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NHS news review : ConDem scum privatise the NHS

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The UK’s Conservative and Liberal-Democrat(Conservative) coalition government – the ConDems’ – brutal attack on the National Health Service continues.

  • So far the New Statesman and the Financial Times have noticed that Lansley is to announce today the abolition of the cap on private work that hospitals can do. Hospitals can now exclusively treat private, paying patients.

Lansley opens the door to full-scale NHS privatisation

The 49% cap on private work done by NHS trusts will be abolished.

When the government unveils a policy change on a Friday it’s a sure sign that it doesn’t want you to notice. Today, Andrew Lansley will announce that the 49% cap on private work done by NHS hospitals, which his bill introduced, will be abolished (so far, only the FT has noticed). In other words, the Health Secretary has just opened the door to the full-scale privatisation of the NHS, with hospitals able to raise 100% of their income from private healthcare.

Sue Slipman, the chief executive of the NHS Foundation Trust Network, describes the removal of the cap as “a really creative way of bringing more money into the health service”. What she doesn’t say is that foundation trusts, in pursuit of profit, will likely prioritise the treatment and care of private patients over NHS ones. Since the most profitable procedures are usually the simplest, those requiring more complex treatment will be pushed to the back of the queue. As Howard Catton, head policy at the Royal College of Nursing, has previously warned: “NHS patients may feel a subtle pressure to reach for the credit card.” Since all of the remaining 113 NHS trusts are required to become self-governing foundation trusts by April 2014, the removal of the cap will apply to all NHS services – hospitals, ambulances, mental health, community services and clinics.

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http://www.google.com/search?q=nhs+%22not+privatisation%22+lansley

http://www.google.com/search?q=nhs+%22not+privatisation%22+cameron

http://www.google.com/search?q=nhs+%22not+privatisation%22+clegg

 

How the Orange Bookers took over the Lib Dems

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What Britain now has is a blue-orange coalition, with the little-known Orange Book forming the core of current Lib Dem political thinking. To understand how this disreputable arrangement has come about, we need to examine the philosophy laid out in The Orange Book: Reclaiming Liberalism, edited by David Laws (now the Chief Secretary to the Treasury) and Paul Marshall. Particularly interesting are the contributions of the Lib Dems’ present leadership.

Published in 2004, the Orange Book marked the start of the slow decline of progressive values in the Lib Dems and the gradual abandonment of social market values. It also provided the ideological standpoint around which the party’s right wing was able to coalesce and begin their march to power in the Lib Dems. What is remarkable is the failure of former SDP and Labour elements to sound warning bells about the direction the party was taking. Former Labour ministers such as Shirley Williams and Tom McNally should be ashamed of their inaction.

Clegg and his Lib Dem supporters have much in common with David Cameron and his allies in their philosophical approach and with their social liberal solutions to society’s perceived ills. The Orange Book is predicated on an abiding belief in the free market’s ability to address issues such as public healthcare, pensions, environment, globalisation, social and agricultural policy, local government and prisons.

The Lib Dem leadership seems to sit very easily in the Tory-led coalition. This is an arranged marriage between partners of a similar background and belief. Even the Tory-Whig coalition of early 1780s, although its members were from the same class, at least had fundamental political differences. Now we see a Government made up of a single elite that has previously manifested itself as two separate political parties and which is divided more by subtle shades of opinion than any profound ideological difference.
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Nick Clegg’s demand for the NHS to be broken up (2005)

Continue ReadingNHS news review : ConDem scum privatise the NHS

‘People Will Die’ – The End Of The NHS.

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Medialens has a couple of articles on the failure of the UK media – particularly the BBC – to cover the passage of the Health and Social Care / Destroy the NHS Bill. Medialens propose the “sham of UK ‘democracy'” since the bill passed without widespread public awareness due to corporate media’s complicity with vested interests.

    ‘People Will Die’ – The End Of The NHS. Part 1: The Corporate Assault

Few political acts have exposed the sham of British ‘democracy’ like the decision to dismantle the National Health Service. In essence, the issues are simple:

1. The longstanding obligation of the UK government to provide universal health care has now been ditched.

2. The NHS is being carved open for exploitation by private interests.

The media, notably the BBC – often ranked alongside the NHS as one of the country’s greatest institutions –  have failed to report this corporate assault on the country’s health service.

What is deeply disturbing is how little the British public has been told about what has happened, and about the likely consequences for an institution we all hold dear.

Much Profit To Be Made!

On March 20, 2012, MPs passed the Health and Social Care Bill (commonly called ‘the NHS bill’) more than 14 months after it was first put before Parliament. Virtually every major professional medical body had fought against it, and there were numerous public protests. But the opposition was given scant media coverage and the government was able to force the bill through.

Recall that the Conservatives, led by David Cameron, won just 36% of the vote in the 2010 general election. Outrageously, the Conservative manifesto said nothing about the NHS bill. The former Conservative minister and leading political pundit Michael Portillo explained the reasoning:

‘They did not believe they could win an election if they told you what they were going to do because people are so wedded to the NHS.’

Cameron had pledged that there would be: ‘No more pointless and disruptive reorganisations’. Instead, he said change would be: ‘Driven by the wishes and needs of NHS professionals and patients.’ The coalition agreement between the Tories and the Lib Dems of May 2010 had promised: ‘We will stop the top-down reorganisation of the NHS.’ That promise has been well and truly smashed.

The government tried to justify the bill by arguing that the NHS is not working and that it must be ‘reformed’. In fact, the NHS is one of the fairest, most cost-effective and efficient healthcare systems in the world. Its per capita costs are half that of the US healthcare system, a country which has lower life expectancy and higher infant mortality (OECD figures). One can only look on in horror across the Atlantic to see the way our health service is headed.

Michael Moore, writer and director of Sicko, a film about the US health system,  tweeted of Cameron’s recent visit to the United States:

‘Is British PM Cameron here in USA this week to study our health care system & bring it back to the UK? There’s much profit to be made!’

‘Last nite, Brit PM watched 1st ever basketball game. Today he goes to hospital 2 watch sick ppl turned away & denied care. It’s a fun trip!’

The NHS bill was hideously complicated and virtually unreadable. Critics claimed this was intentional, serving to hide the bill’s true purpose – selling off more and more of the NHS to private companies. The British Medical Association denounced the bill as ‘complex, incoherent and not fit for purpose, and almost impossible to implement successfully, given widespread opposition across the NHS workforce’.

In a rare instance of BBC Question Time actually putting a senior politician on the spot about something that matters, Dr Phil Hammond challenged Andrew Lansley, Secretary of State for Health, on the disaster the bill would create for genuine health care, for cooperation between medical professionals and for basic human compassion. Imagine if news editors and journalists had been consistently making this kind of challenge in the 14 months before the bill became law.

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‘People Will Die’ – The End Of The NHS. Part 2: Buried By The BBC

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Along with the NHS, the BBC is supposed to epitomise the best of British institutions. The BBC has a duty, enshrined in its Charter, to report objectively on stories of national and international interest. The NHS affects every man, woman and child in the country. And yet we suspect very few members of the public realise what has just happened to their health care system.

The BBC mostly failed to cover the story, and otherwise offered coverage heavily biased in favour of the government’s perspective. On the very day the bill passed into law, the tag line across the bottom of BBC news broadcasts said ‘Bill which gives power to GPs passes’. The assessment could have come from a government press release, spin that has been rejected by an overwhelming majority of GPs. The BBC has also repeatedly failed to cover public protests, including one outside the Department of Health which stopped the traffic in Whitehall for an hour.

It is nigh-on impossible for Media Lens, with our meagre resources, to closely monitor the prodigious output of BBC television and radio news; even on a single topic. But one activist who has been following the NHS story closely over an extended period sent us this last month:

‘For the past two years there has been so little coverage of this bill that even as some were desperately fighting to stop it – through e-petitions, lobbying campaigns and even demonstrations – many people did not appear to be even aware of it. I have been on a demonstration in which people sat down in the road in Whitehall, outside the Department of Health and blocked the traffic, yet this was not mentioned at all on the news.

‘When the BBC have reported on the bill they have been sparse with their explanations of its implications or the reasons why so many – including most medical professionals – have objected to it. They have tended to limit their comments to those of the type “Some people say it’s privatisation” without explaining why or exploring the issue.

‘There have not been – as we might have expected for so momentous a change – debates on the Today Programme, on BBC Newsnight, or blackground analysis programmes, with politicians being challenged and questioned on the policy. Radio 4 ran a programme at 8pm [The Report, on March 22, 2012] which appeared to be very biased in favour of the bill, with opposing views not adequately represented. Contrast this programme with this article by Hackney Keep Our NHS Public (KONP)

‘Whatever one’s views on the Health and Social Care bill, surely such large scale changes which may affect the health of so many, should have been widely reported and debated, especially when you consider that the coalition government was not elected and did not put this issue in their manifestos.’ (Email, name withheld, March 23, 2012)

Why did we never see a BBC television news report like this one from RT: ‘UK govt bill opens up NHS to private profiteering’?

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Continue Reading‘People Will Die’ – The End Of The NHS.

NHS news review

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A few recent news articles about the UK’s Conservative and Liberal-Democrat (Conservative) coalition government – the ConDem’s – brutal attack on the National Health Service.

NHS news is dominated by the substandard breast implants made by the French company PIP.

A story by the Guardian from about a week ago David Cameron’s pledge to protect NHS clouded by emerging reality of cuts | Society | The Guardian.

Day by day, the hope that frontline NHS services would somehow remain magically untouched by the coalition’s austerity drive is revealed as a fantasy. The problem for David Cameron and his health secretary, Andrew Lansley, though, is their repeated promises – in opposition and in government – that the NHS was different, its budget would be ringfenced and that care would be maintained. That was encapsulated in the prime minister’s clear pledge that “We’ll cut the deficit, not the NHS”. But what was politically useful then is becoming politically perilous now.

A survey of its members carried out by Doctors.net.uk reveals that four out of five GPs and hospital doctors have seen cuts to staff or services in their own part of the NHS in the last year. It was a small sample, just 664 respondents; and it was self-selecting, which tends to skew any poll towards the malcontented, and thus exaggerate the negative. But key organisations working at or near the frontline agree that the findings give a broadly accurate picture of the emerging reality in the NHS.

In Surrey and Hampshire dozens of children with ME or chronic fatigue syndrome are preparing to lose the support of a consultant and a nurse specialising in that condition, as both the Frimley-based health professionals are not being replaced. In Lewisham, south London, almost £500,000 has been chopped in this financial year from the budget for children’s mental health services. In Camden, north London, doubt surrounds the future of the InterAct Reading Services charity, which gets actors to read stories to hospital patients to help their rehabilitation, because local primary care trusts (PCTs) – which are being abolished in April 2013 as part of the coalition’s NHS shake-up – have reduced or withdrawn funding ahead of their disappearance.

NHS-funded public health observatories in London, the north-west and the north-east – which are not scheduled to close – are nevertheless also at risk, says the Commons health select committee.

Some PCTs have reduced the amount of Viagra they will supply to men with erectile dysfunction. In Lambeth, south London, the PCT has cut the number of patients eligible to receive free incontinence pads, reports Dr Clare Gerada, a local GP and chair of the Royal College of GPs. Access to IVF, cataract removal or a new hip or knee has been tightened by dozens of PCTs. In addition, hospitals appear to be reducing the number of follow-up appointments they give patients suffering with rheumatic, skin or urology problems, as they too, like PCTs, seek to save money and contribute to the ‘Nicholson challenge”, which wants the NHS in England to make £20bn of efficiency savings by 2015.

In Ashford, Middlesex, Dr Peter Kandela, a local GP, tells his patients in his regular surgery bulletin of three different money-saving measures. Some patients have been switched from their usual medication to other branded drugs because the latter “are far cheaper and save the NHS money”. GPs have also been told by the local PCT to stop issuing long-term repeat prescriptions and to hand out scripts for just two months supply of drugs instead, except for the pill. And lastly, “we have received notifications from the skin department at Ashford & St Peter’s hospital that they would no longer accept referrals for benign moles, cysts, skin tags and other non-cancerous conditions. Workload is blamed for these decisions. Sadly, we shall no longer be able to make referrals for these conditions,” Kandela explains.

These are not life-saving services, and indeed removal of unsightly but benign skin tags is arguably not what the NHS is there for anyway. But these services do aid patients’ quality of life, boost their chance of recovering or enhance their mental health. Yet they are increasingly being deemed no longer affordable by NHS bosses.

Dr Mark Porter, chairman of the British Medical Association’s hospital consultants committee, says: “Things like orthopaedic surgery, eye surgery and IVF are not even debatable in the way that tattoo removal might be. There’s an ethical debate to be had about [cutting] some things, but not about things like knee pain and back pain, which can be offered to patients but we are choosing not to.”

No wonder private health providers are starting to see an increase in the number of people prepared to pay for rapid treatment of conditions that their local NHS deemed unnecessary or not an urgent priority.
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In other news, housing benefit is getting cut imminently causing a housing shortage and driving the working poor as well as the unemployed and disabled into ghettoes.

Housing benefit cuts will put 800,000 homes out of reach, according to study | Society | The Guardian

A further 800,000 homes will be put out of reach of people on housing benefit because of government welfare cuts – leaving low income families the choice of cutting spending on food to pay the rent or moving out, according to a study by housing experts.

The Chartered Institute of Housing has found there will be thousands more claimants than properties that are affordable on benefits alone, raising the possibility that the poor will migrate to “benefit ghettoes” in seaside towns or the north of England.

From this month, the government has capped housing benefit payments to, for example, a maximum £250 a week on a two-bedroom home. The cut is compounded by the allowances being scaled back by pegging them to the bottom third of rents in any borough.

The result is that in many towns and cities there will not be enough affordable homes to rent for those claiming local housing allowance, the benefit paid to tenants of private landlords. The problem is most acute in central London, where in two of the country’s richest boroughs – Westminster, and Kensington and Chelsea – more than 35,000 homes will at a stroke be put out of reach of people on housing benefit.

It is unlikely that the poor will be able migrate to cheaper parts of the capital: in Newham, east London, there will be twice as many claimants as there are low-cost homes. In Croydon, 17,000 people will be chasing 10,000 properties.

The effect will be felt not just in south-east England. Before today, Birmingham had more than 37,000 homes with rents affordable on welfare. Now 34,500 housing benefit claimants will be chasing 23,000 low-cost houses, according to the analysis, carried out for the Guardian. On the Mersey, 21,000 people collecting local housing allowance will only be able to afford 12,000 homes in Liverpool.
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The changes will also see people forced to move from where jobs are to where there are far fewer, the institute warns. “The analysis shows that big cities where we expect to find most of the jobs and the most varied employment are the worst hit by the government changes. If this (is supposed) to help people in terms of getting them into work then it looks as if it will not succeed.”

Charities said the analysis vindicated their warnings that the government’s plan will cause homelessness. Leslie Morphy of the charity Crisis said: “The figures make clear that there will just not be enough properties anywhere that are affordable on these reduced benefit levels. With unemployment rising and more people relying on housing benefit, yet soaring demand for properties, the government’s plans just don’t add up – we urge them to stop and reconsider.”
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The Destroy the NHS / Health and Social Care Bill passed it’s third reading yesterday with a mjority of 65. The bill will now pass to the House of Lords.

Many doctors and professional medical associations raised serious objections to the bill. The Royal College of Nursing and the Royal College of General Practicioners took exception to Prime Minister David Cameron’s claim that they supported his proposals.

Colin Leys – co-author of ‘The Plot Against the NHS’ – has an article in the Guardian.

Campaign group 38degrees responds to the government’s so-called Myth-busting nonsense and to many claims made by Andrew Lansley yesterday.

Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.

The Plot Against the NHS #1

The Plot Against the NHS #2

Conservative election poster 2010

A few recent news articles about the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.

Health professionals deny Cameron’s claim they back NHS shakeup | Politics | The Guardian

 

David Cameron faced embarrassment when medical leaders rejected his claim that they supported the government’s health reforms.

The row came hours before the health and social care bill was approved by MPs, after Cameron hailed the profession’s support at prime minister’s questions.

“Now you’ve got the Royal College of GPs, the physicians, the nurses, people working in the health service, supporting the changes we’re making,” he said.

The bodies questioned the prime minister’s claim. Peter Carter, general secretary of the Royal College of Nursing, told the BBC: “While we acknowledge that the government has listened to our members in a number of areas, we still have very serious concerns about where these reforms leave a health service already facing an unprecedented financial challenge.

“At a time when the NHS needs to find £20bn in efficiencies, tackle waste, work harder to prevent ill-health, and deal with an ageing population, we are telling MPs this bill risks creating a new and expensive bureaucracy and fragmenting care.”

Clare Gerada, chairwoman of the Royal College of General Practitioners (RCGP), said: “The college supports putting clinicians at the centre of planning health services. However, we continue to have a number of concerns about the government’s reforms, issues we believe may damage the NHS or limit the care we are able to provide for our patients.

“As a college we are extremely worried that these reforms, if implemented in their current format, will lead to an increase in damaging competition, an increase in health inequalities, and massively increased costs in implementing this new system. As independent research demonstrates, the NHS is one of the most efficient healthcare systems in the world and we must keep it that way.”

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The end of the NHS as we know it | Colin Leys | Comment is free | guardian.co.uk

What Wednesday’s vote on the health and social care bill shows more clearly than anything is that many, if not most, of the political elite no longer care whether they are carrying out the wishes of the electorate, and barely pretend that we are any longer a democracy.

The prime minister promised before the 2010 election not to introduce any “top-down reorganisations” of the NHS; to say he, Andrew Lansley and Nick Clegg lack an electoral mandate for the bill is an understatement. It is also an understatement to say that they have not told the truth about the bill’s intentions, and that they have reduced Department of Health statements, such as its latest so-called MythBuster document, to a level of brazen mendacity that demeans a once great office of state.

The principle seems to be that if an official lie – such as that the bill does not imply privatisation – is repeated often enough, most people will feel it must be true. And by using existing powers to abolish PCTs and set up “pathfinder” so-called GP consortia, and making arrangements with foreign private companies to take over NHS hospitals, the government has also pre-empted such debate as MPs are inclined to have. The Conservative MP Dr Sarah Wollaston, who originally denounced the bill, now says that changes have already gone too far to oppose it any further – a remarkable statement of political impotence.

The bill will end the NHS as a comprehensive service equally available to all. People with limited means will have a narrowing range of free services of declining quality, and will once again face long waits for elective care. Everyone else will go back to trying to find money for private insurance and private care. More and more NHS hospital beds will be occupied by private patients. Doctors will be divided into a few who will become rich, and many who will end up working on reduced terms and with little professional freedom for large corporations (the staff of the hospitals that are being considered for handing over to private firms will have noted that the firms in question want “a free hand with staff”).
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The one serious obstacle to the bill’s promoters has been the impact of social media: 38 Degrees, Facebook, expert bloggers and tweeters. Along with the million-plus people who work for the NHS, a steadily growing portion of, especially, younger voters, have been exposed to a different narrative and see through the spin. At the moment most of them may be more cynical than politically active. But if the bill becomes law and the reality begins to be felt in people’s daily lives it is this counter-narrative that will make sense. MPs – and now the Lords – would be well advised to ponder the implications of this.

38 Degrees | Blog | Busting the NHS myths

Yesterday morning at 9:31 the Department of Health published a “myth buster” on a government website. It is published below, along with a number of corrections (shown in red).

TOP MYTHS

MYTH: The Health Secretary will wash his hands of the NHS
The Bill does not change the Secretary of State’s duty to promote a comprehensive health service.

This is very carefully worded. It totally avoids addressing one of the main issues with Andrew Lansley’s plans – that the bill would remove the “Duty to Provide” a health service currently contained in s.3(1) and 1(2) of the 2006 Act. Why do you continue to dodge the issue Mr Lansley?

MYTH: Bureaucracy will increase significantly
We are abolishing needless bureaucracy, and our plans will save one third of all administration costs during this Parliament.

The plans may abolish some bureaucracy, but our legal advice warns that the plans have the potential to increase bureaucracy too. See the quote from pages one and two of the executive summary, below:

The procurement regime is a complicated and developing body of rules and case law which gives rise to enforceable rights in the High Court and makes available draconian remedies and penalties for breach of the Regulations. The practical and financial implications of ensuring that goods and services are procured compliantly are considerable. There is a real risk that there will be a deficit of incumbent expertise in new consortia to cope with the regulatory burden. It appears however that the government has simply failed to grapple with the frontline issues in procurement, has wholly underestimated the increasing rather than diminishing complexity in the area and has had no or perhaps little regard to the administrative and financial burdens arising from the regime.

Taken from: IN THE MATTER OF THE HEALTH AND SOCIAL CARE BILL AND THE APPLICATION OF PROCUREMENT AND COMPETITION LAW – an independent legal opinion provide by Rebecca Haynes of Monkton Chambers.
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MYTH: NHS hospitals will be managed by foreign companies
Even if independent sector management is used, NHS assets will continue to be wholly owned by the NHS. And there would be rigorous checks to ensure that any such independent provider is reputable and fit for purpose.

We note that they are confirming that this is not a myth, it is a fact.
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38 Degrees | Blog | Save our NHS: What Lansley said in the House of Commons

Below is a transcript (copied from Hansard) of the specific things mentioned, along with our comments (shown in red).

Mr Lansley: This Bill, for the first time, stops the Secretary of State—and, indeed, Monitor or the NHS commissioning board—from trying deliberately to increase the market share of a particular type of provider. If the previous Labour Government had put such a requirement in law when they were in office, hundreds of millions of pounds would not have been paid to independent sector treatment centres to carry out operations that were not required and never took place. If the Opposition had their way this afternoon, the safeguards that we intend to put in place would not be available.

In its response to the opportunity provided by Report stage, the Labour party is being not progressive but reactionary, while the trade unions are being misleading in the presentation of their campaign. To be specific, the trade unions and other proxy organisations such as 38 Degrees have gone to some trouble to misrepresent the Bill in order to attack it.

That’s simply not true. We have not misrepresented information, deliberately or otherwise. If the Secretary of State still believes we have then we would invite him to provide examples. We note Mr Lansley made this statement inside the House of Commons – where libel laws do not apply.
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NHS news review EXTRA: NHS Birthday

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The NHS is 63 today. Health professionals are united in their opposition to the ConDem coalition government’s Health and Social Care Bill which has the intention of destroying the NHS.

UNISON Press | Press Releases Front Page

UNISON General Secretary, Dave Prentis, delivered a giant birthday card to the Department of Health today (5 July), to mark 63 years since the NHS was founded.

The chief of the UK’s largest union, joined other union heads and health workers, to warn the Government that the NHS would not make its 64th birthday if plans set out in the Heath and Social Care Bill go ahead.

The plans will lead to the break-up of the NHS and private companies grabbing huge chunks of the NHS birthday cake.

Across the UK, health workers and members of the public are also hosting birthday events and campaigning against the reforms.

Dave Prentis said:

“For 63 years doctors, nurses and other health workers have made the NHS the national treasure it is.

“Now the Government is trying to destroy the health service and open it up to private companies, who will put patients before profits.

“The Bill should be binned and started from scratch, as it is a recipe for disaster.

“The NHS must be safeguarded, so it can celebrate its 64th birthday.”

The card, which was signed by the TUC General Council and senior union officials, along with many members, said:

“We need to safeguard the future of the health service for generations to come.

The greeting inside the card reads: ‘The Health and Social Care Bill sets out hugely damaging changes to the NHS. We are worried that they could mean taxpayers’ money for the NHS diverted to big business, and competition instead of the increased collaboration patients need. We want to safeguard our NHS and make sure that there is a 64th birthday to celebrate too.”

Happy 63rd birthday NHS – Royal College of Midwives

RCM general secretary Cathy Warwick this morning joined representatives from the TUC and unions representing health workers, and helped hand deliver a giant birthday card to the Department of Health to celebrate 63 years of the NHS.

The card will be delivered to health secretary Andrew Lansley at Whitehall. Carrying a four-foot card, the union leaders will highlight concerns that the changes the government is proposing in the Health and Social Care Bill will fundamentally undermine the founding principles of the NHS.

Cathy Warwick said: ‘The NHS is a national treasure and should be protected not dismantled. Midwives are some of its many unsung heroines. They work long hours because they want to be with women before, during and after childbirth. The erosion of midwives’ pay and conditions, however, is making working conditions unsatisfactory for midwives because they are not able to give the care they want to women.

‘Meanwhile, there are not enough midwives to deliver the care that women need now. I have real fears that maternity care could suffer as trusts struggle to cope with health reforms and the profound change in its structure.’

Listen to Cathy Warwick talking about delivering the card and her concerns about the Health Bill in the RCM Communities vlog.

Continue ReadingNHS news review EXTRA: NHS Birthday