Category Archives: NHS

Outsourcing 5: a “40-year failed experiment” ?

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:

“Labour’s policy of bringing services back into government hands by default risks throwing away the benefits of outsourcing”.

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.

Damned with faint praise:

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:

“When councils bring services back in-house they save money, improve quality and have more control over the services.

“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.

 

 

 

 

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A Scandinavian challenge to the FT’s rejection of Corbyn’s social democracy

Britain needs ‘a more conventional social democratic project’ according to a recent article by the FT editorial board – not Jeremy Corbyn’s radical ‘socialist’ programme.

The board rejects the claim by Jeremy Corbyn’s ‘media outriders’ that his programme aims to bring the country into line with the rest of Europe and is akin to German or Scandinavian social democracy. But Jonas Fossli Gjersø, (left) a Scandinavian who has spent more than a decade living in Britain, writes:

“From his style to his policies Mr Corbyn would, in Norway, be an unremarkably mainstream, run-of-the-mill social-democrat . . . his domestic policies are largely identical with the Norwegian Labour Party manifesto . . . Yet, here in the United Kingdom a politician who makes similar policy-proposals, indeed those that form the very bedrock of the Nordic-model, is brandished as an extremist of the hard-left and a danger to society”.

Modern social democratic thinking

Professor Richard Hoefer, in his essay in “Social Welfare Policy and Politics” 2013, writes: “Modern social democracy is characterised by a commitment to policies aimed at curbing inequality, oppression of underprivileged groups and poverty”.

Jeremy Corbyn would agree with this, and with Thomas Meyer and Lewis Hinchman, who add that social democracy includes support for universally accessible public services like care for the elderly, childcare, education, health care and workers’ compensation. They comment: “Libertarian democracies are “defective” in failing to protect their citizens adequately against social, economic, and environmental risks that only collective action can obviate. Ultimately, social democracy provides both a fairer and a more stable social order.”

Jonas Fossli Gjersø sees the British media’s portrayal of Corbyn as ‘verging on the realm of character assassination (media collage) rather than objective analysis and journalism’.

He suggests that the Nordic model would be a useful benchmark for Britain to move towards and thinks it possible that we are witnessing the social-democratic mirror image of the Thatcherisation process today in Britain, ‘with a prevailing wind from the left rather than the right’.

 

 

 

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Surprised? Rich and poor in England receive different levels of service from the NHS

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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 Timessome 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.

 

 

Broken Britain 19: poor redress for war veterans damaged by government policy

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?

 

 

 

 

 

Austerity 5: former Conservative MP deplores the effects of austerity

Matthew Parris writes in the Times, “the cracks are showing in austerity Britain”

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.

 

 

 

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Accountable Care Organisations in the NHS: a privatising mechanism?

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On 1 April 2018 the government will introduce the first Accountable Care Organisations (ACOs), which are to act as partnership bodies incorporating hospitals, community services and councils into the NHS in England. 

The Health Service Journal reports that ACOs organisation, a corporate joint venture with GPs, will bring together most of a local area’s NHS services under a single budget, run directly by one big organisation – the ACO. which are to act as partnership bodies incorporating hospitals, community services and councils

Government intends to pass laws allowing ACOs to be set up (see above) without an automatic vote in Parliament.

The Accountable Care Organisations Briefing may be downloaded here

A BBC website reports that campaigners has been given permission to challenge a government health policy in the High Court. They will pursue a judicial review against Health Secretary Jeremy Hunt and NHS England over plans to create ACOs. Campaigners say it risks privatisation, but this is denied by ministers. The group bringing the case to court says an act of Parliament would be needed for the changes.

The DHSS said the claims would be resisted and it is irresponsible scaremongering to say ACOs were supporting privatisation. A spokesman said: “The NHS will remain a taxpayer-funded system free at the point of use; ACOs are simply about making care more joined-up between different health and care organisations. “Our consultation on changes to support ACOs is entirely appropriate and lawful”.

Dr Kailash Chand, an honorary Vice President of the British Medical Association, claimed ACOs could be a “Trojan horse for privatisation” adding:

“At worst, they are the end game for the NHS.”

The British Medical Association union warned: “Combining multiple services into one contract risks the potential for non-NHS providers taking over the provision of care for entire health economies.”

And the Commons Health Committee chair Dr Sarah Wollaston (Conservative) said: “There is a great deal of anxiety out there that this is going to be a mechanism for privatising the NHS.”

 

 

 

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Francesca Martinez: a word on the latest Corbyn ‘mural’ outrage

While we’re all debating whether Corbyn’s a spy or a Putin stooge, or an anti-semite, people are dying in NHS corridors, disabled people are starving to death, our public services are being cut, our assets are being privatised, our wages are being driven down, our environment is plundered and polluted, and wealth and power remain in the hands of the 1%.

Francesca writes:

This is, as always, about politics. If anyone needs convincing, please read about other socialist leaders around the world. They are routinely called commies, anti-semitic, insane etc. It is an age-old tactic.

Corbyn can’t be touched on policy so they have to manufacture shit-storms.
He is a life-long anti-racist campaigner with a thirty year record of standing against racism in all its forms.

He is one of only 8% of MPs to have signed the five UK parliamentary motions that condemned antisemitism.

No other MP has such a record of commitment to fighting racism and anti-semitism.

While we’re all debating whether Corbyn’s a spy or a Putin stooge, or an anti-semite, people are dying in NHS corridors, disabled people are starving to death, our public services are being cut, our assets are being privatised, our wages are being driven down, our environment is plundered and polluted, and wealth and power remain in the hands of the 1%.

Make no mistake, this is a war.

If Corbyn goes, we, the 99%, all lose.

 

We will never achieve a more equal, democratic, humane and peaceful society, if we allow the elite to destroy anyone who stands up against them.

 

 

 

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Assisted Dying 14: Or be ‘sentenced to years of mournful dissolution’

In 2016, former archbishop, Lord Carey, and Archbishop Emeritus Desmond Tutu declared in favour of assisted dying – as do over 80% of the British public whenever polled.

Under a crude and ungracious Times headline, Jason Allardyce now quotes Richard Holloway, former bishop of Edinburgh, writer and TV/radio broadcaster, who notes that keeping most people alive into their eighties is one of the ‘successes’ of modern medicine.

He reflects that doctors fight too hard to keep old people alive, leading to “a medicalised existence whose sole purpose is staying alive long after any joy in doing so has fled” and adds that it is having “a profoundly distorting effect on the balance of society as a whole”, placing a huge financial strain on the NHS.

In his new book, Waiting for the Last Bus, which is out in March, he writes: “Care of the elderly is close to swamping the resources of the National Health Service, turning it into an agency for the postponement of death rather than the enhancement of life.”

He claims that “modern medicine keeps too many people alive long after any pleasure or meaning has gone from their lives” and that old age can be bitter if experienced “not as a period of calm preparation for death but as a grim battle to keep it at bay”.

Holloway, who favours legalising assisted suicide, has found that instead of being “sentenced to years of mournful dissolution” many of them “long to be blown out like a candle”.

 

 

 

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Secret State 19: the government’s secret Brexit impact studies

There has been a lot of interest in ’50 secret studies’ the government has undertaken into the impacts of Brexit. A British MEP, Dr Scott Cato, wrote to Brexit Secretary David Davis after hearing of these alleged studies requesting further details. See her article for politics.co.ukWhy is the government so afraid to publish its Brexit impact studies?

The government refused to disclose the findings but acknowledged in a response, that they have conducted analysis of the impacts of Brexit in over 50 sectors of the economy. Since these studies came to light, she has been urged to get them released through a Freedom of Information request. That she now done.

One study undertaken by the Department of Health was leaked. This revealed that Brexit could result in a shortage of more than 40,000 nurses by 2026. To avoid prevarication on grounds of cost and other spurious reasons, she limited the request to the release of details on this one study. More information here.

The European Movement, with the support of Scientists for EU and Healthier in EU, has set up a new petition, calling on the government to publish all the findings. This initiative is receiving cross-party backing and strong support from the public.

The petition is already on its way to 13,000 signatures. She asks all to add their name if they haven’t done so already and to share widely through the usual channels. Dr Scott Cato ended:

“Whether you voted Leave or Remain, it is surely in the public interest that the Brexit process is as open and transparent as possible. If the government is withholding significant information about the future of our country, then it is working against the very principle of democracy”.
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Did the young Michael Fallon, Jeremy Hunt and Theresa Brasier play SimCity?

Having seen the beneficial effect of this computer game on a six-year old, a teacher advocates placing it on the national curriculum.

In every different edition of SimCity, the player is given the task of founding and developing a city from a patch of green land, defining what buildings are constructed via development zones – residential zones for Sims to live in; commercial zones for Sims to shop and have offices within; industrial zones to provide work through factories, laboratories and farms – as well as ensuring their citizens are kept happy through establishing various services and amenities, all while keeping a stable budget.

People report problems and the mayor addresses them – his objective: to keep as many people happy as possible.

SimCity 3000: (the environment and localisation now come into the equation); by allowing certain structures to be built within the city, the player could receive a substantial amount of funds from them. The four business deal structures are the maximum security prison, casino, toxic waste conversion plant, and the Gigamall (a large shopping center). Business deal structures however have serious negative effects on a city. The toxic waste dump lowers both the land value and residential desirability in the area surrounding it and produces massive pollution. The prison dramatically decreases land value. The casino increases citywide crime and the Gigamall weakens demand for local commerce.

Too late now – but if the young Michael Fallon, Jeremy Hunt and Theresa Brasier had been educated by the SimCity ’game’ (now used in urban planning offices!), Michael might well have grown up less willing to play real-life war-games, Jeremy could be ensuring good care for all the sick and frail and Theresa might be putting into practice her rhetorical concern for the less fortunate in our society.