Workers' Weekly On-Line
Volume 46 Number 5, March 8, 2016 ARCHIVE HOME JBCENTRE SUBSCRIBE

The Battle for the Future Direction of the NHS

NHS In Crisis - Save Lewisham Hospital
Campaign Conference and Discussion Day


On Saturday, December 5, at Goldsmiths College, South London, the Save Lewisham Hospital Campaign (SLHC) held a very successful and significant day-long conference entitled "NHS In Crisis - Why is our NHS under threat and what can we do to defend it?" Over a hundred people - health workers, NHS campaigners including some from other parts of London and beyond, patients, interested and concerned local people attended the conference.

The conference was opened by Heidi Alexander, Shadow Secretary of State for Health and Lewisham East MP. Heidi Alexander paid tribute to the SLHC saying that if it were not for the SLHC she would not have been given the job of Health Secretary. She pointed, "We saved our hospital, now we have to save the NHS" which was "on the brink of its biggest crisis for a generation". Heidi Alexander paid tribute to the Junior Doctors saying that they were "the front line for the NHS". She opposed the scrapping of bursaries for student nurses and again praised the SLHC saying that "it is still needed".

Louise Irvine


Louise Irvine and Tony O'Sullivan

The Chair of the SLHC, Louise Irvine, gave an introductory keynote talk: The NHS in Crisis. We give some of the main points of her speech:

This conference has been organised by the Save Lewisham Hospital Campaign to help to raise the general understanding of what is happening to the NHS just now, and to arm the participants with information, arguments and ideas to enable them to organise and campaign effectively in defence of the NHS. The Save Lewisham Hospital Campaign has continued as an active campaign. The hospital was saved, but there can be no illusions that the victory is secure for all time and Lewisham must fully expect further attempts at downgrading the hospital. Furthermore, the campaign to save Lewisham hospital taught everyone that no one service can be safe unless all the NHS is safe. Lewisham does not exist in isolation and all the pressures on the NHS nationally also affect Lewisham. So it can be said that the local is national and the national is local. That is why the conference has invited speakers from other parts of London and beyond. The English NHS is facing attacks on many fronts that undermine its fundamental nature as a public service, free, equitable, comprehensive. But there has also been resistance to those attacks - which have led to some successes or are managing to hold the line - and strength and inspiration should be drawn from those campaigns. Today's conference will hear from campaigners in north west London and also in Leicester where they are facing major reconfigurations of services and hospital and bed closures. The threats to the NHS are in four main areas: funding, privatisation, attacks on staff, and reconfiguration of services leading to cuts and closures.

Funding

As regards NHS funding, despite government rhetoric, funding is not protected as it does not match rising need due to changing demographics and increased costs of health and medical technology. Rising health care needs would require a 4% annual real terms funding increase - the same as in other developed countries - but there has only been and will only be a 0.9% annual real terms increase so that means inadequate funding in relation to need and reduced spending in real terms per capita. George Osborne's fanfare announcement of another £3.8 billion for the NHS in his Autumn Statement is "front loading" of the promised extra £8 billion by 2020. Such "front loading" was vital in the face of a £2 billion hospital deficit and impending winter crisis like last year. However, over the next five years the annual increase will be less and overall, adjusted for inflation, it is only 0.9% annual increase - no different from the past five years, and not nearly enough to meet growing health care needs. In addition, cuts to social care will exacerbate the problems in the NHS as inadequate social care leaves many older and disabled people vulnerable and at risk of deterioration in their health or unable to be discharged from hospital, and at least £1.5 billion being taken out to shore up social care as the Better Care Fund. The NHS budget is no longer ring fenced and non clinical services have seen big cuts with £1.5 billion removed from the public health and the education and training budgets to contribute to the £3.8 billion "increase" for front line care. Moving money around from one section of the NHS to another is not a genuine funding increase. It is short- termism to cut public health and training and education budgets.

Despite government boasts to the contrary, this is the lowest average annual change of any decade, contrasting with average annual increases of 5.7 per cent under the Labour administrations between 1997/8 and 2009/10 and 3.2 per cent under the Conservative administration between 1979/80 and 1996/7. This represents the largest ever sustained reduction in NHS spending as a percentage of GDP. Compared to others, the United Kingdom (for which figures are given by the Organisation for Economic Co-operation and Development) has slipped further into the bottom half of the OECD health spending league - overtaken by Finland and Slovenia. But even with the promised £8 billion by 2020 the NHS must find £22bn efficiency savings by 2020 that nearly all informed opinion believes is highly unlikely. Around three quarters of savings found in the last five years in the NHS have come through cuts to tariffs (the price paid to hospitals for treatments) and capping NHS workers' pay. But neither are sustainable going forward, with hospitals in open revolt over tariff reductions and NHS staff increasingly voting with their feet.

Regarding local authority spending on social care for older people, since 2009/10 this has fallen in real terms by 17 per cent; over the same period, the number of older people aged 85 and over rose by almost 9 per cent. It has become much more difficult for people to get publicly funded social care and that numbers had fallen by 25 per cent since 2009 (from 1.7 million to 1.3 million) and in 90 per cent of local authorities only those with "substantial" or "critical" needs will get publicly funded services. Social care is often neglected, and just trotting out statistics does not do justice to what is really happening. Health and social care must both be properly funded. It is a political choice, and the austerity argument that there is no more money is unsustainable when there is money for bombs, but that for health care is denied. So much money is being wasted on the market, management consultants and so on. Abolishing the market in the NHS would liberate resources for front line care. Yet, the amount of contracting and privatisation has increased steadily throughout the last government and into this one. This was accelerated by the Health and Social Care Act 2012.

Privatisation

This Act also created new structures which changed the NHS from being a public service with a duty on the part of the government to provide a comprehensive health service to a marketised system with groups of GPs in clinical commissioning groups (CCGs) allocating resources by contracting services out to the market, allowing private companies to bid for contracts and to compete with NHS providers. The government claimed last year that only 6% of clinical services had been privatised but that was before 2013, before the section 75 regulations kicked in. According to the NHS Support Federation, which monitors contracting, between April 2013 and October 2014, £18.3 billion worth of contracts to run or manage clinically related NHS services were advertised in the first 18 months since the Health and Social Care Act came in to effect in April 2013. In the same period £5 billion worth of contracts were awarded through the market. Non-NHS providers have won two thirds of these clinical contracts. The value of NHS contracts being awarded through the market is rising significantly. In the first six months after the Health and Social Care Act came into effect (April-September 2013) over £400m of NHS contracts were awarded. A year later the number of awards in the same six-month period (April-September 2014) had doubled and their value was over seven times higher, at £3bn. She said that 10% of General Practice was owned by companies like Virgin and that spending on private firms to provide 999 ambulances has doubled in the last three years from £24m to £56m.

In the sphere of community care, Virgin Care was awarded a £130 million contract from March 2013 in Devon to run children's services and services for people with learning difficulties and adolescents with mental health problems. It has a £450 million contract to run a range of community services in Surrey, and recently won the contract for community child health in Wiltshire. In the sphere of elderly care, an £800 million contract in Cambridgeshire was tendered out at a cost of £1 million for the tendering process itself. The contract was won by two NHS Trusts who have, after just eight months, handed it back to commissioners as it was not "financially viable". As regards cancer care, in July 2014, four NHS GP-led clinical commissioning group areas in Staffordshire tendered for a £687 million, 10-year contract, the first such contract in this area opened up to private companies. The four CCGs involved are also seeking bidders for a separate £340 million 10-year contract to provide end-of-life care. Together the contracts are worth £1.04 billion. Health care planning and management has been privatised. Recently a £6 billion, 5-year contract for commissioning support was given to a private company. Capita won a £6 billion contract to provide back office functions for general practice, pharmacies and opticians. £600 million a year is spent on management consultants like Deloitte, Ernst and Young, Price Waterhouse Cooper and McKinsey's.

PFI repayments are having a devastating effect on many hospitals, costing nearly twice the amount of a publicly funded scheme. In 2013-14, nine out of the 15 most indebted Trusts had PFI schemes.

Attacks on staff

Over the past five years NHS staff have suffered a pay freeze that amounts to a 15% pay cut in real terms. The overall problems of NHS staff, including the Junior Doctors who are currently waging the fight against the imposition by Jeremy Hunt of a new contract, have been caused by the relentless attacks on their pay and conditions by this government, resulting in low morale, staff shortages, cuts in training places and reliance on agency nurses. Staff shortages were the main cause of the Mid Staffs scandal where staffing levels had been cut to save £10 million a year in an attempt to show financial balance to secure status as a Foundation Trust.

Reconfiguration of services

Having promised no top-down reorganisation and no closure of A&Es and maternity units in the 2010 election, the Coalition and now the Tories have been carrying on relentlessly with so-called reconfiguration plans. These are aimed at closing district general hospitals but are dressed up as bringing care closer to home and improving specialist services. The SLHC was born out of a campaign to prevent our hospital being closed as part of a reconfiguration of hospital services in south east London – the TSA (Trust Special Administrator) process. This followed on one about five years ago called "A Picture of Health". And now the OHSEL (Our Healthier South-East London) process – strangely reminiscent of the language of previous attempts – is all about bringing care closer to home. This is coded language for downgrading hospitals.

The OHSEL Report is a 5-year plan currently being developed by the six south east London Clinical Commissioning Groups for redesigning local health services. The report uses language that is worryingly reminiscent of the TSA arguments for cutting hospital beds by "improving" community care in their plan to downgrade Lewisham Hospital. The SLHC lobbied OHSEL for clarification about whether proposals would include the possibility of closing Lewisham A&E and had received reassurances that future plans would not mean downgrading or closure of Lewisham Hospital. We are certain that it is due to our lobbying that we have been given these assurances. At the same time we don't trust the process and will remain vigilant, asking questions about where they will make £1.1 billion funding cuts, while properly funding good community care. The role of the SLHC in this is a proud one. It flexed its muscles again and forced the announcement that the two A&Es are protected, with a promise of a similar announcement about maternity services. Genuine plans to improve community services cannot be implemented at the expense of acute services.

As regards devolving healthcare to the local council in the Manchester area, known as "Devo Manc", it is a continuation of the process of government divesting itself of responsibility or accountability for its health and social care decisions.

What of the future?

This conference is to equip its participants with deeper understanding of the many and varied ways our NHS is under attack but also the ways that this is being resisted. Let us discuss how we work together better and what strategies we should employ to do this. In this way, both local and national campaigning efforts can be strengthened.

The Junior Doctors' Dispute

Louise Irvine's opening speech was followed by two talks on the Junior Doctors' dispute.

The first talk was given by Dr Helen Fidler, a consultant in the Lewisham and Greenwich Trust. Dr Helen Fidler spoke of the importance of the dispute, praising the Junior Doctors as being "the vanguard of our NHS". Dr Fidler talked about her experience when a Junior Doctor herself: of the very long unregulated hours they had to work and how it was not safe for patients because of the problem of lack of sleep. She said that the Junior Doctor's fight was against the removal of the restrictions of working long hours and how crucial it was for the Junior Doctors to win, not just for themselves but for the whole future of the NHS.

Dr Shruti Patel, a Junior Doctor at Lewisham Hospital then spoke. She said that the reason why Junior Doctors were so angry was that Jeremy Hunt's plan represented "the wholesale destruction of our working practice". Hunt's plans would result in "financial hits" for the very people who provide a 24/7 NHS service and that the Junior Doctors hardest hit would be in A&E, Paediatrics and Intensive Care. Dr Patel pointed out they already work anti-social hours, she herself working every other weekend. The new contract would further penalise Junior Doctors taking time off for necessary research, for example in new cures for cancer, as well as those taking time off to have children. The dispute is not about a pay rise. Hunt's plan involves an actual 40% pay cut, so that Hunt's much publicised 11% "offer" would still amount to an overall 30% pay cut.

Dr Patel said that the decision to go on strike was a hard one to take yet 98% of those voting favoured strike action. The November/December period is a time when traditionally Junior Doctors apply for speciality training, but there has been a huge dip in numbers applying to train. "We would like to show Hunt that we are making a stand for our patients, we are also doing something positive in our community."

(to be continued)


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