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
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.
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
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.
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)
In Leeds ‘there is a need’ to collectively deliver £800m of savings across health and social care over the next five years based on poorly designed policies from the recent governments at national level and unrealistic levels of investment in the NHS to make way for the private sector which has always been Simon Stevens’ preferred option since his early roles in health policy for the Blair government, his role at United Health (including his interest in Optum – the United Health subsidiary in the UK taking over large framework agreements for services) and his role at NHS England. Don’t believe us? Read on !
Leeds, as part of West Yorkshire, had been successful in becoming an ‘Urgent Care Vanguard’ site the city as a health and social care economy was unsuccessful in its bid to be a ‘Multi-speciality Community Provider (MCP) Vanguard’ site. Despite this there is an expectation from NHS England that the development of new models of care should not wait for the results of Vanguard prototypes and that all parts of England are now expected to develop new models of care at pace, or have a model imposed on them in the not too distant future. In summary let’s not wait for evidence of whether anything from these expensive restructuring experiments works or not !
The joint LYPFT & LCH tender for prison services had scored better than the preferred provider across all elements of quality, however, they were beaten on price by Care UK, who have been awarded the contract of £370,000 with effect from the 1 April 2016 and that 9 Trust staff will be transferred across to the new service provider. There is continued activity looking at appeals within the council and NHS Trusts. The news this week about £165k paid to private sector provider for 2 home visits during a year in the West Midlands continues to highlight not just the disastrous inefficiencies of privately delivered care but service users left with poor care and the NHS is expected to pick up the more complex pieces.
Care UK as a private provider will cherry pick the community services as warned by NHS campaigners over a number of years. There is more work to be done with commissioners in Leeds to highlight the dangers of privately delivered expensive, fragmented care that results from less skilled staff delivering less skilled care, impossible large scale purchasing efficiencies and worse health outcomes overall for patients and service users.
The recruitment crisis brought on by these ill-thought out decisions nationally continues to result in services being closed unnecessarily. Service users are reporting less consultation and involvement with own care over the last five years.
If you want to have a say, join us on the march on 16th in Leeds and/or help campaigners across Yorkshire work together to restore a publicly funded, accountable and delivered NHS. You may know someone who works in health, social or council services and wants to see people get the best care from staff who are happy, trained well and able to deliver it well, we can use all help! Care is not just for a privileged tax avoiding few but for everyone.
Leeds KONP supported junior doctors across Leeds and will continue to do so with any future industrial action. We had good presence at LGI with substantial help from excellent Leeds Hospital Alert members. Others supported Jimmys and Pinderfields. Leeds KONP will continue to support action against any other threats to healthcare staff including nurses, student nurses & AHPs, GPs.
- 2-4pm, NHS campaigns Yorkshire regional meeting – Unison regional office, Leeds
- 5.30-7pm practice session for our flashmob choir, Quaker Meeting House, Woodhouse Lane, Leeds
- 1pm Huddersfield & Calderdale A&E demo, St George’s Square, Huddersfield
- 2-3.30pm stall outside Boots, Commercial St
- 2pm, NHS Leeds West CCG Public Governing Body meeting, Fulneck Room at Pudsey Civic Hall, Dawson’s Corner, Pudsey, LS28 5TA
- 7pm Huddersfield & Calderdale A&E, Methodist Mission, Lords St, Huddersfield
29th – 10.30am Calderdale & Kirklees Joint Scrutiny committee meeting Huddersfield, Council chamber, town hall
30th – Health Campaigns Together national meeting, London – 4 x Leeds KONP attending
5th – closing date for contributions to Leeds Health & Wellbeing strategy
1oth – 6.30pm Leeds KONP meeting, O’Neills, Great George St behind Town Hall, Leeds
12th – 7.30pm Privatisation – this is the big one – Priory Street Centre, York, YO1 6ET, Speakers:
- Dr. Clive Peedell Specialising in clinical oncology. Co-leader & co-founder of the National Health Action Party
- Prof. David Hunter Professor of Health Policy and Management at Durham University
- Rachael Maskell MP. Labour MP for York Central, speaking out for the National Health Service
24th – 6.30pm Leeds KONP meeting, O’Neills, Great George St behind Town Hall, Leeds
NHS Leeds news
Public sector cuts.These were put before LCC Exec last week.
Future cuts to public health spending report
Yorks Commissioning Support Unit bid has been won by a private consortium calling themselves eMBED comprising Kier, who have done health care development projects, Dr. Foster, who provide variation analysis and benchmarking solutions , BDo who do service redesign and Engine who do communications. The official spiel says that the Consortium will provide Business intelligence, IT services , corporate governance, and public/ patient engagement support., HR, procurement and service redesign to the 23 Clinical Commissioning Units in our region. They take over in March 16.
LGI redevelopment plans. The plan is to create more and better facilities on LGI site but sell off parts of the listed building and some other space to help fund it.
NHS national news
Government ignored and buried minimum safe staffing guidelines – non HSJ subscribers can also view full details
NHS Commission – on 6th Jan Lib Dem Norman Lamb asked Parliament for leave to bring in a Bill to establish a Cross Party Commission to examine the future of the NHS and Social Care system. The Bill is backed by a number of Lib Dems, Tory Philip Lee who has hard right view on charges, right wing labourite Alan Lewis, former Conservative Health Sec, Stephen Dorrell and former Labour Health Sec, Alan Milburn. Dorrell has described this as “a new Beveridge report” with the most pressing need being “to establish new funding and management structures that ensure joined up and tailored care” ( sounds like charges !) Lamb said the Commission would engage public and staff , suggesting involvement of “NHS Survival” and “Care England” which represents social care providers. The next reading of this Bill is scheduled for 11th March, the same day as the NHS Bill so likely to crowd out discussion of the NHS Bill.
Inspired by #march4nhs? We are and getting ready to visit all the parties.
First up is Labour. Come along to Manchester at 2.30pm on 21st September outside Manchester Central,
More details and transport: https://www.facebook.com/events/598141010307347/
There will also be fringe events and some of the #march4nhs 300 milers / #darlomums plan to be there
Conference notes NHS England’s 18 August announcement that all new GP contracts will be short-term APMS contracts. GP leaders have warned this marks the “death knell” of traditional life-long general practice, promoting corporate takeover of services.
Conference notes that last year £10bn from NHS spending went to “private providers” like Virgin and Care UK.
Conference notes that while PFI expenditure building hospitals was £12.2bn, the NHS is repaying £70.5bn.
Conference agrees with Andy Burnham that responding to NHS privatisation cannot wait until the election. We welcome Clive Efford’s private member’s bill if it reverses the worst privatisation.
Conference welcomes countrywide demonstrations in defence of the NHS, including the August-September Jarrow-London 999 march.
Conference supports the Living Wage campaign of Care UK workers in Doncaster, who since 29 July have taken five weeks strike action against wage cuts imposed by the private-equity firm which owns their employer. This situation shows the need for a public care system.
Conference commits to:
Repeal the Health and Social Care Act and “competition regulations” promoting marketisation/privatisation
Restore ministerial duty to provide comprehensive services
Reverse privatisation and outsourcing
Exclude healthcare from international “free trade” agreements
Rebuild a publicly-owned, publicly-accountable, publicly- (and adequately) funded NHS
End PFI and liberate the NHS from crushing PFI debts
Ensure any integration of health and social care is a public system
Ensure decent terms and conditions, including a Living Wage, for health and care staff
Reduce waiting times and implement health unions’ demand for a maximum patient-nurse ratio of 4:1.
This Saturday hundreds of campaigners departed from Jarrow intent on delivering a petition calling on the government to be more transparent about it’s plans for the NHS. The March is expected to arrive in Leeds on the 23rd of August as it follow the route of the original 1936 march from Jarrow to Parliament.
Doctor Jacky Davis, a consultant radiologist at Whittington Hospital since 1981 who was called as a witness by the House of Commons Health Committee enquiry into Top-up fees in the NHS in 2009, will speak at the rally taking place in Leeds to welcome the marches into the city. Dr Davis has written at length on the impact healthcare reform has had on the NHS, previously expressing a worry that the NHS will become a two tier system.
“We fear NHS services being reduced to a core of poor services for poor people, with those who can afford it topping up their personal health budgets with insurance or out-of-pocket payments and those who can’t afford it going without.
The problem we have come to realize is that we aren’t just fighting the Tory government; we are fighting the global medical industrial complex with all its power, influence and money. And its cozy relationship with today’s politicians.”
Doctor Davis recently co authored ‘NHS SOS: How the NHS Was Betrayed and How We Can Save It’ with Ray Tallis which was published in 2013.
The march comes from Harrogate on the 22nd August, arriving in Leeds around 5.30pm and leaves Leeds the following morning around 9.30am to march to Wakefield. A number of campaigners intend to complete the route in full from Jarrow to Parliament, with a planned arrival date of 6th September.