“We cannot run the NHS on the basis that anyone who expresses dissent is for the chop” – by Martin Rathfelder, Director Socialist Health Association


As you know, Karen Reissmann has been sacked by the Manchester Mental Health Care Trust. 

I have now got a copy of the article which got her into bother and it is reproduced below. (see separate post: The interview which got Karen sacked

Also below is something from the PCT website which make substantially the same point Karen was making, but much more bluntly, and naming the voluntary organisation concerned.

I have kept clear of this dispute up to now partly because I didn’t have the full story and partly because I know that Karen is a well known political activist and troublemaker as far as the Trust is concerned.  However she is also an elected member of Unison’s National Health Group Executive and Chair of the Unison Branch at the Trust. 

I happened to meet her this evening and found her perfectly reasonable.  I don’t agree with everything she says, but her ideas are certainly no more revolutionary than those expressed by many members of the Labour Party to ministers at events I have attended. 

To claim that the article below brought the Manchester Care Trust into disrepute is not a sustainable position and will be overturned as soon as this case gets before an impartial tribunal.  The Trust will be liable to pay unlimited and exemplary  damages in a case of Trades Union victimisation.

It appears to me that the new Chief Executive decided that she need to get a grip on the Trust, which is in deep trouble, and has been for some time, and took this article (which was actually published in January) as an opportunity to sack the most vocal Trades Unionist in the organisation.  I think that is an abuse of power, and it will also prove to be a waste of public money.

I don’t think we can stand by and let this happen.  Quite apart from any principle of Trades Union solidarity we cannot run the NHS on the basis that anyone who expresses dissent is for the chop. 

I already find that junior doctors are only prepared to talk to me about what goes on in their Trust under cover of anonymity.  One of the reasons that the great scandals such as the Bristol Royal Infirmary cardiac patients occurred was because of the suppression of dissent.  Doctors and nurses now, as a result, are professionally obliged to draw attention to the failings of their colleagues – including management

The problems to which Karen was drawing attention are not imaginary or exaggerated but are recognised by the PCT.  If Gordon Brown’s stated ambition of “more power locally in the hands of patients and staff” is to be realised then NHS employers will have to accept that their staff must be allowed to debate the merits of what is proposed without the threat of dismissal.  Otherwise the problems (which are already widespread) of senior managers not knowing what is actually happening because everyone is afraid to tell the truth as they see it will become worse.

What do you think?

Martin Rathfelder
Socialist Health Association
22 Blair Road
M16 8NS
0870 013 0065

*While ministers are promoting social enterprise as a solution to problems in the NHS, campaigners against health service privatisation are sceptical. Karen Reissman is a leading member of anti-privatisation campaigns in Manchester. Sarah Irving heard her concerns about social enterprises in mental health provision…

Karen Reissman is an experienced community psychiatric nurse working in North Manchester, and although she welcomes some of the changes in the NHS over the last decade, she is deeply unhappy about others.
“I’ve had 5 employers in the last 13 years,” she says. “Each time the new headed notepaper and name badges costs thousands. Does it improve anything? No.”

She is concerned about the privatisation of NHS services, including by transfer to the voluntary sector and social enterprise, because of the effects she sees for both staff and patients.

She worries that voluntary sector and social enterprise organisations can win tenders through cutting costs, and this can mean lower standards of care and poorer conditions for workers on the mental health front line: “One of Manchester’s current assertive outreach teams is voluntary sector. One of the main things this has meant is that experienced NHS staff have been replaced with inexperienced staff,” she explains.

“This is partly because the voluntary sector organisation pays less, and because staff moving to it lose their NHS or local authority pensions.

“Experienced staff are likely to be older and therefore more concerned about their pensions, so they are very unlikely to want to move to new social enterprise sector organisations. This means that some of the most severely mentally ill people in the area are being cared for by people who themselves are newly qualified or in some cases trained in-house.”

Another concern is that the transfer of mental health services can also mean a shift in the culture and priorities of organisations. While Karen acknowledges that workers in social enterprise organisations are genuinely committed to their patients’ care, she questions whether the organisations themselves can really meet the demands of the sector: “One of the other areas being shifted to private sector organisations are community living projects, which run schemes such as arts projects and occupational activities,” she describes.

“A lot of these have been or are facing being turned into social enterprise organisations. My concern would be that this changes them from primarily being a treatment and therapy service to an entity which has to break even.

“Staff then spend their time looking for funding and subsidies, or trying to cut costs, rather than delivering the care they want to and which patients need. It downgrades the situation for both staff and
patients and moves the organisation from being mainly a service to being a commercial organisation which has to keep its eyes on the bottom line.

“There is one award-winning national project which uses art for people with mental health issues, some of whom have been very damaged by their illness, and helps them express themselves and get some fulfilment from life. Some of the artwork produced might be sold, but that happens in individual cases if it’s appropriate and it helps the patient. It faces becoming a social enterprise, and then selling work or being part of projects that bring in funding will become much more of a motivation.”

According to Karen, privatisation of the NHS in Manchester is proceeding quickly, fragmenting teams and cutting resources, including reducing the number of mental health beds in the region and making it harder for community nurses like her to spend adequate time with their patients.

“There are several bits of privatisation going on in the Manchester area at the moment,” she says. “Four of the Community Mental Health Teams are up for private tender at the moment, and it is likely that some of these will go to joint NHS/voluntary sector projects.”
Mental health workers in Manchester are currently balloting for strike action against privatisation and cuts in community mental health teams. “The chaos is frustrating, but it also motivates people to do something if we can get them organised,” argues Karen. “As bad as it is, it would have been worse if we hadn’t acted.
“Thatcher tried to tell people that private was good, public bad. She convinced some, but when they saw the privatised rail services they came to their senses.”

For more information on NHS Campaigns in Manchester see  www.stopthecuts.nr <http://www.stopthecuts.nr>

Below is the report from the PCT’s own website which Martin Rathfelder refers to above. He can’t see much difference with what Karen says in her interview. Can you?

Report from the Community sub group of the Visioning process (on 
>> <http://www.bestforhealth.nhs.uk/page.asp?pagekey=236&branchkey=5>) 

 “The community group agrees this action (ie the expansion of assertive outreach) is required however concerns have been expressed about how this will be achieved. Manchester’s assertive outreach service is currently provided by the voluntary sector, through its service Ngage. Currently there are proposals for HARP to extend the service provided by Ngage but there have been a number of worrying concerns about governance and existing management arrangements and a number of worrying SUIs (serious and untoward incidents). Within the group there was a belief that without substantial partnership development the expansion of this service to cover up to 300 of the city’s most chaotic and worrying patients will be very difficult to achieve. A view has been expressed that without a partnership
arrangement the existing consultants would not be willing to act as community consultants for patients because of risk issues. The group therefore believes that a partnership arrangement with staff seconded
from the Trust and much closer management and governance input from the Trust would be a preferred option.”

This group included representatives from Manchester mental health and social care trust directors, medical staff, senior managers, clinical managers, Assertive outreach chief exec, commissioners etc. No minority report or objection was recorded. It seems they all agree with Karen’s views (they must all be ‘political extremists’ then, ed) – but Karen is the one who has been sacked.



Filed under Free speech, KAREN'S INTERVIEW, Socialist Health Association

2 responses to ““We cannot run the NHS on the basis that anyone who expresses dissent is for the chop” – by Martin Rathfelder, Director Socialist Health Association

  1. Thanks Martin

    This is very helpful. Referring to the original interview I find an extensive and closely worked up comment/response and I think it would be useful for others to read this also.

    I’m not suggesting it is more correct than Karen’s point of view or analysis – like you I have found it pretty hard to get at the full story and I still do not feel I’m there – but it is different.

    Best wishes

    Chris P

  2. karenreissmann

    From the Ed….

    We also are grateful for Martin Rathfelder’s wise and principled comments – it was Karen’s idea to give them a wider audience. So Chris, maybe you should thank Karen for being open to democratic debate? Unlike the Trust, of course. I think however, that most people now know the full story, the justice of which is not obscured by the lengthy self-justification posted in a comment at the end of the ‘offending’ interview, to which you refer.

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