Charities and Hospices warn peers against Section 75 RegulationsTuesday 23rd April 2013
(PARLIAMENTARY BRIEFING: Debate on The National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013 (SI 2013/500).
Lord Hunt of King's Heath has tabled a motion to annul The National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013 (SI 2013/500), with a debate scheduled to take place on 24 April. The Regulations set the rules for how Clinical Commissioning Groups (CCGs) should commission NHS services.
This briefing from Help the Hospices, Marie Curie, National Voices, Sue Ryder and Together for Short Lives provides members of the House of Lords with details of our concerns about the Regulations, and what we believe will be their unintended negative impact on charitable providers of NHS healthcare such as hospices.
Our concerns, in brief, are:
1 The Regulations as they are currently worded will mean that competitive tendering could become mandatory in all but the most exceptional circumstances.
2 Given the burden of having to put each individual service out for tender, CCGs will tend to bundle services together to put out for contract, as currently happens in local government.
3 If contracts are bundled, then this could put them out of reach of voluntary sector providers who are, by their nature, providers of specialised care.
4 If voluntary sector providers are forced out of the market then this could have a negative impact on patients and the communities they live in, as voluntary sector providers add value by using charitably raised funds for patient care.
We know that the Government wants the voluntary sector to have a greater involvement in delivering NHS services. The unintended consequence of this piece of secondary legislation is that voluntary sector providers may have fewer opportunities to provide NHS services, to the detriment of patients and their families.
We ask that the Lords take this into consideration when they debate and vote on the motion relating to The National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013 (SI 2013/500) on 24 April.
Our Detailed Concerns with the Regulations:
1. We think that the Regulations as they are currently worded could lead to mandatory use of competitive tendering by CCGs in all but the most exceptional circumstances.
We know that the Government does not intend for this to happen, as it has made clear on several
occasions when the Health and Social Care Bill was making its way through Parliament. However,
the Regulations do not reflect this intent.
The problem hinges around the use of the word 'capable' in Section 5 of the Regulations, which
state that CCGs may award a new contract to a single provider without advertising if they are
satisfied that there are no other providers capable of delivering the service.
In the Impact Assessment for the Regulations, the Department of Health has taken a broad view of the word 'capable'. A provider might be the only capable provider because it offers the highest standards of clinical safety, or because it can establish and provide the service more swiftly than others.
We suspect, however, that 'capable' will be interpreted narrowly to mean only that a provider is able to provide the service within the budget set out by the commissioner. This means that:
* There will be few if any services where there is only one capable provider.
* Providers will feel confident to regularly challenge CCGs' commissioning decisions.
* Without legal cover to award contracts without advertising, CCGs will simply put all services
out to competitive tender to avoid challenge.
2. We think that, given the administrative and financial burden of having to place each individual service out for tender, CCGs will tend to bundle services when contracting.
We are not against competition and support a mixed economy in healthcare, particularly where it serves patient interest. However, the Regulations as currently worded will likely lead to all contracts being tendered. This will place huge administrative and financial burdens on CCGs, who will likely seek to bundle contracts to reduce the financial and administrative impact of competitive tendering. This is what currently happens in local government, where competitive tendering is mandatory.
We are already seeing this happen, with Cambridgeshire and Peterborough CCG, for example - currently, they have put out for expressions of interest for a £1bn contract where all services related to older people have been bundled together. 1
3. If contracts are bundled, then they are out of reach of voluntary sector providers who are, by their nature, specialist providers of care.
If the majority of contracts are bundled, this will start to force voluntary providers out of the market. Voluntary providers are by and large specialised providers who are governed by charitable objectives. Even the largest charitable providers would struggle to justify the resource and the risk needed to bid for large, bundled contracts, especially if most of the contracts were for services outside of their specialism. For small organisations, like independent hospices this would be impossible.
In some instances this will lead to voluntary sector providers being forced out of the market. Some would be able to survive by offering reduced services using their charitable funds alone, but many would lose their NHS income.
4. If the voluntary sector is forced out of the market then this will have a negative impact on patients and families and also the communities in which they live.
Ultimately, the loss of voluntary sector providers would lead to:
* Loss of specialism: voluntary providers deliver niche services, but they do it well.
* Loss of added value: many providers match or beat the funding they receive from the NHS in charitably raised funds and they use this money to enhance the care they offer, conduct
cutting edge research, and investing in local communities.
* Added cost to the NHS, who would have to meet the gap left by charitable funding.
We know that the Government does not want to exclude voluntary sector providers from delivering NHS services. The Prime Minister and members of the Cabinet have repeatedly stated they want voluntary providers to play a vital role in the newly reformed NHS.
However, the unintended consequences of wholesale competition is that it could lead to a diminishing of voluntary sector participation. We fear this will lead to a loss of specialist services
and skills that will ultimately lead to poorer care for patients and their families.
We ask that the Lords bear this in mind when they debate and vote on the motion relating to The National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013 (SI 2013/500) on 24 April.
About Help the Hospices:
Help the Hospices is the UK charity supporting hospices and championing hospice care. As the national membership charity for 218 local hospices across the UK, we work with them, and other organisations, to advocate for and raise awareness of hospice care, promote and support clinical excellence and support those providing hospice care.
About the Marie Curie Cancer Care:
Marie Curie provides care to terminally ill people and their families across the UK, both through our hospices and nurses providing care directly in patient's own homes. We facilitate one of the largest palliative and end of life care research programmes in the UK. We use the findings to deliver practical improvements in care and support and to campaign on behalf of terminally ill people, their carers, and their families.
About National Voices:
National Voices is the national coalition of health and social care charities in England. We work together to strengthen the voice of patients, service users, carers, their families and the voluntary organisations that work for them.
We have more than 150 members with 130 charity members and 20 professional and associate members. Our broad membership covers a diverse range of health conditions and communities and connects with the experiences of millions of people.
About Sue Ryder:
Sue Ryder is a charitable provider of health and social care services across the UK. We provide specialist neurological and palliative care in a range of environments including community and home?based care delivery alongside our seven hospices and six neurological care centres. We work across communities with patients, their families, commissioners, GPs and other health and social care professionals.
About Together For Short Lives:
Together for Short Lives is the leading UK charity for all children with life?threatening and life?limiting conditions and all those who support, love and care for them. We support families, professionals and services, including children's hospices.
For Further Information:
Scott Sinclair Policy & Public Affairs Manager Marie Curie Cancer Care
T: 020 7599 7116
NHS Health & Social Care Act Section 75: Short letter to send to a peer asapSaturday 13th April 2013
This draft has been produced by Wendy Savage drawing on research by Caroline Molloy, working with Keep Our NHS Public.
Dear Activist, Here is a shorter letter for you to use in lobbying peers. Please write this letter by hand or send by email having put your name and address, dating and adding anything you want to say personally.
Re: Debate on 24.4.13 on new NHS Health & Social Care Act regulations (SI500)
Please make time to attend the Lords for this important debate and vote to annul these regulations. They will not give the Clinical Commissioning Groups (CCGs) the freedom to commission services that they (and members of parliament) were promised during the passage of the Health and Social Care Act 2012. Lord Howe said
' … commissioners would not have to create markets against the interests of patients. Clinicians will be free to commission services in the way they consider best. We intend to make it clear that commissioners will have a full range of options and that they will be under no legal obligation to create new markets, particularly where competition would not be effective in driving high standards and value for patients. As I have already explained, this will be made absolutely clear through secondary legislation and supporting guidance as a result of the Bill'. (Lords, 6.3.12)
But this is not what has happened. There was such an outcry over earlier regulations that the government withdrew them, laying SI 500 as the substitute. The words are softer but the impact the same.
" CCGs will be forced to put all new services out to tender which is costly
" The wording is ambiguous and may lead to legal challenges
" Law trumps guidance so do not be fooled by reassurance about guidance
" The timing has left insufficient time for the public to contact peers
" Peers have to work on this during their recess, reducing their effectiveness as a second chamber
" There is no need for these regulations to be rushed through now
You will have received detailed letters analysing the meaning of the regulations and the legal opinions which confirmed my fears so I will not reiterate these here.
I am also concerned about the considerable number of peers who have connections with the health care 'industry' and who voted in favour of the Act. I feel they should abstain rather than vote for these regulations which will effectively lock the NHS into a real market under EU law and that US companies are ready to exploit.
Please take this opportunity to annul the regulations so that they can be rewritten to reflect in law what Lord Howe said to you on 6.3.12
For Lib Dems Last sentence before signature
"Remember that the H&SC Act was not in the Coalition agreement and that voting to annul these regulations will not affect that agreement. You have an opportunity to ensure that rewritten regulations reflect your own party's policy and protect the NHS as an important social endeavour beloved by the English people."
New Section 75 regulations no better than the first versionThursday 21st March 2013
Call to urgent action
I am writing to let you know that legal advice (funded by 38 Degrees) has just been published which makes very clear that the government has NOT listened to the concerns expressed by many of us, about the broken promises and privatising effect of 'Section 75 regulations'.
Please write urgently to your MP, asking them urgently to sign the new Early Day Motion (EDM) 1188 http://www.parliament.uk/edm/2012-13/1188 to overturn these regulations. I enclose two letters that you could use (depending on whether your MP signed the now invalid EDM 1104, or not - see http://www.parliament.uk/edm/2012-13/1104. Please also write to Lib Dem and cross-bencher peers raising your concerns (a list of email addresses is at the end of this letter).
Also 38 Degrees are meeting health minister Norman Lamb today (Thursday) and is asking people to vote in a survey right now (https://secure.38degrees.org.uk/page/signup/meeting-with-norman-lamb) about what they should say to him. Based on 38 Degrees legal advice, it is Keep Our NHS Public's view that we should demand Norman Lamb scraps the new regulations and go back to the drawing board until they can meet the promises that were made to the public, parliament and Clinical Commissioning Groups.
KONP does not consider that the idea of more 'guidance' will do anything significant to protect the NHS from privatisation. 'Guidance' can be re-written any time the government feels like it, without any chance of parliamentary oversight.
The legal advice says: "There does not appear to me to be anything substantial in the new Regulations which responds to these very real concerns. The assurances given by Ministers in Parliament about the freedoms that commissioners would have to commission services in the way they consider best for their local populations...do not appear to be honoured by these new Regulations just as they were not honoured by the old Regulations...[if] the contract is capable of being delivered by more than one provider, the CCG must hold a competition even if it is not in the interests of patients to do so...the introduction of wording about integration and co-operation between providers does not amount to any substantial change to the effect of the Regulations." (The full advice is available here https://secure.38degrees.org.uk/pages/38_degrees_legal_briefings_on_si_2013_500).
Thank you for all you are doing to help protect the NHS from privatisation. There is not much time left to stop the government pulling the wool over people's eyes - please act today and forward this email widely to your contacts.
Save Our Hospitals! No to Privatisation!Sunday 17th March 2013
DEMONSTRATION SATURDAY 18 MAY
12 noon Jubilee Gardens, Waterloo
Belvedere Rd, SE1
Support for the demo so far includes: Save Lewisham Hospital Campaign, Defend Whittington Hospital Coalition, Save our Hospitals Ealing, Save Hammersmith and Charing Cross Hospitals, Andy Slaughter MP, Steve Pound MP, Virendra Sharma MP, John Cryer MP, Onkar Sahota GLA member, Rachael Saunders Councillor Tower Hamlets, Unite the Union, BMA Tower Hamlets, Save Chase Farm, Brent Fightback, Kensington and Chelsea Residents Save Our Hospital, Ealing Trades Union Council NHS Campaign, Ealing Southall CLP, Kingston Trades Council, Kingston and Surbiton Green Party, Kingston Keep Our NHS Public , Kingston GMB, We Are Waltham Forest Defending Our NHS, Camden Keep Our NHS Public , Tower Hamlets Keep Our NHS Public, City & Hackney Coalition to Defend the NHS, Lambeth Keep Our NHS Public, Lambeth Pensioners Action Group.
The demonstration has been called by Save our Hospital campaigns across London and London Keep Our NHS Public. It has been backed by Unite the union, a number of MPs and councillors, trade unions and the London Labour Party.
This coalition of London residents, medical staff, trade unions and health campaigners have come together to raise the alarm regarding the biggest threats to A & E’s, maternity units and in-hospital care for a generation.
Closures planned across the capital include nine accident and emergency departments, a number of maternity units and thousands of hospital beds that campaigners believe will put lives at risk..
Hospitals and community services are also threatened with take-over by multi-national private companies. Hundreds of thousands of London residents have pledged their opposition to these privatisation plans for the NHS.
Across the capital, tens of thousands have taken to the streets to protest and demonstrate to save their local hospitals. 80,000 signed a petition against the closures in North West London. 25,000 joined the demonstration to defend Lewisham hospital.
The local campaigns have joined up to call on the government to stop these closures. We are working together to undermine the government’s divisive tactics of playing one hospital off against another. Instead we are demanding that the government provide the funding needed for safe levels of care across the capital.
Please ask your organisation to pledge their support to publicise the demonstration by adding your name.
Donations towards costs will also be gratefully received (Cheques to Keep Our NHS Public c/o 32 Savernake Rd, NW3 2JP).
More information from www.keepournhspublic.com
To unsubscribe please email LondonKeepOurNHSPublic@gmail.com
NEW THREAT TO THE NHS - 5 WAYS YOU CAN HELPSunday 24th February 2013
PLEASE ACT NOW TO SAVE THE NHS!
Right now, the government is trying to sneak through secondary legislation (under Section 75 of the Health & Social Care Act) to force virtually every part of the NHS to be opened up to *compulsory* competitive markets, open to the private sector. We have just over a month to stop them, and we need to start straight away.
These regulations (SI 257) are likely to be the final straw for many of our NHS hospitals and clinics, already damaged by too much costly marketisation and cuts.
Parliament does not normally even debate or vote on this type of regulation - but it is possible. Even those Lib Dems who supported the Health & Social Care Act should be very concerned as the regulations break the reassurances offered to parliament and to the local Clinical Commissioning Groups, that the Act allowed local choice about when to use competition. For example Andrew Lansley promised doctors that "commissioners, not the Secretary of State and not regulators - should decide when and how competition should be used to serve... patients interests" (see briefing for other examples of the promises that were made). But these new regulations do not allow local freedom to decide when to use competition, at all.
Campaigners may also have heard of the successful Gloucestershire campaign which overturned privatisation of nine hospitals, instead keeping them in the NHS without tendering (in October 2012 - ie, even after the Act). The barrister in that case, David Lock QC, has told me that this option will no longer be possible for anyone else, if these regulations go through.
These regulations were laid down on 13th February and will become law on 1 April unless all MPs who care about the NHS first insist on a debate and vote, and then vote them down. Over the next few days the political parties are going to be considering their next moves.
Please take time now to
a) sign this petition to call for a full debate, vote and defeat
b) urgently email your local MP to ask them to ensure these regulations are debated, voted on and defeated in parliament. Send them the Keep Our NHS Public briefing, attached (or at this link: http://www.opendemocracy.net/files/Section%2075%20parliamentary%20briefing%20Feb%202013_0.pdf) & use the bullet points in the briefing to help you explain to your MP why you are so concerned. You can use www.theyworkforyou.com if you don't have your MP's email address.
c) ask others to do the same! please spread this message widely to friends, colleagues, any groups you are in, and write to the newspapers using the points in the attached briefing, along with your own experience.
d) you could also email the clerk of the house of lords committee on statutory instruments which will be examining the regulations shortly, raising concerns about the implications of these regulations and asking them to recommend they get a full debate in the Lords. Their email address is seclegscrutiny[at]parliament.uk. I will let you know when I know more about the way the Commons committees operate.
e) if you are in touch with your local clinical commissioning group (CCG) - and especially if they seem sympathetic - you could ask them if they share your concerns, if they will make a statement about the implication of these regulations, and if they will speak out against them
You can also read more background here
http://www.hsj.co.uk/news/policy/government-tendering-rules-will-lead-to-big-shake-up-in-services-lawyers-warn/5055338.article?blocktitle=Latest-News&contentID=782 (subscriber only)
Finally, if you are not already a member of Keep Our NHS Public (without whom this would not have been possible) please consider joining today
A&E closures will trigger crisis across West London HospitalsWednesday 20th February 2013
In a final destructive act before they are scrapped in April, Primary Care Trusts in North West London voted yesterday to rubber-stamp their own controversial plans to close FOUR A&E units - in Ealing, Charing Cross, Hammersmith and Central Middlesex. This would leave three boroughs - Ealing, Hammersmith & Fulham and Brent, with a combined population of over 800,000, and each with pockets of severe deprivation - with no local A&E.
Worse, the A&E closures are coupled with complete closure of Charing Cross and near complete closure of Ealing Hospital, and run alongside plans already adopted without consultation by NHS NW London for almost 1,000 bed cuts by 2015, averaging 28% cuts across all eight West London boroughs.
This includes drastic cuts of around a third of beds in three hospitals set to carry the additional workload when the A&Es are closed - Chelsea & Westminster, West Middlesex and Northwick Park.
The decision to press ahead with the closures takes place in defiance of the evidence that they will bring chaos: NHS NWL chiefs have been forced to admit that there are NO concrete plans to establish alternative, community-based services to take the place of the axed hospitals, and have offered no answer to expert studies that contradict their claims that 70% of the caseload from busy A&Es can be dealt with in free-standing "Urgent Care Centres".
Health bosses have also ignored detailed responses to their plans, and shrugged off petitions and sustained popular campaigns to prevent the closures: instead they have forged ahead regardless, hoping to make "savings" of £1 billion through these cuts, coupled with cuts in community health services and mental health services. No section of health care is safe.
London Health Emergency director Dr John Lister said:
"This irresponsible decision aims to tie the hands of the new Clinical Commissioning Groups which take over in April, and will have to sort out this ghastly mess or carry the can for the chaos in urgent services.
"Like all similar "reconfigurations" these plans take the heaviest toll on those with the most serious health care needs, who will face longer journeys to hospital and delays in accessing treatment. While minor cases will be able to access Urgent Care Centres, those needing admission will have to travel miles and wait for scarce beds to become available. Their relatives will face even longer and more miserable journeys to visit them. London's emergency ambulance services are already struggling to cope, and will be set back. These cuts will hit the poor, the elderly and the most deprived and vulnerable hardest.
"It's a scandal that Hammersmith & Fulham council has abandoned any fight to defend Charing Cross Hospital: Ealing council is absolutely right to fight on and challenge these cuts. MPs and GLA members must also step up the fight against each and every closure and cutback.
"The Francis Report on Mid Staffordshire was recently strongly critical of NHS managers who made finance-driven cutbacks without regard for the viability of the service - and argued that if there was inadequate money available, managers must say so.
"So the new CCGs must declare now that their first action on taking office in April will be to reverse this disastrous course, stabilise hospital services, and invest in a sustained expansion of community based health services, without which GPs cannot hope to deliver adequate patient care. And if this causes financial problems they must say so, and enlist public support to press for better funding."
DEFEND LONDON'S NHSSunday 10th February 2013
WEEK OF ACTION 09-16 FEBRUARY
HOSPITAL CAMPAIGNS UNITE TO CALL ON GOVERNMENT TO SAVE LONDON’S NHS
An unprecedented coalition of London residents, NHS staff, trade unions and health campaigners has come together to raise the alarm regarding the biggest threats to A & Es, maternity units and in-hospital care for a generation.
Closures planned across the capital include nine accident and emergency departments, a number of maternity units and thousands of hospital beds that campaigners believe will put lives at risk.
Tens of thousands of Londoners have protested and demonstrated to save their local hospitals in recent months. 80,000 signed a petition against the closures in North West London. 25,000 took to the streets in January to defend Lewisham hospital.
The government haven't listened, though they are clearly rattled. First Jeremy Hunt pretends to save Lewisham A&E, and now the Tory council in Hammersmith claim to have "saved" Charing Cross hospital. Local health workers and campaigners can see through these attempts to divert our campaigns to save London's health service.
In a new move, these campaigns have joined up in a coalition to campaign to call on the government to stop these closures.
They plan to work together to undermine what they believe are the government’s divisive tactics of playing one hospital off against another. Instead they are demanding that the government provide the funding needed for safe levels of care across the capital. Doctors will challenge the notion that planned closures are clinically led, as increasing numbers of clinicians speak out against the damaging impact these cuts will have on patient care.
The campaign is being launched with a week of action across London from 09 - 16 February.
The week-long actions will include protests, a singing flash mob, candle lit vigils, rallies and demonstrations.
Joint Press Conference
Monday 11 February House of Commons
Those attending include: Andy Slaughter MP (Hammersmith), Dr Louise Irvine, Chair Save Lewisham Hospital Campaign, Dr Onkar Sarota, Chair Save Ealing Hospital Campaign, Shirley Franklin, Chair Defend Whittington Hospital Coalition, John Lister London Health Emergency, Frank Wood Chair Unite the Union Health Regional committee, Julie Reay, Save Kingston Hospital campaign
Defend Whittington Hospital Public Meeting
Tuesday 12 February 7.30pm Archway Methodist Hall, Archway Close N19
Speakers include Jeremy Corbyn, David Lammy, Frank Dobson & Emily Thornberry http://dwhc.org.uk/
Valentine Day card for Ealing hospital
Thursday 14 February Handed in to NHS NW London
Save Lewisham Hospital Rally
Friday 15 February 1pm Lewisham Hospital
Defend the NHS Singing Flash Mob
Friday 15 February 5.45pm A central London station
Hammersmith and Charing Cross Hospitals Campaign Protest March
Saturday 16 February 12 noon Lyric Square King Street
Kingston Save Our Hospitals Demonstration
Saturday 16 February 12 noon Norbiton Station march to Guildhall
Defend Whittington Hospital Action
Saturday 16 February Holloway Road N19
Ealing Hospital Action
Saturday 16 February 12 noon Ealing Broadway shopping centre
More information from www.keepournhspublic.com
Francis Report fails to address root problems: Thursday 7th February 2013
impossible targets, inadequate cash limits, fragmenting reforms
Filling three massive volumes and offering 290 recommendations the Francis Report on the scandalous failures of care at Mid Staffordshire Hospitals Foundation Trust appears to be a heavyweight offering.
Some of its recommendations are of course welcome, not least recommendation 18 (requiring all NHS trusts and foundation trusts to review their standards, governance and performance in the light of the report); the insistence on the priority of safety and quality in patient care; and the call for enhanced leadership role for doctors and nurses.
But despite getting some things right, the report ducks many key issues.
" It avoids pinning any direct responsibility on any of the senior managers, commissioners or strategic health authority bureaucrats whose indifference and negligence allowed such appalling lapses from acceptable standards to go without intervention or investigation.
" It creates a new 'duty of candour' and imposes legal obligations on front line staff to report failures in care, but offers them no protection, and no sanctions against those who respond with bullying and victimisation.
" It fails to address the flawed reforms and the unrealistic financial targets that led management into such desperate actions, and therefore fails to make the connection that needs to be made between those terrible days in Mid Staffordshire and the pressures faced today by trusts up and down the country.
The shocking revelations of the sheer scale of the cash-driven cutbacks in staffing which were central to the calamitous deterioration in care are not adequately reflected in the recommendations, despite the fact that many trusts and foundation trusts - driven by the government's insistence on the £20 billion "Nicholson challenge" are even now embarking on cutbacks as large or larger than those which caused such tragic consequences in Mid Staffordshire.
The report fails to engage with the broader political context of the Mid Staffordshire crisis: the changing culture of an NHS being transformed by the policy of successive governments from a public service into a competitive market, in which trusts and their directors are driven by targets and balance sheets rather than by a focus on patient care.
The Mid Staffordshire trust, despite its serious financial problems, was being pressurised to shape up to achieve "foundation trust" status - at the expense of sharply reduced staffing levels and quality of care. But dozens more trusts are even now being driven down a similar path, towards targets to achieve foundation status, as required by the government's controversial Health & Social Care Act, which sets the tight deadline of 2014.
Many of them are seeking drastic savings through cuts in medical and nursing staff: the Trust Special Administrator report on South London Healthcare, endorsed only days ago by Jeremy Hunt, includes drastic cuts in clinical and nursing staff to save money. And these proposals have been finalised, and now endorsed by ministers despite a chorus of complaints by consultants, nurses, midwives and other health professionals that they will jeopardise standards. It has become routine for NHS managers and their political masters to turn a deaf ear to protests and to hope for the best when they endorse cutbacks. Mid Staffordshire managers were not exceptional on that issue.
Robert Francis in his report declares that:
"The Board of the time collectively must bear responsibility for allowing the mismatch between the resources allocated and the needs of the services to be delivered to persist without protest or warning of the consequences. It was or should have been the directors' primary responsibility to ensure either that they did deliver an acceptable standard of service or, if this was not possible, to say so loudly and clearly, and take whatever steps were necessary to protect their patients." (page 211)
But this welcome, far-reaching challenge to the logic of cash limits and balancing the books, one long argued by campaigners, is not mirrored in the recommendations.
Nor does Mr Francis explore the contradiction between this approach and the new, competitive health care market being created by the Health & Social Care Act, in which providers are required only to deliver services as contracted by commissioners. He does not discuss whether the new Clinical Commissioning Groups that will be the principal local-level bodies commissioning health care from April have the expertise or resources to monitor standards of care on the level he proposes.
This will also be made harder as existing NHS providers, themselves already squeezed by constant cuts in tariff and referrals and requirements to deal with historic deficits, face increasing loss of market share to private sector and "social enterprises" - organisations in which scrutiny on the level proposed in the report will run against barriers of 'commercial confidentiality', and accountability is limited to that between a company and its shareholders.
Given the inadequacies that have been repeatedly exposed in its performance, there are few grounds to be optimistic that the Care Quality Commission could adequately take on most of the duties of Monitor, and the prosecuting role of the HSE - and it is already clear that the CQC does not wish to do so. Francis himself pulled back from proposing to regulate senior managers - but does propose regulation of low-paid and exploited Health Care Assistants, who are far from being the cause of the problem.
Equally Francis appears to have quite unwarranted faith in the ability of untested local Healthwatch bodies, widely criticised for their limited brief, and lack of teeth and investigatory powers, to deliver improved scrutiny of services from April.
But perhaps the most glaring omission, since it would have widespread public support, and carry little if any cost, is the failure to stipulate legal protection for those who have the courage to speak out and reveal problems in the quality of care.
There is much of value in the Francis report: but if the fundamental direction of government reforms to the NHS is not addressed and halted, the brutal pressures of cash limits, business methods and the new health care market will undermine whatever measures are brought forward to improve the quality of patient care.
(This analysis also appears on the National Health Action party website)
Message for 2013: Fight now for NHS - before it's gone!Sunday 30th December 2012
By April this year, the NHS we have known will have been swept away by the Tory Health & Social Care Act. Local and relatively accountable public bodies – Primary Care Trusts and Strategic Health Authorities – will have been scrapped.
In their place will be a new, experimental system which claims to put GPs in charge through ‘Clinical Commissioning Groups’, but in fact hands local control over to private management consultants and a new, bureaucratic NHS Commissioning Board.
Planning is to be replaced by a competitive market. Existing NHS hospitals and services will increasingly be cut back to make room for new private sector providers that depend upon NHS contracts. These companies will pick and choose which services they see as profitable, and leave the rest – emergencies, complex cases, chronic illness, most mental health – to what’s left of the public sector.
The new CCGs will be dominated by government demands for £20 billion “cost savings” by 2015: they will not be so much commissioners as rationers of care, deciding only which hospitals and services to close, which treatments and drugs to exclude, which patients should be treated as second class.
One area they will not be encouraged to cut is spending on Private Finance Initiative contracts that are milking billions from the NHS in over-priced deals for new hospitals. It’s clear that while everything else is cut, PFI is being left intact whatever the cost, with generous subsidies to satisfy private shareholders.
We already know NHS managers’ response is to press for more cuts in hospital care: the New Year message from Mike Farrar, chief executive of the NHS Confederation warns politicians not to support local campaigns to stop hospital closures.
Hospitals under pressure
But despite all the so-called think tanks and desperate NHS managers like Mr Farrar arguing for closures of A&E units, beds and whole hospitals, official figures show serious pressures on existing services.
Since 2001, A&E attendances in England have increased by 60%, and routine hospital admissions and emergency admissions by 35%. In London emergency admissions are up by 51% and routine admissions by 60%. Yet numbers of general and acute beds have been cut by 22%, with more cuts to come.
Reports from the Dr Foster and the King’s Fund have warned that hospitals are “full to bursting” and that 2013 might mark the turning point as spending cuts leave inadequate capacity.
Plans to “reconfigure,” “centralise” or “downsize” hospitals rest on vague promises of community services for which no plans or resources exist, and wildly over-optimistic and unproven assumptions. There is no actual evidence these policies might work.
Nor will any NHS cash savings be reinvested in health care: instead we have seen the first £3 billion snatched back by George Osborne and the Treasury … to spend on tax cuts for the rich and big business.
So 2013 is a testing year. As people have found in Lewisham, where a local hospital faces fast-track closure, we have to fight for services if we want to keep them . We also have to challenge privatisation and the carve up of the NHS budget by grasping private firms.
We can’t guarantee any of these fights will succeed: but we can be sure that if we do nothing we will see our NHS broken up, with some services closed down and others parcelled out to profiteers.
Nye Bevan said in 1948 that the NHS would live for as long as there were people ready to fight for it. 2013 is the time for everyone to respond to that call.
2012: the year Cameron hijacked our NHSTuesday 18th December 2012
We are grinding towards the end of a momentous year - which for millions will be remembered for all the wrong reasons. Yes there was Danny Boyle's celebration of the NHS before the sunshine and gold of the Olympics: but 2012 was also the year that Andrew Lansley's reactionary Health and Social Care Bill was passed into law on the basis of LibDem votes.
Coupled with the brutal imposition of £20 billion in cuts by 2014, and the continued haemorrhage of NHS cash to the private sector through the Private Finance Initiative (PFI) - soon to be accelerated with its barely distinguishable offspring PF2 - the HSC Act is set to sweep away the NHS as we know it from April 2013.
The pattern is clear: all of the cuts fall on public sector providers, while all the expansion and opportunities are being offered to the private sector.
Grasping companies like Serco, Richard Branson's Virgin Health and others are cashing in as an ever wider range of services are opened up for private profit, while those that don't offer profits are run down, reconfigured and closed.
And behind every reconfiguration, reprofiling and tendering exercise is a consultancy firm charging a fortune for duff advice, dodgy figures, phony theories and failed policies, snapping up fat profits from the crisis. Like the cockroaches that are thought to be the most likely survivors of a nuclear holocaust, the lowest forms of life, management consultants who borrow your watch to tell you the time and charge you £3,000, seem to be the main beneficiaries of the Tory created crisis in the NHS.
They will be cashing in soon on more and more "Commissioning Support Services" set up to advise GPs on the new Clinical Commissioning Groups on how to spend the budgets they will now be made to feel responsible for, even though it's plain GPs will have little real discretion or control.
GPs have been press-ganged into these bodies despite a majority of GPs consistently opposing Lansley's Bill. In the run-up to the launch of the CCGs they are now bombarded with bureaucratic rules and paperwork, and by deliberately confusing policy guidance from the NHS Commissioning Board - while the organisations that should have led the fight to stop the Bill stand by paralysed, like rabbits in car headlights.
Behind all this apparatus of a new market being expensively wheeled into place comes another parasitic group - the lawyers, picking up fat fees from all sides at every stage. One thing they seem agreed upon is that little should be done to challenge the Act - or even to encourage GPs and CCGs to exploit the few loopholes that have been left in the guidance.
For example CCGs should be taking full advantage of the NHSCB guidance that they are not obliged to operate the "any qualified provider" policy: they should be lining up four-square against a policy that would deprive GPs of any actual control, and which is designed to impose maximum fragmentation and to let a host of new and untested providers into the new healthcare "market".
Instead lawyers working for campaign group 38 Degrees have drafted up weak-kneed general statements which are so vague they offer no real challenge to the NHSCB. Rather than test the government's willingness to use competition law and the NHSCB's willingness to intervene in local CCG decisions, this approach dodges all conflict - just when we need a real fight.
In the background, we are always told, are European competition laws (which were of course hatched up and backed to the hilt by British governments). It's like an old war movie in which gallant allied troops are warned "resistance is futile". But is it? How will we know unless somebody tests it out, has a go, makes a fight of it?
How will this happen if the BMA, and the Royal Colleges which are supposed to uphold ethical values, don't encourage doctors to stand up and fight, or even to assert any real control as commissioners of services? And how likely is this to happen when the TUC health unions are taking such an ambiguous position, occasionally talking a good fight but challenging so little on the ground?
The unions of course, tend to take their lead from the Labour Party, which is sitting on a hefty lead in opinion polls - and doing as little as possible to draw attention to the fact that Lansley's Bill, and most of the current problems in the NHS, trace back to Tony Blair's disastrous experiments in marketising the NHS.
Ed Balls and Andy Burnham still doggedly defend PFI and their stupidity in office in rubber-stamping unaffordable deals which are now dragging trusts like South London Healthcare and Peterborough into massive, unpayable debt. South London has gone bust, and Peterborough ran out of money to pay bills on November 30. Labour has nothing to say on how these and other crises they created must be now be resolved.
New Labour ministers also set up the so-called Cooperation and Competition Panel, which is now used to prise open local NHS contracts to let the private sector pick off the bits they want - and leave the rest.
It was Labour who commissioned the 2009 McKinsey proposals on cost-cutting, the bogus assumptions and evidence free policies from which are now the basic management bible for cuts up and down the NHS. Labour lined up the Circle takeover of Hinchingbrooke Hospital. And Labour first began the carve-up of community health services and coined the term "any willing provider", and welcomed in profiteering private companies to run Treatment Centres, GP surgeries, and a host of other contracts.
Of course the Tories are going much further, faster and doing far more lasting damage. They are cutting not only acute hospitals but also mental health services: the mental health budget is now falling for the first time in ten years. Community mental health is cut, broken up and privatised. Disability benefit cuts clobber the mentally ill. Social care is slashed to ribbons, along with crisis services and home support, while employment and day centres for mental health sufferers have also been slashed back.
But where is the coordinated Labour campaign to stop the cuts and keep private hands off our NHS?
Why won't they declare they will support all of the tens of thousands of local people protesting against cuts and closures, rejecting the feeble pretence that threatened A&E services will be replaced by community health care for which there is no money, plan or political commitment?
The stakes are growing ever higher. In South East London the Trust Special Administrator, using dictatorial powers drawn up by Labour, is trying to prop up the disastrous PFI contracts for two hospitals in Woolwich and Orpington by a smash and grab raid on neighbouring Lewisham Hospital.
Upwards of 30,000 emergencies and seriously ill patients a year in one of the most deprived English boroughs would be unable to access treatment locally at Lewisham Hospital, and face long and arduous journeys for care in other hospitals - which are already full to the rafters.
4,000 women in labour each year would have to trek out to surrounding hospitals with the closure of Lewisham's maternity unit. Children's services are also to be cut. Hundreds of jobs would go, upwards of 400 hospital beds, and 60% of the Lewisham hospital site would be flogged off and most of Queen Mary's Sidcup.
In North West London, health chiefs want to axe 28% of beds by 2016, close 4 A&E units and cut 5.600 jobs, most of them clinical staff. In North East London King George's Hospital faces dismemberment in a desperate bid to bail out the bankrupt PFI-funded Queen's Hospital in Romford.
Other A&E units and emergency services are under threat with reconfigurations threatened across England, from the south coast to Bolton, Yorkshire and beyond.
The reconfigurations, like that in SE London, are all based on spurious claims, figures and assumptions. But from next April the HSC Act will mean that when gaps appear and services are thrown into crisis there is no strategic planning body able to intervene.
Our NHS has effectively been stolen: but we must still fight to minimise the damage, oppose the privatisation, keep services intact - and defend those GPs who take a stand and the brave doctors, consultants and health workers who have challenged the cutbacks at Lewisham Hospital.
We must find every way to delay, obstruct and frustrate those implementing the new system, deter the private profiteers, encourage those who stand for NHS values, and demand Labour spell out plans to roll back the Tory counter-reforms.
We've got three months before the Act kicks in, and immediate battles to fight right now against cuts. Let's make sure January campaigning gets off to a flier and not a minute is wasted.
All together now, in the panto spirit: Jeremy Hunt thinks he's going to flog off your NHS. Oh no he isn't! Have a good Christmas and a fighting New Year!
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