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Compiled by: The Scottish Socialist Party (Glenrothes Branch) July 2001 CONTENTS 1. Finance 4. Older People 5. Services For People With Mental Health Problems 6. Services For People With Learning Disabilities The complexity of the issues facing NHS Fife at the moment are reflected in the Right For Fife document in both the length of the document and in the wide range of services discussed. This complexity is compounded by the fact that many of the services within Fife are provided in partnership with other organisations and voluntary sector groups. In this response, Scottish Socialist Party members in Fife have sought to give an overview of the issues within the document from the stance that successive governments have done little to eradicate poverty within our society. This we believe has been one of the root causes of the increasing strain on NHS resources. Another crisis facing NHS nationally as well as locally is that of an apparent skill shortage. This we believe is a problem which has resulted from repeated cost-cutting exercises aimed at off-setting the effects of ever-reducing government investment in staff wages leading to a huge exodus to the private sector or out of health care altogether. The problems facing the NHS in Fife at this time are identical to those faced all over the UK. Too many patients, too few beds. Too few resources, not enough money. Outdated equipment, not enough money. Staff paid unfairly not enough money. Low morale, bleak future. The Scottish Socialist Party was founded around two and a half years ago. The basis of our policies is the redistribution of wealth from the wealthy to the impoverished. It seems criminal that at a time when around 32% of Scottish children are living in poverty that big businesses are paying rates of Corporation Tax (34%) which are lower than under the first nine years of Margaret Thatcher’s government (52%). According to the Institute of Fiscal Studies, the proportion of GDP spent on public services has fallen from over 50% in the 1970’s to below 40% today. As spending on public services has fallen, the state of the NHS has declined accordingly. Those working within the NHS know this to be the case and NHS Fife should be raising this issue at every opportunity. This failure of the present government to raise taxes realistically, while introducing a paltry minimum wage which keeps the poor in low paid jobs is negligent – and culpably so. The problems facing NHS services are fundamentally financial brought about by poor investment in modernisation and maintenance by successive governments. The problems faced by those using NHS services are more than simply medical; they have deep sociological and political roots. Poverty hits health hard. Low wages and poor conditions result in poverty. Poverty puts greater stresses on an already struggling and increasingly technologically outdated health service. The case for private health care (for those who can afford it) appears stronger than ever. Private health care excludes those without the finances to pay for it. If one were prone to paranoia, one might suspect that the NHS was being deliberately allowed to fall into disrepute so as to pave the way for wholesale privatisation. Such was the case with many of our former nationalised industries before they were privatised, so perhaps paranoia is the wrong word: insight perhaps; recognition of history repeating? In a climate of low wages, little accountability for conditions, low taxation rates, and an ever-developing private health market, big business laughs all the way to the bank. Now we are told that new hospitals are being built with private finance through the Public Private Partnership - which is totally different from the Private Finance Initiative, in that public money is invested also. Big businesses still profit from a guaranteed pay cheque annually from the public purse for decades, new equipment still becomes obsolete decades before the loan is repaid, but PPP is not at all like the PFI. At least that is what we are told. The medical profession must: - Condemn the present taxation system that effectively punishes the poor, sick and disabled for being poor, sick and disabled. - Condemn the government for reducing Corporation Tax on big business which results in the quality and availability of services dropping due to underfunding, leading to private finance being used to underpin the NHS in exchange for profit. (Are we supposed to be grateful for these finances?) - Demand fair wages and conditions for nurses, doctors, and auxiliary staff such as cleaners, porters, kitchen staff, etc. The suggestion that hospital services be centralised in a single hospital in Fife appalled the vast majority of the people we have spoken to. The logistics involved for those living in the Levenmouth area who are already at a disadvantage to the rest of Fife in terms of travel to their nearest general hospital in Kirkcaldy should be sufficient to rule the idea out altogether. The Levenmouth area has the highest unemployment rates for all of Fife. The effects that this has on health already would be worsened by making access to health care even more difficult – a centralised hospital would do just that. A centralised hospital is a horrifically disturbing proposal. We have heard that this prospect features in only three of the thirty-four proposals at NHS Fife’s disposal. We would urge that these three proposals be immediately discarded. Similar feelings have been expressed from those resident in Dunfermline area, where the strength of feeling was demonstrated by the huge attendance at public meetings. Again, the apparent skill shortage comes into play. The scaremongering apparent within this area of the Right For Fife document appalled many of our members as well as members of the public. The skill shortage issue was addressed above. In the scenario presented regarding Mr & Mrs Bell and Mrs Campbell the strongest case is for Mrs Campbell to remain at home while her daughter is ill. This makes the most sense after all it is not Mrs Campbell whose immediate circumstances have changed. The scenario does however illustrate that for many older people (although many children and young adults are in this position too) their immediate family are their principle carers. It must be recognised that much has been done to provide support for these carers. Many families with a relative who requires consistently high levels of care are unaware of what support and advice are available to them. One suggestion mooted at the Glenrothes public meeting in Rothes Halls was to publish a resource manual listing benefit advice, support information etc. and distribute this to all affected families. The benefits would be far outweighed by the difficulties of producing a comprehensive dossier of information and the costs involved. Families trying to work out which support applied would also face problems to them. The personal touch is far better in this situation, as was recognised by Tony Ranzetta at the time. Information packs could be produced for GP services and other involved professionals so as to allow a consultation process at the point of need. These needs could then be met in a flexible way so that all affected families would be given the help and support they so greatly deserve. The existence of these resources could be advertised effectively without the risk of wasteful over-publication of the packs themselves. Additional funding for the resources to meet the needs of the families who fall into this category may be necessary. Again government (local and national) have a responsibility for ensuring that tax breaks to big business and the wealthy in our society are not paid for at the expense of services to those who struggle to look after themselves as well their loved ones. NHS Fife could advocate for numerous affected families in the area by calling on the government to increase Invalid Care Allowance to a rate that reflects the sacrifice involved in caring for a loved one at home. As a party, the SSP have made it a manifesto promise to abolish prescription charges, eye test charges and dental check-up charges. These measures would increase the level of early prevention which at the moment is reliant upon ability to pay. This is simply not acceptable, and often leads to emergency treatment becoming necessary, especially in the case of dental treatment. However, free eye tests would also enable early detection of cases of glaucoma and diabetes. Charges for basic check-ups discriminate against the poor and low waged and result in the long term in greater stress being placed on NHS resources. One of the more significant issues within communities in Scotland as a whole and in many of the poorer areas of Fife is that of substance misuse. This is particularly true of heroin addiction, although alcohol is a factor in the majority of violent incidents dealt with in accident and emergency departments. Setting up programmes supplying clean pharmaceutical heroin to those addicts who are not yet ready to come off the drug would free up a great deal of finance from criminal justice and prison budgets which could be reallocated to health services. This would allow addicts to begin to rebuild their lives. Studies in Switzerland where this kind of programme has been running for some time show that a majority of the participants would be able to return to work and start paying taxes again. A programme of this kind would also result in a significant drop in crime levels, including a fall in the number of people being treated for the stress of crime-victim related illnesses. While the initial outlays for such a treatment programme would be quite high, the benefits would more than outweigh the costs. Alcohol related incidents are an increasing worry for many who have been victims of violence. Sadly, many hospital workers have had to deal with violence while attempting to treat patients who are under the influence. It is the feeling of the SSP that a ban on all alcohol advertising would be a start in changing the culture of consumption that seems predominant in Scotland today. The instances of alcohol and tobacco related illnesses also place an incredible strain on NHS resources and work should continue to educate people of all ages about the dangers involved. NHS Fife can be pro-active in joining with us to call for more expenditure on creating low cost leisure facilities for everyone in Fife. A greater consciousness of health matters is not enough where the opportunity to act on this awareness is lacking. Older people are more at risk than ever during the winter months. Unfortunately it is not always as a result of slips and falls on treacherous paths in icy conditions. We have in recent years been faced in Fife with the shameful rise in deaths as a result of hypothermia. These are deaths linked directly to poverty. A study conducted in 2000 by the New Policy Institute on behalf of the Joseph Rowntree Foundation discovered that almost a third of pensioners live in poverty. That this figure is only fractionally below the percentage of older people who are in receipt of only State Pension, Income Support, or a combination of both tells the tragic truth that pensioners are not being valued by the society they have served all their working lives. No amount of public consultation or reassessment of NHS budgets can hope to deal with a problem for which the rising poverty of older people is to blame. Certainly, more community based resources should be made available to enable older people to retain their independence for as long as possible, however the resources made available to NHS Fife are not enough to make this realistically possible for all older people. This ultimately leads to some receiving what they need and others missing out. There is no allegation of discrimination on the part of NHS Fife being made here, rather it is the government themselves who are failing older people, and who should be held accountable. 5. Services for people with mental health problems The progress that has been made in allowing greater inclusion in society of people for whom mental health is an issue is heartening. Work needs to be ongoing in altering the general public’s perception of mental health issues and the people affected. There is still a great fear of stigmatisation for individuals with mental health problems, and in some cases this will result in extending a period of ill health. The growing number of ‘Nurse Counsellors’ is another positive step towards the integration of psychiatric treatment with traditional GP services. It also provides a good point of contact for those in the early stages of developing psychiatric illnesses. Life is increasingly stressful in this day and age. Many of these stresses relate to unforeseen events such as violent incidents, sudden illness or bereavement. Poverty is also a factor as expenditure catches up with and then overtakes income. People are healthier psychologically when they are earning a good wage, in a job they enjoy and for which they feel appreciated. How sad, then that nurses, the very people who would seek to help others to recover their sense of well being, are among the most at risk from stress. This is perhaps a good time to reiterate the need for all within the health care profession in whatever capacity to be rewarded fairly for their efforts, both financially and in terms of their working conditions. A good point is raised in the case study of Diane who attended two appointments with a psychologist but then failed to attend further. While there is a need to maintain clients’ confidentiality, there may also be a need for some kind of unobtrusive follow up for those who do not see through treatment. It is quite likely that at the moment resources are so sparse that psychologists have such weighty caseloads and such restrictive schedules that this is not possible. Many clients may begin treatment and feel that they do not need to continue. This is within their rights and no-one would take that from them. There is a risk however that some clients stop attending for a simpler reason that could be dealt with by a visit from someone to reassure them about the treatment and the benefits in store long term. 6. Services for people with learning disabilities NHS Fife are to be commended for their swift implementation of steps leading to compliance with the requirements of the The Same As You? Review of services. Inclusion of individuals and groups with learning disability is a crucial step in the right direction for all civilised societies. We would express concerns that (according to our information) a private company is managing the new projects. We feel that whenever the issue of profitability becomes a priority, patient and client service will decline. It may be that funds available to meet clients’ daily needs will be cut. It may be that staffing levels have to be reassessed. Whatever the case, clients will suffer directly or indirectly. This cannot be a positive precedent in NHS Fife. As the Right For Fife document points out, children make up 20% of Fife’s population. This amounts to around 70,000 children. If the figures quoted in Indicators of Poverty in Scotland are taken as an indicator 32% or 22,400 children in Fife are living in poverty. A statistic such as this demonstrates that far too many children and young people are not getting the best start in life, and it is generally accepted that this can have dire health consequences in later life as well the detriment caused now. The effects of poverty on children are well documented. Poor diet leads to weight difficulties, dental caries, nutritional problems, below average concentration and memory, and reduced immunity to infection – leading to longer recovery times after infection. Not being able to afford the clothes and toys that peers are acquiring can lead to social exclusion and the knock-on effects on self-esteem. Poverty places affected youngsters at a great disadvantage in terms of immediate well being, and long term prospects. Many youngsters are at a disadvantage before they are born because their mothers are already living an impoverished lifestyle. Education about what is best for pregnant women to eat can only achieve so much. Once again, these complaints are no fault of NHS Fife, however many would argue that a local health board has a responsibility to flag up to national government any areas where present fiscal policy is a direct detriment to the people whose health is their top priority. NHS Fife has failed in this. Scottish Socialist Party MSP Tommy Sheridan is currently at work on a Bill for the Scottish Parliament to introduce free school meals for all state school pupils. We would urge NHS Fife to lend their support publicly to this proposal which would provide a vital step toward eradicating the ravaging effects of poverty in Scotland. As mentioned above, the SSP call for the abolition of prescription, dental check-up and eye test charges. Such a move would allow low waged parents to set an example for their children by undertaking necessary regular check-ups and promoting healthy lifestyle choices. A healthy lifestyle breeds a healthy life. NHS Fife can help set a higher standard of opportunity by calling for check-ups to be available for all. Vaccination is vital to the needs of the new-born. Epidemics in the past of diseases which can be easily guarded against now are a demonstration of how far medical science has progressed. There are still concerns held widely by many parents over the controversial MMR vaccine. The SSP have made it a manifesto policy to call for the option of separate vaccinations for measles, mumps and rubella. Making this choice available and advertising it as part of an education programme will help to reach the highest possible levels of uptake. That so many parents fear being responsible for the onset of autism in their child should motivate action now. The comments of NHS Fife’s delegate to the BMA’s 2001 Conference that distrust of the MMR vaccine was a "recipe for death " were not helpful to the cause of giving Scotland’s children the best possible start in life, making an alternative available to parents would be. The Right For Fife document was inevitably going to be a long, complex document even though providing merely an overview of the issues facing NHS Fife. The time constraints involved will not have made its preparation any easier. The wording of the questionnaire could have thought out a little better so as to be less vague. The wording of some of the questions also appeared to mask a hidden agenda, namely getting popular support in principle for a single centralised Fife general hospital. No-one would accuse NHS Fife of having a hidden agenda, and the sentiment of the majority of Fife’s people will hopefully be reflected in NHS Fife’s final decision on the matter. Our members felt that the public meetings organised by NHS Fife were too short to allow comprehensive question and answer sessions at the end. These could be a valuable tool if used correctly in the future however, and if they were advertised a lot better. The Glenrothes branch of the Scottish Socialist Party would like to thank Tony Ranzetta for his invitation to contribute to the consultation process. We would be interested to hear in due time the board’s comment to our response to Right For Fife. © 2001 Glenrothes Scottish Socialist Party | Top | Back to Health Issues Index | Back to Local Index | Home | |