The kinds of things we need to look out for in Salisbury

Here are some lessons from the “Coastal West Sussex Clinical Commissioning Group”.  Apart from commissioning Virgin Care to deliver Sexual Health Services in what looks like opaque circumstances here is a news item which demonstrates that there is a real risk that the Health and Social Care Reform Bill will allow for NHS patients to be charged for treatments that were, or still are, free under the NHS while at the same time tax payers/NHS money will be used to subsidise private patients.   In other words this looks like yet another example of transfer of funds from the 99% to the 1%.

This and the many other potential conflicts of interest could destroy the GP – patient relationship which is currently the jewel in the crown of the NHS.

“GP surgery’s private sessions could break BMA ethics guidance”  West Sussex County Times, Monday 20 February 2012: http://www.wscountytimes.co.uk/news/health/gp-surgery-s-private-sessions-could-break-bma-ethics-guidance-1-3540121#

Virgin Care to deliver Sexual Health Services in what looks like opaque circumstances

Salisbury NHS Watch: News

In case you didn’t know, Clinical Commissioning Groups (CCGs) are taking over from the old PCTs (Primary Care Trusts). Our local CCG is the “Sarum NHS Alliance”.  However it seems that the Sarum NHS Alliance is merging with other Wiltshire CCGs to form one county wide CCG.

The news report linked below indicates that the merger is due to the work loads involved and to the need to avoid a “post code lottery”.  This last point is interesting because it is exactly what the previous , chief executive of Salisbury NHS Foundation Trust, Matthew Kershaw, admitted the reforms could lead to.

In an article from last year (see link below). Kershaw discussed the risk that neighbouring CCGs could offer different levels of service, refuse to provide certain treatments or allow longer waiting lists for more expensive treatments.  Conversely he warned of the possibility of CCGs merging together to provide a more uniform service in an area but that this would undermine and prevent the competition that the Government is aiming for.  Interesting issues – see link below for more details.

The new CCG will operate in shadow form and work closely with NHS Wiltshire this year before it takes over the reins in April 2013.

So What are Clinical Commissioning Groups?

Clinical Commissioning Groups are groups of GPs that will, from April 2013, be responsible for designing local health services In England. They will do this by commissioning or buying health and care services. (There is also the NHSCB and the four SHAs but more of those in a future post).  Apparently, aboard of 5 GPs and 2 non GPs was formed last April to run a Clinical Commissioning Group based around Salisbury Hospital, called Sarum NHS Alliance. It consists of 27 practices and approximately 150,000 patients.

This all sounds great – who better to control our health service than dedicated well known and trusted local GPs.  Unfortunately it might not turn out like that in the long run – the kind of GP who is dedicate to his/her patients and the community is unlikely to enjoy the management and committee work of a CCG.  Evidence is already appearing which indicates that CCGs are likely to end up consisting disproportionately of GPs who own stakes in non-NHS providers and could use their decision-making power to simply commission their own companies to offer services.  Here is an example. I stress that I have no reason to believe that any of this is true for our local CCGs and am sure that those that have got involved have done so for the best of reasons – to ensure that they can adapt and guide  the reforms for the benefit of their local communities. However, we all need to be vigilant to ensure that we spot the conflicts of interest that could develop in the long term.

News:
A Salisbury GP has resigned as chair of Sarum NHS Alliance commissioning group. The Doctor, who was previously heavily involved in practice-based commissioning, said ‘The CCG role was becoming too much. I had to make a choice and in the end my priority was my patients’:  http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/13150087/gps-quit-ccg-roles-as-commissioning-enthusiasts-lose-heart

NHS reforms ‘risk’ creating a postcode lottery: http://www.onmedica.com/viewsArticle.aspx?id=ab2354d4-b1b2-4b85-8cbf-c7f3bf68ea98

Three Wiltshire CCGs (including Sarum NHS Alliance) to merge:  http://www.gazetteandherald.co.uk/news/9628367.Three_Wiltshire_CCGs_to_merge/

Half of GPs on clinical commissioning groups have financial links with private providers:   http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/13150087/gps-quit-ccg-roles-as-commissioning-enthusiasts-lose-heart

What happens in Surrey today could happen in Salisbury tomorrow

“The people of Surrey did not vote for their NHS to be gutted and served on a silver platter to Virgin Care, but that’s what they got”:  Healthy competition in the NHS is a sick joke (Daily Telegraph)

So this is what David Cameron meant when he promised that the NHS would not be privatised. He clearly uses a disingenuous definition of privatise.

The people of Surrey were not consulted, there was no democratic process. Surely we need to be more proactive in Salisbury?

Letters to Salisbury Journal

This is a copy of  a letter that I wrote to The Salisbury Journal letters page (Postbag) and which appeared on Thursday 22nd March 2012.  Link

Having been the recipient of excellent healthcare from my Salisbury GP service and Salisbury District Hospital, I am compelled to write about my concern that we, the patients and taxpayers, seem to be doing little to prevent the destruction of our NHS.

According to independent and objective international comparisons, the NHS is one of the most cost effective and successful health care systems on the planet. This is despite political interference and chronic underfunding for most of its existence.

Yes, there are defects, as there are with all other systems, and we should be ashamed that we have not fought harder for these to be fixed.

But the government reforms, not mentioned in any manifesto, and with no democratic mandate, will result in an NHS run by companies who will make decisions which prioritise their shareholders’ interests and will channel huge sums of tax payers’ money into their profits and CEOs’ bonuses.

Some of these companies already have a dubious track record. Their contracts and finances are subject to confidentiality and they are immune to the Freedom of Information Act.

We cannot trust any of the political parties.

The Labour Party, when in power, introduced privatisation by stealth and the present Tory/Lib Dems want to turbocharge this and enshrine it in law to prevent any reversal. If we want to retain a National Health Service we will have to fight for it ourselves.

If we care about the NHS we need to pay attention and get involved – it will soon be too late and there will be no going back – our children and grandchildren will not forgive us if we do not fight the self-interest and ideology which threatens our NHS.

COLIN LAWSON, Salisbury

The Postbag editor clearly wanted to liven things up and so gave my letter the headline:  “Political parties cannot be trusted with our NHS”.  I do not think this fairly reflected the thrust of my letter but nevertheless it did prompt Steve Fear from the Labour party to write in response.  This is a link to his letter. I have not pasted it hear in case the Journal has the copyright.

In the following week there was a response from John Wigglesworth. Link here.

As I do not believe either of these responses addressed the focus of my original letter, I followed it up with another letter to the Journal – this was published on Thursday 19th April with another letter from Steve Fear. Here is the link to Steve’s message. I have posted my letter, in full, below (the Journal’s version was significantly edited).

Letter to Salisbury Journal Post Bag (published 19th April)

My recent letter to Postbag (21st March 2012) regarding the demise of the NHS has generated a couple of responses but both were of a party political nature.  They did not address the focus of my letter which was that the passing of the Health and Social Care Bill effectively means the end of the NHS as we have known it and that health care in the future will be subject to huge conflicts of interest with inadequate safeguards.

At the local level, a senior GP has resigned as chair of Sarum NHS Alliance Clinical Commissioning Group (CCG) due to the adverse impact on his professional and personal life and the care he felt he could provide his patients.

In case you didn’t know, CCGs are taking over from the old PCTs (Primary Care Trusts), does this mean that people are being made redundant from the PCTs, at great expense, only to be reemployed by the new CCGs?

I note that at least one experienced local GP is giving up one day a week in her surgery because of her membership of Sarum NHS Alliance. How many more GPs are being taken away from contact with their patients?

It now seems that our local Sarum NHS Alliance is going to amalgamate with the rest of Wiltshire to form a county wide CCG.  Will this be good or bad for Salisbury?

What happens if our local GPs decide that they didn’t enter medicine to become managers of multi million pound budgets and they decide to hand over the CCG to management consultants with service delivery run by Virgin Health Care or the health care equivalent of A4E?

I don’t know the answers to any of these questions.  It would be great if someone who does could write a letter to Postbag giving us an update.

The reform bill gives a legal basis for charging and providing fewer health services this could mean a large number of private beds in our hospital and, as seems likely, GPs telling their patients that they will have to pay for services currently provided free through the NHS.

Please don’t think I am making this up – check for your self, these changes are already happening in other parts of the country.  If we care about this we need to pay attention to what is happening locally and be prepared to fight for the retention of a comprehensive, integrated health care system that serves the whole community.

Colin Lawson

Salisbury NHS Watch

On March 27th 2012 the Health and Social Care Bill became law and at a stroke brought to an end sixty years of the NHS. What the future holds I do not know but what is clear is that it will not be a universal, comprehensive integrated health service available to the whole community as we have now.  It will be a system in which huge conflicts of interest, mixed with huge sums of tax payers money, will offer individuals and international corporations unrivalled temptations to make huge sums of money at our expense.

This has happened on our watch, our children and grandchildren will not forgive us.  With a few notable and commendable exceptions the media, political parties, health care professionals and us the patients and taxpayers have all stood back and allowed this to happen with a virtually non existent level of public debate.  And to top all this the “reform” of the NHS was on no parties agenda – there is no democratic mandate whatsoever for the biggest change in health care since the formation of the NHS.   When David Cameron said the NHS was safe in his hands and that the NHS would not be privatised he was simply not telling the truth – we have been taken as fools.

I have started this branch of my blog as a place to document and log the development in Health Care in my home City of Salisbury in the vain hope that it may serve as some use in the fight to ensure that we can avoid the worst excesses of what could happen to health and social care in England over the next few decades.

Salisbury NHS Watch – more …

The NHS is threatened by legalised corruption

The Health and Social Care Bill is hugely complicated, few have the time to read it and it is difficult to predict the consequences with any confidence.  So instead of asking if the NHS reform bill is a disaster waiting to happen, let’s ask a different question – do we trust those who are doing the re-organisation?

All the evidence suggests that private health care corporations from all over the world are queuing up (with government encouragement) for some of the action – a 100 billion pound budget.  When you view the links below you will find evidence that every level of the NHS reform, including the government, has been infiltrated by the private sector and it is very difficult to detect anyone who will be looking after the interests of the patients or taxpayers.

In the run up to the 2010 election, David Cameron warned that lobbying was ‘the next big scandal waiting to happen’, unfortunately he has done precious little about this issue since gaining power and there have already been a series of scandals. The control of NHS reform by corporate lobbyists looks set to be a scandal on a massive scale. If we are not vigilant this will result in the bulk reallocation of huge sums of tax payer’s money to private sector profits and CEO million pound bonuses. It will make the sums of money involved in the  A4E scandal look like pocket money.

Let’s not wait until it’s too late to expose this threat.  The NHS needs continuing reform, perhaps radical reform, but reform based on evidence and reason, cooperation and collaboration, not the blind ideology and self interest of free market libertarians.

There will be a place in any NHS reform for private contractors to earn a reasonable profit by providing quality services but the evidence and track record of some of the big players suggest they are in this for a lot more than reasonable profits. In the US, the health care industry has usurped democratic control with the result that health care is run for the benefit of insurance companies and private health care providers. This is to the detriment of the people, many of whom experience third world standards of health care or no health care at all. Any meaningful attempts at reform in the US are always vetoed by the industry despite a strong popular mandate for reform.

In the UK we need to be sure that those leading the reforms have the best interests of patients and taxpayers at heart and  are not influenced by, at best, massive conflicts of interest, or at worst, a form of legalised corruption.

Note: Monitor is the new regulator of the NHS. Whoever controls Monitor controls the reforms. Monitor’s chief executive is a former private equity financier and McKinsey man, seconded from a private health business. Its chief operating officer and director of strategy are both from KPMG, which has recently acquired substantial NHS contracts, with many more to come as such firms move in on commissioning.  Who is representing the patient and taxpayer???

NHS fairness tsar urged to quit by doctors over ‘conflict of interest’ following £799,000

NHS privatisation: Compilation of financial and vested interests.

Conflicts of interest and NHS reform

The firm that hijacked the NHS: MoS investigation reveals extraordinary extent of international management consultant’s role in Lansley’s health reforms

“This NHS Bill has the handprints of the US insurance industry all over it’ Wendell Potter US Insurance Industry Whistleblower

Lords conflict of interest investigation: Letter of complaint sent into Commissioner for Standards

Public services, big earners: a sector-by-sector analysis

Click here for even more evidence of: The revolving door between healthcare companies, lobbyists, think tanks, special advisers and government

Click here for more information on the NHS Bill: It looks like people are finally paying attention to the government’s Health & Social Care Bill – let’s hope it’s not too late

Here is a list of the latest reasons for being very wary of attempts to outsource public service  contracts to the private sector:
Welfare boss Emma Harrison made a pile renting out her stately home to A4e

IT firm behind ‘unworkable’ NHS database keeps IT deal

A4e employee forged signatures to boost job placement numbers

The insidious, incremental growth of a huge, private shadow state has taken Britain by surprise

100 Tories revolt over Wind Farms part 2

Recently 100 MPs wrote a letter to Dave Cameron demanding cuts to financial support for wind farms.

The letter contained a series of assertions with no reference to evidence or rational argument. The MPs could only make naïve or more likely disingenuous assertions such as wind power is intermittent, as if no one had thought of that before.

The fact is that all energy sources have been subsidised one way or another. Oil and gas exploration gains from massive tax breaks. Oil and Gas companies make excess unearned profits due to regular political crises which put up market prices – those unearned profits come from the ever increasing price to the consumer.

Coal has been subsidised because it has never had to pay for the damage that over a hundred years of pollution has done to our health, forests, buildings and our environment.

In the case of Nuclear Power the costs have been so lacking in  transparency and governments have been so cagey about publishing the costs involved that it is true to say that we really have little idea of the true cost of Nuclear Energy.

Here is an interesting article about Nuclear Power which should be essential reading for all those who think Wind Power is too expensive: Environmental research Web

100 Tories revolt over Wind Farms part 1

100 Tories revolt over wind farms

More misinformation and made up facts from Tory MPs.

If they are genuinely concerned about the subsidies devoted to wind power then why are they not also concerned about the unquantified, opaque and open ended subsidies for nuclear power.

What about the subsidies/tax breaks for North Sea Oil and Gas?

In fact all new sources of energy have been subsidised at least in their initial development.

What about the hidden subsidies due to pollution and ill health caused by coal fired power stations and the ill health and environmental damage due to coal extraction.

If those 100 MPs are genuinely worried about consumer’s energy bills why don’t they admit that renewable energy subsidises are a very small part of the increases in fuel prices . The reason for the rise in energy bills is the rapidly rising wholesale costs of oil and gas and  the massive profits being made by the six big energy companies.  The energy companies, many foreign owned, are able to increase their profits simply on the back of the rising international prices – they do not work more efficiently or harder, all they do is put the prices up a bit more than their costs.  So why don’t the MPs start with those unearned profits  if they are concerned about consumers?

Fossil Fuel Subsidies Six Times More Than Renewable Energy

IEA: fossil fuel subsidies must be cut

Why are energy prices rising (OFGEM)

Why Tory MPs opposition to wind power will put your energy bill up

Instead of sending baseless letters to the media, the 100 MPs would be better off using their time  signing up to this: http://www.38degrees.org.uk/page/s/the-big-switch#petition

“Only the little people pay tax”

“We don’t pay taxes. Only the little people pay tax” this is what millionairess Leona Helmsley said when she was caught fiddling her tax in 1989.  Things haven’t changed – this attitude seems to pervade the ranks of those who are paid more than they know how to spend.  The current government, full of inherited wealth, is really keen and enthusiastic about taking fast and ruthless action to root out ‘benefit scroungers’ and ‘feckless lazy council house tenants’. But when it comes to doing something about the much larger amounts lost to tax evasion and the pernicious corrupting effect of tax havens they suddenly become very cautious.   So much for “We are all in this together”  the evidence suggests that in reality they also believe that “Its only the little people who pay tax.”   Take a look at these:

Civil servant tax claims: Danny Alexander orders review (Special deals for high earning civil servants)

There’s one rule for the rich and another for everyone else

Dave-Harnett-to-step-down-from-HMRC Dave Harntettt chief at HMRC walks away with a comfortable pension having done his best to ensure that “only the little people pay taxes”

Update:  Government embarrassed into action:  Student Loans chief  ‘to pay tax at source’ like the rest of us.

The loopholes which destroy HMRC’s claim that Swiss tax deal will see a £4-7bn Treasury windfall

The revolving door between healthcare companies, lobbyists, think tanks, special advisers and government

The revolving door between healthcare companies ( in black), think tanks ( in grey) and government is shown in the chart below. It spreads through Labour as well as the Conservatives. It started under New Labour and under the Coalition it is out of control.  All areas of government have been penetrated by industry sponsored think tanks, lobby groups and special advisers with their feet firmly planted in financial interests.  It is clear that health policy in particular must be deeply compromised by these cosy links. Where are the patients in this process??  (Note the chart is a little out of date – Tony Blair has moved on to more lucrative pastures. But nevertheless we can be confident that the situation has not improved.)

(Click chart to enlarge)

Private Healthcare Network (thanks to Spinwatch and Open Democracy)

The Plot against the NHS

Watch this video for more info on the work of Lobbyists

Andrew Lansley bankrolled by private healthcare provider (Slightly old news but still relevant)

Investigation reveals extraordinary extent of international management consultant’s role in Lansley’s health reforms

The Health Service is being privatised! I don’t remember voting for that, was there a referendum?