commissioning Government Policy Social Care

An unequal society is an unhealthy society

Life expectancy is falling for the first time in over a century, driven by growing social inequality and a decade of ideological Conservative austerity.

Sir Michael Marmot, the director of University College London’s Health Equity Institute, specifically cited government policy as a driver of worsening health and shorter lives for people in the UK.

“England is faltering,” says Marmot. “From the beginning of the 20th century, England experienced continuous improvements in life expectancy but from 2011 these improvements slowed dramatically, almost grinding to a halt.”

His report, Health Equity In England: The Marmot Review 10 Years On, lays out in excoriating detail how the government’s failure to address social injustice has led to a less healthy society.

“When a society is flourishing health tends to flourish. When a society has large social and economic inequalities there are large inequalities in health.”

This is not just about the NHS, says Marmot. It’s about every part of society.

“The health of the population is not just a matter of how well the health service is funded and functions, important as that is: health is closely linked to the conditions in which people are born, grow, live, work and age and inequities in power, money and resources – the social determinants of health.”

There is apathy from the government, inaction on addressing a social care crisis for the last ten years, and an NHS straining under the weight of a decade of neglect. But there is also a vicious zealotry in their policies that make the lives of working people harder.

Doctors in Unite Chair Dr Jackie Applebee rightly condemns the findings of the report. “Yet again the evidence shows that austerity is bad for your health,” she says. “It is shocking that in one of the richest countries in the world, life expectancy is decreasing. It is an indictment of this government’s policies that it is the poor and vulnerable who are disproportionately affected.”

In the lead up to budget day, health workers across the NHS are coming together to put wellbeing at the centre of the country’s finances. Nothing is worth more than good health.

Doctors in Unite urges all members, all doctors, and anyone who cares about our society becoming less just and less healthy to sign the Health and Wellbeing Budget pledge, organised by medical justice charity Medact.

Join with us and sign the pledge now.

DiU and Unite

University strike action – their fight is our fight

The junior doctors strikes of 2015 were in response to an unprecedented attack on doctorsʼ working conditions, unequal pay and unsafe demands by then Health Secretary Jeremy Hunt. Now, Doctors in Unite stands in proud solidarity with the striking educators, lecturers and researchers in the University and College Union, who have stood shivering on picket lines around the country to protest the unfair working environment they are being asked to endure.

UCU members have been forced to take industrial action following years of stagnating wages, and insecure, zero-hours contract arrangements which leave staff overworked, underpaid, and with no job security.

One striking university researcher explained how workers were simply not getting paid for hours worked. “Many of us are on part time hourly paid contracts. Weʼre paid to lecture, but only the one hour of the lecture. It can take up to two days to properly prepare. So you can either prep a poor quality lecture quickly, or take the necessary time to put the work in – but thatʼs unpaid labour.”

Staff pay has fallen by 20% in real terms in the last decade, with women and BAME workers suffering disproportionately. UCU calls the workloads staff experience “unsafe”, criticising the entrenched culture of casual contracts, while staff are being pressured to work longer hours than ever before.

“I was contracted to work month by month,” said one UCU member. “I didnʼt know how much I would get paid. Itʼs highly unpredictable, very difficult to budget, and incredibly stressful.”

All industries rely on the training that happens in universities. Doctors would not have their jobs without the dedicated enthusiasm of their medical school lecturers and teachers. Educators are passionate about their work, and often conflicted about taking time out from crucial research and teaching. But theyʼve been backed into a corner by an unsustainable culture of casual, insecure work. UCU states that without the threat of strike action, “the employers would not have entered talks and that without the threat of further action, no more progress will be made.”

Doctors in Unite recognises the struggle of all workers to gain proper, fair recognition for their labour. There is no excuse when employers exploit their workforce. We urge all trade unionists and all workers to contribute to the UCU strike fund if they can. Their fight is everyoneʼs fight.

Donate to the strike fund on the UCU website

commissioning COVID-19 Government Guidelines Government Policy

Coronavirus: how will an overstretched NHS cope?

Wuhan Novel Coronavirus (CoVid-19) has claimed over 1,300 lives and infected 60,000 worldwide so far, with no sign of slowing down. The NHS has become an increasingly fragmented service supplied by multiple providers, which is at risk of failing to deliver the co-ordinated, effective response that Coronavirus requires.

The last potential pandemic the NHS responded to was swine flu in 2009. Since then, the NHS has altered significantly – although privatisation was well under way, there were some notable differences that meant it was in a better position to respond to pandemic flu.

At the time there was a clear hierarchy from the top table decision makers: the Chief Medical Officer, Department of Health and the Health Secretary, down to the Primary Care Trusts and GPs. The Strategic Health Authorities operating above the PCTs had power to realign funding priorities between PCTs as needed.

An excellent report from the Centre for Health and Public Interest in 2014 reviewed the response in 2009 and found this hierarchy had a “clear line of sight,” allowing the co-ordinated response that swine flu required. There were flaws, such as a lack of evidence base for the widespread delivery, and the unnecessary stockpiling of anti-influenza medication, but in terms of interdepartmental communication and a joined up response, things worked well.

None of the organisations that existed then remain today, due to the top-down reorganisation that followed the Health and Social Care Act in 2012. We are now undergoing another costly reorganisation with the creation of Sustainability and Transformation Plans and Accountable Care Organisations. £79.9 billion of the NHS budget is controlled by Clinical Commissioning Groups, who purchase services from local providers. There is a fragmented landscape of different providers and disparate service provision across different regions. According to NHS England there are 150 independent providers of health services in England on top of the 233 NHS providers.

The Secretary of State for Health retains emergency powers to demand co-ordinated action, but these are yet to be exercised. It remains to be seen how these disparate services, with different contracts and arrangements, can be centrally directed to deal with a possible pandemic. We have lost the organisational memory that the swine flu response developed. With so many different providers with varying contractual arrangements offering widely differing health care services, an effective response to Coronavirus may be far more challenging.

Monitoring of the contracts with private providers is often poorly done, so it is conceivable that these arrangements might not be conducive to scaling up service provision in the event of a global health emergency. The chaotic healthcare architecture is exacerbated by the continuing cuts to local government public health services, as much as 8% from 2013 to 2018, and by our already overwhelmed emergency departments.

Coronavirus may well spread in large numbers. The neglect and fragmentation of our health service by the last 10 years of Conservative government could make a difficult situation catastrophically worse.

Dr Sammy Luney is a junior doctor and member of Doctors in Unite. A longer version of this article can be found on his Medium page.

Government Policy

Universal Basic Income – ‘playing the game for smaller stakes’

In the late 1980s our union first published proposals for a citizen’s income – what we would now call universal basic income. This was long before the idea became fashionable.

Our proposal was simple – we would give an income of two thirds the average GDP per person to everyone, so long as they contributed meaningfully to society for a specified number of hours a week.

The contribution could be through work, self-employment, voluntary work, parenting or caring, or by undergoing education.

Hours contributed by employment, self-employment or voluntary work would be transferrable within households, to include those who bore a disproportionate burden of housework.

Individuals who were too sick or disabled to work or were beyond retirement age would be exempt from making a contribution. We hoped that the numbers who were too disabled to make any kind of contribution would be small, and the aim would be to find a meaningful contribution for everybody.

For those who did not contribute meaningfully there would be a smaller subsistence income of one third of GDP per capita. There would be a sliding scale between the two figures for those who contributed something, but less than the specified qualifying minimum.

Therefore, everybody would be able to qualify – if you couldn’t find employment there would be ample alternatives to choose. The only people who wouldn’t qualify would be those who chose not to.

Children before school starting age would be exempt from making a contribution and once children started school they would qualify by being in education. Payments made in respect of children would be divided between a payment to the parents to provide for the child, and a payment into savings to be accessed when reaching adulthood.

This method distributes two thirds of GDP in an egalitarian way – the labour market and financial markets would distribute the rest. It is what John Maynard Keynes called “playing the game for smaller stakes”. Keynes recognised the importance of incentives but also suggested that they need not be as great as they currently are.

To finance the arrangements there would be a one-off downward adjustment of existing incomes to reset the market. The money consequentially released to business by, for example, lower wages, would be recouped by a range of green taxes which would fund the new system.

Although the gross cost to be financed would be very high, the net cost would be quite small when you ignore the money which has simply been transferred to flow by one route rather than another. There would be savings to public services from eliminating poverty, and savings to individuals from greater security and therefore the lesser need to save for a rainy day.

If you assume a significant Keynesian multiplier from poor people having more money to spend, the net cost might even be less than zero.

There are also considerable benefits to health. Poverty is one of the largest determinants of health – ill health caused by inadequate income would be abolished. With wages contributing a much smaller part of the income of the low paid, most unskilled workers would be instead working predominantly for the qualifying credits. With many other options available for achieving those credits, their labour market power over working conditions would be dramatically transformed.

The credits for caring would liberate carers from the invisibility of currently unrecognised vital work. A guaranteed income makes it substantially easier to make neighbourly arrangements for supporting sick and disabled people – it reinforces rather than fragments society.

The spirit level which measures the health of all societies is remarkably consistent: with equality comes good health. Universal basic income would, at a stroke, eradicate the injustice and illness which plagues our current social system.

Dr Steve Watkins is the Vice President of Doctors in Unite. His paper on Universal Basic Income can be found here.

Doctors declare climate change a public health emergency

The UK’s oldest medical trade union has sent an open letter to the four Labour party leadership contenders, demanding they recognise climate change as a public health emergency. 

Doctors in Unite said that flooding, heatwaves, tropical diseases and toxic air pollution are already putting the public’s health at risk.

The union’s chair Dr Jackie Applebee urged all candidates to commit to a series of transformative green policies, including massive public transport investment, extra money for hospitals during extreme weather events, and an increase in international aid for other nations affected by climate change.

“A Labour government managed to create the welfare state out of the ashes of the second world war,” she wrote. “You could make the UK a world leader in green technology and a beacon of hope for other countries to emulate.”

Doctors in Unite plans to protest the COP26 climate summit in Glasgow later this year, to highlight the devastating impact of climate change on the health of everyone in the UK.

Read the letter in full

Defend the NHS DiU and Unite KONP and other campaigns

Joint campaigning to defend the NHS

The annual NHS winter crisis is now a continuous crisis. The latest performance figures for emergency departments are the worst ever and waiting lists continue to increase. The government has promised much, but there is little hope this will translate into real improvement.  The situation continues to worsen due to chronic underfunding of health and social care, cuts, closures and huge staff shortages. Brexit and the looming threat of a US Trade Deal are also on the horizon.

We must stand together with other campaigning groups to speak out and take action to defend the NHS. Dr Jackie Grunsell’s motion at the Doctors in Unite AGM commits the union to this coordinated effort.

Our starting point will be on February 15th, the Winter Crisis Day of Action, arranged by Health Campaigns Together and Keep our NHS Public. Other national and local events are running around the country.

We are stronger when we work together. Doctors in Unite resolves to do all in our power to join with other campaign groups and trade unions for the organised resistance now required.

DiU and Unite

Doctors condemn escalation of Middle East tensions

The UK’s oldest medical trade union has denounced the assassination of Iranian General Qassem Soleimani. Doctors in Unite chair Dr Jackie Applebee said she was “appaled” by the killing, citing fears that this would “further destabilise the Middle East” and “set off a chain of tit for tat actions that will lead to the deaths of countless innocent people”. 

Our union stands with anti-war movements across the world in the condemnation of the killing of General Soleimani. At our 2020 conference, we committed to building and attending anti-war demonstrations, and participation in lobbying efforts to prevent worsening conflict.

Government Policy

The devastating impact of alcohol must not be ignored

The Doctors in Unite conference focussed its attention on the destructive effect of alcohol this year, and committed to making tackling alcohol harm its key priority for 2020.

There are over 80 alcohol related deaths each day in the UK, and over a million hospital admissions a year are associated with alcohol use. In England, alcohol is the leading cause of ill health, disability and death in people aged 15-49.

Yet only one in five people who could benefit from treatment are in specialist care.

There is a sinister imbalance in alcohol’s impact on our society. Despite on average consuming less alcohol, those with greater socioeconomic disadvantage experience more alcohol related harm. 

This inequality must be acknowledged. Our union stands shoulder to shoulder with everyone whose life has been impacted by alcohol. We urge for meaningful, non-stigmatising change that prevents alcohol harm and provides treatment to those in need.

The World Health Organisation recommends tackling the key drivers of alcohol harm: price, promotion, and availability.

Industries involved in the manufacture and distribution of alcohol have a responsibility to change their practices, and local and national governments have a duty to listen and to act.

Doctors in Unite suggests:

Empowering local communities to make decisions about alcohol licensing.

Protecting children from exposure to alcohol advertising.

Targeting policy at the cheapest, strongest alcohol that causes the most harm.

Government Policy

A call to activism from chair Jackie Applebee

The chair of Doctors in Unite has called her union to action in the face of the calamitous 2019 general election result.

Dr Jackie Applebee said she was “horrified” by the outcome.

“We cannot sit back and wait for the next general election in five years, before campaigning on issues that affect the people’s health” she wrote in a motion before the 2020 conference.

Dr Applebee explained that five more years of unchallenged Tory rule will mean “potentially fatal attacks on the NHS” and “further increases in mortality as austerity is extended.” She also feared that unchecked, the government would create a “headlong gallop into irreversible climate change.”

Extinction rebellion

She urged the union to build and take part in climate action in workplaces and communities, and successfully passed a motion to affiliate the union to the Campaign Against Climate Change and Extinction Rebellion. She recommended that union members protest the 2020 UN Climate Change Conference in Glasgow, beginning November 9th.

Dr Applebee argued that the new government would also undermine trade union rights, and called on the union to oppose any attacks on workers.

Hostile environment

Broader concerns were raised about the impact of the government’s ‘hostile environment’ policy, where immigration enforcement can access personal data collected by the NHS. A linked proposal to affiliate the union with Stand Up To Racism was passed unanimously.

Budget cuts for local councils were also addressed as a concerning prospect under the new Tory government. A commitment to campaign against such cuts was made. 

Dr Applebee made a final, heartfelt call for doctors to “continue to campaign for the reinstatement of the NHS as a comprehensive health service, publicly funded, publicly provided”.

Government Policy Hostile Environment

Doctors in Unite to affiliate with human rights organisation Liberty

The UK’s oldest medical trade union is affiliating with the human rights organisation Liberty. Both groups fight for people’s rights and freedoms, hold the powerful to account, and challenge those who abuse their authority.

Doctors in Unite and Liberty stand together against the home office’s discredited ‘hostile environment’ policy, where immigration enforcement can access personal data collected by hospitals, schools, and job centres, and use it to track down children and adults for deportation. This robs doctors, teachers, police and other public servants of the trust that’s key to everything they do. That’s why we call on government departments to commit to a data ‘firewall’ – a cast-iron promise that personal information collected by trusted public services will never be shared with the Home Office for immigration enforcement purposes.

Liberty counts dozens of unions among their growing network of members, and our union is proud to stand with them to help make the UK a fairer place.