English NHS doesn’t need polyclinics, study shows

So, will New Labour’s plans to open up GP services to big business be halted by the facts? Obviously not, but it is worth noting who the victims will be in this case (aside from the patients who might suffer worse services) it will be middle-income professionals.

Consider also that the English NHS is controlled by the British government. Would an English parliament make it easier to resist corporate takeover of public services? Who knows? But it is interesting that polyclinics are not being considered in Scotland or Wales…

From the BBC:

Average-sized GP surgeries are just as good as “super-surgeries” at providing extra services, a study suggests.

Ministers in England have asked health chiefs to create a network of polyclinics to provide extra care, such as diabetes clinics and minor surgery.

But a Kent-based GP’s study of 384 practices found no difference between the range of extra services offered by standard surgeries and polyclinics.

The government said polyclinics would provide a valuable service to patients.

Every NHS trust in the country has been told to set up at least one polyclinic, with a whole network being created in London.

Ministers believe the super-surgeries are the best way of moving care out of hospitals and into the community.

But the study by Dr Hendrik Beerstecher, who specialises in research, found large surgeries already operating were no better at providing the specialist care the government is so keen on.

He looked at the range of extra services, beyond the average package of GP care, being provided by a range of different-sized practices up to ones serving a population of more than 30,000.

He found small surgeries – classed as having fewer than 6,300 patients – tended to provide less diverse extra services.

But once the threshold of 6,300 was reached – the average size for a practice in England – there was little difference no matter how big the surgery was.

On average, these had between 10 and 11 extra services.

‘No evidence’

Dr Beerstecher, who is not a member of the British Medical Association, the doctor’s trade union body which has campaigned against polyclinics, said: “I am not sure why the government is pushing ahead with polyclinics.

“As the study shows, there is no evidence that they provide more services so why are we having them set up all across the country?”

Dr Richard Vautrey, the deputy chairman of the BMA’s GPs committee, said: “This proves what we have been saying all along – that we should not be rushing headlong into setting polyclinics up.

“GPs have always been innovative. You do not need a big surgery for this to happen.”

Wildcat strikes at oil refineries

Let’s be clear, this is not a racist or xenophobic protest – though, no doubt the fascists will try and jump on the bandwagon. The strikers are not motivated by hatred, but by a fear that they might be lose their jobs in the future.

The contention is not that Italian or Portugese nationals living locally should be barred from employment, but that it is crazy that bosses would bring in workers from overseas before first seeking to take on unemployed people who live near the refinery.

These workers should be praised for defying the anti-union laws which criminalise wildcat action, for breaking the law to defend their living standards.

The BBC reports on the growing protests:

Hundreds of energy industry contractors have walked out at sites in northern England and Scotland in an escalating protest over the use of foreign labour.

The dispute began at the Lindsey Oil Refinery, North Lincolnshire, on Wednesday after a construction contract was awarded to an Italian firm.

Unions said the contract should have been given to British workers.

In a second day of action, 800 people protested outside the refinery as workers from other sites joined them.

Hundreds of contract workers at the neighbouring Conoco Phillips oil refinery took part in Thursday’s action.

Employees at BP’s Dimlington gas terminal in East Yorkshire and its chemical manufacturing plant in Saltend, Hull, also walked out in support of the Lindsey refinery workers.

Unofficial strike action was also taken by workers at Scottish Power’s Longannet power station in Fife.

Total, which owns the Lindsey refinery, said its main refining operations on the 500-acre site remained unaffected by the action.

It also stressed that there would be no direct redundancies as a result of the construction contract being awarded to Italian-based contractor IREM.

Unite union regional officer Bernard McAuley said workers at the refinery had been joined by hundreds of trade unionists and other supporters from around the UK.

He said: “They’ve come from all over the country. We reckon there were almost 1,000 people here today.

“We’ve also had huge numbers of messages of support from people who are incensed by this decision. It’s a total mockery.

“There are men here whose fathers and uncles have worked at this refinery, built this refinery from scratch. It’s outrageous.”

Drop the dead dogma – privatisation isn’t efficient or cheap!

Two items from Tribune on health and education show that New Labour are far from burying the failed neo-liberal model.

First, healthcare:

UNISON has urged the government to rethink its whole approach to NHS reforms in the wake of a damning new report on the cost of commissioning and outsourcing in the health service.

The public sector union has called on the Secretary of State for Health, Alan Johnson, to concentrate on giving NHS patients the care they need and deserve – as well as ensuring the taxpayer gets real value for money – rather than using health service reforms as a smokescreen to outsource or privatise services and “throw precious money away to the private sector”.

The call comes in the wake of a hard-hitting new report – called Driven by Dogma – from the Office for Public Management. In a damning verdict it says outsourcing in the NHS has failed to deliver value for money, proper patient involvement or improved working conditions for staff.

The Government’s pre-Budget report made much of the potential efficiency savings to be made by the NHS from shared service operations with the private sector. But first hand evidence in the new report, examining the experience of those commissioning and delivering services, reveals that promised cost benefits have failed to materialise and quality has suffered.

Unison general secretary Dave Prentis said: “At a time when finances are increasingly tight, the NHS cannot afford to be throwing precious money away to the private sector and wasting time and resources on the complexity of the commissioning process.

“Patients want more involvement in decision-making and staff want to spend more time on providing excellent patient care rather than tendering for contracts.

“Unfortunately, this report shows that the various reforms to outsource or privatise parts of the NHS are working against these goals.”

The union says there are realistic alternatives – Scotland has recently announced it will no longer permit any contract cleaning and Wales has done away with the purchaser-provider split in favour of a more sensible and user-friendly integrated system.

Second, education:

TRADE unions have hit out at plans by the Office for Standards in Education, Children’s Services and Skills to privatise parts of the schools inspection service.

According to a leaked memo, Ofsted intends to outsource inspections of early education and childcare provision early next year.

It says privatising early years inspections – which ensure nurseries, pre-school provision, summer play schemes and childminding services are safe and secure and meet educational standards – will “provide better outcomes and save money” but Unison, the PCS and the FDA senior civil servants’ union say the idea is wrong is principle and bad in practice.

Unison national officer Jon Richards said: “It is outrageous that Ofsted is privatising early years inspections. Parents need to have confidence in the inspection system and know their children are safe and will be well cared for.

“There is a very real danger that jobs will go and the quality of inspections will fall if the focus shifts from raising and maintaining standards to cutting costs and making a profit.

“The decision to privatise inspections has serious implications for staff, parents and children.”

PCS national officer Neil March said: “Introducing the profit motive into inspections, combined with the naive belief that ‘the market’ has all the answers, will end in failure and further demoralise dedicated staff. It will lead to corners being cut and a loss of expertise.”

The unions think Ofsted wants to “wash its hands” of staff. Mr Richards said: “It has hundreds of equal pay cases outstanding and this is a crude attempt to deal with the problem as the workers pursuing these claims will be the ones to go.”

Devolution for England, a modest proposal

Here’s my submission to Compass’s How To Live In The 21st Century project:

Devolution for England

“It’s worked in Scotland and Wales!”

Contrary to the opponents, an English parliament would provide constitutional balance within the UK; an English parliament would have a progressive majority.

2. How does it fit with Compass’ core beliefs of equality, solidarity, democracy, freedom, sustainability and well being?

An English parliament would give England the same kind of representation that Scotland and Wales were granted in the late nineties and put an end to the anomaly of England-only laws being voted on by MPs whose constituencies lie in Scotland, Wales, or Northern Ireland.

It would allow the articulation of a civic conception of English national identity – based not on race and exclusion, but on place and participation – as has happened to some extent in Scotland and Wales.

The arguments against: it would make no difference to ordinary people; it would encourage the break-up of the UK; and it would reduce England to Tory domination.

3. How does it build the institutions of social democracy, like social groups and collective and cooperative forms of ownership and control?

An English parliament will provide a focus for those issues that are currently decided by the British government – which is comprised of MPs from across the nations of the UK – issues such as healthcare and education.

The establishment of devolution involved referenda in both Scotland and Wales; there is every reason to expect that there would be a public vote within England on the question of a national parliament and this will reinvigorate a sense of popular soverieignty, perhaps leading to more decisions being made through the use of plebisites.

4. How much will it cost or raise and where will any cost come from?

An English parliament could sit in the Commons at no extra cost.

5. Which groups in the electorate are likely to support or oppose this measure? Is there any polling evidence you have on this?

In November 2006, an Ipsos Mori poll for the Sunday Telegraph found 68% support. In January 2007, a telephone survey conducted by ORB (Opinion Research Business) for the BBC last year found that 61% of people in England were in favour. In April 2007, an opinion poll conducted by ICM for the Campaign for an English Parliament found 67% in favour.

Opponents have long suggested that an English parliament would lead to the break-up of the UK, but polling suggests greater support in Scotland and Wales for an English parliament than for either nation’s idependence!

6. Is there a place or country where it’s worked? Please provide some information.

As above, it has worked in both Scotland and Wales.

7. What are the three main arguments in favour/against it?

The arguments in favour: it’s popular amongst the general public who have seen the benefits in Scotland and Wales; it would allow decision-making on issues specific to England; and it would lead to the transformation of the UK into a federal republic.

English water, anyone?

The Stonemason has blogged about the eagerness of the Adam Smith Institute to see Glas Cymru (which owns Welsh Water) subjected to the “disciplines of private sector ownership”.

While it’s no surprise that they are calling for a successful publicly-owned company to be used as a cash-cow for shareholders, I feel I must unpick this particular assumption.

The issue of “discipline” relates to the principle-agent problem. How can those running a company be held accountable to its owners?

The Adam Smith Institute may argue that privatisation has been a wonder – but this is only true for shareholders. And some of these shareholders are ordinary people who are facing huge bills because of prices that go up when costs go up and stay up even when costs go down – yet they cannot as shareholders demand this of the company.

Because Glas Cymru is a company limited by guarantee its purpose is not to maximise the dividend paid to shareholders but to meet its objectives of providing high quality water and sewerage services to customers. This year each customer of Glas Cymru will recieve a dividend of £21.

Now, I’m not saying that it has the most socially-just model of ownership.

The company’s workforce – and the employees of contractors – should be regarded as stakeholders just as much as consumers. The objective of high-quality service cannot be met if workers are disempowered; good wages, working hours, and democratic representation ensure that high standards are maintained.

The remit should also include efficient use of energy and minimising any negative effects on the environment or natural wildlife.

Though Glas Cymru may not be perfect, it looks a damn sight better than what we have in England! We are being told that the only way to lower our bills is to have the profiteering water companies competing with each other. We have this with our gas and electricity suppliers – but do our bills come down? No, they compete with each other to squeeze as much money out of customers!

Privatisation has been a disaster. Public assets sold off at knock-down prices to the friends and sponsors of the governing party (Tories, now New Labour). Prices have been allowed to skyrocket -natural monopolies are milked for profit by colluding suppliers in gas, electricity, and railways. Rather than seeing greater private investment in our railways, more public money is invested in rail than ever before!

The likes of the Adam Smith Institute can try all they like to convince the public of the benefits of handing public resources over to big businesses. Their nonesense is only heeded by those politicians hoping to get cushy non-jobs in business after they leave office.
We need to return the privatised utilities to public ownership and democratic control, with the involvement of workers and consumers in the process of management.

Surveys of public opinion have never found a clear majority in favour of privatisation – and with the credit crunch being perceived as resulting deregulation and demutualisation, more and more people will begin to see the necessity of reversing the neoliberal era.

Privatisation of water and sewage services did not take place in Scotland or Northern Ireland. Scottish Water is owned by the Scottish government and both the incumbent nationalist party and the opposition Labour Party are committed to the company remaining in the public sector. The Scottish Tories are for privatisation, but are at pains to point out they don’t want what has happened in England! Northern Ireland Water priovides water and sewage services in the six counties; like Scottish Water it is still part of the public sector.

So, there’s Northern Ireland Water, Scottish Water, Welsh Water – how about English Water?

Baby P and the failure of the business model

From the Workers’ Liberty site, an account of how the business model imported from the private sector harmed the quality of a vital public service:

Until 2006 Pauline Bradley worked as a social worker for Haringey council, whose social work department has been in the news over the death of “Baby P”.

During her time at Haringey Pauline saw the tragic death of Victoria Climbie, the inquiry into her death by Lord Laming, and the subsequent reforms made by the government. Here Pauline, who now works in Dumbarton, explains why she thinks the social work system can fail children like “Baby P”.

The Lord Laming Inquiry made 108 recommendations, to do with tightening up procedures and communication in child protection. Updated computer systems were introduced which made it easier for social workers, occupational therapists and other professionals to record visits and communicate with each other. These systems varied in places and had teething problems too.

Not all Laming’s recommendations were implemented by central government, particularly the ones regarding how social work departments communicate with politicians and other agencies. Initial assessments, core assessments and other practices were implemented and should have been standardised throughout England and the UK.

The government was closely watching Haringey, so they pushed the changes through with vigour there to try to prove that all was different and better. The council changed their logo to “Better Haringey” to show a change from the bad old past.

The press had called the social worker involved with Victoria Climbie “incompetent”. Haringey Council wanted to prove they’d got rid of all the “incompetent, bad” social workers who were employed at the time of Victoria Climbie’s death.

But the new management regime were not qualified social workers! Anne Bristow, the new Director of Social Services, had many qualifications in management and marketing. David Derbyshire, the Children’s Director wasn’t a qualified social worker either. But the politicians seemed to think that was what was needed.

Our union, Unison, had for years complained that the social workers in Haringey were the second lowest paid in London. Overnight the new management regime (who came in after existing mangers had suddenly left, before the Victoria Climbie story hit the press) put up the pay of children’s social workers by as much as £8,000. (But not learning disability, older people’s or physical disability social workers). They introduced bonuses and enhancements such as the “golden handcuffs” (£500 for staying for two years), or a fast track up the spinal column pay scale.

They advertised for people to work in Haringey straight from college. They wanted people they could mould, not experienced social workers like me who might disagree with management decisions on cases. They got a full complement of staff very quickly, draining social workers from other boroughs.

Haringey was a special case after Laming. Other councils could discuss, debate and decide how best to implement changes without the same pressure

It may be that some councils didn’t implement them all — as long as they met their performance and inspection targets, they could be flexible elsewhere.

The problem with the regime at Haringey was that it deprioritised the human element to social work, which cannot be measured and which you only get through life and social work experience. For instance the skill and confidence to challenge a parent who you think is lying — to say “you look as though you have taken a drug, have you?”. Or in the case of Baby P: “Wash his face, I want to see his face clean”.

Parents will react, get angry, etc., but you have to stand your ground, because that’s what saves children’s lives. And the system, your manager, etc. have to back you up. If you know they won’t back you then you’ll be reluctant to say what your guts are telling you.

On reports I heard that a legal team had said there was “not enough evidence” to take baby P into care ten days before he died. If the social worker dealing with the case knew that, she’d be less confident about challenging his mother.

It is very basic to social work to assess the truth and veracity of an adult’s claims. But Haringey had become a borough where the management and politicians did not base themselves on social workers’ abilities but on the idea of a process for everything. If you followed all the procedures everything would be okay. Haringey had a business model of targets and form-filling. That does not protect children. We need a welfare model.

There is starting to be a debate about whether it is better to leave children with their parents or take children into care. At least in care they survive and don’t die (usually). Every case is different and must be seen for its own merits.

In Scotland, where we see a child at risk or in need, we try to engage the parents/carers as much as we can. We literally throw resources at them if it will improve their and their children’s lives, e.g. nurseries, after school clubs, counselling, parenting classes, money for heating or food (but not drugs, we have to be vigilant with that one; supervised shopping may be needed), drugs rehabilitation, addiction services etc. If the parents engage, then there’s a chance to keep the family together with these supports. These resources are crucial.

If they don’t engage, if they lie and avoid us, then we’re more concerned. We may need to take the case to a child protection case conference for more vigilant measures, or to the Scottish Children’s Reporter’s System for a hearing and a legal order.

The Scottish Children’s Reporter’s System is outside of social services and is a welcome check and balance on the local authority. It was inspired by Lord Kilbrandon in 1968, who wanted to focus on young criminals and their “needs not deeds”.

Any child who comes to the attention of authorities, e.g. police, schools, youth clubs, nurseries, etc., can be referred to the SCRA. The SCRA is run by lawyers who have specialised in children’s law. An SCRA reporter then writes to all agencies in that child’s network and asks them for a report. They write to social services and we go out and meet the child, family, etc., and write our report for the SCRA with our recommendation.

When the SCRA have received all the reports, they decide if a children’s hearing is needed. If it is, they call one and the child, parents, social services , school etc are invited to attend.

There are three panel members (not all of the same sex) who are members of the community and trained up to be SCRA panel members. They talk to the child and everyone else present, then decide on whether a legal order is needed. They are advised legally by a SCRA Children’s Reporter.

When they make a decision, in my experience they usually go with the social workers’ recommendation. If a supervision order is ordered, it is the social worker’s job to visit the child and family every month without fail and more often if necessary. The case gets reviewed at intervals, decided at that hearing; it may be one month, three months, six months, eight months, a year, etc.

Social work managers meet SCRA reporters regularly for “case progression meetings”. I feel that their being outside of local politics and local spending decisions makes them a welcome check on social work departments. They will kick up if they’re told “Child A can’t go to this resource as the local authority can’t afford it.”

There should be no limit on the amount of money that can be spent on children’s welfare. Remember Gordon Brown’s unlimited war chest? How about an unlimited child welfare budget? A welfare system should be implemented with no illusions that the market place or businesses can help us in that.

There should be no witch hunts of social workers (the Sun is running a nasty campaign to sack all social workers in the Baby P case).

It is complicated for the labour movement to have an effective campaign in the area, as all the cases are different. The media loves heads to roll, but I don’t feel that helps us; we need to get to the truth and prevent it from happening again.

There were mistakes made with baby P by individuals, just as the man who threw his cigarette down led to the Kings Cross fire, and the man who didn’t close the bow doors on the Herald of Free Enterprise led to that ship sinking. We have to look at the whole story and improve things from for the future. The social worker involved is said to be suicidal, and I know Lisa Arthurworry is still suffering eight years after Victoria Climbie’s death.

But there might be a few slogans for us: no witch hunts of social workers; unlimited spending on child welfare services; a nursery place for all children; no waiting lists for support services; pupil support services in every school; a Guidance Teacher for every child

And how about this: a welfare system for children based on the Children’s Act? “The welfare of the child is paramount.”

Why the City’s not scared of the publicly-owned mega-bank

Auntie’s economics wonk Robert Peston explains the motives behind the world’s newest banking group, UKFI plc:

The great fear in the City about the Treasury taking stakes in three of our biggest banks is that this partial nationalisation will turn them into non-commercial public services.

No bad thing, some might say.

But it’s not what the chancellor and prime minister want.

So they are putting the shares that will be acquired for taxpayers in Royal Bank of Scotland, HBOS and Lloyds TSB into a new company that will be owned by the Treasury, but will be managed at arms length.

That company will be chaired by a former finance director of Lloyds TSB, Sir Philip Hampton, who is currently chairman of the supermarket group Sainsbury.

So Sir Phil’s an Establishment figure, and he figures that he’ll be able to both increase cheaper lending to business AND quickly return money given by taxpayers.

No doubt New Labour wants to help the banksters get back to their normal business of fleecing workers, consumers, and small businesspeople.

But that promise of helping out the local businesses that provide so much employment has been made loudly and repeatedly.

Since Sir Phil is likely to side with the City over this issue rather than with the general public, New Labour are delaying a conflict – just as Brown’s policy of the credit bubble was designed to stall industrial conflict.

Robert Peston goes on to say,

And there’s a further risk in its decision to create the vehicle for owning the bank stakes as a formal Companies Act company.

How so?

Well as the chairman of a proper company, Sir Philip could not be formally directed to take this or that action by ministers.

So that promise of helping out small businesses was just that – a promise and no more…

Which begs the question, will the promise to ensure that public money isn’t used to fund lavish pay-offs?

At a time when ordinary people are being asked to show restraint and businesses across the land are preparing lay-offs, the inability of the government to keep these promises could be as haunting as the 10p tax affair.

That’s to say nothing of the HBOS/Lloyds job losses and the future of the Scottish Labour party…

And to think it all started with a former building society called Northern Rock.

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