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    To Members of the West Midlands SHA

    Dear Colleague
    Please find below the Sunday Times Response to the Government
    Courtesy of Spellar News
    John Charlton
    Secretary

    Coronavirus: how the government tried to dismiss Sunday Times investigation

    Senior scientists, a former civil service chief and Tory ex-ministers criticise the official response to our report

    Insight | Jonathan Calvert and George Arbuthnott  Saturday April 25 2020, 6.00pm, The Sunday Times

    The government’s defence of Boris Johnson over his failure to attend five successive meetings of the Cobra national crisis committee on the coronavirus has been dismissed by former Whitehall officials and senior politicians.A former head of the civil service, three Conservative ex-ministers and a former Downing Street chief of staff said it was usual for the prime minister to attend Cobra if he was in easy reach of London.They spoke out after the government issued a 14-point response in a 2,100-word blog to The Sunday Times’s account of the five weeks from late January, detailing how government inaction compromised attempts to tackle the virus.

    The government’s most senior ministers — including Dominic Raab, Michael Gove and Matt Hancock — leapt to the prime minister’s defence and tweeted copies of the blog, which claimed that the Insight team’s report contained a “series of falsehoods and errors”.Gove, the Cabinet Office minister, said on the BBC last week that “most Cobra meetings don’t have the prime minister attending them”.The government’s spin doctors were accused of misrepresentation by a doctor and a scientist who were quoted in the official response as suggesting that the severity of the threat from the coronavirus was not fully appreciated when Johnson missed the first Cobra meeting.The doctor, Richard Horton, editor of the medical journal The Lancet, accused the government of “Kremlinesque” manipulation of his words.The scientist, Martin Hibberd, professor of emerging infectious disease at the London School of Hygiene and Tropical Medicine, said the government’s response used his words out of context, cutting out a sentence calling for urgent action to gather evidence in preparation for a possible pandemic.

    The Sunday Times article revealed that Johnson did not attend his first Cobra meeting on the virus until March 2. He skipped the January and February Cobra meetings despite being in Westminster on four of the days that they were held and an hour’s drive away in Kent on the other.An analysis of more than 40 Cobra meetings on major emergencies that have been published in the decade since the Conservatives came to power shows that prime ministers usually chaired them — unless they were too far away from London to get to the committee on time. Only three were chaired by a secretary of state when the prime minister was in Westminster.

    Lord Kerslake, the head of the civil service between 2012 and 2014, said the prime minister typically chaired three-quarters of the Cobra meetings and the main reason for non-attendance was that they were away from London.He said: “[Cobra] is there for a national emergency and you don’t call it unless there’s something pretty serious. And if there’s something pretty serious, you would expect the prime minister to chair it.”His views were supported by three Conservative former ministers who were familiar with the workings of Cobra and by Jonathan Powell, Downing Street chief of staff under Tony Blair, who said he was not aware of an occasion when Blair had missed a Cobra meeting while he was at Westminster.Powell said: “It’s not impossible for the prime minister to miss Cobra meetings if something is happening in the world that’s more important or he’s out of the country. But the point of missing five is it’s a sign that we’re not taking the problem seriously enough.”

    In Johnson’s defence, the government’s “blog” gave three examples of times when a minister had chaired Cobra instead of the prime minister over the past 11 years. In two of these examples, it has emerged that the prime minister was unable to attend because he was abroad. One occasion was when Gordon Brown was in Poland — and yet he still phoned in to take part in Cobra. The other was when Johnson’s plane had just touched down in New York.The third example given by the government said Gove chaired Cobra over preparations for a no-deal Brexit. This meeting had never previously been acknowledged in public and this weekend Downing Street declined to say when it took place.

    Yesterday, Downing Street responded to our inquiries by sending a short paragraph taken from the 2011 cabinet manual, which states: “In general the chair [of Cobra] will be taken by the secretary of state of the government department with lead responsibility for the particular issue being considered.”However, a 2013 government document gives a fuller description of Cobra’s role. It says Cobra is mostly convened for “level 2” international emergencies — using the example of the swine flu threat — and says these meetings are controlled by the “Strategy Group”, which is chaired by the prime minister, home secretary or foreign secretary.Kerslake said it was customary for the prime minister to chair the strategy group.“Under the emergency planning guidance you would expect the prime minister to attend Cobra over the coronavirus crisis because it is clearly at least a level 2 emergency. Given its seriousness, I would be surprised if it was classified [as] any different from this.”

    Here we reproduce each section of the government’s statement and The Sunday Times’s replies.

     Government statement:

    Claim [by The Sunday Times] – On the third Friday in January Coronavirus was already spreading around the world but the government ‘brushed aside’ the threat in an hour-long COBR meeting and said the risk to the UK public was ‘low’.

    Response [by the government] – At a very basic level, this is wrong. The meeting was on the fourth Friday in January. The article also misrepresents the Government’s awareness of Covid 19, and the action we took before this point. Health Secretary Matt Hancock was first alerted to Covid 19 on 3 January and spoke to Departmental officials on 6th Jan before receiving written advice from the UK Health Security Team.

    He brought the issue to the attention of the Prime Minister and they discussed Covid 19 on 7 January. The government’s scientific advisory groups started to meet in mid-January and Mr Hancock instituted daily coronavirus meetings. He updated Parliament as soon as possible, on January 23rd.

    The risk level was set to “Low” because at the time our scientific advice was that the risk level to the UK public at that point was low. The first UK case was not until 31 January. The specific meaning of “public health risk” refers to the risk there is to the public at precisely that point. The risk was also higher than it had been before — two days earlier it had been increased “Very Low” to “Low” in line with clinical guidance from the Chief Medical Officer.

    The WHO did not formally declare that coronavirus was a Public Health Emergency of International Concern (PHEIC) until 30 January, and only characterised it as a global pandemic more than a month later, on 11 March. The UK was taking action and working to improve its preparedness from early January.

    Sunday Times reply:
    It was indeed the fourth Friday in January, but the date (January 24) was correct. We regret the error. The article does not misrepresent “the government’s awareness of Covid-19” before January 24. The article begins its narrative on January 24 and does not comment on what actions were taken before that date. The rest of this section challenges nothing that was reported in the article.

    ● Government statement:

    Claim [by The Sunday Times–‘This was despite the publication that day of an alarming study by Chinese doctors in the medical journal The Lancet. It assessed the lethal potential of the virus, for the first time suggesting it was comparable to the 1918 Spanish flu pandemic, which killed up to 50 million people.’

    Response [by the government] – The editor of the Lancet, on exactly the same day – 24 January – called for “caution” and accused the media of ‘escalating anxiety by talking of a ‘killer virus’ and ‘growing fears’. He wrote: ‘In truth, from what we currently know, 2019-nCoV has moderate transmissibility and relatively low pathogenicity. There is no reason to foster panic with exaggerated language.’ The Sunday Times is suggesting that there was a scientific consensus around the fact that this was going to be a pandemic – that is plainly untrue.

    https://twitter.com/richardhorton1/status/1220606842449072128?s=19

    Sunday Times reply:
    This is misrepresentation. Mr Horton issued his tweet at 7.18am and the alarming new Chinese study came in later the same day and was published straight away by The Lancet, which is confirmed by a tweet by Mr Horton at 3.05pm. Next day Mr Horton tweeted: “The challenge of 2019-nCoV is not only the public health response. It is clinical capacity. A third of patients so far have required admission to ICU. 29% developed ARDS. Few countries have the clinical capacity to handle this volume of acutely ill patients. Yet no discussion.” Two months later (March 27), Mr Horton said on BBC Question Time: “Honestly, sorry to say this, but it’s a national scandal. We shouldn’t be in this position. We knew in the last week of January that this was coming. The message from China was absolutely clear that a new virus with pandemic potential was hitting cities. People were being admitted to hospital, admitted to intensive care units and dying and the mortality was growing. We knew that 11 weeks ago, and then we wasted February when we could have acted. Time when we could have ramped up testing time when we could have got personal protective equipment ready and disseminated. We didn’t do it.”

    After the government cited Horton in its statement on Sunday night, Mr Horton tweeted on Monday: “Just for the record: the UK government is deliberately rewriting history in its ongoing COVID-19 disinformation campaign. My Jan 24 tweet called for caution in UK media reporting. It was followed by a series of tweets drawing attention to the dangers of this new disease.” On Tuesday Mr Horton told The Sunday Times that the government’s use of his tweet in their response to the article was “redolent of Kremlin-esque manipulation of evidence”. He added: “I find it very funny that Matt Hancock was asked a question about disinformation and he said, ‘we take it very seriously and we need to correct disinformation’. They really are scared that the verdict of history is going to condemn them for contributing to the deaths of tens of thousands of British citizens. And because they know they wasted a minimum of five weeks through February and early March they are desperately trying to rewrite the timeline of what happened. And we must not let them do that.”

    ● Government statement:

    Claim [by The Sunday Times] – It was unusual for the Prime Minister to be absent from COBR and is normally chaired by the Prime Minister.

    Response [by the government] – This is wrong. It is entirely normal and proper for COBR to be chaired by the relevant Secretary of State. Then Health Secretary Alan Johnson chaired COBR in 2009 during H1N1. Michael Gove chaired COBR as part of No Deal planning. Transport Secretary Grant Shapps chaired COBR during the collapse of Thomas Cook. Mr Hancock was in constant communication with the PM throughout this period.

    At this point the World Health Organisation had not declared COVID19 a ‘Public Health Emergency of International Concern’, and only did so only 30 January. Indeed, they chose not to declare a PHEIC the day after the COBR meeting.

    Examples of scientific commentary from the time:

    Prof Martin Hibberd, Professor of Emerging Infectious Disease, London School of Hygiene and Tropical Medicine, said:

    “This announcement is not surprising as more evidence may be needed to make the case of announcing a PHEIC. WHO were criticised after announcing the pandemic strain of novel H1N1_2009, when the virus was eventually realised to have similar characteristics to seasonal influenza and is perhaps trying to avoid making the same mistake here with this novel coronavirus. To estimate the true severity of this new disease requires identifying mild or asymptomatic cases, if there are any, while determining the human to human transmission rate might require more evidence.”

    Dr Adam Kamradt-Scott, Senior Lecturer in International Security Studies, University of Sydney, said: “Based on the information we have to date, the WHO Director-General’s decision to not declare a Public Health Emergency of International Concern is not especially surprising. While we have seen international spread of the virus, which is one of the criteria for declaring a PHEIC, the cases in those countries do not appear to have seeded further local outbreaks. If that was to start to occur, it would constitute a greater concern but at the moment the outbreak is largely contained within China.”

    Sunday Times reply:
    It is unusual for the prime minister not to chair Cobra, although, at times, ministers can stand in for the prime minister, especially when he or she is away. Boris Johnson was in Westminster for four of the five Cobra meetings and was a one-hour drive away in Kent for the other, yet he did not attend any of them. Alan Johnson chaired a meeting of Cobra during H1N1 because Gordon Brown, the prime minister, was in Poland (and phoned in from there). Mr Shapps chaired the Thomas Cook Cobra because Boris Johnson was in New York. Mr Gove chaired a daily “operations committee” known as XO in the Cabinet Office’s Cobra room while in charge of no-deal planning in 2019, but these were not Cobra meetings.

    The use of the two experts for the scientific commentary is selective quotation and misrepresentation. These two quotes are taken from six opinions published on January 24 by the Science Media Centre (SMC), a not-for-profit organisation that provides expert information for journalists. They were issued in response to the decision by the World Health Organisation not to declare the China coronavirus outbreak a public health emergency of international concern.

    It is notable that the government statement did not include Professor Hibberd’s final sentence, which says: “However, all this new evidence needs to be rapidly obtained over the next few days if the world is to be as prepared as possible, so WHO should issue a different type of alert to mobilise a full investigation.”

    Last week Hibberd told The Sunday Times that the government had taken his comment out of context and scientists’ warnings proposing caution and preparedness did not appear to have been acted on sufficiently by the government. He added: “I think all of the comments made on the 24th January in response to the WHO response, including my own full comment, reflected the need to prepare as much as possible for this new virus. While we were still seeking to learn what its full impact might be, we also expected our preparedness plans to be in place and in action, so that we could remain in control of this outbreak as much as possible. This was certainly done by other governments at the time, such as Singapore. We should not be caught unaware, even if we were unsure of the true severity.”

    The government also ignored another of the opinions published by the SMC that day, which amounted to a warning that the situation was very serious. It was by Dr Jeremy Farrar, the director of the Wellcome Trust, who unlike Hibberd and Kamradt-Scott is on the government’s key Scientific Advisory Group for Emergencies (Sage) committee. He said: “This virus has crossed from animals into people. That does not happen often, and it is, without doubt, very serious. People are scarred by the memory of Sars, and a global outbreak of a novel respiratory virus like this, is something experts have warned about for many years.”

    ● Government statement:

    Claim [by The Sunday Times] – ‘Imperial’s [Professor Neil] Ferguson was already working on his own estimate — putting infectivity at 2.6 and possibly as high as 3.5 — which he sent to ministers and officials in a report on the day of the Cobra meeting on January 24. The Spanish flu had an estimated infectivity rate of between 2.0 and 3.0, so Ferguson’s finding was shocking.’

    Response [by the government] – Infectivity on its own simply reveals how quickly a disease spreads, and not its health impact. For that, it is necessary to know about data such as associated mortality/morbidity. It is sloppy and unscientific to use this number alone to compare to Spanish flu.

    Sunday Times reply:
    The article made clear that what made the virus frightening in late January was the combination of the infectivity rate and the high rate of people dying and needing intensive care in the early study by the Chinese scientists.

    ● Government statement:

    Claim [by The Sunday Times] – No 10 “played down the looming threat” from coronavirus and displayed an “almost nonchalant attitude … for more than a month”.

    Response [by the government] – The suggestion that the government’s attitude was nonchalant is wrong. Extensive and detailed work was going on in government because of coronavirus, as shown above.

    Sunday Times reply:
    There are no examples given “above” of the government’s “extensive and detailed work”. Whether the government was nonchalant is a matter of opinion. The Sunday Times reported the facts.

    ● Government statement:

    Claim [by The Sunday Times] – By the time the Prime Minister chaired a COBR meeting on March 2 “the virus had sneaked into our airports, our trains, our workplaces and our homes. Britain was on course for one of the worst infections of the most insidious virus to have hit the world in a century.”

    Response [by the government] – This virus has hit countries across the world. It is ridiculous to suggest that coronavirus only reached the UK because the health secretary and not the PM chaired a COBR meeting.

    Sunday Times reply:
    The article did not say this.

    ● Government statement:

    Claim [by The Sunday Times] – “Failure of leadership“ by [the prime minister, according to an] anonymous senior advisor to Downing Street.

    Response [by the government] – The Prime Minister has been at the helm of the Government response to Covid 19, providing the leadership to steer his Ministerial team through a hugely challenging period for the whole nation. This anonymous source is variously described as a ‘senior adviser to Downing Street’ and a ‘senior Downing Street adviser’. The two things are not the same. One suggests an adviser employed by the government in No10. The other someone who provides ad hoc advice. Which is it?

    Sunday Times reply:
    The source was in a position to observe the prime minister’s leadership style. It is notable that no attempt has been made to deny the prime minister’s absence from key meetings and from Downing Street itself. Michael Gove has confirmed the prime minister missed five coronavirus Cobra meetings.

    ● Government statement:

    Claim [by The Sunday Times] – The government sent 279,000 items of its depleted stockpile of protective equipment to China during this period in response to a request for help from the authorities there.

    Response [by the government] – The equipment was not from the pandemic stockpile. We provided this equipment to China at the height of their need and China has since reciprocated our donation many times over. Between April 2-April 15 we have received over 12 million pieces of PPE in the UK from China.

    Sunday Times reply:
    Downing Street told The Sunday Times before publication of the article that the 12 million pieces of PPE from China was a commercial deal. It was not reciprocation for generosity.

    ● Government statement:

    Claim [by The Sunday Times] – Little was done to equip the National Health Service for the coming crisis in this period.

    Response [by the government] – This is wrong. The NHS has responded well to Coronavirus, and has provided treatment to everyone in critical need. We have constructed the new Nightingale hospitals and extended intensive care capacity in other hospitals.

    Sunday Times reply:
    The Nightingale hospital programme was announced in late March, long after the period in question, and was acknowledged in the article.

    ● Government statement:

    Claim [by The Sunday Times] – Among the key points likely to be explored are why it took so long to recognise an urgent need for a massive boost in supplies of personal protective equipment for health workers; ventilators to treat acute respiratory symptoms; and tests to detect the infection.

    Response [by the government] – The Department for Health began work on boosting PPE stocks in January, before the first confirmed UK case.

    – Discussions on PPE supply for COVID-19 began w/c 27 January (as part of Medical Devices and Clinical Consumables), with the first supply chain kick-off meeting on 31 January. The first additional orders of PPE was placed on 30 January via NHS Supply Chain’s ‘just-in-time contracts’. BAU orders of PPE were ramped up around the same date.

    – Friday, 7 February, the department held a webinar for suppliers trading from or via China and the European Union. Over 700 delegates joined and heard the Department’s requests to carry out full supply chain risk assessments and hold onto EU exit stockpiles where they had been retained.

    – Monday, 10 February, the department spoke with the major patient groups and charities to update them on the situation regarding the outbreak and to update them on the steps it was taking to protect supplies.

    – Tuesday, 11 February, the department wrote to all suppliers in scope of the Covid 19 supply response work – those trading from or via China or the EU – repeating the messages from the webinar and updating suppliers on the current situation relating to novel coronavirus. The NHS has spare ventilator capacity and we are investing in further capacity.

    Sunday Times reply:
    The article reported that the department had placed orders under “just-in-time contracts” on January 30. However, it pointed out that the source said these ran into difficulties because they were with manufacturers in China, which desperately needed its own PPE supplies at the time. Downing Street and the Department of Health confirmed to The Sunday Times that the “just-in-time contracts” were proving difficult. In contrast to what the government is claiming to be “detailed and extensive” activity, it presents no evidence of any further activity on PPE acquisition between February 11 and the beginning of March or any activity before the week beginning January 27. Its failure to point to a single delivery of PPE, testing equipment or ventilators during this period suggests a level of achievement even lower than the article reported.

    ● Government statement:

    Claim [by The Sunday Times] – Suggestion that “lack of grip” had the knock-on effect of the national lockdown being introduced days or even weeks too late, causing many thousands more unnecessary deaths.

    Response [by the government] – The government started to act as soon as it was alerted to a potential outbreak. Mr Hancock was first alerted to Covid 19 on 3 January and spoke to Departmental officials on 6th Jan before receiving written advice from the UK Health Security Team. He brought the issue to the attention of the Prime Minister and they discussed Covid 19 on 7 January. The government’s scientific advisory groups started to meet in mid-January and Hancock instituted daily meetings to grip the emerging threat. We have taken the right steps at the right time guided by the scientific evidence.

    Sunday Times reply:
    The government response does not address whether the lockdown was too late.

    ● Government statement:

    Claim [by The Sunday Times] – Scientists said the threat from the coming storm was clear and one of the government’s key advisory committees was given a dire warning a month earlier than has previously been admitted about the prospect of having to deal with mass casualties.

    Response [by the government] – The government followed scientific advice at all times. The WHO only determined that COVID 19 would be a global pandemic on 11 March. Claiming that there was scientific consensus on this is just wrong. Sage met on January 22 but the first NERVTAG meeting was held on 13 January (NERVTAG is the New and Emerging Respiratory Virus Threats Advisory Group – see here https://www.gov.uk/government/groups/new-and-emerging-respiratory-virus-threats-advisory-group).

    Sunday Times reply:
    These statements of fact contradict nothing in the article.

    ● Government statement:

    Claim [by The Sunday Times] – The last rehearsal for a pandemic was a 2016 exercise codenamed Cygnus, which predicted the health service would collapse and highlighted a long list of shortcomings — including, presciently, a lack of PPE and intensive care ventilators.

    Response [by the government] – The Government has been extremely proactive in implementing lessons learnt around pandemic preparedness, including from Exercise Cygnus. This includes being ready with legislative proposals that could rapidly be tailored to what became the Coronavirus Act, plans to strengthen excess death planning, planning for recruitment and deployment of retired staff and volunteers, and guidance for stakeholders and sectors across government.

    Sunday Times reply:
    The Coronavirus Act received royal assent on March 25 of this year, so any measures brought in under the law were put in place after the virus had seriously taken hold in Britain and almost four years after the exercise itself.

    ● Government statement:

    Claim [by The Sunday Times] – By February 21 the virus had already infected 76,000 people, had caused 2,300 deaths in China and was taking a foothold in Europe, with Italy recording 51 cases and two deaths the following day. Nonetheless NERVTAG, one of the key government advisory committees, decided to keep the threat level at “moderate”.

    Response [by the government] – This is a misrepresentation of what the threat level is. This is about the current public health danger – and on February 21, when the UK had about a dozen confirmed cases, out of a population of over 66 million, the actual threat to individuals was moderate. In terms of the potential threat, the government was clear – on 10 February the Secretary of State declared that “the incidence or transmission of novel Coronavirus constituted a serious and imminent threat to public health”.

    Sunday Times reply:
    If on February 10 the virus was considered — even potentially — a serious and imminent threat to public health, why did the prime minister not attend a Cobra meeting until March 2?

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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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    Sion Simon

    We’ll defend our NHS, prioritising mental health and championing a healthy region
    I want to see an outstanding NHS in the West Midlands – with parity of esteem between mental and physical health,  supported by a physical activity strategy for everyone in the region. Yet the Tories are doing their best to destroy it.

    This is how we will take control of our NHS in the West Midlands:

    • Defend the NHS against Tory cuts – demanding our fair share so that frontline services in the West Midlands are of the highest standard. Seek powers to devolve more NHS strategic planning and commissioning to the regional level.
    • On taking office I will immediately convene a task and finish group, using the outstanding professional expertise we have in the region – to radically redesign our approach to both the health care and social care of our older people. We will seek extra powers from government if needed.
    •  The Tories have shortchanged the care of our older people. We will have to use our skills strategy to create a bigger care workforce, encourage new entrants to the market through social enterprises and push for universal recognition of the Ethical Care Campaign, which champions our region’s caring home-workers.
    • Back the NHS by working with local universities to train more nurses and doctors in the West Midlands – and keep them in the region. We’ll work with our hospitals to grow the number of local people we train to deliver the NHS of the future.
    •  Mental health to have parity of esteem with physical health – working with partners to achieve early diagnosis and treatment, more and better support for carers, and steps to tackle stigma. Fully implement the WMCA Mental Health Action Plan, while extending a pro-active approach towards mental health to childhood.
    •  Work with local authorities to produce a West Midlands strategy for physical activity, giving everyone in the region the confidence, opportunity and motivation to participate in sport and recreation.
    •  Maintain and grow the world class research base in life sciences of the West Midlands – strengthening partnerships between universities and local business.
    •  Give people more control over their own health – by supporting the development of apps that provide health information, supporting the development of personalised care budgets, and crucially improving prevention of health
      problems. We’ll bring public services together to promote health initiatives, promoting healthy food availability and tackling bad practices in advertising and promotion of unhealthy food.
    • Make the public realm as supportive and inclusive as possible for those with dementia, autism, and all those with conditions that need particular forms of support – and encourage a wider understanding of the care required for these people to live with appropriate dignity and vitality.
    • We will raise awareness of the importance of children’s oral health, promote new schemes in nurseries and schools and aim to reduce the number of child tooth extractions – which cost our NHS millions every year.
    • In line with our ethos of early intervention, we will introduce a new general principle in the West Midlands that no child here who needs mental health support will be turned away or forced to wait long periods to access the support they need.
    •  We will encourage innovative approaches to GP prescribing across the West Midlands, where GPs are able to offer patients a range of non-traditional support, working with voluntary organisations to deliver more counselling and
      help to get active.
    •  Monitor the impact of health and social care  devolution in Greater Manchester and move to replicate successes, providing sufficient funding is secured from central government.
      • Working with the NHS to tackle health inequalities and improve awareness of LGBT issues and tackling domestic abuse in the LGBT community and the barriers that exist around reporting.

    More about Sion’s manifesto

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    From the West Midlands Socialist Health Association, April 2016

    Towards a Manifesto for the NHS

    There were two significant health events during March: on the 3rd Shadow Health Secretary Heidi Alexander addressed a Labour Health Dinner in Birmingham (organised by WM Labour Finance & Industry Group), followed by Q&A with her and Philip Hunt (Labour’s Deputy Leader in the Lords, and former Health Minister). The discussion was continued at the WMSHA AGM on 19th March, when Philip spoke at greater length about current events in the NHS. It was clear from what they both said that the NHS faces a crisis, exacerbated by the actions of the Conservative Government that took office in 2015.

    Key issues from Heidi Alexander and Philip Hunt

    On– very recently – taking up her role, Heidi’s three immediate concerns were NHS funding, workforce and the development of Labour Party policy on health and social care over the next 3-4 years. At the AGM, and in discussion on both occasions Philip Hunt and others raised, in addition, implications for Labour Party policy on the balance between resources and cost pressures, and the structural issues of devolution and integration of social care with health care. These are the headings for what follows:

    Funding

    Labour raised NHS from 6% GDP in 1997 to 8% by 2010. Osborne is trying to reduce total public sector to 1950s levels (37% of GDP), and NHS is slipping back towards 6% again.

    The NHS is now well down the international league tables on both resources and performance: 24 OECD countries spend more as % of GDP (eg Germany 11%), and 20-30 have more modern medicines and equipment. The 95% 4 hour target for A&E has not been met for 6 years, and now stands at 86%.

    The ‘extra £8bn’ negotiated by Simon Stevens has mostly been spent already to plug 2015/16 Trust deficits and the pension shortfall. The rest of his £30bn requirement depends on 3% pa ‘efficiency gains’ – levels never achieved before, and not achievable. Clinical Commissioning Groups are already rationing care to stay solvent. Acute Trusts will be £2.5bn overspent by end March – but at the same time Jeremy Hunt is requiring many to increase staffing. A Trust Finance Director has written to the Health Select Committee to say that Regulators are making Trusts disguise their real financial position.

    The promise of ‘equal esteem’ for Mental Health has not been met. Present provision is very poor, especially for adolescents, storing up even greater future problems.

    Alongside reducing real resources, cost pressures are increasing:

    • Patients with multiple chronic conditions have increased from 1.9 to 2.9 milion since 2002, and the proportion of the population over 75 is also on an upward trend;
    • Poverty has huge impacts on health, and inequalities are increasing;
    • New medicines and technologies are seen as a cost not a benefit, even when giving better care;
    • New medicines developed here are often not available to NHS: this is putting UK presence of US-based firms at risk.

    The fall-out between Ian Duncan-Smith and George Osborne may be an opportunity to reopen resource issues, but demographic and cost pressures (above) mean there are no easy choices.

    Workforce

    The NHS has never been good at aligning training provision with its future staff needs. Ill thought out short-term changes have led to indefensible raids on trained staff from poorer countries and escalating agency costs. This has got even worse over the last 5 years:

    Removal of student nurse bursaries, and nurses having to pay for their clinical experience as well as course fees and costs (which many mature students will be unable to do);

    Professional development is being lost as a casualty of short-term, crisis driven decision-making;

    Turnover of CEOs/managers prevents longer-term planning

    The handling of Junior Doctors’ dispute continues to be disastrous:

    • Cavalier overturning recommendations of independent pay reviews;
    • Implying Junior Doctors don’t currently work week-ends is simply wrong;
    • For a uniform 7-day week service consultant rotas would have to change more and the cost implications of that are unknown;
    • The legacy of industrial unrest, poor morale and potential exodus are all escalating.

    Integrating health and social care,

    Sir John Oldham’s Health Commission provided a template for ‘whole person care’, but Health and Social Care are still differently priced and delivered. Councils cannot overspend, so must use assessments to ration Social Care to fit their budget. This means the NHS will be forced to spend more: whether by re-badging Health money or accepting the costs of delayed discharge.

    Bringing Health and Social Care together requires us to tackle this basic problem, but already Social Care budgets are being raided to balance DoH books.

    ‘Sustainable Transformation Plans’ (cuts) are being required of Clinical Commissioning Groups. There are 44 CCG consortia in England, but these do not relate to Council boundaries or roles.

    Prevention of ill-health through Public Health action is essential to the long-term sustainability of the NHS, but budgets have already been cut (£200m cut this year, £300m next).

    Devolution

    Devolution could improve efficiency (eg early years education that focuses on future health), but:

    • Councils must ration to stay within budgets while the NHS is demand-led: so one or both must change, meaning structural changes would be needed in parallel;
    • There are not enough councillors who understand health issues, so Combined Authority leadership will be crucial;
    • There is a risk of devolution being a device for Government to blame Councils for NHS failures;

    The link between the healthcare sector of the local economy and innovation in the NHS could be strengthened with benefits to both, but the Innovation hub infrastructure has been run down and needs regeneration (in Manchester it is in better shape).

    IT could be key to changing relationships, but would require an approach that fostered participation, trust and enthusiasm rather than imposition, suspicion and resistance. The bottom-up strategy successfully pioneered by Bologna perhaps offers lessons.

    Developing Labour Policy

    (a) Process

    Heidi expressed her intention listen to those with expertise over the next 3-4 years while policy is being developed (communications by e-mail to her or her assistant, Tom Witney). Pointers that should guide the process include:

    1. The present Government piles on demands, but without accepting the associated costs. Under Labour the NHS needs to take fiscal responsibility, so there must be room for manoeuvre between headings: setting priorities means some expenditure headings may need to be reduced.
    2. Looking forward, money is the big issue. We can’t accept Government story that NHS expenditure must be reduced, but the public appetite for more taxation is limited. Labour must have a credible story on how it will meet costs, so other funding sources may have to be considered.
    3. The perpetual imbalance between acute medicine (urgent, politically sexy) and prevention (non-urgent, unsexy but important), needs to be recognised as a political, not technical question. The notion of a ‘Non-political NHS’ is a pipe dream. The Labour Party must lead on what NHS should look like and how it should be paid for.
    4. Labour MPs want less privatisation, and no-one wants more top-down reorganisation, but dismantling the present system is a substantial restructuring in itself;
    5. At present managers are not in control – consultants are, and this may need to change;
    6. PFI costs not huge in context of NHS overall – may be waste of time/money to undo?
    7. Competition law still exists but tendering is no longer favoured by NHSE (a powerful disincentive);
    8. Should not be panicked as private interest already tempered by lack of room to make profits;
    9. However, TTIP remains a real threat (though an isolationist US may be less keen to sign?)

    Current private members bills seeking to return NHS to its roots may pre-empt necessary debates about structures, funding and priorities, especially if treated as ‘loyalty test’ (SHA Central Council has yet to consider).

    Real workforce planning is crucial to institutional stability and longer-term financial sustainability.

    (b) Next steps

    At the AGM we agreed that the issues arising from the presentation and subsequent discussion should be circulated preparatory to holding a West Midlands Health Conference in the autumn. We also noted that a national SHA policy conference is to be held in Birmingham on 18 June, providing both a milestone and further opportunity for our input.

    Alan Wenban-Smith

    1 Comment
    On Tuesday 4 March the West Midlands Socialist Health Association Executive discussed the proposals from the SHA Governance Group, with the benefit of input from Rachel Harris who is a member and Peter Mayer who is one of our Central Council representatives.  We understand that the proposals are to be considered at the SHA AGM on 8 March, and we feel that as the largest SHA Branch outside London our views should carry some weight. 
    We agreed that the following points should be brought to the attention of the AGM:
    1. Process: The proposals are voluminous and far-reaching in their implications, but even as committed and engaged members of SHA we have only become aware of their existence in the last few days. While we understand the need to consider an overhaul, we do not believe that these (or any other) proposals should be adopted until there has been a more active process of consultation with members.  With all due respect we do not think that posting material on the website fulfils the aspirations for ‘Democracy, Accountability and Transparency’ espoused by the document itself. 
    2. Structure: the paper is not structured in a way that assists understanding of its purpose and how the measures proposed will achieve them.  We think it would be helpful in carrying out a consultation with members to revise the paper to distinguish at least these three elements:
      • A preamble stating the purposes to be pursued and the strategic approach proposed;
      • The key elements of the constitutional changes that flow from that approach (with any consequent wording changes to the existing constitution relegated to an Appendix)
      • A series of headings briefly stating what kinds of changes might be necessary to subsidiary administrative instruments (Standing Orders, etc).  These should not be developed in any detail until and unless the guiding constitutional principles have been agreed.
    3. Policy: while we can see the need for clearer processes for deciding and promulgating SHA policy, and for handling complaints and HR issues, we feel that a sledgehammer is being taken to a nut. The processes and structures seem over-elaborate, more suited to a larger (and richer) organisation, and risk compromising the essence of the SHA as a small but responsive and nimble organisation. We are concerned that the proposal for a small Executive Committee with effective oversight of all policy work risks an oligarchy that undermines rather than promotes transparent member involvement.  The present Director has achieved this admirably over several years, and changes should therefore be made with care and circumspection. 
    4. Branches: as one of the largest branches of SHA we feel strongly that proposals affecting branch rights, obligations,  structures and relationship to the SHA should be brought together into a single coherent statement. We would like to invite the Chair of the Group to come and discuss the proposals (as a whole) at a Branch meeting convened for the purpose.
    With best regards
    Alan Wenban-Smith
    Chair, West Midlands Socialist Health Association
    1 Comment

    A look at the DH’s ‘secret’ risk analysis of the NHS changes, and why Lansley blocked its publication

    From the West Midlands Socialist Health Association, May 2012

    The Health & Social Care Act – the missing Risk Register

    The Health & Social Care Bill is now an Act, thanks to the failure of LibDem peers to listen to the pleas of their remaining supporters.  Before it passed, Labour made strenuous efforts to secure publication of the Department of Health (DH) official Risk Register, so that legislators would know the risks the Government was taking.  Andrew Lansley refused publication, claiming it would undermine advice given to Ministers by making civil servants pull their punches.  But apart from the slur on civil service professionalism – would the outcome have been any different if Labour had won the case?  The Risk Register has leaked [1], so now is your chance to find out.

    What is in the Risk Register?

    The Register is only 7 pages, but lists 42 major risk headings, rating each in terms of immediacy, likelihood and impact – with a brief note about how the impact might be mitigated.  One third of the risks were rated as both highly likely and high impact, and in half these cases the danger was described (in September 2010) as ‘imminent’.  To give just a few of the more striking examples:

    1. Costs and where they will fall are not known, so the new system could be unaffordable: eg GP consortia could add to costs by using private sector organisations or staff.
    2. Implementation will begin without knowing how the transition is to work, making accountability unclear. Who is responsible for funding when outgoing Strategic Health Authorities and incoming National Commissioning Board are running in parallel? Or for commissioning with both outgoing PCTs and incoming GP Commissioners in place?
    3. A transition managed by people who are themselves at risk will lead to worse performance, delays and losses of key staff.
    4. NHS changes will overtake changes to DH, public health and social care, so the parts of the system do not work properly together. Good people will be lost from PCTs and then have to re-recruited, while PCTs pass their roles to GPCs before their functions and budgets are clear (this, incidentally, is regarded as only a medium impact outcome).

    The Risk Register is just about the process of transition, but the problems that were identified in October 2010 may have been serious enough to give Ministers a shock, particularly as the mitigation measures are generally unconvincing.  This may be one reason why they agreed to a ‘pause’ in April 2011, though some of the risks (eg the diversion of GPs from clinical work to managing £20bn cost savings) have come to pass, unmitigated.  Moreover, although begun well ahead of Parliamentary approval, the transition still has a long way to go.

    However, several of these ‘transition risks’ are also implicit criticisms of the new system, which we turn to next.

    What is not in the Risk Register?

    The complexity of the new structure will, in itself, make it more difficult to improve productivity and quality or to reduce health inequalities.  Further major risks resulting include:

    1. As there is no equivalent half-managed, half-regulated structure anywhere else in the world to use as a model or benchmark, the risks are unknown and impossible to mitigate;
    2. In undergoing marketisation the NHS riks the same fate as the rail network and water utilities, where the resulting chaos led to restoration of partial Government control through further structural change and regulation.  It might also lead to introduction of privatised intermediaries on the US model with massive cost increases (see Briefing No 6 on the Americanisation of the NHS, and further comments below);
    3. Unbridled localisation makes it difficult to tackle inequalities, driving unsustainable increases in costs because inequality is itself a major cause of increasing ill-health;
    4. Longer term ‘outcome’ targets may be a good idea, but the risk of simply doing away with ‘process’ targets (because they are unpopular) means the end of Labour’s steady gains in productivity, quality and safety.  These are even more vital when resources are short.

    Why was the Register not published?

    The refusal by Andrew Lansley to publish the Risk Register has been severely criticised in a report this month by the Information Commissioner (http://www.bbc.co.uk/news/health-18071681).  The law permits Ministers to refuse publication only in ‘exceptional circumstances’: this is only the third occasion on which this power has been used, and the Commissioner does not believe the test has been met. There are two possible reasons for such an extraordinary decision, not mutually exclusive:

    1. This government has been characterised by gung-ho actions by Ministers keen to burnish their right-wing credentials (as well as Lansley, Gove and Pickles come to mind).  Authoritative risk analysis from Departmental officials would cramp their style, risking rebellion by LibDems and other doubters.
    2. Their aim of extending privatisation of the NHS in due course will require further acts of concealment from the public, so Ministers are testing the instruments of secrecy.  It is notable that although they have been criticised in this case, they have nevertheless succeeded in getting the legislation passed in the meantime.

    How should Labour respond?

    Moving onwards from marketisation to privatisation is the right’s hidden agenda.  The crucial step would be a move from a single-payer system (like the NHS, and other cost-effective national health services) to a multi-payer system (as in the US, where 10,000 insurance-based players generate enormous profits, add hugely to costs, and deny access to healthcare for nearly a third of the population).  This would effectively end the concept of universal national standard of care based on need, replacing it with one based upon provider profitability.

    Commissioning by GP-run CCGs was supposedly the whole point of the legislation.  But Commissioning Support Units (CSUs) are already in place, and in the process of taking over the commissioning function.  Because CSUs are non statutory they are free of public accountability or public duties.  The privatisation of the first CSU would thus signal a tipping point.  Labour must work hard to alert the public to this danger, fight any such move – and continue to demand that relevant information is placed in the public domain, so that debate can be informed.


    [1] get yours here: http://origin.library.constantcontact.com/download/get/file/1102665899193-912/Health-Bill-Transition-Risk-Register-NC-15-Oct-10-Dept-Bd-Version-v1.pdf

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