With more and more campaigns forming to fight against the government’s cuts agenda, many are asking whether the courts have a role to play in stopping the swingeing attacks on the public sector.

We took our fight against library cuts to the High Court and won - but like other library campaigners have found, our legal success has not dealt a knockout blow. Our council intends to retake its decision and press on with its plans.

How our campaign began

The campaign - the Surrey Libraries Action Movement (SLAM) - formed in June 2011. Our group is an alliance of library campaigners, residents and trade unionists across Surrey. The group formed to campaign against Surrey County Council’s proposal to replace paid staff with volunteers, managing and delivering library services in ten Surrey communities.

SLAM ran a full campaign against the proposals throughout 2011, including protests, demonstrations, petitions signed by thousands in the affected communities, and letter-writing. Local residents asked questions and made submissions to all council meetings where the library proposals were discussed, raising serious and legitimate concerns.

The council ignored them all and pressed ahead with its plans in the face of wholesale public indignation.

People decided legal action was the only route

Previously non-political residents - people who had never taken part in any form of campaign - felt aggrieved that the council would not listen to what they had to say, and wholly unsatisfied that such a far-reaching decision could be taken without consultation and with precious little scrutiny. So when the prospect of legal action was raised - although there was reluctance and anxious debate - the final verdict of the group was decisive: the council had created a democratic deficit that only the law could remedy.

How judicial review works and why it's important to move fast

The law has it that an application for judicial review must be made promptly from the date of the authority’s decision and, in any case, within three months. Due to the research and debate required before we felt ready to take action, we instructed Public Interest Lawyers late to act on our behalf. PIL therefore lodged our application on the very last day of the three month window.

We would recommend that other campaigners act as soon as possible after the “challengeable” decision - it is easy to run out of time!

The claimants in the case were in receipt of legal aid. Although the Legal Services Commission (LSC) granted legal aid, it did insist that the affected communities made a contribution to the costs of £18,000, which was later reduced to £12,000 - still a significant amount of money to raise in a very short period of time, and the cause of much stress for campaigners.

The basis of our case was that the Council was in breach of section 149 of the Equalities Act 2010, having not shown “due regard” to its public sector equalities duty (PSED).

We argued that in removing paid staff, the council would be removing the permanent presence in the libraries that, through experience, knowledge and consistent contact, met the needs of vulnerable users (including children, the elderly and people with certain disabilities). Further, that a continual rota of volunteers working just one or two hours every other week could not, even with the best intentions, hope to replace that essential and obvious “equalities” need.

Indeed, throughout the campaign, we spoke to many residents who described the expected embarrassment of having to explain their particular needs every time they wanted to use the library.

The judgement

In his ten thousand word judgment, Mr Justice Wilkie agreed with us and ruled that the council’s decision to replace paid staff with volunteers in ten libraries across Surrey was “unlawful” and that the council was indeed in breach of its PSED. The judge further handed down an order on the 1st May 2012 quashing the council’s decision.

The fight goes on

We always knew the High Court judgment would not be the end of the story, and so it has turned out. SCC has vowed to retake its controversial decision with not one change to the original plan. The council will conduct a very brief consultation, although from what we’ve seen so far, it still seems to be showing insufficient regard to its PSED. SLAM and Surrey residents will campaign ahead of the new decision, but whether SCC again dismisses residents’ concerns remains to be seen.

The injustice of library cuts in Surrey has galvanised previously non-political residents into action. It was not library staff, library users or young children that caused the financial crisis, and many say that they should not be made to pay for it.

Challenging cuts in the courts is a tactic, and can produce good short term wins. But the High Court has a limited role, and it can not ultimately tell a local authority what it can and can not do. The fight against the ideology of austerity will only be won by organisation, political argument, and ultimately by the triumph of hope over cynicism.

Lee Godfrey is co-leader of the Surrey Libraries Action Movement (SLAM) and editor of SLAM’s blog, where more information about the legal case and campaign can be found. Lee is the Secretary of Runnymede and Weybridge Constituency Labour Party.

Find out more about other successful legal challenges to public sector cuts and privatisation here.

Interviewed recently in the Observer, Labour’s opposition business secretary, Chuka Umunna, argued that the ‘traditional totems for the centre-left’ – progressive taxation, redistribution – are harder to maintain in straitened times.

‘If we had a more progressive tax system’, he added, ‘that would not necessarily address the living standards crisis that millions of people are facing.’

A similar argument was used by successive Labour administrations from 1997. During their 13 years in power, despite being a time of relative economic prosperity, little was done to reverse the regressive structure of the British tax system, one which takes proportionately more from those on low than those on high incomes. Although Labour eventually introduced a top income tax rate of 50p, this alone would have had a limited impact in making the tax system fairer.

Yet, apart from the question of fairness - Adam Smith argued in favour of progressive taxes – a shift to a more progressive system would have a number of wider economic benefits, most importantly on the health of public finances.

Over the last 30 years an increasing number of rich countries have been hitting an apparent limit on their ability to raise revenue through taxation. While demands on the state for improved services have been upwards, the ‘tax-take’ has been largely static or downwards.

Take the UK.

Between 2001 and 2007, spending as a share of GDP rose by four percentage points from 36.8 per cent to 40.9 per cent, largely as a result of improved health, education and welfare programmes. Tax revenue, in contrast, remained static at 38.6 per cent of the economy over the period. As a result of this rising fiscal gap, the
national debt rose from 30 to 37 per cent as a percentage of GDP.

The share of tax revenue in the economy peaked in the UK in the early 1980s at over 45%. It then fell sharply over the next decade and since the early 1990s has settled at the much lower average of 37-38%.

This has meant that tax revenue has fallen short of public spending for most of the last 20 years. Though some of this shortfall is explained by the use of borrowing to fund capital spending, Britain’s deficit is as much a problem of under-taxation as over-spending.

Ultimately, of course, such shortfalls are unsustainable. Either governments need to moderate spending, or increase the tax base.

The long term stagnation in revenue stems from two key economic trends. First, the tax policies of the 1980s that shifted the tax system from progressive to regressive. In 1979, the top fifth paid 37.6% of their incomes in tax and the poorest fifth paid only 30.5 per cent. By the end of the 1980s, these shares had been almost reversed.

Second, by the rising share of the national cake in the hands of the rich. The share of net income held by the top 1% has nearly tripled in the UK, standing at over 15.4% in 2009 compared with a low point of 5.6% in 1978.

The combined effect of these two changes has been that since 1979 the share of earnings paid in tax by those in the top one per cent has fallen from over a half to around a third, while the average tax rate on most of the rest of the population has risen to over 35%.

Supporters of the 1980s reforms have long argued that by boosting economies, lowering tax rates on high earners would actually increase revenue – the so-called Laffer curve.

This is the argument used by the Republicans in the United States to cut taxes on the rich and by George Osborne to cut the 50 p tax rate in the last budget. But the evidence has long been clear. Cutting tax rates does not increase revenue. Along with many contentions of market advocates, the ‘dynamic effect` from lowered taxes at the top is a myth.

The policy strategy of the last 30 years - making economies more unequal while cutting tax rates on the rich - neither leads to a larger economic cake nor to boosted tax revenue. It simply shrinks the tax base. The latest evidence for this comes from a significant paper from Thomas Piketty and colleagues.

They show that the optimal rate of tax on the rich – the rate which maximizes revenue – is well above current rates. Indeed, it has recently been disclosed by the former cabinet secretary, Lord O’Donnell, that George Osborne was advised that the optimal top tax rate is 48p, contradicting the Chancellor’s argument for the proposed cut to 45p. Piketty suggests it is a good deal higher than this.

The lesson is clear. Maintaining fiscal balance requires more progressive tax systems with a much larger contribution from the very rich. This seems to be accepted by the Secretary-General of the OECD, Angel Gurrí, in his recent call on rich nations to reform ‘their tax systems to ensure that wealthier individuals contribute their fair share of the tax burden.’

Stewart Lansley is the author of The Cost of Inequality: Why Economic Equality is Essential for Recovery, Gibson Square, 2012

These guides and information have been put together for people who want to learn more about how they can get involved in and influence new NHS structures, and how to campaign to fight privatisation and outsourcing across the public sector.

Campaigning groups around the country have successfully challenged cuts and outsourcing decisions through the courts. Some of those experiences and expertise informs the guides we are collating.

We will be adding to these guides over the next few weeks.

Guide one: Make the NHS work for us – not for big business (PDF)

This is a guide to the NHS’s new structures. The Health and Social Care Act is now law. The Act outlines the basic policy that will underpin the NHS, but it does not give detail. The detail of the policy will be determined through secondary legislation and the ways that these regulations will be carried out will be determined locally.

This is where you can get involved: join the organisations that are being set up and volunteer your time to make the NHS work for our benefit and not for the benefit of big business. Read the full guide to participation here.

Thanks to the superb Richard Blogger, whose work forms the basis of this guide. Thanks also to Lucy at @SomersetLINk whose NHS chart is included in the guide.

Guide two: Protecting the NHS from privatisation - suggested questions and approaches for campaigners

Public opinion is still strongly against more private involvement in the NHS, so decisions to privatise services are often taken secretively, or hidden behind confusing rhetoric, and then presented as a done deal.

This detailed guide suggests how to ask questions, who and where to ask, what to ask, what to ask next, and what to do with the information that you find.

Thanks go to Caroline Molloy at Stroud Against The Cuts for her outstanding work on this guide. Caroline is one of the activists who was involved in the successful campaign through the courts to stop a major Gloucestershire NHS outsourcing deal earlier this year.

We will be adding to these guides over the coming weeks and months, so keep watching this space for more. You're welcome to leave details of other good campaign guides and information in the comments.

I’ve spent the last couple of days in Rome at the excellent ‘Beyond Austerity’ conference, not to be confused with the TUC’s own upcoming (and highly recommended) ‘After Austerity’ conference.

Most of the papers from Beyond Austerity are available here and are well worth a look.

I can’t really do justice to two days of discussions in one blog post (and another post specifically on banking and financial regulation will follow next week) but I thought it might be interesting to try and summarise the key points of what a European growth agenda might look like.

The general view (no longer at all controversial) was that austerity has failed in Europe – austerity kills growth, throws people out of work, drains confidence from the private sector, retards investment and often leads to higher not lower deficits. The social costs are often tragic and the political impact can be extremely severe.

There was widespread recognition that the main driver of the Eurozone crisis had been a balance of payments problem rather than a problem of excessive public spending/deficits.

Indeed, one participant remarked that it was tragedy that Greece had been the first country to run into serious problems – had it instead been Spain or Ireland (where public finances were in excellent health before 2008) then the causes of the crisis would have been much clearer. The narrative of ‘profligate periphery’ countries would have been harder to form and austerity would not have been the default cure.

The plight of the periphery countries (and in particular Spain, Portugal and Greece) was widely recognised. Austerity is killing their economies but they have little room for a fiscal expansion given the bond market’s concerns.

Given this situation the immediate short term steps required are:

- Fiscal expansion where there is room: In a Eurozone context the key country here is obviously Germany. But Eurozone countries faced with low bond yields, external surpluses and relatively low debt/GDP ratios should be launching targeted, timely and temporary fiscal expansions aimed at boosting domestic demand. This would have important spill over effects into the Eurozone periphery boosting their exports.

- Wage growth where there is room: Given the inability of countries to externally devalue by allowing their currency to depreciate, then the burden of restoring competiveness falls on ‘internal devaluation’.

Stripping away the econo-speak, this means cutting real wages in the periphery. Leaving aside the social consequences, the economic impact is also very damaging. The burden should instead be shared more symmetrically – rather than just hoping for falling real wages in deficit countries, Europe should be arguing for rising real wages in surplus countries – both to help expand domestic demand there and to provide a boost to the competiveness of deficit countries.

- Balanced budget expansions everywhere. Even in countries without the fiscal space for a debt financed expansion, fiscal policy is not useless. Countries should launch taxation funded increases in public investment. If these taxes are levied on the better off with lower marginal propensities to consume, then the multiplier of this expansion could be reasonably high.

- ECB action. The ECB should act decisively in the short term to end soaring yields in periphery countries by intervening in the bond markets and placing a ‘yield ceiling’ on periphery debts. A credible commitment to act from the ECB could end the problem of soaring yields in hours. This isn’t a long term solution to the underlying balance of payments issues but is an important step in stopping contagion.

- Expansion of the European Investment Bank. The EIB should have its capital at least doubled (relatively cheap in the context of the current ‘bailouts’ of Greece, Portugal, Ireland, etc). This would allow around an additional €60bn annually of new lending. This should be concentrated in infrastructure investments and export industries in the periphery aimed at raising their competiveness  and supporting their balance of payments.

- Eurobonds. In the medium term, Eurobonds of some sort (pooling of Sovereign debt so that all members stand behind each other’s liabilities) are probably required but in the short run there maybe problems with implementation. As a first step, the EC should issue its own bonds (backed by all EU or Eurozone member states collectively) and use the proceeds to fund major investment and infrastructure problems. This would also have the effect of providing a new source of ‘safe’ assets to the markets.

Taken together this package has the real potential to stop the rot in Europe and allow people to start to look towards a recovery.

Duncan Weldon blogs at Touchstone.

In partnership with the Guardian, the TUC is holding an After Austerity conference in June which will debate proposals to avoid a decade of stagnation, and to secure jobs and living standards for the future.

There were some attempts to restrict the numbers of private patients that Foundation Trusts could treat, but, as I’ll explain below, these are largely ineffective.

Subsection (1) of section 164 of the Act adds some new subsections to the 2006 NHS Act.

The first of these new subsections (43(1)) says that the principle purpose of a Foundation Trust is to provide NHS services. It is quite amazing that the government thought that it was important to specify this. To the rest of us, it is quite clear that NHS hospitals exist to treat NHS patients: the clue is in the name.

The 2012 Act adds a new subsection to the 2006 Act (43(2A)) that says this:

“An NHS foundation trust does not fulfil its principal purpose unless, in each financial year, its total income from the provision of goods and services for the purposes of the health service in England is greater than its total income from the provision of goods and services for any other purposes.”

This says that at least half (that is, 50%) of the FT income must be from NHS work.

Currently, the average private patient income for an FT is just over 1% (in 2010/11 FTs generated £252m income from private patients out of a total income of £26,867m).

There is a lot of confusion over this figure.

Some people report that there is an absolute cap of 5%. This is nonsense. The NHS Act 2006 (44(1)) says that the proportion of the total income of an FT from private work (including, but not exclusively from private patients) should not be greater that the proportion in 2003.

Later Acts said that mental health trusts could earn up to at least 1.5%. As a result, there was a range of caps applied to FTs (to find what it was for your local trust, go to the Monitor FT directory and look for the Schedule 4 document under terms of authorisation). The average cap was around 3%, but some were as high as 30%.

The new subsection 43(2A) puts an absolute private patient income cap on all trusts of 50%. This dwarfs the actual average private patient income of 1%. There may be one or two trusts that may get near to this new cap, but for the vast majority this cap is unobtainable, and so it is pointless.

Clause 164(3) of the 2012 Act adds a new subsection 43(3D) to the 2006 Act. This says that an FT can only increase the proportion of its total income generated from private patients by 5% or more proposes in a single year if a majority of FT governors agree.

This is does not say that a vote is needed to increase the amount of private patient income by 5% (eg £1m to £1.05m) since the 5% relates to the total income which is a far greater figure (for some trusts total income is over £1bn).

This is such a huge threshold that it will never occur.

To put it in perspective, a medium sized district general hospital will have an income of about £200m, so to trigger such a vote the FT would need to propose that it took on an extra £10m of private patient income, in a single year. The threshold was deliberately set far too high.

The final section to consider concerns the strategy document that every trust has to prepare to indicate its plans for the following year. The board of directors prepares this strategy document and they must "have regard to the views" of governors (27(3) of Schedule 7 of the 2006 Act.

Since it is only to “have regard” this means that directors can ignore the wishes of governors. This strategy document must mention any non-NHS (ie private) activities that are planned and the expected income from those activities (section 164(3) adds a new section 43(3B) to the 2006 Act).

Governors must decide whether these activities “interfere” with the trust's NHS work, and must inform the board of their decision. However, the Act does not say that directors have to act on governors' concerns.

The Health and Social Care Act 2012 has been written to increase the number of private patients in NHS hospitals. The few places in the Act where there are “safeguards” these have been written in such a way that they are ineffectual.

The clear intent of the government is to introduce a two-tier healthcare system where your ability to pay gives you preference.

A set of guidance notes for other campaigners accompanies this article.

What did Gloucestershire campaigners do?

Earlier this year, local health bosses in Gloucestershire were forced to scrap plans to outsource NHS services to a social enterprise following a legal challenge by Michael Lloyd, 76. Lloyd's challenge was backed by Stroud Against the Cuts and other community groups. Nine NHS hospitals and 3000 district nurses, health visitors, podiatrists, physiotherapists and others were at risk of outsourcing.

When the case got to the High Court, NHS Gloucestershire was forced to back down and sign a consent order. They agreed to halt plans and go back to the drawing board.

How did campaigners achieve this extraordinary result?

Essentially, lawyers argued that the healthcare that Michael Lloyd received would be damaged if services left the NHS. They used existing procurement law to argue that the Primary Care Trust could not just "give" services to a body (that include social enterprises) outside the NHS without a competitive tender. They argued that health bosses had acted unlawfully when they ruled out NHS options without proper consideration. The PCT crumbled and failed to defend the claim.

Local anti-cuts groups had realised that the term ‘social enterprise’ (really, a ‘Community Interest Company’, or CIC) was being used by local health bosses to disguise backdoor NHS privatisation in Gloucestershire.

A CIC is a private company. Compared to the NHS, a CIC has higher tax liability, wasteful reorganisational costs, no internal democracy or external accountability and is required to turn a profit. Cut loose from NHS financial and administrative support, CICs would be forced to compete as minnows in a shark-filled sea – which never ends well. The only way for CICs to survive and compete is to cut corners and services and staff terms and conditions (as revealed in a secret KPMG options appraisal which was disclosed in court).

NHS Gloucestershire bosses ignored strong staff opposition to their plans and deliberately evaded public scrutiny - while brazenly talking about ‘greater ownership’ and invoking ‘the spirit of the Rochdale co-operators’. A horrified senior figure in the co-operative movement described the plans as ‘a management buyout without the cash’.

Lessons for other campaigners

A clear lesson from the Gloucestershire case is that what all PCTs can (and should) do is try and find a home for health and care services inside the NHS, in existing or new NHS Trusts, without needing to tender. NHS options have been chosen without tender in most other places (even since the passing of the Health and Social Care Act - though expect devious moves ahead).

Circumstances on the ground will vary, so if you want to try using the law to halt privatisation, you need to consult solicitors without delay. We used the excellent Leigh Day & Co.

You will also need a claimant who uses the services, is willing to be named publicly and who is eligible for legal aid (like Mr Lloyd in the Gloucestershire case). You will be expected to raise some funds as a community (we raised £7,000) and to be prepared for hard work and research.

Another line of attack is consultation - or, more specifically, failure by "reformers" to consult with people about proposed changes. The law is weak, but if health bosses have plans to change NHS services, PCTs/Clinical Commissioning Groups must at least ‘involve’ the public.

If you do decided to pursue the "we haven't been consulted" route, you can expect "reformers" to claim that services ‘aren’t changing.’ You can also expect to be told that misleadingly advertised ‘stakeholder events’ to which hand-picked people were invited in fact amounted to ‘involving’ the public. Again, it is worth talking to lawyers, because these claims deserve challenging as far as possible - both in law and in the media.

Above all, remember the NHS privateers' main weapon everywhere is secrecy (or misleading rhetoric). Shining a light into the dark corners of decisionmaking is essential. It may reveal enough evidence of unlawful actions to take a court case, or rouse public opinion to an extent which will force a rethink. All these things help campaigners elsewhere.

The time to act is now

Ask tough questions of PCTs (who are still responsible for a year) and the new shadow clinical commissioning groups about their plans now. If they are going to try and privatise, they should at least have the decency to tell us!

Remember - if anyone tells you they are legally obliged to tender services currently in the NHS, ask them to put that in writing, tell us, and talk to lawyers! Local health bosses are under undoubted political pressure to tender out services, but ultimately it is their choice, and ours to influence any way we can.

Beyond the courts

A legal case in itself can only halt a flawed, unlawful decision. It buys time for a political campaign to make health bosses do the right thing and to keep our NHS public. In Gloucestershire, several demonstrations (there were 500 people at the largest), regular public meetings with up to 350 people, film nights, letter writing, pledges, postcards, lobbies of elected representatives and board meetings, as well as town leafleting and working with unions, have all helped raise awareness and funds. The campaign is ongoing.

“The key aim now is to get the PCT to heed the popular will, and also to get another NHS body to come forward to take over services,” said James Beecher, Chair of Stroud Against the Cuts, who estimates that nonetheless, 5 or 6 strongly committed local campaigners is enough to make a difference "and to focus the support and feelings of hundreds if not thousands more in their communities."

There are battles ahead to be fought – and won. To save the NHS, we need to find out what privatisations are planned, let people know, and make as much noise as we can to stop them, whether in court, in your local papers, on the streets, to our elected representatives, or where the privateers themselves are doing their business. In a possible taste of things to come, the last week has seen both Virgin stores and a Gloucestershire NHS privateers conference shut down by protestors.

Meanwhile the last word should be left to Mr Lloyd - who is old enough to remember a time before the NHS, before ‘”freedom from fear”. He says simply “The NHS isn’t perfect, but it’s a lot better than the American-style system they are trying to introduce. There is no place for the market in the NHS.”

Caroline Molloy is a campaigner with Stroud Against the Cuts.

See also: Richard Blogger on Where to now with the NHS and Stone Soup: how campaigners can work together to share information and campaigning work. Eoin Clarke at the Green Benches also has very good posts on getting involved to halt the privatising of the NHS. 

Stopping NHS privatisation – suggested questions for local campaigners

Public opinion is still strongly against more private involvement in the NHS, so decisions to privatise services are often taken secretively, or hidden behind confusing rhetoric, and then presented as a ‘done deal’.

This guide suggests how to ask questions, who and where to ask, what to ask, what to ask next, and what to do with what you find out.

How to ask questions – by email, phone, letter, at meetings (public or otherwise):

1. Aim to clarify who has decision making power, where they are exercising it and who is influencing decisions (eg consultants). When you read minutes or attend public meetings - does it appear to you that the real decisions are being made in other groups or discussions. Can you identify what or where these might be? (This knowledge can help you shape a Freedom of Information request).

2. If possible, do some research first. Ask contacts what is going on, check websites for minutes and reports, search for news stories, investigate any private companies you hear about and see what others know (check Eoin Clarke's site thegreenbenches as well as falseeconomy). Asking questions that you already know the answers to will also help you work out how open and honest someone is being with you. Ask them nicely if they agree with your assessment of the facts. Double check everything!

3. Otherwise, just ask what you want to know openly. Don’t underestimate what you already know and don’t worry about appearing uninformed. Anyone who is hostile or patronising is either covering their own lack of knowledge or trying to hide something. Let them know (in a good humoured way) if you spot them evading and if they're answering a question they would have preferred you to ask. If you need them to spell out their answer in simpler terms ask, ‘what does that mean in practice’?.

Remember - public officials are there to answer your questions. They have a have a duty to to deal with the public openly and honestly and act reasonably. Elected representatives have duty to help the public understand the way a PCT makes decisions and to exercise democratic oversight of decisions to ensure these are made in our best interests. After all, in health, we are talking about huge sums of public money, and even matters of life and death.

4. Always ask people to state the evidence they are basing their answers on. Be like a three year old and ask ‘why? But why?’ or ‘says who?’ - or politely, ‘on what basis?’.

5. You are looking to reveal decision making processes and behaviour that are either:

a. unlawful and could be the basis of a legal case (consult solicitors early)
b. go against codes or public commitments. For example - check the ‘involvement reports’ that PCTs have to produce annually and their ‘involvement strategies’. Breaches could be the basis of a complaint.
c. should be revealed and will generate a public response.

Who and where to ask

The main decision makers are the Primary Care Trusts (for now), Clinical Commissioning Groups (in ‘shadow’ form now, to take over next year), with local councils having strong influence due to the social care integration agenda and the Department of Health. The new NHS Act will restrict CCGs powers, but local decisionmakers can stand up to the Department of Health and regulators, if they have the courage/public backing.

1. Write to board members and chairs of both the Primary Care Trust and your shadow CCG. Ask questions at their formal meetings open to the public (phone and check procedures first. Normally, you need to submit a written question in advance and don’t have to attend, but if you do, you may be able to ask follow up oral questions). Open letters (ccd to the press) are harder for decisionmakers to ignore.

2. Ask your elected representatives (councillors, MPs). You can contact them by email, or visit them in their surgeries or in parliament, submit written questions, or send a delegation or petition to their meetings (contact them to find out procedures, which vary). There is good guidance here.

They have influence, though only limited power over PCT/CCG decisions.

They have considerable power to ask questions on your behalf, including:

a. asking questions of council leaders/health ‘leads’/cabinet members, either privately or (better) in minuted meetings, or a letter. Supportive MPs can ask oral or written questions in parliament.

b. asking Health Overview and Scrutiny Committees and/or parliamentary committees to investigate. The PCT has a duty to consult HOSC on any ‘substantial variation’ to services, in a meaningful and timely way. It is good practice for HOSCs to have defined ‘substantial variation’ but many have not.

c. asking questions of Primary Care Trust officials and shadow CCG boards, either directly or via more senior or more directly involved councillors.

d. getting their, or their organisation’s, researcher (MPs and councillor party ‘groups’ have them) to do research for you.

e. asking for written reports from officials – and chasing them up, if necessary!

3. Be polite to members of staff and public officials, who can be very helpful, especially in explaining policies and procedures to you. Phone up and ask who the right person is, or do some internet research to find out first.

4. In meetings where you have a chance to put questions to politicians and decisionmakers, ask one question at a time to ensure that it is answered.

5. Ask people if they agree with public involvement and follow up by asking what is being done to deliver that involvement?

6. Getting a journalist to ask questions.

7. For NHS workers, join a union and speak to your elected union representative who can ask management your questions and report back to you. Other union members can get in touch with health workers representatives to offer support, via their branch secretary or local Trades Council.

8. One option people are considering is getting elected or co-opted onto boards and committees. This strategy should be seen as just one way of getting questions
asked and concerns raised – probably not as a way of changing policy dramatically in itself. Many, if not most, of the boards open to public membership or representatives have very little decision making power - including Foundation Trust governors, HOSCs, LINk/HealthWatch, and the new Health and Wellbeing Boards – even if you can get a majority of supporters on the board. However: PCTs and, in future, CCGs do have significant decisionmaking powers, so getting as many patient reps as possible (and as democratically elected as possible) directly on the new CCG boards is a good idea.

9. Try and ensure the structures and strategies being developed now to underpin these boards are as democratic and pro-public sector as possible. If this isn’t possible, don’t feel you have to compromise – walking away and making a lot of noise may be effective as part of a wider campaign. CCGs need at least two patient reps and they must have a ‘patient involvement strategy’ which will spell out how these reps are chosen/elected and how the wider public will be involved. This will be written by the ‘patient involvement lead’ on the shadow CCG – who may well be the PCT’s ‘patient involvement manager’.

Ask to be involved in developing structure and strategy. Similarly, find out who is on the ‘shadow Health & Wellbeing Board’ and in particular, who is writing their ‘Health and Wellbeing Strategy’, which will be the only real source of H&W Boards limited power.

10. Use ‘involvement’ or ‘engagement’ or ‘stakeholder’ meetings/’roadshows’ to tell others what is going on with your campaign.

11. Find out if there are local GP-based Patient Participation Groups, how their chairs are chosen/elected, whether they meet with other PPGs in the area and whether
they have a place on the CCG board or other real influence (experiences vary). Unlike HealthWatch, these groups are not ‘corporate bodies’.

12. Freedom of Information Requests – there is a good reason the government is looking to abolish these. They are very powerful campaign tools, especially as
more and more decisions seem to be taken outside of publicly minuted meetings. www.whatdotheyknow.com makes it easy to ask and www.cfoi.org.uk can advise you. Read CFOI's guidance - especially on how to narrow your request - that will help you avoid a situation where a request is refused because it is too broad or time consuming.

13. Local auditors – if you think money is being wasted/misspent.

What to ask – some suggested questions

1. What plans are there to commission health and social care services currently in the public sector (or to use external expertise to ‘assist’ with commissioning itself?)

2. Do these plans include the possibility of a competitive tender open to private sector bidders, and if so, why? What stage are such plans at, and for which services? Do they recognise they do not have to open up these services to the private sector via tendering, but could commission inhouse without tender?

3. Which meetings & forums/groups have a say in the decision about NHS services being tendered or commissioned and are all their meetings open and publicly minuted?

4. Which meetings and forums/groups are discussing integration of health and social care, personalised budgets, reconfiguration of services, efficiency savings, co-production, contestability, patient pathways, or other issues that might impact on NHS commissioning decisions(*)? Are all their meetings open & publicly minuted?

5. What have they done/are they doing to investigate what effect any proposals under 1-4 would have on services, on patients, on staff, on finances?

6. What have they done / are they doing to look at NHS options or other in-house homes for these services?

7. Do they recognise their obligations to consult and involve the public on these matters and what have they done/are they doing to fulfil them?

8. Do they support the right of people to choose for these services to stay in the public sector, if they wish?

9. What reports from 3rd parties (external consultants, lawyers, the Department of Health) have they requested to influence their decision making on these matters?

10. For shadow Clinical Commissioning Groups and shadow Health and Wellbeing Boards – who is on these? Can the public see, and input into, the constitutions and strategies they are currently developing? Will they increase patient representation on their boards, and commit to the Fair Commissioning Charter? When does the CCG plan to apply for authorisation?

You may have others…

(*) In many cases what sounds like good idea – moving services closer to home/the community, integrating health and social care, choice, involving people more in their care – is used as a way of shaking things up, introducing the private sector and reducing provision. The NHS at the moment is particularly vulnerable as £20-40bn efficiency savings are having a ‘shock doctrine’ effect.

Recommended reading – “The Plot Against the NHS”, Colin Leys & Stewart Player

What to do with your information

• Sometimes you might want to hold it back as a bargaining chip, or to time its release for maximum impact. But generally, get information out there.
• Press release it to local and national media
• Tell your community, supporters and workplaces
• Consult lawyers – sooner rather than later
• Share it with other campaigners, via www.falseeconomy.org.uk, http://www.konp.org.uk

If you find this information useful, please consider donating to KGNP.

From today, the government limits the time for which contribution-based Employment and Support Allowance (ESA) is paid. The change limits the amount of time people in the work-related activity group can receive contribution-based Employment Support Allowance to 365 days. These changes are part of the Welfare Reform Act.

Louise Whittle explains the effects this change will have on her.

My Employment Support Allowance (ESA) finishes today.

The reason is that due to the Welfare Reform Act, contributory ESA has now a one year time limit. I do wonder actually how many people who are on contributory ESA know their money will run out after a year.

I applied for ESA on 1 May 2011 after a traumatic time after losing my job. I faced the dreaded Atos interview work capability assessment. They found me “fit for work” (indeed I have a pulse and that’s enough for Atos). Then months later, I won my appeal.

By then my money was coming to an end. In May 2011, I had heard rumours that the government wanted to time-limit contributory ESA. The Lords put forward an amendment which was overturned by the government.

What is in store for me now?

Financially, I will be worse off. Contributory ESA gave me financial independence, but now I will have to rely on my low paid partner. If I apply for means-tested ESA, they will take my partner’s salary into consideration and I won’t qualify because of that. I am now investigating whether I quality for Job Seekers' Allowance (JSA) and if I fulfill the contributions criteria for it.

The dramatic loss of income will undoubtedly have major consequences on some people's health. Some people may find themselves slipping backwards. They may have improved with support, but the sudden loss of income could severely damage their mental health once again - coupled with increase poverty and misery.

In my own personal circumstances, I have become more stressed and depressed about this. It makes it harder for people to survive the day-to-day experiences of life - for example, to apply for jobs, especially jobs where you need to ask for four duplicate photocopies of an application form and/or you need to budget for job interviews. Losing broadband because of cost means being unable to search on the internet for jobs. Libraries provide access to free internet, but, combined with cuts, many will find that provision will go. The government desperately wants you to find a job, yet undermines you in every way.

Certainly, one year of contributory ESA is not nearly enough. There was absolutely no need to time-limit this benefit. But with this unholy alliance, it was an ideological and vicious attack on contributory based benefits, I am sure they would love to make all benefits means-tested.

What will happen? I am sure many people who are coming to an end of their ESA will disappear off the radar and the likes of Chris Grayling and Iain Duncan Smith will cheer loudly exclaiming that there are people coming off benefits. But where will those people go to?

Legal challenge

A firm of lawyers - Irwin Mitchell - is looking to challenge ESA time-limits. Unfortunately, I can't be part of this action as I don't qualify for legal aid. I've contacted the trade union Unite Community department (I am an unemployed member and am sure there are other members who are in the same position as me ) asking whether they would work with Irwin Mitchell, provide support, legal advice and solidarity to members in this situation. It would be well received. I'm waiting for an answer from Unite Community.

Louise Whittle blogs at harpymarx

This report is from a recent Derbyshire county council meeting. Service users and campaigners are concerned about a Derbyshire county council proposal to cut youth service budgets by about £800,000 this year and to outsource youth services to the voluntary and independent sectors (PDF 34KB). They say that they doubt the same services can be delivered, particularly on reduced budgets.

Buildings may also be closed as part of the council's plans.

Local youth campaigner Greg Roberts collected more than 16,000 signatures for a petition to save directly-provided youth services. He and other service users talk about their concerns in the video below. The video also follows the petition's progress through the council meeting.
 

The council says that it is still looking at consultation findings.

Local press stories:
Turning our backs on youth spells disaster
Heated exchanges as shakeup to youth services voted through