Integrated Care Systems threaten patient care, jobs, pay, working conditions and the integrity of the NHS as a public service. we oppose them.

Resolution on ICSs 9 May 2020

Doctors in Unite notes:

  • While attention is focused on Covid, the NHS in England is being rapidly reorganised into 42 regional Integrated Care Systems (ICSs). This will strengthen the role of private companies, including US health insurance corporations, in clinical services and management of the NHS. ICSs will mean more private contracts, more down-skilling and outsourcing of NHS jobs, reduced services and significant spending cuts.
  • The Government plans new legislation to turn ICSs into legal bodies. Their February 2021 White Paper “Integration and Innovation” is based on NHS England proposals, derived from a US model which aims to spend less on care.
  • ICSs will have fixed annual budgets based on area-wide targets, rather than providing the care needed by the individuals who live there.
  • NHS England has accredited 83 corporations and businesses, including 22 from the US, to help develop ICSs. The White Paper will allow private companies to sit on both tiers of the ICS Board: an NHS body including representation from a local authority and open to unspecified others, and a Health and Care Partnership including independent sector partners and social care providers.
  • ICSs will sideline local authorities, threatening the future integrity of social care and reducing local accountability to elected Councillors, let alone patients and NHS staff.
  • NHS providers will be bound to a plan written by the ICS Board and to financial controls linked to that plan.
  • Procurement will be streamlined, eliminating safeguards for compliance with environmental, social and labour laws and the ability to reject bidders with poor track records.
  • The White Paper proposes that unspecified NHS roles currently covered by professional regulation could be deregulated in future due to changing technology.
  • NHS England proposes agile and flexible working with staff deployed at different sites and organisations across and beyond the system.
  • NHS England calls for most NHS funding to be delivered through a fixed block payment, based on the costs of the ICS system plan, whose value is determined locally. Local funding levels could threaten national agreements on wages, terms and conditions. Local pay could lead staff to leave areas where funding is cut, further reducing care.

Doctors in Unite believes:

  • Integrated Care Systems threaten patient care, jobs, pay, working conditions and the integrity of the NHS as a public service. We oppose them.
  • After 30 years of marketisation, it is time to restore the NHS to a fully accountable, publicly run service, free to all at the point of use. As unanimously adopted at Labour Party Conference in 2017, full scale repeal of the 2012 Health & Social Care Act and new legislation for a universal, comprehensive and publicly provided NHS are required.
  • We need a separate, collaborative, publicly funded Social Care Service.
  • Genuine integration based on the wider determinants of health, such as housing, involves more input from local authorities not less.

Doctors in Unite resolves:

  • To immediately report these threats to the NHS and social care, to appropriate Union structures and to find out what action the Union is taking.
  • To press the Union to take urgent action, including using its influence with other unions, the Government and opposition parties, based on the following demands:
  1. An immediate halt to the rollout of ICSs,
  2. An extended and meaningful consultation with the public and Parliament to decide how health and social care services are provided in England.
  3. The introduction of legislation to bring about a universal, comprehensive and publicly provided NHS, free at the point of use and fit for the 21st century.
  4. New technology must be used to improve patient care, not to deskill or replace or performance manage staff, or to deprive patients of face-to-face interaction with clinicians and other care staff that they may want or need.

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Revealed: Boris Johnson’s controversial policy chief leading secretive NHS task force

Munira Mirza heading up group meeting ‘daily or weekly’ to plan ‘radical NHS shakeup’. Open Democracy 19.11.20

Boris Johnson’s government has for the first time confirmed the existence of a prime ministerial task force which is reportedly planning a “radical shake-up of the NHS”.

Freedom of Information disclosures to openDemocracy show the new “No.10 Health and Social Care Taskforce” reports to a Steering Group chaired by Munira Mirza, the influential head of Boris Johnson’s policy unit, and that it “met weekly” from July to September with a further meeting in October.

Mirza, a political appointee who previously worked for Johnson when he was London mayor, has no background or policy experience in health.

The disclosures also reveal that whilst some Department of Health officials do attend the task force, it is led by four senior civil servants based at the Treasury, and none of whom are from the Department of Health.

The government has not published any information about the task force’s existence, work, terms of reference or membership – and has refused to answer questions about the nature of its work.

However in July, The Guardian reported that Boris Johnson was planning a “radical and politically risky reorganisation of the NHS” – in response to “frustration” with the NHS’s performance during the COVID crisis.

And in September, the Financial Times reported that inside sources had revealed an interdepartmental health task force with a wide remit, “determining what the health service’s goals should be”.

The government has previously claimed that rumours regarding the work of the task force are “pure speculation,” and did not even formally confirm its existence, insisting that instead: “As has been the case throughout the pandemic, our focus is on protecting the public, controlling the spread of the virus, and saving lives.”

Not only is the group now confirmed to exist, but Mirza’s leading role and the lack of leaders from the Department of Health suggest that its work is politically focused.

Jackie Applebee, Chair of Doctors in Unite, told openDemocracy, “It is shocking that people with no background in health are meeting regularly to determine the future of health and social care. COVID-19 has surely shown us that putting people with no health experience in charge of the NHS is a disaster.”

Meanwhile Tamasin Cave, a lobbying expert, has called Mirza “a political hire who is unqualified to mess around with the NHS”. She also questioned the timing: “Why are they doing this now, given how much the NHS – and the country – has on its plate already?”

The revelations come as concerns are mounting about post-COVID pressures on the NHS.

Kailash Chand, former deputy chair of the British Medical Association, told openDemocracy. “The waiting lists have built up to an awful level, and they’ll use that as an excuse to bring the private sector in, as they did under the previous Labour government.”

He described Boris Johnson as “dangerous” and having “no faith in public services.”

Secrecy ‘the worst possible way’ to do NHS reform

In their Freedom of Information responses, the Department of Health, the Treasury and Number 10 have all denied having a full record of who has been attending the task force and steering group meetings.

Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, has criticised the government’s secretive approach as “the worst possible way to design a major reform.”

“Secrecy encourages groupthink. The government rightly stresses the importance of public and patient involvement and co-production with users when designing new models of care. It is bizarre to reject these ideas for the really big decisions.”

What today’s disclosures do show is that the task force’s civil service policy lead is Adrian Masters. An alumnus of the management consultancy McKinsey, Masters played a key role in shaping the last major piece of NHS legislation, the 2012 Health and Social Care Act.

McKinsey was reported to have drafted large parts of that bill, which was criticised as enabling increased fragmentation and private sector outsourcing of large parts of the NHS.

The task force also includes William Warr: Johnson’s health advisor and a former lobbyist at the firm of Lynton Crosby, who masterminded numerous Conservative Party election campaigns and Johnson’s successful 2008 London mayoral bid.

Warr described the NHS as “outdated” in a Telegraph article penned shortly before he and Johnson entered Downing Street last year, suggesting that the incoming prime minister should ask himself: “If I created the NHS today from scratch, what would it look like?” Warr answered: “Nothing like the monolith we have today.”

Boris Johnson’s first Queen’s Speech in December last year promised to “bring forward detailed proposals” and “draft legislation” to “accelerate the Long Term Plan for the NHS, transforming patient care and future-proofing our NHS.”

The British Medical Association (BMA) has characterised this Long Term Plan as a “plan for a market-driven healthcare system”.

Kailash Chand, the former BMA deputy chair, told openDemocracy he believed the purpose of the task force was part of a wider effort to drive forward more NHS privatisation: “These people are really clever at bringing these things in disguise. This is essentially about getting us towards… big pickings for private companies. It’s not going to happen overnight but this is the road map.”

Referring to McKinsey’s regular NHS recommendations that were implemented under the Cameron government, he said: “McKinsey were brought in previously to recommend financial savings. The easiest way for hospitals to achieve those targets was to cut beds, cut nurses and the salary bill. And we’re still suffering today.”

Political appointments

Boris Johnson has faced criticism for appointing political allies with no health experience to key roles in the COVID-19 response. Test and Trace head Dido Harding, another former McKinsey employee and Tory peer, is in the process of taking over a large portion of the soon-to-be-abolished Public Health England’s remit, the government announced in August. She has also been tipped as favourite to take over as chief executive of the English NHS from the current incumbent, Simon Stevens, next year.

Stevens’ own proposals for major NHS reform last year attempted to allay fears about further privatisation, though campaigners raised concerns that they could make outsourcing less transparent.

Both the Department of Health and the NHS now appear to be taking a back seat in policymaking. Stevens is not on the task force, and none of the four top senior servants in charge comes from the department.

Open Democracy approached Munira Mirza, Adrian Masters, Number 10 and the Treasury for comment, but all have declined to respond by the time of publication.

This is a reprint of an aricle in Open Democracy by Caroline Molloy 19.11.2020: https://www.opendemocracy.net/en/opendemocracyuk/revealed-boris-johnsons-controversial-policy-chief-leading-secretive-nhs-task-force/

Statement on Integrated Care Systems

Integrated care systems are part of the government’s plans for NHS organisations, in partnership with local councils and others, to take collective responsibility for managing resources, delivering NHS standards, and improving the health of the population they serve.  This seemingly laudable development has the potential to further undermine the NHS, particularly since the Covid-19 pandemic. 

The NHS in England is being rapidly and profoundly changed under the cover of COVID-19. There is no public consultation or the necessary legal Local Authority scrutiny on what are emergency measures being made permanent as part of Integrated Care Systems (ICS) development.

The changes include unproven innovation, privatisation and paid for care, and the developing systems present clear opportunities for commercialisation and private investment. The government’s procurement response to the COVID pandemic has been wholly unaccountable and riddled with corruption.

We call for full democratic Local Authority scrutiny and public consultation, as well as democratic representation (i.e. partnership) throughout the incipient ICS structures.  We demand a renationalised National Health Service in the longer term. 

We passed the following motion at a recent meeting of Doctors in Unite.

Integrated Care Systems:

ICS have been introduced and developed undemocratically, without consultation and with a lack of transparency.  Their aim is to impose ‘reduced per capita cost‘ control totals to force unproven and unsolicited  innovation, including elements of privatisation and paid for care, in each system’s struggle to meet local population need. This has been NHSE/I’s practice with individual Provider Trusts over recent years. Each ICS will form a new Integrated Care Provider (ICP) organisation. NHS England plans for ICP organisations to be managed through commercial contracts. We therefore call on government to ensure that:

 1.Local Authority Scrutiny Committees across England be allowed to fulfil their legal responsibilities to scrutinise fully the significant changes in NHS services that have been initiated without scrutiny under the COVID-19 emergency measures before they become any permanent part of ICS development. If the Committees decide that the changes require full Public Consultation then this must also happen before the changes are allowed to remain. These actions are well established legal process.

 2. Some democratic representation is created in the Governance structures of ICSs by: i) an increase in Local Authority Councillor representation on the Governing Bodies so as to match in numbers the NHS representation (Partnership) and ii) full public engagement and involvement for all significant changes and developments in the NHS, with full Consultation as well on the more major issues as decided by the Scrutiny Committees which have been set up in our democracy for this purpose.

 3. In the longer term there must be a return to universal risk pooling and funding with renewed efforts for National equity of care and National decisions about affordability. ICS must be replaced by Health Boards with the return to geographically based responsibility for the delivery of health to local populations. The apparatus of the market that divides the NHS must be dismantled. Health Boards as public, accountable bodies would plan and provide the full range of NHS services, with participation from elected councillors, community organisations, Neighbourhood Health Committees as advocated in our paper “Public Health and Primary Care” and trade unions. The quality of services would then be monitored by locally-based independent bodies involving local patients and community groups, with the powers once enjoyed by Community Health Councils.

One Stop Shops – trick or treat?

The media recently highlighted the fact that NHS England has announced:

The NHS is set to radically overhaul the way MRI, CT and other diagnostic services are delivered for patients . . . . Community diagnostic hubs or ‘one stop shops’ should be created across the country, away from hospitals, so that patients can receive life-saving checks close to their homes. The centres could be set up in free space on the high street or retail parks.”

“The need for reform of NHS diagnostics was recognised in the Long Term Plan” – so begins the recent report by Professor Sir Mike Richards, ‘Diagnostics. Recovery and Renewal’.

The key recommendations are:

  • Acute and elective diagnostics should be separated wherever possible to increase efficiency.
  • Acute diagnostic services (for A&E and inpatient care) should be improved so that patients who require CT scanning or ultrasound from A&E can be imaged without delay. Inpatients needing CT or MRI should be able to be scanned on the day of request.
  • Community diagnostic hubs should be established away from acute hospital sites and kept as clear of Covid-19 as possible.
  • Diagnostic services should be organised so that as far as possible patients only have to attend once and, where appropriate, they should be tested for Covid-19 before diagnostic tests are undertaken.
  • Community phlebotomy services should be improved, so that all patients can have blood samples taken close to their homes, at least six days a week, without needing to come to acute hospitals.

Motherhood and apple pie

On the surface of it, these are laudable aims that have been welcomed by hospital bosses. The COVID-19 pandemic has had a devastating effect on management of non-covid conditions with, for example, a 75% reduction in cancer referrals and a reduction in 210,000 imaging procedures each week. Before the pandemic there were 30,000 patients who had waited longer than 6 weeks for a diagnostic test, a figure that has now increased to 580,000. Urgent consideration must be given both to how the NHS is put back on its feet and how it addresses the huge backlog of problems as well as the ongoing pandemic. There is logic in separating acute and non-acute service provision into covid and covid free areas, and who could object to patients having convenient and rapid access to the best available technology? This does of course depend on many factors, not least having an efficient coronavirus testing system at some point in the future, but raises other crucial issues.

Where will the staff be found?

The plan as set out requires the recruitment of around 11,000 staff including 2000 radiologists, 500 Advanced Practitioner radiographers, 3,500 radiographers, 2,500 assistant practitioners, 2,670 administrative staff and 220 physicists. Bear in mind the current staffing crisis on the NHS, with around 140,000 vacancies across the board exacerbated by low pay and workplace stress. Cancer Research estimated that staff would need to double by 2027 to meet demand, with one in ten posts in diagnostics unfilled at the start of the pandemic. Furthermore, massive investment in equipment will be needed. The report points out that in relation to the 20 other countries making up the Organisation for Economic Cooperation and Development, the UK ranks bottom for CT and 3rd from last for MRI scanners. The Clinical Imaging Board claims that nearly 30 per cent of the UK’s MRI stock is at least ten years old, with no replacement plans for almost 40 per cent of systems more than seven years old.

All that’s left to find – money and staff

The last settlement for the NHS was £20.5 bn, which over a five year period amounted to an annual increase in budget of 3.4%. This did not include funding for training and employing the staff of the future. Most commentators thought a minimum 4% increase in funding was needed, and the Office for Budget Responsibility put the figure at 4.3% in order to meet increasing demand. COVID-19 has now blown all these estimates out of the water with the additional costs of restarting and sustaining the service, dealing with COVID-19 long term and developing and implementing a workforce transformation.

Private sector – the spectre lurking in the wings

In Simon Stevens’s letter to health care providers in July this year, he mandated:

Ensuring that sufficient diagnostic capacity is in place in Covid19-secure environments, including through the use of independent sector facilities, and the development of Community Diagnostic Hubs and Rapid Diagnostic Centres”.

As pointed out in The Lowdown in a comment on diagnostic hubs:

“References . . . to high street and retail park sites are possibly of no real concern – perhaps they’re more about exploiting cheap-to-rent locations during the pandemic-driven economic recession than a push to link-up with high-profile brand sponsors – but the well-established presence of private sector interests operating in the diagnostic and pathology arena suggests there may be rich pickings on offer somewhere in the hub programme, if only until the backlog is cleared”.

In fact the privatisation of diagnostic and laboratory facilities is already well underway. There is no comfort here in Professor Richard’s report which even cites as a case study:

The East Midlands Radiology Consortium (EMRAD) was launched in 2013 to create a common digital radiology system. Pioneering work led to the development of a Cloud-based image-sharing system through which the seven NHS trusts involved in the partnership could share diagnostic images, such as X-rays and scans. In 2018, EMRAD formed a partnership with two UK-based AI companies, Faculty and Kheiron Medical, to help develop and test AI tools in the breast cancer screening programme in the East Midlands.”

There is no mention of the fact that EMRAD paid £30m for the picture archiving and communication system from GE Healthcare but refused to pay full service costs until GE sorted out chronic problems causing a dangerous backlog of CT and MRI images.

Like many of the aspirational service developments contained within the Long Term Plan, ‘one stop shops’ could offer real value to patients. As the report by Professor Richards recognises:

These new services will require major investment in facilities, equipment and workforce, alongside replacement of obsolete equipment. Training of additional highly skilled staff will take time but should start as soon as possible. International recruitment should be prioritized.”  

This is no small ask and needs to be part of a generous new funding settlement for the NHS by government.  This should be an investment in the NHS as a public service rather than a source of rich pickings for private companies.

This article was written by John Puntis for Keep Our NHS Public

Policy statement on a National Care Service.

Doctors in Unite believe that the current model for social care is not working and that this has been brought into sharp focus during the COVID 19 Pandemic. Care homes bore a huge burden of deaths during the first wave, for many reasons, but not least due to the fragmentation that privatisation has imposed on that sector. This has led to a lack of local capacity and national coordination of care for some of the most frail and vulnerable in society.

Social Care at home is in a similarly parlous state. Domiciliary care is also largely outsourced to the commercial sector and provided by a workforce on extremely low pay, poor conditions and zero hours contracts. Many workers are not paid for the time they spend travelling between clients. Workers have too little time to spend with clients and it is difficult for them to build trusting relationships.

We do not wish to reinvent the wheel. Keep Our NHS Public and the Socialist Health Association are launching National Care Support and Independent Living Service on 10th October, The TUC and the Labour Party, through Reclaim Social Care, have good policy on how social care should be organised which Doctors in Unite would be able to broadly align with. These are set out in the appendices at the end of this statement.

We believe that:

  1. Care is a basic human right and is good for society as a whole. There must be a national care service which is publicly funded, publicly provided and free at point of need. It should be paid for out of general taxation and years of underfunding must be reversed. The Keynesian Multiplier for care service is substantially higher than the 2.5 figure at which spending is self-funding because for every £1 spent on the service the economy benefits by £2.50 which generates £1 in taxation. Within reason, spending on services with a multiplier above 2.5, such as health, care, environments, education and welfare actually reduces the deficit and so is money well spent.
  • Private/for profit care services should be brought back into public control.
  • The national care service must be subject to local democratic control. Users, their families and workers, through their trade unions, must have a strong voice and local councils must be accountable. Neighbourhood health committees should be set up as we suggest in our earlier paper “Public Health and Primary Care”.  https://medicalpractitionersunion.files.wordpress.com/2020/05/public-health-and-primary-care.pdf   The service should be funded centrally but organised locally.
  • Users and their families must be at the centre of their care, which should be personally directed and flexible, but not through personal budgets. We acknowledge that users are usually best placed to determine the care that they need but we are concerned that personal budgets can be unnecessarily expensive and bureaucratic to administer and will give some an economic advantage over others with equal need. Everyone should be able to access the care that they require in the way which is most suitable for them as individuals without the need for personal independence payments. We would like to work with disability action groups to develop personally directed care while taking the economic inequalities out of the system. There must be proper funding and support in place to enable users to access the system and find services that meet their needs.
  • There is a broad spectrum and continuum in social care needs Doctors in Unite believe that the natural home of social care is within the local authority not the health service. Nevertheless, where necessary, a National Care Service and the NHS should work collaboratively for the needs of a user. There is no need to merge the two services.  It is unhelpful to classify a need as either social or medical, a need is a need. Services must be properly funded so that if someone needs a bath they get help with a bath without the historical arguments as to whether the need for that bath is social or medical.
  • The National Care Service should be funded sufficiently so that people can be supported to live independently if they wish. People should not be pressured to go into a care home because services, such as night sitting, are not available in the community or deemed too expensive. Similarly, residential care home options should be available if this is what people prefer and need.
  • Care must be dignified and both residential and domiciliary care should be comfortable, homelike and run by the local authority. Many small locally run services strive to provide this though often they struggle to remain viable. Bringing these providers into public ownership whilst maintaining their ethos would provide stability for staff and clients. Proper service planning would also end the geographic perversity such that residential care homes are set up not where they are needed but where the real estate is cheapest, meaning long journeys for relatives to visit their loved ones distant from where they live.
  • Domiciliary care should be brought back into social ownership under Local Authority control immediately. As already stated, users and their families must have a strong voice as well as fully engaging with care providers.Existing small locally run businesses could be organised to work collectively as not for profit cooperatives. Current owner managers could be employed by the publicly owned National Care Service with a national wage structure rather than owning the businesses. We think that many might prefer this as their jobs would be less precarious. A national care service should capture the ethos of the smaller organisations, providing comfortable homely care but relinquish the current commercial economic model. Smaller providers often aren’t able to respond to crises and weren’t prepared for the pandemic, for example, they had totally inadequate supplies of PPE. A national care service should take the best of all the models, be properly funded and brought back into public ownership.
  • Under a National Care Service care workers must be properly paid, we support an immediate 35% pay increase. Care workers must have a proper career structure with progression and training which must be funded and transferable, including into the NHS. These must be nationally agreed, along with terms and conditions, as is the case with Agenda for Change in the NHS. We would like to see an end to all zero hours contracts, though acknowledge that some workers do find their flexibility helpful. We therefore would support an opt in to a zero hours contract after three months of working, as is currently available in Wales.
  • All social care vacancies must be filled within a year.

  • Last but by no means least we must note that a large proportion of care workers are overseas migrants, many with precarious residency in the UK. Without these people a National Care Service could not function. We demand that they are all granted permanent status immediately and that care workers are regarded as essential workers for immigration purposes.

APPENDIX 1

KONP/SHA NACSIL demands:

Publicly funded, free at the point of use    Publicly provided, not for profit 

  • Nationally mandated but designed and delivered locally
  • Co-produced with service users and democratically accountable
  • Underpinned by staff whose pay and  conditions reflect true value & skills
  •  Meets needs of informal carers   Sets up an independent living task force

APPENDIX 2

Reclaim Social Care policy and demands:

https://www.reclaimsocialcare.co.uk/policy/

Reclaim Social Care is clear that the country requires social care to be:

  • based on supporting independent living for all
  • free at the point of use
  • paid for, like the NHS, through central taxation
  • brought into the public sector
  • staffed by people well supported and with a positive career structure
  • with financial support for voluntary carers 

Reclaim Social Care composited the below motion which is now Labour Party Policy:

SOCIAL CARE COMPOSITE RESOLUTION PASSED AT LABOUR PARTY CONFERENCE SEPTEMBER 2019

This was brought together from motions from across the country, many based on Reclaim Social Care’s text. It is now Labour Party policy.

Conference notes the current postcode lottery of Social Care funding and the real hardship and unfairness this causes, impacting on the most vulnerable within our society reducing life expectancy, health outcomes and wellbeing. 

Labour to develop a universal care and support service working with user groups, in collaboration with a national independent living support service and available to all on basis of need, based on Article 19 of the UNCRPD. 

England’s social care system is broken. Local Authorities face £700million cuts in 2018-19. With £7billion slashed since 2010. 26% fewer older people receive support, while demand grows. Most care is privatised, doesn’t reflect users’ needs and wishes, whilst charges increase. 

Disabled and elderly people face barriers to inclusion and independent living, thousands feel neglected. 8 million unpaid, overworked family carers, including children and elderly relatives, provide vital support. 

Make the provision of all social care free to recipients as is the case for health care under the NHS. 

A service:

  • That provides a new universal right to independent living
  • Enshrined in law and delivered through a new National Independent Living Service co-created between government and service users.

Consequences of marrying social care to the NHS include medicalisation, isolation, indignity, maltreatment, bringing social care under a struggling NHS umbrella is not the answer. 

Transfer responsibility for funding social care from the LA to the national exchequer through progressive taxation. 

Distribute funding to the LAs for social care on the basis of the population served (age, sex and deprivation) and the cost of care. 

Locally democratic and designed by service users and carers in partnership with LAs and the NHS, delivered as far as possible by service users. 

Publicly, democratically run services, designed and delivered locally, co-productively involving local authorities, the NHS and service users, disabled people and carers. 

Providing staff with nationally agreed training qualifications, career structure, pay and conditions. 

Fund social care to provide a pay rise of at least 35% to all care workers. 

Giving informal carers the rights and support they need. 

Conference resolves that within the first term of a new Labour government to provide a universal system of social care and support based on a universal right to independent living. 

https://www.reclaimsocialcare.co.uk/a/40563951-40565561

Summary

  1. Social care is in a deep crisis created by severe cuts enforced on local government by central government and the failure of the system to defend itself from these attacks.
  2. Integrated care is now proposed as a solution to the social care crisis, but not only is it not the answer, but it will harm, both social care and the NHS itself.
  3. Social care is a distinct public good state and it needs to be organised in ways that recognise its strengths and its role as an agent of citizenship for all.
  4. The problems facing social care today are the result of decades of poor policy-making and the refusal to put social care on a level footing with the NHS and other services.
  5. The resources necessary to transform social care into a universal public service are modest and can easily be achieved with the necessary political will.
  6. Universal social care should be implemented alongside a range of other reforms, including the reintegration of social care for children and adults.
  7. Creating the case for a decent social care system also demands the creation of a wider alliance for change and systems that can protect the system in the future.
  8. Better coordination of health and social care services will only occur if the NHS itself begins to work more effectively with citizens, families and communities.

APPENDIX 3

TUC Key recommendations:

https://www.tuc.org.uk/research-analysis/reports/fixing-social-care

Key recommendations

  • A new funding settlement: This year’s spending review should fully offset the cuts of the previous decade and establish future rises at a level that will allow local authorities to meet rising demand and improve pay and conditions for staff. 
  • Immediate funding to fill all social care vacancies: In a time of rising unemployment, social care could provide a steady source of new decent jobs. The government could act now to unlock 120,000 existing vacancies, to help those losing their jobs.  
  • Fair pay and conditions for care workers: To provide sustainable livelihoods and an attractive career, all social care workers must get a sector minimum wage of at least £10 per hour. There must be an end to the zero-hours contracts, and poor or non-existent sick pay that put social care workers at risk during the pandemic. And all social care workers must have guaranteed opportunities for training and progression. 
  • A national Social Care Forum: A new body is needed to bring together government, unions, employers, commissioners and providers to coordinate the delivery and development of services, including the negotiation of a workforce strategy. 
  • A reduced private sector role: The government should strengthen rules to prevent financial extraction in the care sector and should phase out the for-profit model of delivery, so that all public funding is used to deliver high-quality services with fair pay and conditions for staff. 
  • A universal service free at the point of use: The changes above can be made quickly. Longer-term, the government should make social care a universal service, paid for through general taxation to ensure high-quality social care can be quickly accessed by everyone who needs it, in every part of England, without any variation in cost and qualifying rules. 

Speech by Dr Jackie Applebee, Chair of Doctors in Unite to the BMA Annual Representative Meeting, 15 September 2020

Dr Applebee proposed the motion by TOWER HAMLETS DIVISION of the BMA: That this meeting, in response to COVID 19, demands that government:

i) ensure that workers are not under pressure to attend work either for financial or workforce reasons while they are unwell or self-isolating and at risk of inadvertently passing on the disease;

ii) provide the equivalent of day-one statutory sick pay to those on zero hours contracts;

iii) allow the NHS to requisition private health care facilities to accommodate effective COVID-19 treatment and quarantine provision if needed;

iv) ensure workers are paid in full while they are unwell or self-isolating.

With respect to point iii)

The COVID 19 pandemic has surely blown the myth that private is good and public is bad.

We have heard repeatedly today how the NHS has stepped up to the plate to deal with the crisis, though years of an unprecedented funding squeeze has led to the collateral damage that Chaand (Dr Chaand Nagpaul, Chair of the Council of BMA) referred to earlier of  those whose other health needs could not be met due to the lack of slack in the system.

On the other hand outsourcing to the likes of Deloitte and Serco has led not to the world beating test trace isolate and support system trumpeted by Boris Johnson, but a wholesale fiasco where people are having to drive miles to get a COVID test and where, despite the billions spent, the global multinationals cannot do as well with contact tracing as the very poor relation that are local public health departments.

Private hospitals were handed hundreds of millions back in March to increase capacity to deal with COVID 19 but they were largely unused, gifting a nice windfall to their shareholders at a time when their usual work had all but dried up.

Now they are likely to commissioned to help with the backlog of NHS care. Don’t get me wrong the backlog needs to be cleared, patients need their treatment, but the private sector should not be able to profit from this. They should be brought into the NHS family and their activity now should be offset against the money they were given in March. There must be value for public money spent.

The fact that the NHS had to shut down everything except dealing with COVID in March is a stark illustration of the chronic underfunding and that there has to be spare capacity inbuilt into the system to deal with crises. The extra money thrown at the system should have been thrown at the NHS not the private sector.

With respect to points i), ii) and iv):

If we are going to crush COVID, really get on top of it, we need people to be able to afford to stay at home and isolate if they are in contact with an index case. If there is enough money in the economy to subsidise eating out there is surely enough to guarantee that if someone is in quarantine that they are paid in full.

Many of the lowest paid, for example cleaners, refuse collectors and care workers, many of whom have looked after patients with COVID, often of precarious zero hours contracts, cannot work from home, and to make ends meet many of them have two jobs. They need to be reassured that they wont’ lose out financially if they stay off work otherwise they will have no choice but to go in and the virus will continue to spread.

Covid is with us but Government could do so much more to minimise it’s devastating impact.

The pandemic has surely underlined the huge value of publicly funded, publicly provided health service which is free at the point of delivery and the demonstrated the dedication of the staff who work within the NHS and Social Care.

As has been said today already, we have an opportunity to reshape the future, it’s up to us whether we grasp the nettle.

Please support this motion in all it’s parts.

The Motion was passed with overwhelming support from delegates