Though not overtly political, NHS Change Day empowers and liberates its staff – and that in itself is a political act
If traditional politics isn't working, what's next? Voter apathy combined with public rage towards Westminster has left people wondering where the next model of social and political engagement is going to come from. We know political parties are in decline. We know trade unions are struggling to recruit. We know much of what's happening on social media fails to engage with hard politics. So what's next?
Consider next Monday – the second NHS Change Day. The idea is that hundreds of thousands of people, mainly working in the NHS already, pledge publicly to do things to improve the system: challenging fossilised hierarchical structures; staying behind after work to humanise hospitals; spending more time with patients, and so on. It's an idea that began with NHS workers frustrated about the system's lethargy and resistance to change. It spread almost entirely through social media. And it's certainly a mass movement.
This year the intention is to get up to half a million pledges – a huge step change. At this level of individual engagement and growth, NHS Change Day is more successful than any political party. And yet, before we celebrate further, there are some hard questions to be asked.
First, many on the left will note that this is not a movement calling for more investment in the health service or better pay for those working there. It has nothing to say about privatisation. Its basic idea is that the NHS, our national religion, can be hugely improved and defended inside current budgets and within current policies. What's needed is a culture change. Therefore it's the kind of "radical" movement that can be, and is, supported by the likes of Sir David Nicholson, the health service's chief executive, the health secretary Jeremy Hunt, and Boris Johnson.
Second, although the mass levels of support and enthusiasm are very impressive, many of the individual pledges appear to be little more than people promising to do the job they are already paid for slightly better, or merely to continue doing what they are doing already – Boris's personal pledges are, in essence, to carry on being Boris. If change is so easy, is it really change?
These are real questions and I expect them to be discussed at a major conference in Manchester next week. But having said that, I regard the NHS Change movement as a hugely optimistic and energising development in politics. Here's why.
We have to ask some very basic questions about what politics is, and can be. The NHS is loved in this country but it cannot thrive through Whitehall alone. It's both a massive organisation – the Chinese army, Walmart and McDonald's are the few other institutions that employ as many people – and an intensely intimate one.
Politicians spend their time arguing about structures and budgets; for those of us using hospitals and health centres, the difference between a bad day and a good one is about smiles, clear explanations – and nurses and doctors who actually listen. The two things are linked, of course. But they're not quite the same.
Consider a scowling receptionist; or a long wait in casualty with no explanation; or a nurse who takes blood roughly. Any of these things can lead patients to leave the hospital seething, not just about their day but about the NHS itself. At this level the health service is composed not just of budgets, but of human actions; and not simply of structures, but of people.
So while it's easy to mock some of the 217,000 public pledges made so far: to "communicate in a more honest and compassionate way"; or to better manage a patient's hospital discharge; or to work to combat patients' suicidal thoughts; in the aggregate they add up to the difference between a popular NHS and an unpopular, therefore politically vulnerable NHS.
As the movement itself puts it, "No matter how big or small the pledges were – from a clinician trying a child's medicine to understand how it tasted, to a receptionist promising to smile more, they gave us all a focus and reinforced our belief in the values of the NHS."
But the second thing we need to understand is that this is genuinely a bottom-up movement, and a large part of its purpose is to challenge petty authority. It has already empowered and liberated many NHS staff, encouraging them to speak out publicly, using Twitter and other social media to express themselves.
And that is itself a highly political act. The pioneers of the NHS change movement were aided and abetted by the Citizens Organising Foundation, the movement that began in Chicago and is now well established in Britain, where it is probably best known for its championing of a living wage.
Citizens' organising is essentially about giving the relatively powerless and under-heard the tools and confidence to make a difference. It's where the friendly societies and trade unions first began, and the suffragettes too. It's partly behind Ed Miliband's enthusiasm for "people power". The £3 Labour supporter movement could, if it took off, help fill in some of the ideological gaps in the NHS change movement.
For too long, people power has been contaminated by the easy sneer – Wolfie Smith, the Tooting Popular Front, all that. But it's real, a mighty force. It's alive inside the NHS. And after all, what better cause could there be than defending that glorious national tradition?
Twitter: @JackieAshleyJackie Ashley
Union leader Len McCluskey says such a pact would keep country 'bogged down in failed consensus' for years to come
Labour's biggest financial backer called on the party not to form a coalition with the Liberal Democrats after the next election, saying the prospect of Labour's programme being "filtered through the soggy Lib-Dem sieve" would keep the country "bogged down in the same failed consensus" for years to come.
Speaking to a student audience at the University of Cambridge on Wednesday, the leader of Unite the union, Len McCluskey, said that under Ed Miliband Labour was beginning to offer a genuine alternative to the failed neo-liberal model "taking on the energy giants, asking the rich to pay a bit more tax, building homes, tackling inequality". But he said he had to "suppress a shudder" at the thought of a Lib-Lab pact at the next election.
He said: "For those of us who believe in a real alternative and a fresh start, the thought of Nick Clegg standing on the threshold of Downing Street again with his arm around Ed Miliband rather than David Cameron is not one to set the pulse racing."
McCluskey's intervention follows reports that David Cameron was set to rule out a coalition with the Lib Dems ahead of next year's election, although that has not been confirmed by No 10.
In recent months senior Labour and Lib Dem figures have made conciliatory noises prompting speculation about talk of a deal if Labour emerges as the largest party after the election but short of a majority.
But during his speech, McCluskey said if Labour was the biggest party but short of a majority it should be "bold enough to form a minority government, set out its programme and dare MPs from the failed coalition parties to vote it down".
The union leader challenged the gathered students to leave their mark on the world, saying they had the advantages of background and education to make a difference.
"I hope you set your sights higher than the loads-a-money generation … You can be the people who renew our economic values. You can reinvigorate democracy. You can banish hunger and homelessness."
McCluskey also used the speech to announce a new leverage campaign to defend the NHS. He said: "We have seen one of this country's most treasured institutions gutted and sold off. This is not even privatisation by stealth – there is nothing stealthy about it."
He said trade unionists would be targeting businesses, employers and politicians who were benefiting from this "robbery in plain sight". "It is not about turning up outside directors' houses and demonstrating. It is about putting pressure on employers and others to face up to their corporate and social responsibilities."
Although number of admissions is slightly down on previous 12 months it is still alarmingly high, obesity expert says
Reality check: we are we really overweight?
There were almost 11,000 admissions to NHS hospitals in England for obesity in 2012-13, official figures have revealed.
Although the number is down on the previous 12 months – the first time there has been a year-on-year decrease since the dataset begins in 2002/03 – it is more than eight times the amount 10 years earlier and still alarmingly high, according to an obesity expert.
Dr Aseem Malhotra, who sits on the Academy of Medical Royal Colleges obesity steering group, said: "These figures show that the obesity epidemic is still a major public health crisis. While there may be a minor decrease from last year, they are still alarmingly high.
"It's concerning that one year after the Academy of Medical Royal Colleges [AoMRC] – which represents almost every doctor in the UK – published a list of 10 recommendations on obesity, not a single one has been adopted. Until this happens, this problem is only going to get worse."
The academy recommendations include a tax on sugary soft drinks, public funding to extend weight management services, action to reduce the proximity of fast food outlets to schools, and a unified system of traffic light food labelling for supermarkets and food manufacturers.
The Health and Social Care Information Centre statistics showed there were 10,957 admissions to hospital with a primary diagnosis of obesity in 2012/13, compared with 11,736 over the previous 12 months and 1,275 in 2002/03. Despite the overall year-on-year fall, there was an increase in admissions among both the youngest and oldest age groups. The number of admissions among under-16s rose 12% to 556 and the number of admissions among those aged 65 and over rose 6% to 594.
There was also 10% increase last year from 2011/12 in the total number of admissions with a primary or secondary diagnosis (when it is deemed relevant to care but not the first diagnosis listed) of obesity to 292,404.
Alison Tedstone, director of nutrition and diet at Public Health England, said: "PHE are committed to tackling obesity as people who are overweight or obese have an increased risk of developing type 2 diabetes, heart disease and certain cancers. There is no silver bullet to reducing obesity; it is a complex issue that requires action at individual, family, local and national levels. We can all play our part in this by eating a healthy, balanced diet and being more active."Haroon Siddique
Key services will now be moved to neighbouring units after scathing findings over death rate at Stafford hospital
The hospital involved in the worst NHS care scandal in years is to lose specialist services and come under the control of new management, the health secretary, Jeremy Hunt, has announced.
Stafford hospital will see downgrades of its paediatric and critical care services in the shakeup proposed by special administrators at Mid Staffordshire NHS foundation trust, and backed by regulator Monitor. But Hunt is asking NHS England to consider whether a consultant-led obstetrics unit, which was due to be downgraded to a midwife-led unit, could be kept.
The trust will be dissolved, with Stafford coming under the University Hospital of North Staffordshire trust, and its sister hospital in Cannock Chase becoming part of the Royal Wolverhampton hospitals trust. But Support Stafford Hospital campaigners want to keep more important services, arguing that patients may have to travel up to 18 miles on poor roads for acute services. They are particularly worried that patients will be reluctant to use a downgraded obstetrics and maternity unit.
Hunt said in a written ministerial statement to the Commons that although great strides had been made at Stafford, the challenges remained stark. "Without over £20m in subsidy funding from the Department of Health in 2012 and 2013, the trust would have been unable to pay its staff and suppliers. At the same time, a number of services are being operated with consultant numbers below Royal College guidelines, and the trust has experienced ongoing challenges in recruiting and retaining staff. Patients deserve high-quality services which are clinically sustainable."
Hunt also said 90% of patient visits would continue to take place at Stafford and Cannock hospitals, promising improvements to some services such as specialist support for elderly and frail patients. "All of this will contribute to a much improved offer for local people," he said. "Local people suffered too much for too long under a system which ignored appalling failures of care in their local hospital. They now deserve to know that same system has learned the lessons and is guaranteeing high-quality, safe services for local people."
The plans, which will take up to three years to implement, mean Stafford keeps its current limited-hours A&E department but loses in-patient paediatrics.
In December, administrators said the overall trust was "financially and clinically unviable" and that without changes Mid Staffordshire would face annual debts of more than £40m by 2017.
Sue Hawkins, of Support Stafford Hospital, described the obstetrics review as "a start" but called for a review of paediatrics as well. She did not to rule out court action, but warned that such a move might increase the period of uncertainty. "The hospital has already come to its knees because of that uncertainty. After two and a bit years of protest, that has led to staff jumping ship, and you can understand that."
Philip Atkins, leader of Staffordshire county council, said: "There are still significant concerns over the financial fragility of the whole Staffordshire health economy and the wider impact this decision will have, especially as only last week Staffordshire was identified as one of 11 financially challenged health economies."
Christina McAnea, head of health for Unison, said: "It is bitterly disappointing for the local community who have campaigned for local services and have rallied behind the hospital, as well as for staff who have worked hard to turn the trust around.
"The facts show that patient care has improved massively and a staff survey showed that 73% would now be happy with the standard of care at the hospital if a friend or relative needed treatment – higher than the 65% national average.
"If key services are to be transferred to neighbouring trusts, it is vital that they are given the financial resources needed to take on the extra responsibility. It is also crucial that robust clinical assessments have been made to ensure that the people of Mid Staffs are able to access safe, appropriate healthcare when they need it."
An inquiry by Robert Francis QC into the unnecessary suffering of hundreds of people at Stafford last year led to Hunt promising widespread reforms across the NHS in England, including possible financial penalties for hospitals if they cover up mistakes.
Clive Peedell, co-leader of the National Health Action party, said Hunt's decision looked like a politically motivated fudge, "partially retrieving" some services to help save the seats of local Conservative MPs at the election.
The NHS's £20bn efficiency savings programme, planned to continue until 2020, means that Stafford will not be the only hospital facing downgrading and merging of services. "This won't improve patient care and patient safety", said Peedell. "This will put lives at risk. It is vital the government stops its efficiency savings programme and properly funds the NHS."
Labour's Andy Burnham, the shadow health secretary, said: "However ministers dress it up, this is a significant downgrade of Stafford hospital and a desperate blow for the town.
"After all they have been through, the people of Stafford had a right to expect that the purpose of this lengthy process of inquiry was to make their services safer, not to take them away. They will feel bitterly let down."James Meikle
News, comment and analysis across the sectorClare Horton
The cost of NHS competitive tendering is a scandalous waste of public money. So what can be done?
A flurry of freedom of information (FoI) requests from government departments requesting data about spending on NHS competitive tendering signals the start of political parties gearing up for their election campaigns.
While I am not a huge fan of FoI due to the additional burden they place on stretched resources, I welcome this sudden interest in a hugely costly exercise that is draining much-needed frontline resources at a time when we are all facing enormous financial challenges to make unprecedented savings.
Our response to these FoIs makes for salutary reading indeed: more than £1m a year is being spent on the competitive tendering process. Assuming that we are not unique, the overall cost to NHS providers is quite simply eye watering – a scandalous waste of public money.
Over the years there has been much talk about improving the bid process while retaining robust governance and intelligent commissioning. However, talk has not translated into change and costs continue to rise year on year. Now must surely be the time to take decisive and urgent action to streamline the process and save the NHS millions of pounds.
Even at the pre-qualification stage, there is no standard format meaning that each tender requires a new response. Some questions may be similar but either have a slightly different angle or require information that has not been requested before or is required in a different format. There is limited opportunity to use previous responses to streamline the process and reduce the cost of responding to each individually.
There are occasions when, having invested huge amounts of resources, the tendering process is stopped or suspended for various reasons. On other occasions, the process has been stopped and then restarted with a slightly different tendering requirement so bidders have to invest similar resources again if they want to stay in the running.
This is not just a burden on providers: commissioners are also investing resources in coming up with new tender documentation and rules of procurement – not to mention the considerable amount of time and money in administering the process itself. Many of these functions are outsourced, which can only add to the expense. Clinical commissioning groups have not learned the lessons of the past. If anything, the expectations placed on bidders have increased.
We need a wholesale review of this process so that the NHS can lead the field in sensible, efficient procurement that ensures the best bidder is selected while saving money at the front line. We already have a model that offers some potential to achieve this in the "any qualified provider" process. Its core features are:
• Online submissions: reducing the costly and environmentally unfriendly requirements of paper submissions
• Standardised questions: this means previous responses on issues such as organisational form, clinical governance, quality, financial management, patient engagement and feedback can simply be re-used
• Service specific questions: this targets resources to providing information about how the particular service being commissioned would be delivered
• Local questions: these enable commissioners to ask one or two additional, specific questions to deal with local challenges and demographics
We could go further and make better use of Monitor's licensing regime and the Care Quality Commission's inspection processes. Both are designed to provide assurance around viability and the quality of care, providing commissioners with assurance and reducing the requirements of individual procurement exercises.
Through the use of technology, we could develop a centralised procurement hub where organisations respond to a set of core questions which can be accessed by commissioners to supplement the more local and specific information needed for individual bids – all of which would be managed online. Information could be updated as required and would reduce the huge amount of resources needed to manage the process for both providers and commissioners alike.
I would love to see someone rise to the challenge of reviewing the procurement process as a political priority, so we can target our increasingly stretched resources to where they are most needed –at the front line, on high quality services for patients.
Sue Ward is head of business development and market at Central and North West London NHS foundation trust
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Plans already drawn up to move key services elsewhere after scathing findings over death rate at Stafford hospital
Public Health England is too close to the government, in the judgment of the Commons health select committee
The body charged with tackling obesity, smoking and alcohol misuse is failing in its task and is far too close to the government, MPs warn on Wednesday.
A critical report by the Commons health select committee says that Public Health England, created as part of the coalition's NHS shake-up last year, "has not yet shown that it is able to be an effective champion of the nation's public health interests".
The cross-party group of MPs casts serious doubt on the idea that Public Health England, which is an executive agency of the Department of Health, has the autonomy it is meant to have from the department or is free to speak out on issues of concern. It is not discharging the role parliament gave it "to provide a fearless and independent national voice for public health in England", the committee's report states.
Health organisations, including the British Medical Association, told the MPs in evidence they were concerned that Public Health England staff were not free to contradict government policy. Endorsing that view, the report continues: "We are concerned that there is insufficient separation between PHE and the Department of Health. The committee believes that there is an urgent need for this relationship to be clarified and for PHE to establish that it is truly independent of government and able to 'speak truth unto power'."
Committee members were surprised when they asked Duncan Selbie, chief executive of Public Health England, to detail any government policies he felt may be damaging people's health. Selbie declined, saying that to answer that question directly, so soon after his organisation's creation just a few months earlier, would be "too controversial". The MPs were "concerned" that Public Health England's boss "should regard any public health issue as 'too controversial' to allow him to comment directly and believes the organisation should be able to address such matters without constraint."
The MPs want Public Health England to gain the freedom health secretary Jeremy Hunt recently gave to the Care Quality Commission, the NHS care watchdog, to raise important issues publicly.
When the coalition last July dropped its plan to introduce minimum unit pricing of alcohol, Public Health England failed to make clear unequivocally that it supported the policy, the report says.
"Tackling alcohol misuse, smoking and the crisis of obesity are fundamental to improving the nation's health, but PHE has yet to strike the right tone when addressing these issues", said Stephen Dorrell, the committee's chair. "Its public comments have often been faltering and uncertain when they should have been clear and unequivocal", added Dorrell, who was health secretary in 1995-97 under John Major.
Labour accused the coalition of deliberately restraining Public Health England from the start. "David Cameron's government created a body that is too weak to stand up to its damaging health policies", said Luciana Berger, the shadow public health minister.
Selbie said he was pleased that the committee had recognised Public Health England's success in bringing together more than 100 organisations when it formed, such as the Health Protection Agency, and for having done well in tackling last year's measles outbreak and pushing ahead with a campaign to ensure that 10- to 16-year-olds who had not been fully immunised with the MMR jab when they were younger received full doses.Stephen DorrellDenis Campbell