Derbyshire Save our NHS

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We are facing:

  • A cut of £219 million from the NHS in Derbyshire
  • Cutting 535 NHS beds in Derbyshire (30% of the total)
  • Rationalisation of Estates (property and land)

We must act NOW. There ARE things you can do. Read on to find out more.

Derbyshire’s Sustainability and Transformation Plan (STP) is one of 44 being presented to the government and NHS England from ‘footprints’ like Derbyshire.

An information meeting at County Hall in Matlock on  7th December was attended by approximately 50 people, including representatives from Amber Valley, Ashbourne, Belper, Chesterfield, Derby City and Matlock areas, who came to listen to Gary Thompson, CEO of Derbyshire STP and Dave Allen (Derbyshire County Council Cabinet member for Health and Communities) Labour. The meeting was called by Derbyshire Save Our NHS and chaired by Keith Venables Chair Health Campaigns Together.

 

Derbyshire’s  STP (subtitled ‘Joined Up Care’): http://www.southernderbyshireccg.nhs.uk/publications/joinedupcarederbyshire/

was published on 18th November 2016, but without key Financial, Estates, Business Plan or Staffing appendices. These were published on 7th December just prior to this meeting. The ostensible aim of the STP is to provide joined up care closer to home.

 

The meeting

No photographs were allowed (Gary Thompson challenged a member of the audience when he took a photo of the speakers).

No commitment was given about:

  • initiating a formal consultation of the proposals;
  • a route for individuals to query aspects of the STP – and get a response;
  • specific plans for closing the funding gap (currently the Derbyshire STP area has ‘shortfall of £219 million) The STP ‘team’ as a whole is not accountable to the Public. The only democratically accountable voice is the  Local Authority cabinet member (Dave Allen)
  • when the plans will be actioned.

 

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It’s all about Money, Money, Money . . . and Privatisation

Simon Stevens, CEO of NHS England, has asked for cutbacks of £22 billion across England following his Five Year Forward View, and will put somewhere between £6 and £8 billion back in through transformed services.

By 2021 each ‘local health economy’ must be spending on average £450 million less.

There is no need for this. Chancellor Philip Hammond says we don’t have to concentrate on balancing the books at this stage.

Two aspects of the 2012 Health and Social Care Act:

  • up to 49% of a foundation hospital  trust’s total income can  be generated from treating private paying patients
  • There is no longer any requirement for the Secretary of State for Health (currently Jeremy Hunt) to ensure that the NHS is providing health care for everyone  - only that the internal market within the NHS is working effectively.

Some LA’s have refused to ‘sign off’ the STP for their area. Derbyshire’s view at the moment is to not support any changes until adequate alternative care is provided. Dave Allen stated that DCC (whilst it remained a Labour Local Authority) would not support any changes until adequate community-based care is provided.

 

Nationally STP plans will mean:

  • More care classified as ‘social care’  - not free NHS care and so subject to charging
  • No growth in NHS services despite population growth (18% in some areas)
  • Replacing qualified doctors with ‘Physician Associates’  - who have 2 years’ training (compared with 6 for a newly qualified doctor)
  • Replacing other healthcare professionals with unqualified ‘assistants’
  • Loss of up to 25% of community pharmacies
  • New structures leave the NHS vulnerable to takeover by private healthcare corporations.

(source www.keepournhspublic.com)

 

What we can do

  • Press the Government to adequately fund both Health and Social Care
  • Press for services to remain publically accountable, not in the hands of private business
  • Support the NHS Reinstatement Bill that will restore the NHS  (due to get its second reading in Parliament 24th February 2017)
  • Write to your MP, sign petitions e.g. on the Labour Party website, 38 degrees, http://www.nhsbill2015.org/take-action/ to support the above
  • Participate in events to publicise the difficulties the NHS faces e.g. stalls, walks etc.
  • Attend meetings organised by Save our NHS, Keep our NHS Public and Derby save our NHS e.g. 9th Jan at Designate, Smedley St Matlock
  • Attend the DCC Health and Scrutiny Board meeting on 23rd January (at County Hall?) http://www.derbyshire.gov.uk/council/council_works/improvement_scrutiny/

 

There is no overarching organisation challenging cutbacks to the NHS and the impact of the 2012 Health and Social Care Act (passed into law by the coalition government of Conservatives and Liberal Democrats).

Derbyshire Save our NHS is an alliance of campaign groups and Unions across Derbyshire and Derby City Local Authority areas. 

National campaign groups including Keep our NHS Public http://keepournhspublic.com/ and Health Campaigns Together www.healthcampaignstogether.com/  have local connections with Derbyshire campaigners.

 

 

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commented 2016-12-27 15:33:33 +0000
The main drive to innovation in the private sector is the maximisation of profits. This prioritisation distorts medical practice. For example,in the USA countless unnecessary investigations and operations have been performed to the detriment of patients, because there is money to be made from them. Private companies are not subject to the Freedom of Information Act, which makes it harder to scrutinise their activities and safety standards. They can, and do, avoid answering awkward questions, for example, about staffing levels and qualifications or capability to cope with emergencies, by citing “commercial confidentiality”. Private medicine is inefficient – which is why USA spends more than twice what UK spends per capita on healthcare. When the internal market was introduced administration charges were less than 5% of the health budget. Within a short time they went up to 15%, and they continue to rise. Most marketised systems spend between 20 and 40% of their budget on administration. The Washington-based Commonwealth Fund in its 2013 report found the publicly-run NHS to be the most cost-effective healthcare system. The privately-based USA system came bottom of the league. Increasing privatisation is costly, inefficient and dangerous. This conclusion is evidence-based and has nothing to do with ideology.
commented 2016-12-21 18:36:40 +0000
It is the difference between our share on GDP spent on healthcare and that of other equivalent economies which is the fractional figure not the comparisons of the totals spent in each country. This excludes the USA of course but they have just chosen to retain their worst of all options model at the ballot box! We are at the lower end of the spread compared with our neighbours and the vast majority goes through the NHS unlike equivalent European states who have a less monolithic supply model which includes private providers. If our model is more efficient as the campaigners claim then that alone would explain the fractional differences.

The accusation that private companies profit out of ill health is an updated version of the age old criticism of the medical profession profiting from ill health (which certainly goes back to the classical Greeks!). Society has, over the many millennia since the accusation first surfaced, developed processes to manage that risk whilst gaining the benefits. So it becomes a meaningless ideological rant in the context of improving the service.

The NHS, in the operation of NICE, has shown world class skills in managing the private pharmaceutical industry so clearly has the skills to manage other private sourcing. Whether they always deliver those skills is different but equally it can struggle at times to effectively manage the skills of their own directly employed staff. I see no difference in the level of skill required between either challenge at a senior management level. If operational practises at a private providor to the NHS put the health outcomes of the patients at risk then both parties need to fix it just as they are when they occur in a state run service.

I cannot comment on the management overhead of the current organisational model and the previous one but a view that an operation which consumes £120 billion of public money will not have an army of accountants and managers working it is naïve. Every large organisation has to manage similar problems in measuring and improving performance and the internal market is a quite common solution. I have worked at a senior level in enough organisations to see many such models tried and I have used it successfully on large transformation programs. Fortunately I retired nearly a decade ago and now see myself as a consumer of the NHS as I grow older and am impressed at the service I currently receive from both the local GP practise and Chesterfield Royal. The only poor experience was at Newholme where the paucity of skills failed my disabled son which is why I support centres of excellence. Fortunately the consultant involved has long since retired so it is no reflection on current staff but I am still angry at the incompetence even though it was many years ago. I had to go private to use a consultant (whose day job was at an NHS hospital) to get a correct diagnosis.

The STP document showed me that innovation is vital if we are to preserve the NHS, if the only response is to keep asking for lots more money (another £30 billion a year is a lot!) without showing clinical improvements then the NHS will disappear as we know it. Innovation comes from new service models, new clinical behaviours, new technologies etc etc. We need to continue to involve all sources of those both private and public and not draw unhelpful outdated ideological boundaries.

The Labour Party needs to be on the forefront of engaging such new thinking so we can retain a free at the point of use model and improve the health outcomes of all our population. As future governments struggle with funding the requirements of an ageing population, societies demands for improved services (24X7 etc) and maintaining a vibrant economy (especially with the likely damage from Brexit) then not innovating will lead to introducing a new funding model and a new service model. At the moment the emerging debate is about the former but poorer outcomes will move it onto the latter at some stage. All this is obvious so why is the campaign pursuing such a narrow agenda and worse producing half truth slogans which always annoys me? Help the STP be a success not campaign against it!
commented 2016-12-21 10:26:04 +0000
Dr Lesley Hyde
I would totally disagree about private health care being part of the solution to the underfunding of the NHS. These companies main objective is to make a profit out of ill health. They are not more efficient than NHS but cut corners eg. there are no junior medical staff in private hospitals which could make a vital difference in the not uncommon event of an emergency. The patient then has to be transferred to the NHS. There is no way of checking on staff qualifications or the outcomes of treatments. This is said to be commercially sensitive information and problems are only identified later when the NHS has to deal with the consequences of poor private care.
A start can be made to increasing funding for the NHS by abolishing the internal market in health care which takes up a ridiculously large amount of money. This could be spent on front line services rather than the army of accountants, lawyers, managers ect. co-operation not cmpetition is the way to improved health outcomes. That and adequate funding. We spend a fraction of our GDP on health and social care compared to other developed countries. Labour support for the NHS Reinstatement bill currently going through parliament would be a vital first step to saving our NHS. STPs are not in theory a bad idea but to execute safely with the right amount of staff (NHS and care service) would require vastly more funds than would be liberated by closing 12 acute, 3-4 community and 1mental health wards plus selling off some “estates” hospitals?. Nor will social cre provide additional funds Bing overstretched already.
commented 2016-12-19 18:52:24 +0000
As I have put in a previous blog I attended the meeting Keith hosted and I think there needs to be a correction to the summary. In defence of Mr Thompson and his team, they were the guests of the meeting and Keith, on behalf of the meeting, agreed to the no photograph request. Nobody challenged it at the time so it is ill mannered to raise it now. The STP and the supporting models are in the public domain, nobody needs a photograph of some speakers to put it into context!

Of the three major issues covered by the STP then only the move from hospital to home based care was extensively discussed and dominated the meeting. The county council representatives (elected and staff!) agreed that the move to home based care was what was clinically required so clearly supporting that element of the STP. The two other significant issues of health inequalities and funding were not discussed as no time was allocated to them.

The funding issue raised in the STP cannot be ignored, in the next four years, without change, the funding requirement will rise by 25%. To put that in context the “keep our NHS“ site referenced in this article asks for a 4% per annum rise in NHS funding which delivers a 16% increase which is still leaves a huge shortfall whilst delivering a clinical model which is not achieving its aims. To try and protect the business as usual model which has an unsupportable financial model and a clinical model which does not meet the wants or needs of its recipients clearly takes us nowhere. With the changes proposed by the STP then the financial model then just falls within the funding demands of the campaign and could deliver the clinical model supported by our local NHS and the County Council.

One of the key passionate points made in the debate was the lead times to develop and train qualified staff, basically even if the funding was there the NHS could not resource the business as usual model so deskilling will happen anyway so a model which allows for it is simple common sense. Involving the private sector in this huge challenge is also a common sense solution so we have to move outside ideological comfort zones. We cannot move the NHS forward if we divide into two camps, the old fashioned right wing private good, public bad and the equally anachronistic extreme lefty public good, private bad. The last Labour government understood this which is how they had three terms in office so why are we losing that insight?

In practise the production of the STPs are now a fait accompli and will be used by whatever government is in power as they fight the inevitable budget battles. Obviously the lack of public consultation in their preparation was a decision to ensure this. We are now where we are and we should be focussing on how they get implemented not whether they should be implemented. Wasting emotion on changing the past is pointless and will marginalise our contribution. How do we encourage adult debate with which we can engage the electorate rather than the misleading bylines which serve no practical benefit?
commented 2016-12-18 15:44:27 +0000
The clear intention of STPs is to further reduce the cost of the NHS – despite it being the most cost-effective health system in the world – for ideological reasons, and to keep taxation of the rich to a minimum. The NHS will become more unable to cope and treatments and procedures will be increasingly rationed. Patients who can afford it will increasingly choose to queue-jump by going private. Conveniently the government now allows 49% of hospital income to come from private patients, which will also result in fewer and fewer beds being available to NHS patients. Social care, which is already known to be inadequate, will be even more stretched and people will be forced to pay for more and more of what used to be freely available services. It is vital that Labour responds with a positive policy, based upon the NHS Reinstatement Bill which would abolish the internal market and privatisation. Piecemeal opposition to Tory “reforms” has not worked in the past. Clearly and repeatedly explained support for the NHS Reinstatement Bill has to be the way forward. The public need something positive to latch on to.

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