Tuesday 23rd July 2019

W
e would like thank Professor Allyson Pollock for her wonderful contribution to our public meeting at Brinkburn community centre, and for leading the discussion on health and social care and supporting the hundreds of campaigns all over the country to safeguard the future of health services - even though as she said - they are largely ignored by the national and even local media.

In particular, she exposed the whole corporate direction in which the government is driving NHS Trust Boards, with mergers that go hand-in-hand with reducing services and setting up private companies. She pointed out that we have to be very aware that the government is trying to find alternative ways of funding, in addition to expensive PFI, councils are under pressure to raise bonds to finance hospitals and services, while facing massive cuts themselves. She said any such money should be used immediately for council services and not tied into new forms of 'Project Finance' for hospitals and NHS services. Professor Pollock supports our call to stop our council from financing the "Path to Excellence" phase-2 capital funding project.

On Professor Pollock's initiative, we will continue to work with her to highlight the issues facing our campaign and to expose the government's plans for the NHS. Following this meeting, Professor Pollock has been working hard to try to get the issues around the chilrden's A&E, SCBU and maternity closures raised nationally in the media and to get them shared widely. Her article “A war of attrition against hospital services in South Tyneside and across the country” was published by Open Democracy on August 4th 2019.

We greatly appreciate the message we received from Emma Lewell-Buck MP for South Shields, and we will keep both South Tyneside MPs updated. Thanks also to the councillors who attended, representing different political parties, as well as independents.

We also thank the Truth & Memory Preparatory Committee for helping to organise this event, and also a big thanks to Brinkburn Community Centre for hosting the event, and also our thanks to the Unison health branch, Unite, and Sunderland KONP for their support in organising this event.
Statement by Emma Lewell-Buck
MP for South Shields

O
ur NHS is the pride of our country. Free healthcare is a right that everyone should have access to and I am so proud to live in a country and be part of a political party that made this vision a reality many decades ago.

But now, our reality is the danger that faces our NHS. The Tories' privatisation agenda and austerity measures have meant that the NHS is under more strain than ever and it is being slowly dismantled.

Here, in South Tyneside Hospital, we have already lost stroke, consultant-led maternity, 24/7 paediatrics and our Special Care Baby Unit, and now we are looking at losing even more with A&E, emergency and planned surgery, planned care and outpatients and clinical support services all facing changes under phase-2 of this so-called "Path to Excellence".

But let's be clear - if you are finding it difficult to get an appointment with your GP, if you are waiting longer for surgery in pain and discomfort, if you are not able to give birth in your hospital of choice, if you are not able to visit your loved ones in hospital due to the cost of travel, if you are not allowed to take your very poorly child to your nearest A&E during the night - that is certainly not excellence. That is a deterioration of service and that is the real path that we are being taken down here in South Tyneside at the moment.

Underfunding and undermining the NHS to breaking point is a cynical and contrived measure to justify the outsourcing of services to private companies - for profit.

We must do everything in our power to protect our hospital services at both a local and national level. The jobs of those who work in the NHS and the health and wellbeing of our residents are paramount.

I commend our brilliant Save South Tyneside Hospital Campaign group for organising this important event along with the Truth and Memory Preparatory Committee. I thank Professor Allyson Pollock for coming to South Shields tonight and I will continue to do all I can to support and protect our vital services and the staff who deliver them.

This is our NHS, far too precious to lose and far too precious not to fight for.


Emma Lewell-Buck was not present at the meeting because she was in parliament where she raised our concerns about council financing of 'Path to Excellence' phase-2 during a session of questions with the department for health. She was told that the NHS is receiving more money than at any other time in its history???

Professor Allyson Pollock
Director of the Institute of Health and Society
University of Newcastle upon Tyne

M
y name is Allyson Pollock. I currently work in Newcastle University. I started off my life in medicine, and have worked for about 20 years between the NHS and academia, and now I work most of the time in this ivory tower. It's very nice to come out and see you all today, and very kind of you to not be at the beech, but instead to be in this hall to listen to me talk. I'm not going to talk for very long.

I think this campaign is a very important campaign, it's one of hundreds that are going on all around the country, invisible to everyone except in their local areas because our press doesn't bother - even within the local areas - and that's partly because of what has been happening to our press and partly because there is usually [too few] journalists, and they are desperately trying to fill a whole newspaper.

Our health services are the life blood of our local communities. Of course, you will have heard every excuse under the sun for the changes you are fighting against. There is nothing new that I haven't heard.

It's an extraordinary moment politically, and the NHS as you all know came into being at an extraordinary moment in history in 1948, when the country was absolutely broke and on its knees. Capital was broke, and the whole country had to be rebuilt - literally! The NHS was one of the five pillars of the welfare state, one of Beverages five 'giants'...

  1. 'Want'      => Social Security & Pensions
  2. 'Disease'   => Health Care
  3. 'Ignorance' => Education
  4. 'Squalor'   => Housing
  5. 'Idleness'  => Employment
“Governments have become consciously cruel, whether it be welfare cuts, the bedroom tax or cuts in our education services and schools. This conscious cruelty also extends to our communities through what they are doing to our local authorities.”

...all important pieces of the welfare state. But gradually over the last 30 to 35 years, that consensus about what it means to be a society has been broken by our politicians (or perhaps by ourselves because we voted in the wrong politicians). What we have seen over the last 30 years is increasing attrition [(eating away)], culminating in austerity following the financial crash in 2008. Governments have become consciously cruel, whether it be welfare cuts, the bedroom tax or cuts in our education services and schools. This conscious cruelty also extends to our communities through what they are doing to our local authorities. The huge swinging cuts that have taken place in local authorities, which means now that we no longer have freedom from fear, so if we have children who have disabilities, or we ourselves have disabilities, we can no longer know what to expect or what we will be entitled to. I actually think that local authorities should be publishing - every year - the services they can no longer provide because of the devastating cuts. When you lose 30 percent [60 percent in South Tyneside] of your budget, you have a responsibility to your local community not to say 'we can manage change, we can do things better', but to publish list-after-list of all the services which are not provided, and also list-after-list of the people and the children who are no longer getting services.

“Our councils have a responsibility to tell people what is going on, they should put [reports] out every single month to say how much the cuts are and what their consequences are.”

This area [South Tyneside], we know has a lot of inequality in wealth, but also extreme poverty, and in many areas - including this area - almost 50 percent of the children live below the poverty line. That means they are going without clothes, on some days they are not being fed, and school may be the [main] source of food for them. These are all the ingredients for an unhealthy society. When you have the stress an anxiety of how you bring money home, anxiety about how you feed your children, how you get housing and access benefits, these make all the ingredients for a return to [Beverage's] five 'giants', a return to disease, poverty and despair. That's why campaigns like this one are so important, because they inject hope into our community :- it's really important that we galvanise [(awaken and take action)]. Councils should not only be publishing the lists of services that they are no longer providing, but also the names of people they are taking services away from and denying care to. I think we should be having a very different campaign (on top of campaigns like this one) to expose [the truth] about who is not getting care.

We have the "invisible hand of the market". What the "invisible hand of the market" means is that those who can afford to pay in a market place [of health services] get care, and those who can't will increasingly do without. Our councils have a responsibility to tell people what is going on, they should put [reports] out every single month to say how much the cuts are and what their consequences are. I've only seen one council do that, and that's in Tower Hamlets in London, but I think we should be doing it all over the country, and mobilising our public.

“On top of the cuts, what we have is a policy over the last 30 years of deliberate privatisation.”

On top of the cuts, what we have is a policy over the last 30 years of deliberate privatisation, and of course that comes from the New Labour government that came to power under Tony Blair, when the philosophy was 'it doesn't matter who provides the services, as long as they're publicly funded'. So what we have had is the incremental privatisation, [including] contracting-out and compulsory-tendering, mainly for the non-unionised staff, mainly women, low paid workers, cleaning staff, catering staff and porters, and we saw that [happening] all through the 1980s. By the 1990s we had what was called the Private Finance Initiative (PFI), where the government changed the whole system of accounting in 1990, and created a purchaser-provider split [in the NHS] so that hospitals and services would have to compete against each other for contracts, and hospitals now - some of which are falling into terrible decay and disrepair - will only be funded through something called 'Project Finance' (I.e. PFI). PFI is totally discredited and is buying-in your children and grandchildren to exorbitant debts for the next 60 years. And now the government is looking for other sources of funding, including persuading councils to raise bonds to finance hospitals or services. This money should be used now for the public immediately, it should not be tied into new forms of Project Finance.

So we have the internal market which is breaking everything up, and that has paved the way for increasing marketisation, and when the government can't persuade you that you no longer need your hospitals and services, then they do it in different ways. So, they merge hospitals (Trusts) together, because it makes it much easier to close [services], because you don't need the same forms of consultation, and you bring all these hospitals and the Trust CEOs together, and they can decide that they no longer need a bit of what was once two hospitals, because it is now one big corporate entity. These corporate entities have new powers, to get into joint ventures and privatise their staff. Bus also remember that these Foundation Trusts are nearly 50 percent private - up to 50 percent of their funds can be raised through charging and private income - that means that nearly 50 percent of the beds, services and staff can go out for private income. In an area like this nobody can afford to pay privately.

“The government is setting up the NHS to fail. It's setting up huge deficits and then putting in the mechanisms to enable [the NHS] to close services and generate more [private] money.”

The other thing that the government has done is to laden these Trusts [with debt]. In a period of austerity [the Trusts are still] supposed to break even, [so they] have enormous debts sitting on their balance sheets. South Tyneside and Sunderland hospitals both have debts, and in merging them, they brought these debts together - called a deficit - and the only way out of the deficit is to close hospitals, sell off the land, and close services. So really what you are seeing here is a microcosm of a much bigger picture, which is about how governments are managing to transform the system from a public universal service, to one where they can increasingly persuade the public that 'we can't afford it, and so now you must start to pay or go without'. In areas like this where there is not a lot of wealth, [many people] will go without (although some of you may have private health insurance), or you will travel and sit on waiting lists for Sunderland Hospital.

The government is setting up the NHS to fail. It's setting up huge deficits and then putting in the mechanisms to enable [the NHS] to close services and generate more [private] money. That is what that whole big piece of legislation was in 2012 - the Health and Social Care Act - that's why the only way we can get our NHS back is by a new act of parliament, which is why we've spent the last six years drafting Bills to try and get them into parliament. But, because of the chaos in parliament at the moment - because of Brexit - it means that nobody is focusing on domestic policy. The civil servants are basically doing whatever they want, and there is nobody in parliament to call them to account. Increasingly, and partly because of Brexit and partly because of the multinationals, our democracy is broken. There is nobody calling this government and the civil service to account. Parliament is the only body that can call the government to account, and yet parliament is not doing its work at the moment because of the debacle over Brexit.

We have to fight locally. We have to do our best to try and get parliament to listen, as Emma did with her statement and debates, but nobody [in parliament] really cares, and I'll bet that chamber was nearly empty when she gave that statement. So we have to fight locally, and we have to make our local councils much more accountable, and they should be calling out what's actually happening to our health service and not capitulating. I think your doing an amazing job of doing that here.

The other thing that you'll be told is 'it's not just that we can't afford it any more, but we can't get the staffing'. Staffing is a problem, but there are all sorts of imaginative ways of dong it. The other thing you will be told is that 'services are no longer viable'. Over the last 30 years (I've been doing this work for a long time - since PFI - so I've heard every story and excuse - including using the European Working Directive, although that does not stop people doing double shifts if they want to moonlight in the private sector), I've heard every story, but if the political will is there, all of the solutions can happen, the solutions are there. It's the lazy reply [when you are told] "it's not affordable", "we can't get the staff", "the services are no longer viable", "we need to centralise". These are lazy, glib answers that have been honed over 30 years. You'll hear them on every platform on which the CEOs and their array of managers sit. They've gone to management college, they hear the management speak from the likes of The Kings Fund and the Nuffield Trust, they've all been carefully honed like clones to give the same responses, and you need to challenge that.

I'm really sad that the children's emergency care has been withdrawn, with this gradual whittling away by closing the service after 10pm. The nurse-led midwifery service is great, but we all know what happens next. You have to continue fighting, and you have to get to the young people. We need this hall to be full of young people. If the climate change activists can get them out on the streets... We need the young people to realise what they are losing. The problem is that most young people are very well and they don't know what's around the corner.

The tide will turn, the tide is turning, and an economic crisis, which is probably what we are going to be facing again in the next few years, means that communities have to become even more resilient. You're part of a much bigger movement... just don't give up and keep on fighting.

Selected Questions and Answers

The Australian health system is excellent in a technical sense, but they have payments. My daughter who lives in Western Australia paid $4500 for a test that formed part of her treatment for breast cancer. There are other aspects of the Australian system such as GP visits and the ambulance service that require payments. Despite this, the daily telegraph promotes the Australian health care system as a more sustainable alternative to the NHS. Can you say what features of the Australian system can be readily implemented in Britain, and if that would be a bad thing?

I'm sorry to hear about your daughter's cancer and then the trauma of having to pay for treatment. You ask about the Australian system, well you could kill off all the older people here and that might help! The Australian demographics are different from here, but also it's a very privatised system, there are a lot of private companies operating and on top of that you have charges and huge inequities. You also have huge inequity in pay and salaries because the doctors are paid incredibly well, and there is a lot of private practice also. If you want all those ingredients, then by all means, lets bring them in, and indeed we already have some Australian companies here.

Your example described the one thing that Bevan was very keen on, which is freedom from fear and health care bills. But when you start to [charge] you also do something else, you bring in a conflict of interest between the doctor and the patent, and we've seen this in private hospitals. Where doctors in private hospitals will do things that they would never do in the NHS, because those conflicts come into the doctor patient relationship. So, in America there are scandals where doctors have given surgeries (including heart surgery) to patients who haven't needed them, because [in the USA, a doctor's] job is to find what they can bill for, not what the patient needs. There have been huge scandals from HCA [Health Corporation of America] in Florida, which only came out because of the fraudulent billing of government funds amounting to hundreds of millions of dollars.

So the commercial imperative creates huge new conflicts, and you'll see this even in the Foundation Trusts, because they can generate up to half of their income privately, they're thinking now with a commercial hat on, they're not thinking "what do our public need, what do our patients need", but rather "how do we bring in money". It changes the whole dynamic. I see this in the university where I work, as we think about things differently because of that imperative to make income.

In response to an open ended comment about children's services: Children are the most precious people in our society, yet our government is being consciously cruel to them. The great scandal of our age is that we have a UN declaration on the rights of a child, which our government is a signatory to, but it has never put those rights into law - Respect, Protect and Fulfil. The Scottish government is trying to do this at the moment. It's important to look north - not saying everything in Scotland is rosy, it's not - but there are some things they are really trying to do.

What kind of society are we where we are leaving 50 percent of our children in poverty, with all the stresses and strains that it brings. We get very obsessed about social media and mental health, but actually the reality is much closer to home. So one again, councils should be publishing details of the cuts in services and the children who are not getting treatment. They should publish the details of the community services and provisions that are closing, including the likes of this wonderful centre [The Brinkburn Community Centre] that is so important for children, but that is always struggling to make ends meet because the council can no longer give grants, so you get voluntary community organisations to run it, and that applies to lots of services in general. It all comes down to the politics.

Do we know the cash requirement to fund the NHS in the way that it used to be? I know lots of people would be happy to pay more tax if we knew it was going into the NHS.

We are all quite heavily taxed actually, except for the very rich and also for businesses. Business rates have fallen. Business tax in the 1960s was around 50 percent, and it has gradually fallen to around 17 percent, and there are all the tax breaks that come with it.

The real question is are we spending our money wisely? We might be happy to pay a bit more if we thought it was going into the services we need. But I don't think that Private Finance (PFI), Project Finance or Bond Finance is a good use of money. Is there good evidence for all the medicines we have at the moment. Why is the price of medicine high and escalating? The NHS is [struggling] to keep pace with inflation, it needs about 4 to 5 percent [budget growth] per year, but it has not had that in real terms. That inflation is nothing to do with wages, because wages can be kept low by not giving staff an increase [as has been the case]. It is all the other things that create inflation - the management consultants, the teams of lawyers, private finance and the costs of technologies, and our government is not negotiating the best deals that it can.

We need to prioritise, are we putting enough into rehabilitation services for children and older people [for example]? The answer is clearly no. Our health service has been gradually reorientated and restructured to meet the needs of industry through what's called the "medical industrial complex". That industry includes layers, management consultants, pharmaceutical companies and technology companies. This is not a conspiracy theory, it's absolutely real, you have to look to see where the money is going! So before I would address the tax problem, I would ask 'where is the money going'?

Does anybody have an idea of the actual shortages of doctors and nurses?

Once upon a time there was workforce planning that was being done through the colleges. I think it is a great question. I think you should be writing to Health Education England (HEE). HEE is responsible for employment, for junior doctors, for workforce planning. You should say "show us the workforce plans for each area", "how many GPs are their per head of population in each area?".

We should be going back to the traditional planning norms that we once had. Which was a way of deciding how we allocate resources but not on the basis of one hospital taking over another and deciding that they can't provide the services in a given area, that is no way to plan for people's health needs.

The leaflet currently being distributed by South Tyneside and Sunderland NHS Foundation Trust regarding the closure children's A&E says "please do not attend after 10pm". Do you think that this goes against the ethics, constitution and ethos of the NHS as it requests parents not to attend an A&E with their children?

I really can't answer this question. It's an interesting idea, but what we are seeing are political acts, to close a service at 10pm, to not have an A&E. For children this is the thin end of the wedge. [Next they will say] we don't have a consultant, we don't have enough staff. It will go on and on. These are political steps. They are not breaking the law, and they are doing it incrementally in order to try and get around accountability and challenges to consultation.

If we get another Conservative government, where do you think that will leave the NHS?

If we have another Conservative government (or even another [Tory] coalition) we will carry on as we are carrying on. You don't destroy an NHS overnight because it is too deep rooted in people's psyche. So you have to do it incrementally, in stages, and that is what has been happening over the last 30 years.

As well as campaigning to save your hospital, political campaigns are really important, to get the party that you really want making sure that the party is behind the NHS Reinstatement Bill. Until you get a party that will support this, our NHS can never be reinstated in England until there is another act of parliament - an act of parliament that does away with all the marketisation.

In what way are people being charged for the NHS? Can you give some examples of charging and discuss ways in which charging is being introduced?

They get people to gradually accept that they don't have so many services, that things will be harder, especially on that divide between health and social care. Although the government is integrating health and social care, it has not integrated the services or the funding, and neither does it have the legislation to do so, because social care is means-tested and charged for. We have already seen that slippery slope over the last 30 years, as care that was once provided for free, especially for longer term care, has moved under the jurisdiction of local authorities who no longer have the money to pay, so they have to charge or withdraw services, forcing people to go private.

Sometimes you don't see the charges. We know that 30 percent fewer people receive social care than they did 3 to 4 years ago. The numbers are stark, they have fallen off a cliff - the numbers of people receiving home care, meals on wheels etc. Increasingly [because of cuts] these services need to be targeted only at those who are most needy, so non of the prevention to keep people at home in the way that it was envisaged is happening.

Other forms of charging result from the government simply no longer providing care. The government has published some lists of services that will be excluded. For example, a second cataract operation, or one hearing aid instead of two hearing aids. These are not myths they are real, and they should be documented. People should be coming forward to say, these are the cuts and these are the consequences case-by-case.

So it's happening by the gradual withdrawal, and the growing expectation of people to have less, and as services get harder to access and waiting lists go up people who can afford to pay will go private. The government is slowly trying to get into our psyche to accept that we can't afford it, but it does not need to be this way.

Can you tell us a little bit about the Reinstatement Bill, and where it is at, at the moment?

We have a website, and basically the bill will reinstate the NHS.

The government is breaking up the NHS. It has removed the duty on the secretary of state to provide universal health care throughout England. That duty was put in place in 1948. The absence of that duty is one of the reasons why you can have service closures. The Reinstatement Bill would restore that duty.

The Reinstatement Bill would end the internal market and the external market, and reintegrate services as has happened in Scotland and Wales. You would have none of these Trusts getting more and more powerful and making their own decisions.

Hospitals and services would be accountable to local people through bodies similar to what used to be Local Health Authorities / Health Boards. That is what still happens in Scotland. There is no purchaser provider split, there is no tendering, there is no pricing, there is no bidding, so you take out all that bureaucracy that is so expensive. So the Reinstatement Bill would make health services accountable to local people though proper area-based health boards.

The Reinstatement Bill would get rid of Trusts completely. So you would have no Foundation Trusts going out to borrow money. There would be no borrowing or Project Finance. There would be proper capital budgets in place, and [if needed] government would do the borrowing. Trusts would [effectively] be brought back into line to serve the local people. It is a nonsense that the CEO of Sunderland Hospital can be making decisions about what is happening in South Tyneside. It's quite extraordinary and visa-versa. How do they know what local people really need and really want. It is a nonsense because we have a corporate structure that is not interested in the details of people's homes and lives.

The Reinstatement Bill would make sure that PFI contracts are all opened, and the treasury would then have the job of renegotiating those contracts or closing them, and showing the public what they contain.

The Reinstatement Bill has had a first reading but not a second reading. Linda Smith from Wolverhampton took it, but because of Brexit we have had no domestic policy. We have played right into the Conservative governments hands because they love this, because it means that they can continue with their privatisation and opening up of health services to the market. American companies are here already - big time! They are not just here providing the services, they are advising the government, the CCGs and the Trusts. Health corporations are advising them on their implementation strategies.

We have just finished writing a piece on Centene, who are present in Nottingham at the moment doing their Integrated Care System. Optum (AKA UnitedHealth) is another one. They are not delivering the front end of the services, they are redesigning the health system to further enable the market.

Can you explain what happened following the legal case last year against the ACOs?

Please look at the website. We won some aspects of it, and lost some aspects of it, but we lost overall. We were challenging the right of CCGs to award multi-billion pound contracts for periods of 10-20 years to private providers who could then deicide what they could provide and how those services would be provided. We took the government to court over that, and the judge said basically that the legislation as drafted is so broad that the government can do almost anything.

We did win some battles on the accountability, transparency and a bit on the consultation process.

NHS England has said that they will not fund phase-2 of the "Path to Excellence". It has been reported that talks are taking place between the Trust and council CEO to borrow £35-million from South Tyneside Council and £15-million from Sunderland Council. Do you have any views of that?

The "Path to Excellence" fills me with horror. It is an example of why we no longer have a national health service. The idea that a hospital that is [supposedly] part of a national health service, having to borrow money locally tells you a story.

Once upon a time there were capital budgets that flowed, and the government did any borrowing on behalf of the nation. Why are cash-strapped councils in the poorest areas of the country borrowing on behalf of their local hospitals. It's because they think they will get an income stream from the bonds that they issue. So what you will probably hear in Sunderland and South Tyneside is that 'our budgets have been cut, so we're going to generate an income stream from the NHS'. And the Trusts, instead of providing care for patients, will be diverting it's income into the local area. This will be the contorted reasoning that will be going on board rooms.

It is no longer a national health service if you have to borrow locally. If you are 'robbing Peter to pay Paul' by getting an income stream from the health service to prop up other services, then the councils are not doing their jobs. If I was a council CEO I would make sure that people can see what the cuts are, and what the services we are no longer providing year-on-year are. I would be shaming the government, not doing deals. Also, if the councils have reserves of £35-million or the ability to borrow as much, why are they not funding the services that they are cutting? It's tortured reasoning, but when you look at it, your getting into the mindset of a government that no longer wants a national health service, but a return to the 19th century system of poor-laws and parishes, where the rich parishes will be able to raise money for nice hospitals, schools and services, and the poor will not. So you must make this from a local to a national campaign - and oppose it!

How is money wasted in the NHS, what costs are associated with the internal market?

When the NHS was created, the NHS was one of the most efficient health services because it spent less that 6 percent on administration. When the internal market was created (the 'purchaser-provider split') it doubled to 12 percent, and in America the costs of administration are 25 to 30 percent. The government has been very careful to not let us see the actual figures pertaining to the use of management consultants, law firms and accountants, so we don't have good data, but it's probably fair to describe it as being anything between 18 and 30 percent covering marketing, billing, invoicing, and all the management structures that are needed to run a pricing system.

How do you argue against all of [the Trust's and CCG's] arguments. As you said before, it is very glib and persuasive. For example, the stroke service at Sunderland and South Tyneside as D rated, now that it is integrated it is B rated. How do you argue against that?

We are expected to be willing to travel to where there is a centre of excellence, and we are told not to ask for everyone to have access to good health services where they live, and where they have up till now been provided. How do we counter the spin that they put on this?

When they say 'this or that service was bad', that is not an analysis. What you want to ask is why those services were bad. Show me the report, show me the funding levels, show me the staffing levels, show me what was going on, so challenge them on that basis. Keep de-constructing, asking why. They might say 'we couldn't get any staff', so you ask 'why not, and which staff, what was the evidence, what did you do?'. Keep reflecting the big picture to them also. Don't trust reviews of services, they are always political.

For some things it does make sense to have centralisation, but not for everything and we need to look carefully at the evidence around centralisation for different surgeries. They don't need to do that for everything.

The Trusts are moving Sunderland Eye Infirmary to the new site built where the Vaux brewery used to be. That could release the old site for development, and it could be a prime housing site. The Trust currently leases the old Eye Infirmary site from NHS Property Services. If the Eye Infirmary is moved, how will the move be funded, and what will happen to the land attached to the old site? If it is sold, will the money go to the government, or will it go back into local health services?

NHS Property Services was a company set up by the (2010 Con-Dem) coalition government. They transferred £5-billion pounds worth of NHS property into this company, and the basis of selecting properties for transfer was if the property was less than 50 percent used by the NHS. NHS Property Services would then charge rent for the use of the properties.

The Naylor Review advocated selling off a lot of land for housing, so what you say makes sense. We can't answer your question definitively, but it is a big concern and we should look into it more.

NOTE - A Freedom of Information request made after this meeting has confirmed that the Eye Infirmary site is owned by South Tyneside and Sunderland Foundation Trust not NHS Property Services. The Trusts has also mentioned that there is no intention to move or sell it.

Following your judical review, the government held a consultation about contracting for Accountable Care Organisations, can you tell us about the result of that?

Just before we went into court, NHS England conceded that they did need to consult, so they conducted a consultation and published the response, but they are still going full steam ahead with Integrated Care Systems. The consultation gave a very partial analysis because [they took no little account of your answer] if you answered the consultation outside of the scope of their questions. There is a line in their response stating that a lot of the respondents were very concerned about privatisation, but that is all. They did not address any of the fundamental issues that we had raised. They responded in terms of the questions they had asked, but not of the questions we were asking of them.

Is there any monitoring in place to gauge the effect of closing the stoke unit, and other services as they close like maternity. Is there a way of getting some facts and figures?

That's a good question. If we do lose those services and we don't manage to hold off with our court appeal, then monitoring is going to be vital for the campaign. We should be making more use of the Freedom of Information Act.

Save South Tyneside Hospital Campaign Update : Roger Nettleship - SSTHC Chairperson

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e have been fighting over the last 3 years to save our 24/7 children's A&E, full maternity service and our special care baby unit, and retain our hospital stroke rehabilitation service in South Tyneside.

We are now facing an even further reduction of our A&E and acute services in phase-2 if this so-called "Path to Excellence" goes ahead later this year.

Allyson has exposed the facts behind the government's market system, and she says that campaigns like ours have helped to reveal more about this whole corporate direction as we find ourselves fighting a corporatism within local bodies like the CCG.

“Staff from South Tyneside hospital have given us examples including a patient who had a stoke in A&E for which a cat-2 ambulance call was issued to take the patient to Sunderland. It should have taken 18 minutes, but it took over 2 hours. We were told that many such incidents are not being recorded.”

We are presently locked in a battle with our local authorities to stop them providing the finance to further downgrade our hospital. Whilst at the same time, the staff through their unions in the hospital are having to deal with corporate-style mergers and the creation of arms-length privately registered companies, such as 'Choices' in Sunderland, to which the Trust transfer some hospital staff, leading to worse terms and conditions.

Emma Lewell-Buck (MP for South Shields) is absolutely right when she says that we must do everything in our power to protect our services at both a local and national level. The jobs and well-being of those who work in the NHS are paramount.

It shows the strength of our campaign that so many people still turn up to our fortnightly meetings to discuss what we should do, before implementing the decisions we make. Everyone is welcome, and even those who can't make the meetings can make their contribution by working directly or indirectly for the campaign, and by defending the rights of all to health care and defending our right to comprehensive local health services here and throughout England.

The campaign to save Poole Hospital [(Defend Dorset NHS)] is now going to judicial review. This is going on all over the country, but joining together in a campaign empowers local people, enabling us to build the authority to set the public agenda.

On August 5th, the Trust will close the full maternity unit, the Special Care Baby Unit, and prevent children from attending the local A&E during the night. The NHS constitution makes it clear that there should be no discrimination on the grounds of age in accessing NHS services. Children attending A&E have the same rights to safe and quality services, but now our local A&E will carry a serious risk to children at night, and that is why the Trust has sent everyone a copy of their warning leaflet, they would not have done that if there was not a serious risk.

Staff have raised their serious concerns in meetings and in writing. The Trust themselves have admitted concerns about children presenting at A&E during the night, but they are prepared to take that risk. A&E staff who are currently providing adult services, but who might now have to manage a sick child at night, raised their concerns during the service review. We have had nurses speaking to our campaign, stating that they are not paediatric nurses, but that they may have manage children admitted to A&E during the night.

Middle-grade doctors at the children's A&E in South Tyneside have been doing 150 percent of their full time hours over the last eight years. The service has been running with locum doctors because there was no attempt to recruit new doctors when the previous ones left. The money saved by not recruiting new doctors was used to pay for locum doctors at night. One of the reasons given for closing the service was that this was costing the Trust too much money, ~£200-thousand a year, but this is less than what a chief executive gets, and ignores the fact that middle-grade doctors in Sunderland have also been seriously compromised in the same way.

We will lose full maternity services and the Special Care Baby Unit (SCBU), but 50 percent of mothers who used the SCBU last year were low risk mothers. So, low risk births can turn into high risk births very quickly, and to be in a landlocked place (enclosed by 2 rivers and the sea) and then to get an expecting mother to Sunderland in an emergency is no small task. Staff from South Tyneside hospital have given us examples including a patient who had a stoke in A&E for which a cat-2 ambulance call was issued to take the patient to Sunderland. It should have taken 18 minutes, but it took over 2 hours. We have been told that many such incidents are not being recorded. This is not a 'Path to Excellence'.

The University Hospital of Hartlepool lost their A&E and full maternity service a few years ago. They opened a midwife-led maternity service instead, but I read this week that they now want to close it because they say they can't get the staff. We don't believe that is true as we know that very few mums go there. The "Path to Excellence" documents say that if our new midwife-led unit does not get at least 300 mums a year it won't be viable. So you can see that in a few years time when they are looking to whittle the services down further, they will just use that as the excuse to close maternity altogether. It's quite clear that it's all being set up to fail.

Lots of mums were out delivering leaflets to advertise this meeting. They have never stopped fighting, and they formed their own mums campaign group called "It's not a done deal!".

We we very pleased when the Joint Health Scrutiny Committee referred phase-1 of the "Path to Excellence" to the secretary of state, with very good reasons. But of course, the independent review panel did not do a serious investigation, and the government of course ignored those concerns.

We also launched a judicial review which went to the high court in Leeds in December 2018, where the judged ruled in favour of the "Path to Excellence". We have since prepared an appeal against this, but the judge has taken 7 months to hand down the decision (a formality which delays the start of any appeal), whilst the Trust has ploughed on with its changes regardless of the legal process. We think this is a denial of the rights of the people of South Tyneside to put up a legal case to defend their services. ...Our solicitors are poised to launch an appeal, and we will launch that appeal because we have a right to undertake this judicial process. We will do everything we can to save these services.

Turning to phase-2 (of the "Path to Excellence"). The CCG say that a consultation will be launched in late summer 2019 on new proposals to downgrade our hospital services. That time-frame looks like it will be delayed as they don't have their funding in place. In the mean time they are trying to dress their proposals up with some shiny new buildings and a shiny new car park, which is ridiculous when you compare it to the shiny theatres, diagnostic centre - and even a car park - that we already have. As Emma Lewell-Buck (MP for South Shields) said in her statement on the day we handed in our petition to oppose the council funding phase-2:

“To shift the focus to bricks and mortar at the hospital site, with no reference to the loss of services dehumanises the critical issue, and only gives half of the true picture.”

So what is the reality of their ideas? In all three sets of their working ideas, South Tyneside will lose trauma and emergency surgery from our A&E. The hospital will default to low-risk day surgery. They are pushing this as a "surgery centre of excellence", but South Tyneside Hospital is already renowned for some of the surgery it does such as laparoscopic bowel surgery.

In their second set of working ideas (referred to as "some change"), the A&E will be fully downgraded to an "urgent care centre", which is like a glorified minor injuries walk-in centre. The hospital will lose all critical care services and the number of beds will be reduced from about 300 to about 95 (mostly step-down beds). There will still be some acute admissions via GPs.

The third set of working ideas (referred to as "greater change") is their favoured option. It requires the most investment and will see South Tyneside hospital lose all acute beds, leaving about 65 step-down beds. We'll mainly have day-surgery, some diagnostics and a midwife-led maternity unit in South Tyneside. All of which the hospital provides now.

What we will loose is local access to vital acute services, critical care, coronary care, intensive-care unit and acute beds other than a few step-down beds - South Tyneside hospital will have fewer beds than you might expect at a community hospital. When I started work in the NHS in 1986 at Palmer's Community Hospital (in Jarrow), that hospital had 80 beds.

”The whole direction of the "Path to Excellence" is towards a loss of beds (with some additional beds in Sunderland).“

Matt Hancock (Secretary of State for Health at the time of writing) and NHS England CEO Simon Stevens is saying [(in a Health Service Journal article dated 19th June 2019)] that there is a need for more acute beds. But driven by the "hidden hand" of the massive cuts to our health service - that they have championed -, it is all out of control. The whole direction of the "Path to Excellence" is towards a loss of beds (with some additional beds in Sunderland). Maybe this is why NHS England have refused to fund phase-2 of the "Path to Excellence", because they don't want people to blame NHS England and the government for what is happening, and instead they can blame local authorities or anyone else who funds it, claiming that it is a local decision. In fact when you look at the answers that Emma Lewell-Buck (MP for South Shields) gets from the government when she raises our concerns, they typically deflect responsibility onto local bodies such as the CCGs.

The chair of South Tyneside CCG recently said that 'we need to push back on the industrialisation of our health care system'. So gone is the equal access to services in local towns. It's almost like a Thatcherite de-industrialisation sweeping across our NHS, through Hartlepool, North Durham, Northumberland who have less equal access to services than they ever had before.

Our campaign has also been supporting some of the palliative care nurses following the sudden closure of St. Clare's Hospice. We have been involved in the fight to restore and improve the dedicated inpatient and home palliative care service. We are asking for it to be comparative to what is provided in Sunderland, which is not unreasonable considering South Tyneside and Sunderland NHS Trust claim to be providing services for both populations.

Extinction Rebellion shutting down Oxford Circus, London
If you follow the official reports in the media, you could be forgiven for feeling that society is divided, so that we can't achieve our aims at this time. However they try to do block us, society is changing. Allyson mentioned the massive public uprising centred on the environment, and just two weeks ago 200 thousand people attended the Durham Miners' Gala, and our banner was there, along side the trade union banners. It all reveals the new optimism around our shared values against the market system, against privatisation, against the corporate direction and for a humane society, where health staff and local communities really do make the decisions.

Statement on behalf of staff at South Tyneside and Sunderland : Marion Langley - South Tyneside and Sunderland staff-side chair and Unison branch secretary

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e've talked about the services, the changes and the cuts that may or may not come, but the staff in South Tyneside are going to face major changes to their jobs and their workplace.

With regard to staff in South Tyneside in phase-1, the maternity services, as we know, will change come the 5th of August. There has been a call to arms by present and past maternity staff. They all came together on Sunday, but I could not go - I don't think my heart would have been in it. The staff at the hospital are really upset at the changes and the way they are being treat at the moment. They are really struggling with some of the changes they are being given. They are moving bases, moving jobs, being down-banded and being regraded. There are some protections for them because we work hard as trade unions to make sure those protections are in place, but I have to say that if phase-1 is anything to go by, then what we face in phase-2 is going to be horrendous.

Let me be very clear, I have supported this campaign from the start, but so have our staff in South Tyneside. They are coming on-board in Sunderland now. I am now chair of Sunderland staff-side, which is overarching for the whole of the organisation now [since South Tyneside and Sunderland Trusts merged]. I thank my colleagues for putting me in that position, but if we are facing the same sort of changes in phase-2, the organisation now has a free hand to send staff to where they decide services are needed, whether in South Tyneside or Sunderland.

“We are seeing nurses in dire straights with their finances, using food banks, receiving heating allowances, and struggling to pay for their children's clothes before they go back to school. We are not having this easy.”

The people who have worked long and hard in South Tyneside, feel very loyal to the organisation in South Tyneside, many of them do not want to work in Sunderland, and we are told that on a regular basis, but they have no option because they have mortgages to pay and families to raise. We are seeing nurses in dire straights with their finances, using food banks, receiving heating allowances, and struggling to pay for their children's clothes before they go back to school. We are not having this easy.

We are worried about how the staff will cope in the future. You mentioned Hartlepool, now a lot of those nurses have retired or moved on to other jobs because they did not want to work in Sunderland. They are worried for their collogues in South Tyneside who may not have a workplace in the future if the same thing happens to South Tyneside as happened to Hartlepool. This news has just broke this week, and I find it very hard to take when we are looking at a maternity midwife-led unit in South Tyneside in a very deprived area.

The staff have been behind [the Save South Tyneside Hospital Campaign] all of the way, and they are wanting more people to support [the alternatives] to what they feel are unnecessary changes. A lot of these staff have had the answers right from the beginning. Some of their ideas have been taken on board, but lets be honest, in the [pre-consultation] focus groups for phase-2, some of the staff's ideas have been put forward, but they did not get the option to do that in phase-1, as many of the staff have testified.

Phase-1 has not been the success that the organisation wanted it to be, but that might be down to the fact that we got wind of what was happening and opposed it, so I just want to let you know that the staff are behind you.