Category Archives: NHS
It was noted after the election that many will be dreading any further impact the money-takers will have on the lives of the vulnerable – and the first ‘welfare’ action taken by the Johnson government has not been reassuring.
On Monday 16th it was reported that the government’s Department for Work & Pensions (DWP) can now send letters to doctors telling them not to sign patients’ sick notes if they have been found “fit for work” by the work capability assessments.
Linda Burnip, who founded the campaign group Disabled People Against Cuts, said that the change was what “disabled people were dreading before the election”.
She also added: “To some extent, doctors might as well not exist any more in relation to benefit claims because they are totally ignored . . . You have someone who has seven or eight years’ training and their opinion counts for nothing . . .”
Undermining the GP’s role
An article in the medical magazine Pulse, How the benefits clampdown is undermining the GP’s role, reports GPs’ accounts of their patients being refused welfare benefits, counter to the GPs’ opinion that they were unable to work. Later 68% of employment support allowance claimants assessed as fit for work later had the decision overturned on appeal.
Official figures relating to Personal Independence Payments, which slipped out hours after the election result on Friday, illustrate the record of the former Conservative government. They include findings that:
- 46% of all those who have moved from old system DLA to Personal Independence Payments (PIP) lost out financially.
- More than 650,000 people on disability benefits had their payments cut or stopped totally after moving to a new system.
Other figures were highlighted by journalist and campaigner Alex Tiffin
Alex is just one of an army of observers who are concerned about the deprivation and the repeated harassment of those least able to cope with added stress and loss of income.
John Pring on 5th December 2019 in Disability News Service reports official records have revealed that a company paid to assess disabled people’s fitness for work was put under “immense pressure” by the Department for Work and Pensions (DWP) to find claimants ineligible for out-of-work disability benefits,
An ATOS doctor made it clear that DWP was partly to blame for the decision to find his patient ineligible for disability benefits
The claim was substantiated in a document unearthed by the family of Michael O’Sullivan, a disabled man who took his own life after being found unfairly fit for work. It was contained in evidence provided to the General Medical Council (GMC) nearly three years ago when it was investigating complaints about Dr Fathy Awad Sherif, the orthopaedic surgeon who carried out the face-to-face assessment of Michael O’Sullivan in March 2013
The doctor’s representatives told GMC investigators: “Following the conversion of Incapacity Benefit to ESA, the DWP put immense pressure on ATOS disability analysts to deem claimants fit for work when they previously would have qualified for benefits.”
A coroner who blamed failings in the notorious work capability assessment system for his death, wrote to DWP to request urgent changes to prevent further deaths. Those changes were never made, and further deaths have continued to be linked to the WCA – 80 named here.
As Paul Halas writes (Western Daily Press, 7 December 2019, p. 30):
“Over the past few decades privatisations have included Royal Mail, British Gas, electricity, water and sewage treatment, the 999 calls service, much of the ambulance service, the NHS appointments service, British Steel, large parts of the education service, the Coal Board (as was), the probation service, many prisons and detention centres, large chunks of the care services, British Airways, British Rail… ad infinitum”).
Martin Rudland draws attention to the ‘we own it’ website which focusses on privatisation of public services which wastes billions each year on shareholder dividends and high borrowing costs, giving links to research into costs in several sectors including water, energy, transport, broadband, Royal Mail and NHS.
Transnational Engie is on the list of Luton and Dunstable University Hospital’s suppliers of domestic, catering and cleaning services. Unison and GMB are calling for these services to be brought back in-house once Engie’s contract ends next year.
UNISON, the union representing workers at Luton & Dunstable Hospital, points out that staff who were transferred from the NHS in 2015 are being paid NHS rates of £9.02 an hour but anyone who started since is paid the legal minimum of £8.21 an hour.
New starters are paid at least £1,400 less than colleagues who were at the hospital before cleaning services were sold off. Engie employees have also told UNISON that they are being denied leave and being made to take the blame when the contractor is pulled up by the Trust for any shortcomings in service.
UNISON’s Eastern regional organiser Winston Dorsett said, “Engie has confused and demoralised its staff further with a third set of pay and conditions brought in last year to squeeze a bit more cash out of the taxpayer. This firm is making its profits off the backs of some of the lowest-paid workers in our NHS”.
GMB regional organiser Hilda Tavolara agrees that the workers “deserve to be treated fairly by their employer” and points out that last year, housekeepers’ working hours and wages were cut, yet they were still expected to do the same amount of work. This has had a knock-on effect on the patients, their families and visitors.
Hospital chiefs are offering Engie a new 10-year contract to provide the services, proposing to outsource a number or employees currently working for the NHS but UNISON is calling on the Trust not to renew Engie’s contract next year and bring cleaning, catering and housekeeping back in-house.
This week an IPPR study revealed the cost of private finance initiatives (PFI) contracts in the NHS.
These contracts brought £13 billion of initial investment capital into the health system but by the time they have ended the NHS will have spent £80 billion on them.
This is money which could have been spent on doctors’ and nurses’ salaries, on improving treatments, or on making sure young mental health inpatients don’t have to stay in hospitals hundreds of miles away from their family and friends.
The IPPR report reveals that £55 billion of this debt is still outstanding – representing a huge burden on tight NHS resources if the government does not take action. It recommends that bad deals be brought back into public ownership.
After wondering whether what’s left of the NHS is really going to remain in the public domain under the Tories, Paul Halas adds: “What they (private companies) all have in common is poorer service, higher prices, worse wages and conditions for employees, and a haemorrhaging of money to highly paid executives and shareholders, many of them based overseas and avoiding tax in this country”, ending:
“The Tories’ long-term goal has always been to shrink the public sector to the size of a walnut and until the NHS, the last of the public service dominoes, is toppled it’ll remain a thorn in their ideological flesh”.
NHS: Boris Johnson proposes to let Africa and India educate our medics, engineers, scientists and technicians – then poach them
Early this morning Radio 5 reported that Boris Johnson has promised to lure more medics educated in poorer countries by halving the cost of the ‘NHS visa’ and speeding up the application process. This followed an announcement of measures to attract specialists in science, engineering and technology.
Boris Johnson proposes to intensify the harmful practice of importing doctors, nurses, workers in agriculture, service industries and IT experts from poorer countries. Rather than bearing the costs of educating our own, he advocates depriving developing countries of the able young enterprising citizens they desperately need.
In March, the Telegraph quoted figures from the General Medical Council showing that last year Britain imported more doctors than it trains. New figures show a steep rise in the numbers recruited from overseas. 53% of those joining the medical register came from overseas to do so – a rise from 39% in 2015.
This is the first time since 2006 that overseas doctors have outnumbered UK medics joining the register
NHS Providers, representing hospital, mental health, ambulance and community services, has written to Boris Johnson to demand action (FT 5.11.19). It made ominous references to ‘a complicated pension problem’ and advises recycling some unused employer pension contributions as salary.
Rule changes introduced in 2016 meant that rising numbers of consultants and other senior staff were facing unexpected tax bills linked to the value of their pensions. The FT article alleges that some high earners are left some facing effective marginal tax rates of more than 100% and in June the Guardian reported that some staff have had to remortgage their homes to cover their tax bills, while others were faced with the choice of cutting their hours.
Raise job satisfaction: as austerity continues, news of distressing delays and anecdotal accounts of neglect in NHS hospitals abound. A Labour government could:
- heed Simon Stevens, head of the NHS: “We need to train more health professionals in this country and that includes doctors. We’ve got five new medical schools coming online as we speak which will be a 25% increase in undergraduate medical places – arguably, that needs to be more”;
- reduce ratio of managers to medical staff;
- train nurses on the wards for the first three years before they undertake part-time university or technical education and
- as pledged by the Department of Health in 2007, bring back matrons who would once more be responsible for all the nursing and domestic staff, overseeing all patient care, and the efficient running of the hospital.
“We’re emptying Romania of doctors” a moral issue
Simon Stevens, speaking at the Spectator Health Summit in London, said the health service must stop “denuding low income countries of health professionals they need” amid warnings of a growing moral crisis. We need to do so in a way that is ethical so we are not, certainly, denuding low income countries of health professionals they clearly need,”
See https://thenewleam.com/2018/01/crisis-public-health-system-india/ There were many excellent photographs of long queues to see doctors in rural India but Alamy demanded a high price for them.
In March. the Telegraph reported that cancer surgeon Professor J Meirion Thomas told the conference: “We’re emptying Romania of doctors … they’re coming from eastern Europe, they’re coming from Pakistan, India, Egypt and they’re coming from Nigeria . . .
“I think there is a moral issue here. We are poaching doctors from abroad and have done for decades. They are coming from countries where they have been trained at public expense and where they are sorely needed.”
A provisional Labour election “grid” which was leaked to the Sunday Times is said to reveal that while Mr Johnson is framing this as “a Brexit election” Jeremy Corbyn will continue with two main themes.
Mr Corbyn will first focus on the National Health Service, described by the FT’s George Parker and Laura Hughes as “traditionally Labour’s strongest suit”.
He sees Brexit leading to a “toxic Trump trade deal”, opening up the health service to rapacious US corporations and will challenge PM Boris Johnson about the claims in a recent Channel 4 Dispatches programme, alleging that the Tory government was secretly discussing NHS drug pricing in the context of a possible post Brexit US trade deal.
The FT journalists say that the risk that voting might take place against the backdrop of one of the NHS’s periodic winter crises, “keeps Tory strategists awake at night”.
The second campaigning focus will be on evidence that post-Brexit workers’ rights and regulations will be changed for the worse
The BBC and Financial Times have seen a leaked internal government document marked “Official Sensitive”. This “Update to EPSG (Economic Partnership Steering Group) on level playing field negotiations” was drafted by DExEU, the government department for exiting the EU.
The document suggests that Mr Johnson – a persistent critic of what he sees as unnecessary regulation from Brussels – wants to diverge ‘significantly’ from the EU on regulation and workers’ rights after Brexit, despite a pledge to maintain a “level playing field”.
The FT reports that it was told by one senior adviser to Mr Johnson, “We’re not confident at all. Of course this is a gamble. But it’s the least worst option.” Mr Corbyn’s supporters expressed confidence in his campaigning ability, first shown in the 2017 election, when he captured 40% of the vote.
A report, Government outsourcing: what has worked and what needs reform? was released on Sunday night by an independent think tank, the Institute for Government (IFG).
Lamiat Sabin reports its finding that the cost savings outsourcing is supposed to deliver have been heavily exaggerated and that public support for renationalising services will increase as a result of “repeated failures”.
In the words of General union GMB national secretary Rehana Azam: “All too often the apparent ‘savings’ from outsourcing take the form of cutting wages, terms and conditions and pensions . . . We need to rebuild our public services and return them to public and democratic ownership, serving citizens and their communities not the shareholders of big business”.
But under the headline: Labour plan to reverse outsourcing criticised by think-tank, Valentina Romei (below right) puts a very different emphasis on the report’s findings, quoting the words of Tom Sasse, senior researcher, Institute for Government:
Noting that the government spends about £292bn, more than a third of all public spending, on goods and services from external suppliers and that a series of failures has brought the system under intense scrutiny, Valentina points out that these often stem from recurring issues and failures, including:
- an excessive focus on the lowest prices . . .
- the finding that some of the people most in need in society — jobseekers, benefits claimants, ex-offenders — have been let down by government outsourcing services. . .
- the outsourcing of probation services which have failed on every measure, harming ex-offenders trying to rebuild their lives . . .
- setting the cost ceiling to provide services in Cornwall in 2011 too low for many GP services providers and
- the repeated failure of the company finally selected to meet both its performance and quality targets.
Valentina concluded that: “Opening up prisons to competition has led to innovations that have improved the lives of prisoners . . . Contracting out waste collection, cleaning, catering and maintenance in the 1980s and 1990s led to significant savings”.
John McDonnell, Labour’s shadow chancellor, also scrutinised this “40-year failed experiment”. He focussed on several points made in the report, including:
- the fact that politicians regularly cite headline savings of up to 30% but recent evidence shows any savings are more typically around 5 to 10%.
- 28% higher rates of MRSA infection were found in hospitals which had outsourced cleaning to companies that often employ fewer staff.
- Private prisons also tend to pay prison officers and support staff considerably less than in public prisons (by 15 and 22% respectively) while paying managers and directors more.
- The fact that NHS will have spent £80bn by the time all the PFI contracts for buildings such as schools and hospitals are paid off, in return for just £13bn of initial investment (IPPR think tank).
The website of public ownership campaign group We Own It, set up in 2013, is well worth visiting. Its founder and director Cat Hobbs (right) said:
“It doesn’t make sense to hand over crucial services to companies that are motivated to make a profit rather than serve the communities.”
(Ed) A statistician could objectively assess the findings of this report which may be downloaded here. Until that is done the public will continue to regard privatisation as an abysmal failure and a gross misuse of tax income by government.
Frequently reported differences in health outcomes are generally ascribed to factors beyond the control of the health service, such as unhealthy lifestyles or poor living conditions. However, research has disclosed that there is a difference in the level of service received by poorer communities.
Though the NHS’s funding formula is designed to provide more money to the neediest areas, an FT article reported last week that – according to data analysed by the Nuffield Trust for the Financial Times – some poorer communities being “left behind” when accessing GP services.
Sarah Neville, Global Pharmaceuticals Editor, summarising the data, reports that rich and poor people in England receive different standards of care from the UK’s universal free health service.
Despite the higher burden of ill health in lower socio-economic groups, there are markedly fewer GPs per head in poorer areas of England than in richer areas
There was an average of 1,869 patients on GP lists for each doctor in the most affluent clinical commissioning groups, compared with 2,125 in the most deprived, according to Nuffield researchers. One in seven people in the poorest areas was unable to get a GP appointment, compared with one in 10 in the richest areas.
As GPs act as the crucial “gatekeeper” to other health services, a delay in seeing a doctor can lead to delays in securing other appropriate treatment. Emergency admissions were nearly 30% higher in the most deprived fifth of CCGs, compared with the least deprived fifth, which could point to delays in securing — or seeking — the right treatment. (See references to Sandwell here)
Nigel Edwards, chief executive of the Nuffield Trust, said that the new analysis showed there were “concerning discrepancies between the standards of care rich and poor receive from some NHS services”.
NHS England, “more medical treatment isn’t by itself the only answer”:
“ (T)he NHS long-term plan will be setting out new action to tackle inequalities including in access to primary care. But with the root cause of ill health lying in factors such as diet, smoking and exercise, income security, housing, air pollution and social connection, more medical treatment isn’t by itself the only answer.”
Ms Neville concludes that the findings raise questions about how well the 70-year-old National Health Service is meeting its founding principles of equity. They increase pressure on the NHS to outline plans to reduce health inequalities when it publishes its long-awaited spending plan next month.
At last, the case of people whose health has been seriously damaged caused by infected blood bought by a government agency is coming to the fore. But the plight of farmers, whose health suffered because government compelled them to use organophosphate sheep dips, is yet to be addressed – many affected veterans and farmers have died after long suffering.
OP-affected Richard Bruce writes: Dr Davis and Dr Ahmed wrote some informative papers on the subject. One may be read here: https://psychcentral.com/lib/what-is-functional-magnetic-resonance-imaging-fmri/
Allowed to sink into obscurity
In 1996 Defence minister Nicholas Soames confirmed that many of the soldiers returning from the Gulf War reporting fatigue, memory loss, weakness, joint and muscle pain and depression – a condition now known as Gulf War Syndrome, had been exposed to some sort of organophosphate pesticide.
From the archives:
1999: the US Government accepted that their veterans’ illnesses were mostly due to service in the Gulf. Of their 700,000-plus troops deployed there, 88% became eligible for benefits through their equivalent of the Veterans Agency and 45% had by then sought medical care. The US Government also accepted the extremely serious consequences of using organophosphates.
2000-2001: the UK government funded more research into the effects of organophosphate exposure and poisoning. The results of some studies provided support for the poisoning hypothesis but the research was delayed by the FMD outbreak and only completed in 2007.
2004: A study published in the British Medical Journal: ‘Overcoming apathy in research on organophosphate poisoning’, concluded that high rates of pesticide poisoning in developing countries and increasing risk of nerve gas attacks in the West mean effective antidotes for organophosphates should be a worldwide priority.
2008: the American government concluded an intensive study into the cause of “Gulf War Syndrome” Their $400,000 study found that OPs had causal responsibility for the harm inflicted. This finding was reported to the British Government by the Chief of Defence Staff [RAF].
Conflicts of interest: those campaigning for a ban on organophosphate pesticides have to face opposition from the agro-chemical industry, whose representatives sit on expert committees advising governments on pesticide safety.
As the Countess of Mar explained: There seems to be a nucleus of about 25 individuals who advise on a number of committees. The scientific community is very close-knit and because the numbers of individuals in specialties is small, they will all know one another. They are dependent upon one another for support, guidance, praise and recognition. If they wish to succeed, they must run with the prevailing ethos of their group, department or specialism Hansard 24 Jun 1997: Columns 1555-9
The Scotsman reported the findings of the 2004 independent inquiry into illnesses suffered by veterans of the first Gulf War which was headed by the former law lord Lord Lloyd of Berwick, called on the Ministry of Defence finally to recognise the existence of a “Gulf War syndrome”. It said that it was clear the cocktail of health problems suffered by an estimated 6,000 veterans were a direct result of their service in the 1991 conflict and urged the MoD to establish a special fund to make one-off compensation payments to those affected.
Is the long and inhumane delay due to the fact that the establishment of a link between Gulf War Syndrome and organophosphate poisoning would cost the MoD vast sums in compensation?
We don’t think enough about local government, one of whose jobs it is to mend potholes. When in our own lives our nearside front tyre is shredded, the pothole, Parris believes, represents “a momentary twitching-back of one tiny corner of a great curtain, behind which lie, no, not potholes, but a million anxious human stories, caused in part by cuts in public spending”.
He adds that accidents due to potholes are usually relatively trivial compared with cuts which for others may have meant:
- the loss of social care in dementia,
- no Sure Start centre for a child,
- the closure of a small local hospital
- or the end of a vital local bus service.
Potholes are a parable for others that matter even more. Unfilled potholes put lives at risk and have become a symbol of the damage done to every walk of life by spending cuts.
All the pressures on those who run government, local and central, are to worry about the short-term. it is usually possible to leave issues like road maintenance, decaying school buildings, rotting prisons, social care for the elderly, Britain’s military preparedness or a cash-strapped health service, to tread water for years or even decades. “They’ll get by,” say fiscal hawks, and in the short-term they’re often right.
- Nobody’s likely to invade us;
- the NHS is used to squeezing slightly more out of not enough;
- cutting pre-school provision is hardly the Slaughter of the Innocents;
- the elderly won’t all get dementia at once;
- there’s little public sympathy for prisoners;
- teachers can place a bucket under the hole in the roof
- and road users can dodge potholes.
Parris continues: “But beneath the surface problems build up. The old get older, and more numerous. Potholes start breaking cyclists’ necks. Care homes start going under. The Crown Prosecution Service begins to flounder. We run out of social housing. Prisoners riot. And is there really no link between things like pre-schooling, sports and leisure centres and local outreach work, and the discouragement of knife crime?”
“When New Labour was elected in 1997 we Tories groaned as it tipper-trucked money into the NHS, school building and other public services. Thirteen years later when Labour left office the undersupply was monetary, the red ink all too visible”.
Parris asks: “Must we forever oscillate like this?
One answer: Green & Labour Party leaders would meet these needs and avoid red ink by redirecting the money raised by quantitative easing.