December 2015 – January 2016 Issue #21
IN THIS ISSUE:
- UHMB Trust: N Lancs CCG
- Lancashire North CCG
- Campaigns and media
- The NHS funding crisis
- How the NHS is being privatised step-by-step
- The NHS ‘devolution’ debate
- SPECIAL FEATURE: The Care Services crisis
- TTIP and ISDS
- How PFI works
Quote of the month
“It is crystal clear that the impact of fragmentation through privatisation is slowly eroding what was a National Health Service.”
From a report on NHS North West London’s Shaping a Healthier Future (SaHF) programme by the Independent Healthcare Commission (chaired by Michael Mansfield QC).
We are the 38 Degrees Lancs North NHS campaign group. We campaign only on NHS-related issues. We are Chris Holdsworth, Margaret James-Barber, Mary Linthwaite, David Nott and Jean Taylor.
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University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT)
Become a Trust member!
If you have not already joined, do consider becoming a Trust Member. Joining is easy – just follow the link and click on the ‘membership’ tab.
As a Trust member, you have a vote in elections to the Council of Governors.
The UHMB Trust Board
The UHMB Trust Board meets in public at 10.00 a.m. every month. Dates of forthcoming meetings, agenda papers, and minutes of previous Trust Board meetings, can be found on the Trust’s website.
700 additional pharmacists
When Morecambe Bay University Hospitals NHS Trust announced it would be selling off its outpatient pharmacy services to Lloyds Pharmacies (owned by a giant US corporation), it claimed that the Trust had neither enough cash nor enough pharmacists to keep these services (and the profits from them) in-house. Yet NHS England recently doubled the funding available for its national pilot of clinical pharmacists in general practice, meaning 700 practices will benefit from a share of the £31m fund. We welcome this development, which confirms that there is no nationwide shortage of pharmacists, but we wonder why GP surgeries find it possible to recruit pharmacists while our local hospitals seemingly cannot:
29 Vanguards, including Morecambe Bay
‘Integrated care’ is the new watchword. Read about the 29 NHS ‘Vanguard’ groupings.
Lancashire North Clinical Commissioning Group (CCG)
This is our local CCG. Its Governing Body meets in public at 2.00 p.m. every two months at the offices of the former Primary Care Trust, Moor Lane Mills, Lancaster. From 1.30-2.00 p.m., the Chief Officer and one or two other members of the Governing Body are available for informal discussion. The agenda papers for each of these 2-monthly meetings are very informative. Items on Strategy, and on Performance, are particularly worth consulting. See details of previous and forthcoming meetings.
What happens when a CCG can’t make ends meet?
Its management gets “taken over” by NHS England. Debt-ridden East Surrey CCG, which commissions healthcare in Tandridge, Reigate, Redhill and Horley, has been placed under legal directions, effectively stripping its autonomy to appoint board members and make key decisions. See Surrey Mirror article.
Campaigns and media
What happens when we tell the Government what we want?
The Government received 127,400 responses to its consultation on the NHS Mandate. This is what we said: “The main issues raised by members of the public were around the extent of private sector involvement in NHS services, whether the NHS is sufficiently – and the impact of seven-day services,” says the report on the consultation. People want less private sector involvement, more funding and aren’t bothered about the focus on seven-day-a-week care. Read how the Government intends to respond.
Don’t treat more patients, or you’ll go broke!
University Hospitals of Birmingham NHS Trust is in deficit for the first time in 20 years. Why? Listen to this enlightening interview with the Chief Executive, Dame Julie Moore, on Radio 4’s World at One (14 December). The 7-minute interview starts at 29:30.
Did you know that GPs have failed as a profession?
The government’s chief inspector of GPs told the Daily Mail that GPs have ‘failed as a profession’. Read this response from Dr David Wrigley, Carnforth GP and BMA Council member.
A 220-mile journey costing £100 to visit your daughter?
A petition to Lancashire Care NHS Trust to bring young people’s mental care services closer to home.
What do you know about ‘Devo-London’?
New Keep Our NHS Public Co-Chair and health campaigner Dr Tony O’Sullivan listed the dangers of the plans to devolve health budgets to five London boroughs in an interview for London Live on 15 December.
Government ministers have paid thousands trying to prevent the public from knowing which lobbyists and private health care companies Andrew Lansley met when he was health secretary preparing to privatise the National Health Service. See The Canary article.
‘No Health Sell-off’ screened in California!
A campaign group in California screened the film ‘No Health Sell-off’. Here is what the organiser reported to a KONP member about audience reaction:
We screened the movie last night. It sparked a lot of conversation and concern. Some of it went over our heads because it referred to incidents and politicians we are not totally familiar with, but that did not prevent us from understanding what is going on with the privatization of the NHS and the dire nature of situation. What struck us is that the “nightmare scenario” predicted if the “reforms” continue is that the UK system will resemble exactly the disastrous system we have in the U.S. In fact, we laughed dejectedly when the overhead numbers were listed. 5% pre-Thatcher, 14% post Blair, 30% if things aren’t corrected. 30% is where we were for decades.
Here in the states what is happening with the NHS is happening with our Medicare and Social Security Systems. The film lays the methods and motivations bare. Another chapter of our group Health Care for All is also going to screen the film. Our plan is to organize a Skype with you and Dr. Reynolds after they screen the film so we can all participate in a conversation. I know we’ll all have lots to share and strategize on. I will be in touch with some dates and times to propose to have that conversation. Thank you again for reaching out, for your participation in the film, and your offer to have a Skype session. We will be in touch very soon!
‘NHS mandate’ consultation
There were 130,000 responses to the Government’s NHS mandate consultation (the one they tried to keep quiet).
The ‘postcode lottery’
Variations in healthcare – maps showing regional variations in a large number of healthcare statistics.
The NHS funding crisis
Where will the ‘extra £3.8bn NHS funding’ go?
King’s Fund economist backs Labour claims that NHS trust deficits and pension costs mean little of the extra money will be available for better care. See The Guardian article.
Here’s where some of it is going!
“Nursing staff have been repeatedly told that there isn’t enough money to improve their pay, even after years of pay restraint. To learn that many senior NHS staff are enjoying pay rises and bonuses while nurses struggle to make ends meet is immensely demoralising”, said
Janet Davies, chief executive of the Royal College of Nursing. Read the Telegraph article.
New rules make it easier to ‘hide strain on NHS’
“Hospitals can no longer go on ‘black’ alert except in highly unusual circumstances (Christopher Furlong)
Health chiefs have been accused of covering up the strains on the NHS by changing the rules for when hospitals say they are struggling to cope.
An internal NHS document reveals that hospitals have been banned from declaring a “major incident” even if they are so overcrowded that patient safety is at risk.
In addition, trusts can no longer go on “black” alert, which is used to indicate when they are so overwhelmed that patient safety is at very high risk, except in highly unusual circumstances. These include patients being at risk in all the other hospitals in the area.
Hospitals’ declarations of “major incidents” and “black alerts” have previously drawn media attention to their difficulties. At least a dozen trusts had declared major incidents or black alerts by this time last winter after more patients came through accident and emergency departments than there were beds available.”
Starving the NHS of resources is the surest way of ensuring that more and more bits of it are outsourced/privatised/commercialised. Instead of demanding more capital investment and more annual funding for our hospitals, CCGs passively follow the ‘Choose and book’ rules of the 2012 Act, offering patients the ‘choice’ between private treatment ‘on the NHS’ with minimal waiting, and treatment, after many weeks’ wait, in an under-resourced, under-staffed and over-stretched NHS Trust hospital. Here are some recent examples of what this means for patients and for our NHS:
Back to the good old days – of rationing
Patients are being denied mental health care, new hips and knees, and drugs to boost their recovery from illnesses including cancer as the NHS increasingly rations treatments to try to overcome its growing cash crisis.
‘We are all potential patients, rich and poor alike, and to starve the NHS will ultimately have a negative impact on the health of the population as a whole,’ writes Dr Keith Paver. Read his and other letters on the NHS funding crisis.
The NHS is gripped by “an accelerating financial disaster” that could mean hospitals are unable to pay their staff next year, says Christopher Smallwood, chairman of St George’s University Hospitals NHS foundation trust.
The dangerous shortage of nurses
Nine out of 10 hospitals in England are reporting dangerous shortages of nurses. Staff said they were left fighting back tears because they were unable to provide safe levels of care – let alone provide comfort to patients.
Why are there not enough nurses?  not enough training places
Removal of nursing student bursaries is the latest in the government’s string of attacks on the NHS. Nurses are already in a recruitment crisis. The number of nursing training places has dropped by 8,000 in the last four years.
Why are there not enough nurses?  not enough people want to be nurses
Education bosses are forecasting a 40% shortfall in the number of postgraduate GP practice nurse training places they will fill this year.
The emergency ambulance emergency
In November 2015, London Ambulance Service was put into special measures by the Care Quality Commission, after a 54-member inspection team found a number of concerns regarding the safety and effectiveness of the service it provides to London’s 8.6 million residents. It is a finding which would surprise very few frontline ambulance personnel. In recent years, across the nation 999 staff have laboured under increasingly intolerable conditions.
How the NHS is being privatised step-by-step
You need to know about CSUs (Commissioning Support Units)
A huge privatisation is underway that will put US health insurance company United Health in a position to bid for contracts to provide NHS clinical services, at the same time as it advises clinical commissioning groups on what clinical services to plan and buy.
Emergency ambulances are provided by the NHS, right? Well, not exactly
Did you know that the use of non-NHS ambulance providers has risen substantially? They are now being used by all ten ambulance trusts in England to attend the most life threatening of incidents. Between January 2014 and March 2015, non-NHS ambulances responded to 139,086 life-threatening emergencies and 313,661 emergencies.
Spend, spend, spend – on management and consultants
A report on NHS North West London’s Shaping a Healthier Future (SaHF) programme by the Independent Healthcare Commission (chaired by Michael Mansfield QC) states that,
“It is crystal clear that the impact of fragmentation through privatisation is slowly eroding what was a National Health Service.”
Personal Health Budgets
NHS managers are spending more than £1m on the drive to get CCGs to offer more people personal health budgets despite ongoing concerns about how they will affect the health service.
Keeping private hospitals (very) private.
Jeremy Hunt is crying crocodile tears on patient safety – squeezing patients out of the NHS and towards private hospitals that are a ‘black hole’ of information.
Why ‘choose and book’ a private hospital?
The first reports from the CQC’s new inspection regime for private hospitals suggest that the risks to patient safety associated with the private hospital model in England may remain quite widespread. Did you know that a patient in a private hospital is the responsibility of the surgeon who brings them to the hospital, not of the hospital? Did you know that two private hospitals which were found to have significant safety risks were given an overall rating of ‘good’ by the CQC? Want to know more? Read this report (How safe are NHS patients in private hospitals? Learning from the Care Quality Commission) by the Centre for Health and the Public Interest (CHPI), an independent think tank committed to health and social care policies based on accountability and the public interest.
The NHS ‘devolution’ debate
The end of the National Health Service?
On 18 November 2015, PMQs included a crystal clear statement by Cameron in reply to a question about problems with Devo Manc:
Devolution of powers to local government will include health and social care.
This devolution includes devolving responsibility for the success or failure of these services.
Hey presto – the N in NHS disappears.
This is not news, but it has rarely been so clearly stated.
(Maurice Neville, KONP)
Devolution takes the N out of NHS
The end game is for devolution to replace Clinical Commissioning Groups (CCGs) – those local groups of GPs that the government told us would run our services in a less bureaucratic way. They are to be federated out to regional groups.
Where the Devolution Bill is taking us
The Devolution Bill lays the foundations for a complete reconstruction of the English state from which the Health Service is not exempted. At the heart of the Bill is a new power for the Government, through relatively lightly scrutinised secondary legislation, to transfer the functions and property of any ‘public authority’ to a county council, or a combined authority. ‘Public authorities’ include NHS England, CCGs, regulators, and trusts including Foundation Trusts. The functions to be transferred could include not just the commissioning but the provision of every area of NHS care.
Under cover of Devolution, local authorities and Combined Authorities are gaining the freedom to take their own piece of the NHS pie and dish it out as they see fit.
Devolution in question
Will NHS decentralisation create more efficient and integrated services closely fitted to local need, or will it become yet another damaging and distracting top-down re-organisation, compromising accountability and quality of leadership, as well as equity of access to services?
Devo Manc means big changes for GPs
GPs in Manchester are the first to be offered the chance to ditch the national contract and become part of large organisations that could eventually run services for the whole local population:
The Care Services crisis (Special Feature)
Give local authorities less money, and ask them to spend more on care services
According to the House of Commons Public Accounts Committee’s Report following its inquiry into the implementation of the first phase of the Care Act, which places additional cost burdens on local councils, “carers and the people they care for may not get the services they need because of continuing reductions to local authority budgets and demand for care being so uncertain”.
No help from the Spending Review
As the dust begins to settle on the November spending review, it is clear that it represents another setback for people who need social care.
‘Let councils pay for care’ – if they’ve got any money!
Using council tax to offset care cuts will widen the gap between rich and poor, because disadvantaged areas will be able to raise too little extra revenue to make any difference.
What happens to older people who can’t afford good care?
It’s time for us, as a society, to accept that the financial limitations we put on the funding of care inflict real pain on people. So far, the dedication and goodwill of underpaid staff has allowed the system to continue. See Guardian article.
The benefits cap on carers is discriminatory and a false economy
A judge asks: Why, if your aim was to save on public expenditure, he suggested, would you persist with a benefit cap that, by making carers homeless and those they care for reliant on social care services, piled huge extra net costs onto the taxpayer?
Care homes provision at risk
Crisis talks are taking place between care home owners and council leaders amid mounting concern a large number of providers are preparing to pull out of the market.
The UK’s biggest care-home operator has sold £20m worth of properties to an aggressive US investment fund as it reportedly struggles with a debt burden and diving profits. See Independent article.
Meanwhile, private investors are being enticed to purchase rooms in UK care homes on a buy-to-let basis with the promise of large profits and rental income.
Local concern over care for mental health patients
Lancashire Care NHS Foundation Trust (LCFT) has been rated as Requires Improvement by the Care Quality Commission (CQC).
Lancashire patients £800 a night beds crisis
Up to £800 a night is being spent on private beds for mental health patients in Lancashire as care providers struggle to cope with a huge increase in demand.
How to keep people with mental health problems out of A&E
In January, mental health admissions to A&E reached record levels, but some argue A&E is not appropriate for someone in crisis. How about a late night cafe?
Mental health patients crisis
At least eight people died in the two years 2013-14 after problems accessing psychiatric beds for mental health patients in crisis. This long article from November 2014 sets out the issues in great detail.
– and the following item shows clearly what is meant by ‘crisis’: After a mental health patient died after a “failure” to respond in a “timely way” by a stretched health trust team, the Norfolk and Suffolk Foundation Trust said there were “serious capacity issues” with its crisis resolution team.
Mental health has become the area of NHS and social care the public most worry about and want improved, with delays in getting treatment and too little support for people in need their main concerns.
A system at breaking point?
In February 2015, the Royal College of Psychiatrists said that the lack of acute beds available to mental health patients has left the system at breaking point.
In September 2015, an NHS trust was told there were no mental health beds available across the NHS and among private providers in England. The Norfolk and Suffolk NHS Foundation Trust medical director’s revelation prompted Norwich MP Clive Lewis to call for delays in planned bed closures:.
What happens (or doesn’t happen) in one part of the NHS affects other parts
A perceived crisis in the availability of mental health beds is actually caused by delayed patient discharges, according to an inquiry chaired by Lord Crisp.
An interim report by the Commission on Acute Adult Psychiatric Care has identified significant factors that could lie behind a shortage of beds in mental health services. See Nursing Times article.
£800 million care deal collapses
One of the largest NHS ‘market’ contracts to date has collapsed. The £800million (originally £1 billion) deal to provide NHS care for older people in Cambridgeshire and Peterborough failed after only 8 months, deemed “financially unsustainable”. What does this mean for the future of health care in the region? See Open Democracy article.
TTIP and ISDS
TTIP stands for ‘Transatlantic Trade and Investment Partnership’
The current EU-US TTIP negotiations are much more than just another move to lower barriers to international trade. What have these EU-US negotiations to do with the future of our NHS? Step in ISDS. ISDS stands for ‘Investor-State Dispute Settlement mechanism’
This is a provision which already exists in some investment agreements between individual countries to give foreign investors legal recourse if they feel the country in which they are operating has passed discriminatory legislation. If this becomes part of the proposed TTIP, it could for example make it illegal for any EU government to ban US private healthcare companies from gobbling up even more of the UK healthcare market.
The trouble with TTIP
A one-hour documentary about the dangers of the Transatlantic Trade and Investment Partnership trade talks being held between the European Union and the United States of America. See video.
Can’t spare an hour? Then watch this 8-minute video from Wikileaks. But keep your hat on, in case it makes your hair stand on end.
TTIP = a for-profit NHS – by law
Doctors in the United Kingdom are warning that passage of the Transatlantic Trade and Investment Partnership (TTIP) will mean certain death for the country’s public healthcare system, opening the door for privatisation and lawsuits from the United States’ for-profit medical industry.
What TPP does to others today, TTIP will do to us tomorrow
We still don’t know all the details of the Trans-Pacific Partnership (TPP) trade deal tentatively agreed to on Oct. 5 by negotiators from 12 Pacific Rim countries, but already critics are slamming it for many reasons, including its generous concessions to the pharmaceutical industry. Doctors Without Borders claims the TPP will “go down in history as the worst trade agreement for access to medicines in developing countries.” That’s because the TPP will extend patent protection for brand-name drugs, thereby preventing similar generic drugs (which are far less costly) from entering the market. This will drive up the prices.
‘But something even worse is coming, the result of negotiations conducted, once more, in secret: a Trade in Services Agreement (TiSA), covering North America, the EU, Japan, Australia and many other nations’ [George Monbiot, The Guardian, 3 Nov 2015].
How PFI works…
Bristol is home to one of the largest Private Finance Initiative hospitals in the country. But what is PFI? How does it work? And how can we find out more?
You could never tell just by looking, but Southmead hospital is half owned by a company called HICL headquartered offshore in Guernsey. Strange, no? It’s exactly this kind of weird fact that got me interested in my local hospital, who owned it and what, exactly, is the Private Finance Initiative. In my case, it was a short article in the local paper saying that Hereford hospital had failed a fire safety test. Why did it fail? Who was responsible? What were they doing about it? No-one was ever going to admit to it openly, there was far too much money at stake, so I set about sending Freedom of Information requests to try and find out.
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Two years and 1.5Gb of documents later, I’m still not entirely sure what happened. Except that it was much worse than I originally thought. But I managed to make some headway into the murky world of PFI, where public money and public services are dictated by private companies and commercially confidential contracts.
The new Southmead hospital is the fourth largest PFI hospital in the UK, one of 728 PFI contracts in total. It cost £430m to build, but over the next 35 years North Bristol Trust will pay £2.1bn in finance, service and maintenance costs.
Here’s how it works. Bristol needs a new hospital but the government doesn’t want to stump up a few hundred million in cash to get someone to build it. So instead, two private companies, Carillion and Aberdeen Asset Management, join together to borrow the money themselves, they design, build and maintain the hospital and we rent it back to pay off their loan, with interest and with a lot of strings attached.
The idea is that it’s like a mortgage, you pay in instalments rather than a lump sum. Except that this kind of mortgage comes with an exclusive contract for robots to carry around your laundry for the next few decades and the maintenance contract means you’ll need to ask permission, and pay a fee, every time you want to put a picture up on the wall.
Then you get the complicating factor that chunks of the contract can be sold off on an open market for public infrastructure. North Bristol Trust started out with Carillion, but it recently it sold off its £50m stake in the hospital to the aforementioned HICL, for a tidy £87m. The difficulty with private finance is that it is more expensive than public borrowing. Exactly how going with the supposedly pricier option is justified is a long and complicated story about the problems of financial modelling, better told by the National Audit Office, but the reason why PFI comes out cheaper is quite simple.
In theory, the answer to your value for money calculation should decide who pays for the hospital: the private sector or the public purse. But realistically, everyone knows that the government are never going to pay for it. If PFI doesn’t end up cheaper then Bristol doesn’t get a new hospital.
To get the calculation to work, you’re relying on two sets of assumptions that need to stay true for the next 30 years. On the Trust’s side, it needs to meet a set of stringent performance targets to make sure that it can keep patients flowing through a hospital with a third fewer beds than the combined Frenchay and Southmead sites. And on the contractor’s side, all the finance and service costs need to be accurate enough for the Trust to afford it.
It’s too early to tell how the Trust will manage with the new hospital. But on the financial side, we might never know. Exactly what North Bristol Trust is paying for is a commercially sensitive secret. Beyond the fact that the contract as a whole will cost £50m per year, there isn’t a lot of detail as to why.
The Trust and the PFI consortium have been fighting against providing more detail for two years. They are currently at the Information Rights Tribunal, the court for Freedom of Information requests, arguing against disclosing the full and unredacted PFI contract which will show exactly where the Trust is spending its money. For now, there are lots of questions and not many answers. What’s certain is that the Cable will be embarking on its own journey into the world of investigating PFIs.