Cutting the NHS to the bone

Submitted by Matthew on 10 November, 2016 - 12:51 Author: Gemma Short, Charlie Bell and Romesh Amaradeva

The NHS Bill 16/17 (formerly the NHS reinstatement bill) was due to have its second reading in Parliament on Friday 4 November.

NHS campaigners gathered outside Parliament to support the bill. The bill did not get discussed on that date and the second reading has now been rescheduled to 24 February 2017. The bill was presented to Parliament on 13 July by Labour MPs Rachel Maskell and Margaret Greenwood. The bill would restore the NHS as an accountable public service by reversing 25 years of privatisation and marketisation.

The bill would: abolish the purchaser-provider split; reinstate the government′s duty to provide the key NHS services throughout England; integrate health and social care services; declare the NHS to be a ″non-economic service of general interest″; abolish the NHS Commissioning Board; require national terms and conditions under the NHS Staff Council and Agenda for Change system for relevant NHS staff; centralise NHS Private Finance Initiative (PFI) debts; abolish the 2014 legal changes which require some immigrants to pay for NHS services.

NHS bosses across the country are quietly drawing up plans for hospital closures, cutbacks and radical reorganisations to cope with a projected £20bn shortfall by 2020. NHS England has asked local trusts to draw up so-called ″Sustainability and Transformation Plans (STP)″ for how they will operate within the budget shortfall.

Almost certainly most of these plans will include the restriction of non-life saving treatments, closures and amalgamations of A&Es, and increased involvement of private providers.

At Labour Party conference Momentum launched a national campaign around the NHS. If it is to grow this campaign needs to be taken up by local groups and taken into the Labour Party.

• NHS bill campaign

• Momentum NHS

• Stop the STPs campaign

NHS workers need a payrise

Unison’s annual survey of health workers has found that in the last year two out of every three have sought financial help or made major changes to their lives due to erosion in pay levels. 63% say they are worse off than last year, 10% have resorted to pay day loans to get by. This is the reality of government pay freezes in the public sector.

Health workers' pay has fallen by an average of 12.3% in the last six years and if the trend continues Agenda for Change rates are set to drop below the minimum wage. This is the background to the current NHS pay review body consultation on pay for 17/18.

Within their submission employers argue the current 1% pay restraint is appropriate to allow trusts to make the “efficiency savings” required by the NHS plan. They also argue that Agenda for Change needs reform to remain “sustainable”, signalling a continuation of the current picture where cuts have fallen squarely on the shoulders of health workers.

The health unions firmly and loudly oppose any cuts in unsocial hours pay, in line with the junior doctors dispute. Their proposals on Agenda for Change reform — including abolition of the lowest pay points to achieve the living wage as minimum pay, less increments within pay scales for faster pay progression — are also good.

However they couch the Agenda for Change negotiations as if the desire for “reform” from employers mirrors that of workers, when in fact it is directly counter posed. The financial hardship of health workers cannot be solved through partnership with employers who are implementing government cuts. There needs to be an active campaign amongst members for a £10 a hour minimum wage and to break the pay freeze.

Junior doctors fight not over

Last month, the Junior Doctors’ Committee of the BMA voted to suspend its planned industrial action in the face of mounting pressure. Concerns about patient safety, combined with reluctance from junior doctors to take the financial and training hit of recurrent prolonged strike action, led to the JDC decision.

This has been met with a significant backlash from some junior doctors. A poll on Facebook suggests strong continuing support for a reduced three day strike, with about 2,500 voting for this option. It is clear that since the referendum and the decision taken by junior doctors to reject this contract the BMA has been unable to develop a convincing or coherent narrative about the way forward.

With the contract being introduced in stages and the first obstetrics and gynaecology trainees already now on the contract, focus from the BMA has shifted towards fighting the way the contract is implemented. With concern mounting about the ability for NHS Trusts to impose this contract in a suitable manner, this is likely to inflame tensions further and an already demoralised workforce will take further hits.

How this contract dispute will continue to play out is yet to be seen, and how it will interact with the restarted consultant contract negotiations and the first steps towards Agenda for Change negotiations will have a lasting impact on the legacy of the dispute.

Social care cuts put more pressure on NHS

“The NHS is going into its toughest winter yet with the odds stacked against it.

“Demand for healthcare is on the rise, funding for both health and social care is being squeezed and A&E departments are missing their targets.”

That was the warning from Nigel Edwards, the Nuffield Trust’s chief executive. The full effect of the latest tranche of cuts to local social care will be felt by the most vulnerable this winter. This at a time of unprecedented demographic change and financial austerity and privatisation in the NHS.

Delays in discharging medically fit patients, due to the lack of social care (add to this an understaffed hospital transport system) means patients are at risk of developing further complications, such as hospital acquired infections, and due to prolonged bed rest are less likely to make a complete recovery once they are home.

To relieve pressure on hospitals, local NHS community teams are often diverted from seeing patients who would otherwise benefit from more intensive or specialised input, to plug the gap in capacity created by local cuts to social care. Savings made by local councils go beyond efficiency. They have already impacted on the provision of services; people with social care needs may no longer qualify for it.

The hallowed sustainability and transformation plans (STPs) are likely to be implemented in the same way for primary services. When local NHS bosses talk about “demand reduction” and “prevention”, this will really mean reducing access to patients and service users. This will certainly lead to more pressure on A&E departments, as carers and patients feel they have nowhere else to turn.

Stephen Dorrell, the NHS Confederation Chair, admits “As a result, we are increasingly using our acute hospitals as unbelievably expensive care homes.” In a report on social care he proposes a move away from micromanaging local health initiatives and vague support for Devo Manc. These ideas fall well short of what is needed, and do nothing to address the costly and poor quality private social care provider market.

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