More cuts in cancer treatment and care

There are more than 2 million adults living with cancer in the UK.

On 23 May, I revealed the massive increases in the number of people waiting for cancer endoscopy tests. [See: ‘Now cancer diagnostic times up’ below]

Yesterday, it was revealed that the Government is planning sweeping cuts to the funding of England’s 28 Cancer Networks, which play a vital role in improving the quality of care for cancer patients.

This year, the funding for cancer networks alone was £18.5 million. Now, it has been confirmed that the budget for all clinical networks, including cancer networks, is to be slashed to just £10 million next year.

Cancer networks play an absolutely vital role in improving the quality of cancer care, by bringing hospital and community services together, sharing best practice and involving cancer patients and the groups that represent them.

Started in 2000, the cancer networks have been key players in increasing survival rates, and improving the quality of treatment and care. The North Trent Network – covering South Yorkshire and North Nottinghamshire and North Derbyshire is based in Sheffield. This area has one of the highest levels of cancer incidence and mortality in the country.

Sheffield’s Weston Park Hospital is a world leader in cancer research and provides many specialist services that are only available in a few places across the country. It is onw of only three purpose built specialist cancer hospitals in the United Kingdom. Many of the services provided at the hospital are used to treat patients from all over the country.

We have made huge progress in diagnosing and treating cancer in the last decade. Now, this Government seems intent on destroying the foundations of better cancer services.

It is wasting billions on a massive, quite unnecessary, top-down reorganization of our NHS, whilst increasing waiting times for diagnosis and treatment in all health specialties, including cancer.

Paying the price

The Conservative-led government has started a number of hares running on pay, pay bargaining and security of employment.

First, a number of Conservative MPs started a campaign to scrap the National Minimum Wage. Currently, the government appears to have no appetite to pursue this.

Secondly, David Cameron commissioned Adrian Beecroft, a Conservative Party donor and venture capitalist – whose investments include the controversial high-interest pay-day lender Wonga, whose loans can carry an interest rate of more than 4000% –  to propose reforms to employment law.

Beecroft made proposals to scrap ‘unfair dismissal’ and give powers to employers simply to dismiss employees, for whatever reason, with minimal compensation.

Beecroft said "The downside of the proposal is that some people would be dismissed simply because their employer did not like them. While this is sad, I believe it is a price worth paying for all the benefits." Older readers will remember that it was Conservative Minister Norman Tebbitt in the 1980s who told us that “unemployment is a price worth paying.”

After considerable opposition from several employers’ organisations, it appears that the government is backing away from many of Beechcroft’s proposals, although it has doubled the time in employment before any claim for unfair dismissal can be made.

Thirdly, the government proposed scrapping national pay-bargaining to be replaced by workplace negotiations and the introduction of regional pay in the public sector. George Osborne instructed all the Independent Pay Review bodies to consider how they might do this.

In the UK, nearly a quarter of all people in employment have a job in the public sector – in the NHS, schools and universities, government departments and agencies, local councils. The local proportion varies considerably – more than 50% in Nick Clegg’s Sheffield Hallam constituency to less than 20% in my own constituency of Sheffield South East.

Any regional pay arrangements would inevitably exacerbate the North/South divide, as areas with higher unemployment would see wages falling in relative terms and, perhaps, in actual terms. Academic analysis of the data also shows that women in low-paid jobs in areas of the highest unemployment would be the hardest hit by such proposals.

In reality, although there are national arrangements and agreements for most public sector employees, these already provide for many local and regional variations. So, for example, teachers in London are paid more than teachers doing the identical job in Sheffield.

But, it also worth considering what actually happens when national agreements are replaced with regional and workplace arrangements.

-         After privatisation in 1996, rail industry earnings rates accelerated ahead of general earnings and by 2002 they were nearly 50% higher. Real earnings of train drivers moved ahead of general rail industry earnings throughout the period, and by 2002 they stood 80% above general manual earnings.

-         In the 1990s the Conservatives introduced local pay bargaining to the NHS. A review of the experience notes that this was not a great success, with evidence of significant additional costs in managing the process and massive increased complexity.

-         Local councils are free to set pay as they wish, but the vast majority choose to negotiate through the national arrangements. About 40 councils have local arrangements, but most still closely shadow national agreements and find little advantage in local variation. Between 2001 and 2008, pay under the national arrangements increased 26.5%, whereas local deals produced a 27.8% increase.

So, the evidence suggests that the government’s objective – cutting public sector pay, under the guise of being responsive to local employment markets – is unlikely to be realized by regional or workplace bargaining.

Opposition to these proposals has now come from Conservative and Liberal Democrat MPs in the North and in marginal seats. Nick Clegg’s recent opposition is a little surprising when one remembers that the Liberal Democrats opposed the National Minimum Wage and supported different Regional Minimum Wages.

So, the coalition now appears to be getting cold-feet about these proposals as well..

But, there are so many u-turns being made that it’s difficult to keep up.

Housing shambles

The real impacts of the Government’s economic policies were exposed this week as official figures revealed that affordable house building had collapsed across the country.

In 2010/11, 49.363 affordable homes were started. This was the legacy from the last Labour government’s policies. In 2011/12, the numbers had slumped to just 15,698 – a 68% fall – a direct result of the government’s decision to cut the housing budget by £4bn.

Locally, the figures are even worse. In South Yorkshire, there was a 75% slump. In the whole of Sheffield, just 2 (yes, two) new affordable homes were started in 2011/12.

To put this in context, the government itself predicts that an average 232,000 new homes need to be built each year for the next 30 years, just to keep pace with household formation.

Last week, the official figures also revealed that more than 50,000 homeless households met the strict criteria to be housed by their local council during 2011/12 – a 14% increase on the previous year and a worrying 26% rise on 2009/10. There has also been a 44% increase in those housed in bed and breakfast accommodation.

These figures simply illustrate the disastrous impact of the Government’s housing and economic policies and the need for urgent action to build much needed homes and get the economy going again.

The Government has been warned time and time again that its policies would make the housing crisis worse - locking families out of the housing market, fuelling rising rents in the private rented sector and leaving more people on housing waiting lists. Unfortunately, it doesn’t seem to want to listen. 

Losing energy

Energy bills are soaring, driving up inflation and contributing to the cost of living crisis afflicting millions of families hit by the recession. At the same time, energy companies are enjoying huge profits.

This week, it was revealed that an energy trader for E.ON – one of the Big Six energy companies operating in the UK – had lost £20m betting on European energy prices. There is no transparency in the speculative trading activities of the energy companies.

There is now a real suspicion that the COMPANIES are privatising the profits from this speculation – for the benefit of the shareholders - whilst socializing the losses – meaning that we all meet the cost of those losses in our bills. I’ve written to the regulator, OFGEM requesting a comprehensive investigation.

The government’s only answers to rising energy bills are to tell consumers they’re to blame for not shopping around enough and to cut back on the support it is offering to help people heat their homes.

There are things the government could do.

• First, it could make the energy companies check that all pensioners over 75 are on the cheapest possible tariff – saving up to 4 million pensioners as much as £200 a year.
• Second, it could make the energy companies ensure that all vulnerable pensioners and low-income families with children at risk of fuel poverty, and who receive the Cold Weather Payment, automatically receive the Warm Homes Discount.
• Third, it could reform the energy market by breaking the dominance of the Big Six, by requiring them to sell power into a pool, allowing new businesses to enter the market, increasing competition and driving down energy bills for families and businesses.
• Fourthly, it could protect small businesses from the energy companies’ rip-off tactics.

But, I don’t expect it will.

Betts tells councils – make a fuss

Local government is faced with reshaping services in an uncertain world – and with government's plan for reform looking fragmented, select committee chairman Clive Betts tells Public Service Events' Redesigning Local Services conference. There are solutions, reports David Allaby


Clive Betts, the Commons Communities and Local Government Select Committee chairman, could muster only a hesitant prognosis for local government as he opened his address to local government officers at Westminster Central Hall: "The reality is we have enormous uncertainty and I don't think anyone in the room could say with certainty where we will be in 10 years time." 

The former leader of Sheffield City Council, a keynote speaker at Public Service Events' Redesigning Local Services conference, feels that reform of local services is fragmented and some government departments show little interest in or have any plan for localism and devolved powers. 

"If I say what have free schools, police commissioners and GP commissioning got in common, it is that they have been thought up by different government departments in different ways without any thought to how they relate to the whole and how strategic accountability at local level can take place," he told the conference.

Betts believed the troubled families' initiative was full of possibilities. "But are we really going to get the Home Office, the police, Department for Education, councils and DCLG all signed to troubled families budgets, and how on earth do payment by results fit?" he asked. 

"How do you deal with academies, free schools or police commissioners who decide they don't want to take part in a troubled families budget because they all have their independence. All these have been set up without any thought to the wider strategic whole." 

Local government had to drive a new systemic approach to service redesign, said Essex County Council deputy leader David Finch. Redesign and efficiencies would deliver savings of £330m at the authority by next year. It was not just about keen procurement or negotiation with suppliers, more about how well local government could intervene in and shape the market. Local government was part of a change agenda that needed more responsive suppliers in a systemic approach.

"We want to make sure that collaboration in the market will help to move those markets where we want them to move," Finch said, and that was not always achieved through having one or two businesses in a dominant position. 

Localism as a concept was well supported, said Betts. "I am not saying we have got to the Promised Land yet in terms of delivering on localism, but general support for the concept is very strong across all political parties," he told the CMC Partnership-sponsored event.

And government wanted to engage with councils. He challenged local authorities to force Whitehall to accelerate devolution. "There is some truth in the fact that when you say to minister Greg Clark why aren't you giving more powers to councils, he says they don't ask for them – no one comes and knocks on our door and if they do we will take it seriously. The challenge is there to go and knock on government's door and make an awful fuss if you don't get a positive response," said Betts.

Councils needed time and management expertise, political will and sometimes upfront funding to reconfigure and meet the challenge, but he warned: "Many of them haven't got time because the savings have to be made in the first two years of a four-year period, management is preoccupied with cuts, and management itself is being cut, upfront funding is not available, and political will is sapped when councils have to take the hits from the public on service reductions."

Turning Point chief executive Lord Victor Adebowale admitted he was worried by the transition gap as cuts hit services before they could be redesigned. Government may have missed the opportunity to redefine commissioning, he said. 

Conference chairman Ian Briggs of Birmingham University's Inlogov said too much time was still taken up "doing process maintenance on existing systems". 

Betts saw community budgets as "a challenge to the silos of Whitehall. Sir Humphrey doesn't like community budgets, and there is a lot of resistance in Whitehall to them because it means a central government department doesn't necessarily control the money in their budget and decide the priorities for it in every area".

For all that the Localism Act was a step forward, he said, there were still too many restrictions on local government "which a real localism agenda ought to be challenging and getting rid of". 

'They don't know what they don't know'

• A former Downing Street insider, Campbell McDonald, of the Baxi Partnership, gave delegates an insight into some of the benefits and pitfalls of setting up cooperatives and mutuals from the public sector. He said that getting up in the morning was a far better experience when you had a stake and a say in how a business was run. It was a powerful experience. However, there was always much to learn, and Cabinet Office minister Francis Maude and Communities Secretary Eric Pickles had a habit of saying "Here's a good idea, go away and do it". But McDonald cautioned that there was a "Rumsfeld gap" of knowledge and experience for those spinning out businesses from the public sector: "They don't know what they don't know."

• The managing partner of an early Whitehall spin-out, John Craig of the Innovation Unit, said: "Unless you are engaging leaders and pushing them to a commitment to one another to do better, innovation will crash on the rocks of vested interest."


http://www.publicservice.co.uk/feature_story.asp?id=19773

Further education loans are a gamble too far for adult learners

Hot on the heels of trebling of tuition fees and the scrapping of Education Maintenance Allowances from 2013/14, the government is now planning to withdraw the support it currently offers for people aged 24 and over taking A-level equivalent courses and above (Level 3 and higher which includes apprenticeships). Last year, more than 4200 such students were in colleges in South Yorkshire.

Instead, it is planning a system of loans for Further Education students. As the Government is cutting its support - currently 50% of the cost, course fees are expected to rise dramatically to around £4000 a year. When students complete their courses and start to earn £21,000 or more, they will pay back the loans.

Isn't there something bizarre about expecting individual apprentices over 24, rather than their employers, to take on loan responsibilities when they are already taking a salary cut because of their training status?

The Government has no real evidence to suggest that the majority of people will feel either able or willing to take on such loans. Far from it; it has plenty to suggest they will not, especially given the gloomy economic climate. People who didn’t enjoy or do well at school often have to be supported and incentivised towards adult learning. Even the Government believes that a minimum of 20% of existing adult learners will simply fall by the wayside as a result of these changes.

The coalition also seems determined to introduce fees for access-to-HE courses, which are designed for those who missed out on university the first time; 70% of students are female.

It’s another attack on aspiration. It will particularly hit women.

When economic growth has stalled and public confidence is at an all-time low, introducing a ‘big bang’ loans system with potential learners and re-skillers - worried about debt, family circumstances and unemployment - seems particularly misconceived.

Now cancer diagnostic times up

Earlier this week, I revealed the massive scale of the shift of NHS resources – from the poorest areas, with the biggest health challenges, to the wealthiest areas, with the best health - that the Government is now planning. 

£345 million is to be taken from the NHS in Derbyshire and South Yorkshire and given to Surrey and Hampshire.

I also reported on the dramatic increase in the number of people waiting more than 18 weeks for hospital admission, both locally and nationally. In Derbyshire and South Yorkshire there has been a more than 70% increase since May 2010.

Now, I can reveal that there has been a 131% increase in the number of people waiting more than 6 weeks for cancer endoscopy tests since May 2010, according to this week’s Department of Health statistics.

Under the last Labour government, there were significant year-on-year cuts in waiting-time for cancer diagnostic tests and treatment. There were also clear plans to improve and speed up cancer tests in primary care. But, this government simply scrapped them, and now we see the results.

Catching cancer early is the only way to get survival rates up. Investment in early testing can save money from the costs of treating advanced cancers.

You might think that the Government is seriously concerned about these increasing delays. It isn’t. It has simply floated the idea of introducing charges for a fast-tracked testing service through one of its advisors. This is both disgraceful and unacceptable. The treatment of cancer must not be based on the ability to pay.

Is our NHS safe in this Government’s hands? Based on its record to date, the answer is short: No.

All in it together?

I make no apologies for returning to my concerns about what the Government is doing to our NHS.

After David Cameron promised ‘no top-down re-organisation of the NHS” and Nick Clegg promised a “bonfire of the quangos”, we now find ourselves in the biggest top-down re-organisation the NHS has ever seen and the creation of new quangos, whose spending powers swamp all the other quangos put together.

Meanwhile, waiting-times for treatment are continuing to rise, month-by-month. This government inherited a decade of falling waiting-times, year-on-year. Since Cameron, Clegg and Lansley took control they have shot up.

Between May 2010 and March 2012, the number of patients who have waited more than 18 weeks for admission to hospital have shot up by 68% in Sheffield, 78% in Rotherham, 21% in Barnsley, 61% in Doncaster and 141% in Derbyshire.

Now, the government has announced a new funding formula in the way it distributes money to address health inequalities. You will not be surprised that, rather like the new funding formulae for local government, the outcome is that funds are being massively transferred from the poorest areas in the country – those with the greatest health needs – to the wealthiest areas.

The scale of the cuts is dramatic. Sheffield will lose nearly £73m a year; Rotherham will lose more than £64m; Barnsley will lose nearly £90m; Doncaster will lose more than £78m, and Derbyshire will lose nearly £40m.

Meanwhile, Surrey will gain more than £400m; Hampshire will gain more than £322m and Oxfordshire – partly represented in parliament by David Cameron – will gain nearly £174m.

As with the budget announcement on taxes, this government has turned “to him that hath shall be given, and he that hath not, from him shall be taken even that which he hath” into a mantra to be implemented.

We’re all in it together? You must be joking.

Queen’s Speech fails the test

The Queen’s Speech is a grand occasion, with lots of pomp and ceremony. But the contents of the speech itself showed that the Government’s plans for Britain are deeply out of touch with what businesses, families and the jobless need.

Basically, the message was “No change, no hope”. For a young person looking for work, for a family whose living standards are being squeezed, for a small business which can’t get money from the bank, this speech offered no hope.

This speech was supposed to be the government’s answer to the clear message from the local elections. But on this evidence, they still don’t get it.

The Government says people have turned against them because they don’t understand the plan for the economy. The truth is that it’s not the Government’s communications strategy that is the problem – it’s the policy failure.

David Cameron and Nick Clegg promised recovery, but they have delivered recession. We have the worst unemployment in 16 years, over a million young people out of work and the first double-dip recession in 37 years. We needed action that put building an economy that works for working people centre stage. It should have been a boost to family living standards. It was none of these things.

Bizarrely, David Cameron still responds to the alternative growth strategy by saying that it isn’t affordable because it would increase debt. It’s as though he hasn’t yet recognised that his government is now going to borrow an extra massive £150bn more than it said it would, because of the failure of his economic policies.

We’re now borrowing more to pay for the costs of increased unemployment and failing businesses. The same money could and should have been used to invest, creating real jobs, providing people paying tax rather than claim benefits.

People want to see the government offering practical, affordable ways to help people right now and get our economy moving again. The Queen’s Speech should have been quite different.

Building for the future

I chair the House of Commons All-Party Select Committee on Communities and Local Government. We’ve been conducting an investigation into housing supply and have just published our conclusions.

For decades, successive Governments have failed to deliver sufficient homes to meet demand. The country faces a significant housing shortfall, and the financial crisis has amplified the problem.  232,000 new households are forming each year in England, and yet last year fewer than 110,000 new homes were completed.
There is no 'silver bullet'. We have to muster all the resources we can.  The Government’s housing strategy has, in some aspects, made a useful start and I hope many of its measures will provide a stimulus over the short to medium term. But we need much more action if we are to see significant long term improvement in housing supply.
We set out four key areas for action, which, taken together, could go a long way to raising the finance needed to meet the housing shortfall:

• Large-scale investment from institutions and pension funds
• Changes to the financing of housing associations, including a new role for the historic grant on their balance sheets
• Greater financial freedoms for local  authorities
• New and innovative models, including a massive expansion of self build housing

We think that pension funds and large financial institutions have a blind spot when it comes to housing but their investment could deliver a significant number of new homes for rent.

After a visit to Almere in the Netherlands, we were convinced that there was real potential in self build, where people manage the construction of their own homes. Self build schemes could be a major new source of housing, but it will require government, local authorities and lenders to work together to get schemes underway very quickly. I’m pushing to get this initiative piloted locally.