Private equity running the NHS?

October 29, 2007

There was an interesting article in the Observer today, “Is it healthy for the NHS to go private?” The article makes the point that ever increasing proportions of the NHS budget are going into the hands of the private sector – increasingly to private equity companies. While there is a prediction that Alan Johnson may slow down the pace of privatisation, there is no suggestion that it will not continue, let alone be reversed.

Private equity company Cinven bought BUPA’s 26 hospitals this summer for £1.44 bn. Who is this latest entrant to the healthcare market? What is their expertise that will benefit NHS patients?

Their website makes their priorities clear:

  • Established in 1977, Cinven is one of the most prominent and successful investors in the European buyout market.
  • Our reputation has been built on our ability to deliver complex transactions, the quality of our people and the exceptional success of our funds.
  • Our achievements rest on our skill in applying effective strategies to our businesses, creating value and long-term growth.

So, an emphasis on funds, value and growth. Not much about healthcare, but a lot about profit.

BUPA sold the hospitals because that business line was less profitable than their health insurance business (and BUPA, of course, is busy helping the Government privatise NHS commissioning these days). Cinven believe they can increase the profitability of these hospitals, and the Government will ensure they succeed by pushing elective surgery to the private sector.

It’s increasingly clear that we’ll end up reading the Companies pages of the Financial Times to find out what is happening to our health service. Transparency and accountability are way down the agenda.

We need to reverse privatisation. Health workers know it doesn’t work, and there is little public support for the Government’s ‘NHS Reforms’. There is a growing awareness that ‘reform’ means cuts, privatisation, and worse patient care.

There was another massive demonstration on Saturday – this time in Chichester. Over 15,000 marched to oppose the closure of St. Richard’s Hospital, from the same Trust where 14,000 marched in Haywards Heath a couple of weeks ago.

If 29,000 can march in West Sussex, we should be able to get a massive demonstration in London next Saturday, November 3. We cannot afford any more Cinvens. Let’s show Gordon Brown and Alan Johnson we mean business.

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Pleural Plaques

October 26, 2007

People get sick. In most cases there is little we can do to prevent it. The great thing about the National Health Service is that it is always there (or should be) for people when they need it.

Some illnesses, though, are preventable. Some illnesses are caused by employers who show a singular lack of concern for the health of those who work for them. Over the years many industries have proved to be unhealthy. Frequently the employers know or can guess this because they see the big picture, they have the sickness absence records, they have access to the research.

It’s usually only later that employees find out the dangers they have been facing – frequently too late to safeguard their own health.

One example of this is the asbestos industry. Employers were well aware of the dangers of producing and working with asbestos, but that did not stop them continually putting their workers at risk. Profits always had to be protected. As the public perception of the risks became greater, employers had to be more inventive – they opened factories in depressed areas, areas of high unemployment, where workers – however reluctantly – felt they had to take the jobs.

Many of those who worked in the industry a few decades ago now suffer from asbestosis and related diseases. Their health is ruined. The quality of their lives is ruined. The one thing that has helped, a little, is that they have often won financial compensation for the grotesque damage to their health and wellbeing.

Workers have won compensation primarily because trade unions have fought for it. For all the criticisms one can make of the trade union movement, our record on fighting for health and safety has been sound. It has been our unions that have been at the forefront of every fight for protective legislation. It was our unions that campaigned for health and safety reps to have statutory powers.

It is distressing to see that we suffered a serious reverse last week. The House of Lords has ruled that sufferers of pleural plaques will no longer be entitled to compensation.

Pleural plaques are almost aways caused by exposure to asbestos, and are associated with a greatly increased risk of developing fatal conditions like mesothelioma or asbestosis. Something like 14,000 cases come up every year. Until the House of Lords ruling last week, workers with pleural plaques had been entitled to compensation – a right established for over 2o years.

The insurers are happy. They argued that no compensation should be paid because the lung damage had not quite yet turned into life threatening illness. The House of Lords supported them. Sufferers now have to wait for compensation until their whole quality of life becomes intolerable.

I don’t always agree with my General Secretary, Derek Simpson, but he was absolutely right to oppose the House of Lords decision. Derek said, “This is a harsh decision which will affect thousands of people with pleural plaques now and in the future.”

This was a significant setback, and one we have to resist. Trade unions must continue to fight to safeguard the health and safety of all our union members and those who work alongside us. The insurers and the bosses believe they have saved themselves £1.4 bn over the coming years. It’s our job to ensure they haven’t.


A candidate from the defence industry

October 23, 2007

On Saturday, I was at the meeting of Eastern and London Region Gazette supporters (the Gazette is the broad left grouping within Amicus) that chose who to support for the regional seat in the Unite Executive Council elections.

After a long meeting, where we all had the opportunity to listen to and question the various candidates, we decided to back Raymond Morell. Raymond is a senior rep in the defence industry.

I fully backed that choice even though it might seem a strange one for a health worker. Raymond is a good trade unionist who has unionised his plant and won a recognition agreement earlier this year.

He is more than that though. While he fights for the members in his own industry, he also recognises, unlike many today, that trade unionism has a wider social purpose. At the Amicus Policy Conference he moved the motion against Trident replacement, arguing that the billions it was going to cost could be much better spent on health and education.

Many of his colleagues in his industry opposed his stand, but, as he argued on Saturday, a good trade unionist has to put the interests of all the members first, not just those from their own section. Raymond also argued for a restructuring of the defence industry to provide socially useful jobs, giving a productive long term future to his members.

I don’t blame people who work in defence, just as I don’t blame people who work in the tobacco industry. It is always refreshing, though, to meet people who have a wider vision and don’t feel that they have to protect nuclear weapons, tobacco, nuclear power and the like because these things might appear to meet immediate interests.

I hope those of you in the Eastern & London region will consider supporting Raymond. He put out a statement to the meeting on Saturday which is worth reading to discover where he stands on a variety of issues. If you want to meet him, he’s happy to come to workplace or branch meetings, and he’ll be on the NHS demo on November 3rd.


Patient care or keeping up appearances?

October 20, 2007

An interesting story from a leading Foundation Trust hospital in London. I got this from a Unite rep in Pathology.

In the good old days back in the dim and distant past, samples from Theatre were taken straight up to the Path labs. Then, a few years ago, there was a cost saving measure and Pathology staff were expected to come down to Theatre to pick up the samples themselves.
There were no great problems. Samples were kept on a short-term basis on a trolley behind Theatre reception. Lab staff popped down as and when necessary. It was a simple enough system, and it worked.

Recently, a senior manager decided that it was unsightly to have test tubes in plastic boxes sat on a trolly behind Theatre reception. The instruction was given – samples had to be stored at the other end of the Theatre unit. So now, Pathology staff walk past the door of every operating theatre, wearing lab coats that have been worn for up to a week, wearing their outdoor shoes, simply in order to pick up the samples to take back to the Path lab. The risk of infection has absolutely soared – but, hey, Theatre reception looks a lot better.

Staff have, of course, pointed out the risks. They have not been listened to. The manager isn’t from a clinical or scientific background, and isn’t that interested. The focus in the NHS these days is less and less about patient care, and more and more about keeping up appearances or hitting meaningless targets.


“NHS Trusts failing”

October 19, 2007

That was the headline on many of the press reports following yesterday’s publication of results from the Healthcare Commission’s annual survey. Very few of the reports, though, had any real look at why things were going wrong.

It’s not unusual for the press to be unwilling to scratch the surface to discover the real stories. They are usually content with the horrific headlines. On Wednesday, when Brown and Cameron debated the impact of “targets” during PM Questions, Adam Boulton, political editor of Sky News, complained it was all too technical. He only showed enthusiasm for the debate about a European referendum. If Brown and Cameron are above Boulton’s head when it comes to understanding the NHS, what hope has he got of understanding what’s really happening!

Royal Cornwall Hospitals were highlighted by the Healthcare Commission as one of the four worst NHS Trusts in England. It’s worth looking behind the headlines a bit.

Health bosses are to ignore the wishes of 27,000 marchersIn August last year 27,000 people marched through Hayle against cuts to Cornish health services (report). They were protesting against the cuts arising from the Trust’s budget shortfall of £31m. There have been hundreds of redundancies, alongside ward closures and cuts in services.

Surgeons were instucted by senior management to slow down on admissions last year. They had completed 4,600 more operations than had been budgeted for.  One surgeon, Peter Cox, was quoted at the time: “This is all about finance”. The surgeons had apparently been “too aggressive” in meeting the Government’s waiting list targets. Making cost savings was more important to managers than making people better.

The Trust is certainly not a model employer. As part of the overall cuts package last year, 30 workers aged over 65 were sacked  just before the age discrimination regulations came in – a clear attempt to avoid redundancy payments. Unison won their reinstatement by threatening to go to the European Court.

Sue Wolstenholme, the Trust’s Director of Communications, complained that the Hayle demonstrators “need to understand the reality behind the situation much more clearly”. Disgracefully, she said the Trust would ignore the protests. Typical of senior management in much of the NHS, Trust bosses are more concerned with implementing the Government’s agenda than protecting patients, services and staff.

NHS management teams are only the transmision belt for cuts and chaos, though. The £31m budget deficit in Cornwall was just one element of the artificial NHS financial crisis manufactured by Patricia Hewitt. If Royal Cornish is failing now, it is because Government funding was insufficient to meet the needs of the patients in Cornwall, and the redundancies and service closures ordered by the Govermment have made things far, far worse.


Crisis in Speech & Language Therapy?

October 18, 2007

On Tuesday night, I sent an email request around speech and language therapists requesting information on what was happening in their own Trusts. This was in response to a request to Unite from the BBC. The journalist had picked up both on the forthcoming Bercow Review of speech and language therapy, and the extent to which SLTs are being seen as a ‘soft target’ for cuts.

It remains unclear if the BBC will be interested in taking the story any further. I really hope they do. The feedback from many therapists was heart breaking. Comments included: ‘We can barely function’, ‘Staff morale is at rock bottom’, ‘We are undervalued’, ‘We are being dumped after a lifetime of dedication to the profession’. Many therapists reported that the pressure they work under is making them ill.

This is a very brief summary, anonymised here to protect individuals.

There are now direct redundancies amongst SLTs. Service managers seem to be particularly vulnerable, with several reports of redundancies amongst senior colleagues. It’s obvious that too many decision makers don’t understand why clinical management – by senior colleagues who understand clinical issues – is so important to us. One Highly Specialist SLT has just been handed her redundancy notice. The justification? Apparently school-age children with complex language disorders no longer need support – an early preventative approach will work just fine.

Pay is being driven down. Job descriptions are rewritten to match lower pay bands. One Trust has replaced Band 8s with Band 5s! Vacancies are routinely left unfilled, or replaced with posts of a lower grade.

Children with the most severe speech and language disorders are losing out. Specialist units are being closed down. An AAC service continues to offer high quality assessment for communication aids – but finds community SLTs have no time to train users and their families, so clients suffer.

Many, many SLTs report workloads that prevent them doing their jobs adequately. Unfilled posts leave the remaining clinicians desperately plugging the gaps. One area has lost over a fifth of their staff. Clients and patients are being put at risk. Acute dysphagia (eating and drinking) therapists report real clinical risk, with too many patients and inadequate time to provide a safe service. In one paediatric service, children are now waiting up to a year to be seen – a long time in the life of a young child.

Training budgets have simply gone in many places. Therapists pay for their own training when they can afford to, while others go without. The loss of professional leadership is another key issue. Over time – unless we can reverse this – we’re looking at a steady ‘dumbing down’ of standards of clinical care. Outsourcing is an increasing threat, with numbers of Trusts gearing up to hand over their provider services to external suppliers. Newly qualified therapists are still finding it very hard to get a job, and are often working under immense pressure when they do.  Bureaucracy and targets and reported ‘pointless emails from people with the word strategic in their job title’ interfere with clinical work.  

What was clear from many comments was the immense pride that we still have in our profession and the work that it does, and the overwhelming commitment that we have to our clients and patients. What’s happening to the NHS is wrong, because it stops us delivering the high quality care that we are trained to provide. Some SLTs, out of despair, have left the NHS to work privately. This is understandable. I also think it’s not the way forward. The NHS is damaged but still here, it offers essential care to millions of people, and it’s still worth fighting for. A good place to start the fight is the 3rd November demonstration in defence of the NHS.


Nurse of the Year

October 17, 2007

Justine Whittaker was annouced as “Nurse of the Year” by the Nursing Times only last February. Today it is announced that she is leaving the NHS because she is “fed up with cuts and reforms.”

She complains that she is spending more time filling in paperwork than working with patients. She recognises that cuts have reduced the overall quality of care – outside the “target” areas.

I sent out an email yesterday to Speech and Language Therapists across the country asking for their experiences because I had been asked by Unite to talk to the BBC. I’ll post a more detailed summary of the responses tomorrow, but it is clear that Justine’s complaints are echoed by virtually every SLT who replied. Whatever Gordon Brown says, there is a crisis in morale in the NHS.

Brown said in the Commons today that he had appointed Darzi to listen to health workers. Darzi would be travelling around the country listening. It’s a funny sort of listening when you have already decided what the way forward is! Brown has already indicated that Darzi’s reorganisation plan for London will be rolled out nationally.

While we can all identify with Justine, I don’t believe her solution – to go private – is the right one. I know it looks attractive. Many SLTs – sick and tired with the reorganisations that have undervalued clinical skills – have talked about doing the same. In the end though, this just helps the Government to push through their privatisation plans.

If the “market” is allowed to become dominant in health provision, then our wages, our working conditions and our clinical practice are threatened whether we work in the private or public sectors. In the short term a few of us may do OK. But with the Government’s commissioning plans , we will all in the future face having to compete – with bids going to the lowest cost provider. It was called Best Value in local government, and everyone suffered. In the NHS, we know that our privatised cleaning staff are worse off than if they had remained NHS employees, and we know their employers cut corners to increase profits.

If going private were the solution then the US must be the model. Angela Gorman, an NHS nurse in Unison, was invited recently to speak at the California Nurses Association Conference. This is one of the largest of the American unions. Angela’s report shows what the future could be like. It’s not one that many of us in the NHS would welcome.

Justine is right in her criticisms, but I wish she had stayed in the NHS and leant her weight to a collective fight back in its defence. If we want to rebuild an NHS where people like Justine feel able to continue working, a good place to start is the November 3rd demonstration in London.