Marxist-Leninists respond to attack outside of Parliament with profound Statement:

Unite in Action to Defend the Rights of All

Statement of RCPB(ML), March 22, 2017

RCPB(ML) sends its condolences to the families and friends of those killed and injured today on and near Westminster Bridge. It pays tribute to the courage, professionalism and compassion of the emergency services, including those nurses and junior doctors who immediately left St Thomas’ Hospital to rush to attend to the victims.

The latest reports are that a lone individual at around 2:40pm used a vehicle to mow down pedestrians on the bridge, before stabbing a police officer at the gates to New Palace Yard, who died shortly after of his wounds. Five people, including the police officer and the alleged attacker, have died at the time of writing, the latter being shot by armed police at Westminster, and as many as 40 people injured, some very seriously. The alleged attacker has not been named, though Scotland Yard says his identity is known. Downing Street said that Prime Minister Theresa May would chair a Cabinet Office Briefing Room (COBRA) emergency meeting this evening.

The attack has occurred in a climate of anarchy and violence. The ruling elites in this country, the US and other big powers have been intent on demonising so-called enemies of democracy, particularly Muslims, and criminalising those that they label as enemies of their values. Thus news reports have been full of such quotes as that the terrorist has struck at the home of British democracy.

The climate of fear being imposed is an assault on the right to conscience. The imposition of “British values” is part of this assault. The people must demand that the colonialist past and imperialist present of the big European powers be repudiated and that the stated policy of governments in Britain, for illegal intervention and regime change in Iraq, Libya and Syria, which has only brought more insecurity, instability and violence, be ended.

Instead of calm, hysteria is being promoted. Far from a government based on the rights of the people and their sovereignty, the government is even standing in the way of self-determination of the peoples of Scotland as well as Wales, as well as rewriting the history of the crimes of Britain ruling the waves, its colonial heritage and present outlook, to re-establish a “Great” Britain and an Empire 2.0. This is the reality of “our way of life”, “cherished democracy” and “British values”.

The state is attempting to sway public opinion in a grossly self-serving way, against anything alleged to be “foreign” and particularly Muslim. Its own creation of divisions and hate is accompanied by grossly hypocritical words against “hate crime” and the need for “integration”. In effect, this is being used to foster their warmongering project abroad, as well as to promote racism and chauvinism and to attack rights at home.

The context of the tragic incident is also one where the anti-war movement and the stand of the people against racism and Islamophobia are being vilified. Meanwhile the First World War is being glorified, with praise for “our glorious dead”, while the actions of millions upon millions in the Second World War to defeat Nazism and fascism are being turned into one of a stand against “totalitarianism”, while the right to resist oppression and the right to be are themselves labelled terrorism.

The people are being incited to define this tragic incident as “terrorist”. This has happened even though the attacker was reported as acting alone and nothing is known as to his motives, save that attention is being drawn to the fact that today is the first anniversary of the attacks in Brussels. This incident is called “terrorism”, while the killing of MP Jo Cox by a neo-Nazi is not. In reality, this incident underlines that the people must unite in action in defend of the rights of all, opposing anarchy and violence, racism and reaction, including Islamophobia.

The people must take a stand against this tragic action being used to negate the rights of the people. “Standing together” must mean taking a stand based on justice. It means unity in action in defence of the right to conscience, and to resist reaction and retrogression. This reaction and retrogression is real, but so is the people’s spirit of resistance and the desire for empowerment.

No to the Imposition of Allegedly “British Values”!
Unite in Action in Defence of the Rights of All!

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John McDonnell MP Speech at Newcastle “New Economics” Conference:

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What’s gone wrong with social care

10 charts that show what’s gone wrong with social care

  • Elderly people, in a care home, play a board gameImage copyrightISTOCK

Ministers in England have said they are looking for a solution to the problems in social care. That has raised hope that next month’s Budget could include measures to tackle what many describe as the crisis facing the sector.

But what exactly has gone wrong? And who’s affected?

Social care – organised by councils – is a broad term that covers everything from children’s social workers and fostering through to services for disabled adults and the care provided to people in their old age. But some have been affected more than others.

1. Social care spending has stopped rising

Over the years, more and more has been spent on services. The growth in the population, the fact people are living longer and those with disabilities are more likely to survive to an older age are all contributory factors.

But this upward trend in funding has tailed off in England over the past decade.

Graph on spending

You do not have to look far to find the cause of this. Central government funding for councils was cut by a third during the last parliament.

2. Councils are prioritising care

Councils have tried to protect social care. The proportion of their budget being spent on these services has increased over the years and now well over half of their spending goes on care services.

Pie chart

But that, of course, has meant deeper cuts elsewhere – in libraries, leisure centres and refuse collection.

3. The NHS is propping up care

What’s more, if you delve further into the figures you can see even this level of spending has been maintained only with a little help from elsewhere.

A third of last year’s £24bn budget went on children.

That left just over £16bn for adults. But nearly £2bn of that was thanks to a transfer of money from the NHS into care services, ordered by the government.

Graph on spending

This is a recognition that what happens in social care has a direct impact on the NHS.

4. No care means patients get stranded

If people are not given the support they need in the community, they can end up in hospital.

And if it’s not available when they are then ready to be discharged, they can end up stranded on wards – doctors will release frail patients only if they know there are care packages in place in the community.

The number of delays of this sort has nearly doubled in five years.

Graph on delays

Not all of these delays are down to a lack of social care, but it is the fastest growing reason for them.

And when beds are occupied by patients who cannot leave, it gets more difficult to admit new patients.

That’s one of the reasons why we have heard so much about lengthening trolley waits and worsening waiting times in accident and emergency departments in recent months.

5. Councils are looking after fewer older people

This situation is understandable. To make savings, councils have started to ration care, particularly to the elderly, rather than younger adults with disabilities.

The number of older people getting care from councils has fallen by over a quarter between 2008-09 and 2013-14.

Graph on care

We don’t know what has happened since 2014, as the way the data is collected has changed. Although, it’s pretty clear there hasn’t been a huge turnaround.

Councils agreed to help less than half the older people who approached them for help last year.

What about elsewhere in the UK? Whereas all adult council care in England is means-tested – those with assets of over £23,250 pay the full costs of their care – Wales, Northern Ireland and Scotland have slightly different systems.

In Wales, the cost of help in the home for daily tasks such as washing and dressing is capped at £60 a week, in Northern Ireland it is provided free to the over-75s, and in Scotland personal care is free whether the individual is in their own home or a care home.

Many argue these systems are more generous. That may be so. But all have had to ration services in recent years by restricting access to only the people with the most severe needs.

How the care system works across the UK

The alternative options

6. People are being left to fend for themselves

The result of this is that people make their own arrangements. Four in 10 people in care homes pay for themselves.

Others rely on family and friends to look after them. But growing numbers are being left to struggle on with no or little help.

Pie chart

The charity Age UK has been charting this. It estimates the number of those falling into this group has risen by nearly 50% since 2010, to 1.2 million.

These are people who have pretty substantial needs. They cannot wash or dress themselves. They may struggle to go to the toilet. The stories they tell are heart-breaking.

7. Self-funders appear to be subsidising councils

But it’s not just individuals who have tales of woe. The companies providing the services – councils tend not to run them in-house – have started voicing concerns.

They report the prices councils are paying are being squeezed so much that they are now making a loss in some areas from local authority work.

The UK Home Care Association has calculated the cost of helping people in their own home is £16.70 an hour, but councils across the UK pay over £2 less than this on average.

Meanwhile, analysts LaingBuisson have calculated that the fees being paid by councils for a care home place are £100 a week less than the true cost.

Graph on fees

It means the fees for those who pay for themselves are rising to offset the losses from local authority funded residents. In effect, self-funders are subsidising the state sector.

Is this fair? LaingBuisson thinks not. It has called the trend a “hidden care tax”.

And these bills can rack up. An estimated one in 10 people faces care costs in excess of £100,000 after the age of 65.

8. The care market could be at risk

There is concern this is destabilising the sector. The Care Quality Commission raised the alarm about this last autumn.

The risk is care companies start to focus on areas where there are more of the high-paying self-funders.

That could create a shortage of places in some areas of the country, as self-funders are more likely to be found in the south of England.

Self-funders distribution
Image captionThe map of the UK shows self-funders are more likely to be found in care homes in the South East of England

There has not been a big exodus yet, although the number of care and nursing homes operating in England has fallen by over 1,500 in the past six years to 16,500.

9. The population is ageing

So what does the future hold? The population is growing older.

Graph showing predicted population increase of the UK

And their needs are getting ever more complex. At the age of 65, one in six people has trouble with daily living – washing, dressing or eating. By 85, half do.

10. Council tax bills are rising to help councils cope

Ministers have already taken steps to relieve the pressure.

The health service and councils are being encouraged to work together on joint projects.

They have also given councils permission to increase council tax to pay for social care.

But there is a limit to how much this will bring in.

This year, councils have been allowed to increase household bills by 2%.

Most have done so, but it is raising less than 3% of what councils plan to spend on adult social care from their own funds, once NHS money has been deducted.

Graph on budget breakdown

By 2020, the Local Government Association believes, there will be a shortfall of £2.6bn in funding.

It wants more substantial reform – and many in academia, in the health service and in the charity sector agree.

Health Secretary Jeremy Hunt has said this is on the government’s agenda. But many have tried to find a solution before and failed.

The social care system was created in 1948 and has hardly changed since.

When Tony Blair came to power, he set up a Royal Commission. But nothing came of it.

Under Gordon Brown’s premiership, the idea of a universal care system – where everybody would get a basic level of care – was floated, before it fell victim to the Tories’ 2010 “death tax” election campaign warning.

The coalition government proposed a cap on care costs. That was meant to be introduced last year, but has been pushed back until 2020. Many now doubt it will ever see the light of day. And so the social care problem rumbles on.

Additional reporting by Rachel Schraer

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The Nazis: “The campaign of disinformation about the past is directly related to the warmongering of the present”.

For Your Information

War Crimes, Ukrainian Nationalists and
the Canadian State

Defendants in the dock at the Nuremberg Trials, 1945-46.

Lubomyr Luciuk, a professor at Royal Military College in Kingston, Ontario, writes in the Ottawa Citizen on March 9: “I’ve heard it all before. It was fake news then and still is. Allegations about ‘Nazis in Canada’ — the most recent regurgitation targeting Foreign Affairs Minister Chrystia Freeland — have circulated for decades.

“Understandably, just after the war’s end, Jewish Canadians were alarmed at the prospect of ‘Ukrainian Nazis’ escaping justice by posing as Displaced Persons. In response, the Liberal government initiated high-level inquiries, ensuring no such villains resettled here. Yet claims about ‘thousands of Nazi war criminals hiding in Canada’ resurfaced in the early 1980s, resulting in a Conservative government establishing the Commission of Inquiry on War Criminals, headed by Justice Jules Deschênes. Tellingly, its 1987 report rebuked those who had spread ‘increasingly large and grossly exaggerated’ figures about ‘Nazi war criminals.'”

The learned professor goes on to take credit for the fact that not a single person was ever convicted of being a “Nazi” in a Canadian criminal court. In reaction to the formation of the Deschênes “Commission of Inquiry on War Crimes” Luciuk helped create the Ukrainian Canadian Civil Liberties Association (UCCLA) to whitewash the war crimes of Nazi collaborators in the Ukraine. In its own words, it was founded “in 1984 to meet the defamatory accusations that ‘Ukrainian war criminals’ were being harboured in Canada.” Luciuk however never uses the word war criminal which was the prohibited class and the issue then and now.

In making this assertion, Luciuk rejects the conclusion of the United Nations War Crimes Commission (UN WCC) that the Waffen SS was a criminal organization and its members guilty of war crimes. In doing so, he rejects the decision Never Again! of the world’s people following the defeat of fascism and that aggression is the supreme international crime.

The UN WCC, the International Military Tribunal, that presided over the war crimes trials at Nuremberg, expressly declared the Waffen SS, the armed wing of the Nazi Party, to be a criminal organization. Until 1943 the Waffen Schutzstaffel (SS) was comprised only of German units. After its defeat at the Battle of Stalingrad an increasingly desperate Nazi Germany organized collaborators into Waffen SS Divisions in all occupied countries, including two Ukrainian divisions.

The UN WCC, ascribed war criminal status to members of organizations it determined to be criminal organizations. Only those who had not voluntarily joined but had been forcibly conscripted were excluded from criminal status.[1]

In October 1947, the Polish representative on the UN WCC put forward specific charges against the members of the Ukrainian SS Galizien and the Ukrainian Insurgent Army (UPA). These included the wanton devastation and destruction of property; complicity in deportation; systematic terrorism; putting hostages to death; complicity in mass murder.

The Short Statement of Facts transmitted by the Polish representative on the UN WCC states:

“The above listed persons took part in organizing — according to the instructions issued by the Hitlerite authorities — of UPA (Ukrainska Powstanesa Armia – Ukrainian Insurgent Army) and SS – Schuertzen – Galizien, later called ‘Halyczyn.’ Both were used for deportation of the civilian Polish population, for destruction of whole villages and for murdering their inhabitants.

“A letter dated November 3, 1947 to the Main Commission for the Investigation of War Crimes in Poland states that the investigation had been suspended by the United Nations War Crimes Commission in London until specific information is provided regarding the position, the level of authority, and the time span in office of the following major figures accused of committing crimes against the Polish people in several regions…” Seven individuals were named.[2]

Members of Waffen SS Galizien transferred
to England, 1947.

Surviving members of the SS Galizien surrendered to the British and were interned in Rimini, Italy, an area controlled by Polish II Corps forces (part of the British army). Although they had changed their name to First Ukrainian Division of the Ukrainian National Army, their identity as an SS unit was well known. Through the intervention of the Vatican, the SS members were not deported to the Soviet Union as required under the Yalta Agreement. Instead their status was changed from prisoners of war to surrendered enemy personnel. Later their status was again changed, this time to “displaced persons.” In 1947 they were allowed to emigrate to Britain and later to Canada. Their names have never been released, but about 7,100 members of the SS Galizien emigrated to Britain.[3]

In 1950, all surviving members of the Waffen SS Galizien who wished to immigrate to Canada were “cleared” for immigration to Canada, despite the fact that the Waffen SS was a prohibited class and not eligible for immigration at that time.

The Ukrainian Canadian Committee (UCC) was extremely active in pressing the Canadian government to allow members of the SS Galicien to emigrate to Canada, as well as for the admission of leading members of the Organization of Ukrainian Nationalists (OUN) and the UPA.[4]

The UCC was directly organized by the government of Mackenzie King following the arrest and incarceration of the leaders of the Ukrainian Labour Farmer Temple Association (ULFTA) and the declaration that the association was illegal. The presses, halls and other property of the ULFTA were handed over to the UCC.

There is indisputable evidence of the war crimes, crimes against humanity and crimes against the peace committed by the Waffen SS divisions, and the closely-associated and overlapping memberships of the OUN and UPA.[5]

What inquiry if any the Canadian Commission of Inquiry on War Crimes (Deschênes Commission) conducted as to how these forces, who betrayed their own people and were responsible for countless civil deaths and the deaths of anti-fascist partisans, had been “cleared” of war criminal status is unknown.[6] The government refused to follow the Commission’s recommendations and did not release the 560 page report of the Director of Research, Alti Rodal. The New York Timesreported that the report concluded that the U.S. had used Canada as a “dumping ground” for Nazis no longer considered useful intelligence assets. A heavily redacted version supported the conclusion that members of the Galizien Division had participated in war crimes.

There has never been an official acknowledgement that Canada acted in contempt of its own laws and the will of the Canadian people who had sacrificed so much to defeat fascism. The role of individuals and organizations such as the UCC in lobbying for admission of war criminals and Nazi collaborators has not been officially investigated either.

Anglo-American Imperialist Refusal to Prosecute War Criminals

As the 1985 Deschênes Commission reported, war crimes trials were shut down by the British and Americans as an integral part of Cold War policy. The Deschênes Report quoted a 1948 memo from the British government explaining that it would no longer prosecute war criminals on the basis of the Cold War logic that “it was now necessary to dispose of the past as soon as possible.”

The Parliamentary Summary regarding the Deschênes Commission states: “Faced with the reality of a new and dangerous enemy, the western powers became reluctant to pursue the remnants of the old. Their limited security resources were re-deployed to uncover suspected Soviet agents and Communists, rather than to identify and track down Nazi war criminals. In Canadian immigration policy, which was rapidly liberalized after the war, the restrictions against the entry of ex-enemy aliens were systematically relaxed.”

Nazis carry out mass killings in Vinnytsia, Ukraine, 1942.

In this way world reaction, led by U.S. imperialism, declared its refusal to accept the verdict of the world’s people that a new definition of democracy had come into being which did not permit the existence of fascism. It was a negation of the demand for new arrangements on the international scale to establish that aggression was the supreme international crime and to bring to justice those guilty of war crimes, crimes against the peace and crimes against humanity.

Even the justification about not pursuing “remnants of the old” is disinformation. U.S. imperialism in particular was actively pursuing and recruiting the “remnants of the old” — that is, leading Nazis, collaborators from the countries occupied by the Nazis and war criminals. But it was not to bring them to justice; it was to secretly arrange their escape and safe passage to the U.S. and to incorporate them into the state apparatus, especially the military and intelligence services.

From the time that the tide turned with the defeat of Germany at Stalingrad, the hopes of the imperialist powers that Nazi Germany would crush the Soviet Union and its nation-building project were dashed. The Cold War signalled not the emergence of a “new and dangerous enemy” but the same agenda to smash the new which had arisen with the Great October Revolution. U.S. imperialism now assumed the mantle of Nazi Germany, incorporating top Nazi scientists, military intelligence and others into its war machine, with the aim of accomplishing what Nazi Germany had been unable to do.

Today the Cold War is over, but the danger of a new world war remains and grows more serious with each passing day. The campaign of disinformation about the past is directly related to the warmongering of the present. It is a crime against the memory of all those Canadians who sacrificed to defeat fascism. It is a grave crime against the millions of Ukrainians who fought to defeat the Nazi scourge and who as a nation suffered the loss of millions of lives.


1. Judgement of the International Military Tribunal, here.

2. “Short Statement of Facts, United Nations War Crimes Commission charges against German war criminals of Ukrainian origin registered number: 6697/P/U/1124, case number 1124 received October 23, 1947,” from Genocide and Rescue in Wolyn: Recollections of the Ukrainian Nationalist Ethnic Cleansing Campaign Against the Poles During World War II, Tadeusz Piotrowski editor, McFarland & Company (2000)

3. Tottle, Douglas, Famine, Fraud and Fascism, The Ukrainian Genocide Myth from Hitler to Harvard, Progress Books, Toronto, 1987; Daniel Foggo, the Telegraph, 22 June 2003.

4. New York Times, August 9, 1987; Per Anders Rudling, “The Honor They So Clearly Deserve:’ Legitimizing the Waffen-SS Galizien,” The Journal of Slavic Military Studies, Volume 26, 2013.

5. Serbyn, Roman, “Alleged War Criminals, the Canadian Media and the Ukrainian Community,” (provides a sanitized history of the Galizien Division).

6. Kevin C. Ruffer, “Cold War Allies: The Origins of CIA’s Relationship with Ukrainian Nationalists,” Studies in Intelligence, 1998, (contains declassified CIA documents); Simpson, Christopher, Blowback, America’s Recruitment of Nazis and Its Effects on the Cold War, New York: Weidenfeld & Nicolson, 1988.

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Portsmouth: bed blocking costs:


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Why the NHS is in trouble:

10 charts that show why the NHS is in trouble

The NHS faces unrelenting pressure despite funding rising. Why?

The sheer scale of the NHS can take the breath away. Every 24 hours it sees one million patients, and with 1.7 million staff it’s the fifth biggest employer in the world.

This vast enterprise absorbs eye-watering amounts of money.

1. We spend more on the NHS than ever before

Last year £140bn was spent on health across the UK – more than 10 times the figure that was ploughed in 60 years ago.


And that’s after you adjust it for inflation.

2. A bigger proportion of public spending goes on health

Governments over the years have had to invest more and more of the public purse into it. Today 30p out of every £1 spent on services goes on health.

Even during the years of deep austerity, extra money has been found for the health service – £8bn more this Parliament in England alone.

Graph: change in proportion of public services budget spent on health 1955-56 (11.2%) 2015-16 (29.7%)

Yet it seems no matter how much is invested, it’s still not enough. The NHS is creaking at the seams.

3. Key A&E targets are being missed

The best barometer of this is the four-hour A&E target. We often think of it as an indication of how good an emergency department is. But it’s not. It doesn’t tell you about the quality of care – how quickly you get pain relief or whether the unit is good at spotting the signs of a heart attack.

Instead it’s a sign of whether the system is under stress – both in the community and in the hospital.


When there’s perfect harmony between the numbers arriving and leaving 95% of patients will be dealt with in four hours.

But this isn’t happening. You have to go back to the summer of 2015 for the last time it was met in England, with performance deteriorating markedly year on year.

A&E performance in England

The rest of the UK is not immune either. Four-hour performance is worse in Wales and Northern Ireland. Scotland is performing a little better, but is still some way short of the target – its major hospitals have been hovering around the 90% mark in recent weeks.

4. The UK’s population is ageing

The ageing population is certainly a major factor – and it’s one that all health systems in the world are struggling with. Medical advances have meant that people are living longer. When the NHS was created, life expectancy was 13 years shorter than it is now.

This is something to celebrate. Infectious diseases are no longer a significant threat. Heart attacks do not claim the lives of people early in the same numbers. Even cancer is not the death sentence it once was – half of people now survive for a decade or more.


But this progress has come at a cost. People are living with a growing number of long-term chronic conditions – diabetes, heart disease and dementia. These are more about care than cure – what patients usually need is support. By the age of 65, most people will have at least one of these illnesses. By 75 they will have two.

5. Care for older people costs much more

The average 65-year-old costs the NHS 2.5 times more than the average 30-year-old. An 85-year-old costs more than five times as much.


As the numbers continue to rise so does the cost to the NHS. This is compounded by the rising cost of new drugs. The health service is currently considering capping the amount it will pay for new drugs at £20m each a year. A fifth of new treatments coming on stream cost more than this.

Then there’s obesity. A third of adults are so overweight they are risking their health significantly.

All this contributes to what health economists call health inflation – the idea that the cost of providing care outstrips the normal rise in the cost of living across the economy.

This is why health has tended to get more generous rises than other areas of government spending.

Over the years this has been achievable through a combination of economic growth, which brings in more money through tax, and reducing spending in areas such as defence, which has led to the NHS taking an ever-greater share of the public purse.

6. Increases in NHS spending have slowed

But, of course, the economy goes through cycles and over the years governments have varied the amount they were willing or able to give.

Since the NHS was created in 1948, the average annual rise has been just over 4%. During the Labour years under Blair and Brown this was closer to 7%.


As you can see the period since 2010 has seen the tightest financial settlements. What is more, the spending squeeze is continuing during this Parliament at almost exactly the same rate, even with England’s extra £8bn going in.

Ministers in England are right to say they are increasing funding – it’s been frozen in Wales and Scotland – but it’s just that it doesn’t compare favourably with what the NHS has traditionally got.

Indeed, the Institute for Fiscal Studies believes over the 10 years to 2020, the NHS budget across the UK will not have increased enough to keep pace with the ageing and growing population.

7. The UK spends a lower proportion on health than other EU countries

But is it just a matter of more money? Would an extra few billion make all the problems go away? If you look at other European nations the UK is certainly spending less as a proportion of GDP, which is a measure of the size of the economy.


The result, as you would expect, is fewer beds, doctors and nurses per patient in the UK than the big spenders.

But a number of these countries achieve that by taxing more. Would the UK public stomach that? If a poll by Ipsos MORI for the BBC this week is anything to go by, they are pretty split – 40% would back a rise in income tax and 53% would support National Insurance going up.

Nor does it seem there’s appetite for a change in the system. A majority were against charging for services or moving to an insurance-based model like some of our European neighbours do.

But even if more money was spent or raised, that would not lead to an overnight improvement. More doctors and nurses would need training and that takes time and, crucially, there is not a flood of people wanting to work in key posts.

Trainee posts for GPs are being increased, but the NHS cannot fill them all.

There also remain big questions over whether the structure of the NHS is right for 21st Century healthcare.

Nurses protesting in 1962

The NHS is still centred on the network of district general hospitals that emerged during the hospital building boom of the 1960s.

But in an era where people are struggling with those chronic illnesses, what they really need is support in the community.

The problem is there’s a serious shortage of this. The number of district nurses in England has been cut by 28% in the past five years, while getting a GP appointment is becoming increasingly difficult.

8. Demand for A&E is rising

The result is that people end up going to hospital. The numbers visiting A&E have risen by a third in 12 years.


Not all of this is down to people with these chronic conditions, but they tend to be the cases that take the most care. Two-thirds of hospitals beds are occupied by the one-third of the population with a long-term condition.

There are attempts to change this. To place more emphasis on care outside hospital. NHS England chief executive Simon Stevens has set out a five-year plan to create more integrated care, which involves hospital services working more closely with their local community teams. Similar moves are being made in Scotland, Wales and Northern Ireland.

There also an emphasis on prevention – getting people to be more active, eat better diets and drink less.

9. Fewer older people are getting help with social care

But perhaps the biggest problem is council-run social care. This encompasses day centres, help in the home for tasks such as washing and dressing, and good quality care in care homes during the final years of life. It is seen as essential to keep people well and living independently – and out of hospital.

In an era when the population is ageing you would expect more people to be getting help from the state.

However, the opposite is true. In England over the past four years, the number of older people getting help has fallen by a quarter. The result is large numbers going without care or having to pay for it themselves.

Pie chart

The other parts of the UK can make a case for being more generous in this respect – home care is capped at £60 a week in Wales and free for the over-75s in Northern Ireland, while Scotland provides free personal care (washing and dressing) in both care homes and people’s own homes.

10. Much more is spent on front-line healthcare than social care

But none of them has cracked it. Indeed, if you were setting up a health and care service today, ask yourself this – how would it be done?

Would you separate medical care from personal care? Give one service to a national institution and the other to local councils? Would you provide one free at the point of need and charge for the other? Would you increase the budget of one, but cut the other?

Graphic spending

Would you build more than 200 hospitals and spend over half of your budget on them when the biggest users of care are people with long-term illnesses that need care rather than medical intervention?

But as that is the system we have got at a time when money is limited, we are falling back on a typical British trait – making do.

Additional reporting by Rachel Schraer

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Stress – time to stop blaming the workers

Yesterday I attended the HSE stress summit in London for the launch of their new stress campaign.

The conference went well and the main thrust of the conference was on the importance of prevention, using the risk prevention and risk management approach that is contained in the HSE stress management standards. This is the approach that unions all support and the TUC and HSE have just produced advice for union representatives on how to use them.

However, what surprised me was the number of speakers (not HSE ones) who were talking about using resilience. Resilience is the idea that you can prevent people becoming stressed by making them more resilient. This is of course nonsense. If people are getting stressed you remove the causes of stress. This is the approach that is used for every other workplace hazard – after all we don’t try to change workers to make them more resilient to dangerous chemicals why on earth should we do it with stress.

The idea behind resilience is that it sees the worker as being the problem, so what you do is fix the worker, and that is the crux of the problem. Employers like resilience because it means they do not have to address the real problem, which is how they treat workers. Bosses can claim that if someone goes off sick with stress it was because they were not resilient enough. It reminds me of twenty years ago when employers (and lawyers) talked about people who suffered from stress as having an “eggshell personality”.

There is also no evidence to support the idea that you can make your workforce more “resilient” to stress – even if you wanted to. There has been a lot of research into the subject which seems to show that teaching people how to recognise and deal with the symptoms of stress can help their recovery and this is the principle behind one of the main treatments that is offered to those with stress, cognitive behavioural therapy (CBT). This is different from an employer trying to make their workforce less likely to suffer from stress so that you can keep on piling on the stress.

People who suffer from a stress-related illness do of course need support in getting better. It is also important to remember that around 70% of stress-related absence is not primarily caused by workplace stress but by other factors and employers can do a lot to help them get better. This includes access to counselling or treatments such as CBT. Unions have been at the forefront of trying to encourage employers to offer support. We also support a lot of the wellbeing initiatives that employers are introducing and have guidance on this. However, where I disagree with a lot of the consultants who are selling well-being or stress awareness training to employers is that these are not a substitute for prevention.

For too long, employers have been able to ignore workplace stress with impunity, knowing that the HSE will not take action against them, and instead they have focused on anything except preventing the causes of workplace stress. They are acting like the king’s men in Alice in Wonderland who are trying to put Humpty Dumpty together again rather than stopping him falling off the wall in the first place.

Well, it is time that approach stopped. The HSE stress summit is a great start but if it is going to really be effective, it needs to be followed up by strong simple regulations that make it clear what employers need to do and a campaign of enforcement against those employers who knowingly subject their workforce to harmful workplace stress.

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