Monday, January 31, 2011

Tory/Lib Dems Out To Destroy OUR NHS

UNISON nurses protested outside the House of Commons today 31st January 2011 as did nurses at St Georges Hospital Tooting, they were protesting against the Tories/Lib DemsNHS.

Not only do the Tories and Lib Dem's want to hive off large bits of the NHS to the private sector, many local District Hospitals are now under real threat of closure.

As commissioning of health services are left to the whims of General Practitioners.

For example if GPs fall out with consultants at your local hospital and they decide to switch the contract, your local hospital closes.

Any money saved in commissioning can be paid in cash to GP's as a bonus, who are already on £150k a year, so dont have an expensive illness.

GP's don't even need to declare a financial interest in a private health care company, GP decisions do not need to be taken in public, they do not have to involve or ask any patients about their views and are not subject to the Freedom of Information Act.

Tuesday, January 04, 2011

St Georges Nurses vow to Defend the NHS

St Georges nurses vow to defend the NHS

Nursing and NHS professionals at St Georges, Tooting, South London started 2011 by taking time out at lunch time to protest at the Governments p
lanned NHS reforms and decision to cut £10bn a year from the NHS through so called efficiency savings.

UNISON Nursing staff at St George's have signalled
that they will not hesitate to speak out against Government plans for swinging cuts and privatisation of the NHS.

Michael Walker UNISON Regional Officer states

"UNISON will not sit ideally by and watch our NHS services slashed and privatised. Britain did not vote for the introduction of an American health care system, a system which is not comprehensive, bureaucratic, expensive and where increased competition not collaboration costs patients lives".

Jane Pilgrim UNISON Nursing Convenor at St George's Hospital, Tooting states

"Over one hundred nurses at St Georges Hospital have already
signalled they will be joining the TUC rally to defend public services on Saturday 26th March 2011 in Central London and we are receiving incredible support from the local community".

Geoff Thorne UNISON Branch Secretary stated
"Be clear, our branch will take any action necessary to defend our members and the future of the NHS".

Tory NHS Reforms - GP's Forced to Privatise the NHS

Even the Tories now foresee chaos in Lansley's NHS

Polly Toynbee

The Guardian

3rd January 2010

The health secretary's reforms will not bring slow and stealthy change, but a radical explosion. Cameron must sack him

    In a startlingly forthright article on Comment is free last week, the new Conservative MP Sarah Wollaston challenged the fundamental principles of the coalition government's National Health Service upheaval. As a GP, she knows the significance of what is happening. Wielding a deft scalpel, she has exposed what has only been a whispered understanding within the government. She put her rubber glove on the precise mechanism by which cosy-sounding GP commissioning leads to fierce commercial competition – and privatisation.

    As private companies step in to run commissioning for GPs, she warns that they may "turn to private providers at the expense of NHS providers". Some GPs are eager to run the £80bn NHS budget and become the chief rationers but, she says, "most are not". And there are good legal reasons why not.

    The government has sold this as a homely notion whereby your well-respected family doctor will commission the services you need – and who better to make those decisions? It seems to make sense that those who spend the money by referring their patients should control those budgets. But as Dr Wollaston sees so clearly, there is a cancer at the heart of the plan that denies them that right.

    For the first time the entire NHS has been put under competition law. The financial and clinical safety of NHS foundation trusts used to be the responsibility of the regulator, Monitor. Now its website proclaims: "The first of Monitor's three core functions is to promote competition." That means "enforcing competition law" and "removing anti-competitive behaviour". Few yet understand the nuclear nature of this. It compels every NHS activity to be privately tendered. If the NHS is the preferred provider, that can be challenged in the courts or referred to the Competition Commission. Red-in-tooth-and-claw commercial competition breaks all partnerships.

    Europhobic Tory MPs take note: this makes NHS contracts subject to EU competition law. The NHS was exempt as an essentially state-run service, but GP consortiums will no longer be allowed to use a trusted local hospital without tendering first, for fear that a private company could take them to court. Some global companies will happily run loss-leader services for a while, driving NHS services to close, and no doubt raising their own prices later.

    This may not be a slow and stealthy change, but an immediate and radical explosion. As I reported last month, it's happening already. Take the huge new Great Western Commissioning Consortium, amalgamating Hounslow, Hillingdon and Ealing primary care trusts – now considerably more distant from patients. GPs there have hired the US company United Healthcare to run their "referral facilitation service", taking over next month. It will guide and arm-twist, if not quite order, local GPs' referral habits. It will even step in where one hospital consultant directly refers a patient to another specialist and the PCT picks up the bill. Wollaston predicts such commercial commissioners may break old NHS ties and bring in fellow private providers; now we shall watch it happen.

    The British Medical Association is alarmed. In tomorrow's British Medical Journal Dr Laurence Buckman, who chairs the BMA's GP committee, says: "I am very disappointed that people are coming to financial arrangements with commercial organisations. If you give someone a toehold, they'll take a foothold. I hope this will not be repeated elsewhere" – but he thinks that it will be.

    Dr Clare Gerada, who heads the Royal College of General Practitioners, has already voiced her concern, pointing out that only a quarter of GPs are enthusiastic about a system that supposedly puts them at the helm – hardly surprising if they face lawsuits for staying with trusted NHS hospital partners. Don't assume most doctors have yet got their heads around the full implications; most tend not to bother until something impedes their everyday practice – but then they will kick up a huge fuss.

    Stirrings around David Cameron suggest that some are taking a closer look at Andrew Lansley's extraordinarily radical revolution. But this stealthy road to privatisation – never spoken of in public – meets the approval of senior Tories like Francis Maude and Oliver Letwin. What suddenly worries them is impending chaos along the route – financial, organisational, clinical and political. The NHS may fall over before Lansley's £3bn reorganisation is in place.

    Dissect the Great Western Commissioning Consortium with its new United Healthcare partner. Three shaky PCTs join up, ordered to cut 50% of their staff. With no less a workload, everyone reapplies for half the jobs just as GPs need more help. Hounslow has tens of millions in historic debts. Hillingdon was bailed out by £19m last year, promising to stay in budget, but is already £6m overspent this year. After heroic efforts, Ealing balances its books, but is "incredibly fragile". Like the whole NHS, they must cut 4% a year every year for three years – which the Commons select committee warns was never achieved by any health service in the world: the NHS needs a 3% budget increase to stand still. With only half the managers, they will be even less able to guard outgoings day by day.

    The district prided itself on shutting a whole hospital floor, by providing better community services. But with the freeze causing bone breaks, and now the flu, all 60 beds have been re-opened, at huge cost. The cuts mean GPs here, following other areas, will soon be banned from referring anyone for non-emergency surgery until April's new financial year.

    That leads to three disasters: it only shunts trust debts to next year; it passes debts this year to hospitals whose surgeons twiddle their thumbs; and waiting lists soar. That's political poison since Labour all but abolished waiting lists for the first time ever. Meanwhile patient "choice" will be carried out on a stretcher. Cameron's personal pledge that the NHS budget was "protected" will be proved false – and privatisation will be unstoppable once the Pandora's box of competition law has been opened.

    Labour has a good record on the NHS: the sneers that it spent too much will cut no ice with the public if the coalition causes a meltdown. Cameron has to face a government-shaking NHS crisis – or signal a sharp U-turn with the necessary sacking of Andrew Lansley.

Saskatchewan's Struggle for Medicare

Unsung Heroes in Saskatchewan's Struggle for Medicare

By Jim Harding

(listen to Jim’s interview on Vancouver Co-op Radio at:

Also see The Struggle for Medicare in Saskatchewan

While mainstream discourse on the struggle for Medicare tends to credit the high-profile political leaders who fronted the movement, the struggle was in fact a collective one, won through popular grassroots support and the tireless work of countless community activists. These activists, whose combined voices were the real strength of the struggle, are however left out of the history books. They are systematically ignored in Saskatchewan’s Centennial Encyclopedia.

History is typically reconstructed by those currently in power, which serves to help stabilize the status quo. The idolization of Medicare’s political champions disregards the contributions of the popular grassroots movement to Medicare’s success across the country, which is disempowering and leaves us all more inclined to wait for the next Tommy Douglas to help us make history. In view of the imperative of tackling the climate crisis and moving towards sustainability we really can’t engage in such a waiting game. Remembering the grassroots history of Medicare is also a good first step toward reengaging to rejuvenate today’s deeply troubled healthcare system.

The text book history

Tommy Douglas
The standard story of the origins of Medicare highlights the contributions of Saskatchewan premiers Tommy Douglas and Woodrow Lloyd, Minister of Public Health Bill Davies and high-profile opponents of Medicare such as Father Athol Murray and Saskatchewan Medical Association (SMA) president Dr. Staff Barootes. Douglas is most readily associated with Medicare, which is likely why he won CBC’s “greatest Canadian” poll a few years back. In 1944, on a radio announcement during his election campaign, he famously declared “We believe…we can ultimately give our people a completely socialized system of health services, irrespective of…individual ability to pay.” In 1947, as Minister of Health as well as Premier, he brought forward the Saskatchewan Hospitalization Act – the first public financing for hospitals in Canadian history. Then, in 1959, when the economy was stronger and federal government under John Diefenbaker more supportive Douglas announced his plan to proceed with Medicare.

This deeply aggravated the province’s doctors who at the time jealously guarded private enterprise medicine. The Saskatchewan College of Physicians and Surgeons vocally opposed the plan, and they were supported by “Keep Our Doctors” (KOD) committees, which were established among mothers who were erroneously told they would lose their personal doctors under Medicare. The only mothers who were threatened during the actual crisis were those who were expecting babies and whose pro-Medicare doctor was refused hospital privileges. One pregnant mother protested this by parking herself on the doorsteps of a hospital. The political forces whipped up recently in the U.S. to oppose Obama’s watered-down attempt to get a public option in healthcare insurance are reminiscent of the extremist rhetoric of the KOD campaign. Some people feared for Premier Lloyd’s safety. We also now know that in 1962 American medical and pharmaceutical organizations worked behind the scene to try to stop Saskatchewan from becoming a continental beachhead for Medicare.

Woodrow Lloyd/Tommy Douglas
In 1961 Douglas left Saskatchewan to head up the newly founded New Democratic Party (NDP). Premier Woodrow Lloyd picked up the gauntlet for universal health coverage, introducing and eventually passing the Saskatchewan Medical Care Insurance Bill, making Saskatchewan the first province to have free universal medical insurance. As Minister of Public Health, Davies helped the province to avert a potentially catastrophic doctor shortage during the Doctors’ Strike of the summer of 1962 by bringing in doctors from abroad. After the Doctor’s Strike ended, Allan Blakeney replaced Davies as Health Minister. Later Blakeney became NDP leader after Woodrow Lloyd was forced out of this position in 1970, after losing the 1964 election to Ross Thatcher and the provincial Liberals. Lloyd went on to briefly work in international development with my father Bill Harding in the United Nations Development Program (UNDP) until his untimely death in 1972. In 1979 Diana Lloyd published a compelling and politically revealing biography of her father, entitled “Woodrow”.

Soon after Medicare was established, Chief Justice Emmett Hall headed a federal Commission appointed by Diefenbaker that recommended that Medicare be expanded across Canada, and in 1966 the Lester Pearson Liberal government passed the Medical Care Act which guaranteed publicly funded universal health insurance for all Canadians. The heated struggle in Saskatchewan had laid the basis for a Canada-wide plan. In 1984, under the committed leadership of the federal Health Minister, Monique Begin from Quebec, the liberal government passed the Canada Health Act to set out conditions for federal transfer payments for provincially-controlled healthcare. Medicare however continued to be threatened by the expansion of for-profit medicine.

The role of community clinics

Community clinics played a critical but often ignored role in the struggle for Medicare. While the Lloyd government was weakening, after the KOD rallied 5,000 people to the legislature on July 11, 1962 to oppose Medicare, grass-roots meetings were being held across the province to raise money to buy buildings and start community clinics that could hire doctors who supported Medicare. Thousands of people were mobilized. Doctors like Sam Wolfe and Orville Hjertaas helped establish clinics in Saskatoon and Prince Albert. British doctors were hired in Regina and elsewhere. Sam Wolfe went on to co-author the still definitive 1967 book, Doctor’s Strike: Medical Care and Conflict in Saskatchewan.

Woodrow Lloyd consistently praised the role of the community clinics in consolidating support for Medicare. Jack Kinzel, the first Secretary of the Medical Care Insurance Commission (MCIC), called the birth of the community clinics “a very important aspect of putting Medicare in place.” According to him, the “the activities of the clinics – the opening of the clinics in key centres in the province, small and large – did frighten the doctors and did make them uncertain about their ability to bring off what they were trying to do.” Speaking to Regina Community Clinic’s 1987 AGM, past Premier Allan Blakeney said that “Community clinics were on the very front line in the Medicare battle in 1962. They made Medicare possible”.

Unsung heroes

Stan Rands, who became the executive secretary of the Community Health Services Association (CHSA), is one of the unsung heroes in the development of community clinics and the launching of Medicare. Rands quit his 11-year job in Psychiatric Services, most recently as Assistant to the Director, to take on the new position in the midst of the heated conflict between doctors and government. In the Introduction to Rands book, Privilege and Policy: A History of Community Clinics in Saskatchewan, published post-humously, retired theology professor Ben Smillie wrote, “Rands, who calmly stood with [his wife] Doris in the eye of the storm, is one of the true heroes of Saskatchewan Medicare, and therefore a national hero of Canada.”

Stan worked closely with the CHSA’s founding President, Bill Harding, who had just returned from his first assignment with the UNDP to later become Provincial Secretary of the NDP and was Chairman of the Regina clinic board from 1962-65. These two men worked to the edge of exhaustion to establish clinic groups in 35 locations throughout the province. Stan and Bill also worked closely with Ed Mahood, renowned professor of Educational Foundations at the University of Saskatchewan, who was the first chair of the board of the Saskatoon clinic, which pioneered interdisciplinary community medicine in the province; and with Roy Atkinson, known most for being president of the National Farmers Union, who was founding Vice-President of the CHSA and followed Harding as its president There were hundreds of others putting their heart and soul into this work, but Stan Rands, Bill Harding, Ed Mahood and Roy Atkinson were the peaceful “generals” in the grassroots struggle for Medicare. They kept their cool in the face of provocation that tried to polarize and escalate the conflict and derail the Medicare legislation, and put organizational voice to the broad-based grass-roots support for Medicare.

Several other citizens groups sprung up in support of Medicare. Citizens for a Free Press, founded by long-time community activists Ben and Adele Smillie, lobbied the Saskatoon Star Phoenix newspaper to stop rejecting pro-Medicare letters to the editor. Saskatoon’s Citizens in Defense of Medicare also rallied people to show their support for Medicare.

Roy Atkinson
Though Medicare is certainly the highest profile event in Saskatchewan’s first hundred years, none of the major community clinic activists are mentioned in Saskatchewan’s Centennial Encyclopedia. (A tiny piece by Denis Gruending, who in 1973 authored The First Ten Years, Saskatoon Community Clinic, mentions only the doctors involved with the birth of the clinics.) Contrast this with high-profile opponents of Medicare. One of the most vocal anti-Medicare spokespersons was Father Athol Murray who regularly made incendiary speeches on behalf of the KOD, once saying “We must get off the fence and make our views known”, continuing, “This thing may break out into violence and bloodshed any day now, and God help us if it doesn’t.” He is profiled in the Centennial Encyclopedia as the founder of Notre Dame College at Wilcox, home of the Hounds hockey team, and being in the Saskatchewan Sports Hall of Fame, but his provocative, outrageous opposition to Medicare isn’t mentioned. Another high-profile, staunch opponent of Medicare profiled in the Encyclopedia is Dr. E.W. (Staff) Barootes, who was the SMA President in 1962, went on to be appointed to the Senate by the Mulroney government, and like Father Murray, was appointed to the Order of Canada.

The important role of the labour movement in creating Medicare is indirectly acknowledged in mainstream history. Public Health Minister Davies, who helped bring pro-Medicare doctors to Saskatchewan, came from labour into politics, as did Walter Smishek, Minister of Health under Blakeney, who the Centennial Encyclopedia notes stood alone in opposing user and deterrent fees when he sat on the Advisory Planning Committee prior to Medicare. The Encyclopedia also notes that long-time labour activist Clarence Lyons was the “first president of the Saskatoon Community Clinic.”

Margaret and Ed Mahood
Women have been mostly left out of the discourse around the origins of Medicare. During the Doctors’ Strike, when the overwhelming majority of doctors closed their doors, it was female doctors like Saskatoon’s Marg Mahood and Joan Whitney-Moore that kept their doors open to provide medical services. And the community clinics wouldn’t have gotten off the ground without women’s unpaid domestic labour – organizing fund-raising events, physically setting up and decorating the new clinics, and doing some volunteer office work. My mother, Bea, worked many long nights to sew curtains for all the Regina clinic office windows.

An unfortunate compromise

Desperate to end the Doctors’ Strike, the Lloyd government agreed to a compromise with the SMA. On July 23, 1962 the two parties signed the Saskatoon Agreement, which saw government acquiesce to doctors’ demands to keep fee-for-service as the sole form of payment. Those working at the grassroots to build community clinics tried to get the provincial cabinet to hold out for more popular support, but the government buckled under the political panic created by the strike. It agreed to alter the legislation to allow doctors to practice outside Medicare, to pay doctors under the plan 85% of the College of Physicians fee schedule, and to increase the power of the doctor’s business association, the SMA, within the MCIC. In his official centennial history, Saskatchewan: A New History, Professor Bill Waiser oversimplifies this by saying this was “removing sections…that implied government control of doctors.” This was the SMA’s clarion call but not what the conflict was about; it was primarily about defending for-profit , fee-for-service medicine or replacing this with a public system, like our educational system.

This rolling back of public policy was devastating to the community clinics. As Bob Reid notes in his 1988 popular history, More Than Medicine, the Regina clinic went through years of internal power struggles over community versus medical control of staffing and policy. Still having a monopoly on the clinic’s earning power, some doctors wanted to keep organizational power, and a clinic so divided could not build the needed team-work. The introduction of global budgets in the 1970s helped by providing some resources for interdisciplinary and preventative program development, but by then the momentum for community (“socialized”) medicine had waned. The hopeful province, which had seen 25 community clinics spring up from the grass-roots in less than a year, ended up by the mid-1990s with only 5 struggling clinics.

The history we create today

Despite passionate and hopeful beginnings, public healthcare in Canada is now in relapse. In 2001, with the growth of for-profit clinics threatening to expand two-tiered medicine, past Saskatchewan Premier Roy Romanow was appointed to head the federal Commission on the Future of Healthcare. One main recommendation was about the need for primary healthcare reform. As Romanow said in 2002 “no other initiative holds as much potential for improving health and sustaining our healthcare system.” This will require full-service community health clinics, such as were envisaged during Saskatchewan’s struggle for Medicare. It was telling and a little ironic that Romanow had to go outside Saskatchewan, to a community clinic in Sault Ste. Marie, Ontario, to find what he called “the best kept secret in the country”. Today, only four community clinics survive in Saskatchewan.

Rather than Medicare leading to community-based access to progressive medical practice, much of the province’s and country’s population is dependent on impersonal, for-profit, walk in clinics. Provincial health care systems are a hodge-podge of private and public services, with important preventive services in Saskatchewan like massage and chiropractics now totally un-funded, while there is escalating public expenditure for many unnecessary, ineffective, risky but profitable pharmaceutics. Pharmacare user-fees discriminate against the disadvantaged and disabled, homecare for the bulging senior population is severely under-resourced, and dental insurance is far from universal and remains in private hands.

Evidence-based medicine makes only slow progress in an environment where private interests dominate and could have flourished much better in a thoroughly public Medicare. Meanwhile, many families are without continuity of care from family doctors. During the visionary days of the struggle for Medicare no one imagined the widespread indignity to come. Learning a balanced history of the struggle that acknowledges Medicare’s grass-root pioneers is the first step to creating new momentum to realize the vision of Medicare. Better knowing this popular history can also inspire us for making other vital social changes, such as the shift to a public, democratic renewable energy system.