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We all need to get behind anti-Health Bill campaign

By Clive Peedell - 5th August 2011 9:38 am

The NHS Consultants’ Association backs the BMA campaign to withdraw the Health and Social Care Bill.

Following the Executive Committee meeting of the NHSCA on the 4 August 2011, there was a unanimous decision to congratulate and support the BMA over its decision to mount a public campaign to call for withdrawal of the Health and Social Care Bill.

The NHSCA continues to believe that the Health and Social Care Bill represents the greatest threat to the NHS in its history. Despite the government’s proposed changes to the Bill following the Future Forum report, the key policy levers to deliver a full blooded market based system with increasing NHS privatisation remain intact. Worse still, the bill is now even more complicated and will be more costly to implement.

The Royal College of GPs has worked out that the number of NHS statutory bodies is going to increase from 163 bodies to 521! No wonder why Dr Hamish Meldrum, chair of BMA council stated that the Bill was: “Hopelessly complex and it really would be better if it were withdrawn.”

We are now left with a policy mess, at a time when the NHS is facing the greatest funding crisis in its history, with the QIPP efficiency drive aiming to deliver £20bn of savings by 2014. This will actually act as a catalyst to drive increasing privatisation of the NHS, as PCT clusters are forced to ration NHS care due to financial constraints, and NHS trusts come under huge financial pressure to cut costs.

We are already seeing an increase in NHS waiting lists and many PCTs reducing their lists of ‘NHS core services’, both of which result in increasing uptake of private health insurance policies. This has been widely reported in the media (here and here).

The Bill will also abolish the private practice income cap on foundation trusts, which will be under severe financial pressure to treat more PPs to increase their income. Some trusts will be forced into mergers, management takeovers, or even have to close down under the proposed legislation. This pressure will be increased with the introduction of new providers into the system through the ‘any qualified provider’ (AQP) policy, which is just a rebranded version of the previous ‘any willing provider’ policy.

The AQP policy is a key privatisation mechanism and is strengthened by the abolition of the NHS ‘preferred provider policy’. This will clearly impact upon the working lives of doctors as increasing numbers will find themselves working for private healthcare companies. Existing workers will have their terms and conditions protected by TUP legislation, but new employees to the NHS will not have these protections.

The most worrying aspect of the legislation is that once the Bill is enacted, the NHS is highly likely to be subjected to EU competition law because of the more open market nature of the system. This will make it nearly impossible to reverse the policies and the NHS will be finished as a comprehensive publicly funded, publicly provided and publicly accountable system.

It is therefore crucial that the profession backs the BMA over this public campaign to call for withdrawal of the bill. The presidents of the royal colleges should also be lobbied to back this campaign. This is the last chance saloon for the NHS and we must grasp it before it is too late.

Conflict of interest of author: Dr Clive Peedell is co-chair of the NHSCA and also a member of BMA council. However, the decision of the NHSCA exec committee to back the BMA was unanimous.

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15 responses to “We all need to get behind anti-Health Bill campaign”

  1. [...] original here: We all need to get behind anti-Health Bill campaign » Hospital Dr Related Posts:Right to Work | Countdown for the campaign to scrap the Health Bill Health [...]

  2. John Puntis says:

    I entirely agree with the stance being taken by the BMA and NHSCA, the background nicely summarised by Clive Peedell. My own large teaching hospital is in the process of trying to make £60 million savings this year and has paid management consultants several million pounds to help them with this process; around 700 posts will go through so called ‘natural wastage’. On top of this will come a major reorganisation if the Bill becomes law. The government’s agenda is ‘privatisation’ with all the wastefulness and inequity typified by the US system of health care. The people of this country deserve better and other parts of the UK (Scotland and Wales) are showing that market forces do not have to be in the driving seat in order to provide good quality care..

  3. Mark Aitken says:

    The jumbo sized sticking plaster which the Government wants to stick over the festering wound caused by decades of successive political non-clinical interventions to curb NHS expenditure is, as Clive rightly points out, worse than useless.
    Why are not ALL doctors up in arms about this?
    Dare I say it?
    Some amongst our ranks can see a nice little earner once the NHS has been buried.
    Shame on them!
    Who is prepared to blow the whistle on these good for nothing profiteers?
    You only need to look at the earnings from private practice of colleagues in certain clinical specialities to realise who these might be.
    Yes, they are all connected with the business of surgical intervention.

    If the politicians really want to reduce non-clinical spending in the NHS then get rid of the mushrooming bureaucracy.
    Admittedly, the NHS would then have to rely on the honesty of its doctors to spend the money doing good for patients ahead of doing good for themselves.
    Surely, our Hippocratic Oath should cover that.

  4. Raymond Tallis says:

    Many thanks for your tireless work in opposing this bill whose catastrophic effects will dwarf the impact of all previous ill-judged and ideologically-driven meddling with a service that is consistently rated higher by its users than most other organisations in the public and private sector.

  5. Andrea Franks says:

    I agree with Clive’s excellent article and the comments above.

    This is not a time to be inactive. We can see the huge dangers of the Bill and the dreadful effects it is bound to have on health care in England. I think all doctors who realise this, as most do, need to ask themselves whether in years to come they want to look back on the ruins of the NHS and think they didn’t even try to do anything about it.

  6. Brambo says:

    Another strong vote of support and in a week where yet another report indicates that our NHS is still probably the best and most efficient and equitable health service in the world. It was created by a post-war concensus that believed that our returning servicemen deserved a ‘land fit for heroes’ and at a time when we were technically backrupt. In similarly dire financial straits we can’t afford not to fight for it now. Perhaps the £100+ billion lost to the exchequer through ‘legal’ tax avoidance and windfall taxes on the obscene city bonuses would cover its costs nicely? All power to your keyboard Clive!

  7. Paul says:

    So what is your solution?

    I asked this on 21 July http://www.hospitaldr.co.uk/blogs/our-news/public-campaign-for-withdrawal-of-the-health-bill-to-be-launched/comment-page-1#comment-2560 but there’s been no response. You need to come up with something, even Professor Maynard agrees with that https://twitter.com/#!/ProfAlanMaynard/status/100831894425436160

    All I’ve seen from you so far is that you’ve made things worse, as the 521 statutory bodies shows.

  8. Mark Aitken says:

    Paul, the solution must surely come in a number of phases.
    Phase 1 stop the Bill.
    Phase 2 return to the system by which the Hospital Service was remunerated before PbR i.e. each hospital would receive a budget related to the size and complexity of its catchment population, and in that respect would be similar to what currently happens in Scotland.
    Phase 3 get rid of the £20bn of superfluous bureaucracy and all the quangos that clutter the NHS.
    Phase 4 make hospitals (and general practice) accountable to their local population.
    Phase 5 get rid of all those impediments to continuity of care, starting with chucking out the EWTD.

    One can go on and on.
    There is a lot to do but all the Politicians can think of are bureaucratic and fiscal straitjackets rather than clinical solutions.

    Clearly the present bunch of medical advisors to the Government have proved themselves to be worse than useless.
    So how do we get them to appoint a representative group of real clinicians to plan the way ahead?

  9. Andrea Franks says:

    Paul: Remove the market from the NHS as Scotland has done. Then services could once more be planned and co-ordinated and all the wasteful admin costs of running a market would go.
    After all, the Parliamentary Health Select Committee concluded last year that the internal market should be scrapped ‘after 20 years of costly failure’. The international
    evidence is that markets are unsatisfactory in health care, resulting in higher costs and worse care.

  10. Clive Peedell says:

    Paul,
    The Market and purchaser provider split must be abandoned.
    We need to return to the “trust” model of healthcare delivery i.e putting professionals back in control.This must be accompanied by proper mechanisms of accountability. This can be achieved by measuring meaningful outcomes and cracking down on those who abuse their NHS roles for private practice gains. The abuse of private practice poisoned the relationship between the profession and the political class, and only served to support the arguments of public choice policy wonks, who believe that professionals must be disciplined by markets.

    I would actually advocate a royal commission to flush all these issues out. The NHS will have to try and survive in the meantime. Many policy experts agree that the current structures can just about keep the NHS afloat until we put something better in place.

    Of course, the pro-marketeers will never let this happen. The coalition will do whatever it takes to get this bill through.

    Best wishes,
    Clive

  11. Paul says:

    Thanks Mark, Andrea and Clive, that’s a start, though I think that they are totally unrealistic.

    Mark’s and Clive’s approaches seem to be way too hospital centred, which is contrary to the type of health care that we need these days. That may apply to Andrea’s system too - I don’t know enough about the system in Scotland, and as someone who struggles to get NHS care in England, it’s not high on my priorities to find out. And under Mark’s and Clive’s systems I don’t see what would stop every hospital from setting up its own programme to provide this or that service, to meet either local “demand” or doctor vanity.

    For all approaches, assuming that we won’t have a market based system just ignores reality. Without it I don’t see how you’re going to control costs under any of the systems. I also think that they will be too doctor controlled and I don’t think that that is appropriate. Mark and Clive talk about accountability, but you’ve never done it before so why should I believe that you’ll do it this time. Even where there have been gross errors you’ve had to be dragged kicking and screaming into admitting it.

    Andrea: could you please provide references for your claim “The international evidence is that markets are unsatisfactory in health care, resulting in higher costs and worse care.” If you want to change my opinions I want evidence rather than assertion. Personally, I’m prepared to pay a little more to get care that responds to my needs as shown but what I will pay for. Unfortunately, there’s nothing in the NHS that gets even close to that, as the NHS ensures that doctors and nurses and managers get paid regardless of whether you’re doing what patients want or not. I still remember that consultant on “Gerry Robinson Saves the NHS” who was allowed to continue using an outdated, slower procedure that was worse for patients because he wouldn’t adopt the new one on the basis that “you can’t teach an old dog new tricks.” If he didn’t get paid I bet he’d learn some new tricks pretty fast!

    Speaking as a patient, I don’t want any of your approaches. For a start, the people I know in Scotland with my condition tell me that the treatment they get is even worse that the treatment that I get here in England. And none of them seem likely to be flexible enough to provide the sort of care that people want these days since they won’t be responsive enough to patient demands, especially for minority groups who won’t have enough numbers to use any local accountability, assuming that you guys in the NHS actually accepted that (see my comments above). I just don’t have any confidence in professional control - your actions to date just don’t warrant it.

    What I want is a much more flexible system that responds to what patients need and want. That’s why I like GP Commissioning (I’m realistic that I can’t get rid of the NHS). At least with GP Commissioning I’d be able to give my GP a hard time if I wasn’t getting treatment, or even stand outside the surgery with a placard. The NHS as it is (and as you’ve suggested) just doesn’t work for people like me who have a moderately rare condition that just requires care from a GP with some special skills. Because the NHS requires everyone to register with just one GP practice, there is no incentive for an NHS GP to get those skills, because there will never be enough people like me in their practice to make it worthwhile. Similarly, because I don’t need treatment at a secondary or tertiary level, care isn’t commissioned there.

    This is different to market based systems where a GP with an interest in my condition, or who sees an opening in the market, can build up a practice by focussing on people like me. That just can’t happen in the NHS, and I don’t see it happening under any of the systems that you’ve described above.

    Please remember that the NHS is there for patients. From what I can see from your systems you are still thinking that it is there for doctors and staff, with patients a distant second.

  12. Paul says:

    Just following on my last post, it’s news like this http://www.nursingtimes.net/nursing-practice/clinical-specialisms/rheumatology/nurses-bemused-by-doctors-resistance-to-decision-aids/5033178.article that doesn’t give me much confidence that any system set up by doctors is likely to provide me with good, patient centred, health care.

  13. Mark Aitken says:

    Paul, I can sympathise with your predicament. You need to understand that there are ways and means of addressing the sort of issues that your personal healthcare problem throws up. Uncommon or rare conditions are best dealt with by real experts. Naturally these doctors are usually based in Teaching Hospitals which are not the easiest or most patient friendly places to go to.
    I have spent most of my working life as a Consultant in a peripheral “District General Hospital”. My special interest, outside the day to day emergency and less urgent general medical problems, was Endocrinology (which includes diabetes). I would be the first to admit that I am not an expert in all aspects of Endocrinology. As a result I set aside a clinic, held every three months, to deal with these problems. I invited a Teaching Hospital Professor of Endocrinology (ex-colleague) to “assist” me in this clinic and between us we achieved something which (I think) was a great benefit to patients with these uncommon endocrine problems.
    I was expecting our Management Executive to pay this Professor at least a nominal fee for his services or, failing that, to pay his travelling expenses (a round trip of >100 miles). Unfortunately our local bureauacratis thought otherwise.
    This meant that every three months, this highly distinguished doctor devoted a whole day of his time to charity. The fact that the two of us thoroughly enjoyed the experience and exchage of ideas was the motivation to continue this clinic until I retired in 2003. Thereafter my successor chose not to avail himself or our patients of this service. That was a great shame.
    As you can see it is possible to deal with rare conditions in a sympathetic way that benefits both the doctors and, most importantly, the patients. The fly in the ointment is the current NHS bureaucracy. We don’t need National Initiatives or Supercentres, we just need to be able to use the existing medical resources in the most innovative and patient-friendly way.

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