Tag: #NHS

WORKING FOR PATIENTS OR NOT? – a guest post by Suzanne Kelsey

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A guest post by Suzanne Kelsey, who is a key campaigner for the NHS, amongst other things.

In 1988, when Margaret Thatcher had been in office for some 9 years, and the very foundations of our NHS had been shaken with more of the public encouraged to use private medical care,  there were serious concerns about capacity in the hospital services as waiting lists increased and wards closed.  The Conservative government appointed a group of people, without consulting the health professions, to look at this growing problem.

As a result of this the NHS experienced the most significant cultural shift since its inception with a White Paper entitled, ‘Working for Patients, ’ which proposed what we now  know as the ‘Internal Market’ and the development of the purchase provider split. GPs become the purchaser and the hospitals are the providers. This passed into law as the NHS and Community Care Act 1990. Understandably there was a great deal of opposition from trade unions, Labour and the general public but it went ahead as did the Private Finance Initiative in 1992 implemented for the first time in the UK by the Conservative government of John Major.

There is no doubt that further major problems were created for our NHS, although I would question if on the same scale as we are currently witnessing with the threat of complete privatisation and the sell-off of our publically funded service to huge private international companies, who have been waiting in the wings for quite some time and would have been rubbing their hands in glee some years ago if Thatcher and the Conservatives had continued in office.

The definition of ‘privatisation’ also needs to be acknowledged because with the downgrading of facilities and existing provision struggling to meet demands, more and more people will become anxious and tempted to pay for their treatment even if it is to ensure they have a hospital bed!

We must never let this practice become the ‘norm.’ Campaigners must ensure that the ‘free at point of use’ core principle is upheld or we will be taken back to pre-war years, removing freedom from fear that was fought long and hard for by our champions of social justice. At the same time we must remember the mantra, ‘public health not private wealth’ with numerous examples available to us of how private companies will always put profits before patients, but more of that later.

When Tony Blair became Prime Minister in 1997 he inherited a very impoverished NHS and although we expected him to abolish the internal market this did not happen, perhaps for a variety of justifiable reasons. How do you replace crumbling hospitals and inadequate resources without massively raising taxes, whilst also limiting the upheaval that had already been caused?

Alan Milburn was Minister of State at the Department of Health during this time and he stated that after years of the Tory’s gross underfunding, there was absolutely no money to fund the infrastructure, hence the use of John Major’s PFI initiative. Labour therefore it would seem had little choice but to implement this because of the historic neglect of the NHS under the Conservatives that led to understaffing and an NHS unable to manage with the rising expectations of the population, coupled with the costly advances in modern medicine and technology.

A global recession, which was not Labour’s fault, further compounded the challenges of meeting the complex needs of the nation’s health care. Dennis Skinner MP for Bolsover Derbyshire, passionately summarised this in parliament in 2014 when he stated; ‘Between 1997 and 2010 Labour dragged the NHS from the depths of degradation that the Tories had left it in and hoisted it back to the pinnacles of achievement.’

I would like to pose some questions to those experts of marketisation and competition. My knowledge is very limited on the economic implications but I am learning, slowly but surely, through my long involvement with local and national campaigning, speaking to key people in politics and campaign groups, who are also passionate about our NHS. I become increasingly frustrated when people continually blame Labour for the introduction of privatisation  Yes Blair did carry on certain aspects of it which was a disappointment for many, including me, but perhaps my arguments surely go some way to addressing why this was.

  •  My first question is in the title of this article; ‘IS THIS WORKNG FOR PATIENTS OR NOT?’
  •  If Labour had made such massive inroads into privatisation surely there would have been no need for the Coalition’s unwieldy and costly three billion pound reforms, so huge they were just about visible from outer space and the truth is many of those who voted for it would not have time to read it fully. The bill was a long time in the writing and despite the pause because of massive opposition it was nevertheless hastily introduced by the Coalition, despite all the election promises, notably, ‘there will be no top down reorganisation of the NHS.’ They have as predicted caused unprecedented chaos and in fact a major crisis in our NHS, with exhausted frontline workers propping up a system, becoming totally stressed, angry and demoralised.

Many of the population are afraid of becoming ill, because of worrying inadequacies not only at primary and secondary health care levels but also in social care. The frail and elderly feel a burden as they are constantly labelled as ‘bed blockers,’ Thus long queues have been created to see your GP and at A+E, the gateway to the hospital, all of which can result in a lack of timely care. In contrast however Labour ensured patient satisfaction was at its highest with waiting times were at their lowest and the NHS during their time was lauded as one of the best, if not the best health service in the world.

  • Were the massive and unprecedented reforms therefore unnecessary and unjustified?
  • What are the implications for binding private contracts that have taken place across large swathes of the country if hopefully there is a change of government?
  • What lesson have been learnt from the withdrawal of Circle, the private company that took over Hitchingbrooke hospital, with claims of managers installed by these private operators creating a ‘blame culture?’ Allegedly Circle were willing to ensure local GPs incurred financial losses as long as it meant corporations continued to make a profit and the damning report about the quality of care in this hospital is shocking. CQC inspecting the hospital felt obliged to intervene when they became fearful of a sickening child and Professor Mike Richards the chief inspector of hospitals said that the findings were the worst it had ever published.
  • Clive Efford Labour MP for Eltham, South East London,   presented a private members bill to parliament in November 2014,which in order to avoid further top down reorganisation, focussed on the most damaging aspects of the Health and Social Care Act 2012, that gave powers to competition regulators to interfere in decisions of local health care commissioners. The most significant change is that the Secretary of State is once again accountable to you and me through parliament. If the bill is passed he can no longer avoid answering parliamentary questions by saying that it is down to local decision making and not his responsibility. Efford’s Bill also provides that neither EU competition rules nor EU procurement rules will apply. That is an important change from the present because, at the moment, a disappointed private provider can sue an NHS commissioner for damages for failing to put a service out to tender or running a tender process wrongly. My thanks to Clive Efford for that explanation and for securing a vote of 241 for the bill to 18 against.
  • How is this Bill progressing and how it is being supported by NHS campaign groups and health professionals.
  • If the Conservatives are allowed to waltz back in by a public who have been influenced by the hype and propaganda through a biased media and/or have become disengaged, disenchanted or disillusioned , or indeed confused by the outrageous claims of some minor parties who seem to be making it up as they go along, what do we do next!?

I hear talk of a revolution being the only answer from those extremists who are likely to be the least affected by one. Perhaps we would do well to remember that our NHS has just seen the biggest revolution since its inception in 1948. Unfortunately we have seen a glimpse into our future and the outcomes are dire, if we do not use our votes wisely.

Suzanne Kelsey 1stFebruary 2015

http://www.nhshistory.net/shorthistory.htm#_ednref15

http://www.nhs.uk/NHSEngland/thenhs/nhshistory/Pages/NHShistory1948.aspx

https://abetternhs.wordpress.com/2011/01/18/commissioning-and-the-purchaser-provider-split/

http://www.healthp.org/node/71

http://labourlist.org/2014/11/commons-pass-vote-on-clive-effords-nhs-bill/

http://www.telegraph.co.uk/news/politics/11333986/Damning-report-as-first-private-firm-to-run-NHS-hospital-pulls-out.html

Battle with GPs led to Circle’s retreat from Hinchingbrooke hospital,   The Guardian, January 9, 2015

Hinchingbrooke staff in CQC abuse concerns fear bosses BBC, September 29, 2014

http://www.independent.co.uk/news/uk/uks-healthcare-ranked-the-best-out-of-11-western-countries-with-us-coming-last-9542833.html

Welfare reforms, food banks, malnutrition and the return of Victorian diseases are not coincidental, Mr Cameron

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The coalition will leave more debt than all Labour governments since 1900. The current government is now responsible for £517 billion of the trillion-plus-pound UK public debt, compared to £472 billion accrued during the 33 years Labour led the country since the turn of the twentieth century.

And the figures look even worse when you adjust for inflation. When you do that, the Coalition’s share jumps to nearly half of the total debt.

But the Coalition don’t meet any public needs, they simply serve the wants of a powerful, wealthy elite. Labour invested in public services, the Tories have bled them dry. So, what have they done with the money? Because the public have seen only austerity cuts. And the most vulnerable citizens bear the brunt of the cuts.

Oxfam’s director of campaigns and policy, Ben Phillips, said: “Britain is becoming a deeply divided nation, with a wealthy elite who are seeing their incomes spiral up, while millions of families are struggling to make ends meet.”

“It’s deeply worrying that these extreme levels of wealth inequality exist in Britain today, where just a handful of people have more money than millions struggling to survive on the breadline.”

Diseases associated with malnutrition, which were very common in the Victorian era in the UK, became rare with the advent of our welfare state and universal healthcare, but they are now making a reappearance because of the rise of numbers of people living in absolute poverty.

NHS statistics indicate that the number of cases of gout and scarlet fever have almost doubled within five years, with a rise in other illnesses such as scurvy, cholera, whooping cough and general malnutrition. People are more susceptible to infectious illness if they are under-nourished.

In 2013/14, more than 86,000 hospital admissions involved patients who were diagnosed with gout – an increase of 78 per cent in five years, and of 16 per cent on the year before. Causes of gout include a lack of vitamin C in the diet of people who are susceptible.

The figures from the Health and Social Care Information Centre (HSCIC) show a 71 per cent increase in hospital admissions among patients suffering from malnutrition – from 3,900 admissions in 2009-10 to 6,690 admissions in 2013-14.

Cases of scarlet fever admitted to hospital doubled, from 403 to 845, while the number of hospital patients found to be suffering from scurvy also rose, with 72 cases in 2009/10 rising to 94 cases last year.

The figures also show a steep rise in cases diagnosed with cholera, a water-borne disease which was extremely prevalent in the 19th century, causing nearly 40,000 deaths.

While total numbers remain low, the 22 cases last year compare with just 4 in 2009/10, the statistics show.

Dr Theresa Lamagni, Public Health England’s head of streptococcal infection surveillance, said the total number of notifications of scarlet fever this year has already reached 12,580 cases – the highest since 1970.

Cases of measles in hospital rose, from 160 to 205 cases, with a small rise in admissions for whooping cough, from 285 to 289 cases over the five years examined.

The figures on malnutrition follow a series of scandals of care of the elderly, with doctors, remarkably, forced to prescribe patients with drinking water or put them on drips to make sure they do not become severely dehydrated.

Charities have warned that too many patients are being found to be malnourished after being admitted to hospitals from care homes, as well as from their own homes.

However, Labour have said the figures a national scandal.

Luciana Berger MP, Labour’s Shadow Public Health Minister, said: “This shouldn’t be happening in 21st century Britain and the Government’s response is hopelessly complacent.

“People are living under greater pressure and struggling with the cost of living”.

“Hundreds of thousands are forced to turn to food banks and sadly it’s unsurprising people are eating less, and eating less healthily too”.

“David Cameron needs to listen to what the experts are saying and tackle the cost of living crisis that is driving people into food poverty.”

Cases of malnutrition have been steadily increasing since the 2010 general election.

In 2009/10 there were 3,899 hospital admissions for this, in 2010/11 there were 4,660, in 2011/12 there were 5,396 then in 2012/13 this had risen again to 5,594.

People unable to feed themselves adequately needing hospital admission saw a significant rise to 6,686,  where malnutrition was the primary or secondary diagnosis during 2013/14.This is a rise of 71 per cent from 3,899 in the year up to April 2010.

Chris Mould, chief executive of the Trussell Trust which runs a nationwide network of food banks, said: “This shows increases in diseases related to poverty and that’s alarming.

“Our food banks see tens of thousands of people who have been going hungry, missing meals and cutting back on the quality of the food they buy.

“We know quite a large proportion of the population are struggling to get nutritious food on the table. And at the extreme end of that you get people who are malnourished”.

“We don’t believe anyone should have to go hungry in the UK”.

“The scale of the increases we’re seeing must be further investigated to find out why this is happening”.

Scurvy is a disease associated with pirates stuck at sea for long periods – has increased by 31 per cent in England since 2010. This is caused by a lack of vitamin C and is usually due to an inadequate diet without enough fresh fruit and vegetables.

Figures from January this year from the NHS indicate that there were 833 hospital admissions for children suffering from Rickets – a condition which is caused by a lack of Vitamin D, from 2012-13. Ten years ago, the figure was just 190.

The disease, which causes softening of the bones and permanent deformities, was common in 19th century Britain but was almost eradicated by improvements in nutrition. The body produces vitamin D when it is exposed to the sun, but it’s clear that adequate diet plays an important role, too, since the decline of Rickets happened at a time when we saw an improvement in the diets of the nation as a whole.

It is thought that malnutrition is the main cause, children are most at risk if their diet doesn’t include sufficient levels of vitamin D.

Low incomes, unemployment and benefit delays have combined to trigger increased demand for food banks among the UK’s poorest families, according to a report commissioned by the government and released earlier this year,

The report directly contradicts the claim from a government minister that the rise in the use of food banks is linked to the fact that there are now more of them. It says people turn to charity food as a last resort following a crisis such as the loss of a job, or problems accessing social security benefits, or through benefit sanctions.

The review emerged as the government comes under pressure from church leaders and charities to address increasing prevalence of food poverty caused by welfare cuts. The End Hunger Fast campaign called for a national day of fasting on 4 April to highlight the issue.

The report was written by  food policy experts from the University of Warwick, and it was passed to ministers in June 2013 but had remained undisclosed until February 2014, creating reasonable speculation that the government suppressed its findings.

Examining the effect of welfare changes on food bank use was not a specific part of its remit, and the report is understood to have undergone a number of revisions since early summer, ordered by the Department for Food and Agriculture and the Department for Work and Pensions (DWP).

The researchers found that a combination of rising food prices, ever-shrinking incomes, low pay, increasing personal debt, and benefit payment problems meant an increasing number of families could not afford to buy sufficient food.

In a letter to the British Medical Journal, a group of doctors and senior academics from the Medical Research Council and two leading universities said that the effect of Government policies on vulnerable people’s ability to afford food needed to be “urgently” monitored.

The group of academics and professionals said that the surge in the number of people requiring emergency food aid, a decrease in the amount of calories consumed by British families, and a doubling of the number of malnutrition cases seen at English hospitals represent “all the signs of a public health emergency that could go unrecognised until it is too late to take preventative action”.

The health specialists also said:“Access to an adequate food supply is the most basic of human needs and rights”.

The authors of the letter, who include Dr David Taylor-Robinson and Professor Margaret Whitehead of Liverpool University’s Department of Public Health, say that they have serious concerns that malnutrition can have a long-lasting impact on health, particularly among children.

Tory ministers have repeatedly insisted that there is no “robust link” between the welfare reforms and rising food bank use, whilst welfare minister Lord Freud claimed the rise in food bank use was because there were more food banks and because the food was free.

It ought to be noted, not least by the government, that people may only access food banks when they are referred by a professional agency, such as social services, the DWP or a Doctor. In particular, vouchers for emergency food parcels tend to be given by benefits officials.

In all but exceptional cases, Trussell Trust food banks will only issue a food parcel to someone with a voucher from an accredited agency. Claimants are limited to emergency aid on three occasions only. This indicates that need, rather than availability, is the key reason for the increased use of food banks since 2010.

Together with the pressure created by rising prices and falling wages, there has been a marked increase in demand for emergency food aid since the welfare reforms came into effect. And this is affecting both people in and out of work.

More than half of people who have visited a food bank since April were referred because of social security problems.

The Government claimed the rapid increase in malnutrition cases “could be partly due to better diagnosis”.

I don’t imagine that it’s likely that Doctors have suddenly become better at diagnosis since 2010.

I do, however, think there is much scope for improvement in the capacity of Tory ministers for understanding correlation, basic cause and effect and simple connections.

However, Tory skills in mendacity, creating diversions and ad hominem are second to none.

 

See also:

Poverty

 An email to authoritarian Tory MPs Charlie Elphicke, Priti Patel and Conor Burns

Quantitative Data on Poverty from the Joseph Rowntree Foundation.

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Pictures courtesy of Robert Livingstone