Category Archives: West Midlands

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
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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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