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  • International Association of Health Policy - IAHP
    CALL FOR SOLIDARITY

    Sunday 11th September 2016

    The International Association of Health Policies (IAHP) stands in support of two of their board members of the European region and members of “Academics for Peace” and Education and Science Workers Union (Egitim-SEN), who were discharged from their positions at public higher institutions in Turkey!

    Turkey experienced a failed coup attempt on July 15, 2016, and the Turkish government holds the religious group led by the US resident cleric Fethullah Gülen responsible. In the aftermath of the failed coup the Government and university administrations have ordered for the dismissal of 42,881 state employees, especially in the Ministry of Education, but also at universities, where 2,346 employees were discharged. The latest mass purge imposed on the basis of a cabinet decree within the context of the state of emergency rule (September 1, 2016), included more than 41 Peace Petition signatories that were deemed “supporters of terrorism” and banned from public service.

    In January 2016, 2,218 scholars from Turkey signed a petition titled “We will not be a party to this crime,” also known as the Peace Petition, which demanded Turkey’s state to abandon its deliberate massacre and deportation of Kurdish and other peoples in the region. Since then the signatories (“Academics for Peace”) have been subject to heavy pressure and persecution and have faced criminal and disciplinary investigations, custody, imprisonment, or violent threats.

    The dismissal of the 41 Peace Petition signatories and Education and Science Workers Union (Egitim-SEN) members in the latest mass purge, among them the International Association of Health Policies (IAHPE) board members ONUR HAZAOGLU and ÖZLEM ÖZKAN, is yet another demonstration of the rapid escalation of violations of human rights and fundamental freedoms in Turkey, where the failed coup attempt has served as a pretext for the Erdogan government to cleanse all critical voices, both political opponents and human rights defenders.

    The IAHP strongly condemns the dismissal of two of its board members, ONUR HAZAOGLU and ÖZLEM ÖZKA, and urgently demand that our colleagues get reinstated to their positions and have their employee rights fully restored.

    Mauricio Torres-Tovar

    On behalf of IHAP

  • The plans may still be fantasy: but NHS cuts are starting to get real

    Sunday 14th August 2016

    Theresa May's government is stepping up George Osborne's programme of relentless real-terms reductions to NHS spending, to reverse Labour's decade of expansion. And NHS chiefs are raising the pressure on hospital trusts, GPs and Clinical Commissioning Groups, demanding concrete plans for cuts to tackle monster deficits.

    The Health & Social Care Act of 2012 made clear that the Secretary of State has no duty to provide health services: so the cuts and privatisation that are taking shape are being done by 'remote control', through Simon Stevens and NHS England, under the approving eye of Jeremy Hunt.

    This is why since Christmas Stevens and NHS England have carved England into 44 "Footprint" areas in which the "local health economy" of NHS trusts, CCGs and local authorities are required to work together rather than compete.

    However this is no enlightened reintegration to scrap the competitive market. It's a desperate effort to cut the deficit, balance the books and "transform" services - collaborating in secret, to develop Sustainability and Transformation Plans (STPs), which must all be vetted, and may be changed, by NHS England.

    It's NHS England's way to assert central control, to speed the implementation of the policies outlined in Stevens' Five Year Forward View. Alongside the rapid development in each "Footprint" of 5-year plans to bring the NHS back within budget, more tangible, painful cuts are already taking shape.

    This very quest for "sustainability" is now threatening services. As a recent report by the King's Fund on trust deficits argues:

    "The scale of the aggregate deficit makes it clear that overspending is largely not attributable to mismanagement in individual organisations - instead it signifies a health system buckling under the strain of huge financial and operational pressures. The recent strategy of driving efficiencies by cutting the tariff has placed disproportionate strain on providers and is no longer sustainable."

    The same report goes on to warn that: "cuts in staffing and reductions in quality of care are inevitable if the government's priority is to restore financial balance".

    Right on cue Stepping Hill Hospital in Stockport, with a deficit of over Ł40m, is closing 30 beds, cutting 350 staff and selling off part of the site to cut costs and raise short term cash; trust managers argue that this is in line with plans for other similar trusts.

    Just down the road East Cheshire NHS Trust, delivering acute and community services, has declared it is not sustainable in its current form.

    And in a nasty echo of the bad old Thatcher era of cuts in spending from 1985, the chief executive of the Care Quality Commission has argued that he prefers cash-strapped trusts to let waiting times increase rather than reduce the quality of care. Not long ago long waiting times were themselves a measure of poor quality.

    In another blast from the 1980s St Helens CCG has now resorted to a complete 4-month halt to all non-urgent referrals to local hospitals, reducing services to emergencies only.

    Across the country trusts are repeatedly missing targets for prompt treatment of A&E patients - with performance often worst for the more serious Type 1 patients, who need admission to a bed.

    However the regulator mis-named 'NHS Improvement,' now obsessed with the effort to wipe out deficits, has discarded any pretence of concern for quality of care, and announced that staffing wards at more than the bare minimum of 1 nurse per 8 patients is not affordable, warning that trusts with higher staffing levels may have to cut back as a condition of extra funding.

    NHS England, meanwhile, has announced a fresh drive to "reset" the finances. The main components of the "reset" are:

    " Pumping in Ł1.8m of additional cash in a one-off effort to clear deficits;

    " Setting tight financial cash limits for every trust and CCG;

    " Even tighter controls on use of agency staff;

    " national action to implement Lord Carter's recommendations for savings in procurement and "back office" teams;

    " Setting up another team within NHS Improvement to promote efficiency improvement

    " Programmes in each STP to increase efficiency through "transforming" services.

    But big savings require big cuts. Section 4 of NHS England's Reset plan argues that hospitals and services which now depend on locums and agency staff need to be closed and centralised in "nearby" larger units.

    "By the end of July STPs should have reviewed services which are unsustainable for financial, quality or other reasons […]. They should have developed plans to re-provide these services in collaboration with other providers to secure clinically and financially sustainable services, both for 2016/17 and for future years."

    Despite the fine words about "transformational efficiency" it's plain that NHS England is primarily resorting to old fashioned cuts to balance the books.

    Trusts are being squeezed by CCGs, and in turn have to shed staff and squeeze down on prices they pay to suppliers and agencies.

    In many areas - Cumbria, Calderdale, Oxfordshire, Lincolnshire, Devon, North West London, Bedfordshire, Essex, and more - the most vulnerable targets are A&E units, or smaller hospitals that are to be sacrificed on the altar of "sustainability."

    However little has so far emerged from the 44 "Footprint" areas: the details of the STPs have so far been kept firmly under wraps.

    The completed documents may have little more of substance to offer than early sketchy drafts. They could yet be a diversion from the actual cuts at trust and workplace level.

    The recent publication of at least the 40th version of the North West London STP Plan announces a renewed determination to drive through the closure of Ealing and Charing Cross Hospitals, based on plans debated since 2012 - now openly seen as a way to save money.

    However the rest of the 54 densely-packed, chaotically-presented pages in tiny type, indicates that while the volume of paper consumed has increased, management thinking remains stuck in the realm of fantasy.

    The same old assertions that have been around for well over 20 years are again embraced by desperate NHS managers -despite the absence of evidence that they can deliver the promised results. The STP shows a semi-religious belief in the effectiveness of prevention programmes to produce rapid improvement in public health. Trendy new apps and digital devices are expected miraculously to keep frail older people out of hospital, and the answer to any problem is seen as paying management consultants to draft another document, or strategy.

    It's a wish-list more than a plan.

    However amongst the incantations and pious hopes there is also a commitment in the NW London STP to create "Accountable Care Partnerships" along the lines of the US-style Accountable Care Organisations proposed by the Five Year Forward View.

    These would be provider organisations which would work for a fixed budget to cover a defined population. It's a risky business. In the US private health insurers have homed in on with these, but lost money - despite much higher levels of health spending. Similar NHS "lead provider" projects covering older people's services in Cambridgeshire and cancer care in Staffordshire have seen private sector bids withdrawn, and the Cambridgeshire plan collapsed for lack of adequate funding.

    Nonetheless NHS Improvement have clearly declared their intention to push for much more private sector "partnership" and involvement in local "transformation" plans. The STPs are vehicles to open up contracts for possible privatisation or outsourcing as well as cuts.

    With Labour largely silent on this, the only questions seem to be coming from a few local authorities. Councils are being roped into STPs, bribed by pitifully small additional sums towards their meagre social care budgets, then bullied by threats that this could be withheld.

    Council leaders are being pressured to sign up in support of STPs without seeing or studying the full document - and many are doing so.

    However one or two are standing firm: Hammersmith and Ealing councils in North West London have bravely refused to sign up for an STP which threatens hospitals in their boroughs, and saddles them with even more under-funded responsibilities.

    Northamptonshire's Tory-led county council, facing Ł60m of cuts, has announced it will cut funding for social care, including support for discharging patients from Northampton and Kettering hospitals.

    In Warrington, the chief executive of the Labour-led borough council has spoken out against NHS "naďve" attempts to drive through STP plans without proper consultation, describing them as a "recipe for disaster," and warning that there was little sign of partnership in the relations between NHS and social care.

    Whether it's STPs, old-fashioned cuts, or the privatisation offensive that is the greatest concern, every part of the country faces a major test in the autumn and winter as a result of the ruthless spending squeeze.

    Health campaigners wanting to understand what's involved, compare their problems and share lessons with others, and reach out to trade unions to build more powerful movements in defence of our NHS are urged to join us at the Health Campaigns Together conference 'The Challenge of STPs', in Birmingham on September 17. More details and registration from www.healthcampaigntogether.com.

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