Tag Archives: conservative

Finally! Exposed! The Deficit Myth! So, David Cameron When Are You Going to Apologise?

4 Mar
I have just seen this as a tweet.  Although it’s off subject and out of date I think it says a great deal about the behaviour of the present government in relation to where it is trying to take the country.  And this from a Conservative too…
HuffPost Social Reading
Ramesh Patel

Economist, worked in media and the financial sector

“A lie gets halfway around the world before the truth has a chance to get its pants on”
– Winston Churchill

As a Conservative I have no pleasure in exposing David Cameron’s deficit claims. However, as long as the party continues to talk down the economy via the blame game, confidence will not be given an opportunity to return. For it is an undeniable and inescapable economic fact: without confidence and certainty there can be no real growth.

Below are the three deficit claims – the mess. The evidence comes from the IMF, OECD, OBR, HM Treasury, ONS and even George Osborne. The claims put into context are:

The last government left the biggest debt in the developed world.

After continuously stating the UK had the biggest debt in the world George Osborne admits to the Treasury Select Committee that he did not know the UK had the lowest debt in the G7? Watch: Also, confirmed by the OECD Those who use cash terms (instead of percentages) do so to scare, mislead and give half the story.

Its common sense, in cash terms a millionaire’s debt would be greater than most people. Therefore, the UK would have a higher debt and deficit than most countries because, we are the sixth largest economy. Hence, its laughable to compare UK’s debt and deficit with Tuvalu’s who only have a GDP/Income of £24 million whilst, the UK’s income is £1.7 Trillion.

Finally, Labour in 1997 inherited a debt of 42% of GDP. By the start of the global banking crises 2008 the debt had fallen to 35% – a near 22% reduction page 6 ONS Surprisingly, a debt of 42% was not seen as a major problem and yet at 35% the sky was falling down?

Labour created the biggest deficit in the developed world by overspending.

Firstly, the much banded about 2010 deficit of over 11% is false. This is the PSNB (total borrowings) and not the actual budget deficit which was -7.7% – OBR Economic and Fiscal Outlook March 2012 page 19 table 1.2

Secondly, in 1997 Labour inherited a deficit of 3.9% of GDP (not a balanced budget ) and by 2008 it had fallen to 2.1% – a reduction of a near 50% – Impressive! Hence, it’s implausible and ludicrous to claim there was overspending. The deficit was then exacerbated by the global banking crises after 2008. See HM Treasury. Note, the 1994 deficit of near 8% haaaaaah!

Thirdly, the IMF have also concluded the same. They reveal the UK experienced an increase in the deficit as result of a large loss in output/GDP caused by the global banking crisis and not even as result of the bank bailouts, fiscal stimulus and bringing forward of capital spending. It’s basic economics: when output falls the deficit increases.

Finally, the large loss in output occurred because the UK like the US have the biggest financial centres and as this was a global banking crises we suffered the most. Hence, the UK had the 2nd highest deficit in the G7 (Not The World) after the US and not as a result of overspending prior to and after 2008- as the IMF concur.

Our borrowing costs are low because the markets have confidence in George Osborne’s austerity plan and without it the UK will end up like Greece.

Yes, the markets have confidence in our austerity plan and that’s why PIMCO the worlds largest bond holder have been warning against buying UK debt.

The real reason why our borrowing costs have fallen and remained low since 2008 is because, savings have increased. As a result, the demand and price for bonds have increased and as there is inverse relationship between the price of bonds and its yield (interest rate) the rates have fallen. Also, the markets expect the economy to remain stagnate. Which means the price for bonds will remain high and hence, our borrowing costs will also remain low.

Secondly, the UK is considered a safe heaven because, investors are reassured the Bank of England will buy up bonds in an event of any sell off – which increases the price of bonds and reduces the effective rate. Note, how rates fell across the EU recently when the ECB announced its bond buying program. Thirdly, because, we are not in the Euro we can devalue our currency to increase exports. Moreover, UK bonds are attractive because, we haven’t defaulted on its debt for over 300 years.

David Cameron would like people to believe the markets lend in the same way as retail banks lend to you and I.

Overall, when the facts and figures are put into context these juvenile deficit narratives and sound bites (“mere words and no evidence”) simply fail to stand up to the actual facts. The deficit myth is the grosses lie ever enforced upon the people and it has been sold by exploiting people’s economic illiteracy.

So, David Cameron when are you going to apologise?

Cameron is playing the blame game to depress confidence and growth to justify austerity. Secondly, to use austerity as justification for a smaller state to gain lower taxes. Thirdly, to paint Labour as a party that can not be trusted with the country’s finances again. Therefore, we Conservatives will win a second term because, people vote out of fear. The latter strategy worked the last time in office (18 years) and will work again because, in the end, elections are won and lost on economic credibility. Hence, as people believe Labour created the mess they won’t be trusted again.

Finally, as the truth is the greatest enemy of the a lie I urge you to share this on Facebook, Twitter, blogs, text and email etc etc. So the truth can be discovered by all. Finally, have no doubt, people have been mislead by the use of the following strategy:

“If you tell a lie big enough and keep repeating it, people will eventually come to believe it” Joseph Goebbels


The real force behind the NHS Act – the EU/US trade agreement

25 Feb
Linda Kaucher 19 February 2013


An EU-US drive to harmonise services – particularly health – is critical to the NHS reforms. As the Trade Commission acknowledged, without the financial crash this would not have been possible. Britain’s ‘shock’ programme continues.

The NHS changes have been both promoted and fought as a national issue. However, they are actually part of the preparation for a corporate-interest US/EU Free Trade Agreement. David Cameron has flagged[1]this trade deal, due to be formally launched in the spring, as his priority in his chairing of the G8 this year[2].

Even though the NHS changes have at this point been fixed in the complex legislative framework of the Health and Social Care Bill, the relationship to this wider international investment context has still not emerged as public information. What opportunities does knowledge of this background provide?

I have been looking at international trade agreement issues for about 12 years[3].  Outside of big business, the small amount of UK interest in international trade agreements has tended to focus on the effects on developing countries, whereas I have focussed more on the effects on people in the UK.

I attend EU Trade Commission civil society dialogue meetings in Brussels where some information is given out, with the opportunity to ask questions. The other ‘civil society’ attendees are overwhelmingly business group representatives.

In a 2010 civil society dialogue meeting Trade Commission personnel flagged the intention to push forward a US/EU Free Trade Agreement.

In fact transatlantic integration has been a priority since 2007[4] when a Transatlantic Economic Council was set up for ongoing work and six monthly progress reporting. It was left off the public agenda for a period because of the banking crisis.  Financial service liberalisation, the primary cause of the banking crisis, is a major part of this trade agreement.

In the 2010 civil society dialogue meeting I’ve referred to, the Trade Commission admitted:

–       That while it would normally not be possible to get this agreement through, the economic crisis would now actually be used to push through the agreement as quickly as possible[5].

–       That the important preparatory process would be regulatory ‘harmonisation’ before the launch of negotiations

–       That the first thing to be ‘harmonised’ would be health

Since then we have had the Health and Social Care Bill in the UK, preparing the sector for transnational health investors.

Liberalisation changes are often in a two-step mode. In the UK, the establishment of privatised GP consortia is being encouraged. In this segmented, privatised format, businesses can easily be sold to investors[6]. In such two-step processes, the end game is obscured.

Although the focus of this paper is health, some background explanation of the international trade agenda is necessary.

Firstly ‘trade’, which goes on all the time anyway, is not the same as ‘trade agreements’, which are effectively irreversible commitments made at the level of international law, i.e. beyond changes at the level of the UK government or the EU.

Trade agreements are negotiated by governments but on behalf of corporations, and in the interests of transnational corporations.

Although the pretence is maintained that ‘trade’ is primarily about goods[7], most EU and UK trade is in ‘services’, in which financial services and investment play a major part.

The trade agenda is about liberalising. While liberalising trade-in-goods is about countries reducing at-the-border taxes, when countries liberalise a service sector they open it to transnational investors. (The UK always does this anyway, unilaterally, outside of any agreements).

When countries commit services to international trade agreements, the liberalisation of those services is then locked in i.e. a commitment to keep the service open to transnational investors.

With aspects of public services privatised, either via privatised contracting or sell-offs, the privatisations underpinning the liberalisations also become irreversible.

The categories of ‘trade-in-services’ are all-encompassing, but the financial services industry is a major force for the liberalisation of services. The City of London[8], made up of transnational financial service corporations, is the main driver of commercial policy within the EU and of EU external trade policy.

In the UK, City of London financial services dominate policy-making to ensure that national policy both fits with that wider liberalisation agenda and provides an international model for it.

For financial services, the transforming of the NHS is an exemplary model of how to turn a globally-respected universal health service into a cash cow for transnational investors.

Trade-in-services trade commitments involve states giving transnational corporations rights to come in and operate and to keep operating, without limits on their activities or on the number of transnational corporations that enter the sector[9], with rights to the same or better treatment than that which national companies receive (including any subsidies)[10], and rights to sue the government in an international jurisdiction if there is any attempt, by any level of government, to limit  those rights or to introduce any regulation which might, even  incidentally, limit corporations’ expected future profits[11].

As corporate rights are thus increased via trade commitments, the rights of governments to control them are correspondingly diminished and democratic control over the activities of corporations is forfeited.

When applied to health, this means the whole emphasis of health care changes. The rights of transnational corporations become the priority and health becomes primarily a trade issue.

Trade agreements are usually conducted very secretly but David Cameron, led by the financial service industry, has emphasised the US/EU Free Trade Agreement – though he hasn’t spelt out what it involves. It is also being promoted by ‘business leaders’, such as CEOs of banks[12].

Yet despite the front page report of the Prime Minister’s speech and his focus on this trade agreement, the media, including the publicly funded media, have failed to analyse or question the implications of it or indeed what it has meant so far for the NHS.

There are as yet no organised critical voices to take this up.

Health is just the starting point. Regulatory ‘harmonisation’ with the US will be much broader.

For instance, until now the EU has resisted the importation of genetically modified human foodstuff and seeds (GMOs) which are the norm in the US. A push for a change in EU regulation on GMOs, for ‘harmonisation’ with the US, is inevitable[13].

Another obvious target for ‘harmonisation’ is the European public broadcasting model. The US media model is overwhelmingly corporate with public broadcasting marginalised. Recent events undermining public trust in the BBC have increased its vulnerability to calls to narrow its activities in favour of private media.  At this point, the EU Commission is proposing a ‘harmonisation’ of media laws across the EU, monitored by the Commission[14], an ominous start.

A major aspect of the ongoing work of the weighty Transatlantic Economic Council, headed by the top-level US Trade Representative and the EU Trade Commissioner, is to work pre-emptively with regulators to ensure that any new regulation takes account of the intended trade deal, so it is ready ‘harmonised’.

With the UK taking the lead in this trade agreement, albeit behind the scenes, and with the information from the Trade Commission two years ago about harmonising health, we can assume that the Health and Social Care Bill was prepared in this way,  yet without public information to this effect. The debate on the passage of the Bill was not properly informed.

The Trade Commission is the most heavyweight part of the EU Commission and its work is driven to a great extent by financial services based in the City of London. Yet neither the existence of this part of the Commission, nor what its bureaucrats are signing us up to in free trade agreements[15], are mentioned in current UK discussions on the EU and the terms of UK membership. Without public knowledge of this major function of the EU, any referendum would be misinformed.

The failure of the media to provide this information is partly due to the fact that there is so little knowledge of the trade agenda among reporters except those who are complicit, even among BBC senior economics reporters.


Summary and suggested action

– It is in health that the effects of ‘harmonising’, towards this Free Trade Agreement, are already manifest. The fact that the NHS has been prepared for transnational investors as part of a planned US/EU free trade agreement should be made public

–  The similar threat to other areas should also be public.

–  The activities of the EU Trade Commission on our behalf should be an important part of the debate about EU membership

–  There is a job to be done on disseminating information and demanding reporting and analysis of the implications of the US/EU Free Trade Agreement, so that it is not just the perspective of transnational capital that is being presented. (The BBC has a Business Unit presenting this perspective but has no such unit for workers or public service users). The nationwide concern about the NHS and established networks of concern could be the means for a strong, clear and concerted public voice on this.

– The juggernaut of the trade deal backed by business voice propaganda is unlikely to be questioned otherwise.

– The lack of public information on this broader context of the NHS changes is grounds for the Health and Social Care Bill to be repealed. The Opposition Labour Party needs to call for this.

– Raising the issue in relation to health would support information-seeking etc. for other areas which will be affected.


*Update 20th February –  

The High Level Working Group on Jobs and Growth (transatlantic – chaired by the EU Trade Commissioner and the US Trade Representative) issued its delayed final report on 11 February http://trade.ec.europa.eu/doclib/docs/2013/february/tradoc_150519.pdf
recommending, as expected, that a US/EU Free Trade Agreement be launched, and completed as quickly as possible.

(‘Jobs’ is the current spin for trade deals. Previously trade deals have been proposed as the answer, sequentially, to global terrorism – after 9/11, to climate change and to the international banking crisis.)

Two days later, on Feb 13th, to coincide with the State of the Union Address, President Obama and President Barroso jointly committed to launching a US/EU  FTA in June 2013.


[1] The Guardian, front page 2.1.2013 The web version appeared and was dated 1.1. 2013


[2] The UK has the presidency of the G8 this year. The annual meeting will be In Northern Ireland in June. The G8 members are Canada, France, Germany, Italy, Japan, the Russian Federation, the United Kingdom and the United States. The European Union is represented by the president of the European Commission and the leader of the country that has European Union presidency, which is Ireland for Jan –June 2013. This will be a united front in promoting the trade deal, though the FTA is not technically in the hands of the G8 institution.

[3] When the World Trade Organisation Doha Development Agenda Round, launched in 2001, stalled in subsequent years, the EU switched in 2005 from the multilateral possibilities of the WTO to a program of bilateral and regional trade agreements. An essential difference between the WTO round, which often saw globalised protests, and bilaterals, is that the latter are inherently more secretive. In fact texts and negotiations are secret – at least to the public on whose behalf they are being negotiated – until the deals are completed. NGO Corporate Europe Observatory is currently taking legal action against the Commission for withholding information on the EU/India Free trade Agreement that was made available to business.

[4] http://www.eurunion.org/partner/summit/20070430sum.htm See the Framework for Advancing Transatlantic Economic Integration between the European Union and the United States of America. The 2008 report has some mention of the work of the Transatlantic Economic Council. The 2009 report doesn’t. The 2010 report reasserts the role of the TEC, with a focus on ‘jobs’.

[5] Trade spin unfailingly presents further liberalisation as the answer to whatever is perceived as the current problem. The Doha deal was put forward consecutively as the answer to global terrorism (after 9/11), to climate change, and to the international financial crisis. ‘Jobs’ is the favoured current spin.

[7] Coalition Secretary of State for business, Vince Cable particularly maintains the impression that ‘trade’ is about the UK selling widgets overseas, whereas Peter Mandelson in that position used a different strategy to deter attention from trade-in-services and effects in the UK, refocusing trade discussions onto developing countries.

[8] The City of London Corporation joined with International Financial Services London, the previous financial services lobbying institution, to form TheCityUK in June 2010. At that time, the third partner was UK Trade and Industry, a UK government unit, attached to the Department of Business, Innovation and Skills (BIS) and to the Department for International Development (DfID). Thus business and a UK government unit were organisationally joined. This was quickly dropped and now senior representatives of government departments attend TheCityUK board meetings, including on international trade, as ‘observers’. For useful reading on the City of London see the ‘Griffin’ chapter in ‘Treasure Islands’ by Nick Shaxson, and TheCityUK website

[9] This is the Market Access rule in trade-in-services agreements

[10] This is the National Treatment rule of trade-in-services agreements

[11] This limiting of corporate profits, including expected future profits, is called ‘expropriation’. The provision for corporations to sue governments in trade disputes is called ‘investor protection’. The EU has recently introduced ‘investor protection’ into the bilateral trade deals it is currently negotiating with Canada, India, and Singapore. The experience where it has been included in other trade deals such as in the North American Free Trade Agreement (NAFTA), between the US, Canada, and Mexico is that it is likely to result in either very big payouts by governments to corporations or to have a chilling effect on proposed legislation e.g. social or environmental legislation. See Corporate Europe Observatory’s downloadable document on the investor protection ‘industry’ called ‘Profiting from Injustice’.

[12] Letter to the Financial Times 18th January signed by CEOs of 12 transnational corporations.

[13] Article in direct relation to the FTA http://mobile.reuters.com/article/idUSBRE8BA05Y20121211?irpc=932

State of play in EU: 26 genetically engineered crops are currently being considered for approval in the European Union.19 out of these 26 are genetically engineered to be tolerant to herbicides.



[15] The EU has now either completed, is negotiating or is ‘scoping’ bilateral or regional trade deals with much of the world. Of particular importance is the planned EU/India FTA. The Trade Commission admits this is essentially a UK deal and that the single demand India is making is for Indian firms to be able to supply cheap labour into the EU (mainly UK). This is called Mode 4 in trade terms. In 2011 the Trade Union Congress voted unanimously for the TUC bureaucracy to publicise and oppose this FTA. However the TUC bureaucracy has failed to implement this directive of the Congress. On 21st Jan 2013 in Brussels the Trade Commission refused to discuss if there are any numerical limits because it has agreed with Member States (though actually the UK government) not to. Yet it is workers in the UK who will be primarily affected.


The Lib Dems must not stand for any more lies over the NHS

25 Feb

The Tories have misled their coalition partners – and us – repeatedly over the true extent of their health service vandalism

Joe Magee illo for polly toynbee

‘At first patients may not notice … But the change will be irreversible when NHS services atrophy once contracts are let out.’ Illustration by Joe Magee

It remains a shock when a government lies through its teeth – deliberately and outrageously. I resist the idea that politicians are liars by nature: the art of politics and persuasion is difficult and more honourable than it gets credit for. But over the Conservatives’ true intentions for the NHS, right from the start David Cameron and his team set out to mislead the public, the clinicians and their own coalition partners.

As parliament broke for half term, regulations for the Health and Social Care Act slipped out – a legal document anyway unlikely to make headlines. The act is a spatchcock confusion of quangos that carefully left most details to be laid out in this dense legalese. But read clause by clause, this document shows how far the act does the reverse of what ministers promised. Commercialisation and competition is written into its key section 75, opening up virtually all the NHS to public tender in a market supervised by Monitor. Secondary legislation is rarely challenged – but this is a final chance for parliament to strike out the obligation of clinical commissioning groups (CCGs) to advertise almost every service to any bidder under EU competition law. It will pass, unless the Liberal Democrats rebel at having been hoodwinked. And they just might.

When the bill was shipping water, the medical professions and many peers so strongly opposed the threat to commercialise the NHS that David Cameron “paused” the legislation. Expecting the Lib Dems to wreck it, he was reportedly surprised they accepted relatively minor amendments. What swung them were public assurances from ministers that seemed convincingly cast-iron.

From the start the plan was misrepresented to the public “as putting GPs in the driving seat”, free to commission best services for their patients. The health department was at it again this week, announcing more commissioning groups approved: “All 8,000 GP practices in England will be members of a CCG, putting the majority of the NHS budget in the control of frontline clinicians for the first time.”

Clare Gerada, head of the Royal College of GPs, calls that “disingenuous”, since all GPs are legally forced to join, yet only a minority of CCGs are led by GPs. Most are not involved, she says, with “barely time to do their day job”. She is shocked by the section 75 requirement for every service to be tendered out and advertised on a national NHS website. However satisfied GPs may be with local NHS services, if anything is not put out for tender Monitor can step in to enforce it. As the bill went through parliament, Monitor’s role was amended from “promoting competition” to “preventing anti-competitive behaviour” – a change in grammar, not in law, repeated in regulations. That’s what the act is for.

Let’s reprise the reassurances that soothed Lib Dem fears. The Tory health minister Earl Howe, steering the bill through a rebellious Lords, promised: “Clinicians will be free to commission services in the way they consider best … they will be under no legal obligation to create new markets … this will be made absolutely clear through secondary legislation.” But now that legislation makes the opposite crystal clear.

Andrew Lansley wrote to all CCGs: “I know many of you may have read that you will be forced to fragment services, or to put services out to tender. This is absolutely not the case … The healthcare regulator Monitor would not have the power to force you to … You will have the freedom to work with whoever you want to in commissioning services … You will be free from top-down interference.” None of that is true, but ministers promised anything, including an “integration” that was never compatible with competition.

Labour will “pray against” the regulations next week to try to strike them out. Andy Burnham says: “The wording is very explicit. It writes EU competition law into the NHS.” But also uncomfortably clear in the small print is how many legal foundations were laid by Tony Blair and his health ministers – many now employed in private health. Burnham has clean hands: as health minister he stemmed the slide by returning the NHS as “preferred provider”, and would do so again. For decades the private sector has usefully provided the NHS with some services, but compulsory marketising of everything regardless of local need is ideologically propelled vandalism. Jeremy Hunt has barely mentioned the act, speaking only of care, but in this debate he will need to praise raw competition – or lie about it.

Campaigners from Keep Our NHS Public, 38 Degrees, Open Democracy and others urge the Lib Dems to block the regulations. Remember the reassuring letter Nick Clegg and Shirley Williams wrote to their MPs and peers: “We will introduce measures to protect the NHS from any threat of takeover from US-style healthcare providers by insulating the NHS from the full force of competition law.” On Monday Lib Dem leaders in the Lords meet Howe: how firm will they be? Baroness Jolly, Lib Dem health spokeswoman, says: “The regulations fail to reflect the assurances or the spirit of the debate on the act.” Lord Clement Jones tells Open Democracy: “Earl Howe’s statements in the House of Lords appear completely at odds with these regulations.” Surely they will not be so easily soothed again?

At first patients may not notice who profits from their services, as private companies hide under the NHS logo. But the change will be irreversible when NHS services atrophy once contracts are let out. The Lib Dems still have a chance to stop this becoming the most indelible legacy of their time in government.

What the Bookies have been thinking

21 Feb
Dr Taylor’s NHS campaigners are a force to be reckoned with

Change is in the air in British politics, with voters increasingly willing to look beyond the major parties. We’ve heard plenty about UKIP and Respect, but Paul Krishnamurty of Betfair reckons a new single-issue party presents a more potent threat to the coalition…

If there’s one thing that the left, right and politically-neutral punters should be able to agree upon, its that the established parties are in trouble. Whether it’s UKIP rising in the national polls, Respect winning a by-election in a safe Labour seat or independents dominating the Police Commissioner elections, the message is the same. More and more voters are crying out for an alternative.

For all their recent success, however, when it comes to the next General Election, minor parties will face the same enormous hurdle that has thwarted newcomers in the past – Britain’s first-past-the-post voting system. UKIP deserve their moment in the sun, and their progress is certainly significant with regards the effect on Conservative support, but nobody expects them to win a single constituency. Second-place in the Rotherham by-election was hailed as a breakthrough, yet their 22% tally was less than half of the required winning total, despite a low turnout and the perfect local context. When asked, even their leader Nigel Farage cannot name a seat UKIP expect to win.

The same frustrating result will probably await any new party founded on ideology, but there is another way to shake the establishment. Imagine there was a candidate, well-known and respected locally, campaigning on a specific single issue which has overwhelming local support. Then imagine there were dozens of other similar candidates running on the exact same issue, with specific regard to the local effects. Meet a party you’ll be hearing a lot more of before the next General Election – the National Health Action Party.

The NHAP offer a broad agenda aiming to offer a ‘platform for community minded people to fight back against self-interested career politicians’ and to ‘protect the NHS, stabilise the economy and provide the British people with politicians they can trust’ but their policies have been formed in response to one specific issue. When the coalition pushed through it’s health reforms against overwhelming public opinion and fierce opposition from within the NHS, it made thousands of articulate, credible political enemies. Give today’s disillusioned public a choice between a career politician and a local GP with a popular cause, and my money would be on the latter.

As the NHAP’s most prominent figure knows full well, this is nothing new. Dr Richard Taylor stunned Westminster in the 2001 election by winning the Wyre Forest constituency with a massive 18,000 majority under the guise of Independent Kidderminster Hospital and Health Concern, which had already made it’s mark by winning 16 council seats in response to the threat to close Kidderminster General Hospital. In parliament, Taylor became a leading, expert critic of Labour’s public-private NHS reforms and went on to regain his seat in 2005, albeit with a reduced majority.

Now he’s going national. It is not clear how many NHAP candidates will stand or where, but there are plenty of options. Hospital closures, privatisations, service cuts and regional pay proposals are gaining traction as key issues in constituencies across the country. The appointment of local health monitors is becoming a key issue in council elections and doubtless lay behind some of Labour’s success in the most recent contests. Since the last election, Labour’s five point lead over the Conservatives regarding best healthcare policies has risen to 18% and the reforms are only beginning to take effect.

They probably don’t realise this yet, but Taylor’s party represents a grave threat to both coalition partners, not least because he is tactically astute. Initially, Taylor was elected in opposition to New Labour reforms and he remains a stern critic of Tony Blair to this day. However, Ed Miliband’s pledge to repeal the latest reforms has met his approval, opening the way for a potent tactical alliance. Check out this interview on BBC Daily Politics, where Taylor specifically says the NHAP would not want to stand against candidates that agree with them.

Presumably, the plan would involve Labour standing aside in certain seats where they have no chance of beating the Tories, but where the NHAP might just do so. At the very least, this will present an unwelcome diversion of resources away from the key marginals. If Labour win the election, the NHAP want to be on hand to make sure the right bits of the bill are repealed. In return, the endorsement of popular, senior health professionals can only improve Labour’s credibility on the issue.

Westminster Village commentators often predict that coalition government is here to stay, based on the highly dubious assumption that the Lib Dems will win enough seats under FPTP to stay relevant. I’ll bet none of them have ever considered the prospect of the country being governed by a Labour/NHAP alliance. Political punters should watch this space very carefully, as these doctors have the potential to transform Britain’s electoral map.

Latest Odds To Win Most Seats At Next General Election

Labour 1.72
Conservative 2.4
Lib Dems 130.0
Any Other 160.0

Andy Burnham’s speech to The King’s Fund – ‘Whole-Person Care’ A One Nation approach to health and care for the 21st Century

21 Feb

Finally Labour are starting to get to grips with the NHS issue – even if, like me – you find the whole One Nation Labour thing dispiriting.

Andy Burnham’s speech to The King’s Fund – ‘Whole-Person Care’ A One Nation approach to health and care for the 21st Century

Andy Burnham MP, Labour’s Shadow Health Secretary, said today at the King’s Fund:

Today I open Labour’s health and care policy review.

For the first time in 20 years, our Party has the chance to rethink its health and care policy from first principles.

Whatever your political views, it’s a big moment.

It presents the chance to change the terms of the health and care debate.

That is what One Nation Labour is setting out to do.

For too long, it has been trapped on narrow ground, in technical debates about regulation, commissioning, competition.

It is struggling to come up with credible answers to the questions that the 21st century is asking with ever greater urgency.

I want to change the debate by opening up new possibilities and posing new questions of my own, starting with people and families and what they want from a 21st century health and care service.

For now, they are just that – questions. This is a Green Paper moment – the start of a conversation not the end.

But what you will hear today is the first articulation of a coherent and genuine alternative to the current Government’s direction.

It is the product both of careful reflection on Labour’s time in government and a response to what has happened since.

Everything I say today is based on two unshakable assumptions.

First, that the health and care we want will need to be delivered in a tighter fiscal climate for the foreseeable future, so we have to think even more fundamentally about getting better results for people and families from what we already have.

Second, our fragile NHS has no capacity for further top-down reorganisation, having been ground down by the current round. I know that any changes must be delivered through the organisations and structures we inherit in 2015.

But that can’t mean planning for no change.

Those questions that the 21st century is bringing demand an answer.

When the modern condition means we are all living with higher levels of stress, change and insecurity, how do we give families the mental health support they will need and remove the stigma?

How will we ensure we are not overwhelmed by the costs of treating diseases linked to lifestyle and diet?

And how can we stop people fearing old age and have true peace of mind throughout a longer life?

Huge questions that require scale and a sense of ambition in our answers.

When a Labour Opposition last undertook this exercise, the world looked very different. But it had to be similarly ambitious.

People were waiting months and years for hospital treatment, even dying on NHS waiting lists.

So Labour set itself the mission of rescuing a beleaguered NHS which was starting to look as if it was on the way out.

A big ambition and, by and large, with help of the professions, we succeeded.

We left office with waiting lists at an all-time low and patient satisfaction at an all-time high; a major turn-around from the NHS we inherited in 1997.

But that doesn’t tell the whole story.

I can trace the moment that made me think differently, and challenge an approach that was too focused on hospitals.

In early 2007, my sister-in-law was in the Royal Marsden dying from breast cancer.

After visiting one night, she called me over and asked if I could get her home to be with her four children.

I told her I thought I would be able to.

But, after a day of phone calls, I will never forget having to going back to Claire and say it couldn’t be done.

And I was a Minister who knew how the system worked, so what chance have families who are at a low ebb and don’t know where to start?

As a Government, we were talking about choice. But it was a painful discovery for me to find we were unable to deliver to this most fundamental of choices.

Concerns about the way we care for people in the later stages of life, as well as how it is paid for, has built and built over recent years.

Stories of older people neglected or abused in care homes, isolated in their own homes or lost in acute hospitals – disorientated and dehydrated – recurred with ever greater frequency.

I have thought long and hard about why this is happening.

It is in part explained by regulatory failures and we will of course learn the lessons emerging from the Francis Report as part of this policy review.

Changes in nursing and professional practice may also have played a part.

But, in my view, these explanations deal with the symptoms rather than the cause of a problem that goes much deeper.

My penny-drop moment came last year when I was work-shadowing a ward sister at the Royal Derby.

It was not long after the Prime Minister had proposed hourly bed rounds for nurses.

I asked her what she thought of that. Her answer made an impression on me.

It was not that nurses didn’t care any more, she said. On the whole, they did.

It was more that the wards today are simply not staffed to deal with the complexity of what the ageing society is bringing to them.

When she qualified, it was rare to see someone in their 80s on the ward after a major operation.

Now there are ever greater numbers of very frail people in their 80s and 90s, with intensive physical, mental and social care needs.

Hospitals hadn’t changed to reflect this new reality, she said, and nurses were struggling to cope with it.

They were still operating on a 20th century production-line model, with a tendency to see the immediate problem – the broken hip, the stroke – but not the whole-person behind it.

They are geared up to meet physical needs, but not to provide the mental or social care that we will all need in the later stages of life.

So our hospitals, designed for the last century, are in danger of being overwhelmed by the demographic challenges of this century.

And that is the crux of our problem.

To understand its roots, it helps to go back to the 1948 World Health Organisation definition of health:

“a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

A simple vision which stands today.

But, for all its strengths, the NHS was not set up to achieve it. It went two thirds of the way, although mental health was not given proper priority, but the third, social, was left out altogether.

The trouble is that last bit is the preventative part.

Helping people with daily living, staying active and independent, delays the day they need more expensive physical and mental support.

But deep in the DNA of the NHS is the notion that the home, the place where so much happens to affect health, is not its responsibility.

It doesn’t pay for grab rails or walk-in showers, even if it is accepted that they can keep people safer and healthy.

The exclusion of the social side of care from the NHS settlement explains why it has never been able to break out of a ‘treatment service’ mentality and truly embrace prevention. It is a medical model; patient-centred, not person-centred.

But, in reality, it’s even worse than that.

For 65 years, England has tried to meet one person’s needs not through two but three services: physical, through the mainstream NHS; mental, through a detached system on the fringes of the NHS; and social, through a means-tested and charged-for council service, that varies greatly from one area to the next.

One person. Three care services.

For most of the 20th century, we just about managed to make it work for most people.

When people had chronic or terminal illness at a younger age, they could still cope with daily living even towards the end of life. Families lived closer to each other and, with a bit of council support, could cope.

Now, in the century of the ageing society, the gaps between our three services are getting dangerous.

The 21st century is asking questions of our 20th century health and care system that, in its current position, will never be able to answer to the public’s satisfaction.

As we live longer, people’s needs become a complex blur of the physical, mental and social.

It is just not possible to disaggregate them and meet them through our three separate services.

But that’s what we’re still trying to do.

So, wherever people are in this disjointed system, some or all of one person’s needs will be left unmet.

In the acute hospital ward, social and mental needs can be neglected. This explains why older people often go downhill quickly on admission to hospital.

In mental health care settings, people can have their physical health overlooked, in part explaining why those with serious mental health problems die 15 years younger than the rest of the population.

And, in places, such is the low standard of social care provision in both the home and care homes, barely any needs are properly met.

What, realistically, can be achieved from a home care service based around ten-minute slots per person?

On a practical level, families are looking for things from the current system that it just isn’t able to provide.

They desperately want co-ordination of care – a single point of contact for all of mum or dad’s needs – but it’s unlikely to be on offer in a three-service world.

So people continue to face the frustration of telling the same story over again to all of the different council and NHS professionals who come through the door.

Carers get ground down by the battle to get support, spending days on the phone being passed from pillar to post.

So far, I have spoken about the experience of older people and their carers.

But the problems I describe – the lack of a whole-person approach – holds equally true for the start of life and adults with disabilities.

Parents of children with severe disabilities will recognise the pattern – the battle for support, the lack of co-ordination and a single point of contact.

CAMHS support at the right time can make all the difference to a young life but is often not there when it is needed.

Children on the autistic spectrum are frequently missed altogether.

The mantra is that early intervention makes all the difference. But it is rarely a reality in a system that doesn’t have prevention at its heart.

If we leave things as they are, carers of young and old will continue to feel the frustration of dealing with services which don’t provide what they really need, that don’t see the whole-person.

They won’t provide the quality people want.

But nor will they be financially sustainable in this century.

For One Nation Labour, this is crucial. Protecting the institutions that bind us together, like the NHS – the expression of what we can achieve together when everyone plays their part.

Right now, the incentives are working in the wrong direction.

For older people, the gravitational pull is towards hospital and care home.

For the want of spending a few hundred pounds in the home, we seem to be happy to pick up hospital bills for thousands.

We are paying for failure on a grand scale, allowing people to fail at home and drift into expensive hospital beds and from there into expensive care homes.

The trouble is no-one has the incentive to invest in prevention.

Councils face different pressures and priorities than the NHS, with significant cuts in funding and an overriding incentive to keep council tax low.

So care services have been whittled away, in the knowledge that the NHS will always provide a safety net for people who can’t cope. And, of course, this could be said to suit hospitals as they get paid for each person who comes through the door.

In their defence, councils and the NHS may be following the institutional logic of the systems they are in.

But it’s financial madness, as well as being bad for people.

Hospital Chief Executives tell me that, on any given day, around 30 to 40 per cent of beds are occupied by older people who, if better provision was available, would not need to be there.

If we leave things as they are, our DGHs will be like warehouses of older people – lined up on the wards because we failed to do something better for them.

But it gets worse. Once they are there, they go downhill for lack of whole-person support and end up on a fast-track to care homes – costing them and us even more.

We could get much better results for people, and much more for the £104bn we spend on the NHS and the £15bn on social care, but only if we turn this system on its head.

We need incentives in the right place – keeping people at home and out of hospitals.

We must take away the debates between different parts of the public sector, where the NHS won’t invest if councils reap the benefit and vice versa, that are utterly meaningless to the public.

So the question I am today putting at the heart of Labour’s policy review is this: is it time for the full integration of health and social care?

One budget, one service co-ordinating all of one person’s needs: physical, mental and social. Whole-Person Care.

A service that starts with what people want – to stay comfortable at home – and is built around them.

When you start to think of a one-budget, one-service world, all kinds of new possibilities open up.

If the NHS was commissioned to provide Whole-Person Care in all settings – physical, mental, social from home to hospital – a decisive shift can be made towards prevention.

A year-of-care approach to funding, for instance, would finally put the financial incentives where they need to be.

NHS hospitals would be paid more for keeping people comfortable at home rather than admitting them.

That would be true human progress in the century of the ageing society.

Commissioning acute trusts in this way could change the terms of the debate about hospitals at a stroke.

Rather than feeling under constant siege, it could create positive conditions for the District General Hospital to evolve over time into a fundamentally different entity: an integrated care provider from home to hospital.

In Torbay, where the NHS and Council have already gone some way down this path, around 200 beds have been taken out from the local hospital without any great argument as families have other things they truly value.

Unlike other parts of England, they have one point of contact for the co-ordination of health and care needs.

Occupational Therapists visit homes the same day or the day after they are requested; urgent aids and adaptations supplied in minutes not days.

If an older person has to go into hospital, a care worker provides support on the ward and ensures the right package of care is in place to help get them back home as soon as possible.

Imagine what a step forward it would be if we could introduce these three things across England.

For the increasing numbers of people who are filled with dread at the thought of mum or dad going into hospital, social care support on the ward would provide instant reassurance.

It is a clear illustration of what becomes possible in a one-service, one-budget world with prevention at its heart.

If local hospitals are to grow into integrated providers of Whole-Person Care, then it will make sense to continue to separate general care from specialist care, and continue to centralise the latter.

So hospitals will need to change and we shouldn’t fear that.

But, with the change I propose, we can also put that whole debate on a much better footing.

If people accept changes to some parts of the local hospital, it becomes more possible to protect the parts that they truly value – specifically local general acute and emergency provision.

The model I am proposing could create a firmer financial base under acute hospitals trusts where they can sustain a back-stop, local A&E service as part of a more streamlined, re-modelled, efficient local healthcare system.

So A&Es need not close for purely or predominantly financial reasons, although a compelling clinical case for change must always be heard and we would never make the mistake of a blanket moratorium.

I am clear that we will never make the most of our £120 billion health and care budget unless hospitals have positive reasons to grow into the community, and we break down the divide between primary and secondary care.

It could see GPs working differently, as we can see in Torbay, leading teams of others professionals – physios, Occupational Therapists, district nurses – managing the care of the at-risk older population.

Nerves about hospital take-over start to disappear in a one-budget world where the financial incentives work in the opposite direction.

NHS hospitals need the security to embrace change and that change will happen more quickly in an NHS Preferred Provider world rather than an Any Qualified Provider world, where every change is an open tender.

I don’t shy away from saying this.

I believe passionately in the public NHS and what it represents.

I think a majority of the public share this sentiment.

They are uncomfortable with mixing medicine with the money motive. They support what the NHS represents – people before profits – as memorably celebrated by Danny Boyle at the opening ceremony of the Olympic Games.

Over time, allowing the advance of a market with no limits will undermine the core, emergency, public provision that people hold dear.

So I challenge those who say that the continued advance of competition and the market into the NHS is the answer to the challenges of this century.

The evidence simply doesn’t support it – financially or on quality grounds.

If we look around the world, market-based health systems cost more per person not less than the NHS. The planned nature of our system, under attack from the current Government’s reforms, is its most precious strength in facing a century when demand will ratchet up.

Rather than allowing the NHS model to be gradually eroded, we should be protecting it and extending it as the most efficient way of meeting this century’s pressures.

The AQP approach will not deliver what people want either.

Families are demanding integration. Markets deliver fragmentation.

The logical conclusion of the open-tender approach is to bring an ever-increasing number of providers on to the pitch, dealing with ever smaller elements of a person’s care, without an overall co-ordinating force.

If we look to the US, the best providers are working on that highly integrated basis, co-ordinating physical, mental and social care from home to hospital.

We have got to take the best of that approach and universalise it here.

But there are dangers of monopolistic or unresponsive providers.

Even if the NHS is co-ordinating all care, it is essential that people are able to choose other providers. And within a managed system there must always be a role for the private and voluntary sectors and the innovation they bring.

But let me say something that the last Labour Government didn’t make clear: choice is not the same thing as competition.

The system I am describing will only work if it is based around what people and families want, giving them full control.

To make that a reality, we want to empower patients to have more control over their care, such as dialysis treatment in the home or the choice to die at home or in a hospice.

We will work towards extending patients’ rights to treatment in the NHS Constitution.

This would mean the system would have to change to provide what people want, rather than vice versa.

The best advert for the people-centred system in Torbay is that more people there die at home than in any other part of England.

When I visited, they explained that they had never set out to do that – a target had not been set – but it had been a natural consequence of a system built around people. A real lesson there for politicians.

So an NHS providing all care – physical, mental and social – would be held to account by powerful patient rights.

But, as part of our consultation, we will be asking whether it follows that local government could take a prominent role working in partnership with CCGs on commissioning with a single budget.

This change would allow a much more ambitious approach to commissioning than we have previously managed.

At the moment, we are commissioning health services. This was the case with PCTs and will remain so with CCGs.

The challenges of the 21st century are such that we need to make a shift to commissioning for good population health, making the link with housing, planning, employment, leisure and education.

This approach to commissioning, particularly in the early years, begins to make a reality of the Marmot vision, where all the determinants of health are in play. Improving PH will not be a fringe pursuit for councils but central to everything that they do.

But it also solves a problem that is becoming increasingly urgent.

Councils are warning that, within a decade, they will be overwhelmed by the costs of care if nothing changes.

They point to a chart – affectionately known as the ‘graph of doom’ – which shows there will be little money for libraries, parks and leisure centres by 2020.

One of the great strengths of the one-budget, Whole-Person approach would be to break this downward spiral.

It would give local government a positive future and local communities a real say.

The challenge becomes not how to patch two conflicting worlds together but how to make the most of a single budget.

To address fears that health money will be siphoned off into other, unrelated areas, reassurance is provided by a much more clearly defined national entitlement, based around a strengthened NICE, able to take a broader view of all local public spending when making its recommendations.

It won’t be the job of people at local level to decide what should be provided. That will be set out in a new entitlement. But it will be their job to decide how it should be provided.

That would provide clarity about the respective roles of national and local government, too often a source of confusion and tension.

But I want to be clear: nothing I have said today requires a top-down structural re-organisation.

In the same way that Andrew Lansley should have refocused PCTs and put doctors in charge, I will simply re-focus the organisations I inherit to deliver this vision of Whole-Person Care.

Health and Well-Being Boards could come to the fore, with CCGs supporting them with technical advice.

While we retain the organisations, we will repeal the Health and Social Care Act 2012 and the rules of the market.

It is a confused, sub-optimal piece of legislation not worthy of the NHS and which fails to give the clarity respective bodies need about their role.

This approach creates the conditions for the evolutionary change towards the Whole-Person vision rather than structural upheaval.

At a stroke, those two crucial local institutions – council and hospital – have an alignment of interests and a clear future role to grow into.

But the same is true for social care.

At present, it is trapped in a failing financial model.

The great attraction of the Whole-Person approach, with the NHS taking responsibility for coordination, is that it will be in a position to raise the standards and horizons of social care, lifting it out of today’s cut-price, minimum wage business.

Social care careers would be more valued and young people able to progress as part of an integrated Whole-Person workforce.

Of course, the change we aspire to, particularly in social care, won’t come by simply changing structures. It will need a change of culture including leadership, training, working in teams, better information and seeing patients and families as partners in achieving better health and care.

So Whole-Person Care is the proposal at the heart of Labour’s health and care policy review which is formally launched today.

It will be led by Liz Kendall, and will run alongside Diane Abbott’s separate Public Health Policy Review. Over the next six months, we will be holding events in all parts of England seeking views on two central questions.

First, do you see merit in this vision of Whole-Person Care and support the proposals for the full integration of health and social care?

Second, if you do, how far down this path of integration do you think we should go?

The fact is that, even if we move to a fully integrated model, and shift resources from hospital to home, it won’t be enough to pay for all of one person’s care needs.

We need to be very clear about that.

So this opens up the question of the funding of social care.

It is the case that, with the shift of resources out of hospital, more preventative social care could be provided in the home and, in all likelihood, better standards of social care offered, as we have seen in Torbay.

For instance, we have already proposed that this should include people on the end-of-life register. It would also include provision for those with the highest needs and at risk from going into hospital.

But rather than leave this unspecified, people need to know exactly where they stand. Currently, council care provision is the ultimate lottery.

In a single system, it would be right to set for the first time a clear entitlement to what social care could be provided and on what terms, as part of a national entitlement to health and care.

That would help people understand what is not covered – which is very unclear to people at present.

But the question arises: what is the fairest way of helping people cover the rest?

At present, beyond the £23,000 floor, care charges are unlimited.

These are ‘dementia taxes’: the more vulnerable you are, the more you pay.

As cruel as pre-NHS or US healthcare.

No other part of our welfare state works in this way and, in the century of the ageing society, failure to resolve how we pay for care could undermine the NHS, the contributory principle and incentives to save.

Some people might ask why they should save for retirement, when the chances of it all being washed away increase every year?

In this century, we can’t carry on letting people go into old age with everything – home, savings, pension – on the roulette table.

So there is a political consensus that the status quo is the worst of all possible worlds and it needs to change.

We agree about the need to find a fairer way of paying for social care, but not on what that system should be.

The Government have begun to set out their version of Andrew Dilnot’s proposals.

A cap, not of £35,000 but over the £50,000 Dilnot recommended, and possibly up to £75,000.

This is better than the status quo.

But we all know that setting a cap of up to £150,000 for a couple is not a fair solution.

For Labour, it fails a basic One Nation test.

Offering some protection to the better off, but doing little to help a couple in an average semi in the Midlands or the North.

But it also fails a sustainability test.

By failing to address the shortfall in council budgets, it leaves people exposed to ever-increasing care charges and more likely to pay up to the level of the cap.

This won’t feel like progress to many.

So, as part of Labour’s policy consultation, we will ask for views on other ways of paying for social care.

We will only have a solution when all people, regardless of their savings and the severity of their needs, have the chance to protect what they have worked for.

There are two basic choices – a voluntary or all-in approach – and, at this stage, we are seeking views on which path people think we should take, building on the foundations of a fully merged health and social care system.

Both would represent a significant improvement on the status quo, but both present significant difficulties in terms of implementation.

Andrew Dilnot’s proposed cap and means-test would help everyone protect their savings.

It would mean people only pay as much as they need to, but, in the worst case scenario, could stand to lose a significant chunk of their savings.

If people support this option, we would be interested in hearing views on how it could be funded.

One of the problems with the voluntary approach is it assumes the continuation of two care worlds – one charged for, the other one free-at-the-point-of-use – with all its complexity.

So it is right to ask whether we can move to an all-in system, extend the NHS principle to all care.

This would mean asking people to pay differently for social care to create a level playing field on how all care is provided.

But it would only work on the all-in principle and that is its major downside: all people would be required to contribute, rather than just those needing care.

People’s exposure to care costs in an all-in system would be significantly lower. But, as with any insurance system, people might pay and never end up using the service.

As with the voluntary option we would be interested in hearing people views on the pros and cons of the all-in principle and options for how this could be done.

It is an open question whether a broad consensus can be found on funding social care on either a voluntary or all-in principle.

But Labour is clear that this must not stand in the way of progress now to get much more for people from what we currently spend on health and care.

To Beveridge’s five giants of the 20th century, the 21st is rapidly adding a sixth: fear of old age.

If we do nothing, that fear will only grow as we hear more and more stories of older people failed by a system that is simply not geared up to meet their needs.

A One Nation approach to health and care means giving all people freedom from this fear, all families peace of mind.

Whole-Person Care is a vision for a truly integrated service not just battling disease and infirmity but able to aspire to give all people a complete state of physical, mental and social well-being.

A people-centred service which starts with people’s lives, their hopes and dreams, and builds out from there, strengthening and extending the NHS in the 21st century not whittling it away.

A service which affords everyone’s parents the dignity and respect we would want for our own.

There will be many questions which arise from what I have said today.

I don’t yet have all the answers.

But that’s why Labour is opening this discussion now.

It’s an open invitation to anyone who has anxieties about what is happening to the NHS right now to help us build a genuine alternative – integrated, collaborative, accountable.

I don’t want to do the usual politician thing of pulling a policy out of the hat at the time of the next manifesto that takes people by surprise.

Instead, I want to involve as many people as I can in shaping an alternative they can believe in.

The task is urgent because the NHS is on the same fast-track to fragmentation that social care has been down.

The further it carries on down this path, the harder it will be to glue it back together.

Unlike the last Election, the next one needs to give people a proper choice of what kind of health and care system they want in the 21st century.

That’s why I started by saying it’s time to change the terms of the debate and put more ambition into our ideas.

Labour is rediscovering its roots and its ability to think in the boldest terms about a society that cares for everyone and leaves no-one behind.

People need One Nation Labour to be as brave in this Century as Bevan was in the last.

That’s the challenge and we will rise to it.

UK e Petition – Please sign

19 Feb

Private Firms bidding for NHS Contracts should be fully tax compliant

Responsible department: Department of Health

This petition calls upon the government to introduce new regulations, so that only companies fully compliant with UK tax laws can bid for NHS Contracts. Private Health Companies who based themselves overseas, for tax purposes, should be barred from bidding for NHS contracts. Specifically, any profit private firms make from the NHS should be taxable in the United Kingdom.

Number of signatures:
Created by:
Dr Éoin Clarke
15/01/2014 10:23

Harmoni preferred to local GPs – the realities of Britain’s new health market

15 Feb

Harmoni preferred to local GPs – the realities of Britain’s new health market

The writer of this piece is Deborah Colvin.  She is a GP in Hackney. She has worked at the Lawson Practice for 26 years. She is also the chair of City and Hackney Local Medical Committee and, as a representative for the Medical Practitioners Union, has a place on the General Practitioner Committee of the BMA.  It was published by Open Democracy on their new Our NHS blog: http://www.opendemocracy.net/ournhs/deborah-colvin/harmoni-preferred-to-local-gps-realities-of-britains-new-health-market

City and Hackney GPs decided to take back responsibility for out-of-hours care but were overlooked in favour of Harmoni, the Care UK owned firm who have been accused of endangering patient safety and putting cost before clinical need. A local GP gives her account.

For some years GPs in City and Hackney have been concerned about the quality of out-of-hours care (OOH) care and have discussed how we could improve it. We realised that we needed to take back the responsibility ourselves as the care we could give people when we were a co-operative, prior to opting out of OOH, had been excellent. We could see that being able to work closely with our local hospital and with other local services would improve the pathway for patients and thus the care they received.

Two years ago we started planning to opt back in to providing OOH care. We discussed this in detail with the Primary Care Trust (PCT). We produced a business plan which was discussed with the PCT on numerous occasions and in June 2012 this was sent to the PCT cluster board of inner north east London. There was some urgency about this. Harmoni had been given the contract for OOH in City and Hackney on a temporary basis in 2010 and was then formally awarded it following a ‘mini-procurement’. Their contract has already been extended and is due to run out on 31st March 2013. The plan was that the GPs would opt back in and then provide the OOH care via a social enterprise. The social enterprise would take over on 1st April.

The PCT board met and decided to ask their procurement panel for an opinion as to whether allowing GPs to opt back in was risky or not. The procurement panel decided that this was the least risky option and advised the board that we should be able to opt back in.

However, on 30th January this year the PCT cluster board met and decided that it was too risky to allow the GPs to opt back in. Furthermore they announced that they would extend Harmoni’s contract again by another nine months.

At the Hackney Health Overview and Scrutiny committee on February 6th, two of the board members attended to explain why they had made this decision. They said that GPs opting back in to providing OOH care is ‘illegal’. I pointed out that GPs in Leicestershire had been allowed to opt back in to out-of-hours care two years ago. A contract variation is perfectly allowable.  The PCT should withhold its consent only if there are reasonable grounds to do so. Who is being reasonable here? The two representatives continued to insist that they had no choice, but they did have a choice. They chose Harmoni.

So let’s look at the concept of ‘risk’. Risk to whom: to PCT managers or to patients? All are agreed that the proposed GP organisation would be very likely to offer an excellent service to our population. There have been several articles in the Guardian newspapers querying the conduct of Harmoni. One article cites local GPs with a number of concerns over the firms operations, suggesting “decisions about treatment appeared to them to be made on the grounds of cost and payment rather than clinical need”, while another describes senior doctors warning that “its service in London is so short-staffed it is regularly unsafe”.   A recent survey of patients attending A&E at Homerton Hospital had 25% patients reporting they were dissatisfied with the GP out-of-hours. Also, a full 62% of patients didn’t know how to contact their out-of-hours provider which makes me wonder what efforts Harmoni have made in Hackney to inform patients of their presence. Interestingly, Harmoni in Hackney receives nearly 50% less calls than the OOH organisation in neighbouring Tower Hamlets despite having a very similar demographic. In summary, the risk the managers talk about is presumably to themselves rather than any risk to patients.

Let’s look at how this fits with the Health and Social Care Act 2012. The government sold this act by repeatedly stating that it was all about giving power to GPs (who know best what is good for their patients) and patients (who know best what is best for themselves). As readers may be aware, Andrew Lansley stated in early 2012 that ‘It is a fundamental principle of the Bill that you as commissioners, not the Secretary of State and not regulators, should decide when and how competition should be used to serve your patients’ interests. The healthcare regulator, Monitor, would not have the power to force you to put services out to competition’.

The GPs in City and Hackney have acted altruistically. We don’t want to work out of hours. We would far rather be doing other things with our evenings and weekends. However we are proposing to do this because we truly believe we have to improve the care our patients receive out of hours. We have set up a social enterprise so we would not be ‘lining our pockets’ as some wish to imply. We wish to work closely with the Homerton Hospital to provide an ‘integrated’ service (another buzz word in the Department of Health who are all for integration, we hear). We want to be able to offer a top quality educational opportunity to young GPs who are training. We want to be able to work together in the organisation so that younger GPs can learn about Hackney and how it works from more experienced GPs, while the more experienced GPs can learn some cutting edge medicine from the younger ones. Most of all we want to provide a service that gives appropriate and high quality primary care to the citizens of City and Hackney.

However this is not to be, according to the PCT cluster board. They would rather extend the contract of a commercial organisation about which a number of concerns have been raised relating to their performance and safety. They say there will be a proper procurement process which will have to be run by the Clinical Commissioning Group (CCG) and that we ‘need not worry as it is a level playing field’. Of course it is as level a field as the corner shop bidding against Tescos but that doesn’t seem to worry the cluster board. They have taken no account of patient safety or what the patients in City and Hackney want in spite of being written to by Hackney LINKS (the local patient organisation) prior to the board decision. They continue to insist they have patient safety as their first concern but I fail to understand how they can possibly argue this. At the very least they could have asked the GP organisation to take on OOH on 1st April as a temporary solution. They didn’t. I do not understand why.

The Daily Mail recently suggested that GPs should opt back in and take responsibility for their patients. We have offered to do just that. But the response has been that the market must be involved. Is a huge company like Harmoni (now part of Care UK) bidding against a handful of GPs running a social enterprise a level playing field? We have learnt the answer the hard way in City & Hackney, and it is patients who may suffer.

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