Privatised good, nationalised bad? Think again

The NHS has about 1,700,000 UK workers:

“In December 2016, NHS Improvement forecast that NHS trusts would end 2016/17 with a potential deficit of £750–£850 million.”

https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/trusts-deficit

COMPARE WITH:

Carrillion has about 48,500 UK workers:

Shares in the beleaguered Carillion construction group, which is working on the HS2 London to Birmingham rail line and the vast Battersea Power Station project, plunged by 20% on Friday after the company issued its second profit warning in two months.

Carillion reported a first-half loss of £1.15bn and said its full-year performance would be worse than previously expected. It described the loss as “disappointing”. The shares, which were changing hands at 190p little more than three months ago, closed at 51p.

The company is struggling with a large debt pile and badly-performing contracts. It said it would write down £200m on 23 support services contracts, and was taking a £134m charge relating to its UK and Canadian construction businesses. …”

https://www.theguardian.com/business/2017/sep/29/hs2-contractor-carillion-profit-loss-construction-debt

“John McDonnell ‘would bring existing PFI contracts in-house’ “

Wouldn’t THAT put the public cat amongst the private (fat) pigeons!

http://www.bbc.co.uk/news/uk-politics-41379849

So, this is what you get when you destroy the NHS

PRESS RELEASE:

Shocking news is just emerging from the Midlands. Nottinghamshire is one of the first 8 ‘Accountable Care Systems’ (ACS) which the Sustainability and Transformation Partnerships (STPs) are morphing into.

We’ve just discovered that US Centene Corporation via Capita, has landed a contract with this ACS for upwards of £2.7m of our public money, to come and impose the discredited public/private healthcare system on the area. This involves a health management company running an area’s entire health service and hospital buildings, paid for with a mix of private and public money, with the Nottinghamshire ACS completely ignoring the fact that Ribera Salud system, which Centene half owns and is setting up here, is being investigated by police in Valencia for corruption,

Centene Corporation runs the publicly funded Medicaid programmes in 20 states and an Insurance business for low income people who have lost their Medicaid status. Remember Insurance companies are there for shareholders not for patients and do everything they can to avoid paying out. Is that what we want here?

If this is happening in Nottinghamshire, what is happening in the other 7 ACSs? Healthcare does not fit with the market.

We do not want to increase health inequalities.

The US has the worst healthcare in the developed world, exporting that here via Valencia is unacceptable!

The UK is the 6th richest counry in the world and CAN afford a proper health service.

Please help us STOP the STPs, by signing and sharing the petition.

https://you.38degrees.org.uk/petitions/stop-the-plans-to-dismantle-our-nhs

What Swire’s mate Heffer thinks of local authorities

Just before the last general election, Swire made one of his very rare appearances at what he called a “hustings” in Exmouth. Except no other parties were invited to participate and his one guest was Telegraph journalist Simon Heffer.

In today’s Sunday Telegraph Heffer calls for privatisation of everything that currently makes any semblance of profit, or which might make profits in future, and hiving off the loss-making tasks to unitary authorities or, in our case, the unelected, unaccountable and opaque business-run Local Enterprise Partnership.

Oh to be a fly on the wall when Swire and Heffer have their fireside chats …

He says:

“… There is too much local government. Pointy-headed theorists have banged on about localism, but all that is missing is evidence that “local” people are either capable or motivated enough to deliver “local” services. The best way to deliver “localism” is to take councils out of the equation altogether, as has been done in many cases by removing schools from their control. …

But local government will not work well until it is stripped of duties that individuals or the private sector can provide for themselves: which brings us back to social care … the government must … develop an insurance scheme that will encourage private providers to take over what threatens to become a crippling state responsibility …”

Sunday Telegraph, Sunday Comment, page 16

Unfortunately Mr Heffer neglects to explain how private providers, with shareholders mouths to feed, will be able to do it more cheaply.

Hawking totally skewers Hunt on NHS!

The NHS is facing severe crises, from staffing to funding. Hunt misquoting me and misrepresenting research doesn’t help.

The secretary of state for health, Jeremy Hunt, has challenged me on Twitter and in an article for the Sunday Telegraph over a talk I gave recently to the Royal Society of Medicine in defence of the NHS. Having been accused by Hunt of spreading “pernicious falsehoods”, I feel the need to respond.

Hunt doesn’t deny that he dismissed research contradicting his claim of excess deaths due to poorer hospital care and staffing at the weekend. He admits he relied on one paper by Professor Nick Freemantle and colleagues. But even if one accepts its disputed findings, the authors explicitly warn that “to assume these excess deaths are avoidable would be rash and misleading”. The editor-in-chief of the British Medical Journal, Fiona Godlee, wrote to Hunt to reprimand him for publicly misrepresenting the Freemantle et al paper. As a patient who has spent a lot of time in hospital, I would welcome improved services at the weekend. For this, we need a scientific assessment of the benefits of a seven-day service and of the resources required, not misrepresentation of research.

Hunt’s statement that funding and the number of doctors and nurses are at an all-time high is a distraction. Record funding is not the same thing as adequate funding. There is overwhelming evidence that NHS funding and the numbers of doctors and nurses are inadequate, and it is getting worse. The NHS had a £2.4bn shortfall in funding in 2015-16, bigger than ever before. NHS spending per person will go down in 2018-19. According to the Red Cross, the NHS is facing a humanitarian crisis. There is a staff recruitment crisis. The BBC reported that on 1 December 2015 there were 23,443 nursing vacancies, and a 50% increase in vacancies from 2013 to 2015. The Guardian reported in May that the number of nursing vacancies had risen further to 40,000. There are increasing numbers of doctor vacancies and increasing waiting times for GP appointments, treatment and surgery.

Hunt misquoted me, saying that I claimed the government wants a US-style insurance system. What I said was that the direction is towards a US-style insurance system, run by private companies. The increasing involvement of private health companies in the NHS is evidence for this. Hunt chose to highlight – dare I say, cherry-pick – the fact that private companies’ share of NHS contracts rose 0.1% over the last year. This is an anomaly among the data since 2006. The NHS private providers’ share was 2.8% in 2006-7 and rose steadily to 7.6% in 2015/16. The amount of private health insurance has fallen since 2009 as Hunt said, but that is because of the financial crash. We can conclude nothing about health policy from this and in any case, it is now increasing again. As waiting times increase, private companies report an increase in self-pay where patients pay directly for care such as hip and knee replacements.

Further evidence that the direction is towards a US-style system is that the NHS in England is undergoing a complete reorganisation into 44 regions with the aim of each being run as an “accountable care organisation” (Aco). An Aco is a variant of a type of US system called a health maintenance organisation in which all services are provided in a network of hospitals and clinics all run by the HMO company. It is reasonable to expect the powerful US HMO companies such as Kaiser Permanente and UnitedHealth will be bidding for the huge contracts to run these ACOs when they go out to international tender. Hunt referenced Kaiser Permanente as a model for the future budgetary arrangements in the NHS at the Commons health select committee in May 2016.

The NHS is political, but not necessarily party political. I am a Labour supporter but acknowledge that privatisation increased under Labour governments in the past. The question is whether democracy can prevail and the public can make its demands for proper funding and public provision undeniable by any government.

• Stephen Hawking, the author of A Brief History of Time, is director of research at the Centre for Theoretical Cosmology at the University of Cambridge, where he was Lucasian professor of mathematics”

https://www.theguardian.com/commentisfree/2017/aug/25/jeremy-hunt-attack-nhs-stephen-hawking-crisis

Honiton fighting back on bed cuts

Since this article was written, it has been announced that all Honiton Hospital’s community beds will close on 28 Augusy 2017:

“A BAND of angry residents calling itself Honiton Patients Action Group says it plans to keep hospital beds in Honiton by taking direct action to stop the removal of ward beds and equipment.

The group, consisting of several local patients and their families, say they have become increasingly frustrated at the ‘failure of NEW Devon CCG to listen to the voice of local people and their representatives’.

They claim some end of life patients have already been informed by local GPs that Honiton Hospital will not be available after September and, if they need a local hospital bed, they must be prepared for an out of area transfer to Tiverton, Exmouth or Sidmouth.

A spokesperson for the action group said: “It is quite clear that NEW Devon CCG have never been prepared to fully engage in a sincere dialogue.

“There has been a failure to listen to the voice of local people and our representatives. We believe they decided in advance they would close these beds despite the fullest and proper representations that have been made by locals and their representatives, including MPs, district and town councils. We have tried sitting down and discussing it with them. We have tried large public meetings, marches, deputations and lobbying including the county council. Now we intend to sit down to stop the closure.

“We feel we have been disgracefully let down by the Health Secretary Jeremy Hunt, by Devon County Council and their local representative Cllr Sarah Randall Johnson, and by Cllr Paul Diviani who seems to be representing no one except himself.

“While they prevaricate, the rundown of the wards has begun and it may well be more serious than they are letting on.

“With the closure of the maternity unit and privatisation of the site Honiton Hospital could be scrapped in the near future – this has happened at 45 other hospital sites.

“Meanwhile there is not a scrap of evidence the promised alternative care system is ready or will be effective.

“As patients we will not meekly accept this and at a time of our choosing we plan to take direct action to prevent the removal of beds and equipment and the stripping of wards.

“This will be a peaceful, non-violent, direct action to prevent contractors gaining access to remove the beds and equipment using whatever peaceful methods we can.

“We are also contacting health trade unions to set up a picket line. We shall invite nurses, doctors and local health groups to join in solidarity, along with Neil Parish MP who claimed he would ‘hold feet to the fire’ to stop the closure. Our MP has become very quiet but this is his last chance to show solidarity.

“When we have finalised our plans we hope that local people and families, all of whom could potentially require these beds in future, will join us to keep up the action as long as we can. We need help and support to organise and publicise this if we are to be effective.

“It is the last real chance for Honiton Hospital and our community and we appeal to everyone to search their conscience.

“While we have life and the will to fight ‘They Shall Not Pass’.”

https://www.viewnews.co.uk/honiton-patients-group-promises-direct-action/

East Devon community bed closures to be speeded up – Seaton to close next week, Honiton the week after

From the blog of Claire Wright – did Diviani and Randall-Johnson know this? Do they care?

“I have seen this SO many times.

A threat to hospital beds. Hospital beds close temporarily due to staffing shortages (because understandably staff leave) and then the permanent closures are brought forward.

What I am not reassured on here is how the loss of the existing beds will morph into the new care at home service and the message on staff redeployment is as vague as ever. Last autumn, I was told by the CCG chair, Tim Burke that around double the number of staff will be appointed… the CCG now talks in terms of ‘redeployment’ and ‘recruitment’ of 50 staff, which is difficult to get to the bottom of, given what we have already been told.

What we also still don’t know (because the CCG won’t tell us) is what happens to those hospitals that lose their beds…

Devon County Council’s health scrutiny committee needs to keep a very close eye indeed, on this issue.

The letter below has been sent to Health Scrutiny committee members:

Your Future Care

I am writing to let you know that we are ready to proceed with the changes to improve care for people across Eastern Devon as part ‘Your Future Care’.

These changes are intended to shift the focus of health and care services to keep more people well and independent at home. Part of this shift will be the redeployment and recruitment of over 50 nursing, therapy and support worker roles to enhance the existing community services in each local area. This will enable the reduction in the number of community inpatient beds across the Eastern locality of Devon.

In order to achieve this safely, we will take a phased approach – working closely with staff and partners – to implement the changes as per the following timetable:

• Seaton Community Hospital week commencing 21 August 2017
• Okehampton Community Hospital week commencing 21 August 2017
• Honiton Community Hospital week commencing 28 August 2017
• Exeter Community Hospital week commencing 4 September 2017 (this is the original closure timetable).

The provision of inpatient services at these locations will cease from these dates. All other services at these hospitals will continue as normal. Patients in these areas in medical need of a community inpatient bed will be accommodated at either Tiverton, Sidmouth or Exmouth hospitals, depending on where they live.

It has become apparent over the last couple of weeks that the schedule for the closure of the in-patient beds at Seaton, Okehampton and Honiton would need to be brought forward by a number of weeks due to the increasing pressures on safely staffing the current configuration of seven community inpatient units.

We have been preparing the comprehensive plans for each area since March 2017 and are confident that moving to the new model swiftly is in the best interests for our patients and our staff. For example, our new Community Connect out-of-hospital service, introduced this Spring, has already led to a reduction in demand for community inpatient beds.

Gateway Assurance Process

As you may be aware, part of the implementation process included a clinical assurance panel reviewing the implementation plans against a series of 30 gateway questions. These were developed to provide assurance of the RD&E’s and the wider system’s readiness to switch to the Your Future Care model.

The Gateway Assurance Panel has given its recommendation to proceed. The workforce HR consultation has been completed and staff have been informed of their new roles and working environments. We have also received the approval of the Equality and Quality Impact Assessments, which took place on the 4th August. We can now commence the redeployment of staff into our enhanced community teams and into the remaining community hospital sites. This change will provide extra capacity and resilience to meet the needs of our local population.

Your Future Care is just the beginning of the work needed to move fully to a model of care which proactively averts health crises and promotes independence and wellbeing for our population.

There is still much more to be done and we at the RD&E look forward to continuing this in partnership with you and our local communities.

Yours sincerely,

Adel Jones
Integration Director”

“Conduct of health committee members investigated by Devon council” – Diviani and Randall-Johnson heavily criticised for behaviour

“Devon County Council has confirmed it is looking into the conduct of members of one of its committees following a debate and vote not to refer a decision to close 72 community hospital beds in Devon to the secretary of state for health.

The matter was debated by the health and adult care scrutiny committee meeting at Exeter’s County Hall on July 25.

Among those who have expressed their concerns is Val Ranger, East Devon District Council ward councillor for Newton Poppleford and Harpford.

She says that at a meeting of East Devon District full council meeting on July 26, Cllr Paul Diviani, who sits on the committee as a representative of district councils, admitted he had not asked the opinion of other district councils about whether they wished to refer the decision to close local hospital beds to the secretary of state, and could offer no evidence on that basis that he was representing their views.

At the meeting Cllr Diviani was among those who voted not to refer the decision to the secretary of state.

Cllr Ranger said: “He said he voted not to because it was unlikely that the secretary of state would overturn the decision.

This seems duplicitous on two count. The first for failing to adequately represent the views of the district councils.

“Secondly for assuming the role of the secretary of state by stating there was no point in referring the matter to him as he was unlikely to overturn the decision.

“At the EDDC scrutiny committee on June 22, EDDC’s views and recommendations were very clear; Northern, Eastern and Western (NEW) Devon Clinical Commissioning Group (CCG) has failed to provide the evidence needed to support their plans.

“However, Cllr Diviani failed to represent those views or the views of other district councils as he did not seek them. He has admitted he voted independently of both EDDC and other district councils, rendering his vote as entirely without integrity in his role at the DCC meeting.

“The vote is an entirely unsafe and undemocratic way of conducting business and brings both EDDC and DCC into disrepute.”

A spokesman for Devon County Council said: “We have received a number of comments, representations and complaints about the health and adult care scrutiny committee held last week and about the conduct of members at that meeting.

“We will be looking at all the points raised by Cllr Ranger and others under our normal procedures to see if there are any issues to be addressed.”

However, Cllr Diviani is confident the investigation by DCC will conclude there has been no wrong doing.

He said: “I take this predictable and entirely politically motivated complaint against me by people who contribute little or nothing positive to the debate at face value, and feel sure that DCC will dismiss the allegations as unfounded.

“I have neither seen or heard anything from Ms Ranger on how her party would address the huge challenges facing the NEW Devon CCG and the NHS.

“As the web cam at County Hall malfunctioned and didn’t record properly, the gist of what I said is as below. I did also explain that my position on that scrutiny committee is by virtue of my being elected by the other leaders of all the Devon districts to represent the county-wide views of the district councils, not just East Devon, and is a function I perform regularly both locally and in London through the District Councils Network where I represent the South West.

“There is a tendency to assume that everything is fine as it is, when it quite clearly is not, and that the government will keep throwing money at the NHS as they always have in the past.

“What that underestimates are the social care costs which are massive, but if tackled correctly will reduce the acute care costs, as evidenced by the Kings Fund report. We will still need our hospital buildings which in Honiton are already being used differently, for example, for kidney or chemotherapy treatments. Staffing is still a problem but that is not building dependent.

“Many of us have made a positive decision to live and indeed work in the countryside and a direct result of that decision is a diminution of accessible services we can reasonably expect the state to provide. When able, it is a price we gladly pay for the quality of life afforded.

“In straightened times, we need to cut the cloth accordingly. As is well documented, the largely under funded cost of adult social care is a significant factor in the problems besetting the NHS where the acute care service is the treatment of last resort, and very good it is too, but with the budget sliced off to the top tier local authority.

“As the truly excellent Kings Fund Report from 2016 made exceedingly clear, sorting adult social care comes first and if we tackle that with the help of the district councils the benefits will flow. The NHS cost pressures will diminish and the money can best be spent where most needed.

“In East Devon we have enormous and justifiable pride in our local hospitals and all our existing towns were well endowed. Costs are, however, never static and will always rise without innovation.

“But here we are talking service industry which is always people dependent and where low wages do not necessarily translate into low cost. Simply put, if one person falls, it will take two people to rectify the situation, and if not rectified speedily, the condition and costs multiply exponentially.

“And speedily must mean access to care, quickly. Our travel times are well known and until they are resolved, we will always need staging posts to either stop people occupying the acute provision when unnecessary or to maintain them in a degree of comfort until they can reach the comfort and safety of their own living space.

“The major flaw appears to me to be the ever present ‘one size fits all’. Flexibility is key and our response should be the start.

“Attempting to browbeat the secretary of state with a demand to overturn his own policies is counter intuitive. I prefer to ask him to rural proof our rural situation before allowing any further reductions in service which we on the ground can see will be detrimental, but our transformers would discount. But that is a local decision which should be made locally.”

Also among those who have raised concerns over the debate and vote at the scrutiny meeting is Claire Wright, Devon County Councillor for Otter Valley Ward.

She has said how she was “disappointed” by the behaviour of scrutiny committee chair Sara Randall Johnson who “appeared to do her utmost” to prevent any referral.

She said: “I am also disappointed with the attitude of the majority of the Conservative group who used a variety of ill-informed views and remarks to justify their determination not to refer, refusing to hear or see any member of the public’s distress, frustration and disbelief at the proceedings.

“The chair’s attitude made me angry and led to a protracted row where I repeatedly asked her why she had allowed a proposal to be made and seconded at the very start of the meeting by her conservative colleague, Rufus Gilbert, not to refer to the secretary of state for health, when I already had a proposal that I had lodged with her and the two officers, before the meeting.”

She added: “When they did what they did at the health scrutiny meeting, the Conservatives betrayed thousands of local people.”

The close vote whether to refer the decision was six votes to seven, with two abstentions. All those who voted with Cllr Gilbert’s motion were Conservative’s.

Cllr Wright, who is seeking advice on what happened at the meeting, concluded: “I am quite certain that with a different approach by the chair the outcome would have been different, and local peoples views would have been respected and acted upon.”

http://m.devonlive.com/conduct-of-health-committee-members-investigated-by-devon-council/story-30478465-detail/story.html

Clinton Devon Estates to take over work of Jurassic Coast Trust

Oh dear sweet Lord – clifftop holiday homes and Disneyland here we come – and definitely no National Park!

An East Devon landowner is set to play a significant part in the future of the Jurassic Coast World Heritage Site.

Clinton Devon Estates, which owns and manages 25,000 acres of land across Devon, has pledged its support to the Jurassic Coast Trust which is taking over the management of the 95-mile stretch of world heritage coastline, from Devon and Dorset county councils this July.

The landowner is joining the Trust as one of four Lead Business Partners, currently the only partner in Devon alongside three based in Dorset, and will pledge £3,000 per year to the charity, helping to safeguard its future.

The Trust’s link with businesses and landowners is essential in ensuring it can carry out its work looking after the world class coastline, which stretches between Exmouth in Devon and Studland Bay in Dorset, on behalf of UNESCO for the “benefit of the whole of mankind”.

A large part of the Estate’s East Devon acreage is made up of the Pebblebed Heaths, which are named after the Budleigh Salterton pebblebeds and are a designated conservation area.

The Trust is poised to support the landowner’s existing educational outreach, which focuses on the ecology and management of the heaths by the Pebblebed Heaths Conservation Trust.

Kate Ponting, countryside learning officer at Clinton Devon Estates, said: “We have had an informal, mutually supportive relationship for a long time as our paths have crossed over the years.

“The Estate owns land very close to, or on the Jurassic Coast, and the Trust is keen to extend its work in East Devon, so the partnership should afford more opportunities for collaborative working.

“We have a lot in common with the Trust whose work is based on geology; the geological story of the Pebblebed Heaths is part of our shared heritage which we’re passionate about.

“We hope to celebrate this heritage further, through extended community engagement and we’re hoping the Trust’s expertise will enhance what we already do.”

The Trust also plans to provide downloadable audio guides about East Devon’s geology for the Clinton Devon Estates’ website.

Guy Kerr, Programme Manager for the Jurassic Coast Trust, said: “We are delighted to have Clinton Devon Estates on board as one of our Lead Business Partners. The East Devon pebblebeds are a crucial part of the Jurassic Coast World Heritage Site and we look forward to working closely with Clinton Devon Estates to preserve this landscape and enthuse people with its incredible stories.”

http://www.devonlive.com/clinton-devon-estates-take-over-management-of-jurassic-coast-world-heritage-site/story-30478379-detail/story.html

Shortage of care home beds in Devon – except for the rich, of course

Too ill to be cared for at home or in community-bedless Devon? Tough.

But no worries for the rich in their luxurious “assisted living” apartments in places like Pegasus in Sidmouth and Millbrook Village in Exeter!

And even there no use having beds if there are no carers to take care of people post-Brexit.

“Devon and the South West is heading for a major shortfall in care home beds, a leading property expert has warned.

The region will need to create 1,350 beds a year to offset closures and pressures from an ageing population.

Anthony Oldfield, director at property consultancy JLL, which has an office in Exeter, said: “Even before we take into account the impact of bed closures, the care home sector needs to double the delivery of new beds. Demand for private pay stock set to increase across all regions of the UK, not just the wealthy prime markets, as a result of historic house price growth and no change in the threshold for publicly funded care since 2010.

“The election showed what an emotive subject social care and how it is going to be funded can be. But it is essential that the government reaches a sustainable solution as to how social care is to be funded in a way that doesn’t pass the burden to a shrinking working age population.”

JLL estimates that there will be a shortfall of nearly 3,000 care home beds in 2018 based on the current development pipeline and anticipated increase in demand due to growing demographics in the UK.

Just within the South West, the forecasts suggest a need for an extra 15,100 beds by 2026, or roughly 151 beds per year. With just over 1,200 beds lost in the market in 2016, the regional build rate could actually be closer to 1,350 new beds per year in order to offset home closures.

At the same time that demand is rising, the pipeline of planned developments in the South West suggests that just 700 beds will be built during 2018.

With about 77% of all care home beds built before modern quality standards were adopted in 2002, there is an urgent need for new development to meet demand and improve living standards for future care home residents.

Mr Oldfield said that priority should be given to care home provision in planning policy.

“A change of mindset is required that sees the development of care homes as an imperative for society and ensures that applications are resolved in a timely manner and without the frustrations that many operators report. “Attendant to reforms contained in the green paper should perhaps be protection or classification of land allocated to retirement living developments to ensure that the right type of housing is being built in the right locations. This would enable people to extend the period of independent living.”

http://www.devonlive.com/care-home-bed-build-has-to-double-to-offset-major-shortfall/story-30468122-detail/story.html

Budleigh “health hub” advertises for (paying) tenants

“The Budleigh Salterton Community Hospital Health and Wellbeing Hub (Budleigh Salterton Hub) will bring together local residents, the NHS, the voluntary, statutory and business sectors under a common purpose – to improve the quality of health and wellbeing for approx 48,500 people in the Woodbury, Exmouth and Budleigh (WEB) areas, including all the local villages and hamlets.

As a provider of health and wellbeing support, whether it be through fitness, social activities and groups, holistic therapies, mental health guidance, weight management, physiotherapy, healthy eating and lifestyle choices, art therapies, NHS outpatient services, catering, or childcare provision, this is your opportunity to get involved in this new and exciting project, supporting babies and children from early years through to older people.”

https://www.westbank.org.uk/Pages/FAQs/Category/budleigh-hub

Here is the “information pack”:

https://www.westbank.org.uk/Handlers/Download.ashx?IDMF=48d9c97d-1ad5-4ec3-86f5-1aab4f405774

Rooms ( including the kitchen) are from (not at) £15-25 per hour (NHS or private) and it seems from reading the brochure that, as yet, it has no tenants.

The (ir)responsibility of politicians

This long article is about the crisis in prisons. But the last four paragraphs quoted here could be about anything that is the responsibility of politicians:

“Who allowed this systematic irresponsibility? Civil servants could no doubt have been more robust in their advice. But the truth is that Grayling and Gove [and here add names of other ministers] at least did not broach any challenge. Any senior officials that they felt were obstructing their plans or raising awkward questions were edged out. It’s tough to push back when your job is at stake.

No doubt some governors and prison officers could have done more to raise problems and find solutions – but most of them had crises to manage.

The only conclusion I can really draw is that the blame lies with the politicians. They cut prison budgets without having a good understanding of the likely impact, then carried on cutting long after those consequences were clear. They focused on pet projects rather than getting the basics right.

They were supported in doing so from the very top. Cameron and Osborne [and now May and Hammond] made the call that people didn’t much care about the condition of our prisons [hospitals/schools/environment], and if budgets were to be cut this was a place to cut particularly deeply. They ignored signs that the system was creaking, and forgot that changing your justice secretary [or any minister except Hunt where no-one wanted his job] every 18 months is a sure-fire way to create problems. Most important, they forgot that there is no better symbol that government is out of control than riots [bed shortages/failing schools/concrete jungles] within the facilities they are meant to run.”

https://www.theguardian.com/commentisfree/2017/aug/02/prisoners-rioting-serial-ministerial-incompetence-justice-chris-grayling-michael-gove

The execution of the NHS

The extent of the crisis in England’s GP services has been laid bare. And if there was any doubt as to why patients are struggling to get appointments with their doctors, Jeremy Hunt now has the answer right in front of him. And it’s staggering.

Staggering numbers

NHS Digital has released statistics [pdf] on the number of GP surgeries that have opened and closed, for the year up until 30 June 2017. And they show that, in the space of 12 months, 202 GP practices either closed or merged across England; with just eight opening to replace them.

As GP Online reported, the regional breakdown of closures and mergers was:

North of England – 64.
South of England – 54.
Midlands and East – 45.
London – 39.
GPs pushed to the brink

But the closures were confined to 47% of the 209 Clinical Commissioning Groups (CCG); meaning the majority of England saw no closures or mergers at all. In contrast, NHS Digital’s data showed that the number of patients registered with GPs had increased, again; up 55,178 in July compared to June. And there are now 2,427,526 more registered patients than in July 2013. Meanwhile, the number of full-time GPs dropped by nearly 3% in the year up to March 2017.

NHS Digital’s figures come as the British Medical Association (BMA) has balloted its GP members for industrial action. This would involve GP practices stopping taking any new patients. They would either suspend new patient registrations, or apply for a formal closure of patient registration lists.

The broader context

But any action by GPs comes in the context of a wider crisis within the NHS. As The Canary has repeatedly documented:

The amount the NHS paid to ‘independent’ companies has more than doubled since 2010 to over £8bn a year.

8% of government health funding now goes to private companies.
Private companies working in the NHS have seen their profits soar by up to 100%.

The NHS has seen a real-terms cut in the amount of money given to it per patient.

The Tories have cut the number of people getting social care by 26%. And they’ve cut £50m from children’s mental health services.

Successive Tory-led governments have capped [paywall] the pay rises of doctors, nurses and healthcare workers at just 1%.

Additionally, between 2010 and 2015, mental health trusts lost the equivalent of £598m a year from their budgets. And findings show that there are still £4.5m of mental health spending cuts to come. Also, there will be an additional £85m in cuts to public health budgets this year alone.

A GP speaks out

The Canary spoke to writer and GP Dr Kailash Chand OBE. And he perhaps best summed up the situation:

General practice, ‘the jewel in the crown of the NHS’, is at the brink of extinction. Across the board, GPs today are underpaid and overworked. The NHS is losing good people because GPs feel demoralised. They haven’t had a pay rise in seven years: a 1% uplift this year is a real-terms pay cut. The entire crop of GPs is undervalued, and more and more work and expectations are being put on them.

But the NHS is also facing financial meltdown, catastrophic workforce issues and political uncertainty. It is a world-class institution – with world-class practitioners now being torn apart by second-rate politicians. We are already on the way to the end of comprehensive healthcare, free at the point of need, available to all who need it.

Once the NHS is gone, it will be gone forever. And sick people will face the nightmare of not being able to afford the treatment they need. It’s time to stand up and fight!

The end of the NHS?

We have a now-permanent crisis in hospitals; GP surgeries over-subscribed and at breaking point; and social care is severely under-funded. But many believe that the Tories’ approach to the NHS is one of ‘shock therapy‘; that is, create a crisis so bad that the only apparent solution is to sell it off to private companies. And with this latest news about GP practices, we could – as Chand says – be well on the way to the end of the NHS as we know it.”

https://www.thecanary.co/2017/07/14/youre-wondering-cant-get-gp-appointment-jeremy-hunt-now-knows-shocking-answer/

When privatisation goes bad – Carillion part 2

We are endlessly being told that “privatisation good, state ownership bad”. There is an implied belief that anything state-run is inherently badly managed, inefficient and wasteful whereas companies which take on former state-run entities are well-managed, efficient and better at using resources.

Carillion (and earlier on this year Capita and Mitie – not to forget all the utility companies) have proved that this idea totally wrong.

“… there is a support services arm [of Carillion], which includes maintenance on buildings and cleaning services. And, thirdly, there is PPP, where it might fund and manage the building of a new NHS hospital.

PPP is one of those financial inventions that was sold as being a win-win for both sides. The government might get some new infrastructure more quickly and without having to pay the huge upfront costs of building it, while the private companies financing the deal gained a valuable long-term income stream – often over 20 years or so. At least, that was the theory.

Just three Carillion PPP contracts – thought to be the Midland Metropolitan hospital in Smethwick, Merseyside’s Royal Liverpool hospital and an Aberdeen road project – are behind the bulk of the £375m losses that relate to the UK.

Industry watchers say that project delays – caused by such astonishing occurrences such as cold weather in Aberdeen over the winter – have introduced huge extra costs. Construction of the Royal Liverpool hospital has also been beset with hold-ups, most recently after workers found “extensive” asbestos on site and cracks in the new building.

Meanwhile, just before the profit warning, it was revealed that another Carillion project – an experimental tram-train linking Sheffield and Rotherham – has cost more than five times the agreed budget and is running almost three years late. The government has been forced to compensate tram operator Stagecoach for the delays with a £2.5m payment.

These types of setback are frequent complaints of investors in the sector and is one of the reasons the City has long taken a dim view of Carillion. For months, the company has been one of the UK stock market’s most shorted companies – meaning that investors have been placing bets on a fall in the company’s share price. …”

So, what do we learn from this? Well, one thing is that big investors, such as hedge funds, never lose. As soon as they sniff failure of a company, they lay bets on that failure and collect if they are right. Other “investors” seeing these bets also bet on failure.

Cream off profits, increase directors’ pay when things are going well, collect on bets when things go wrong and sometimes STILL increase director pay. And the state ends up picking up some, or all, of the losses.

Privatisation: as big as the sub- prime mortgage scandal but more secretive till the excrement hits the climate controller.

And here a couple of observations about the company from commentators on the article:

“Would love to see this company fold this is the best news I’ve heard all year. Having worked for this poorly managed company for 2 years from which I resigned because the management made life difficult this is music to my ears. Please remember this is also the company that operated the black book they kept a lot of good people on the dole because their faces didn’t fit. Hopefully They will be history very soon.”

and

“The FCA should look into this debacle. A company of almost 50,000 employees and annual revenue of £5bn does not suddenly sink like this without good reason. Many companies survive on slim margins in competitive industries. Senior managers must be held to account and for the umpteenth time …. what were the auditors doing?”

“What we should learn from the crisis at Government contractor Carillion”?

“Given how many have struggled, should we really be handing so many state services to these businesses?

How long can it be before a crisis at a Government contractor turns really nasty, and the National Audit Office’s warning that the big guns have become too big to fail proves prophetic?

The week in the City has kicked off with yet another finding itself in the midst of a very big mess. This time it’s Carillion.

Having trumpeted it’s “high quality order book”, reassured that performance was “in line with expectations” and repeated a pledge to reduce debt in March, things have taken a dramatic turn for the worse.

The company, that does everything from catering to construction, and employs 47,000 people worldwide, has issued a brutal profit warning and suspended its dividend in a bid to save cash. Chief executive Richard Howson is on his way out and a “comprehensive review” of the business is to be launched (KPMG is already poking around the construction operations).

Amid longstanding investor concerns about its finances, debt continues to rise, despite the actions that the company has taken to stop the rot.

They include exiting construction public private partnerships in this country, pulling out of construction in the Middle East, and being ultra careful when it comes to taking on new projects.

It looks awful, and it’s interesting to note that Mr Howson is supposed to be sticking around to help keep the show on the road with his interim replacement Keith Cochrane while the company tries to find someone to get it back on an even keel.

The thing is, we’ve seen this sort of thing before, and on repeated occasions. As the mania for outsourcing took hold on the part of Government and in the private sector, a host of companies like Carillon grew and got fat.

They used the vast revenues they earned to expand overseas, taking on more and more diverse streams of work in more and more parts of the world. Jacks of all trade, masters of… well it hardly needs saying.

Pick a contractor, any contractor, and Google will probably be able to find you a crisis like the one at Carillion.

Just last year, Capita’s shares hit a ten year low after the second profit warning in three months. Meanwhile Serco, which appointed Winston Churchill’s grandson to sort out its financial mess, has found itself smack in the middle of an operational foul up.

Having taken on a big contract at the four hospitals overseen by the Barts NHS Trust (ironically Carillion previously handled part of it), perhaps evidence of renewed official faith in its abilities, it managed to provoke a strike among cleaning staff at the Royal London Hospital after just three days.

Three months on, and 1,000 cleaners, porters, caterers and security staff, at the latter and the other hospitals, are poised to begin industrial action.

And so it goes on. And on and on.

Badly managed finances, badly managed contracts, unhappy staff, unhappy customers, unhappy workers.

You’d think, given all this, that someone would ask seriously whether it’s really such a good idea to have handed such a wide range of state services to companies that operate in this manner, and that keep falling flat on their faces.

Yet, with the notable exception of the NAO, it’s not happening.

Faced with situations like those above, the Government shrugs its shoulders, perhaps because, ultimately, the companies concerned have always just about found a way through their difficulties.

It seems we might have to wait for a truly dreadful crisis, one that really hurts people, for this to change.

It always seems to be that way in modern Britain.”

http://www.independent.co.uk/news/business/comment/carillion-government-contract-crisis-outsourcing-profit-warning-construction-richard-howson-a7833216.html