Patient at Newham Acute Day Hospital launches campaign to fight closure

By our reporters

Thirty one year old James Blampied is currently a patient in the Newham Acute Day Hospital in east London. He wrote to NHS Fightback and the Socialist Equality Party on the plans of the East London NHS Foundation Trust’s (ELFT) to shut down its day hospital where he receives care, in April. The hospital was opened in 2000 and has been the lifeline for thousands of people who suffer from mental health problems and those that would otherwise be treated at inpatient hospital

james-blampiedJames Blampied

ELFT, which received a rating of “outstanding” as a mental health trust last year by the Care Quality Commission (CQC) has slated Newham Acute Day Hospital for closure, along with streamlining the Community Learning Disability Services. ELFT was appointed as the provider for the new contract of Community Learning Disability Services by the Tower Hamlets Clinical Commissioning Group.

ELFT admits that the Newham Acute Day Hospital “has provided a good service to patients over the years” but says that it is “important that mental health services modernise and adapt to respond to current circumstances and the needs of patients.” The reality is that ELFT is trying to “adapt to respond to current circumstances”, i.e. cut spending, rather than meet patients needs. The Trust plans to save money from the closure while giving lip service to investing some of the money saved to improve the Home Treatment Team in order to “reduce the impact of Day Hospital’s closure.”

Between 2010 and 2014, ELFT imposed £41 million in “efficiency savings”, as part of the Conservative/Liberal Democrats coalition demands to cut £20 billion from the National Health Service. In its Strategic Plan for March 2015-2019, the ELFT foresees a financial gap of £56 million in a “do nothing” scenario by the end of that period. This is happening due to the lowest ever funding increase for NHS in its nearly 70 year history under this government and its predecessor.

The Tories are demanding the NHS is cut by a further £22 billion in this parliament via efficiency savings. To achieve this, they have formed 44 Sustainability and Transformation Plans (STPs) across England, accelerating the process of downgrading and closure of Accident and Emergency (A&E) departments, maternity units, children units, mental health facilities and walk in centres across country.

The North East London (NEL) Sustainability and Transformation Plan, which includes ELFT, identifies the area as one of 11 “challenged health economies.” The STP is predicting a financial gap of £578 million by 2021 and says that, “cost improvement programmes will no longer be enough to achieve the scale of efficiency required to address our system-wide financial challenge.”

It states, “The STP has given providers the impetus to co-design new opportunities for productivity and service efficiency improvements beyond traditional organisational boundaries.” The closure of Newham Acute Day Hospital on which many vulnerable patients with mental health needs depend, is part of the “co-design.”

the-newham-acute-day-hospital

 Newham Acute Day Hospital

Cuts to mental health services have led to a situation where there is enormous demand, with little capacity to meet the need. In the five years up to 2016, mental health trusts in England had £600 million slashed from their budgets. Meanwhile the number of people seeking mental health community help has jumped by almost 500,000 a year, to 1.7 million, since 2010.

ELFT has set up dates for obligatory but bogus public consultation this month in order to appease the public. James with the help of other patients has launched a parliamentary petition to avoid the closure. The petition states, “Newham Acute Day Hospital has helped 1000s of people with mental health problems who are in crisis. The hospital is a vital, life-saving alternative to inpatient admission. Let’s take a stand against NHS cuts at a time when mental health problems are at epidemic levels in the United Kingdom.”

James recently spoke to us at the hospital site.

He said, “I am 31 year old and I have been suffering from depression since 2005 and have more recently been diagnosed with Bipolar Disorder. I have attended the Newham Acute Day Hospital twice in 2015 and I am currently a patient there. Newham mental health centre has been the real turning point in my recovery.

NHS FightBack:
How many patients and families benefit from the Newham Acute Day Hospital?

JB:
There are approximately 20-25 patients admitted to the Newham Acute Day Hospital for an average period of 4-6 weeks per patient, and approximately 300,000 people have access to the hospital complex.

NHS FightBack:
What would happen to you and other patients as a result of the day hospital closure?

JB:
The current treatment at the day hospital includes group therapy, consultations, and the support from fellow patients is a large part of the treatment. There is a large community spirit fostered by the communal activities. As a result of the closure, the home treatments would not include any of this group treatment but would rather consist of 10 minute per day home visits.

The day hospital is also an alternative to being admitted to the Mental Health Inpatient Ward, allowing those requiring treatment to attend during the day but remain living at home, which is considerably preferable for mental health. Without the day hospital, many patients will have no other option but to be admitted to the general hospital ward, which is a less favourable environment for the recovery of patients with mental health issues.

Ambulance and police services and Accident and Emergency departments are inadequately prepared for mental health issues and are already oversubscribed. General recognition is that many people suffering with mental health issues would be worse off through these more general outlets of treatment.

NHS FightBack:
The East London NHS Foundation Trust says they are going to incorporate the services provided by the day hospital with Newham Home Treatment team as an alternative. Would the home treatment service provide you the same level of service at home?

JB::
The home treatment team would not provide same level of treatment. Not only are the planned treatments vastly reduced in time per day than the time patients spend at the day hospital, but the treatment that the home treatment team are able to provide is on an individualistic basis and the patients would not have the same access to consultants and benefits resulting from group therapy.

NHS FightBack:
Are you aware that the ELFT is going to streamline the Community Leaning Disability Service in addition to the closure of the day hospital?

JB:
I am not aware of these intentions to streamline the Community Learning Disability Service.

NHS FightBack:
Why do you think they are doing this?

JB:
Patients are being told that the hospital is being “underused” which I think may be a result of the referral problems. But many people with mental health problems benefit from the day hospital.

NHS FightBack:
Do you think this is part of the wider attacks on the NHS?

JB:
I recognise the closure of the day centre is part of the wider attack on mental health–other patients also recognise that mental health and those most vulnerable seem to be the hardest hit. Hackney mental health centre has already or is planned for closing, and possibly Barking mental health centre.

NHS FightBack:
Have you contacted any organisations other than the Socialist Equality Party/NHS FightBack? What are their responses?

JB:
I have contacted Save our NHS, local and national mental health charities (e.g. Mind), local press—an article is forthcoming. I have written to the local Labour MP, Stephen Timms, but not received any reply as of yet.”

NHS Fightback also spoke to a member of staff at Newham Acute Day Hospital Closure, who said, “Patients and we are gutted by this decision to shut down this well-functioning unit. We haven’t been given an acceptable reason as to why this is going to be shut down in April. The decision is coming from the management of the Trust.”

Asked about the number of referrals to the hospital, he said, “Patients may be referred to the day hospital through the Community Mental Health Team, the Assessment and Brief Intervention Team (ABT), and the GPs or the hospital crisis team. We have got a capacity for 25 patients and we have got 18-20 patients a day. So we are not underused.”

NHS FightBack calls for the widest possible campaign among health workers in London and the public to fight the closure of Newham Acute Day Hospital.

The petition created by James Blampied is here

Privatisation and cuts agenda exacerbates NHS staffing crisis

By Ajanta Silva

The starving of funds from the National Health Service (NHS) by successive governments has created an enormous crisis of hospital bed provision, with falling staff levels and a lack of resources severely jeopardising patient care and safety in the UK hospitals.

The new year dawned with harrowing accounts of patients dying in hospital corridors—after awaiting treatment for hours—stretched waiting lists, cancellations of elective and non-elective operations, missed accident and emergency (A&E) targets, and staff struggling to cope in hospitals. The Red Cross described the situation prevailing in hospitals as a “humanitarian crisis.”

By analysing the official data for the period 2014/15-2016/17, the Health Service Journal (HSJ) exposed the scope of the nursing staffing crisis in the NHS.

In England, 96 percent or 214 out of 224 acute hospitals operated without an adequate level of nursing staff during day shifts last October, while 85 percent of them did not have the right staff levels on night shifts. These are the worst figures since the hospital trusts started to publish staffing levels in 2014, in the aftermath of the investigation into the failures at Mid-Staffordshire Hospital in 2013.

Among the trusts with the lowest percentage of nursing shifts filled were Dewsbury and District Hospital (75 percent), Pontefract General Infirmary (77 percent), Princess Alexandra Hospital, Harlow (77 percent), University Hospital of North Tees (77 percent) and Royal Albert Edward infirmary, Wigan (79 percent).

The consequences of these shortages are disastrous. They include patients having to wait for medication, not having their personal care needs met and not having observations checks on time. Nurses raised concerns with the HSJ that having inadequate staff levels meant hospitals were providing substandard care, causing a severe risk to patient safety.

Janet Davies, chief executive of the Royal College of Nursing (RCN), said, “This is yet more evidence that there are too few nurses caring for patients, putting people at serious risk. Safe staffing levels aren’t an optional extra. Having the right number of nurses is essential to ensure that patients can recover properly.

“There are already at least 24,000 nursing vacancies in the UK and it’s getting worse every single day.”

An important issue arising from the figures analysed by HSJ is the increased and routine use of less qualified Health Care Assistants (HCAs) to cover nursing staff shifts. Professor Peter Griffiths of Southampton University, who is a member of the NHS Improvement’s safe staffing committee for acute wards, points out that relying on HCAs to substitute for nurses in the long term risks compromising patient safety and gives a false reassurance.

The NHS staffing crisis, brought about by the policies of successive governments, goes far beyond a lack of nursing staff.

The Royal College of Midwives (RCM) says there is a 3,500 shortfall in full-time midwives in England. Thousands of women in labour face “Red Flag” incidents, including delays of up to an hour or more in washing or suturing, medication being missed, delays in getting pain relief. Staff are not able to provide continuous one-to-one care and support to a woman during established labour as result of staff shortages.

The RCN, RCM and other professional bodies representing Allied Health Professionals point out that the Tory government’s plan to scrap bursaries from this year will aggravate the already dire shortage of frontline workers. The government falsely claims that replacing bursaries with student loans will attract more students for these professions—creating an extra 10,000 nurses training places during this parliament.

The latest figures from UCAS, the university admission service, disprove these claims. There is already a sharp 23 percent drop in nursing applicants this year compared to 2016. There were 43,800 applicants in England in January 2016 compared to 33,810 in January 2017.

The real aim of getting rid of bursaries is to slash the funding available to Health Education England (HEE).

A senior clinician in Bournemouth Hospital said that cutting the funds of HEE would also result in scrapping secondments, which helped less qualified staff to gain qualifications.

Junior doctors repeatedly stressed the implications of understaffing in hospitals during their industrial action last year. The strike, eventually sold out by the British Medical Association, was in opposition to government plans to impose inferior contracts, further endangering patient safety and care.

Staff shortages and the lack of beds in Intensive Care have created an enormous crisis in lifesaving surgeries. Leading doctors who staff Intensive Care Units (ICUs) told the Guardian, “ICUs are becoming so full that patient safety is increasingly at risk because life-saving operations—including heart, abdominal and neurosurgery—are having to be delayed.

Dr. Carl Waldmann, the dean of the Faculty of Intensive Care Medicine (FICM), said, “Intensive care is at its limits in terms of capacity and struggles to maintain adequate staffing levels.” According to the new survey, based on data collected by FICM, one in three of the 220 ICUs across the UK have a vacancy for at least one consultant.

The ITV broadcaster recently reported on the crisis facing ambulance services in Kent and Sussex. They are operating with a serious shortage of paramedics, putting patients’ lives at risk. There is a shortage of 140 paramedics (almost one in six of positions unfilled). Similar conditions are widespread in ambulance services across the country.

General Practices also face severe pressures due to underfunding and understaffing. Patients are struggling to obtain appointments to see a family doctor when necessary. The government claims that GP numbers will increase by 5,000 by 2021. However, the British Medical Association (BMA) disputes this. GP Committee Deputy Chairman Dr. Richard Vautrey said, “There has been woefully inadequate progress towards recruiting more GPs to cope with rising patient demand.”

He continued, “The government is simply not on course to recruit the extra 5,000 GPs it promised at the last election.”

Staff levels of all categories in the NHS are set to worsen as a result of the uncertainty created around Brexit. Currently, 5 percent of the 1.3 million NHS workforce consists of workers from European Union countries.

At the Conservative Party conference last October, Health Secretary Jeremy Hunt cynically said, “My job is to prepare the NHS for the future, and that means doing something today that we have never done properly before, and that’s training enough doctors.”

This was yet another bogus attempt by the government—stuffed with MPs who hate the very notion of free and universal public health care—to appear as champions of the NHS, committed to increasing the number of nurses, doctors, midwives and other clinical and non-clinical staff.

However, Hunt ordered the National Institute of Health and Clinical Excellence (NICE) to stop determining safe staff levels in hospital wards and units in 2015, with the intention of cutting funding on staffing.

NICE started drawing up guidelines on NHS-wide safe staffing levels in the aftermath of Sir Robert Francis’s inquiry into the failures in Mid Staffordshire Hospital in 2013. One of the key findings of the probe into the substandard care provided by the hospital, which resulted in excessive deaths, was chronic understaffing.

Since 2006, Mid Staffordshire hospital, like many other hospitals trusts, was on a mission to save millions of pounds by further cutting down already insufficient staff numbers in order to gain Foundation Trust status. This was carried out under the direction of the then-Labour government.

The 2010 Conservative and Liberal Democrat coalition government sought to blame hospital workers, while ignoring the key findings and recommendations outlined by Francis, which centred on more resources and money being made available.

Since 2010, Tory-led governments have intensified the attack on the NHS, building on that carried out by Labour. Hospitals trusts are saddled with more than £2.5 billion in deficits as a result of systematic funding cuts. Many more hospital trusts are being forced to follow the fate of Mid Staffordshire Hospital.

Spending cuts deepen crisis in NHS mental health services

By Jean Gibney

The National Health Service (NHS) in the UK is, according to the Red Cross, facing a “humanitarian crisis.” Its assessment followed the recent deaths of two patients who died while waiting on trolleys in hospital corridors for treatment. These tragic deaths underline the deliberate, ongoing destruction of the NHS.

This process is part of the privatisation and slashing of funding for all public services. Every aspect of public health care is currently under attack.

A recent report by the Nuffield Trust—a health policy research body—on the increasing rise in waiting times for all treatments revealed dangerous levels of delay in those waiting for diagnostic tests. The trust revealed that waiting times for diagnosis and diagnostic testing doubled from 2008 to 2016. In December 2008, 403,955 people were waiting for diagnostic tests. In January 2016, this had increased to 818,599, and rose further to 882, 321 in September 2016.

Cuts to mental health services have led to a situation where there is enormous demand, with little capacity to meet the need. In the five years up to 2016, mental health trusts in England had £600 million (US$751 million) slashed from their budgets. Meanwhile the number of people seeking mental health community help has jumped by almost 500,000 a year, to 1.7 million, since 2010.

The 1997-2010 Labour government was instrumental in cutting the number of overnight beds available for those requiring mental health support. The number of beds available fell from 34,124 in 2001 to 19,249 in 2015.

Figures made available last year by the King’s Fund think tank estimated that 40 percent of 58 mental health trusts in England s aw their budgets cut in 2015-2016. Six of the trusts saw their budgets slashed three years in a row.

Government data obtained last September showed that 73 local areas will see their General Practitioner mental health budgets slashed in 2016-2017. In Haringey, one of the poorest boroughs in London, the Clinical Commissioning Group is to cut 16 percent of its mental health budget.

Recent figures for mental health waiting lists in the Greater Manchester Area in North West England reveal a huge crisis in patients unable to access mental health services. Over 200 patients waited for treatment for 90 days, double the regional wait of 27 days and almost five times the already high national average wait of 18.8 days.

Patients who find themselves in crisis due to the unavailability of doctors’ appointments, hospital referrals and lack of community social care services are forced to attend accident and emergency (A&E) departments.

The BBC noted in January that data compiled by NHS Digital “showed that between 2011-12 and 2015-16 the number of patients attending A&E units with psychiatric problems rose by nearly 50% to 165,000.”

These do not include those patients who may have been recorded as attending for other reasons.

The BBC reported that some trusts it had spoken to “said as many as a tenth of patients were attending A&E because of mental health problems.”

The Crisis Care Concordat—set up by the Department of Health with a remit to improve outcomes for patients with mental health issues—was already warning in 2015 of an NHS “system failure.” This had led to large numbers of people in mental distress turning to A&E for help, due to inadequate community-based mental health services, it said.

The warning was echoed by the Rethink Mental Illness charity, which said cuts to funding for mental health services were costing lives.

In response to the innumerable cases revealing that NHS and social care services can no longer provide basic services, Conservative Health Secretary Jeremy Hunt callously dismissed any such claim. Instead, he attacked the thousands who use A&E departments—unable to get GP appointments and hospital referrals and find themselves in crisis—as “frankly selfish.”

Prime Minister Theresa May, attempting to divert attention away from the crisis ripping apart the NHS, pledged to prioritise mental health services. However, she failed to mention the impact on mental health due to her government’s overall assault on the welfare state, as well as the proven link between mental health and job insecurity, low wages, poor housing and benefit reform.

A 2014 report by the Faculty of Public Health (FPH) charity linked the rise in the number of mental health patients to the economic crash of 2008. The FPH describes itself as a “standard setting body for specialists in public health in the United Kingdom” and a “joint faculty of the three Royal Colleges of Physicians of the United Kingdom (London, Edinburgh and Glasgow) and also a member of the World Federation of Public Health Associations.”

The report said the UK is experiencing “a prolonged economic downturn with rising unemployment and uncertain recovery since 2008.” It added, “Economic crises increase the risk factors for poor mental health (poverty and low household income, debt and financial difficulties, poor housing, unemployment and job insecurity).”

It added, “There is evidence to suggest that the UK recession may result in an increase in mental health problems and lower levels of wellbeing, with a widening of inequalities.”

Labour’s Shadow Health Secretary John Ashworth attacked the Conservative government for this crisis and appealed to Hunt, May and Chancellor Philip Hammond to pledge more funding to prevent a repeat of recent events.

Ashworth called for a new funding settlement for health and care in the next budget “so this year’s crisis never happens again.” He said May should commit to bringing forward £700 million of social care money to help hospitals cope this winter.

While Ashworth criticised May for “not shining a light on cuts to mental health services,” no mention was made of the track record of the Tony Blair/Gordon Brown Labour governments—which laid the basis for today’s disaster by launching the huge cuts now wrecking the NHS and inaugurating privatisation policies. Labour introduced the private finance initiative (PFI) into the NHS, resulting in hospital closures, shortages of staff and ward closures—as hospitals faced huge debts paying off PFI mortgages.

This was overseen by the health trade unions such as Unison and Unite—with the co-operation of Labour councils—ensuring that any opposition by the working class to the breakup of the NHS and what remains of the welfare state was sabotaged.

The unions have not led a single successful struggle to prevent the closures of hospitals, cuts to social care services and savage benefit reforms—nor will they. Their role is to prevent any independent action to fight back against the destruction of the NHS and every social gain won over generations.

Death toll mounts as UK National Health Service deliberately destroyed

By Robert Stevens and Chris Marsden

Years of spending cuts have been used to intentionally bring about the destruction of the National Health Service (NHS).

At the weekend, the British Red Cross said the NHS was facing a “humanitarian crisis.” Its statement follows the deaths of two patients in Worcestershire Royal Hospital corridors while waiting for treatment. According to the BBC, a woman died of a heart attack after waiting for 35 hours on a trolley in a corridor. A man suffered an aneurysm after a long wait on a trolley, and, despite being treated, could not be saved.

The Daily Mirror reported that in recent days, a man was found hanged in a toilet cubicle at the hospital and may have been “accidentally strangled” by a drip feed cord.”

The deaths all occurred between New Year’s Day and January 3.

Some patients are waiting even longer for treatment, with John Freeman telling the Guardian that his 66-year-old wife Pauline waited for 54 hours on a hospital trolley in Worcestershire after suffering a stroke.

However, the situation in Worcestershire is only a microcosm of that facing the entire NHS. The chief executive of the British Red Cross, Mike Adamson, said, “[We are] responding to the humanitarian crisis in our hospital and ambulance services across the country. We have been called in to support the NHS and help get people home from hospital and free up much needed beds …”

Hospitals are increasingly forced to close A&E departments to patients. In December, more than a third of health trusts in England (52 of 150) issued an “alert,” meaning they required urgent action in order to cope. Seven of the trusts could not provide comprehensive care. In the county of Essex, with a population of more than 1.4 million, every hospital was forced to issue a “black alert”—the highest level—in the last few weeks. Nationally emergency departments closed their doors to new patients more than 140 times in December. Last week, ambulances on 42 occasions had to be diverted to other hospitals due to A&E’s not allowing in more patients.

The weekend’s events and the Red Cross declaration prompted a torrent of media comment and government rebuttals. Typical was the Observer, which editorialised, “The government must get a grip” because the “NHS is facing unprecedented strain.”

Prime Minister Theresa May replied, “I don’t accept the description the Red Cross has made of this,” while Education Secretary Justine Greening said the comments made were “inappropriate” because Red Cross involvement was “not particularly unusual”!

Professor Keith Willett, NHS England’s director of acute care, said “on the international scale of a humanitarian crisis, I do not think the NHS is at that point.” His defence is based upon comparing Britain with war-torn countries, as made explicit by Conservative health select committee chair Sarah Wollaston who declared baldly, “This is not equivalent to Syria or Yemen.”

In fact, just as with the imperialist-inspired wars in the Middle East, the crisis facing the NHS is a product of deliberate governmental policy.

In 2012, the health service of another country, Greece, was also described, by Doctors of the World, as being in a humanitarian crisis. There, too, brutal austerity cuts were to blame, as spending was slashed according to the dictates of Greece’s creditors and the world’s banks by more than €5 billion—almost a third—by the social democratic PASOK and Conservative governments. This offensive continues under the pseudo-left Syriza government, which pushed through a further €350 million in health cuts in 2016.

Britain has suffered cuts—in terms of a real-terms fall in wages the UK is second only to Greece—which have eviscerated the NHS and other vital services so that the Red Cross reported of Britain, “We’ve seen people sent home [from hospital] without clothes, some suffer falls and are not found for days, while others are not washed because there is no carer there to help them.”

During the 2010-2015 Conservative/Liberal Democrats government, billions in spending cuts to the NHS were imposed. A further £22 billion, again under the guise of “efficiency savings,” is to be slashed in this parliament to 2020. These cuts are to be implemented through new Sustainability and Transformation Plans being drawn up by health trusts in England, aimed at destroying the NHS and opening the doors to private health care that would be adequate only for the privileged few who can afford large contributions.

Having set the NHS up to fail, the government and the media will inevitably unite to insist that the answer to the present crisis is for the NHS to be made more efficient through the closure of “failing” services and additional privatisation measures.

In these circumstances, the response by Labour leader Jeremy Corbyn is politically criminal.

He demanded that May answer urgent questions on the NHS, as Parliament returns after its recess today, and lay out her plans to “fix” it. He did so while declaring that this crisis was “made in Downing St. by this government—a crisis we warned them about.”

Corbyn’s statements are shot through with hypocrisy. In the first instance, he presents the NHS crisis has having nothing to do with the policies of previous Labour governments led by Tony Blair and Gordon Brown—backed by most of the MPs in his party. Then he makes great play of his role in warning the government.

Rather than offering advice to May and her predecessor Cameron, the millions of health workers who supported Corbyn as Labour leader based on his pledge to end austerity had every right to expect him to fight the government on their behalf. Instead, Corbyn has stood by as every struggle by health workers in opposition to these attacks has been sabotaged by the trade unions and their Labour allies.

Last year, 50,000 junior doctors mounted a wave of unprecedented strikes to protest the government enforcing an inferior contract and as a way of halting the ongoing destruction of the NHS. In March last year, junior doctors accused Corbyn of ignoring their fight, even when it came to the ritual of Prime Minister’s Question Time. Jeremy Corbyn’s official spokesman admitted to the Daily Telegraph that Corbyn had indeed “decided to focus on other issues rather than question the Prime Minister over the strike.”

Corbyn responded by belatedly making a face-saving appearance at a picket line in April, while calling for the government to reach a negotiated settlement with the British Medical Association. His ally Diane Abbott issued a “jam tomorrow” statement to the Guardian August 24, pledging a future Labour government would “rescue the NHS,” by allowing “its budget to grow in line with the economy” and “shift[ing] resources to frontline care” by “bearing down on the costs of the private finance initiative (PFI)” rather than ending privatisation.

The end result was to facilitate the isolation of the dispute by the health unions and the Labour Party and a sell-out by the British Medical Association.

In 2012, the Socialist Equality Party launched the NHS FightBack campaign warning that “the destruction of the National Health Service as a universal and comprehensive service free at the point of delivery” was underway. In order to defend public health care as a social right, not a privilege, the working class must begin to organise a counteroffensive against the government, which must be waged independently of Labour and the trade unions on the basis of a socialist programme.

Britain’s National Health Service being prepared for privatisation

By Barry Mason

Brutal cuts to services built up over decades are being prepared by UK National Health Service (NHS) management under new Sustainability and Transformation Plans (STP).

STPs marks a significant step in the dismantling of the NHS. Their aim is to exacerbate the crisis in health-care to the point of collapse in order to justify wholesale privatisation.

Billions of pounds in cuts are to be made which will involve the closure of hospitals and slashing of services. A further £22 billion of cuts in NHS funding are to be made by 2020 under the guise of “efficiency savings,” using plans drawn up by the STPs and the health managers in every region of England.

According to the King’s Fund health think-tank, which has seen some of the STP plans produced so far, in southwest London one of five hospitals—St George’s, Kingston, Croydon, St Helier or Epsom—will close. In North Central London, a consolidation of services on fewer sites could result in Whittington Hospital losing its Accident and Emergency (A&E) services.

In the Merseyside and Cheshire region, a merger of four hospitals—the Royal Liverpool, Broadgreen, Aintree and Liverpool Women’s—and a threat to existing services is being mooted in order to deal with a £1 billion funding shortfall.

The Liverpool Echo noted, “The trust that runs the Royal Liverpool and Broadgreen hospitals must make £42.8 million of savings between now and 2021—more than £8 million a year, the document reveals. Mental health trust Mersey Care will also be hammered with £25.4 million to be slashed from its books, followed by Aintree hospital with £21.6 million. Liverpool Women’s hospital, which previously warned it could become ‘financially unviable’ due to massive funding issues, is expected to find £6 million.”

In Birmingham and Solihull maternity services could be reorganised, leading to fewer units remaining.

At the North Tees, in the North East, it is proposed to centralise specialist services, including A&E, on two sites. This will result in a downgrade of services at one of the three major local hospitals.

In the county of Devon in the south of England, some A&E, maternity and stroke services at hospitals may close under the guise of centralised services at larger sites.

In 2015, the government drew up proposals on how the NHS would allocate funds and services across England. The country was divided up into 44 geographical areas or “footprints”, each covering an average population of around 1.2 million people with the largest having a population of 2.8 million and the smallest 0.3 million. Each area was charged with creating an STP, outlining how the money allocated for health provision would be spent and how the services offered would be delivered. The area leader does not have to be a member of a clinical commissioning group or hospital trust, but could be from local government.

A major task of the STP was to outline the spending allocation for the next five years up to 2021, even though these are statutory bodies. Nigel Edwards, chief executive of the health think-tank the Nuffield Trust, described them thus: “They’re not organisations. They’re ‘footprints’—lines on maps. There’s no building with a name on the door.”

NHS England, the body that holds budgetary responsibility for commissioning health service provision states the STPs will be responsible for, “how local services will evolve and become sustainable over the next five years—ultimately delivering the Five Year Forward View vision of better health, better patient care and improved NHS efficiency.”

But behind the official gloss and verbiage put forward by the NHS is the reality that the STPs are part of the sustained attack on health provision by the current Conservative government, its preceding coalition with the Liberal Democrats and the 1997-2010 Labour government.

The Kings Fund alludes to this in its December 2 paper explaining the origins and role of STPs. Under the heading, “What do STPs mean for the NHS?” It wrote: “It also recognises the growing financial problems in different parts of the NHS can’t be addressed in isolation… providers and commissioners are being asked to come together to manage the collective resources available for NHS services for their local population. In some cases this may lead to ‘system control totals’—in other words, financial targets—being applied to local areas…”

In plain words, rationing service provision.

The British Medical Association (BMA) representing doctors in the UK issued a statement on November 21 headed, “STPs risk ‘starving services of resources’.” They were to slash “£26 billion from health and social care costs in five years,” the article stated quoting BMA council chair, Dr Mark Porter, that “There is a real risk that these transformation plans will be used as a cover for delivering cuts, starving services of resources and patients of vital care.”

A blog posted on the Huffington Post by GP David Wrigley, BMA Council deputy chair, noted it would be “an impossible task to make such ‘savings’ when hospitals are already bursting at the seams, general practice is on its knees with GP surgeries closing each week and social care is in tatters across the country due to huge cuts to local authority funding… We have an ageing population with more complex health and social care needs and they rightly deserve high quality health and social care. However there are serious concerns about whether STPs can deliver this.”

Health professionals warn the implementation of the STPs can only accelerate the ongoing loss of beds and closures of A&E departments now taking place. A Daily Telegraph article of November 21 noted, “Almost half of NHS authorities are drawing up plans to cut hospital beds and one third intend to close Accident and Emergency departments, research suggests.”

The plans have been drawn up by a small number of participants with many in the health service having little knowledge of the process. It is reported that between 75 percent and 90 percent of doctors have not been consulted. According to the Telegraph, “NHS England had told local health leaders not to reveal the plans until they were finalized and had been approved by their own officials. The national body even told local managers to refuse applications from the media or public wanting to see the proposals under the Freedom of Information Act.”

By the middle of December, all the STPs had been drawn up and the plans published. Concerned health professionals had leaked some early.

Under the 2012 Health and Social Care Act, the government’s duty to provide health care was reduced to that of merely commissioning care. This has opened up the health service to further privatization. The introduction of STPs will accelerate this process.

In November, it was announced that Richard Branson’s Virgin Care group had won a £700 million, seven-year contract to provide adult social care, continuing healthcare and children’s community health services for the Bath and North East Somerset NHS Clinical Commissioning Group. Said to be the largest privatization yet carried out in the NHS and Virgin Care’s largest deal to date, it will oversee 200 social service and health care facilities. The group was awarded a £126 million contract to run hospitals in Kent earlier this year.

Branson is helping to fund a new group headed by Labour politician Alan Milburn that will campaign to reverse the 52 percent vote in favour of Leave in the referendum on the UK’s membership of the European Union (EU). According to the Independent, he has also offered office space to help the new group set up.

There is a direct connection between the billionaire’s support for the EU and his role in helping the privatisation of the NHS. EU policy is strongly in favour of the “liberalization” of health provision across its member states, as with all other areas of social welfare.

Huge increase in hospital admissions for malnutrition in Britain

A recent Department of Health (DoH) report found a 44 percent rise in UK hospital admissions related to malnutrition over the past five years.

The DoH revealed the number of bed days accounted for by someone with a primary or secondary diagnosis of malnutrition rose from 128,361 in 2010/11—the year the Conservative-Liberal Democrats coalition came to power—to 184,528 last year.

Malnutrition as the main cause of hospital admissions has more than doubled over the past decade. From 65,048 bed days in 2006-2007, the total surged to 184,528 hospital bed days last year.

Each bed costs the National Health Service (NHS) on average £400 a day to staff and a spell in hospital because of malnutrition averages between 22 and 23 days. Information supplied by the House of Commons library shows that 57 percent of the patients involved were women and 42 percent were aged over 65.

The National Institute for Health and Care Excellence (NICE) classes someone as malnourished if they have a body mass index of less than 18.5, or have suffered the unintentional loss of more than 10 percent of their weight over the last three to six months, or have both a body mass index under 20 and have unintentionally seen their weight drop by more than 5 percent over the previous three to six months.

According to NHS statistics, 3 million people are at risk of malnutrition, with 7,366 of these admitted to hospital with the condition between August 2014 and July 2015, a 51 percent increase since the corresponding period from 2010 to 2011.

Speaking about the increasing numbers of elderly people being admitted to hospital with malnutrition, Simon Bottery, director of policy at the Independent Age charity, said, “These new figures on malnutrition are genuinely shocking. As a society there is no excuse for us failing to ensure that older people are able to eat enough food, of the right quality, to stay healthy.”

He continued, “Yet we have been cutting back the meals on wheels services and lunch clubs on which so many vulnerable elderly people relied and reducing the numbers who receive home care visits.”

Research by the National Association of Care Catering found that only 48 percent of local councils still provided meals on wheels, compared to 66 percent in 2014. Freedom of information requests submitted to local councils in England found that 220,000 fewer people were receiving meals on wheels in late 2014 than in 2010, a fall of 63 percent. Only 17 percent of councils in the northwest of England still do so, and 91 percent of providers expect the provision to fall further in the next year.

The response of the Department of Health to the findings was not to address the causes of malnutrition, but to glibly suggest that better data collection, more training and a paltry £500,000 to Age UK would assist in the spotting and reduction of malnutrition in the elderly.

Malnutrition is not only confined to the elderly. The figures for the rise in cases of malnutrition and other health issues show the impact of increasing poverty is widespread among all age groups. It is linked to cuts and sanctions to welfare benefits, cuts to and privatisation of health and social care services, unemployment and low pay. This is seen in the massive rise in people who now regularly depend on charities for basic food supplies.

Recent figures by the Trussell Trust, an anti-poverty charity, report a huge uptake in emergency food supplies between April 2016 and September 2016. Across the UK, they distributed 519,342 three-day emergency food supplies to people in crisis, compared to 506,369 during the same period last year. Of these, 188,584 went to children. The staggering number means that the food bank network is on course to distribute the highest number of food parcels in its 12-year history during 2016-17.

The Trust cited changes to the benefits system and low pay and unemployment as the main causes of the rising use of food banks. It said, “Benefit delays and changes have been the biggest reasons for food bank use, accounting for 44 percent of referrals to Trussell Trust food banks (27.4 percent benefit delay; 16.6 percent benefit changes). Low income was the second largest cause of a crisis, accounting for nearly one in four of all referrals to Trussell Trust food banks, driven by problems such as low pay, insecure work or rising costs.”

A long-term study into increasing levels of deprivation and social and economic inequality since 1983, “Breadline Britain: The Rise of Mass Poverty,” by Joanna Mack and Stewart Lansley, revealed poverty levels have soared, with the current figure standing at 20 million people (around a third of the population). Lansley, the co-author of the 2015 report, stated, “This study paints the most appalling picture of levels of deprivation across the country and of how generations are being denied opportunities.” He added, “It is horrifying and appalling to me that we have a society that has built into its DNA growing levels of poverty. It is completely unjust and completely unnecessary.”

Lansley warned, “You have a situation where levels of poverty will already be rising significantly and the picture can only get bleaker as people become more desperate. On current trends, the next five years will see more people in the UK in poverty, more often and for longer. Despite falling unemployment, the combination of an increasingly polarised labour market, rising housing costs and a continuing squeeze on benefits will put further pressure on low incomes.”

Linking increasing levels of poverty with economic and social inequality, the Oxfam charity revealed that in Britain millions of workers are struggling to cope to put food on the table, let alone maintain a healthy nutritious diet: “The UK is one of the richest countries in the world, but it’s a nation divided into the ‘haves’ and have-nots.’ While executive pay soars, one in five people live below the poverty line and struggle to pay their bills and put food on the table.”

Jonathon Ashworth, Labour shadow health secretary, expressed dismay at the DoH malnutrition figures, stating, “Real poverty is causing vulnerable people, particularly the elderly, to go hungry and undernourished so much so that they end up in hospital.” The research, he said, “reveals a shocking picture of levels of malnutrition in 21st century England and the impact it has on our NHS. This is unacceptable in modern Britain.”

Ashworth did not address the previous Labour government’s systematic assault on the living standards of the working class in the wake of the 2008 economic crash. He also omitted to mention that while in opposition Labour has supported every cut to welfare benefits and public services. Nor did Ashworth mention the role of Labour councils that have carried out every single cut to services and, along with the trade unions, have supported the assault on the living standards of millions of workers and the decimation of the welfare state.

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Dire situation in UK social care for the elderly

By Dennis Moore

Age UK and the Alzheimer’s Society, charities supporting older people, have published reports describing the way older people are cared for as “shameful” and “scandalous.”

Figures suggest that the number of older people not getting necessary help from the authorities now stands at 1.2 million, rising by 48 percent since 2010. Age UK found that since 2010, there are 383,000 people aged 65 or over living with some level of unmet need.

Care in the UK is funded by individuals themselves or local councils, but there are increasing numbers of people reliant on family and friends to support them.

The 1.2 million seniors with insufficient assistance includes 696,500 who receive no help from paid carers, friends or family. A further 487,400 receive some help but not enough, due to help only being available at particular times of the day or their carers only being able to manage some tasks and not others.

Those older people who reported having unmet needs included 291,400 people who have difficulty with three or more essential tasks, including getting out of bed, going to the toilet, dressing and washing. Of this figure, 52,700 people receive no help at all. Overall, local authorities agreed to help just under half of the 6.6 million people who approached them for help.

Where care in the home was provided, there were serious problems identified as to the way patients with dementia were treated. Families of those cared for reported examples of poor care, including loved ones being left in dirty clothes for days at a time, not being given medication and residents going missing from homes due to lack of security.

Staff said they had not been given enough training to enable them to deal with people with complex needs.

The Care Quality Commission, the official inspection body that investigates standards of care, warned a month ago that the sector was at “tipping point.”

The lack of care is having a direct effect on public hospitals, which are experiencing more and more elderly people arriving at local accident and emergency departments needing help.

The day-to-day impact on people’s lives, including those who are carers, is mounting. The BBC identified 11 councils who had rejected more than 75 percent of applications for help. One example is that of Lorna Wheatley, from North Yorkshire, who has been trying to secure a nursing home place for her 82-year-old mother Celia. Speaking to the BBC, Wheatley said, “My mum can barely walk or look after herself, and the council says she only qualifies to live in sheltered housing. I’m terrified that without constant support, she could die.”

An Alzheimer’s Society investigation exposed serious shortfalls and a lack of training for home care staff working with people with dementia, leading to intolerable levels of stress for sufferers, family, carers and staff. The investigation utilised a survey of homecare workers and included a Freedom of Information (FOI) request sent to all local authorities in England. The survey included first-hand testimonies of 1,220 people directly affected by dementia.

The Alzheimer’s Society documented numerous failings in the system, including people not being provided with food or water, being left to sleep in wet or soiled bed sheets, not giving people baths or showers for weeks and people being left with infections that have led to emergency admissions to hospital.

Care workers are facing enormous pressures, with the adult social care budget cut by 40 percent since 2010.

The budget for training and the development of staff is usually the first to be cut. The FOI request showed that 71 percent of the local authorities that responded do not include money for training within their homecare contracts. Another 38 percent do not fund dementia training sessions for homecare providers.

The number of homecare workers who have had dementia training stands at 38 percent of the workforce, with 71 percent not receiving dementia training that is accredited. Fully 43 percent of homecare workers have asked for further dementia training, yet 54 percent of applications for training are turned down.

Linda Jackson, from Orpington in Kent, struggled to get good homecare for her father, Ken, who had Alzheimer’s disease. She said, “’Dad was challenging at times and I was told that some carers refused to come back and care for him. They simply didn’t know how to cope with his behaviour. He was distressed and worried, yet no one seemed equipped to look after him and give him the basic things he needed—food, medication, and comfort.”

She added, “Dad’s last year was a living hell and he was eventually sectioned under the Mental Health Act before dying six weeks later.”

Such accounts provide a shocking insight into the lives that many older people and their families endure each day, left struggling to manage tasks that are the most basic human functions and intrinsically connected to a person’s sense of dignity.

Those having to work with older people suffering with conditions such as dementia face enormous challenges in attempting to carry out their work. They are generally poorly paid and have to work 60 to 80 hours a week to make a living. A recent employment tribunal case, involving 17 care workers employed by the private contractor Sevacare in the north London borough of Haringey revealed that some of the staff were being paid £3.27 an hour. This is less than half the minimum wage. It is the largest-ever legal claim brought in the care sector. Sevacare, which last year raked in profits over more than £1 million, has contracts across England employing 5,500 care staff, providing care and support to 9,600 people a week.

According to the Unison trade union, some of those on £3.27 an hour were women, employed as live-in carers. They stayed for seven days a week at a time in the home of an elderly women with severe dementia. These carers were on duty 24 hours a day, sleeping on a bed next to the person they were looking after, attending to the woman’s needs throughout the night.

One carer likened the experience to being “in prison”, saying they were not allowed to leave the house all week. Workers were also not being paid for the time they spent travelling between home visits. One of the careers, Florence Wambulu, said she worked seven days a week in order to make sure she could pay her bills and look after her family. “They have to treat us like human beings, not just someone who is there to make money for them,” Wambulu said, adding, “We were working like slaves.”

Last year, whistle-blower Gillian Demet resigned from her job as a care worker at Sevacar because she was only allowed to spend 15 minutes at a time on visits with frail pensioners.

The care of older people in privately-run care homes, and their own homes, has been increasingly outsourced to the private sector under Conservative and Labour governments. Labour-run councils throughout the UK routinely offer contracts to private companies to provide care. The intolerable conditions outlined by the charities are inhumane. For those being cared for, and the workers tasked with looking after them. They are both exploited by a system that sees them, first and last, as a source of profit.

UK government accelerates privatisation of National Health Service

By Ajanta Silva

Conservative Health Secretary Jeremy Hunt often appears in the media cynically proclaiming that the government “wants the NHS [National Health Service] to be delivering the safest, highest quality care anywhere in the world.”

He shamelessly claims, “We will be increasing our emergency care provision over the next few years. We are putting more resources. We are training more doctors and nurses.”

What is actually taking place is an unprecedented gutting of services and a wholesale privatisation of the NHS. With virtually no publicity, last month the government put out to tender a massive £7.9 billion worth of NHS services in London, the North West, South West, Yorkshire and Humber, South East, and East Midlands regions of England. This amounts to 7.3 percent of the total NHS budget. Bidding for the contracts ended on November 4, and it is not yet known who won the tenders. If private companies were successful in winning the bids, this would represent the biggest sell-off in the nearly 70-year history of the NHS.

NHS England states that they “intend to award whole contracts for 2017-2019 using the NHS Standard Contract to the incumbent providers without further publication, unless expressions of interest are received from alternative economic operators.”

Appealing to the alternative economic operators (private companies) to make inroads into NHS-run services, NHS England writes in tender notices in each region: “From service reviews and from locally led change through sustainability and transformation plans, we expect there to be more networks of specialist providers and re-shaping supply models and contracting approaches to integrate care around patients.”

Services up for grabs in these areas are termed as “prescribed specialised services” on the government web site. These encompass large parts of the NHS including accident and emergency (A&E), cancer care, mental health, women and children services, blood and infection, and pharmacy services.

The call for outsourcing of services comes as the NHS is bled dry by a thousand cuts, destroying its ability to “integrate care around patients.” Over the last six years, the share of Department of Health funding that has gone to private providers has more than doubled, from £4.1 billion to £8.7 billion. However, private sector involvement is most likely far greater. Denis Campbell, the Guardian ’s health policy editor, points out, “The myriad different bodies that make up the NHS in England and their opaqueness, especially in terms of contracts to provide services, makes mapping the true extent of the privatisation of public healthcare difficult.”

What is certain is the Tory government, on behalf of the capitalist class, is on a mission to destroy the NHS. They oppose its founding principles—i.e., that it meet the health needs of everyone, that it be free at the point of delivery and that it be based on clinical need, not ability to pay.

According to figures gathered by investigative health journalist John Lister, in 2014, £1.76 billion out of £9.74 billion of Primary Care Trust (PCT) spending on community health services were going to private providers. From PCT spending on mental health care services, £1.3 billion went to private providers in the same year. In 2013/2014 alone, 3.7 percent of elective and emergency hospital care was outsourced.

The 2010-2015 Conservative/Liberal Democrat coalition introduced the Health and Social Care Act in 2012 and created 211 Clinical Commissioning Groups (CCGs) in order to expedite the privatisation process. These CCGs were given authority to buy care from “any qualified provider”. Under the act, the secretary of state for health no longer has a “duty to provide care” for the population, only a “duty to arrange care.” Since its implementation in 2013, private firms have won NHS clinical contracts worth £5.5 billion. Year 2015/2016 has seen 37 percent of the CCG contracts going to private providers.

One of the main beneficiaries of the privatisation process is private health care company Virgin Care. It has won over £1 billion in contracts to run vital services ranging from community health services to General Practices (doctor’s surgeries). This month, it was awarded a £700 million contract to run a wide range of services, in both the NHS and social care, in Barth and North East Somerset, to nearly 200,000 people over a seven-year period.

Many private health care giants, especially operators using tax havens as their bases, will fight for their share of the £116.4 billion NHS budget. Early this year, the Independent reported, “[R]ules that prevent tax-avoiding private companies from securing NHS contracts are being scrapped” by NHS England.

To create the most favourable conditions for private firms to make profits from publicly run services, the government of Prime Minister Theresa May and its predecessors deliberately starved the NHS of funds. The last six years saw the lowest-ever funding increase to the NHS in its history, under conditions in which the demand for patient care services has soared.

May and Hunt routinely claim the Tories are putting an additional £10 billion into the NHS by 2021. Five members of the health select committee, including Sarah Wollaston—a Conservative MP and qualified GP—refute this claim. They put the true figure between £4.5 billion and at most £6 billion.

Even if the £10 billion were allocated, this still represents a cut in funding, as the government is demanding a further £22 billion in “efficiency savings” from NHS hospital trusts, which are already mired in an overall £2.5 billion deficit.

To carry out the “Five Year Forward View” of the chief executive of NHS England, Simon Stevens, the government has carved England into 44 Sustainability and Transformation Plans (STPs). The role of the STPs is to carry out at local level the cuts demanded by government. Some English Counties have already made plans to close down or downsize A&E units, maternity units, children units and community hospitals. Many NHS properties that become vacant through these closures are to be sold in order to cover the deliberately created deficits.

The Labour Party played a critical role in laying the basis for privatisation of public health care. In 2002, the Labour government of Tony Blair introduced Foundation Trusts (FTs) as semi-autonomous organisational units. FTs allowed the private sector to earn income from private patient treatments and paved the way for a two-tier system, in opposition to the founding principles of the NHS. Those who have money to spare were able to jump the queues to receive early treatment. The FTs had a cap of 2 percent, with some variations across country for the income they could earn from private treatments. The Health and Social Care Act abolished this income cap.

According to the Act, FTs have to do a majority of their work for the NHS. This means 49 percent of their income can be generated from treating private patients. FTs made a collective income of nearly £750 million in 2013 and 2014, largely thanks to long waiting lists and selling treatments to patients from other countries. Income earned from private treatment has remained relatively low in many NHS hospitals. However, this is set to increase substantially with hospitals struggling with deficits and the government demanding further “efficiency savings.”

The privatisation of the NHS poses a grave threat to patient care and safety and to the pay, terms and conditions of the 1.3 million NHS workforce. Neither the NHS trade unions nor Labour—despite its left-talking leader Jeremy Corbyn—are doing anything in opposition to these attacks. Rather, any struggles that have broken out, such as that by 50,000 junior doctors, have been localised, isolated and led to defeat.

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Dorset NHS management pushes health cuts amid growing opposition

By Ajanta Silva

Hundreds of patients, hospital workers and members of the public recently demonstrated in Poole against the slashing of health services in the county of Dorset, England. The rally was called by the Keep Our NHS Public (KONP) organisation.

This followed a protest by thousands of people and hospital staff who marched against the closure of the Kingfisher ward and Special Care Baby Unit at Dorset County Hospital this summer.

Tens of thousands of people have given their verdict on proposals by Dorset Clinical Commissioning Group (CCG) to gut public health services by signing petitions opposing them and taking part in protests.

Dorset CCG, which faces an annual £158 million deficit by 2021 due to Conservative government National Health Service (NHS) funding cuts, revealed its plans in a recently published “Clinical Services Review” (CSR). It aims to downsize two major Accident and Emergency (A&E) departments in Poole and Dorchester and close children units, maternity units and more than a half dozen community hospitals delivering inpatient care.

Thirteen community hospitals, which mainly operate as rehabilitation units and significantly lessen the pressure on acute hospitals, are going to be replaced with a handful of “Community Hubs,” many without beds. According to the CSR, three community hospitals—St. Leonards, Alderney and Westhaven—will shut and the sites will be used for “other purposes.”

Dorset CCG is carrying out a simultaneous review of mental health services called “Mental Health Acute Pathway” and “Primary Care Strategy” for General Practices (GPs, doctors’ surgeries). One can expect nothing but a further destruction of services from these. Mental health services will see attacks on what remains of the scarce facilities in the county, following the closure of Kings Park Hospital mental health unit in Bournemouth and the Chalbury Unit for highly specialised dementia needs in Weymouth. Shutting Alderney Community Hospital will also threaten two mental health wards.

The GP review takes place under conditions in which GP services are being slashed nationally. Last month, a leaked NHS England letter revealed the government wants struggling GP surgeries to be allowed to fail and “wither by the system.” At the same time, a pilot Uber-style private GP service, Doctaly, is to be rolled out nationally

Dorset’s population of more than 750,000 are going to lose hundreds of inpatient beds, despite acute hospitals already being overwhelmed with high inpatient volumes. Hospitals are already struggling due to lack of beds, staff shortages and scarce resources.

These devastating proposals, hatched behind closed doors over the last two years, are to undergo a bogus 12 weeks “public consultation” exercise in November before being implemented early next year. The CCG has already despatched its public relations agents to sell the proposals to NHS workers, with some meetings being held with the tacit support of the trade unions. The AGM of the Royal College of Nursing (RCN) Dorset branch, held in Bournemouth Hospital last month, featured a guest CCG speaker brought in to “explain” the plans.

The CCG’s promise to improve community integrated services is lip service, as the scrapping of community palliative services in Poole and Bournemouth has vastly increased the workloads of already shrunken district nursing teams and other community intermediate teams. Their claim to have “more care home beds in community” is equally a fraud, as such facilities do not exist and there are no concrete proposals to build them in the CSR. They expect nothing but having beds from privately run care homes, further outsourcing the services.

The CSR has nothing to do with providing improved, well-funded health services. Rather, it is a mechanism of NHS management in Dorset to impose its share of cuts, as part of the government’s overall plans to extract £22 billion in “efficiency savings” from the NHS via its Sustainability and Transformation Plans (STPs). England has been carved up into 44 “local health and care systems,” each of which has to submit cost-cutting STPs. That this is the aim was revealed when NHS Providers CEO Chris Hopson called for a debate on what services ought to be sacrificed.

This was a cynical announcement designed to cover up the fact that rationing of vital health services by CCGs is already the order of the day. Many hospital trusts are being forced into mergers, leading to loss of services and jobs. A&E departments, maternity units, heart units and ambulance services are facing downsizing or closures across the country.

Many CCG board members nationally, who have business interests in private companies, intend to exploit the opportunity to enrich themselves at the expense of patient care, as well as pay, terms and conditions of health workers.

Parallel to the CSR in Dorset, a “review” in Cumbria has come up with similar draconian cuts to NHS services in order to curb the looming deficit of £163 million a year by 2020. Its plan, too, includes the removal of consultant-led maternity care from the West Cumberland Hospital in Whitehaven and closing down three community hospitals—Alston, Maryport and Wigton.

In one case, leaked STPs show that in north-west London, 500 hospital beds are to be cut.

In West Yorkshire, there are proposals to close the equivalent of five wards in the Leeds Teaching Hospitals Trust and a “major reconfiguration” of frontline NHS services in Wakefield, North Kirklees, Calderdale and Huddersfield.

In the West Midlands region, there are plans for major changes to frontline services at Midland Metropolitan Hospital, including the closure of the hospital’s A&E unit and the closure of two District General Hospitals as part of a planned merger.

Growing opposition from clinicians, other hospital staff and people across Dorset County further repudiates the claims of the CCG that their plans are a product of the views of clinicians and the public that they met over the last two years during their “road shows.”

The fact is many clinicians and members of the public did not even bother taking part in these bogus consultations, already knowing that the outcome would disregard their views with the plans imposed anyway. The CCG admits in a bullet point in the document: “number of responses not high enough to be conclusive.” Even with a limited public engagement, they could not find any support to slash services. Instead, they found “strong support for care closer to home.” Hence, with these attacks the CCG is trying to enforce the opposite of what those who responded asked for.

The reorganisation plans of Dorset CCG, as in other parts of the country will inevitably deepen the plight of patients, including the most vulnerable sections of society, and continue to worsen the pay and conditions of its 31,000 workforce.

Workers and young people throughout Dorset, alongside hospital workers, have as in other areas nationally shown their desire to fight back against these attacks. The government is only able to impose its agenda, aimed at the break-up and privatisation of public health care, due to the treacherous role played by the trade unions and the Labour Party.

They have done everything possible to avoid a unified offensive of the working class against slashing of services. Unison, Unite, GMB and other health unions have not only been silent over the cuts in Dorset and nationally, they are complicit in implementing them.

KONP trades the illusion that the NHS can be defended by appealing to the very politicians who are committed to its destruction. KONP, which gravitates around the Labour Party and includes members of various pseudo-left outfits, backs the NHS Reinstatement Bill brought by the Labour in July. The Bill called for a reversal of the recent attacks made on the NHS by the Tory government. However, fewer than 50 MPs turned up to debate the Bill, which was presented as restoring the NHS to public ownership, ensuring it fell. Those not present included Labour’s “left” leader Jeremy Corbyn, and his close allies John McDonnell and Dianne Abbott.

Hospital workers, patients and working people in Dorset and throughout the UK must turn to the building of action committees, independent from the unions, to wage a genuine political struggle against these attacks and the Tory government carrying them out.

NHS official suggests GP surgeries “be allowed to fail and wither

By Ajanta Silva

A leaked letter from a senior official of National Health Service (NHS) England exposes plans that could result in the closure of up to 800 “vulnerable” General Practices (doctor’s surgeries).

Over the last six years, Conservative-led governments have been demanding GP surgeries merge into partnerships. This has forced the closure of hundreds of practices, displacing many patients and jeopardising their care and safety.

Many GPs struggle to provide services due to a rising demand, cuts to social care, workforce shortages and increases in workload. These have all been exacerbated by years of austerity and budget cuts that are central to the NHS privatisation agenda of the Tories.

However, the latest NHS England leak indicates far wider and unprecedented attacks on General Practices. The closure of more surgeries will result in patients in many areas being left without any access to local GP services.

The NHS England leak was revealed by the BBC. It cited sections of a letter by Paul Twomey, medical director of the Yorkshire and Humber area team, sent to NHS managers and GP leaders in the region. Twomey demands: “vulnerable practices must either transform and deliver a quality service or be allowed to fail and wither by the system. We are no longer in a position to continue supporting practices irrespective of their willingness or ability as a provider to transform appropriately.”

While preparing a massive assault on GP services across the country behind closed doors, NHS England and the secretary of state of health, Jeremy Hunt, claim that struggling practices are being resourced in order to improve them. NHS England says it will invest half a billion pounds on struggling practices, along with an action plan to reverse the underfunding over the past. But the amount of money being proposed is minuscule. Last year, Hunt promised to spend just £10 million on practices considered vulnerable, but even this has not materialised according to the medical magazine Pulse .

The Royal College of General Practitioners (RCGP) states: “General practice is at risk of losing £33m in 2016/17, through underspending by Clinical Commissioning Groups (CCGs), and up to £760m in 2020, through the roll out of regional NHS plans [Sustainability and Transformation Plans (STPs)].”

The promised funds are a drop in the ocean given that the last six years have seen the lowest-ever funding increase in the NHS, due to the government’s policy for a further £22 billion in “efficiency savings” by 2021. To achieve these drastic cuts, England has been carved up into 44 STPs.

Recently, Chris Hopson, chief executive of NHS providers, an umbrella association for hospital trusts, said, “While demand and costs increase 4 percent a year, the funding increase will be cut to 1.4 percent next year, to 0.3 percent in 2018 and 0.7 percent in 2019.” He called for a debate over which services have to be sacrificed.

According to NHS England’s own estimates, around 800 GP practices out of nearly 8,000 are struggling. Many of the surgeries that are struggling are small practices in rural areas. The financial year saw the closure of 201 practices, many due to mergers. Many others have been forced into cost-cutting measures, as they are struggling financially.

In July, an Oxfordshire doctor’s surgery announced it would close because it claimed changes to the national GP contract made it “financially unviable.”

The groundwork for closures is being laid by the Care Quality Commission regulator. It has rated many practices as “inadequate,” with the instruction, “requires improvement.” Any faults identified are blamed on individual practices, ignoring the sustained attacks on public health service provision by successive governments.

The BBC reported that in September, 2,000 patients were left without a GP after a surgery was closed in Nottingham following an “inadequate” regulatory rating.

Many patients are waiting weeks to get non-urgent appointments. RCGP points out that over the last seven years, the workload of family doctors “has risen by 16%, yet the number of GPs has risen nowhere near in step.”

There is a general increase in demand for NHS services. General practices see around 1.3 million patients a day. Compared with 2004-2005, hospitals are treating 4 million (32 percent) more patients today. The number of GP consultations has increased by an estimated 25 percent, and community care activity has increased by 14 percent over that period.

The government claims that GP numbers will increase by 5,000 by 2021. But official data released last year showed a 2 percent decline in GP numbers while there was only 0.3 percent (108 GPs) increase over the last six months. British Medical Association (BMA) GP Committee Deputy Chairman Dr. Richard Vautrey said, “These figures show that there has been woefully inadequate progress towards recruiting more GPs to cope with rising patient demand. The government is simply not on course to recruit the extra 5,000 GPs it promised at the last election.”

General practices in Scotland, Northern Ireland and Wales face the same problems as those in England.

In Northern Ireland, 75 percent of practices are struggling due to staff shortages and funding. Dr. Tom Black, chair of the Northern Ireland BMA General Practitioner Committee, said, “For now I would say that I would be concerned that we could lose 20 practices through closure in Northern Ireland this year out of a total of 349.”

More than 20 practices have been closed in Wales over the last two years.

Earlier this year, Royal College of General Practitioners Scotland said that the “funding for general practice in Scotland has faced cuts of £1.6 billion over the last 10 years.”

Denouncing the government’s attacks on GP surgeries, Dr. Peter Swinyard, chair of the Family Doctor Association, said, “Starve the practices of resources. Micromanage them into the ground. Over inspect and over criticise. Then stamp on them. It is hard to be transformative when you cannot recruit doctors or nurses and are under the cosh of all the stresses we know, then have your income and resources reduced making it even more likely that you cannot manage change and adapt.”

At the heart of these attacks is the acceleration of the privatisation process within the NHS.

Last month, it was reported that a new private GP company, Doctaly, aims to roll out its pilot Uber-style GP appointments service across England by 2018. Currently, patients in two London boroughs can book a 15-minute appointment, costing up to £70, depending on the time and day of the week.

The central aim of the policy that GP practices “be allowed to fail and wither” is nothing but creating the most favourable conditions for these private companies to profit from patient care services.