Recent Health Articles

How much do we really Care?

by Guest     June 30, 2013 at 3:51 pm

by Joseph Cottrell-Boyce

Last Thursday the BBC released a video of 83-year-old Muriel Price, sobbing pitiful protests to an empty house as she lay stranded in her bed, her agency carer having failed to turn up to work. Her quiet desperation painted a shameful picture of how little our society values the elderly and vulnerable.

I found it hard to watch Muriel’s video, but wasn’t remotely surprised by the content. Just as with other recent care scandals in the UK, the pattern of failure and neglect was all too familiar to me.

I stumbled into agency care work as a 19 year old looking for employment that required neither qualifications nor experience. After two days of basic food hygiene and health and safety training I was sent to out support young adults with learning difficulties in day centres and residential homes for £5 an hour. I was utterly unprepared for the demanding work. Some of my clients had extreme behavioural difficulties; no one had told me what I should do when a charge of the same body mass as me bit an old woman in a shopping centre for example, or kicked children in a playground.

There was also little support; often I’d be left bathing, changing and moving clients alone, when for safety reasons these should have been two-person jobs. This was backbreaking work for me, and often humiliating for the person being cared for. Then there would be the times at the end of an exhausting 7am – 3pm shift when my manager would call and inform me he hadn’t managed to find cover for the afternoon and I’d have to do a ‘double’ sixteen hour day.

Although most of my colleagues were diligent and genuinely caring, I regularly witnessed malpractice. In one care home, waking night staff would tie emergency alarm cords out of reach of disabled residents, leaving them crying impotently for help in the night as the staff would catch up on sleep. I saw teenagers with learning difficulties locking in rooms for hours to ‘cool down’, by staff who’d had no training to deal with their complex needs.

Then there was the casual neglect. I’d regularly come on shift to find that an incontinent client had not been changed in the preceding 8 hours, or incapacitated clients who should have been up, washed and dressed had instead been left in bed while their carers watched TV.

To my great shame as an awkward 19 year old I never spoke up or reported wrongdoing. I did the best I could and kept my head down. I also saw the futility of complaining about individuals; this wasn’t about a few bad eggs, it was a systematic problem. We were all undertrained, underpaid and overstressed. I knew that colleagues who were negligent were also exhausted by erratic shift patterns, long commutes between different jobs and the usual stresses of trying to feed their families below the poverty line.

As frontline workers, we were also in the firing line for the failings of more senior staff; either our own managers or thinly spread social-workers. If something did go wrong or if our company lost contracts we knew that as agency workers we could be sacked at a moments notice.

The net result of all this was a sense that our work was unimportant. To many, care work was just another insecure stop on a merry-go-round of crap, poorly paid jobs and occasional spells on the dole.

It shouldn’t be like this.

Caring isn’t just another job; it is a vital component of a civilised society. The justifiable public outrage at widespread substandard care is testament to this. And despite all the stress, the antisocial hours, the lack of training or support and the rubbish pay, in many ways I loved my job. I got a buzz from enabling people to lead fuller lives than their circumstances would otherwise allow. At times the work could be genuinely rewarding and even fun. I’d go home drained, but feeling far more fulfilled than I had in the mind numbing call centre job I had paid my rent with up till then. Caring should be a vocation, but the current framework denies workers the support and security to make this possible.

Norman Lamb MP, Minister for Care and Support, has recently called for recommendations on how to reform the care system, stating the need for sweeping change. This is encouraging, but really the recipe for reform is very simple and is already working in other countries.

A few years ago I met a Swedish woman who had recently qualified as a care worker after two years of formal training. She was on a decent salary and was employed directly by the state on a permanent contract. She also had opportunities for further training and education to develop her career in the sector. She felt valued and supported and consequently took her job very seriously.

In Sweden, caring is a profession. In the UK it’s a dead end.

The neglect experienced by Muriel Price was not inflicted by one lazy carer; it is systemic neglect which implicates our priorities as a society. If we take the care of our most vulnerable seriously we need to invest in carers, giving them the tools and support to do their job properly and pay which reflects the demands of their vital work.

—
Joe Cottrell-Boyce is a Policy Officer at the ICB’s Traveller’s Project

Ten reasons why the Tory plan to limit visits to the GP is barmy and will cost lives

by Kate Smurthwaite     May 29, 2013 at 4:18 pm

Monty Python famously had a Ministry of Silly Walks. Sometimes it starts to look like David Cameron is running a Ministry for Silly, Stupid and Downright Dangerous Ideas. The latest of these to be floated* by the Conservative Policy Forum is to limit the number of GP visits individuals are entitled to on an annual basis.

Another way of phrasing this would be “penalise people who are sick a lot”.

Here are ten sets of circumstances in which this could lead to, well, death, among other issues.

1. Currently the people who make the most appointments are the elderly. If older people feel that they’re a burden, especially with long term conditions like high blood pressure, they won’t seek help. Thousands of elderly people, including my grandma, already fail to spot and report conditions like pneumonia and minor strokes.

2. People with long-term medical conditions that affect their immune system. AIDS is an obvious one, people taking immuno-suppressant medication after organ transplant is another. These people need to be vigilant in reporting any minor illness to their GP.

3. Patients with multiple interacting conditions. For example Crone’s Disease sufferers may not be able to readily absorb medicines given for other conditions so may need repeated visits to adjust the dosage.

4. People with minor symptoms of potentially serious conditions. Charities addressing conditions like bowel cancer are forever telling people to go to their GP if they spot blood in their stool or seem to be losing weight for no reason. Knowing there’s a limit on visits is surely going to encourage people to wait longer before raising these apparently small issues.

5. Similarly new parents with sickly kids may visit doctors multiple times over fairly small issues, it’s natural for new parents to be over-cautious. Discouraged from making frequent visits serious conditions like meningitis could be missed.

6. Those who suffer from mental health problems are also put at risk. This is another group of people who use more GP visits than average at present. Mental health conditions can’t be treated in a one-off way, they’re long-term and need monitoring and a variety of approaches tried to tackle them. Refusing to treat such patients would inevitably lead to deaths from anorexia and suicide.

7. People feeling unwell who have already “used up” their allocated number of visits may resort to borrowing a friend’s ID to speak to a doctor. Faced with the wrong set of medical records doctors may prescribe medicines that are dangerous for the patient.

8. People with sudden emergency medical problems – car crash victims, heart attacks, epilepsy sufferers, are placed at greater risk because Accident and Emergency rooms are suddenly clogged up with people who’ve run out of GP appointments to use.

9. Young people visiting their GP to discuss sexual health issues in confidence. What will happen when they are unwell and their parents or carers suggest they see their GP? How will they explain they have fewer appointments left to use? This breeches their right to confidentiality and risks encouraging them to lie and avoid medical attention.

10. People who are unhappy with the care they’ve received from their GP. Everyone’s entitled to seek a second opinion. A simple example would be a woman who’s doctor refuses to refer her for a termination. If you happen to live in an area where high numbers of doctors are unwilling to help women seeking abortion, you could end up using up all your remaining appointments without getting the referral you need. Or a victim of rape or assault who wants to try different professionals until they find one they are comfortable talking to.

But I guess what Cameron and his team are trying to build is a health service that works perfectly well for everyone except the old, children, the sick, parents, the poor, young people, people with mental health problems, people with sexual health problems, and victims of car crashes, cancer, meningitis, stroke, heart attack, epilepsy, AIDS, Crone’s Disease, crisis pregnancy, rape and assault.

In short there are millions of people who might need to see their GP more often than an arbitrary number of times in a given year. Actually I’m one of them. Sometimes I feel I should get reward points I’m there so often. Over the last couple of years I’ve found about six lumps in my breasts. Each time the doctor asks me to make a couple of repeat appointments so she can check if the lump is temporary or changing, each time I get referred to the local hospital for an MRI and sometimes a biopsy. So far the diagnosis is that I have “dense breast tissue”. This may explain why the published political opinions of The Sun’s page three models never seem all that insightful, but it’s nothing to worry about.

What my doctor has never told me is “hey, if you find another lump – just ignore it”.

There’s a petition you can sign online on this issue. https://secure.38degrees.org.uk/page/s/dont-cap-GP-visits

Help me find out how to address the UK’s care crisis

by Guest     May 22, 2013 at 9:04 am

by John Kennedy

Ever since I first worked as a care assistant in the mid-1980s, care homes have been in some kind of crisis or turmoil. The issues are the same now as they were 30 years ago. The pressures, though, are growing more and more acute as our society ages.

I am now responsible for the management of a range of services including care homes and housing-based support and I want to find out what we can do about it. That is why, supported by JRF, I am embarking on an inquiry into risk and relationships in care homes.

What is it that needs to change? The half a million people currently living in care homes is likely to rise significantly in the near future. These people are our parents, our siblings, our friends and one day ourselves! Chronic concerns about quality of care, funding, pay, regulation continue to persist, in spite of numerous commissions, inquiries, regulators and Government interventions.

I want to get under the skin of care homes in the UK and discover what people really think, what has to change, what is good and why.

Over the next 12 months, I’ll be visiting care homes and talking to people with real experience; residents, relatives, friends, care staff, managers, cleaners, volunteers.

I’ll also be posing a series of questions to expose the real issues, get an honest debate going, and expose the contradictions and misconceptions that exist in the relationship between care homes, residents, staff and the general public.

So please let me know what you think, by:

• commenting on blogs
• tweeting me @JohnnyCosmos
• liking and commenting on my Facebook page

What do we already know?

• The quality and equality of good relationships is key – respect for individuals’ personalities, sense of humour; trust me as I trust you?
• People working in care homes often feel overwhelmed, anxious, self-doubting, guilty and under attack.
• The public perceives care homes as unwanted, expensive, unkind, indifferent and miserable places.

Care homes just don’t seem to work for us. Or do they?

A recent MORI survey found a surprisingly high level of satisfaction amongst care home residents. Are care homes that awful? Are our expectations too high or too low? What is the reality?

What makes a good care home and what gets in the way? Is there something about our attitude to risk? Do the ‘rules and regulations’, designed to protect and ensure quality, do so or do they actually get in the way? Are they the right ‘rules and regulations’?

What do I want to do?

I want to get out there and visit people and places known for excellent relationships – to understand how this has been achieved. I also want to visit and speak to people in places that are not succeeding. I want to hear why. What is in the way?

I want to encourage people with experience and knowledge to talk about what they think is really the problem. I am sure there is plenty of ‘unspoken’ truth just waiting to be heard. I also want to speak to people with no experience of care homes. What do they think, what is their perception?

This is personal, because if I am fortunate enough to live to a good age I want to be cared for in a nice place by valued and compassionate people – people who treat me kindly and have the time to care.

So please join me on this journey and let’s see if we can make a better future.

—
John Kennedy is Director of Care Services at JRHT

Wednesday is the day we learn whether the NHS is privatised fully

by Guest     April 22, 2013 at 9:43 pm

by Dr Tom Riddington

The privatisation of the NHS wasn’t announced with any triumphant fanfare. Instead a subtle shift in statute law is creeping its way through parliament, one that’s set to flood our health service with private sector companies.

The government replaced Primary Care Trusts with Clinical Commissioning Groups, and gave GPs the responsibility of juggling a £60 billion NHS procurement budget.

But it’s Section 75 of the Health and Social Care Act that sets out the coalition’s true agenda for NHS privatisation. It puts huge restraints on CCGs, forcing doctors to let private companies bid for NHS services.

Under Section 75, GPs will have to demonstrate that there is only one “capable provider” for a particular service. If the private sector can offer it too, CCGs will be forced into ‘competitive tendering’. This is a short step from a two-tier NHS.

Private companies will be able to hoover up the most lucrative services, while the public sector is left with the most costly, most necessary aspects of healthcare.

The Royal College of GPs has already expressed considerable concern about section 75. The government responded by redrafting the section with little real change. GP commissioners will remain powerless to stop private competition from engulfing the NHS.

And now CCGs are up and running, the coalition has an effective scapegoat when cracks begin to appear. It will be doctors who commission these services, and so doctors, not politicians, who will be blamed when things go wrong.

Even if you disregard the precedent set by the atrophied services that followed public sector privatisation in the UK, healthcare doesn’t operate like rail or heavy industry.

International comparison reveals private sector care as more costly with greater variation in quality than state-operated or not-for-profit providers. America’s privatised healthcare is the most expensive in the world by proportion of GDP.

The US spends more on health than France, Germany, Japan, Canada, Australia, Norway, Sweden, or the UK, but it’s at the bottom of that list of World Health Organisation ranked healthcare systems. The motivation for dismantling the NHS can only be ideological.

On April 24th the House of Lords will debate the latest draft of the procurement and competition legislation. There will be an opportunity for the Lords to reject section 75.

There is a possibility that the government may re-think their bulldozing of a health service where prior to the start of these reforms, patient satisfaction was at an all time high. But if the coalition continue headstrong with their dogmatic destruction of the NHS, we are destined to healthcare overwhelmed by a mismatch between public need and private profiteering.

Charging for the NHS – another dam is to be breached

by Natalie Bennett     April 16, 2013 at 4:16 pm

Last month I was in Tremough, at the University of Exeter Cornwall branch, addressing a public meeting.

The subject of the NHS came up in the questions session, and I spoke about the Green Party’s belief in a publicly owned and publicly run system, and about how our current progression towards rapid privatisation was sending us in the direction of the American healthcare system, where obtaining most healthcare is dependent on your ability to pay (or to sustain insurance).

Having belonged for many years to an email list for mostly freelance copy editors with many American members, I know how worrying about health insurance shapes their lives. I know about horrors such as “drive-through” mastectomies, which I cited.

Some in the audience clearly thought this was not a fair comparison – we’d never see patients have to pay upfront in the NHS.

Then I remembered reading an article in the Financial Times (partial paywall), based on an interview with Malcolm Grant, chair of NHS England.

It notes that Professor Grant said he personally wouldn’t support charging for NHS services. But he is then quoted as going on to say:

It’s not my responsibility to introduce new charging systems but it’s something which a future government will wish to reflect [on], unless the economy has picked up sufficiently, because we can anticipate demand for NHS services rising by about 4 to 5 per cent per annum.

To say this looks like the start of a softening-up process is an understatement… a sense only magnified by today’s Financial Times editorial, which says in part:

There is room for serious debate about what role co-payment should play in healthcare. The NHS must continue to be a needs-blind system… but this does not preclude levying a charge to access the healthcare system. This would not only raise revenue but could serve to curb unnecessary demand.

All of this, as the Mid Staffs foundation trust is “declared bankrupt”, the second trust to meet this fate and the first of the supposed financial flagship foundation trusts to do so and as campaigners battle to see the NHS exempted from the US/EU Free Trade Agreement.

To say that the NHS and its “free at the point of use” principle is under attack is now surely beyond question. I’m also unsurprised that Professor Grant is at the centre of this.

I first encountered him in his still “main” job, the NHS one being only a sideline, as UCL provost. It was at a meeting to discuss the then proposed controversial UCL-sponsored academy secondary school in Camden, just opened after a troubled birth.

Like many others at the meeting, I left enraged by the professor’s arrogant certainty about the wisdom of the academy system, and at the idea that the university knew best about secondary education, rather than experienced teachers and parents. I encountered him next again in his UCL provost role resisting the finally successful Living age campaign for UCL cleaners.

He’s a representative of a special class – what you might call the privatariate – extremely well-rewarded proponents of privatisation who’ve moved seamlessly from serving New Labour’s neoliberalist agenda to lapping up posts promoting the Tory ideology of the small state. Another example is Lord Freud – now Tory Lord and Welfare Minister, formerly Labour “welfare reformer”, rightly targeted by UKUncut last weekend.

No surprise that Professor Grant is a standard bearing in threatening the very foundations of the much-loved NHS principle of “free at the point of use”.

Government admits it did not consider impact of welfare changes to disabled people

by Guest     April 10, 2013 at 8:47 am

by Rick B

The community of sick and disabled people behind the WOW petition have now considered the official response given when you pass 10,000 signatures (we are now a third of the way to 100,000) from the Department of Work and Pensions.

Initially, we were shocked at the cursory nature and limited scope of the response. On reflection, we are disappointed and angry.

Our petition calls for a cumulative impact assessment (CIA) of welfare reforms as they affect sick and disabled people. The government says, to paraphrase, that they did not, indeed could not, do a CIA because the changes involved were too numerous and too complex.

The DWP is saying that it embarked upon a programme of changes, which it acknowledges are the biggest changes to welfare in sixty years, without knowing what the effect would be on the most vulnerable people in society.

For a government department the size of the DWP to say that a CIA would have been too difficult is, frankly, risible. It has also been proved to be incorrect by the cross-party think tank Demos, which has carried out its own CIA. Demos has concluded that 3.7million sick and disabled people will be negatively affected by welfare reform, with a total loss of income up to 2018 of £28.3billion.

As Demos is comparatively a small organisation with limited resources, the fact that it was able to do this CIA makes the DWP’s failure to do so remarkable, to say the least.

The issue of a Cumulative Impact Assessment was addressed in the first sentence of the e-petition, but it is the only aspect of the petition that the government has responded to. There is no response to the request for an immediate halt to the Work Capability Assessment, as demanded by the British Medical Association in 2012 because it was harming patients.

Our call for an end to ‘forced work under threat of sanctions for people on disability benefits’ and various other measures, all of which are ignored in the government response.

The response makes clear the government’s total and reckless lack of regard for the health, safety, wellbeing, and human rights of sick and disabled people in the UK. Consequently the Human Rights of sick and disabled people in the UK will be on the agenda for discussion at the Annual General Meeting of Amnesty International on 13/14 April 2013.

For more information and to sign the WOW Petition please go to wowpetition.com

Here’s what’s next in the battle against NHS privatisation

by Alice Hood     April 5, 2013 at 10:40 am

The most sweeping changes to our NHS since its inception were put in place on Monday.

But as the new system grinds into gear the fight continues, including an immediate battle over the competition regulations at the heart of the ‘reforms’. There’s a chance to defeat this core element of the Government’s plans in Parliament this month, and we’re asking supporters to contact MPs and members of the House of Lords to ensure that they act.

When the Procurement, Patient Choice and Competition Regulations under section 75 of the Health and Social Care Act were quietly published in February there was uproar from the public, medical professions and health unions.

They all believed the regulations broke promises Ministers made during the passage of the Act that decisions about whether, when and how to use competition would lie squarely with the new GP commissioners.

Instead they would force services out to competition. The outcry forced the Government to rewrite and a second version was laid in March, coming into effect on 1 April.

So what changed? Some warm words about integration and co-operation were added to the new regulations and some of the most explicit pro-competition wording was removed. But experts agree that the new wording has much the same effect as the previous version.

The key point is the ‘single provider test’ in regulation 5. To award a contract to provide health care services without a competition, commissioners will have to be satisfied that only that provider is capable of delivering that service.

There are lots of sensible reasons why commissioners might not want to put a service out to competition. For instance, they might think the contract is too small to justify the trouble and expense of a competition, or they might want to support a local NHS provider that is already delivering a good service for patients.

But if they can’t be certain there is only one possible provider, they will have to subject the service to competition. As this blog explains, there will often be more than one possible provider, for instance where a town has more than one hospital. Private and voluntary sector providers are likely to claim that they are potential providers too.

The bar is set so high that CCGs will end up feeling that the only way to ‘prove’ there is only one provider is to hold a competition. They are also likely to be nervous that they will face legal challenges from private providers who want to get into the NHS.

Not only will this increase the privatisation of the NHS, it will mean time and money wasted on complicated contracting processes. It will make money for lawyers and management consultants that could be better spent on providing care.

The medical professions are not convinced by the cosmetic changes. The BMA, RCN, RCGP and NHS Clinical Commissioners have all spoken out and 250 doctors have signed an open letter in the British Medical Journal.

Legal advice for 38 degrees by David Lock QC sets the risks out clearly.

A key Lords Committee examined the new regulations and their incisive report (see section C) was critical of the rushed, last-minute policy-making process and the confusion over what the revised regulations mean. The Committee sympathised with the view the regs should be revoked to allow more time for consultation, and have referred them for the ‘special attention’ of the House of Lords.

We’re asking people to contact peers and ask them to give the regulations the scrutiny they deserve by joining the debate on 24 April and supporting the ‘fatal motion’ laid by Labour’s health lead in the Lords, Phil Hunt.

If enough Liberal Democrat and Crossbench peers can be persuaded to support it the motion will scrap the regulations and force the government to think again.

MPs have a part to play too. The equivalent procedure to ‘pray against’ the regs in the Commons is an Early Day Motion signed by the leader of the Opposition. Make sure your MP has signed EDM 1188 to secure a debate there too.

There will be much more to do to protect our NHS from the worst of these reforms over the coming years. But at this point a defeat for these dangerous regulations is vital.

Why our anti-bullying policies at school don’t work

by Guest     March 24, 2013 at 12:05 pm

by J.C. Piech

Last week, 14 year old Ayden Olson committed suicide. His mother said on Twitter her son had been ‘bullied to death’. There is no denying what a tragedy this is, yet sadly it is a common one: type ‘bullied student commits suicide’ into Google and you’ll find thousands of cases.

It’s compulsory for UK schools to have anti-bullying policies, yet when so many children are suffering we must ask meaningful questions about why these policies aren’t working.

First, anything ‘anti-bullying’ requires a child to identify themselves as a bully before they can take action to stop being one. Yet bullies are vilified; we portray them as nasty people who should know better. So who is likely to think of themselves that way?

In truth, most of us have blurted out an unkind word, or ignored someone, or stood by when someone is being treated unfairly. But, you might argue, you were having a bad day. Or you were angry. Or you were only six at the time.

And when we don’t consider children to be mature enough to have sex, or join the armed forces, or drive or smoke or drink, why do we expect them to have full comprehension of how their actions and words affect others?

This is why anti-bullying policies don’t work. They demand a differentiation between good and bad children, and they perpetuate the idea that only bad people bully.

Second, schools state that children are encouraged to report incidents of bullying, yet this is a redundant offer when it’s not safe to do so. Many teachers don’t handle bullying with much skill or insight.

In 1997, when I was 11, I was being bullied by a friend. I didn’t want to say anything about it because I didn’t want to get her into trouble. But eventually I’d had enough and summoned the courage to mention it to my form tutor. The tutor took me and my friend aside to talk about what was going on. I started to explain, when my friend started crying and said it was in fact me who was bullying her.

Because I was unable to cry at that time in my life, even when I wanted to, the tutor took my friends tears as a sign she was telling the truth, and I was told to stop bullying her. Some weeks later, the truth came out and my head of year apologised to me. Yet the damage was done.

As long as adults insist on labelling children as either the villain or the victim, bullying will continue destroying lives. No case of bullying is black and white. Perhaps the bully is mirroring what’s happening to them at home, or maybe they’re jealous of the child they’re picking on, or maybe they’re trying – in their clumsy, unskilled way – to make friends by joking around.

Teachers need to find out what’s really going on, for all involved, and facilitate communication. And this isn’t some fluffy idealistic idea: when done properly, it works. After successfully facilitated conversations between the bully and the bullied, children often leave on amicable terms, sometimes even as friends.

Lastly, if schools are serious about tackling bullying, more needs to be done about teachers who are bullies. I’ve heard countless stories of teachers screaming into pupils’ faces, of teachers not allowing teenage girls on their periods to go to the bathroom during class, of teachers embarrassing children in front of their classmates, including one school that produced a video advocating the use of shaming as a technique.

Children mirror the behaviour they receive. So to combat bullying we don’t need stronger policies. We’ve wasted enough time pushing paper. What we need now are emotionally literate and aware adults to show children, by example, how to treat each other with respect, tolerance and care.

—
J.C. Piech is a freelance writer. She has also facilitated community workshops for people with mental health issues. http://twitter.com/jcpiech

The government is hiding its sexual health policy, and it’s important to ask why

by Guest     March 14, 2013 at 11:38 am

by Katherine O’Brien

On 1st April of this year, local authorities across England will take over the commissioning of sexual health services. They will be responsible for contraceptive services, testing and treating of STIs including HIV, and sexual health outreach, education and training.

To help them with this extremely difficult transition, the government promised a Sexual Health Policy Document would be published in spring 2011.

But with just over two weeks left, it has yet to arrive.

This document was to be, according to the then health minister Anne Milton, a “vital source of information and current evidence” to be used by local authorities as “guidance to help them” complete the task the government has placed on their shoulders. It seems at best poor planning and at worst complete negligence to have delayed the document for this long, an issue that has been raised by MPs on both sides of the House.

Whilst the government has mandated local authorities to providing sexual health services, it is unclear as to what the government expects these services to look like.

Because the document has been postponed and postponed yet again, sexual health experts have stated that in some areas local authorities are “waiting” for the document to arrive before making these decisions as they simply “don’t have anything to work with.” Due to this wait, PCTs have not brought in strategies to reduce unintended pregnancies.

Sexual health is only one demand on the local authorities public health grants – and it isn’t a popular one. It’s an area of health care that is essential but contentious and divisive.

And without proper guidance on how they should be providing sexual health service, there is a real concern that this task will drop to the bottom of priorities for the already over-stretched local authorities.

Sexual health is not an issue politicians want to talk about, and it’s not an issue that voters want to hear about. It’s hard to imagine a public outcry over lack of access to sexual health clinics in the same way you might see over dentists.

On this basis, it seems perhaps worryingly understandable that without real care sexual health could fall through the gaps.

Local authorities are currently planning what sexual health services they will commission and how. The government should have acted two years ago.

With only a matter of weeks to go until local authorities are responsible for these services, the government had better act fast to ensure that sexual health care does not lose out in the scramble for funding.

Still too early to say that NHS ‘back-door privatisation’ through s75 is averted

by Guest     March 13, 2013 at 11:47 am

by Caroline Molloy

On Monday, the government published revised regulations under Section 75 of the Health & Social Care Act 2012. The government has hastily re-written these regulations, the first draft of which would have forced commissioners to open just about every part of the NHS up to private sector competition. Howls of protest from grassroots groups, healthcare professionals, all the Royal Colleges, all the unions, and even those few parts of the NHS previously supportive of the Act, were taken up publicly by the Labour front bench, and (we are told) privately by the Lib Dem leadership. 

Having been caught red-handed, trying to sneak in drastic changes and broken promises through the back door, does the rewrite do enough? It remains to be seen.

Lib Dems should be very wary of boxing themselves in by rushing to hail these new regulations as enough of an improvement. A cosmetic re-write, that seeks merely to better disguise the true privatising aim of these regulations, was widely expected, as Earl Howe opined that all was needed was to ‘improve the drafting’ and ‘clarify’ them, to avoid ‘confusion’.  

Lawyers will be looking very closely at these regulations over the coming few days, but it is surely inappropriately hasty to bring them into force on 1 April – ie, before any parliamentary scrutiny and vote can take place.  Last week Norman Lamb assured campaigners that he shared their concerns, and was ‘determined to ensure there is complete transparency in this process’. Shirley Williams hinted at this weekend’s party conference, that Lib Dem ministers had not even seen the first regulations before publication. Surely, in these circumstances, transparency is best served by simply revoking the regulations so that the coalition can take time to consult and consider what if regulations, if any, may be needed – particularly in the light of the recent Francis recommendations.

In the mean-time, the Clinical Commissioning Groups are capable of getting on with making decisions that respond to the needs of local people, as promised. Currently, commissioners can decide what is best for patients, from a wide range of options, including (for example) an in-house arrangement between NHS bodies.  The government confirmed such an arrangement was entirely legal a few months ago, but it would be outlawed under the first draft regulations.  This is a crucial point and no new regulations should be accepted without addressing it.

The excessively tight exceptions for tendering appear – on face value- to have been loosened very slightly, but it is little help if some exemptions are allowed, but only – as Earl Howe has suggested – in unprofitable areas (like A&E) that the private sector probably doesn’t want anyway. His soothing words in themselves do nothing to stop the private sector picking off everything that really brings in the government money – all the ‘routine’ operations, home visits, and outpatient appointments – damaging what’s left of the NHS quite possibly beyond repair.

In any event, the problem with these regulations was never about just one clause. Sweeping pro-competition clauses like section 10(2) seem, on first glance, little changed, along with extensive provisions to enforce other forms of competition, like Any Qualified Provider. And Monitor will be the sole legislator, judge and jury, of what is supposedly in ‘patients best interests’, within a legal framework that appears still to unnecessarily extend competition law in several ways. Its sidekick, the Competition and Co-operation Panel (headed by a private healthcare mogul) would also gain statutory powers.

Thanks are due to Andy Burnham and Lord Phil Hunt, who quickly got behind campaigners and cross-party backbenchers who sounded the alarm.  It was good to hear Burnham talking in outraged terms of ‘back door privatisation’.  But it was worrying to see the news report this, rather prematurely, as a U-turn. Vigilance, and indeed political will, must not be sapped by arcane parliamentary procedures or Tory spin.

The NHS should be in Labour’s – and indeed the Liberals – blood. To protect the NHS against Tories who have admitted they intend to dismantle it in one term, and are prepared to lie to do so, will involve an Opposition strategy more sophisticated than ‘blaming the Lib Dems’.  The public – four out of five of whom don’t want any more markets in the NHS – deserve better. No-one voted for NHS privatisation, it’s not in the coalition agreement, it won’t save money, it won’t provide better results, and if it happens, it will be possibly the biggest failure of democracy in living memory.

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This is cross-posted from openDemocracy