Cuts and privatisation behind NHS patients’ deaths from listeria and streptococcus infections

6 elderly people have died this year from listeria in sandwiches sold to NHS hospitals by a private company. 13 people in Essex receiving community treatment for wounds have died from the spread of group ‘A’ streptococcus. Some were in care homes but most were in their own homes.

These are real people, beloved and mourned by their families and friends. How could this have happened to them?

A Royal Society of Medicine Journal article about the recent NHS patient deaths from listeria and streptococcus blames the deaths on the 2012 Health and Social Care Act’s hand over of public health responsibilities to local authorities. But this doesn’t seem like an adequate analysis.

This article looks at NHS privatisation and cuts as the context for the spread of deadly infections in our NHS.

John Ashton, the author of the Royal Society of Medicine Journal article , says that the 2012 transfer of public health responsibilities to local authorities means:

“[M]any directors of public health were placed in structures in which they are line managed by directors of adult social care, with restrictions placed on their scope for action and freedom of expression.
“There is a schism in which the clinical perspective in local government has been disappearing and the links between local authorities and the NHS have become ever more dysfunctional.”

And he says the “lesson from history” is that

“we should not embark on another re-organisational folly but rather find ways to strengthen what we now have and support its evolution into something fit for purpose.”

This misses the point of another lesson from history: that austerity spending cuts and privatisation are government-induced disasters.

And if, as Ashton writes, “the links between local authorities and the NHS have become ever more dysfunctional”, what does this say about the current re-organisational folly of integrating local authority and NHS services through so-called place based Sustainability and Transformation Partnerships and Integrated Care Systems?

NHS privatisation is directly linked to patients’ deaths from listeria

Privatisation of hospital food started under the Thatcher government.

This summer, 6 patients in NHS hospitals in the North West, Midlands and West Susses have died after being infected with listeria from pre-packed sandwiches bought in from a private company, Good Food Chain.

Public Health England says that 43 hospital trusts across England have been affected by the outbreak.

A Food Standards Agency investigation has cleared the Good Food Chain of responsibility, but found it was supplied with meat produced by North Country Cooked Meats in Salford, that carried the outbreak strain of listeria. Both companies have now gone out of business.

Of course this is not just about privatisation of NHS food. It also concerns the rubbish food system in the UK and globally, and the urgent need to improve it.

Mid and South Essex NHS services have been particularly vulnerable to the government’s austerity shock doctrine

13 NHS patients being treated by an Essex community wounds service have died after being infected with Streptococcus A.

It seems that this service is provided by Essex Partnership University Trust. I have asked Mid and South Essex Sustainability and Transformation Partnership for confirmation of this.

The Trust is part of the cost-cutting Mid and South Essex Sustainability and Transformation Partnership, set up in April 2017 to eliminate the area’s NHS, social care and public health “deficit” by 2020/21. Really this means cutting spending to stay within the limits of the government’s underfunding of the NHS, social care and public health services.

In 2015 Mid and South Essex NHS services were put under NHS Englands/Monitor’s so-called Success Regime. This Orwellian name in fact connotes the opposite – the Success Regime was a kind of Shock Doctrine for the NHS.

NHS England categorised Essex as “a challenged health economy” – an area where health and care services face massive problems. The reasons it gave for imposing its Shock Therapy in the area included:

  • Operational and quality challenges which presented risks to clinical sustainability
  • Financial sustainability challenges across the whole economy
  • Workforce challenges across primary and secondary care
  • Recognition that additional levers and regulatory mechanisms may be required to introduce new ways of working

Under the Success Regime, Mid and South Essex NHS services were basically put under the control of the government’s quangos NHS England and Monitor, in order to speed up the imposition of a Sustainability and Transformation Plan that would cut costs and redisorganise the NHS, social care and public health services into a version of the USA’s Medicare/Medicaid system. This provides a limited range of state-funded health care for people who are too poor or ill to afford private health insurance.

Shock doctrine – £216m NHS and social care cuts planned over 3 years to 2018/19 in order to “balance” the budget

The Success Regime’s aim was to balance the area’s NHS and social care budget by 2018/19 in order to avoid a projected deficit of £216 million by 2018/19. In other words, to cut £216m from Mid and S Essex’s NHS and social care spending over those three years.

The Mid and South Essex Success Regime informed the development of the area’s Sustainability and Transformation Plan, published in 2016, and its specific plans for health and care services. These included introducing a single management structure for all three acute trusts within the Success Regime area and achieving “financial balance” throughout the region by 2020/21.

Under the Success Regime, the Mid and S Essex Sustainability and Transformation Plan was rushed through. It was published on 1 March 2016, ahead of the national schedule for Sustainability and Transformation Plans to be published in November 2016.

By April 2017, the Mid and South Essex Sustainability and Transformation Partnership was established.

In 2018, the Mid and S Essex Sustainability and Transformation Partnership reported that it:

“is improving its financial position year on year to return to financial balance by 2020/21. The health economy in Essex has a history of deficit and debt as a result of having to spend more than the allocated funds each year, in order to maintain services.”

Translated, this means it is making cuts each year, as required by the Success Regime’s Shock Doctrine.

How has this maelstrom of cuts affected the community wound dressing service?

This Trust provides mental health, learning disability and community health services.

Essex Partnership University Trust has identified itself as part of the Mid and S Essex Success Regime

The Trust was formed in 2017 from a merger of North Essex Partnership University NHS Foundation Trust (NE PUT) and South Essex Partnership University NHS Foundation Trust (SEPT).

In 2016 N Essex PUT had been under investigation from Monitor because of concerns over quality of the organisation’s services and state of its finances. The Trust had predicted an underlying deficit of £3.3 million for that financial year.

Where does the EPUT tissue viability service sit in the Sustainability and Transformation Partnership’s new Primary Care Strategy?

In June 2018 the Mid and S Essex Sustainability and Transformation Partnership agreed its new primary care strategy, in line with the government’s plan in NHS England’s GP 5 year forward view 2014-19:

  • Build on development of localities/hubs within each CCG area
  • Expand primary care workforce to include mental health and social care workers and physiotherapists, leaving GPs to see only the patients with greatest needs
  • Invest an additional £30m in primary care by 2020.21

Where is Essex Partnership University Trust’s wound dressing service – aka Tissue Viability Service – in all that? I have asked the Sustainability and Transformation Partnership that and other related questions:

  • If in fact patients who were infected with streptococcus A were being treated by the EPUT tissue viability service and if not, who was treating them
  • Where the Essex Partnership University Trust wound dressing service sits in the new primary care strategy, announced in June 2018.
  • Whether the service is benefitting from the extra £30m investment into primary care by 2020/21.
  • The financial state of Essex Partnership University Trust, specifically: if it is in deficit; if so, what is the deficit and what measures are being taken to eradicate it; is it in debt to the Department of Health and if so what is the annual cost of interest repayments on the debt and what plans if any are in place to pay off the debt.
  • What exactly has caused the spread of Streptococcus A through the Essex Partnership University Trust wound dressing service – and if this is not yet known, what investigations are being carried out to identify the cause of the infections acquired by patients of the Essex Partnership University Trust wound dressing service.If in fact these patients were being treated by the EPUT tissue viability service and if not, who was treating them
  • Where the Essex Partnership University Trust wound dressing service sits in the new primary care strategy, announced in June 2018.
  • Whether the service is benefitting from the extra £30m investment into primary care by 2020/21.
  • The financial state of Essex Partnership University Trust, specifically: if it is in deficit; if so, what is the deficit and what measures are being taken to eradicate it; is it in debt to the Department of Health and if so what is the annual cost of interest repayments on the debt and what plans if any are in place to pay off the debt.
  • What exactly has caused the spread of Streptococcus A through the Essex Partnership University Trust wound dressing service – and if this is not yet known, what investigations are being carried out to identify the cause of the infections acquired by patients of the Essex Partnership University Trust wound dressing service.

I will post the answers when I receive them.

Central government has slashed public health spending by a quarter per person since 2014/14

In December 2018, the government announced that it would slash public health budgets for local authorities by £85m in 2019-20, cutting its grant to £3.134bn. How does this make any kind of sense?

Councils’ public health grant funding has been cut by £531m between 2015-16 and 2019-20. The Health Foundation think-tank estimated there had been a real terms cut of £900m in public health between 2014-15 and 2019-20. This means the core public health grant has fallen by a quarter per person since 2014-15.

The Royal Society of Medicine Journal article about NHS patients’ recent deaths from listeria and streptococcus doesn’t mention these cuts – even though it attributes the spread of listeria and streptococcus infections to the handover to local authorities of responsibility for public health.

This omission may be because these radical public health spending cuts are not directly relevant to the spread of deadly infections in NHS hospitals and community health services – after all, local authorities’ public health spending goes on services like sexual health services, stop smoking campaigns, and drug and alcohol treatment.

But surely we should not ignore these cuts. Fewer resources to improve sexual health, respiratory health and reduce drug and alcohol abuse mean extra strains on NHS hospitals and community health services, which must make effective infection control harder.

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