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

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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

Winter is coming. How bad is the scale of the NHS financial crisis?

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The NHS winter is coming – what’s the one thing all progressive politicians must do to save it?  by Caroline Molloy – Firsted posted 9th October 2015 at OurNHS

 

All week we’ve been waiting for the figures that would show just how bad the scale of the NHS financial crisis was.

The regulator, Monitor, had been ‘leaned on’ to delay publication til after the Tory Party Conference.

And no wonder.  The figures that were finally released today were bad.  Really bad.  NHS Trusts and Foundation Trusts have gone nearly a billion pounds in the red in just three months.  And patients are suffering as waiting lists are soaring.

Monitor said in today’s report that Foundation Trusts ‘could not go on like this’.

Health campaigners have reacted with anger – and a very clear message about the necessary way forward, urging politicians from across the spectrum who truly care about the NHS, to back the NHS Bill.  The Bill was developed with a team of campaigners led by Professor Allyson Pollock, and presented in parliament by Caroline Lucas MP in June – with backing from Jeremy Corbyn, John McDonnell and other Labour MPs, as well as the SNP, Plaid Cymru, and Lib Dem MP John Pugh.

The NHS Bill sweeps away the complex and expensive system of ‘autonomous’ Trusts forced into a game of ‘beggar my neighbour’, competing against each other for commissions, patients and dwindling funds.

“At what stage will those who advocated ‘standalone’ Foundation Hospitals, which have dominated health policy for 13 years, admit they were wrong?” asked Lord David Owen in response to today’s figures.

Owen – former health minister and leading critic of the Coalition Health & Social Care Act – told OurNHS that the way forward was clear:

“We have to return to an NHS that provides comprehensive care across each geographical area, as spelled out in the NHS Bill.  This Bill is now before the House of Commons in the name of Caroline Lucas and supported by Jeremy Corbyn.  The progressive alliance in Parliament now must be supported by all the Royal Colleges and anyone committed to evidence based medicine.  The evidence is now before us all that Foundation Hospitals have been a disaster.  The Health and Social Care Act must be changed and the NHS Bill is the way to do it.”

Caroline Lucas told OurNHS today, “Our fragmented, marketised NHS is in crisis.  This latest failure highlights the urgent need for a change in direction.  We need to return the NHS to its founding principles and reverse the creeping marketisation of the last 25 years.  That’s why I’m calling for MPs from across the political spectrum to be part of saving our health service by supporting my NHS Reinstatement Bill.”

Deborah Harrington, spokesperson for the National Health Action Party also weighed in with support for the bill, saying:

“It took a series of legislative changes to get us where we are today, on the brink of losing a precious and vital service available to us all.  We need legislation to restore it to health and end these daily reports of financial ‘failure’.  We need the NHS Bill tabled by Caroline Lucas.”

Harrington explained further:

“This is murder disguised as accidental death. If the public want to continue to have healthcare free of the fear of huge bills or insurance payments they need to stand up for an NHS back in public ownership and free of the threat of bankruptcy, a term which should never have been allowed to apply to our public services in the first place.”

Professor Sue Richards, Chair of Keep Our NHS Public, savaged Health Secretary Jeremy Hunt, saying his government was “responsible for massive mis-spending in bringing the market into the NHS”.

Richards highlighted how restoring the government’s duty to provide comprehensive healthcare across the whole country is a key feature of the NHS Reinstatement Bill that Keep Our NHS Public supports.  The duty to provide comprehensive healthcare was abolished in the 2012 Act, allowing the government to blame underfunded local hospitals for ‘local decisions’ when they make cuts or simply fail to provide quality, timely services.

Richards elaborated: “It is not just that Hunt is not up to the job.   It is also that he thinks the job of Secretary of State has been abolished by the Health and Social Care Act 2012, and that he can wring his hands and blame others, without having to step up and take charge.   MPs should call Hunt to account for the state of NHS finances and the deteriorating performance in patient care.  Let’s reinstate the Secretary of State’s responsibility for the NHS, and sack him if he continues to fail.”

GP Charles West – co-author of a rebel Lib Dem report into the true costs of running the NHS as a ‘market’ -accused the three main political parties of a “pathetic spectacle” at the May General Election, saying they were “falling over themselves to promise small amounts of additional money to the NHS whilst simultaneously weighing it down with expensive and unnecessary bureaucracy.  The pseudo-market imposed on the NHS has been reliably estimated to cost £20bn a year.  Even if George Osborne comes up with the £8bn he has promised it will not solve the problem, it will simply pour more money into the hands of the private providers and management consultants who are gathering like vultures round a corpse.”

West concluded: “There is a straightforward and simple solution to the problems faced by the NHS. It lies in the National Health Service Bill tabled in July.  Up till now the leaders of Labour, Conservative and Liberal Democrat Parties have preferred to administer larger and larger doses of the very medicine that has done so much harm to the NHS.  It will be interesting to see if recent changes of leadership will bring a new wave of common sense.”

Privately, many senior NHS campaigners express frustration that so far under the Corbyn opposition, there has been little shift in tone in Labour’s NHS message.  They will be hoping for a greater confidence soon from Labour (and indeed the Lib Dems and Nationalists) in being prepared to challenge the old mistakes and Blairite market arrangements.

There are a few encouraging signs around Corbyn’s willingness to talk about the Private Finance Initiatives that are costing the NHS dear.  Joel Benjamin of People Vs PFI said that it was “absurd” that the “5 year plan” for the NHS made “NO mention of PFI, even though NHS trusts will pay out close to £10bn in PFI repayments over this period, and 2/3 of NHS trusts in financial stress have PFIs.” 

The current predicament of Trusts and Foundation Trusts was entirely predicted by those who worked on producing the NHS Reinstatement Bill – and it’s suddenly more relevant than ever.  The Bill is due to be read in March 2016 – but is unlikely to get a proper hearing unless Corbyn, who signed it as a backbencher, can bring the full weight of his new leadership role into play behind it.

Winter is coming.  The NHS is dreading it.  Will politicians offer it some hope for the spring?

 

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If I were Chancellor …. My Health of the Nation Autumn Statement (part 1)

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If I were Chancellor…Part 1 of my Autumn Statement

First posted 5.12.2013 by tantalusredux at Stuck Between the Democratic Deficit and the Abuse of Power

INTRODUCTION

Over the past several decades, successive Budgets and Statements have become a rather monotonous charade in which a pre-set agenda is tweaked at the margins.  Will the tax on beer and spirits be raised above inflation?  Will corporation taxes be raised or lowered?  Each year there is a guessing game as to the ‘main event’, this year stamp duty is number 1 in the charts, as the pressure is apparently on to make the housing ladder more accessible without stoking another property bubble.  Afterwards there will be an analysis of ‘winners and losers’ in the media.

Every Budget has an issue on which it is ostensibly focused, this year being about ‘Living Standards’.  Since every Budget raises and lowers the relative affordability of everything then every Budget is, in fact, about living standards.  Affordability issues are perhaps rather more pertinent this year as the Chancellor has outlined his concerns about the affordability of the Welfare State.

I believe it is time for a new kind of Budget.  A Budget that not only addresses the underlying malaise of the country, but which seeks to address it in a more fundamental manner than 2p on a pint of beer or a reduction of stamp duty ever could.  A Budget is also a manifesto, a statement of intent.  And so I present to you for consideration my ‘Health of the Nation’ Budget.

Why call a Budget on matters fiscal ‘Health of the Nation’?  Health and wealth are closely bound and a Budget which ignores this reality has a hollow core.  A Budget is a time to reflect on the values of a nation and to ensure that the Common Wealth; that amalgamation of income, purchase and corporate taxes collected for the Common Good; is spent in a way which enables a healthy, equitable, just and dynamic society to prosper.

Part 1: HEALTH

The Problem:

In order to speak with authority and clarity about the health of the nation, we do need to examine its financial basis.  At its foundation, the principle per se of a National Health Service was welcomed overwhelmingly by the people of this country.  They had lived through times of war and great hardship frequently made intolerable by ill health.  Doctors had to be paid for and only those in relatively steady employment could afford insurance.  To know that from the cradle to the grave anyone could see a doctor without fear of the ‘collector’ at the door come to get payment was, in 1948, a relief it is hard to imagine in 2013.  And yet one issue we now face is whether we should decide that the NHS is no longer affordable on a free to all at the point of delivery for all services basis.  Should it be the case in the more affluent 21st century that those who can pay should pay from their own pocket, leaving the State to pay the bill only for those in reduced circumstances?

We must look at the truth behind some of the figures then and now and ask: what is a reasonable approach to the very real financial crises being faced by some Hospital Trusts and to the general funding of the Health Service.  Much has been made of the size of the National Debt but it is not a ‘crisis’ in itself, as the borrowing rates are long term and low and the bonds issued by the Government are safe investments for pension funds, for example. In other words our National Debt is of benefit to the economy. This makes it fundamentally different from private household debt.

The Background

Looking at these problems of debt and deficits is not a distraction from the issue of the NHS and the Hospital Trusts in financial difficulty.  It is crucial to forming a decision about the spending plans in relation to that service and others.  Overall, since 1945, the economy has grown at an average rate of roughly 2.6% a year (ONS figures).  This is relatively consistent regardless of who is in Government.  Between 1948 and 1973 there were a few monthly contractions, but not significant enough to create an annual downturn.  It is worth noting that the ‘3 day week’ in January to March 1974 caused very little contraction in the economy and was followed by rapid recovery.
There have been downturns approximately once a decade since the 1970s, with the banking and financial sector crash of 2008 being the worst. It has also taken approximately 3 times longer for the economy to recover from that than from previous downturns.

These figures appear to suggest that our state expenditure may well be constrained by present economic circumstances.  But they do not give the whole picture.  In 1945, at the birth of the Welfare State, the National Debt was 215% of the country’s GDP.  This enormous debt did not stop the government of the day investing in a massive spending programme, building publicly owned housing, investing in infrastructure, including the national railways, and creating the NHS. With the aims of universality, equality, accessibility, the highest standards of care, and a system of payment free at the point of delivery to the patient, funded through the general tax contributions of all, the NHS sits as the foundation stone on which Britain was rebuilt in the post war years.  This expansive programme of state funded works did not expand the National Debt in the way one might have predicted. It increased slightly in 1946 and 1947 then fell steadily until 1992. Since then it has fluctuated in the 30 and 40% range until the 2008 banking and financial sector crisis.

The consequence of the banking bailout, that was agreed across all parties and which followed the 2008 crisis, is an increase in the National Debt as a percentage of GDP.  It is currently over 50% and is expected to rise over the next few years, for the first time since 1961, to over 100%.

This bears repeating.  A destroyed and exhausted post war Britain, with a National Debt of 215% rebuilt the country with public funding AND reduced the debt.  A country brought to the brink of disaster by the banking sector bailed it out with public funding and the debt RISES while the social security network built 65 years ago has had its funding systematically reduced.  What is the fundamental difference and how does it influence our current spending decisions?

Between 1945 and 1979, there was a broad political framework common to all political parties known as the ‘post war consensus’.  The guiding principles of this consensus included the idea that it was in the interest of the country as a whole that certain infrastructure organisations were best held in the common good.  These were seen as ‘natural monopolies’.  They included transport links (road, rail and airports), communications (telephony, postal service) health (NHS) and utilities (gas, electricity, water).  The economy contains a mix of private, public and voluntary sector organisations: all of these contribute to and benefit from publicly funded infrastructure.  A second tier to this framework was the belief that full employment was a proper objective of government, but that a social security net was crucial to prevent periods of unemployment reducing people to destitution.

Since 1979 successive governments have worked within a different political framework, known variously as neo-liberal, monetarist, or free market economics.  The guiding principles of this framework are that on the one hand the market is the best regulator of supply and demand and that the process of competition provides the best balance of price and quality, and on the other that the role of the state in the marketplace should be limited.  ‘Natural monopolies’ do not exist in this economic model and therefore the liberalisation agenda included selling some state assets into the private sector (some transport, all utilities, all communications) and sectioning off parts of the NHS to create private service providers.  This latter action has fundamentally redefined the principles of the NHS, leaving for the moment one core principle that the services provided are free at the point of delivery and funded by central taxation.  This excludes those NHS services which are already paid for at the point of delivery, dentists, opticians, prescription medicines.

There is, however, a significant debt which is absent from the nation’s balance sheet.  Since 1992 loans in the form of Private Finance Initiatives (PFI) have been used as a way of allowing money to be raised for public expenditure by different governments without that expenditure appearing as a debt.  These loans have come in various guises, but essentially they have been delivered from a politically almost universally accepted standpoint that the private sector is better at management than the public sector.  The truth is more likely that the public sector has different management criteria than the private sector.  These loans are extremely expensive.  By 2011 the NHS owed £121.4 billion for infrastructure which was valued at £52.9 billion, and as PFI repayments are rising at approximately 18% a year this figure will continue to escalate.  Because these repayments are being made from NHS annual budgets, rather than from capital, they are diverting money from front line services.  Before PFI when budget restraint was imposed on the NHS the costs of maintenance and renovation of buildings would have been a lower priority than patient care.

The Proposal

Given that the focus of this Budget is the health of the nation and that health is better served by patient care than by buildings maintenance the first spending priority must be to recapitalise the infrastructure costs of the NHS and to cancel all existing PFI debt.  These financial arrangements have largely been the product of successive mechanisms to divert public monies into private profit.  It should be unthinkable that private capital should benefit at the cost of patient care when the service in question is the health of the nation.

What then of more general funding issues affecting the NHS?  The cost of the NHS as a percentage of GDP is increasing.  Until 1992 it had never exceeded 5%.  Early costs did not include health centres, health visitors, ambulances, vaccination and other services which were in the remit of local authorities and only transferred to central government in 1974.  Since 1992 PFI agreements have been in place and growing in terms of their cost to the service.  It was also around this time that the market principle of a purchaser/provider split in the service was implemented, leading to an increase in administration costs.  All fragmentations of the service and reorganisations carry substantial administration costs.  By 2010/11 the cost of the NHS had climbed to 8.2% of our annual expenditure.  Of course modern developments in healthcare are far more costly than the treatments available 65 or even 15 years ago, but it is also true that the NHS is now subjected to more non-core activities and costs than prior to 1992.  The current privatisation agenda, involving further fragmentation of services and complex tendering processes focus resources away from patient care.

We cannot ignore the relationship between private funding, fragmenting services and private provision and the overall growing cost to the NHS.  These issues have added more to the cost of the service than all the additional responsibilities which were transferred to it from local government in 1974.  To pretend otherwise will lead to further chaos within the service.

These issues are the reason this Budget has addressed historical changes of service and finance in the NHS.  Budgets and Governments are notoriously short term in their objectives.  History is used as a means to score points off the opposition and future goals are limited by the horizon of a General Election.  In addressing issues of Health the political process needs to be more grown up.  If we allow perceived short term financial constraints to control far reaching decisions about who can access services, when the evidence indicates political rather than service driven financial problems then future generations suffering ill health and unable to afford a doctor, repeating the experiences of families pre-1945, will curse us and rightly so.

Therefore the recommendation on revenue funding for the NHS must be to maintain it at current levels for the current period and to focus activity on restoring the service to full public ownership.  Removing competition will reduce costs significantly and enable a proper audit of resource allocations to be made in future Budgets.  With so many cost streams currently not accountable to Parliament it is not possible to properly forecast service provision.  To announce further budget changes with such a range of variables and a service under such pressure would be irresponsible in the extreme.

RT shows up the BBC with ‘UK govt bill opens up NHS to private profiteering’.

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Wealthcare: UK govt bill opens up NHS to private profiteering

Uploaded by RussiaToday on Apr 1, 2012
A bill restructuring the UK health service has been passed by parliament in spite of mass protests against the controversial reforms. Opposition accuses MPs of pandering to private interests, signing the death warrant of free healthcare in the UK.

RT shows the BBC, how it failed to inform or adequately analyse, the implications of the Health and Social Care bill.