NHS: Farewell to planning?

December 21, 2008

A depressing milestone was reached last week in the unravelling of the NHS. The regulator of Foundation Trusts announced that over a half of hospitals in England now have ‘foundation status’. The Guardian report is here.

We now have 112 hospitals that are still part of the NHS, subject to planning, control and regulation. We have 113 hospitals that are run as small businesses, that – so long as they are financially viable – can do whatever the hell they like. A majority of the remaining NHS hospitals are likely to follow in their footsteps. William Moyes, in charge of regulating Foundation Trusts, boasted that by 2011 or 2012, the whole hospital system could be outside ministerial control.

Is this sensible? No, of course not. Simple commonsense dictates that the provision of healthcare should be on a planned basis. We should work out how many people are likely to need, for example, hip replacements; ensure resources are allocated to the right geographical areas; plan the workforce to ensure we have enough surgeons, nurses, physiotherapists and so on – and do the same for across the whole health and public health agenda. Alternatively, we close our eyes, cross our fingers, and hope that the market will provide.

A concrete example of the absolute idiocy of deregulating the hospital system came last year. The Department of Health, sensibly enough, decided that every hospital should undertake a ‘deep clean’ to reduce the incidence of hospital acquired infections. Even better if they’d insisted on hospital cleaning being taken back in house, and provided the resources to enable a reduction in bed occupancy rates – but still a deep clean exercise was the right thing to do. Monitor, on behalf of Foundation Trusts, reacted with fury. Apparently it is now against the law for an elected Government, or for the Department of Health on behalf of an elected Government, to tell Foundation Trust hospitals what to do! Where’s the accountability in that? The priority for Foundation Trusts is their financial viability – that, and only that, will dictate the care available to patients. Stark, raving bonkers.

Aneurin Bevan, the driving force behind the NHS 60 years ago, once said, “A free health service is pure socialism”. There was a large element of truth in this. The NHS was created only in order to meet the needs of human beings. Profit and competition and market forces didn’t come into the equation. That’s why the Tories were so hostile to the NHS back in 1948. Sadly, that’s maybe also why Brown’s Labour Government is intent on dismantling the NHS in 2008.

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Two Meetings

December 17, 2008

I’ve been to two frustrating meetings this week.

On Monday night, members of Unite’s Health Sector National Committee met three MPs with a claimed interest in the NHS. They included Kevin Barron, Chair of the House of Commons Health Select Committee.

The lay members present expressed real anger about pay and privatisation. A porter talked about how the lowest paid health workers are being squeezed hardest by the credit crunch. A health visitor talked about community nurses with case loads of 1000 families, and the escalating risks of another ‘Baby P’. A mental health nurse raised her concerns about the state of mental health services – the government claimed services were a priority, but when money was available, it was in little short-term ‘pots’ that were taken out of existing services. A craft worker talked about the enormous waste of money associated with ‘contestability’, and a health care scientist reported that in his hospital the private sector charges three times the going rate to change a bulb in an X-Ray machine. I talked about the rock bottom morale of health workers and the deep damage being caused to the NHS by privatisation.

I was impressed with our representatives. We were well-informed, articulate, and spoke from a starting point of strong commitment to a publicly owned and publicly accountable NHS.

It’s a shame that the MPs present didn’t seem to share our agenda.

Barron acknowledged that the Government had destroyed a lot of good will by its handling of public sector pay – but said that MPs weren’t in a position to shape the outcome.

He continued with a facile characterisation of privatisation being about stopping consultants playing golf when they should be doing NHS work, and pretended the agenda was primarily around ‘destroying the vested interests of doctors’. The truth perhaps came out with one of Barrons’s final comments: “It’s not going to be an easy ride for anybody, especially yourselves”. There was little evidence here of any willingness to understand what privatisation is actually doing to the NHS. And respecting and listening to health workers I suspect isn’t going to happen any century soon.

Tuesday saw a special meeting of the Union’s Health Sector National Committee to discuss where we are with pay.

We’ve run a pretty good campaign on pay.  Our members initially voted by 95% to reject the three year deal, and this autumn voted in favour both of strike action and industrial action short of strike action. We’ve run days of action, in July and at the start of this month.

This meeting was probably crunch time in terms of taking the fight forward. The National Officer and many lay representatives talked about the problems – the unevenness of the day of action, the lack of confidence amongst sections of the membership, the impact of the recession on confidence and organisation and so on. The Committee voted against taking any action now to progress strike action. We’ll be meeting again in January – but it looks less and less likely that were going to see a serious fight over pay in this year’s pay round.

So what went wrong? There is certainly unevenness in the levels of confidence and organisation on the ground. I argued in the meeting that we couldn’t afford to be paralysed by that, and that leadership was about building on what we’d got- but most representatives were obviously unconvinced of this. An absolutely key job for activists is rebuilding organisation, workplace by workplace and section by section.

The prospects for united action across the public sector have got less and less over recent months. Action alongside the PCS and NUT would have been a different prospect to fighting on our own. Action across local government and Health could have had real power. Action across all NHS unions would obviously have been brilliant – but was ruled out by the divide and rule tactics from the leaderships of Unison and the RCN back in April. There are lessons to be learned here for all public sector unions. We’re stronger fighting together.

The recession has sapped confidence, certainly – but when you read about Madonna’s divorce settlement with poor deprived Guy, you realise that the grotesque inequalities of our society are alive and well. A large part of this is about politics. Why should public sector workers pay for an economic crisis that is not remotely of our making?

I also wonder about the commitment from the very top of Unite. It was a disheartening experience on Tuesday night to have a thoroughly unsympathetic MP tell us, with a slight smirk, that one of our Joint General Secretaries thought the pay deal didn’t look too bad. From previous remarks I’ve heard Derek Simpson make on NHS pay, an informed guess is that this came from him. I’ve always believed that an over-friendly relationship with New Labour is bad news for public sector workers.

The bottom line for trade unionists is that we get what we fight for. Meetings with MPs can make you cross, but they don’t deliver decent pay unless the meetings are backed up with industrial muscle. It’s looking likely now that the fight isn’t going to happen this financial year. That means real pain for our members who are struggling with increased fuel bills, food bills, council tax, public transport and the like. We need to do far better than this next time.


Barry Sheerman MP: UK children possibly not safe in his hands!

December 14, 2008

I read a totally bizarre press report last week about Barry Sheerman MP, Chair of the House of Commons Children, School and Families Committee. Sheerman and other members of the Committee grilled Christine Gilbert, Head of Ofsted, in the wake of Baby P’s death and the conviction of the adults who should have cared for him.

Sheerman was apparently surprised at the figure given by Gilbert of 282 child deaths in the 16 months to August 2008, with 210 being attributable to abuse or neglect. He is reported as saying, You have brought to us the most horrific figures I’ve ever seen brought into the public domain”.

The figures are shocking, and a real indictment of the way our society treats children. But why on earth was Sheerman surprised? The data on child deaths was included in Ofsted’s  annual report , published on 19th November 2008. Presumably Barry hasn’t got around to reading it yet. He’s obviously a very busy man, but someone heading up a Select Committee that’s investigating child protection might have brought himself up to speed before a key meeting.

It isn’t just November’s report that Barry missed. The November data was an update of figures released by Ofsted in early July in a detailed report entitled Safeguarding Children. Again, Barry and his researchers seem to have missed the report – and gone on missing it for the last five months.

The reality is that around 150 children each year in the UK are likely to die as a result of abuse or neglect. Recent research published in the Lancet flags up that around a million children in the UK experience physical, sexual, or emotional abuse or neglect. A press summary is here.  Barry Sheerman probably missed this research as well.

Blaming individual social workers for a society where a million children suffer harm isn’t particularly useful. Even Barry Sheerman got this half right, commenting There is something deeply wrong with a society with this number of child deaths a year and a child protection system that does not save them” (my emphasis).

Of course child protection procedures can and should be improved. But can an effective child protection system on its own deal with the problems faced by children in the UK? A recent review of child deaths and serious injuries from abuse and neglect highlighted the overwhelmingly strong link with social deprivation. And the issues are far wider than child abuse and neglect.  Will a child protection system tackle the plight of the 3.9 million children in the UK living in poverty? Will a child protection system reduce the health inequalities of poor children, or end a situation where children from poor families are thirteen time more likely to die than children from rich families? The UK locks up more children than any other country in Europe. Will a child protection system sort that one out? Probably not.

If we’re serious about the welfare of children, then we have to demand that Sheerman and his pals take responsibility for the policies of their own Government. Poverty kills children – through illness, accidental death, and through child abuse and neglect. Hysterical witch hunting of social workers solves nothing. Shouting at the boss of Ofsted isn’t all that useful either. Sheerman might usefully stop shouting and try a bit of thinking.

The wider political context, though, is a frightening one. The economic crisis will drive more families into poverty. Labour’s assault on the welfare state will sharply increase family stress and poverty. The likelihood is that the number of children experiencing abuse or neglect will increase, however good we get at tightening up our child protection policies and procedures.


Unite Day of Action

December 4, 2008

Today was the Unite Day of Action against pay cuts. It’s too early to have a detailed picture of what happened and where – but a quick Google search showed that action of one sort or another took place across the UK. This reflects the very real anger that health workers feel. People have had enough.

We have a Government that continues to treat public sector workers with open contempt. We were right to take industrial action today. The task ahead of us now is to build this fightback.

A fairly random selection of press reports is here:

Sunderland: The Sunderland Echo 

Scotland:  Highland News

Yorkshire: The Press

Northern Ireland: BBC

Whitehaven:  Whitehaven News

There are plenty of others!


Victory for Baby P?

December 2, 2008

“Victory for Baby P” screamed the Sun, as heads rolled in Haringey. No, guys – Baby P is dead. There’s no victory here.

The Sun, over the last week or two, has run a very nasty campaign in which they’ve ‘named and shamed’ social workers and demanded their dismissal. Local Lib Dem MP Lynn Featherstone has worked hard to build her own career by cheer leading the witch hunt. Tory leader David Cameron has joined the ritual condemnations of staff, saying “It’s good that some of the people have been named and been suspended” – and is calling for their pay to be stopped.

The ‘victory’ for the witch hunters is that three senior staff have been suspended, and another three are under review. Are they culpable? It’s hard to know – because Children’s Secretary Ed Balls has refused to publish the enquiry report.

Human beings make mistakes. We know that, for the simple reason that most of us do it from time to time. Possibly even Sun journalists and career-minded MPs get stuff wrong sometimes. Condemning individuals here is not particularly useful. The tragic death of Baby P wasn’t caused by an evil social worker trying to kill him. Almost certainly, we’re looking at a series of system failures – around resources and workloads, procedures, training, supervision and so on.

We’ve already heard from a senior social worker at Haringey about the culture of bullying and the massive workloads. She flagged up her concerns long before Baby P died, incidentally. If individual social workers were stressed, overworked and bullied, there’s a good chance that they weren’t doing the job that we (and they) would want them to.

Child protection is way too important to leave to the likes of the Sun and David Cameron. If we can stop the hysterical witch hunt for a moment or two, it’s worth thinking about what needs to happen. It’s too late for Baby P, but not for other children who are abused or at risk of abuse. What needs to be happening is a careful, honest detailed review of why Baby P died, and what lessons need to be learned. Then we need to look at the resources, training and structures that are needed to implement change at national level.  It might be more fun shrieking at individual social workers – but children deserve better than that.


Unite: Is the merger finally on track?

December 1, 2008

It’s an open secret that the merger between the Amicus and T&G sections of Unite has been in real trouble. Progress towards integration has been painfully slow. Over the last few months, there have been bizarre decisions such as the instruction to Amicus reps that they’re not allowed to attend T&G training courses, and restrictions on the allocation of Amicus Full Time Officers to support T&G members. Very serious allegations have been made, at senior levels of the union, that one section has been deliberately withholding information from the other in order to obstruct integration. I’ve heard a growing number of reports – again at very senior levels of the union – that the leadership of the T&G has considered ‘demerging’: simply walking away from the whole Unite project.

As we slide into a serious economic recession, it’s more important than ever that we have a strong, united union that can fight for jobs, pay and pensions. For Unite to be diverted into the infighting and power games that have been going on is simple nonsense. A ‘demerger’ would be genuinely catastrophic. If we were to end up in this situation, it would be hugely damaging to the confidence of our reps and activists – and I believe would very seriously damage our movement as a whole.

The Executive Council meeting last week I hope will have been very significant indeed in changing where we are with establishing Unite. I’m working on a more detailed report of a three day meeting – but as a lot of people have asked me what happened, it seemed worth pulling out a few of the more significant discussions.

The last few weeks have been characterised by escalating levels of tension between the Joint General Secretaries of Unite. Media reports have claimed that Derek Simpson, in a meeting of officers in Scotland, “chose to liken union organisers to SS troops and cheerleaders in ra-ra skirts.” Few activists would see this as helpful in building a united union. The organising agenda isn’t perfect – but it’s the single most important element we have in building a strong fighting union that can defend its members.

Reports also emerged before the Executive Council meeting of a meeting of the Finance and General Purposes Committee – an important sub-committee of the Executive. Derek Simpson (JGS from Amicus) had been at this, but Tony Woodley (JGS from the T&G) had not, as he was attending a funeral. Rather oddly, Derek Simpson recorded the meeting, and sent the recording to Tony Woodley. Verbal and written reports of the meeting indicate that it was dominated by a very lengthy contribution from Derek Simpson, in which he highlighted sharp disagreements over union finance, membership integration, the leadership of different departments in Unite, the implementation of a voluntary redundancy programme, and a number of other issues.

Correspondence shared with Executive Council members showed that sharp disagreements between the two Joint General Secretaries remained at the time our meeting took place. The United Left meeting that took place prior to Executive meetings confirmed this. A number of Executive Council members therefore went into the Executive meeting feeling it was ‘make or break’ time for Unite. Without some sort of resolution to stark disagreements between the General Secretaries of the union, it was hard to see any way forward.

The whole of the first day was dominated by sometimes sharp divisions on where we are and who is to blame. The debate on the minutes of the Finance and General Purposes Committee was a particularly sharp one. JGS Tony Woodley gave his own view on the lack of progress towards full integration of the two halves of the union. He said that demerger wasn’t an option, and history would never forgive us if we allowed Unite to disintegrate.

Tony Woodley felt that the delays and the ‘dilly dallying’ with merger were deliberate. His criticisms of the leadership of Amicus were fierce. He talked about an attitude of paranoia, people trying to gain advantage, and people being more interested in who was going to be next General Secretary than in building a merged union. He sharply criticised the management of finance in Amicus. He rebutted, in a great deal of detail, claims that had been made by Derek Simpson around finance, education, the deployment of officers, the integration of membership, and the deployment of officers and organisers on the Amicus side without regard for agreed procedures. He defended the organising agenda, and the real growth in membership and new shop stewards arising from this. A little later in the meeting, he expressed strong concerns at the treatment of an individual staff member on the Amicus side.

There was a good discussion by Executive Council members. The mood was overwhelmingly for the games playing to stop, and for real progress to be made with integrating the two sections of Unite. There were strong views expressed that we’ve got to have real and accurate membership and financial information to do our job. EC members made it clear that there’s an expectation now of real, concrete steps towards progress, with EC members taking on much more direct hands-on control if this doesn’t happen. Particularly sharp criticisms were made of inappropriate handling of finance on the Amicus side.

The Chair put to the meeting proposals that senior officials should share information and progress integration – and, importantly, that the Executive Council would be meet again on 18th December to evaluate progress – and to take control if adequate steps towards integration had not been taken. Derek Simpson was evidently unhappy with this, concerned that some Amicus members might not be at the meeting on 18th December, and looked for a commitment that the Executive Council would not take a vote or seek a ‘shoot out’ if insufficient progress had been made. This simply didn’t fit. The Executive Council voted overwhelmingly – on the Amicus and T&G sides – to progress merger, to meet again on 18th, and to evaluate progress at that meeting.

So where are we now?

This was, without question, a very important meeting. The people who want to progress merger won. The people who want to obstruct merger lost. There is an expectation now of progress. My view is that one General Secretary emerged from a bruising encounter with his authority quite substantially diminished. The prospects for building Unite – as a real union that organises in the workplace and fights for its members – look far better than they have done for some time. The Executive Council, for the first time in my experience on the Executive, made a serious assertion of our own rights as the representatives of lay members. There were real steps forward. This was a positive meeting. If the commitments made at the meeting are carried through, demerger is a good deal less likely – and this can only be good.

It isn’t all plain sailing of course. The games playing that’s gone on to date needs to stop – but we have no guarantees that it will. That’s one danger. The other danger is one of ‘tribalism’ – that the Executive meeting will be seen as a victory for the TGWU and a defeat for Amicus. That would be to the detriment of all our members, from both sections of the union. The real task facing us isn’t about one section of the union slogging it out against the other section – it’s about working together to transform Unite into the union that our members deserve. That means building our industrial strength. It also means having the political courage to challenge Brown’s Labour Government.