Corbyn pins Labour"s local election hopes on NHS and schools

Jeremy Corbyn has pledged to put the NHS crisis and lack of school funding at the heart of Labour’s local election campaign, and blamed the party’s poor polling on the media for failing to give those issues due prominence.

The Labour leader launched the campaign in Newark, Nottinghamshire, against a backdrop of low support in the polls and warnings that his party could lose dozens of seats on 4 May.

His supporters booed when Corbyn was asked whether the local elections would be the ultimate and perhaps final test for his leadership.

“These elections are a chance for us to take our case out to the country about how we want to make a fairer Britain, an investment-led Britain, a Britain that isn’t in health crisis, schools that are not underfunded where they have to collect from the parents, that we don’t have to go around the whole country seeing Sure Start centres closed, libraries closed, all these things,” the Labour leader said.

“We will take the case out there for what Labour councils can do and do their best in a period of austerity but show that a Labour government will invest in the needs of people not in tax giveaways.”

He added: “Our party is very strong and very active on all of the doorsteps.”

During his speech, Corbyn highlighted figures suggesting life expectancy in Britain for pensioners is falling.

When asked why opinion polls show support for the Conservatives is so much higher than for Labour when the NHS is struggling and life expectancy falling for some groups, Corbyn said: “Too often our media do not deal with the issues people face day to day. There are more than a million people waiting for social care in this country and there are many people stuck in hospital who frankly shouldn’t be in hospital but can’t leave … and so I’m not expecting or wanting an easy ride from the media, I don’t care about that.

“But what I do care about is an obsession by so many to ignore the reality of homelessness, of social care … It simply doesn’t have to be the case in modern Britain. So these elections give us an opportunity and I hope all newspapers and radio and TV will at least get involved in the serious debate about health, social care, schools, housing because at the end of the day if people grow up in poverty they tend to underachieve at school and if they underachieve at school, they tend to lead less fulfilling lives. If they lead less fulfilling lives, we all lose.”

The local government elections – including many county council seats – will take place across England, Scotland and Wales, alongside a number of mayoral elections in areas such as Greater Manchester and the West Midlands.

Prof John Curtice, the leading election expert, has warned there could be a 12-point swing from Labour to the Conservatives in May’s contests, with Corbyn’s party at risk of losing control of councils in Nottinghamshire and Derbyshire.

The latest Guardian/ICM poll put Labour at 25%, their lowest support in these polls since the 2015 general election and joint equal to their lowest performance going back to 1983.

Corbyn pins Labour"s local election hopes on NHS and schools

The banana republic of Surrey has shown local council funding is broken | Simon Jenkins

The algebra is simple. The NHS is having another terrible winter. It does not collapse, but “spills demand” on to the next line of defence, local government welfare. But while the NHS gets more money annually from the Treasury, local government gets less, some 30% less since 2011. It cannot cope with the new pressure.

The equation resolves itself into rationing, by quantity and quality: fewer care places, fewer home visits and fewer district nurses leads to more bed-blocking, fewer operations, longer trolley waits.

Tory Surrey is a responsible supplier of post-hospital care. Like all councils, it is allowed by the Treasury to increase its council tax by 5%, specifically to boost its care budget and thus ease pressure on the NHS – which the Treasury is responsible for funding. Surrey county council regarded this as nothing like enough. It therefore activated its statutory right to hold a referendum on a 15% increase.

Far from showing delight at a wealthy council accepting this burden, the Tory government was appalled. Tories do not increase taxes. The chancellor (and Surrey MP) Philip Hammond duly did what Jeremy Corbyn called a secret deal. If Surrey abandoned its referendum and the 15% hike, it could retain revenue from a different tax – the local business rate, which normally went to the Treasury. That is, the Treasury would in effect spend more on health and care in Surrey, but secretly and, so far, just for Surrey.

This is the stuff of a banana republic. If Britain wants to spend more on health and elderly care, it should raise it and spend it honestly. Instead, the Treasury is running around its fiscal A&E department, staunching the flow of political blood by slamming on plasters wherever a patient screams or twists an arm.

Leaked Surrey council tax texts allow Corbyn to ambush May at PMQs

Some might argue that an NHS free at the point of delivery has had its day. New disciplines and incentives, through fees or insurance or more prevention, must constrain marginal demand. But for the time being, it makes no sense to squeeze the NHS at the top – where politicians are exposed – and dump its problems on to local government and different funding streams at the bottom. It wastes money and distorts priorities. It is illiterate public finance.

If Surrey is harbinger of a new health and care service, and business taxes are to relieve an ever-burgeoning NHS, so be it. But few places are as rich as Surrey. Revenue will have to be redistributed from rich to poor areas. In other words, it is not just the NHS that needs rethinking, but the whole murky world of local government finance.

The banana republic of Surrey has shown local council funding is broken | Simon Jenkins

How local accents have replaced Stephen Hawking-style voiceboxes

Stephen Hawking’s synthetic speech box is so fundamental to his persona that he reportedly refuses to upgrade to a more natural-sounding voice. But for the rest of the estimated 5,000 people with motor neurone disease in the UK – at least 80% of whom experience loss of speech – sounding like Stephen Hawking isn’t a particularly desirable prospect.

That is why MND researchers are working to ensure patients can still use their own voices, even after they lose the ability to speak. Jason Liversidge, a 41-year-old father from Scarborough, was diagnosed with MND in 2013 and his speech is already impaired. Now specialists at the Anne Rowling clinic in Edinburgh are making him a synthetic voice with a Yorkshire accent, generated by dozens of speech donors from the Scarborough area – including his best friend Phil. “I just don’t want to be a programmed voice on a computer,” Liversidge recently told the BBC, describing his voice as “a form of identity”.

Karen Pearce, a director of care at the MND Association, says people underestimate how central their speech patterns or catchphrases are to their identity. “I can’t imagine anything more important than being able to say to your wife, your husband or your children that you love them in your own voice,” she says, pointing to the case of an Irish man with MND who found that the off-the-peg selection of synthesised voices did not include an Irish male.

“He either had to choose ‘Irish Mary’, or use a Scottish voice. So now he talks in a Scottish accent. That really has an impact on someone’s identity.”

Liversidge is a lucky exception: he got involved with the University of Edinburgh’s Speak Unique project, a pilot programme collecting voice donations from every region, gender and age group in Scotland, which can theoretically be used to blend tailored voices resembling those of people with MND.

The MND Association encourages people to bank their own voices as soon as possible after they’re diagnosed, before the condition begins to affect their speech. Services such as CereVoice Me, ModelTalker and VocaliD invite patients to record several hundred phrases, from which they can generate an infinite selection of words and sentences using an iPad app controlled by the flick of a finger or the movement of an eye.

Stephen Hawking’s current voice machine interface was custom-made by Intel in 2013, and is controlled by an infrared switch that he operates by twitching his cheek. But the voice itself is the same one he has had since 1986, when he got his first speech synthesiser. Even he can’t tell where it’s supposed to be from, writing on his website that his accent “has been described variously as Scandinavian, American or Scottish”.

How local accents have replaced Stephen Hawking-style voiceboxes

The Guardian view on local government: put up or shut up | Editorial

No one, ever, wants to talk about remote, unglamorous, local government funding. As long as the bins are emptied, most fit adults put up with the closure of the local library or reduced hours at the leisure centre as a sad but minor inconvenience. It is time to take a refresher course.

What and how councils were funded was settled with a sigh of relief audible around the country after Margaret Thatcher was destroyed by the poll tax in 1990. Now the results of these decades of political neglect are in the headlines – but only because the cash crisis in locally funded social care is a major contributor to the crisis in the NHS. Local government finance is a long way from the point where it is threatening a prime minister. But that doesn’t mean it can’t happen again.

Councils’ income comes mainly in Whitehall grant. Much of it is tied to particular budgets like schools, or pothole repair. In various permutations, it also comes from the regressive council and business taxes that are based on property values not disposable income. Since 2010, increases in council tax have been capped at 2%, unless a local referendum authorises a rise. At the same time, central government has cut its grant to councils by more than 25%. Last month, the communities secretary, Sajid Javid, confirmed the budget for the coming year; now the local government association has crunched the numbers. It warns that by 2020 there will be a shortfall in cash of nearly £6bn. On the ground, that represents further and deeper cuts in every department. In particular it means further pressure on adult social care. There’s too little money for services that help people stay at home; care homes are shutting or going bust, and vulnerable elderly people are forced to move. And it means more hospital beds occupied by people who’d like to get out, but have nowhere to go. Last week Surrey, a Tory heartland, announced one radical answer: a referendum on raising council tax by 15%. In leafy Surrey, that will generate an extra £90m a year. But in Liverpool, where a 10% increase has been considered, it would bring in barely a third of that.

Things have to change. In health and social care, no policy maker can make rational decisions when social care is paid for by the client or the council while the NHS is free at the point of use. Every sensible reform starts with pooled local health and care budgets. The NHS’s programme of individual sustainable transformation plans being prepared district by district may be one way of working out how to do this, but they are likely to come with an unpopular bill in terms of reforms of wider NHS provision.

Health spending, however, is only one part of what is needed. The northern powerhouse, which in effect devolves industrial strategy, may evolve into a model for other local government organisation. Its advantage is not only that it can tailor policies in education and skills training, infrastructure development and housing to meet its particular needs but, by growing the local economy, it can also increase the region’s tax take. For the question at the heart of the dilemma is how to fund local government in a way that is both sustainable and locally accountable. As LSE’s local finance wizard Tony Travers put it, we cannot go on running Swedish-style services on a US-style tax system. We have to choose.

The Guardian view on local government: put up or shut up | Editorial

London health and care reforms finally emerge to face local scrutiny

A report from thinktank the King’s Fund says the latest government plans for reorganising health and social care in England have been kept shrouded in secrecy by NHS England and taken little note of the views of the public and frontline staff. This will come as no surprise in London, where there’s been great annoyance that draft plans produced in October were not immediately opened up for general scrutiny by Londoners.

Two local authorities went ahead and published anyway. “There’s no way the NHS can produce these plans in secret,” tweeted Camden’s Labour leader Sarah Hayward when her council became the second in the country (after Birmingham’s) to unveil the 68-page draft sustainability and transformation plan (STP) for the North Central London area, which also takes in the boroughs of Barnet, Islington, Haringey and Enfield. “There is a national crisis in both the health and social care systems,” she said in a statement. “Both need to change and we recognise they could be more efficient. As the provider and commissioner of social care services in Camden, we want to be sure that future needs are reflected in this plan.”

The other borough to publish was Lib Dem-controlled Sutton, which fits into the South West London organisational “footprint” along with Croydon, Kingston, Merton, Richmond and Wandsworth. Sutton leader Ruth Dombey acknowledged some “strategic engagement” on the part of the various local NHS bodies involved and said boroughs had been informally updated on the progress of their STP. However, she said that central NHS’s not allowing the general release of its provisional version “is raising worries about its content and the process around its development”. That’s why she put the 61-page South West London draft STP out there smartish.

In all, five STP “footprints” cover Greater London out of the 44 in England as a whole. The other three are: North West London (encompassing Brent, Harrow, Hillingdon, Ealing, Hounslow, Hammersmith and Fulham, Westminster and Kensington and Chelsea); North East London (Barking and Dagenham, City of London, Hackney, Havering, Newham, Redbridge, Tower Hamlets and Waltham Forest); and South East London (Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark).

The draft STPs for the full quintet all have now been published, so at least – some will say at last – everyone can now have a look at what’s in store: see the North West one here, the North East one here and the South East one here. Passions have long been running high about these templates for reform, with some seeing them as exacting yet in some ways also potentially beneficial devolutions and integrations of vital services and others doubting they amount to anything other than mechanisms for ruthless cuts, closures and privatisations. All concerned with their creation have been feeling the strain. Now comes the anxious and heavy scrutiny.

In London, the debate has been taking place very much in the context of meeting the particular needs of a city with such a large, diverse and shifting population. The case for proper input from patients and practitioners seems exceptionally strong here. The Kings’ Fund report concludes with a summary of recommendations about the development of STP’s nationally. Several ring very true for the capital. They include:

Involvement in the STP process should be strengthened at all levels within the health and care system, particularly among clinicians, frontline staff and local authorities.

Meaningful involvement of patients and the public in the plans has not happened so far and must now be a priority.

National bodies in the NHS should ‘stress-test’ STPs to ensure that the assumptions underpinning them are credible and the changes they describe can be delivered. Realism is needed about what can be achieved within the timescales and funding available. Honesty is needed in communicating these messages to politicians and the public.

Read the report in full via here.

London health and care reforms finally emerge to face local scrutiny

Will the cultural chasm between NHS and local government threaten plans?

Serious tensions are emerging between the health service and local government.

There are three sources of conflict – centrally-imposed secrecy over the sustainability and transformation plan (STP) process, whether the aim of STPs is to fix the NHS or develop an integrated health and care system, and disputes over whether the financial plans being sent to NHS England are fact or fantasy.

At least five councils have now published the STP, despite NHS England asking local areas to keep them hidden until the central bodies have given their verdict.

This pointless subterfuge has put local politicians in an invidious position; if they do as they are told they run the risk of being accused of conniving in a cover-up of plans to shut services. Faced with incurring the wrath of either NHS England chief executive Simon Stevens or local voters, it is not a difficult choice. The surprise is that more councils have not taken the same step.

The first local authority to reveal one of the plans was Birmingham city council. Its chief executive, Mark Rogers, articulated publicly the frustrations many in local government express privately. He complained in the Health Service Journal that Stevens and NHS Improvement chief executive Jim Mackey were pressurising NHS organisations to sort out the health service debt crisis rather than make the entire health and care system sustainable.

At the Ncas social care conference on Friday, NHS England operations director, Matthew Swindells, was forced to apologise after he said that councillors needed to be “managed” in the STP process.

“When I said ‘managed’ I meant brought into the whole of the conversation,” he responded to angry lead members for adult social care, who protested that they had been shut out of local STP discussions. “That was not our intention. If that has happened, that is not satisfactory and I apologise for that.”

Swindells admitted that NHSE’s handling of the STP process had been “not our finest hour”, explaining that while “most” of the 44 plans were good work, “a lot” needed rewriting before they were understandable by a wider audience. They would all be published before Christmas.

The Five Year Forward View held out the prospect of moving the centre of gravity of the health and care system at least a few inches towards primary and community services. But the STP process is now in danger of reinforcing the domination of the hospital sector rather than reforming it. The implications of that are far more serious than simply maintaining a system that is failing to cope; it will require even more money to be pumped into hospitals to expand the number of beds.

Arguably the biggest weakness of the STP process is that the pressure on hospitals to get their finances under control is so intense that some are offering up plans for savings that have virtually no chance of being achieved. One council chief executive said a local deeply-indebted hospital was claiming that it would save millions but did not have a credible plan for making it happen.

On Tuesday, Rogers took to the Today programme’s airwaves to ram the point home, pointing out that the funding gap will not be closed by “simply using the transformation word endlessly”.

Another local government chief I spoke to was visibly angry at the failure of his local hospital to take even the most basic steps to improve their estatesmanagement, back-office systems and procurement, while his authority was being eviscerated by another round of cuts – with public health taking a big hit.

There is a cultural chasm between the NHS and local government when it comes to handling public money. It is illegal for local authorities to run a deficit on their services spending, so they are compelled to make tough decisions to live within their means. Chief financial officers have extensive powers to intervene if they believe unlawful expenditure is going to be incurred.

In contrast, in some trusts there appears little connection between the financial decisions of the board and what actually happens. It is that disconnect which lies behind scandals such as the financial collapse of St George’s in Tooting in 2015.

Local government is no nirvana, of course. Several authorities – including Birmingham and Manchester – are still struggling to deliver effective child protection services, and although councils face severe increases in demand, these are not on the scale confronting the NHS. But local government’s financial management is far more effective.

Despite the inevitable tensions, the good news is that local government and the NHS are learning to work together, marrying up clinical services with a stronger sense of place and beginning to develop a clearer vision for integrating health and care.

The challenge now is to drive hospital efficiencies such as those proposed by Lord Carter before hospital debt derails the chance of building one system.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Will the cultural chasm between NHS and local government threaten plans?

STPs: Radical local modernisation plans or the end of the NHS as we know it? | Denis Campbell

To some, they are bold, painful, inevitably controversial but nevertheless necessary local blueprints designed to save the NHS in England, area by area, by making it fit for the clinical, financial and organisational challenges it is facing. To others, though, they are sinister schemes that will see parts of, or even entire hospitals shut, fewer beds, the number of GP surgeries drastically reduced, NHS land sold to profiteers and private healthcare firms treating more NHS patients. What an NHS boss calls modernisation is an NHS campaigner’s road to destruction.

Either way, Sustainability and Transformation Plans (STPs), are the most important issue in the NHS and the thing that will do more than anything else to decide if it is still a viable and well-functioning healthcare system that can live within its means by 2020. They will dominate and form the backdrop to many of the speeches and debates at the NHS Expo in Manchester today and tomorrow. From an NHS point of view, they absolutely have to succeed. However, to do so, these microcosms of the NHS Five Year Forward View survival masterplan from 2014 must overcome a daunting array of very difficult obstacles.

Back in March, the NHS England chief executive, Simon Stevens, outlined the importance of STPs when he declared that: “Now is the time to confront – not duck – the big local choices needed to improve health and care across England over the next five years, and STPs are a way of doing this. Their success will largely depend on the extent to which local leaders and communities now come together to tackle deep-seated and longstanding challenges that require shared cross-organisational action.”

Six months on, England has been divided into 44 STP “footprints”. Each is a collaboration between all the statutory bodies in that area involved in health and social care – such as NHS trusts and clinical commissioning groups, and local councils, which fund social care. NHS England describes them as “collective discussion forums” and Stevens sees them as evidence of unprecedented cooperation between organisations which historically have done their own thing.

In the Lancashire and South Cumbria STP, for example, there are 31 different statutory bodies — nine clinical commissioning groups (CCGs), six NHS provider trusts, four upper-tier local authorities and 12 district councils. It is led by Dr Amanda Doyle, a GP who is also the chief clinical officer of Blackpool CCG. Its discussions also involve voluntary organisations, four local Healthwatch branches and several local committees, which represent GPs.

“We have three aims. Firstly, to improve the health of the population. On our patch we have some of the poorest health and shortest life expectancy in the country. Secondly, to improve the outcomes of care. Some of those outcomes could be improved if care was delivered in a different way, for example, if more stroke or cancer patients were treated in specialist centres,” says Doyle. “And thirdly, to make our bit of the system more financially sustainable. Although we’ve had extra investment, rising demand is outstripping that, so we need to make our population healthier so that we can in some way control the demands they put on the healthcare system.”

Doyle, like other STP advocates, is clear that achieving these objectives will involve big changes to the way NHS services are organised, and care delivered. She admits that a reorganisation of hospital services will be part of that. “It could also mean looking at the number of sites on which we do certain things and rationalising some of that. We are starting to look at all of our services to see if they are in the right place or whether we are duplicating efforts.” The local NHS’s inability to recruit enough staff to work in every department of all four of the STP’s acute hospital trusts – especially in A&E, dermatology and radiology – will mean fewer centres in key areas of care, she hints.

But will rationalisation necessarily help the NHS make the £22bn of savings it has to deliver by 2020? “There are concerns that some areas are focusing on plans to reorganise acute hospital services, despite evidence that major reconfigurations of hospital services rarely save money and do not necessarily improve care,” says Chris Ham, chief executive of the King’s Fund thinktank. Plans in some STPs to reduce the number of hospital beds are also unlikely to succeed, he believes. Nigel Edwards, his counterpart at the Nuffield Trust thinktank, says: “I’ve been visiting a lot of STPs and nobody I’ve spoken to is confident they can reduce the financial gap. One insider said to me: ‘Optimism bias abounds’.”

Ham adds: “It would be a huge shame if a vital opportunity to improve services for patients is derailed by bruising rows about ill-conceived hospital closures.” Colin Crilly, a spokesman for the Keep Our St Helier Hospital campaign group in south-west London, speaks for grassroots NHS campaigners who are profoundly worried by the emerging details of how STPs could affect hospitals. ”With the government’s annual budget [for the NHS] shrinking in real terms, the NHS is facing huge debts. STP is a quick plan to get rid of these debts by getting rid of services, wards or hospitals.”.STPs are odd entities, as Edwards points out. “They’re not organisations. They’re ‘footprints’ — lines on maps. There’s no building with a name on the door.”

It is unusal to find what are in effect high-level talking-shops expected to tackle the biggest problems in the NHS and then agree push through changes that no one pretends will be popular. The fact that they are non-statutory bodies and have no formal power – and, crucially, their reliance on reaching agreement among bodies with sometimes different agendas – could yet prove a flaw, adds Edwards. What happens if a hospital that is set to lose a much-loved A&E or maternity unit as a result of an STP decides to go to court to thwart it? The cooperation vital to the whole programme would disappear.

Perhaps the biggest risk, though, is that while the NHS has talked for years about building up out-of-hospital services, little progress has been made, as acute hospitals have received an ever-bigger slice of the cake. NHS England say that general practice, mental health and community-based services will get more and more of the cake in coming years. But will it be enough to cope with the planned massive shift of care into places that are as yet undefined and unfunded, and will there be enough staff there, in or closer to people’s homes, to enable that?

Doyle admits that, while general practice will need to expand its role, “GPs are already busy, that’s their trouble.” But she points to innovation in out-of-hospital care, such as last year’s introduction on the Fylde coast, in Lancashire, of “wellbeing support workers”, who try to keep frail elderly people as well as possible at home, to reduce their risk of hospital admission. STPs are looking to replicate good ideas like that everywhere.

The stakes could not be higher. So will STPs save the NHS?

“It’s absolutely vital that they succeed. We have to have a sustainable NHS and to do that we have to adapt how we do things,” says Doyle.

Jim Mackey, chief executive of the financial regulator NHS Improvement, says there is no option. NHS bodies need “to work together, to think boldly and to work out how change — no matter how radical — can best be achieved to meet the major challenges we face,” he says.

Despite all the dramatic rhetoric about STPs, Edwards remains sceptical. “There are a significant number of risks associated with them and the jury is still out as to whether they are going to work or not,” he points out. “ It’s too early to say.”

STPs: Radical local modernisation plans or the end of the NHS as we know it? | Denis Campbell

Local difficulties in the cash-strapped National Health Service | Letters

I pity the civil servants in the Department of Health who are forced to give platitudinous responses to the press (Leak reveals doubts over ‘seven-day NHS’, 23 August). In 2012 the then secretary of state for health, Andrew Lansley, fought tooth and nail (using taxpayers money) to hide the risk assessment done before the disastrous health and social care bill, despite intervention by the information commissioner. There, the “worst case scenario” has occurred after the passage of the Health and Social Care Act 2012. Civil servants are right to be worried that there is not enough money or sufficient trained staff available to carry out the policy, as there is insufficient money to run the NHS as it exists, providing a five-day elective (planned) and seven-day emergency service.

The lack of detailed planning of the proposed service is analogous to the way the Cameron government approached the EU referendum. What the NHS needs is more money to deal with rising demand, which could easily be found by scrapping the wasteful tendering processes which have resulted in almost £20bn of contracts going to the private sector since 2013, reviewing PFI debts costing over £2bn per year, reducing expenditure on the CQC, which has become unwieldy but arguably has failed to prevent hospital disasters, and reducing the six-figure salaries that too many top managers are now paid. Private contracts are expensive and have not yielded the promised innovation or improved services.
Wendy Savage
President, Keep Our NHS Public

• Most people will agree that the NHS is the jewel in the crown of British life and prized by almost everyone. David Nicholson wrote on his retirement as chief executive of the NHS, “It is built into what it is to be British” (Sunday Times, 2 March 2014).

Yet it is “threadbare, scrappy, perilously understaffed and barely held together by legions of nurses, doctors and allied health professionals” (These leaks show Hunt’s deception on the seven-day NHS, 23 August).

As a retired NHS physician and former independent MP, I talk to many people about the NHS and, without exception, they would willingly accept an increase in income tax, if it was hypothecated to the NHS, and if all measures for increasing efficiency and economy within the NHS had been adopted.

Would the Guardian consider carrying out a survey of its readers to assess the support for such a measure to rescue our beloved NHS?
Richard T Taylor
Kidderminster, Worcestershire

• You report that NHS England expects local doctors, hospitals and councils to work together in each of 44 “footprint” areas for the “first time on shared plans” (Revealed: plans to fight NHS deficit, 26 August). We recall how, in a 1968 green paper, health minister Kenneth Robinson proposed just such area health boards, to meet his paramount requirement that all the different kinds of care and treatment should be readily available to the individual citizen. We, who were involved in the preparation and promotion of those novel ideas in 1968, can but hope that our successors will get past the green stage.
Dora Pease and Tim Nodder
Ministry of Health long-term study group 1967-74

• Save Our Hospitals: Hammersmith and Charing Cross has been campaigning for more than four years against the downgrading of hospitals in north-west London, where we have already lost two A&Es, with dire effects on other A&Es in the area, and where two further major acute hospitals, Charing Cross and Ealing, are to be downgraded to as yet undefined local hospitals. As you note, these hospitals will be little more than glorified urgent care centres (Councils reject plans to ‘transform’ NHS, 26 August).

Already all hospitals in NW London are working at full capacity, failing to meet A&E targets, and with accelerated population growth in NW London, out-of-hospital care is even less likely to meet the health needs of our local population.

For four years we have been asking the local health authorities for the evidence that the proposed out-of-hospital provision can replace acute in-hospital care. For four years we have been promised this evidence. And for four years we have been presented with no evidence that suggests the changes can work.

It has become increasingly clear that financial considerations are driving the plans for this new top-down restructuring of the NHS. The outcome will be even greater privatisation of the NHS.

That two council leaders have been prepared to stand up to the NHS bullies and reject this attack on local health provision and local democracy is admirable. We know that the leaders of Hammersmith & Fulham and Ealing councils have the support of the local population as well as local campaign groups.
Merril Hammer
Chair, SOH: Hammersmith & Charing Cross

• Among your articles on the “sustainability and transformation plan” for the NHS, you mentioned the current efforts to remodel healthcare in North, West and East Cumbria. My local community hospital is threatened with removal of all inpatient beds. Alston Moor is a sparsely populated area of high moorland with four of the five roads leading over high passes; all are slow, frequently impassable in winter. The nearest hospitals are 20 miles from Alston, another five miles for some parts of Alston Moor; the nearest main hospital is over 30 miles away, in Carlisle. There is no meaningful public transport; even by car, it takes 40 minutes to the smaller hospitals, an hour to Carlisle.

If there are no inpatient beds, there will be no nurses. If there are no nurses, there will be no nurse-led minor injuries unit, and all will have to get to A&E in Carlisle. Without the hospital, our GP surgery is not viable (the relatively low returns of GP services for a mere 2,000 people are supplemented by the hospital work).

What family will want to live here with children if there are no medical services? Without children, our schools are doomed. What older person will want to live here knowing that their dying days will be spent in a hospital far from family and friends? What carer will cope with the burden of their task with no respite care?

How can it be OK to destroy a community? First they came for the small rural communities and I did not speak out because I did not live in a small rural community…
Alice Bondi
Alston, Cumbria

• Join the debate – email guardian.letters@theguardian.com

Local difficulties in the cash-strapped National Health Service | Letters

The NHS secret is out. And local communities won"t like it

When Simon Stevens became NHS England’s chief executive in April 2014 he disavowed his predecessor David Nicholson’s radical centralisation of specialist hospital treatment into far fewer places.

Stevens also went further, using his first interview in the post to pledge to maintain local hospitals. Every NHS leader, and every MP, knows how attached the great British public is to the bricks and mortar of their local NHS. The last thing Stevens wanted was to face opposition by campaign groups, councillors and MPs to a particular A&E or maternity unit being downgraded or closed, and certainly not a wave of such protests in many parts of England simultaneously battling to save much-loved local services.

Yet that is the growing risk he now faces as a result of the 44 regional sustainability and transformation plans (STPs). The disclosure of controversial changes planned in north-west London, Leicestershire and the West Midlands – including entire hospitals being downgraded or closed – could easily result in England-wide protests.

NHS bosses say the plans are necessary for the sake of better care, modernisation and financial balance but an angry, disbelieving public is expected to fight tooth and nail against the loss of the local services.

The standoff over STPs has been coming for months and prefaces major political battles ahead which will involve unprecedented examination of the government’s record on and plans for the NHS. Are STPs part of an undeclared Tory plot to prepare the NHS for much greater privatisation after 2020? Or are they designed to move the health service from an illness treatment service to one that prevents ill-health in the first place?

Until now, STPs have been shrouded in secrecy. NHS England, which is driving the process, advised the boards of acute hospital trusts to discuss the plans in the private session of their monthly meetings. Labour MP Justin Madders, a shadow health minister, recently outlined his concern about the lack of public attention so far on “Jeremy Hunt’s opaque and secretive reorganisation of the NHS, which is being drawn up behind closed doors at this very moment through sustainability and transformation plans”. That deliberate hiding from public view of plans for significant changes to how and where patients are cared for is now over, earlier than NHS England planned. The public debate about what NHS services need to look like in order for the country’s most cherished institution to survive is now under way, and not before time.

Official NHS documents, albeit laden with the service’s usual array of buzz phrases, set out the purpose of STPs. NHS England calls them “blueprints [which] will be place-based, multi-year plans built around the needs of local populations”. It continues: “STPs are geographic areas in which people and organisations work together to develop robust plans to transform the way that health and care is planned and delivered for their populations.”

The overall rationale is simple: transform how care is organised and provided in order to keep the NHS sustainable as a system of healthcare. But it will be hugely difficult to convince a sceptical public to back such far-reaching changes.

Whether Jeremy Hunt or Theresa May likes it or not, the belated disclosure of the STPs will lead to fierce scrutiny of the government’s performance on and plans for the health service. Are the proposals helping to prepare the service for much greater privatisation after 2020? Have they only come about because the government has for years been giving the NHS much less money than it needs to deal with the rapid, relentless rise in demand it is facing as a result of the ageing population and the emerging disaster of lifestyle-related illness? Or are they a sincere attempt to make a stay in hospital the last resort because people are much better looked after in or near their homes by GPs, nurses, therapists and specialists?

For NHS chiefs such as Stevens, rapid progress on STPs is an urgent priority. They see the changes that STPs will usher in as the best way to achieve three key aims: to improve people’s health; to tackle the fact that there is still far too much variation in the quality of care many patients receive; and to address the £30bn gap in NHS funding which is projected to have emerged by 2020-21. Ministers have pledged to provide £8bn of the £30bn. But Stevens and Jim Mackey, head of the service’s financial regulator, NHS Improvement, have to find the other £22bn. Almost no one in the NHS thinks it can be done, but STPs are their way of trying. They have to satisfy the Department of Health, and it has to persuade the Treasury, that the NHS can sort out a financial mess that, incidentally, it did not create.

Reconfiguration of hospital services – NHS-speak for shutting things such as A&E and maternity units – is a key part of their plans. NHS Improvement last month told the leaders of the 44 STP footprints to plan for “the consolidation of unsustainable services”. The growing fear among NHS campaigners is that the definition of “unsustainable” has already been agreed behind closed doors, and that it will lead to a huge reorganisation of NHS services.

The whole STP process is fraught with risk and uncertainty. As Hugh Alderwick of the King’s Fund points out, closing bits or all of hospitals does not necessarily save money or improve care. There is also the fact that, as the Nuffield Trust health thinktank’s chief executive, Nigel Edwards, points out, care still has to be provided somewhere and that still costs money.

Crucially, for services to be delivered outside rather than inside hospitals there has to be enough capacity in GP and other community-based forms of care. There isn’t, especially with family doctors already struggling to meet demand. They have no spare capacity. There are also, as some of the STP plans admit, too few staff across the NHS to make this bright new dawn a reality. All these practical considerations may prove even more significant obstacles to the implementation of this covert reorganisation of the NHS than public and political concern.

The NHS secret is out. And local communities won"t like it

Is Simon Stevens appropriate to back local community hospitals?

There will not be a return to an era exactly where hospitals were staffed by matrons who ruled with a rod of iron, writes Malcolm Prowle. Photograph: George Freston/Getty Photographs

In a current interview, Simon Stevens, the head of the NHS in England, appeared to mark a change in policy by calling for a shift away from large centralised hospitals and in the direction of community hospitals with new models of care created all around smaller local hospitals. In some methods this sounds radical but closer examination may suggest that it is just a phase on an evolutionary pathway.

For 60 many years, the bedrock of the NHS was the district standard hospital (DGH), which delivered a variety of hospital companies, other than specialised tertiary providers at university hospitals, to a regional population of possibly half a million folks. However, in recent many years this procedure has started to change with a far more varied pattern of providers developing, incorporating DGHs specialising in particular facets of healthcare, expanded major care centres, walk in centres and community hospitals.

Community hospitals are properly positioned to help patients on their complicated journeys of care through the health and care technique. They can be noticed as a nearby hub for a variety of easily accessible wellness providers and may well also offer signposting to other solutions such as individuals provided locally by the third sector. Community teams can also assist to prevent emergency admissions to acute hospitals and can play a significant role in supporting the reduction of hospital delayed discharges.

Nonetheless, this does not imply a return to an era where hospitals had been often staffed by matrons who ruled with a rod of iron and exactly where general practitioners popped in to do a bit of schedule surgery. Neither does it indicate that many existing, and a lot loved, community-based hospitals will not be closed the place they are identified to be obsolescent, inappropriate or just plain outmoded. This will undoubtedly make a great deal of local opposition but, personally, I have observed scenarios in which the public opposed the closure of a hospital which was not just unsuitable but unsafe.

However, new local community hospitals will carry on to be built. All through the nation it is possible to discover examples of exactly where an outdated community hospital has been closed and replaced, a few years later, by a new one particular nearby.

Complicated health care and surgical care will nonetheless be offered at large hospitals, in which doctors can specialise in particular elements of medicine and can have better clinical outcomes than in hospitals the place no such specialisation requires location. Nevertheless, other services this kind of as care of older folks, lengthy-term care and patient rehabilitation may be far better undertaken in the significantly calmer atmosphere of a community hospital. In some instances, diagnostic and some therapy actions for acute patients may well also be presented at a spot far more hassle-free to the patient.

Some will argue that smaller community hospitals are inherently significantly less productive due to the fact of their dimension but this might not be the situation. Usually larger organisations (this kind of as a DGH) can have inefficiencies that are identified in several largeish bureaucracies and tiny hospitals can have higher scale and flexibility. It is, consequently, a debateable point as to whether local community hospitals will cost more to run and will need added funding.

There will be strong barriers to the notion of more local community hospitals. Not all healthcare experts will be pleased to operate in such units and could see them as boring considering that they are not functioning at the cutting edge of healthcare. Consequently, they might see this as a block to their individual profession prospective customers.

Several individuals, including myself, will look on neighborhood hospitals favourably as a area for elderly family members to invest the final years of their lifestyle. The calmer setting and the higher degree of familiarity with nursing and other staff will be a welcome alter from the hustle and bustle of the huge hospital.

A single may wonder why Simon Stevens has selected this controversial topic to mark one particular of his earliest interviews as head of the NHS. Could it be that community hospitals are extremely popular with the public and that this will generate good news for the NHS even however, as currently observed, the variety of local community hospital being proposed is very various from that of the romantic past? Alternatively, is it just a signifies of distancing himself from the previous NHS regime by a substantial change in policy? Time will tell how far the configuration of the NHS will alter as a consequence.

Malcolm Prowle is professor of business efficiency and co-director of the Wellness and Social Care Finance Study Unit at Nottingham Business School

What do you consider of Simon Stevens’s programs to finish centralisation in the NHS and back neighborhood companies? Have your say.

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Is Simon Stevens appropriate to back local community hospitals?

My local GP just supplied me the "alternative quackery" of homeopathic medicine. What on earth"s going on?

Nevertheless, I was absolutely horrified when I went to my neighborhood GP a couple of months in the past. I had gone with a purpose. Most of us presently have done some analysis on the world wide web just before we go to the doctor and most very good medical doctors are pleased about that.

We have looked at the hazards and side effects of any drugs we could be requesting and have analysed our signs and symptoms to narrow down the diagnosis prior to we even get by means of the door. I knew roughly that I needed but was of course ready to consider guidance on specifically what type of the drug may possibly be best for me.

I was not expecting to be offered homeopathyinstead. Not in conjunction with tradition medicine but rather of it. This was my regional NHS surgery and I see that if I search up homeopathy on my NHS website it confidently tells me that there is completely no proof that it is an effective treatment for something, something at all. It tells me that there is no plausible way that homeopathy can help in any way.

I come from an extended family of doctors. I grew up knowing that Christmas lunch was bound to be interrupted as an Uncle or Aunt was called away to some emergency. I have two cousins who work at the cutting edge of cancer remedies and I admire them hugely, so I’m afraid when my GP recommended homeopathy she got quick shrift from me. “No, I would desire to consider some thing that has some scientific research behind it. If I wished some different quackery I would not come to my GP for it.”

In 2010 the Property of Commons Science and Engineering Committee concluded that there is no evidence that homeopathy is effective as a treatment method for any well being condition … so why on earth was I provided it by my NHS medical professional?

^{Homeopathy is‘nonsense’, according to some – so why is the NHS giving it?}

The only feasible impact that homeopathy can have is the placebo impact. Typically, nonetheless, the placebo result functions since you feel it will. If you do not believe then it will not function. I do not think.

Dr Ranjana Srivastava, a medical oncologist, has maybe found the reply as to why some sufferers even now adhere to the homeopathic path. The straightforward reason is that when they visit a homeopath they truly feel listened to. They sense sympathy for their issue. When we visit the physician we inevitably feel vulnerable and not at our ideal. A bit of bedside method goes a long way. Bedside method and some medicine that may in fact perform.

Of course we should have a selection. If we pick to use alternative approaches of healing that is entirely up to us. It is a free of charge nation. But I do object when an NHS physician employs NHS time to recommend a treatment method that the NHS has informed me will not work. There will often be people who want to attempt different medicine with no clinical proof but do not request the tax payer to fund it.

What is your see? Does homeopathy perform? Tweet us @Telewonderwomen

My local GP just supplied me the "alternative quackery" of homeopathic medicine. What on earth"s going on?

GP-led local NHS bodies forced to place health solutions out to tender

Providers set to be place out to tender for competition integrated contracts for out-of-hrs GP care and ultrasound. Photograph: Graeme Robertson/Getty Photographs

Numerous GP-led local NHS bodies are being forced to place health solutions out to tender despite government assurances that that would not occur.

New analysis by Wellness Services Journal displays that 29.1% of the leaders of 93 clinical commissioning groups (CCG) which responded to a survey explained had opened up, or have been opening up, services to competition which they would not have carried out if they have been not concerned about the influence of new guidelines contained in the controversial Health and Social Care Act.

They incorporated contracts for out-of-hours GP care, older people’s services, audiology, ultrasound and podiatry.

In 2012, the wellness secretary Andrew Lansley wrote to all the 211 CCGs pledging unequivocally that they individually would be ready to choose, rather than ministers or the NHS regulator, Monitor, when to put contracts out to tender.

But HSJ identified that twenty% of CCGs had encountered a challenge under the new competitors guidelines to a choice they had taken about the commissioning of solutions, even though 57% had knowledgeable “informal challenge or questioning”.

In addition, 65% of the 103 bosses of the 93 CCGs mentioned that they had incurred further charges associated to commissioning as a result of the regulations, although 36% explained they had hampered programs for local hospitals to merge or grow to be foundation trusts.

Peter Melton, the co-chair of the NHS Commissioning Assembly, said that the competitors rules needed to be simplified to make tendering choices less complicated for CCGs.

Sir David Nicholson, who stepped down last week as NHS England’s chief executive, warned MPs final 12 months that the NHS was “obtaining bogged down in a morass of competitors law.”

GP-led local NHS bodies forced to place health solutions out to tender

A day in the daily life of ... a local community pharmacist

Reena Barai owns a pharmacy in a small residential community in which men and women can walk in and get professional guidance and remedy.

I’m a community pharmacist and personal a pharmacy. We open at 9am and I consider to arrive early to catch up on admin tasks just before then. The pharmacy is in a little residential local community, and I usually bump into my sufferers on my walk in. It provides me a wonderful sense of belonging when I can greet folks on the street.

Mornings are usually the busiest element of the day as I have numerous patients coming in to acquire their prescriptions. As a neighborhood pharmacist, I do not just dispense medicines, I also dispense guidance and solutions relevant to healthier residing. Nowadays, while dispensing some antibiotics for a younger kid, I was talking with the mother about how her little one usually seems to get chest infections. I asked the mom if any person in her family smokes and she admitted to me that she did but that she genuinely wished to give up. As a trained NHS cease smoking adviser, I am able to supply assistance and advocate providers to aid her, and other folks, quit smoking.

Much more and far more people enjoy the truth they never need an appointment to see me and they can just stroll in, and get professional tips and treatment for their symptoms more than the counter. Since I have worked in my pharmacy for a lot more than ten many years, I have built up believe in and rapport with my patients. It helps make my work come to feel worthwhile when I can offer help and assistance to folks I see in the community on a weekly basis. These days, a lady came in to thank me for my guidance when she came in to get some antacid (a substance that neutralises abdomen acidity) last week. She imagined she was struggling from heartburn but I was concerned that it may well be something far more significant. She decided to consider my suggestions and had it checked out it turned out she was getting a heart attack.

Afternoons are typically invested carrying out Medicine Use Reviews (MURs), and I have a private consultation area in my pharmacy exactly where these consider place. These days, I saw a woman whose GP had referred her since she had turn into confused about her medicine. I was capable to evaluation and simplify her medicines regime, and she really appreciated the time I invested with her.

I have a excellent doing work romantic relationship with my neighborhood GP practices. On a day-to-day basis, I obtain calls from receptionists, nurses, carers and GPs asking for assist with their individuals or for advice on medication. I also attend the neighborhood clinical commissioning group meetings in which I signify all the pharmacies in my spot. I usually run neighborhood health promotion campaigns and try out to collaborate with other nearby organizations.

As soon as, I ran a wellness MOT initiative with the garage across the road from my pharmacy. I gave out flyers to people bringing their vehicle in for an MOT and I encouraged them to have a overall health ceck-up while they waited. I performed mini-overall health checks and answered general well being concerns, giving men and women advice on how to adopt a healthier way of life.

The end of my day usually entails delivering medicine to housebound or sick individuals, several of whom dwell alone and rely on my deliveries. Many of my evenings are spent attending meetings and lectures. I’m a nearby pharmacy tutor in my location and arrange workshops to assist other pharmacists develop their capabilities and companies.

Operating six days a week indicates I will not have much spare time to loosen up, although I do switch off from my day job when I get property. I really like being a mum reading through with my youngsters, cooking dinner and watching period dramas on Television. Before I drift off to rest I normally program my timetable for the up coming day in my head.

Reena is supporting Pharmacy Voice’s Dispensing Overall health campaign, to raise awareness of neighborhood pharmacy companies

If you would like to characteristic in our Day in the Daily life series, or know an individual who would, electronic mail healthcare@theguardian.com

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A day in the daily life of ... a local community pharmacist