“Austerity kills: this week’s figures show its devastating toll”

” … According to a bombshell report in the British Medical Journal last year, austerity has been linked to 120,000 extra deaths since 2010. In practice, it suggested, that could lead to 100 early deaths every single day in the coming years. The impact is, predictably enough, felt by the poorest.

Remember when Theresa May stood on the steps of Downing Street in July 2016 and delivered her first speech as prime minister, promising to correct Britain’s “burning injustices”? One of these injustices was that those born poor die nine years earlier. And yet according to David Buck – an expert in health inequalities at the King’s Fund – the gap in health outcomes and life expectancy between the most affluent and the least well-off is only widening under her abysmal premiership.

What could possibly be causing this national disaster? Rule out alcohol use: it has been steadily falling, with the ONS finding in 2016 that alcohol consumption had fallen to its lowest rate since the survey began in 2005. There are fewer smokers in England than ever. As Dorling notes, there has not been a major influenza outbreak since the increase in life expectancy ground to a halt. Neither is it credible to suggest Britain has simply reached a plateau – that life expectancy cannot keep increasing for ever. “We are a long way off that,” as Professor Martin McKee has put it, observing that life expectancy in Japan and Scandinavian nations is higher.

Given the government is refusing a national inquiry into the great standstill in life expectancy, experts are left without a credible explanation other than austerity.

Consider specific policies. The NHS has suffered the longest squeeze in its funding as a share of the economy since it was founded after the war. Its annual increase in funding in the first four years of Tory-led rule was 1.3%, despite growing patient demand and increasing healthcare costs. Then there’s social care for the elderly: a devastating £6bn less spent since David Cameron entered Downing Street. As Dorling and Basten note, since 2010, many care homes – all too often a privately run racket – have closed; and cuts to social security, not least disability benefits, have undoubtedly played a role. There are other chilling factors at play, too. Until the financial crash, Britain’s suicide rate had been falling. Since then, experts believe there could have been an extra 1,000 deaths from suicide and an additional 30 to 40,000 attempts, with austerity playing a role.

This country and its people will be paying for the Tories’ ideologically driven disaster for years to come. Those children driven into poverty will have worse health and lowered educational opportunities as a consequence, undermining their potential, and with it the potential of the whole country. As living standards stagnate, a consumer debt bubble beckons, with potentially disastrous economic consequences. Public services and infrastructure will creak. But there is far more at stake.

Austerity is literally a matter of life and death. Unless it is stopped, lives will continue to be unnecessarily shortened. That Cameron and Osborne crow over a project that has caused so much misery is grotesque. Among the many injustices they have perpetrated, history must surely record the robbing of human life for ideological means.”

https://www.theguardian.com/commentisfree/2018/aug/08/austerity-kills-life-expectancy-standstill-britain

Devon CCGs want to merge (but looks like they already did it!)

Owl says: anyone recallveing consulted about this? And surely, if it is for cost-sVing, all previous financial scenarios at the two CCGs must be recalculated. And shouldn’t this be rescrutinised by DCC?

“North East and West (NEW) Devon CCG is hoping to merge with South Devon and Torbay CCG in April next year. Both CCGs have expressed an interest to NHS England to merge the organisations, in what they say is the ‘next natural step’. In May last year, NEW Devon CCG refuted claims it had ‘gone bust’ – though it did have a defecit of £42million in 2016/17.

Last year (2017/18) NEW Devon CCG had a planned defecit just shy of £50million.

It is thought the merger would help both organisations face funding challenges in the years ahead; they have already made a saving of £4million working together in the last year. This has includinged merging the two executive teams and establishing a common governing body and committees.
Executive directors now sit in Devon-wide roles working across both CCGs.

Dr Sonja Manton, director of strategy at the two CCGs in Devon, said: “We have made significant progress working as a health and care system in Devon over the past two years.

“As commissioners (buyer) of health care services for our local population, our two CCGs have worked more closely together for over a year, and this has brought many improvements and benefits such as speeding up decision making and making cost savings and efficiencies of nearly £4million on running costs.

“We have achieved much more together than we would have working separately. “A merger of our two organisations is the natural next step, and we have expressed an interest to NHS England to merge our two organisations from April 2019. “We are working with staff, clinicians, partners and stakeholders to ensure that everyone is involved in the changes as they develop. “This is an important step in our journey to better integrate health and care services to benefit our local communities.

“In Devon, we have well-established joint working arrangements with our local government partners and this will be strengthened as we design a new more integrated approach.”

https://www.northdevongazette.co.uk/news/proposals-to-merge-two-devon-ccgs-1-5642433

“Virgin awarded almost £2bn of NHS contracts in the past five years”

“Virgin has been awarded almost £2bn worth of NHS contracts over the past five years as Richard Branson’s company has quietly become one of the UK’s leading healthcare providers, Guardian analysis has found.

In one year alone, the company’s health arm, Virgin Care, won deals potentially worth £1bn to provide services around England, making it the biggest winner among private companies bidding for NHS work over the period.

The company and its subsidiaries now hold at least 400 contracts across the public sector – ranging from healthcare in prisons to school immunisation programmes and dementia care for the elderly.

This aggressive expansion into the public sector means that around a third of the turnover for Virgin’s UK companies now appear to be from government contracts. …

Sara Gorton, the head of health at the trade union Unison, said: “The company has been so keen to get a foothold in healthcare, it’s even been prepared to go to court to win contracts, moves that have cost the NHS dearly.

“While the NHS remains dangerously short of funds, taxpayers’ money shouldn’t be wasted on these dangerous experiments in privatisation.”

One former surgery manager who spoke to the Guardian said Virgin appeared to be paid more for doing less in her area, although the company said “because the contracts are generally not directly comparable, we don’t believe it to be true”.

Guardian analysis reveals the way the company that began selling records in the early 1970s has diversified in a bewildering way over recent years. …

In March 2017, it had almost 1,200 staff – a five-old increase from the year before. Over the same period, its turnover increased from £133m to £204m and its operating profit rose from £7.3m to £8m.

Though healthcare is a growing part of the group, Virgin still appears to make most of its money from transport.

Virgin UK Holdings, the UK business which holds its rail and healthcare ventures, reported revenues of £1.5bn in 2016 and paid £22m in tax.

Earlier this year, Virgin Trains had its west coast line franchise extended for another year. …

Paul Evans, the director of the campaign group NHS Support Federation, said: “Virgin Care are the biggest private sector winner to emerge out of the NHS experiment with competition and outsourcing.

“We don’t know the final shape of it, but players like Virgin and Care UK clearly see a big opportunities for business to continue to deliver clinical services for the NHS.”

https://www.theguardian.com/society/2018/aug/05/virgin-awarded-almost-2bn-of-nhs-contracts-in-the-past-five-years

Local Government Association debates tax rise to fund social care

“One of the many downsides of Brexit is that for the last two years or more it has sucked all the energy out of the Westminster policy making process, with the result that other problems are being ignored. It is a major opportunity cost. There are plenty of examples, but adult social care is probably the most glaring. Experts agree the situation is in crisis. The Conservatives floated some audacious plans in their manifesto, but they proved electorally toxic and since then they have gone silent on the topic, putting off announcements until the much-delayed green paper due later this year. Labour’s own plans are sketchy and, understandably, they are reluctant to propose reforms that will involve higher when the government won’t take the initiative itself.

So all credit to the cross-party Local Government Association that is today floating plans in a green paper (pdf) to raise taxes to put care funding on a sustainable footing. With councils in England receiving almost 5,000 new requests a day for adult social care, the LGA says this is essential.

Since 2010 councils have had to bridge a £6bn funding shortfall just to keep the adult social care system going. In addition the LGA estimates that adult social care services face a £3.5bn funding gap by 2025, just to maintain existing standards of care, while latest figures show that councils in England receive 1.8m new requests for adult social care a year – the equivalent of nearly 5,000 a day.

Decades of failures to find a sustainable solution to how to pay for adult social care for the long-term, and the Government’s recent decision to delay its long-awaited green paper on the issue until the autumn, has prompted council leaders to take action.

Short-term cash injections have not prevented care providers reluctantly closing their operations or returning contracts to councils and less choice and availability to a rising number of people with care needs. This is increasing the strain on an already-overstretched workforce and unpaid carers, and leading to more people not having their care needs met.

Increased spend on adult social care – which now accounts for nearly 40 per cent of total council budgets – is threatening the future of other vital council services, such as parks, leisure centres and libraries, which help to keep people well and from needing care and support and hospital treatment.

The LGA is publishing its green paper to start a public debate on how adult social care could be properly funded. There’s a summary here:

https://www.local.gov.uk/about/news/lga-launches-own-green-paper-adult-social-care-reaches-breaking-point

Source: https://www.theguardian.com/politics/blog/live/2018/jul/31/council-leaders-float-plans-to-raise-income-tax-or-other-taxes-to-fund-adult-social-care-politics-live

Very important case law on consultation

This has great relevance to NHS consultations, the wording of consultation comments, the treatment of those comments and the duties and respinsibility of the DCC Health and Wellbeing Scrutiny Committee to scrutinise evidence presented.

It is going to be much easier to challenge flawed consultations.

Those involved in these matters MUST read the full document (see source at end of post. Only a couple of the relevant sections are published here but should be read with the whole document.

“… “Commentary on
R (ex parte Kohler) v The Mayor’s Office for Policing and Crime
[2018] EWHC 1881

This Briefing Note considers the judgment handed down by Lord Justice Lindblom and Mr Justice Lewis on 20th July 2018. It details the circumstances of the case, its wider context and, in particular discusses practical issues which will be of concern to consultation practitioners.

Background

In common with other police forces, the Metropolitan Police has needed to make huge savings in its budget. Unsurprisingly it has led to a review of what premises they occupy and whether they still need over-the-counter services at their police stations.

In July 2017, the Mayor’s Office for Policing and Crime (MOPAC) published a Public Access and Engagement Strategy, a dual-purpose document simultaneously consulting the public about the future direction of public engagement on policing and seeking views on proposals to close or ‘swap’ 37 police counters.

The consultation was heavily criticised, and at the Institute, we published a detailed critique under the provocative title Is this the worst consultation of 2017?

https://www.consultationinstitute.org/worst-consultation-2017/

Some of the complaints were heeded and a revised set of questions emerged three weeks after its original launch.

The legal challenge

Professor Paul Kohler lives in Wimbledon and in 2014, was subjected to a serious assault. He believes his life was possibly saved only thanks to the prompt response by police from Wimbledon Police Station.

The MOPAC proposal included a provision for that facility to be transferred elsewhere in the London Borough of Merton – to Mitcham, so that the site at Wimbledon could be sold and generate capital receipts. These in turn, according to the consultation document, would help the Met Police fund technology improvements needed to support the case for changing public access and reduce the traditional reliance on police counters. …

The Kohler case spells an end to the practice of sending decision-makers a summary report (or an unreadable tome) with a message ‘Don’t worry, there’s nothing here to stop you from going ahead!’. If a failure to consider a specific argument can spell illegality following a consultation, someone somewhere has to decide what might constitute such an argument. Who can be trusted to decide?

The Consultation Institute View [on the case]

• The Kohler case is a game-changer, placing the Gunning Four Principle of ‘conscientious consideration ‘ at centre stage. There have been few comparable cases, as flawed consultations have, in the past failed the pre-determination or the sufficient information tests. It remains to be seen if the judgment opens the door to more claims that decision-makers never properly studied consultee submissions. It could happen!

• One consequence is that campaigners and other smart stakeholders will structure their comments to ensure that they cannot easily be summarised, and may specifically seek assurances that their submissions will have been read by decision-makers.

• To respond to such pressures and to safeguard themselves, consultors will need to look again at their data analysis practices, possibly strengthening the independent element both in analysis and in reporting to decision-makers. They will also need to be better at political risk assessments. Independent Quality Assurance becomes even more attractive for controversial consultations.

• The case for Public consultation hearings is further strengthened, as decision-makers will be able to prove that they heard and understood particular arguments. …”

Full document here:

http://files-eu.clickdimensions.com/consultationinstituteorg-alksu/files/briefingnote21-mopac.pdf

Seaton fights for Axe Valley health care

Owl says: good to see the deprived eastern side of East Devon banding together to fight for its (similarly deprived) health services.

Priorities identified for Axe Valley healthcare provision

“A ten point plan to safeguard healthcare provision across the Axe Valley has been drawn up.

The list of priorities has been agreed following a series of meetings between representatives from statutory and voluntary health groups along with local councillors.

Following the workshops, organised by Seaton Area Health Matters group, 10 priorities have emerged:

* To take an area approach for the Axe Valley, not just Seaton.

* Improving communication and co-ordination between voluntary organisations.

* Maintaining and extending NHS services in GP practices and at Seaton Hospital.

* The challenges in older age groups (chronic diseases, loneliness and isolation).

* The challenges in younger age groups (drug and alcohol addiction, housing, poverty).

* Mental health support.

* Transport difficulties to access services.

* Promoting health and wellbeing

* Communication on what is available.

* Co-ordination and ownership to tackle the challenges.

To look at these challenges a steering group has been established under the chairmanship of Seaton town councillor Jack Rowland.

A Terms of Reference was agreed at the last meeting on July 12 and two initial working parties have been established to work on the priorities and report back on progress at the September 6 meeting of the steering group.

A website and Facebook page will also be set up to communicate what is happening and enable people to contribute their views and receive answers, where appropriate.

Explained Cllr Rowland: “The working parties will utilise the experience and knowledge of whoever they need to as part of producing recommendations for approval by the Seaton Area Health Matters Steering Group and then potential approval and support from the Clinical Commissioning Group (CCG) and the Royal Devon and Exeter Trust (RDE).

The next meetings of the Seaton Area Health Matters group are:

Thursday, September 13, at
2pm

and

Thursday, December 13, at 2pm

both at the Marshlands Centre, Harbour Road, Seaton.

Anyone who has an interest in healthcare in the Axe Valley is welcome to attend.

Representatives from groups involved in health, care and wellbeing are actively invited to become members of Seaton Area Health Matters by attending the meetings.

Other members of the steering group are: Cllr Geoff Pook (vice chair), Cllr Marcus Hartnell, Victoria Parry (Healthy eating charity and Clinical Commissioning Group community representative), Cllr Martin Shaw, Roger Trapani (CCG community representative) Tina Trapani (Devon Senior Voice representative), Dr Mark Welland (Seaton GP and chairman of Seaton and District Hospital League of Friends).”

http://www.midweekherald.co.uk/news/group-identifies-patients-needs-1-5616100

Sky News claimed 55% of the NHS budget is spent on over 85s – the REAL amount is VERY different

A Sky News article claimed that 55% of all NHS spending went on people 85+:

https://news.sky.com/nhs-in-numbers

An independent fact-checking charity decided to research this claim.

Sky News told them it calculated the figures based on data published by the Institute for Fiscal Studies (IFS), but the IFS told us they don’t recognise these figures. They have asked Sky for more information.

Other figures the charity has seen from the IFS suggest that the proportion of health spending across the UK (rather than just the NHS budget) which goes to those aged 85 and over is likely to be around 10% by 2021/22.

The Institute for Fiscal Studies (IFS) told them it wasn’t familiar with the figures used by Sky News, but did provide them with other information.

When compared to a 30 year-old, spending across the UK on health (not just the NHS) for an 85 year-old is projected to be 5.6 times higher in 2021/22, and twice as much for a 65 year-old. That’s taking account of the fact that not all people of those ages will necessarily need to use health care.

But that doesn’t mean that 85 year-olds will require 5.6 times as much of the budget as 30 year-olds, because there are fewer people at that age.

Using population projections for 2021 we can see that those aged 85 and over are projected to make up just 3% of the population of the UK. Those aged between 65 and 84 made up 16% and those aged 30-64 made up 45%.

Based on this, 10% of health spending across the UK would go to those over the age of 85 by 2021/22, 32% would go to those aged 65 to 84 and 35% would go to those between the age of 30 and 64.

https://fullfact.org/health/how-much-nhs-budget-spent-people-over-85/