Private providers must serve the public interest

In the middle of March 2020, it was clear that the NHS would not have the capacity to deal with the increased demands of the Covid-19 epidemic. This lack of spare capacity is clear evidence of continuing government failure to invest in the NHS to provide the required flexibility to meet unplanned needs.  As a necessary but panic measure to deal with the threat of COVID 19, Johnson’s Government struck a deal with the private hospital sector to rent beds from them at a cost of £2,400,000 per day.

By the end of June, after approximately one hundred days this will already have cost the NHS a quarter of a billion pounds. It is clear that the Government can find funds when they are needed and that their default position is to throw money at the private sector despite the shocking record of commercial organisations in providing health and social care.

This is a disgrace which has thrown a lifeline to the private health providers who would have not been able to operate normally during the pandemic and would have lost huge quantities of money but for this.

NHS hospitals have largely coped with the first wave of the COVID 19 pandemic by ceasing all other activity and by the public co-operating with a country-wide lockdown. The extra capacity has been mostly unused. Effectively the private hospitals have received tens of millions of pounds of public money, and rising, to do nothing.

As the NHS begins to deal with the huge backlog of non COVID care these private hospitals must be obliged to make their facilities available to help with the catch up in care and they must do so taking into account the windfall they have obtained to date.

There must be no profiteering from Covid-19.

We demand:

  • Private hospitals must provide value for the money already paid to them and make their facilities available to help clear the backlog of NHS care for no extra charge.
  • There must be full scrutiny and open book accounting to ensure that taxpayers can see that they are getting value for money.
  • Commercial organisations must not be permitted to cherry pick their way to bigger profits at a time of great national emergency.

https://www.independent.co.uk/news/health/coronavirus-nhs-waiting-times-surgery-privatisation-a9550831.html?amp

Doctors in Unite statement 28/06/20

Tens of Thousands of Avoidable Deaths Due to The Government’s Callous Indifference to the effects of Covid 19

June 1 2020 heralded the official start of the easing of the lockdown that has been in place since 23rd March to try to contain the spread of Covid 19.

The current reality is that due to the Westminster Government’s repeatedly vague and confusing messaging, compounded by their unwavering support of the Prime Minister’s rule breaking Chief Advisor, Dominic Cummings, people are already relaxing social distancing.

We have now known about the threat from Covid 19 since January this year, and through the lens of the media watched it heading our way via Iran, Italy and other countries. The UK had more time than most to prepare, however this opportunity was squandered by the Westminster Government.

Instead of learning from the experience of other countries and making sure that key workers had sufficient personal protective equipment and that time honoured locally coordinated test, trace, isolate and support programmes were in place to contain the spread of the virus, Boris Johnson glibly announced that the UK’s strategy would be one of developing herd immunity (a form of indirect protection from disease that occurs when a large percentage of the population has become immune) and that we should prepare ourselves for our loved ones to die.

Soon after, Imperial College published modelling which showed the NHS would be overwhelmed by Covid cases if more stringent measures were not put in place.

The Government publicly abandoned their herd immunity strategy and the UK went into lockdown. Over two months later, following a shockingly high peak in early April, the daily death rate and reporting of new cases has declined significantly, but not enough to suppress the virus to a level that makes it safe to start to open up schools and businesses.

The much heralded national contact tracing scheme is beset with problems and unlikely to be up and running (let alone working well) before the end of June at the earliest. Meanwhile, local projects are being held back, starved of resources and undermined.

We must ask ourselves why our Government have careered from one position to another during the Covid 19 crisis, seemingly out of control and always on the back foot. They, like anyone else, can be forgiven for the odd mistake, but this has had the appearance of a complete shambles.  They have the more conservative of the best scientific minds at their disposal and experience from other countries which were beset by the virus before the UK to draw on.

So why has their response been so seemingly incompetent and why are they now insisting that it is safe to ease lockdown when the evidence suggests that this will trigger another viral surge? Could this be construed as akin to corporate manslaughter?

We believe that the Westminster Government has been forced by events to address the health of the public in this crisis but has done so through gritted teeth because it is at odds with their ideological programme of dismantling the welfare state. For them the crisis is also an opportunity to expose more public services to privatisation.  This is why they have so vigorously prevented NHS laboratories and local public health teams from expanding their services appropriately to meet the demands of the pandemic, instead choosing to  contract with Tory-contributing, multinational, outsourcing agencies like SERCO despite the fact that these companies’ incompetence and corruption in providing health care are well known.

Easing lockdown may “stimulate” the economy, but in the process thousands, if not tens of thousands of lives, especially those of the elderly, will be sacrificed as the virus surges again.

This is disgraceful and callous. Lives are far more important than profit.

We have said before that lockdown should not be eased until

  • Proper locally coordinated test, track, isolate and support systems are in place and shown to be working
  • There is financial support so workers do not lose income if they need to isolate
  •  There is adequate ongoing supply of appropriate PPE for all key workers

None of these things are yet adequately in place.

History shows that pandemics have lethal subsequent waves.

We believe that to end lockdown in the current circumstances will lead to huge numbers of avoidable deaths as the virus surges again. When these deaths occur the question must inevitably arise – ‘was this corporate manslaughter?’

There is no rationale to the behaviour of the Westminster Government other than to put profit before people – we demand a change in strategy to put the health of the people first.

Doctors in Unite 7 June 2020.

References:

  1. https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea68b5
  2. https://www.theguardian.com/world/2020/mar/12/uk-moves-to-delay-phase-of-coronavirus-plan
  3. Britain Drops Its Go-It-Alone Approach to Coronavirus – Own Matthews, Foreign Policy 17/03/20
  4. https://www.theguardian.com/commentisfree/2020/may/28/coronavirus-infection-rate-too-high-second-wave
  5. https://www.bbc.co.uk/news/health-52473523
  6. https://www.theguardian.com/commentisfree/2020/may/28/ppe-testing-contact-tracing-shambles-outsourcing-coronavirus
  7. https://www.bbc.co.uk/news/health-52284281
  8. https://doctorsinunite.com/2020/05/25/isolate-trace-and-support-is-the-only-safe-way-out-of-lockdown/
  9. https://doctorsinunite.com/2020/05/18/testing-times-require-radical-solutions/
  10. https://www.history.com/news/spanish-flu-second-wave-resurgence
  11. https://www.theguardian.com/world/2020/may/31/did-a-coronavirus-cause-the-pandemic-that-killed-queen-victorias-heir

Public Health and Primary Care

In January 2019, Doctors in Unite issued proposals relating to public health and primary care. This document has now been revised.

In the light of COVID-19 the authors believe that if these proposals had been implemented before the pandemic struck then the UK would have been able to respond much more quickly to the need and would have been in a much stronger position to plan and deploy local responses.

The government has allocated significant resources into protecting the front line of the NHS at the level of hospital services, with particular investment in the building of Nightingale hospitals. However, it has put almost no additional resources into primary care or community services to deal with COVID-19.

We believe that strengthening primary care and community services as laid out in our paper would mitigate the effects of COVID-19 for five main reasons:

1. Those working in primary care should look after populations and communities as well as individuals and their families. Dual training and accreditation for GPs and nurses in public health and primary care is essential. Neighbourhood public health leads would co-ordinate appropriate local responses to a pandemic, for example, by supporting people at home with COVID-19, isolating them and contact tracing in ethnically and culturally appropriate ways.

2. Primary Care Networks of GP practices should be funded to provide care home and appropriate domiciliary care during the pandemic. Community organisations should be integrated with primary care, which during theCOVID-19 lockdown could deliver food, medicines and other essential items as well as provide support for isolation, loneliness and respond to mental health issues.

3. We support a social prescribing model, which in normal times encourages patients to go out, meet people, socialise and stay active; during a pandemic this is necessarily amended, and patients are asked to stay in and not meet people, but to still socialise, keep in touch with others and remain active.

4. We develop the idea of local democracy through Neighbourhood Health Committees which would organise appropriate medical, psychological and social care, led by public health leads working seamlessly with directors of public health who have authority and independence which has been devolved from central control.

5. We propose professionally independent public health advocacy so that the people can trust the advice and information they receive.

Read the full paper here

Matt Hancock offered to auction his football shirt for the NHS – we need proper funding, not charity gimmicks

Doctors in Unite would like to remind the Secretary of State for Health and Social Care that the NHS is not a charity but a government funded health service, set up in 1948 with the specific intention to remove health care from the precarious state of reliance on income or beneficence.

Matt Hancock has his hands on the levers of government, he should be using his time and influence to bring investment in the NHS and Social Care up to the levels needed to redress the years of systematic underfunding, fragmentation and privatisation which have contributed hugely to the failures we now see in the government’s ability to cope with the challenges of COVID-19, not trivialising matters by suggesting that all of the problems can be solved with the sale of a football shirt.

Dr Jackie Applebee is the chair of Doctors in Unite

Government ineptitude has undoubtedly led to many unnecessary deaths – they must be held to account

Richard Horton, respected editor of the medical journal ‘the Lancet’, aptly summed up the current pandemic in the following words: “Coronavirus is the greatest global science policy failure in a generation. Austerity blunted the ambition and commitment of government to protect its people. The objective was to diminish the size and role of the state. The result was to leave the country fatally weakened”. China implemented a lockdown in Hubei province on 23rd January in response to a new and severe respiratory infection. One week later the World Health Organisation declared a global emergency in recognition of what had become a worldwide pandemic. It then took nearly two months for the UK government to grasp the seriousness of the problem and to implement social distancing and isolation. This delay has led to many unnecessary deaths.

Despite there being core public health principles of “test, isolate and contact trace” in response to an epidemic, this process has not been implemented in the UK. There was talk of ‘herd immunity’ as an alternative strategy, but scientists then pointed out this could mean hundreds of thousands of deaths before the infection was under control. A panicked government decided to abandon its irrational belief in ‘British exceptionalism’ and on 23rd March instituted a lock down of sorts, with people encouraged to stay at home, and most businesses closed down. News footage still showed London underground packed with people and construction workers as key workers were expected to turn up for work as usual.

Unrecognised dangers included the risk to the elderly living in care homes together with their carers, the risk to bus drivers and other key workers with public-facing roles in the community.  The fact that many workers on zero hours contracts and those outsourced from the NHS and not entitled to sick pay would be forced to continue to go to work even if ill. Sick and elderly patients were discharged to care homes only to spread infection without having been tested for the virus, and outrageously, ‘do not attempt cardio-pulmonary resuscitation’ orders proliferated for pensioners and those with learning difficulties or disabilities often without discussion. The official death toll has gone up to above 20,000 – but these are confirmed deaths in hospital and there may be at least as many again in the community without a definitive diagnosis.

In the meantime, countries like Singapore, South Korea, New Zealand and Germany, which rapidly instituted widespread testing and contact tracing were demonstrating a much lower number of cases and deaths. While the UK government kept promising more testing, numbers grew painfully slowly. Centres specially created to test key staff were set up by the accountancy firm Deloitte, given the contract without it going out to tender under obscure legislation passed in 2015. As usual, reports of problems with lost samples and mis-communication of results followed, just as the privatisation of NHS logistics caused problems with distribution of personal protective equipment (PPE). Despite repeated reassurance from government ministers that stocks of PPE were available, this turned out not to be the case as week after week front line staff complained of being sent to war without the necessary armour. Around 132 NHS and care staff have now died from the disease and will be remembered along with many others on International Workers’ Memorial Day.

Worse still for government credibility were details of the unpublished Cygnus report from a 2016 pandemic planning exercise, and more from the 2019 National Security Risk Assessment, both showing that the government knew full well of the major risk posed by the likelihood of a new pandemic, and the need to stockpile PPE and equipment such as ventilators for intensive care, yet did nothing. As one commentator remarked: “We have been paying for a third-party fire and theft policy for a pandemic, not a comprehensive one. We have been caught out”.

Things which have assisted the pandemic response include the fact that we still have a ‘national’ health service and brilliant staff with a public service ethos. Things that have hindered the response include government reforms over recent years promoting marketisation, fragmentation, privatisation and outsourcing. NHS England has rightly taken over commissioning functions from Clinical Commissioning Groups, and government has wiped away the £14 billion hospital overspend to let Trusts focus attention on doing what was necessary to fight the infection. The small private sector capacity was harnessed to assist the NHS. However, the huge PFI debt millstones remain in place, and private hospitals are only too happy to be subsidised to the tune of £2.3 million/day through block contracts- one of the businesses that will not now go under in the coming recession.

The hostile environment aimed at those migrants with uncertain immigration status not only meant the end to universal health care under the NHS, but now fear of being reported to the home office or financially charged will undermines planned contact tracing. This charging needs to be abolished now, as does the yearly surcharge of £625 for members of NHS staff coming from abroad, and each of their family members.

Government policies left the NHS in a weak starting position, with over 100,000 staff vacancies, cuts in bed numbers of 17,000 since 2010, and near the bottom of the European league table in relation to intensive care beds (half as many as Italy and around one fifth of those in Germany). The government will be constructing a narrative portraying themselves as victims of a natural disaster, doing their best in impossible circumstances and leading us all to victory in the war against Covid-19; in this they will be aided by large sections of the media.

Trade unionists must make sure that ministerial incompetence, arrogance and callous disregard for human life are not forgotten and there is a holding to account. When the pandemic is over, we cannot go back to how things were before. We need to take the public with us in demanding a return to NHS founding principles, a publicly funded, managed and delivered health service with democratic control, linked to a national social care service. Renationalisation of the NHS; proper funding; an end to PFI, the Health and Social Care Act and the Long-Term Plan for the NHS; and an end to outsourcing and privatisation. We are witnessing a tragedy unfold and a government scandal of momentous incompetence. The right lessons must be learned.

Dr John Puntis is co-chair of the campaign group Keep Our NHS Public.

Doctors in Unite statement on payouts for those who die in service with COVID-19

It is an insult for the government to claim that a life assurance pay out of £60,000 to the families of a health or social care worker who dies of COVID-19 in any way compensates for the loss of life.

Despite their protestations that they “will do whatever it takes”, this again shows the scant regard the government has for frontline workers.

It follows the abject failure to ensure that staff are properly protected at work, and a testing and contract tracing regimen that is too little, too late. The government has now neglected to correct historic inequalities in the provision of death in service benefits.

On April 27th Matt Hancock announced the £60,000 payout. But the conditions that go with it are an insult to those who are lost and those left behind.

One of the criteria is that the deceased must have been in work within two weeks of developing symptoms.

We do not yet know enough about COVID-19 to be able to confidently state that the longest period from exposure to symptoms is fourteen days.

Many health and social care workers do not qualify for full death in service benefits. These include people who have opted out of the NHS pension scheme due to an inability to afford contributions, or because their jobs have been outsourced to the private sector. 

GP locums who die on a day they are not in work, and retired health and social care workers who have generously returned to work during the pandemic are also not eligible for the full amount.

Widowers will also only receive a pension based on their spouses membership of the pension scheme after 6th April 1988.

Families of those with less than two years membership of the pension scheme will receive no short term pension or long term adult dependants/child’s pension.

Full death in service benefits should extend to all health and social care workers regardless of bureaucratic caveats. The criteria that the deceased must have been in work two weeks before developing symptoms should be dropped.