need redesign to cope with new patient flows and requirements for cleaning etc

    Actions:

    • Funding must be found where premises need improving
    • Consider links with housing associations

     

    BOOSTING DEMOCRACY IN THE NHS

    Challenges

    • The NHS has used the Coronavirus Act to push through significant changes to the infrastructure of ICSs. This is baking in the risks posed by them: privatisation, fragmentation and cuts.
    • Hosp reconfigurations are happening rapidly without consultation and no equality assessment

    Actions

    • Call out these dangerous changes and use them to explore new approaches to democracy. For instance:
      • PCNs run with a Board with a broad representation of opinion
      • Link PCNs and local government through local forums with budgets – a form of participatory budgeting
      • Community development would assist participatory democracy

     

    ADVANCED CARE PLANNING

    Opportunities

    • Advanced care planning will need to sensitively change for the better.
    • General practice is well- placed to have discussions that allow patients to express their wishes, which will reduce unnecessary and possibly undignified hospital admissions.

    Challenges

    • There seemed to be sporadic inappropriate behaviour from CCGs and practices issuing blanket DNR notices to care homes
    • The pandemic seemed to cast a harsh light on relationships between some practices and care homes

    Actions:

    • Patients suitable for advanced care planning conversations could be identified— perhaps informed by frailty scores — and discussed in multidisciplinary meetings as part of routine care.
    • The public need to be involved, and the sector need to emphasise that these discussions are about providing quality of care.

     

    SOURCES:

    https://www.rcn.org.uk/news-and-events/blogs/covid-19-out-of-this-crisis-we-must-build-a-better-future-for-nursing

     

    https://ihv.org.uk/our-work/publications-reports/health-visiting-during-covid-19-an-ihv-report/

     

    A brave new world: the new normal for general practice after the COVID-19 pandemic.

    https://bjgpopen.org/content/early/2020/06/01/bjgpopen20X101103

     

    https://www.rcgp.org.uk/policy/fit-for-the-future.aspx

     

    CONTRIBUTORS

    Dr Onkar Sahota

    Dr Duncan Parker

    Dr Joe McManners

    Dr Robbie Foy

    Dr Brian Fisher

     

    CONFLICTS OF INTEREST

    Dr Fisher:

    I am Clinical Director of a software company called Evergreen Life www.evergreen-life.co.uk . We are accredited by the NHS to enable people to access for free online their GP records, to book appointments and order repeat prescriptions. We try to help people stay as fit and well as possible.

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    By Shaun Noble in BAME, COVID-19, Science, Staffing, Technology, Unite the Union

    ‘Class and race’ biggest factors for victims of coronavirus, says Unite

    June 2, 2020

    Class and race are the biggest factors in determining those that have died or been taken ill by Covid-19, Unite, Britain and Ireland’s largest union, said today (Tuesday 2 June).

    Unite called for a raft of policies to tackle the ‘systemic failures’ that has led to the disproportionate death toll amongst the Black, Asian and minority ethnic (BAME) communities and also the poorest groups in society

    The union was commenting on Public Health England’s report Disparities in the risk and outcomes of Covid-19 which highlighted those groups that had been hardest hit in terms of mortality due to coronavirus.

    Unite assistant general secretary Gail Cartmail said: “This report shines a searing light that reveals the pandemic in the UK is intrinsically linked disproportionately to class and race.

    “These wide disparities are detailed in this data and point to age, race and income and accompanying health inequalities as key determinants as to whom has been the worst affected by Covid-19.

    “This has been amplified among those in undervalued occupations and jobs where zero hours’ contracts and precarious employment are the norm.

    “Working hard to provide for your families is no defence against Covid-19 for these groups – these systemic failures need to be tackled urgently and that work should start now.

    “No one policy size fits all, but such an agenda should include ethnically sensitive risk assessments and income guarantees for workers who through ‘test, track and trace’ would otherwise be reliant on statutory sick pay (SSP), while in isolation.

    “The Real Living Wage should be the basic minimum for those in ‘at risk’ occupations as an interim measure, with a commitment to sectoral bargaining for care workers and the guarantee of the necessary funding.

    “All these measures are achievable with government support. If austerity is over, as ministers claim, the best defence against the inequalities which the report exposes is to narrow the income gap and invest in public services with priority to social care.

    “The pandemic has shown that the crisis in social care can no long be pushed into the political long grass. The lack of testing for residents and staff, and also the shortage of PPE, in care homes has wreaked a terrible toll on the elderly who have died in their thousands due to Covid-19.

    “Social care can no longer be regarded as the poor relation when it comes to funding from the budgets of central and local government – a ministerial blueprint for social care should be a top priority as we emerge from the lockdown.

    “Poverty is the parent of disease and Covid-19 has been a willing accomplice in this respect. Once this pandemic has passed, we need to look as a country anew to how we can recalibrate economic and social policies to create a fairer society.

    “All these issues must be investigated in depth when the post-pandemic public inquiry takes place, which will be needed in the interests of accountability, openness and transparency.”

    The PHE report said that those parts of UK society most affected included the elderly; Black, Asian and minority ethnic (BAME) populations generally and those BAME NHS staff on the frontline in particular; those with underlying conditions, such as diabetes and dementia; those living in care homes; and those from deprived communities.

    Twitter: @unitetheunion

    Facebook: unitetheunion1

    Web: unitetheunion.org

    Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.

     

     

    1 Comment

    By Brian Fisher in Accountability, BAME, Children, COVID-19, Education, Mortality, Science, Socialist Health Association, Staffing, Teachers, Technology, Work and health

    SHA statement on reopening schools in England during the COVID19 pandemic

    May 31, 2020

    This is a collective statement on behalf of SHA bringing together public health evidence and other opinions on a key Covid policy issue.

    The Westminster Government announced on May 10th that:

    “As a result of the huge efforts everyone has made to adhere to strict social distancing measures, the transmission rate of coronavirus has decreased. We therefore anticipate, with further progress, that we may be able, from the week commencing 1 June, to welcome back more children to early years, school, and further education settings. We will only do this provided that the five key tests set by the government justify the changes at the time, including that the rate of infection is decreasing. As a result, we are asking schools, colleges, and childcare providers to plan on this basis, ahead of confirmation that these tests are met”

    We believe that the 5 tests will not be fully met by June 1st and that this announcement was premature. This decision has been taken without transparency about the evidence that has been used on the direct and indirect health impacts. We now see French schools having to reclose.

    We also believe that the Government should have attempted to agree a consensus with Local Authorities and Teaching Unions before announcing a country wide directive around schools in general. The announcement has left schools without clear expectations, without a structure for managing this. We understand that many Local Authorities and schools will now have to seek the skills and information to figure this all out themselves. We believe that this uncertainly will lead to decisions that could adversely affect the health of children, teachers, families, and vulnerable people in their communities. We do not want a repeat of the mistakes in respect of care homes.

    In addition, it breaks the consensus across the four nations in the UK and shows little regard for regional variation or for impacts on inequities in health outcomes for everyone, and educational outcomes for children. Educational opportunities are a powerful determinant of long-term health outcomes.

    The SHA believes that the education sector has been systematically under-resourced and discouraged by this Government since 2010 under austerity, which leaves many schools with insufficient staff, increasing class sizes and inadequate environments that are less able to meet the stringent conditions to enable them to open as safely as possible in such a short timescale.

    We believe that the Government should have considered the following:

    1. How risks would be minimised, and benefits maximised:
      1. In the school environment, such as through safe distancing, handwashing, and other logistic measures to minimise transmission of COVID19, where staffing levels may not be sufficient and school buildings are not always suitable. Children use their bodies to learn.
      2. To children, in particular those in deprived neighbourhoods, in vulnerable groups, children from BAME families, and those with special needs. There is no clarity on alternative arrangements that could have been much more robust to safeguard, and to ensure their nutrition, learning and emotional needs. This should not rely on schools to provide these solutions now
      3. Allowing for the full autonomy of schools and their local authorities within their safeguarding obligations on an area basis
      4. To other groups, such as teachers, communities, and vulnerable groups, and weigh these against the benefits and risks to the wider society
    1. How harm would be minimised, and benefits maximised:
      1. To children who may be missing education which is likely to have a long-term impact on those from more deprived neighbourhoods and those who are less likely to have received equitable support at home
      2. To children who become infected, including asymptomatically and to their immediate household and contacts
      3. To the wider community, especially those that have had a high incidence of COVID19 and remain at high risk of further outbreaks and resurgences. These have disproportionately affected more deprived communities and those with a high proportion of BAME people
    2. How the overall public health response would support this move:
      1. How potential school outbreaks would be identified and managed in the absence of a fully functioning test/ treat/ isolate programme, particularly as some businesses are reopening at the same time.
      2. How schools will be supported by local public health services unless further resources and decision-making powers are decentralised to allow a robust and appropriate and rapid local multi-agency response

    The SHA believes that this decision has been reached without a clear rationale on the benefits and risks, and without demonstrating that the 5 key tests have been met:

    Test one: Making sure the NHS can cope

    Test two: A ‘sustained and consistent’ fall in the daily death rate

    Test three: Rate of infection decreasing to ‘manageable levels’

    Fourth test: Ensuring supply of tests and PPE can meet future demand

    Fifth test: Being confident any adjustments would not risk a second peak that would overwhelm the NHS

    We would add a Sixth: A fully functioning test/ treat/ isolate programme

    The SHA believes that the decision has been reached without sufficient consultation with key stakeholders and before the 5 tests have been fully met. In addition, the National Education Union has set 5 tests specific to educational settings, and we support their belief that in many areas these have not been met.

    We expect a more supportive response from the Dept for Education including investment into online learning and into a revived Sure Start model.

    The SHA believes that schools should be reopened at the right time but that the Government should make the best efforts to ensure that there is a consensus for when this should happen based upon relevant expert input rather than political pressure.  This has clearly not been achieved, as it has been in other countries that have gradually opened schools.

    We encourage Local Authorities and Academy Trusts to follow the example of LAs such as Liverpool, Haringey, North of Tyne, Hartlepool, and Brighton – and devolved governments in Wales, Scotland, and NI – in making it clear that they will not reopen schools until they feel it is safe.

    Sources

    Actions for schools during the coronavirus outbreak updated 18th May. Department of Education for England

    https://www.gov.uk/government/publications/covid-19-school-closures/guidance-for-schools-about-temporarily-closing

    NEU five tests for Government before schools can re-open

    https://neu.org.uk/neu-five-tests-government-schools-can-re-open

    ONS figures reveal 65 COVID-related deaths in education workforce

    https://schoolsweek.co.uk/ons-figures-reveal-65-covid-related-deaths-in-education/

    Which occupations have the highest potential exposure to the coronavirus (COVID-19)? ONS May 11th https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/articles/whichoccupationshavethehighestpotentialexposuretothecoronaviruscovid19/2020-05-11

    Coronavirus (COVID-19) related deaths by occupation, England and Wales: deaths registered up to and including 20 April 2020 May 11th https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/coronaviruscovid19relateddeathsbyoccupationenglandandwales/latest

    https://www.tes.com/news/coronavirus-doctors-back-teachers-fears-over-schools-reopening?fbclid=IwAR2JD0Np1x_lgG49xo1Hig4T9ozNto36vsG09Ue-mvAtMrTvhWVyegtphBE

    Prof John Edmunds

    https://www.theneweuropean.co.uk/top-stories/john-edmunds-tells-lords-decision-to-re-open-schools-is-political-1-6660526?utm_source=Twitter&utm_medium=Social_Icon&utm_campaign=in_article_social_icons

    Prof Devi Shridhar, Professor of Global Public Health, Edinburgh Uni &  Ines Hassan.

    https://www.theguardian.com/commentisfree/2020/may/20/british-schools-science-children-education-testing-tracing

    https://www.newschain.uk/news/young-children-will-still-socially-distance-school-health-chief-says-8334

    Schools re-close in France after 70 new Covid cases following re-opening  6-11yr classes. NB. French schools starting age is 6 not 3.

    https://www.independent.co.uk/news/world/europe/coronavirus-france-school-cases-reopen-lockdown-a9520386.html

    Comparative school age starts

    https://data.worldbank.org/indicator/SE.PRM.AGES

    NB. Denmark is also 6 and easier to manage s/d. long term impacts of formal learning too soon

    https://www.newscientist.com/article/mg22029435-000-too-much-too-young-should-schooling-start-at-age-7/#

    Formal learning in early years linked to criminality in teens

    https://www.res.org.uk/resources-page/the-impact-of-school-starting-age-on-teenage-criminality–evidence-from-denmark-.html

    Posted by Brian Fisher on behalf of the Policy Team.

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    By Shaun Noble in Accountability, Care Sector, Carers, COVID-19, Discrimination, Doctors, NHS, Nursing, Paramedics, Regulation, Staffing, Unite the Union, Work and health

    Johnson’s refusal to waive £400 charge for NHS migrant workers ‘mean-spirited’, says Unite

    May 21, 2020

    Boris Johnson’s hardline stance not to waive the £400 NHS surcharge for overseas health and social care workers combating coronavirus was described as ‘mean-spirited and shabby’ today (Thursday 21 May) by Unite, Britain and Ireland’s largest trade union.
    Unite, which has 100,000 members in the health service, said the hypocrisy of the prime minister was given extra piquancy as he singled out two non-UK  nurses – one from New Zealand and the other from Portugal – for praise after he survived his fight with Covid-19.
    The NHS fee of £400-a-year for care workers applies to those from outside the European Economic Area, regardless whether they use the NHS or not. It is set to rise to £624 in October.
    There is also controversy over the £900m figure which the prime minister told MPs is raised by this charge. The Institute of Fiscal Studies put the sum at a tenth of that – £90 million.
    Unite national officer for health Colenzo Jarrett-Thorpe  said: “Of all people, Boris Johnson should appreciate the wonderful and dedicated work of NHS health and social care professions, including the two non-UK nurses he singled out for particular praise in his fight for survival against coronavirus.
    “Therefore, the fact he won’t waive this £400 fee for overseas health and social care workers is mean-spirited and shabby.
    “With this prime minister warm words of praise come cheap, but a small financial gesture for NHS migrant workers, many of them low-paid, is beyond his compass. His stance is hypocritical.
    “Tonight, we will have the Thursday ‘clap for carers by the people of the UK, many of them who voted for Boris Johnson as recently as last December – there is a big irony here. This charge should be waived immediate.”:
     
    Unite senior communications officer Shaun Noble
    Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org
    Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.

     

    1 Comment

    By Theresa Griffin in Children, COVID-19, Education, Liverpool, Mortality, Science, Staffing, Teachers, Work and health

    To get our children back into education, but we need a locally managed approach and data.

    May 21, 2020

    Vested interest alert – yes I’m claiming that word back – I come from a family of school staff, teachers, TAs, school governors. The dedication and hard work of all school staff, caretakers, cleaners, cooks, governors have shown for the safety, education, well-being, in many instances feeding, their pupils throughout this crisis has been extraordinary.

    I am totally dismayed at any criticism. Staff have the well being and safety of their pupils at their very heart. Their views on the total opening of schools and the views of their representatives have to be totally respected. The issue is complex. In Liverpool, the elected City Mayor has chosen not to open schools on June 1st as a safe-guarding issue as this wonderful city is still reeling from a high rate of infection. Questions are being asked as to why Mayor Joe Anderson has taken this stance when schools in Denmark, led by our sister party, are opening. Joe has never said Liverpool can’t open its schools, he has said when it’s safe to do so and only then. Each local authority has its own characteristics, not only in terms of levels of this dreadful pandemic, but the physical nature and age of its school buildings, levels of deprivation, staffing, the amount of public funding available and not available, the differing needs of its pupils. Country by country comparison is far too simplistic. This is an educational, health and societal issue.

    We all want all our children back in school and we are most worried about our most vulnerable, where home-schooling in a cramped flat with no outdoor space is stretching our children’s educational and physical and mental health well-being. I have family members with differing views – what I do know is that they are taking decisions based on local circumstances and always with the education and health of their pupils and staff foremost in their thinking. What is clear is that our health and education services, so starved of resources in this dangerous and false economy of austerity, especially in cities like Liverpool, have to be funded properly based on demographic need. I sincerely hope this Government remembers that but I fear not. Is it safe to open schools to children other than those of key workers or classed as vulnerable? There will always be risk – the question is how to reduce it. We must now learn from other countries – transmission from children to adults, children returning to schools in Italy presenting with multisystem inflammatory syndrome weeks after exposure.

    The UK did not have community testing, contact tracing and isolation early. Surely the question is are schools safe enough to open? Which means we need information and monitoring at a local level, the amount of new cases locally and rates of transmission. Local data should be driving policy and assuming a date for the entire country is ideologically rather than data driven. We need to get children back into education, but a locally managed data driven approach has to be the only way. Prioritising testing over a date. Listening to our teaching staff and our unions.

    For Liverpool in present circumstances – I’m with Joe.

    Theresa Griffin Labour MEP North West 2014-2020

    Member SHA

    1 Comment

    By Shaun Noble in Carers, COVID-19, Health Care, Mortality, NHS, Nursing, Staffing, Unite the Union, Work and health

    Unions’ blueprint on NHS reopening is a ‘rocket booster’ for ministers to tackle PPE and testing crises, says Unite

    May 15, 2020

    The nine-point blueprint by 16 health unions for reopening the NHS should act as ‘a rocket booster’ for ministers to tackle the lack of PPE and the shambolic testing regime, Unite, Britain and Ireland’s largest union, said today (Friday 15 May).

    Unite, which has 100,000 members in the health service, is one of the 16 unions that has contributed to the blueprint designed to make the NHS the safest possible environment for patients, staff and visitors as the lockdown is eased by the government, and out-patient clinics and operations resume.

    Unite said that the three key issues that needed to be addressed urgently were the continuing lack of PPE; the ‘messy’ testing regime which has seen samples sent to the USA; and the withdrawal of the threat that NHS staff could be subject to a public sector pay freeze highlighted in leaked Treasury documents.

    Unite national officer for health Colenzo Jarrett-Thorpe said: “This blueprint by the health unions should act as a rocket booster for ministers to really get to grips with key elements of the pandemic.

    “A continuing shortage of PPE is a dark stain on the government’s response to the coronavirus emergency. We have ambulance, biomedical scientist, nursing and speech and language therapist (SALT) members telling us that there are still shortages and, in some cases, when it does arrive it is out-of-date, ill-fitting or not up to standard.

    “We have feedback from our members that they are being leaned on by NHS bosses not to raise the PPE shortages – but Unite urges them to #staysafenot silent and to #telluswhatPPEyouneed.

    “And we will back you to the hilt in raising these legitimate concerns that are of the highest public interest.

    “The testing regime totters between the shambolic and the messy. There is little openness and transparency about how the government will hit its increased 200,000 daily test target.

    “We have thousands of healthcare science members who could be used to better effect and engaged more substantively, so we can avoid the situation where samples are sent to America for analysis.

    “It appears that the right hand does not know what the left hand is doing as the ‘test, track and trace’ initiative struggles to get off the ground in a meaningful way.

    “Finally, our members are furious at the leaked Treasury assessment that a public sector pay freeze could be on the cards to pay for the cost of the pandemic. If the Thursday ‘clap for carers’ means anything, it should be that there can be no return to the age of austerity.

    “More than 270 NHS and social care workers have died due to Covid-19 and hundreds of thousands more are risking their lives on a daily basis to care for others – yet this does not seem to stop Treasury mandarins drawing up heartless proposals to freeze public sector pay, which a recent Unite survey has shown the public does not want.”

    The unions’ blueprint includes fast, comprehensive and accessible testing, and the ongoing, ample supply of protective kit, as well as calls for staff to be paid properly for every hour worked.

    Notes

    The NHS unions are: British Association of Occupational Therapists, British Dental Association, British Dietetic Association, British Orthoptists Society, Chartered Society of Physiotherapists, College of Podiatry, Federation of Clinical Scientists, GMB, Healthcare Consultants and Specialists Association, Managers in Partnership, Prison Officers Association, Royal College of Midwives, Royal College of Nursing, Society of Radiographers, UNISON and Unite.

    The final text of the blueprint is here

    Unions have been asking the government to fund a consistent approach to overtime across the whole NHS. They are currently awaiting government sign off on a joint proposal from employers and unions.

    The 16 unions represent health workers covering the whole of the UK. There may be issues specific to Scotland, Wales and Northern Ireland that can be taken up with the employer/union structures of those administrations.

    Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org

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    By Joe Karp-Savey in COVID-19, FBU, Pay Freeze, Regulation, Staffing, Work and health

    Treasury leak: Firefighters vow to fight any public sector real-terms pay cut

    May 13, 2020

    A confidential Treasury document leaked to The Telegraph revealed the government is considering a two-year public sector freeze to pay for the coronavirus response.

    The Fire Brigades Union (FBU) has hit back at any attempt to make key workers pay for yet another crisis they did not cause and has vowed to fight any real-terms pay cut.

    Matt Wrack, FBU general secretary, said:

    “Public sector workers were forced to pay for a financial crisis caused by the banks’ drive for endless profits and by a negligent government deregulation agenda. Now, once again, the Tories are preparing to make the same workers pay for another crisis they did not cause.

    “Firefighters have had a real-terms pay cut of around £4,000 over the last decade, much like workers across the public sector. Key workers and the public they serve will not accept another attempt to pass the buck from the rich to working people.  Far from discussing pay cuts, the government should instead be considering how best it can reward those who have got us through this pandemic.

    “The government is talking about dishing out medals to key workers in one breath, whilst planning pay cuts for them in another. We will fight any attempt to make those who see us through the coronavirus crisis pay for it with another real-terms pay cut.”

    Media contacts

    Joe Karp-Sawey, FBU communications officer
    FBU press office
    press@fbu.org,uk

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