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Monday, 6 August 2012

Olympic Deployment Centre - London Ambulance Service


Back in May as Chair of the London Ambulance Service Patients Forum, I attended Operation Amber, along with Malcolm Alexander, one of the Forum's Vice Chairs. We visited the Olympic Deployment Centre in the Docklands, which is currently being used to operate all of the emergency ambulance functions for all of the Olympic venues. The LAS are operating together with other ambulance services drafted in to support over the period, including West Midlands Ambulance Service. We were quite impressed with what we saw. Here are some photos from the day.

Green Party Leader Election - Guest Post from Alan Wheatley

Having resigned from the Green Party 6 months ago on a point of principle regarding the introduction of a cuts budget by the Green led council in Brighton, I have not commented on the election for Leader or Deputy Leader of the party. I have given my endorsement, as Chair of the London Ambulance Service Patients Forum and a health activist to my friend and colleague on the Coalition of Resistance, Romayne Phoenix, who is also Chair of the Coalition fighting cuts and austerity. I am, of  course, following the campaign with some interest, as the outcome will be important for politics and the fight against cuts and austerity in the UK.

I have agreed to post the following from my friend, Alan Wheatley, with whom I have worked closely on disability and welfare issues, as Alan does not have a blog and wishes to make his comments on one of the candidates public. I am not aware of the background to the issues which Alan raises and would point out that the view expressed is Alan's and not mine as I have not been involved in the party over the period which Alan refers to. Alan has already put these comments on the blog of Stephen Wood, a Green Party blogger here.

I am one of those who will be giving #1 vote to Romayne Phoenix, having worked with her on anti-austerity measures. As well as being a great speaker, Romayne is a very caring person and great encourager. She is also a survivor who can lend her experience of hard times to helping build bridges with working class people and disability benefit claimants. I give my own statement to this effect at the Romayne & Will website.
 
And as an ex-member of Camden Green Party who has transferred into Haringey Green Party without moving out of the Borough of Camden, I note that Natalie Bennett's behaviour as Chair of Camden Green Party was one of the cues for me to leave Camden Green Party. For in the London Assembly elections, I observed that Haringey Green Party welcomed Enfield Green Party member and Enfield & Haringey constituency candidate Peter Krakowiak to their meetings from the time that he was elected for the two seat constituency. But Camden Green Party seemed to ostracise candidate A.M. Poppy from Barnet Green Party, giving her minimal exposure. As a Camden Green Party member at the time, I objected to the way that Poppy was not even invited to the launch of the Camden Green Party campaign. Natalie Bennett responded to me, "Poppy will be included later." Of all the Camden Green Party leaflets for the London elections, not one had a photo of Poppy, and a Camden Green Party member told me this week, "The reason Poppy was sidelined was that she was seen as too abrupt and abrasive for our borough."
 
I believe that what Natalie achieved by sidelining Poppy was more space to raise her own profile as parliamentary candidate -- eg, her own face alongside that of mayoral candidate Jenny Jones on p. 4 of eve-of-poll leaflet. She was arguably desperate to raise her profile after getting fewer votes for the whole parliamentary constituency in 2010 than Cllr Maya deSouza got for one electoral ward. That was also after Natalie had replaced Adrian Oliver as parliamentary candidate in mid-term, apparently finding it easier to replace him with herself than to support him.
 
These are my own views and observations and I would encourage Green Party members to do thorough research on all the candidates before voting.

Alan Wheatley
Ex-Spokesperson on Social Security & Social Care,
now with Haringey Green Party while also a mainstay of Kilburn Unemployed Workers Group.
 
 

Monday, 23 July 2012

Press Release on Healthwatch from NALM


PRESS RELEASE                                                                         July 23 2012




Healthwatch must be the peoples’ independent, powerful, public watchdog in health and social care



A report by NALM analysing the results of FOIs sent to 152 Local Authorities in England has explored progress with development of Local Healthwatch (LHW), following Royal Assent of the Health and Social Care Act 2012. The survey explored funding, transition of LINks to Healthwatch, involvement in Health and Wellbeing Board and public engagement in the development of Local Healthwatch.



The survey showed many local are authorities are doing excellent work in collaboration with Local Involvement Networks (LINks) to establish Healthwatch, but that only 58% of local authorities were able to confirm that resources were in place for LINks to continue their work until abolished in March 31st 2013.



Government policy that LINks should go through a transition to Local Healthwatch whenever possible was not evidenced by the survey, which showed that whilst 51% of local authorities were working closely with the LINk to establish Local Healthwatch, there were few examples of genuine transition – notable exceptions were Islington and Hertfordshire. There was little evidence of plans for LINk legacy to be carried forward to LHW and little evidence of public participation from children and young people in the development of LHW. Leading edge examples of public participation were found in Suffolk and Plymouth.



Evidence of local authorities unlawfully taking over the running of LINks (Swindon) or attempting to control the LHW were also revealed, e.g. one local authority is consulting the public on what priorities LHW will have before it even exists.



Malcolm Alexander, Chair of NALM said: "our survey shows great progress in some parts of the country. But, Healthwatch must be an independent of the system it monitors and a powerful public watchdog in health and social care. It is a complete waste of time and money to establish a system of public involvement that is toothless and beholden to the local authority that funds it. We need Healthwatch to be democratic, led by its members, with ring-fenced funding and able to monitor and lead the development of local needs-led services. Local Healthwatch must be able to blow the whistle when services are failing local people. We have made 10 recommendations to Ministers and local authorities".



RECOMMENDATIONS



1)     A renewed government and local authority commitment to the transition of LINKs into Local Healthwatch (LHW)



2)     Use of grant-in-aid by local authorities to enable genuine transition from LINks to LHW



3)     Active public engagement of the community to ensure inclusive and diverse approaches to involving people in the development of the LHW.



4)     Involvement of children and young people in the development of LHW.



5)     Ensure that LINks continue to monitor and influence health and social care with local people until abolition on March 31st 2013.



6)     Ensure LINks legacy carries over to LHW to avoid the loss of experience and knowledge – new organisations usually take two years to establish.



7)     Training for all LINks members in all areas, to ensure that the usual mass migration of volunteers that accompanies the abolition of community organisations is stopped.



8)     Support for LINk members on Health and Wellbeing Board to that they can carry their experience forward to LHW.



9)     LHW should include advice and information services and the Independent advocacy service as an integrated model. Subcontracting bits of LHW will be inefficient, expensive and a waste of time and resources.



10)  Healthwatch England should to advise LHW how to access critical information to assess the safety and quality of local health and social care services.



NOTES FOR EDITORS:





Malcolm Alexander is Chair of the National Association of LINks Members. He can be contacted on: 0208 809 6551 or 07817505193   - NALM2008@aol.com



Ruth Marsden is the Vice Chair of the National Association of LINks Members. She can be contacted on: 01482 849 980 or 07807519933 or ruth@myford.karoo.co.uk



Local Involvement Networks (LINks) were set up by statute in 2008 to give citizens a stronger voice in how health and social care services are delivered.



NALM is the national organisation of Local Involvement Network members and was formed on April 1st 2009. NALM aims to stimulate more powerful approaches to public and user involvement and build a major grass roots movement of LINks and LINks’ members which can influence government policy.



The Health and Social Care Act 2012 abolishes LINk and replaces them by Local Healthwatch in 2013. Many of the duties of LINks and LHW will be similar.



The Local Government and Public Involvement in Health Act 2008 established Local Involvement Networks (LINks) to promote and support the involvement of people in the commissioning, provision and scrutiny of local NHS and care services. They do this by monitoring services and obtaining the views of people about their experiences of care   and making reports and recommendations about how services should be improved, to persons responsible for commissioning, providing, managing or scrutinising local care services.

Note of the development of Healthwatch



Local HealthWatch will take on extra duties such as providing information and signposting to the public who need help with understanding how the NHS and social services structures work, and potentially supplying advocacy for those who need help complaining to the NHS about poor treatment.



 LINks are made up of volunteers, supported by a small professional team. They have responsibility for scrutinising all health and social care services in a local authority area.  They are tasked, by statute, with providing the voice of those who use our health and social care services.



It is intended that Local HealthWatch be the voice of the user and patient, and a guardian of patient safety. LINks and Local HealthWatch should be the first line of defence against another Mid-Staffs, they have a right to inspect services.


Sunday, 8 July 2012

The Afghan Solution - Meeting on Wednesday

I will be going to this meeting on Wednesday. The war is far from over and the casualties continue to mount. Always good to hear what is happening from informed sources rather than establishment media.


PUBLIC MEETING

organised by Afghanistan Withdrawal Group of MPs

supported by Stop The War Coalition

Wednesday 11th July 2012

18.30 to 20.00

Committee Room 21, House of Commons, SW1A 0AA

via Portcullis House Entrance* (next to Westminster tube station)

THE AFGHAN SOLUTION

How Western Hubris Lost Afghanistan

Speaker: Lucy Morgan Edwards

Co-chairs: Paul Flynn MP and Caroline Lucas MP



m  Lucy Morgan Edwards is author of The Afghan Solution: The Inside Story of Abdul Haq, the CIA and How Western Hubris Lost Afghanistan. A former political advisor to the EU Ambassador in Kabul, Lucy has been an election monitor, and a correspondent for the Economist and Daily Telegraph. She spent seven years in the region, including in Jalalabad and Kandahar. Lucy has written papers on post-9/11 Afghanistan, and made presentations on Afghanistan at Chatham House, the Royal Society of Asia Affairs, and the Frontline Club.

m  Afghanistan Withdrawal Group of MPs was launched to press for British withdrawal and consider constructive ways in which the conflict might be ended. The group is co-chaired by MPs Paul Flynn and Caroline Lucas.  Supporters are drawn from across the political parties.

* IMPORTANT: There are likely to be long queues for public entry to the House of Commons via St Stephen’s and other entrances. Please assemble at Portcullis House at 18.15 where parliamentary staff will be waiting to take you to the meeting.

Wednesday, 4 July 2012

A Pride which is a Shame - excluding older and disabled LGBT people

This email from Age UK London's Open Door Coordinator to older LGBT members in London sums up the sheer anger and frustration from many older and disabled LGBT people who are being excluded from Pride this year. We are either a community for all or we are nothing.


Dear friends and colleagues



Further to the e-mail sent on Friday which contained the July edition of the Opening Doors London newsletter.  As advised, due to the changes and cancellations announced by Pride London, Opening Doors London has had to cancel the brunch (our planned start time for that conflicting with the new start time of the “procession” at 11am), and similarly with the changes in times to other events for the day, we have had to cancel the older LGBT community space at St Anne’s.



In regards to the parade itself, Pride London has announced an exclusion of vehicles from the procession, so we no longer have the Older LGBT Community open decked bus serving as an access vehicle for those wishing to take part but who wouldn’t be able to walk the parade route.



However we also had the Older LGBT Community booked in as a walking group.  Age UK Camden’s Opening Doors London project, although lead agency for involvement at Pride, has maintained this space to allow for other older LGBT groups and individuals taking part.  We HAVE NOT cancelled the Older LGBT Community walking group allocation.  Whilst we are totally opposed to the decision made to bar vehicles from the parade, effectively preventing less mobile and/or disabled people taking part, after much discussion and consideration of all options available, we believe that the older LGBT community still demands a presence and a voice and their rightful place at the front of the parade..  There wouldn’t be a Pride without our older LGBT men and women.



On speaking with several of the members, many are still planning on coming along and taking part in the procession anyway, so Opening Doors London will be there unofficially/officially.  Pride London has stated “let’s take the parade back to its roots”.  Well, we intend to do just that, with a few well worded placards and banners too… Please feel free to bring your own, lets really show Pride how LGBT veterans campaign!!  We just regret that many of our friends won’t be able to join us on the day due to the cutbacks and not having our bus!



Pride has advised us that we will be in the Red Section Number 21 in the parade. Line-up is in Baker Street with the red section being between Fitzharding Street up to George Street and you should arrive from 10:15am to 10:30 am for an 11am start. We will have our usual “Older LGBT Community” banner.  But like I said please feel free to bring your own banner.



As you know, months have gone into planning our celebration of World Pride, not just for the older LGBT community, but for LGBT groups and individuals everywhere, at considerable investment in time and money to groups and to individuals. This has now been LOST!   To have the parade scaled down, vehicles barred (especially our older LGBT access bus) and whole sections of the day is a total disgrace.  We assure you that we at Age UK Camden’s Opening Doors London, along with colleagues throughout the LGBT sector, will be pushing for an investigation into how we were allowed by different organisations involved to arrive at this shambolic affair.



Maybe see you on Saturday.





Best wishes



Nick Maxwell

LGBT Development Coordinator (men)
phone:  020 7239 0446


Age UK Camden
Tavis House, 1 - 6 Tavistock Square, London, WC1H 9NA

Reception: 020 7239 0400

Fax: 020 7383 2550




Now to be known as Age UK Camden

Monday, 25 June 2012

London Ambulance Service Patient Forum's questions to the LAS Board and submission re the LAS's Quality Account.

The London Ambulance Service Patients Forum has listed the following questions for the public board meeting of the London Ambulance Service NHS Trust tomorrow. I am unable to attend the meeting because of work, but Malcolm Alexander, the Vice Chair of the Forum is attending in my place.

We have also issued a response to the London Ambulance Service's Quality Accounts which are going to be passed at tomorrow's meeting and will then be placed on the LAS website and made available to stakeholders. Our own website is here and we will putting our questions there also. We have also sent our questions and the response to the Quality Account to all LINks in London.



Dear Colleagues, please find below and attached our submission to the London Ambulance Service's Quality Account. We have also put the following questions to LAS Board which meets on Tuesday:

1) Is the LAS in negotiations with the directors of commissioning for North East London and City PCT concerning the low availability of HASU (acute stroke) beds, and if so what progress has been made?



2) In view of the overall increase in complaints for the last quarter, and in particular the increase in the number of complaints about delays, will the LAS ensure that lessons are being learnt from each complaint about improvements in response times,  communication with patients about the cause of delays, and the clinical outcome for patients?



3) Will Command Point provide opportunities, in the near future, for 'patient specific protocols' and their wishes about 'end of life' care to be communicated quickly to front line staff?



4) Does the LAS have a plan for the development of a 24/7 bariatric care service and have resources been identified for this service?



5) Will the research methodology for interviews with non-conveyed patients include detailed, qualitative interviews?



6) In view of the abnormally high current utilisation rate of the LAS (22% increase of Cat A), does the LAS Board believe it is sufficiently funded for this level of activity?


7) The data on performance figures given to the Patients Forum contain some concerning figures for the East zone on Category A patients in particular. What is the explanation for this and what is being done to address it? We are putting this question again (having put it at the last Board meeting) as the figures which the Forum has recently received for both the year ending April and for the month of April from the East have given further cause for concern. We are also aware that commissioners are concerned about this also.







Quality Accounts 2011-12 statement

Patients’ Forum Ambulance Services (London)



Forum Officers



Company Secretary: John Larkin

___________________________________________________________________

Chair:   Joseph Healy       PatientsforumLAS@aol.com/ j-j@freezone.co.uk                                          __________________________________________________________________



Vice Chair:                   Sister Josephine Udie             sisterjossi@hotmail.com

Vice Chair:                   Lynne Strother                   Lstrother@ageuklondon.org.uk    

Vice Chair:                   Malcolm Alexander                 PatientsforumLAS@aol.com







1) Public Involvement



a) The LAS has a strong commitment to public involvement and the Forum plays an active part in the following LAS committees: Patient and Public Involvement, Equality and Diversity, Mental Health, Clinical Quality, Safety and Effectiveness Committee, Infection Prevention & Control Committee Meeting, Clinical Audit and Research Committee, and the Learning from Experience Committee.



b) Questions put the LAS by the Forum are usually responded to quickly and fully.



c) The LAS supports the Forum by providing, information, meeting rooms, refreshments, photocopying and presentations to meetings.



d) The Forum has been unable to obtain a response to the issues it submitted to the LAS for the 2011-2012.



e) Evidence of patient experience having real influence on policy and practise in the LAS is weak.



Recommendation: The LAS should develop a greater focus on collecting detailed qualitative data from service users especially where they have criticised or complemented the service. They should develop methodologies to demonstrate how qualitative data collected from patient groups, individual patients and the public has influenced LAS services. Evidenced based public involvement work in which public influence on the LAS can be demonstrated should be a priority.







2) Corporate Objectives CO2 and CO5 – Equality and Diversity



CO2. To improve the experience and provide more appropriate care for patients with less serious illness and injuries



CO5. To develop staff so they have the skills and confidence they need to deliver high quality care to a diverse population



a) The Forum was pleased with the decision of the LAS to hold a meeting for the public on the Equality Delivery System (EDS) and felt this was an important way of including the public in the developing EDS. 



b) We have concerns about the care of patients with sickle cell disease. We have met with the Sickle Cell Society which is committed to working with the LAS and the Forum to improve the care of people in a sickle cell crisis. We do not believe that the LAS gives sufficient priority to the health needs of black and ethnic minority communities and strongly recommend that a focus on the care of people with sickle cell disease. This would enable the LAS to demonstrate how they are prioritising the needs of protected groups.



c) The priority given to diabetic care by the LAS could expanded to ensure that front line staff are trained to appreciate that some ethnic groups have higher levels of diabetes.



d) The LAS has been unable to attract significant numbers of staff from black and ethnic minority communities, despite this matter having been raised by the Forum continuously since 2003. We understand that 94% of front line clinical staff are white. We recommend the LAS seeks expert advice to address this problem and initiate a programme of work to transform the ethnic composition of staff and Board members.





3) Quality Domain 5: Clinical Outcomes



a) The Forum welcomes progress made by the LAS in examining clinical outcomes of LAS interventions for patients with cardiac arrest, STEMI and stroke.



b) We would like to see this approach to quality developed by mainstreaming a system that enables frontline LAS clinical staff to review the outcomes of clinical care they have provided to acutely ill patients who are admitted through A&E. This could be done on a cohort basis, or through the selection of patients that LAS clinical staff have particular concerns about. The development of joint clinical meetings between LAS frontline staff and A&E staff would be an important step in meeting this important quality objective and supporting reflective practice and annual appraisal for paramedics, technicians and medical staff.







4) Mental Health and Dementia Care



a) The Forum is very pleased with the progress made by the LAS with the development of their mental health strategy, the prioritisation of this work over the past year and the employment of a mental health specialist.



b) The Forum would like to see this work developed though targeted qualitative research with patients who have been taken by the LAS to A&E departments and Places of Safety, with a diagnosis of a severe mental illness, e.g. sectioned under s4, s135 or s136 of the Mental Health Act.



c) The Forum would like to see prioritisation of rapid admission to appropriate mental health services – waits of several hours to handover patients to appropriate mental health practitioners are appalling. Urgent negotiations are needed with commissioners and the acute and mental health sector in London to resolve this problem.



d) Progress with providing appropriate care for people with dementia should be a priority. The Forum has recently met with Alzheimer’s UK, who would like to work the LAS to ensure that people with Alzheimer’s disease receive appropriate assessments, referral to memory clinics and mitigation of long waits in A&E.



5) Bariatric Care



a)     The QA identifies appropriate care for heavy patients as a cause of concern. The Forum is concerned about the distress caused to these patients and their families, when staff do not have the right equipment, and training to provide appropriate care and support.



b)     We recommend the LAS ensures staff have access to appropriate equipment and vehicles 24/7, and fully trained staff are available to ensure heavy patients do not suffer delay in their care or treatment.





6) Learning from Serious Incidents and Complaints Patients Safety and Patients Complaints



a)     We compliment the LAS on significant progress made through the Learning from Experience Committee.



b)     We recommend the LAS formally adopts the Health Service Commissioner’s statement ‘Driving improvement and learning from NHS complaints information’, which provides a bridge for learning from incidents, accidents and complaints.



c)      We would like to see details of all recommendations made following complaints investigations placed in the public arena with evidence of enduring improvement to LAS services.









7.0 Being Open



a)     We would like to initiate a joint project with the LAS to gather evidence that people are informed when something has gone wrong with the treatment or care provided to them by the LAS.





“Open and honest communication with patients is at the heart of health care. Research has shown that being open when things go wrong can help patients and staff to cope better with the after effects of a patient safety incident.
Healthcare staff may be fearful of upsetting the patient, saying the wrong or admitting liability. This guidance and the associated actions outlined in the Alert, provide reassurance that Being open is the right thing to do, and encourage NHS boards to make a public commitment to openness, honesty and transparency”.
National Patients Safety Agency (NPSA) 2009




Friday, 11 May 2012

The European Crisis - Time to resist!




I have not posted here for some time, partly because I was away in Ireland last month but also as I have been very involved in the anti-cuts movement here (Coalition of Resistance) as well as attending meetings to establish a new group supporting the people of Greece in their hour of need, called the Greek Solidarity Campaign. I have also been busy with my voluntary work as Chair of the London Ambulance Service Patients Forum, attending an all day event last Saturday around preparations for the Olympics by the various ambulance services around the country and visiting the new Olympic Deployment Centre in Docklands, from where the ambulance service will service the various Olympic and Paralympic sites.

COR has been pushing for a national demonstration against the cuts, spearheaded by the unions, for some time. We were enormously encouraged when UNITE took the lead on this, after a series of meetings with COR, and these regular meetings are continuing, and the TUC finally decided to act. It now looks as if the national demonstration will happen in October. Initially it seems that it would be branded by the TUC as a march to "save the NHS". While I agree that saving the NHS is a vital political issue, I also think it vital, and I have said this at COR meetings, that the other cuts, resulting from the Welfare Reform Act etc, are not overlooked. This is especially important at a time when several million disabled people are about to be fed into the mincing machine operated by Atos, G4S and others, in multimillion pound contracts awarded by this government, and which will lead to many living in destitution, resulting in many suicides etc. Also at a time when one London borough after another is announcing the removal of its poor and homeless to areas in the Midlands or the North. The latest I have heard about is the very wealthy Royal Borough of Kensington and Chelsea, which is considering exporting its homeless applicants and others to Stoke on Trent. Cromwell's cry of "To hell or to Connacht" issued to the Irish Catholics deprived of their land has echoed down the centuries but the Tories and Lib Dems equivalent "to hell or to Hull" looks like following it into the accounts of the dark and inhuman actions from English history.

The strikes yesterday against cuts and the removal of pension rights are a foretaste of what is to come in the autumn and it is high time that the unions, and the TUC in particular, got down and fought the dismantling of the welfare state and the driving of millions of people into penury.

The elections in Greece and France have opened a window of light on to the eternal gloom of austerity which has been the prevailing condition in Europe for the last few years. The delegation from COR which went to Athens recently were shocked by what they found. Suicides had multiplied, as they have in all of the states covered by austerity plans, including Ireland. During my recent visit to Dublin, I visited my brother and his family who live in Howth, a former fishing village which is a suburb of Dublin. He and his wife told me that there had been a series of suicides there, including a pregnant woman who had jumped from the cliffs and anothe woman with several small children who drowned herself in the harbour. The real rate of unemployment in Ireland is estimated to be 30% if you take into account the large numbers of young people who are being forced to emigrate to Canada and Australia.

The Irish government, who are acting as the agents for the austerity agenda, are trying to push through support for the Austerity Pact, the only country in Europe being given a choice on this issue. The Irish Green Party, who were part of the government which got the country into the mess in the first place, are about to take a position on the Austerity Pact and their position re the referendum. It can safely be assumed that they will take a pro line, as they are now totally bankrupt, both politically and financially, and are taking their lead from their funders in the Berlin and the German Green Party. They are attempting to relaunch themselves this summer and detoxify their reputation and change their brand. Unfortunately, like New Democracy and Pasok in Greece, they are totally associated with the mess in Ireland and the attempt to force the Irish taxpayer to prop up toxic banks for years to come and pay for bondholders in the UK and elsewhere.

The acerbic and campaigning Irish journalist, Vincent Browne, has on two occasions recently demolished the case for the bailout and the enslavement of the Irish people for a generation. Here he questions why Irish taxpayers should continue to pay for a bank which is defunct. It almost reminds one of the famous Monthy Python dead parrot sketch - dead, defunct, finished.
http://www.youtube.com/watch?v=HAf7J4a_T1g

And here Browne demolishes the arguments of the right wing Fine Gael minister, Leo Varadkar, on the Fiscal Compact and the referendum.
http://www.youtube.com/watch?v=4P20r3es1ew

The only way out of this is default and the people of Ireland and of Europe need to loudly tell the bankers and the spivs, and those who politically represent them, where to get off.

Tuesday, 3 April 2012

The crisis in Europe - the Eastern European Model

At the BASEES conference on Saturday and Sunday in Cambridge, the opening address was given by the Bulgarian intellectual and foreign policy theorist, Ivan Krastev. Krastev presented a fascinating theory about what is currently happening in Europe in terms of both politics and economics. And he drew striking parallels with what happened in Eastern Europe following the end of socialism there.

He began by stating that some years ago the aim of EU policy makers was how to make Bulgaria more like Greece, whereas now it was how to make Greece more like Bulgaria. He asked how universal is the Eastern European experience and why, for example, there had been protests against austerity in Latin America but not in Eastern Europe in the 90s. The question now was could Poland be transplanted to Spain or Italy?

His explanations for this were several. Eastern Europe post 1989 had held a radical consensus about the need to abolish the welfare state established under the Communist regimes. There had also been the almost total absence of a radical discourse to attack the reforms. Because of a history of corruption under Communist rule, EU institutions were more trusted than national ones.Brussels was regarded as an ally to control national elites. Elections became about personalities and not policies and produced inherently unstable governments - Bulgaria was an example where virtually every post-Communist government had been replaced in subsequent elections and extra parliamentary parties gained seats. The old regime, the Communists, were regarded as having had nothing to contribute to the debate and thus the 'transition' was regarded as everything.

The austerity state, first in Eastern Europe and now in Southern Europe was based on the concept of 'no alternative'. There was now a clear attempt to roll out the Eastern European model across Southern Europe. The main losers in Eastern Europe post 1989 were the old, but in Southern Europe it was the young. An interesting example he gave of this was when in the 90s, two Bulgarian economists had said that the transition period was over. They were roundly attacked in Bulgaria as the people were not prepared to accept this, and thought that there must be more to the reforms than what they saw. In Southern Europe, civil society was far stronger and there would be much stronger resistance to the implementation of the Eastern European post-Communist model.

He told an Eastern European joke from the early 20th century to illustrate his point. Two trains were underway, one from Paris to Moscow and the other from Moscow to Paris. They both met in Warsaw and each was certain that they had reached their destination.

A fascinating historical and political question was to compare the discourse around the fate of the Soviet Union with that of the Eurozone. In 1985 the collapse of the USSR was considered "unthinkable" but by 1995 was considered "inevitable". He compared the USSR and the Eurozone as both ideological projects in search of reality.

The real problem in contemporary Europe was that electorates could change their governments but not their policies. This move away from economic debate in politics would lead to a rise in identity politics and this was already visible. This was what Krastev termed "the rise of the demographic imagination". This he described as shrinking majorities, e.g. the old, or white Europeans etc, feeling that they are becoming the minorities. This would be a major feature of European politics. There was a deep seated feeling in Europe that the future had disappeared and that its people were living in an eternal present. The Far Right would not really benefit from this as the main uncertainty in Europe was cultural, rather than economic, but it would profoundly affect mainstream parties and move them to the Right.

I think that Krastev's analysis is very interesting and worth further study. Certainly it would seem that Europe's elite, hand in gloves with its bankers, wants to impose what they consider the successful Eastern European model on the rest of Europe, beginning with its periphery.

A sad footnote to this was the documentary 'My Perestroika' by the US film maker, Robin Hessman, set in Moscow among a group of school friends and illustrating the disillusionment which quickly set in following the collapse of the USSR in 1991.

Monday, 2 April 2012

Brain drain from Baltic states

http://www.youtube.com/watch?v=KHX0F_H0KB0

Further evidence of the impact of Europe's austerity measures etc on the former 'wonder economies' of the Baltic States and the drift of more EU migrants towards other EU states already suffering from high unemployment.

Thursday, 22 March 2012

LINks and the Big Society

I went to a meeting of London LINk last night at City Hall, where there was a heated discussion about how those involved in patient and public involvement will continue to operate under Healthwatch as now laid out in the Health and Social Care Bill, soon to be Act. Listening to the discussion and the difficulties which many of these people already face in dealing with local authorities - Merton has a particularly difficult situation with an uncooperative local authority - the set up for Healthwatch, which will replace LINks in one year, looks even more difficult.

As someone who has been involved in PPI work for some years, listening to the discussion, I asked myself, who would sign up for this in their right mind? For all the talk of the 'Big Society' this demonstrates how difficult the government are making it for volunteering patients and members of the public, who spend vast amounts of time and energy on this, to be treated as part of the current involvement buzzword, 'co-production'. Malcolm Alexander, who has struggled valiantly against the provisions of the Bill on public involvement, was quoted in the debate on the Bill in the Commons on Tuesday. His arguments (contained in Hansard) are below. The key quote for me is:
“existing LINks members and volunteers become disenchanted about the new arrangements for local HealthWatch and leave the system”

From what I heard last night I would not be at all surprised if this happens. And as Malcolm said at the meeting, every time the government reorganises public and patient involvement (and it has happened 3 times over the last 11 years) it takes on average 2 years for the new organisations to bed down. If one were a conspiracy theorist, one would assume that the government's intetion is to wreck public and patient involvement.


HOUSE OF COMMONS - HEALTHWATCH




20 Mar 2012 : Column 737    -  8.30PM

Liz Kendall: I start by sharing with hon. Members a letter to the Prime Minister on 13 March from Malcolm Alexander, who is the chair of the National Association of LINks Members, the national body representing statutory independent local involvement networks that promote the public and patient voice in health and social care. The letter is about the amendments to HealthWatch that were made in the other place and are before us now. He wrote to register his

“strong objections to the government’s major policy change on Healthwatch—specifically your decision to abandon plans to establish statutory Local Healthwatch bodies…Instead of creating independent statutory bodies led by local people who can monitor, influence, involve the public, hold the local authority and NHS to account; the government plan to create weak bodies that will not be independent, but will be funded by and accountable to the local authority they are monitoring. There will be no genuine accountability to the public.”

He then makes this rather perceptive comment:

“Plans for a statutory Healthwatch body were probably the only part of the Health and Social Care Bill that had any public support.”

He continues:

“Your government’s ambition”—

not your Government, Mr Deputy Speaker, but the Prime Minister’s—

“to establish independent, statutory Healthwatch organisations that would help achieve equity and empowerment in relation to access to NHS and social care services, has been diminished to such a degree, that Healthwatch will have little impact…The aspiration to achieve equity and excellence in public involvement in health and social care, especially for the most vulnerable people, has been replaced by a model that has lost its central purpose of building effective patient and user led bodies that can influence the planning of health and social care.”

I will continue reading from this letter because if the Government really want to hear the patient and public voice, Members should do too, and that is what Malcolm Alexander represents. He writes:

“In our discussions with the Earl Howe and”

the Department of Health

“over the past year, we were led to believe that LINks would evolve and go through a transition into Healthwatch. It is incomprehensible to us that the plans that were developing for Healthwatch have been replaced, at very short notice, by a highly confusing set of amendments to the Health and Social Care Bill that are very unlikely to achieve the objectives of the Transition Plan and will be very poor”

value for money. He continues:

“It was the stated policy of the Coalition that patients and users of social care must be at the heart of everything that is done—not just as beneficiaries of care, but as participants, in shared decision-making.”

Malcolm Alexander also writes that the Secretary of State

“has continuously said, ‘there should be no decision about us, without us’. Why has this promise and aspiration been abandoned and why is the government planning to abolish plans for an effective statutory model of local Healthwatch and replacing it with one that will be chaotic, diffuse and weak with no leadership role for patients and the public? Instead of engaged and empowered patients and users of social services taking a leading role—many

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volunteers who have led LINks are feeling disempowered, demoralised and demotivated. We had hoped and believed that at last Healthwatch would genuinely empower”

patients and the public

“through being populated by ordinary people in the community. This hope is now lost.”

He finishes with an apt comment on the entire Bill:

“This is a betrayal of public trust and an appalling waste of public money.”

The Government have repeatedly claimed that the Bill will put patients and the public at the heart of the NHS and that a crucial core purpose of the Bill is that for patients there will be “no decision about me without me.” Nothing could be further from the truth. Opposition Members have consistently argued, since the first Commons Committee stage, that the Government’s proposals for HealthWatch are weak and ineffective, and will fail to give patients a strong and independent voice to shape local health and council services. [Interruption.] The Minister chunters from a sedentary position. We always saw through the Government’s plans; now everyone else has too.

More than 67 Government amendments about HealthWatch England and local healthwatch bodies were tabled in the other place. These amendments make major changes to the Government’s original proposals, ensuring that they will be even weaker still. The Government’s amendments 181 and 366, tabled in the other place, remove clause 179 and the related schedule 15, which place a requirement on local healthwatch organisations to be statutory bodies. As the NALM rightly says, the Government made this change without any prior mention to the House, or even in Committee in the other place, and more importantly without any consultation with patients’ groups.

Local authorities will now contract social enterprises or voluntary organisations to provide local healthwatch functions. Councils will be able to split these functions if they choose. The small voluntary groups, social enterprises and, indeed, private sector bodies will be expected somehow to provide a strong and critical voice on behalf of patients about local services—services that may be provided by the very local councils contracting and funding them. The joint effect of these amendments is to divide up the functions of HealthWatch, to break down the synergies between the different roles, to require bidding to win tenders for the delivery of various services and to leave local healthwatch bodies with no automatic consistency or authority to speak on behalf of a community.

The Government have repeatedly argued that the Bill is necessary to give clinical commissioning groups statutory status, to guarantee that professionals are in the driving seat. The question is: why are the Government giving organisations that are supposed to empower professionals a statutory status, but now removing that status from the bodies that are supposed to empower patients? The weak status of HealthWatch England nationally remains. It is still a mere committee of the Care Quality Commission. All that the Government have done is say that a majority of members on the committee should not be members of the CQC. HealthWatch England should be the voice of the people in the NHS. Making it a committee of the CQC is a fundamental error. Patients and the public must have confidence that HealthWatch England will speak up for them, including where it believes that the Care Quality Commission has failed to monitor or

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inspect local NHS services or local council services properly, including care homes. How will HealthWatch England do that if it is funded and housed within the CQC, an organisation that has already been criticised for lacking strategic focus and the resources necessary to do its job effectively?

The Government say that HealthWatch must be part of the CQC in order to get access to information and other resources. However, if the duty in the Bill on all NHS organisations to collaborate—a duty that the Government have made much of—is so strong, why would it not also apply to the CQC in collaborating with a separate, independent HealthWatch England? The Government have also completely failed to ensure that HealthWatch will have the ring-fenced funding that it needs to do its job properly. Funding for HealthWatch England and local healthwatch bodies is only £20 million, compared with £492 million for the NHS Commissioning Board and £140 a year for Monitor. HealthWatch would have already struggled to provide an equally strong voice in the NHS for patients and the public on the basis of those resources, but now the Minister in the other place, Baroness Northover, has made it clear that funding for local healthwatch bodies will not be ring-fenced, but instead be part of the formula-based grant to local councils. Failing to ring-fence local healthwatch funding will virtually guarantee that those bodies will fail to provide a strong local voice.

That is not just my view: it is the view of National Voices, the organisation that represents 150 patient groups, which says that giving local healthwatch groups a strong voice will be possible only if

“the funding is ring-fenced. Otherwise local authorities will continue to use the funding for what they regard as higher priorities.”

National Voices says that HealthWatch is being “set up to fail”. It is right. In its latest briefing on the Bill, it says that the risks the Bill poses include a

“lack of independence at national and local levels…insufficient power…insufficient funding,”

weak support for the transition, and

“reform fatigue among local activists.”

Andrew George: I am listening carefully to the hon. Lady’s arguments about the structure and funding of local healthwatch bodies and HealthWatch England. I ask this question not to be deliberately mischievous, but in view of her comments and criticisms, what is the preferred option of the Labour party for those scrutiny bodies?

Liz Kendall: I would encourage the hon. Gentleman to read the Opposition Front Bench amendment tabled in the House of Lords which set out how we could have a separate independent body with clear lines of accountability to local healthwatch organisations. That is the policy of the Opposition. Unfortunately, however, that amendment was not accepted.

National Voices represents 150 patient groups. I was interested that the Minister said that the Richmond Group of charities somehow supported everything that the Government were doing in this area. However, I should remind the House that National Voices includes groups such as Asthma UK, Arthritis Care, the British Heart Foundation, Breast Cancer Care, Carers UK, Cancer Research UK, Diabetes UK, Dementia UK,

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Mencap, Mind, Macmillan Cancer Support, Rethink Mental Illness, the Stroke Association and many others. Those groups are saying that the Government are setting HealthWatch up to fail, because it will not provide a strong enough voice for patients and the public.

Interestingly, officials within the Government’s own Department are saying the same thing. Hon. Members will know that the Government have refused to publish the transition risk register, but today I have been passed the risk register from the Department of Health’s programme board for HealthWatch. It is marked “Restricted”, and it sets out clearly what the Department’s officials see as the risks involved in the Government’s proposals on HealthWatch. It deals with high risk in terms of impact, as well as with likelihood, so it does involve prediction.

The risk register says that there is a high risk that

“existing LINks members and volunteers become disenchanted about the new arrangements for local HealthWatch and leave the system”

because of “insufficient consultation”. It goes on to say that there is a high risk that local authorities

“will not invest in establishing effective relationships with existing LINks and other community organisations”

because the process has been poorly managed. It states that there is a high risk that there will be a “narrow engagement group” and that HealthWatch

“doesn’t work effectively with providers and commissioners. HW is not fully representative.”

It identifies the cause for that as the engagement process having been “insufficiently inclusive”. It sees a further high risk in relation to HealthWatch England:

“The establishment of the HWE committee within CQC is either too isolated or too prescribed by DH/CQC plans.”

The cause is identified:

“Early design processes for establishing HWE do not engage broad range of partners resulting to ineffective regulations being laid.”

Those ineffective regulations are being laid by this Government, according to the risk register of the Department of Health’s own HealthWatch programme board.

Some of the Lords amendments in this group would make minor improvements to the Bill in relation to the National Institute for Health and Clinical Excellence and to the functioning of the information centre. I want to return to the Minister’s earlier claim that huge improvements would be seen in public health. Some amendments relate to the employment of public health professionals by local authorities. The trouble is that the Faculty of Public Health, the body that represents those people, opposes the Bill and wants it to be dropped. It has stated that the Bill will widen inequalities, increase health care costs and reduce the quality of care. It says that there are significant risks—[ Interruption. ] If hon. Members are making claims that their Bill will improve public health and that the amendments will improve arrangements for public health professionals, perhaps they should listen to the views of those public health professionals. The Faculty of Public Health has identified

“significant risks associated with the NHS structures, the new health system and environment that the Bill will enact.”

The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) was, perhaps courageously, trying to get the Minister to set out what powers local

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authorities would have under the new system. He will know, however, that health and wellbeing boards will not have the final say over GP commissioning plans. They will not be able to stop them. The only course left to them will be to appeal to the NHS Commissioning Board. I would respectfully point out to the right hon. Gentleman that if he thinks that the NHS Commissioning Board will automatically agree to complaints from local authorities, his experience of the NHS is very different from mine. We need to be clear that there will be no sign-off by health and wellbeing boards.