Forest of Dean & Wye Valley

Why our Campaign to Keep Community NHS Services within the NHS Failed

In C.Spiby on December 14, 2011 at 4:42 pm

by C. Spiby

{this is a revised edition of the article, which has some significant differences to the edition that went to print – please consider this version definitive}

Most if not all the campaigns and struggles that I have been involved with have failed. But as any seasoned fellow traveller will tell you, that alone is not a reason enough to give up the fight. It only begs that we fight harder.

One way to do this is to learn from our campaigns. Forest of Dean Against the Cuts spearheaded the local SOS Again campaign, seeking to keep local community health services within the NHS. It opposed the formation of Gloucestershire Care Services (GCS) as a non-NHS, non-public sector provider of local health services.

But it was the Forest of Dean & Wye Valley Morning Star group which kicked off local opposition against the savage cuts in public spending with UNISON’s Peter Short taking some of the lead. After a couple ofmonths we connected with a fledgling Forest of Dean group. Both sent coaches to the March 2011 march for Public Services in London, which was still seeing activists arrive at Hyde Park as the speeches came to a close at about 4pm that afternoon.

The Forest side of the Morning Star group joined what had now become Forest of Dean Against the Cuts. But the national movement faltered. For sure, UK-Uncut was doing good work with their bail-in’s against legal tax loop-holers like Vodafone, but it was Pete Stanway of the Forest group who brought to the local agenda the issue of community hospitals and health services that were under direct threat through the creation of GCS.

GCS had all the right acronyms: it was to be a CIC(Community Interest Company) created in the guidelines of the SET (Social Enterprise Trust). But, as we warned, GCS was not a charity, and it was not part of the NHS. And it was not in the public sector even, irrespective of how it classified its surplus, not for profit or otherwise.

FoD Against the Cuts bailed-in into Lydney Tesco to highlight the price of public sector cuts, which would, of course, affect the health budget. Meanwhile Tesco was named amongst the biggest legal tax avoiders. There was an almost weekly rant by the group’s activists in the letters pages of the local press, and gradually the profile of our opposition was steadily raised. We were aware, however, that we couldn’t fight a battle on two fronts. The national NHS reform bill and public sector cuts were an entirely different issue to the formation of GCS. What was happening locally was, instead, a warning of what would happen nationally under the reform bill. Either way, the GCS takeover would happen irrespective of whichever way Parliament would vote on the national issue.

So, the takeover of formerly NHS-run local community health services by GCS became the sole preoccupation of the group, which was guided by the 1st October 2011 go-live of the new company.

We believed that few people knew of this out-sourcing, and ever fewer had had the opportunity to voice their opposition to the most fundamental change to our local community NHS health services.

Out of this anxiety and tight deadline arose our first strategic error. In a rush to oppose the formation of GCS we were sloppy with our wording of the petition. It referred to the ‘privatisation of community services’ with specific reference to Lydney and the Dilke hospitals. In my opinion the word ‘privatised’ is publicly loaded with ‘profit’, and this is exactly as Harper read it, and rejected it. Thus when we presented the 2,000 or so signatures to Mark Harper MP, he discounted the claim out of hand and would not countenance any public debate precisely because of the petitions’ wording.

Granted, a Tory MP is unlikely to rebel against his own government on the national issue (of the NHS reform bill), but on the local issue of GCS we at least had Harper on the fact that he had come out in favour of the SOS campaign first time around, when he was in opposition. What should have been awkward and embarrassing for him was brushed aside because of his rejection of our petitions’ claim. No wonder he was happy to write and explain this personally to all 2,000 who had opposed the take-over.

We argued that the spirit of the petition revealed that there was a real fear among the public, that the overwhelming majority of those asked to sign did so gladly and had heard nothing of GCS and the changes –highlighting the lack of proper consultation. But while this enabled us to dissect his position, it still didn’t change the fact of the petition’s wording which is how he was obliged to accept it. Incidentally, when pushed on why he wouldn’t hold a public meeting and/or debate on the topic he simply declined saying ‘He didn’t have to,’ and ‘Didn’t want to.

Our meeting with Harper wasn’t helped by a number of us seeking to oppose both the local issue and the national NHS reform bill at the same time. This presented a mish-mash of opposition based on ideology alone, not solid argument. He clearly thought we opposed what was happening by default and took none of our claims seriously. These two separate issues was used by Harper to belittle our concerns for attempting to mix them. Despite assurances that we knew they were separate we failed to present a coherent opposition at that meeting and had no solid demands of our MP. He was good enough to entertain our views for 45 minutes or so, but that was the extent of it. Otherwise we had handed him a useless petition which he would rebuff in his own letters to signatories, and without a voice for our argument.

Bruised but undeterred we sought to organise our own public meeting. We arranged good speakers from both the Royal College of Nursing and UNISON NHS.

But here again, we failed to present an entirely coherent front sending mixed messages over whether or not people should challenge GCS execs at a forthcoming presentation to the Dean Health Forum, for example.

We did, at least, have a letter prepared on the national issue and Diana Gash personally delivered the letters to Harper’s Westminster office on the day of the Bill’s next reading in Parliament. But Harper was undeterred and supported the Bill’s onward progress.

Someone in the audience that night raised what seemed like an odd question at the time, asking why hadn’t we done something before? October by that point was barely weeks away. This seemed obtuse – we are all voluntary activists trying to do what we can with what we have – but, on hindsight, it was a point well made, even if the questioner didn’t realise how pertinent their enquiry actually was.

In fact, the issue only came to light after we had repeatedly been fed by GCS and its allies that the decision to outsource the services was not made by GCS, but by the board of the Gloucestershire Primary Care Trust (PCT) and that we had to direct our questions and opposition to them.

In what I see as the last days of the local campaign, we finally got to the nub of the problem and it all began with New Labour. In reality we had missed the policy created by the former government which gave rise to GCS, and the legislation which sought to split commissioning of services with provision. The stark reality is that we had missed the point at which our opposition should have started.

The original SOS campaign had halted closures of our community hospitals, but in its wake the New Labour government had created the NHS Operating Framework (in2010). This sought to split PCT commissioning so that they couldn’t be providers and commissioners of their services at the same (you will recall the new NHS reform bill seeks to achieve this with GP commissioning and ‘any willing provider’). This has left the door wide open for what many see as creeping privatisation in the NHS.

All of this should have been uncovered at the start of our campaign. We had passion and anger in spades, but I feel we failed to take responsibility for our claims and for the detail. Of course, as a member of the group I too hold that responsibility and had failed.

We missed the boat and should have opposed the original policy and legislation first came into being. Perhaps it was – but I am unaware of any such local attempt to oppose it, and therefore any such attempt failed.

It was all too little too late. We had some victories, though. Ironically, the local Labour Party executive issued a statement against the formation of GCS, pushed by our lobbying of it.

As the countdown to the 1st October transfer finally came a last minute legal challenge seems to have postponed GCS at the last breath. This seeks to oppose the transfer based on irregularities of the tendering process. But in a letter issued to GCS staff on the back of the challenge, the PCT said: “If taken to its logical conclusion the challenge would mean that community services would be competitively tendered with the result that bodies both within and outside the NHS sector could respond.

Well, YES, that was kind of OUR point, which is why we were worried. We don’t want private companies wading in. But you can be sure the PCT will hide behind the policy instruments. Even if we won that contest, we’d actually be bringing forward our worst fears. It is a risky strategy.

Perhaps a groundswell will enable us to oppose the national policy now – now that we can see the consequences of it. But I rather doubt we will get the Tories to reverse it when their national NHS reform bill seeks to put the GCS project example into legislation at best, ‘any willing provider’ at worst.

The lesson learned is that we came to the argument too late. For sure, we asked GCS some embarrassing questions in public meetings and got about 100 people to our own meeting at the Miner’s Welfare Hall. But the question really was spot on when it was asked ‘Why haven’t we done anything before?’

This is more philosophical than it first appears.

How is it possible for activists let alone concerned citizens to be aware of all policies, legislation and boardroom decisions and their ramifications all of the time? Whose duty is it to impart this information? How accessible is this information, both physically and intellectually? How can we hold governments and local public bodies to account, particularly when policies go across the floor from Parliament to Parliament even with a change of government?

Perhaps it is this powerlessness which is truly the best example of what it really means to be living in a ‘Broken Britain’.

Perhaps it is from this powerlessness that the ‘occupy’ movement is drawn. The anti-war march of 2003 proved that marching alone probably isn’t enough anymore.

This is a personal view and does NOT represent the views of Forest of Dean Against the Cuts, The Clarion or the SOS Again campaign. On the national NHS reform Bill, please ensure you write to as many Lords as you can to ensure they don’t allow the Bill to proceed.

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