Health and Social Care Bill

In defence of the NHS: why writing to the House of Lords was necessary

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d6535 (Published 11 October 2011)
Cite this as: BMJ 2011;343:d6535

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Displaying 1-10 out of 16 published

I read with interest the most recent Observation on the Health and Social Care Bill by McKee and colleagues. As a public health physician I can only welcome an upcoming and long due debate on this whilst I adhere to the opinion of Martin McKee et al. and the over 400 signatories of the open letter to the House of Lords.

As an independent public health physician I have also read and reflected upon the numerous articles published in recent months which describe the ongoing debate regarding this English Bill. More professionals and practitioners from the wider public health group must dedicate some priority time to reflect on the proposals as there is no room for complacency when the principles on which the NHS works as a system are at stake.

The first and crucial point for any health care system is: if the political stakeholder holds no accountability following the delivery of health services under any proposed changes (in this case accountability is delegated to CCGs etc.), then who would be really held accountable for example, for aspects affecting the equitable resource allocation?

A second and also immediate un-answered question remains: do all public health and social care professionals and practitioners understand what goes on and how their practice will be affected? Do they all agree with the proposed changes for the NHS? Has their opinion been widely shared?

There is no very clear position as to where the wider public health family stands on this (e.g. the social care group). The issue merits an urgent and clear attention before the dialogue on the Bill continues. This is to allow all parties: a) to be heard on remaining issues before more changes are brought in and b) to understand as to what would they be held accountable for if the implementation of changes as proposed is to go ahead.

Competing interests: As an independent public health physician I subscribe to the interest of the continuing survival of the NHS

Andreea Steriu, Public health physician

Independent Contractor

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17 October 2011

Yes, we will experience the fears of the past again. Those lifelong fears that troubled our antecedents: not having money enough for coping with illnesses, being admitted to a crumbling hospital with obsolete physicians and outdated technology, being left alone with one's sickness and fading self-sufficiency. Are we prepared to face all that ? Remembering the good old days when the NHS took over most patient needs ? I believe that the time is ripe for re-setting the NHS. We need good physicians and nurses filtering the best existing technology on clinical grounds and solid evidence and offering the best options at the lowest cost. Everywhere, we need the right person in the right place at the right time. Otherwise, it's a losing battle.

Competing interests: None declared

Giovanni Melandri, Cardiologist

Policlinico Sant'Orsola, Bologna, Italy

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17 October 2011

I agree with the concerns of the public health doctors who wrote an open letter to the Lords and if asked I would have been happy to sign the letter.

Yes, we need to continually improve health and health care in the UK, but this will not be achieved by another reorganisation and increasing the commercialisation of the NHS. It is unfortunate that the evidence so far suggests that these changes will increase bureaucracy and administrative costs, rather than improve health.

In nearly 20 years of work in public health in health authorities and PCTs, we always sought clinical input into health service improvements so I do not see the need for a bill to increase clinical involvement in commissioning. The increased bureaucracy involved in commissioning is one of the reasons I took early retirement this summer.

Competing interests: None declared

Anita C Roy, Retired Consultant in Public Health

Ripon

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17 October 2011

I am a Consultant Cardiologist who has along with my colleagues delivered a Consultant led service which has substantially improved cardiac outcomes for the local population with a high deprivation index. This was achieved by developing services which were sometimes opposed by various vested interests whose primary motives, I suspect were to maintain the status quo and possibly their influence. The 'concern for patients' is the often repeated excuse. The NHS requires radical reform so that clinicians use their expertise to develop and deliver services.

Competition is good provided there is no 'cherry picking' and will result in superior standards plus better access. The necessary savings can be made by streamlining management, greater use of generic drugs, abolition of various quangos, true devolution of power locally and greater clinician involvement.

I do not support this open letter to the House of Lords and the authors do not represent me.

Competing interests: None declared

Kanarath P Balachandran, Consultant Cardiologist

East Lancashire NHS Trust

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While trying to improve health services, whether that of NHS of Britain or that of any other nation, a lot can be achieved if attention is directed to the basics as explained in the following blog: http://doc2doc.bmj.com/blogs/doctorsblog/_improving-quality-of-health-ca...

Competing interests: None declared

Vijayaraghavan Padmanabhan, Physician, Professor of Medicine

Stanley Medical College, Chennai, India

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Further to your comments on the erosion of the community character of the NHS, i would like to say that i fully endorse your commitment to a more responsive and caring NHS in respect of the needs of individual patients. It is in my long experience of these services; having the misfortunes earlier alluded to in previous correspondence that the upcoming Conservative-inspired reforms are designed to have two main effects:

1. to control local expenditure by centralizing power on Whitehall and directly into the hands of Consultants and GPs. Their aim in this is misguided because the blatant top-down approach will make the previous government's attempts to make the hospital a user-friendly environment, into a threatening and more puritanical patristic establishment. Reactionary pressures concentrating the budgets into private and director's hands will inevitably cut corners on clinical requirements, being less rigourous in the pursuit of oversight and complaints. I fear for patient safety. Moreover the incentive within the system will encourage doctors to abandon caution, and some will openly invoke a hinterland of territorialism over low-born patients. The unfortunate class metaphor will spring its ugly head, and it is my humble belief, that the poorest in the community will suffer. The other eventuality:

2. The diminution of choice will flow from concentration of doctor's time on more profitable patients. This will affect doctor's time spent in community activities, treatment will suffer as the best will migrate out of the service into private clinics. The huge growth of the private sector in the last decade will encourage clusters of private sprecialists in middle-class leafy areas to the detriment of the inner city. In many areas, such as the south, e.g. Somerset, the Conservative controlled area in dominated by a private financial consortium Wyvern Health (Somerset's red wyvern logo) that means that efficient financial management allows doctors to opt out of patient care and make money from richer patients, whilst also inflicting second-rate care on the poor. In some areas there will be more imprisonment as the recession bites; and some crimes will inevitably be treated as mental illness.

3. Recent policing measures to revoke Human Rights (which in fact has already been repealed) on consideration of the convention reveals how the Justice Minister (left) and Home Secretary (right) are to offer a conflicting leadership on the rights afforded to all those who wish to claim the best possible care, becuase of the lack of time, money, and jurisdiction to challenge lapses in care competences. It is a worrying development.

4. National cuts will affect local people disproportionately and the political case will not be improved after the next General Election.

5. The case should be made on the clinical needs of those want care; as a contrast to those who do not. The voluntary offer of consent should not be foregone. All patients must still seem to have the right to full access to all the information available on how and what the treatment will do. It is crucial that there is no further erosion in the principles of priority care and the voluntary aspect following on from considered and substantive advice in all areas.

6. BBC have reported that Nurses are not being trained properly. What exactly does this mean? Was the training worse or better before? And the fact that young people seem unable to know what care should be seems inexplicable, given university expansion. Is there really that much cruelty happening to the frail, old and weak? It would be wrong morally to return to the dark days of 1980's. I hope most sincerely that people are not made to pay the price for unemployment, recession, and a growing income gap. The balance must be right between prioritisation and emergency. Doctors must not return to a reactionary class culture to bullying patients, who therefore stay away when needed treatments because of fear and ignorance.

Those are my concerns and somewhat hacked responses. Thanks.

Justin Grant-Duff.

Competing interests: None declared

Justin Grant-Duff, in training

concerned citizen, Sheffield

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14 October 2011

The new Health &Social Care Bill has stirred an unsettling debate which is likely to continue whether the Bill will be released from parliament or not. The whole issue is money. The economic crisis is forcing the government to save money. They are trying to do it in a smart way by claiming that the Bill is aimed at equity and excellence. They should be honest and open and state that it is ALL about money.

Competing interests: None declared

Ayman M Yakoub, neurosurgeon

L7 8XL

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14 October 2011

I've cut and pasted below Baroness Hollis speech in the Lords 4th October 2011, part-cited by Zoe Williams in today's Guardian:

"the main thing is to talk about language. ... Until recently, when we introduced a Bill like this it would not have been a welfare reform Bill, it would have been a social security Bill. The gap between social security and welfare is precisely the gap between entitlement and stigma. We forget, when using words like "welfare reform", what is the structure of who pays and who gains in our welfare state. We all know that a very substantial part of "benefit expenditure" is actually a redistribution of resources through people's lifetimes, particularly from the working years to retirement. Our pension work falls into that.

A second key group of redistribution is what we would call the category benefits. They go to children and to disabled people. There are more methods of redistribution than merely from rich to poor. Instead, they go from those without children to those with children; they go from those who are in good health to those in poor health. That is something that all civilised societies would sign up to. Only the third category of benefits, those which are means tested, reflect a straightforward redistribution from rich to poor. They have been allowed to dominate and cloud the language and to stereotype claimants in ways that portray them as dependent on handouts and the good will of others. We should return instead to the more appropriate, all-inclusive language of social security. Apart from the very lucky few, who are probably white millionaires, male and in very good health indeed, all the rest of us will need recourse to the welfare state, to the social security state. We should all hold that firmly in mind and refuse to engage, wherever it is spoken, in language that seeks to make distinctions between the deserving and the undeserving poor-or, as the Victorians would have said, God's poor, poor devils and the devil's poor.

The second point I want to make, which follows that, is the point made rightly by the noble Lord, Lord Kirkwood. I strongly support the principles and much of the structure of the Bill, although, like others, I have real concerns about what I regard as the pressure points. In dealing with the Bill, we must not only be concerned with the question of language, but we must encourage the Minister to respond to those adjustments we need to make, particularly where the language of the amendments run by the Minister, or his replies, may suggest what I call the econometric model of the Treasury, which is that people have to be pained or punished into work, because the only stimulus that they will respond to is an economic one.

What many of us said in our Second Reading speeches, and what I hope we will all remember, is that when we ask people to move from being on benefit to coming into work, whether they have a disability, whether they have been a lone parent, whether they have struggled for a long time with being chronically unemployed because of the demography and the economic structure of their region, the issue for them is not just about whether they are better off; it is primarily about risk. Unless people understand- and I fear that too often the Treasury does not-the issue of risk and the abatement of risk that needs to go on, we are not going to make a success of the Bill. I think that the Minister understands this perfectly well. I think and I hope that he will accept arguments and that where, in future amendments, we seek to abate risk as well as reward work, he will understand that this is in order to make a philosophy that so many of us sign up to work today."

Competing interests: None declared

Trisha Greenhalgh, Professor of Primary Health Care

Queen Mary University of London

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14 October 2011

The proposed Bill is an attack to the main principles of free health care for all. It will create a complicated system of administrators with very difficult to disentangle accountability arrangements and will create an environment where the public and private sectors will compete at the patient's expense. Medicine is all about collaboration, not competition, is not about finances is about care and compassion. A privatised and fragmented market, as this Bill is set up to develop, does not care about people does care only about accumulation of wealth in the hands of the few. The Bill is going to damage public health services beyond repair and it is going to change entirely the way services are provided creating a USA influenced market system. Please Save Our NHS from a system which in USA has created so much grief and inequalities!!!

Competing interests: None declared

Xenofon Sgouros, Consultant Psychiatrist

Newcastle under Lyme

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14 October 2011

If I understand correctly that major aspects of this Health and Social Care Bill are not evidence based as it should be. This will not only do irreparable harm to the NHS but also create an enormous burden on already troubled NHS work loads and resources.

Competing interests: None declared

Samar N Laha, Retired Consultant Physician

Altrincham

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