Ara Darzi – Privatisation’s Biggest Fan

Remember the General Election that never was? Just before Gordon Brown bottled it, he asked his mate Lord Ara Darzi to rush out an interim report on the future of the NHS.The report is entitled, ‘Our NHS, our future’. You might want to call it, ‘Their big business, our future’.

I read the report carefully last week, because I was attending Darzi’s ‘International Clinical Summit’ on behalf of Unite. This was quite an unreal event that I will report on properly in another posting. Darzi’s report, though, is a significant one, as it shows only too clearly the Government’s vision of the NHS.

Privatisation runs right through the proposals like the letters through a stick of rock. Darzi calls for a number of ‘immediate steps’. These will include making patient care ‘more personal’ by embedding choice ‘within the full spectrum of NHS funded care, going beyond elective surgery into new areas such as primary care and long term conditions’.  I think this probably means that patients will be encouraged to get their leg ulcers dressed privately, or their diabetes or arthritis managed by the local big business provider. It’s hard to see how this will make health care more personal, but Darzi obviously knows something we don’t.

Darzi praises payment by results on the grounds that it’s ‘making it easier for money to follow the patient’. This, of course, has nothing to do with health care, but allows private sector providers to make money. Payment by results also creates a massive and unnecessary bureaucracy within the NHS, as hospitals now charge PCTs for every single procedure they carry out (and sometimes indulge in overcharging manoeuvres known as ‘gaming’). This is what happens when you turn the NHS into businesses that are forced to compete with one another in order to survive.

Darzi believes that ‘independent sector providers have also helped extend choice, add capacity and spur innovation’. The reality is that Independent Sector Treatment Centres have been feather-bedded by the Government, with guaranteed income whether they do the work or not; they have done little to expand capacity but have destabilised hospitals by stripping away routine work; there is evidence of worse patient outcomes; and ISTCs have cost up to six times as much as an NHS provider! This could perhaps be called innovative – but it certainly isn’t desirable.

There is also enthusiastic support here for the privatisation of commissioning. This is very, very sinister indeed. This is about removing accountability from the NHS to a shocking degree. Big business will plan health care, big business will purchase health care (with public money), and big business will sign the contracts either with their subsidiary companies or with companies with whom they’ve done partnership deals. This is all about handing over our NHS to private sector sharks. It has nothing to do with high quality patient care.

GPs are also under attack – a major theme of Darzi’s report, and of real significance. The Government has wanted for a long time to break the power of the family doctor service. Getting a doctor to do it for them is quite a clever plan.

Lord Darzi is very skilled at dressing up privatisation in progressive language. There’s stuff here that most health workers would agree with wholeheartedly – about integrated care, the safest possible health care, fair health care meeting the needs of a diverse population and so on. There is an obvious challenge, though. Ripping the NHS into tiny pieces, and handing out the profitable bits to the private sector, cannot conceivably be of benefit to patients.

Karen Reissmann – A Fight For All Of Us

I had the privilege yesterday of attending the Manchester demonstration in support of Karen Reissmann.

Karen is the psychiatric nurse sacked by her employers for speaking out against cuts and privatisation. Her victimisation represents the most vicious possible attack on the rights of trade unionists to organise in the NHS. In a magnificent act of solidarity, 150 of Karen’s colleagues are now taking indefinite strike action to demand her reinstatement.

The demonstration will send a clear message to the Chief Executive and Board of Manchester Mental Health Trust that this dispute isn’t going to go away. The police estimate of numbers yesterday was 1500. Trade union activists from across our movement came together, with representation not just from Unison, but also from unions including Unite, PCS, RMT, and CWU. This was an impressive display of solidarity.

It was good to see Unison throwing its weight behind Karen. Speakers at the rally included Bob Abberley, Unison Assistant General Secretary. Abberley paid tribute to the people taking industrial action, and said they should feel proud of themselves, because they had the values and ethics that the NHS should have. He went on to say, “A trade union is like a family. When you attack one, you attack them all. They’ve attacked one of our family, and we’re going to kick them back good and hard”.

Service users spoke movingly about their respect and support for Karen. Karen’s Mum – a nurse for much of her life – spoke at the rally, and talked about how she and Karen had often disagreed on whether it was right for health workers to strike.  She now thought it was right, and knew that what Karen did was for the patients.

Local MP Tony Lloyd spoke robustly in Karen’s defence, supporting the fundamental right to speak out and speak out without fear.

A striker commented that Chief Executive Sheila Foley was now back from her luxury holiday in Dubai, and had tried to sneak into work early without being spotted. Unfortunately she had forgotten that the strikers are used to getting up early!

Karen Reissmann summed up brilliantly. She said, “I’ve been sacked because I’m a trade unionist and a nurse who refuses to accept cuts and refuses to keep her mouth shut. If that’s what I’m accused of, I plead guilty”.

This is an incredibly important dispute. The NHS is under attack on an unprecedented scale. Cuts, redundancies and privatisation are tearing our health service apart. Brown and Johnson have tweaked the presentation, but the Government’s plans for the NHS remain unchanged. It is essential that trade unionists in the NHS have the right to defend the services that every single working class person in the country needs. Karen’s fight is not just an issue for Unison, but for every single trade union activist, and everyone who cares about the future of our health service.

We have to ensure that this fight wins. Rush messages of support and donations to Unison’s Manchester Community and Mental Health Branch, Union Office, Chorlton House, 70 Manchester Road, Manchester M21 9UN (email unison@zen.co.uk )

What comes first – Government or Union members?

I was at a Unite branch meeting tonight – not my own branch, but a London health branch I was visiting in my role as an NEC member.

I spoke about the problems we face in the NHS – the fake financial crisis of 2005/6, the loss of at least 26,000 jobs, the threat to pathology and other diagnostic services through privatisation, and the rapidly escalating attacks on primary care. I also talked about the way Unite has ended up putting the interests of New Labour ahead of the interests of our members – the recent NEC decision that our Union’s priority is ‘two years peace for Gordon Brown’, for example, and the threats to call off the national NHS demo if Brown had called his snap General Election.

Most people in the meeting agreed with me. There was one New Labour supporter, a local councillor, who disagreed. He couldn’t come up with a single argument to justify the Labour Government’s attacks on the NHS, and made no attempt to defend the Union’s subordination to Labour. He didn’t even bother to try – instead, all he could do was to snidely make clear he would not support me in the forthcoming elections for the new Executive.

It seems to me to be fundamental to trade unionism that you put the interests of your members first. Unions must make it an absolute priority to defend their members when it comes to pay, conditions, equalities and so on. If unions can’t do that, then everything else is just so much fluff.

It’s sad to see individual union activists putting loyalty to Labour ahead of their commitment to the members they represent. It’s even sadder to see many General Secretaries in our movement so devoid of vision that they throw their weight behind Gordon Brown irrespective of the compromises and capitulations they are expected to make.

Torrential rain but a good meeting

It was my Unite branch meeting tonight – quite a good turnout, despite torrential rain. We discussed the candidates for the Unite Executive Council election. We nominated candidates who we believe will fight hard for lay control in the Union, and who will put the interests of members ahead of the interests of the Labour Government, including Raymond Morell for London and Jane Stewart for one of the Women’s seats.

The second important item on the agenda was Karen Reissmann’s victimisation, and the magnificent fight by Karen and her colleagues for her reinstatement.

Branch members agreed unanimously to send a message of support to the campaign, together with appropriate letters of condemnation to the Chief Executive and Chair of the Trust, copied to Alan Johnson, and to donate £500 towards the fightback.

£500 is a lot for a Unite branch, as our finances are typically quite limited. A donation of this size reflects the importance that we attach to this dispute. Several members at the meeting raised their own stories of senior managers bullying or victimising trade union activists. We simply can’t allow Karen to lose, as this would be the green light to NHS bosses everywhere to turn on the best activists in our movement. A victory for Karen will be a victory for every single trade union activist in the health service – an assertion of our right to do our jobs as trade unionists, and to defend our members (and our NHS) against cuts and privatisation.

The demonstration calling for Karen’s reinstatement is this Saturday, 24th November, assembling at 1pm, Peace Gardens, Manchester (back of Manchester Town Hall). We need the largest possible turnout at this event.

NHS privatisation in reverse?

A story on the BBC website starts:

“Health bosses have provoked uproar among family doctors over plans to franchise out services along the lines of fast food outlets or estate agents.”

It goes on to say:

“They have told the existing doctors unless they move into the buildings they will bring in the private sector.

Bosses said they could learn from the likes of supermarkets Tesco and Asda on improving customer service.”

This is Heart of Birmingham tPCT. This is not just a quirk of one PCT, though. It closely follows the plans outlined in the Darzi report for London for the setting up massive Polyclinics and closing down smaller GP practices. Plenty of Primary Care Trusts are already going down a similar route. Birmingham makes it clear what this direction is all about. Who believes that the bosses in Tesco really care about their customers? ‘Customer service’ is just another way of maximising profit.  So it fits right in to the Government strategy of bringing in the private sector to promote competition in health care provision.

Hasn’t the Government strategy changed though? Thursday saw an announcement by Alan Johnson proposing to slash future ISTC contracts worth around £3bn. The press is talking about this being a reversal of Blair’s NHS strategy by the Brown Government. I think is something different. Brown is slowing down the rate of privatisation in the acute sector – although even there the number of NHS patients treated in private hospitals has doubled in the last month – in order to push ahead faster in primary care.

The ‘commissioner provider split’ is about ending the role of PCTs as providers of community health care. ‘Plurality of provision’ is Labour’s vision for community services. We’re heading for a future where health visiting, district nursing, physiotherapy and the like are provided by private sector companies with little interest in patient care and an overwhelming priority of making money. Last week, I met as a stakeholder (that’s a Union rep to readers of this blog) with a consultant brought in to my Trust to map out the future of service provision. Favoured options include services being moved out of the NHS into the private sector, or to the half-way house of social enterprises. The same process is underway in most PCTs. It is not as dramatic as a £3bn contract for ISTCs, but the overall effect will be even greater.

I think the BMA have had the right response in Birmingham:

“Over the 600 years that there have been GPs no one has come up with this model, and people feel uncomfortable with it because they don’t think it will work. And nobody has asked us whether we’re prepared to work that way.”

The BMA is also worried about private firms coming in to run the franchises, and putting shareholders before patients. We need our Unions to oppose all privatisation of our NHS, and to respond with united opposition. We cannot afford, as some of our Union leaders do, to believe that the Alan Johnson announcement represents a reversal of Government policy. Clutching at straws has never been a good starting point for defending members’ jobs and a fully public health service.

Shhh! Don’t mention the patients!

I’ve been reading Board papers again – a habit I really need to break.

Don’t struggle too much with the detail of this, but here’s a typical paragraph:

SLAs between PCTs – De-hosting and full cost recovery – the old District Health Authorities and community or whole district Trusts were disaggregated to PCTs five years ago. This was not a straightforward process, as information systems and costing methodologies were much less developed then than they are now. In many cases, pragmatic decisions were taken. The issue of shared services and provider SLAs which do not recover at full cost becomes increasingly important with the separation of PCT provider and commissioning functions, and with provider services increasingly needing to compete with other potential providers. SLAs which result in one PCT provider including in its cost base all the estates costs and overhead for some of its services distort the service line costs for both PCTs. PCT providers should therefore notify other PCTs by 30 November of the areas which they propose are reviewed for 2008/9 and PCTs should agree a process for detailing and agreeing the impact by 31 December. PCTs will need to demonstrate a fair distribution of overheads following the proposed re costing. No resource limit adjustments will be undertaken in respect of these changes as they will all have the effect of aligning spending more closely with the capitation based resource limit of the responsible commissioner. In order to accurately cost provider services, PCTs must be able to allocate an appropriate fair proportion of overheads to the provider arm of the PCT. In addition, it is clear that the current allocation of overheads varies across PCTs and a clear methodology is required that shows how support services have been allocated and demonstrate that an appropriate share of costs has been allocated to both provider and commissioner. Further detailed guidance will be developed with PCT FDs.

At a superficial level, you look at this and marvel at people who can construct syntactically perfect sentences that mean nothing at all.

The trouble is, there is a meaning here, as there is in most Board papers like this. This is all about separating ‘commissioner’ and ‘provider’ services to make it easier to hand over the provision of clinical services to the private sector. It’s also about running the NHS as a series of competing businesses. The language is increasingly that of big business. Another paper I looked at today talked about our ‘range of products’, and about ‘units of production’.

Patients? Healthcare? Quality of care? All of that is old hat. Gordon Brown’s NHS is about ‘market testing’, fragmentation, and out and out privatisation.

Blame the victims

Remember the shocking reports from Maidstone and Tunbridge Wells NHS Trust back in October? While the Board was obsessing about its new PFI project and its urgent need to eliminate a £17 million deficit, at least 90 patients died from C. difficile, with a further 179 deaths potentially attributable to the infection.

People died as a direct result of cuts. Patients were left lying in their own excrement, while nursing, healthcare assistant and cleaning services were cut to the bone.

Media reports this week are that two healthcare assistants have been sacked. A nurse and a further healthcare assistant have been disciplined.

Was it the nurse who implemented Government policy? Was it the healthcare assistants who decided to drive through cuts? Was it the healthcare assistants who played privatisation games while patients died?

No. Let’s be clear – the culprits are the Board members, the former Chief Executive, and the senior managers who took the strategic decisions that caused the deaths. At another level, the culprits are Hewitt, Blair and Brown – the politicians who demanded that NHS Trusts balance their books no matter what the cost was to patients.

NHS cuts harm patients and harm staff. Virtually every union rep in the NHS will have come across cases where NHS bosses victimise individual staff instead of acknowledging the staff shortages and lack of resources that are really to blame. I’m in the middle of a fight exactly like this in my own Trust, where managers are trying to sack three dedicated nurses instead of sorting out staff shortages.

Health workers are typically decent human beings who do the very best they can. It is the extraordinary dedication and commitment of health workers that keeps the NHS going. If we’re going to point the finger of blame, let’s start looking at the politicians who are dismantling the NHS, and the NHS bosses who go along with the ‘reform’ agenda.

http://news.bbc.co.uk/2/hi/uk_news/england/kent/7090195.stm

The NHS crisis ain’t over

A couple of weeks ago I was at a meeting of health workers where Ann Keen MP spoke. Keen is now some sort of Junior Minister for Health, with a specific responsibility for workforce planning. Her credentials are that once upon a time – a very, very long time ago – she used to be a District Nurse. She told us that she knew the last two years had been incredibly difficult for the NHS and for us health workers who did such a brilliant job, and she was listening to us, and she really, really wanted to work with us. A colleague’s comment was, “Don’t you just want to slap her?” The same phrase had gone through my head listening to Keen. Patronising doesn’t begin to describe her manner.

The trouble is, we’re being encouraged to believe this nonsense by senior union officials who should know better. We’re being told that the bad old days of Blair and Hewitt are over, but now we’ve got Gordon Brown and that nice Alan Johnson, and Ann Keen who’s just dying to work with us. The bad times for the NHS are over, and things can only get better.

Is this true? If it is, there’s certainly very little evidence so far. It’s important to remember that Brown is the architect of PFI – the horror story that continues to bleed our hospitals dry. Let’s remember also that Brown as Chancellor of the Exchequer demanded this year’s effective pay cut for health workers, and he and Johnson enthusiastically carried this forward under the new regime. We’ve seen the announcement of ‘FESC’ a few weeks ago – a frightening scheme that hands over the planning and purchasing of NHS services to private sector companies (including the particularly unscrupulous US company United Health). Darzi’s plans for the NHS are about cuts and closures, dressed up in lovely rhetoric about world class services, innovation, and care closer to home. ‘Modernisation’ apparently demands closing maternity units, A&E Departments, and – in the near future – an awful lot of hospitals.

We’re also continuing to see the stark evidence of hospitals in financial crisis, and the vicious service cuts arising from this. One example comes from a story in yesterday’s Evening Standard, under the headline, “Wards and staff are cut at bankrupt hospital”. This is about the Bromley Hospitals NHS Trust. The story is worth checking out as an illustration of the realities of New Labour’s NHS. The Trust is bankrupt, and surviving on handouts from the Department of Health. Hospital bosses are trying to save £23 million in a single year. The Standard reports that drugs budgets are being slashed, and operating theatres merged. Staff have been ordered to question every decision that “may disadvantage the hospital’s financial situation” – with no such emphasis on safeguarding patient care.

The reason for the deficit isn’t that complicated. The Trust has to pay off a £155 million PFI scheme for the Princess Royal University Hospital, opened only four years ago. They can’t generate enough income to pay off the debt, thanks to Labour’s record of siphoning off patients to the private sector, and fiddling around with the national tariff. So the Trust slides deeper and deeper into chaos, its debts rise year on year, and Trust bosses now have no conceivable way of getting out of this mess. The savage cuts being driven through now certainly won’t solve the crisis. Let’s be clear that this has got nothing at all to do with incompetent managers failing to balance the books. This is the direct result of Labour’s policies on health.

So is the NHS crisis over? Sadly, no. Do they want to work with us? Yes, but only so long as we compromise on every key issue, and allow our NHS to be dismantled. It has never been more important to build a massive, militant campaign to defend the NHS.

Karen Reissmann speaks

Karen Reissman speaking at a meeting on Tuesday after she had learned that she had been sacked by her employer,  Manchester Mental Health & Social Care Turst, for speaking out against cuts and privatisation. 

Her work colleagues in Unison are now on an indefinite official strike to secure her reinstatement.

A national demonstration has been called in her support on Saturday, November 24 at 1pm. Meeting place: Peace Gardens, off St Peters Square, behind the Town Hall, Manchester. Please try to get as many people there as possible. We cannot allow any health worker to be victinised for speaking out.

The pressure is on. Even the local newspaper, the Manchester Evening News, is attacking the Trust’s Chief Executive. This is a fight we can win.

Disaster for Scottish Community Nursing

There are enormous problems within the health visiting profession, and more generally in community nursing.

In England, cost cutting has led to sharp reductions in the provision of a universal health visiting service, leaving very many children at risk. ‘Skill mix’ is fine when its used to extend and develop services, but far more often is being used crudely to cut costs and reduce service quality. The vital preventative and public health roles of health visitors are very much under threat. The CPHVA has its work cut out – from a trade union and a professional perspective – to defend its members and the services they provide.

Like a lot of people, I’d thought that the NHS in Scotland was in relatively good shape. I was shocked to learn the details of the Scottish proposals for community nursing. There is a real horror story in the making in Scotland – driven by the same resource issues as the cuts in England, but a proposal that goes for a ‘big bang’ approach to dumbing down services.

The last Labour Government led a review of community nursing. The SNP used to be fiercely critical of the proposals, but have changed tack now they are in power. The plans are clearly driven by cutting costs and covering up a shortage of staff. The intention is to take the separate and distinct professional roles of health visitors, school nurses and district nurses and roll them into a single ‘community nurse’ function. This is meant to start as soon as April 2008, although there is apparent secrecy (or total lack of planning) around how existing staff will be retrained and supported in taking on totally different roles.

This is just mad. It’s like telling a Cardiac Consultant that they have to be a Paediatrician and an Oncologist and an ENT specialist as well. It makes no sense at all. Health visitors and school nurses are skilled professionals. Both play a vital role in health promotion, supporting individual children, and in preventing and detecting child abuse. They are specialists in their own areas of work. The role of District Nurses – equally specialist and valuable – is a totally different one of supporting sick, disabled or terminally ill adults in living with dignity in their own homes.

If these proposals go ahead, it will be the most vulnerable people who suffer: very young children, parents who are struggling to cope, ‘at risk’ school age children, and the adults who are least able to have a voice and fight their corner.

The CPHVA has carried out a survey of its members in Scotland. These members are rightly furious. Their anger isn’t just about their own jobs – it’s about the threat of a social model of care being replaced with a medical model, about the loss of a meaningful public health role, and about the enormous damage to the people they work with.

One health visitor summed it up nicely: “The proposals are a disaster in the making. Staff will be deskilled. There will be less time to provide support for vulnerable children and families. This is a cost cutting exercise that will be detrimental to children and to society as a whole”.

The Union is working hard to reverse the proposals. There is still time for this insanity to be stopped.