Door opens to NHS privatisation in Wirral

Below is the speech I gave at last night's full council meeting on the new Integrated Commissioning Hub for Wirral.  I've written about this previously, particularly in terms of the threat it poses to privatisation of health services locally.

Although some 13 Labour councillors agreed with me that this agreement should be referred back to the relevant cabinet committee and several more abstained, a combination of the remaining Labour councillors with Conservative and Lib Dem support, voted the deal through.

This clearly demonstrates the extent of the split in the Labour group on this issue.

You can watch the debate via the council's web stream. My contribution starts at 1.45.23

Two months ago, along with Cllr Sullivan, I warned council that creating an accountable care organisation in Wirral was opening the door to privatisation of health services in Wirral.

 

If council, as I believe many Labour councillors wanted to, had accepted our advice, we could have paused, avoided the call-in, and spent the past two months addressing the serious flaws in these arrangements.

Instead, as the Lib Dem amendment refers, we are told time is short and we need to press on regardless of the long term implications.

I don't believe that's good enough for the people we represent.

And there was ample evidence in the call-in debate to support my concerns.

In particular, Yvonne Nolan's evidence was extremely clear that:

•    this model paves the way for privatisation

•    joint working between council social care and the NHS was entirely possible without pooled funding

•    that, given these concerns and the financial risks to the council, she would have advised caution

To me, that is a polite way of saying "you are making a big mistake here"

Another witness, Dr Derek Timmins went further saying the signing of this agreement "will lead to increasing privatisation of our nhs and more cuts in services"

This all fits in to the wider agenda of privatisation by stealth – creating single organisations with pooled budgets and weak democratic oversight that are ripe private interests to colonise.

In the face of these warnings, the bland reassurance from the cabinet member that this will not lead to privatisation lacks credibility.

In the circumstances and given the limited powers of council to act tonight, the only responsible course of action is to reject the amendment, refer the entire decision back to the cabinet committee and urge them, in the strongest possible terms, to think again.

Climate Emergency

At this Monday's council meeting I am asking Wirral Council to declare a "climate emergency". Here is a copy of my motion:


CLIMATE EMERGENCY

Council notes the findings of the Intergovernmental Panel on Climate Change (IPCC) report ‘Global warming of 1.5°’ published on 8 October 2018, in particular:

that human activities are estimated to have already caused approximately 1.0°C of global warming above pre-industrial levels;

that if we continue at the current rate, we are likely to surpass the Paris Agreement target of 1.5°C as early as 2030;

that, at the current level of commitments, the world is on course for at least 3°C of warming with irreversible and catastrophic consequences for humans and the natural world.

Council believes that:

the impacts of global temperature rise above 1.5°C, are so severe that governments at all levels must work together and make this their top priority.

as well as large-scale improvements in health and wellbeing around the world, bold climate action can deliver economic benefits in terms of new jobs, economic savings and market opportunities.

Therefore, Council requests that the Leader and Cabinet relevant Overview & Scrutiny Committee establish an Overview and Scrutiny Committee working group, with a remit to

(i)   Seek advice from experts to develop a robust carbon budget and set a challenging target date for carbon neutrality in Wirral;

(ii) Consider systematically the climate change impact of each area of the Council’s activities;

(iii) Make recommendations and set an ambitious timescale for reducing these impacts;

(iv) Report to full Council with the actions the Council needs to take to address this emergency.

In addition, Council further requests that the Leader & Cabinet:

-   require all report risk assessments should include Carbon Emission Appraisals, including presenting alternative approaches which reduce emissions wherever possible.

 -  task a director level officer should be tasked with responsibility for reducing as rapidly as possible, the carbon emissions resulting from the Council’s activities.

 - that the leader writes to inform the Prime Minister that Wirral has declared a climate emergency.

NHS privatisation: Letter to the press

Following my recent work in highlighting the threat of creeping privatisation in the NHS and Wirral Council's complicity in this, the following letter has been published in both the Liverpool Echo and the Wirral Globe:


On October 16th, Wirral Council and NHS Wirral agreed to establish an Integrated Commissioning Hub. Wirral's Clinical Commissioning Group will be using it to procure a range of NHS services from April 2019.

This rather mundane sounding agreement has huge implications for health services in Wirral. The background papers confirmed that this agreement "will facilitate the introduction of a wider Accountable Care Organisation across the Wirral." Accountable Care is widely recognised as a means of facilitating privatisation within the NHS.

Currently, in most NHS contracts a needs-based payment is made for each treatment provided to individual patients. But the new contract would pay the provider a fixed lump sum at the start of each year, to cover the costs of a range of treatments for the whole population. This switch from a needs-based payment to a fixed contract is crucial. It means the introduction of rationing for health services. Fixed capital budgets will be allocated which are no longer based on clinical need and must not be overspent.

Despite warnings from myself and others, Labour councillors have chosen to proceed with this agreement. As the campaign group Defend our NHS has said "Members of the DONHS executive are alarmed that Labour councillors have defied their own party policy and voted to open the door even wider to the privatisation of health services in Wirral".

It is clear that the Conservative government is working to privatise by stealth our treasured NHS. It is deeply worrying that Labour councillors in Wirral have helped to facilitate this.

Why is Labour helping to privatise the NHS in Wirral?

update: you can watch my speech via this link starting at 2.37.50

At tonight's full council meeting, a Labour party motion opposes the current closure threat to walk-in health centres across Wirral and explicitly states: “This council is opposed to all forms of privatisation in the NHS”,
 

Tomorrow, October 16th, a meeting of the Joint Strategic Commissioning Board for Wirral will consider a proposal to approve an Integrated Commissioning Hub for Wirral.  This will be opening the door to an accountable care organisation and health privatisation in Wirral.

I've tabled an amendment to Labour's motion asking council to specifically reject plans for an Accountable Care Organisation. These are my reasons why:

I welcome the very clear statement in this motion which states: “This council is opposed to all forms of privatisation in the NHS” and earlier public statements by the Leader of the Council that he opposes the development of an accountable care system in Wirral. Accountable care is widely recognised as a means of facilitating privatisation within the NHS.

Sadly, if the proposals for an Integrated Commissioning Hub for Wirral Council and NHS Wirral in front of tomorrow’s meeting of the Joint Strategic Commissioning Board (agenda item 6) are adopted then this council will in fact be opening the door to an accountable care organisation and health privatisation in Wirral.

There can be no ambiguity about this.  Throughout the associated due diligence report from Price Waterhouse Coopers there is reference to the development of an Accountable Care System and that the Integrated Commissioning Hub is the first step towards this. Crucially, the report concludes by saying:

The introduction of an integrated commissioner with a single pool of funds will facilitate the introduction of a wider Accountable Care System / Accountable Care Organisation across the Wirral.

Significantly, the publication of this all-important due diligence report was repeatedly denied up until a few weeks or so ago. No meaningful and proper public consultation and engagement has taken place. The public has been locked out. This is unacceptable and undemocratic.

If this contract goes ahead, our Clinical Commissioning Group will be using it to procure a range of NHS services from April 2019. 

Currently, in most NHS contracts apart from mental health, a needs-based payment is made for each treatment provided to individual patients. But the new contract would pay the provider a fixed lump sum at the start of each year, to cover the costs of a range of treatments for the whole population.

This switch from a needs-based payment to a fixed contract is crucial. It means the introduction of demand management and rationing for health services. Fixed capital budgets will be allocated which are no longer based on clinical need and must not be overspent.

This is a clear route to new “care models” that are based on the USA’s Medicare/Medicaid system that provide limited health care for people who can’t afford private health insurance.

A new government would be powerless to stop and reverse this because the contracts would be locked in for a continuous period of up to 15 years or more. 

And, we already know how this model operates. In mental health, the introduction of fixed lump sum contracts means that it is now normal for there to be NO hospital beds for acute mental health patients in their own area. They are routinely taken by ambulance across the country to wherever there is a hospital bed. 

This is not a model we should be rolling out across the health service. A model that allows for price competition between providers when bidding for contracts leading inevitably to a reduction in the quality of care and, potentially, a Carillion type collapse.

And, even if an Accountable Care Organisation is initially kept within the public sector it would still decimate the founding principles of the NHS. ACOs represent the breaking up of a single national health service into sub-regional care packages with fixed budgets and rationed services. This means a loss of universalism, comprehensiveness, national terms and conditions and quality standards.

Let me finish by repeating the all-important concluding sentence from PWC’s due diligence report:

The introduction of an integrated commissioner with a single pool of funds will facilitate the introduction of a wider Accountable Care System / Accountable Care Organisation across the Wirral.

There is no legislation in place forcing these changes on Wirral. The changes are entirely voluntary. In fact, if the clear statement in this motion – “This council is opposed to all forms of privatisation in the NHS” means anything then we must say an emphatic and resolute no to Accountable Care in Wirral.

I therefore urge all councillors to support this amendment and send a clear message to the relevant cabinet members that they must not support the proposals for an Integrated Commissioning Hub in Wirral and must not sign this legally binding contract.

Wirral's green belt: under threat from Labour

Last night there was a special council meeting on the threat of wide scale development on Wirral's green belt. Below is a copy of the speech I delivered. You can also watch it via this link starting from 52 minutes in.

The threat to Wirral's Green Belt

Green Party response to full council meeting, September 10, 2018

I know I speak for many when I say how grateful I am to Professor David Gregg for the work he has done in interrogating the government's assessed need for housing in Wirral over the next 15 years.

He has systematically demolished the assumptions used to generate these targets, especially those around the economy and population trends.

Moreover, the very latest population projections dramatically reduce the likely demand for new housing in Wirral. Professor Gregg has shown that the council's own forecasts for brown field housing on top of Peel Holdings medium range expectation for Wirral Waters plus a modest reduction in our many empty homes is more than enough to meet likely future demand.

His analysis on its own provides compelling evidence to robustly challenge the government's target.

And that is the least the people of Wirral should expect from those elected to represent them and preserve our precious green belt.

But that's not what we are getting and, frankly, this council has form when it comes to undermining the green belt.

As we speak, a new fire station is under construction on green belt land in Saughall Massie. The fire services' own figures as part of that planning application clearly showed that response times from the new station would, on average, increase. 

If labour councillors are prepared to sacrifice green belt for a new fire station in a sparsely populated village that increases emergency response times then they clearly have a very elastic view of what constitutes "very special circumstances".

And then there is the proposed golf resort in Hoylake. The economics of this scheme are so questionable it requires 160 executive homes on green belt land. If the cabinet thinks council tax receipts from these new homes is reason to sacrifice our green belt then people will quite reasonably form a view that no green belt land is safe under this administration.

If the monies already spent on the golf resort had instead been spent on vital infrastructure for Wirral Waters then we would be much further down the road in providing the kind of new housing that everyone in Wirral would support. 

Don't forget our empty homes and commercial buildings

Officially, Wirral has 4.650 empty dwellings. Almost 2,000 of these are classed as "long term". But this is an underestimate. I regularly report empty properties in my ward. Many are unknown to the empty properties team. 

I have nothing but praise for the empty properties team. Their response to my enquiries is always constructive and comprehensive. But, with just three full time members of staff there is clearly massive untapped potential to reduce the number of empty properties. This should always be a priority to increase the housing stock. Additional investment can be recouped through increased council tax never mind the obvious social benefits.

And its not just empty dwellings. Last year, Wirral Council submitted planning applications to demolish two of its own office blocks by Hamilton Square and convert them into car parks. Just what Birkenhead doesn't need. One can only hope the new arrangement with Muse will bring more enlightened thinking and recognise the obvious potential to convert such assets into new residential accommodation.

The government's targets are unreasonable and unrealistic

The rate of housebuilding required under these government targets is more than double the actual delivery rate in Wirral over the past decade. Where is the evidence that underlying market conditions indicate such a rapid escalation in demand for new housing? How on earth would the supply chain cope with such a rapid escalation in construction activity?

We already have some of the worst standards for new homes in the EU. Our new homes are smaller and colder than our European peers. If these targets are accepted and implemented we will inflict acres of low quality, high carbon housing, with poor access to public transport. Few if any of these houses will be affordable to those on low incomes.

A council truly concerned about climate breakdown, poor air quality and inequality in housing provision would react with horror at these targets. They would mount a principled, reasoned and robust defence of our green belt. 

All of that is absent from the Labour motion. It raises the white flag and meekly accepts the surrender of our green belt. 

For the sake of our current and future generations that simply isn't good enough.