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Post by Admin on Jul 5, 2021 17:36:32 GMT
How the NHS Was Won By Ronan Burtenshaw The National Health Service was born on this day in 1948. Although celebrated today, its creation was the product of a long struggle by the workers' movement against healthcare profiteers. tribunemag.co.uk/2019/07/how-the-nhs-was-wonIn the decades before the National Health Service (NHS), health care in Britain was guided by very different ideas. Most of the country’s hospitals were grim Victorian centres for the destitute, derived from workhouse infirmaries established under the Poor Law. This 1834 statute saw poverty as a moral failing — and one that should be punished with hard labour. The Royal Commission report which preceded its passage summed up its perspective: “every penny bestowed, that tends to render the condition of the pauper more eligible than that of the independent labourer, is a bounty on indolence and vice.” The rich avoided the nightmare of the workhouse infirmary by using private doctors, who would often perform surgeries as well as more general practice on house calls. But for a growing proportion of Britain’s workers and poor, the infirmary became the norm for hospital care. When the medical journal the Lancet was given leave to form a commission of examination into their conditions in 1865, they dubbed the infirmaries “a disgrace to our civilisation.” The facilities, they said, “sin by their construction, by their want of nursing, by their comfortless fittings, by the supremacy which is accorded to questions of expense, by the imperfect provision made for skilled medical attendance on the sick, by the immense labour imposed on the medical attendants, and the wretched pittances to which they are ground down.”
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Post by Admin on Jul 7, 2021 15:42:39 GMT
Webinar: NHS reform – what do the proposals mean for general practice? Why primary care must engage with the government's health and care reform agenda 15 July 2021 www.health.org.uk/about-the-health-foundation/get-involved/events/webinar-nhs-reform-what-do-the-proposals-mean-for-general-practiceGeneral practice is busier than it has ever been. GPs and their teams are striving to meet spiralling patient demand while establishing primary care networks and contributing to the COVID-19 vaccine roll-out. And even more change is on the horizon. On 6 July, the UK government introduced the Health and Care Bill to Parliament. The full text of the Bill, setting out details of proposed NHS reforms, was published the following day. General practice barely gets a mention, but the planned changes would likely have a major impact on primary care. Our expert panel will set out what the proposed changes are and explore: Why and how should primary care engage with NHS reform? What does it mean for PCNs and the future of general practice? Does the end of CCGs matter and what did we learn from them? How can primary care work best within integrated care systems?
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Post by Admin on Jul 10, 2021 16:29:10 GMT
David Olusoga: ‘The story of the NHS and the story of immigration are completely intertwined’ Nurses, doctors and health workers have been arriving for many decades, often overcoming prejudice and discrimination to serve Britons in their hours of need inews.co.uk/news/health/david-olusoga-history-nhs-immigration-1097035The historian and broadcaster Professor David Olusoga has made British history uncomfortable – and makes no apologies for it. Britons, he argues, are trapped in a make-believe past which has written out the contributions of a host of largely non-white people who have helped to shape the nation into what it is today. He fears that because we are unaware or unable to recognise how our history has shaped our nation and its culture, we will struggle to reshape our institutions for the better. His latest target is arguably his riskiest yet, an institution central to the lives and dearest to the hearts of most – the National Health Service. In his new BBC programme Our NHS: A Hidden History, Olusoga investigates how the health service has relied on immigration – one of the most divisive social and political issues of the age – for its survival. Nurses, doctors and health workers who have been arriving for many decades, often overcoming prejudice and discrimination to serve Britons in their hours of need, describe their experiences of “helping and healing with one hand while fending off the sharp end of discrimination and racism with the other”, as the broadcaster puts it.
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Post by Admin on Jul 13, 2021 16:14:56 GMT
The Tories’ Latest Plan to Wreck the NHS By John Lister The Tories' Health and Care Bill not only provides new opportunities for private firms to decide policy and pick up contracts – it also reduces the local accountability which keeps essential services in place. tribunemag.co.uk/2021/07/the-tories-latest-plan-to-wreck-the-nhsThe continued Covid pandemic, now again on the rise, the record summer demand for emergency ambulance services and emergency admissions to hospital, the ever-growing waiting list for elective treatment, mounting pressures on mental health services, and chronic staff shortages – these are just some of the problems faced by the NHS in 2021 going forward. But the government’s new Health and Care Bill does nothing to address any of them, and could even drive some demoralised staff to leave. The Bill brings no extra funding for services, and no additional investment to tackle the mounting backlog of maintenance that has now risen above £9 billion. Instead, it is yet another major top-down reorganisation of the NHS, less than ten years after the last one. It will hugely disrupt and divert the energies and resources of local NHS bosses for at least the next two years, and cost many millions in redundancy and consultancy services. Far from ‘integrating’ services, as claimed by the February White Paper that preceded it, the Bill as it stands could make disintegration easier, enabling private companies to pick up NHS contracts with minimal scrutiny or regulation. While trade unions and campaigners wanted to get rid of the 2012 Health and Social Care Act and end competitive tendering in the NHS, we wanted the NHS to become the default provider of services. However, the Bill scraps only the 2012 regulations requiring NHS services to be put out to competitive tender, without establishing any clear new regulatory structure. This leaves scope for even more contracts to be awarded without competition to Tory cronies and donors, as we have seen on PPE and other contracts during the pandemic. It also leaves local people with less influence than ever over their health services. It replaces local Clinical Commissioning Groups with just 42 regional level ‘Integrated Care Boards’ (ICBs), covering populations of up to 3.2 million, giving less local voice or involvement on the NHS than any time in the last 50 years. Sweeping new powers for Secretary of State Sajid Javid would also give him control at all levels. Each Board will be led by a chair appointed by Javid; they cannot be removed without his agreement, and would appoint the chief executive and have a decisive voice on other Board appointments. On recent form, a rampant expansion of cronyism into the new bodies seems inevitable. Local authorities in each ICB area have to choose just one representative between them on the Board, as NHS do trusts: but the private sector could wind up with a stronger voice. The GP representation on any ICB could potentially be a GP working for Centene, Virgin, or another corporate provider that has bought up GP practices. And beyond the minimum five Board members, ‘local areas will have the flexibility to determine any further representation’, which could well mean private companies. Already one of the early shadow ICBs (Bath, Swindon and Wiltshire) has given a Board seat to Virgin, raising the question of how many private companies and management consultants will be represented when the 42 ICBs and their committees are given statutory powers by the Bill. In all, the Bill gives 138 new powers to the Health Secretary, not least to intervene as he wishes into local plans to reconfigure services—over the heads of local communities, effectively marginalising the local authorities which currently have the responsibility to stand up for the interests of local people—and powers to refer controversial changes to the Secretary of State. The Bill requires ministers to be informed of every proposed service change, so they can decide whether to formally ‘call them in’, and the Secretary of State would have powers to intervene anywhere at any stage, either to block local plans or indeed to demand (‘be the catalyst for’) a reconfiguration – possibly closing, merging, or downsizing local hospitals and services. The extent to which there would be any local control is left to his discretion. To make matters even worse, each ICB will have a single, tightly limited pot of funding, and will be under pressure to cut services to fit the budget. The Bill would also repeal the section of the Care Act 2014 which requires local authorities to carry out social care needs assessments before a patient is discharged from hospital. Given the lack of adequate community health and social care services in many areas, and the lack of funds to expand them, this so-called ‘discharge to assess’ could amount to a charter to dump patients without proper support. It’s clear the Bill would not expand, improve, or integrate the NHS or social care, but reduce local accountability and offer new openings for private firms to decide policy and pick up contracts. It would be a step backwards rather than a step forward to reinstate the NHS as a public service, publicly provided, and publicly accountable to local people. For that reason, it must be opposed.
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Post by Admin on Jul 13, 2021 19:08:41 GMT
Forget the spin – new English NHS bill is all about cutting our right to healthcare Far from reversing the disastrous 2012 reforms, this new bill makes it even easier to axe and privatise services – that’s the real COVID ‘recovery plan’ www.opendemocracy.net/en/ournhs/forget-the-spin-new-english-nhs-bill-is-all-about-cutting-our-right-to-healthcare/We all know the NHS has a huge backlog. As things stand, it will struggle to meet its legal obligations to provide us with the healthcare we need for the years ahead. The government faces a simple choice. It can either support the NHS to meet those obligations – ideally in a way that improves its long-term sustainability. Or it can reduce those obligations – reduce our rights to access healthcare. New English health secretary Sajid Javid claims that his goal is to “build a better NHS and bust the backlog”. But experts who’ve pored over the detail of the new Health and Care Bill, published last week and due for its second reading in Parliament tomorrow, have spotted alarming signs that the bill will follow the latter strategy. That it will “bust the backlog” by further reducing the government’s obligations to secure NHS care for us all – and our ability to get that care. It’s a direction of travel the government has been on for some time. But this bill goes far further – even, according to the lawyer Peter Roderick and public health doctor Allyson Pollock, removing the current legal duty to arrange the hospital care people need, from surgery and consultant care to physiotherapy and diagnostic tests. Such a possibility may sound hard to countenance. But the warning comes from the team that was the first to explain why the 2012 NHS reforms were a poorly understood disaster – as then Prime Minister David Cameron himself later admitted. Pollock was also the most prominent early voice to warn that Private Finance Initiative (PFI) hospital schemes were an enormously overpriced way of building NHS capacity, as pretty much everyone now admits. The bill enables a power grab by the Treasury, the money men, the private sector and their lobbyists Other leading health campaigners and experts – including Keep Our NHS Public, We Own It, Public Matters, John Lister, and David Rowland of the Centre for Health and Public Interest – have all raised the alarm that the substance of the recent white paper and now the bill, dumped on an exhausted NHS, an exhausted Parliament and exhausted population, appears to be being driven by principles opposite to those that are being spun. They are also entirely against the wishes of the public, who remain strongly wedded to a universal, comprehensive and publicly delivered NHS. Power grab by the money men The problems with the bill cannot be waved aside as minor details, to be sorted out in committees as it makes its way through Westminster. Far from being a power grab by the health secretary as some media reports assert, the bill enables a power grab by the Treasury, the money men, the private sector and their lobbyists – one which will have terrible implications for ordinary people’s access to healthcare and the future of their local hospitals and other NHS services. The bill and its accompanying measures impose an iron grip on costs, at least in terms of cash for local NHS services, whilst dramatically watering down the public’s rights in terms of what healthcare we will have a right to receive, where, when, and from whom, in the future. Alongside the alarming drafting on rights to hospital care, the performance targets imposed by the bill scrap the 18-week target for waiting times, mentioning only a target of 52 weeks, for example. Pollock and Roderick point out that it scraps the “responsibility” the government has to arrange healthcare for each of us in England and replaces it with a – seemingly undefined, but presumably more restricted – “core responsibility” for uncertain “groups of people”. It also gives the health secretary the power to water down the requirement for staff to be properly trained and qualified. The bill also makes it far easier for whatever government money flows into the NHS to flow straight back out again to private firms, and allows private corporations to play a huge part in shaping virtually every aspect of our healthcare. Much of the crucial detail is left out of the bill. It instead empowers the health secretary to fill in the gaps without returning to Parliament. And it allows him to appoint the local chairs of the new local health boards – so-called Integrated Health Boards – and allows them, in turn, to grant seats on those boards to representatives of private health and care companies. These boards are given latitude to decide what healthcare local groups of people will and won’t receive in future, what services are kept open, which are shut or scaled back or ‘digitalised’. The firms that could take seats on them include the likes of Centene, a US insurance and Medicaid giant rapidly expanding in England’s NHS, now the largest provider of GP services in England and with a stake in an outsourced hospital surgery firm, Circle Health. Boris Johnson recently appointed the head of Centene’s UK operation, Samathana Jones, as his senior health advisor. Then there are firms like Babylon, which supplies digital NHS GP and 111 services across London and beyond, and is now part-owned by both Centene and controversial US tech giant Palantir. Or the private-equity-owned giants that already provide the large part of England’s mental health and care homes, and whose lobbying for inclusion on these boards looks set to bear fruit. The bill even explicitly gives private firms a say in deciding how much they should be paid Or Virgin – which since 2012 has won contracts for huge chunks of community health services, and already has a seat on at least one ‘shadow’ version of these new boards as a result. A race to the bottom in which patients are the losers As well as helping shape what services an area gets, the bill also tears up the existing rules about procurement. If it becomes law, it will be far easier for private firms to get their hands on new contracts, and hold onto existing ones, regardless of past performance or social and labour standards. The bill even explicitly gives private firms a say in deciding how much they should be paid for the contracts they have won, and thus how risks and rewards are shared between the public and private sector – and allows richer providers and areas to pay more to lure NHS staff away at the expense of a brain drain elsewhere. In short, the bill is a disaster waiting to happen. As David Rowland, writing in the BMJ, points out: “As long as the NHS relies on private companies to deliver NHS services it will require a highly effective form of market regulation to protect it against the well-documented tendency of for-profit healthcare companies the world over to fix prices, generate illegitimate income through fraud, engage in collusive and monopolistic behaviour, and win public sector contracts through cronyism.” As Rowland says, “Simply shifting the policy goal of the NHS from competition to collaboration will not mitigate these risks.” In other words, you can ask the private sector to collaborate all you like. But you’re simply not on a level playing field if you surrender your right to properly regulate, in the way this bill does. The bill also – despite carefully worded denials – does nothing to restrict the government’s ability to sidestep NHS structures entirely and hand vast health-related contracts to its outsourcing, tech, data, consultancy and finance friends. £37bn for Test and Trace, anyone? The bill fails to put this new infrastructure on a statutory footing, health data privacy campaigners MedConfidential point out. When Javid claims the bill will “embed the lessons learned from the pandemic”, it seems the biggest lesson the government has learned is that if you move when people are reeling, disoriented and grieving, you can get away with cronyism and with demolishing accountability, privacy and rights to comprehensive and publicly delivered services. And it contains enough to raise alarm that the long-term vision is a future in which the NHS provides underfunded, fragmentary and second-rate, US-Medicaid-style care to the poor, old and sick, whilst a plethora of private companies pick up ever fatter contracts to diagnose, operate on and care for the rest of us. NHS local executives and the think tanks (and journalists) with whom they orbit appear to be hoping that these freedoms will primarily benefit NHS hospitals and clinics, if a little bother about the health secretary’s powers can be sorted out. But that issue is a distraction to the seismic changes in this bill. And if they fail to speak out strongly, they are closing their eyes to the reality – made explicit in accompanying policy papers – that these freedoms will, as things stand, fall equally to the private sector, which is being enabled to exploit them far more ruthlessly in a deepening ‘austerity’ climate. The result? A race to the bottom in which patients are the losers. Even those groups that have cautiously welcomed some of the proposals – the Royal College of Physicians amongst them – said that this bill should be nowhere near Parliament until some of the huge outstanding questions, notably around social care and the public health and prevention organisations, are answered. The public don’t want this – and they will not forgive MPs who fail to learn from mistakes.
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Post by Admin on Jul 15, 2021 14:49:57 GMT
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Post by Admin on Jul 22, 2021 11:35:38 GMT
The future of the NHS hospital payment system in England From recovery to transformation July 2021 Matthew Bell Anita Charlesworth Richard Lewis Publication REAL Centre Briefing Funding and sustainability Policy www.health.org.uk/publications/reports/the-future-of-the-nhs-hospital-payment-system-in-englandKey points How health care providers (such as hospitals) are paid is one way of influencing the quality and efficiency of NHS care. Over the coming years the NHS will face unprecedented challenges as it tries to recover the substantial backlog of unmet need after the pandemic, deliver on already demanding efficiency targets and redesign care, shifting services towards more community and primary care. Before the pandemic, the NHS payment system was moving towards a blended approach where providers receive an annual fixed payment supplemented by activity and quality-related funding – to replace the payment by results (PbR) tariff. With waiting lists at record highs, it might be tempting to move back to the PbR tariff to incentivise hospitals to treat many more patients. But over the coming years the NHS also needs to improve care of an ageing population with complex, long-term health problems. Coordinated care across hospitals, community, primary and mental health services is a priority and activity related payments are not well suited to this goal. Even after the pandemic, a blended payment system to replace the PbR tariff remains the right direction of travel to help balance these potentially competing priorities for the NHS. The whole health service needs to recover well from COVID-19 and transform to meet the challenges of the post-pandemic environment. This briefing, produced with Frontier Economics, considers these challenges and the role of a new payment system in meeting them as the NHS embarks on further reform and recovery from the pandemic. It begins by setting out the kinds of payment structures available to the NHS and describes the hallmarks of a ‘good’ system. It concludes by exploring what kind of system will be needed for the immediate COVID-19 recovery and to transform care. About the authors Matthew Bell is a Director at Frontier Economics where he leads Frontier’s Health and Care work. Richard Lewis is an independent consultant and Senior Associate at Frontier Economics where he advises on health care reform. Anita Charlesworth is Director of Research and the REAL Centre at the Health Foundation.
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Post by Admin on Jul 23, 2021 23:15:19 GMT
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Post by Admin on Jul 27, 2021 23:38:25 GMT
England is sleepwalking towards a two-tier health system www.msn.com/en-gb/news/uknews/england-is-sleepwalking-towards-a-two-tier-health-system/ar-AAMBxsnThe pandemic has driven both the NHS and a growing number of its patients towards private healthcare. Heightened awareness of the health service’s frailties, fuelled by repeated warnings that it could be overwhelmed, has prompted a surge in private medical insurance. As the UK drifts into a possible future of two-tier healthcare, with the wealthy given more chances to skip the queue, we need to ask whether the founding principle of the UK’s health service – free at the point of need – is being eroded in front of our eyes. There are about 90 private healthcare providers in the UK, such as HCA, Circle, Ramsay, Bupa, Spire and Nuffield Health. The industry is worth about £9bn a year, compared with £177bn of government healthcare spending across the UK in 2019. It includes hospitals, clinics, diagnostics and imaging and urgent care; typical work is general surgery, oncology, obstetrics, trauma and orthopaedics. Its customers are medical tourists, NHS referrals, people with private medical insurance and self-pay individuals – so-called “out of pocket” payers. This last group includes people paying for one-off operations to avoid waiting for NHS treatment. Ramsay earns about 80% of its revenues from NHS referrals, Spire 30%. Alongside the private companies, many NHS hospitals – particularly specialist ones – provide private care. The Royal Marsden cancer centre’s income from private practice has been growing strongly, reaching £133m in the year to March 2020. This sort of activity is justified on the grounds it helps fund NHS care but is vehemently opposed by anti-privatisation campaigners who argue it is simply a mechanism for the wealthy to jump NHS queues in the same hospital. Private healthcare firms have done massive business with the NHS during the pandemic, worth around £2bn. In May, the Independent Healthcare Provider Network said its members carried out 3.2m procedures in the previous year for NHS patients, including more than 160,000 for cancer and cardiology. This was a lifeline for the private sector, which would have struggled to continue running with its NHS-based clinicians fully occupied in NHS hospitals tackling Covid. The company Totally has just reported record results, with revenues up 7.4% to £114m, as the impact of the pandemic on revenue from private patients was mitigated by a substantial rise in NHS work. Most private providers have now signed a four-year deal with NHS England worth up to £10bn to help clear the NHS backlog. The final cost will depend on how many procedures are carried out.
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Post by Admin on Aug 20, 2021 13:39:31 GMT
Health and Care Bill 2021 The Health and Care Bill presented to Parliament for its first reading in July 2021 will implement many of the proposals in the Government’s recent White Paper on NHS reform. Campaigners are concerned about the possibility of another top down reorganisation of the NHS, following on from the Health and Social Care Act 2012 which was deeply unpopular. The changes outlined in this Bill are unwelcome as it will not solve any of the problems the NHS faces, and will distract from efforts to rebuild the NHS, while it is still dealing with the Covid pandemic. The main issues facing the NHS are understaffing, underfunding, and privatisation. The Bill will do nothing for the first two of these and will accelerate privatisation. keepournhspublic.com/privatisation/health-and-care-bill-2021/Petition - www.change.org/p/health-secretary-sajid-javid-protect-the-nhs-stop-the-health-and-care-bill
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Post by Admin on Sept 1, 2021 0:51:21 GMT
Consequences of the The Health & Care Bill
The Health and Care Bill seeks to divide the NHS into 42 integrated care areas, replicating the United States Managed Care System. Private US healthcare companies have been working within the NHS for the past ten years to prepare for privatization. If the Bill becomes law, these are some of the consequences: There will no longer be a statutory duty on any NHS body to arrange provision of secondary services, including hospital services. Integrated Care Boards will be able to award and extend contracts for healthcare services, of unlimited value, without having to advertise, including to private companies. This is what the Department of Health has got away with during the pandemic – and very lucrative it has been for friends and relatives of Government ministers. Private healthcare companies will be able to be members of Integrated Care Boards, their committees and sub-committees. These will plan NHS services and decide where money is spent. NHS England will have new powers to impose limits on expenditure by NHS Trusts and Foundation Trusts, which will lead to blanket bans on some treatments. To save money, there will be more down-skilling, such as nurses replacing doctors, which has happened during the pandemic, causing staff stress, lack of patient trust and greater risk of accidents. No longer the envy of the world Until recently, the NHS was the envy of the world, the best value for money. But cuts to services year on year and more and more privatisation (now you have to pay to have your ears syringed) has knocked it down several places. The United States has one of the worst healthcare systems in the world and the most expensive. Health insurance does not cover all procedures – patients needing long-term and expensive treatments are often refused them. If they can’t afford private treatment, they are just left to suffer and decline. Speak out now If we don’t want a US private healthcare system in England, we need to speak out now, tell our friends and family, spread the word on social media.
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Post by Admin on Sept 9, 2021 12:44:37 GMT
NHS Dentistry Is in Crisis – The Only Solution Is a Real Public System By Rizwana Lala NHS dentistry in England is facing a crisis, with 80% of appointments delayed since Covid-19 and a 40% increase in fees since 2010 – the only solution is a proper public system: well funded and free to access. tribunemag.co.uk/2021/09/nhs-dentistry-is-in-crisis-the-only-solution-is-a-real-public-systemThe Covid-19 pandemic has demonstrated how the social and economic circumstances of people’s lives affect their health. As such, the widely publicised Marmot report calls for the nation’s health to be placed as the highest government priority to build back fairer. Access to comprehensive healthcare, including dental care must be part of this fairer vision of Britain. Funding and access to NHS dentistry have remained a low priority for successive governments. Dental charges were introduced just three years after the inception of the NHS — a policy Bevan vehemently opposed. Today, dentistry is the only part of the NHS that receives a lower budget than 2010. Therefore, it has not kept pace with increasing costs and population growth and this long-standing underfunding has made NHS dentistry less able to wither the storm of the pandemic. Recent research by Healthwatch England showed that since the Covid-19 lockdown, 80% of patients are struggling to access timely NHS dental care with people asked to wait up to three years for an appointment. It is estimated that over 19 million appointments have been delayed since the first lockdown and 14.5 million fewer procedures are taking place. Those lucky enough to get an appointment struggle to pay the ever-increasing dental charges. To plug the successive dental funding shortfall, patient charges have increased by over 40% since 2010. Even during the pandemic, dental charges have continued to increase at a rate higher than inflation. Dental charges have been shown to be one of the biggest barriers to accessing dental care, even for those who are entitled to free care. This is because eligibility for free dental care is complex and differs from free prescriptions. Official surveys consistently show that over a quarter of respondents struggle to pay dental charges, and this leads some people to avoid dental care altogether. Mirroring the effects of the pandemic, those on low incomes and people from ethnic minority communities are most affected by the lack of appointments and dental charges. So, it is welcome news that the Scottish government is moving towards the direction of free dental care. Young people in Scotland, aged 18-25 years are now eligible for free dental care. However, the availability of appointments remains an issue. Treatments delivered by NHS dental services in England are at a quarter of pre-Covid levels. The pandemic resulted in 9 million children missing out on free NHS dental care. As such, the British Dental Association has requested capital funding from the government for ventilation equipment. This would enable dental practices to reduce the time between treatments to deliver care safely and restore patient access to pre-covid levels. However, the scale of oral diseases and barriers to dental care are such that it needs a radically different policy approach. Access to free dental care should be available to everybody at the point of need. With costs of up to £282.80 in England and £384 in Scotland, a lot of people simply cannot afford NHS dentistry. As well as affordability, policy and investment must consider equitable availability of care. Even before the pandemic, people from working-class and ethnic minority communities struggled to access the dental care they are entitled to. Children who are unable to access timely dental care often need hospital treatments. Dental extractions are the leading cause of hospital admissions amongst UK children. Working-class children are four times more likely to be admitted. Children from ethnic minority communities are also more likely to experience dental decay. Dental pain, sleepless nights and hospital appointments lead to missed school days affecting educational attainment and life chances. Pain and the stigma of missing and decayed teeth can have mental health consequences for adults and children alike. For adults, this can affect the ability to fully participate in the labour market which reinforces the cycle of poverty and poor health. Several policy shifts are needed to increase the availability of NHS dentistry. Firstly, there simply needs to be more dental practices in deprived areas of high dental need; dental practices are too often predominantly located in affluent areas. This is due to a historical legacy of inequitable healthcare commissioning practices and an NHS dental contract that does not consider the needs of high-need groups living in deprived areas. Secondly, dental reforms must secure labour rights for NHS dental teams. Research shows that dentists with higher NHS commitments have higher rates of burnout and mental health issues. This is both due to a target-based NHS dental contract and the challenges dental professionals experience in providing timely high-quality care for their patients in an under-funded system. Thirdly, the NHS dental contract must be prevention focused and deliver equitable care for all groups. This includes giving dental teams the contractual time and resources needed to deliver high-quality care for vulnerable groups. The neglect of dentistry has impacts on overall health, the wider NHS system, and people’s social and economic circumstances. With the poorest and ethnic minority communities hit the hardest, Healthwatch England has described the ‘twin crisis of access and affordability’ in NHS dentistry a social justice and equity issue. Therefore, investment and access to dental care should no longer be considered an optional extra if health is to be placed as the highest priority. And if we are to build back fairer, access to dental care must stop being dictated by people’s social and economic circumstances. About the Author Rizwana Lala is an NHS dentist and a clinical lecturer in dental public health at the University of Sheffield.
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Post by Admin on Sept 18, 2021 15:16:21 GMT
How a Decade of Austerity Brought the NHS to its Knees By Colin Leys Today, the NHS is celebrated. But for ten years it has been subject to destructive cutbacks, which led to crumbling facilities, outsourcing, privatisation and staff pay freezes – now is the time to demand better. tribunemag.co.uk/2020/07/how-a-decade-of-austerity-brought-the-nhs-to-its-kneesAdecade ago, when the Coalition government began its austerity cuts, spending on the NHS was supposed to be ‘protected’ from the cuts inflicted on other public services. It is true that average real spending on health and social care increased by 1.4% a year. But this compared with average increases of 3.7% a year from 1948 down to 2010. In other words, government policies implied a halt to any hope of normal improvement and modernisation. On top of this the need for healthcare rose significantly throughout the decade. First, because the proportion of people aged over 75 rose by 12%, to 5.4 million in 2019, and the cost of providing them with care is from three to four times higher than for people under 50. And second, because austerity impoverished millions of families and simultaneously eviscerated the social security safety net. By 2019 14 million people, a fifth of the population, were living in poverty, with consequently deteriorating health. The combination of stagnant funding and rising need led to a decline in access to care, and in its quality. Between 2008-’09 and 2018-’19 the number of people admitted to hospital every year rose by 20%, while the number of people waiting for treatment almost doubled, from 2.2 m to 4.3 m. The NHS coped initially by keeping staff salaries below inflation – i.e. cutting them – and employing as few as possible. For comparison, by 2018 France was spending 22% more per head on health than the UK, and employing 17% more doctors and 38% more nurses per 1000 people. Germany was spending 47% more per head, and had 48% more doctors and 65% more nurses per 1000. In order to force hospitals to make annual ‘productivity savings’, as businesses are supposed to have to do in order to stay competitive, the ‘tariff’ of payments that hospitals received per completed treatment was cut by 4% a year. But they were not given the funds to make the investments needed to achieve increased productivity, and so had to squeeze ever harder to find savings out of existing resources. And rather than investing, they had to postpone even routine maintenance: today there is a backlog of £6 billion simply for repairs. Even so, many were forced to overspend, as their income fell short of covering costs, for a total deficit by 2015-16 of £4.3 billion. When this happened the Treasury provided loans to cover the deficits which carried interest and had to be repaid, increasing the pressure to make still further spending cuts. On top of this, many hospitals had the financial burden of paying for privately financed hospital building schemes, which account for most of the £83 billion a year being paid for PFI schemes by the health and social care sectors. By 2019 many hospitals were unable to meet the true needs of patients. The overall result was an erosion of morale and quality, and growing staff shortages. By the end of the austerity decade primary care was also in serious trouble. GPs felt increasingly stressed. Few newly-trained GPs were willing to take on the responsibility of running practices and more and more opted for part-time work, while large numbers of older GPs were due to retire and others planned to retire early. This was not unconnected with austerity-driven cuts in the number of district nurses and other community-level health services (health visitors, school nurses), driving people to seek more help from GPs. The resulting difficulty in many areas of getting a GP appointment led people to present themselves at hospital A&E departments instead, which meant they were often crowded with people who really needed non-hospital treatment but didn’t think they could get it. This game of pass-the-parcel reflected the fact that the NHS had been simultaneously subjected not just to austerity, but also to a series of steps towards converting it from a unified national service to a set of businesses competing in a healthcare market. This culminated in Andrew Lansley’s 2012 Health and Social Security Act, which cost an estimated £3 billion in reorganisation and added substantially to the NHS’s ongoing administrative costs. While the Act actually reduced the NHS’s capacity to ensure that its budget was being well spent, it reinforced the subjection of the NHS to a management regime in which meeting financial targets displaced improving health outcomes, or even patient safety, as the overriding priority. Also abandoned in the drive for marketisation was any serious commitment to public health, as documented by David Rowland in Tribune. The Covid-19 pandemic thus caught the UK without its former structures of protection against an infectious epidemic and with a hospital system so depleted that it could only meet the needs of Covid-19 patients by abandoning almost all other kinds of care. The outcome that Lansley and his predecessors had expected – a healthcare market in which private health companies would compete with NHS trusts and drive down costs – did not materialise. One reason is that providing good healthcare to everyone in the population is arguably never likely to be profitable. In the absence of public subsidies, the way profits are made from healthcare is typically by cherry-picking profitable patients (the healthiest or wealthiest), or by fraud. But austerity also forced a recognition that a healthcare market would undoubtedly be more costly than an integrated national service. This truth was vividly revealed when Circle Health tried to make a profit out of running an NHS hospital in Hinchingbrooke in Cambridgeshire, at the level of funding of the rest of the hospital sector, and failed comprehensively. Since then the watchword of government policy has been ‘integration’, but cherry-picking and subsidies have continued to offer some opportunities for profit-making from the NHS. The most obvious has been the way private hospital companies got the chance to provide hundreds of thousands of routine treatments a year – chiefly routine surgery, and especially hip and knee replacements and cataract removals – to NHS patients. NHS hospitals had growing waiting lists for elective surgery but no spare operating theatres or surgical beds; yet they faced government-imposed financial penalties if they kept patients waiting more than 18 weeks for treatment. So they took to referring more and more patients to nearby private hospitals, where they were operated on by – none other than their own NHS consultants, who also practised privately at those hospitals. In effect, NHS hospitals were simply renting theatres and beds from private hospitals. By 2018 the share of NHS patients receiving hip and knee replacements in private hospitals had risen to 29% and 19% respectively, to the point where NHS patients accounted for some 50% of all private hospital beds and a third of their income – much of which, of course, also represented a loss of income for the NHS trusts concerned. The private hospital companies were happy, because the rapid growth in the supply of NHS-funded patients, combined with NHS patients choosing to receive treatment at a private hospital under the government’s ‘patient choice’ agenda, allowed them to weather the drop in private patient demand that resulted from the 2007-08 crash. Of course, there is a limit to this development, since all the surgery is being done in their non-NHS hours by NHS consultants, of whom there is a fixed supply – and the UK private hospitals’ business model depends on not having to pay anything towards either their salaries or their pensions (the work they do at private hospitals is paid for by the private patients, or by the NHS for NHS patients, on top of their NHS salaries). But this intimate involvement of for-profit companies in NHS provision puts them in a new position to influence NHS policy, in a way that a new ‘deal’ currently being negotiated behind the scenes for the years following the pandemic seems liable to consolidate. In-between the hospital sector and primary care lies a fertile area for potential further private sector inroads. Hospital costs having been pared to the bone, the only remaining way to save money was believed to be to ‘unbundle’ as many services as possible from hospitals and relocate them, more cheaply, in ‘the community’. To achieve this, NHS England’s Chief Executive, Simon Stevens, divided the country into 44 organisational areas, called ‘footprints’, to serve as the bases for planning a shift of specialist services out of hospitals and integrating them with community-based services. The power to spend the NHS budget for local populations remains legally vested in Clinical Commissioning Groups (CCGs) led by GPs; but 44 informal bodies, one for each footprint, called ‘Sustainability and Transformation Partnerships’, or ‘Integrated Care Systems’, and led by people hand-picked by NHS England, now decide how the money is to be spent. This move represents a decisive rejection of the competition model embodied in Lansley’s 2012 Act, and a return to population-based planning and management. But these unelected bodies, with no basis in law and hence no democratic accountability, are now deciding what services will be available to us, how they will be provided, by whom, and at what cost. It is also envisaged that in future commissioners may ‘award a long-term contract to provide a range of health and care services to a defined population following a competitive procurement. This organisation may subcontract with other providers to deliver the contract… The contract could also involve a bigger role for private companies if they decide to enter the market.’ Implied here is the ‘prime contractor’ model of outsourcing, in which a company like Serco wins the contract and then parcels out the work. While no proposal to do this has so far materialised, the government’s default preference for private companies suggests that this could change. How far the pandemic has changed the prospects for the NHS remains to be seen. It would be naïve to think that the government’s dependence on the NHS in face of Covid-19 has converted the Conservative Party to the original ideals of the NHS, let alone the welfare state of which it was a key component. As semi-normal life resumes we will have to fight hard to undo the far-reaching damage of the austerity years. The NHS needs an increase in its budget on a scale far beyond anything the government is currently envisaging – note Johnson’s latest proposal to give NHS hospitals £1.5 billion for ‘hospital maintenance, eradicating mental health dormitories, enabling hospital building and improving A&E capacity’, when the outstanding backlog of repairs alone will cost £6 billion. To raise the NHS’s staffing and facilities to the level of comparable countries, unify it with social care, and make it democratically accountable, is a project that the left needs to build broad support for, and soon. About the Author Colin Leys is the co-chair of the Centre for Health and the Public Interest (CHPI), an independent think-tank on health and social care policy. He is also an emeritus professor of political studies at Queen's University, Canada.
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Post by Admin on Oct 5, 2021 9:38:39 GMT
Britain’s GP provision in crisis due to COVID-19 pandemic and years of cuts www.wsws.org/en/articles/2021/10/04/gpcr-o04.htmlWhile governments and media outlets the world over have proclaimed the end of the COVID-19 pandemic, the reality is starkly different. The pandemic is continuing to wreak havoc on health services across the UK, as the decades-long cutbacks that have crippled the National Health Service (NHS) bite ever deeper. The impact of COVID, the vaccine rollout and backlogs across the system are resulting in increased demand on a National Health Service already barely able to cope. The crisis in primary care services in which General Practitioners (GPs) surgeries the GPs play a vital role, is having a crippling effect. Last month the Guardian quoted Prof Martin Marshall, Chair of the Royal College of General Practitioners (RCGP) who said, “The fact that general practice is under such enormous pressure means it can’t deliver the patient-centred services that it wants to. Many GPs are even finding it challenging to maintain a safe service.” Marshall was referencing the 4.5 percent decline in GPs across England. In 2015, the Conservative government pledged an increase of 5,000 GPs by 2020. In 2019, then Health Secretary Matt Hancock admitted the target would not be reached. The latest assurance of an additional 6,000 GPs by 2025, under conditions in which the latest fall in GP numbers is 1,307, confirms this promise is worthless.
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Post by Admin on Oct 9, 2021 10:52:25 GMT
Britain’s Ambulance Services: “Totally broken and beyond fixable” Richard Tyler www.wsws.org/en/articles/2021/10/08/ambu-o08.htmlMembers of the armed forces have now been deployed to assist ambulance services across the whole of Britain. It was announced yesterday that 110 personnel will be sent to Wales from October 14, after the local government made a Military Aid to the Civil Authorities (MACA) request. Another 97 soldiers have been supporting ambulance services in the east, north-east, south central and south-west of England since August. In Scotland, 114 soldiers have been carrying out non-emergency driving work for the last two weeks.
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