Mental health problems equal discrimination and poverty / FRFI 236 Dec 2013/Jan 2014

Fight Racism! Fight Imperialism! 236 December 2013/January 2014

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.

Cuts to health care and disability benefits disproportionately affect people with mental health problems. More than 1,500 mental health beds have closed over the last two years. The NHS has spent millions shipping vulnerable people in need of acute care hundreds of miles away to private hospitals. There are documented cases of desperate patients killing themselves after spending days failing to access a bed in a psychiatric unit. Meanwhile, services such as drop-in centres providing support, rehabilitation, housing and employment advice have seen funding slashed. While mental health problems account for 40% of illnesses in Britain, it receives 13% of NHS funds. Funding for mental health services fell 1% in 2012-2013 – a loss in real terms of around £150m – on top of a 1% fall in 2011-2012. Despite talking therapies approved by the National Institute of Health and Care Excellence proving both successful and cost-effective, the flagship Improving Access to Psychological Therapies programme has stalled, with only 500 of a needed 800 therapists being trained and funding for vital patient appointments cut by up to 30%.

The infamous Work Capability Assessments (WCA) used to determine if someone is eligible for sickness benefits are worse than useless in assessing mental health. The WCAs are humiliating, asking intrusive, personal and often irrelevant questions. They focus overwhelmingly on physical indicators and take no account of fluctuations – very common in mental health – in each individual’s ability to cope, or the difference between forcing yourself to do something once and doing it every day. Many people speak of it taking them hours to get ready to leave the house for the WCA and days to recover. Yet ironically the very act of turning up then renders them fit for work in the eyes of the assessors and thus not entitled to benefits! A recent survey revealed that six per cent of all GPs (approximately 2,000) had known a patient attempt suicide as a result of an Atos assessment.

The failings of the WCA are made clear by the fact that so many appeals, particularly in mental health cases, succeed – around 40%. However, the appeal process itself involves a long wait, with benefits kept at the same below-subsistence rate as Jobseeker’s Allowance throughout this time. Appeals are held by a tribunal, usually in the intimidating setting of a courtroom. This can be particularly stressful for people with mental health problems, many of whom will have experienced mistreatment by the police and misunderstanding by the justice system. People ‘acting strangely’ are more often taken into police custody than offered appropriate care. Young black men with mental health issues – such as Roger Sylvester and Sean Rigg – are more likely to be taken to a ‘place of safety’ that is in fact a police cell and subjected to inappropriate restraints. Approximately half of all the 954 deaths in police custody since 1990 have been of people with mental health problems; the figure rises to 61% of deaths in state custody overall, including those detained under the Mental Health Act. Black people make up over a third of that figure.

There is no set ‘cure’ for most mental health problems. The glib assertion by the government that people get better through work is false when that work is isolated, repetitive and badly paid, which is the reality for the majority of working class people, particularly those who have long periods of sickness. A combination of approaches, some of which require expensive one-to-one therapy by experts, is often the only solution. Even common problems such as depression or anxiety require personalised therapy. The capitalist state has proved unwilling to fund this, instead handing out vast numbers of prescriptions for drugs, which may or may not be suitable for the individual, but are of course far cheaper than funding talking treatments or tackling the practical factors – poverty, job insecurity, discrimination, loneliness, neglect or abuse – that make people ill in the first place or exacerbate their condition.

Over the decades, the state has preferred to rely instead on ever-cheaper, one-size-fits-all solutions: the old-style asylums until the 1960s; chemical coshes such as valium in the 1970s; over-prescription of anti-psychotic drugs and institutionalised patients placed on under-funded ‘care in the community’ schemes from the 1980s; under-tested new anti-depressants from the 1990s.

People with poor mental health are an oppressed group under capitalism. The majority of people experiencing mental health problems struggle to access treatment and support while experiencing ongoing stigma and discrimination. Groups like Disabled People Against Cuts have shown a way forward in empowering people to fight against discrimination and for ‘full human rights and equality’. This struggle should be placed clearly within the wider fight for decent health funding and against cuts, poverty, racism and oppression. Within any movement to overthrow this rotten system, disabled people, including those who have experienced mental health problems, like other oppressed minorities, will play a significant part.

Sam McDonald

Lewisham Hospital victory for campaigners/FRFI 235 Oct/Nov 2013

Fight Racism! Fight Imperialism! 235 October/November 2013

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.

In Essex, two other hospital Trusts with huge PFI projects are creating financial problems. Queen’s Hospital in Romford cost £230m to build under a PFI scheme and is now forcing the part-closure of A&E and other acute services at nearby King George’s Hospital in Ilford. Both are part of Barking, Havering and Redbridge NHS Trust.

The hospital nearest to King George’s is Whipps Cross in Leytonstone. Its services are also under threat following a merger with Newham and Barts and the Royal London Hospital, to create Barts Health covering east London. This is now the biggest Trust in England. Within two months of the new financial year, it had accumulated a debt of £16m, and continues to lose £2m per week. This means it is nowhere near a savings target of £77.5m for 2013-14, 6% of its £1.25bn annual budget.

The source of its financial problems is a PFI scheme that saw the rebuilding of the Royal London Hospital and the redevelopment of Barts. The whole scheme cost £1bn, and annual repayments are currently £115m, over 14% of the annual turnover of the old Barts and the London Trust. These repayments are scheduled to increase over the years, so that in the end, the £1bn PFI hospital will cost £7bn. The debt drove the merger with Newham and Whipps Cross, and has created a bankrupt Trust that will savage services to get anywhere near the savings needed. Whipps Cross will axe 323 nursing and administrative jobs and impose pay cuts on 1,000 nurses and low-paid support workers. The Royal London was unable to admit any patients for 48 hours in the second week of September because it had no beds available. In the last 25 years, the total number of hospital beds in England has been cut by over half, from 282,918 in 1988-89 to 136,486 by April 2013. PFI hospital schemes always involve cutting bed numbers, typically by up to 30%. Across the NHS, PFI repayments have increased by nearly £200m in two years, from £459m in 2009-10 to £628.7m in 2011-12, leaving 20 Trusts in serious trouble with huge implications for staff and the health of the people using the service. It is clear that services will be sacrificed to pay off PFI debts.

This is all taking place in a situation of financial meltdown where the NHS faces a £30-50bn funding gap by 2020. The consequences are already proving to be devastating. By 2016, the NHS is forecast to be 47,000 nurses short just as study after study shows ward nurse staffing shortages are undermining patient safety. In September, Jeremy Hunt announced that 20 more hospitals in England will be put into special measures, following 11 Trusts already deemed to be failing.

Rather than fund decent and safe services with enough staff, the government is creating more and more layers of inspection with the appointment of two inspectors of hospitals and primary care. Professor Steven Field has been given the job as the first inspector of primary care. His tick list includes making sure 8,000 practices answer their phones between 08:23 and 08:27, ensuring disabled parking exists and that opening hours are appropriate and so on. This will require an army of inspectors costing some £30m, on top of the army inspecting hospitals and those staffing the Care Quality Commission, Monitor and NHS England. 48 senior executives at NHS England earn over £142,500, the annual salary of the prime minister. A total of 291 have a salary of over £100,000, so that almost one in 20 of the organisation’s 6,115 staff earns a six figure sum.

This bureaucracy is part and parcel of the government’s Health and Social Care Act, the alleged purpose of which was to enable GPs to lead the commissioning of health care services through Clinical Commissioning Groups (CCG). However, figures obtained under the Freedom of Information Act from 74 CCGs in England show that a third of their boards have had a GP member resign and, overall, 43% of CCG board membership is made up of GPs as opposed to 49% when they were set up. They are reverting to the old Primary Care Trust model as GPs cannot spend that time outside their surgeries.

However the government spins it, whatever management gimmick it puts in place, the NHS is grinding to a halt. Now more than ever is the time to take to the streets to highlight this, in the knowledge that campaigning works and the responsibility for the future of health care lies with us, the people who need it.

Hannah Caller

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).

In fact the report, by NHS England medical director Bruce Keogh, was very careful in presenting its findings. The hospitals it reviewed had been selected because they had higher Hospital Standard Mortality Ratios (HSMRs) than expected. HSMRs are measurements of the death rates which take into account patients’ age, illness severity and place of residence in terms of affluence or poverty. HSMRs allow the predicted number of deaths to be compared to the actual number who died. Keogh referred to the ‘complexity of using and interpreting aggregate measures of mortality, including HSMR and Shmi’ (Summary Hospital-Level Mortality Indicator), and pointed out that the two different measures of mortality gave two different lists of hospitals to investigate. He warned that ‘however tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths’. This did not deter either the press or the government from abusing Keogh’s figures, and ignoring his point that ‘It is important to understand that mortality in all NHS hospitals has been falling over the last decade: overall mortality has fallen by about 30% and the improvement is even greater when the increasing complexity of patients being treated is taken into account.’

Keogh did find poor and unsafe services in these hospitals. He also found that seven of them had shed 1,117 nursing jobs since the 2010 general election. Several of them are in parts of the country where it is difficult to recruit clinical staff and so the hospitals have to rely on expensive agency staff and locums. The bottom line is that underlying unsafe or inadequate services is a shortage of staff, and underlying the shortage of staff are the £20bn cuts in NHS spending. The government says it will step up the inspection regime for hospitals: yet this requires more money and more clinical staff, which it will of course not fund. The Keogh report required a £2.8m contract with Price Waterhouse Cooper. No amount of inspection can deal with the problem that 80% of A&E departments do not have consultant cover for the minimum 16 hours a day regarded as essential for safety, and the situation is worse at weekends.

Even prior to the current round of £20bn cuts, the NHS in England had one of the lowest ratios of beds and staff per head of the population in the OECD. In 2010, there were three hospital beds per 1,000 population in England compared to the OECD average of 4.9 per 1,000. This is set to get worse. NHS England’s information director Tim Kelsey has said that there will be a funding gap of £30bn by 2020, while Mike Farrar, chief executive of the NHS confederation representing health service managers, puts it at £50bn. The government says it has ring-fenced NHS funding, and that it will be maintained in line with inflation. This ignores the fact that funding has to increase by 4% per annum to keep pace with medical and pharmaceutical advances, as well as with the requirements to provide adequate health care to an ageing population.

The lack of money will encourage a well-spring of reactionary solutions. A survey of GPs in July 2013 found that 51% now think it’s a good idea to introduce patient charges of up to £25 per visit – up from 34% in 2012. All this will do is penalise the poor. Punishment is the name of the game when targets drive the NHS. East Midlands Ambulance Service has been fined £3.5m for missing a 95% target of reaching life-threatening emergencies within 19 minutes by 3%. That fine will just make the service worse.

Hospitals throughout the country are facing bankruptcy. Barts in London is one example. Saddled with a ruinous PFI debt of £1bn costing £115m a year, the trust, which runs six hospital sites, has to find £77m savings this year. It is £15m behind schedule. Price Waterhouse Cooper has been parachuted in and proposes to cut up to 1,600 jobs as the solution. Meeting minimum ward staffing levels will become an impossibility. In south London, Lewisham hospital is threatened with partial closure to help bail out the South London Hospital Trust which has PFI schemes consuming 18% of its income. Local services are being sacrificed for the interests of bankers, shareholders and corporate stakeholders.

No to the cuts! No to PFI!

Hannah Caller and Robert Clough

Fight Racism! Fight Imperialism! 234 August/September 2013

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.

Read more ...

NHS emergency services face collapse/ FRFI 233 Jun/Jul 2013

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.

Is this the care in the community that health minister Jeremy Hunt talks about as he calls for further A&E closures and blames old people and those with dementia for increasing attendance in A&E? People attend A&E because there is often nowhere else to go. Figures obtained from the NHS Trusts where Newark patients now go following the closure of Newark A&E in Nottinghamshire two years ago, show an increase of 37% in death rates. A&E departments are on the brink of collapse. The number of people going to A&E has risen by four million since 2004. The number of people waiting for more than four hours in A&E has risen by 50% in the last year and by 90% since 2011. Retaining and recruiting doctors-in-training to A&E is increasingly difficult due to the pressures. There are currently over 200 vacant posts for trainees, with some NHS trusts spending £2,700 a day for locum doctors to fill vacant posts in A&E departments. The College of Emergency Medicine warned that one in five A&E departments relies entirely on junior doctors in the evenings and at weekends and there are shortages of senior doctors. The average number of consultants per A&E department is 7.4, while the recommendation is 10-16. The funding system penalises A&E departments that have a rise in attendance – they are deemed to be over-performing.

In 2011/12, NHS organisations in England reported a combined overall surplus of £2.1bn. Yet the government is demanding £20bn in ‘efficiency savings’ by 2015. Health care provision is increasingly at the mercy of private companies. Private Finance Initiative repayments are bankrupting hospitals as repayments take precedence over patient care. Virgin earns about £200m a year running over 100 NHS services across the country. Conflicts of interests are evident when doctors providing care are also involved with private for-profit companies. A Nuffield Trust study reports that NHS spending on private providers has risen by £3bn since 2006 to £8.7bn in 2012. 20% of hip and knee replacements are now carried out by private providers – there were hardly any in 2003. In Yorkshire and Humberside, 10% of all NHS funds are going to private providers.

Out of hours (OOH) GP services are struggling to find doctors with some GPs being paid up to £150 an hour, while the Royal College of GPs states that there is a shortage of over 10,000 GPs across all services. Harmoni is a private company contracted to provide OOH GP services in some parts of England. It is so short of doctors that it is offering huge bonuses to doctors who refer a colleague to them. In north Somerset, Harmoni used one advanced nurse practitioner to cover up to 250,000 patients overnight. Harmoni has the contract for OOH care in parts of north and east London and has a base at the Homerton Hospital, where its contract, which had no formal tendering process, is still under an interim arrangement from 2010. There is evidence that rotas are not always covered and a GP on the local BMA division is leading an investigation. However, Harmoni has refused to supply information to the BMA requested under the Freedom of Information Act, saying it is exempt as a private company. It has refused to supply the information for NHS North East London and the City on the basis of commercial sensitivity. Harmoni’s secrecy over the rotas make it more suspicious. A full report from the Care Quality Commission is now awaited. While doctors enrich themselves in a chaotic increasingly unregulated system, access to health care worsens.

Meanwhile, NHS Direct, the phone support system which started in 1998 with 30 nurse-led call centres and 170 more nurses working from home, has been privatised and is now known as NHS 111. More than a quarter of the contracts have been awarded to Harmoni. The 46 replacement call centres are no longer nurse-led but have phones answered by people trained to use algorithms. Although the requirement is to answer calls within 60 seconds, some people have waited 20 minutes for a response. Seven of the centres remained non-operational in early May, others have been suspended. The whole implementation has been a complete shambles; three deaths have resulted and now £8m is required to bring back some NHS Direct staff to supplement the service at weekends.

In the Queen’s speech at the opening of Parliament in May, the government stated it will limit health care for certain groups of migrants. Temporary migrants will have to make a contribution before being able to use NHS services. This will be in addition to guidance for NHS bodies on recovering charges for overseas visitors issued in 2011. These state that if someone has not lived lawfully in Britain for the previous 12 months, they should be notified that charges might apply. This is also transferred on to their children. Not surprisingly the Royal College of GPs said that ‘General Practitioners should not be expected to police access to healthcare and turn people away when they are at their most vulnerable.’

The NHS is beginning to break under the strain as FRFI argued would happen with the introduction of the Health and Social Care Act. The Labour Party and trade unions, far from doing anything effective to fight back, are demobilising opposition especially in London.

It is time the working class took the defence of health services into its own hands.

Fight Racism! Fight Imperialism! 233 June/July 2013

More Articles ...

  1. Health matters: Cuts kill people /FRFI 231 Feb/Mar 2013
  2. Lewisham Hospital and the PFI parasites – Feb 2013
  3. Lewisham Hospital and the PFI parasites – Feb 2013
  4. NHS emergency - Save Lewisham hospital/FRFI 230 Dec 2012/Jan 2013
  5. ConDem health reforms - The end of the NHS in England /FRFI 229 Oct/Nov 2012
  6. Banks get bailed out, hospitals go to the wall / 228 Aug/Sep 2012
  7. Health privatisation gathers pace
  8. Health and Social Care Bill - The taste of things to come /FRFI 226 April/May 2012
  9. NHS sinks deeper into crisis / FRFI 225 Feb/Mar 2012
  10. Health care secondary to profits/ FRFI 224 December 2011/January 2012
  11. Stop the NHS sell-off / FRFI 223 Oct / Nov 2011
  12. The Plot Against the NHS - Review - Sep 2011
  13. The end of free universal health care? / FRFI 222 Aug/Sep 2011
  14. Profiteering and Abuse in Care – Demand Decent Services as a Right! - 10 Jun 2011
  15. NHS – open for business, closed for treatment / FRFI 221 June/July 2011
  16. Kill the Bill – not the NHS! /FRFI 220 April/May 2011
  17. ConDems propose privatisation of the health service / FRFI 219 Feb/Mar 2011
  18. NHS: Opposition grows as chaos looms / FRFI 218 Dec 2010 / Jan 2011
  19. How the Coalition plans to abolish the National Health Service / FRFI 216 Aug/Sep 2010
  20. Health Coalition wields the knife / FRFI 215 Jun/Jul 2010
  21. Spending freeze, cuts and closures – the great NHS cover-up / FRFI 213 Feb / Mar 2010
  22. Health matters: The privatisation of health care in Britain / FRFI 211 Oct / Nov 2009
  23. Why is Labour privatising health?
  24. Labour catapults NHS into chaos
  25. Old age tax / FRFI 203 Jun / Jul 2008