Recent Health Articles
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:
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
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.
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”.
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
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.
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
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.
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.
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.
This is cross-posted from openDemocracy
The current horsemeat scandal raises serious concerns about our food supply chains, as Fraser Nelson argued so well last week.
The same economic pressure to supply this food cheaply applies to the labour costs as well as to the cost of the raw material. There are serious questions about the complex nature of the supply chains and the conditions and experiences of those low-paid workers who produce, process and pack our food.
We already know that migrant workers are being exploited in different parts of the food industry. The workers in our study told of:
- paying upfront fees to work;
- excessive workplace surveillance, including problems taking breaks;
- overcrowded tied accommodation;
- racism, threats and bullying;
- fear of dismissal that ensured workers remained compliant; and
- a range of infringements on pay.
Most of this exploitation was linked to informal gangmasters. Other evidence shows that long supply chains and high levels of subcontracting facilitate forced labour.
The Equality and Human Rights Commission (EHRC) conducted a wide-ranging Inquiry into the Meat and Poultry Processing Sectors.
The inquiry found there was widespread mistreatment of agency workers, especially pregnant and migrant workers. While progress has been made by the industry in a number of areas, EHRC points to several areas where problems persist: discrimination against agency workers, and workers not being able to feed in confidentially to ethical audits carried out by supermarkets.
The UK Human Trafficking Centre estimates that around 19 per cent of ‘trafficking for labour’ exploitation victims are in the food and processing and agriculture sectors.
These extremes of labour exploitation are thankfully only found in a small segment of the huge UK food industry. Indeed, the supermarkets have put in place a system of ethical auditing to inspect the workplaces of their suppliers and support the Gangmasters Licensing Authority, which plays a vital role in tackling unscrupulous labour providers.
However, as the evidence, plus cases like that recently exposed in Kent show, there remains a serious problem.
This horsemeat scandal should act as a catalyst for retailers and caterers to re-examine their supply chains, to ensure our food is not only safe to eat, but also slavery-free.
Louise Woodruff manages the Forced Labour programme at the Joseph Rowntree Foundation
Take a walk down any high street these days and you’ll probably see a cluster of betting shops. Pack-like, they feed off of the customers of the others, safe in the knowledge that there will always be demand for their most addictive product – the FOBT.
The FOBT, or Fixed Odds Betting Terminal, is a touch-screen twin-screen roulette and casino gaming machine found in the bookies. They have been described as the “crack cocaine of gambling” because of the high stakes and high speed of play – it is possible to bet up to £100 every 20 seconds. Law limits each betting shop to four, so bookies open as many shops as possible. This is why we get clustering, and it’s not surprising when each FOBT is worth over £900 per week in profit to them.
But bookies are a business, they exist to make a profit, what’s wrong with that? Well, a number of things.
Firstly, research commissioned by Dispatches and carried out by Geofutures found there to be more than twice as many betting shops in areas of high unemployment than in areas of low unemployment. The trend across the country suggests they are targeting the poor.
Secondly, the FOBT-driven proliferation of betting shops in some of our most deprived areas is not creating jobs. In 2010, there were 8,822 shops employing 57,319 people. Last year, with 9,128 shops the industry creates just 54,449.
A magnet for violence and anti-social behaviour, bookies are an irresponsible industry, proliferating in our most deprived areas, sucking demand out of local economies and treating their staff with total contempt, many of whom have spoken to us in confidence but are frightened to speak out in case they lose their jobs.
Thirdly, there isn’t the infrastructure in place to deal with the number of problem gamblers we’re going to have if we keep seeing an incremental rise in the number of FOBTs. There won’t be a Prevalence Survey this year as the funding has been cut, but in 2010 there were 450,000 problem gamblers in the UK.
According to international evidence, each problem gambler costs the state £8,000 per year – yet the industry give £5m, just 0.1% of their £5bn profits – to the Responsible Gambling Trust, which funds one single NHS Clinic for Problem Gambling in the entire country. I spoke to someone recently who’d been on the waiting list for eight months.
For these reasons, this week we launched the “Stop the FOBTs” campaign in Westminster. Sign up, get involved, share your stories. If you know someone who has been affected by FOBTs, or if you have yourself, then we want to hear from you.
Despite stating that “common sense dictates there is a problem with FOBTs”, the government has said they will wait for the conclusion of research carried out by the Responsible Gambling Trust before it imposes any restrictions. But when the chair of the Responsible Gambling Trust is also the chair of the Association of British Bookmakers, is it surprising this issue has been kicked into the long grass until just before the election, when corporations start writing cheques to political parties?
We believe we can win by highlighting to MPs the extent of the problem, so find out how much is gambled in your constituency on our website, write to your MP, and join our campaign.
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