Defending the NHS: the real fight has yet to start

On 4 March, 250,000 people marched through London in defence of the NHS. Like so many other anti-austerity marches that have taken place since 2011, there was no idea what to do next. The extra money that came in the Budget the following week was a drop in the ocean: a paltry £100m for GP-led triage in A&E and £325m capital funding over three years for Sustainability and Transformation Plans (STPs) – and then only if they jump certain hurdles. The £2bn promised for social care over three years is non-recurrent and will not meet a growing annual funding shortfall estimated currently at £1.9bn. Social care will continue to be cut, and private care companies will reject more and more the minimal payment rates local councils offer for their services. And within days of the Budget, it was announced that £800m reserves earmarked for mental health services will be used to pay off this year’s hospital debts. Robert Clough reports.

The success of the 44 STPs across England is crucial for the process of re-organising the NHS. The long-term aim is to create an integrated management structure across each of the STP ‘footprints’ or regions which in the short term can slash services sufficiently to keep costs in line with savage funding cuts over the next three years. GP-led Clinical Commissioning Groups (CCGs), over 200 of which were set up under the 2013 Health and Social Care Act, will start to reduce in number. Harbingers of this development are the very recent merger of three CCGs in Manchester and three in Liverpool together with the publication of national guidance on the process in November 2016. That 11 CCGs in the West Yorkshire and Harrogate footprint have agreed to form a joint commissioning group is further evidence of this trend.

 

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Grinding down the NHS - An attack on the working class

womens hospital

The willingness of the Tory government to drive the NHS into the ground tells us how far the balance of class forces has shifted against the working class over the past decades. Prime Minister Theresa May and Health Secretary Jeremy Hunt are confident that they will face no significant opposition as NHS services are strangled by an unprecedented level of funding cuts. British Red Cross chief executive Mike Adamson has called the situation a ‘humanitarian crisis’ as staff have been called in to assist hospitals and ambulance services. Robert Clough reports.

At a time when there needs to be a massive and militant mobilisation of working class people to defend a service vital for their well-being, Labour-led councils are implementing cuts in social care which will make the crisis worse, and the trade unions are all but invisible. All that is on offer by way of opposition is the ritual of a national demonstration on 4 March – an event that will be tightly managed to ensure it presents no real challenge to the government. Meanwhile more and more people will suffer and die as they are unable to get the care that they need.

 

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NHS cuts round-up

Save NSH

The wide-ranging attack on NHS services is documented by FRFI supporters from around the country.

STPs and Grantham A&E

Lucy Roberts

In August 2016, it was announced that Grantham and District Hospital Accident and Emergency unit would be closed between the hours of 18:30 and 09:00. United Lincolnshire Hospital Trust (ULHT) has said it does not have enough doctors to staff the department safely while also maintaining services in Lincoln and Boston.

 

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Fight to save free health and social care

Save the nhs protest

There was no extra money in the Autumn Statement on 23 November for the NHS, despite the fact that it is so obviously in a catastrophic financial crisis, we must now expect savage cuts, with an escalation in rationing services and tightening of eligibility to those that remain. These will be set out in the local Sustainability and Transformation Plans (STPs) that are now being published and whose purpose will be to show how £22bn can be cut from the NHS budget over the next four years. Robert Clough reports.

What is happening to the NHS cannot be explained by Tory ideological hostility to state provision of health care alone. A nationalised health service is the cheapest and most efficient way of meeting the health needs of the working class under capitalism. The ruling class is not opposed to the NHS in principle: it simply regards its level of health care provision as far too generous for the working class. Although it seems that the working class pays through its taxes for the NHS as with any other state service, in fact the worker never sees this money nor has any choice about its deduction. The process obscures the underlying reality: that state expenditure is paid for by part of the surplus value extorted by the ruling class. Taxation is the means by which this transfer to the state takes place, and it reduces the surplus value available for profitable capital accumulation. Furthermore, since most of state health care is directed towards the maintenance of workers who do not produce surplus value for the capitalists, either because they are employed unproductively or because they do not work at all through retirement or disability, there is an added reason for the ruling class to axe it (for a thorough discussion of these issues, see Revolutionary Communist No 3/4: Inflation, the crisis and the post-war boom). The pressure is therefore on: the cost of the NHS must be slashed and slashed again. What will determine the outcome will be the extent of resistance both within and outside the NHS, and this presents a political problem for the ruling class: the popularity of the NHS is likely to generate serious opposition to A&E or hospital closures.

 

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Hospitals as border control – no to racist checks and charges!

‘Women forced to show passports.’ ‘Photo ID to access care’. The media reported with interest on St George’s NHS Trust’s October board papers,[1] which propose that all women should show their passports at their first midwife appointment in order to prove their eligibility to receive care. Condemned by Labour leader Jeremy Corbyn in Prime Minister’s Questions, the proposal received support from Theresa May, who stated: ‘Where there are people who come to this country to use our health service – and who should be paying for it – the health service identifies those people and makes sure it gets the money from them. I would have thought that would be an uncontroversial view.’ Accompanying editorials and articles argued for the need to ‘crackdown’ on ‘health tourism’ to limit the NHS’ growing debt. The financial crisis in the NHS is not the fault of people needing care. Measures such as those proposed by St George’s Trust will be harmful to the people who do need care, and will ultimately cost more. Even more importantly, they strengthen racist arguments about who should be cared for and who should not, and begin to normalise the NHS charging for care.  

 

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Health Matters fight the cuts

The crisis in the NHS is now so acute that Chris Hopson, chief executive of NHS Providers, which represents NHS hospitals, has warned that the years of underfunding have left hospitals facing ‘impossible’ demands, and that if there is no extra money in the November budget statement, it will have to face what he calls ‘unpalatable choices’, adding: ‘The logical areas to examine would be more draconian rationing of access to care, formally relaxing performance targets, shutting services, extending increasing charges, cutting the priorities the NHS is trying to deliver or, more explicitly, controlling the size of the NHS workforce.’ (The Observer 10 September)

 

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NHS ‘Reset’ into chaos

The Conservative government has now made it clear that the NHS is to be allowed to descend into chaos with the NHS Improvement (NHSI) instruction that NHS organisations will have to ‘reset’ their finances to ensure that there is no repeat of the 2015/16 overspend of £2.45bn. Waiting time targets – such as the four-hour target in A&E – are to be abandoned. Waiting lists will soar: the historical way of rationing essential health services for those who cannot afford to buy them privately. Services will be cut and hospitals will close. All this will be overseen by the richest Cabinet member, Health Secretary Jeremy Hunt, who received a £972,000 dividend from his education company in 2014/15 on top of his £135,000 Cabinet member salary. There were many who hoped that Hunt would be sacked for overseeing the worst financial crisis in the history of the NHS. It was not to be: his arrogance makes him ideally suited for bringing the NHS to its knees and dealing with resistance such as that shown by junior doctors.

 

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NHS in financial meltdown

In a significant retreat, Health Secretary Jeremy Hunt has agreed to talks with the junior doctors on their proposed new contract. Since they started their strike action, the doctors have received widespread public support. They have refused to back down in the face of government intransigence and lies, and instead have linked their struggle to the need to take action against the government’s deliberate running down of the NHS and the associated privatisation of its services.

Starting with the 2010 ConDem coalition government, the NHS has faced an unprecedented squeeze on its finances. This will continue until 2020/21, by which time NHS spending as a proportion of GDP will have fallen from 8.8% (2009) to 6.6%. GDP is forecast to grow in real terms by around 15.2% between 2014/15 and 2020/21, but NHS spending will grow by only 5.2%. The annual real-term increase in NHS spending between 2009/2010 and 2020/21 will be a mere 0.9%; it needs to be 4.5% to keep pace with rising need and the costs of advances in medical technology. This represents the difference between government lies that it is protecting NHS funding and a reality of insufficient staffing at every level and collapsing services.

 

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NHS maternity services up for sale

NHS for sale

‘We are all trapped in a marvellously pure ideology, the ideal socialist dream.’ So said Tory peer Baroness Cumberlege in 2000 of the NHS, as she advocated for an injection of private companies, competition and profit-making to improve ‘freedom of choice’. Cumberlege is the ‘independent’ chair of the 2016 NHS Maternity Review ‘Better Births’, and it seems her interests remain the same. The review recognises some maternity service problems, but offers a solution which would pave the way to further undermining of free, accessible, universal care.

 

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Unite in struggle to save the NHS

The NHS grinds steadily towards a government-engineered financial collapse. After five years of flat-line funding, spending on health has dropped from 11% of GDP in 2007 towards 6.6%.  Chancellor George Osborne may have announced £10bn investment in NHS England last November, but only £8bn of that represents new funding, and most of this is to paper over the fact that NHS spending must expand at 4% per annum to keep pace with demand.

In February 2016, the NHS provider sector recorded a deficit of £2.26bn, £622m worse than planned. A report to the joint meeting of Monitor and the National Trust Development Authority boards showed that as of 31 December 2015, 179 (75%) out of 240 NHS providers reported a deficit, of which 131 were acute hospitals; providers had made £1.94bn of savings, £257m less than planned. Hospitals as a whole missed the A&E waiting time target of seeing 95% patients within four hours between October and December 2015, and the size of the waiting list for routine operations reached 3.14 million as they failed the referral to treatment 18-week health care standard for the first time.

 

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Starving the NHS of staff and money

An adequate system of health care needs people to deliver it and the funding to sustain and develop it. In Britain, both are severely threatened, despite this being the fifth richest nation in the world. Services are being closed or handed to the private sector, poorer working conditions are being imposed on the remaining staff, and increased zero-hour contracts and job losses introduced for the already lowest-paid, tendered-out hospital staff, such as domestics, porters and caterers, vital members of any health care team.

The NHS employs more than one in 20 of the working population in Britain and nearly 80% of its workforce are women. Across the country there are tens of thousands of unfilled doctor and nurses’ posts, while training places are cut and student nurses, midwives and others are about to have their bursaries axed. Thousands of pounds are spent recruiting abroad for short-term gain in the NHS.

In 2013, Britain spent 8.5% of its total GDP on health care, ranking it 13th out of the 15 original EU members. For NHS spending to match the average European country’s level of expenditure by 2020 would require a 30% increase, equivalent to £43bn a year. The government has promised a mere £8.4bn extra, little more than 1% more a year. In the past five years, the average increase in NHS spending has been 0.8% per year. Yet annual spending on the NHS has to increase by 4% just to keep up with the annual increase in costs of treatments and running services. The future is one of yet more cuts, with the NHS facing continuing financial crises.

 

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Crisis in mental health services

On 25 January 2016 The Guardian exposed the collapse of NHS mental health services, citing figures from the NHS’s Health and Social Care Information centre showing that the number of registered mental health nurses (RMNs) working in psychiatry has decreased by 10.8% since 2010 as funding for the service has been slashed. The following day the paper revealed that the number of unexpected mental health patient deaths had risen by 21% over the last three years. This was inevitable given that mental health service budgets fell 8% in real terms under the last government. Claire Wilkinson reports on the crisis engulfing NHS mental health services.

Working on an acute psychiatric ward for the last four years, my experiences certainly correspond with this data. The North West mental health trust I work for is increasing its training and employment of Assistant Practitioners (APs), a relatively new role where a healthcare assistant is trained to take on many of the duties of a nurse while remaining unregistered in a professional capacity. APs are employed on a Band 4 in the NHS pay scale, whereas an entry-level RMN is employed on the more highly-paid Band 5. There is an obvious financial incentive for trusts to employ fewer RMNs and replace them with the cheaper APs, who are unable to progress past Band 4 or register with a professional body.

 

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NHS under-funded and under pressure

The Autumn Statement’s proposal to increase NHS funding by £3.8bn in 2016/17 is the minimum required to avoid financial disaster over the next 18 months, but may be too late to avoid a crisis this winter. The NHS needs £30bn by the next general election just to stay still; however, the government has only promised £8bn. The health service will have to find the balance of £22bn through ‘efficiency savings’ – about 20% of its current budget. This is an impossible target: but the government pretends not only that it can be achieved, but also it will be sufficient to meet what it defines as a 24-hour, seven-day-a-week service. The savings require productivity improvements at twice the rate of the past five years, during which time the increase in health spending has averaged 0.8% per year, the smallest five-year rise since the NHS was introduced in 1948. In reality, annual spending has to increase by 4% to keep up with increasing need and escalating costs of new drugs and treatments.

 

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No solution but to fight for health care

The financial crisis of the NHS is now so deep that Tory Health Secretary Jeremy Hunt has been forced to concede its existence. Typically, however, he has blamed it on factors beyond the government’s control: ‘There’s a triple whammy of the ageing population which means there will be a million more over 70s by the end of the parliament than there are today – that’s a massive impact; the financial pressure which means that the government is not able to increase spending in real terms on the NHS by the amounts it has done historically – that’s something we’ve had to get used to over the last five years; and raised expectations from people who use the NHS about accessing it more easily but also raised expectations post Mid Staffs in terms of the quality and standard of care.’ The underlying message is that capitalism will not provide a decent health service for the mass of the people. There was an £822m deficit in the NHS last year and the NHS is facing a £2bn deficit this year. Had the Department of Health and NHS England not put in £350m, the deficit would have been bigger.

 

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NHS: More fragmentation, privatisation and rationing

During the election campaign the Conservatives made great play of their commitment to put an extra £8bn into the NHS. This was their response to the Stevens Report from 2014 which identified a £30bn gap in NHS funding by 2020, and which argued that £22bn of this could be met with ‘efficiency savings’. Meeting such a target was always fanciful, and now senior NHS managers are stating openly that it is impossible, and that achieving even £15bn of savings is unlikely. Health Secretary Jeremy Hunt has seized the opportunity to express his doubts about the long-term viability of funding the service through taxation. Further fragmentation, privatisation and rationing are inevitable as part of undermining a universal service free at the point of use.

 

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The NHS: facing a financial nightmare

As the financial crisis engulfing the NHS deepens, Conservative promises to create a ‘seven-days-a-week’ NHS by 2020 already ring hollow. Its election commitment to invest an extra £8bn a year by 2020 will at best keep the NHS standing still: more likely, it will involve further cuts to an increasingly threadbare service.

Desperate pleas for an immediate cash injection of £1bn into the NHS demonstrate how close it is to a financial abyss. Hospital, mental health and community services collectively ended 2014/15 £821m in deficit, nearly eight times the 2013/14 figure of £107m. The total deficit for acute hospitals was just over £1bn, with Barts £80m overspent and foundation trust Kings College £47m overspent. On current trends, the projected NHS deficit for 2015/16 is in excess of £2bn.

 

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Who will defend the NHS?

The Labour Party has long presented itself as the principal defender of the NHS. Yet in one fell swoop, the Conservative Party outflanked it with an apparently unconditional guarantee that in government they would meet the 2019/20 £8bn funding gap identified in the December 2014 Stevens review: The NHS Five Year Forward View. Labour was left looking flat-footed: it has pointedly refused to meet the gap, pledging instead an extra £2.5bn to fund training and employment for an extra 8,000 GPs, 20,000 nurses, 5,000 care workers and 3,000 midwives. Even this, however, is conditional on receiving matching income, in particular from the so-called Mansion Tax to be imposed on homes worth more than £2m, and a levy on tobacco companies to guarantee a week’s turnaround time for cancer tests and results. The reality is that the NHS is not safe in Labour’s hands: its pledges during the election campaign to end privatisations are just lies.

 

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Health Matters - Capitalism is bad for your health

At the end of March the NHS deficit stood at £1bn; on current projections by the end of March 2016 it will be £2.5bn. The NHS is in financial meltdown, and despite a poll showing that 46% of the electorate regards the NHS as the issue that will decide which way they vote at the general election, all we get from the major bourgeois parties is smoke and mirrors.

 

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Health matters - Fight to save the NHS

As we approach a General Election, the depth and extent of the crisis in the NHS is evident. In an unprecedented step, hospitals responsible for 75% of care across the country have rejected a proposal to cut the tariff (a standard amount for each type of treatment) by 1.9%. They have stated that they cannot manage a fifth round of cuts without either endangering patient safety or reducing the number of operations they perform. The majority of foundation trust hospitals are in financial deficit; 80% of all hospitals will be by the end of March. They will also face a transfer of £1.9bn to social care from April and further cuts of £290m in specialist care and £220m for some A&E services. There are insufficient numbers of nurses, GPs and A&E doctors. General practice as whole is almost broken with few trainee doctors wanting to become GPs; waiting times for appointments are running into days and sometimes weeks. Mental health service provision is a disaster area. Hospitals around the country are declaring major incidents because they are unable to cope with the number of people coming into their A&E departments and then requiring admission. Meanwhile the proportion of GDP being spent on health services is falling as a result of austerity. HANNAH CALLER and ROBERT CLOUGH report.

 

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Nothing is irreversible – act now to save the NHS

The NHS faces meltdown. The third week in November revealed the extent of the crisis: a 5% rise in attendances at A&E departments across the country compared to the same period in 2013 led to units as far apart as Cambridgeshire, Scunthorpe, Middlesbrough, Wigan, the Wirral and King’s Lynn urging patients to stay away. The situation has been made worse by cuts in social services which have meant patients cannot be discharged safely, reducing the number of available beds. The reason is quite simple: there is not enough money. Five years of flat-line funding has left it facing a £30bn budgetary shortfall by 2020. With their commitment to austerity, none of the parliamentary parties have the slightest intention of plugging the gap. In the meantime, stories of bad care and deteriorating quality are cynically used by the media to claim that a nationalised service cannot work.

 

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NHS - End privatisation and save our surgeries

The NHS budget has a £2bn shortfall for 2015-2016 and still there is the target of £30bn efficiency savings by 2020. In England between 2012-13 and 2013-14 the number of trusts in deficit rose from 45 to 66 and a £383m surplus in 2012-13 became a £100m deficit in 2013-14, despite emergency funding. This included £500m in summer 2013 to help prepare for the winter pressures, followed by another £150m in November. In June this year, a further £400m was provided to reduce the pressure on A&E and allow 100,000 extra operations in July and August when it emerged that waiting times for many operations, such as hernia repairs, cataract removal, tonsil and adenoid surgery, hip and knee replacements, are rising sharply. It is estimated that following three years of standstill funding, the NHS needs £15bn for the five years from April 2015 to avoid collapse.

 

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Fighting to save Whittington NHS Hospital

Whittington Hospital is a local general hospital with a maternity wing and an A&E department that serves 40,000 patients a year; it has the reputation of being the safest hospital in the country. Its situation on Highgate Hill, which is a prime site two miles from the City of London, has long tempted private interests to grab the land for development. Unfortunately for them, the land is granted by ancient charter for the purposes of hospital welfare only.

 

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Mental health: services ground down

In May, a woman was admitted to the acute mental health ward on Merseyside where I work as a full time nursing assistant. She had tried to kill herself using an overdose of prescription medication and a bottle of vodka. We found out that she had been financially supporting her daughter, who has two disabled children and had got into thousands of pounds worth of debt – because the disability benefits had been stopped. Now, without any prospect of getting the money to pay off her debts, the woman had attempted suicide in an effort to get away from the relentless tyranny of telephone calls and letters demanding repayments. She was on our ward as a direct result of poverty and welfare benefit cuts.

Her case shames me, both as a mental-health worker and as a citizen in our so-called society. In a true and functioning society no one is left behind. Not our patient, not her daughter, and not her grandchildren. The disabled grandchildren have been failed due to the cut in the benefits which were there to sustain and support them. Their mother is failed because her needs as the carer of these children have been ignored. Our patient was failed because it fell to her to pick up the bill for the needs of her disabled grandchildren, while her basic needs as a human being had been ignored.

 

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Health Service: remorselessly deepening crisis

Every politician knows that the NHS faces financial collapse in 2015. As a proportion of GDP, health spending reached a peak of just under 9% in 2009; it is now predicted to fall to under 8%. The scale of service cuts required to meet a £20bn funding gap for 2011-14 is already huge, with soaring waiting lists and extended A&E waiting times. With flat-level funding expected for the three years from 2015/16, the overall gap will reach a massive 23%. General practice services are facing disintegration with some practices unable to offer a consultation for two weeks. NHS Monitor is requiring foundation trusts to rework two-year financial plans submitted in April because their assumptions are unrealistically optimistic. These are the consequences of slashing state welfare: the ruling class may be sitting on ever-growing and obscene levels of wealth, but it will always ensure less and less is spent on the working class. Hannah Caller and Robert Clough report.

 

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Big Pharma rip-off

The independent NHS watchdog, the National Institute for Clinical Excellence (NICE), decided that a new breast cancer drug, Kadcyla, developed by Roche is too expensive. It costs more than £90,000 per patient per year to extend life by 5.8 months. The decision was criticised by Roche and some breast cancer charities, but the episode is the latest in a series of revelations showing how the pharmaceutical industry (Big Pharma – multinational monopolies including Roche, Bayer, Novartis, Astra Zeneca, GlaxoSmithKline, Pfizer, and Merck) is ripping us all off. The Tamiflu saga, where the UK government paid Roche close to £500m for a drug no more effective than paracetamol, shows the level of robbery. With the NHS facing budget shortfalls as it is privatised by stealth, and with cancer rates set to double between 2002 and 2020, Big Pharma profiteering is unsustainable and things are coming to a head.

 

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NHS: fragmented, privatised and on the brink

March against the partial sell-off of Whittington Hospital in north London - March 2013

The NHS faces a real possibility of collapse before the 2015 general election. Two factors will have led to this situation: real cuts in NHS funding and the fragmentation of services that has been the consequence of the 2012 Health and Social Care Act. A programme of impossible savings is pushing many foundation hospital trusts towards bankruptcy. Clinical commissioning groups, responsible for buying health care services for their local population, are signing contracts left right and centre with private companies. At least £6bn worth of work is out to tender in the NHS in England. Financial pressure to make savings of £30bn by 2021 will mean that trusts that don’t make money can expect to be closed, aided by the new powers that the Health Secretary has now enshrined in law with Clause 119 of the 2014 Care Act. A market in health care inevitably leads to priorities that are not in the interest of people’s health care.

 

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Mental health problems equal discrimination and poverty

In October, the government once again delayed the implementation of so-called Personal Independence Payments (PIPs), the replacement for Disability Living Allowance (DLA), saying it had not been able to carry out enough assessments. PIP is part of the latest attempt by successive governments to cut benefits – already at almost subsistence levels – to people with disabilities and introduce draconian checks on whether claimants are ‘really’ disabled.

Such discrimination and contempt is particularly severe for people whose disabilities are caused by a mental health problem. Mental health problems can be as debilitating as any physical illness and are equally exacerbated by difficult economic or social circumstances such as poverty, isolation, poor housing or inappropriate work. Mental health problems are more common among poorer people in general and already oppressed groups such as black people, migrants and the LGBT community.

 

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Lewisham Hospital victory for campaigners

On 31 July, the High Court found that the Secretary of State for Health, Jeremy Hunt, had acted unlawfully when he decided to cut two-thirds of services and close departments at Lewisham Hospital in southeast London. He had exceeded his powers when he parachuted in a Trust Special Administrator to make cuts in Lewisham to save the neighbouring South London Healthcare Trust and rescue two bankrupt Private Finance Initiative (PFI) hospital contracts in the region. On 21 August, the government confirmed it will appeal against the judgment and implied it may investigate changes to the law to prevent similar challenges to its plans in the future. The High Court ruling is a victory for all those who campaigned in Lewisham and for all those who continue to fight for services that are being taken away or pared down around the country. Had it not been for the campaign, the government would have got away with unlawfully destroying health services. This case also makes it clear that providing excellent services and meeting local needs are no safeguard against government-imposed cuts.

 

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Health matters / FRFI 234 Aug/Sep 2013

As the NHS descends into chaos, the government knows who to blame: uncaring nurses, greedy doctors, poor management, negligent hospitals, patients who do not look after themselves, old people, inaccessible GP services – anything but the tightening squeeze on the NHS budget and the burden of the Health and Social Care Act. In an orchestrated campaign to denigrate the NHS as a public service, the Department of Health leaked a report into the quality of care and treatment provided by 14 hospital trusts in England to the press in advance of its publication. The result was hysterical and lying headlines claiming that ‘13,000 died needlessly at 14 worst NHS trusts’ (Sunday Telegraph).

 

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We want our NHS back

This video is produced by north London Fight Racism! Fight Imperialism! as a record of our unremitting and principled campaign on the streets and in the communities against the plan for a sell-off at Whittington Hospital. The proposal, launched in January of this year, to sell-off £17 million worth of buildings, halve in-patient beds to 177 and cut jobs by 570 and put a cap on maternity services of 4,000 a year, has now been cancelled. In July the hospital board was forced to tell the local press that this original plan was ‘just and idea’. There can be no doubt that the mobilisation of local protest against the sell-off plans must have influenced this retreat which is to be seen as a victory for the people.

 

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NHS emergency services face collapse

Gloria Foster, aged 81, died in hospital in early February after being found at home by a district nurse on a chance visit. She had been stranded in bed for nine days with no access to food, fluid or medication. Until that time she had been receiving four visits a day from carers from the private company Carefirst24, contracted to provide care for elderly people by the London borough of Sutton. On 15 January, the UK Border Agency raided Carefirst24 and arrested staff whom they accused of employing undocumented immigrants. Despite warnings to Sutton and Surrey councils, no alternative arrangements were made for Gloria Foster. Surrey police have announced that there will be no criminal charges. Hannah Caller reports on the disintegration of the National Health Service.

 

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