A party divided by ?


What exactly is it that the 4.5% MPs* disagree with Jeremy Corbyn about?   I mean which of his domestic policies?   I have to say that for all their daily media attacks, I’m still none the wiser but I defy them to disagree in principal with Jeremy Corbyn’s speech… otherwise, why on earth did they join the LP and not the Conservatives?


Liverpool July 2015

(What’s more Jeremy Corbyn is the sort of human being who’ll retweet about a missing cat)

4.5% MPs refers to those MPs who supported Liz Kendall’s candidature for the leadership – 4.5% is the % of the membership who voted for her.

Don’t want the Government to let the NHS die?


Don’t want the Government to let the NHS die?  Here’s one crucial thing you can do right now – Caroline Molloy – first posted 13.11.15

The government is setting out what it will tell the NHS to do for the next five years (the ‘mandate’) – and there are lots of worrying signals. Here’s ourNHS/openDemocracy‘s response – you’ve until the 23rd November if you’d like to respond, too.

You probably won’t have noticed, but you’ve got just ten days to comment on the only bit of democracy left in the NHS. It’s the NHS mandate – ie, what the government tells the NHS to do for the next 5 years.

Pretty important, huh? 

As the introduction to the mandate consultation explains:

“The mandate to NHS England sets the Government’s objectives for NHS England, as well as its budget. In doing so, the mandate sets direction for the NHS, and helps ensure the NHS is accountable to Parliament and the public… This consultation document sets out, at a high level, how the Government proposes to set the mandate to NHS England for this Parliament.”

The mandate is what Jeremy Hunt talks about whenever he’s accused of no longer having any proper responsibility or political accountability for securing a comprehensive NHS service, since the 2012 Act.

At the end of October, the Department of Health quietly put the mandate aims and objectives out to consultation for 4 weeks, with a deadline of 23 November. Local HealthWatch organisations have stated that they only became aware of the consultation on 11 November, although since this article was first published, HealthWatch England (the national body that is supposed to give patients a voice in the NHS) have asked OurNHS to point out that they did take some steps to publicise it to those groups prior to that date (see editors note below). 

Do have a read through here, and think about submitting your own response

Here’s what OurNHS has just submitted. I’ve written a fair few consultation responses in my life, and this is probably the grumpiest I’ve ever done. So do feel free to use any of this – but you may wish to tone down the grumpiness and make your response more formal!

Bear in mind, ‘high level’, in this context, means the government’s document contains lots of vague, aspirational sounding stuff – so you have to read through it carefully for clues about what kind of policies it might open the door to…

OurNHS’s response to the NHS mandate consultation

  1. It is very worrying that the word ‘comprehensive‘ doesn’t appear in the document once, which seems a pretty major omission given this document is supposed to summarise what our NHS will do in future…
  2. It is worrying – particularly given the current fraught relationship between government and NHS staff, and the exodus of the skilled staffthat are the backbone of the NHS – that the document mentions ‘staff’ only once (in the context of a commitment to continue the flawed friends and family test) – and doesn’t mention doctors or nurses once.
  3. It is worrying that the document does not say anything that would rule out an increase in health co-payments (ie patient charges), given that voices within government such as health minister Lord Prior have been floating the consideration of such charges.It does state that the mandate will focus on “the changes needed to ensure that free healthcare is always there whenever people need it most.” But hang on – why do we need that last word, ‘most’? Are we creating a mandate for unelected people to decide when people need free healthcare ‘most’ – and when we may be charged for previously free healthcare?
  4. It is worrying the document does not say anything that would rule out large groups of people being prevented from accessing NHS serviceson account of (clinically unrelated) lifestyle choices/diseases, as Devon attempted to dolast year. Government ministers criticised Devon – Eric Pickles said the plan was “not the kind of Britain I recognise” – but if these are not to be crocodile tears, government needs to make sure no other cash-strapped local health bosses try the same plan. 
  5. It is worrying that the document commits the NHS to ‘maximise income’, without saying how, exactly. NHS hospitals are already increasing their private patients, meaning fewer beds and longer waits for people without means to pay. The mandate should not be encouraging this practice – the supposed safeguards we were promised in 2012 are clearly insufficient.
  6. As for setting the NHS an objective to ‘minimise costs’ – well, there isn’t an NHS hospital in the land that is not already desperately trying to do that! Indeed, as hospitals’ duties to provide mandatory services are whittled away, and again in the absence of an overarching duty to provide comprehensive health services across England, we are told by governors that many hospitals are discussing how they can shed unprofitable procedures and patients. This must be stopped – not encouraged.
  7. It is worrying that there is no commitment to sufficient funding through the fairest and most efficient system (which the evidence shows, is public funding through progressive taxation). 

Of course, we recognise that this gaping hole is inherent in the ‘mandate’ system set out in the 2012 Act, with its greatly narrowed political accountability. We want to put on record how unsatisfactory it is, to be ‘consulted’ on a document that is separated from the political and financial settlement in this way, and which blithely states we have to wait for the Spending Review to see if any of the commitments are actually deliverable. 

  1. We also feel concerned about the heavy emphasis on self-care/self-management of patients own care. Given the lack of commitment to proper funding and a comprehensive system, we fear this opens the door to excusing reductions in the amount of care patients are entitled to receive on the NHS.
  2. We also feel particularly concerned about the related heavy emphasis on so called ‘person-centred’ care without any proper explanation of what this nice sounding buzzword means, beyond patients being “empowered” to “make meaningful choices”. We fear that – given Simon Stevens commitment to rolling out personal health budgets to millions– ‘person-centred’ may be interpreted as treating patients as consumers, shopping around with their personal health budgets. Such a system we see as little different to the Thatcherite voucher schemes of old, and similarly likely to lead to cost caps for patients and devastated budgets/planning for NHS providers. There is a paucity of independent evidence for the benefits of personal health budgets, per se – and some evidence that they are dangerous even at an individual, short-term sweetened level.
  3. It is also worrying that the proposed mandate green-lights the continued merging of NHS and local authority spend. The impacts of expenditure through this route to date have not been sufficiently assessed, and the Public Accounts Committee foundmuch money had been wasted. We also have serious concerns about the pace of, and lack of accountability of, the delivery of some of this merging of expenditure, through devolution, vanguards, ‘success regimes’, and personal budget roll-out. The mandate is worryingly silent on the implications of all of these – despite the fact the Kings Fund has just raised serious concerns that the NHS cannot cope with devolutionon top of its other challenges.
  4. It is very worrying that there is a green light given to a vague commitment to ‘harness digital and online technology‘. This is misleadingly implied to be mostly about patient access to records online. In fact there is a mushrooming of initiatives (and expenditure) where not just admin, but patient careis increasingly delivered through digital means. Once again, there is a paucity of evidence for the benefits of much of this ‘digital health’ and a surplus of magical thinking about its benefits.

For example, NHS England’s recent submission to the Department of Health for the spending review (as reported in Digital Health) was full of claims that remote monitoring equipment “has the potential” to reduce length of stay, and that in primary care tele/web consultation “may lead to substantial benefits” (my emphasis). The summary of the Department of Health’s submission (in a heavily McKinsey influenced presentation) also states that “While it is envisaged that data transparency may (my emphasis) have benefits for patient care direct evidence for economic impact has not been found.” And in primary prevention it admits that there is “relative scarcity of longitudinal studies linking digital programmes to encourage healthy living to long term impact”. In integrated care and screening it admitted the evidence for telehealth was “mixed”. 

  1. Indeed it is very worrying indeed that the word ‘evidence’ doesn’t appear in this document about what should drive the NHS – not once.

The Kings Fund have raised similar concerns, particularly in relation to mental health, where they said this week that ‘trusts have embarked on large-scale transformation programmes aimed at shifting demand away from acute services towards recovery-based care and self-management. This has seen a move away from evidence-based services in favour of care pathways and models of care for which the evidence is often limited. There has also been little formal evaluation of the impact of these changes.’ The Kings Fund characterised this as a ‘leap in the dark’ approach with highly deleterious consequences for the quality of patient care.

We need a mandate that stops the toys for boys / creative destruction / disruptors and heretics / leap in the dark approach, and returns to a proper, evidence-based approach to health care improvements. 

Lastly, we have an allergic reaction to phrases like this:

“We propose to set an objective for NHS England to support the transformation of out-of-hospital care using whole system approaches to ensure people get the right care in the right place at the right time.”

Banalities do not improve un-evidenced policies.

In summary, our view is that the mandate’s aims and objectives need to be driven by the NHS values the public understand (and hold dear).

These are not buzzwords like ‘transformation’, but values that actually mean something to patients – a service that is comprehensive, universal, staffed with sufficient skilled and properly rewarded staff, run ethically, and underpinned by proper evidence. 

 Like this piece? Please donate to OurNHS here to help keep us producing the NHS stories that matter. Thank you.

Editors note: HealthWatch England have asked us to clarify that they “contacted local HealthWatch groups to let them know that the consultation was coming” on 14 October, adding “though we had not ourselves been informed of a specific date at that time”. OurNHS understands this took the form of a brief mention in a newsletter. HealthWatch England also advise that “when the consultation was launched on 29 October we retweeted it and this was retweeted by a number of local HealthWatch” and that they also sent a tweet and a message on their internal “Yammer” network “to provide some advice on how local HealthWatch could promote this Department of Health consultation”.

This article is published under a Creative Commons Attribution-NonCommercial 4.0 International licence. If you have any queries about republishing please contact us. Please check individual images for licensing details.

We need to fight for the NHS or it won’t survive


An open letter to members of the British public from Dr Rob Galloway.

I am writing for your help in trying to stop the unprecedented damage happening to the NHS.  Please read, share, like, tweet and tell your friends. 

As someone who has the privilege of working for the NHS as an A&E doctor, I see first hand what is happening.  Please trust the real doctors and not the spin-doctors.

The NHS is on its knees and unless things change, it may not survive.  It has been attacked, part privatised, demoralised and starved of funds.

We have tried to highlight what is going on; through the media, marches, speeches and endless tweets and face-book posts.  But it is not working.  Things are getting worse and the NHS, which we all care so much about may soon no longer, be able to care for us.

The only things which might save it is if the British public no longer just accept what is happening – but start to fight back.  This is above party politics.  This is about what we want our society to be like.  Fight back for the greatest safety net we have – the knowledge that as a UK taxpayer if we get sick, then we will be looked after; an envy throughout the world.

The NHS was born on the 5th July 1948.  Heroes from World War Two, no longer wanted to accept a society where if you were rich you would prosper and if you were poor you were left to suffer.  It was born in a period of great austerity but money was found because health and welfare was made a priority above all else.

The attached letter was sent through the door of every citizen.  The opening lines were:

“It will provide you with all medical, dental and nursing care. Everyone – rich or poor, man, woman or child – can use any part of it. “

This promise is one we may soon not be able to keep.

The NHS has its problems and needs refom.  But its ethos was what made it great; patients before profits, co-operation instead of competition.  But the last few years has seen a determined effort to undermine all that is good about the NHS – its socialised system of working for the good of our patients.

The government have started a process of privatisation.  Billions have been wasted on re-organisations and competition and contracting out of services to the private sector which have destabilised the hospitals we all use.  Despite this, the NHS kept going because of the skills and commitment of its staff.

So to deliver the politically ideologically driven plan of reducing the size of the state and selling off the NHS to the private sector – the government have started to attack the staff.  Destroy the staff, you damage the NHS.  A damaged NHS is one which the public would go along with privatising.

If this happens, things will become like the USA where they spend double on health care to what we do, but the money is wasted on profit, beaurocracy and excessive wages and the standards of care are so much lower than in the UK, especially for the poor.

Why are they doing this?  It has been their plan all along.  The extreme right wing in this country do not believe in working together for the common good.  They do not believe in the concepts of the NHS.  They believe in individuals floating or sinking.  Jeremey Hunt even co-authored a book on this 10 years ago in which the authors said the NHS is “no longer relevant in the 21st Century.”

The new contracts they are proposing for junior doctors will mean an exodus of doctors from the NHS.  Without these doctors, standards of care will fall, waits will rise and patients will die.

They have said this about a 7 day working.  They are lying.  The new contract will harm 7 day working.  How do you improve care at weekends if you stop incentivising people to work in jobs with lots of out of hours work by saying evenings and Saturdays are normal working hours.

They have also lied by saying there will be an 11% pay rise.  Junior Doctors salaries have a large component made up of supplements because they work so many nights, weekends and evenings.  If you cut these payments by 30% and increase basic pay by 11% that is not pay rise.

And you can tell they are lying by simple maths my 6 year old can do.  They have said that everyone will get an 11% basic pay rise but the pay envelope will not rise.

So we need the British public’s help in understand what is happening because there is so much misinformation and lies out there spun by the politicians and propagated by sections of the press.

Public opinion matters.  There may well be a strike by junior doctors.  During the strike consultants like me will be doing what we can to make things safe.  No one wants the strike – especially not the doctors.  They have said they will negotiate with the government as long as the government say they will not impose a contract.  That can only be fair – but the government refuses.  A strike will be the fault of the government.

If the doctors strike , it would be to protect the NHS and not to harm it.  Protect if by forcing the government into a climb down so that they do not bring in these disastrous policies which will lead to so much damage to the NHS.

But it is bigger than just this issue.  We as a society must think about our priorities.  Do we starve the NHS of resources whilst having tax cuts for millionaires and multinational businesses?  Do we value and protect the bankers and speculators who have harmed this country so much or do we value and protect the doctors and nurses who heal the country?

We must start to fight back.  Do what ever you can to let people know what is happening.  Campaign on the street, pubs and ballot box.  Even if we win the junior doctor battle and even if Mr Hunt is forced to resign, that is only the first war in a generational battle for the NHS .

Remember what Nye Bevan said on the day the NHS was founded.  The NHS will last as long at there are the folk with the with faith to fight for it.  We as members of the British public need to have the faith and we need to fight for it.

If we don’t, the NHS which our grandparents so proudly formed, will no longer be there for our children.  They may never forgive us.

Yours sincerely

Dr Rob Galloway, A&E Consultant

Jeremy Hunt’s Plan for the NHS


It may not look like it, but Jeremy Hunt DOES have a plan for the NHS – Caroline Molloy  First posted 23 October 2015 on openDemocracy/OurNHS

The Tories would have us believe that they are backing away from NHS privatisation.  In fact, they’re stealthily laying the groundwork for maximum profit opportunities – and comprehensive healthcare may be their first casualty.

Don’t worry about the fact that 82% of GPs are planning to leave or cut their hours in the next five years. Don’t worry that junior doctors aren’t any happier. And don’t worry that every week reveals another NHS hospital deeply in the red – even ones we thought were ok.

Don’t worry about any of that, because Jeremy Hunt has a plan.

It’s the NHS’s own plan, he repeats in every media interview. It’s the plan it would be a ‘disaster’ to deviate from, he told us before the election.

But what is this plan?

We’ll get to that in a minute.

First, let’s look at what we’re being told it’s not.

It’s not like that toxic Andrew Lansley stuff, the pro-competition 2012 Act, the “reorganisation so big you can see it from outer space”. No, that was Cameron and Osborne’s “worst mistake”, they’ve let it be known. It wasn’t really their fault, of course – they didn’t have “a clue” what the then Health Secretary was up to.

They were so cross with him, they made him a Lord. And he was such a fool, he’s just landed a job at private equity firm, Bain, advising on healthcare privatisation.

But let’s not worry about that. Lansley’s Act is “being ignored” anyway, the pro-market Health Services Journal tells us. Forget competition, forget the idea of external takeovers and internal dog-eat-dog competition between standalone trusts and powerful CCGs – under current Health Secretary Jeremy Hunt and NHS boss Simon Stevens’ plan, it’s all about collaboration now. Even KPMG (who’ve just poached another former Health Secretary, Steven Dorrellsay so.

So what is this plan? And, er, collaboration with whom?

Has Stevens – long-time Blair advisor and former United Health Vice President– really sent the private sector packing? And – after a few brand-damaging failures – have private health firms really scuttled away defeated from the £120bn “unopened oyster” of the NHS budget, deciding the NHS would be ‘shown some mercy’ after all?

It would be nice to think so. The more naïve sections of the liberal media have certainly bought that idea. When Simon Stevens launched his “Five Year Plan” last year, Andrew Rawnsley in the Observer said he had “only one fundamental objection” to the “generally excellent” plan – that it had the wrong picture on the cover. Polly Toynbee in the Guardian told us it was great because “the word competition doesn’t appear once in his 37 page document”. Shadow Health Secretary Andy Burnham appeared to sort of welcome the Stevens plan, then to sort of welcome it not quite so much.

Aside from this site, one of the few mainstream commentators to nail what the Stevens’ plan was really about was Fraser Nelson, in the Telegraph. “Like the best revolutions, it came carefully disguised,” Nelson observes. Yes, “the c-word didn’t appear once” but (like Nelson himself) Stevens still “firmly believes” in the competition/choice agenda – he’s just experienced enough to know that “the secret of successful radical reform is not to announce it with any fanfare.”

Nelson nails it when he says: “Stevens’ Grand Plan is to have no more Grand Plans but, instead, lots of smaller plans.”

So what are these smaller plans – and what do they mean for the future of the NHS?

Whilst even Jeremy Hunt and his regulator Monitor have tacitly admitted that standalone, competing Foundation Trusts aren’t working, Hunt and Stevens see more privatisation, not less, as the answer.

‘Collaboration’ turns out to mean hospital mergers into ‘chains’ – a theme developed in the Stevens report. The man tasked to develop the ‘chains’ plan, Sir David Dalton, has suggested it could lead to more private takeovers. Junior health minister Lord Prior wants private takeovers of hospital chains, too – and he also thinks they should close lots of beds.

As Circle have found in the UK with their disastrous Hinchingbrooke foray, at the moment it’s hard to make a profit from competing to provide full service local hospitals.

As United Health, Kaiser and others have found in the U.S. – profit opportunities are much bigger if you integrate both the purchasing and provisionof healthcare under private control or influence, enabling you to ration or deny more expensive healthcare interventions. And it’s much easier to do that if you use your control or influence to reorganise provision away from full service local hospitals, towards a chain of disparate community-based clinics and far-flung specialist centres. Of course you have to claim all the while that this is all about integration, prevention, empowerment, localism, personalisation, specialisation, reducing ‘variation’, and ‘care closer to home’.

Stevens is pushing this approach through a range of supposedly ‘integrated’ new ‘smaller plans’. Like the new multi-billion pound lead provider framework to ‘help’ with purchasing healthcare (which United Health subsidiary Optum has won a sizeable chunk of). And a ‘prime provider’ framework to ‘integrate’ purchasing and providing (which both Circle and Virgin have won contracts worth billions for already). Not to mention the the array of ‘local’ NHS ‘Vanguard’ projects, which Stevens explicitly suggests could be modelled on US firm Kaiser Permanante’s ‘Accountable Care Organisations’ or similar Spanish companies. The tech-heavy projects are full of private sector opportunities and partnerships – particularly outside of unprofitable acute care. Meanwhile, tariff cuts leave the sword of Damocles dangling over many local full service hospitals.

Profit opportunities also expand if firms set their own easily-gamed ‘outcome based’ success measurements. Out go what Stevens calls ‘mechanistic’measurements (like the requirement to have enough nurses, properly trained healthcare workers, and hospital beds).

Since the general election, Stevens and Hunt have been busy tearing up such requirements.

And in come easily gamed ‘outcome’ measures – exactly what we see in the new style contracts.

Profit opportunities also expand if co-payments (ie, patient charges) are permitted. The right are getting more confident in calling for such chargesLord Prior has tried to launch an inquiry to consider it – and the government has still not clearly disavowed such an inquiry. The growing number of exponents of charges and co-payments are usually keen to stress it would only be for freshly defined ‘non-core’ services which, if you look closely, turn out to mean things like a bed to recover in after your op (£75 a night please!).

And there are many other attempts underway to undermine the comprehensive, universal, publicly funded core values of the NHS, by bringing the ‘undeserving’ narrative from benefits, into the NHS. An early sign is the attempt to refuse people care if they smoke or are obese, for example (cavalier to the fact that it is poorer people who will be disproportionately hit by such clinically uninformed decisions). Whilst Devon’s attempt to do this failed, experts saw it as a sign of things to come.

Stevens has just given all of this a big boost by pushing integrated health and social care budgets (and indeed integrated benefits budgets in some devolved areas, like Cornwall). All of this may be nice in theory, perhaps, but it’s pretty terrifying in a climate of ‘austerity’, where social care users already can, and have to, top-up or co-pay for services (and benefits are already heavily conditional).

And integrated personal budgets – which Stevens has been pushing since day one in the job – are now being rolled out to millions. No-one has yet managed to explain how these are any different from the old Thatcherite voucher plan (which would basically finish the job of destroying the NHS).

Lastly, as a big bonus, once firms nabbing all these contracts have their hands on the patient data needed to commission healthcare (or obtained by delivering it ‘digitally’), they can also make a packet selling our information to data, insurance and pharmaceutical companies – or worse.

Of course this entire bureaucratic market nightmare costs a fortune to administer, though the scale of the fortune is a closely guarded secret. The Health Select Committee pointed all this out in 2010 (referring to earlier data – and we’ve had two or three more tranches of ‘marketisation’ since then).

So if that’s the Stevens plan, what’s our plan B to get out of this mess?

First, the NHS urgently needs a cash injection to get it through this current manufactured crisis (with the DoH handing billions back to the Treasury in ‘underspends‘ in recent years – ‘doh!’ indeed!).

Healthcare needs are not a bottomless pit, as the neoliberal ideologues claim – but the demands of health, insurance, pharmaceutical, data, consultancy and tech companies for profit streams, may well be.

Ultimately, all this destruction is possible, not because of Stevens himself, but because the Coalition government finally removed the duty to secure comprehensive healthcare which was offered to the nation in 1948 and persisted, just about, til 2012. We need to restore that duty.

And we need to recognise that hospitals have been brought low by a combination of PFI debt and the dog eat dog, beggar my neighbour nightmare of even the ‘internal’ market, let alone the external one. We need to get rid of that market – as Scotland has done.

The NHS Bill – sponsored by Caroline Lucas, signed by Jeremy Corbyn when he was a backbencher, and due for its second reading in March 2016 – is a serious attempt to do both.

The market, internal or external, disguised as ‘collaboration’ or not, is not an effective way to allocate healthcare – we’ve known that since the pioneering work of Nobel prize winner Kenneth Arrow in the 1960s. It forces hospitals to hammer down staff costs and offload unprofitable patients, and creates impossible choices between the bottom line and patient safety.

It’s only ideology and vested interests that would seek to persuade us that the answer is more of the same.

And if anyone – Tory, Labour, or ‘non-political’ – says they support the NHS, we need to ask – do you mean an NHS that is comprehensive, universal, publicly funded, high quality, timely and ethical?

If not, they are not defending the NHS as the public understand and love it. And that’s what we need to fight for.


This article is published under a Creative Commons Attribution-NonCommercial 4.0 International licence. If you have any queries about republishing please contact us. Please check individual images for licensing details.