“Wo ich war, sollte es werden” [1]

[1] With apologies to Freud. ‘Wo es war, soll Ich werden’ – “Where it was, I should become” – is his version of the Enlightenment goal of knowledge that is in itself an act of liberation – the ego replaces id and so we develop. Here we have the reverse, ‘Where I was, it should become’ – an undoing. The Health and Care Bill 2021 is an act of destruction. Greed and indifference fuel these changes; a wish for continuous exploitation will undo our greatest achievements.

How the ICS will work in practice

The way ‘Accountable Care’ works is through its funding mechanism and the legal duty put on the ICS and all the individual Partners [2] not to overspend their and the system budgets. The sheer size of the ICS is important to allow this to be possible.

Alongside the budgetary control totals [3] , the structure will be built using Payment Incentives for ‘aligned’ services and required percentage spends on ‘integration’ development. With the ‘new models of care’ in place and the absence of any legal duty to provide secondary care services then referral avoidance and the whole range of other efficiency measures as described in McKinsey‘s 2009 paper ‘Achieving World Class Productivity’ [4] can be fully used to try to cut costs. The increased waits and lists of Procedures of Limited Clinical Value (PoLCVs) [5] will increase the number of people willing to pay for care either directly from Private providers or as ‘NHS paying patients’ utilising the NHS or the developing public-private partnerships’ services.

Clinical activity, costs and ‘outcomes’ will be monitored in real time – everything will be developed as a ‘currency’- and ‘best value’ for the system
(possibly decided using IT) will be used to explain away individual decisions not to provide care.

The majority of the limited community spend will be focused on those patients selected as ‘at risk’ of requiring elective secondary care by the predictive Artificial Intelligence algorithm. They must be kept away from any test ordering, hospital admitting doctors.

Squeeze the system control total and watch the system work.

Integrated Care Boards will be able to enter into financial agreements with external parties. They and their Partners will generate income streams; this is already evident at the Royal Marsden Trust, the HCA-UCLH Trust partnership and the Johnson and Johnson- St Thomas and Guys Trust partnership. There are also 65 NHS Trust subsidiaries (2018 figure) [6] currently trading as private companies which could also generate capital income streams, perhaps with private partners, once the ICSs are set up and current capital spending limits relaxed. Essentia, a St Thomas and Guys subsidiary in SE London, is currently a partner in Optimedis COBIC UK and is accredited on the Health System Support
Framework (HSSF).

NHS Trusts and major academic organisations will become ‘anchors’ of place and help with inequalities through preferred employment of local people within their organisations and preferred contracts for local Small and Medium Enterprises using subsidiaries to negotiate this. They could also use their financial resource to leverage finance for local community development and Public Health initiatives.

Community care will be ‘asset- based’ [7] (MacLeod & Emejulub 2014) and digitised, with all digital platform providers only accredited by NHSE if they can support Personal Health Budgets. ‘For profit’ and ‘Not for profit’ providers will be heavily involved and both will be able to receive financial assistance directly from the Secretary of State or bodies to which he has delegated this function. It also seems that many of the huge number of community healthcare apps carry adverts [8] – a new market – which will gain a huge boost described as ‘the rise of the consumer in healthcare’ when apps and devices are linked to Cerner Millenium or similar health information packages [9].

Not having private corporations on the board will not stop any of this.

It is the removal from the remit of PCR 2015 [10] and the CMA [11] that will deregulate the market with the loss of all its labour and environmental protections. PCR 2015 allows procurement without tendering but only within public services, so it seems they need deregulation if they wish to give contracts to private providers. The NHS Provider Selection regime also makes it easier for ‘Any Qualified Providers’ to get accredited and placed on Provider lists, and makes it more difficult to remove them- it will be mandatory for the Secretary of State to impose standing rules on NHS England and ICBs to enable people receiving certain treatments to exercise choice.

National pay scales and collective bargaining will become virtually impossible as each of the 42 ICSs will develop its own plan and outcomes, and will need to provide the services required to achieve them while bound to its own legally agreed budget/control total. There are expectations for ICSs to innovate to achieve sustainability. Also the People Plan requires a flexible, agile workforce that can move between disciplines and the Partners and can be ‘passported’ between NHS and social care and beyond the system. There is an ambition that technology will allow the deregulation of various groups of staff.

Notes

[2] The Provider organisations within an ICS will be called Partners. The ICBoard is a ‘body corporate’. So in North Central London we have ‘North London Partners’.

[3] IC Boards are required to keep revenue expenditure within an agreed range set by NHS England.

[4] See here for the McKinsey paper

[5] They used to be called Procedures of Limited Clinical Effectiveness (PoLCEs) but the immaterial nature of ‘value’ broadens the scope of what can be rationed and allows comparison with activities across the system when decisions are to be made about where to spend the limited budget.

[6] Jan Savage, Marion Macalpine and Carol Saunders ‘How come we didn’t know about SubCos? The growing use of NHS-owned private companies’. Pamphlet 2021

[7] a specific kind of neoliberal community care developed during the Reagan administration relying heavily on ‘assets’ e.g. volunteerism, families and friends, charities etc and the use of the market and marketing

[8] Healthcare apps are booming (53,979 registered on Google) and many/most carry adverts to pay developers, and once apps and health devices are linked to health records it will allow tailored adverts to help care and optimise markets.

[9] As Distie Profitt CEO Cerner UK reported in Digital Health- The challenges of leading Cerner UK during the Covid-19 pandemic 2020.

[10] Public Contracts Regulations

[11] Competition and Markets Authority


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.

.

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. 

Doctors in Unite support Independent SAGE’s emergency 10-point plan to stop a national lockdown

We sent the following message today, 20 September 2020, to Independent SAGE:

“Doctors in Unite fully endorse Independent SAGE’s emergency ten point plan to avoid a national lockdown. [The plan can be found here: https://www.independentsage.org/wp-content/uploads/2020/09/Emergency-Plan-PUBLISHED.pdf ]


Experience from other countries such as Germany, South Korea and Japan has shown that if the correct measures are adopted the case rate of COVID 19 can be substantially reduced and unnecessary deaths prevented. Equally these proposals are not alien to the United Kingdom as virtually all of the recommendations are already policy in our devolved administrations.

However, despite governing one of the richest countries in the world, Boris Johnson and the Tory Party callously ignore what can be done and what needs to be done and instead throw billions of pounds at private sector providers such as Serco, Sitel and Deloitte whose national “test, trace, isolate and support” programme is demonstrably unfit for purpose, and is contributing to the current alarming rise in Covid-19 infection.

Doctors in Unite call on the Tory Government to take off their ideological blinkers and to listen to the experts and people on the front line, to give the NHS and Public Health the tools they need to crush the virus and to immediately adopt i-SAGE’s emergency ten point plan”


We did suggest an amendment to point 2 of the plan which says there should be “no return to workplaces until they are certified Covid-safe”. It is very difficult to make any indoor space completely Covid-safe and the Health and Safety Executive (HSE) has suffered swingeing cuts over the last decade to the point where it is unable to fulfil its statutory duties in the workplace. We suggest therefore that there should be no return to the workplace “until it has been fully risk-assessed”, which will allow for trade union and worker involvement in ensuring that workplaces are as safe a possible.