Coalition’s changes to NHS were damaging and distracting, says new reviewBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h633 (Published 05 February 2015) Cite this as: BMJ 2015;350:h633
All rapid responses
Reactions to the news item and the responses so far.
1. There ARE no independent investigators or commentators. The independents would be ignored by the left and by the right.
2. The politician who started the liquidation of the NHS was Sir Keith Joseph who decided that the tripartite health service ( Local authority, general practice and hospital service) was bad and brought in the NHS reorganisation of 1974.
3. Labour's Mrs Barbara Castle said she would implement it though she did not like it.
4. Mrs B started messing up " terms and conditions of service" of hospital doctors and dentists . She decided to bring in free family planning service and in the process she agreed to give, hospital consultants in the relevant specialities, a fee for item of service and to the GPs, a fee for prescription of the pill and for fitting the IUCD and even for prescribing ( not fitting) the condom.
5. Money is always in short supply. Back in the fifties, the government bleated about not having enough money for free prescriptions. In the mid-sixtees, the government bleated about not having enough money for renal dialysis. Dr Sheldon started the national kidney dialysis charity. The ashamed central government took over and expanded the dialysis services and the local authorities accepted the responsibility for building alterations and installation, on the condition that when the dialysis machine was no longer needed or the property was sold, the LA would have the first call on the property for reimbursement of its expenditure.
6. In the 1960s, gender reassignment was NOT available on the NHS. I know of a patient who went to North Africa for the purpose. Now the NHS does it.
7. Time was when plastic surgery on the NHS was restricted to genuine medical need. Of course the phrase 'medical need ' is flexible. But those who had the money went private. And now?
8. Time was when the RAF, the army and the RN had their own hospitals where, subject to availability, the NHS patients were treated free of charge. Then these hospitals were liquidated and neighbouring ( ie, twenty miles or more) NHS hospitals took over the responsibility for treating the forces' personnel. Admittedly the NHS hospitals also housed the forces' staff who continued to treat the uniformed and the NHS patients. But there were NO extra beds provided.
9. At interval of fifty years, private consultants who had nothing whatsoever to gain by treating me free of charge, did so and refused to accept fee proffered..
In the first case, the consultant told me brusquely, to depart from his NHS hospital clinic and to see him at his " rooms". I did and he got even more upset when I offered a fee.
10. We are short of money as a country. Yet, we find the money for foreign adventures. We treat the injured forces personnel in the acute phase. Where is the money, where are the facilities for the survivors with broken lives and broken minds?
It may be that my memory is faulty. There must be others who worked in the NHS even before me and with better memories. Could they, please, correct my memories and add their own?
Competing interests: 1. Worked in and experienced as a patient, the NHS, from the Bevan model onwards. Later years only on the receiving end. 2. Experienced treatment as a private patient, a couple of times, at interval of fifty years. 3. Attended King's Fund course a generation ago.
Zosia Kimietowicz states that Andrew Lansley claimed that he was introducing the legislation in 2012 "so that a future health secretary could not modify or dilute" them. He clearly convinced the government and the Health Act was passed. There was a bigger deception that the government fell for. It is difficult to decide whether it was deception or downright ignorance of the 1999 Health Act when he wrote: "The NHS currently has no legal obligation to improve continuously the quality of care"1. This despite the definition of clinical governance based on the Duty of Quality laid down in the Act by which 'NHS organisations are accountable for continuously improving the quality of their services'. The similarity in the wording of his comments are so close to the wording in the definition of clinical governance that he could not have been ignorant of the existing requirements in law or he blindly put his name to an article written by another ignoramus. One will never know the truth but what we know is that the prime minister soon realised that he was fooled by Mr. Lansley's reason for the Act and the benefit he claimed for the NHS in his new Act. The prime minister's worst fears have now been confirmed',the King's Fund describing the NHS Reforms as 'damaging and distracting'.
1. Lansley A. Why legislation is necessary for my health reforms. BMJ 2012;344 e789 (1 February)
This was sent last night but might not have been transmitted?
Competing interests: No competing interests
Could it be there's an election coming ?
"NHS reorganisation in England was damaging and distracting"
Self evident to those wedded to the sacred cow NHS monolith. But some of us, though once utterly besotted 'socialist idealogues', learned forcefully that there are many other ways to provide effective universal healthcare. Take a look at Sweden or France. And despite it being clarionned as 'a prelude to privatisation', fundholding was more flexible and locally responsive than any Health Board I have known. I proposed local GP-Commissioning Boards to replace piecemeal fundholding, and wanted evidence and practical proof of concept through local pilots. It was a great shame that did not happen, and instead GP-Commissioning was launched wholesale upon England at the worst of times.
But what does work ?
Where's the scientific evidence, as opposed to ideological polemic, for harm from GP commissioning ? Wales, Scotland, and Northern Ireland provide three control groups. I would be very interested to hear how much better they have fared, if at all ( But fear that political interests will prevent honest and transparent comparisons).
Surely an independent academic body such as the King's Fund could next focus the outcome data analyses comparing the four NHS models ??
Competing interests: No competing interests