current affairs

Why no NHS osteopathy in Brighton & Hove?

I was pleased to see a report in today’s Argus about osteopathy services on the NHS. The piece isn’t online but in essence it says a new report from the British Osteopathic Association has found that whilst NHS West Sussex referred over 1,800 patients for osteopathic treatment – no referrals were made by the NHS in Brighton & Hove nor in East Sussex.

NHS Brighton & Hove are quoted in the article saying that they provide the full range of NICE recommended treatments through their physiotherapy service. I don’t question the quality of the physiotherapists, but they are not the same as osteopaths. They operate in a similar field but with quite different techniques and approaches.

NICE guidance for lower back pain includes osteopathy. Indeed there’s a growing body of quality clinical evidence to show that osteopathy is at least as, if not more effective, than other methods for treating back pain. These include a recent meta study and the ROMANS study which found that “outcomes improved more in the osteopathy group than the usual care group” whilst osteopathy was not significantly more costly. Indeed when my daughter was born through a ventouse delivery, the hospital midwife recommended an osteopath for helping with the damage the delivery had done to her little head. Four years later and you can barely feel on her skull where the ventouse was used, but I paid for every osteopath treatment myself.

In January of this year, the Council’s Health Overview & Scrutiny Committee received a petition and a funding proposal calling for therapies including osteopathy to be made available through the local NHS. This was of great interest to me so I prepared for the item in detail including collecting abstracts of studies to cite such as those I have mentioned above.

Osteopathy clearly has a solid evidence base to back its use. However when I attempted to have this discussion the Conservative committee chair and the Chief Executive of NHS Brighton & Hove both were keen for no discussion to be held at all. Against my protests the item was not debated. The following committee meeting I tried to discuss it again or at least find out if the local NHS had done anything about the petition. Nothing.

So I applaud NHS West Sussex for looking beyond conventional medicinal disciplines in treating their residents. It would be great if other local NHS primary care trusts would, before they are abolished, set a precedent that osteopathy should be available under the NHS in their areas. There should be no argument over providing treatments backed by guidance and sound clinical studies.

UPDATE 27th October 2011:

Brighton chiropractor Matthew Bennett (of Sundial Clinics) sent me a link to an interesting case study which further supports the benefits of chiropractic, osteopathic and physiotherapy treatments – and that they end up being cheaper for the NHS too.

current affairs

What evidence that Lansley’s plans will improve NHS results?

As I’ve been appointed the local Green finance spokesperson this letter, which I submitted to The Argus, was my last as local health spokesperson:

While the current NHS structures are by no means perfect, Conservative minister Andrew Lansley’s plans for the NHS threaten at least three years of massive change, disruption and uncertainty, with no evidence to show any improvements will be the result.

These changes are being foisted on us because they ‘feel right’ to Lansley. That feeling has probably been helped along by financial contributions to his office by the head of Care UK – one of the firms that stands to most benefit from these reforms.

The sad fact is that the majority of GPs won’t have the necessary skills to organise commissioning and so will end up hiring those who do, the sacked managers who will be selling back their services to the NHS at inflated rates as independent contractors.

GPs aren’t keen on becoming managers running half-year long tendering processes, they are more interested in making people better. NHS workers certainly don’t want to see their pay and conditions threatened by being transferred to private providers. And I see no reason why taxpayers should stump up for corporate healthcare firms’ profits when we are being treated by our great public health service.

Greens firmly oppose these changes, which take Labour’s health privatisation schemes to their distasteful conclusion.


Cllr Jason Kitcat, Green Group Health spokesperson

notes from JK

Speech: Maternity Services in Brighton & Hove

This speech was presented to the Full Council meeting of Brighton & Hove City Council on 18th March 2010. It was to propose a Green notice of motion on maternity services, which was passed by the meeting:

Amidst much downbeat news on the NHS, it is doubly worth celebrating, as this motion does, the local Primary Care Trust’s plans to introduce a midwife led birthing centre in our city.

For far too long the majority of mothers have had to trek to Crowborough for a midwife led birth or go to the Royal Sussex County hospital for a ‘standard practice’ birth. An increasing number have been wanting to have home births but the resources have not always been available to support this. Furthermore Crowborough birthing centre only has six beds – so the choice has not been a reality for many families.

Of course good, trouble-free births do happen every week at hospitals. I support the good work our local hospital does, this motion is about offering families meaningful choices.

For so-called “normal” pregnancies home and birthing centre births are just as safe, if not safer than the hospital environment. For it is in hospitals, where birth still tends to be overly medicalised, that unnecessary interventions with unintended side-effects still happen too often.

Much obstetrician thinking is still too male dominated. Doctors tend to treat birth as something that happens to a women, in the way disease happens to someone, rather than an incredible thing that women do and have been doing for millennia.

We celebrate the advances in medicine which have dramatically reduced childbirth mortality rates. But traumatic births, due to inconsiderate and inappropriate medical interventions, should be avoided wherever possible. For the trauma of a difficult birth has lasting physical and psychological impacts on mother and child, hence their partners and surrounding family too.

Women being offered epidurals, “because the anaesthetist is around now”, being strapped to monitors which restrict their movement in the critical stages of labour and being given epistomies because mums are made to deliver lying in that most unnatural position, on their backs. These are all examples of unnecessary interventions which still happen in NHS hospitals. These are actions which have a lasting impact on the wellbeing of mothers.   Medical interventions often require additional recovery and healing, hindering mothers from caring for their children in those precious early days.

Such interventions are extremely rare in midwife led-birthing centres. Midwifes have a different, more nurturing model of birth which trusts women in their ability to deliver safely and naturally. Of course they have the training and skills to deal with the complications which can occur, but most births can and do proceed without major intervention.

Birth is a life changing moment for all concerned. The mother in a state of anxiety, pain and intense physical vulnerability and the father trying to make himself useful in one way or another. A midwife is in a unique position of experience and skill to empathise with and support the expectant family.

When my wife was expecting a few short years ago, we started off with different midwives at each checkup. After a few months we were fortunate enough to be assigned to one midwife who stayed with us until a week after the birth. However for the birth itself, none of the midwives or other staff were known to us. This made a difficult situation that much more stressful. A familiar face would have made a world of a difference.

The NHS need to find a way to resource greater continuity of maternity care. This also applies to post-natal care. Midwives generally stop seeing a mother 5 to 10 days after birth. Health visitors pick up the baton from there, yet they are suffering from increasing caseloads where 70% of health visitors in one survey saying that they didn’t have time, due to their caseloads, to help even the families that are most in need. The number of health visitor home visits are in decline as are the number of clinics they run.

This leads to an increased risk that child development problems and post natal depression are less likely to be picked up. Unless parents are proactive in accessing services, they are likely to get only very occasional visits backed by postal surveys. This isn’t enough to form the bond needed to spot problems in the early days of parenting.

A good relationship with a midwife and then health visitor is vital. These are tender, challenging, vulnerable times. For the mother who wants to discuss problems she may be experiencing, for example the physical after-effects of giving birth or during breastfeeding, there must be a level of trust and understanding for them to share these concerns.

That’s why this notice of motion calls on the PCT and the Health Secretary to support greater midwife provision and post natal care. Offering counselling after a traumatic birth received near unanimous support in the PCT’s survey. Such counselling can prove vital in speeding psychological recovery. There is plenty of evidence that when not dealt with birth trauma can have an impact for years, on the mother and her relationship with those around her.

Let’s work to try and eliminate as many unnecessary birth traumas as possible, but where they do happen, let’s support parents with the best services we possibly can.

I urge you to support this motion. Thank you.

notes from JK

Speech: Responding to GP-led clinic scrutiny report

I presented this speech in response to a scrutiny panel report I contributed to being presented to full council 28th January 2010. Nobody answered my question at the end of the speech:

I would like to thank Cllr Denise Cobb who was chair of HOSC at the time for agreeing to create this panel after several months of questions on these matters by myself and other members.

I also thank the panel Chair Cllr Alford for his very even handed and co-operative working, as well as Cllr Allen, with whom it always a pleasure to serve with. My thanks to our officer Giles Rossington for his excellent support. I do commend this report to members.

This report is very timely given the continued pressure to further privatise parts of the NHS and package public services off to private businesses.

The panel’s concerns over the tender process favouring larger corporations should trigger alarm bells for all those worried about the future of the NHS. Similarly how such changes are consulted upon with the public was cause for concern with the panel and continue to be a public issue of importance.

These private contracts are riven with problems. The President of the British Orthopaedic Association recently wrote to The Times highlighting grave concerns over their quality control and service levels. A study of one private treatment centre found two third of operations showed poor technique and that after 3 years 18% needed revision operations compared to a 0.9% NHS-wide rate.

Cataract operations at a private treatment centre in Oxfordshire have cost up to 600% over the odds and performed only 93 of 572 contracted procedures for half a year. Meanwhile eye operations in a private contract treatment centre in Portsmouth have cost seven times more than they would on the NHS.

Health service experts the King’s Fund argue these contracts are a drain on Primary Care Trust finances. At a 2008 HOSC meeting a clinician from Brighton & Sussex University Hospitals Trust admitted that the private orthopaedic procedures alone were costing them £2-3 million a year.

The chosen contractor for Brighton’s clinic, Care UK, do have serious ongoing questions over their ability to provide consistent high quality care in our area as well as the rest of the country. In spite… or perhaps because of this… their annual healthcare profit has been in double digit growth for years, including 44% growth in profit for 2009.

Clearly the Conservative Party want more of this kind of privatisation when their 2010 health manifesto states that they aim:

“To give patients even more choice, we will open up the NHS to include new independent and voluntary sector providers…”

We recently learnt that the chairman of Care UK and his wife are giving tens of thousands to fund the Conservative shadow health secretary Andrew Lansley’s office.

So, the question I must ask the Conservative group is…. Is this the kind of privatising corporate ‘greed is good’ politics we can expect if David Cameron wins the general election?

notes from JK

Organic flour has more minerals

Continuing tonight’s health theme, I wanted to post about some interesting data I’ve come upon. I followed up some letters published in the Soil Association’s Living Earth magazine.

The letters continued the debate over the FSA’s controversial report claiming no significant health benefits from eating organic. I’m not a food scientist but the terms and methods of the FSA report seemed destined for a narrow result which could be easily misinterpreted by the media. Though the pretty categorical wording of the FSA’s release helped the media along:

“there are no important differences in the nutrition content, or any additional health benefits, of organic food when compared with conventionally produced food”

What’s odd is that we’ve known for a long time that the mineral content in conventionally farmed produce has been declining. We also know that minerals are vital for maintaining our health. For example this 1997 paper shows how only Phosphorous has escaped significant decline over the fifty years between 1930s and 1980s whilst water content in fruit has increased significantly.

With financial support from some Soil Association members Peter Symonds, a chemist, analysed a variety of flours for their mineral content. Wholemeal, organic UK-grown flours were found to have by far the highest mineral levels for Selenium and Zinc. I’ve copied below the full data and comments from the chemist.

How we grow our food is important not just for the environment around us (e.g. fertilisers polluting our rivers) but for our longterm health. Mineral deficiencies can have long term debilitating health consequences. Sadly the government agency supposed to be championing healthy food is not just ignoring this issue but actively creating the impression the problem isn’t there!

[Full Data]

January 2010

Hans Lobstein of Brighton and Ian Bowyer of Chelwood Gate, East Sussex,  members of the Soil Association,  have funded an initial consumer survey of white and wholemeal flour for bread making which is sold in England. The  brands Stoneground organic and Marriages organic which were grown in the UK have the highest amount of selenium than conventionally grown.

BRAND AND TYPE                     ORGANIC                   SELENIUM                 ZINC

ug/100 grams        mg/100 grams

Marriages       strong  white               yes                         20.0                         —

Stoneground   strong  wholemeal       yes                         18.0                         —

Marriages       strong  wholemeal        yes                        17.6                         3.4

Marriges         strong  white                no                         15.6                         3.3

Allinsons         strong  wholemeal        no                         11.6                         2.8

Carr                strong  wholemeal        no                         10.2                         —

Dove               strong  wholemeal        yes                         4.2                          —

Hovis               strong  white               no                           3.6                          —

Hovis               strong  wholemeal        no                           3.2                          —

Tesco              soft      white                no                           2.2                         0.8

Morrisons        soft      wholemeal         no                           2.0                         2.6

Dove               soft      wholemeal        yes                          1.0                         2.7

Carr                strong  white                no                           1.0                          —

I have a sneaking suspicion that supermarket own brand Organic will be found to be like the Dove organic rather than the Marriages and Stoneground organic.  The Marriages wholemeal is £ 1.35 per 1.5 kilogram while the supermarket own brand is about £ 1.  I fear that people who think they can get organic at lower price in the supermarket are being short changed overall.

Peter Symonds  B.Sc. C.CHEM. M.R.S.C.

[Earlier notes accompanying initial results]

1st December 2009


The Food Standards Agency has published a report that reviewed some published literature. The report concluded that organic food was not more nutritious than conventionally grown.  Hans Lobstein, a member of the Soil Association,  has funded an initial survey of wholemeal and white flour for breadmaking sold in England. The  brands Stoneground organic and Marriages organic which were grown in the UK have and higher amounts selenium and zinc than conventionally grown, see table.  The Dove flour is derived from wheat grown in Kazakhstan.

The full consumer survey would involve testing other premium brands such as Hovis and McDougal and supermarket own brand Organic flour.

The survey could be further extended to testing for all trace elements.  These can be measured reasonably cheaply using a modern analytical instrument, X Ray Fluorescence,  which measures all trace elements in one go.

A final effort would involve choosing 10 conventional farms and 10 organic farms (matched for wheat variety, soil and climate) and testing the wheat for selenium and trace elements.

300 grams of Stoneground flour per day provides about 56 ug of Selenium while other foods provide about 30 ug per day. Brazil nuts have approx 1560 ug per 100 grams so a few grams of nuts would bring the daily intake to the lower end of the recommended, 100 to 200 ug per day,  all without taking a supplement.  The figure for Brazil nuts has not been found from analysing nuts in health food shops but taken from The Composition of Food by McCance and Widdowson.  Of course,  Brazil is a big place and the composition of nuts may vary across the country.

Peter Symonds

current affairs

Conservative health policy

I’ve been trying to find the time to post an analysis of the Tory draft health manifesto. But the more I’ve thought about it the less I’ve had to say. Not because it’s marvellous but because the essential points are so simple.

Much of the manifesto is contradictory – calling for less government control in some sections and more in others. Their thinking is muddled at best.

I find it astonishing that despite the NHS being clearly a huge Labour achievement the Conservatives several times over claim they are “the party of the NHS”. What an absurd thing to say. As a Green I feel no need to make such claims, just to offer policies that will improve our wellbeing such as more community-based healthcare and abolishing prescription charges.

The absolutely critical parts of this manifesto refer to that old political favourite of ‘choice’:

“We will give everyone the power to choose any healthcare provider that meets NHS standards.”

“To give patients even more choice, we will open up the NHS to include new independent and voluntary sector providers…”

There we have it. The NHS will be broken up and left to compete with other providers. Private providers I would suggest is where they are going. Because for Tories government provided options are ‘bad’ and in their free-market worldview competition is needed to boost the quality of government services.

We already know that marketisation, competition and privatisation in the NHS thus-far has been hugely expensive, resource intensive, problematic and with very mixed quality outcomes. (Read more: On this blog here and here, plus from the NHS Support Federation & Keep our NHS public)

I’m not entirely surprised by a Conservative push for further privatisation of the NHS, destroying public service and end-to-end treatments without changing providers n-times. But the revelation that the shadow health secretary Andew Lansley’s office is being bankrolled by the Chairman of Care UK makes things even clearer. Care UK are a leading private beneficiary of the NHS privatisation work Labour have done already. I’m sure Care UK can see very significant profits to reap from a Conservative-controlled NHS break-up.

I don’t believe that’s what the majority of British people want to happen, I just hope the manifesto’s weasel words will be exposed before people come to vote.

current affairs

Licensing & alcohol – we need action

While Police, Councillors and residents have been working together more effectively to block unnecessary new licensing applications, the problems of alcohol are continuing to weigh on our society.

The warnings are stark: The Royal College of Physicians and NHS Confederation are telling us that the costs of dealing with alcohol-related health problems could financially cripple the NHS. Meanwhile the Health Select Committee have slammed government’s failure to act on these problems whilst calling for minimum pricing per unit of alcohol.

The Committee also highlight what is an open secret in the licensed trade, that the Government has been in the pocket of the alcohol lobby. The 2003 Licensing Act was exactly the permissive piece of law that alcohol industry body The Portman Group wanted. The BBC report on the Health Committee’s findings includes strong criticism of the government by MPs, the British Medical Association, the British Liver Trust and Alcohol Concern.

I would say about 70-80% of my casework in the last few months has related to alcohol and licensed premises. The Licensing act is weak and we’re seeing locally a race to the bottom as one venue after another races to the latest opening hours (if they’re already licensed) or raced to become an off-license if not already licensed.

The local Licensing committee (on which I sit) also recently received a shocking report on the “Health Impact Assessment of Licensing” [PDF]. It highlights a sharp local increase in domestic violence whilst under the influence of alcohol and a very sharp increase in the level of alcohol-related hospital admissions — and this excludes A&E admissions.

Indeed it’s strangely inconsistent that this Labour government have appeared to come down hard on smoking whilst failing to recognise the steep costs of irresponsible alcohol consumption.

notes from JK

Naked shoes – Going barefoot style

Women running on the beach

I don’t recall how, but a while ago I somehow ended up reading a post by Tim “Four Hour Work Week” Ferriss on barefoot alternatives. The post and its comments fascinated me. In discussing his experiences of barely there shoes, the post opened me up to a new world of discussion about what shoes might be doing to our feet.

I had been aware for some time of long distance runners going barefoot, particularly those from Africa. But I hadn’t given it much thought as I don’t see myself as much of a runner. But when you consider how marvellous our feet are, it does seem strange that we shore them up with a vast array of padding and strapping in modern shoes. As I read more on the topic it appeared that there was in fact very little science behind many of the technological claims made by shoe manufacturers.

It just seems intuitively and scientifically reasonable that we should let our highly complex and flexible feet to work as freely as possible to spread and balance the pressures of our movements. That current shoe designs are rarely questioned is indicative of the tendency for ‘common knowledge’ to stagnate for too long. Historians of science will be able to point many similar examples with regards to hygiene, blood letting and so on.

We have been paying top dollar for shoes which could well be doing more harm than good, and very few have questioned that. How carefully are the claims of shoe manufacturers verified versus those claims made by pharmaceuticals or even ‘active’ yoghurt products? Back pain costs us huge amounts each year in distress, treatment and time off work. Can shoe manufacturers be trusted on this issue?

My reading took me to New York Magazine’s marvellous article on the barefoot vs shoe debate. The Daily Mail had a surprisingly good piece on the risks of hi-tech shoes. After digesting all these and visiting specialist sites like I came to the conclusion that I wanted to try out some ‘barefoot-style’ shoes.


I found there were three likely candidates – the odd-looking Vibram FiveFingers; the Nike Free range and Terra Plana’s VivoBarefoot shoes. The Vibram’s were too wacky for my liking and, according to online reviews, the Nike’s would be too small for my boat-like feet. Terra Plana, luck would have it, have just opened a shop on West Street in Brighton so I popped in to try their Aqua shoes and… wow!

So comfortable, so close to the ground, so… very light! I hadn’t expected them to be so light, suddenly I realised I’ve been lugging extra weight on my feet every day of the week.

I didn’t hesitate to buy them given Terra Plana’s excellent ethical and environmental credentials (but not perfect yet I hasten to add). Walking in the Aquas is a very different experience, much more sensory and stimulating as you feel everything beneath your feet. The thin, extremely flexible sole is just enough to protect but doesn’t feel restrictive at all.

After two weeks of near constant use — but for walking only, nothing more active as yet — I am absolutely evangelical about these very well made shoes. My feet feel like they are stretching outwards and getting stronger. It’s definitely noticeable that over time I’m clomping heel-first less and less.

If we’ve been doing the wrong thing with shoes all this time, what else do we need to seriously re-evaluate? Perhaps our working patterns? Our financial and banking systems? Or perhaps how we elect our politicians? All up for debate, but this shoe story emphasises to me the importance of staying open minded and critically evaluating the terms of any received wisdom.

current affairs

More evidence that private treatment centres are expensive

Further to my earlier mega-post on health privatisation which focussed primarily on the local Sussex Orthopaedic Treatment Centre, some more news has emerged about the true cost of these privately run NHS centres:

  • The Times reports on a study of hip operations sent to a treatment centre in Weston-super-Mare where two-thirds of operations showed poor surgical technique and 3 years since operation a whopping 18% had undergone or were waiting for a revision operation. The NHS-wide rate for such follow-up procedures is 0.9%. These revision operations are expensive, so on top of the treatment centres being more expensive per procedure, they are also costing taxpayers more due to the remedial work needed.
  • The Times also has a comment piece by Michael Bell, President of the British Orthopaedic Association, which is critical on the lack of data to monitor quality and the disjointed nature of treatment centre operations.

Using the private sector to provide frontline NHS services not only runs contrary to the principle of public service, but again and again is shown to provide worse value and worse quality. Neither Tories nor Labour seem able to see beyond their false sacred cow of private = efficient.

Of course private companies do provide value and quality, look at the Apple iPod, but it’s a completely different market and set of pressures to providing public services. Perhaps if we stopped this trend of calling citizens ‘customers’ we could reset the mindset which seems to want to turn everything into a business.

notes from JK

Report into Care UK contract for GP-led clinic is approved

I’m very pleased that the report into Care UK being contracted to run Brighton & Hove’s GP-led clinic contract was approved by today’s full Health Overview & Scrutiny Committee. We’re going to keep watching Care UK’s performance very carefully given the criticism they’ve come under for other contracts across the country.

More detail in my press release which is copied below.

You can read the full panel report on the Council website here.

My earlier blog post on Care UK and private corporations getting involved in the NHS.


A special report looking at why Care UK was chosen to run Brighton’s new ‘GP-Led health centre’ has raised concerns about the ability of the company to deliver quality care. *

The report, produced by members of Brighton & Hove City Council’s Health Overview and Scrutiny Committee (HOSC), states ‘members still have reservations about Care UK’s ability to deliver the quality of care required it is evident that special measures must be put in place for monitoring the early progress of this contract.” **

Green City Cllr Jason Kitcat, who sits on HOSC and is also the Green Group of Cllrs’ spokesperson on Health issues said:

“Our investigation found problems with both the method used by the PCT to decide who should run the health centre, and their final choice of Care UK.

“The whole selection process seemed to unfairly favour big business over smaller and more local providers, because of the complex and intensive bid system.

“In choosing Care UK, the PCT have plumped for a company with a very mixed reputation – their management of the Sussex Orthopaedic Treatment Centre led the Healthcare commission to put it in special ‘measures’ after concerns were raised about hygiene among other things.

“In light of this, we’re urging the PCT to monitor the new health centre very closely and want a comprehensive update on how things are going after the first year.

“I’m really pleased we were able to find a cross-party consensus while drawing up this report, and would like also to commend the PCT for their co-operation with our investigation.”


Notes for Editors:

Following detailed questioning by Cllr Jason Kitcat and members of Keep our NHS Public Brighton, the Chair of the Health Overview & Scrutiny Committee called for a panel to be formed in March 2009. The panel examined the process and bidders involved in the procurement process for a city centre GP-led health centre. These health centres are a national initiative created on the insistence of Labour health minister Lord Darzi.

The new ‘GP led health centre’ in Brighton opened on the 1st of July 2009, on Queen’s Rd, Brighton.

** Please see pages 65 – 66 of the report

For more information, please call Cllr Jason Kitcat on 07956 886 508