Bury the bill
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d4050 (Published 26 June 2011) Cite this as: BMJ 2011;342:d4050All rapid responses
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I must admit to seeing the front cover of the BMJ of 2/7/11 and
wondering when it stopped being a scientific journal and became a
political paper.
There seem to be several truths that we are apt to forget -
1) No system designed by humans can ever be perfect.
2) As humans we will always try to improve systems in the attempt to make
them perfect (but will always fail - see 1, above).
3) All change brings loss. "Good" change just brings less loss and more
benefits.
4) Humans will always criticise systems and proposed changes, because
systems are not perfect, and change cannot make them perfect. (Thus from 1
and 2 above -there will always be critics!)
It seems therefore that the best we can do is accept that there will
always be change. In fact we should welcome it, but try to maximise the
benefits and minimise the damage that is inevitable with any change.
So, quite rightly, the BMA, RCGP and Future Forum have had their say.
Now it is time to let the politicians do their job. And doctors should do
theirs.
Competing interests: No competing interests
Believers and opponents of NHS reform might find common purpose in
opposing the revised health bill because it is now a baroque mess from any
point of view.
But one of your reasons for opposing the bill is complete nonsense
and propagates one of the worst myths about the current NHS. While the
newly revised structures proposed in the bill and their baroque
compromises with anti-reformers will leave us with a bureaucratic tangle
somewhat akin the the pre World-War-1 Austro Hungarian Empire, there are
nothing like enough managers to staff such a system. The proportion of
managers (or bureaucrats) is likely to be one of the smallest in any large
or complex organisation on the planet (it was already very low before the
government announced its populist target of cutting management costs by
45%).
The balance of evidence (see the Kings Fund report on Leadership and
Management) is that the NHS was under-managed before the cuts. The
likelihood is that the future NHS will struggle to manage the baroque
complexity of the new structures never mind actually delivering any
improvement in productivity or quality.
Competing interests: No competing interests
Yes the government has achieved many of its aims without legislation.
It has saved money on the public sector pension bill with a raft of PCT
redundancies and got elected GP representation at local level (which never
happened properly with PCTs). It has also moved Public Health into local
councils - arguably a much more logical place for it to sit.
Why not now just let the slimmed down BSU's and GP consortia get on with
the job?
Competing interests: No competing interests
Two arguments are commonly rolled out as to why we shouldn't oppose
the Bill. One is that we must embrace it because it promises to get rid of
PCTs and SHAs which were anathema to many GPs. This reminds me of the
bumper sticker that was around during the cold war - do you hate the
Russians more than you love your children?
Do people really hate PCTs and SHAs (already endangered species) so
much that they are prepared to see the NHS and the profession bombed to
oblivion by the Bill? It makes no more sense now than it did during the
cold war. And the RCGP has already calculated that the amount of
bureaucracy is about to rise exponentially so farewell to reducing
management costs.
Then we hear that GP commissioning is a good idea, and surely GPs can
do it all better. Yes, of course, a no brainer. Except that what is on
offer is not some commissioning nirvana but a commissioning nightmare,
with the NCB breathing down your neck on one side, the Orwellian Co-
operation and Competiton panel on the other, the private sector waiting to
asset strip you and 20 billion savings to be made.
The Bill is on offer in its entirely. It can't be cherry picked for
morsels, although it's not even clear whether any remain. It has to go,
and hats off to the BMJ for saying so
Jacky Davis
Competing interests: Co chair NHSCAmember KONP
I agree entirely. The Bill should be scrapped completely. It will
destroy all that we know and love about the Health Service:
. impartiality
. quality
. value for money spent
. investment for the future
. past experience of systems and staff skills
. trust of the patients and staff
. training passed on to new staff by seniors
. innovation and development based on
. secure structure
. inclusion of BAMER patients needing level playing field
. values drawing on human rights rather than finance
Please fight this Bill for all we are worth! The NHS must be saved
from it.
Competing interests: No competing interests
Over the past 18 months there have been substantial management cuts in many primary care trusts and strategic health authorities across the country. For many smaller primary care trusts, they will have lost any economy of scale in terms of management capacity to be effective or efficient. Scaling them back up will take time, and considerable expertise and organisational memory will have been lost in the recent management cuts. So in the meantime we are stuck in limbo, in the middle of a tight rope, trying to figure out whether to go forward towards the untested and uncertain clinical commissioning groups model, or back to the familiar old health structures.
However, the proposed health sector reforms is only a smokescreen for a far bigger problem - that is the demographic change we as a country are experiencing in the context of financial and resource constraints. This government has sidestepped its one essential responsibility in determining what services can be afforded and provided for by the state. Instead, they have tried to 'pass the buck' on to clinicians for what will ultimately be an unpopular and unpalatable decision to ration further health services if no new monies are found.
This is by no means the end of the story yet.
Competing interests: No competing interests
Delamothe et al propose that the Health and Social Care Bill be
buried in an unmarked grave.1 While I agree that it should be buried,
preferably six feet under and encased in concrete, it would be unwise to
bury it in a grave that is unmarked.
"Mr Lansley's monster" should be laid to rest in a marked grave with
a large headstone outlining exactly what he planned to do to the NHS in
England.2 This would act as a reminder so that future Health Secretaries
do not repeat his mistakes. There should be a proper funeral, and the
lessons learned from this episode should be engraved on the headstone for
all to see.
It remains a concern that this bill, with its 181 tabled amendments,
may clear the house before the summer parliamentary recess. There are too
many amendments. It is not the same bill. I agree that burial should
occur, but internment must be in a marked grave close to Westminster, so
that politicians do not come up with a new NHS bill with the same flaws as
we've seen with this one.
1. BMJ 2011;342:d4050
2. BMJ 2011;342:d4129
Competing interests: No competing interests
"Change? Why?
Things are bad enough"
* Robert Cecil, 3rd Marquess of Salisbury
* British Prime Minister
25 June 1895 - 11 July 1902
Competing interests: No competing interests
This bill has the potential to destroy all that fundamentally works
in the NHS in favour of the people. That it is comprehensive and truly
national, focusses on population health promotion and not just disease,
is motivated by a service ideology rather than a profit motive. I
couldn't agree with you more. We see clearly the risks of this contagion.
Let's bin it and incinerate it before it infects the NHS.
Competing interests: No competing interests
A call to action to all UK health professionals
Dear Editor,
The future of our NHS is in our hands. In little under a week's time
politicians in Westminster shall agree to or discard a series of reforms
to our health service, with potentially catastrophic consequences for
patient health. As current and future healthcare professionals we are
concerned that the health service as we know it is soon to be dismantled.
Despite recent amendments, the Health and Social Care Bill remains
committed to widening involvement from commercial healthcare companies.
Accountability for services is proposed to be relinquished from the
Secretary of State and handed over to GP commissioning boards; many shall
call on commissioning services from healthcare companies to assist them.
The end result is likely to be fragmentation, increased and uncontrolled
competition, and a marketised healthcare model that damages cooperation
between healthcare teams.
There has been insubstantial evidence to support the need for these
reforms. All major trade unions and health organisations including the
British Medical Association and Royal College of Nursing are fundamentally
opposed. There is no mandate for these changes which were not discussed
prior to the general election.
In this time of great need we call to action all professionals and
members of the public with a vested interest in openly protesting for a
health system run for the public, by the public. Our greatest chance of
halting the reforms may stand in the House of Lords: interested readers
may wish to contact a peer through www.goingtowork.org.uk/peers. Now is
the time for action; if not, it shall be communities and families across
England that ultimately suffer.
Signed by:
Dr James Chan (Foundation Doctor, York), Dr Jonny Currie (Foundation
Doctor, Bristol), Dr Erica Pool (Foundation Doctor, York), Guppi Bola
(Public Health), Amelia Cutts (Medical Student, Southampton), Alex Elliott
-Green (Medical Student, Bristol), Dr Sarah Walpole (Foundation Doctor,
York), Dr Fred Martineau (Junior Doctor, London), Danny McLernon Billows
(Medical student, Peninsula Medical School), Dr Abi Smith (Obstetrics
& Gynaecology Trainee, Bristol), Dr Sam Bartlett (Foundation Doctor,
Slough), Dr Timothy Rittman (Specialist Registrar, Cambridge), Dr Chris
Tiley (GP, Cornwall), Dr Danni Kirwan (CT1 Trainee), Daniel Bunce (medical
student, Peninsula), Emily Ward (medical student, Newcastle), Marion Birch
(Medact), Chris Bem, (Consultant ENT and Neck Surgeon), Dr Frank Boulton
(Medact Chair), Joe Piper (medical student, Oxford), Dr Lucie Potter
(Foundation Doctor, Liverpool), Margaret Greenwood, Dr Harriet Burn
(Foundation Doctor and member of Medact South Yorkshire), Joe Piper
(medical student, Oxford), Dr Kathryn Boyd (Foundation Doctor, Bristol),
Claire Ferraro (Medical Student, Newcastle).
Supported by:
Dr Jacky Davis, Co-Chair KONP, BMA Council Member; Prof Ian Banks,
BMA Council, President European Men's Health Forum; Dr David Wrigley GP
Lancashire, BMA Council member, BMA General Practitioners Committee
member.
Competing interests: No competing interests