Another fine mess

Another fine mess!Two years after promising to abolish them, the government has now reinvented the community health council.

Speaking during the Lords debate on The NHS Reform and Healthcare Professions Bill health minister Lord Hunt said that the new PCT Patients Forums will now: enable people locally to express their views about health matters; monitor and review local services;employ staff to commission or provide independent support to help individuals to make a complaint;work to empower their local population to express their views about health issues that matter to them; and offer a one-stop service by providing advice and information to the public about public involvement and complaints processes.

In other words, they will offer all the services that CHCs currently provide. Unfortunately, because there will be many more PCT Patients Forums than CHCs, but with no extra money, the new Forums will be even more under resourced for their work than the CHCS were. And the new blueprint for the PCT Patients Forums remit could well overlap, duplicate or even conflict with the local authority health scrutiny and overview role.

When the government was working on The NHS Plan, the intention then was not to abolish but to reform CHCs, and the Secretary of State of the day, Frank Dobson MP, was robust in his support for reformed CHCs. CHCs were to be reduced in number and would cover a greater catchment area. They would have more staff and more resources. Their Councils would be reduced from the present 24 members of assorted provenance to a more manageable eight. These eight members would be selected through a stringent recruitment process, and would be chosen for their commitment and ability effectively to represent the public interest in their local NHS.

These reformed CHCs would complement the other proposals for patient and public involvement in The NHS Plan, and the reforms were well thought out. However, at the last moment and without warning or consultation, the reform proposal was dropped and replaced in the final NHS Plan with the single statement of intent to abolish CHCs.

This provoked a huge backlash, and not just from the opposition parties, and the government was forced to put abolition on hold while it enacted the Health and Social Care Act. After the Election, and with CHC abolition this time in the Labour Partys election manifesto, the proposal appeared in the NHS Reform and Healthcare Professions Bill. Again, however, opposition was wide ranging because the structures intended to replace CHCs were neither independent nor integrated, and they were also incomprehensible.

Following fierce all-party opposition in the House of Lords, ably supported by David Hinchliffe MP and Linda Perham MP amongst others in the Commons, the governments compromise to transfer the bulk of the CHC role and responsibilities to the PCT Patients Forums was finally accepted.

It has taken two years to reach this unsatisfactory state, and the new arrangements will be far less effective and robust than reformed CHCs. In the process the government has also managed to alienate many of its natural supporters, lost the services of many talented CHC staff and members, and demoralised those members and staff who remain. Had the original proposals for CHC reform been progressed, the mechanisms for effective public and patient participation in health care would already be up and running.

RIGHTS NOT COMPULSION

Mental Health Alliance Marchand RallySaturday 14 September 2002

Gather at 12 noon in Whitehall Place, London SW1.March to the Rally in the Geraldine Mary Harmsworth Park at the Imperial War Museum.

The government has published a draft Mental Health Bill that, if enacted, will be the biggest change in mental health legislation for 20 CONTENTS

National Poet

Some challenges for Primary Care Trusts

Innovations in Primary Care

Better care for refugees and asylum seekers in London

Now we are Ninety!.

The State Medical Service Scheme

A few reasons for advocating a State Medical Service

A Diamond Jubilee and a Centenary.

Obituary: Dr. D. Elizabeth Hilliard (Bunbury)

Forthcoming SHA Meetings..

SHA Conference: involving patients and the public in healthcare.

Fringe meetings at Labour Party Annual Conference 2002 ..

Branch contacts

Socialist Health Association22 Blair RoadManchesterM16 8NS

Tel: 0870-013-0065admin@sochealth.co.uk

Editor: Judith Blakeman

The views expressed in this journal are not necessarily those of the SHAyears. It will affect everyone who uses mental health services, their carers, and those who provide services. The effects will be felt for many years.

There has been widespread criticisms of the draft Bill, and the Mental Health Alliance (and others) are determined to change it. The best of the proposals such as rights to advocacy and a new tribunal system must be retained, but there must be changes to the parts that could see far more people subjected to compulsory treatment. What the Bill lacks is any right for people to receive the mental health services they need.

The Mental Health Alliance is a coalition of organisations established to comment on the draft Bill. The Alliance is calling for rights, not compulsion, including:

a reduction in the use of compulsory powers;an individual right to assessment of needs, and to have those needs met;statutory enforcement for advance directives;a law that takes account of peoples capacity to make their own treatment decisions;adequate safeguards governing treatment without consent.

For more information see:www.mentalhealthalliance.org.uke-mail to mha@mind.org.ukor telephone 020-8215-2323_______________________NATIONALPOET

Carol Batton is one of the most prolific and popular poets in Manchester. She is also out as a manic-depressive. Through her poems about psychiatry in a wide sense Carol hopes to inform a larger audience and help to create a kinder and better understanding of mental ill-health. She was reappointed as the SHAs National Poet at this years annual general meeting, and has sent us some new poems, some of which appear in this edition of Socialism & Health.Those with Mental Health Problems

Those with mental health problemsIncludeDeluded, demented, depressed,Drug-addicted, alcoholic,Food disordered, hyper, very hyper,Under-active, withdrawn, too extrovertToo angry, never angry, unable to grieveValium-addicted, psychopathic,Unemployed, sexually-abused,Over-religious, traumatised, abused,Cant cope, still cant cope, ante-natal,Isolated, over-worked, peri-menopausal,Disorganised, still cant cope,Semi-orphaned, poverty stricken,Homesick, and hysterical.

Is that Everyone?

Carol Batton11 April 2002_____________________________

Some challenges for Primary Care Trusts

A PCT board member writes . . .

With the introduction of Strategic Health Authorities, primary care trusts (PCTs) have new responsibilities, enhanced roles and an involvement in the widest spectrum of health care across broad areas. One new and fundamental PCT responsibility is to improve the overall health of its population, but without the ability to influence all the determinants of that populations health.

Contradictions

There are also some implicit contradictions in the requirement for PCTs to meet national targets and the new NHS Plan responsibility to reflect local needs and priorities. National targets do not necessarily reflect local priorities, and a balance must be struck between any conflicting demands.

Public health issues will play a key part in improving the health of the PCTs local population, and the ability of a PCT to develop its public health role to suit local needs is dependent on having the right staff. It may also be appropriate for neighbouring PCTs serving similar communities to share some specialist public health staff.

In addition, the PCTs responsibility for health improvement must be delivered in close liaison with other local strategic bodies, and the PCT may have to contribute to the Local Strategic Partnerships of more than one local authority. However, local authorities themselves may have differing local priorities and capacities, and the PCT must ensure that its local authorities themselves are fully aware of their own responsibility for the health of their populations.

Capacity issues

PCTs must have the management and staff capacity to deal with their enlarged responsibilities and to liaise effectively in partnership working with other members of the local health economy including neighbouring PCTs, acute hospital trusts, the ambulance service, the mental health trust, and social services departments. Additionally, they must develop effective partnerships with the wider local community, such as local branches of unions and health professional bodies, voluntary sector and community groups, and service users.

The patient experience

In seeking to develop better primary health care in the 21st Century, it can be a very complex process disentangling the many strands that contribute to health care, and delivering quality care in new ways means that the experiences of the patient will crucial. New developments and innovations in health care provision must be designed with user involvement from an early stage, and to achieve this, staff time and resources must be available.

The expertise of health professionals, no matter how proficient they are at their job, can be negated if the patients perception is one of individuals with no time to listen and explain what is happening. A patients journey through one episode of health care can achieve a good medical result, while also being a frustrating experience if effective communication and understanding is not shared between the health professionals and the patient.

It is important, too, to remember that staff and their families are also users of the service, but involving staff in decision-making means top level support for time out for meetings and discussions, as well as administrative support. If the NHS is serious about effective staff involvement at all levels, it must recognise that there is a cost element.

Patient participation

Members of community health councils (CHCs) and the successor Patients Forum members must also be involved. These individuals may be expert patients or they may be informed citizens. However, care must be taken to reduce the danger of the patient who is focussed on a single issue or who has an axe to grind becoming too involved in a one dimensional way.

The use of juries or health panels to assess community reactions to health issues may also be very useful. It is usual to find that every health organisation has some contact with patients and users in both informal and structured ways. The PCT should thus identify and co-ordinate existing involvement, identify gaps and develop ways to fill them, and engage with them in ways that are appropriate for the local community.

Major new challenges

The Shifting the Balance of Power agenda therefore sets major new challenges for PCTs. For their part, the PCTs must embrace these challenges and develop new and innovative ways of delivering high quality primary health care with enthusiasm and commitment.Innovations in Primary Care

PCTs now have the opportunity to experiment and innovate in the way that local primary health care is delivered. An SHA member has drawn our attention to the Access to Primary Care project initiated by the Somerset Coast PCT, as an example.

This project aims to improve patients out of surgery opening hours contact with a variety of health care services. Patients need to make one telephone call, their conditions will be assessed, and they will be advised and/or directed to the most appropriate service, such as an on-call GP, the local ambulance service, the minor injuries unit, a community nursing service, or a community hospital. If the problem is less urgent the patient will be referred to his/her own GPs surgery the following morning.

The Advice Line gives advice on common illnesses and injury self-care, providing advice also on general health questions as well as more serious complaints. The nurse staffing the advice line is supported by an on-call local GP, who will be available for treatment and medication if required.

Many additional services are available through this innovative out of hours service. These include the minor injury unit and minor illness clinic at the local community hospital, extended cover from community nursing teams, and nurse led telephone triage and advice during the out of hours period. Care is also provided by the Rapid Response Vehicle in addition to the regular emergency vehicles. The rapid response vehicle is staffed by a local paramedic, and is fully equipped to respond to any emergency call.

Socialism & Health would like to hear from PCT Board members and others about any local innovations and examples of good practice that they wish to share with a wider audience.Tomato

My grandma was a tomatoMy grandfather was a tomato.But in betweenTheyve added a gene,And now Im a bastardSoya bean.

Carol Batton16 February 1999

Better Care for Refugees and Asylum Seekers in London

The first resource pack for health care workers who care for refugees and asylum seekers in London was launched recently by the London Directorate of Health and Social Care.

Meeting the health needs of refugee and asylum seekers in the UK: an information and resource pack for health workers is a handbook providing comprehensive information to help improve the health care offered to refugee and asylum seekers in London. It was written by Dr. Angela Burnett and Yohannes Fassil, both of whom have extensive experience of working in the health service, and both of whom have a personal interest in refugees and asylum seekers.

Refugees and asylum seekers arrive in the UK seeking help. They may have suffered traumas that the host population cannot begin to imagine. Around 85% of refugees and asylum seekers who enter the UK settle in London. Some have need of special care and resources. However, they often miss out on appropriate health care because of the lack of guidance and advice available to healthcare workers.

This resource pack provides a good understanding of how to meet their needs. It is user-friendly and provides information and lists of useful contacts. It is designed to be read either in full, or to be used as a reference point. The pack provides an array of useful tools and information designed to help GPs and health centres provide the best possible healthcare for refugees and asylum seekers.

Asylum seekers and refugees are entitled to NHS care. However, difficulties can arise through, for example, trying to understand their health problems. Access to an interpreter or translation service is vital. The resource pack provides help on this, and much more. It will be updated regularly on the Internet, and is now available through the Department of Health website.

The Department of Health has also commissioned the Refugee Council to produce a resource pack for NHS and social services staff on the health and social care needs of asylum seekers who are dispersed through the National Asylum Support Service. At the time of writing this was not yet available, but is expected shortly.

The London resource pack is available at www.doh.gov.uk, and details of the Refugee Council pack in preparation can be obtained from Alison Beedie on 020-7210-4985 or Michael Swaffield at the Specialist Health Services Directorate on 0113-254-5002.

The Tranquilliser

A Tranquilliser is painful;But you must take it;It calms the Doctor.

Carol Batton,August 2001

Friends

I have friends.Therefore I am socially included.

Carol Batton July 2000

Relax

Relax ...

There is absolutelyNothing thePsychiatrist can do!So take off yourSlippers, forgiveYourself, and cry!

Carol Batton_____________________________

Now we are Ninety!

A brief foray into the archives of Socialism & Health reveals an interesting letter from the late Dr. Elizabeth Bunbury. In it she says that some of the founders of the Socialist Medical Association (SMA) always regarded the State Medical Service Association (SMSA), founded in 1912, as the precursor of the Socialist Medical Association. The SMSA was a non-party organisation, although it was heavily influenced by the Fabian Society.

Sadly, reference to Dr. David Stark Murrays definitive history of the SMA/SHA Why a National Health Service? indicates that we cannot truly regard the birth of the SHA as 1912, since in 1930 the SMSA very briefly ran alongside the newly formed SMA. However, there was continuity in personnel, since the first President of the SMA Mr. Somerville Hastings, at that time MP for Reading and subsequently for Barking, was also the President of the SMSA. In that dual role he recognised that the SMA was the organisation of the future, and consequently the SMSA withered on the vine.

Within our archive, two SMSA pamphlets survive The State Medical Service Scheme, a paper read before the Bournemouth Division of the British Medical Association on Wednesday 2 October 1912 by J. E. Esslemont MB, and A Few Reasons for Advocating a State Medical Service, author unknown.

The State Medical Service SchemeA summary of the 1912 paper by J. E. Esslemont MB

In 1912 a key debate amongst Medical men (sic) was the organisation of the profession. Three possible models were being debated: a State Medical Service in which the bulk of the profession will become a branch of the Civil Service;a Public Medical Service organised by the profession itself; and practice that remains as purely private as possible.

Mr. Esslemont comes down firmly on the side of a State Medical Service, albeit one that is compatible with and working side by side with private practice for well-to-do individuals. He felt that the countrys medical service would be improved by closer affiliation with government, and that government would be improved by closer affiliation with the medical profession. He drew attention to six benefits.

Research

The first is research, and Esslemont notes that the country is falling way behind Germany in making strides in science and industry. In Great Britain, provision for research work depended chiefly on the capricious support of private beneficence. The list of preventable diseases was short, and that of unpreventable ones very long. Furthermore, what little research that was undertaken was not being collected, classified and disseminated.

Preventive treatment

Next comes preventive treatment. Issues that needed to be addressed included bad housing, bad drainage, tainted milk, unhealthy trades, segregation of infectious diseases and the like a list that remains familiar to this day. The role of an efficient public health service, allied to efficient research, would be swiftly to transfer the list of unpreventable diseases to the list of preventable diseases, and thence to the list of prevented diseases. Chief amongst these was tuberculosis, a wicked waste of life . . . going on unheeded and unchecked. We forget what a scourge that disease was until very recently in this country, and we should note with concern its return as a manifestation of poverty and homelessness.

A State Board of Health

The next need was the establishment of a State Board of Health composed of leading members of the medical profession and with a President of Cabinet rank, acting as both an advisory and an administrative body. It would receive research reports, make recommendations to government on public health matters and other legislation and it should be able, when necessary, to demand the expenditure of millions for public health with the same assurance as the Admiralty asks for Dreadnoughts!

Its administrative role would be wide ranging, including examinations for admission to the profession, supervision and control of the work of all branches of the medical, dental, nursing and pharmaceutical professions, the administration of all hospitals, asylums, nursing homes, sanatoria and other medication institutions, and the promotion of research. Esslemont speculated that eventually, through this Board, the medical profession could come to exert an influence in the affairs of State commensurate with that which the legal profession, the Church, the Army and Navy exert now and that considerations of health, heredity, and the improvement of the race . . . will at last receive serious attention.

The ordinary practitioner

The role of the ordinary practitioner in the State Medical Service would also be addressed. Practitioners in those days felt that their work was being encroached upon by the public health officer, the schools medical officer, the hospital, sanatorium and one public institution after another and that far greater encroachments were coming. Esslemont notes that the poorer classes, even with the utmost assistance of voluntary charity, are unable to provide for their own adequate treatment and that it would pay the State to look after the health of the poor. Practitioners should therefore welcome the advent of the State into the field of general practice so long as satisfactory financial arrangements were in place. In effect, Esslemont is promoting a salaried GP service which would be remunerated partly by salary and partly by capitation fees, and would include even such benefits as a course of post-graduate study on full pay.

Hospitals

The State Medical Service would promote a great increase in the number of hospitals, with a much larger number of medical men than at present. These would over time be brought into the National Scheme and be used for consultative, operative and therapeutic work at the request of . . . the patients own doctor. Each district or town would also have its own Central Medical Depot, including pathology and laboratories, a medical library, district nurses and a drug and dispensing department.

Promotion

Finally, Esslemont considers the promotion (or career prospects) of his medical men, believing that too much consideration is given to seniority and social status and too little to keenness and ability, the result being that enterprise and originality are discouraged, and the service attracts the wrong class of men. The State Medical Service would move the round men in square holes, or feeble men in powerful positions in favour of fitness for work, letting the best man win, no matter what his age or his origin.

Esslemont sought to re-assure the members of the Bournemouth BMA that he was not proposing a cut and dried scheme but merely highlighting the need for a new scheme, stressing in particular the roles of research, prevention and hospital administration that the BMA in 1912 did not consider part of its remit. He argued that while medical attendance and medicine had their places, there was a fundamental need to devise a plan or organisation which shall cover the whole field of medical work and deal with the problem of the Nations Health in a scientific and statesmanlike fashion.

A Few Reasons for Advocating a State Medical Service

This 1912 SMSA pamphlet presents thirteen good reasons for advocating the creation of a State Medical Service. These include:

the waste of medical resources generated by competition and overlapping functions between the various branches of the medical profession;the need to free medical men and women from such distasteful and incongruous work as the assessing and collecting of fees for services rendered;the need to establish the medical profession firmly as a scientific calling;the need for large scale spending on investigations into the prevention and cure of disease;the unequal distribution of doctors that left a very considerable portion of the poorer class with no proper medical supervision;the reform of a hospital system that was at the mercy of uncertain and inadequate voluntary charity and not keeping pace with modern scientific methods;the lack of opportunity for practitioners to refresh their knowledge and become acquainted with modern methods and practice;the need to guarantee every medical practitioner an adequate and certain salary, gradual promotion and a generous pension.

How far the NHS has overcome these shortcomings and achieved the objectives laid out so clearly in 1912 is still a matter for debate in 2002!_____________________________

A Diamond Jubilee and a Centenary!

Nevertheless, in some respects we may lay claim to being 90 years old and, although we will celebrate 75 years of the SMA/SHA in 2005, we could perhaps also consider celebrating the Centenary of the first demands for a national health care service in 2012._____________________________

OBITUARY

Dr. D. Elizabeth Hilliard (Bunbury)

Dr. Bunbury, the widow of Dr. Leslie Hilliard, died in her 98th year on 10 June 2001.

She was the only child of missionaries, born in Hong Kong in 1903. She started her medical training in 1921 at the Royal Free Hospital Medical School, and decided to specialise in mental illness once she had qualified.

She met and married Dr. Hilliard in 1936 while they were both at the Maudsley Hospital, and throughout their 60 years together their partnership extended to all their activities in a manner reminiscent of Beatrice and Sidney Webb.

After the Second World War, Dr. Bunbury worked to rehabilitate patients damaged by war service and also with the survivors of the Japanese POW camps. She and her husband were by then very active members of the Socialist Medical Association.

Both were on Central Council and were members of the SMA group known as The Buniards, playing a leading and consistent role in the demand for a National Health Service. They also campaigned avidly to humanise the treatment of mental illnesses.

Elizabeth Bunbury was for many years the editor of Medicine Today and Tomorrow and its successor journal, Socialism & Health. She was also Honorary Secretary of the SMA for five years until 1950.

Dr. Bunbury was fascinated by plants, nature and gardening. After the War she created a garden at the Tooting Bec Hospital out of the post war debris, planting cherry trees and turning the garden into a haven for bees as well as a calm and pleasant space for the patients of the Hospital.

She and her husband also established a childrens zoo there for the benefit of children who otherwise had little contact with animals.

On their retirement to Bath, she and her husband fostered a number of museums and she continued to develop beautiful gardens. She was also instrumental in the restoration of the ruined Lansdown Tower, beside which her ashes were scattered, joining those of her father and her late husband.

When Elizabeth Bunbury retired in 1950 as Hon. Secretary of the SMA, Somerville Hastings paid her and her husband the following tribute:

it is not only for what they have done that Elizabeth and Leslie deserve the respect and affection of us all, it is for what they have been and are the best of friends and colleagues, always ready to listen always ready to help.

It is because they have put above all else the welfare of the organisation they have so well served and because they have maintained in it the true spirit of socialism that we revere and respect them..

forthcoming SHA MEETINGS

Saturday 7 SeptemberScottish Branch MeetingNational Policy Forum11 a.m. to 2.00 p.m.Edinburgh City Chambers, Edinburgh

Saturday 14 SeptemberLondon National Policy Forum and SHA Central Council11.00 a.m. to 3.00 p.m.Wesleys Chapel, Old Street, London EC1.

Saturday 14 SeptemberLiverpool Branch MeetingNational Policy Forum 7.00 p.m.Liverpool TUC24 Hardman Street, Liverpool L1 9AX

Saturday 21 SeptemberWest of England Branch MeetingNational Policy Forum with Doug Naysmith MP9.30 a.m. to 12.30 p.m.Gatehouse Centre, Hareclive Road, Hartcliffe, Bristol BS13

Saturday 28 SeptemberManchester Branch MeetingNational Policy Forum11.00 a.m. to 1.00 p.m.22 Blair Road, Manchester M16 8NS

Saturday 16 NovemberSHA Central Council with David Hinchliffe MP11.00 to 2.30 p.m.Wakefield

(To be confirmed)________________________

SHAConference

Involving Patients and the Public in the NHS

Friday 29 November 200210.00 a.m. to 4.00 p.m.London Voluntary Sector Resource Centre356 Holloway Road, London N7 6PA

Speakers include:

David Gilbert Head of Patient and Public Involvement, Commission for Health Improvement

Peter Walsh Director, Association of CHCs of England & Wales

Christine Hogg Department of Health Transition Advisory Board

Pauline QuennellManchester University

Dr. Iain Chalmers

To book your place contact

Martin RathfelderSocialist Health Association22 Blair RoadManchester M16 8NS

Tel: 0870-013-0065

e-mail toadmin@sochealth.co.uk

Canter

I seek to take a canter by the Seas of TimeI ride the shores bright edge at the very tideFor all we can see from saddle can be ours til dyin

If I fall off horses, I cannot keep from cryinAnd that is always why I cried;I seek to take a canter by the Seas of Time.

It can hurt to ride a horse The goings never fine (at night),But from the higher saddles God can hardly hide.All we can see from saddle can be ours til dyin

I never fall off,(You never hear me cryin);Though I am lyinI never canter fast Because its hard to ride . . . Im only cantering within a Sea of Time Id trot, if Time were .longer than my life.

Im trying to go further, and see things not mine.Sometimes I feel that nothing has ever died For all we can se from saddle can be ours til dyin

Both Love and Leaf the world can shine divine,Both I and nature, both like bride and brother;I seek to canter by the Sea of Time;For all we can see from saddle is ours til dyinEven though were crying.Carol Batton6 June 2002_____________________________contact the SHA

Do you have a point of view? The pages of Socialism & Health are open to everyone. All letters and articles will be considered for publication.

And the SHA welcomes any other expertise or help you can offer to ensure that the SHA remains a dynamic and respected campaigning pressure group in the 21st Century.