Category Archives: Health

The NHS may yet sink the Tories

The NHS is deteriorating fast, faster and more seriously than many of the public yet realise.  Nearly half a million patients waited more than 4 hours in A&E for treatment, referral or discharge in the last quarter of 2014, half as many again as in the previous quarter and the worst performance for over a decade.   In December 2014 there were 113,000 patients waiting longer than 18 weeks for treatment, a 30% increase over the year before.   The cancer care waiting time target – within 62 days of referral from a GP – has now been missed for 3 consecutive quarters.   Delayed discharges from hospital rose sharply to more than 5,000 per day in November 2014, 20% more than the previous year.   Cuts to local authority adult social care of £4.6bn are behind this bed-blocking  as 400,000 fewer elderly people get home care than 5 years ago – a false economy if ever there was one.
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The real shocker is Tory hubris over unfunded spending they’re scattering about

It’s not just the unfunded £8bn which Osborne is throwing at the NHS in a desperate attempt to keep it afloat after the Tories’ £20bn cuts have nearly crashed it on the rocks, it’s the recklessness with which they comfort themselves that the public will accept that these huge sums can somehow be conjured up out of nowhere.   It’s also the fact that this is not just a one-off – to get the Tories out of a very tight corner they’ve inflicted on themselves over the NHS by their £20bn health cuts over the last 5 years – it’s suddenly become par for the course in Tory policy-making.   They’re also now saying that they’ll (i) ease inheritance tax for the very rich at a cost of £1bn, (ii) give a Right to Buy to all 3m housing association tenants at a cost of several £bn, and (iii) lower the higher rate income tax threshold for the rich (as Osborne said in the budget) at a cost of £7.5bn.   So where is this £8bn + £1bn + £3-5bn + £7.5bn (total £20bn+) set to come from?
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The Tories are beginning to panic

Osborne’s last-minute claim that he would provide £8bn a year to meet the NHS funding gap says it all.  After years of sniping at Labour for even the slightest deviation from funded expenditure, he now suddenly offers, as the polls begin to slip away from the Tories, a colossal pile of unfunded NHS commitments worth £40bn over the next 5 years, on top of the £7.5bn tax cuts for the rich which he frittered away in his last budget.   This is a staggering slippage from his hitherto relentless demand for fiscal prudence and consolidation, but it certainly reveals how desperate the Tories have now become as health services top electors’ concerns and Labour’s lead stretches on the NHS.
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NHS charges are certain if Tories win election

The BMA rightly raises the spectre of the NHS being subject to charges for medical treatment after the election.   This has become a real threat as a result of Tory policy over the last 5 years – partly from the unprecedented imposition of £20bn cuts amounting to nearly a fifth of the entire NHS budget, and partly as a result from a third or more of hospital trusts now being in deficit and a growing minority being cast into actual bankruptcy.   All three political parties deny they have any such plans, and of course it would be politically suicidal if they did anything else.   But are they all credible?   The Tories have hugely increased charging for social care by imposing 40% cuts in the social care of the elderly and disabled.   They have expanded private dental care to such a degree in cost and coverage that DIY dental first aid kit is now growing fast – one estimate now by DenTek, one of the biggest sellers of kits, claims there are already a quarter of a million users.   And there are other reasons too why charging is very likely to be Tory policy after the election.

The Tories are now deploying the same tactic over the NHS that they’ve already applied over the Welfare State as a whole.   Create a deficit and then argue there’s no alternative but to pay it off either by cutting benefits, reducing services or imposing charges.   It’s no accident the government’s budget deficit has come down at a glacial pace and is still stuck at £92bn.   That suits the Tories very well because it provides the perfect excuse to make further huge cuts, notably the additional £12bn Osborne has promised for the next parliament.   Similarly, they would never dare charging £10 for a visit to the doctor – the most likely first element in a new charging system- if they hadn’t first deliberately generated the huge current NHS deficit by paying for the NHS merely in nominal terms, i.e. without taking account of inflation, let alone the higher than inflation annual costs of a rising elderly population and fast rising drug and medical technology prices.

The Tories have therefore landed a charge bombshell on the NHS.   The forecast £30bn gap in the NHS budget by 2020 is to be filled by £22bn efficiency savings (i.e. cuts) plus £8bn of extra annual funding from the Treasury (i.e. an increase in privatisation and outsourcing).   The real answer to the plight of the NHS is two-fold.   End Osborne’s lethal policy of contracting the economy in favour of steady expansion to generate sustainable growth, real jobs, higher incomes, and increased government tax receipts to pay off the deficit faster.   Second, in that very different context end any further cuts to the NHS and recognise that higher public spending on the NHS is justified when the health service in the UK absorbs only 8% of GDP compared with 10-11% in Germany and France and 17% in the US.

Labour should make clear rules for disability benefits will be radically reformed

No section of the population has suffered worse abuses from the government over the last 5 years than disabled people – those who are least able to bear it.   They are subject to assessments about their capability to work, enforced by Atos at the behest of the Department of Work and Pensions (DWP), which in thousands of cases grotesquely ignore the patent inability of many severely disabled people who cannot conceivably find work in their current circumstances.

They can then be deprived of all benefit income for at least 4 weeks (and for 3 months the second time round) and thus made destitute if they have been late for appointments or are considered by Atos/DWP not to be making enough job searches or for what are clearly trivial infringements of draconian DWP rules.   In many such cases  claimants do not understand why they’ve been penalised.   If as a result of being deprived of all income they experience severe financial hardship, to the extent of being unable to feed themselves or their families or to pay the rent, they then claim hardship payments, they are told in all but a very few cases that they don’t qualify.   So what should be done?
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NHS staff in England are being treated worse than any other public sector workers

It was Nigel Lawson, I think, who once opined that the NHS was the nearest thing the British had to a religion.    If so the government has treated its priestly acolytes uniquely badly.   The average real pay of NHS workers has fallen by over 10% since 2009.   No less than 40,000 are paid below the living wage, and many NHS workers have to have second jobs to survive and some even have to use food banks.   Effectively NHS staff donate £1.5bn a year in unpaid overtime.   The government’s decision to refuse to pay even the 1% cost of living increase recommended by the Pay Review Body for 2014-5 added insult to injury.

Now the government has taken its provocative stance still further.   The Health Pay Review Body (PRB) is currently taking submissions on 7-day working in the NHS.   Whilst Agenda for Change sets out unsocial hours rates for NHS staff working evenings, weekends and bank holidays, the Department of Health’s submission to the PRB argues that even unsocial hours payments should now be cut through changing the times defined as ‘unsocial’, paying them plain time rates on Saturdays and lowering rates for Sundays and bank holidays.

These are execrable terms and conditions for devoted personnel so gratefully lauded by patients.   But this is the public face of what is now being done to the NHS.   Spending on the NHS peaked at nearly 8% of GDP in 2009; it’s now just above 7% and is projected to fall to just over 6% by 2021.   That represents £30bn less being spent annually on the NHS compared with 2009.   For comparison France and Germany spend nearly 10% of their GDP on their health services and the US spends 17%!

Other unwelcome pressures are are now exerting themselves on the NHS.   As a result of cuts in local authority social care services because local authority budgets have now been reduced by up to 40%, people either turn to A&E thus increasing the overload so marked in this last winter or are forced to remain an in-patient for longer (bed-blocking).   Again, when NHS Direct was closed down – a serious mistake when it made nurses more accessible on the phone – the new 111 service that replaced it does not have call-handlers with the same level of training, so that people are jamming up A&E to get a medical opinion.

Although the 5-year Forward Review document recently promoted by NHS leaders including Simon Stevens, chief executive of NHS England, demanded £2bn extra to meet health needs, hospital trusts faced with relentlessly increasing savings targets continue to reduce these very same services.   Thus several trusts are currently targeting district nursing services for significant cuts, yet with more than a third of district nursing staff over 50 years old and with community nursing marked as an essential service to reduce inpatient stays, this is totally counter-productive.  Now the government is proposing to implement a mutualisation model for the NHS: this is what existed before the NHS was created in 1948 – a patchwork of provision with no consistency in access to services, care quality or employment arrangements.   As the Cabinet Office minister Francis Maude has himself admitted, “mutualisation is a form of privatisation”.


The plain packaging vote exposes the lies about the innocence of TTIP

The Commons voted by 367 to 113 in favour of introducing standardised cigarette packaging in England, and with a healthy majority of 254 you might think that finally settles it.   That will require the packaging of all cigarettes sold in England to be of uniform size, shape and design, with only the make, brand name and graphic health warning images permitted on the front.   Although the vote only applies to England, Scotland and Wales have said they would introduce similar legislation (Ireland having passed such legislation this month).    Already about 100,000 people die from tobacco in the UK every year – nearly 300 every day on average – and standard packs will undoubtedly reduce this lethal trail over years to come.

But that is not the end of the story.   Imperial Tobacco has the gall to announce that it would sue the British government to protect its intellectual property rights, i.e. its profits.   This may sound groteque given the lethality of its products, when it might seem more appropriate that the UK government should be suing Imperial Tobacco for selling a product which was known to be fatal in very many cases.   But this is where TTIP (the deceptively entitled Transatlantic Trade and investment Partnership) raises its ugly head.   Australia was the first country to introduce similar legislation in 2012 and has been sued on the same grounds by the giant Philip Morris tobacco corporation.   The Australian government is now having to defend its introduction of plain packaging in a case before the WTO.   The incoming UK government faces the same threat.

In one sense it is remarkable that the plain packaging lobby has had this success in the UK given the powerful forces ranged against it.   The Tory government announced plans in 2012 to legislate on cigarette packaging, but then dropped the proposal from the Queen’s Speech in 2013 after intensive lobbying by the tobacco industry.   The scheming hand of Lynton Crosby, the bete noir of Cameron and link man with the tobacco industry, was widely seen to lie behind this sudden change of policy.   For once the tenacity of the anti-tobacco lobby prevailed as it became clear it commanded the overwhelming majority of public opinion, hardly surprisingly when smoking-related disease, Primarily lung cancer, remains the main cause of preventable deaths in the UK.

The last obstacle remains the corporate threat of TTIP or trial before the WTO .   A newly elected Labour government must vigorously defend this life-saving legislation, whilst campaigning strongly against this multinational corporation attempt to override democratic decisions to uphold its profits even at the expense of thousands of lives.


10 objectives for Labour for 2015

As the election comes into sight, what should be the 10 pledges that Labour should make to maximize its vote for 7 May 2015?   Here are some proposals which should certainly be included:

1  End austerity because the policy of endless spending cuts is clearly not working – deficit reduction (the ostensible purpose of the whole exercise) has ground to a halt and the deficit may even rise this year.   Adopt the obvious alternative policy, which would cut the deficit far more quickly, by expanding the economy, creating hundreds of thousands of real jobs, raising household incomes, and using the higher tax take to pay down the deficit faster.

2  Make the revival of British manufacturing industry the key objective of domestic economic policy as the only way to pay our way in the world and reverse the disastrous slide to the biggest balance of payments deficits in British history.

3  Make full employment equally a central objective of economic policy when  there are still today 2 million persons jobless and up to a further 5 million in short-term insecure jobs often dependent on zero hours contracts.
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NHS must be exempted from TTIP

The only way to stop the US-EU trade deal (euphemistically called the Transatlantic Trade and Investment Partnership, TTIP) from interfering with the freedom of an incoming Labour government to reverse NHS privatisation is by demanding that the UK government vetoes TTIP unless health services are clearly and fully exempted.   At present they are not, and the government minister Lord Livingston has confirmed that the NHS will be covered by TTIP.   As a result a US investor such as Blackrock or Invesco) profiting from NHS privatisation could use TTIP to sue the UK government if it could prove to a panel of 3 trade lawyers sitting in secret, one of which would be chosen by the investor, that its rights under TTIP had been breached.   That could occur if, in the words of the EU’s Chief Negotiator, there was a claim”for example by expropriation without compensation, a denial of justice or manifestly arbitrary treatment”.   In such cases the tribunal would be able to award unlimited compensation and there is no right of appeal.
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