Workers Daily Internet Edition Year 2003 No. 49

Year 2003 No. 49, June 4, 2003	ARCHIVE	HOME	SEARCH	SUBSCRIBE

Daily On Line Newspaper of the
Revolutionary Communist Party of Britain (Marxist-Leninist)
170, Wandsworth Road, London, SW8 2LA.
Phone: (Local Rate from outside London 0845 644 1979) 020 7627 0599
Web Site: http://www.rcpbml.org.uk
e-mail: office@rcpbml.org.uk
Subscription Rates (Cheques made payable to RCPB(ML)):
Workers' Weekly Printed Edition:
70p per issue, £2.70 for 4 issues, £17 for 26 issues, £32 for 52 issues (including postage)
Workers' Daily Internet Edition sent by e-mail daily (Text e-mail):
1 issue free, 6 months £5, Yearly £10

Government Ploughs Ahead with Foundation Hospitals in Spite of Opposition

Recently Allen Milburn, Secretary of State for Health, announced that 29 trusts have been successful in their preliminary application for NHS Foundation Trust status. The government has also advertised for the post of independent regulator.

This is in spite of the fact that the Bill on Foundation Trusts has not yet passed through Parliament, where it has received unprecedented opposition for such a Bill. The committee stage for the whole bill will not be completed till June 19. That is followed by the Third Reading and the House of Lords debate. It is also in the face of the growing opposition to the proposals from health workers and their trade unions.

The 29 trusts that have passed the preliminary application will now have to make "second stage applications". The Independent Regulator grants the licences to NHS Foundation Trusts in accordance with provisions set out in legislation. Before an NHS Trust applicant can be granted a licence to operate as an NHS Foundation Trust, it will need to seek agreement from the Secretary of State for Health that the existing organisation should be disestablished and its assets transferred to a new organisation.

Unison has issued instructions to its branches to take advantage of the guidelines to demonstrate their opposition to the proposals. The second stage applicants need to provide evidence that both the NHS Trust Board and key stakeholders – for example Primary Care Trusts, staff, partner organisations and local people – have been consulted and support the application and the strategic vision.

At their recent Unison Health Group Conference a speaker at the focus group who had made a detailed analysis of the proposals said that, far from allowing people to "exercise ownership and control," Foundation Hospitals will decide their own constituency and the proposed arrangements will accommodate vested interests but clearly not the interests of the health workers. The interests of the staff, for example, will be accommodated with one staff side representative on the board. At the same time, nothing in the legislation, or guidelines, shows how these hospitals will even consult with the public or the members.

Should it not be the case that society should guarantee the health care for all its members at the highest possible level, without discrimination as to ability to pay, locality, or any other consideration? If this is so, what is the significance of the government’s plans for foundation hospitals? Can they be considered a step in this direction? The government argues that it allows people to "exercise ownership and control", as though this were the fundamental issue. The facts suggest that the government’s argument that people have any control whatsoever is highly questionable. It is not the people organised as decision-makers, it is not health workers and health professionals, or the local communities that are being enabled to control the direction of the health service or guarantee its future. If exercising ownership and control were to have any meaning, then such decisions would be in their hands and they would be able to provide the right to health care with a guarantee.

It is only the government that can guarantee funding for a health service in which everyone’s claim for health care is met as of right. If the government refuses to provide this funding, or ties it in with reforms under the banner of modernisation, or delivers funds to businesses or puts the emphasis on the regulation of the marketplace, how can investment in health care be guaranteed? To state that the people should be able to exercise "ownership and control" and leave them powerless to do so suggests that the government has another aim in its programme for the NHS other than meeting the health care needs of the people.

Some Important Questions Which are Not Answered

The guidelines state:

That the process of applying and then being established as an NHS Foundation Trust will fall into three distinct phases. The preliminary stage will be brief and will focus on the current status of 3-star NHS Trusts that apply. Those organisations short-listed following the preliminary stage will be given support to prepare detailed second stage applications that should articulate a vision for how the freedoms associated with foundation status will be used to deliver improvements for patients. In addition, they will need to demonstrate the support of key stakeholder groups and proposals for how local communities will be encouraged to exercise ownership and control within the new organisation. During the period between the application being approved in principle and formal establishment as an NHS Foundation Trust there will be a third phase to allow for setting up of the new governance arrangements and detailed discussion on the content of the licence and its legally binding agreements with NHS bodies.

Thus the "second stage applications" must articulate a vision for how the freedoms associated with foundation status will be used to deliver improvements for patients. In addition, they will need to demonstrate the support of key stakeholder groups and proposals for how local communities will be encouraged to exercise ownership and control within the new organisation.

But how will local communities be encouraged to "exercise ownership and control"? The guidelines to the bill state that; An NHS Foundation Trust will be subject to a legal regime that replaces accountability to Whitehall with accountability mechanisms to local people, most notably:
• its governance arrangements will define its accountability to its local community through a Board of Governors and Management Board;
• its licence, issued and monitored by an Independent Regulator, will require it to uphold NHS standards and guarantee that it operates according to NHS values;
• agreements with the organisations that commission its services will specify the range and volume of services to be provided, focusing on the delivery of outputs and introducing greater transparency;
• inspection by the Commission for Health Audit and Inspection2, as well as annual performance assessment, will ensure that services meet health care standards, with reports fed back to the Independent Regulator.

So, community "ownership and control" is to be through a Board of Governors. But how are they appointed?

Each NHS Foundation Trust will have a Board of Governors and a Management Board. The members of an NHS Foundation Trust will elect representatives from amongst the members to the Board of Governors. The Board of Governors will be responsible for ensuring that the Trust operates in a way that fits with its statement of purpose and complies with licence conditions. It will not be responsible for the day to day management of the organisation; that will be a matter for the Management Board.

What are the accountability mechanisms to local people that the board is supposed to introduce?

This is set out in the duties and responsibilities of the Board of Governors;
• establishing mechanisms for consulting the members or partner organisations they represent;
• holding at least one meeting each year that is open to all the members to approve:

– the annual report and accounts of the NHS Foundation Trust;

_ appointment of the Auditor;
• meeting on no less than two other occasions a year – when the main business will be to advise the Management Board on the Trust’s forward plans;
• from time to time3, at an open meeting or another general meeting to:

– elect or re-elect the Chair and non-executive directors to the Management Board;

– approve appointment of the Chief Executive by the Chair and non-executive directors of the Management Board;

– ratify appointment by the Chief Executive of executive directors to the Management Board.

Guide to NHS Foundation Trusts:

http://www.doh.gov.uk/nhsfoundationtrusts/

Opposition to Foundation Hospitals

Trade unions will present their opposition to Foundation Hospitals to Health Secretary Alan Milburn on June 5.

The joint campaign – including UNISON, the TGWU and GMB and other professional organisations – wants Alan Milburn to treat the first stage of foundation hospitals as pilots only, according to Unison.

In May, more than 60 Labour MPs voted for an amendment in the health and social care bill aimed at blocking foundation hospitals. Others have promised further opposition in the committee stage.

"This is not a fait accompli," said Karen Jennings, Unison's head of health. "We will continue to campaign as the bill goes right through Parliament, including the House of Lords and at the Labour Party Conference. We have serious concerns for the health service. The only previous evidence of marketising the NHS was under the Thatcher years and we all agree this was a failure. We will be asking Milburn to pilot the proposals rather than push ahead with more structural change. We need to reinforce the recent Commission for Health Improvement report which said the NHS was working well."

Unison has contacted constituency Labour parties, in areas where foundation hospitals have been approved, and asked them to raise the issue with their MPs. It will also host a breakfast seminar for MPs and other key decision makers in the run up to its National Delegate Conference in June.

"Members in non-foundation trusts feel that the league star rating – whereby only three-star hospitals were allowed to apply for foundation status – has a lot to answer for," Karen Jennings said. "Some of the hospitals have outstanding individual departments but because of the perverse system of measuring they have not made it up the league tables. They are embarrassed at being overlooked and demoralised. Members at foundation trusts also have serious concerns about the freedom being given to management."

On April 7, delegates to the Unison health section conference in Harrogate endorsed a motion condemning the policy of foundation hospitals. The "so-called freedoms" given to the new hospitals would be at the expense of spending on other parts of the health service, delegates heard.

More than 129 MPs have signed an Early Day Motion against the Foundation Hospitals reform.

Former Health Secretary Frank Dobson said: "Foundation hospitals will be like a cuckoo in the local NHS, developing their own priorities at the expense of everybody else. They will be able to borrow from the private sector and, if they get into a mess, will have to be bailed out at the expense of the rest of the NHS."

The independent think tank Reform has suggested that the shift to foundation hospitals would create "phoney competition" in the NHS. The group suggests that more radical changes to the structure of the NHS are needed.

Ruth Richardson, from Reform, said: "Foundation hospitals simply preserve the same structure. What you need is a dramatic shift that will put the money into the hands of consumers."

Accident and Emergency is the most expensive hospital service, but the least lucrative. Consequently, hospitals with foundation status could opt to close their A&E departments.

Critics of the Health Secretary’s Foundation Hospitals reform have said that it would return Britain to the pre-NHS era when independent charitable hospitals were needed for those unable to pay.

TUC Statement on Foundation Hospitals

International Day of Action for Justice In Palestine (London Action)

INTERNATIONAL DAY OF ACTION

On June 5, 2003, the thirty-sixth anniversary of the Israeli occupation of the West Bank and Gaza, we call for linked actions by Palestinian, international, and Israeli peace groups to protest the escalating violence against the Palestinian community and international human rights workers in the occupied territories. We demand protection for Palestinian civilians and for internationals, a moratorium on construction of the apartheid wall and its associated land confiscations and home demolitions, and an end to the occupation.

I. Who is Initiating this Call?

The United for Peace and Justice is initiating this call together with Palestinian based, Israeli, and other international peace groups. Committed convening groups include the Peace and Justice Studies Association (PJSA), the International Women's Peace Service, and the International Solidarity (ISM) Movement, which attempts to protect civilians and supports the non-violent resistance within Palestine, and the US Campaign to End the Israeli Occupation. We seek and welcome endorsements by all groups and individuals that support our points of unity.

II. What Would Happen on June 5?

* Demonstrations and acts of non-violent resistance by Palestinians and internationals within the occupied territories of Palestine.

* Sister demonstrations, vigils and non-violent direct actions by Israeli peace groups within the pre-1967 borders of Israel.

* A massive campaign of lobbying at the United Nations and of the U.S. Congress culminating on June 5.

* Teach-ins and educational programs in communities around the world.

* Demonstrations, vigils, and non-violent occupations of Israeli embassies and consulates worldwide, and at offices of corporations that profit from the occupation.

III. Why This Call?

There can be no true peace or security in the Middle East without justice for the Palestinian people. In the wake of the war on Iraq, the Sharon government has stepped up a campaign of land confiscation, enclosure and isolation of Palestinian communities, and attacks on non-violent human rights workers.

The Sharon government is rapidly moving ahead on the second phase of construction of a mammoth "security fence" in reality an apartheid wall which dwarfs the Berlin wall. A thirty-foot high concrete wall with gun towers in some areas, in others, a giant electrified fence surrounded by a wide swathe of "no-mans land," it strays far from the 1967 borders to confiscates more than thirty percent of the proposed Palestinian state. It encloses the illegal settlements that have undermined peace negotiations since Oslo, annexes water resources and the traditional lands of Palestinian villages without compensation, and will turns Palestinian cities into giant, open-air prisons.

In Gaza, construction of the security zone along the Egyptian border has resulted in destruction of olive groves and homes. On March 16, Rachel Corrie, a human rights worker with the International Solidarity Movement, was deliberately killed by an Israeli Occupation Forces bulldozer driver while trying to prevent home demolitions. The Israeli military has refused to seriously investigate her death, and the United States government has declined to pressure them.

The result has been tacit encouragement of attacks on non-violent peace workers and inconvenient witnesses. In Jenin, Brian Avery was shot in the face on April 5 by soldiers in an armoured personnel carrier that opened fire on clearly visible, unarmed members of the ISM. On April 12, ISM member Tom Hurndall was shot in the head by an Israeli soldier on the Rafah border as he attempted to rescue children who were under fire from Israeli sniper tower. On April 20, Palestinian journalist was shot dead by a gunman from an Israeli tank as he attempted to cover an incursion into Nablus.

These attacks on human rights workers make visible the ongoing violence against Palestinian civilians. In Rafah, more than two hundred and fifty people have died since the beginning of the intifada; forty-five of them were children.

Unless the international community responds strongly to these attacks, no human rights workers, medical personnel, journalists or NGOs will be able to operate safely in the occupied territories. Without those who are prepared to intervene against, witness, or report on acts of aggression by the Israeli military, the way is open for even further escalations of violence and repression against the Palestinian people.

Linked actions by groups within the territories, within Israel and by the international community would send a powerful message to the Israeli government. Moreover, they would break the isolation of the Palestinians, encourage and support the non-violent resistance within Palestine, making that aspect of the struggle more visible, highlight the ongoing violence against Palestinian civilians and shift the climate of public opinion that allows this injustice to continue.

IV. Demands

1. Protection and Accountability:

* We demand that the U.S. and British governments, the United Nations, and the world community hold the Sharon government and the Israeli Occupation Forces accountable for the death of Rachel Corrie and the shootings of Brian Avery, and Tom Hurndall which make visible the ongoing violence against Palestinian civilians. We demand a full and impartial investigation of these and other attacks on non-violent human rights workers.

* We call for an immediate deployment of UN international observers in the West Bank and Gaza Strip.

2. Moratorium on the Wall:

* We call for a moratorium on the building of the so-called "security wall," an end to the land theft, home demolitions, appropriation of water and resources, destruction of villages and of livelihoods that this apartheid wall requires.

*End the Occupation: We call for an end to the policies of control and de facto imprisonment that violate the human rights of Palestinians: closures, curfews, checkpoints, roadblocks, incursions, snipers, and ongoing attacks on civilians. An end to attacks on the Palestinian economy and civil society, the obstruction of education, health care, emergency services that are part of an ongoing assault on daily life. An end to the occupation.

V. Points of Unity

Non-violence
For this campaign, we ask that groups that participate commit to non-violent actions that maximize respect for life, and that embody the openness, creativity and compassion we are calling for.

Palestinian focus
Attacks on international human rights workers are an important focus of this campaign, but we ask that they always be seen in the context of the overwhelming daily violence directed against the Palestinian population.

Diversity
We represent a very broad coalition of groups that may hold out different visions for this issue. As a coalition, we can unite around the specific goals named for this campaign. Individual groups are free to pursue their own broader goals and demands in their own names.

Independence
We welcome support from a broad variety of political groups and organizations, but as a coalition we do not identify with or align with any political party or affiliation.

Tolerance
Jewish and Israeli peace groups are part of this campaign, and allies in this struggle. Charges of anti-Semitism are often hurled at anyone who challenges the Israeli government. We refuse to be silenced or intimidated by those charges, while we also recognize that some recent attacks on Jewish institutions do betoken a resurgence of actual anti-Semitism. Our campaign is directed against the policies of the Sharon-led Israeli government and military, and the U.S. funding and support for those policies, not against Jews or Israelis as a people.

Only justice for Palestinians can assure real security in either Palestine or Israel. We cherish the lives of Israelis and Palestinians. While we especially condemn attacks on civilians, whether Palestinian or Israeli, we understand that attacks on Israeli civilians are a response to the conditions of the occupation, that are only furthered by the policies of collective punishment and brutality practiced by the Sharon government. At the same time, we understand that such attacks stir fear and rage among Israelis that lends a spurious legitimacy to brutal actions of the Sharon Government.

We encourage participating groups to be proactive in reaching out to their local Jewish communities to begin dialogues and discussions around this issue, and to hold out the hope that even those who are now our opponents may change their views.

Autonomy—Within the framework of these points of unity, local groups are free to plan their own actions and campaigns. Local groups know best how to organize in their own areas, and how to speak to their own communities.

VI. Structure

The June 5 coalition would be a loose network of affiliated groups, providing coordination and support for autonomous actions within the framework of the points of unity. Convenor groups would take responsibility for coordination nationally or regionally, in Palestine, Israel, the U.S., Europe, and other regions. A central website would be created and maintained, where support materials could be posted and where a list of planned actions and contacts could be maintained. Media coordination could be centralized regionally.

Funding would be sought for the website and to support media centres. Groups would fund their own actions independently.

For more information contact http://www.peacejusticestudies.org/palestine.php

For a map of the wall, see http://www.gush-shalom.org/thewall/index.html.