2018 – We are asking Leeds Council

We recently held discussions with councillors and the LA re the Leeds Health and Care Plan and West Yorks and Harrogate STP.

We had a response to a letter to the Pudsey councillors re the Outer West Community Committee. We had a meeting to share concerns with Rebecca Charlwood, Chair of the Health and Wellbeing  Board, Helen Haydon, Head of adults and Health Scrutiny Board, Paul Bollom and Tony Cooke from the LA who are responsible for System Integration and presented our list of Health & Social Care plan ASKS:

1. Insist on figures and evidence – where are the “savings” coming from , what is going to go and with what impact on whom.

2. With the public – TELL NOT SELL and be pro-active.

3. Don’t agree to Sustainability and Transformation Plans that involve cuts and closures of services in other areas. Leeds shouldn’t collude in plans for downgrading or closing services elsewhere, comfortable in the knowledge that Leeds may well profit from others’ loss.  

We should insist changes are clinically not financially driven, based on sound evidence and subject to proper consultation with the affected populations.

4. Resist the setting up of Accountable Care Systems/Organisations, which have no legal status, no proper governance, no mandate from the public or Parliament and carry major risks of fragmenting health care and eroding the NHS. There is plenty of scope for developing more  seamless and integrated care, better prevention of illness, promotion of wellbeing etc without ACOs

5. Don’t give contracts to private firms and don’t set up Special Purpose Vehicles or pursue other “in house” outsourcing as is happening throughout Yorkshire with Facilities and other non- clinical, hospital staff.

Privatisation of health and social care is wrong, unnecessary, wasteful and creates massive instability. (just look at Wakefield’s Academies!)

6. Be very wary of Naylor report/ Phoenix project plans to sell off NHS estate. It is one off fundraiser and there is no guarantee that monies raised will be ploughed back into local health services. With the NHS in dire straits financially, monies can just be sucked up to cover deficits. There is also pressure and incentives to make quick sales, which may not be the best deal, to vacate buildings which have a high sales value regardless of whether the building is needed and to use PFI to bring buildings up to a reasonable standard to put on the market  

7. Join up and stand firm with other Councils to tell the Government Rumpelstiltskin isn’t real!  You can’t knit good health and social care out of split hairs.


Minutes from last meeting



Junior docs contract dispute

Junior docs due to ballot on the latest offer at the end of June – result 6th July BMA organising road shows early June. There’s already much dissatisfaction re the significant shortfalls in the offer but not sure whether there is sufficient appetite for escalating action. At least one court case is ongoing and the outcome of the challenge re inequality for women might have an impact. Christine noted that GPs and Consultants are hard on the heels of the junior docs in autumn re their contracts.

Sustainability and Transformation 5 year plans to reconfigure services and cut the deficit

All new footprints ( ours West Yorks) have to submit their plans to NHS England by 30th June. Consultation has been virtually non existent. Simon Stevens has asked the Footprints to leave consultation until after they have received and examined the plans ie expect consultation after the fact and in August !! Please sign the petition insisting on consultation re STPs and raise questions at all the CCG meetings


STP Questions asked at Leeds North CCG

Concerns re Sustainability and Transformation Plans – for Leeds North CCG 5.16

1 That CCGs are being forced to try to make unrealistic cost savings by a Government that has driven down the % of GDP we send on health to near the bottom in Europe – just over 8% while France Germany and the Netherlands are all near 11%. The CCG shouldn’t be colluding with the devastation of our health service. and acting as puppets on a string.

2. It is clear that the footprints are a desperate attempt to create a fast route to closing A and Es and hospital beds. This is a heavy handed top down taking of control by a Govt. who said in 2011/12 that it was introducing the Health and Social Care Act to disperse power over planning to local GPs. Now they are panicking about a 2.5 bn deficit we are back to top down control with menace ! The S&TPs feel a bit like Stalin or Mao’s 5 year plans!

3. The plans have not been tried and tested over time. Not only is there concern re the lack of independent evaluation of the recent Vanguards , what evidence there is suggests that improvements in community care ( and these are likely to be pretty limited in the current financial situation ) don’t necessarily have a huge impact on the need for hospital care and what impact there might be will manifest over time, not magic right by 2020.

4. Health bodies smarting at the Hobsons choice they / you have been given will say that at least we will get extra money if we do what we have been told. However Chris Ham from the Kings Fund suggests the most of the front loading of the £8bn promised will be swallowed up paying off deficits not creating new services and the Chartered Institute of Public Finance and Accountancy ( Cipfa) , not noted for being left wing, suggests that the shortfall in NHS spending is likely to grow by £10bn by 2020 and the 5 year forward view on which these STPs are meant to be based has already floundered.

5. One of the positive aspects of the footprints which is closer working together between Health and Social care should flash red warning lights as Social Care has been seriously degraded and largely privatised with LA budgets almost halved so the NHS is not integrating up , it is integrating down and will find itself neatly aligned with a service that already has means testing and charging at its heart. Just in the last few weeks there has been a lot of talk on the radio and in the press re charging and rationing as the Govt try to convince people we can’t a afford a decent, public health care system.

6. Care in the Community without proper funding is likely to put more pressure on families looking after their own with little help, which is most likely to mean increased burdens on women who probably form the biggest army of carers .This is quite apart from Agenda for Change pushing tasks down the chain and hoping for a barefoot army of volunteers to provide Custer’s last stand.

7. And how much do the public know about these changes or longer term vision for the CCGs to morph into Accountable Care Organisations like the Health Maintenance Organisations in the USA. Nothing I would suggest .


As I feel that the best hope for the NHS and quality patient care is that the public do understand what is happening, don’t like it and demand a change in the Government and society’s priorities to put health care pretty much top of the agenda, along with food in bellies and roofs over heads, I would like to know

  1. What the CCG is going to do about informing the public and seeing them as allies and not potential irritants to be kept quiet and


  1. What if anything this CCG is doing with other bodies like the H and WB Boards to tell it as it is and contest directives from NHS England and the Dept. of health, insisting on appropriate funding for the NHS before the NHs as we know it becomes little more than a rump service for the poor and most vulnerable. Some of the Hospital Trusts are now speaking out. Where are the CCGs?

Bootham Park and mental health services in York.

We went to the march in York on 12th June which had about 150 users and supporters of the mental health service. People are still being sent to Teesside for treatment and a large number of different sites are being explored for a new hospital unit.

We noted that we should give mental health a higher profile in our campaigning in Leeds.

Planned protest / stall outside Boots on Commercial St. Sat 4th June 2 – 3.30

John Puntis has put together an excellent piece on Boots drawing from the Guardian articles and sent it round staff at LTHT.

4th June is also the day for the Bursary or Bust demo in London so we will be collecting signatures supporting the nurses and other health workers who face loss of their bursaries

KONP at Triathalon Sunday 12th June

Agreed we aim for late morning on Sunday 12th ( poss 11-12. 30ish outside Brotherton Wing entrance of LGI when Millennium Square should be particularly busy

Public meeting with John Lister Wed 22nd June 7-9pm

Steady response to the facebook event invite. York Defend our NHS have said that some people from the mental health/ Bootham Park demo on 13th June have shown interest.

NHS Birthday

Tuesday 5th July

We have suggested to KONP that we try to highlight privatisation through protests outside private providers as well as doing any flag/ flower day / celebratory activities that week. Discussed a few possible targets for 4/4.30 – 6pm event on 5th . This likely to be discussed at KONP national Steering Group on Sat 11th June

There are now NO NHS dentists in Dewsbury !!

Possible Health Campaigns Together Conference in the autumn

Agreed we should offer a conference in Leeds. Adrian O’Malley’s mid Yorks Unison branch have offered to donate around £200 towards a venue. We though October good, avoiding school hols.

Next Leeds KONP Meeting Wednesday 8th June 6.30pm in O’Neill’s

#Boots and the #Leeds Way

from Dr John Puntis

Should LTHT partners be expected to walk ‘The Leeds Way’?

Boots was a family company founded by Jesse Boot who grew up in Nottingham in the 19th century. Between 1883 and 1920 Boots developed as a successful chain of 660 shops and was keen to invest some of its profits in the workforce and local community. Welfare workers were recruited to improve the health of employees, staff were taken on day trips for recreation and all sorts of sporting clubs were set up. Boots also endowed Nottingham University and built some of the main buildings on campus, a remaining monument to the philanthropy of its founder.FB_IMG_1423403621553

Boots is the largest pharmacy chain in the UK and takes around £2bn a year from NHS prescriptions, a third of its annual income in the UK. Taxpayers money is now being used to fund contracts with Boots for other patient care services including hosting in store GP surgeries, running hospital pharmacies (as in Leeds Infirmary and St. James’s), managing hearing test centres and anticoagulant clinics.

In 2007 Boots was bought for £11bn, the biggest buyout ever seen in Europe, and backed by one of the world’s largest private equity groups, Kohlberg Kravis Roberts (KKR). The buyout was led by the billionaire Stefano Pessina who merged Boots with his wholesaling business AllianceUniChem to form Alliance Boots, and then bought the entire business and took it into private ownership. Pessina’s business philosophy locates the company not in healthcare but in the retail sector.

Five years after taking Alliance Boots private, Pessina and KKR began selling the firm to America’s biggest pharmacy chain, Walgreens – a process completed at the end of 2014. Pessina claims to have tripled the value of KKR’s investment in the company and he himself moved from 428th to 99th in Forbes magazine list of richest men in the world. In 2010, David Cameron and George Osborne – both of whom describe tax avoidance as “morally repugnant” – took Pessina as part of their entourage to China for a business charm offensive. He is now both chief executive and the single largest shareholder in the all new entity ‘Walgreens Boots Alliance’. Following the merger 700 jobs in Boots UK were lost as part of the restructuring.

Pessina and KKR are estimated to have made £2bn profit out of Boots in five years. They had invested £2.5bn of their own money, borrowing an additional £9bn from some of the major banks. Pessina and a small consortium of wealthy investors, having picked up a 158 year old company employing around 70,000 Britons, put their borrowed billions on the balance sheets of Boots in the UK, pushing it deep into debt. A firm that provided an essential social service is now private, and the profits made by Boots UK are used to repay the lenders faster and leave more profit for the investors. The KKR funds that owned Alliance Boots were housed in the tax haven of the Cayman islands, while the stakes held by Pessina were located in Luxembourg. A few months after going private, Alliance Boots shifted its headquarters from Nottingham to the low-tax canton of Zug in Switzerland. Headquarters of Walgreens Boots Alliance have since moved to Delaware, described as “the longstanding leader among US states in providing opaque corporate structures”.

In 2013 a report published by War on Want and others claimed that Alliance Boots had legally avoided paying over £1bn taxes in the UK since going private, while 40% of the revenues for its British business come straight from the cash starved NHS. The large debt loaded onto Boots threatens its future financial stability, and when things go wrong for private equity buyouts providing patient services, it will be the taxpayer who picks up the bill. Boots is now about limiting tax, squeezing labour costs and taking out the dividends rather than reinvesting in the business. Even its own workers say that all the company now cares about is profits and targets, while patient safety, appropriate staffing levels, staff training and wellbeing are low down the agenda. Boots also stands accused of “trying to deceive the public”, after a letter sent to the Guardian purporting to be from an independent pharmacist defending the company’s record was found to have been processed and extensively revised by the retailer’s senior executives.

Virtually all hospital outpatient pharmacies have been outsourced. This has been positively encouraged by Lord Carter of Coles who has led a review on NHS productivity and performance. The noble lord is chairman of the US owned health care giant McKesson which has contracts with more than 90% of NHS organisations, as well as other private health care companies. In the US, McKesson Pharmaceutical distribution supplies branded, generic and over-the-counter pharmaceuticals to more than 40,000 customers spanning retail chains, independent retail pharmacies and institutional providers such as hospitals, health systems, integrated delivery networks and long-term care providers. Interestingly, in his report Lord Carter does not mention the £4.5bn a year lost on market transactions, which according to independent and parliamentary reports into the NHS since 2010, add nothing to patient care. While asserting that £900 million a year could be saved if patients were moved out of hospital more quickly, he ignores the additional funding which would be needed by social services to provide the extra care required in the community. He is an advocate of NHS “surplus land” being sold off, and the use of existing buildings being reviewed (for a local example, think of the sudden closure of Bootham Park hospital in York, now likely to find its way onto the property market and leaving the people of York with 50 miles to travel for the nearest mental health bed).

The Leeds Way

Leeds Teaching Hospitals NHS Trust (LTHT) describes ‘the Leeds Way’ as “who we are and what we believe”. The key elements are being patient centred, fair, collaborative, and accountable. While Jesse Boot’s business philosophy would have fitted comfortably within this outlook, it is clear that the same cannot be said of the new Boots. The outsourcing of the outpatient pharmacies may bring some limited short term gains to patients, and small financial benefit to the Trust through sharing VAT saving, but commissioning services from Boots is likely in the long run to bring damage to the NHS. While most of us see ‘the Leeds Way’ as having been a positive development, its continuing relevance will depend on a demonstration that it can be developed and refined over time. I would suggest that there needs to be an ethical component to commissioning so that the business philosophy of prospective partners is taken into account. In addition, LTHT should celebrate not only its own successes but those of the NHS as a whole. ‘

The contract with Boots should be reconsidered at the next opportunity, and the question asked: is their business model consistent not only with the traditional values of the NHS as a public service, but also with ‘the Leeds Way’?
(For more information see: ‘The long read. How Boots went rogue’. Guardian 13 April 2016; Aditya Chakrabortty – JP)