Why Are Doctors Striking Again?

The BMA are planning a further series of walkouts, this time stretching to five consecutive walkouts each month (8am-5pm). But why are doctors still unhappy? NHSpace looks at some if the reasons.

1 – The contract still isn’t fair

There are some serious problems with the contract that Hunt is imposing, including poor treatment of pregnant women and parents who work part-time. The latest version of the contract pretends to fix these, but the fix is time-limited so that future doctors will suffer. Hunt is treating the contract like a broadband contract, offering a good deal initially but a bad one in the long run. Doctors care about their future colleagues and aren’t about to sell them out.

2 – The government is slashing the NHS

Groups such as the NHA have been aware of the STP hospital closure plans for several months. Now that these ‘secret plans’ are finally being reported in the media, you can be certain that every doctor is aware of the latest hatchet job being performed on the NHS. The idea that Hunt could achieve a ‘truly 7 day NHS’ with no additional funds was nonsensical; expecting it to happen in the midst of massive service cuts is utterly ridiculous.

3 – Whistleblowers are still being punished

The Chris Day case highlighted the fact that doctors in training posts has no whistleblowing protection and could lose their careers just for speaking up. The BMA has made some headway by asking Health Education England to acknowledge their duty as a de facto employer, but you can expect doctors to push for a cast iron commitment to whistleblower protection.

4 – The government are privatising the NHS 

The STP hospital closure plans will create huge gaps in England’s healthcare system; gaps which the private health companies will be happy to fill, for a fee. Healthcare is already being rationed (ask anyone applying for routine surgery that requires ‘funding approval’), but the STPs will take us to the point where co-payments and top-up health insurance become the norm. This isn’t what today’s doctors signed up for.

Read more about privatisation: 5 Forms Of NHS Privatisation You Should Know About.

5 – Jeremy Hunt was reinstated

By inviting Jeremy Hunt to continue as Health Secretary, Theresa May has shown a lack of respect for medical professionals. But in all honesty, Hunt is just a figurehead. The gradual sell-off of the NHS and mistreatment of its workforce is a core Conservative policy, both due to the party’s ideology and their ties with corporate party donors, many of whom own shares in private healthcare. Doctors will express their anger at Hunt, but of course the problem goes much deeper.

5 Things You Should Know About STP

The Sustainability and Transformation Plans have divided the NHS in England into 44 local areas, and each has been told to cut services as part of a nationwide ‘financial reset’. But what’s actually going on, and how much of the government’s reasoning is just spin? NHSpace brings you a handy myth-busting guide.

1 – NHS Trusts aren’t overspending

The narrative of STPs is that our hospitals are in debt due to overspending. That would be true if the government had matched the NHS budget to the actual healthcare needs of our country, but they haven’t.

The cost of healthcare increases by 4% each year. In the UK, this is referred to as ‘NHS inflation’. If NHS funding doesn’t keep pace with this inflation, then services have to be cut or closed.

David Nicholson and Simon Stevens have both used their time as NHS England CEO to implement austerity measures, leading to a cumulative shortfall in funding of at least £35bn per year by 2020:

Year Increase Needed Actual Increase Shortfall
2010-2015  £20bn  £7bn  £13bn
2015-2020  £30bn  £8bn  £22bn
Total (2010-2020)  £50bn  £15bn  £35bn

The NHS is underfunded, and is actually spending less than it should on healthcare. That’s quite the opposite of an ‘overspend’!

2 – The NHS isn’t unaffordable

Pundits love to tell us about the new challenges facing the NHS, claiming that we now cannot afford universal healthcare. We are told that hospitals are overspending and that they are in debt.

In fact, the NHS is extremely affordable. Here’s a list of healthcare spending in several westernised countries in 2014:

Country Per person ($) % of GDP
Belgium 4,884 10.6
Canada 5,291 10.4
France 4,959 11.5
Germany 5,410 11.3
Holland 5,693 10.9
United Kingdom 3,935 9.1
USA 9,402 17.1

As the table shows, the UK could easily choose to dedicate an extra percent of its GDP to healthcare, providing the NHS with the funds needed to sustain a modern health service.

3 – Hospitals aren’t overstaffed

The ‘financial reset’ planned for the NHS includes a limit on staff recruitment, the implication being that hospitals need to cut back on excessive hiring of permanent staff. Considering the billions spent on hiring agency staff to fill rota gaps, this is certainly not true.

The underlying issue here is safety. Following the Francis Report into the Mid Staffs scandal, hospital managers decided that they would rather exceed their budgets and hire more staff, than be guilty of manslaughter. Fed up with being ignored, the DoH is now coming down on managers with an iron fist. Anyone caught protecting staffing levels by overspending will be subject to a ‘failure regime’.

4 – This Isn’t About Centralisation 

Centralisation of specialised services can improve outcomes for patients with specific illnesses. But trauma, cardiac and stroke services have already become centralised. For many other illnesses, and for maternity and step-down care, it’s important to have smaller District General Hospitals (DGHs) and Community Hospitals. These provide care closer to home and take the pressure off the big, specialised centres.

So don’t be fooled. Closing A&Es and taking services away from local hospitals isn’t centralisation. It’s un-evidenced vandalism in the name of cost savings.

5 – This Is About Creating A Two Tier System

The level of cuts and closures required by the STPs is such that the NHS will become unable to provide a universal service. Rationing will increase, so that most routine procedures will be refused funding. Once various DGHs have closed, the hospitals still standing will struggle with their increased catchment areas and will be forced to provide essentials only.

This was already envisaged by Simon Stevens, who is keen to separate emergency care from routine care. Emergencies will be handled in NHS hospitals, whilst the routine work will be handled by the private sector. Patients wishing to undergo non-essential procedures will find themselves needing to pay to have their cataracts and hernias treated or their tonsils removed.

5 Reasons We Need A General Election

NHSpace looks at the arguments for calling a snap general election this autumn.

1 – The Country Dislikes ‘Unelected’ Leaders

When Gordon Brown took over the premiership in 2007, there were moans from the press that he was ‘unelected’. This wasn’t strictly true. Brown had been elected by his constituency, inherited the role of Labour leader from Tony Blair, and had been invited by the Queen to form a government. However, he lacked the mandate that many leaders gain by leading their party through a general election. George Osborne later stated that such leaders lack democratic legitimacy, and William Hague claimed that such leaders are “unacceptable” to the majority of the public. Of course they were talking about Brown; they may not feel the same way when the boot is on the other foot.

2 – Cameron and Johnson Have Abdicated Control

Having lost the EU referendum, David Cameron found himself lacking the legitimacy to continue leading the country. But his Brexit counterpart Boris Johnson has pulled out of the Tory leadership race, apparently knifed in the back by the charmless Michael Gove. The favourite for the leadership is now Theresa May, who backed the Remain campaign. With the options for Tory leader now consisting of Remainers and second-tier Leave figures, the public is unlikely to be happy whatever the result.

3 – There Was No Brexit Manifesto

Despite making a range of promises regarding NHS funding, immigration and the single market, the Leave campaign did not have a formal manifesto. (Since the referendum, they have in fact gone back on several promises and deleted almost all the content from their campaign website.) The manifesto on which the Tories were elected last year also did not detail how they would manage a Brexit vote. Nobody in Westminster has a specific mandate from the public on how to deal with Brexit. The public should now be given a chance to elect MPs based upon their plans to deal with the referendum outcome.

4 – The Country Needs Certainty

The Brexit vote has plunged the country into uncertainty. The country is currently leaderless, nobody is certain if or when Article 50 will be triggered, and the markets have responded by plummeting to historic lows. Without a general election, there will continue to be a lack of strong government, and discontent will continue as the country remains divided by the referendum result.

5 – The Public Want An Election

While most are against the idea of a second EU referendum being called, polls indicate that the majority of the British public want a general election this year. This includes 4 out of 10 Leave voters, some of whom feel they were misled by the Brexit campaign claims.

5 Steps For A New Politics

NHSpace looks at five key steps required to achieve true political reform in the UK.

1: Transparent, Evidence-Based Politics

Decisions made by government are often based on political ideology and are not subject to challenges from outside of the Westminster bubble. The result is a system that puts the needs of the government before the needs of the people. What’s needed is an evidence-based approach to politics, where decision making is supported by expert advice and can be transparently justified to the public, without spin.

2: No More Wasted Votes

Unless your favoured candidate won a seat at the last election, you aren’t truly represented in Parliament. With 50% of votes going to losing candidates in last year’s general election, it’s pretty clear that the First Past The Post system is not fit for purpose. We’d like to see a move towards a proportional voting system, so that the wide range of political opinions in this country can be fairly represented in Parliament.

3: A Cleaner Politics

UK politicians are infamous for indulging in self-centred behaviour, as any reader of Private Eye will no doubt be aware. The expenses scandal in 2009 led to some minor reforms, but many problems remain. MPs are permitted to vote on matters despite having vested interests. Parties take large donations from corporations, then hand privatised services to them. And MPs are still free to pass through the “revolving door”, taking jobs from companies in return for political favours. The system is in dire need of reform.

4: Respect For Public Services

Public services in the UK are currently poorly funded and subject to constant political interference. There is little evidence that perennial reforms to healthcare and education have had any beneficial effect, despite costing billions of taxpayers’ money. We believe that public services should be publicly owned, properly funded, and managed at arm’s length from government, by experts rather than politicians.

5: Economic Reform

Political and economic reform are strongly interdependent. The current political system strongly favours the richest 1% of the population, who in return support the two party system. Deregulation has led to a global financial crash and growing inequality. There is a need for economic reform, including greater regulation of the financial sector and an end to the austerity regime. The party also supports a fair living wage and investment in jobs in public services.

Bye Bye, Heidi

NHSpace reflects on the sudden departure of the Labour shadow health secretary.

To be honest, we were hoping this day would come. Meetings involving Heidi Alexander have all ended in disappointment. The shadow health secretary persisted in supporting Simon Stevens and his privatising Five Year Forward View. She was a damp squib when it came to the doctors’ strikes, and she did nothing to support the NHS Reinstatement Bill.

As one NHA executive member puts it:

“I have been in 2 meetings with HA. She refused to go on [junior doctor] picket lines. She refused to even wear a BMA badge. Her stance on health policy supported the ongoing privatisation in the form of Stevens 5YFV. Quote ‘I believe Stevens has the best interests of the NHS at heart’. A former UnitedHealth president here to complete the transition to an American style insurance system has her confidence. That says it all.”

Now that the Blairites liked Heidi Alexander are leaving Corbyn’s cabinet, there’s hope that JC will install someone who truly supports the NHS as his shadow health sec. Someone who will come out strongly in favour of a renationalised NHS, and recognise that things don’t have to be the way that Hunt and Stevens want them to be.

The STP hospital closure plans are already being rolled out, and it won’t be long before A&Es and DGHs start being forced to close in order to pay off local NHS ‘debts’. Labour need to start shouting from the rooftops about these sorts of healthcare issues. With the right MPs in charge, maybe they will.

United We Stand

Alex Ashman ponders the need for a united left movement.

There are too few houses, because the government don’t build them any more. There are too few jobs, because government austerity is preventing economic growth. The NHS is suffering, because the government refuse to fund it properly.

But with the current system, it is hard to fight back against the government. The 51% win for Brexit looks slim when you consider the 63% who voted against the Tories last year. There was a huge protest vote, with a swing towards the Greens, SNP and UKIP, and yet the Tories remained.

And then people were given another outlet for their discontent. Some of those voting Leave will have done so in protest of the lack of housing, jobs and healthcare, thinking the EU was to blame for their woes. But once more, the government remains the same, and so nothing will change. Who will people blame next, once they realise that the problems are still there? Nationalism is on the rise, and populist right-wingers will continue to blame migrant workers and benefit frauds for all our woes. Just because Farage has won his precious Brexit doesn’t mean he’ll retire and go home. Quite the opposite, in fact.

If ever there were a pressing need for a united left movement, now is the time. Voters protesting against the government need to be offered an alternative narrative. A narrative that recognises that the real villain lies in Westminster, not Calais. A narrative in which austerity is rejected and public services are properly supported. A narrative in which Britain is great because we support each another, instead of blaming one another. Until the left unites, though, the Tories will continue unchecked. Action is needed, and soon.

Open Letter from Dr Clive Peedell to Jeremy Hunt regarding the legality of the latest top-down NHS reorganisation

To the Rt Hon Jeremy Hunt, MP, Secretary of State for Health

Dear Mr Hunt

I am writing to you on a subject of great urgency regarding the changes to the NHS proposed on 19th May 2016, by Simon Stevens, CEO of NHS England.

Mr Stevens has suggested that the health service could create a form of ‘combined authorities’. He talks of spanning hospitals and commissioners and consolidating CCGs.

These proposals appear to run contrary to the provisions of the Health & Social Care Act (2012) and contrary to the stated objective of the Act of a locally driven commissioning service provided by GPs, who have an intimate knowledge of their local community needs.

Whether or not the CCGs have fulfilled this function satisfactorily, they are, nonetheless, a legal creation. I am, therefore, asking for clarification of the legal status of the changes being made under the Sustainability and Transformation Plans.

Mr Stevens has also referred to removing veto powers. Does that mean, in effect, that no-one will be able to object to changes as they will be imposed? Could you clarify which powers are being removed, under what statute were those powers granted, and what legislation been passed to allow their removal?

This announcement was paired with the publication of the funding allocations expected for 2020-2021. Mr Stevens said that these numbers would give a better focus than the funding ‘gap’ numbers people try to come up with. His predicted figures are shockingly low.

I do not write as a legal expert, but as a doctor with great concern for the impact of these extensive changes on my patients. I ask that you clarify with urgency the law that is being used for these changes which are happening on a large scale with great speed.

My specific concerns are about transparency, responsibility and accountability. There does not appear to be adequate time to prepare proper risk or equality impact assessments.

I look forward to hearing your response on these serious matters.

Yours sincerely

Dr Clive Peedell
cc Rt Hon David Cameron MP, the Prime Minister
cc Rt Hon Jeremy Corbyn, Leader of Her Majesty’s Opposition
cc Hon Heidi Alexander, Shadow Secretary of State for Health