Poor response from new “Integrated Care Board” in North East

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“North East and North Cumbria Integrated Care System” (NENC ICS) has been responsible for commissioning all health care in the region since July 2022. There are, of course, major difficulties with this organisational system, and these are identified on our webpage here.
The Board of the ICS meets every two months and, on reading the Agenda and papers for 28th March 2023 Board meeting, members of KONPNE were shocked to see the number of services in the region which, following CQC inspections, “require improvement” and, also, the required overall “efficiency” target of £48.4 million – all evidence of underfunding and the Governments strategic run down of NHS provision. Click here for the “Integrated Delivery Report” – scroll to item 8:1 on page 96
>> OUR QUESTION: With regard to this important issue, we submitted the following question to the March 2023 ICS Board meeting:
“Keep Our NHS Public North East (KONPNE) is a group of people who strongly believe that the NHS should remain a public service.
Members of KONPNE are very concerned to read in the North East North Cumbria ICB: Integrated Delivery Report February 2023 (Agenda Item 8.1) that a number of services within the ICS are inadequate, according to the CQC. We are aware that the Board have noted this. 
Please detail, specifically, what the Board’s plans are for addressing this situation, given the requirement for the ICB to meet an overall efficiency target of £48.4 million”
>> THE VERBAL FEEDBACK to our question at the meeting was astonishing in both content and brevity. The person who made the response (we remain unsure who it was, as no surname or role was provided) seemed keen to assure that there was nothing to see here, as follows:
No services were rated as OVER-ALL inadequate; North East Ambulance Service was rated inadequate in part and a support package has been put together to look at elements of that (yes – but our question asked for specific details, which  we need to know about)
There is a need for Enhanced Surveillance of some services (yes….details…?)
KONPNE notes that CQC rated a number of other services as “requires improvement” (this issue wasn’t developed in the response – it would have been a good opportunity to update on the actions regarding these services, instead of closing the question down)
Apparently the requirement to bank £48.4million in efficiency savings (flowery name – we know this as BUDGET CUTS) won’t affect the budgets of the services which require improvement (- so end of subject there, apparently no need to expand on that point….)
And the so-called “efficiency savings” / cuts will be made on “prescribing and CSE packages of care” (information about the effects of this and action plan regarding these services would have been useful). 
Thus, in short, we feel this to be a minimal and superficial reply to an important issue, deserving of a considered and respectful verbal  response. Click here to watch the video of the verbal response – click on the image for 28th March, go to 3:28 on the timer slide at the bottom of the video, and don’t blink.
>> As for the WRITTEN FEEDBACK to our question…. o dear, o dear….  the following, ….err….exceptionally brief written response was received from the ICB on April 23rd 2023, three weeks after the meeting….. what can we say…..:
“Thank you for your question. 
None of the 11 provider organisations in the ICB are rated as inadequate overall. In North East Ambulance Service’s (NEAS) recent inspection, they were rated as inadequate for Well Led but overall as requires improvement. NEAS are being supported by the ICB to work through the actions identified by the CQC.”
>> KONPNE: Obviously, “North East and North Cumbria Integrated Care Board” need to do better regarding public involvement. We read on the ICB website that “The ICB is committed to providing clear and accessible public information to build understanding and trust….. The ICB will provide good quality accessible information that meets the needs of all people in our communities”.  There’s some way to go, then.  We will, of course, be writing to the ICB regarding their paucity of response and  seeking more information about these issues.
>> PUBLIC INVOLVEMENT: And while we’re about it – some issues for the Board to develop around the PROCESS of public accessibility to the Board meeting…. that is, if true public involvement is to be welcomed….
1) We need to know who is speaking? Important for all verbal reports, but especially for the response to the public question!  2) The time period between the publication of the Agenda and the cut off date for the receipt of questions to the Board was NIL for both the November 2022 and January 2023 Board meetings and ONE DAY for the March 2023 meeting.  Given that the Board meets every two months, this window for submitting a question is either non-existant or ridiculously small and is an indisputable barrier to involvement  3) We query why a question from the public to the Board must be based on the Boards’ Agenda?  We require an openness and willingness to engage with the patient agenda regarding Board activity   4) Placing questions from the public at the very end of the meeting gives a message of reduced importance and can, furthermore, add another barrier to engagement for people with certain health or attentional difficulties. It is useful to note that questions from the public are at the start of the local full Council meetings.   5) An option to ask the question in person and a right to reply would be welcomed  6) Space is required on the agenda for receipt of petitions.
We will be contacting the ICB about these issues as a matter of priority.
UPDATE 15.5.23
– We have contacted all seven Healthwatch organisations in the NE, so that they are aware of our concerns.
– NENC ICS have been in touch to offer a meeting to discuss our concerns – this is a positive development, we intend to accept this offer and will keep you updated.

Enough is Enough

The Royal College of Nursing is currently balloting for strike action, putting patient safety at the heart of the campaign. Unless we address workforce shortages and staff pay and conditions things will not improve.

Angela, North East resident, KONPNE supporter and Nurse (retired) speaks from experience

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We at Keep Our NHS Public care passionately about the NHS and the people who work in it. We are demanding a pay increase for all NHS staff and an end to NHS privatisation.
I recently retired as a registered nurse. I have worked at home and abroad in hospital and community settings. The emphasis on patient care rather than profit differentiates the NHS from anywhere else I have worked. The Tories were against the NHS when it was formed in 1948 and they want to see it privatised now.
Recently, the Health And Care Act was carefully rushed through Parliament, avoiding media coverage. There is no longer a NATIONAL Health Service – it has been split into 42 parts, called Integrated Care Systems. We believe that this Act drives the NHS further down the road of privatisation. Integrated Care Boards can now decide which services will be provided and who provides them. The NHS will no longer be the default provider. The NHS is in crisis – the Government would have you believe this is due to the pandemic when, in fact, there have been years of underfunding and outsourcing of services.
Let’s not forget the suffering of essential workers during Covid. Healthcare workers were caring for patients with no or inadequate PPE, and many healthcare workers died . The government awarded contracts for PPE to totally unsuitable providers, without any scrutiny – such was their concern for workers. There was a Fastlane for Tory friends and donors. Millions of pounds were wasted on PPE which was not fit for purpose. When it came to testing for Covid, they could have used proven local Public Health services , but instead they paid Serco and Sitel £37 Billion for a Test and Trace service which has been shown to have had no effect on the course of the pandemic. Who says there is no magic money tree?
Morale in the NHS is extremely low. NHS staff want to give you good care. A recent survey of tens of thousands of nurses showed that, on their last shift, a huge majority said there was not enough staff or time to give the care they wanted to. We want minimum staffing levels enshrined in law, as they are in Wales and Scotland. The government are refusing to do this.
The Health And Social Care Committee say there is a shortage of 50,000 nurses – we know that in the last year 40,000 nurses have left the NHS, with workplace stress and lack of work-life balance being some of the reasons cited for leaving. Whilst the committee made it clear that it is unacceptable that some nurses are struggling to feed their families, pay rent and travel to work, the Government ignored their calls for a meaningful pay rise. Last week’s budget will see the poorest in our society suffer even more. There is already talk of benefit cuts and cuts to public services.
The Royal College of Nursing is currently balloting for strike action. We are putting patient safety at the heart of our campaign. Unless we address workforce shortages and staff pay and conditions things will not improve. We are demanding a pay award of 5% above inflation. We are saying ENOUGH IS ENOUGH. We demand fair pay and working conditions so we can give you the care you deserve.
We are asking you to please support us. Thank you.
INFO: Click here for the Enough is Enough website

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Loud and clear from the North East

We need emergency investment now to rebuild a publicly provided NHS, deliver pay justice for health and care workers, and end private interests in the NHS. 

The speakers at the February 2022 “SOS NHS” events in the North East tell it as it is at Newcastle Grey’s Monument, Tynemouth Longsands and Sunderland Seaburn Beach. One day = three rallies.

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Julia Charlton, Senior Lecturer in Nursing (retired):
“Beyond this Spring, we will need legislation and change at the top to re-establish a fully publicly funded and provided national health service, protected from private companies who put profit before patients. We need a national care service, and we need to make the NHS the default provider for health service provision. 
The NHS was once the best health care service in the world. It can be again. This Government has shown it won’t change course without pressure from below: but U-turns have occurred. It’s up to us to pile on that pressure”.
Click here for the full speech, Tynemouth, 26.2.22


Julia Charlton at Tynemouth Longsands, 26th February 2022

Gail Ward, Organiser for “Disabled People Against Cuts” and “Protect Tynedale NHS”:
“We all need a healthcare system to be provided free at point of use, not the two tier systems that operate in USA and other countries. Integrated Care is not the answer to social care that many need and it’s not only the elderly, it is disabled people too. Many disabled people will be denied insurance on basis of  pre-existing conditions. Are you really going to allow that to happen? All our lives are precious. 
If we don’t stand up for the NHS now, then we will lose it”.
Click here for the full speech, Newcastle and Tynemouth, 26.2.22

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Gail Ward, pictured at a previous rally

Laura Murrell, Keep Our NHS Public Sunderland and District:
“If money can be raised to be wasted or to support a struggling private sector why can’t it be raised to invest in the NHS and build a stronger better public sector. But no – instead Rishi Sunak’s spending review locks in underspending on the NHS until 2025. It’s not good enough. Our NHS deserves better. Let’s actually do something to make the call for building back better mean something. 
We must reverse the 6 million plus waiting lists, stop patients dying in the back of ambulances outside hospitals because there are no beds, or forcing people to wait all night for an emergency ambulance for a suspected stroke only to be told in the morning that they have to drive 34-mile, a one hour journey, to that county’s only Accident and Emergency Department.
The NHS was once the best health care service in the world. It can be again.”
Click here for the full speech, Seaburn, 26.2.22

Laura Murell

Laura Murrell at Seaburn, 26th February 2022

Roger Nettleship, Chair of “Save South Tyneside Hospital Campaign”:
“The necessity is for a public healthcare system that is human centred. A human centred system is where health staff and the communities engage to provide health and social care that is accessible to all day and night. For a modern borough like South Tyneside with a growing population 160,000 plus it is not acceptable that our hospitals do not provide full maternity services, a consultant led Children’s led A&E and and A&E with all the acute services necessary.
It is the people who should decide. They are our hospitals, they are our workplaces and it is our NHS. Health care is a right!”
Click here for the full speech, Newcastle and Seaburn, 26.2.22


Roger Nettleship at Grey’s Monument, Newcastle-upon-Tyne, 26th February 2022

Dr Pam Wortley, retired GP and member of the “Socialist Health Association”:
“The Health and Social Care Bill is the greatest threat to socialised healthcare. The NHS will be broken up into 42 regional bodies, where even emergency care is no longer guaranteed. The private sector can sit on NHS Boards, with powers to decide what care to provide, based on finances, not clinical need. Deregulation of professional staff, and national pay, terms, and conditions, and pensions will be threatened through local pay deals to cut costs. Hospitals will no longer need to do social care checks before sending patients home. It will allow contracts for private profit, fragment the NHS, and make it harder for patients to obtain the care they need.
We will not allow our service to be privatised and sold off to American companies; America, where millions of people, unable to pay get no care or are forced into bankruptcy.
This must be stopped”.
Click here for the full speech, Newcastle and Seaburn, 26.2.22

Pam Wortley

Dr Pam Wortley at Seaburn, 26th February 2022

Dr Helen Groom, retired GP, NHS campaigner and member of the “No to Hassockfield Campaign”:
“What horrifies me is that over the last few years, as a country, we seem to believe that there’s nothing we can do to stop the increased privatisation of the NHS. We can. We need to start giving our politician’s very clear and unambiguous messages…. So where are we now. We have a demoralised NHS workforce who understand that their employers, the government, are more interested in lining their own and their mate’s pockets than in supporting them to provide the best services. We have hospitals and ambulance services who have been stretched to their limits. Staff are exhausted and demoralised. Many are leaving in droves
Click here for the full speech, Newcastle and Tynemouth, 26.2.22


Dr Helen Groom at Tynemouth Longsands, 26th February 2022

Tony Dowling, Chair, North East Peoples Assembly:
“I get very annoyed these days when it seems that the person popping up everywhere to supposedly defend the NHS from this Tory government’s attacks is none other than former Tory Health Secretary Jeremy Hunt!! So I just want to remind people a little about Hunt.
Jeremy Hunt took over responsibility for the NHS in 2012 and was the longest-serving Health Secretary in history. By the time he left the post 6 years later, patient experience and staff morale had both taken a dramatic turn for the worse across many key indicators. The British Medical Association reported that by 2018 “the winter crisis” has truly been replaced by a year-round crisis. There were three times more patients waiting over four hours to be seen in A&E when Hunt left office than when he took over. Hunt oversaw years of historically low funding increases – around 1%, compared to an average of 6% in the years between 1997 and 2010, and compared to the 4.3% recommended by the Office of Budget Responsibility.
But perhaps most damagingly, he oversaw a significant cut to the amount that hospitals were paid per procedure. Meanwhile, it’s been quids in for the private companies routinely used to provide beds to make up the shortfall – Virgin Care, for instance, won almost £2 billion of contracts during Hunt’s tenure! Hunt’s legacy was: missed targets, lengthening waits, crumbling hospitals, missed opportunities, false solutions, funding boosts that vanished under scrutiny, and blaming everyone but himself. 
That is the real story of Jeremy Hunt. So please remember that next time you hear him waxing lyrical and being given a free-pass all over our uncritical media! And we really should not be surprised. Because back in 2005, Hunt co-authored a book called ‘Direct Democracy’ which stated that: “Our ambition should be to break down the barriers between private and public provision” and that the NHS was “no longer relevant in the Twenty-first Century.” In effect, calling for the denationalising of our NHS!
Jeremy Hunt is no defender of the NHS. Like all Tories he tells ‘Tory lies’, so any defending of the NHS and fighting for the NHS is down to us”.
Click here for the full speech, Newcastle and Tynemouth, 26.2.22


Tony Dowling at Tynemouth Longsands, 26th February 2022

Sean Fahey, Regional Secretary, North East Pensioners Association:
Re: Health and Care Bill / ICSsThere however seemed to be no comprehensive workforce strategy, no forecasting of supply and demand and no independent scrutiny/provision of this to allow for the needs to be fully funded and met. This is supposed to be about devolution and reduction of bureaucracy from the centre but the Secretary of State has introduced amendments which allow for direct intervention. 
Re: Alternative Health Systems as in the USAThese are failed schemes. They cost double our, main source of household bankruptcy and the 3rd source of death in the system is medical error”.
Our Best System The NHS. Publicly funded by tax, publicly run and open to all at the point of need
Click here for the full speech, Newcastle and Tynemouth, 26.2.22


Sean Fahey at Grey’s Monument, Newcastle-upon-Tyne, 26th February 2022

Message of support from Kate Osborne MP (Jarrow):
The fact is however that the NHS is in crisis and under severe pressure. Staff are working long hours, exhausted by the last few years and many not receiving fair pay. The NHS is not being funded properly, services are being privatised and there is a huge backlog of patients. Locally, we have seen a dissemination of NHS services being cut or moved out of South Tyneside Hospital. That is why we must now all come together, and support SOS-NHS’ demands.
We need emergency funding of £20billion to save lives this winter. We need investment in a fully publicly owned NHS with a guarantee of free healthcare for future generations. And we need fair pay for NHS workers. Thank you all for coming along today and for all you do in keeping pressure on the Government surrounding these demands. 
Click here for the message in full. to KONP Sunderland and District 26.2.22

Kate Osborne MP Jarrow

Kate Osborne MP (Jarrow)

We are grateful to our other speakers – Joe Kirwin (Councillor and chair of North Tyneside health scrutiny committee), William Jarrett (Unite, Newcastle Hospitals Branch), Jude Letham (Keep Our NHS Public North East), Grace Dowswell (Psychologists for Social Change), Stacey Richardson (NHS Staff Voices, North East Peoples Assembly), and others. Thank you.

For a report on all of the NE “SOS NHS” events, please click our News page here and scroll down to 26th February 2022.
For guest blogs from North East poet Joan Hewitt about the Longsands event, click here (for poetry at Longsands) and here (for reflections)
….and click here for more info about the “SOS NHS” national coalition of health campaigns

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(1) Approve emergency funding of £20 billion to save lives this winter
(2) Invest in a fully publicly owned NHS & guarantee free healthcare for future generations
(3) Pay staff properly: without fair pay, staffing shortages will cost lives 

Who’s NHS??

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With heart from Newcastle, Tynemouth and Seaburn

KONPNE meets monthly via Zoom: Join in with the Campaign, ALL are welcome – click here for details

True North; two extremes

Poetry at Longsands

Joan Hewitt, award-winning Tynemouth Poet, describes an afternoon by the North Sea and we hear about two extremes: an inept Government and a NHS which shows many different kinds of love  

Follow Joan at https://twitter.com/Tynemouthpoet  and  https://www.facebook.com/joan.hewitt.73


Joan Hewitt at Longsands, 26th February 2022
I promised to post some of the poems read at Tynemouth’s Keep Our NHS Public North East event last Saturday.
First up is Harry Gallagher, Boro man in Cullercoats and true poet of the North. His introduction and first poems were really moving- but – as a consummate showman – he saw the shivering crowd needed warming up and got us yelling the word Lies at the end of each verse (cos let us not forget that Johnson must still be held accountable).
For Harry’s latest book, see True North – A Kiss for Your Soul
Boris Just Lies

Pigs live in sties,
Yorkshire puds rise,
wet paint dries,
James Bond spies,
Boris just lies.

Coconuts sit on shies,
rain falls from the skies,
a jobseeker applies,
advisers advise,
Boris just lies.

A town crier cries,
a happy shopper buys,
a beach bum fries,
leaky ships capsize,
Boris just lies.

Fat lads love pies,
an aeroplane flies,
wasps terrorise,
rugby players score tries,
Boris just lies.

I only believe
what I see with my eyes.
His lips are moving?
No surprise – 
because Boris just lies.


Harry Gallagher at Longsands, 26th February 2022

And the second poem from last Saturday’ s Keep Our NHS Public North East event on the beach in Tynemouth;
I read a poem by children’s poet Michael Rosen , who was in a Covid coma for months in an intensive care unit. When he woke, he found the nurses and helpers had kept a daily Patient Diary for him. I also read one of those entries, which helped him piece together that dark time, and which can be found alongside the poems in his book. This and the care shown him during a long recovery left him with enormous gratitude to NHS staff.
Michael : “The NHs is at the very heart of who we are and what we are here for. It is a reminder that we are nothing if we do not care for each other, regardless of how much money we might have, or because of where we are from.”
“It was an intimate time
but I don’t know them.
Lying side by side
hardly wearing a thing
high on morphine,
tubes down our throats
drips in our arms
peeing down pipes
shitting on pads,
our bodies in the hands of others
We were waiting to surviveor die.

The space was arranged for 11,
one nurse for one bed
but there were 24 of us
so the one nurse ran between two beds,
sometimes more.
The PPE that turned up one day
was second hand,
the consultant said,
there was blood on it…”

Michael Rosen.
Click here for details of Michaels book:  Many Different Kinds of Love

Michael Rosen


Finally, the two poems I did not read on Tynemouth’s Longsands last Saturday at the Keep Our NHS Public North East event.
Because I was on almost last, just before the musician James Ince who had waited 1.5 hours for his set; because the wind was biting sharply and the faithful crowd were visibly nithered. Because you can’t praise NHS staff for caring if you as an event organiser don’t take care of your audience.
I omitted them, yes, not because these poems by Martin Figura are anything other than absolutely beautiful, compassionate, deft. They come from conversations with and observations of stressed, over-worked staff in Salisbury hospital where he was poet-in-residence at the height of the pandemic. Buy ‘My Name is Mercy’, Fair Acre Press, £7.50, or buy two and give one to someone you love or admire. Thank you, Martin.

Figura 1

Figura 2a

Figura 3a

KONPNE: for a report and photos of this event, part of the national SOS NHS Day of Action, please click here and scroll to 26th February 2022

SOS NHS on Tyneside

To #OURNHS with heart from Tynemouth

Joan Hewitt, award-winning Tynemouth Poet and NHS Campaigner, spends a bracing February Saturday afternoon on Longsands

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In the end, the heart for the NHS on Longsands had 102 people. Here it is still forming, squishily. 
Thanks to two briliant musicians Pete A Shaw and James Ince, we drew and held a crowd, despite a rising cold wind. Jimmy was on at the end but retained most of the nithered crowd- dancing and singing, yes! 
Every fifth person walking on the beach seemed to be working for the NHS, or had a family member who did! Only one refused a leaflet – he preferred private medicine, he said…
Passionate pro-NHS speeches from the hardworking KONPNE;  from Julia Charlton on the crisis in nursing and where our NI contributions end up; from Joe Kirwin as Chair of the Health Scrutiny Committee; from the People’s Assembly;  and many more. 
Humour and sadness from Cullercoats poet-of-the-North Harry Gallagher, with audience participation – we all happily/ angrily shouted LIAR at the end of every verse of his Johnson poem!
Seeing the crowd shivering near the end, I cut my set in half, leaving out Martin Figura’s poems from his lovely book My Name Is Mercy, which evolved from conversations with and observations of stressed staff in Salisbury Hospital. 
I read a poem  from Michael Rosen‘s book Many Different Kinds Of Love. He was in a Covid coma for months and is still in the hell of Long Covid. Then a short extract from the Patient Diary kept for him by nurses and helpers.  
In the Diary, Beth wrote:  You have done really well overnight. You are starting to move little bits which is excellent. Hope you continue this great progress. You’ve got this!! Looking forward to meeting you when you wake up, you wrote my favourite book…’We’re Going on a Bear Hunt’.
and Michael Rosen wrote: “The NHS is at the very heart of who we are and what we are here for. It is a reminder that we are nothing if we do not care for  each other, regardless of how much money we might have, or because of where we are from.” 
Todays “SOS NHS” Event report and photos from Tynemouth, Newcastle and Sunderland are at: https://konpnortheast.com/news/  (scroll to 26th February 2022)
Photos by Mark Husmann  
Useful, if scary. information and what you can do: on https://konpnortheast.com/   and Facebook: https://www.facebook.com/NHSPublicNorthEast and twitter: https://twitter.com/KONPNorthEast
Sign up for the monthly KONPNE newsletter at https://konpnortheast.com/stay-up-to-date/

Fresh air is free

On chilling out at The Helix, Newcastle-upon-Tyne

John Whalley, KONPNE Steering Group member / retired nurse 

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26th Feb 2022 8.30am kicked off bright n chilly with an early-morning leafletting session outside the Labour Party Conference, Newcastle. This took place at the Helix Centre; the futuristic, blue, angular high rise campus opposite St.James Park seems a very impressive environment and is part of Newcastle University but at the end of the day is only bricks and mortar – importantly, its crucial for us to keep the UCU pensions and deteriorating pay and working conditions in sight.  
Great to speak with Labour Party members in the queue – many expressed their solidarity – but it would have been even better inside!! KONPNE had asked Labour North for a table inside the venue (to provide information, display posters and chat with delegates regarding health campaigning in the north, the privatisation of services in the region, the Health and Care Bill etc etc) and were quoted £250 !!!…. reduced to £200 on our appeal !!!…. but all totally out of reach for a Campaign group. We made the decision to stand outside for free, have thawed out now, but appeal once again: we are all in this together, we need to join forces and work collaboratively in fighting for #OURNHS and PLEASE, next year, lets share ideas around a table and a coffee?

New Years Eve 2021

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NEW YEARS EVE: Behind the NHS tinsel and glitter is the reality of life and death – 24/7 operating, assessing, measuring, scanning, recording, medicating, exercising, washing, cleaning, feeding, transporting – and we give our heartfelt thanks to all NHS workers for caring for us in many varied ways over the festive period and throughout the year….
Some say that the NHS is a system or organisation – but we know that it is our friends, relatives, the guy next door, the woman in the cafe and that person up the street who want to do their very best – not “angels” or “heroes”, but people with families and homes who have their own share of happiness and joy and stress and sadness and who, at work, are caring and hardworking professionals who want to make a difference.
Throughout 2022, the Government now need to match this by providing a good working environment – and not running down our services; by ensuring adequate staffing – and not diminishing our workforce; and by paying a fair wage – and not a low wage.
Behind the tinsel and glitter, that is the reality. 2021 has been a long and difficult year, and we give our sincere thanks to all NHS staff. We also thank all KONPNE supporters for their persistence in fighting for a publicly funded, publicly provided and publicly accountable NHS, which is available to all. Thankyou for being part of the team in 2021 – and we’ll be back in the New Year to join forces and to continue the fight. See you then – and wishing all a very happy and healthy New Year
xx Keep our NHS Public North East

Covid-19 Testing Laboratories and privatisation

Many thanks to a member of KONPNE for this overview on developments regarding Testing Labs – crystal clear that every aspect of the Governments response to Covid-19 is typified by privatisation.

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In recent weeks the media has been consumed with talk about testing and there has been much discussion concerning the privatisation of goods and services relating to the COVID-19 pandemic. This article discusses the first of these.
Since the start of the pandemic, it has been acknowledged by many public health experts that an efficient test, track and trace system was vital for the UK to reduce the impact of the Covid-19 pandemic. The government strategy of a centralised system has come under a great deal of scrutiny and criticism. In September, Maggie Rae (President of the Faculty of Public Health) stated in the BMJ (21/09/20) that localised systems of contact tracing, with a more agile and intelligent testing strategy such as is seen in Germany, could work to better effect, with potentially less testing.
At the start of the pandemic, in response to the need for extra testing capacity, the government chose to set up the centralised system of Lighthouse laboratories in collaboration with private companies and universities, and not with pre-existing NHS laboratories. This did not meet with universal approval; many public health experts called on the government to utilise and develop the local laboratory infrastructure.
Testing was designated into four groups known as ‘Pillars’, two of which are relevant to this discussion. Testing carried out in healthcare settings for NHS workers and patients going into hospital is referred to as Pillar One. These tests have been caried out in NHS and Public Health England (PHE) laboratories.
For the general public, with suspected community acquired infection, testing is designated Pillar 2. These tests are performed in the country-wide Lighthouse laboratories that receive swabs from the commercial drive-in/walk-in test sites set up by Deloitte; the £12 billion Test and Trace contract. The availability of Pillar 2 testing has been an issue and in September the Sunday Times (13/09/20) reported that swabs were being sent to Italy and Germany for analysis.
The President of the Institute of Biomedical Sciences, Allan Wilson, stated The Lighthouse lab model isn’t sustainable in the long term, and we need an exit strategy, (BMJ 21/09/20).
Clinical virologists writing in the BMJ 15/10/20 stated
“The opportunity to bring together UK laboratory expertise…was lost as a result of a spurious assumption of lack of capacity, leading to the outsourcing of pillar 2 testing to Lighthouse laboratories. This approach, divorced from the NHS and Public Health England diagnostic expertise, has [had problems] accessing testing, sample receipt and processing, test quality, and data linkage to public health and other NHS structures. All of these would have been minimised if the testing programme had been developed and expanded…[using]…existing NHS centres of expertise…”
Development and expansion of pre-existing facilities was required because successive governments had presided over a series of changes and cuts to the UK Public Health Laboratory Service (PHLS) which had worked alongside the NHS hospital laboratories.
The PHLS had been set up in 1946 with the passing of the National Health Service Act that year. It became a nationally organised network of laboratories which were able to exchange information about new scientific and epidemiological methods. The laboratories could collaborate and support one another when outbreaks of infection occurred and facilitate a response to national challenges. In 1994 the PHLS comprised approximately 50 laboratories, organised into nine groups across England and Wales. In addition, there were two national centres: the Central Public Health laboratory and the Communicable Disease Surveillance Centre. Thus, the PHLS was able to deliver an integrated microbiology and epidemiology service to the population of England and Wales.
In 2003 the PHLS merged with additional facilities to form the Health Protection Agency which protected the population from infectious diseases and environmental hazards.  As stated on GOV.UK:
The Health Protection Agency’s role was to provide an integrated approach to protecting UK public health through the provision of support and advice to the NHS, local authorities, emergency services, other Arms Length Bodies, the Department of Health and the others. The HPA became part of Public Health England in 2013”.
Writing in the Guardian, 01/04/20, Professor Paul Hunter (Professor of Medicine at the University of East Anglia) stated:
“Many of the laboratories in the old network were shut down, taken over by local hospitals or merged into a smaller number of regional laboratories”.
Following another reorganisation, Public Health England became the body whose remit included to protect the population from infection.  But now, following further cuts, there are just four ‘public health’ laboratories and yet more reorganisation has been announced as stated on GOV.UK:
“Public Health England has a superb professional and scientific base, on combating infectious disease, other health hazards and other risks to health….But [it] has not had the at-scale response capacity we have needed to handle a full-blown pandemic…”
…so government cuts have come home to roost, but there is a new plan…
“To give the UK the best chance of beating COVID-19, and continue to monitor, identify and be ready to respond to other health threats, now and in the future, we are creating a brand-new organisation to rigorously extend our existing science-led approach to public health protection – the National Institute for Health Protection.”
Public Health England is now to be replaced by the National Institute for Health Protection, headed initially by Baroness Dido Harding.
The following links provide some additional reading:
Covid-19: Government ramps up “Moonshot” mass testing BMJ 17 Nov 2020.
Covid-19: politicisation, “corruption,” and suppression of science    BMJ 13th Nov 2020
Government fails to publish details £4 billion shady Covid contracts  The London Economic 9th Nov 2020
BMJ lashes out at UK ‘state corruption’ and ‘suppression of science’  The London Economic 16th Nov 2020
Corruption and covid-19—the story so far  Transparency International  8th July 2020
Government test tsar has £770,000 shares in drugs firm that sold us £13million of “pointless” antibody screening kits—after it emerged that Sir Patrick Vallance has a financial interest in company racing to find vaccine  Daily Mail 26th Sept 2020
Covid-19: Mass population testing is rolled out in Liverpool BMJ 3rd Nov 2020
See also: All rapid responses  BMJ  11th and 16th Nov 2020
Covid-19: Rapid test missed over 50% of positive cases in Manchester pilot   BMJ 6th Nov 2020
Testing times for the government’s favoured antibody kit BMJ 16 Nov 2020
Mass testing for covid-19 in the UK  BMJ 16 Nov 2020


More information is on our “Covid-19 and NHS Privatisation” webpage here

Why it is crucial that MPs vote for amendments to the Trade Bill: Parliamentary scrutiny and NHS protection

Dr Sarah Walpole, Newcastle-upon-Tyne


“We were absolutely gobsmacked” – the words of Prof Boland whose research has just highlighted that bottle fed babies are consuming in the order of a million microplastic particles per day. Why was this such a gobsmacking result? Well, firstly, because it wildly outstrips previous estimates of adults’ microplastic consumption; World Health Organization studies suggested that adults consume 300 to 600 microplastics per day. Secondly, and perhaps more importantly, because of the potential health implications.
While the health risks of microplastics are not well understood and certainly not well quantified, the precautionary principle applies here. Given that microplastics may harm babies’ growth, development and health, avoiding introducing microplastics into babies’ milk is a sensible precaution.
Legislation in the USA has tended to pay less heed to the precautionary principle. Which is why, for example, USA law allows cosmetics companies to use any of over one thousand chemicals (some of which are likely carcinogens) in the make-ups, creams and other products that US citizens apply to their skin. And also why it is important that we pay attention to the Trade Bill and future trade deals if we wish to maintain regulations that are in place to protect health in the UK.
The Trade Bill: Decisive for UK standards, the UK health services and UK health
The Trade Bill is the piece of UK law that will determine how the UK designs, debates and agrees to future trade deals as well as how previous deals, agreed when we were in the EU, will be ‘rolled over’. It will determine the extent to which the UK maintains its existing food standards, labour rights and cosmetics legislations post-EU exit. The Trade Bill is now going through the House of Lords, where a date for the ‘Report stage’ is awaited. After it has been voted on by the Lords, it will go back to the House of Commons for decisive votes by MPs, our elected representatives.
Members of Parliament (MPs) will be voting on an amendment to the Trade Bill which allows ‘Parliamentary approval of trade agreements’ (amendment 57). This amendment would give MPs a chance to scrutinise and debate future trade deals before they are agreed and become enshrined in international law. With this scrutiny amendment in place, MPs would have a vote and the chance to ensure that UK standards are protected.  
An alternative future is one where trade deals are passed without MPs having a say on the contents. There are mechanisms in international trade law through which corporations can promote their own interests, even if this might be at the expense of public health. Any company with a foreign operations base can challenge the UK government under international law (sue them under the Investor-State Dispute Settlement (ISDS)) if they perceive that the government is putting up barriers to trade. For example, if the UK government tried to limit the sale of cosmetics containing asbestos, the company selling the cosmetics could sue the UK government in the international corporate courts.
Managing invisible, future risks – challenging, but critical
Microplastics fall into a broad category of things that you cannot see, which may cause you significant harm. It’s difficult enough to take into account risks that are invisible, but to add to the trouble, the harm that microplastics may cause is likely to be felt at an unknown point in the future. Prof Boland and his team have developed simple guidance on how parents and carers can prepare bottle milk avoiding such high doses of microplastics. Yet, it’s challenging to encourage healthy choices in relation to microplastics, not only because you can’t see them, but also because there is a delay between making positive changes and potentially reaping the health benefits.
In ‘The Intelligence Trap’, David Robson explores some of the biases that cause humans, regardless of their intelligence, to make ‘stupid’ decisions. These include ‘future discounting’, where we do not count future benefits as highly as those in the present, and the ‘availability heuristic’ where we pay more attention to risks that are easier to bring to mind.
Trade legislation faces some similar issues. Trade issues are not news items or an area of policy that enjoy a high profile in the media. The connections between UK domestic law on trade (the UK Trade Bill), the loss of state protections and the rise of corporate power and influences on health may seem tenuous and complex; yet there are clear and critical risks to the health of UK populations if we do not pay attention to these issues.
Protecting public ownership – the only way to keep our NHS
We have seen increasing marketisation of the NHS over recent years, and this leaves the NHS open to trade on the international market unless it is explicitly excluded from future trade deals. The risk to our beloved and yet neglected NHS if it is opened to trade on the international market, is that privatisation is locked in. Resultant privatisation could be irreversible beyond any one parliament. An international company could sue in the corporate courts using ISDS if the UK government tried to bring a health service back into public ownership.
Private healthcare providers with new models and ideas might seem an attractive proposition, but directed from abroad and lacking in responsiveness to local needs and accountability to local communities, would these companies really be able to promote health and provide high quality, sustainable healthcare? The realities would only be experienced once the damage had been done and there was no turning back.
The NHS provides a safety net for everyone. We have become so used to this luxury that we may not recognise how much it affects our lives. For over 40% of people who get cancer in USA, their treatment costs them most of their life savings. In the UK, cancer treatment is free on the NHS, even though cancer medications can cost thousands. Without careful scrutiny of a future trade deal with the USA, we are likely to see medicines prices rising towards USA levels (often four times as much). This would be unsustainable for the NHS and lead to many medicines being available only to those who can afford to pay for them.  
MPs will soon vote on the Trade Bill – ask them to protect the NHS
The Trade Bill will soon return to the House of Commons and be voted on by MPs. To protect the NHS and UK population health, our demands of MPs must be clear.
Firstly, the fate of the NHS is in their hands. To ensure that parts of the NHS, from service provision to digital services, are not contracted out to foreign companies, we call for MPs to vote for an amendment to keep health services off the table in future trade deals (amendment 51).
Secondly, it is critical that MPs are involved in decisions about matters as important and influential as trade deals are binding under international law. We can ask our MPs to vote for the scrutiny amendment (amendment 57) to ensure that current and future MPs have a vote on future trade deals, a necessary provision for democracy to endure in the UK.
Dr Sarah Walpole works at a hospital in Newcastle-upon-Tyne, and is a member of Keep Our NHS Public North East.
For more information about the Trade Bill Campaign, please click here

NHS Trade Deals are still on the table & MUST be resisted

Allowing businesses to buy up parts of the NHS through international trade deals would fragment a national institution that we depend on and mark the end of the NHS as we know it.

Dr Sarah Walpole, Junior Doctor, Newcastle-upon-Tyne

I’ve seen the damage that treating healthcare as a business, and the patient as a commodity, can do.
This reality first hit home for me when I was a junior doctor in cardiology. A patient had come in with chest pain and we were reviewing images of their heart in a clinical meeting. We were surprised to see that they’d had a heart valve replacement. When they’d previously attended hospital with chest pain they’d had only limited heart valve disease.
The patient’s consultant filled in the gaps – apparently, while on a short trip to the USA, the patient had experienced chest pain, attended hospital, and been advised by a cardiothoracic surgeon that their insurance company should pay for a heart valve replacement. We’ll never know for sure whether their heart valve disease had suddenly got much worse before or during their trip to America, but it would be a vanishingly rare scenario.
In private healthcare, a financial incentive exists alongside an information imbalance. The person who holds the information and makes decisions about what intervention is or is not needed also stands to gain financially if the intervention is provided. In the USA and many other countries, conflicts of interest exist between those who fund medical research, those who write guidance for health professionals, those who develop and sell medications and medical devices and those who provide healthcare services.
The COVID-19 pandemic has shown us the importance of collecting and bringing together information about the spread and treatment of diseases to guide effective policies and planning. During COVID-19, a private provider, Serco, was given the contract for disease monitoring, Test and Trace.
Test and Trace has fallen far short of what was needed – many positive COVID-19 cases have not been followed up. The government could have used the UK’s existing public health systems and experts to run a programme to monitor COVID-19, which would have ensured links to local public health knowledge, effective planning and public health capacity development.
It is important that NHS and public health data is stored safely and securely and used to improve health, not sold to private companies or used by businesses to make profits. If amendments to the Trade Bill are not passed to exclude the NHS and supporting institutions such as the National Institute for Clinical Excellence and Public Health England from future trade deals, our health data may be held by companies in other countries where rules on data protection are less stringent.
Failing to exclude UK health services from international trade deals may cause the prices of some medicines to skyrocket. Some drugs that patients rely on may become unavailable on the NHS. Certain medications would be out of reach, except for the very rich, so health inequalities would increase.
A critical problem with allowing the NHS to be part of international trade deals is that we would ‘lock in’ marketisation. International trade law promotes international trade by putting more power in the hands of businesses. Businesses can sue the government if they deem that the government is putting up ‘barriers’ to free trade. And if things go wrong or a service isn’t up to standard, it is difficult or impossible to end a contract with a private provider early.
Donald Trump has said that ‘Everything will be on the table’ when it comes to trade deals with the UK. Whilst he has later rowed back this comment, the reality is that unless there are specific provisions in Monday’s Trade Bill to exclude the NHS from future trade deals, the NHS and UK health institutions remain very much ‘on the table’. And we must take our lead from the British public, three-quarters of whom do not want the NHS included in any trade deals.
The NHS is unlike any other health system in the world. It was designed to meet health needs without discriminating and it still has these principles at its core. Like most UK health professionals, I chose my career because I wanted to help patients and improve health, and I feel fortunate to have trained as a doctor in a publicly provided health system where negotiating contracts and providers has not been part of my role.
MPs have a chance to vote in amendments to the Trade Bill that would protect the NHS by excluding it from future trade deals. I stand with fellow health professionals in urging MPs to stick with their election promises – and cast a vote for the NHS.
Dr Sarah Walpole is a Junior doctor and member of Keep Our NHS Public who has written an open letter NHS_Staff_OpenLetterToMPs_FINAL to the UK government signed by 450 high ranking NHS health professionals and academics calling for the NHS to be excluded from all future trade deals.
This article was written for the national KONP website and was published on 20th July 2020 here. The national website also contains a range of relevant links and information.
Click here for more information about the local KONPNE Trade Bill campaign.